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1.
Acta Biomed ; 91(11-S): e2020003, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-33004773

RESUMO

n December 2019, in Wuhan (Hubei, China), the first COVID-19 cases due to SARS-COV-2 had been reported. On July 1st 2020, more than 10.268.839 million people had developed the disease, with at least 506.064 deaths. At present, Italy is the third country considering the number of cases (n=240.760), after Spain, and the second for the cumulative number of deaths (n=249.271), after the United States. As regard pediatric COVID-19 cases, more than 4000 cases (have been reported; however, these figures are likely to be underestimated since they are influenced by the number of diagnostic tests carried out. Three pediatric deaths have been reported in Italy to date. We aimed to review the peculiar aspects of SARS-COV-2 infection in the pediatric population.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Estado Terminal/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Medição de Risco/métodos , Criança , Saúde Global , Humanos , Morbidade/tendências
2.
Stud Health Technol Inform ; 273: 262-265, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-33087624

RESUMO

The outbreak of COVID-19 has led to a crucial change in ordinary healthcare approaches. In comparison with emergencies re-allocation of resources for a long period of time is required and the peak utilization of the resources is also hard to predict. Furthermore, the epidemic models do not provide reliable information of the development of the pandemic's development, so it creates a high load on the healthcare systems with unforeseen duration. To predict morbidity of the novel COVID-19, we used records covering the time period from 01-03-2020 to 25-05-2020 and include sophisticated information of the morbidity in Russia. Total of 45238 patients were analyzed. The predictive model was developed as a combination of Holt and Holt-Winter models with Gradient boosting Regression. As we can see from the table 2, the models demonstrated a very good performance on the test data set. The forecast is quite reliable, however, due to the many uncertainties, only a real-world data can prove the correctness of the forecast.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Betacoronavirus , Humanos , Morbidade , Federação Russa/epidemiologia
3.
Rev Assoc Med Bras (1992) ; 66(9): 1252-1257, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33027454

RESUMO

OBJECTIVE: To describe the characteristics of patients treated at a level III surgical Neonatal Intensive Care Unit outside of a maternity service and analyze possible risk factors for mortality in this population. METHODS: A retrospective cohort study evaluating patients admitted to a level III surgical Neonatal Intensive Care Unit from June/2015 to November/2017. Univariate analysis was performed by the Chi-square test and T-student test or Mann-Whitney test. Multivariate analysis by logistic regression was performed including in the model the variables with a P-value <0.2 in univariate analysis. Kaplan-Meier curve and Log-Rank test were performed using the variables that were statistically associated with death in the multivariate analysis. A significance level of a=5% and an error B=80% were adopted. RESULTS: During this period, 246 patients were admitted to this service. 58 (23.8%) patients died, with a mean time until death of 18 days. Half of the patients had a clinical diagnosis of sepsis (50.6%), blood culture was positive in 25.2%, and gram-positive bacteria (48.4%) were the main pathogens isolated. The variables that remained in the final model after multivariate analysis were diagnosis of congenital heart disease (OR = 4.5; p = 0.016), clinical diagnosis of sepsis (OR = 8.1; p = 0.000), and isolation of gram-positive bacteria in blood culture (OR = 3.9; p = 0.006). CONCLUSION: The level III surgical Neonatal Intensive Care Unit outside of a maternity service has a different profile of morbidity and mortality, and death was associated with the diagnosis of congenital heart disease, the clinical diagnosis of sepsis, and the isolation of gram-positive bacteria in the blood culture.


Assuntos
Unidades de Terapia Intensiva Neonatal , Feminino , Humanos , Recém-Nascido , Morbidade , Gravidez , Estudos Retrospectivos , Fatores de Risco , Sepse
4.
BMC Infect Dis ; 20(1): 728, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028235

