Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 428
Filtrar
1.
PLoS Biol ; 17(8): e3000372, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31465433

RESUMO

The 2016 Frank Lautenberg Chemical Safety for the 21st Century Act (Lautenberg TSCA) amended the 1976 Toxic Substances Control Act (TSCA) to mandate protection of susceptible and highly exposed populations. Program implementation entails a myriad of choices that can lead to different degrees of public health protections. Well-documented exposures to multiple industrial chemicals occur from air, soil, water, food, and products in our workplaces, schools, and homes. Many hazardous chemicals are associated with or known to cause health risks; for other industrial chemicals, no data exist to confirm their safety because of flaws in 1976 TSCA. Under the 2016 Lautenberg amendments, the United States Environmental Protection Agency (EPA) must evaluate chemicals against risk-based safety standards under enforceable deadlines, with an explicit mandate to identify and assess risks to susceptible and highly exposed populations. Effective public health protection requires EPA to implement the Lautenberg TSCA requirements by incorporating intrinsic and extrinsic factors that affect susceptibility, adequately assessing exposure among vulnerable groups, and accurately identifying highly exposed groups. We recommend key scientific and risk assessment principles to inform health-protective chemical policy such as consideration of aggregate exposures from all pathways and, when data are lacking, the use of health-protective defaults.


Assuntos
Segurança Química/legislação & jurisprudência , Conservação dos Recursos Naturais/legislação & jurisprudência , Conservação dos Recursos Naturais/métodos , Substâncias Perigosas/toxicidade , Humanos , Saúde Pública/legislação & jurisprudência , Medição de Risco/tendências , Estados Unidos , United States Environmental Protection Agency/legislação & jurisprudência
2.
Transgenic Res ; 28(Suppl 2): 111-117, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31321693

RESUMO

Foundational activities at the international level underlie current risk and safety assessment approaches for genetically engineered/modified organisms (GEOs/GMOs). Early risk assessment considerations beginning with the OECD 'Blue Book' established risk/safety assessment as the characterization of the organism and its environmental release; establishment and persistence in the environment; and human and ecological effects, analyzed in principle through existing methods. Important in this context was recognition that GEOs/GMOs as a class did not represent new risks relative to products of traditional plant breeding and that any incremental risk would need to be established on a stepwise case-by-case comparative basis with existing crops and derived-foods as the baseline. Accordingly, concepts of familiarity and substantial equivalence were advanced by OECD and WHO as ways to establish a risk analysis baseline for determining whether and to what extent risk/safety assessment was needed. Regulatory implementations of this paradigm have skewed to increasingly complex portfolios of studies rather than adhering to analysis which is formulated to fit the risk/safety questions relevant to a given case. Plants produced through genome editing technology will benefit from risk analysis that implements sound problem formulation to guide the need for and nature of risk/safety assessments.


Assuntos
Produtos Agrícolas/genética , Inocuidade dos Alimentos , Alimentos Geneticamente Modificados , Plantas Geneticamente Modificadas/genética , Ecologia , Edição de Genes , Humanos , Medição de Risco/tendências
3.
J Wound Ostomy Continence Nurs ; 46(4): 291-297, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31274856

RESUMO

PURPOSE: The purpose of this study was to develop and compare 3 predictive models for pressure injury (PI) occurrence in surgical patients. DESIGN: Retrospective case-control study. SUBJECTS AND SETTING: Data on PI risk assessment and preanesthesia evaluation records from 400 patients (80 patients who developed PIs after surgery and 320 patients who did not) in a South Korean acute care setting who underwent surgery between January 2015 and May 2016 were extracted from the electronic health record. METHODS: Three models were developed with items from the Braden Scale (model 1), the Scott Triggers tool (model 2), and the Scott Triggers tool in addition to type of anesthesia, laboratory test results, and comorbid conditions (model 3) using logistic regression to analyze items (factors) in each model. Predictive performance indices, which included sensitivity, specificity, positive predictive value, negative predictive value, area under the receiver operating characteristics curve, and Akaike information criterion, were compared among the 3 models. RESULTS: Findings showed there were no significant factors in model 1, the estimated surgery time and serum albumin level were significant in model 2, and the estimated surgery time, serum albumin level, and brain disease were significant in model 3. The model performance evaluation revealed that model 2 was the best fitting model, demonstrating the highest sensitivity (84.4%), highest negative predictive value (94.6%), and lowest Akaike information criterion (302.03). CONCLUSIONS: The Scott Triggers tool in model 2, which consists of simple items that are easy to extract from preanesthesia evaluation records, was the best fitting model. We recommend the Scott Triggers tool be used to predict the development of PIs in surgical patients in acute care settings.


