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1.
Bone Joint J ; 103-B(6): 1096-1102, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34058868

RESUMO

AIMS: Although total knee arthroplasty (TKA) is a highly successful procedure, about 20% of patients remain dissatisfied postoperatively. This proportion is derived from dichotomous models of the assessment of surgical success or failure, which may not reflect the spectrum of outcomes. The aim of this study was to explore differing responses to surgery, and assess whether there are distinct groups of patients with differing patterns of outcome. METHODS: This was a secondary analysis of a UK multicentre TKA longitudinal cohort study. We used a group-based trajectory modelling analysis of Oxford Knee Score (OKS) in the first year following surgery with longitudinal data involving five different timepoints and multiple predictor variables. Associations between the derived trajectory groups and categorical baseline variables were assessed, and predictors of trajectory group membership were identified using Poisson regression and multinomial logistic regression, as appropriate. The final model was adjusted for sociodemographic factors (age, sex) and baseline OKS. RESULTS: Data from 731 patients were available for analysis. Three distinct trajectories of outcome were identified: "poor" 14.0%, "modest" 39.1%, and "good" 46.9%. The predicted probability of membership for patients assigned to each trajectory group was high (0.89 to 0.93). Preoperative mental, physical health, and psychosocial factors determined which trajectory is likely to be followed. Poor responders were characterized by a comparatively small number of factors, preoperative expectations of pain and limitations, coping strategies, and a lower baseline physical health status, while the good responders were characterized by a combination of clinical, psychosocial, mental health, and quality of life factors. CONCLUSION: We identified three distinct response trajectories in patients undergoing TKA. Controlling for baseline score, age, and sex, psychosocial factors such as expectations of pain and limited function and poor coping strategies differentiated the trajectory groups, suggesting a role for preoperative psychosocial support in optimizing the clinical outcome. Cite this article: Bone Joint J 2021;103-B(6):1096-1102.


Assuntos
Artroplastia do Joelho/métodos , Indicadores Básicos de Saúde , Avaliação de Resultados em Cuidados de Saúde , Atividades Cotidianas , Idoso , Atitude Frente a Saúde , Feminino , Humanos , Estudos Longitudinais , Masculino , Medição da Dor , Satisfação do Paciente , Estudos Prospectivos , Qualidade de Vida , Transtornos do Sono-Vigília/epidemiologia , Inquéritos e Questionários , Reino Unido
2.
Sci Total Environ ; 784: 147186, 2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34088052

RESUMO

Assessments for groundwater quality and potential health risk are significant for better utilization and exploitation. In the present study, seventy groundwater samples were collected from domestic tube wells and public water-supply wells in the Nanchong area, southwestern China. The integration of statistical analysis, ion correlation, geomodelling analysis, entropy water quality index and health risks assessment were compiled in this study. Statistical analysis indicated the cations followed the concentration order as Ca2+ > Na+ > Mg2+ > K+, while anions' concentrations were HCO3- > SO42- > Cl- > NO3- > F- based on Box and Whisker plot. Piper triangle diagram proposed the hydrochemical type was characterized as Ca-HCO3. Correlations of ions and geomodelling revealed the concentrations of major ions were mainly determined by calcite dissolution and ion exchange process and NO3- concentrations were controlled by agriculture activities. Entropy water quality index computation demonstrated that 96% of groundwater samples possessed the EWQI values of 29-95, and thus were suitable for drinking purpose. The HITotal values for 66% groundwater samples exceeded the acceptable limit for non-carcinogenic risk (HI =1) for infants, followed by 41% for children, 37% for adult males, and 30% for adult females. The non-carcinogenic human health risk of different population groups followed the order of infants > children > adult males > adult females. In future, targeted measures for human health risks of NO3- will focus on the improvements for agricultural activities, including reducing the use of nitrogenous fertilizer, changing irrigation pattern, etc. Our study provides the vital knowledge for groundwater management in the Nanchong and development of the Cheng -Yu Economic Circle.


Assuntos
Água Subterrânea , Poluentes Químicos da Água , Adulto , Criança , China , Monitoramento Ambiental , Feminino , Indicadores Básicos de Saúde , Humanos , Lactente , Masculino , Nitratos/análise , Poluentes Químicos da Água/análise , Qualidade da Água
3.
Biomed Environ Sci ; 34(5): 348-355, 2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34059171

RESUMO

Objective: To examine increases in average height among Chinese children and adolescents. Methods: The data were obtained from the China Health and Nutrition Survey conducted during the period 1989-2015. A stratified multistage cluster sampling method was utilized to select participants aged 2-22 years in each province. Linear regression was used to examine the effects of age, birth cohort, and survey period on height. Results: A total of 15,227 males and 13,737 females were included in the final analysis. Age (A) showed a continuous effect on height. The average heights of the investigated groups increased continuously during the investigation period. By 2015, the average height of the overall group increased by 7.87 cm compared to the average height during the 1989 survey. Moreover, birth year (cohort, C) also had a stable effect on height. Using the height of individuals born in or before 1975 as a reference, the average height of each birth cohort increased in comparison to the previous birth cohort. Conclusions: The height of Chinese children and adolescents was affected by age, period, and cohort effects, and this effect is governed by certain rules. The age-period-cohort model can be used to analyze the trends of children's and adolescent's heights. The findings provide a scientific basis for the formulation of children's and adolescents' growth and development policies in China.


