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2.
BMJ ; 366: l4923, 2019 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-31530561

RESUMO

OBJECTIVE: To develop and validate an integrative system to predict long term kidney allograft failure. DESIGN: International cohort study. SETTING: Three cohorts including kidney transplant recipients from 10 academic medical centres from Europe and the United States. PARTICIPANTS: Derivation cohort: 4000 consecutive kidney recipients prospectively recruited in four French centres between 2005 and 2014. Validation cohorts: 2129 kidney recipients from three centres in Europe and 1428 from three centres in North America, recruited between 2002 and 2014. Additional validation in three randomised controlled trials (NCT01079143, EudraCT 2007-003213-13, and NCT01873157). MAIN OUTCOME MEASURE: Allograft failure (return to dialysis or pre-emptive retransplantation). 32 candidate prognostic factors for kidney allograft survival were assessed. RESULTS: Among the 7557 kidney transplant recipients included, 1067 (14.1%) allografts failed after a median post-transplant follow-up time of 7.12 (interquartile range 3.51-8.77) years. In the derivation cohort, eight functional, histological, and immunological prognostic factors were independently associated with allograft failure and were then combined into a risk prediction score (iBox). This score showed accurate calibration and discrimination (C index 0.81, 95% confidence interval 0.79 to 0.83). The performance of the iBox was also confirmed in the validation cohorts from Europe (C index 0.81, 0.78 to 0.84) and the US (0.80, 0.76 to 0.84). The iBox system showed accuracy when assessed at different times of evaluation post-transplant, was validated in different clinical scenarios including type of immunosuppressive regimen used and response to rejection therapy, and outperformed previous risk prediction scores as well as a risk score based solely on functional parameters including estimated glomerular filtration rate and proteinuria. Finally, the accuracy of the iBox risk score in predicting long term allograft loss was confirmed in the three randomised controlled trials. CONCLUSION: An integrative, accurate, and readily implementable risk prediction score for kidney allograft failure has been developed, which shows generalisability across centres worldwide and common clinical scenarios. The iBox risk prediction score may help to guide monitoring of patients and further improve the design and development of a valid and early surrogate endpoint for clinical trials. TRIAL REGISTRATION: Clinicaltrials.gov NCT03474003.


Assuntos
Rejeição de Enxerto/etiologia , Transplante de Rim , Adulto , Idoso , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Rejeição de Enxerto/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Prognóstico , Reprodutibilidade dos Testes , Medição de Risco/métodos , Estados Unidos/epidemiologia
5.
Adv Exp Med Biol ; 1154: 139-180, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31297762

RESUMO

Clonorchis sinensis, Opisthorchis viverrini, and O. felineus are liver flukes of human and animal pathogens occurring across much of Europe and Asia. Nevertheless, they are often underestimated compared to other, better known neglected diseases in spite of the fact that many millions of people are infected and hundreds of millions are at risk. This is possibly because of the chronic nature of the infection and disease and that it takes several decades prior to a life-threatening pathology to develop. Several studies in the past decade have provided more information on the molecular biology of the liver flukes which clearly lead to better understanding of parasite biology, systematics, and population genetics. Clonorchiasis and opisthorchiasis are characterized by a chronic infection that induces hepatobiliary inflammation, especially periductal fibrosis, which can be detected by ultrasonography. These chronic inflammations eventually lead to cholangiocarcinoma (CCA), a usually fatal bile duct cancer that develops in some infected individuals. In Thailand alone, opisthorchiasis-associated CCA kills up to 20,000 people every year and is therefore of substantial public health importance. Its socioeconomic impacts on impoverished families and communities are considerable. To reduce hepatobiliary morbidity and CCA, the primary intervention measures focus on control and elimination of the liver fluke. Accurate diagnosis of liver fluke infections in both human and other mammalian, snail and fish intermediate hosts, are important for achieving these goals. While the short-term goal of liver fluke control can be achieved by praziquantel chemotherapy, a comprehensive health education package targeting school children is believed to be more beneficial for a long-term goal/solution. It is recommended that a transdisciplinary research or multisectoral control approach including one health and/or eco health intervention strategy should be applied to combat the liver flukes, and hence contribute to reduction of cholangiocarcinoma in endemic areas.


