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1.
Medicine (Baltimore) ; 100(11): e25081, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725985

RESUMO

ABSTRACT: This work aims to explore risk factors for ischemic stroke in young adults and analyze the Traditional Vascular Risk Factors Model based on age, hypertension, diabetes, smoking history, and drinking history. Further, the Lipid Metabolism Model was analyzed based on lipoprotein a [LP (a)], high-density lipoprotein (HDL), low-density lipoprotein (LDL), apolipoprotein AI (apo AI), apolipoprotein B (apo B), and the Early Renal Injury Model based on urinary microalbuminuria/creatinine ratio (UACR). Besides, we estimated glomerular filtration rate (eGFR), cystatin C (Cys-C), homocysteine (Hcy), ß2 microglobulin (ß2m), and validated their predictive efficacy and clinical value for the development of ischemic stroke in young adults.We selected and retrospectively analyzed the clinical data of 565 young inpatients admitted to Zhejiang Provincial Hospital of Chinese Medicine between 2010 and 2020, 187 of whom were young stroke patients. A single-factor analysis was used to analyze the risk factors for stroke in young people and developed a traditional vascular risk factors model, a lipid metabolism model, and an early kidney injury model based on backpropagation (BP) neural networks technology to predict early stroke occurrence. Moreover, the prediction performance by the area under the receiver operating characteristics (ROC) curve (AUC) was assessed to further understand the risk factors for stroke in young people and apply their predictive role in the clinical setting.Single-factor analysis showed that ischemic stroke in young adults was associated with hypertension, diabetes, smoking history, drinking history, LP(a), HDL, LDL, apo AI, apo B, eGFR, Cys-C, and ß2m (P < .05). The BP neural networks technique was used to plot the ROC curves for the Traditional Vascular Risk Factors Model, the Lipid Metabolism Model, and the Early Kidney Injury Model in enrolled patients, and calculated AUC values of 0.7915, 0.8387, and 0.9803, respectively.The early kidney injury model precisely predicted the risk of ischemic stroke in young adults and exhibited a certain clinical value as a reference for morbidity assessment. Whereas the prediction performance of the Traditional Vascular Risk Factors Model and the Lipid Metabolism Model were inferior to that of the early kidney injury model.


Assuntos
Regras de Decisão Clínica , Testes de Função Renal/estatística & dados numéricos , Redes Neurais de Computação , Medição de Risco/estatística & dados numéricos , Lesão Renal Aguda/complicações , Lesão Renal Aguda/diagnóstico , Adolescente , Adulto , Fatores Etários , Consumo de Bebidas Alcoólicas/efeitos adversos , Área Sob a Curva , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Análise Fatorial , Feminino , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Testes de Função Renal/métodos , Lipoproteínas/sangue , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Medição de Risco/métodos , Fatores de Risco , Fumar/efeitos adversos , Adulto Jovem
2.
Am J Prev Med ; 60(4): 471-477, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33745520

RESUMO

INTRODUCTION: Several studies in developed and developing countries have analyzed the health risk factors associated with COVID-19 mortality. Comorbid diseases are a key explanatory factor behind COVID-19 mortality, but current studies treat comorbidities in isolation, at average-population values, and rarely assess how death risk varies for different health profiles across institutions. Estimating death risk variations for different interactions between comorbid diseases and across healthcare institutions is crucial to gaining a significant depth of understanding in relation to mortality during the pandemic. METHODS: This study relies on data from approximately half a million people in Mexico (of all recorded cases through August 15, 2020) and on Bayesian estimation to provide a more robust estimate of the combined effect of several comorbidities and institutional inequalities on COVID-19 mortality. RESULTS: The findings of the study illustrate the additive effects of several comorbid diseases, with the presence of obesity, diabetes, hypertension, and chronic kidney disease increasing the mortality risk of COVID-19. There are also variations in the risk of death across the heterogeneous Mexican health system. CONCLUSIONS: This study shows that COVID-19 mortality risk sharply increases in patients with 2 or more comorbid diseases (obesity, diabetes, hypertension, and cardiovascular diseases) in Mexico. However, death risk varied significantly across institutions for patients with the same comorbidity profile.


