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2.
Malawi Med J ; 32(1): 37-44, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32733658

RESUMO

Background: The report from the World Health Organization (WHO) reveals that health spending worldwide remains highly unequal as more than 80% of the world's population live in low and middle-income countries but only account for about 20% of global health expenditure. Another report by the WHO on the state of health financing in Africa published in 2013 intimates that countries that are part of their member states are still on the average level in meeting set goals in financing key health projects. Objective: The study set out to investigate the association between public and private spending and health status for eight selected African countries, namely Burundi, Eritrea, Ethiopia, Kenya, Rwanda, Sudan, Tanzania and Uganda. Health status indicators include the incidence of tuberculosis, mortality rates, maternal deaths and prevalence of HIV. Methods: Descriptive statistics and pairwise correlation are used to assess the relationship between healthcare spending and health status. Random and fixed effect models are further employed to provide insights into the association between descriptive statistics and pairwise correlation. We used annual data from the year 2000 to 2014 obtained from world development indicators. Results: The relationship between healthcare spending (public and private) and health status is statistically significant. Public healthcare expenditure has a higher association than private expenditure in reducing the mortality rate, tuberculosis and HIV for the average country in our sample. For example, an increase in public healthcare spending is negatively associated and statistically significant at 5% or better in reducing female mortality, male mortality, tuberculosis and HIV. Private healthcare spending is more impactful in the area of maternal deaths, where it is associated negatively and statistically significant at 1%. An increase in private healthcare spending is linked to a reduction in maternal deaths. We also compared the association between an increase in healthcare spending on males versus females and observed that public health expenditure impacts the health status of both sexes equally, however, private health expenditure provides a greater positive benefit to males. It is worth remembering that two goals of the United Nations agenda on sustainable development are gender equality and ensuring healthcare for all. Conclusion: The findings of this research call for the selected African countries to pay more attention to public healthcare expenditure in order to improve health status, especially since private healthcare which provides access to healthcare facilities for some poor people leads to costs that are a burden. So, future research should focus on analyzing components of private healthcare spending such as direct household out-of-pocket spending, private insurance and direct service payments by private corporations as dependent variables to understand what form of private investment should be encouraged.


Assuntos
Assistência à Saúde/economia , Gastos em Saúde , Indicadores Básicos de Saúde , Nível de Saúde , Financiamento da Assistência à Saúde , Saúde Pública/economia , Tuberculose/epidemiologia , África Oriental , Infecções por HIV/economia , Infecções por HIV/epidemiologia , Humanos , Incidência , Morte Materna , Mortalidade , Prevalência
3.
Medicine (Baltimore) ; 99(32): e21564, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769899

RESUMO

In the study's early stage, the research group had established an evaluation index system for the rational drug use of primary nephrotic syndrome in children. To assess the feasibility of the established index system, we conducted this empirical study.The cross-sectional study was conducted by using the Hospital Information System to extract some general clinical data of hospitalized children with primary nephrotic syndrome, which included registration number, age, sex, diagnosis and medication, etc. Utilize the SPSS23.0 software and Excel 2016 to descriptively analyze information.224 hospitalized children with primary nephrotic syndrome who met the inclusion criteria were included, ranging from 18 years old and 10 months to 11 months and 23 days, with an average age of 8.40, plus or minus 4.30 years. 148 males (66.07%) and 76 females (33.93%). The duration of hospitalization was 1-57 days, with an average hospitalization time of 10.59 days. The most common is respiratory infections, such as the bronchopneumonia, the mycoplasma pneumonia, etc. This study had successfully completed the measurement of the evaluation index system for the rational drug use of primary nephrotic syndrome in children.All indicators are feasible, but the operability and applicability need further research and improvement.


Assuntos
Indicadores Básicos de Saúde , Hormônios/uso terapêutico , Fatores Imunológicos/uso terapêutico , Síndrome Nefrótica/tratamento farmacológico , Indicadores de Qualidade em Assistência à Saúde , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Estudos de Viabilidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Masculino
4.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-47729

RESUMO

Apresenta um panorama epidemiológico da pandemia, com um conjunto de indicadores-chave para monitoramento da situação nos estados e regiões do país.


Assuntos
Infecções por Coronavirus , Indicadores Básicos de Saúde
5.
PLoS One ; 15(7): e0235732, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32673323

RESUMO

Mobile geolocation data is a valuable asset in the assessment of movement patterns of a population. Once a highly contagious disease takes place in a location the movement patterns aid in predicting the potential spatial spreading of the disease, hence mobile data becomes a crucial tool to epidemic models. In this work, based on millions of anonymized mobile visits data in Brazil, we investigate the most probable spreading patterns of the COVID-19 within states of Brazil. The study is intended to help public administrators in action plans and resources allocation, whilst studying how mobile geolocation data may be employed as a measure of population mobility during an epidemic. This study focuses on the states of São Paulo and Rio de Janeiro during the period of March 2020, when the disease first started to spread in these states. Metapopulation models for the disease spread were simulated in order to evaluate the risk of infection of each city within the states, by ranking them according to the time the disease will take to infect each city. We observed that, although the high-risk regions are those closer to the capital cities, where the outbreak has started, there are also cities in the countryside with great risk. The mathematical framework developed in this paper is quite general and may be applied to locations around the world to evaluate the risk of infection by diseases, in special the COVID-19, when geolocation data is available.