Assuntos
Clonorquíase , Clonorchis sinensis , Opistorquíase , Opisthorchis , Animais , Ásia/epidemiologia , Clonorquíase/diagnóstico , Clonorquíase/epidemiologia , Clonorquíase/parasitologia , Clonorquíase/prevenção & controle , Clonorchis sinensis/classificação , Clonorchis sinensis/genética , Europa (Continente)/epidemiologia , Humanos , Opistorquíase/diagnóstico , Opistorquíase/epidemiologia , Opistorquíase/parasitologia , Opistorquíase/prevenção & controle , Opisthorchis/classificação , Opisthorchis/genética
6.
Adv Exp Med Biol ; 1154: 279-319, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31297766

RESUMO

This chapter analyses the taxonomic position of Dicrocoeliidae family and several of its genus and species. The biology of the major species causing veterinary diseases such Dicrocoelium dendriticum, Dicrocoelium hospes, Dicrocoelium chinensis, Eurytrema pancreaticum and Platynosomum fastosum, has been reviewed. All these species have an indirect life cycle, involving two intermediate hosts (molluscs as first and ants, grasshoppers and lizards as second). Dicrocoelium dendriticum is a very widespread hepatic trematode in the ruminants of many countries in Europe, Asia, North Africa and North America, even affecting humans. Dicrocoelium hospes is widely distributed in the savanna areas of Africa south of the Sahara, whilst D. chinensis has mainly been found in ruminants in East Asia and some European countries (probably imported from Asia). Eurytrema pancreaticum is a common parasite whose adults live in ruminant bile ducts, gall bladder, pancreatic ducts and intestines in Europe, Madagascar, Asia and South America. Adult P. fastosum live in the liver, gall bladder and pancreas of birds and mammals in Europe, Africa, Asia, North, Central and South America. Information about the epidemiology, pathology, clinical aspect, diagnosis, treatment, control, prevention and economic impact mainly of Dicrocoeliosis produced by D. dendriticum, as well as of Eurytrematodosis and Platynosomiosis, has been included.


Assuntos
Dicrocoeliidae , Infecções por Trematódeos , África/epidemiologia , Animais , Ásia/epidemiologia , Dicrocoeliidae/classificação , Europa (Continente)/epidemiologia , Humanos , América do Norte/epidemiologia , América do Sul/epidemiologia , Infecções por Trematódeos/diagnóstico , Infecções por Trematódeos/epidemiologia , Infecções por Trematódeos/parasitologia , Infecções por Trematódeos/prevenção & controle
7.
BMC Public Health ; 19(1): 855, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262273

RESUMO

BACKGROUND: According to internal observations within a German shipping company, obvious risk-behaviour persists among the crew members coming from the Pacific Island State of Kiribati and representing a large part of the crew aboard merchant vessels of this company. These observations were related to excessive eating habits. This study aims to assess the cardiovascular risk among seafarers and to compare lifestyle factors between Kiribati and European crew members. METHODS: In the present maritime field study 81 sailors (48 Kiribati, 33 European, average age at 38.9 and 36.8 years respectively) were examined from April until August 2014 aboard four container ships crossing the Atlantic Ocean (participation rate of 90.9%). RESULTS: Based on the number of established risk factors, 35.4% of the Kiribati and 16.7% of the European crew members were regarded as a high risk group for cardiovascular diseases. The HDL-values of Kiribati were found to be considerably lower (34.9 mg/dl) than the references values given by the WHO and in comparison to the European crew members (44.8 mg/dl) (p = 0.002). 91.7% of Kiribati and 51.5% of European participants were found to be overweight according to WHO-criteria - with a mean Body Mass Index (BMI) of 30.3 kg/m2 and 25.6 kg/m2 (p <  0.001). Regarding lifestyle factors Kiribati often claimed to eat significantly larger amounts of food aboard while most European sailors stated to eat less or about the same during their shipboard stay (p = 0.017). Daily sleeping hours were slight on both sides; however with a mean of 5.2 h a day Kiribati crew members had significant fewer sleep (p = 0.038). The examined Kiribati sailors had a mean increase in weight of 6 kg over a 12 months period of observation. CONCLUSIONS: In total the compiled data points towards a higher risk of cardiovascular diseases particularly due to alimentary habits within the Kiribati crew members. The distinct weight-gain measured among the Kiribati in spite of higher energy consumption levels at sea is alarming. Thus, the results of this study confirm the necessity of health-improving interventions aboard cargo vessels.


