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1.
BMJ ; 367: l5367, 2019 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-31594780

RESUMO

OBJECTIVE: To estimate the risk of acute myocardial infarction (AMI) or stroke in adults with non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH). DESIGN: Matched cohort study. SETTING: Population based, electronic primary healthcare databases before 31 December 2015 from four European countries: Italy (n=1 542 672), Netherlands (n=2 225 925), Spain (n=5 488 397), and UK (n=12 695 046). PARTICIPANTS: 120 795 adults with a recorded diagnosis of NAFLD or NASH and no other liver diseases, matched at time of NAFLD diagnosis (index date) by age, sex, practice site, and visit, recorded at six months before or after the date of diagnosis, with up to 100 patients without NAFLD or NASH in the same database. MAIN OUTCOME MEASURES: Primary outcome was incident fatal or non-fatal AMI and ischaemic or unspecified stroke. Hazard ratios were estimated using Cox models and pooled across databases by random effect meta-analyses. RESULTS: 120 795 patients with recorded NAFLD or NASH diagnoses were identified with mean follow-up 2.1-5.5 years. After adjustment for age and smoking the pooled hazard ratio for AMI was 1.17 (95% confidence interval 1.05 to 1.30; 1035 events in participants with NAFLD or NASH, 67 823 in matched controls). In a group with more complete data on risk factors (86 098 NAFLD and 4 664 988 matched controls), the hazard ratio for AMI after adjustment for systolic blood pressure, type 2 diabetes, total cholesterol level, statin use, and hypertension was 1.01 (0.91 to 1.12; 747 events in participants with NAFLD or NASH, 37 462 in matched controls). After adjustment for age and smoking status the pooled hazard ratio for stroke was 1.18 (1.11 to 1.24; 2187 events in participants with NAFLD or NASH, 134 001 in matched controls). In the group with more complete data on risk factors, the hazard ratio for stroke was 1.04 (0.99 to 1.09; 1666 events in participants with NAFLD, 83 882 in matched controls) after further adjustment for type 2 diabetes, systolic blood pressure, total cholesterol level, statin use, and hypertension. CONCLUSIONS: The diagnosis of NAFLD in current routine care of 17.7 million patient appears not to be associated with AMI or stroke risk after adjustment for established cardiovascular risk factors. Cardiovascular risk assessment in adults with a diagnosis of NAFLD is important but should be done in the same way as for the general population.


Assuntos
Hipertensão/epidemiologia , Fígado/patologia , Infarto do Miocárdio/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Fumar/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Estudos de Coortes , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/fisiopatologia , Países Baixos/epidemiologia , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Espanha/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia
2.
Medicine (Baltimore) ; 98(43): e17489, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651851

RESUMO

Very few studies have been published on cardiovascular morbidity in Spanish patients diagnosed with systemic lupus erythematosus (SLE). Moreover, knowledge of the predictive factors for the occurrence of nonfatal events in this group of patients is scarce.This was a multicenter, observational, cross-sectional study designed to ascertain the prevalence of nonfatal cardiovascular risk factors and cardiovascular events (CVEs) in 335 Spanish women diagnosed with SLE between 2003 and 2013.The average patient age was 36.0 years (range: 26.4-45.6); 35 patients (10.7%) experienced at least 1 CVE, which most frequently affected the brain, followed by the heart, and finally, the peripheral vasculature. Both the number of admissions because of SLE (95% confidence interval [CI] odds ratio [OR] = 1.024-1.27, P = .017) and the systemic lupus international collaborating clinics (SLICC) chronicity index score (95% CI OR = 1.479-2.400, P = .000) resulted in an increase in the OR of these patients presenting a CVE. Regarding the classic risk factors, only the interaction between hypertension (HT) and treatment with antihypertensive drugs influenced the presence of CVEs (95% CI OR = 2.165-10.377, P = .000). The presence of a family history of early cardiovascular disease was also related to CVEs (95% CI OR = 2.355-40.544, P = .002). Binary logistic regression including the above factors resulted in a model in which the 3 main variables in each group persisted, implying that they must be independent of each other. However, the weight of the interaction between the family history of early cardiovascular disease and the interaction between HT and the use of antihypertensives was higher than for the number of admissions for SLE.The SLE disease activity over time (measured using the SLICC) and the number of hospital admissions due to the disease itself, both increase the risk of women with SLE presenting a CVE. Classic cardiovascular risk factors, especially HT and its treatment, as well as a family history of early CVEs, should be considered when assessing the risk of nonfatal CVEs in women with SLE.


Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Lúpus Eritematoso Sistêmico/complicações , Adulto , Anti-Hipertensivos/uso terapêutico , Estudos Transversais , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Hipertensão/etiologia , Modelos Logísticos , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Medição de Risco , Fatores de Risco , Espanha/epidemiologia
3.
Toxicol Lett ; 315: 55-63, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31445060

RESUMO

Occupational and environmental exposure to pesticides has been associated with thyroid dysfunction, particularly changes in circulating thyroid hormone levels (T3, T4) and thyroid stimulating hormone (TSH). This study assessed the association between environmental exposure to pesticides and the risk of developing thyroid diseases. A population-based case-control study was carried out among Spanish populations living in areas categorized as of high or low pesticide use according to agronomic criteria, which were used as surrogates for environmental exposure to pesticides. The study population consisted of 79.431 individuals diagnosed with goiter, thyrotoxicosis, hypothyroidism, and thyroiditis (according to the International Classification of Diseases, Ninth Revision) and 1.484.257 controls matched for age, sex and area of residence. Data were collected from computerized hospital records for the period 1998 to 2015. Prevalence rates and risk of having thyroid diseases were significantly higher in areas with higher pesticide use, with a 49% greater risk for hypothyroidism, 45% for thyrotoxicosis, 20% for thyroiditis and 5% for goiter. Overall, this study indicates an association between increased environmental exposure to pesticides as a result of a greater agricultural use and diseases of the thyroid gland, thus supporting and extending previous evidence. This study also provides support to the methodology proposed for real-life risk simulation, thus contributing to a better understanding of the real life threat posed by exposure to multiple pesticides from different sources.