Assuntos
Infecções por Coronavirus/epidemiologia , Aplicativos Móveis , Modelos Biológicos , Pneumonia Viral/epidemiologia , Brasil/epidemiologia , Cidades/epidemiologia , Simulação por Computador , Surtos de Doenças , Indicadores Básicos de Saúde , Humanos , Pandemias , Densidade Demográfica , Viagem
6.
Monaldi Arch Chest Dis ; 90(3)2020 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-32696629

RESUMO

Coronavirus disease 2019, i.e. COVID-19, started as an outbreak in a district of China and has engulfed the world in a matter of 3 months. It is posing a serious health and economic challenge worldwide. However, case fatality rates (CFRs) have varied amongst various countries ranging from 0 to 8.91%. We have evaluated the effect of selected socio-economic and health indicators to explain this variation in CFR. Countries reporting a minimum of 50 cases as on 14th March 2020, were selected for this analysis. Data about the socio-economic indicators of each country was accessed from the World bank database and data about the health indicators were accessed from the World Health Organisation (WHO) database. Various socioeconomic indicators and health indicators were selected for this analysis. After selecting from univariate analysis, the indicators with the maximum correlation were used to build a model using multiple variable linear regression with a forward selection of variables and using adjusted R-squared score as the metric. We found univariate regression results were significant for GDP (Gross Domestic Product) per capita, POD 30/70 (Probability Of Dying Between Age 30 And Exact Age 70 From Any of Cardiovascular Disease, Cancer, Diabetes or Chronic Respiratory Disease), HCI (Human Capital Index), GNI(Gross National Income) per capita, life expectancy, medical doctors per 10000 population, as these parameters negatively corelated with CFR (rho = -0.48 to -0.38 , p<0.05). Case fatality rate was regressed using ordinary least squares (OLS) against the socio-economic and health indicators. The indicators in the final model were GDP per capita, POD 30/70, HCI, life expectancy, medical doctors per 10,000, median age, current health expenditure per capita, number of confirmed cases and population in millions. The adjusted R-squared score was 0.306. Developing countries with a poor economy are especially vulnerable in terms of COVID-19 mortality and underscore the need to have a global policy to deal with this on-going pandemic. These trends largely confirm that the toll from COVID-19 will be worse in countries ill-equipped to deal with it. These analyses of epidemiological data are need of time as apart from increasing situational awareness, it guides us in taking informed interventions and helps policy-making to tackle this pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Indicadores Básicos de Saúde , Pneumonia Viral/epidemiologia , Adulto , Fatores Etários , Idoso , Infecções por Coronavirus/economia , Infecções por Coronavirus/mortalidade , Países em Desenvolvimento , Saúde Global , Humanos , Pessoa de Meia-Idade , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/mortalidade , Fatores Socioeconômicos
7.
Ann Hematol ; 99(7): 1655-1665, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32524200

RESUMO

Second allogeneic hematopoietic stem cell transplantation (allo-HSCT) has a low survival outcome and a high non-relapse mortality (NRM) rate which is a major obstacle to this treatment. We hypothesized that the status of malnourishment after first allo-HSCT as represented by the geriatric nutritional risk index (GNRI) could be used as a prognostic factor to determine the outcomes of second allo-HSCT. A total of 108 patients with a median age of 42 (range, 17-69) years, who received second allo-HSCT for disease recurrence after first allo-HSCT from our institution, were included in this study. Low GNRI had a significant impact on NRM at 2 years after second allo-HSCT: 56.9% in patients with GNRI ≤ 92 compared with 27.5% in patients with GNRI > 92 (P = 0.002). In multivariate analysis, GNRI of ≤ 92 was the only significant factor for NRM (hazard ratio [HR] 2.29, 95% confidence interval [CI] 1.15-4.56, P = 0.018). High-risk disease status at second allo-HSCT (HR 2.74, 95% CI 1.46-5.14, P = 0.002) and GNRI of ≤ 92 (HR 1.70, 95% CI 1.02-2.82, P = 0.042) were identified as significant factors for overall survival (OS). A score of 1 was assigned to each factor, and the OS rate at 2 years after second allo-HSCT decreased according to the score: 53.0% in patients with score 0, 32.3% with score 1, and 2.5% with score 2 (P < 0.001). In conclusion, GNRI could be a useful predictor for the outcomes of second allo-HSCT. A prospective study in other cohorts is warranted to validate the findings of our study.