Assuntos
/mortalidade , Hospitais/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Teorema de Bayes , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , México , Pessoa de Meia-Idade , Modelos Estatísticos , Obesidade/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Medição de Risco/estatística & dados numéricos , Fatores de Risco
3.
Appl Nurs Res ; 58: 151410, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33745558

RESUMO

OBJECTIVE: This study aimed to assess the post-contact risk of nurses who provide care for patients diagnosed with COVID-19. METHODS: This investigation employed a quantitative-descriptive design. The study sample was comprised of the frontline nurses in the COVID-19 center hospitals in the northern part of Saudi Arabia. Snowball sampling was used, resulting in 80 frontline nurses. A survey using a self-administered questionnaire in a Google form was employed to collect the data, which was collected from May 20 through June 25, 2020. RESULTS: Some of the study participants were reported to have a history of both staying in the same household with each other (35%) and of traveling with a confirmed COVID-19 patient (20%). These participants were considered as community exposed to COVID-19. There were 8.8% who were classified as high risk due to failure in removing and replacing personal protective equipment (PPE); 6.3% were at high risk for not performing hand hygiene before and after touching COVID-19 patients, and 5% did not follow the recommended guidelines in performing hand hygiene after touching the patients' surroundings. In addition, 3.8% of the participants had an accident related to biological material, such as with splashes of biological fluid (in the eyes). These nurses were classified as high risk for COVID-19 virus infection, CONCLUSION: This study identifies practices that need improvement in combatting this virus. Since policies and guidelines may not always be optimal in all settings, a tailor-fitted guideline is appropriate. Nurse leaders, for example, need to establish an infection control system that provides real-time monitoring and facilitates immediate correction for nurses. Doing so will provide the nurses with a continuous awareness of predisposing themselves to acquiring the virus.


Assuntos
/epidemiologia , Cuidados de Enfermagem/estatística & dados numéricos , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Exposição Ocupacional/estatística & dados numéricos , Medição de Risco/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Arábia Saudita/epidemiologia , Inquéritos e Questionários , Adulto Jovem
4.
Medicine (Baltimore) ; 100(12): e24903, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761648

RESUMO

ABSTRACT: Papillary renal cell carcinoma (PRCC) is the second most common type of renal carcinoma following clear cell renal cell carcinoma, and the role of immune-related genes (IRGs) in tumorigenesis and metastasis is evident; its prognostic value in PRCC remains unclear. In this study, we downloaded the gene expression profiles and clinical data of patients with PRCC from The Cancer Genome Atlas (TCGA) database and obtained IRGs from the ImmPort database. A total of 371 differentially expressed IRGs (DEIRGs) were discovered between PRCC and normal kidney tissues. Prognostic DEIRGs (PDEIRGs) were identified by univariate Cox regression analysis. Then, we screened the four most representative PDEIRGs (IL13RA2, CCL19, BIRC5, and INHBE) and used them to construct a risk model to predict the prognosis of patients with PRCC. This model precisely stratified survival outcome and accurately identified mutation burden in PRCC. Thus, our results suggest that these four PDEIRGs are available prognostic predictors for PRCC. They could be used to assess the prognosis and to guide individualized treatments for patients with PRCC.


Assuntos
Carcinoma de Células Renais/genética , Neoplasias Renais/genética , Medição de Risco/estatística & dados numéricos , Carcinoma de Células Renais/patologia , Quimiocina CCL19/genética , Humanos , Subunidades beta de Inibinas/genética , Subunidade alfa2 de Receptor de Interleucina-13/genética , Neoplasias Renais/patologia , Mutação , Prognóstico , Modelos de Riscos Proporcionais , Survivina/genética , Transcriptoma , Carga Tumoral/genética
5.
Medicine (Baltimore) ; 100(12): e24522, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761634

