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1.
BMC Health Serv Res ; 21(1): 660, 2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34225720

RESUMO

BACKGROUND: Estimating realistic access to health services is essential for designing support policies for healthcare delivery systems. Many studies have proposed a metric to calculate accessibility. However, patients' realistic willingness to use a hospital was not explicitly considered. This study aims to derive a new type of potential accessibility that incorporates a patient's realistic preference in selecting a hospital. METHODS: This study proposes a floating catchment area (FCA)-type metric combined with a discrete choice model. Specifically, a new FCA-type metric (clmFCA) was proposed using a conditional logit model. Such a model estimates patients' realistic willingness to use health services. The proposed metric was then applied to calculate the accessibility of obstetric care services in Korea. RESULTS: The clmFCA takes advantage of patients' realistic preferences. Specifically, it can represent each patient's heterogeneous characteristics regarding hospital choice. Such characteristics include bypassing behavior, which could not be considered using prior FCA metrics. Empirical analysis reveals that the clmFCA avoids the misestimation of accessibility to health services to an extent. CONCLUSIONS: The clmFCA offers a new framework that more realistically estimates patients' accessibility to health services. This is achieved by accurately estimating the potential demand for a service. The proposed method's effectiveness was verified through a case study using nationwide data.


Assuntos
Acesso aos Serviços de Saúde , Serviços de Saúde , Área Programática de Saúde , Humanos , Modelos Logísticos , República da Coreia
2.
Rev Bras Enferm ; 74Suppl 2(Suppl 2): e20200813, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34231778

RESUMO

OBJECTIVE: to analyze the factors associated with urinary tract infection occurrence in institutionalized elderly. METHODS: this is a cross-sectional, analytical, quantitative study with 116 elderly people from a Nursing Home. Urinary tract infection diagnosis was carried out through urine culture and clinical assessment. Demographic data and associated factors were obtained from medical records. Statistical analysis included bivariate analysis and logistic regression models. RESULTS: the factors associated with urinary tract infection (p<0.05) were being female; wheelchair user; diaper use; diuretic use; urinary and bowel incontinence; type 1 diabetes; benign prostatic hyperplasia; dehydration. CONCLUSION: this study revealed that it is important to consider non-modifiable factors such as sex and clinical comorbidities; however, dehydration, a modifiable factor, increased the chances of developing urinary tract infections by 40 times among institutionalized elderly and demands greater attention from the health team.


Assuntos
Infecções Urinárias , Idoso , Comorbidade , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Casas de Saúde , Infecções Urinárias/epidemiologia
3.
Nutrients ; 13(6)2021 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-34204898

RESUMO

Background: This study investigated the association of omega-3 polyunsaturated fatty acids (n-3 PUFA) within erythrocyte membranes and cardiovascular risk assessed by three different estimates. Methods: Inclusion criteria were individuals of both sexes, 30 to 74 years, with at least one cardiovascular risk factor, and no previous cardiovascular events (n = 356). Exclusion criteria were individuals with acute or chronic severe diseases, infectious diseases, pregnant, and/or lactating women. Plasma biomarkers (lipids, glucose, and C-reactive protein) were analyzed, and nineteen erythrocyte membrane fatty acids (FA) were identified. The cardiovascular risk was estimated by Framingham (FRS), Reynolds (RRS), and ACC/AHA-2013 Risk Scores. Three patterns of FA were identified (Factor 1, poor in n-3 PUFA), (Factor 2, poor in PUFA), and (Factor 3, rich in n-3 PUFA). Results: Total cholesterol was inversely correlated with erythrocyte membranes C18:3 n-3 (r = -0.155; p = 0.004), C22:6 n-3 (r = -0.112; p = 0.041), and total n-3 (r = -0.211; p < 0.001). Total n-3 PUFA was associated with lower cardiovascular risk by FRS (OR = 0.811; 95% CI= 0.675-0.976). Regarding RRS, Factor 3 was associated with 25.3% lower odds to have moderate and high cardiovascular risk (OR = 0.747; 95% CI = 0.589-0.948). The ACC/AHA-2013 risk score was not associated with isolated and pooled FA. Conclusions:n-3 PUFA in erythrocyte membranes are independent predictors of low-risk classification estimated by FRS and RRS, which could be explained by cholesterol-lowering effects of n-3 PUFA.