Assuntos
Exposição Ambiental/efeitos adversos , Praguicidas/efeitos adversos , Doenças da Glândula Tireoide/induzido quimicamente , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Espanha/epidemiologia , Doenças da Glândula Tireoide/epidemiologia
4.
Medicine (Baltimore) ; 98(34): e16816, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441853

RESUMO

The erythrocyte sedimentation rate (ESR) is a routine test for inflammation. Few studies have investigated the potential influence of lifestyle factors and common metabolic abnormalities on the ESR. This study investigates the influence of demographic factors, alcohol consumption, smoking, physical activity, obesity, and metabolic syndrome on the ESR in adults.This cross-sectional study covered 1472 individuals (44.5% males; age range, 18-91 years) randomly selected from the population of a Spanish municipality. The ESR was measured using a standardized method. We assessed habitual alcohol consumption in standard drinking units, along with tobacco smoking, regular physical exercise (by questionnaire), body mass index, and variables defining metabolic syndrome. Multivariate analyses were performed, including mean corpuscular volume and hemoglobin concentration in the models.The ESR was higher in females than in males, and increased steadily with age. Median ESR of females was 2-fold higher than that of males, and median ESR of individuals aged >65 years was 2-fold higher than that of individuals in the youngest category (ages 18-35 years). Body mass index, presence of metabolic syndrome, and smoking were independently and positively associated with higher ESR values. Light alcohol drinkers and individuals with high regular physical activity displayed lower ESR values than did alcohol abstainers and individuals with low physical activity, respectively.ESR varies greatly with age and sex, and corresponding reference values are proposed. Lifestyle factors (physical activity, smoking, and alcohol consumption) and common metabolic abnormalities (obesity and related metabolic syndrome) may also influence ESR values.


Assuntos
Sedimentação Sanguínea , Comportamentos Relacionados com a Saúde , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Índice de Massa Corporal , Estudos Transversais , Exercício , Feminino , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Obesidade/epidemiologia , Fatores de Risco , Fatores Sexuais , Fumar/epidemiologia , Fatores Socioeconômicos , Espanha/epidemiologia , Adulto Jovem
5.
Medicine (Baltimore) ; 98(35): e16903, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464922

RESUMO

Staphylococcus aureus prosthetic valve endocarditis (SAPVE) has a poor prognosis. There are no large series that accurately describe this entity.This is a retrospective observational study on a prospective cohort from 3 Spanish reference hospitals for cardiac surgery, including 78 definitive episodes of left SAPVE between 1996 and 2016.Fifty percent had a Charlson Index score >5; 53% were health care-related. Twenty percent did not present fever. Complications at diagnosis included: severe heart failure (HF, 29%), septic shock (SS, 17.9%), central nervous system abnormalities (19%), septic metastasis (4%). Hemorrhagic stroke was not higher in anticoagulated patients. Twenty-seven percent were methicilin-resistant SA (MRSA). Fifteen of 31 had positive valve culture; it was related to surgery within first 24 hours. At diagnosis, 69% had vegetation (>10 mm in 75%), 21.8% perianular extension, and 20% prosthetic dehiscence. Forty-eight percent had persistent bacteremia, related to nonsurgical treatment. Perianular extension progressed in 18%. Surgery was performed in 35 episodes (12 with stroke). Eleven uncomplicated episodes were managed with medical therapy, 8 survived. In-hospital mortality was 55%, higher in episodes with hemorrhagic stroke (77.8% vs 52.2%, odds ratio 3.2 [0.62-16.55]). Early SAPVE was nosocomial (92%), presented as severe HF (54%), patients were diagnosed and operated on early, 38% died. In intermediate SAPVE (9 weeks-1 year) diagnosis was delayed (24%), patients presented with constitutional syndrome (18%), renal failure (41%), and underwent surgery >72 hours after indication; 53% died. Late SAPVE (>1 year) was related with health care, diagnosis delay, and 60% of deceases.Left SAPVE frequently affected patients with comorbidity and health care contact. Complications at diagnosis and absence of fever were frequent. Presence of MRSA was high. Positive valve culture was related to early surgery. Paravalvular extension was frequent; vegetations were large, but its absence at diagnosis was common. Some uncomplicated SAPVE episodes were safety treated with medical therapy. Surgery was feasible in patients with stroke. Mortality was high. There were differences in some clinical characteristics and in evolution according to the time elapsed from valve replacement. Prognosis was better in early SAPVE.