Assuntos
Doenças Cardiovasculares/epidemiologia , Estilo de Vida , Militares/psicologia , Adulto , Europa (Continente)/epidemiologia , Humanos , Masculino , Micronésia/epidemiologia , Pessoa de Meia-Idade , Militares/estatística & dados numéricos , Projetos Piloto , Prevalência , Fatores de Risco , Adulto Jovem
8.
Ophthalmologica ; 242(2): 81-86, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31230058

RESUMO

PURPOSE: To examine the prevalence and incidence of rhegmatogenous retinal detachment (RRD) in Europe. METHODS: A systematic review of the prevalence and incidence of RRD in Europe according to the meta-analyses of observational studies in epidemiology (MOOSE) guidelines was performed using the databases PubMed, Embase, and Web of Science followed by a meta-analysis of incidence data. RESULTS: 658 studies were identified, 76 full-text articles were assessed, and 5 studies were eligible for meta-analysis. Random-effects pooled mean annual incidence of RRD in Europe was 13.3 cases per 100,000 inhabitants (95% CI: 11.3-15.6) based on the examination of 95,765 individuals from the 5 incidence studies. No European studies reporting prevalence of retinal detachment were identified. CONCLUSION: Published articles on the prevalence and incidence of RRD in Europe are limited. Further epidemiological research is needed for adequate healthcare planning.


Assuntos
Descolamento Retiniano/epidemiologia , Medição de Risco/métodos , Distribuição por Idade , Europa (Continente)/epidemiologia , Humanos , Incidência , Fatores de Risco , Distribuição por Sexo
9.
BMC Public Health ; 19(1): 826, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31242875

RESUMO

BACKGROUND: Varicella is a highly contagious childhood disease. Generally benign, serious complications necessitating antibiotic use may occur. The objective of this study was to characterize the rate, appropriateness and patterns of real-world antibiotic prescribing for management of varicella-associated complications, prior to universal varicella vaccination (UVV) implementation. METHODS: Pooled, post-hoc analysis of 5 international, multicenter, retrospective chart reviews studies (Argentina, Hungary, Mexico, Peru, Poland). Inpatient and outpatient primary pediatric (1-14 years) varicella cases, diagnosed between 2009 and 2016, were eligible. Outcomes, assessed descriptively, included varicella-associated complications and antibiotic use. Three antibiotic prescribing scenarios were defined based on complication profile in chart: evidence of microbiologically confirmed bacterial infection (Scenario A); insufficient evidence confirming microbiological confirmation (Scenario B); no evidence of microbiological confirmation (Scenario C). Stratification was performed by patient status (inpatient vs. outpatient) and country. RESULTS: Four hundred one outpatients and 386 inpatients were included. Mean (SD) outpatient age was 3.6 (2.8) years; inpatient age was 3.1 (2.8) years. Male gender was predominant. Overall, 12.2% outpatients reported ≥1 infectious complication, 3.7% ≥1 bacterial infection, and 0.5% ≥1 microbiologically confirmed infection; inpatient complication rates were 78.8, 33.2 and 16.6%, respectively. Antibiotics were prescribed to 12.7% of outpatients and 68.9% of inpatients. Among users, ß-lactamases (class), and clindamycin (agent), dominated prescriptions. Scenario A was assigned to 3.9% (outpatients) vs 13.2% (inpatients); Scenario B: 2.0% vs. 6.0%; Scenario C: 94.1% vs. 80.8%. CONCLUSIONS: High rates of infectious complications and antibiotic use are reported, with low rates of microbiological confirmation suggesting possible antibiotic misuse for management of varicella complications.