Assuntos
Membrana Eritrocítica/química , Ácidos Graxos Ômega-3/análise , Fatores de Risco de Doenças Cardíacas , Adulto , Idoso , Biomarcadores/sangue , Colesterol/sangue , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade
4.
Nutrients ; 13(6)2021 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-34203027

RESUMO

BACKGROUND: Nutritional status influences immunity but its specific association with susceptibility to COVID-19 remains unclear. We examined the association of specific dietary data and incident COVID-19 in the UK Biobank (UKB). METHODS: We considered UKB participants in England with self-reported baseline (2006-2010) data and linked them to Public Health England COVID-19 test results-performed on samples from combined nose/throat swabs, using real time polymerase chain reaction (RT-PCR)-between March and November 2020. Baseline diet factors included breastfed as baby and specific consumption of coffee, tea, oily fish, processed meat, red meat, fruit, and vegetables. Individual COVID-19 exposure was estimated using the UK's average monthly positive case rate per specific geo-populations. Logistic regression estimated the odds of COVID-19 positivity by diet status adjusting for baseline socio-demographic factors, medical history, and other lifestyle factors. Another model was further adjusted for COVID-19 exposure. RESULTS: Eligible UKB participants (n = 37,988) were 40 to 70 years of age at baseline; 17% tested positive for COVID-19 by SAR-CoV-2 PCR. After multivariable adjustment, the odds (95% CI) of COVID-19 positivity was 0.90 (0.83, 0.96) when consuming 2-3 cups of coffee/day (vs. <1 cup/day), 0.88 (0.80, 0.98) when consuming vegetables in the third quartile of servings/day (vs. lowest quartile), 1.14 (1.01, 1.29) when consuming fourth quartile servings of processed meats (vs. lowest quartile), and 0.91 (0.85, 0.98) when having been breastfed (vs. not breastfed). Associations were attenuated when further adjusted for COVID-19 exposure, but patterns of associations remained. CONCLUSIONS: In the UK Biobank, consumption of coffee, vegetables, and being breastfed as a baby were favorably associated with incident COVID-19; intake of processed meat was adversely associated. Although these findings warrant independent confirmation, adherence to certain dietary behaviors may be an additional tool to existing COVID-19 protection guidelines to limit the spread of this virus.


Assuntos
COVID-19/etiologia , Café , Dieta , Comportamento Alimentar , Carne , Estado Nutricional , Verduras , Idoso , Bancos de Espécimes Biológicos , Aleitamento Materno , COVID-19/virologia , Inglaterra , Feminino , Manipulação de Alimentos , Humanos , Incidência , Lactente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Saúde Pública , Fatores de Risco , SARS-CoV-2 , Reino Unido
5.
Int J Mol Sci ; 22(12)2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-34204008

RESUMO

Assisted reproductive technologies impact transcriptome and epigenome of embryos and can result in long-term phenotypic consequences. Whole-genome DNA methylation profiles from individual bovine blastocysts in vivo- and in vitro-derived (using three sources of protein: reproductive fluids, blood serum and bovine serum albumin) were generated. The impact of in vitro culture on DNA methylation was analyzed, and sex-specific methylation differences at blastocyst stage were uncovered. In vivo embryos showed the highest levels of methylation (29.5%), close to those produced in vitro with serum, whilst embryos produced in vitro with reproductive fluids or albumin showed less global methylation (25-25.4%). During repetitive element analysis, the serum group was the most affected. DNA methylation differences between in vivo and in vitro groups were more frequent in the first intron than in CpGi in promoters. Moreover, hierarchical cluster analysis showed that sex produced a stronger bias in the results than embryo origin. For each group, distance between male and female embryos varied, with in vivo blastocyst showing a lesser distance. Between the sexually dimorphic methylated tiles, which were biased to X-chromosome, critical factors for reproduction, developmental process, cell proliferation and DNA methylation machinery were included. These results support the idea that blastocysts show sexually-dimorphic DNA methylation patterns, and the known picture about the blastocyst methylome should be reconsidered.


