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1.
BMC Endocr Disord ; 21(1): 144, 2021 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-34217276

RESUMO

BACKGROUND: Although obesity, defined by body mass index (BMI), has been associated with a higher risk of hospitalisation and more severe course of illness in Covid-19 positive patients amongst the British population, it is unclear if this translates into increased mortality. Furthermore, given that BMI is an insensitive indicator of adiposity, the effect of adipose volume on Covid-19 outcomes is also unknown. METHODS: We used the UK Biobank repository, which contains clinical and anthropometric data and is linked to Public Health England Covid-19 healthcare records, to address our research question. We performed age- and sex- adjusted logistic regression and Chi-squared test to compute the odds for Covid-19-related mortality as a consequence of increasing BMI, and other more sensitive indices of adiposity such as waist:hip ratio (WHR) and percent body fat, as well as concomitant cardiometabolic illness. RESULTS: 13,502 participants were tested for Covid-19 (mean age 70 ± 8 years, 48.9% male). 1582 tested positive (mean age 68 ± 9 years, 52.8% male), of which 305 died (mean age 75 ± 6 years, 65.5% male). Increasing adiposity was associated with higher odds for Covid-19-related mortality. For every unit increase in BMI, WHR and body fat, the odds of death amongst Covid19-positive participants increased by 1.04 (95% CI 1.01-1.07), 10.71 (95% CI 1.57-73.06) and 1.03 (95% CI 1.01-1.05), respectively (all p < 0.05). Referenced to Covid-19 positive participants with a normal weight (BMI 18.5-25 kg/m2), Covid-19 positive participants with BMI > 35 kg/m2 had significantly higher odds of Covid-19-related death (OR 1.70, 95% CI 1.06-2.74, p < 0.05). Covid-19-positive participants with metabolic (diabetes, hypertension, dyslipidaemia) or cardiovascular morbidity (atrial fibrillation, angina) also had higher odds of death. CONCLUSIONS: Anthropometric indices that are more sensitive to adipose volume and its distribution than BMI, as well as concurrent cardiometabolic illness, are associated with higher odds of Covid-19-related mortality amongst the UK Biobank cohort that tested positive for the infection. These results suggest adipose volume may contribute to adverse Covid-19-related outcomes associated with obesity.


Assuntos
Adiposidade/fisiologia , COVID-19/mortalidade , Doenças Cardiovasculares/epidemiologia , Síndrome Metabólica/epidemiologia , Obesidade/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Bancos de Espécimes Biológicos/estatística & dados numéricos , Índice de Massa Corporal , COVID-19/complicações , COVID-19/patologia , Fatores de Risco Cardiometabólico , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/mortalidade , Estudos de Coortes , Bases de Dados Factuais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Síndrome Metabólica/complicações , Síndrome Metabólica/mortalidade , Pessoa de Meia-Idade , Morbidade , Mortalidade , Obesidade/complicações , Obesidade/mortalidade , Fatores de Risco , SARS-CoV-2/fisiologia , Reino Unido/epidemiologia
2.
Zhonghua Yi Xue Za Zhi ; 101(25): 1985-1990, 2021 Jul 06.
Artigo em Chinês | MEDLINE | ID: mdl-34225420

RESUMO

Objective: To investigate the efficacy and tolerability of Polatuzumab vedotin+rituximab±bendamustine (Pola-(B)R) in relapse/refractory diffuse large B cell lymphoma (R/R DLBCL) patients. Methods: The clinical data of 21 patients enrolled in Chinese Pola compassionate use program (CUP) in 4 centers from November 2019 to August 2020 were collected. There were 15 males and 6 females, and the median age was 56 years (ranged 25-76 years). Of the patients, 10 cases received Pola-BR regimen and the other 11 received Pola-R. Their clinical features, regimens, efficacy, and adverse events (AEs) were retrospectively analyzed. Results: Twenty-one patients with at least one efficacy evaluation were included. At data analysis cut-off point (12 Aug. 2020), the best overall response (BOR) rate was 81.0% (17/21) and the complete response (CR) rate was 19.0% (4/21). Kaplan-Meier survival estimation was performed, at a median follow-up of 54 days, three patients (14.3%) had disease progressed, and 18 patients (85.7%) were censored; the median progression-free survival (mPFS) was estimated to be 148 days. The incidence of adverse effects (AEs) of any grade was higher in Pola-BR group than Pola-R group (80.0% vs 63.6%). However, the incidence of grade 3-4 AEs were close in the two groups (30.0% vs 29.3%). The most common hematological toxicities were thrombocytopenia (28.6%, 6/21), neutropenia (28.6%, 6/21) and anemia (14.3%, 3/21), respectively. One patient with pneumonia and 1 patient with hemophagocytic syndrome recovered after symptomatic treatment. No peripheral neuropathy of grade≥2 was observed. Conclusions: The preliminary data suggested that, for heavily treated Chinese R/R DLBCL, the Pola-(B)R regimen still achieves promising efficacy and tolerable safety.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Linfoma Difuso de Grandes Células B , Adulto , Idoso , Anticorpos Monoclonais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Imunoconjugados , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Rituximab/uso terapêutico , Resultado do Tratamento
3.
Front Public Health ; 9: 642163, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34211950

RESUMO

Background: In Brazil, secondary data for epidemiology are largely available. However, they are insufficiently prepared for use in research, even when it comes to structured data since they were often designed for other purposes. To date, few publications focus on the process of preparing secondary data. The present findings can help in orienting future research projects that are based on secondary data. Objective: Describe the steps in the process of ensuring the adequacy of a secondary data set for a specific use and to identify the challenges of this process. Methods: The present study is qualitative and reports methodological issues about secondary data use. The study material was comprised of 6,059,454 live births and 73,735 infant death records from 2004 to 2013 of children whose mothers resided in the State of São Paulo - Brazil. The challenges and description of the procedures to ensure data adequacy were undertaken in 6 steps: (1) problem understanding, (2) resource planning, (3) data understanding, (4) data preparation, (5) data validation and (6) data distribution. For each step, procedures, and challenges encountered, and the actions to cope with them and partial results were described. To identify the most labor-intensive tasks in this process, the steps were assessed by adding the number of procedures, challenges, and coping actions. The highest values were assumed to indicate the most critical steps. Results: In total, 22 procedures and 23 actions were needed to deal with the 27 challenges encountered along the process of ensuring the adequacy of the study material for the intended use. The final product was an organized database for a historical cohort study suitable for the intended use. Data understanding and data preparation were identified as the most critical steps, accounting for about 70% of the challenges observed for data using. Conclusion: Significant challenges were encountered in the process of ensuring the adequacy of secondary health data for research use, mainly in the data understanding and data preparation steps. The use of the described steps to approach structured secondary data and the knowledge of the potential challenges along the process may contribute to planning health research.


Assuntos
Mortalidade Infantil , Projetos de Pesquisa , Brasil , Criança , Estudos de Coortes , Bases de Dados Factuais , Humanos , Lactente
4.
Life Sci Alliance ; 4(9)2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34226277

RESUMO

Here, we recorded serum proteome profiles of 33 severe COVID-19 patients admitted to respiratory and intensive care units because of respiratory failure. We received, for most patients, blood samples just after admission and at two more later time points. With the aim to predict treatment outcome, we focused on serum proteins different in abundance between the group of survivors and non-survivors. We observed that a small panel of about a dozen proteins were significantly different in abundance between these two groups. The four structurally and functionally related type-3 cystatins AHSG, FETUB, histidine-rich glycoprotein, and KNG1 were all more abundant in the survivors. The family of inter-α-trypsin inhibitors, ITIH1, ITIH2, ITIH3, and ITIH4, were all found to be differentially abundant in between survivors and non-survivors, whereby ITIH1 and ITIH2 were more abundant in the survivor group and ITIH3 and ITIH4 more abundant in the non-survivors. ITIH1/ITIH2 and ITIH3/ITIH4 also showed opposite trends in protein abundance during disease progression. We defined an optimal panel of nine proteins for mortality risk assessment. The prediction power of this mortality risk panel was evaluated against two recent COVID-19 serum proteomics studies on independent cohorts measured in other laboratories in different countries and observed to perform very well in predicting mortality also in these cohorts. This panel may not be unique for COVID-19 as some of the proteins in the panel have previously been annotated as mortality markers in aging and in other diseases caused by different pathogens, including bacteria.


Assuntos
COVID-19/sangue , COVID-19/mortalidade , Proteoma/metabolismo , Índice de Gravidade de Doença , Idoso , COVID-19/virologia , Estudos de Coortes , Feminino , Hospitalização , Humanos , Imunoglobulinas/sangue , Masculino , SARS-CoV-2/fisiologia , Sobreviventes
5.
Eur Rev Med Pharmacol Sci ; 25(12): 4400-4404, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34227075

RESUMO

OBJECTIVE: Celiac disease (CD) is an autoimmune disorder, characterized by increased susceptibility to bacterial and viral infections. Therefore, the CD patients could be exposed to an increased risk of contracting SARS-CoV-2, a virus for which the WHO declared a pandemic status in March 2020. This study aims to investigate the incidence of SARS-CoV-2 infection in CD patients, to assess the impact of CD on the risk of contracting this virus. PATIENTS AND METHODS: This retrospective multicentric cohort study evaluated 542 celiac patients, who answered a questionnaire concerning both the underlying disease (adherence to the gluten-free diet, residual symptoms) and the possible SARS-CoV-2 infection (swab outcome, presence and characteristics of symptoms and type of treatment received), referring to the period between 20th January 2020 and 27th October 2020. RESULTS: Five patients (0.92%) tested positive; of these, 2 were asymptomatic and 3 developed symptoms of COVID-19. The incidence of SARS-CoV-2 infection in CD patients was not significantly different from the general population. The ratio of positive/diagnostic swabs tends to be higher in CD patients than in the general population (IR: 0.15; 0.06; p=0.06), whereas the number of subjects who performed the swab in this group is significantly lower (IR: 0.06; 0.15; p<0.001). CONCLUSIONS: Although CD patients are more susceptible to infections, the incidence of SARS-CoV-2 infection in our sample was not significantly different from the general population. However, the positive/diagnostic swabs ratio seems to be higher, probably also due to the lower number of patients tested.


Assuntos
COVID-19/diagnóstico , COVID-19/epidemiologia , Doença Celíaca/diagnóstico , Doença Celíaca/epidemiologia , COVID-19/terapia , Teste para COVID-19/métodos , Doença Celíaca/terapia , Estudos de Coortes , Dieta Livre de Glúten/métodos , Humanos , Itália/epidemiologia , Estudos Retrospectivos
6.
BMJ ; 374: n1637, 2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34230058

RESUMO

OBJECTIVE: To assess the performance of the SARS-CoV-2 antigen rapid lateral flow test (LFT) versus polymerase chain reaction testing in the asymptomatic general population attending testing centres. DESIGN: Observational cohort study. SETTING: Community LFT pilot at covid-19 testing sites in Liverpool, UK. PARTICIPANTS: 5869 asymptomatic adults (≥18 years) voluntarily attending one of 48 testing sites during 6-29 November 2020. INTERVENTIONS: Participants were tested using both an Innova LFT and a quantitative reverse-transcriptase polymerase chain reaction (RT-qPCR) test based on supervised self-administered swabbing at testing sites. MAIN OUTCOME MEASURES: Sensitivity, specificity, and predictive values of LFT compared with RT-qPCR in an epidemic steady state of covid-19 among adults with no classic symptoms of the disease. RESULTS: Of 5869 test results, 22 (0.4%) LFT results and 343 (5.8%) RT-qPCR results were void (that is, when the control line fails to appear within 30 minutes). Excluding the void results, the LFT versus RT-qPCR showed a sensitivity of 40.0% (95% confidence interval 28.5% to 52.4%; 28/70), specificity of 99.9% (99.8% to 99.99%; 5431/5434), positive predictive value of 90.3% (74.2% to 98.0%; 28/31), and negative predictive value of 99.2% (99.0% to 99.4%; 5431/5473). When the void samples were assumed to be negative, a sensitivity was observed for LFT of 37.8% (26.8% to 49.9%; 28/74), specificity of 99.6% (99.4% to 99.8%; 5431/5452), positive predictive value of 84.8% (68.1% to 94.9%; 28/33), and negative predictive value of 93.4% (92.7% to 94.0%; 5431/5814). The sensitivity in participants with an RT-qPCR cycle threshold (Ct) of <18.3 (approximate viral loads >106 RNA copies/mL) was 90.9% (58.7% to 99.8%; 10/11), a Ct of <24.4 (>104 RNA copies/mL) was 69.4% (51.9% to 83.7%; 25/36), and a Ct of >24.4 (<104 RNA copies/mL) was 9.7% (1.9% to 23.7%; 3/34). LFT is likely to detect at least three fifths and at most 998 in every 1000 people with a positive RT-qPCR test result with high viral load. CONCLUSIONS: The Innova LFT can be useful for identifying infections among adults who report no symptoms of covid-19, particularly those with high viral load who are more likely to infect others. The number of asymptomatic adults with lower Ct (indicating higher viral load) missed by LFT, although small, should be considered when using single LFT in high consequence settings. Clear and accurate communication with the public about how to interpret test results is important, given the chance of missing some cases, even at high viral loads. Further research is needed to understand how infectiousness is reflected in the viral antigen shedding detected by LFT versus the viral loads approximated by RT-qPCR.


Assuntos
Teste de Ácido Nucleico para COVID-19 , Teste Sorológico para COVID-19 , COVID-19/diagnóstico , Portador Sadio/diagnóstico , Portador Sadio/virologia , Adulto , COVID-19/complicações , Estudos de Coortes , Feminino , Humanos , Masculino , Projetos Piloto , Valor Preditivo dos Testes , Curva ROC , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Reino Unido
7.
BMJ Open Respir Res ; 8(1)2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34193433

RESUMO

INTRODUCTION: Almost half of all school-age children with bronchopulmonary dysplasia (BPD) have asthma-like symptoms and more suffer from lung function deficits. While air pollution and indoor respiratory irritants are known to affect high-risk populations of children, few studies have objectively evaluated environmental contributions to long-term respiratory morbidity in this population. This study aimed to examine the role of indoor environmental exposures on respiratory morbidity in children with BPD. METHODS AND ANALYSIS: The Air quality, Environment and Respiratory Ouctomes in BPD (AERO-BPD) study is a prospective, single-centre observational study that will enrol a unique cohort of 240 children with BPD and carefully characterise participants and their indoor home environmental exposures. Measures of indoor air quality constituents will assess the relationship of nitrogen dioxide (NO2), particulate matter (PM2.5), nitric oxide (NO), temperature and humidity, as well as dust concentrations of allergens, with concurrently measured respiratory symptoms and lung function.Adaptations to the research protocol due to the SARS-CoV-2 pandemic included remote home environment and participant assessments. ETHICS AND DISSEMINATION: Study protocol was approved by the Boston Children's Hospital Committee on Clinical Investigation. Dissemination will be in the form of peer-reviewed publications and participant information products. TRIAL REGISTRATION NUMBER: NCT04107701.


Assuntos
Poluição do Ar/efeitos adversos , Displasia Broncopulmonar/epidemiologia , Exposição Ambiental/efeitos adversos , Material Particulado/efeitos adversos , Poluição do Ar em Ambientes Fechados/análise , Alérgenos , Asma/epidemiologia , Asma/fisiopatologia , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/fisiopatologia , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/virologia , Criança , Estudos de Coortes , Exposição Ambiental/estatística & dados numéricos , Feminino , Humanos , Umidade , Masculino , Óxido Nítrico/análise , Dióxido de Nitrogênio/análise , Estudos Prospectivos , Testes de Função Respiratória/métodos , SARS-CoV-2/genética , Temperatura
9.
BMC Infect Dis ; 21(1): 667, 2021 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-34238231

RESUMO

BACKGROUND: Hepatitis C virus (HCV) infection represents a global health issue with severe implications on morbidity and mortality. This study aimed to evaluate the impact of HCV infection on all-cause, liver-related, and non-liver-related mortality in a population living in an area with a high prevalence of HCV infection before the advent of Direct-Acting Antiviral (DAA) therapies, and to identify factors associated with cause-specific mortality among HCV-infected individuals. METHODS: We conducted a cohort study on 4492 individuals enrolled between 2003 and 2006 in a population-based seroprevalence survey on viral hepatitis infections in the province of Naples, southern Italy. Study participants provided serum for antibodies to HCV (anti-HCV) and HCV RNA testing. Information on vital status to December 2017 and cause of death were retrieved through record-linkage with the mortality database. Hazard ratios (HRs) for cause-specific mortality and 95% confidence intervals (CIs) were estimated using Fine-Grey regression models. RESULTS: Out of 626 deceased people, 20 (3.2%) died from non-natural causes, 56 (8.9%) from liver-related conditions, 550 (87.9%) from non-liver-related causes. Anti-HCV positive people were at higher risk of death from all causes (HR = 1.38, 95% CI: 1.12-1.70) and liver-related causes (HR = 5.90, 95% CI: 3.00-11.59) than anti-HCV negative ones. Individuals with chronic HCV infection reported an elevated risk of death due to liver-related conditions (HR = 6.61, 95% CI: 3.29-13.27) and to any cause (HR = 1.51, 95% CI: 1.18-1.94). The death risk of anti-HCV seropositive people with negative HCV RNA was similar to that of anti-HCV seronegative ones. Among anti-HCV positive people, liver-related mortality was associated with a high FIB-4 index score (HR = 39.96, 95% CI: 4.73-337.54). CONCLUSIONS: These findings show the detrimental impact of HCV infection on all-cause mortality and, particularly, liver-related mortality. This effect emerged among individuals with chronic infection while those with cleared infection had the same risk of uninfected ones. These results underline the need to identify through screening all people with chronic HCV infection notably in areas with a high prevalence of HCV infection, and promptly provide them with DAAs treatment to achieve progressive HCV elimination and reduce HCV-related mortality.


Assuntos
Hepatite C/mortalidade , Idoso , Causas de Morte , Estudos de Coortes , Feminino , Hepacivirus/isolamento & purificação , Hepatite C/diagnóstico , Anticorpos Anti-Hepatite C/sangue , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , RNA Viral/genética , Estudos Soroepidemiológicos
10.
Arch Iran Med ; 24(5): 419-426, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-34196208

RESUMO

BACKGROUND: The pathogenesis of the COVID19 pandemic, that has killed one million nine hundred people and infected more the 90 million until end of 2020, has been studied by many researchers. Here, we try to explain its biological behavior based on our recent autopsy information and review of literature. METHODS: In this study, patients with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) result were considered eligible for enrollment. Histopathological examinations were done on 13 people who were hospitalized in Afzalipour hospital, Kerman, Iran. Clinical and laboratory data were reviewed. Tissue examination was done by light microscopy, immunohistochemistry and electron microscopy. RESULTS: The most frequent co-morbidity in the patients was cardiovascular disease. The common initial symptoms of COVID-19 infection were dyspnea and cough. In all cases, the number of white blood cells was higher than the normal range. Common histopathological findings were variable degrees of vasculitis as degenerative to necrotic changes of endothelium and trafficking of inflammatory cells in the vessel wall with fibrinoid necrosis. Tissue damage included interstitial acute inflammatory cells reaction with degenerative to necrotic changes of the parenchymal cells. CD34 and Factor VIII immunohistochemistry staining showed endothelial cell degeneration to necrosis at the vessel wall and infiltration by inflammatory cells. Electron microscopic features confirmed the degenerative damages in the endothelial cells. CONCLUSION: Our histopathological studies suggest that the main focus of the viral damage is the endothelial cells (endotheliopathica) in involved organs. Also, our findings suggest that degeneration of leukocytes occurs at the site of inflammation and release of cytokines (leukocytoclastica) resulting in a cytokine storm.


Assuntos
COVID-19/complicações , COVID-19/patologia , Células Endoteliais/patologia , Leucócitos/patologia , Adulto , Idoso , COVID-19/metabolismo , Estudos de Coortes , Citocinas/metabolismo , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Pericardite/patologia , Pericardite/virologia , Dermatopatias/patologia , Dermatopatias/virologia
11.
BMJ Open ; 11(6): e051687, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193505

RESUMO

INTRODUCTION: The COVID-19 pandemic has had profound effects on the working lives of healthcare workers (HCWs), but the extent to which their well-being and mental health have been affected remains unclear. This longitudinal cohort study aims to recruit a cohort of National Health Service (NHS) HCWs, conducting surveys at regular intervals to provide evidence about the prevalence of symptoms of mental disorders, and investigate associated factors such as occupational contexts and support interventions available. METHODS AND ANALYSIS: All staff, students and volunteers working in the 18 participating NHS Trusts in England will be sent emails inviting them to complete a survey at baseline, with email invitations for the follow-up surveys sent 6 months and 12 months later. Opening in late April 2020, the baseline survey collects data on demographics, occupational/organisational factors, experiences of COVID-19, validated measures of symptoms of poor mental health (eg, depression, anxiety, post-traumatic stress disorder), and constructs such as resilience and moral injury. These surveys will be complemented by in-depth psychiatric interviews with a sample of HCWs. Qualitative interviews will also be conducted, to gain deeper understanding of the support programmes used or desired by staff, and facilitators and barriers to accessing such programmes. ETHICS AND DISSEMINATION: Ethical approval for the study was granted by the Health Research Authority (reference: 20/HRA/210, IRAS: 282686) and local Trust Research and Development approval. Cohort data are collected via Qualtrics online survey software, pseudonymised and held on secure university servers. Participants are aware that they can withdraw from the study at any time, and there is signposting to support services if participants feel they need it. Only those consenting to be contacted about further research will be invited to participate in further components. Findings will be rapidly shared with NHS Trusts, and via academic publications in due course.


Assuntos
COVID-19 , Pandemias , Estudos de Coortes , Inglaterra/epidemiologia , Pessoal de Saúde , Humanos , Estudos Longitudinais , SARS-CoV-2 , Medicina Estatal
12.
Pain Res Manag ; 2021: 9946067, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34257765

RESUMO

Objective: To evaluate the relationship between opioid use and specific personality traits among individuals with chronic pain stratified by morphine equivalent doses (MEQ). Design: Observational cohort study. Setting. Chronic pain outpatient clinic in Canada (2017-2019). Patients. Participants were included if they (1) were at least 18 years old, (2) had been diagnosed with chronic pain (pain >3 months), and (3) were able to read and write in English. Interventions. None. Main Outcome Measures. Completion of the following outcome measures: Acceptance and Action Questionnaire, Anxiety Sensitivity Index, Brief-Coping with Problems Experience 28-item, Brief Pain Inventory Short Form, CAGE-AID substance misuse screening tool, EuroQol-5D, Generalized Anxiety Disorder 7-item, and Patient Health Questionnaire 9-item. One-way analysis of variance compared outcomes between MEQ groups. Results: 215 individuals (64.2% female) were included with a mean age of 52.7 ± 11.7 years and time since pain onset of 14.1 ± 10.2 years (range 1-45). There were no significant differences between MEQ groups with respect to sociodemographic and clinical health variables except for gender and employment status and time since pain onset. After controlling for gender, time since pain onset, and average pain severity, patients with MEQ 90+ mg had significantly higher scores for experiential avoidance and anxiety sensitivity in addition to increased pain interference, greater depressive and anxiety symptoms, more dysfunctional coping, and poorer QoL than those with MEQ 1-89 mg or MEQ 0 mg. Conclusions: Compared to individuals using no or lower-dose opioids to treat chronic pain, those using high-dose opioids had higher scores on two maladaptive personality traits (i.e., anxiety sensitivity and experiential avoidance) which was associated with poorer mood, greater pain interference, lower quality of life, and dysfunctional coping. These maladaptive personality traits may help to explain how individuals with chronic pain utilize higher doses of opioid analgesics.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Personalidade , Adaptação Psicológica , Adulto , Idoso , Ansiedade/psicologia , Dor Crônica/psicologia , Estudos de Coortes , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Estudos Prospectivos , Qualidade de Vida
13.
BMC Infect Dis ; 21(1): 694, 2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34281502

RESUMO

BACKGROUND: Support groups for people living with HIV (PLWH) may improve HIV care adherence and outcomes. We assessed the impact of support group attendance on antiretroviral therapy (ART) adherence and viral suppression in four African countries. METHODS: The ongoing African Cohort Study (AFRICOS) enrolls participants at 12 clinics in Kenya, Uganda, Tanzania, and Nigeria. Self-reported attendance of any support group meetings, self-reported ART adherence, and HIV RNA are assessed every 6 months. Logistic regression models with generalized estimating equations were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for support group attendance and other factors potentially associated with ART adherence and viral suppression. RESULTS: From January 2013 to December 1, 2019, 1959 ART-experienced PLWH were enrolled and 320 (16.3%) reported any support group attendance prior to enrollment. Complete ART adherence, with no missed doses in the last 30 days, was reported by 87.8% while 92.4% had viral suppression <1000copies/mL across all available visits. There was no association between support group attendance and ART adherence in unadjusted (OR 1.01, 95% CI 0.99-1.03) or adjusted analyses (aOR 1.00, 95% CI 0.98-1.02). Compared to PLWH who did not report support group attendance, those who did had similar odds of viral suppression in unadjusted (OR 0.99, 95% CI 0.978-1.01) and adjusted analyses (aOR 0.99, 95% CI 0.97-1.01). CONCLUSION: Support group attendance was not associated with significantly improved ART adherence or viral suppression, although low support group uptake may have limited our ability to detect a statistically significant impact.


Assuntos
Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Adesão à Medicação , Grupos de Autoajuda , Adulto , África Oriental , Estudos de Coortes , Feminino , Infecções por HIV/psicologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Autorrelato , Carga Viral
14.
World J Surg Oncol ; 19(1): 216, 2021 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-34281542

RESUMO

BACKGROUND: Gastric cancer (GC) represents a major malignancy and is the third deathliest cancer globally. Several lines of evidence indicate that the epithelial-mesenchymal transition (EMT) has a critical function in the development of gastric cancer. Although plentiful molecular biomarkers have been identified, a precise risk model is still necessary to help doctors determine patient prognosis in GC. METHODS: Gene expression data and clinical information for GC were acquired from The Cancer Genome Atlas (TCGA) database and 200 EMT-related genes (ERGs) from the Molecular Signatures Database (MSigDB). Then, ERGs correlated with patient prognosis in GC were assessed by univariable and multivariable Cox regression analyses. Next, a risk score formula was established for evaluating patient outcome in GC and validated by survival and ROC curves. In addition, Kaplan-Meier curves were generated to assess the associations of the clinicopathological data with prognosis. And a cohort from the Gene Expression Omnibus (GEO) database was used for validation. RESULTS: Six EMT-related genes, including CDH6, COL5A2, ITGAV, MATN3, PLOD2, and POSTN, were identified. Based on the risk model, GC patients were assigned to the high- and low-risk groups. The results revealed that the model had good performance in predicting patient prognosis in GC. CONCLUSIONS: We constructed a prognosis risk model for GC. Then, we verified the performance of the model, which may help doctors predict patient prognosis.


Assuntos
Neoplasias Gástricas , Estudos de Coortes , Transição Epitelial-Mesenquimal/genética , Humanos , Prognóstico , Neoplasias Gástricas/genética
15.
Lancet HIV ; 8(7): e429-e439, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34197773

RESUMO

BACKGROUND: As the HIV epidemic in sub-Saharan Africa matures, evidence about the age distribution of new HIV infections and how this distribution has changed over the epidemic is needed to guide HIV prevention. We aimed to assess trends in age-specific HIV incidence in six population-based cohort studies in eastern and southern Africa, reporting changes in mean age at infection, age distribution of new infections, and birth cohort cumulative incidence. METHODS: We used a Bayesian model to reconstruct age-specific HIV incidence from repeated observations of individuals' HIV serostatus and survival collected among population HIV cohorts in rural Malawi, South Africa, Tanzania, Uganda, and Zimbabwe, in a collaborative analysis of the ALPHA network. We modelled HIV incidence rates by age, time, and sex using smoothing splines functions. We estimated incidence trends separately by sex and study. We used estimated incidence and prevalence results for 2000-17, standardised to study population distribution, to estimate mean age at infection and proportion of new infections by age. We also estimated cumulative incidence (lifetime risk of infection) by birth cohort. FINDINGS: Age-specific incidence declined at all ages, although the timing and pattern of decline varied by study. The mean age at infection was higher in men (cohort mean 27·8-34·6 years) than in women (24·8-29·6 years). Between 2000 and 2017, the mean age at infection per cohort increased slightly: 0·5 to 2·8 years among men and -0·2 to 2·5 years among women. Across studies, between 38% and 63% (cohort medians) of the infections in women were among those aged 15-24 years and between 30% and 63% of infections in men were in those aged 20-29 years. Lifetime risk of HIV declined for successive birth cohorts. INTERPRETATION: HIV incidence declined in all age groups and shifted slightly to older ages. Disproportionate new HIV infections occur among women aged 15-24 years and men aged 20-29 years, supporting focused prevention in these groups. However, 40-60% of infections were outside these ages, emphasising the importance of providing appropriate HIV prevention to adults of all ages. FUNDING: Bill & Melinda Gates Foundation.


Assuntos
Infecções por HIV/epidemiologia , Adolescente , Adulto , África Austral/epidemiologia , Distribuição por Idade , Fatores Etários , Idoso , Teorema de Bayes , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , Fatores Sexuais , Adulto Jovem
16.
Artigo em Inglês | MEDLINE | ID: mdl-34202825

RESUMO

We aimed to investigate whether comorbid musculoskeletal disorders (MSD)s and pain medication use was associated with in-hospital mortality among patients with coronavirus disease 2019 (COVID-19). Adult patients (≥20 years old) with a positive COVID-19 diagnosis until 5 June 2020 were included in this study, based on the National Health Insurance COVID-19 database in South Korea. MSDs included osteoarthritis, neck pain, lower back pain, rheumatoid arthritis, and others, while pain medication included paracetamol, gabapentin, pregabalin, glucocorticoid, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids (strong and weak opioids), and benzodiazepine. Primary endpoint was in-hospital mortality. A total of 7713 patients with COVID-19 were included, and in-hospital mortality was observed in 248 (3.2%) patients. In multivariate logistic regression analysis, no MSDs (p > 0.05) were significantly associated with in-hospital mortality. However, in-hospital mortality was 12.73 times higher in users of strong opioids (odds ratio: 12.73, 95% confidence interval: 2.44-16.64; p = 0.002), while use of paracetamol (p = 0.973), gabapentin or pregabalin (p = 0.424), glucocorticoid (p = 0.673), NSAIDs (p = 0.979), weak opioids (p = 0.876), and benzodiazepine (p = 0.324) was not associated with in-hospital mortality. In South Korea, underlying MSDs were not associated with increased in-hospital mortality among patients with COVID-19. However, use of strong opioids was significantly associated with increased in-hospital mortality among the patients.


Assuntos
COVID-19 , Doenças Musculoesqueléticas , Adulto , Analgésicos Opioides , Teste para COVID-19 , Estudos de Coortes , Mortalidade Hospitalar , Humanos , Dor , República da Coreia/epidemiologia , SARS-CoV-2 , Adulto Jovem
17.
Artigo em Inglês | MEDLINE | ID: mdl-34208194

RESUMO

In 2020, Taiwan's healthcare system faced a notable burden imposed by the coronavirus disease (COVID-19) pandemic. Emergency department (ED) is a high-risk area for severe acute respiratory syndrome coronavirus 2 transmission. The effect of COVID-19 on the utilization of ED services among frequent ED users remains unknown. This cohort study determined the impact of the COVID-19 pandemic on healthcare-seeking behaviors among frequent ED users at Taipei City Hospital, Taiwan. We included ED users aged ≥ 18 years admitted to Taipei City Hospital during February 2019-January 2020 (before the pandemic) and February 2020-January 2021 (during the pandemic). Frequent ED users were patients with four or more ED visits per year. Stepwise logistic regression was performed to identify predictors of frequent ED use during the COVID-19 pandemic. Frequent ED users had shorter hospital stays in the ED during the pandemic. After adjusting for sociodemographic factors and other covariates, patients with a triage status of level 4-5, pneumonia diagnosis, giddiness, or dyspnea were more likely frequent ED visitors during the COVID-19 pandemic. To reduce the risk of acquiring COVID-19, it is important to utilize territorial healthcare or telehealth to avoid inappropriate ED visits for patients with a low level of risk or chronic disease.


Assuntos
COVID-19 , Telemedicina , Estudos de Coortes , Serviço Hospitalar de Emergência , Humanos , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Taiwan/epidemiologia
18.
Transl Psychiatry ; 11(1): 360, 2021 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-34226496

RESUMO

Weight gain and metabolic complications are major adverse effects of many psychotropic drugs. We aimed to understand how socio-economic status (SES), defined as the Swiss socio-economic position (SSEP), is associated with cardiometabolic parameters after initiation of psychotropic medications known to induce weight gain. Cardiometabolic parameters were collected in two Swiss cohorts following the prescription of psychotropic medications. The SSEP integrated neighborhood-based income, education, occupation, and housing condition. The results were then validated in an independent replication sample (UKBiobank), using educational attainment (EA) as a proxy for SES. Adult patients with a low SSEP had a higher risk of developing metabolic syndrome over one year versus patients with a high SSEP (Hazard ratio (95% CI) = 3.1 (1.5-6.5), n = 366). During the first 6 months of follow-up, a significant negative association between SSEP and body mass index (BMI), weight change, and waist circumference change was observed (25 ≤ age < 65, n = 526), which was particularly important in adults receiving medications with the highest risk of weight gain, with a BMI difference of 0.86 kg/m2 between patients with low versus high SSEP (95% CI: 0.03-1.70, n = 99). Eventually, a causal effect of EA on BMI was revealed using Mendelian randomization in the UKBiobank, which was notably strong in high-risk medication users (beta: -0.47 SD EA per 1 SD BMI; 95% CI: -0.46 to -0.27, n = 11,314). An additional aspect of personalized medicine was highlighted, suggesting the patients' SES represents a significant risk factor. Particular attention should be paid to patients with low SES when initiating high cardiometabolic risk psychotropic medications.


Assuntos
Doenças Cardiovasculares , Ganho de Peso , Adulto , Índice de Massa Corporal , Estudos de Coortes , Humanos , Estudos Prospectivos , Psicotrópicos/efeitos adversos , Classe Social
19.
Transl Psychiatry ; 11(1): 380, 2021 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-34234104

RESUMO

Prevention of major depressive disorder (MDD) is a public health priority. Identifying biomarkers of underlying biological processes that contribute to MDD onset may help address this public health need. This prospective cohort study encompassed 383,131 white British participants from the UK Biobank with no prior history of MDD, with replication in 50,759 participants of other ancestries. Leveraging linked inpatient and primary care records, we computed adjusted odds ratios for 5-year MDD incidence among individuals with values below or above the 95% confidence interval (<2.5th or >97.5th percentile) on each of 57 laboratory measures. Sensitivity analyses were performed across multiple percentile thresholds and in comparison to established reference ranges. We found that indicators of liver dysfunction were associated with increased 5-year MDD incidence (even after correction for alcohol use and body mass index): elevated alanine aminotransferase (AOR = 1.35, 95% confidence interval [1.16, 1.58]), aspartate aminotransferase (AOR = 1.39 [1.19, 1.62]), and gamma glutamyltransferase (AOR = 1.52 [1.31, 1.76]) as well as low albumin (AOR = 1.28 [1.09, 1.50]). Similar observations were made with respect to endocrine dysregulation, specifically low insulin-like growth factor 1 (AOR = 1.34 [1.16, 1.55]), low testosterone among males (AOR = 1.60 [1.27, 2.00]), and elevated glycated hemoglobin (HbA1C; AOR = 1.23 [1.05, 1.43]). Markers of renal impairment (i.e. elevated cystatin C, phosphate, and urea) and indicators of anemia and macrocytosis (i.e. red blood cell enlargement) were also associated with MDD incidence. While some immune markers, like elevated white blood cell and neutrophil count, were associated with MDD (AOR = 1.23 [1.07, 1.42]), others, like elevated C-reactive protein, were not (AOR = 1.04 [0.89, 1.22]). The 30 significant associations validated as a group in the multi-ancestry replication cohort (Wilcoxon p = 0.0005), with a median AOR of 1.235. Importantly, all 30 significant associations with extreme laboratory test results were directionally consistent with an increased MDD risk. In sum, markers of liver and kidney dysfunction, growth hormone and testosterone deficiency, innate immunity, anemia, macrocytosis, and insulin resistance were associated with MDD incidence in a large community-based cohort. Our results support a contributory role of diverse biological processes to MDD onset.


Assuntos
Transtorno Depressivo Maior , Bancos de Espécimes Biológicos , Técnicas de Laboratório Clínico , Estudos de Coortes , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Humanos , Incidência , Masculino , Estudos Prospectivos , Reino Unido/epidemiologia
20.
Nat Commun ; 12(1): 4191, 2021 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-34234149

RESUMO

The vaginal and uterine microbiota play important roles in the health of the female reproductive system. However, the interactions among the microbes in these two niches and their effects on uterine health remain unclear. Here we profile the vaginal and uterine microbial samples of 145 women, and combine with deep mining of public data and animal experiments to characterize the microbial translocation in the female reproductive tract and its role in modulating uterine health. Synchronous variation and increasing convergence of the uterine and vaginal microbiome with advancing age are shown. We also find that transplanting certain strains of vaginal bacteria into the vagina of rats induces or reduces endometritis-like symptoms, and verify the damaging or protective effects of certain vaginal bacteria on endometrium. This study clarifies the interdependent relationship of vaginal bacterial translocation with uterine microecology and endometrial health, which will undoubtedly increase our understanding of female reproductive health.


Assuntos
Translocação Bacteriana , Endometrite/microbiologia , Microbiota , Saúde Reprodutiva , Vagina/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Doença Crônica , Estudos de Coortes , DNA Bacteriano/isolamento & purificação , Modelos Animais de Doenças , Endometrite/epidemiologia , Endometrite/patologia , Endométrio/microbiologia , Endométrio/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Proteção , RNA Ribossômico 16S/genética , Ratos , Fatores de Risco , Saúde da Mulher , Adulto Jovem
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