RESUMO

BACKGROUND: Late presentation (LP), defined as a CD4 count < 350/mm3 or an AIDS-event at HIV-diagnosis, remains a significant problem across Europe. Linking cohort and surveillance data, we assessed the country-specific burden of LP during 2010-2016 and the occurrence of new AIDS events or deaths within 12 months of HIV-diagnosis believed to be attributable to LP. METHODS: Country-specific percentages of LP and AIDS-events/death rates (assessed with Poisson regression) observed in The Collaboration of Observational HIV Epidemiological Research Europe (COHERE) and EuroSIDA cohorts, were applied to new HIV-diagnoses reported to the European Centre for Disease Prevention and Control. The estimated number of LP in the whole population was then calculated, as was the number of excess AIDS-events/deaths in the first 12 months following HIV-diagnosis assumed to be attributable to LP (difference in estimated events between LP and non-LP). RESULTS: Thirty-nine thousand two hundred four persons were included from the COHERE and EuroSIDA cohorts, of whom 18,967 (48.4%; 95% Confidence Interval [CI] 47.9-48.9) were classified as LP, ranging from 36.9% in Estonia (95%CI 25.2-48.7) and Ukraine (95%CI 30.0-43.8) to 64.2% in Poland (95%CI 57.2-71.3). We estimated a total of > 320,000 LP and 12,050 new AIDS-events/deaths attributable to LP during 2010-2016, with the highest estimated numbers of LP and excess AIDS-events/deaths in Eastern Europe. Country-level estimates of excess events ranged from 17 AIDS-events/deaths (95%CI 0-533) in Denmark to 10,357 (95%CI 7768-147,448) in Russia. CONCLUSIONS: Across countries in Europe, the burden of LP was high, with the highest estimated number of LP and excess AIDS-events/deaths being in Eastern Europe. Effective strategies are needed to reduce LP and the attributable morbidity and mortality that could be potentially avoided.


Assuntos
Infecções por HIV/diagnóstico , Adulto , Contagem de Linfócito CD4 , Estudos de Coortes , Diagnóstico Tardio , Europa (Continente)/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/mortalidade , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Morbidade , Análise de Sobrevida
5.
BMC Infect Dis ; 20(1): 725, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008316

RESUMO

BACKGROUND: Commencing lifelong antiretroviral therapy (ART) immediately following HIV diagnosis (Option B+), has greatly improved maternal-infant health. Thus, large and increasing numbers of HIV-infected women are on ART during pregnancy, a situation concurrently increasing numbers of HIV-exposed-uninfected (HEU) infants. Compared to their HIV-unexposed-uninfected (HUU) counterparts, HEU infants show higher rates of adverse birth outcomes, mortality, infectious/non-communicable diseases including impaired growth and neurocognitive development. There is an urgent need to understand the impact of HIV and early life ART exposures, immune-metabolic dysregulation, comorbidities and environmental confounders on adverse paediatric outcomes. METHODS: Six hundred (600) HIV-infected and 600 HIV-uninfected pregnant women ≥20 weeks of gestation will be enrolled from four primary health centres in high density residential areas of Harare. Participants will be followed up as mother-infant-pairs at delivery, week(s) 1, 6, 10, 14, 24, 36, 48, 72 and 96 after birth. Clinical, socio-economic, nutritional and environmental data will be assessed for adverse birth outcomes, impaired growth, immune/neurodevelopment, vertical transmission of HIV, hepatitis-B/C viruses, cytomegalovirus and syphilis. Maternal urine, stool, plasma, cord blood, amniotic fluid, placenta and milk including infant plasma, dried blood spot and stool will be collected at enrolment and follow-up visits. The composite primary endpoint is stillbirth and infant mortality within the first two years of life in HEU versus HUU infants. Maternal mortality in HIV-infected versus -uninfected women is another primary outcome. Secondary endpoints include a range of maternal and infant outcomes. Sub-studies will address maternal stress and malnutrition, maternal-infant latent tuberculosis, Helicobacter pylori infections, immune-metabolomic dysregulation including gut, breast milk and amniotic fluid dysbiosis. DISCUSSION: The University of Zimbabwe-College of Health-Sciences-Birth-Cohort study will provide a comprehensive assessment of risk factors and biomarkers for HEU infants' adverse outcomes. This will ultimately help developing strategies to mitigate effects of maternal HIV, early-life ART exposures and comorbidities on infants' mortality and morbidity. TRIAL REGISTRATION: ClinicalTrial.gov Identifier: NCT04087239 . Registered 12 September 2019.