Assuntos
Blastocisto/metabolismo , Reprogramação Celular/genética , Meios de Cultura/farmacologia , Epigênese Genética/efeitos dos fármacos , Caracteres Sexuais , Animais , Blastocisto/efeitos dos fármacos , Bovinos , Cromossomos de Mamíferos/genética , Ilhas de CpG/genética , Metilação de DNA/efeitos dos fármacos , Metilação de DNA/genética , Feminino , Fertilização In Vitro , Ontologia Genética , Modelos Logísticos , Masculino , Anotação de Sequência Molecular , Análise de Componente Principal
6.
Nutrients ; 13(6)2021 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-34205057

RESUMO

COVID-19 is an unprecedented global pandemic. On 12 March 2020, a lockdown order was issued in Italy in attempt to contain the health crisis. The study aimed to assess the impact of the COVID-19 lockdown on diet, physical activity, sleep quality, and distress in an Italian cohort. An online anonymous interview, which included validated questionnaires was created to compare lifestyle habits pre- and during the lockdown. Data analysis from 604 subjects with a mean age of 29.8 years was carried out using multivariate analysis. Compared to pre-COVID-19 times, 67% of people changed their eating habits and increased consumption of foods containing added sugars. Women and men with low adherence to the Mediterranean Diet (MedDiet) were more likely to be physically inactive (p < 0.0001 and p < 0.01, respectively). Results from logistic regression showed a three times higher risk of being inactive if adherence to the MedDiet was low (p < 0.0001), especially in men between 26 and 35 years. Lower levels of distress were reported in males who were physically active (89%) (p < 0.001). Our findings may help to identify effective lifestyle interventions during restrictive conditions.


Assuntos
COVID-19 , Controle de Doenças Transmissíveis , Dieta , Exercício Físico , Comportamento Alimentar , Estilo de Vida , Pandemias , Adulto , Dieta Mediterrânea , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Distanciamento Físico , Angústia Psicológica , SARS-CoV-2 , Comportamento Sedentário , Inquéritos e Questionários , Adulto Jovem
7.
Nutrients ; 13(6)2021 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-34205306

RESUMO

The COVID-19 pandemic resulted in substantial lifestyle changes. No US study has identified predictors of perceived dietary healthfulness changes during the pandemic period. This study included analyses of lifestyle and dietary healthfulness changes using 958 survey responses from US primary household food purchasers. Information was collected related to demographics, COVID-19-related household changes, and health-related habits before and during the pandemic. Binary logistic regression identified predictors of perceived increase in dietary healthfulness during the pandemic period. Overall, 59.8%, 16.4%, and 23.4% of participants reported that their eating habits likely changed, may have changed, and likely did not change, respectively. Of the participants whose dietary habits likely or may have changed, 64.1%, 16.8%, and 19% reported healthier, neither healthier nor less healthy, and less healthy eating habits, respectively. COVID-19-related income loss, more meals consumed with household members in front of the television, an increase in food advertisement exposure, increased perceived stress, and better perceived current health were significant predictors of a perceived increase in dietary healthfulness. Overall, dietary habits were perceived to become healthier during the pandemic. The predictors of perceived improvement in dietary healthfulness were surprising and indicate the need for further study of these factors in crisis and noncrisis situations.


Assuntos
COVID-19 , Dieta , Comportamento Alimentar , Comportamentos Relacionados com a Saúde , Estilo de Vida , Pandemias , Adolescente , Adulto , Idoso , Feminino , Nível de Saúde , Humanos , Renda , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Estresse Psicológico , Inquéritos e Questionários , Televisão , Estados Unidos , Adulto Jovem
8.
Sensors (Basel) ; 21(13)2021 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-34206783

RESUMO

Hyperspectral technology is used to obtain spectral and spatial information of samples simultaneously and demonstrates significant potential for use in seed purity identification. However, it has certain limitations, such as high acquisition cost and massive redundant information. This study integrates the advantages of the sparse feature of the least absolute shrinkage and selection operator (LASSO) algorithm and the classification feature of the logistic regression model (LRM). We propose a hyperspectral rice seed purity identification method based on the LASSO logistic regression model (LLRM). The feasibility of using LLRM for the selection of feature wavelength bands and seed purity identification are discussed using four types of rice seeds as research objects. The results of 13 different adulteration cases revealed that the value of the regularisation parameter was different in each case. The recognition accuracy of LLRM and average recognition accuracy were 91.67-100% and 98.47%, respectively. Furthermore, the recognition accuracy of full-band LRM was 71.60-100%. However, the average recognition accuracy was merely 89.63%. These results indicate that LLRM can select the feature wavelength bands stably and improve the recognition accuracy of rice seeds, demonstrating the feasibility of developing a hyperspectral technology with LLRM for seed purity identification.