RESUMO

BACKGROUND: The intracranial hemorrhage (ICH) risk of oral anticoagulants/non-vitamin K antagonist oral anticoagulants (NOACs) remains largely unknown. Patients who need oral anticoagulants such as aspirin or warfarin often suffer from obvious complications. METHODS: This network meta-analysis intended to assess the ICH risk in patients taking NOACs. The data from PubMed, the Cochrane database, and Embase were reviewed. All phase III randomized controlled trials of NOACs (apixaban, edoxaban, dabigatran, rivaroxaban), aspirin and warfarin were reviewed. RESULTS: Twenty-three trials involving 137,713 participants were included, involving 6 regimens. Warfarin had the first risk of ICH (surface under the cumulative ranking area: 0.82), followed by dabigatran, edoxaban, aspirin, apixaban, rivaroxaban, and placebo. Dabigatran had the lowest risk of all-cause mortality (surface under the cumulative ranking area: 0.63), followed by apixaban, edoxaban, warfarin, rivaroxaban, aspirin, and placebo. CONCLUSION: Warfarin significantly increased the risk of ICH in patients taking oral anticoagulants compared with 4 NOACs (dabigatran, edoxaban, apixaban, rivaroxaban) and aspirin. Apixaban is least likely to induce all-cause mortality.


Assuntos
Antitrombinas/efeitos adversos , Aspirina/efeitos adversos , Hemorragias Intracranianas/epidemiologia , Varfarina/efeitos adversos , Administração Oral , Antitrombinas/administração & dosagem , Aspirina/administração & dosagem , Ensaios Clínicos Fase III como Assunto , Humanos , Hemorragias Intracranianas/induzido quimicamente , Mortalidade , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco/estatística & dados numéricos , Varfarina/administração & dosagem
7.
Emerg Infect Dis ; 27(4): 1164-1168, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33754981
8.
BMC Infect Dis ; 21(1): 242, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33673819

RESUMO

BACKGROUND: Previous studies have indicated that the risk of infectious disease spread is greatest in locations where a population has massive and convenient access to the epicenter of an outbreak. However, the spatiotemporal variations and risk determinants of COVID-19 in typical labor export regions of China remain unclear. Understanding the geographical distribution of the disease and the socio-economic factors affecting its transmission is critical for disease prevention and control. METHODS: A total of 2152 COVID-19 cases were reported from January 21 to February 24, 2020 across the 34 cities in Henan and Anhui. A Bayesian spatiotemporal hierarchy model was used to detect the spatiotemporal variations of the risk posed by COVID-19, and the GeoDetector q statistic was used to evaluate the determinant power of the potential influence factors. RESULTS: The risk posed by COVID-19 showed geographical spatiotemporal heterogeneity. Temporally, there was an outbreak period and control period. Spatially, there were high-risk regions and low-risk regions. The high-risk regions were mainly in the southwest areas adjacent to Hubei and cities that served as economic and traffic hubs, while the low-risk regions were mainly in western Henan and eastern Anhui, far away from the epicenter. The accessibility, local economic conditions, and medical infrastructure of Wuhan in Hubei province all played an important role in the spatiotemporal heterogeneity of COVID-19 transmission. The results indicated that the q statistics of the per capita GDP and the proportion of primary industry GDP were 0.47 and 0.47, respectively. The q statistic of the population flow from Wuhan was 0.33. In particular, the results showed that the q statistics for the interaction effects between population density and urbanization, population flow from Wuhan, per capita GDP, and the number of doctors were all greater than 0.8. CONCLUSIONS: COVID-19 showed significant spatiotemporal heterogeneity in the labor export regions of China. The high-risk regions were mainly located in areas adjacent to the epicenter as well as in big cities that served as traffic hubs. Population access to the epicenter, as well as local economic and medical conditions, played an important role in the interactive effects of the disease transmission.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Transmissão de Doença Infecciosa , Medição de Risco , /epidemiologia , /transmissão , China/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Transmissão de Doença Infecciosa/estatística & dados numéricos , Humanos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Análise Espaço-Temporal , Migrantes , Urbanização
9.
Medicine (Baltimore) ; 100(12): e25274, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761730