Assuntos
Lesão por Pressão/etiologia , Medição de Risco/métodos , Medição de Risco/normas , Atividades Cotidianas/classificação , Adulto , Estudos de Casos e Controles , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Percepção , Complicações Pós-Operatórias/epidemiologia , Lesão por Pressão/epidemiologia , Curva ROC , República da Coreia/epidemiologia , Estudos Retrospectivos , Medição de Risco/tendências , Fatores de Risco , Sensibilidade e Especificidade , Estatísticas não Paramétricas
4.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31278210

RESUMO

BACKGROUND AND OBJECTIVES: An early-onset sepsis (EOS) risk calculator tool to guide evaluation and treatment of infants at risk for sepsis has reduced antibiotic use without increased adverse outcomes. We performed an electronic health record (EHR)-driven quality improvement intervention to increase calculator use for infants admitted to a newborn nursery and reduce antibiotic treatment of infants at low risk for sepsis. METHODS: This 2-phase intervention included programming (1) an EHR form containing calculator fields that were external to the infant's admission note, with nonautomatic access to the calculator, education for end-users, and reviewing risk scores in structured bedside rounds and (2) discrete data entry elements into the EHR admission form with a hyperlink to the calculator Web site. We used statistical process control to assess weekly entry of risk scores and antibiotic orders and interrupted time series to assess trend of antibiotic orders. RESULTS: During phase 1 (duration, 14 months), a mean 59% of infants had EOS calculator scores entered. There was wide variability around the mean, with frequent crossing of weekly means beyond the 3σ control lines, indicating special-cause variation. During phase 2 (duration, 2 years), mean frequency of EOS calculator use increased to 85% of infants, and variability around the mean was within the 3σ control lines. The frequency of antibiotic orders decreased from preintervention (7%) to the final 6 months of phase 2 (1%, P < .001). CONCLUSIONS: An EHR-driven quality improvement intervention increased EOS calculator use and reduced antibiotic orders, with no increase in adverse events.


Assuntos
Antibacterianos/uso terapêutico , Registros Eletrônicos de Saúde/tendências , Sepse Neonatal/diagnóstico , Sepse Neonatal/tratamento farmacológico , Diagnóstico Precoce , Registros Eletrônicos de Saúde/normas , Feminino , Humanos , Recém-Nascido , Masculino , Sepse Neonatal/sangue , Medição de Risco/normas , Medição de Risco/tendências
5.
PLoS Med ; 16(6): e1002824, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170161

RESUMO

In a Perspective for the Tuberculosis Special Issue, Kevin Schwartzman and colleagues discuss the choices and implications for personal versus public health benefits when pursuing tuberculosis elimination in low-incidence countries.


Assuntos
Antituberculosos/uso terapêutico , Política de Saúde/tendências , Tuberculose Latente/epidemiologia , Tuberculose Latente/prevenção & controle , Humanos , Incidência , Tuberculose Latente/diagnóstico , Medição de Risco/métodos , Medição de Risco/tendências , Resultado do Tratamento
6.
Scand J Trauma Resusc Emerg Med ; 27(1): 43, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975178

RESUMO

INTRODUCTION: Soluble urokinase plasminogen activator receptor (suPAR) is a prognostic and nonspecific biomarker associated with short-term mortality in emergency department (ED) patients. Therefore, the blood level of suPAR might be usable for identification of patients at high- and low risk, shortly after arrival at the ED. Here, we investigate the value of adding suPAR to triage and how this may impact on risk stratification regarding mortality. METHODS: The analyses were performed on the TRIAGE III cohort. Patients were triaged in four groups: Red, Orange, Yellow, and Green. Outcome was all-cause mortality within seven days. Discriminative abilities of triage and suPAR on mortality were assessed using the area under the curve (AUC) for receiver operating characteristics (ROC) curves. A suPAR cut-off value was generated using the Youden's index. Patients were subsequently reclassified one triage level up if the suPAR level was above this cut-off and one level down if the suPAR level was below that value. RESULTS: The study included 4420 patients with an available triage category and suPAR measurement. suPAR was significantly better in predicting mortality than triage; AUC (95% confidence interval): 0.85 (0.80-0.89) vs. 0.71 (0.64-0.78), P < 0.001. Combining suPAR and triage yielded an AUC of 0.87 (0.82-0-93). The Youden's cut-off of suPAR was 5.9 ng/mL and reclassified triage using this value resulted in a more accurate risk stratification regarding hospital admission and mortality. CONCLUSION: Addition of suPAR to triage potentially improves prediction of short-term mortality. Measurement of suPAR in relation to the triage process may allow a more accurate identification of ED patients at risk. TRIAL REGISTRATION: Clinicaltrials.gov , NCT02643459. Registered 31 December 2015. https://clinicaltrials.gov/ct2/show/NCT02643459?cond=NCT02643459&rank=1 .