Assuntos
Transmissão Vertical de Doença Infecciosa , Estudos de Coortes , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por Helicobacter/complicações , Helicobacter pylori , Hepatite B/complicações , Humanos , Lactente , Mortalidade Infantil , Leite Humano , Morbidade , Parto , Gravidez , Complicações Infecciosas na Gravidez/virologia , Fatores de Risco , Natimorto , Sífilis/complicações , Universidades , Zimbábue
6.
Rev Saude Publica ; 54: 91, 2020 Sep 04.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32901755

RESUMO

OBJECTIVE: To describe the dietary characteristics of participants in the NutriNet Brasil cohort immediately before and during the covid-19 pandemic. METHODS: Our data stem from an adult cohort created to prospectively investigate the relationship between diet and morbidity and mortality from chronic non-communicable diseases in Brazil. For this study, we selected the first participants (n = 10,116) who answered twice to a simplified questionnaire on their diet the day before, the first time when entering the study, between January 26 and February 15, 2020, and the second between May 10 and 19, 2020. The questionnaire inquiries about the consumption of healthy (vegetables, fruits and legumes) and unhealthy (ultra-processed foods) eating markers. Comparisons of indicators based on the consumption of these markers before and during the pandemic are presented for the study population and according to gender, age group, macro-region of residence and schooling. Chi-square tests and t-tests were used to compare proportions and means, respectively, adopting p < 0.05 to identify significant differences. RESULTS: For all participants, we found a modest but statistically significant increase in the consumption of healthy eating markers and stability in the consumption of unhealthy food markers. This favorable pattern of dietary changes during the pandemic occurred in most sociodemographic strata. We observed a less favorable changing pattern, with a tendency to increasing consumption of healthy and unhealthy food markers, in the Northeast and North macro-regions and among people with less schooling, suggesting social inequalities in the response to the pandemic. CONCLUSIONS: If confirmed, the trend of increased consumption of ultra-processed foods in underdeveloped regions and by people with less schooling is concerning, as eating these foods increases the risk of obesity, hypertension and diabetes, whose presence increases the severity and lethality of covid-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Dieta/tendências , Doenças não Transmissíveis/mortalidade , Pneumonia Viral/epidemiologia , Adulto , Betacoronavirus , Brasil , Estudos de Coortes , Humanos , Morbidade , Pandemias
7.
Int J Equity Health ; 19(1): 153, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32907584

RESUMO

BACKGROUND: The first wave of the Covid-19 pandemic hit Israel in late February 2020. The present study examines patterns of the first wave of Covid-19 morbidity in Israel at the macro level, during the period of late February to early June 2020, when the first wave has faded out. The analysis focuses on the significance of four sociodemographic variables: socioeconomic status, population density, rate of elderly population and minority status (Jewish / Arab identity) of the population in cities with 5000 residents or more. Additionally, we take a closer look into the association between morbidity rates and one SES component - home Internet access. METHODS: The article is a cross sectional study of morbidity rates, investigated on a residential community basis. Following the descriptive statistics, we move on to present multivariate analysis to explore associations between these variables and Covid-19 morbidity in Israel. RESULTS: Both the descriptive statistics and regressions show morbidity rates to be positively associated with population density. Socioeconomic status as well as the size of elderly population were both significantly related to morbidity, but only in Jewish communities. Interestingly, the association was inverse in both cases. i.e., the higher the SES the lower the morbidity and the larger the elderly population, the lower the community's morbidity. Another interesting result is that overall, morbidity rates in Jewish cities were consistently higher than in Arab communities. CONCLUSIONS: We attribute the low morbidity rates in communities with relatively small elderly populations to the exceptionally high fertility rates in ultra-orthodox communities that sustained increased rates of morbidity; the lower morbidity in Arab communities is attributed to several factors, including the spatial Jewish-Arab segregation.


Assuntos
Árabes/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Judeus/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Características de Residência/estatística & dados numéricos , Idoso , Estudos Transversais , Humanos , Israel/epidemiologia , Morbidade/tendências , Densidade Demográfica , Classe Social
8.
PLoS One ; 15(9): e0239175, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941485

RESUMO

The COVID-19 outbreak has forced most of the global population to lock-down and has put in check the health services all over the world. Current predictive models are complex, region-dependent, and might not be generalized to other countries. However, a 150-year old epidemics law promulgated by William Farr might be useful as a simple arithmetical model (percent increase [R1] and acceleration [R2] of new cases and deaths) to provide a first sight of the epidemic behavior and to detect regions with high predicted dynamics. Thus, this study tested Farr's Law assumptions by modeling COVID-19 data of new cases and deaths. COVID-19 data until April 10, 2020, was extracted from available countries, including income, urban index, and population characteristics. Farr's law first (R1) and second ratio (R2) were calculated. We constructed epidemic curves and predictive models for the available countries and performed ecological correlation analysis between R1 and R2 with demographic data. We extracted data from 210 countries, and it was possible to estimate the ratios of 170 of them. Around 42·94% of the countries were in an initial acceleration phase, while 23·5% already crossed the peak. We predicted a reduction close to zero with wide confidence intervals for 56 countries until June 10 (high-income countries from Asia and Oceania, with strict political actions). There was a significant association between high R1 of deaths and high urban index. Farr's law seems to be a useful model to give an overview of COVID-19 pandemic dynamics. The countries with high dynamics are from Africa and Latin America. Thus, this is a call to urgently prioritize actions in those countries to intensify surveillance, to re-allocate resources, and to build healthcare capacities based on multi-nation collaboration to limit onward transmission and to reduce the future impact on these regions in an eventual second wave.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Modelos Biológicos , Pandemias/legislação & jurisprudência , Pneumonia Viral/prevenção & controle , África/epidemiologia , Ásia/epidemiologia , Infecções por Coronavirus/epidemiologia , Previsões , Geografia Médica , Humanos , Incidência , América Latina/epidemiologia , Morbidade/tendências , Mortalidade/tendências , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Dinâmica Populacional , Saúde da População Urbana
9.
PLoS One ; 15(9): e0238214, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32946442

RESUMO

Brazil detected community transmission of COVID-19 on March 13, 2020. In this study we identified which areas in the country were the most vulnerable for COVID-19, both in terms of the risk of arrival of cases, the risk of sustained transmission and their social vulnerability. Probabilistic models were used to calculate the probability of COVID-19 spread from São Paulo and Rio de Janeiro, the initial hotspots, using mobility data from the pre-epidemic period, while multivariate cluster analysis of socio-economic indices was done to identify areas with similar social vulnerability. The results consist of a series of maps of effective distance, outbreak probability, hospital capacity and social vulnerability. They show areas in the North and Northeast with high risk of COVID-19 outbreak that are also highly socially vulnerable. Later, these areas would be found the most severely affected. The maps produced were sent to health authorities to aid in their efforts to prioritize actions such as resource allocation to mitigate the effects of the pandemic. In the discussion, we address how predictions compared to the observed dynamics of the disease.


Assuntos
Betacoronavirus , Infecções por Coronavirus/transmissão , Modelos Teóricos , Morbidade/tendências , Pneumonia Viral/transmissão , Brasil/epidemiologia , Análise por Conglomerados , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Previsões/métodos , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Fatores Socioeconômicos
10.
Front Immunol ; 11: 1997, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32983141

RESUMO

Obesity is a major independent risk factor for increased morbidity and mortality upon infection with Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2), which is responsible for the current coronavirus disease pandemic (COVID-19). Therefore, there is a critical need to identify underlying metabolic factors associated with obesity that could be contributing toward increased susceptibility to SARS-CoV-2 in this vulnerable population. Here, we focus on the critical role of potent endogenous lipid metabolites known as specialized pro-resolving mediators (SPMs) that are synthesized from polyunsaturated fatty acids. SPMs are generated during the transition of inflammation to resolution and have a vital role in directing damaged tissues to homeostasis; furthermore, SPMs display anti-viral activity in the context of influenza infection without being immunosuppressive. We cover evidence from rodent and human studies to show that obesity, and its co-morbidities, induce a signature of SPM deficiency across immunometabolic tissues. We further discuss how the effects of obesity upon SARS-CoV-2 infection are likely exacerbated with environmental exposures that promote chronic pulmonary inflammation and augment SPM deficits. Finally, we highlight potential approaches to overcome the loss of SPMs using dietary and pharmacological interventions. Collectively, this mini-review underscores the need for mechanistic studies on how SPM deficiencies driven by obesity and environmental exposures may exacerbate the response to SARS-CoV-2.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Ácidos Docosa-Hexaenoicos/deficiência , Ácido Eicosapentaenoico/metabolismo , Ácido Linoleico/deficiência , Lipoxinas/deficiência , Obesidade/epidemiologia , Obesidade/imunologia , Pneumonia Viral/epidemiologia , Comorbidade , Infecções por Coronavirus/dietoterapia , Infecções por Coronavirus/virologia , Suscetibilidade a Doenças , Ácidos Docosa-Hexaenoicos/uso terapêutico , Ácido Eicosapentaenoico/uso terapêutico , Humanos , Inflamação/metabolismo , Ácido Linoleico/uso terapêutico , Lipoxinas/uso terapêutico , Morbidade , Obesidade/metabolismo , Pandemias , Pneumonia Viral/dietoterapia , Pneumonia Viral/virologia , Fatores de Risco
13.
Infect Dis Poverty ; 9(1): 121, 2020 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-32867849

RESUMO

BACKGROUND: Intestinal schistosomiasis was not considered endemic in Lake Malawi until November 2017 when populations of Biomphalaria pfeifferi were first reported; in May 2018, emergence of intestinal schistosomiasis was confirmed. This emergence was in spite of ongoing control of urogenital schistosomiasis by preventive chemotherapy. Our current study sought to ascertain whether intestinal schistosomiasis is transitioning from emergence to outbreak, to judge if stepped-up control interventions are needed. METHODS: During late-May 2019, three cross-sectional surveys of primary school children for schistosomiasis were conducted using a combination of rapid diagnostic tests, parasitological examinations and applied morbidity-markers; 1) schistosomiasis dynamics were assessed at Samama (n = 80) and Mchoka (n = 80) schools, where Schistosoma mansoni was first reported, 2) occurrence of S. mansoni was investigated at two non-sampled schools, Mangochi Orphan Education and Training (MOET) (n = 60) and Koche (n = 60) schools, where B. pfeifferi was nearby, and 3) rapid mapping of schistosomiasis, and B. pfeifferi, conducted across a further 8 shoreline schools (n = 240). After data collection, univariate analyses and Chi-square testing were performed, followed by binary logistic regression using generalized linear models, to investigate epidemiological associations. RESULTS: In total, 520 children from 12 lakeshore primary schools were examined, mean prevalence of S. mansoni by 'positive' urine circulating cathodic antigen (CCA)-dipsticks was 31.5% (95% confidence interval [CI]: 27.5-35.5). Upon comparisons of infection prevalence in May 2018, significant increases at Samama (relative risk [RR] = 1.7, 95% CI: 1.4-2.2) and Mchoka (RR = 2.7, 95% CI: 1.7-4.3) schools were observed. Intestinal schistosomiasis was confirmed at MOET (18.3%) and Koche (35.0%) schools, and in all rapid mapping schools, ranging from 10.0 to 56.7%. Several populations of B. pfeifferi were confirmed, with two new eastern shoreline locations noted. Mean prevalence of urogenital schistosomiasis was 24.0% (95% CI: 20.3-27.7). CONCLUSIONS: We notify that intestinal schistosomiasis, once considered non-endemic in Lake Malawi, is now transitioning from emergence to outbreak. Once control interventions can resume after coronavirus disease 2019 (COVID-19) suspensions, we recommend stepped-up preventive chemotherapy, with increased community-access to treatments, alongside renewed efforts in appropriate environmental control.


Assuntos
Surtos de Doenças , Esquistossomose Urinária/epidemiologia , Esquistossomose mansoni/epidemiologia , Anti-Helmínticos/uso terapêutico , Criança , Estudos Transversais , Humanos , Lagos , Malaui/epidemiologia , Morbidade , Praziquantel/uso terapêutico , Prevalência , Fatores de Risco , Esquistossomose Urinária/complicações , Esquistossomose Urinária/tratamento farmacológico , Esquistossomose mansoni/complicações , Esquistossomose mansoni/tratamento farmacológico , Instituições Acadêmicas
15.
PLoS One ; 15(9): e0237422, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881896

RESUMO

In a recent population-based study, an elevated risk of the Metabolic syndrome (MetS) and type 2 diabetes was found in childless men compared to those who have fathered one or more children. Therefore, by using a larger cohort of more than 22 000 men from the Malmo Preventive Project (MPP) we aimed to expand our observations in order to evaluate the metabolic profile of childless men and to evaluate if childlessness is an additional and independent predictor of major adverse cardiovascular events (MACE), mortality and incident diabetes when accounting for well-known biochemical, anthropometric, socio-economic and lifestyle related known risk factors. Logistic regression was used to assess risk of MACE, diabetes and MetS at baseline. Multivariate Cox regression was used to evaluate the risks of MACE and mortality following the men from baseline screening until first episode of MACE, death from other causes, emigration, or end of follow-up (31st December 2016) adjusting for age, family history, marital status, smoking, alcohol consumption, educational status, body mass index, prevalent diabetes, high blood lipids, increased fasting glucose and hypertension. Childless men presented with a worse metabolic profile than fathers at the baseline examination, with elevated risk of high triglycerides, odds ratio (OR) 1.24 (95%CI: 1.10-1.42), high fasting glucose OR 1.23 (95%CI: 1.05-1.43) and high blood pressure, OR 1.28 (95%CI: 1.14-1.45), respectively. In the fully adjusted prospective analysis, childless men presented with elevated risk of cardiovascular mortality, HR: 1.33 (95% CI: 1.18-1.49) and all-cause mortality, HR 1.23 (95%CI: 1.14-1.33), respectively. In conclusion, these results add to previous studies showing associations between male reproductive health, morbidity and mortality. Male childlessness, independently of well-known socio-economic, behavioral and metabolic risk factors, predicts risk of cardiovascular disease and mortality. Consequently, this group of men should be considered as target population for preventive measures.


Assuntos
Doenças Cardiovasculares/mortalidade , Adulto , Estudos de Coortes , Intervalos de Confiança , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Estilo de Vida , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Morbidade , Razão de Chances , Fatores de Risco
16.
PLoS One ; 15(9): e0237307, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915825

RESUMO

OBJECTIVE: To estimate the prevalence of multimorbidity and investigate the socioeconomic factors that are associated with multimorbidity among persons 70 years and older in Trinidad and Tobago. DESIGN AND METHODS: The data were obtained from a nationally representative comprehensive cross-sectional survey conducted in 2014 among elderly persons in the targeted age group. The prevalence of multimorbidity among the elderly population was estimated. A logit model was utilized to determine the socioeconomic characteristics that are associated with multimorbidity in the elderly. RESULTS: The results of the study show that multimorbidity in the elderly population is strongly associated with age, ethnicity, lower education, smoking history, no physical activity and being female. An interesting finding is that elderly persons in the richest quintile are in general, more prone to multimorbidity. CONCLUSION: The findings suggest that interventions to reduce multimorbidity among the elderly population must encourage greater levels of physical activity, provide education on the risk factors of multimorbidity, and discourage smoking.


Assuntos
Escolaridade , Renda/estatística & dados numéricos , Expectativa de Vida , Idoso , Idoso de 80 Anos ou mais , Feminino , Estilo de Vida Saudável , Humanos , Masculino , Morbidade , Fatores Sexuais , Fumar/epidemiologia , Trinidad e Tobago
17.
Orv Hetil ; 161(37): 1569-1573, 2020 09.
Artigo em Húngaro | MEDLINE | ID: mdl-32894736

RESUMO

Worldwide, the prevalence of anemia is high, and iron deficiency anemia is the fifth most common disorder according to the study called "Global burden of disease". It can be attributed to a number of factors, complex pathomechanisms, and etiology is highly variable in terms of age, gender, and geographical distribution. The prevalence of anemia increases with age. Demographic change and the aging of the population are now faster than in previous decades, posing major challenges to societies and health systems. The mean prevalence of anemia in the elderly is 17%, but significantly higher among nursing-home (47%) and hospitalized elderly (40%). The cause is usually multifactorial and often, due to comorbidities, several mechanisms are involved at the same time. The prevalence of preoperative anemia was higher (35%) than the prevalence of anemia in the general population, and evidence showed an unfavorable effect on postoperative morbidity and mortality. Timely identification and correction is a multidisciplinary task and a shared responsibility for both Patient Blood Management program and improving the patients' life expectancy. Orv Hetil. 2020; 161(37): 1569-1573.