Assuntos
Avaliação Geriátrica/métodos , Neoplasias Hematológicas/diagnóstico , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas , Desnutrição/diagnóstico , Estado Nutricional , Adolescente , Adulto , Idoso , Feminino , Doença Enxerto-Hospedeiro/complicações , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/mortalidade , Indicadores Básicos de Saúde , Neoplasias Hematológicas/mortalidade , Neoplasias Hematológicas/patologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Masculino , Desnutrição/etiologia , Desnutrição/mortalidade , Desnutrição/patologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Recidiva , Retratamento/efeitos adversos , Retratamento/métodos , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Transplante Homólogo/efeitos adversos , Transplante Homólogo/métodos , Adulto Jovem
8.
Emerg Microbes Infect ; 9(1): 1537-1545, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32573353

RESUMO

Background: Novel coronavirus pneumonia (COVID-19) is prevalent around the world. We aimed to describe epidemiological features and clinical course in Shanghai. Methods: We retrospectively analysed 325 cases admitted at Shanghai Public Health Clinical Center, between January 20 and February 29, 2020. Results: 47.4% (154/325) had visited Wuhan within 2 weeks of illness onset. 57.2% occurred in 67 clusters; 40% were situated within 53 family clusters. 83.7% developed fever during the disease course. Median times from onset to first medical care, hospitalization and negative detection of nucleic acid by nasopharyngeal swab were 1, 4 and 8 days. Patients with mild disease using glucocorticoid tended to have longer viral shedding in blood and feces. At admission, 69.8% presented with lymphopenia and 38.8% had elevated D-dimers. Pneumonia was identified in 97.5% (314/322) of cases by chest CT scan. Severe-critical patients were 8% with a median time from onset to critical disease of 10.5 days. Half required oxygen therapy and 7.1% high-flow nasal oxygen. The case fatality rate was 0.92% with median time from onset to death of 16 days. Conclusion: COVID-19 cases in Shanghai were imported. Rapid identification, and effective control measures helped to contain the outbreak and prevent community transmission.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Seguimentos , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Eliminação de Partículas Virais , Adulto Jovem
9.
BMJ ; 369: m1714, 2020 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-32499297

RESUMO

OBJECTIVE: To develop an instrument to evaluate the credibility of anchor based minimal important differences (MIDs) for outcome measures reported by patients, and to assess the reliability of the instrument. DESIGN: Instrument development and reliability study. DATA SOURCES: Initial criteria were developed for evaluating the credibility of anchor based MIDs based on a literature review (Medline, Embase, CINAHL, and PsycInfo databases) and the experience of the authors in the methodology for estimation of MIDs. Iterative discussions by the team and pilot testing with experts and potential users facilitated the development of the final instrument. PARTICIPANTS: With the newly developed instrument, pairs of masters, doctoral, or postdoctoral students with a background in health research methodology independently evaluated the credibility of a sample of MID estimates. MAIN OUTCOME MEASURES: Core credibility criteria applicable to all anchor types, additional criteria for transition rating anchors, and inter-rater reliability coefficients were determined. RESULTS: The credibility instrument has five core criteria: the anchor is rated by the patient; the anchor is interpretable and relevant to the patient; the MID estimate is precise; the correlation between the anchor and the outcome measure reported by the patient is satisfactory; and the authors select a threshold on the anchor that reflects a small but important difference. The additional criteria for transition rating anchors are: the time elapsed between baseline and follow-up measurement for estimation of the MID is optimal; and the correlations of the transition rating with the baseline, follow-up, and change score in the patient reported outcome measures are satisfactory. Inter-rater reliability coefficients (ĸ) for the core criteria and for one item from the additional criteria ranged from 0.70 to 0.94. Reporting issues prevented the evaluation of the reliability of the three other additional criteria for the transition rating anchors. CONCLUSIONS: Researchers, clinicians, and healthcare policy decision makers can consider using this instrument to evaluate the design, conduct, and analysis of studies estimating anchor based minimal important differences.


Assuntos
Medidas de Resultados Relatados pelo Paciente , Indicadores Básicos de Saúde , Humanos , Qualidade de Vida , Reprodutibilidade dos Testes , Projetos de Pesquisa , Inquéritos e Questionários
10.
Medicine (Baltimore) ; 99(22): e20398, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481430

RESUMO

Assessment the prevalence of hypertension and its relation to selected indicators of health status and performance, including classification of BMI, obesity classifications, and body structure in a large test group of 19-year-old men.The study was observational-retrospective, and included a group of 17,282 men, aged 19, from the Malopolska region. All subjects met the qualifications for compulsory military service in 2017. We analyzed selected data obtained from the records of the Ministry of National Defense-spiral-ZINT. Data collection and analysis were carried out from April 1, 2018 to August 31, 2018.Hypertension was found at 0.6%, weak body structure at 0.8% and obesityco-existing with cardiorespiratory insufficiency has been reported 2.6% of respondents and it was more frequent in the recruiters from HT II than I. The underweight concerned almost 7%, and the overweight and obesity of 1/4 of conscripts. The vast majority of people with hypertension were characterized by excessive body weight (74.8%), mainly overweight.Hypertension was seen in a negligible percentage of males studied and was significantly associated with an increase in BMI, particularly with regards to being overweight.