Assuntos
Algoritmos , Emergências/epidemiologia , Serviço Hospitalar de Emergência/normas , Receptores de Ativador de Plasminogênio Tipo Uroquinase/sangue , Medição de Risco/tendências , Triagem/métodos , Biomarcadores/sangue , Dinamarca/epidemiologia , Feminino , Mortalidade Hospitalar/tendências , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC
7.
Can J Cardiol ; 35(3): 260-269, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30825948

RESUMO

Antiretroviral therapy (ART) has been pivotal in prolonging the lifespan of people living with HIV (PLWH). However, this also simultaneously increases their risk of cardiovascular disease (CVD) either related to ART, aging, hypertension, immunosenescence, inflammation, immune activation, or other comorbidities. Although the use of risk markers has greatly enhanced the field of cardiovascular (CV) medicine and improved the prognosis and early diagnosis in the general population, this strategy has not been clearly elucidated in PLWH. Developing accurate risk algorithms for PLWH requires an innate understanding of mechanistic factors influencing their risks. Early identification of CV risk will significantly enhance the prospects of PLWH living longer and relatively healthily. Herein, we discuss the use of multimodality noninvasive CV imaging as robust markers for ameliorating CV risk. The ability to prognosticate CV risk and hence prevent CV events in PLWH would represent an important advance in CV medicine, allowing precise detection and early institution of preventative strategies. Using novel CV imaging modalities and strategies would have a positive impact on precision medicine in this patient cohort.


Assuntos
Doenças Cardiovasculares , Técnicas de Diagnóstico Cardiovascular , Infecções por HIV/complicações , Medição de Risco , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Diagnóstico Precoce , Infecções por HIV/tratamento farmacológico , Humanos , Prognóstico , Medição de Risco/métodos , Medição de Risco/tendências
9.
Therapie ; 74(2): 301-306, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30704766

RESUMO

During the past few decades, it has been stated that a paradigm shift has occurred in the assessment and management of patient related drug safety. Some of these changes have resulted in a significant increase in the importance of pharmacoepidemiology and its use in pharmacovigilance. For European member states, the Pharmacovigilance Risk Assessment Committee (PRAC) is responsible for assessing the protocols and results of imposed and non-imposed post-authorization safety studies (PASS). Between 2013 and 2017, the total number of PASS during this 5-years period of the different products, including protocols and results, was 1062. The number of protocols of PASS is increasing over time, except in 2017 where a 25% decrease has been observed. Whereas, PASS results steadily increased over the 5years period. Between 2014 and 2017, about 29% (n=137) of PRAC reviewed protocols were imposed. The number of imposed PASS was almost constant over time with a mean of 34.3±7.6 imposed protocols per year and 3.5±1.74 imposed results per year. The need for the implementation of PASS for pharmacovigilance regulatory activities is increasing. Nevertheless, conducting such studies remains difficult.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Farmacoepidemiologia/métodos , Farmacovigilância , União Europeia , Humanos , Legislação de Medicamentos , Farmacoepidemiologia/tendências , Medição de Risco/métodos , Medição de Risco/tendências , Gestão de Riscos/métodos , Fatores de Tempo
10.
Med Decis Making ; 39(3): 239-252, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30767632