Assuntos
Desenvolvimento do Adolescente , Estatura , Desenvolvimento Infantil , Indicadores Básicos de Saúde , Adolescente , Saúde do Adolescente , Fatores Etários , Criança , Saúde da Criança , Pré-Escolar , China , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Lineares , Masculino , Fatores Sexuais , Adulto Jovem
4.
Epidemiol Serv Saude ; 30(2): e2020722, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34008747

RESUMO

OBJECTIVE: To analyse how testing the population influences the health indicators used to monitor the COVID-19 pandemic in the 50 countries with the highest number of diagnosed cases. METHODS: This was an ecological study using secondary data retrieved on 8/19/2020. Cumulative incidence, mortality rate, case-fatality rate, and proportion of positive tests were calculated. The data were described and presented graphically, with their respective Spearman Correlation Coefficients. RESULTS: The testing rate varied enormously between countries. Cumulative incidence and the proportion of positive tests were correlated with the number of tests, while the mortality rate and case-fatality rate showed low correlation with this indicator. CONCLUSION: Most countries do not test enough to ensure adequate monitoring of the pandemic, and this is reflected in the quality of the indicators. Expanding the number of tests is essential, but it needs to be accompanied by other measures, such as isolation of diagnosed cases and contact tracing.


Assuntos
Teste para COVID-19/estatística & dados numéricos , COVID-19/diagnóstico , COVID-19/epidemiologia , Indicadores Básicos de Saúde , Pandemias , COVID-19/mortalidade , Saúde Global/estatística & dados numéricos , Humanos , Incidência , Quarentena , Estatísticas não Paramétricas
5.
Clin Interv Aging ; 16: 863-875, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34040363

RESUMO

Objective: The Tilburg Frailty Instrument (TFI) is an instrument for assessing frailty in community-dwelling older people. Since its development, many studies have been carried out examining the psychometric properties. The aim of this study was to provide a review of the main findings with regard to the reliability and validity of the TFI. Methods: We conducted a literature search in the PubMed and CINAHL databases on May 30, 2020. An inclusion criterion was the use of the entire TFI, part B, referring to the 15 components. No restrictions were placed on language or year of publication. Results: In total, 27 studies reported about the psychometric properties of the TFI. By far, most of the studies (n = 25) were focused on community-dwelling older people. Many studies showed that the internal consistency and test-retest reliability are good, which also applies for the criterion and construct validity. In many studies, adverse outcomes of interest were disability, increased health-care utilization, lower quality of life, and mortality. Regarding disability, studies predominantly show results that are excellent, with an area under the curve (AUC) >0.80. In addition, the TFI showed good associations with lower quality of life and the findings concerning mortality were at least acceptable. However, the association of the TFI with some indicators of health-care utilization can be indicated as poor (eg, visits to a general practitioner, hospitalization). Conclusion: Since population aging is occurring all over the world, it is important that the TFI is available and well known that it is a user-friendly instrument for assessing frailty and its psychometric properties being qualified as good. The findings of this assessment can support health-care professionals in selecting interventions to reduce frailty and delay its adverse outcomes, such as disability and lower quality of life.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Indicadores Básicos de Saúde , Inquéritos e Questionários/normas , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Avaliação Geriátrica/estatística & dados numéricos , Humanos , Vida Independente , Masculino , Psicometria/métodos , Qualidade de Vida , Reprodutibilidade dos Testes , Estudos de Validação como Assunto , Populações Vulneráveis/estatística & dados numéricos
6.
Medicine (Baltimore) ; 100(14): e25335, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832108

RESUMO

ABSTRACT: The systemic immune-inflammation index (SII) is an independent prognostic predictor of hepatocellular carcinoma (HCC). The present investigation examined whether an association exists between preoperative SII value and postoperative acute kidney injury (pAKI) in HCC patients.The study included 479 hepatitis B virus (HBV)-associated HCC patients undergoing hepatectomy. The SII was calculated as P × N/L, where P, N, and L represent the counts of platelets, neutrophils, and lymphocytes in routine blood test, respectively. After propensity score matching, logistic regression analysis was used to explore independent predictors of pAKI in HCC patients.pAKI was confirmed in 51 patients (10.8%). The average SII value was higher in patients with pAKI than patients without pAKI. After multivariate logistic regression analysis, SII, history of hypertension, and tumor size, among others, were found to be predictors of pAKI. The optimal threshold value of SII for predicting pAKI was found to be 547.84 × 109/L. Multivariate analysis performed after propensity score matching confirmed that SII ≥ 547.84 × 109/L was an independent predictor of pAKI.The preoperative SII qualifies as a novel, independent predictor of pAKI in HCC patients with HBV infection who underwent hepatectomy.