Assuntos
Indicadores Básicos de Saúde , Hipertensão/diagnóstico , Medicina Militar/normas , Índice de Massa Corporal , Humanos , Hipertensão/epidemiologia , Masculino , Medicina Militar/métodos , Medicina Militar/estatística & dados numéricos , Obesidade/diagnóstico , Obesidade/epidemiologia , Sobrepeso/diagnóstico , Sobrepeso/epidemiologia , Polônia/epidemiologia , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/epidemiologia , Estudos Retrospectivos , Magreza/diagnóstico , Magreza/epidemiologia , Adulto Jovem
11.
Epidemiol Infect ; 148: e94, 2020 05 06.
Artigo em Inglês | MEDLINE | ID: covidwho-186670

RESUMO

Coronavirus disease 2019 (COVID-19) patients were classified into four clinical stages (uncomplicated illness, mild, severe and critical pneumonia) depending on disease severity. We aim to investigate the corresponding clinical, radiological and laboratory characteristics between different clinical stages. A retrospective, single-centre study of 101 confirmed patients with COVID-19 at Renmin Hospital of Wuhan University from 2 January to 28 January 2020 was enrolled; follow-up endpoint was on 8 February 2020. Clinical data were collected and compared during the course of illness. The median age of the 101 patients was 51.0 years and 33.6% were medical staff. Fever (68%), cough (50%) and fatigue (23%) are the most common symptoms. About 26% patients underwent the mechanical ventilation and 98% patients were treated with antibiotics. Thirty-seven per cent patients were cured and 11 died. On admission, the number of patients with uncomplicated illness, mild, severe and critical pneumonia were 2 [2%], 86 [85%], 11 [11%] and 2 [2%]. Forty-four of the 86 mild pneumonia progressed to severe illness within 4 days, with nine patients worsened due to critical pneumonia within 4 days. Two of the 11 severe patients improved to mild condition while three others deteriorated. Significant differences were observed among groups of different clinical stages in numbers of influenced pulmonary segments (6 vs. 12 vs. 17, P < 0.001). A significantly upward trend was witnessed in ground-glass opacities overlapped with striped shadows (33% vs. 42% vs. 55% vs. 80%, P < 0.001), while pure ground-glass opacities gradually decreased as disease progressed (45% vs. 35% vs. 24% vs. 13%, P < 0.001) within 12 days. Lymphocytes, prealbumin and albumin showed a downtrend as disease progressed from mild to severe or critical condition, an uptrend was found in white blood cells, C-reactive protein, neutrophils and lactate dehydrogenase. The proportions of serum amyloid A > 300 mg/l in mild, severe and critical conditions were 18%, 46% and 71%, respectively.


Assuntos
Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Adulto , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Prognóstico , Índice de Gravidade de Doença
12.
Epidemiol Infect ; 148: e94, 2020 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-32374248

RESUMO

Coronavirus disease 2019 (COVID-19) patients were classified into four clinical stages (uncomplicated illness, mild, severe and critical pneumonia) depending on disease severity. We aim to investigate the corresponding clinical, radiological and laboratory characteristics between different clinical stages. A retrospective, single-centre study of 101 confirmed patients with COVID-19 at Renmin Hospital of Wuhan University from 2 January to 28 January 2020 was enrolled; follow-up endpoint was on 8 February 2020. Clinical data were collected and compared during the course of illness. The median age of the 101 patients was 51.0 years and 33.6% were medical staff. Fever (68%), cough (50%) and fatigue (23%) are the most common symptoms. About 26% patients underwent the mechanical ventilation and 98% patients were treated with antibiotics. Thirty-seven per cent patients were cured and 11 died. On admission, the number of patients with uncomplicated illness, mild, severe and critical pneumonia were 2 [2%], 86 [85%], 11 [11%] and 2 [2%]. Forty-four of the 86 mild pneumonia progressed to severe illness within 4 days, with nine patients worsened due to critical pneumonia within 4 days. Two of the 11 severe patients improved to mild condition while three others deteriorated. Significant differences were observed among groups of different clinical stages in numbers of influenced pulmonary segments (6 vs. 12 vs. 17, P < 0.001). A significantly upward trend was witnessed in ground-glass opacities overlapped with striped shadows (33% vs. 42% vs. 55% vs. 80%, P < 0.001), while pure ground-glass opacities gradually decreased as disease progressed (45% vs. 35% vs. 24% vs. 13%, P < 0.001) within 12 days. Lymphocytes, prealbumin and albumin showed a downtrend as disease progressed from mild to severe or critical condition, an uptrend was found in white blood cells, C-reactive protein, neutrophils and lactate dehydrogenase. The proportions of serum amyloid A > 300 mg/l in mild, severe and critical conditions were 18%, 46% and 71%, respectively.


Assuntos
Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Adulto , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Prognóstico , Índice de Gravidade de Doença
13.
Anaesthesia ; 75(7): 896-903, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32363573

RESUMO

Critical care survivors suffer persistent morbidity and increased risk of mortality as compared with the general population. Nevertheless, there are no standardised tools to identify at-risk patients. Our aim was to establish whether the Sabadell score, a simple tool applied by the treating clinician upon critical care discharge, was independently associated with 5-year mortality through a prospective observational cohort study of adults admitted to a general critical care unit. The Sabadell score, which is a measure of clinician-assigned survival perception, was applied to all patients from September 2011 to December 2017. The primary outcome was 5-year mortality, assessed using a multivariable flexible parametric survival analysis adjusted for baseline characteristics and clinically relevant covariates. We studied 5954 patients with a minimum of 18 months follow-up. Mean (SD) age was 59.5 (17.0) years and 3397 (57.1%) patients were men. We categorised 2287 (38.4%) patients as Sadabell 0; 2854 (47.9%) as Sadabell 1; 629 (10.5%) as Sadabell 2; and 183 (3.1%) as Sadabell 3. Adjusted hazard ratios for mortality were 2.1 (95%CI 1.9-2.4); 4.0 (95%CI 3.4-4.6); and 21.0 (95%CI 17.2-25.7), respectively. Sabadell 3 patients had 99.9%, 99.5%, 98.5% and 87.4% mortality at 5 years for patients in the age brackets ≥ 80, 60-79, 40-59 and 16-39 years, respectively. Sabadell 2 patients had 71.0%, 52.7%, 44.8% and 23.7% 5-year mortality for these same age categories. The Sabadell score was independently associated with 5-year survival after critical care discharge. These findings can be used to guide provision of increased support for patients after critical care discharge and/or informed discussions with patients and relatives about dying to ascertain their future wishes.


Assuntos
Atitude do Pessoal de Saúde , Cuidados Críticos , Estado Terminal/mortalidade , Indicadores Básicos de Saúde , Alta do Paciente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estado Terminal/reabilitação , Inglaterra/epidemiologia , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Prognóstico , Estudos Prospectivos , Medição de Risco/métodos , Análise de Sobrevida , Adulto Jovem
14.
Health Qual Life Outcomes ; 18(1): 160, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32471430

RESUMO

BACKGROUND: Studies examining the impact of injury on health-related quality of life (HRQL) over time are necessary to understand the short- and long-term consequences of injury for population health. The aim of this systematic review was to provide an evidence update on studies that have measured HRQL over time in general injury populations using a generic (general) health state measure. METHODS: Studies conducted between 2010 and 2018 that assessed HRQL at more than one time point among general injury populations were eligible for inclusion. Two reviewers independently extracted information from each study on design, HRQL measure used, method of HRQL measure administration, timing of assessment(s), predictive variables, ability to detect change, and findings. Quality appraisals of each study were also completed by two reviewers using items from the RTI Item Bank on Risk of Bias and Precision of Observational Studies and the Guidelines for the Conduction of Follow-up Studies Measuring Injury-Related Disability. RESULTS: Twenty-nine studies (44 articles) that met the inclusion criteria were identified. HRQL was measured using 14 different generic measures; the SF-36, SF-12, and EQ-5D were used most frequently. A varying number of follow-up assessments were undertaken, ranging from one to five. Follow-up often occurred 12 months post-injury. Fewer studies (n = 11) examined outcomes two or more years post-injury, and only one to 10 years post-injury. While most studies documented improvements in HRQL over time since the injury event, study populations had not returned to pre-injury status or reached general population norm HRQL values at post-injury follow-ups. CONCLUSIONS: Since 2010 there has been a substantial increase in the number of studies evaluating the HRQL of general injury populations. However, significant variability in study design continues to impede quantification of the impact of injury on population health over time. Variation between studies is particularly evident with respect to timing and number of follow-up assessments, and selection of instruments to evaluate HRQL.