RESUMO

BACKGROUND: Personalizing medical treatment often requires practitioners to compare multiple treatment options, assess a patient's unique risk and benefit from each option, and elicit a patient's preferences around treatment. We integrated these 3 considerations into a decision-modeling framework for the selection of second-line glycemic therapy for type 2 diabetes. METHODS: Based on multicriteria decision analysis, we developed a unified treatment decision support tool accounting for 3 factors: patient preferences, disease outcomes, and medication efficacy and safety profiles. By standardizing and multiplying these 3 factors, we calculated the ranking score for each medication. This approach was applied to determining second-line glycemic therapy by integrating 1) treatment efficacy and side-effect data from a network meta-analysis of 301 randomized trials ( N = 219,277), 2) validated risk equations for type 2 diabetes complications, and 3) patient preferences around treatment (e.g., to avoid daily glucose testing). Data from participants with type 2 diabetes in the U.S. National Health and Nutrition Examination Survey (NHANES 2003-2014, N = 1107) were used to explore variations in treatment recommendations and associated quality-adjusted life-years given different patient features. RESULTS: Patients at the highest microvascular disease risk had glucagon-like peptide 1 agonists or basal insulin recommended as top choices, whereas those wanting to avoid an injected medication or daily glucose testing had sodium-glucose linked transporter 2 or dipeptidyl peptidase 4 inhibitors commonly recommended, and those with major cost concerns had sulfonylureas commonly recommended. By converting from the most common sulfonylurea treatment to the model-recommended treatment, NHANES participants were expected to save an average of 0.036 quality-adjusted life-years per person (about a half month) from 10 years of treatment. CONCLUSIONS: Models can help integrate meta-analytic treatment effect estimates with individualized risk calculations and preferences, to aid personalized treatment selection.


Assuntos
Técnicas de Apoio para a Decisão , Diabetes Mellitus Tipo 2/terapia , Preferência do Paciente/psicologia , Comportamento de Escolha , Diabetes Mellitus Tipo 2/psicologia , Humanos , Meta-Análise em Rede , Medicina de Precisão , Anos de Vida Ajustados por Qualidade de Vida , Medição de Risco/métodos , Medição de Risco/tendências , Resultado do Tratamento
11.
Matern Child Health J ; 23(7): 919-924, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30617441

RESUMO

Introduction Children with special health care needs (CSHCN) are a high risk population with complex medical issues and needs. It is challenging to care for them in a busy, pediatric practice without understanding how many exist and how best to allocate resources. EMRs can be adapted to develop registries and stratify patients to promote population health management. Methods Adaptations were made to the EMR in September 2013 to capture CSHCN and the associated risk level during well-child visits prospectively. All physicians were trained on the definition of CSHCN and on risk stratification levels 1, 2, 3A and 3B. An analysis using one-way ANOVA for children ages 0-21, seen between September 1, 2011 and August 31, 2015, who were identified and stratified after September 2013, was conducted to determine utilization patterns on hospital admissions, emergency department (ED), subspecialty, and primary care visits. Results A total of 4687 CSHCN were identified during the study period. Of the CSHCN, 45% were Level 1, 41% Level 2, 7% 3A and 7% 3B. There were significant differences in utilization across the tiers of CSHCN with the highest level of stratification (3B) demonstrating the most hospital admissions and primary care visits. Level 3B and level 3A (unstable) had significantly more ED visits. Additionally, as tiers increased from level 1 to 3B there was an increase in subspecialty provider utilization (p < 0.0001). Discussion The EMR adaptations developed for CSHCN identified the expected number of CSHCN and predicted utilization patterns across primary, subspecialty, ED and in-patient care.


Assuntos
Crianças com Deficiência/estatística & dados numéricos , Assistência Centrada no Paciente/métodos , Medição de Risco/métodos , Adolescente , Análise de Variância , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde , New York , Atenção Primária à Saúde/métodos , Medição de Risco/tendências , Inquéritos e Questionários
12.
Int J Clin Pract ; 73(2): e13280, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30281876