RESUMO

ABSTRACT: To investigate the influencing factors of fracture nonunion after intramedullary nailing for subtrochanteric fractures and to construct a risk assessment model.Based on the multicenter retrospective analysis of 251 patients, all patients were divided into modeling group and verification group. In the modeling group, postoperative fracture nonunion rate, general data, fracture-related factors, surgical reduction-related factors, mechanical and biological factors were calculated, and the influencing factors of fracture nonunion were screened by univariate analysis. Logistic regression model was used for multifactor analysis to construct the risk assessment model. Based on the logistic regression model, the risk prediction model was constructed by drawing the Nomogram diagram. Through the verification group, the influencing factors were evaluated again, and the differentiation and calibration of the model were evaluated. The calibration degree was evaluated by Hosmer-Lemeshow test, goodness of fit test, and calibration curve. The discriminant degree was evaluated by the receiver operating characteristic curve.Fracture nonunion occurred in 34 of 149 patients in the modeling group. Among the 14 potential influencing factors, univariate analysis and logistic regression analysis showed that postoperative hip varus, intramedullary nail fixation failure, and reduction of fracture with large incision were the risk factors of fracture nonunion. The medial cortex fracture was seen reduced on X-Ray was a protective factor for fracture nonunion, and a regression equation was established. Based on the logistic regression model, the Nomogram diagram is drawn. Twenty-four cases of fracture nonunion occurred in the verification group. The area under the receiver operating characteristic curve was area under curve =0.883 > 0.7, indicating that there was a moderate differentiation to evaluate the occurrence of fracture nonunion after operation. The goodness of fit test: the Hosmers-Lemeshow test (X2 = 2.921, P = .712 > .05) showed that the model had a good calibration.After intramedullary nailing of subtrochanteric fracture, hip varus, failure of intramedullary nail fixation and wide surgical dissection are the risk factors of fracture nonunion, and the postoperative reduction of medial cortex fracture is protective factor.National key research and development projects: 2016YFC0105806.


Assuntos
Coxa Vara , Fixação Intramedular de Fraturas , Fraturas não Consolidadas , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias , Medição de Risco , Idoso , Pinos Ortopédicos , Coxa Vara/diagnóstico , Coxa Vara/epidemiologia , Feminino , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/instrumentação , Fixação Intramedular de Fraturas/métodos , Fraturas não Consolidadas/diagnóstico , Fraturas não Consolidadas/epidemiologia , Fraturas não Consolidadas/etiologia , Fraturas do Quadril/diagnóstico , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/epidemiologia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Radiografia/métodos , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Falha de Tratamento
10.
Medicine (Baltimore) ; 100(10): e24430, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725821

RESUMO

OBJECTIVE: It remains unclear whether transfusion strategies during orthopedic surgery and infection are related. The purpose of this study is to evaluate whether liberal blood transfusion strategies contribute to infection risk in orthopedic patients by analyzing randomized controlled trials (RCTs). METHODS: RCTs with liberal versus restrictive red blood cell (RBC) transfusion strategies were identified by searching PubMed, Embase, the Cochrane Central Register of Controlled Trials from their inception to July 2019. Ten studies with infections as outcomes were included in the final analysis. According to the Jadad scale, all studies were considered to be of high quality. RESULTS: Ten trials involving 3938 participants were included in this study. The pooled risk ratio (RR) for the association between liberal transfusion strategy and infection was 1.34 (95% confidence intervals [CI], 0.94-1.90; P = .106). The sensitivity analysis indicated unstable results, and no significant publication bias was observed. CONCLUSION: This pooled analysis of RCTs demonstrates that liberal transfusion strategies in orthopedic patients result in a nonsignificant increase in infections compared with more restrictive strategies. The conclusions are mainly based on retrospective studies and should not be considered as recommendation before they are supported by larger scale and well-designed RCTs.


Assuntos
Transfusão de Sangue/estatística & dados numéricos , Infecções/epidemiologia , Cuidados Intraoperatórios/efeitos adversos , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Perda Sanguínea Cirúrgica/prevenção & controle , Humanos , Infecções/etiologia , Cuidados Intraoperatórios/métodos , Cuidados Intraoperatórios/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco/estatística & dados numéricos , Fatores de Risco
11.
Medicine (Baltimore) ; 100(10): e24940, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725855

RESUMO

ABSTRACT: Although non-alcoholic fatty liver disease (NAFLD) is strongly associated with type 2 diabetes mellitus (T2DM), the diagnosis of NAFLD for T2DM patients remains a challenge.This study aimed to investigate the prevalence and risk factors for the NAFLD in T2DM outpatients.This is a retrospective, cross-sectional study that included 2405 T2DM patients treated and admitted for glucose control into the Endocrinology Department of our hospital from April 2017 to March 2019. Using strict exclusion criteria, the target patients were screened and divided into two groups: NAFLD patients (study group) and non-NAFLD patients (control group). Subsequently, 34 factors were compared between the two groups. Furthermore, multivariate analysis of the NAFLD risk factors was performed using logistic regression. Finally, the diagnostic significance of individual biochemical predictors, as well as the combined predictive indicator (CPI), for NAFLD was estimated using receiver operating characteristic (ROC) curve analysis.In this study, the overall prevalence of NAFLD in T2DM patients was 58.67%. Of the target patients, 17 factors were identified by univariate analysis to be associated with NAFLD, and 8 factors were found to be significant predictors for NAFLD using binary logistic regression modeling. Furthermore, the CPI and C-Peptide represent high diagnostic value for NAFLD in T2DM patients.This study provides a more comprehensive risk factor analysis for NAFLD in T2DM patients. These data can be used to provide timely diagnosis and effective management of NAFLD.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/etiologia , Prevalência , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , Fatores de Risco
12.
Lancet Glob Health ; 9(4): e418-e430, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33607015

RESUMO

BACKGROUND: The number of individuals with vision impairment worldwide is increasing because of an ageing population. We aimed to systematically identify studies describing the association between vision impairment and mortality, and to assess the association between vision impairment and all-cause mortality. METHODS: For this systematic review and meta-analysis, we searched MEDLINE (Ovid), Embase, and Global Health database on Feb 1, 2020, for studies published in English between database inception and Feb 1, 2020. We included prospective and retrospective cohort studies that measured the association between vision impairment and all-cause mortality in people aged 40 years or older who were followed up for 1 year or more. In a protocol amendment, we also included randomised controlled trials that met the same criteria as for cohort studies, in which the association between visual impairment and mortality was independent of the study intervention. Studies that did not report age-adjusted mortality data, or that focused only on populations with specific health conditions were excluded. Two reviewers independently assessed study eligibility, extracted the data, and assessed risk of bias. We graded the overall certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations framework. We did a random-effects meta-analysis to calculate pooled maximally adjusted hazard ratios (HRs) for all-cause mortality for individuals with a visual acuity of <6/12 versus those with ≥6/12; <6/18 versus those with ≥6/18; <6/60 versus those with ≥6/18; and <6/60 versus those with ≥6/60. FINDINGS: Our searches identified 3845 articles, of which 28 studies, representing 30 cohorts (446 088 participants) from 12 countries, were included in the systematic review. The meta-analysis included 17 studies, representing 18 cohorts (47 998 participants). There was variability in the methods used to assess and report vision impairment. Pooled HRs for all-cause mortality were 1·29 (95% CI 1·20-1·39) for visual acuity <6/12 versus ≥6/12, with low heterogeneity between studies (n=15; τ2=0·01, I2=31·46%); 1·43 (1·22-1·68) for visual acuity <6/18 versus ≥6/18, with low heterogeneity between studies (n=2; τ2=0·0, I2=0·0%); 1·89 (1·45-2·47) for visual acuity <6/60 versus ≥6/18 (n=1); and 1·02 (0·79-1·32) for visual acuity <6/60 versus ≥6/60 (n=2; τ2=0·02, I2=25·04%). Three studies received an assessment of low risk of bias across all six domains, and six studies had a high risk of bias in one or more domains. Effect sizes were greater for studies that used best-corrected visual acuity compared with those that used presenting visual acuity as the vision assessment method (p=0·0055), but the effect sizes did not vary in terms of risk of bias, study design, or participant-level factors (ie, age). We judged the evidence to be of moderate certainty. INTERPRETATION: The hazard for all-cause mortality was higher in people with vision impairment compared with those that had normal vision or mild vision impairment, and the magnitude of this effect increased with more severe vision impairment. These findings have implications for promoting healthy longevity and achieving the Sustainable Development Goals. FUNDING: Wellcome Trust, Commonwealth Scholarship Commission, National Institutes of Health, Research to Prevent Blindness, the Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research, Moorfields Biomedical Research Centre, Sightsavers, the Fred Hollows Foundation, the Seva Foundation, the British Council for the Prevention of Blindness, and Christian Blind Mission.


Assuntos
Saúde Global/estatística & dados numéricos , Mortalidade , Transtornos da Visão/epidemiologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Índice de Gravidade de Doença , Transtornos da Visão/diagnóstico
13.
Aging (Albany NY) ; 13(3): 3190-3201, 2021 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-33550276

RESUMO

Males are at a higher risk of dying from COVID-19 than females. Older age and cardiovascular disease are also associated with COVID-19 mortality. To better understand how age and sex interact in contributing to COVID-19 mortality, we stratified the male-to-female (sex) ratios in mortality by age group. We then compared the age-stratified sex ratios with those of cardiovascular mortality and cancer mortality in the general population. Data were obtained from official government sources in the US and five European countries: Italy, Spain, France, Germany, and the Netherlands. The sex ratio of deaths from COVID-19 exceeded one throughout adult life, increasing up to a peak in midlife, and declining markedly in later life. This pattern was also observed for the sex ratio of deaths from cardiovascular disease, but not cancer, in the general populations of the US and European countries. Therefore, the sex ratios of deaths from COVID-19 and from cardiovascular disease share similar patterns across the adult life course. The underlying mechanisms are poorly understood and warrant further investigation.


Assuntos
Doenças Cardiovasculares , Mortalidade , Medição de Risco , Adulto , Fatores Etários , Idoso , /mortalidade , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Razão de Masculinidade
14.
BMJ Open ; 11(1): e044526, 2021 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-33518528

RESUMO

OBJECTIVES: To determine if obesity and diabetes are risk factors for severe outcomes in COVID-19 and to compare patient outcomes in those two conditions. DESIGN: Retrospective cohort study. SETTING: Urban tertiary care center in New York City. PARTICIPANTS: 302 patients admitted in an inpatient setting, ≥18 years old, with a laboratory-confirmed diagnosis of COVID-19 via nasal PCR swab were randomly selected. Patients were separated into two cohorts based on their body mass index and hemoglobin A1c. 150 patients were placed in the non-obese, non-diabetic cohort and 152 patients were placed in the corresponding cohort (obesity alone, obesity and diabetes, and diabetes alone). MEASUREMENTS: Primary outcomes were development of acute kidney injury, commencement of renal replacement therapy, aminotransferase elevation, troponin elevation, lactic acidosis, development of septic shock, use of vasopressors, presence of acute respiratory distress syndrome (ARDS) and intubation. The secondary outcomes were length of stay in days and mortality. RESULTS: Patients with obesity and/or diabetes were more likely to develop ARDS (79 patients vs 57 patients, p<0.0001) and to be intubated (71 patients vs 45 patients, p=0.0031). Patients with obesity and/or diabetes were more likely to require vasopressors (60 patients vs 41 patients, p=0.0284) and to develop lactic acidosis (median 3.15 mmol/L, IQR 1.8 to 5.2 mmol/L, p=0.0432). When comparing patients with diabetes with and without obesity against patients with obesity alone, they were more likely to develop ARDS (87.5%, p=0.0305). Despite these findings, there was no difference in mortality. CONCLUSIONS: In patients hospitalised with COVID-19, those with obesity and/or diabetes were more likely to suffer severe complications, but had negligible differences in mortality. This highlights the importance of close monitoring of patients with these conditions and additional areas of research needed to explain the mortality findings.


Assuntos
Diabetes Mellitus , Hemoglobina A Glicada/análise , Obesidade , /isolamento & purificação , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , Índice de Massa Corporal , /complicações , /terapia , Comorbidade , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Cidade de Nova Iorque/epidemiologia , Obesidade/diagnóstico , Obesidade/epidemiologia , Avaliação de Processos e Resultados em Cuidados de Saúde , Distribuição Aleatória , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco
16.
JCO Glob Oncol ; 7: 46-55, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33434066

RESUMO

PURPOSE: The COVID-19 pandemic remains a public health emergency of global concern. Determinants of mortality in the general population are now clear, but specific data on patients with cancer remain limited, particularly in Latin America. MATERIALS AND METHODS: A longitudinal multicenter cohort study of patients with cancer and confirmed COVID-19 from Oncoclínicas community oncology practice in Brazil was conducted. The primary end point was all-cause mortality after isolation of the SARS-CoV-2 by Real-Time Polymerase Chain Reaction (RT-PCR) in patients initially diagnosed in an outpatient environment. We performed univariate and multivariable logistic regression analysis and recursive partitioning modeling to define the baseline clinical determinants of death in the overall population. RESULTS: From March 29 to July 4, 2020, 198 patients with COVID-19 were prospectively registered in the database, of which 167 (84%) had solid tumors and 31 (16%) had hematologic malignancies. Most patients were on active systemic therapy or radiotherapy (77%), largely for advanced or metastatic disease (64%). The overall mortality rate was 16.7% (95% CI, 11.9 to 22.7). In univariate models, factors associated with death after COVID-19 diagnosis were age ≥ 60 years, current or former smoking, coexisting comorbidities, respiratory tract cancer, and management in a noncurative setting (P < .05). In multivariable logistic regression and recursive partitioning modeling, only age, smoking history, and noncurative disease setting remained significant determinants of mortality, ranging from 1% in cancer survivors under surveillance or (neo)adjuvant therapy to 60% in elderly smokers with advanced or metastatic disease. CONCLUSION: Mortality after COVID-19 in patients with cancer is influenced by prognostic factors that also affect outcomes of the general population. Fragile patients and smokers are entitled to active preventive measures to reduce the risk of SARS-CoV-2 infection and close monitoring in the case of exposure or COVID-19-related symptoms.


Assuntos
/mortalidade , Sobreviventes de Câncer/estatística & dados numéricos , Neoplasias/mortalidade , /isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , /virologia , Causas de Morte , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Fragilidade/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Neoplasias/complicações , Prognóstico , Estudos Prospectivos , RNA Viral/isolamento & purificação , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Fumar/epidemiologia , Adulto Jovem
18.
Prev Med ; 145: 106435, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33486000

RESUMO

This study aimed to assess the impact of coronavirus disease (COVID-19) prevalence in the United States in the week leading to the relaxation of the stay-at-home orders (SAH) on future prevalence across states that implemented different SAH policies. We used data on the number of confirmed COVID-19 cases as of August 21, 2020 on county level. We classified states into four groups based on the 7-day change in prevalence and the state's approach to SAH policy. The groups included: (1) High Change (19 states; 7-day prevalence change ≥50th percentile), (2) Low Change (19 states; 7-day prevalence change <50th percentile), (3) No SAH (11 states: did not adopt SAH order), and (4) No SAH End (2 states: did not relax SAH order). We performed regression modeling assessing the association between change in prevalence at the time of SAH order relaxation and COVID-19 prevalence days after the relaxation of SAH order for four selected groups. After adjusting for other factors, compared to the High Change group, counties in the Low Change group had 33.8 (per 100,000 population) fewer cases (standard error (SE): 19.8, p < 0.001) 7 days after the relaxation of SAH order and the difference was larger by time passing. On August 21, 2020, the No SAH End group had 383.1 fewer cases (per 100,000 population) than the High Change group (SE: 143.6, p < 0.01). A measured, evidence-based approach is required to safely relax the community mitigation strategies and practice phased-reopening of the country.


Assuntos
/epidemiologia , Saúde Pública/estatística & dados numéricos , Saúde Pública/tendências , Quarentena/estatística & dados numéricos , Quarentena/normas , Medição de Risco/estatística & dados numéricos , Previsões , Política de Saúde , Humanos , Prevalência , Estados Unidos/epidemiologia
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