Assuntos
Antibacterianos/uso terapêutico , Varicela/tratamento farmacológico , Assistência à Saúde/normas , Prescrições de Medicamentos/estatística & dados numéricos , Adolescente , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Varicela/epidemiologia , Varicela/virologia , Criança , Pré-Escolar , Clindamicina/uso terapêutico , Europa (Continente)/epidemiologia , Feminino , Hospitalização , Humanos , Lactente , Pacientes Internados , América Latina/epidemiologia , Masculino , Pacientes Ambulatoriais , Estudos Retrospectivos , beta-Lactamases/uso terapêutico
10.
BMC Public Health ; 19(1): 823, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31242882

RESUMO

BACKGROUND: Triggered by the successive implementation of organized mammography screening programs (MSPs) throughout western European countries over the last decades, there is an ongoing debate questioning their effectiveness. Since it is difficult to assess the effect of MSPs on a population level, we rather aim to assess the impact of the implementation itself on breast cancer mortality rates utilizing an ecological study design. METHODS: We analyzed age group-specific (50-59, 60-69 and 70-79 years) female breast cancer mortality rates in 14 western European countries between 1980 and 2017 using Joinpoint regression, interrupted time series (ITS) regression and multivariable Poisson regression. RESULTS: The Joinpoint analysis demonstrated decreasing trends resulting in annual percentage changes ranging from - 1.5% to - 5.4% (50-59), - 0.2% to - 8.1% (60-69) and 0% to - 7.1% (70-79) depending on the country within 3 years after MSP implementation. The ITS analysis results in highly significant interaction terms (calendar year * binary MSP indicator) for all age groups. The multivariable regression using "calendar year", "year of MSP implementation" and "years with MSP" as independent variables yielded a significant yearly decrease for "years with MSP" ranging from 0.9 to 1.2%. CONCLUSIONS: The results of this study suggest a positive association between the implementation of MSPs and the (accelerated) reduction of breast cancer mortality rates. Measuring and quantifying the isolated effect of MSPs on a population level will require additional studies using individual data.


Assuntos
Neoplasias da Mama/mortalidade , Detecção Precoce de Câncer/métodos , Mamografia , Programas de Rastreamento , Avaliação de Programas e Projetos de Saúde , Idoso , Neoplasias da Mama/etnologia , Causas de Morte , Europa (Continente)/epidemiologia , Feminino , Programas Governamentais , Humanos , Análise de Séries Temporais Interrompida , Mamografia/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Resultado do Tratamento
11.
J Neurointerv Surg ; 11(6): 535-538, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31152058

RESUMO

BACKGROUND: Mechanical thrombectomy (MT) has become the cornerstone of acute ischemic stroke management in patients with large vessel occlusion (LVO). The aim of this guideline document is to assist physicians in their clinical decisions with regard to MT. METHODS: These guidelines were developed based on the standard operating procedure of the European Stroke Organisation, and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. An interdisciplinary working group identified 15 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote evidence based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. RESULTS: We found high quality evidence to recommend MT plus best medical management (BMM, including intravenous thrombolysis whenever indicated) to improve functional outcome in patients with LVO related acute ischemic stroke within 6 hours after symptom onset. We found moderate quality of evidence to recommend MT plus BMM in the 6-24 hour time window in patients meeting the eligibility criteria of published randomized trials. These guidelines further detail aspects of prehospital management, patient selection based on clinical and imaging characteristics, and treatment modalities. CONCLUSIONS: MT is the standard of care in patients with LVO related acute stroke. Appropriate patient selection and timely reperfusion are crucial. Further randomized trials are needed to inform clinical decision making with regard to the mothership and drip-and-ship approaches, anesthaesia modalities during MT, and to determine whether MT is beneficial in patients with low stroke severity or large infarct volume.