RESUMO

BACKGROUND: The impact of the utilisation of such e-health approaches, including mHealth (use of mobile phones and other wireless technology in the delivery of medical care) assessments of health parameters, or the use of decision aids and online risk calculators over time have not been previously described. The objective of this analysis is to assess the time trends in use of the CHADS2 and CHA2 DS2 VASc scores in e-health, and the geographical and specialty uptake of these scores, using data gleaned from a popular online clinical decision tool and medical reference, MDCalc. We hypothesised that the change in use of the scores would reflect the changes in guidelines and trends in clinical practice. RESULTS: The CHA2 DS2 VASc score was the 20th most popular calculator in 2012, rising to the second most popular calculator in 2018; the CHADS2 score showed the converse, dropping from no. 3 to no. 22. Use of the CHA2 DS2 VASc scores particularly increased in the United States, Canada and Australia over time while the United Kingdom experienced a greater traffic share in 2015. The majority users of the CHADS2 and CHA2 DS2 VASc scores were primary care physicians, with cardiologists being in the minority; the proportion of cardiologists was greater outside USA, compared to within USA. CONCLUSION: Over time, use of the CHA2 DS2 VASc score increased, while use of the CHADS2 score decreased. The change in uptake could partly be related to introduction of guidelines recommending the use of the CHA2 DS2 VASc score for stroke risk stratification.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Cardiologia/estatística & dados numéricos , Técnicas de Apoio para a Decisão , Padrões de Prática Médica/tendências , Atenção Primária à Saúde/estatística & dados numéricos , Acidente Vascular Cerebral/prevenção & controle , Fibrilação Atrial/complicações , Austrália , Canadá , Cardiologia/métodos , Tomada de Decisão Clínica , Humanos , Atenção Primária à Saúde/métodos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Medição de Risco/tendências , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Reino Unido , Estados Unidos
13.
Int J Cardiol ; 277: 224-228, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30236497

RESUMO

BACKGROUND: Low reliability of Revised Cardiac Risk Index (RCRI) in predicting major cardiac events (MACE) among Vascular Surgery patients emerged in recent literature, suggesting procedure-specific risk evaluation - particularly in major surgery. METHODS-RESULTS: Comorbidities, perioperative variables, RCRI and MACE were retrospectively analyzed in a consecutive series of 899 elective open abdominal aortic aneurysm (AAA) repairs performed at our Institution. Possible MACE predictors were studied through univariate/multivariable analysis (logistic regression, MVRE) and stepwise-backward elimination/odds ratio (MVR-SBE/OR). Patients were divided by clampsite in 2 subgroups: 1. infrarenal (690 cases); 2. pararenal (209 cases). RCRI resulted predictive for MACE in the whole dataset but its performance resulted lower for pararenal aneurysms (p = 0.11) than for infrarenal ones (p ≤ 0.00). Among RCRI covariates of the whole cohort, dilated cardiomyopathy (p ≤ 0.001), ischemic cardiopathy (p ≤ 0.01) and cerebrovascular disease (p ≤ 0.02) resulted predictive. Peripheral arteriopathy also related to MACE (p ≤ 0.03). At MVR-SBE/OR analysis, the following resulted to be MACE predictors: dilated cardiomyopathy (p ≤ 0.001), cerebrovascular disease (p ≤ 0.02), and surgical access (p = 0.04) in subgroup 1; previous myocardial infarction (p ≤ 0.01), congestive failure (p ≤ 0.03) and chronic pneumopathy (p = 0.04) in subgroup 2. CONCLUSIONS: Predictability of RCRI in elective AAA surgery is influenced by clampsite and resulted to be lower in aneurysms requiring suprarenal clamping. Variables included in the RCRI show to have different weights when patients are stratified by clampsite. Some variables not included in the RCRI model significantly affect the onset of MACE. RCRI should be revised to elaborate a specific score for AAAs including further MACE predictors, to improve risk assessment and to support proper surgical strategy.


Assuntos
Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/epidemiologia , Procedimentos Cirúrgicos Eletivos/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/tendências , Fatores de Risco
14.
Int J Cardiol ; 276: 66-71, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30473334

RESUMO

BACKGROUND: Among patients undergoing transcatheter aortic valve replacement (TAVR), prognosis is impacted by nutritional status, but the influence of the nutritional risk index (NRI) is unknown. Here we calculated the NRI to determine the prevalence and prognostic impact in terms of mortality of malnutrition in TAVR patients. METHODS AND RESULTS: This retrospective multicenter study included 941 patients who underwent TAVR between 2008 and 2016 (mean age, 80.7 ±â€¯6.5 years; 57% female). The NRI was calculated as 1.519 × albumin (g/L) + 41.7 × (real weight [kg] / ideal weight [kg]). The mean NRI was 98.1 ±â€¯7.0%. The patients were stratified into the following groups based on malnutrition risk: severe (NRI < 83.5; n = 83; 8.82%), moderate (83.5 ≥ NRI < 97.5; n = 370; 39.32%), mild (97.5 ≥ NRI < 100; n = 102; 10.84%), and no risk (NRI ≥ 100; n = 386; 41.02%). During the follow-up period (2.1 ±â€¯1.1 years), 186 patients died, representing 19.8% of the total cohort. Cox regression models were used to analyze the relationship between NRI and mortality during follow-up. Compared to patients with no or mild nutritional risk, those with moderate or severe nutritional risk had a 45% greater risk of mortality during follow-up (adjusted HR, 1.45; 95% CI, 1.05-1.99; P = 0.021). CONCLUSION: Malnutrition is common among TAVR patients. Our present data indicated that the NRI was independently associated with increased risk of death during long-term follow-up after TAVR. Based on its potential to improve risk prediction, NRI appears to be a promising tool for the clinical assessment of patients who are candidates for TAVR.