Assuntos
Oryza , Algoritmos , Modelos Logísticos , Sementes , Tecnologia
9.
BMC Med Inform Decis Mak ; 21(1): 207, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210320

RESUMO

BACKGROUND: Clinical risk prediction models (CRPMs) use patient characteristics to estimate the probability of having or developing a particular disease and/or outcome. While CRPMs are gaining in popularity, they have yet to be widely adopted in clinical practice. The lack of explainability and interpretability has limited their utility. Explainability is the extent of which a model's prediction process can be described. Interpretability is the degree to which a user can understand the predictions made by a model. METHODS: The study aimed to demonstrate utility of patient similarity analytics in developing an explainable and interpretable CRPM. Data was extracted from the electronic medical records of patients with type-2 diabetes mellitus, hypertension and dyslipidaemia in a Singapore public primary care clinic. We used modified K-nearest neighbour which incorporated expert input, to develop a patient similarity model on this real-world training dataset (n = 7,041) and validated it on a testing dataset (n = 3,018). The results were compared using logistic regression, random forest (RF) and support vector machine (SVM) models from the same dataset. The patient similarity model was then implemented in a prototype system to demonstrate the identification, explainability and interpretability of similar patients and the prediction process. RESULTS: The patient similarity model (AUROC = 0.718) was comparable to the logistic regression (AUROC = 0.695), RF (AUROC = 0.764) and SVM models (AUROC = 0.766). We packaged the patient similarity model in a prototype web application. A proof of concept demonstrated how the application provided both quantitative and qualitative information, in the form of patient narratives. This information was used to better inform and influence clinical decision-making, such as getting a patient to agree to start insulin therapy. CONCLUSIONS: Patient similarity analytics is a feasible approach to develop an explainable and interpretable CRPM. While the approach is generalizable, it can be used to develop locally relevant information, based on the database it searches. Ultimately, such an approach can generate a more informative CRPMs which can be deployed as part of clinical decision support tools to better facilitate shared decision-making in clinical practice.


Assuntos
Tomada de Decisão Clínica , Registros Eletrônicos de Saúde , Humanos , Modelos Logísticos , Singapura , Máquina de Vetores de Suporte
10.
Int J Mol Sci ; 22(12)2021 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-34198491

RESUMO

Rare germline pathogenic TP53 missense variants often predispose to a wide spectrum of tumors characterized by Li-Fraumeni syndrome (LFS) but a subset of variants is also seen in families with exclusively hereditary breast cancer (HBC) outcomes. We have developed a logistic regression model with the aim of predicting LFS and HBC outcomes, based on the predicted effects of individual TP53 variants on aspects of protein conformation. A total of 48 missense variants either unique for LFS (n = 24) or exclusively reported in HBC (n = 24) were included. LFS-variants were over-represented in residues tending to be buried in the core of the tertiary structure of TP53 (p = 0.0014). The favored logistic regression model describes disease outcome in terms of explanatory variables related to the surface or buried status of residues as well as their propensity to contribute to protein compactness or protein-protein interactions. Reduced, internally validated models discriminated well between LFS and HBC (C-statistic = 0.78-0.84; equivalent to the area under the ROC (receiver operating characteristic) curve), had a low risk for over-fitting and were well calibrated in relation to the known outcome risk. In conclusion, this study presents a phenotypic prediction model of LFS and HBC risk for germline TP53 missense variants, in an attempt to provide a complementary tool for future decision making and clinical handling.


Assuntos
Neoplasias da Mama/genética , Estudos de Associação Genética , Predisposição Genética para Doença , Síndrome de Li-Fraumeni/genética , Mutação de Sentido Incorreto/genética , Proteína Supressora de Tumor p53/química , Proteína Supressora de Tumor p53/genética , Sequência de Aminoácidos , Feminino , Mutação em Linhagem Germinativa/genética , Humanos , Modelos Logísticos , Análise Multivariada , Fenótipo , Conformação Proteica
11.
BMC Infect Dis ; 21(1): 694, 2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34281502