Assuntos
Endocardite Bacteriana/epidemiologia , Próteses Valvulares Cardíacas/microbiologia , Infecções Relacionadas à Prótese/epidemiologia , Infecções Estafilocócicas/epidemiologia , Idoso , Comorbidade , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Gerenciamento Clínico , Endocardite Bacteriana/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Relacionadas à Prótese/etiologia , Estudos Retrospectivos , Espanha/epidemiologia , Infecções Estafilocócicas/etiologia , Análise de Sobrevida , Tempo para o Tratamento
6.
BMC Infect Dis ; 19(1): 697, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387529

RESUMO

BACKGROUND: S. pneumoniae is the leading cause of community-acquired pneumonia in the solid organ transplant recipient (SOTR); nevertheless, the prevalence of colonization and of the colonizing/infecting serotypes has not been studied in this population. In this context, the aim of the present study was to describe the rate, characteristics, and clinical impact of S. pneumoniae nasopharyngeal carriage. METHODS: A prospective observational cohort of Solid Organ Transplant recipients (SOTR) was held at the University Hospital Virgen del Rocío, Seville, Spain with the aim to evaluate the S. pneumoniae colonization and the serotype prevalence in SOTR. Two different pharyngeal swabs samples from 500 patients were included in two different seasonal periods winter and spring/summer. Optochin and bile solubility tests were performed for the isolation of thew strains. Antimicrobial susceptibility studies (MICs, mg/l) of levofloxacin, trimethoprim-sulfamethoxazole, penicillin, amoxicillin, cefotaxime, ceftriaxone, erythromycin, azithromycin and vancomycin for each isolate were determined by E-test strips. Capsular typing was done by sequential multiplex PCR reactions. A multivariate logistic regression analysis of factors potentially associated with pneumococcal nasopharyngeal carriage and disease was performed. RESULTS: Twenty-six (5.6%) and fifteen (3.2%) patients were colonized in winter and spring/summer periods, respectively. Colonized SOT recipients compared to non-colonized patients were more frequently men (79.5% vs. 63.1%, P < 0.05) and cohabitated regularly with children (59% vs. 32.2%, P < 0.001). The most prevalent serotype in both studied periods was 35B. Forty-five percent of total isolates were included in the pneumococcal vaccine PPV23. Trimethoprim-sulfamethoxazole and macrolides were the less active antibiotics. Three patients had non-bacteremic pneumococcal pneumonia, and two of them died. CONCLUSIONS: Pneumococcal colonization in SOTR is low with the most colonizing serotypes not included in the pneumococcal vaccines.


Assuntos
Nasofaringe/microbiologia , Transplante de Órgãos/efeitos adversos , Infecções Pneumocócicas/epidemiologia , Streptococcus pneumoniae/isolamento & purificação , Adulto , Antibacterianos , Criança , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Infecções Pneumocócicas/microbiologia , Vacinas Pneumocócicas , Prevalência , Estudos Prospectivos , Sorogrupo , Espanha/epidemiologia , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/patogenicidade , Transplantados/estatística & dados numéricos
7.
BMC Public Health ; 19(1): 1089, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409397

RESUMO

BACKGROUND: Monitoring seasonal influenza epidemics is the corner stone to epidemiological surveillance of acute respiratory virus infections worldwide. This work aims to compare two sentinel surveillance systems within the Daily Acute Respiratory Infection Information System of Catalonia (PIDIRAC), the primary care ILI and Influenza confirmed samples from primary care (PIDIRAC-ILI and PIDIRAC-FLU) and the severe hospitalized laboratory confirmed influenza system (SHLCI), in regard to how they behave in the forecasting of epidemic onset and severity allowing for healthcare preparedness. METHODS: Epidemiological study carried out during seven influenza seasons (2010-2017) in Catalonia, with data from influenza sentinel surveillance of primary care physicians reporting ILI along with laboratory confirmation of influenza from systematic sampling of ILI cases and 12 hospitals that provided data on severe hospitalized cases with laboratory-confirmed influenza (SHLCI-FLU). Epidemic thresholds for ILI and SHLCI-FLU (overall) as well as influenza A (SHLCI-FLUA) and influenza B (SHLCI-FLUB) incidence rates were assessed by the Moving Epidemics Method. RESULTS: Epidemic thresholds for primary care sentinel surveillance influenza-like illness (PIDIRAC-ILI) incidence rates ranged from 83.65 to 503.92 per 100.000 h. Paired incidence rate curves for SHLCI -FLU / PIDIRAC-ILI and SHLCI-FLUA/ PIDIRAC-FLUA showed best correlation index' (0.805 and 0.724 respectively). Assessing delay in reaching epidemic level, PIDIRAC-ILI source forecasts an average of 1.6 weeks before the rest of sources paired. Differences are higher when SHLCI cases are paired to PIDIRAC-ILI and PIDIRAC-FLUB although statistical significance was observed only for SHLCI-FLU/PIDIRAC-ILI (p-value Wilcoxon test = 0.039). CONCLUSIONS: The combined ILI and confirmed influenza from primary care along with the severe hospitalized laboratory confirmed influenza data from PIDIRAC sentinel surveillance system provides timely and accurate syndromic and virological surveillance of influenza from the community level to hospitalization of severe cases.


Assuntos
Epidemias , Hospitalização/estatística & dados numéricos , Vírus da Influenza A/isolamento & purificação , Vírus da Influenza B/isolamento & purificação , Influenza Humana/epidemiologia , Atenção Primária à Saúde , Vigilância de Evento Sentinela , Humanos , Influenza Humana/diagnóstico , Influenza Humana/terapia , Laboratórios Hospitalares , Reprodutibilidade dos Testes , Estações do Ano , Índice de Gravidade de Doença , Espanha/epidemiologia
8.
Parasit Vectors ; 12(1): 359, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340851