Assuntos
Qualidade de Vida , Projetos de Pesquisa/normas , Ferimentos e Lesões/reabilitação , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Pessoas com Deficiência/psicologia , Feminino , Seguimentos , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Ferimentos e Lesões/psicologia , Adulto Jovem
15.
Value Health ; 23(5): 666-673, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32389233

RESUMO

OBJECTIVES: Patient-reported outcome (PRO) measurements used in cancer research can assess a number of health domains. Our primary objective was to investigate which broad types of PRO domains (namely, functional health, symptoms, and global quality of life [QoL]) most frequently yielded significant differences between treatments in randomized controlled trials (RCTs). METHODS: A total of 229 RCTs published between January 2004 and February 2019, conducted on patients diagnosed with the most common solid malignancies and assessed using the European Organization for the Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30, were considered. Studies were identified systematically using literature searches in key electronic databases. Unlike other PRO measurements typically used in RCTs, the scoring algorithm of the multidimensional EORTC QLQ-C30 allowed us to clearly distinguish the 3 broad types of PRO domains. RESULTS: In total, 134 RCTs (58.5%) reported statistically significant differences between treatment arms for at least 1 of the QLQ-C30 domains. Most frequently, differences were reported for 2 or all 3 broad types of PRO domains (78 of 134 trials; 58.2%). In particular, 35 trials (26.1%) found significant differences for symptoms, functional health, and global QoL, 24 trials (17.9%) for symptoms and functional health, 11 trials (8.2%) for functional health and global QoL, and 8 trials (6.0%) for symptoms and global QoL. The likelihood of finding a statistically significant difference between treatment arms was not associated with key study characteristics, such as study design (ie, open-label vs blinded trials) and industry support. CONCLUSIONS: Our findings emphasize the importance of a multidimensional PRO assessment to most comprehensively capture the overall burden of therapy from the patients' standpoint.


Assuntos
Indicadores Básicos de Saúde , Neoplasias , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
PLoS One ; 15(4): e0230502, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32271790

RESUMO

Early identification of children <5 years with severe acute malnutrition (SAM) is a high priority to reduce child mortality and improved health outcomes. Current WHO guidelines for community screening for SAM recommend a Mid-Upper-Arm Circumference (MUAC) of less than 115 mm to identify children with SAM, but this cut-off does not identify a significant number of children with a weight-for-height Z-score <-3. To establish new specific MUAC cut-offs, pooled data was obtained for 25,755 children from 49 SMART recent surveys in Ethiopia (2016-2019). Sensitivity, proportion of false positive, and areas under receiver-operator characteristic curves (AUC) were calculated. MUAC below 115mm alone identified 55% of children with SAM identified with both methodologies. MUAC was worse in identifying older children (21%), those from a pastoral region (42%) and boys (41%). Using current WHO cut-offs, the sensitivity (Se) of MUAC below 115mm to identify the children severly malnourished screened through Weight-for-height below-3 was 16%. Analysing the ROC curve and Youden Index, Se and Specificity (Sp) were maximal at a MUAC < 133 mm cut-off to identify SAM (respectively Se 61.1%, Sp 81.4%). However, given the high proportion of false-positive children, according to gender, region and age groups, a cut-off around 125 mm to screen SAM could be the optimal one. In Ethiopia, implementation of a MUAC-only screening program for the identification of severe acute malnutrition with the actual cut-off of 115 mm would be unethical as it will lead to many children remaining undiagnosed and untreated. In addition, future study on implementation challenge on screening children with a higher cut-off or gender/age sensitive ones should be assessed with the collection of mortality and morbidity data to ensure that the most in need are being taking care of.


Assuntos
Braço/anatomia & histologia , Pesos e Medidas Corporais/métodos , Desenvolvimento Infantil/fisiologia , Desnutrição Aguda Grave/diagnóstico , Fatores Etários , Viés , Estatura/fisiologia , Peso Corporal/fisiologia , Pré-Escolar , Testes Diagnósticos de Rotina/métodos , Etiópia/epidemiologia , Feminino , Gráficos de Crescimento , Indicadores Básicos de Saúde , Humanos , Lactente , Masculino , Programas de Rastreamento/métodos , Curva ROC , Sensibilidade e Especificidade , Desnutrição Aguda Grave/epidemiologia , Fatores Sexuais
17.
Aust N Z J Public Health ; 44(3): 227-232, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32311191

RESUMO

OBJECTIVE: To develop a framework and indicators to monitor inequalities in health and the social determinants of health for Australians with disability. METHODS: The development drew on existing frameworks and input from people with lived experience of disability. RESULTS: The Disability and Wellbeing Monitoring Framework has 19 domains. Australian national data are available for 73% of the 128 indicators in these domains. Data gaps and limitations include the absence of national data and the absence of disability identifiers in some data sources. CONCLUSIONS: The framework will be used to report baseline data for people with and without disability and to monitor inequalities over time in Australia. It will also be used to locate policy priorities and focus efforts to address data gaps. Implications for public health: Inequality between people with and without disability in relation to health and the social determinants of health is a public health issue that warrants greater attention than it has received to date. The framework provides a robust, evidence-informed tool to address the health inequalities of people with disability, inform the development of effective policy and practice responses, and monitor change over time.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Equidade em Saúde , Disparidades nos Níveis de Saúde , Indicadores Básicos de Saúde , Determinantes Sociais da Saúde , Adolescente , Adulto , Austrália , Feminino , Política de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Pública , Características de Residência , Fatores Socioeconômicos , Adulto Jovem
18.
Sci Total Environ ; 724: 138316, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32272415