RESUMO

BACKGROUND: Support groups for people living with HIV (PLWH) may improve HIV care adherence and outcomes. We assessed the impact of support group attendance on antiretroviral therapy (ART) adherence and viral suppression in four African countries. METHODS: The ongoing African Cohort Study (AFRICOS) enrolls participants at 12 clinics in Kenya, Uganda, Tanzania, and Nigeria. Self-reported attendance of any support group meetings, self-reported ART adherence, and HIV RNA are assessed every 6 months. Logistic regression models with generalized estimating equations were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for support group attendance and other factors potentially associated with ART adherence and viral suppression. RESULTS: From January 2013 to December 1, 2019, 1959 ART-experienced PLWH were enrolled and 320 (16.3%) reported any support group attendance prior to enrollment. Complete ART adherence, with no missed doses in the last 30 days, was reported by 87.8% while 92.4% had viral suppression <1000copies/mL across all available visits. There was no association between support group attendance and ART adherence in unadjusted (OR 1.01, 95% CI 0.99-1.03) or adjusted analyses (aOR 1.00, 95% CI 0.98-1.02). Compared to PLWH who did not report support group attendance, those who did had similar odds of viral suppression in unadjusted (OR 0.99, 95% CI 0.978-1.01) and adjusted analyses (aOR 0.99, 95% CI 0.97-1.01). CONCLUSION: Support group attendance was not associated with significantly improved ART adherence or viral suppression, although low support group uptake may have limited our ability to detect a statistically significant impact.


Assuntos
Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Adesão à Medicação , Grupos de Autoajuda , Adulto , África Oriental , Estudos de Coortes , Feminino , Infecções por HIV/psicologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Autorrelato , Carga Viral
12.
Artigo em Inglês | MEDLINE | ID: mdl-34207999

RESUMO

For most signalized at-grade intersections, exclusive lanes for non-motorized vehicles have been applied to improve the level of service, capacity and safety of both motorized vehicles and non-motorized vehicles. However, because of various factors, riders of non-motorized vehicles have been observed using lanes for motorized vehicles instead of lanes for non-motorized vehicles, which usually negatively influences the performance of signalized intersections and sometimes may cause serious problems such as traffic congestion and accidents. The objective of this paper is to explore factors influencing the lane choice of riders of non-motorized vehicles at exit legs of signalized at-grade intersections and develop a prediction model for riders' lane choice. Data concerning the lane choice of riders of non-motorized vehicles and other impacting factors were collected at exit legs of four typical signalized at-grade intersections. Applying binary logistic regression, a probability prediction model was developed to explain how various factors influence the lane choice of riders of non-motorized vehicles. The prediction model indicates that female riders of non-motorized vehicles have a higher probability of choosing the lane for non-motorized vehicles than male riders. Compared with riders of non-motorized vehicles powered by electricity, riders of traditional man-powered bicycles are more likely to choose the lane for non-motorized vehicles. Right-turning riders of non-motorized vehicles are more likely to choose the lane for non-motorized vehicles than straight-going riders, who in turn, are more likely to choose the lane for non-motorized vehicles than left-turning riders. Decreasing the volume of non-motorized vehicles, increasing the volume of motorized vehicles, and widening the lane for non-motorized vehicles will increase the probability of the correct choice of lane for non-motorized vehicles. The predictions of the model are in good agreement with the observed facts. The model is meaningful for guidance on the design and management of signalized at-grade intersections.


Assuntos
Acidentes de Trânsito , Perna (Membro) , Acidentes de Trânsito/prevenção & controle , Planejamento Ambiental , Feminino , Humanos , Modelos Logísticos , Masculino , Probabilidade , Segurança
13.
Nutrients ; 13(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34208122

RESUMO

The objective of this study was to assess the association between dietary patterns and risk of hepatocellular carcinoma (HCC) among US adults in a hospital-based case-control study. We analyzed data from 641 cases and 1002 controls recruited at The University of Texas MD Anderson Cancer Center during 2001-2018. Cases were patients with a pathologically or radiologically confirmed new diagnosis of HCC; controls were cancer-free spouses of patients with cancers other than gastrointestinal, lung, liver, or head and neck cancer. Cases and controls were frequency-matched by age and sex. Dietary patterns were identified by principal component analysis. Odds ratios (ORs) and corresponding confidence intervals (CIs) were computed using unconditional logistic regression with adjustment for major HCC risk factors, including hepatitis B virus and hepatitis C virus infection. A vegetable-based dietary pattern was inversely associated with HCC risk (highest compared with lowest tertile: OR 0.66, 95% CI 0.46-0.94). A Western diet pattern was directly associated with HCC risk (highest compared with lowest tertile: OR 1.79, 95% CI 1.19-2.69). These findings emphasize the potential role of dietary intake in HCC prevention and clinical management.