RESUMO

BACKGROUND: An outbreak of leishmaniasis caused by Leishmania infantum was declared in the southwest of the Madrid region (Spain) in June 2009. This provided a unique opportunity to compare the management of visceral leishmaniasis (VL) in immunocompetent adults (IC-VL), patients with HIV (HIV-VL) and patients receiving immunosuppressants (IS-VL). METHODS: A cohort of adults with VL, all admitted to the Hospital Universitario de Fuenlabrada between June 2009 and June 2018, were monitored in this observational study, recording their personal, epidemiological, analytical, diagnostic, treatment and outcome variables. RESULTS: The study population was made up of 111 patients with VL (10% HIV-VL, 14% IS-VL, 76% IC-VL). Seventy-one percent of the patients were male; the mean age was 45 years (55 years for the IS-VL patients, P = 0.017). Fifty-four percent of the IC-VL patients were of sub-Saharan origin (P = 0.001). Fever was experienced by 98% of the IC-VL patients vs 73% of the LV-HIV patients (P = 0.003). Plasma ferritin was > 1000 ng/ml in 77% of the IC-VL patients vs 17% of the LV-HIV patients (P = 0.007). Forty-two percent of patients fulfilled the criteria for haemophagocytic lymphohistiocytosis. RDT (rK39-ICT) serological analysis returned sensitivity and specificity values of 45% and 99%, respectively, and ELISA/iIFAT returned 96% and 89%, respectively, with no differences in this respect between patient groups. Fourteen (13.0%) patients with VL experienced treatment failure, eight of whom were in the IC-VL group. Treatment with < 21 mg/kg (total) liposomal amphotericin B (LAB) was associated with treatment failure in the IC-VL patients [P = 0.002 (OR: 14.7; 95% CI: 2.6-83.3)]. CONCLUSIONS: IS-VL was more common than HIV-VL; the lack of experience in dealing with IS-VL is a challenge that needs to be met. The clinical features of the patients in all groups were similar, although the HIV-VL patients experienced less fever and had lower plasma ferritin concentrations. RDT (rK39-ICT) analysis returned a good specificity value but a much poorer sensitivity value than reported in other scenarios. The patients with HIV-VL, IS-VL and IC-VL returned similar serological results. Current guidelines for treatment seem appropriate, but the doses of LAB required to treat patients with HIV-VL and IS-VL are poorly defined.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Infecções por HIV/parasitologia , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/epidemiologia , Adulto , Idoso , Antígenos de Protozoários/imunologia , Coinfecção/tratamento farmacológico , Coinfecção/epidemiologia , Coinfecção/parasitologia , Coinfecção/virologia , Diagnóstico Tardio , Surtos de Doenças/prevenção & controle , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Imunocompetência , Imunossupressores/uso terapêutico , Leishmania infantum , Leishmaniose Visceral/tratamento farmacológico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Minorias Sexuais e de Gênero , Espanha/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
9.
BMC Public Health ; 19(1): 995, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340784

RESUMO

BACKGROUND: Screen time can play a significant role in the health and quality of life of people with disabilities. However, there is a lack of studies on this issue among people with disabilities, and even fewer in the university setting. Thus, the aim of our study was to explore the relationships between screen time, disability grade, body mass index (BMI), physical activity and sociodemographic variables (gender and socioeconomic status) in university students with different disabilities. METHODS: A cross-sectional study was conducted on a sample of 1091 students with disabilities from 55 Spanish universities. Instruments used for data gathering were the Adolescent Sedentary Activity Questionnaire (ASAQ) and the International Physical Activity Questionnaire-Short Form (IPAQ-SF). A Self-Organizing Maps (SOM) analysis was carried out to explore the relationships between the variables under study. RESULTS: Participants reported high values in overall screen time (5.45 h per day/week), with computers being the media most used (2.45 h per day/week). The SOM analysis showed slightly higher screen time values in women than men. People with a high disability grade spent less screen time than those with lower disability grade. Contradictory results exist when a group of men with the highest BMI had the highest screen time and the lowest physical activity (PA) while women with low BMI show the highest screen time and PA. CONCLUSIONS: Gender and disability grade played a moderating role in screen time among people with disabilities while BMI and PA do not play such a role.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Tempo de Tela , Estudantes/estatística & dados numéricos , Adolescente , Adulto , Índice de Massa Corporal , Computadores/estatística & dados numéricos , Estudos Transversais , Exercício , Feminino , Humanos , Masculino , Qualidade de Vida , Espanha/epidemiologia , Inquéritos e Questionários , Universidades , Adulto Jovem
10.
J Laryngol Otol ; 133(8): 713-718, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31317837

RESUMO

OBJECTIVE: The main objective of this study was to determine the prevalence of work-related musculoskeletal symptoms in otolaryngology and head and neck surgery specialists and trainees in Spain, and to measure the effect that physical exercise could have on muscular discomfort. METHOD: A cross-sectional survey was administered between September and December 2017 to practising otolaryngologists. RESULTS: Four hundred and three ENT surgeons responded, with a median age of 44.9 years, and 89.8 per cent reported discomfort or physical symptoms that they attributed to surgical practice. More female surgeons reported musculoskeletal symptoms (92.8 per cent vs 87.1 per cent; p = 0.04). When the level of physical activity was compared with the frequency of physical discomfort, no significant difference was found. CONCLUSION: This study has shown a high prevalence of musculoskeletal disorders among ENT surgeons in Spain but has failed to demonstrate an important role of physical exercise in the prevention of musculoskeletal disorders.


Assuntos
Terapia por Exercício/métodos , Doenças Musculoesqueléticas/epidemiologia , Doenças Profissionais/reabilitação , Adulto , Idoso , Estudos Transversais , Ergonomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/etiologia , Doenças Musculoesqueléticas/prevenção & controle , Doenças Profissionais/complicações , Doenças Profissionais/epidemiologia , Prevalência , Espanha/epidemiologia , Cirurgiões , Inquéritos e Questionários , Falha de Tratamento
11.
Autoimmun Rev ; 18(9): 102359, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31323362

RESUMO

OBJECTIVE: The aim of this study is to compare the frequency of remission, according to DORIS definitions, of inception patients from two European SLE cohorts, with a special focus on the differences between the therapeutic schemes of both Units. METHODS: Inception patients enrolled after 2000 from the longitudinal Cruces Lupus Cohort (CC) and Bordeaux Lupus Cohort (BC) were included. The main endpoint was the achievement of clinical remission on treatment (ClinROnT). ClinROnT was assessed yearly from the 1st until the 5th year following the diagnosis of SLE. RESULTS: 173 patients, 92 CC and 81 BC, were studied. The clinical presentation of both cohorts was similar, with no significant differences in the mean SLEDAI score at diagnosis (6.6 vs. 8.1, p = 0.06). Patients from CC were treated more frequently with hydroxychloroquine (mean 57 vs. 43 months), methotrexate (24% vs. 11%) and pulse methyl-prednisolone (42% vs. 26%), and received lower doses of oral prednisone (average dose during the follow up 2.3 vs. 7.2 mg/d, p < 0.001). Patients in CC were more likely to achieve ClinROnT at year one, 84% vs. 43% (p < 0.001). Prolonged ClinROnT during the 5 years of follow up was more frequent in CC: 70% vs. 28%, p < 0.001. Patients in CC were also more likely to achieve ClinROnT after controlling for baseline SLEDAI (adjusted HR 1.69, 95%CI 1.21-2.35) and for the presenting clinical manifestations (adjusted HR 1.72, 95% CI 1.2-2.4). CONCLUSION: Prolonged ClinROnT was achievable by using a therapeutic regime consisting of lower doses of oral prednisone and maximizing the use of hydroxychloroquine, pulse methyl-prednisolone and methotrexate.


Assuntos
Imunossupressores/administração & dosagem , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Prednisona/administração & dosagem , Administração Oral , Adulto , Estudos de Coortes , Intervalo Livre de Doença , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , França/epidemiologia , Glucocorticoides/administração & dosagem , Humanos , Hidroxicloroquina/administração & dosagem , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Metotrexato/administração & dosagem , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Indução de Remissão , Espanha/epidemiologia , Resultado do Tratamento , Adulto Jovem
12.
Malar J ; 18(1): 230, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291951

RESUMO

BACKGROUND: Malaria was eliminated in Spain in 1964. Since then, more than 10,000 cases of malaria have been reported, mostly in travellers and migrants, making it the most frequently imported disease into this country. In order to improve knowledge on imported malaria cases characteristics, the two main malaria data sources were assessed: the national surveillance system and the hospital discharge database (CMBD). METHODS: Observational study using prospectively gathered surveillance data and CMBD records between 2002 and 2015. The average number of hospitalizations per year was calculated to assess temporal patterns. Socio-demographic, clinical and travel background information were analysed. Bivariate and multivariable statistical methods were employed to evaluate hospitalization risk, fatal outcome, continent of infection and chemoprophylaxis failure and their association with different factors. RESULTS: A total of 9513 malaria hospital discharges and 7421 reported malaria cases were identified. The number of reported cases was below the number of hospitalizations during the whole study period, with a steady increase trend in both databases since 2008. Males aged 25-44 were the most represented in both data sources. Most frequent related co-diagnoses were anaemia (20.2%) and thrombocytopaenia (15.4%). The risks of fatal outcome increased with age and were associated with the parasite species (Plasmodium falciparum). The main place of infection was Africa (88.9%), particularly Equatorial Guinea (33.2%). Most reported cases were visiting friends and relatives (VFRs) and immigrants (70.2%). A significant increased likelihood of hospitalization was observed for children under 10 years (aOR:2.7; 95% CI 1.9-3.9), those infected by Plasmodium vivax (4.3; 95% CI 2.1-8.7) and travellers VFRs (1.4; 95% CI 1.1-1.7). Only 4% of cases reported a correct regime of chemoprophylaxis. Being male, over 15 years, VFRs, migrant and born in an endemic country were associated to increased risk of failure in preventive chemotherapy. CONCLUSIONS: The joint analysis of two data sources allowed for better characterization of imported malaria profile in Spain. Despite the availability of highly effective preventive measures, the preventable burden from malaria is high in Spain. Pre-travel advice and appropriately delivered preventive messages needs to be improved, particularly in migrants and VFRs.


Assuntos
Antimaláricos/administração & dosagem , Doenças Transmissíveis Importadas/epidemiologia , Hospitalização/estatística & dados numéricos , Malária Falciparum/epidemiologia , Malária Vivax/epidemiologia , Adolescente , Adulto , Fatores Etários , Quimioprevenção/estatística & dados numéricos , Doenças Transmissíveis Importadas/parasitologia , Doenças Transmissíveis Importadas/prevenção & controle , Feminino , Humanos , Incidência , Malária Falciparum/parasitologia , Malária Falciparum/prevenção & controle , Malária Vivax/parasitologia , Malária Vivax/prevenção & controle , Masculino , Pessoa de Meia-Idade , Plasmodium falciparum/fisiologia , Plasmodium vivax/fisiologia , Prevalência , Fatores de Risco , Fatores Sexuais , Espanha/epidemiologia , Viagem/estatística & dados numéricos , Adulto Jovem
13.
Rev. chil. endocrinol. diabetes ; 12(3): 170-174, jul. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-1006512

RESUMO

Objetivo: El objetivo del estudio fue describir las características y evolución de los pacientes que acudieron a las urgencias de nuestro hospital y fueron diagnosticados de cetoacidosis diabética (CAD) utilizando la novedosa herramienta de Big Data Savana. Método: Estudio retrospectivo descriptivo de los pacientes atendidos en urgencias del Hospital Universitario Infanta Leonor durante los años 2011 al 2016 con diagnóstico de CAD. La búsqueda se realizó con Savana Manager. Resultados: Se diagnosticaron 95 episodios de CAD en 68 pacientes. Del total de episodios de CAD, 57 fueron en diabéticos tipo 1 (de ellos 4 LADA), 25 en diabéticos tipo 2, 2 en diabéticos postpancreatectomía y 12 fueron debuts diabéticos. Del total, 61 (64,2%) requirieron ingreso hospitalario, de ellos 23 (24,2%) ingresaron en UCI. La media de HbA1c fue de 10,6 ± 2,1%. Tres pacientes requirieron reingreso tras el alta. La mortalidad fue muy baja con el fallecimiento en 1 paciente diagnosticado simultáneamente de cáncer pulmonar. Los desencadenantes de la CAD fueron: 35 casos (36,8%) falta de adherencia al tratamiento, 31 (32,6%) infecciones, 12 (12,6%) debuts, 8 (8,4%) varias causas y 9 (9,5%) no se pudo determinar la causa. Se clasificaron como CAD de gravedad leve un 28%, un 38% como de gravedad moderada y 34% como graves. La duración del ingreso no se relacionó con la severidad de la cetoacidosis. Conclusiones: La CAD es una complicación grave que afecta tanto a diabéticos tipo 1 como a tipo 2 con elevado porcentaje de ingresos hospitalarios y en UCI, aunque con baja mortalidad en nuestro medio. La duración de los ingresos no se relaciona con la severidad del cuadro.


Objective: the study was designed to describe the clinical features and evolution of the diabetic patients attended in our hospital emergency department with diabetic ketoacidosis (DKA) using the novel Big Data tool Savana. Method: Retrospective descriptive study of the patients attended in the emergency room of the Infanta Leonor University Hospital during the years 2011 to 2016 with diagnosis of CAD. The search was made with Savana. Results: 95 episodes of DKA were diagnosed in 68 patients. Of the total episodes of CAD 57 were in type 1 diabetics (of which 4 were LADA), 25 in type 2 diabetics, 2 in diabetics postpancreatectomy and 12 were new onset of diabetes. Of the total, 61 (64.2%) required hospital admission, of which 23 (24.2%) were admitted to the intensive care unit (ICU). The mean HbA1c was 10.6 ± 2.1%. Three patients required readmission after discharge. Mortality was very low with death in 1 patient simultaneously diagnosed of lung cancer. The triggers of CAD were: 35 cases (36,8%) lack of adherence to treatment, 31 (32.6%) infections, 12 (12.6%) new onset, 8 (8,4%) various causes and 9 (9.5%) the cause could not be determined. They were classified as mild DKA 28%, 38% as moderate and 34% as severe. The duration of admission was not related to the severity of ketoacidosis. Conclusions: DKA is a serious complication that affects both, type 1 and type 2 diabetics patients, with a high percentage of hospital and ICU admissions, although with low mortality in our environment. The lenght of the stay in hospital is not related to the severity of the DKA.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Cetoacidose Diabética/epidemiologia , Complicações do Diabetes/epidemiologia , Espanha/epidemiologia , Informática Médica , Epidemiologia Descritiva , Estudos Retrospectivos , Cetoacidose Diabética/etiologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Serviço Hospitalar de Emergência , Hiperglicemia/complicações , Hiperglicemia/epidemiologia
14.
BMC Public Health ; 19(1): 840, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31253111

RESUMO

BACKGROUND: Few reports have examined the association between unemployment and work disability in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). This study explored the key determinants of work disability in a CFS/ME cohort. METHODS: A community-based prospective study included 1086 CFS/ME patients aged 18-65 years. Demographic and clinical characteristics and outcome measures were recorded. Multiple linear regression analysis was performed to identify key risk indicators of work disability. RESULTS: Four hundred and fifty patients with CFS/ME were employed (41.4%) and 636 were unemployed (58.6%). Older age at pain onset (OR: 1.44; 95% CI: 1. 12-1.84, autonomic dysfunction (OR: 2.21; 95% CI: 1.71-2.87), neurological symptom (OR: 1.66; 95% CI: 1. 30-2.13) and higher scores for fatigue (OR: 2.61; 95% CI: 2.01-3.39), pain (OR: 2.09; 95% CI: 1.47-2.97), depression (OR: 1.98; 95% CI: 1. 20-3.26), psychopathology (OR: 1.98; 95% CI: 1.51-2.61) and sleep dysfunction (OR: 1.47; 95% CI: 1. 14-1.90) were all associated with a higher risk of work disability due to illness. CONCLUSIONS: Using an explanatory approach, our findings suggest that unemployment is consistently associated with an increased risk of work disability due to CFS/ME, although further more rigorous research is now needed to help in targeting interventions at the workplace.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Síndrome de Fadiga Crônica/epidemiologia , Desemprego/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia
15.
NeuroRehabilitation ; 44(3): 451-456, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31227658

RESUMO

OBJECTIVE: The objective of this study was to provide normative data for the 5 Objects Test in a large Spanish community sample, as well as some validity evidence. METHODS: The sample was composed of 427 participants (of which 220 females, age 15 to 95 years old; educational level range: 2-17 years). Normative data are provided, as well as correlations with test scores from Benton Visual Retention test, Rey-Osterrieth Complex Figure and Mini Mental State Examination. RESULTS: No association was found between delayed recall score and level of education, age or gender. Immediate recall score was correlated with age. Both immediate and delayed recall significantly correlated with the criteria, evidencing concurrent validity. CONCLUSIONS: It is recommended that the 5 Objects Test be used for assessing persons in primary care, including those from different linguistic backgrounds or with limited language use. Delayed recall scores are especially recommended given the lack of association with demographic variables.