RESUMO

Spatiotemporal distribution of fluoride in drinking water has been posing serious health concerns worldwide. However, in Bangladesh, to date, there is a very limited study reported the probabilistic health risks from fluoride content in drinking water. Therefore, we investigate the spatiotemporal distribution of fluoride concentration in drinking water and associated health risks in the coastal districts of Bangladesh based on randomly collected 840 groundwater samples (Dry-season = 302 and Wet-season = 538). Probabilistic health risk appraisal from fluoride was performed using the Monte-Carlo simulation and sensitivity analysis. Fluoride concentration in 11.89% (Wet-season) and 24.50% (Dry-season) of the samples exceeded the acceptable level of 1.0 mg/L, while 3.90% (Wet-season) and 7.28% (Dry-season) samples surpassed the maximum permissible limit (fluoride: 1.5 mg/L. The deficiency of fluoride content in groundwater (<0.50 mg/L) in Wet-season (60.41%) and in Dry-season (55.63%) was identified from the study area. The seasonality to the spatial change of fluoride concentration in drinking water has been explored. The mean non-carcinogenic risks e.g., hazard quotient (HQ) from the consumption of high fluoride-containing water for infants and children were mostly exceeded the threshold value 1 (HQ > 1) in both seasons. However, the risk of children and infants at the 95th percentile crossed the safe level (SL: 1) in the wet season and the risk of infants, children, teens and adults at the 95th percentile surpassed 1 in the dry season, indicating the potential adverse health effects. Apart from the high exposure, fluoride deficiency might be a severe problem in this region due to the very low concentration of fluoride (<0.50 mg/L) in drinking water. Sensitivity analyses indicate high fluoride-containing drinking water was the most contributing variables affecting the model outcome. Finally, the case-control study should be performed to examine further the health effects from the ingestion of high/low fluoride-bearing groundwater in the study area.


Assuntos
Água Potável/análise , Fluorose Dentária , Água Subterrânea , Poluentes Químicos da Água/análise , Adolescente , Adulto , Bangladesh , Estudos de Casos e Controles , Criança , Fluoretos/análise , Indicadores Básicos de Saúde , Humanos , Lactente , Medição de Risco
19.
Gastroenterol. hepatol. (Ed. impr.) ; 43(4): 193-199, abr. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-190796

RESUMO

OBJECTIVES: Timely identification of patients with acute pancreatitis who are likely to have a severe disease course is critical. Based on that, many scoring systems have been developed throughout the years. Although many of them are currently in use, none of them has been proven to be ideal. In this study, we aimed to compare the discriminatory power of relatively newer risk scores with the historical ones for predicting in-hospital major adverse events, 30-day mortality and 30-day readmission rate. PATIENTS AND METHODS: Patients who had been admitted due to acute pancreatitis were retrospectively investigated. Five risk scoring systems including HAPS, Ranson, BISAP, Glasgow, and JSS were calculated using the data of the first 24h of admission. Predictive accuracy of each scoring system was calculated using the area under the receiver-operating curve method. RESULTS: Overall 690 patients were included in the study. In-hospital major adverse events were observed in 139 (20.1%) patients of whom, 19 (2.5%) died during hospitalization.30-day all-cause mortality and 30-day readmission were observed in 22 (3.2%) and 27 (3.9%) patients respectively. Negative predictive value of each score was markedly higher compared to positive predictive values. Among all, JSS scoring system showed the highest AUC values across all end-points (0.80 for in-hospital major adverse events; 0.94 for in-hospital mortality; 0.91 for 30-day mortality). However, all five scoring systems failed to predict 30-day readmission. DISCUSSION: JSS was the best classifier among all five risk scoring systems particularly owing to its high sensitivity and negative predictive value