Assuntos
Injúria Renal Aguda/etiologia , Injúria Renal Aguda/imunologia , Carcinoma Hepatocelular/cirurgia , Indicadores Básicos de Saúde , Hepatectomia/efeitos adversos , Neoplasias Hepáticas/cirurgia , Injúria Renal Aguda/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/etiologia , Carcinoma Hepatocelular/patologia , Comorbidade , Hepatite B/complicações , Humanos , Contagem de Leucócitos , Testes de Função Hepática , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/patologia , Modelos Logísticos , Pessoa de Meia-Idade , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Carga Tumoral , Adulto Jovem
7.
Health Qual Life Outcomes ; 19(1): 125, 2021 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-33865400

RESUMO

BACKGROUND: Evidence of health utility changes in patients who suffer from longstanding health complaints attributed to dental amalgam fillings are limited. The change in health utility outcomes enables calculating quality-adjusted life-year (QALY) and facilitates the comparison with other health conditions. The purpose of this study was to estimate the validity and responsiveness of the EQ-5D-5L and SF-6D utilities following removal of dental amalgam fillings in patients with health complaints attributed to their amalgam fillings, and examine the ability of these instruments to detect minimally important changes over time. METHODS: Patients with medically unexplained physical symptoms, which they attributed to dental amalgam restorations, were recruited to a prospective cohort study in Norway. Two health state utility instruments, EQ-5D-5L and SF-6D, as well as self-reported general health complaints (GHC-index) and visual analogue scale (EQ-VAS) were administered to all patients (n = 32) at baseline and at follow-up. The last two were used as criteria measures. Concurrent and predictive validities were examined using correlation coefficients. Responsiveness was assessed by the effect size (ES), standardized response mean (SRM), and relative efficiency. Minimally important change (MIC) was examined by distribution and anchor-based approaches. RESULTS: Concurrent validity of the EQ-5D-5L was similar to that of SF-6D utility. EQ-5D-5L was more responsive than SF-6D: the ES were 0.73 and 0.58 for EQ-5D-5L and SF-6D, respectively; SRM were 0.76 and 0.67, respectively. EQ-5D-5L was more efficient than SF-6D in detecting changes, but both were less efficient compared to criteria-based measures. The estimated MIC of EQ-5D-5L value set was 0.108 and 0.118 based on distribution and anchor-based approaches, respectively. The corresponding values for SF-6D were 0.048 and 0.064, respectively. CONCLUSIONS: In patients with health complaints attributed to dental amalgam undergoing amalgam removal, both EQ-5D-5L and SF-6D showed reasonable concurrent and predictive validity and acceptable responsiveness. The EQ-5D-5L utility appears to be more responsive compared to SF-6D. Trial registration The research was registered at ClinicalTrials.gov., NCT01682278. Registered 10 September 2012, https://clinicaltrials.gov/ct2/show/NCT01682278 .


Assuntos
Dor Crônica/induzido quimicamente , Amálgama Dentário/efeitos adversos , Amálgama Dentário/toxicidade , Indicadores Básicos de Saúde , Mercúrio/efeitos adversos , Mercúrio/toxicidade , Qualidade de Vida , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Estudos Prospectivos , Psicometria , Inquéritos e Questionários
8.
Medicine (Baltimore) ; 100(17): e25401, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907094

RESUMO

ABSTRACT: The study aimed to explore the reliability and validity of the Sub-Health Measurement Scale version 1.0 (SHMS v1.0) for the assessment of the suboptimal health status (SHS) of Tianjin residents.This was a cross-sectional study that surveyed 2640 urban residents in Tianjin from June 2016 to January 2018. Demographic and clinical characteristics were collected. Each subject completed the SHMS v1.0 and Short Form-36 (SF-36) scale assessments.The retest coefficient was 0.675. The overall Cronbach's α coefficient was 0.921. The correlation between SHMS v1.0 and SF-36 was 0.781 (P < .01). The SHS frequency increased with age, from 62.4% in participants ≤25 years of age to 72.8% in those ≥ 56 years of age. The multivariable analysis showed that female sex (P < .001), age >25 years old (P = .009), bachelor degree or above (P < .001), obesity (P < .0), regular smoking (P = .043), frequent drinking (P = .045), sleep time < 6 hours (P = .006), working time >10 hours (P < .001), physical exercise <5 times/mo (P < .001), and adverse events >9 (P < .001) were associated with SHS.The prevalence of SHS is high among urban residents in Tianjin.


Assuntos
Inquéritos Epidemiológicos/normas , Questionário de Saúde do Paciente/normas , Vigilância da População/métodos , População Urbana/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , China/epidemiologia , Doença Crônica/epidemiologia , Estudos Transversais , Autoavaliação Diagnóstica , Feminino , Nível de Saúde , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Reprodutibilidade dos Testes , Medição de Risco , Fatores Sexuais
9.
Artigo em Inglês | PAHO-IRIS | ID: phr-53774