Assuntos
Análise de Dados , Rememoração Mental/fisiologia , Testes Neuropsicológicos , Recognição (Psicologia)/fisiologia , Características de Residência , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Linguagem , Masculino , Memória de Curto Prazo/fisiologia , Pessoa de Meia-Idade , Valores de Referência , Espanha/epidemiologia , Adulto Jovem
16.
Vet Res ; 50(1): 45, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31215485

RESUMO

Field studies on Salmonella infection in suckling piglets are scarce due to the intrinsic difficulties of collecting proper samples (i.e. tonsils or mesenteric lymph nodes), and most of them rely on the analysis of rectal swabs that limit their accuracy. We used 495 slaughtered 4-weeks-old male piglets intended for human consumption from 5 Salmonella-seropositive breeding farms to collect gastrointestinal packages and perform a thorough detection of Salmonella on mesenteric lymph nodes and intestinal content. The overall prevalence of both infection and shedding was high (≈ 36%) indicating that piglets played an active role in Salmonella maintenance in the farms. Major serotypes found in piglets included 4,[5],12:i: (35.4%), Rissen (17.1%), Derby (10.9%) and Bovismorbificans (10.3%). In most of the infected animals (72.8%) the same serotype was found in mesenteric lymph nodes and feces. Significant higher ELISA OD% values were found in meat juice samples from non-infected piglets compared to infected ones (median OD% of 12.0 and 17.3, respectively; P = 0.002) suggesting some protective effect of sow's colostrum. Salmonella was also isolated from feces from weaned sows contemporary of the slaughtered piglets, and 89% of the serotypes identified in sows were also detected in piglets. Pulsed field gel electrophoresis analyses showed that 75% of the piglet isolates that were compared to those of sows were related to them, suggesting the circulation of Salmonella strains between sows and piglets. It appears that improving piglet colostrum intake along with the reduction of the shedding in sows may favor the control of Salmonella infection in breeding farms.


Assuntos
Derrame de Bactérias , Salmonelose Animal/epidemiologia , Salmonella/fisiologia , Doenças dos Suínos/epidemiologia , Desmame , Animais , Intestinos/microbiologia , Linfonodos/microbiologia , Masculino , Prevalência , Salmonelose Animal/prevenção & controle , Salmonelose Animal/transmissão , Estudos Soroepidemiológicos , Espanha/epidemiologia , Sus scrofa , Suínos , Doenças dos Suínos/prevenção & controle , Doenças dos Suínos/transmissão
17.
Vet Microbiol ; 233: 5-10, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31176412

RESUMO

This work aimed to determine the prevalence, diversity, antibiotic-resistance phenotype/genotype and virulence factors in staphylococci of farm-animals. Nasal samples of 117 farm-animals (calve: 72; lamb: 37; goat: 8) were collected from one slaughterhouse in La Rioja/Spain and cultured for staphylococci and methicillin-resistant Staphylococcus (MRS) recovery. Identification was performed by MALDI-TOF. Antimicrobial resistance phenotype/genotype was determined by susceptibility testing and specific PCRs. Molecular typing (spa-typing, multilocus-sequence-typing, agr-typing, SCCmec), and detection of 12 virulence genes and human Immune-evasive-cluster (IEC) genes were performed by PCR/sequencing in S. aureus. Two marker genes of arginine catabolic mobile element (ACME) were determined by PCR (USA300-MRSA detection). Staphylococci were identified in 50%, 54% and 21% of goat, lamb and calve samples, respectively. Among the 13 S. aureus isolates recovered, 11 were susceptible to all antimicrobials tested, and two were multidrug-resistant-MRSA [beta-lactams (blaZ, mecA), macrolides [(msr(A)/msr(B)] and fluoroquinolones]. The MSSA harboured either tst or enterotoxin genes, while the MRSA harboured the lukF/lukS-PV genes. Five sequence-types were detected. The two MRSA strains (from lamb and goat) were typed as t5173/ST8/agr-I/SCCmec-IVa/ACME-positive, corresponding to USA300 clone, and were IEC-B-positive. Among the 47 coagulase-negative staphylococci (CoNS), six species were identified, predominating S. simulans (n = 25) and S. sciuri (n = 11). Fifty-three percent of CoNS showed resistance to at least one antimicrobial agent (six multidrug-resistant strains), and the following resistance phenotypes/genotypes were detected: streptomycin [27.6%; ant(6)-Ia, str], tetracycline [23.4%; tet(M), tet(L), tet(K)], clindamycin [19.1%; lnu(A), vgaA], erythromycin [10.6%; erm(C), msr(A)/msr(B)], chloramphenicol (8.5%; fexA), tobramycin (6.4%), penicillin-cefoxitin (4.3%; blaZ, mecA), and SXT (2.1%). The detection of the MRSA-USA300 lineage in food animals is worrisome and should be further monitored.


Assuntos
Portador Sadio/veterinária , Reservatórios de Doenças/veterinária , Variação Genética , Staphylococcus aureus Resistente à Meticilina/genética , Staphylococcus/classificação , Fatores de Virulência/genética , Animais , Antibacterianos/farmacologia , Portador Sadio/microbiologia , Reservatórios de Doenças/microbiologia , Farmacorresistência Bacteriana Múltipla/genética , Genes Bacterianos , Genótipo , Cabras/microbiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Nariz/microbiologia , Reação em Cadeia da Polimerase , Prevalência , Carne Vermelha/microbiologia , Ovinos/microbiologia , Espanha/epidemiologia , Infecções Estafilocócicas/epidemiologia , Staphylococcus/efeitos dos fármacos , Tetraciclina/farmacologia
18.
J Appl Microbiol ; 127(1): 284-291, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31063623

RESUMO

AIMS: To determine the Staphylococcus aureus carriage rate in wild mammals in Aragon, northern Spain, to analyse their antimicrobial resistance phenotype/genotype and to characterize the recovered isolates. METHODS AND RESULTS: Nasal and rectal swabs of 103 mammals were collected in Aragón during the period 2012-2015. Antimicrobial susceptibility, the presence of antimicrobial resistance genes and virulence factors were investigated. Molecular characterization was carried out by spa, MLST, agr and SCCmec. Staphylococcus aureus were recovered from 23 animals (22%). Four of the 23 S. aureus were methicillin-resistant S. aureus (MRSA). Three MRSA were mecC-positive and were isolated from European rabbits and were typed as t843 (ascribed to CC130). The remaining MRSA was a mecA-carrying isolate from European hedgehog, typed as ST1-t386-SCCmecIVa-agrIII and it harboured the blaZ, erm(C), ant(6)-Ia and aph(3´)-IIIa resistance genes. A high diversity of spa-types was detected among the 19 methicillin-susceptible S. aureus isolates, which showed high susceptibility to the antimicrobials tested. The tst gene and different combinations of staphylococcal enterotoxins were found. CONCLUSIONS: Staphylococcus aureus were detected in nasal and rectal samples of wild mammals. Wild rabbits could be a reservoir of mecC-MRSA. SIGNIFICANCE AND IMPACT OF THE STUDY: This work provides information on the presence and characteristics of S. aureus from mammals in a defined geographic region in Spain.


Assuntos
Variação Genética , Infecções Estafilocócicas/veterinária , Staphylococcus aureus/genética , Animais , Animais Selvagens/microbiologia , Antibacterianos/farmacologia , Farmacorresistência Bacteriana/genética , Mamíferos/microbiologia , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/genética , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Coelhos/microbiologia , Espanha/epidemiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Fatores de Virulência/genética
19.
Ticks Tick Borne Dis ; 10(4): 929-934, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31078466

RESUMO

We determined the prevalence of infection and genetic identity of Hepatozoon spp. harbored by Rhipicephalus sanguineus sensu lato ticks in Taiwan. A total of 1082 ticks were collected from dogs and DNA extraction was performed from individual tick specimens. Hepatozoon infection was detected by performing a nested-PCR assay based on the 18S small subunit ribosomal RNA (ssrRNA) gene. The genetic identity of detected Hepatozoon was identified by gene sequencing and phylogenetic analysis. Hepatozoon infection was detected in nymphs, males and females of R. sanguineus s. l. ticks with an infection rate of 20.8%, 22.8% and 29.4%, respectively. Sequence and phylogenetic analysis revealed that these Hepatozoon spp. of Taiwan were genetically affiliated to the same clade within the genospecies of H. canis and can be discriminated from other genospecies of H. americanum and H. felis. Intraspecies analysis based on the genetic distance (GD) values indicates a lower level (GD < 0.005) genetic divergence within the same genospecies of H. canis detected in Taiwan, Brazil and Spain. Interspecies analysis also reveals a higher heterogeneity of Taiwan strains distinguished from other genospecies of H. felis (GD > 0.040) and H. americanum (GD > 0.056). This study provides the first molecular evidence of H. canis detected and identified in various stages of R. sanguineus s. l. ticks in Taiwan. Detection of H. canis in unfed male ticks may imply the possible mechanism of transstadial survival in R. sanguineus s. l. ticks. Further investigations on Hepatozoon spp. harbored by various vector ticks in Taiwan may illustrate the epidemiological significance of this parasite.


Assuntos
Coccidiose/veterinária , Doenças do Cão/epidemiologia , Doenças do Cão/parasitologia , Cães/parasitologia , Eucoccidiida/genética , Rhipicephalus sanguineus/parasitologia , Animais , Vetores Aracnídeos/parasitologia , Brasil/epidemiologia , Coccidiose/epidemiologia , DNA de Protozoário/genética , Eucoccidiida/isolamento & purificação , Feminino , Masculino , Ninfa/parasitologia , Filogenia , Reação em Cadeia da Polimerase , Prevalência , RNA Ribossômico 18S/genética , Análise de Sequência de DNA , Espanha/epidemiologia , Taiwan/epidemiologia
20.
J Autism Dev Disord ; 49(7): 2980-2989, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31053991

RESUMO

The aim of this study was to delve into the role of gender differences in social inclusion of children and youth with autism spectrum disorder (ASD) and intellectual disability (ID). A sample of 420 participants with ASD and ID aged between 4 and 21 years was evaluated using the ASD-KidsLife Scale. Females obtained lower scores in most of the items of social inclusion. These differences remained when the covariables of level of ID, support needs, and age were controlled. None of the items presented differential item functioning as a function of gender. Gender differences, as were found in social inclusion, are discussed and recommendations are given in order to provide equal opportunities to girls and boys with ASD.


Assuntos
Transtorno do Espectro Autista/epidemiologia , Participação da Comunidade/estatística & dados numéricos , Deficiência Intelectual/epidemiologia , Adolescente , Transtorno Autístico , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Espanha/epidemiologia , Adulto Jovem
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