OBJETIVOS: Identificar oportunamente a los pacientes con pancreatitis aguda con mayor probabilidad de evolución negativa de la enfermedad. Esto ha motivado el desarrollo de numerosos sistemas de puntuación a lo largo de los años. Aunque muchos de ellos siguen utilizándose en la actualidad, ninguno ha demostrado ser idóneo. En este estudio se pretende comparar la capacidad discriminatoria de puntuaciones de riesgo relativamente recientes con puntuaciones históricas, en cuanto a su capacidad de predicción de acontecimientos adversos graves durante la hospitalización, mortalidad a 30 días y tasa de reingreso a 30 días. PACIENTES Y MÉTODOS: Se investigó retroactivamente a pacientes ingresados por pancreatitis aguda. Se aplicaron 5 sistemas de puntuación: HAPS, Ranson, BISAP, Glasgow y JSS, utilizando datos correspondientes a las primeras 24h después del ingreso. Se calculó la precisión predictiva de cada sistema de puntuación empleando el método de área bajo la curva de característica operativa del receptor. RESULTADOS: El estudio se realizó en un total de 690 pacientes. Se observaron acontecimientos adversos graves durante la hospitalización en 139 pacientes (20,1%) de los pacientes, de los cuales 19 (2,5%) fallecieron. Se observó mortalidad por cualquier causa a los 30 días y readmisión a los 30 días en 22 (3,2%) y 27 (3,9%) pacientes, respectivamente. El valor predictivo negativo de cada puntuación fue notablemente mayor en comparación con los valores predictivos positivos. De entre todos ellos, el sistema de puntuación JSS mostró los valores de área bajo la curva (AUC) más altos entre todos los criterios de valoración (0,80 para acontecimientos adversos graves durante la hospitalización; 0,94 para la mortalidad durante la hospitalización; 0,91 para la mortalidad a 30 días). Sin embargo, los 5 sistemas de puntuación fracasaron en la predicción de los reingresos a 30 días. Valoración: El JSS fue el mejor sistema de clasificación de entre los 5 sistemas de puntuación de riesgos, particularmente debido a su alta sensibilidad y valor predictivo negativo


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Pancreatite/diagnóstico , Pancreatite/epidemiologia , Índice de Gravidade de Doença , Indicadores Básicos de Saúde , Pancreatite/classificação , Doença Aguda , Hospitalização
20.
Edumecentro ; 12(1): 61-81, ene.-mar. 2020. graf
Artigo em Espanhol | LILACS | ID: biblio-1089999

RESUMO

RESUMEN Fundamento: la hipertensión arterial y la obesidad en la edad pediátrica exhiben altos niveles de prevalencia a nivel mundial, incluyendo Cuba, lo cual fundamenta su diagnóstico precoz para disminuir sus efectos en estas edades y su impacto en la adultez. Objetivo: elaborar una estrategia educativa encaminada al perfeccionamiento de la labor docente para fomentar una adecuada cultura en salud entre los escolares. Métodos: se desarrolló un estudio epidemiológico descriptivo y prospectivo de carácter transversal, que incluyó el cálculo de la obesidad y otros factores de riesgo, en escolares de varias escuelas primarias. Se emplearon métodos teóricos: análisis-síntesis, inducción-deducción y sistémico-estructural; empíricos: análisis documental y encuestas a escolares, docentes y familiares y los matemático-estadístico para los valores analizados. Resultados: en el diagnóstico clínico se encontró elevada prevalencia de factores de riesgo cardiovascular, en cifras relacionadas con hipertensión arterial, obesidad, sobrepeso, sedentarismo y otros; mientras el diagnóstico educativo permitió conocer carencias en la preparación docente y en la familia de los escolares sobre temas de hábitos y estilos de vida saludable, por lo que se elaboró y aplicó una estrategia pedagógica para ofrecer solución a la problemática. Conclusiones: la estrategia permitió dotar a los docentes de los conocimientos y medios necesarios para promover estilos de vida saludables, desde lo curricular y extracurricular donde se fortaleció el trabajo metodológico integrando estos temas al proceso docente educativo, lo cual propició desarrollar una cultura de salud en los escolares.


ABSTRACT Background: high blood pressure and obesity in the pediatric age exhibit high levels of prevalence worldwide, including Cuba, which bases its early diagnosis to reduce its effects at these ages and its impact on adulthood. Objective: to develop an educational strategy aimed at improving the teaching work to promote an adequate health culture among schoolchildren. Methods: a cross-sectional descriptive and prospective epidemiological study was developed that included the calculation of obesity and the test of sustained weight in schoolchildren of several primary schools. Theoretical methods were used: analysis-synthesis, induction-deduction and systemic-structural; empirical ones: documentary analysis and surveys to schoolchildren, teachers and family; and the mathematical-statistic for the analyzed values. Results: in the clinical diagnosis a high prevalence of cardiovascular risk factors was found, in figures related to high blood pressure, body overweight, obesity, and cardiovascular hyperactivity; while the educational diagnosis allowed knowing deficiencies in the teaching preparation and in the family of schoolchildren on topics as healthy habits and lifestyles, so an educational strategy was developed and applied to offer a solution to the problem. Conclusions: the strategy allowed teachers to provide the necessary knowledge and means to promote healthy lifestyles, inside the curriculum and out of it where methodological work was strengthened by integrating these issues into the teaching-learning process, which led to the development of a necessary health culture in the students.


Assuntos
Projetos de Pesquisa , Serviços de Saúde Escolar , Fatores de Risco , Indicadores Básicos de Saúde , Estratégias , Medição de Risco , Promoção da Saúde
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