Assuntos
Isquemia Encefálica/terapia , Trombólise Mecânica/normas , Guias de Prática Clínica como Assunto/normas , Sociedades Médicas/normas , Acidente Vascular Cerebral/terapia , Administração Intravenosa , Isquemia Encefálica/epidemiologia , Europa (Continente)/epidemiologia , Humanos , Trombólise Mecânica/métodos , Seleção de Pacientes , Reperfusão/métodos , Reperfusão/normas , Acidente Vascular Cerebral/epidemiologia
12.
Eur J Endocrinol ; 181(3): P1-P19, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31176307

RESUMO

PARAT, a new European Society of Endocrinology program, aims to identify unmet scientific and educational needs of parathyroid disorders, such as primary hyperparathyroidism (PHPT), including parathyroid cancer (PC), and hypoparathyroidism (HypoPT). The discussions and consensus statements from the first PARAT workshop (September 2018) are reviewed. PHPT has a high prevalence in Western communities, PHPT has a high prevalence in Western communities, yet evidence is sparse concerning the natural history and whether morbidity and long-term outcomes are related to hypercalcemia or plasma PTH concentrations, or both. Cardiovascular mortality and prevalence of low energy fractures are increased, whereas Quality of Life is decreased, although their reversibility by treatment of PHPT has not been convincingly demonstrated. PC is a rare cause of PHPT, with an increasing incidence, and international collaborative studies are required to advance knowledge of the genetic mechanisms, biomarkers for disease activity, and optimal treatments. For example, ~20% of PCs demonstrate high mutational burden, and identifying targetable DNA variations, gene amplifications and gene fusions may facilitate personalized care, such as different forms of immunotherapy or targeted therapy. HypoPT, a designated orphan disease, is associated with a high risk of symptoms and complications. Most cases are secondary to neck surgery. However, there is a need to better understand the relation between disease biomarkers and intellectual function, and to establish the role of PTH in target tissues, as these may facilitate the appropriate use of PTH substitution therapy. Management of parathyroid disorders is challenging, and PARAT has highlighted the need for international transdisciplinary scientific and educational studies in advancing in this field.


Assuntos
Educação/métodos , Endocrinologia/educação , Endocrinologia/métodos , Doenças das Paratireoides/tratamento farmacológico , Sociedades Médicas , Europa (Continente)/epidemiologia , Humanos , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/tratamento farmacológico , Hiperparatireoidismo Primário/metabolismo , Doenças das Paratireoides/diagnóstico , Doenças das Paratireoides/metabolismo , Hormônio Paratireóideo/uso terapêutico , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/tratamento farmacológico , Neoplasias das Paratireoides/metabolismo
13.
Vet Microbiol ; 233: 68-77, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31176415

RESUMO

Swine brucellosis due to Brucella suis biovar 2 (bv2) is enzootic in wild boar and hare in continental Europe and may cause major economic losses to the pig industry, mainly in free-ranged pig farms. The high nucleotide identity found among the B. suis biovar 2 isolates has long hindered the full understanding of the epidemiology and the phylogeography of the disease. Here, we used multilocus variable-number tandem-repeat (VNTR) analysis (MLVA) and whole-genome analysis to identify single-nucleotide polymorphisms (SNPs) in order to gain insights from the largest B. suis bv2 dataset analyzed so far composed of domestic pigs and wildlife isolates collected throughout Europe since the 1970s. We found four major clades with a specific phylogeographic pattern. The Iberian clade contains isolates exclusively from the Iberian Peninsula. The Central European clade includes most isolates from France, Northern Italy, Switzerland and an important proportion of those of Northern Spain. The Eastern European clade clustered isolates from Croatia and Hungary mainly but also from areas of France, Germany, Italy and Poland. Finally, a separated Sardinian clade grouped three isolates from this island. At fine scale, MLVA demonstrated an endemic status of the infection in Europe and it allowed tracking a large outbreak formed by different farms from Spain linked to the same infection source. The whole genome SNP analysis showed that the strains form genetically distinct clades, shared between wild boar and pigs, in agreement with the MLVA clades. Interestingly, all hare isolates clustered together within two groups composed exclusively of wildlife isolates. Our results support the hypothesis that maintenance and spread of B. suis bv2 in Europe is a dynamic process linked to the natural expansion of wild boar as the main wild reservoir of the infection, while spread over long distances is found largely dependent on anthropogenic activities.


Assuntos
Animais Selvagens/microbiologia , Brucella suis/genética , Brucelose/veterinária , Sus scrofa/microbiologia , Doenças dos Suínos/epidemiologia , Animais , Técnicas de Tipagem Bacteriana , Brucella suis/isolamento & purificação , Brucelose/epidemiologia , Surtos de Doenças , Europa (Continente)/epidemiologia , Genótipo , Repetições Minissatélites , Tipagem de Sequências Multilocus , Filogenia , Filogeografia , Suínos/microbiologia , Doenças dos Suínos/transmissão , Sequenciamento Completo do Genoma
14.
Ann Agric Environ Med ; 26(2): 341-349, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31232069

RESUMO

INTRODUCTION: Obesity is a serious health problem in nearly all regions of Europe. During the last four decades, the percentage of obese people increased four times among men and twice among women, reaching a global epidemic scale as the biggest health-related issue in the developed and developing countries. OBJECTIVE: The aim was to assess the epidemiological situation of obesity, according to gender among adults in Europe, compared with other regions and selected worldwide countries, as well as to devise a forecast for the near future based on analysis results. MATERIAL AND METHODS: An overview was performed of the World Health Organization (WHO) statistical database in 1999-2016, concerning obesity prevalence among people over the age of 20 across 28 countries of the European Union. A forecast for the years 2020 and 2030 was prepared by evaluation of gradients for trendline equations. Moreover, some of the world regions, as well as individual countries, five per region, were collated and analyzed to prepare the forecast. RESULTS: The percentage of obese people in the countries of the European Union continues to increase every year. The dynamics of obesity growth in Europe is greater for men than for women (3.09% per year vs. 1.92% per year). With the growth rate remaining at the estimated level, in 2030 there will probably be more obese men (38.1%) than women (32.7%) in Poland, and in Europe likewise - 36.6% and 32.0%, respectively. CONCLUSIONS: Obesity has become a major epidemiological problem and an undisputable health problem not only in Poland and other European countries, but worldwide.


Assuntos
Obesidade/epidemiologia , Adulto , Idoso , Europa (Continente)/epidemiologia , União Europeia/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Organização Mundial da Saúde , Adulto Jovem
15.
BMC Public Health ; 19(1): 699, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170953

RESUMO

BACKGROUND: The majority of empirical studies focus on a single Social Determinant of Health (SDH) when analysing health inequalities. We go beyond this by exploring how the combination of education (micro level) and household arrangements (mezzo level) is associated with self-perceived health. METHODS: Our data source is the 2014 cross-sectional data from the European Survey of Living Conditions (EU-SILC). We calculate the predicted probabilities of poor self-perceived health for the middle-aged European population (30-59 years) as a function of the combination of the two SDHs. This is done separately for five European country groups (dual-earner; liberal; general family support; familistic; and post-socialist transition) and gender. RESULTS: We observe a double health gradient in all the country groups: first, there is a common health gradient by education (the higher the education, the lower the probability of poor health); second, household arrangements define a health gradient within each educational level according to whether or not the individual lives with a partner (living with a partner is associated with a lower probability of poor health). We observe some specificity in this general pattern. Familistic and post-socialist transition countries display large differences in the predicted probabilities according to education and household arrangements when compared with the other three country groups. Familistic and post-socialist transition countries also show the largest gender differences. CONCLUSIONS: Health differences in European populations seem to be defined, first, by education and, second, by living or not living with a partner. Additionally, different social contexts (gender inequalities, educational profile, etc.) in European countries change the influences on health of both the SDHs for both women and men.