Assuntos
Carcinoma Hepatocelular/epidemiologia , Dieta Ocidental , Dieta , Neoplasias Hepáticas/epidemiologia , Verduras , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Estilo de Vida , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco
14.
BMJ Open Respir Res ; 8(1)2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34272254

RESUMO

BACKGROUND: Although several studies have reported an association between atherosclerosis-related diseases and COVID-19, the relationship between COVID-19 severity and atherosclerosis progression remains unclear. The aim of this study is to determine the coronary artery calcium score (CACS) prognostic value in patients with COVID-19 using indices such as deterioration in oxygenation and CT images of the chest. METHODS: This was a single-centre retrospective study of 53 consecutive patients with COVID-19 in Narita who were admitted to our hospital between March 2020 and August 2020. CACS was calculated based on non-gated CT scans of the chest performed on admission day. The patients were divided into the following two groups based on CACS: group 1 (CACS ≥180, n=11) and group 2 (CACS <180, n=42). Following univariate analysis of the main variables, multivariate analysis of variables that may be associated with COVID-19 progression was performed. RESULTS: Multivariable logistic regression analysis of age, sex, smoking history, diabetes, hypertension, dyslipidaemia, number of days from symptom onset to hospitalisation and CACS of ≥180 was performed. It revealed that unlike CACS of <180, CACS of ≥180 is associated with exacerbation of oxygenation or CT images of the chest during hospitalisation (OR: 12.879, 95% CI: 1.399 to 380.401). Furthermore, this model of eight variables showed good calibration (Hosmer-Lemeshow p=0.119). CONCLUSION: CACS may be a prognosis marker of COVID-19 severity. Although coronary artery calcification is not typically assessed in pneumonia cases, it may provide a valuable clinical indicator for predicting severe COVID-19 outcomes.


Assuntos
COVID-19/fisiopatologia , Doença da Artéria Coronariana/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus/epidemiologia , Progressão da Doença , Dislipidemias/epidemiologia , Feminino , Hospitalização , Humanos , Hipertensão/epidemiologia , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Retrospectivos , SARS-CoV-2 , Índice de Gravidade de Doença , Fatores Sexuais , Fumar/epidemiologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Calcificação Vascular/epidemiologia
15.
BMJ Open ; 11(7): e047347, 2021 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-34281922

RESUMO

OBJECTIVE: Develop and validate models that predict mortality of patients diagnosed with COVID-19 admitted to the hospital. DESIGN: Retrospective cohort study. SETTING: A multicentre cohort across 10 Dutch hospitals including patients from 27 February to 8 June 2020. PARTICIPANTS: SARS-CoV-2 positive patients (age ≥18) admitted to the hospital. MAIN OUTCOME MEASURES: 21-day all-cause mortality evaluated by the area under the receiver operator curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value. The predictive value of age was explored by comparison with age-based rules used in practice and by excluding age from the analysis. RESULTS: 2273 patients were included, of whom 516 had died or discharged to palliative care within 21 days after admission. Five feature sets, including premorbid, clinical presentation and laboratory and radiology values, were derived from 80 features. Additionally, an Analysis of Variance (ANOVA)-based data-driven feature selection selected the 10 features with the highest F values: age, number of home medications, urea nitrogen, lactate dehydrogenase, albumin, oxygen saturation (%), oxygen saturation is measured on room air, oxygen saturation is measured on oxygen therapy, blood gas pH and history of chronic cardiac disease. A linear logistic regression and non-linear tree-based gradient boosting algorithm fitted the data with an AUC of 0.81 (95% CI 0.77 to 0.85) and 0.82 (0.79 to 0.85), respectively, using the 10 selected features. Both models outperformed age-based decision rules used in practice (AUC of 0.69, 0.65 to 0.74 for age >70). Furthermore, performance remained stable when excluding age as predictor (AUC of 0.78, 0.75 to 0.81). CONCLUSION: Both models showed good performance and had better test characteristics than age-based decision rules, using 10 admission features readily available in Dutch hospitals. The models hold promise to aid decision-making during a hospital bed shortage.


Assuntos
COVID-19 , Estudos de Coortes , Humanos , Modelos Logísticos , Estudos Retrospectivos , SARS-CoV-2
16.
BMC Infect Dis ; 21(1): 654, 2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34229613

RESUMO

BACKGROUND: Despite the development of a safe and efficacious hepatitis B vaccine in 1982, the hepatitis B virus (HBV) remains a public health burden in sub-Saharan Africa. Due to shared risk factors for virus acquisition, men who have sex with men (MSM) and transgender women (TGW) living with HIV are at increased risk of HBV. We estimated the prevalence of HBV and associated factors for MSM and TGW living with or without HIV in Nigeria. METHODS: Since March 2013, TRUST/RV368 has recruited MSM and TGW in Abuja and Lagos, Nigeria using respondent driven sampling. Participants with HIV diagnosis, enrollment as of June 2015, and available plasma were selected for a cross-sectional study and retrospectively tested for hepatitis B surface antigen and HBV DNA. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with prevalent HBV infection. RESULTS: A total of 717 MSM and TGW had a median age of 25 years (interquartile range [IQR]: 21-27), 5% self-reported HBV vaccination, 61% were living with HIV, 10% had prevalent HBV infection and 6% were HIV-HBV co-infected. HIV mono-infected as compared to HIV-HBV co-infected had a higher median CD4 T cell count [425 (IQR: 284-541) vs. 345 (IQR: 164-363) cells/mm3, p = 0.03] and a lower median HIV RNA viral load [4.2 (IQR: 2.3-4.9) vs. 4.7 (IQR: 3.9-5.4) log10copies/mL, p < 0.01]. The only factor independently associated with HBV was self-report of condomless sex at last anal intercourse (OR: 2.2, 95% CI: 1.3, 3.6). HIV infection was not independently associated with HBV (OR: 1.0, 95% CI: 0.7-1.6). CONCLUSION: HBV prevalence was moderately high but did not differ by HIV in this cohort of MSM and TGW. Recent condomless sex was associated with elevated HBV risk, reinforcing the need to increase communication and education on condom use among key populations in Nigeria. Evaluating use of concurrent HIV antiretroviral therapy with anti-HBV activity may confirm the attenuated HBV prevalence for those living with HIV.


Assuntos
Infecções por HIV/etiologia , Hepatite B/epidemiologia , Homossexualidade Masculina , Pessoas Transgênero , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
17.
Clin Interv Aging ; 16: 1251-1264, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34239298

RESUMO

Objective: To assess how lipid-lowering drugs (LLDs) are administered in the hospitalized patients aged 65 and older and their association with clinical outcomes according to their health-related profiles. Design: This is a retrospective study based on data from REPOSI (REgistro POliterapie SIMI - Italian Society of Internal Medicine) register, an Italian network of internal medicine hospital wards. Setting and Participants: A total of 4642 patients with a mean age of 79 years enrolled between 2010 and 2018. Methods: Socio-demographic characteristics, functional abilities, cognitive skills, laboratory parameters and comorbidities were used to investigate the health state profiles by using multiple correspondence analysis and clustering. Logistic regression was used to assess whether LLD prescription was associated with patients' health state profiles and with short-term mortality. Results: Four clusters of patients were identified according to their health state: two of them (Cluster III and IV) were the epitome of frailty conditions with poor short-term outcomes, whereas the others included healthier patients. The average prevalence of LLD use was 27.6%. The lowest prevalence was found among the healthier patients in Cluster I and among the oldest frail patients with severe functional and cognitive impairment in Cluster IV. The highest prevalence was among multimorbid patients in Cluster III (OR=4.50, 95% CI=3.76-5.38) characterized by a high cardiovascular risk. Being prescribed with LLDs was associated with a lower 3-month mortality, even after adjusting for cluster assignment (OR=0.59; 95% CI = 0.44-0.80). Conclusion: The prevalence of LLD prescription was low and in overall agreement with guideline recommendations and with respect to patients' health state profiles.


Assuntos
Hospitalização , Hipolipemiantes/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Cognição , Comorbidade , Idoso Fragilizado , Fragilidade/epidemiologia , Fidelidade a Diretrizes , Nível de Saúde , Humanos , Itália/epidemiologia , Lipídeos/sangue , Modelos Logísticos , Masculino , Multimorbidade , Guias de Prática Clínica como Assunto , Prevalência , Estudos Retrospectivos , Fatores Socioeconômicos
18.
Artigo em Inglês | MEDLINE | ID: mdl-34198547

RESUMO

The COVID-19 outbreak is currently one of the biggest challenges facing countries around the world. Millions of people have lost their lives due to COVID-19. Therefore, the accurate early detection and identification of severe COVID-19 cases can reduce the mortality rate and the likelihood of further complications. Machine Learning (ML) and Deep Learning (DL) models have been shown to be effective in the detection and diagnosis of several diseases, including COVID-19. This study used ML algorithms, such as Decision Tree (DT), Logistic Regression (LR), Random Forest (RF), Extreme Gradient Boosting (XGBoost), and K-Nearest Neighbor (KNN) and DL model (containing six layers with ReLU and output layer with sigmoid activation), to predict the mortality rate in COVID-19 cases. Models were trained using confirmed COVID-19 patients from 146 countries. Comparative analysis was performed among ML and DL models using a reduced feature set. The best results were achieved using the proposed DL model, with an accuracy of 0.97. Experimental results reveal the significance of the proposed model over the baseline study in the literature with the reduced feature set.


Assuntos
COVID-19 , Algoritmos , Humanos , Modelos Logísticos , Aprendizado de Máquina , SARS-CoV-2
19.
Artigo em Inglês | MEDLINE | ID: mdl-34205268

RESUMO

This study aims to characterize locations on two-way rural roads where head-on crashes are more likely to occur, attending to geometric road design factors. For this purpose, a case-control study was carried out using multiple logistic regression models with variables related to road design parameters, considering several scenarios. The dataset corresponding to cases (places where crashes have occurred) was collected on Spanish "1+1" rural roads over a four-year period. The controls (places where no crashes have occurred in the period) where randomly selected through a specific ad hoc designed method. The obtained model identifies risk factors and allows the computation of the odds of a head-on collision on any specific road section: width of the pavement (when it exceeds 6 m), width of the lanes (for intermediate widths between 3.25 and 3.75 m) and tight curves (less than 250 m of radius) are identified as factors significantly increasing the odds of a crash, whereas a paved shoulder is a protective factor. The identified configurations on two-way rural roads may be susceptible to transformation into "2+1" roads to decrease the odds of a head-on crash, thus preventing possible serious injuries and enhancing transportation safety.


Assuntos
Acidentes de Trânsito , Aclimatação , Estudos de Casos e Controles , Planejamento Ambiental , Modelos Logísticos , Fatores de Risco , Segurança
20.
Nutrients ; 13(6)2021 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-34198781

RESUMO

BACKGROUND: The small-for-gestational-age (SGA) in infants is related to an increased risk of developing Non-Communicable Diseases later in life. The Mediterranean diet (MD) is related to lower odds of being SGA. The study explored retrospectively the association between SGA, maternal MD adherence, lifestyle habits and other SGA risk factors during pregnancy. METHODS: One hundred women (16-44 years) with a pregnancy at term were enrolled. Demographic data, parity, pre-gestational BMI, gestational weight gain, pregnancy-related diseases, and type of delivery were collected. The MD adherence (MEDI-LITE score ≥ 9), physical activity level, and smoking/alcohol consumption were registered. SGA neonates were diagnosed according to the neonatal growth curves. RESULTS: Women were divided into "SGA group" vs. "non-SGA group". The MD was adopted by 71% of women and its adherence was higher in the "non-SGA group" (p = 0.02). The prevalence of pregnancy-related diseases (gestational diabetes/pregnancy-induced hypertension) was higher in the "SGA group" (p = 0.01). The logistic regression showed that pregnancy-related diseases were the only independent risk factor for SGA. CONCLUSIONS: MD may indirectly reduce the risk of SGA since it prevents and exerts a positive effect on pregnancy-related diseases (e.g., gestational diabetes and hypertension). The small sample size of women in the SGA group of the study imposes a major limitation to the results and conclusions of this research, suggesting however that it is worthy of further investigation.


Assuntos
Dieta Mediterrânea/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Recém-Nascido Pequeno para a Idade Gestacional , Estilo de Vida , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Feminino , Idade Gestacional , Ganho de Peso na Gestação , Humanos , Recém-Nascido , Itália/epidemiologia , Modelos Logísticos , Fenômenos Fisiológicos da Nutrição Materna , Política Nutricional , Gravidez , Prevalência , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
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