RESUMO

[ABSTRACT]. Objectives. To present a methodology for the simultaneous setting of quantitative targets that reflect both an improvement in the national average of an indicator for Sustainable Development Goal 3 (SDG3), as well as a reduction in its geographic inequality. Methods. A five-step algorithm was developed: (a) calculate the national average annual percent change (AAPC) for an SDG3 indicator; (b) normatively define geographic strata from the subnational distribution of the indicator in a baseline year; (c) apply a proportional progressivity criterion to the AAPC to project the stratum-specific indicator value for the target year; (d) set the national target as the weighted average of the indicator in the subnational territorial units for the target year; and (e) set the inequality reduction targets by calculating the absolute and relative gaps between the bottom and top strata for the target year. Results. The algorithm was applied to SDG indicator 3.1.1 (maternal mortality ratio, MMR), disaggregated by Guatemala’s 22 departments at the baseline year 2014 (MMR = 113 per 100,000 live births). By sustaining the AAPC rate attained from 2009 to 2014 (-4.3%) and focalizing its actions with territorial progressivity, by 2030 the country could reduce its MMR to 53 per 100,000 and its absolute and relative inequality gaps by 72% and 48%, respectively. Conclusions. The proposed methodology allows for simultaneously setting targets for overall progress and inequality reduction in health, making explicit the primacy of the equity principle contained in the SDG commitment to leave no one behind, whose urgency takes on renewed relevance in the current pandemic scenario.


[RESUMEN]. Objetivos. Presentar una metodología para la formulación simultánea de metas cuantitativas que reflejen tanto la mejoría del promedio nacional de un indicador del tercer Objetivo de Desarrollo Sostenible (ODS3) como la reducción de su desigualdad geográfica. Métodos. Se definió un algoritmo en cinco pasos: a) cálculo del cambio porcentual anual promedio (CPAP) nacional para un indicador del ODS3; b) definición normativa de estratos geográficos a partir de la distribución subnacional del indicador en un año base; c) aplicación de un criterio de progresividad proporcional del CPAP para proyectar el indicador estrato-específico al año meta; d) establecimiento de la meta nacional como el promedio ponderado del indicador en las unidades territoriales subnacionales al año meta; y e) formulación de metas de reducción de desigualdad mediante el cálculo de las brechas absoluta y relativa entre los estratos extremos al año meta. Resultados. Se aplicó el algoritmo al indicador ODS 3.1.1 (razón de mortalidad materna, RMM), desagregado por los 22 departamentos de Guatemala para el año base 2014 (RMM = 113 por 100 000 nacidos vivos). Sosteniendo la intensidad promedio de CPAP observada entre 2009 y 2014 (-4,3%) y focalizando sus acciones con progresividad territorial, el país reduciría al 2030 su RMM a 53 por 100 000 nacidos vivos y sus brechas absoluta y relativa en 72% y 48%, respectivamente. Conclusiones. La metodología propuesta permite formular simultáneamente metas de reducción de las desigualdades geográficas en salud y hacer explícita la primacía del principio de equidad expresado en el compromiso de no dejar a nadie atrás que identifica a los ODS, cuya urgencia cobra renovada relevancia en el escenario pospandémico actual.


[RESUMO]. Objetivos. Apresentar uma metodologia para a formulação simultânea de metas quantitativas que reflitam tanto a melhoria da média nacional de um indicador do terceiro Objetivo de Desenvolvimento Sustentável (ODS3) quanto a redução das desigualdades geográfica nesse indicador. Métodos. Estabelecemos um algoritmo em cinco etapas: (a) cálculo da variação percentual anual média (VPAM) em um país para um indicador do ODS3, (b) definição normativa de estratos geográficos a partir da distribuição subnacional do indicador em um ano base, (c) aplicação de um critério de progressividade proporcional da VPAM para projetar o indicador específico do estrato para o ano base, (d) estabelecimento da meta nacional como a média ponderada do indicador nas unidades territoriais subnacionais para o ano alvo e (e) estabelecimento de metas para a redução das desigualdades calculando a disparidade absoluta e relativa entre os estratos extremos para o ano alvo. Resultados. Aplicamos o algoritmo ao indicador ODS 3.1.1 (razão de mortalidade materna, RMM), desagregado pelos 22 departamentos da Guatemala para o ano base de 2014 (RMM = 113 por 100.000 nascidos vivos). Se mantiver a intensidade média da VPAM observada entre 2009 e 2014 (-4,3%) e concentrar as suas ações com progressividade territorial, o país reduzirá, até 2030, a sua RMM para 53 por 100.000 e sua disparidade absoluta e relativa em 72% e 48%, respectivamente. Conclusões. A metodologia proposta permite formular simultaneamente metas para a redução das desigualdades geográficas em saúde e explicitar a primazia do princípio da equidade expresso no compromisso de não deixar ninguém para trás consagrado nos ODS, cuja urgência assume uma relevância renovada no atual cenário pós-pandêmico.