Assuntos
Escolaridade , Características da Família , Disparidades nos Níveis de Saúde , Fatores Sexuais , Determinantes Sociais da Saúde/estatística & dados numéricos , Adulto , Estudos Transversais , Autoavaliação Diagnóstica , Europa (Continente)/epidemiologia , Feminino , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Condições Sociais
16.
Life Sci Space Res (Amst) ; 21: 73-82, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31101157

RESUMO

The European Space Agency (ESA) is currently expanding its efforts in identifying requirements and promoting research towards optimizing radiation protection of astronauts. Space agencies use common limits for tissue (deterministic) effects on the International Space Station. However, the agencies have in place different career radiation exposure limits (for stochastic effects) for astronauts in low-Earth orbit missions. Moreover, no specific limits for interplanetary missions are issued. Harmonization of risk models and dose limits for exploratory-class missions are now operational priorities, in view of the short-term plans for international exploratory-class human missions. The purpose of this paper is to report on the activity of the ESA Topical Team on space radiation research, whose task was to identify the most pertinent research requirements for improved space radiation protection and to develop a European space radiation risk model, to contribute to the efforts to reach international consensus on dose limits for deep space. The Topical Team recommended ESA to promote the development of a space radiation risk model based on European-specific expertise in: transport codes, radiobiological modelling, risk assessment, and uncertainty analysis. The model should provide cancer and non-cancer radiation risks for crews implementing exploratory missions. ESA should then support the International Commission on Radiological Protection to harmonize international models and dose limits in deep space, and guarantee continuous support in Europe for accelerator-based research configured to improve the models and develop risk mitigation strategies.


Assuntos
Radiação Cósmica/efeitos adversos , Neoplasias Induzidas por Radiação/epidemiologia , Lesões por Radiação/epidemiologia , Proteção Radiológica/normas , Projetos de Pesquisa , Medição de Risco/métodos , Astronautas , Europa (Continente)/epidemiologia , Humanos , Incidência , Doses de Radiação , Radiobiologia , Voo Espacial
17.
Zoonoses Public Health ; 66(5): 526-532, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31119884

RESUMO

The oral rabies vaccination (ORV) programme is the most widespread vaccination programme that is implemented in the European Union and targets wildlife diseases. The size of the project requires significant financial resources, so a cost-benefit analysis is necessary to establish the economic value of the project. We summarized all ORV costs during the period 2011-2016 in Croatia, calculated all established benefits and presented the cost-benefit ratio (CBR). Additionally, we analysed all components included in the ORV and rabies control programme (surveillance, preventive human treatment and vaccination of dogs) to find possibilities to increase the benefits. According to our results, in the period 2011-2016, the CBR was only 0.05, and the majority of the cost was derived from the preventive vaccination of dogs (72.3%). With the implementation of 2- or 3-year vaccination intervals, the CBR can be increased to 1.46 or 1.92, respectively, confirming positive economic value. This study shows the importance of analysing all rabies control and eradication components based on the specific characteristics of a particular country to determine the factors that can be modified to potentially improve the benefits of ORV.


Assuntos
União Europeia/economia , Raposas/virologia , Vacinas Antirrábicas/imunologia , Raiva/veterinária , Vacinação/veterinária , Administração Oral , Animais , Animais Selvagens , Análise Custo-Benefício , Europa (Continente)/epidemiologia , Raiva/prevenção & controle , Vacinas Antirrábicas/administração & dosagem , Vacinação/economia , Vacinação/métodos
19.
Eur Radiol ; 29(7): 3686-3695, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31041566

RESUMO

OBJECTIVES: To assess the incidence of acute adverse events (AAEs) in gadolinium-enhanced cardiac magnetic resonance (CMR) imaging. METHODS: Gadolinium-based contrast agent (GBCA)-enhanced CMR data from the multinational, multicenter European Society of Cardiovascular Radiology MRCT Registry was included. AAE severity was classified according to the American College of Radiology Manual on Contrast Media (mild, moderate, severe). Multivariable generalized linear mixed effect models were used to assess the likelihood of AAEs in various GBCA, adjusting for pharmacological stressor, main indications (i.e., suspected or known coronary artery disease or myocarditis), age, sex, and submitting center as a random effect. RESULTS: In the study population of 72,839 GBCA-enhanced CMRs, a total of 260 AAEs were reported (0.36%), with a minority of severe AAEs (n = 24, 0.033%). Allergic-like AAEs were less likely than physiologic AAEs (29% versus 71%). Patients without pharmacological stress imaging had a lower AAE rate (0.22%) compared to stress imaging (0.75%), with the highest AAE rates for regadenoson (2.95%). AAE rates also varied by GBCA subtype (overall p < 0.001). There was significant interaction between GBCA and pharmacological stressor (interaction p = 0.025), with AAE rates ranging between 0 and 10% for certain GBCA/stressor combinations. There was further marginal evidence that higher GBCA volume was associated with higher AAE incidence (OR = 1.02, p = 0.05). CONCLUSION: GBCA-enhanced CMR imaging demonstrates low AAE rates comparable to those of other body regions. AAE likelihood correlates with GBCA subtype, pharmacological stressor, and imaging indication. Intravenous fluid administration in patients with cardiac impairment might contribute to these findings. KEY POINTS: • Acute adverse event rates in cardiac magnetic resonance (CMR) imaging with gadolinium-based contrast agents (GBCAs) are low (0.36%), especially for severe adverse events (0.033%). • Mild and moderate adverse events are more frequent during stress CMR imaging. • Physiologic AAEs are more common than allergic AAEs in CMR imaging.


Assuntos
Doenças Cardiovasculares/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Imagem Cinética por Ressonância Magnética/efeitos adversos , Compostos Organometálicos/efeitos adversos , Radiologia , Sistema de Registros , Sociedades Médicas , Doença Aguda , Administração Intravenosa , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Incidência , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Compostos Organometálicos/administração & dosagem , Estudos Retrospectivos
20.
BMC Public Health ; 19(1): 534, 2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31077185

RESUMO

BACKGROUND: Life satisfaction is a cognitive and evaluative judgement of one's outlook on life and an integral component of subjective wellbeing. There is a strong association between life satisfaction and mental and physical health, but it is currently unclear how environmental factors may influence life satisfaction. Our aim was to investigate the association between environmental factors and life satisfaction and to gain a better understanding of general life satisfaction statistics in the EU. METHODS: We used a three-level mixed effects logistic regression model to examine the effects of sociodemographic, macroeconomic and environmental factors on life satisfaction using a large sample size from Eurobarometer surveys (n = 268,696) representative of 27 EU countries. Data were collected through face-to-face interviews between May 2014 and June 2015. RESULTS: We found wide variation between countries, as well as between regions within the same country with regards to levels of life satisfaction. Having adjusted for individual sociodemographic factors, our analysis did not indicate statistically significant associations of mean temperature and precipitation with life satisfaction. However, there was a statistically significant association between environmental degradation and lower life satisfaction (OR = 0.98; 95% CI: 0.97-1.00). Consistent with existing literature, our results show statistically significant effects of sociodemographic factors such as sex, financial situation and employment on life satisfaction. CONCLUSIONS: Future research should extend analyses to a wider range of sociodemographic, macroeconomic and geographical variables to gain insight on all possible factors affecting life satisfaction to inform policy makers and ensure higher quality of life, and in turn better mental and physical health.


Assuntos
Emprego/psicologia , Satisfação Pessoal , Qualidade de Vida , Adulto , Emprego/estatística & dados numéricos , Europa (Continente)/epidemiologia , Feminino , Humanos , Renda/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Fatores Socioeconômicos , Estresse Psicológico/epidemiologia , Inquéritos e Questionários
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