Assuntos
Anemia Ferropriva , Anemia , Idoso , Anemia/epidemiologia , Anemia Ferropriva/epidemiologia , Comorbidade , Humanos , Morbidade , Prevalência
18.
JACC Clin Electrophysiol ; 6(9): 1193-1204, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32972561

RESUMO

Current understanding of the impact of coronavirus disease-2019 (COVID-19) on arrhythmias continues to evolve as new data emerge. Cardiac arrhythmias are more common in critically ill COVID-19 patients. The potential mechanisms that could result in arrhythmogenesis among COVID-19 patients include hypoxia caused by direct viral tissue involvement of lungs, myocarditis, abnormal host immune response, myocardial ischemia, myocardial strain, electrolyte derangements, intravascular volume imbalances, and drug sides effects. To manage these arrhythmias, it is imperative to increase the awareness of potential drug-drug interactions, to monitor QTc prolongation while receiving COVID therapy and provide special considerations for patients with inherited arrhythmia syndromes. It is also crucial to minimize exposure to COVID-19 infection by stratifying the need for intervention and using telemedicine. As COVID-19 infection continues to prevail with a potential for future surges, more data are required to better understand pathophysiology and to validate management strategies.


Assuntos
Arritmias Cardíacas/etiologia , Betacoronavirus , Infecções por Coronavirus/complicações , Pandemias , Pneumonia Viral/complicações , Arritmias Cardíacas/epidemiologia , Infecções por Coronavirus/epidemiologia , Saúde Global , Humanos , Morbidade/tendências , Pneumonia Viral/epidemiologia
19.
Math Biosci Eng ; 17(4): 2842-2852, 2020 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-32987501

RESUMO

Since the first case of coronavirus disease (COVID-19) in Wuhan Hubei, China, was reported in December 2019, COVID-19 has spread rapidly across the country and overseas. The first case in Anhui, a province of China, was reported on January 10, 2020. In the field of infectious diseases, modeling, evaluating and predicting the rate of disease transmission is very important for epidemic prevention and control. Different intervention measures have been implemented starting from different time nodes in the country and Anhui, the epidemic may be divided into three stages for January 10 to February 11, 2020, namely. We adopted interrupted time series method and develop an SEI/QR model to analyse the data. Our results displayed that the lockdown of Wuhan implemented on January 23, 2020 reduced the contact rate of epidemic transmission in Anhui province by 48.37%, and centralized quarantine management policy for close contacts in Anhui reduced the contact rate by an additional 36.97%. At the same time, the estimated basic reproduction number gradually decreased from the initial 2.9764 to 0.8667 and then to 0.5725. We conclude that the Wuhan lockdown and the centralized quarantine management policy in Anhui played a crucial role in the timely and effective mitigation of the epidemic in Anhui. One merit of this work is the adoption of morbidity data which may reflect the epidemic more accurately and promptly. Our estimated parameters are largely in line with the World Health Organization estimates and previous studies.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Modelos Biológicos , Pandemias , Pneumonia Viral/epidemiologia , Número Básico de Reprodução/estatística & dados numéricos , China/epidemiologia , Simulação por Computador , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Humanos , Análise de Séries Temporais Interrompida/estatística & dados numéricos , Cadeias de Markov , Conceitos Matemáticos , Método de Monte Carlo , Morbidade/tendências , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Quarentena/estatística & dados numéricos
20.
Pediatr Clin North Am ; 67(5): 843-853, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32888685

RESUMO

Rheumatic heart disease (RHD) remains the most common cause of cardiovascular morbidity and mortality globally in children and young adults. This article focuses on prevention and management of RHD. Pregnancy can unmask previously undiagnosed RHD and poses high risk for mother and fetus. Management of anticoagulation is important. Definitive catheter and surgical intervention are the only treatments that can improve outcomes of patients with moderate or severe RHD. Access to intervention remains very limited in RHD endemic regions. There are ongoing global efforts to increase awareness, public policy adoption, and greater access to treatment.


Assuntos
Gerenciamento Clínico , Programas de Rastreamento/métodos , Cardiopatia Reumática , Criança , Progressão da Doença , Ecocardiografia , Saúde Global , Humanos , Morbidade , Cardiopatia Reumática/diagnóstico , Cardiopatia Reumática/epidemiologia
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