Assuntos
Desenvolvimento Sustentável , Equidade em Saúde , Indicadores Básicos de Saúde , Mortalidade Materna , Guatemala , Desenvolvimento Sustentável , Desenvolvimento Sustentável , Estratégias de Saúde Globais , Equidade em Saúde , Indicadores Básicos de Saúde , Mortalidade Materna , Desenvolvimento Sustentável , Desenvolvimento Sustentável , Equidade em Saúde , Indicadores Básicos de Saúde , Mortalidade Materna , Estratégias de Saúde Globais
10.
Washington, D.C.; OPS; 2021-04-15.
em Espanhol | PAHO-IRIS | ID: phr-53628

RESUMO

El suicidio es un problema grave de salud pública envuelto en estigma, mitos y tabúes. Con un promedio anual de 81.746 muertes por suicidio y una tasa de suicidio ajustada por la edad de 9,3 por 100.000 habitantes (y una tasa no ajustada por la edad de 9,6), el suicidio sigue siendo un problema de salud pública de gran importancia en la Región de las Américas. Contrariamente a la creencia común, los suicidios son prevenibles con intervenciones oportunas, basadas en evidencia y a menudo de bajo costo. Se estima que por cada suicidio que ocurre, hay más de 20 intentos. El suicidio puede ocurrir a cualquier edad y es la tercera causa de muerte en los jóvenes de 20 a 24 años en la Región. El presente informe corresponde al quinquenio del 2010 al 2014. Proporciona una descripción general de la mortalidad por suicidio en la Región de las Américas, por subregiones y países. Analiza la distribución del suicidio según la edad, el sexo y los métodos usados, junto con los cambios registrados en el suicidio entre el 2010 y el 2014. En él se muestran los 12 países de la Región de las Américas que registran tasas elevadas de suicidio en comparación con el promedio regional, en los que se concentran dos tercios de las muertes por suicidio. Se requiere fortalecer los sistemas de información y la vigilancia del comportamiento suicida. No basta con mejorar solamente los registros de mortalidad, también es necesario elaborar registros del comportamiento suicida e implementar mecanismos de seguimiento en los casos de alto riesgo. Los países deberían revisar su marco jurídico respecto de la disponibilidad de servicios y recursos para prevenir y resolver el problema del comportamiento suicida.


Assuntos
Suicídio , Saúde Mental , Transtornos Mentais , Fatores de Risco , Estatísticas de Saúde , Indicadores Básicos de Saúde , América
11.
BMJ Glob Health ; 6(3)2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33771820

RESUMO

Worldwide, approximately 11 million people are currently being held in prison, a number that has steadily grown since the turn of the 21st century. The prison population is more likely to suffer from physical and mental ailments both during and prior to their imprisonment due to poverty, social exclusion and chaotic lifestyles. Recognition of people in prison is noticeably absent from the Sustainable Development Goals (SDGs), despite the goals' ethos of 'leaving no one behind'.We present the first analysis of how improving the health of people in prison can contribute to achieving 15 SDGs. Relevant indicators are proposed to fulfil these goals while meeting the existing international prison health standards. We also assess the political, economic and social challenges, alongside the unparalleled COVID-19 pandemic that can thwart the realisation of the SDGs. To reach the 'furthest behind first', prison health must be at the forefront of the SDGs.


Assuntos
Atenção à Saúde , Objetivos , Prisões , Desenvolvimento Sustentável , COVID-19 , Indicadores Básicos de Saúde , Humanos , SARS-CoV-2 , Organização Mundial da Saúde
12.
Bone Joint J ; 103-B(4): 672-680, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33752468

RESUMO

AIMS: The aim of this study was to assess the quality of life of patients on the waiting list for a total hip (THA) or knee arthroplasty (KA) during the COVID-19 pandemic. Secondary aims were to assess whether length of time on the waiting list influenced quality of life and rate of deferral of surgery. METHODS: During the study period (August and September 2020) 843 patients (THA n = 394, KA n = 449) from ten centres in the UK reported their EuroQol five dimension (EQ-5D) scores and completed a waiting list questionnaire (2020 group). Patient demographic details, procedure, and date when listed were recorded. Patients scoring less than zero for their EQ-5D score were defined to be in a health state "worse than death" (WTD). Data from a retrospective cohort (January 2014 to September 2017) were used as the control group. RESULTS: The 2020 group had a significantly worse EQ-5D score compared to the control group for both THA (p < 0.001) and KA (p < 0.001). Over one-third (35.0%, n = 138/394) of patients waiting for a THA and nearly a quarter (22.3%, n = 100/449) for KA were in a health state WTD, which was significantly greater than the control group (odds ratio 2.30 (95% confidence interval (CI) 1.83 to 2.93) and 2.08 (95% CI 1.61 to 2.70), respectively; p < 0.001). Over 80% (n = 680/843) of the 2020 group felt that their quality of life had deteriorated while waiting. Each additional month spent on the waiting list was independently associated with a decrease in quality of life (EQ-5D: -0.0135, p = 0.004). There were 117 (13.9%) patients who wished to defer their surgery and the main reason for this was health concerns for themselves and or their family (99.1%, n = 116/117). CONCLUSION: Over one-third of patients waiting for THA and nearly one-quarter waiting for a KA were in a state WTD, which was approaching double that observed prior to the pandemic. Increasing length of time on the waiting list was associated with decreasing quality of life. Level of evidence: Level III retrospective case control study Cite this article: Bone Joint J 2021;103-B(4):672-680.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , COVID-19 , Acesso aos Serviços de Saúde , Indicadores Básicos de Saúde , Qualidade de Vida/psicologia , Listas de Espera , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/psicologia , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Análise Multivariada , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde , Melhoria de Qualidade , Fatores de Tempo , Reino Unido/epidemiologia
13.
J Am Geriatr Soc ; 69(6): 1441-1447, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33768521

RESUMO

BACKGROUND/OBJECTIVES: The safety and immunogenicity of the BNT162b2 coronavirus disease 2019 (COVID-19) vaccine in older adults with different frailty and disability profiles have not been well determined. Our objective was to analyze immunogenicity of the BNT162b2 mRNA COVID-19 vaccine in older adults across frailty and disability profiles. DESIGN: Multicenter longitudinal cohort study. SETTING AND PARTICIPANTS: A total of 134 residents aged ≥65 years with different frailty and disability profiles in five long-term care facilities (LTCFs) in Albacete, Spain. INTERVENTION AND MEASUREMENTS: Residents were administered two vaccine doses as per the label, and antibody levels were determined 21.9 days (SD 9.3) after both the first and second dose. Functional variables were assessed using activities of daily living (Barthel Index), and frailty status was determined with the FRAIL instrument. Cognitive status and comorbidity were also evaluated. RESULTS: Mean age was 82.9 years (range 65-99), and 71.6% were female. The mean antibody titers in residents with and without previous COVID-19 infection were 49,878 AU/ml and 15,274 AU/ml, respectively (mean difference 34,604; 95% confidence interval [CI]: 27,699-41,509). No severe adverse reactions were observed, after either vaccine dose. Those with prevaccination COVID-19 had an increased antibody level after the vaccine (B = 31,337; 95% CI: 22,725-39,950; p < 0.001). Frailty, disability, older age, sex, cognitive impairment, or comorbidities were not associated with different antibody titers. CONCLUSIONS: The BNT162b2 mRNA COVID-19 vaccine in older adults is safe and produces immunogenicity, independently of the frailty and disability profiles. Older adults in LTCFs should receive a COVID-19 vaccine.


Assuntos
Formação de Anticorpos , Vacinas contra COVID-19/imunologia , Vacinas contra COVID-19/uso terapêutico , COVID-19/prevenção & controle , Pessoas com Deficiência , Idoso Fragilizado , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Teste Sorológico para COVID-19 , Comorbidade , Feminino , Indicadores Básicos de Saúde , Humanos , Estudos Longitudinais , Masculino , Casas de Saúde , SARS-CoV-2 , Espanha
14.
BMC Pregnancy Childbirth ; 21(1): 183, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33673826

RESUMO

BACKGROUND: Mental wellbeing during pregnancy and the year after birth is critical to a range of maternal and infant outcomes. Many mental health interventions fail to incorporate stakeholder perspectives. The Catalyst Project aimed to work with key stakeholders in Mozambique to develop interventions and delivery strategies which were in-line with existing evidence and the needs, goals, and priorities of those both directly and indirectly involved in its success. METHODS: A qualitative, human-centred design approach was utilised. Focus-group discussions, individual interviews, and observations with young women (aged 16-24 years), their families, community leaders, service providers and government were used to better understand the needs, priorities and challenges to mental wellbeing of young women. These findings were triangulated with the literature to determine priority challenges to be addressed by an intervention. Stakeholder workshops were held to identify potential solutions and co-develop an intervention and delivery strategy. RESULTS: The 65 participants comprised 23 young pregnant women or new mothers, 12 family members, 19 service providers and 11 staff from the Ministry of Health. Participants highlighted significant uncertainty related to living situations, financial status, education, social support, and limited knowledge of what to expect of the impact of pregnancy and parenting. Family and community support were identified as an important need among this group. The Mama Felíz (Happy Mama) programme was developed with stakeholders as a course to strengthen pregnancy, childbirth and child development knowledge, and build positive relationships, problem-solving and parenting skills. In addition, family sessions address wider cultural and gender issues which impact adolescent maternal wellbeing. CONCLUSIONS: We have developed an intervention to reduce the risk of poor maternal mental health and gives young mothers hope and skills to make a better life for them and their children by packaging information about the risk and protective factors for maternal mental disorders in a way that appeals to them, their families and service providers. By using human-centred design to understand the needs and priorities of young mothers and the health and community systems in which they live, the resulting intervention and delivery strategy is one that stakeholders view as appropriate and acceptable.


Assuntos
Saúde Mental , Mães/psicologia , Determinação de Necessidades de Cuidados de Saúde , Intervenção Psicossocial , Participação dos Interessados , Saúde da Mulher , Adolescente , Atenção à Saúde/métodos , Feminino , Grupos Focais/métodos , Indicadores Básicos de Saúde , Humanos , Moçambique , Poder Familiar/psicologia , Gravidez , Fatores de Proteção , Intervenção Psicossocial/métodos , Intervenção Psicossocial/organização & administração , Adulto Jovem
16.
Edumecentro ; 13(1): 149-166, ene.-mar. 2021. tab
Artigo em Espanhol | LILACS | ID: biblio-1149238

RESUMO

RESUMEN Fundamento: la hipertensión arterial es una enfermedad de elevada prevalencia a nivel mundial, a menudo con graves consecuencias para la vida de las personas que la padecen. Objetivo: valorar la efectividad de un programa de intervención educativa para modificar conocimientos sobre estilos de vida saludables en pacientes hipertensos. Métodos: se realizó una investigación acción en el consultorio médico de familia 17-5 del Policlínico Universitario "Chiqui Gómez-Lubián" de Santa Clara, Villa Clara, entre enero-marzo de 2020. Se emplearon métodos teóricos: análisis-síntesis, inducción-deducción e histórico-lógico; empíricos: análisis documental y encuesta en forma de cuestionario a los pacientes antes y después de aplicado el programa; para valorar su efectividad se realizó un análisis estadístico. Resultados: el diagnóstico aplicado demostró que la mayoría de los pacientes tenían desconocimiento sobre su enfermedad y estilos de vida saludables relacionados con los beneficios de sus medicamentos para controlar la hipertensión, la educación nutricional, ingestión de bebidas alcohólicas, el hábito de fumar, el ejercicio físico, el estrés, la obesidad y el consumo de café, por lo que se aplicó una programa de intervención educativa que fue valorado por especialistas. Conclusiones: su efectividad se evidenció porque se modificaron de forma significativa los conocimientos sobre la enfermedad y las prácticas inadecuadas de estilos de vida de los pacientes muestreados.


ABSTRACT Background: hypertension is a highly prevalent disease worldwide, often with serious consequences for the live of people who suffer from it. Objective: to assess the effectiveness of an educational intervention program to modify knowledge about healthy lifestyles in hypertensive patients. Methods: an action research was carried out in the family doctor's office 17-5 of the "Chiqui Gómez-Lubián" University Polyclinic of Santa Clara, Villa Clara, from January toMarch 2020. Theoretical methods were used: analysis-synthesis, induction- deduction and historical-logical; empirical ones: documentary analysis and survey in the form of a questionnaire to patients before and after applying the program; to assess its effectiveness, a statistical analysis was carried out. Results: the applied diagnosis showed that most of the patients had ignorance about their disease and healthy lifestyles related to drug benefits to control hypertension, nutritional education, ingestion of alcoholic beverages, smoking, physical exercises, stress, obesity and coffee intake, for which an educational intervention program was applied that was assessed by specialists. Conclusions: its effectiveness was evidenced because knowledge about the disease and inappropriate lifestyle practices of the sampled patients were significantly modified.


Assuntos
Projetos de Pesquisa , Fatores de Risco , Indicadores Básicos de Saúde , Estratégias de Saúde , Medição de Risco , Educação Médica , Promoção da Saúde
17.
Health Qual Life Outcomes ; 19(1): 45, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33546723

RESUMO

OBJECTIVE: This study aimed to conduct a systematic review and meta-analysis to compare differences in health utilities (HUs) assessed by self and proxy respondents in children, as well as to evaluate the effects of health conditions, valuation methods, and proxy types on the differences. METHODS: Eligible studies published in PubMed, Embase, Web of Science, and Cochrane Library up to December 2019 were identified according to PRISMA guidelines. Meta-analyses were performed to calculate the weighted mean differences (WMDs) in HUs between proxy- versus self-reports. Mixed-effects meta-regressions were applied to explore differences in WMDs among each health condition, valuation method and proxy type. RESULTS: A total of 30 studies were finally included, comprising 211 pairs of HUs assessed by 15,294 children and 16,103 proxies. This study identified 34 health conditions, 10 valuation methods, and 3 proxy types. In general, proxy-reported HUs were significantly different from those assessed by children themselves, while the direction and magnitude of these differences were inconsistent regarding health conditions, valuation methods, and proxy types. Meta-regression demonstrated that WMDs were significantly different in patients with ear diseases relative to the general population; in those measured by EQ-5D, Health utility index 2 (HUI2), and Pediatric asthma health outcome measure relative to Visual analogue scale method; while were not significantly different in individuals adopting clinician-proxy and caregiver-proxy relative to parent-proxy. CONCLUSION: Divergence existed in HUs between self and proxy-reports. Our findings highlight the importance of selecting appropriate self and/or proxy-reported HUs in health-related quality of life measurement and economic evaluations.


Assuntos
Saúde da Criança/normas , Indicadores Básicos de Saúde , Procurador , Autorrelato , Adolescente , Criança , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pais/psicologia , Qualidade de Vida , Escala Visual Analógica
18.
Mayo Clin Proc ; 96(5): 1229-1235, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33581839

RESUMO

OBJECTIVE: To develop a delirium risk-prediction tool that is applicable across different clinical patient populations and can predict the risk of delirium at admission to hospital. METHODS: This retrospective study included 120,764 patients admitted to Mayo Clinic between January 1, 2012, and December 31, 2017, with age 50 and greater. The study group was randomized into a derivation cohort (n=80,000) and a validation cohort (n=40,764). Different risk factors were extracted and analyzed using least absolute shrinkage and selection operator (LASSO) penalized logistic regression. RESULTS: The area under the receiver operating characteristic curve (AUROC) for Mayo Delirium Prediction (MDP) tool using derivation cohort was 0.85 (95% confidence interval [CI], .846 to .855). Using the regression coefficients obtained from the derivation cohort, predicted probability of delirium was calculated for each patient in the validation cohort. For the validation cohort, AUROC was 0.84 (95% CI, .834 to .847). Patients were classified into 1 of the 3 risk groups, based on their predicted probability of delirium: low (≤5%), moderate (6% to 29%), and high (≥30%). In the derivation cohort, observed incidence of delirium was 1.7%, 12.8%, and 44.8% (low, moderate, and high risk, respectively), which is similar to the incidence rates in the validation cohort of 1.9%, 12.7%, and 46.3%. CONCLUSION: The Mayo Delirium Prediction tool was developed from a large heterogeneous patient population with good validation results and appears to be a reliable automated tool for delirium risk prediction with hospitalization. Further prospective validation studies are required.


Assuntos
Regras de Decisão Clínica , Delírio/diagnóstico , Delírio/etiologia , Indicadores Básicos de Saúde , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
19.
Am J Cardiol ; 146: 107-114, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33539859

RESUMO

Exercise testing represents the preferred stress modality for individuals undergoing evaluation of suspected myocardial ischemia. Patients with limited functional status may be unable to achieve an adequate exercise stress, thus influencing the diagnostic sensitivity of the results. The Duke Activity Status Index (DASI) is a clinically applicable tool to estimate exercise capacity. The purpose of the current study was to assess the utility of the DASI to identify patients unable to achieve an adequate exercise stress result. Patients referred for exercise stress testing were administered the DASI pre-exercise. Baseline characteristics and exercise variables were evaluated including DASI-metabolic equivalents (DASI-METs), peak METs, exercise time (ET), and %-predicted maximal heart rate (%PMHR). Criteria for determining adequate exercise stress was defined as ≥85%PMHR or ≥ 5-METs at peak exercise. In 608 cardiovascular stress tests performed during the study period; 314 were exercise stress. The median DASI-METs (8.4 [interquartile range; 6.7 to 9.9]) was associated with estimated peak exercise METs (R=0.50, p <0.001), ET (R=0.29, p <0.001), and %PMHR (R=0.19, p = 0.003). DASI-METs were different between those with < or ≥85%PMHR (7.9 [6.6-9.0] vs. 8.9 [7.1-9.9], P=0.025) and those with < or ≥5-METs (5.8 [4.6 to 6.6] versus 8.9 [7.3-9.9], p <0.001). Receiver operating characteristic curve analysis identified a DASI-MET threshold of ≤/>7.4 to optimally predict adequate exercise stress (sensitivity=93%, specificity=71%). In conclusion, the DASI correlates with peak METs, ET, and %PMHR among patients referred for exercise testing and can be used to identify patients with an increased likelihood of an inadequate stress test result.


Assuntos
Doenças Cardiovasculares/diagnóstico , Teste de Esforço/métodos , Tolerância ao Exercício/fisiologia , Indicadores Básicos de Saúde , Medição de Risco/métodos , Doenças Cardiovasculares/fisiopatologia , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
20.
Curr Probl Cardiol ; 46(5): 100819, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33631706

RESUMO

OBJECTIVES AND METHODS: the current understanding of the interplay between cardiovascular (CV) risk and Covid-19 is grossly inadequate. CV risk-prediction models are used to identify and treat high risk populations and to communicate risk effectively. These tools are unexplored in Covid-19. The main objective is to evaluate the association between CV scoring systems and chest X ray (CXR) examination (in terms of severity of lung involvement) in 50 Italian Covid-19 patients. Results only the Framingham Risk Score (FRS) was applicable to all patients. The Atherosclerotic Cardiovascular Disease Score (ASCVD) was applicable to half. 62% of patients were classified as high risk according to FRS and 41% according to ASCVD. Patients who died had all a higher FRS compared to survivors. They were all hypertensive. FRS≥30 patients had a 9.7 higher probability of dying compared to patients with a lower FRS. We found a strong correlation between CXR severity and FRS and ASCVD (P < 0.001). High CV risk patients had consolidations more frequently. CXR severity was significantly associated with hypertension and diabetes. 71% of hypertensive patients' CXR and 88% of diabetic patients' CXR had consolidations. Patients with diabetes or hypertension had 8 times greater risk of having consolidations. CONCLUSIONS: High CV risk correlates with more severe CXR pattern and death. Diabetes and hypertension are associated with more severe CXR. FRS offers more predictive utility and fits best to our cohort. These findings may have implications for clinical practice and for the identification of high-risk groups to be targeted for the vaccine precedence.


Assuntos
COVID-19/diagnóstico por imagem , Doenças Cardiovasculares/diagnóstico , Indicadores Básicos de Saúde , Radiografia Torácica , Adulto , Idoso , COVID-19/mortalidade , COVID-19/terapia , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/terapia , Comorbidade , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Hipertensão/diagnóstico , Hipertensão/mortalidade , Itália , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Índice de Gravidade de Doença
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