Assuntos
Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/cirurgia , Estado Nutricional/fisiologia , Substituição da Valva Aórtica Transcateter/mortalidade , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/fisiopatologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Medição de Risco/tendências , Taxa de Sobrevida/tendências , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/tendências , Resultado do Tratamento
15.
Int J Cardiol ; 278: 1-6, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30528624

RESUMO

BACKGROUND: Acute myocardial infarction (AMI) patients are at increased risk of death and recurrent ischemic events. We aimed to elaborate a risk score, based on the PEGASUS-TIMI 54 criteria, to predict mortality and non-fatal AMI in AMI patients. METHODS: We retrospectively analyzed two prospectively collected AMI cohorts. We calculated a cut-off for the developed score and investigated its 1-year prognostic power in the derivation cohort (n = 1257). We externally validated our score in 913 AMI patients with a longer follow-up. RESULTS: In the derivation cohort, the area under the curve of the score for the primary endpoint (1-year death and non-fatal AMI) was 0.70 (95% CI 0.65-0.76; P < 0.0001) and a cut-off of 6 was identified. The primary endpoint incidence in patients with a score above and below the cut-off was 12% and 3% (P < 0.001) in the derivation cohort and 16% and 6% in the validation cohort (P < 0.001). At multivariate analysis, the HR for the primary endpoint associated with a score ≥ 6 was 4.45 (P < 0.0001) in the derivation cohort and 2.86 (P < 0.0001) in the validation cohort. One-year major bleeding rate was low (<0.2% overall) and similar between risk groups. The prognostic performance of the score cut-off persisted beyond the first year after AMI in the validation cohort, maintaining a similar risk for death and non-fatal AMI (HR 3) at every following year. CONCLUSIONS: Our score, based on the PEGASUS-TIMI 54 criteria, may identify AMI patients at high risk of recurrent ischemic events, who might benefit from thorough preventive strategies.


Assuntos
Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/fisiopatologia , Índice de Gravidade de Doença , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/tendências , Fatores de Risco
16.
PLoS One ; 13(11): e0207681, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30496204

RESUMO

In Iran, People Who Inject Drugs (PWID), Female Sex Workers (FSW), and prisoners are the main key populations at risk of HIV infection. This study aimed to evaluate the trend of HIV incidence among PWID, FSW and prisoners as an impact measure of HIV harm reduction and prevention efforts in Iran. Data were obtained from the two rounds of national bio-behavioral surveillance surveys among FSW (2010 (n = 872), 2015 (n = 1339)), PWID (2010 (n = 2417), 2014 (n = 2307)), and prisoners (2009 (n = 4536), 2013 (n = 5390)) through facility-based (FSW and PWID surveys) and cluster sampling (prisoner surveys). Time-at-risk was calculated assuming the age at first sex or drug injection as the beginning of the at-risk period and the age at the time of the interview or date when they received a positive HIV test result as the end of this period, adjusted for interval censoring. HIV incidence among PWID in 2014 was 5.39 (95% CI 4.71, 6.16) per 1,000 person-years (PY), significantly lower than in 2009 (17.07, 95% CI 15.34, 19.34). Similarly, HIV incidence was 1.12 (95% CI 0.77, 1.64) per 1,000 PY among FSW in 2015, a significant drop from 2010 (2.38, 95% CI 1.66, 3.40). Also, HIV incidence decreased among prisoners from 1.34 (95% CI: 1.08, 1.67) in 2009 to 0.49 (95% CI: 0.39, 0.61) per 1,000 PY in 2013. Our findings suggest that after an increase in the 2000s, the HIV incidence may have been decreased and stabilized among key populations in Iran.


Assuntos
Usuários de Drogas , Infecções por HIV/epidemiologia , Prisioneiros , Profissionais do Sexo , Estudos Transversais , Usuários de Drogas/estatística & dados numéricos , Feminino , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Prisioneiros/estatística & dados numéricos , Medição de Risco/tendências , Profissionais do Sexo/estatística & dados numéricos , Inquéritos e Questionários
18.
Ageing Res Rev ; 48: 79-86, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30355506

RESUMO

Menopause is a critical period during which, without timely interventions, increased risks of cardiovascular and metabolic diseases, osteoporosis, sexual dysfunction and premature cognitive decline will contribute to diminished quality-of-life in women. Hormone therapy (HT) used to be the standard of care for managing vasomotor symptoms and prevention of chronic diseases until publication of the Women's Health Initiative (WHI) in 2002. Concerned about risks highlighted in WHI publications, many symptomatic women promptly ceased HT which resulted in increased vasomotor symptoms, osteoporosis-related-fractures and insomnia. Data from post-hoc WHI analyses and newer clinical trials consistently show reductions in coronary heart disease and mortality when estrogen therapy is initiated soon after menopause, whereas administration in later years and/or in combination with progesterone carries increased risks. However, no validated primary preventive strategies are available for younger postmenopausal women (<60 years), highlighting the need to re-evaluate the use of estrogen alone for which the risk-benefit balance appears positive. In contrast, in older women (>60 years), risks associated with oral HT exceed benefits; however transdermal estrogen may offer a safer alternative and should be further evaluated. Alternative therapies such as phytoestrogens and non-hormonal prescriptions may be beneficial for older women or those who are unsuitable for HT. Long-term head-to-head comparisons of HT with alternative interventions are warranted to confirm their efficacy for chronic disease prevention.


Assuntos
Terapia de Reposição de Estrogênios/tendências , Pós-Menopausa/metabolismo , Saúde da Mulher/tendências , Idoso , Idoso de 80 Anos ou mais , Ensaios Clínicos como Assunto , Doença das Coronárias/metabolismo , Doença das Coronárias/prevenção & controle , Demência/metabolismo , Demência/prevenção & controle , Estradiol/administração & dosagem , Terapia de Reposição de Estrogênios/efeitos adversos , Feminino , Humanos , Menopausa/efeitos dos fármacos , Menopausa/metabolismo , Pessoa de Meia-Idade , Fitoestrógenos/administração & dosagem , Pós-Menopausa/efeitos dos fármacos , Resveratrol/administração & dosagem , Medição de Risco/tendências , Fatores de Tempo
19.
Per Med ; 15(5): 419-428, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30260295

RESUMO

As new, high-powered sequencing technologies are increasingly incorporated into genomics research, we believe that there has been a break point in how risks and benefits associated with genetic information are being characterized and understood. Genomic sequencing provides the potential benefit of a wealth of information, but also has the potential to alter how we conceptualize risks of sequencing. Until now, our conceptions of risks and benefits have been generally static, arising out of the early ethical, legal and social implications studies conducted in the context of targeted genetics. This paper investigates how the increasing availability of genetic information is changing views about risks and benefits, particularly examining our evolving understanding of psychosocial harms and our expanding conception of benefit. We argue that the lack of robust empirical evidence of psychosocial harms and the expanding view that benefits of genomic research include indirect familial benefit necessitate continued ethical, legal and social implications research.


Assuntos
Testes Genéticos/ética , Genômica/métodos , Humanos , Relatório de Pesquisa , Medição de Risco/tendências
20.
Mo Med ; 115(2): 132-134, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30228704

RESUMO

Screening and early treatment of prostate cancer (PCa) has recently come under scrutiny due to the rates of overdiagnosis of low risk cancer. Randomized trials, including ERSPC and PLCO, have informed our understanding of the survival benefit provided by systematic PCa screening with serum prostate-specific antigen (PSA). To reduce the number of patients diagnosed with indolent disease, new adjuvant risk stratification tests have become available.


Assuntos
Detecção Precoce de Câncer/tendências , Neoplasias da Próstata/diagnóstico , Biomarcadores/sangue , Humanos , Masculino , Antígeno Prostático Específico/sangue , Medição de Risco/tendências
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA