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1.
Heart Fail Clin ; 16(1): 121-130, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735310

RESUMO

Understanding the role of sex- and gender-related factors, when dealing with a global growing epidemic such as heart failure, is a much needed and unmet goal for health care providers and scientists in order to design targeted strategies, aimed at improving both clinical and patient reported outcomes measures in women and men with heart failure. The present review provides an overview of the current available evidence on sex- and gender-related differences in heart failure.


Assuntos
Insuficiência Cardíaca/epidemiologia , Saúde Global , Humanos , Morbidade/tendências , Distribuição por Sexo , Fatores Sexuais , Taxa de Sobrevida/tendências
2.
Medicine (Baltimore) ; 98(50): e18265, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852096

RESUMO

The purpose of this study was to investigate the association between triglyceride glucose (TyG) index and abnormal liver function both in urban and rural Chinese adult populations. The 5824 urban (Nanjing) and 20,269 rural (Hefei) Chinese adults, from random selected households provided clinical history, glucose, lipids, anthropometric, and blood pressure measurements. Liver functions were assessed using Alanine Aminotransferase (ALT). Linear regression was applied to examine the dose-response relationship between TyG index and ALT. Logistic regression was used to estimate the association between TyG index and abnormal liver and function. Cubic spline models were applied to investigate the dose-response association between TyG index and abnormal liver function. C-statistics was used to compare the discriminable capacity over triglyceride, glucose and TyG index. Linear dose-response relationship was identified between TyG index and ALT as 1.222 IU increase by 1 unit increase of TyG index (1.242 for urban population and 1.210 for rural population). The 6.0% of urban and 11.0% of rural Chinese adults were observed to have abnormal liver function. The linear association between TyG index and abnormal liver function was revealed as 2.044 (1.930 to 2.165) of odds ratio by in unit increase of TyG index (2.334 for urban population and 1.990 for rural population). Higher C-statistics was found for TyG index compared with fasting glucose and triglyceride both in Chinese urban and rural populations. This study suggested in both urban and rural Chinese adult populations, TyG index is associated with abnormal liver function. TyG index is a potential indicator to identify high-risk individuals with metabolic disorders, for example impaired liver function in Chinese population, especially in Chinese urban population.


Assuntos
Alanina Transaminase/sangue , Glicemia/metabolismo , Hepatopatias/sangue , Vigilância da População , População Rural , Triglicerídeos/sangue , População Urbana , Adulto , Biomarcadores/sangue , Índice de Massa Corporal , China/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Incidência , Hepatopatias/epidemiologia , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Fatores de Risco , Adulto Jovem
3.
Artigo em Russo | MEDLINE | ID: mdl-31884747

RESUMO

The article presents the results of analysis of indices of total morbidity of population of the Central Federal Okrug (CFD) of the Russian Federation in 2010-2017. The significant differences in indices of total morbidity between the CFD subjects in certain ICD-10 classes were established. The indices of total morbidity of population during study period (8 years) in the Central Federal District factually didn't altered, while dynamics of indices in other subjects was characterized by multidirectionality. The gap in levels of total morbidity of population in the subjects was significant: from 115,123.6 per 100,000 of population in the Kursk Oblast to 194,404.1 per 100,000 of population in the Orel Oblast. The significant difference in rates of increase/ decrease of indices is noted. Thus, in Moscow decrease rate made up to 10%, while in the Orel Oblast morbidity increased up to 13.1%. Besides, in 2017, the Orel Region took a leadership in rate of increasing of total morbidity in such classes of diseases as infectious and parasitic diseases (39.3%), diseases of blood and blood-forming organs (49.1%), diseases of endocrine system (59,1%), diseases of nervous system (26.8%), diseases of respiratory system (28.2%), diseases of musculoskeletal system (16%), malformations (56%). It is very likely that this trend developed under influence of demographic situation in the subject due to significant increasing of percentage of people older than able-bodied age. The city of Moscow occupies leading position in decreasing of rate of prevalence of diseases and last but one place in level of total morbidity being inferior only to the Kursk Oblast. Thus, in Moscow was noted the most significant decreasing of morbidity in classes of infectious and parasitic diseases (26%) and diseases of digestive system (20.6%). The diseases of blood and blood-forming organs (235.2 per 100,000 population) and mental disorders (2353.5 per 100,000 population) were registered the less. The main contribution into trends of increasing or decreasing of indices is made by persons aged 18 years and older (74.1%).


Assuntos
Classificação Internacional de Doenças , Morbidade/tendências , Moscou/epidemiologia , Prevalência , Federação Russa
4.
Artigo em Russo | MEDLINE | ID: mdl-31884758

RESUMO

On the basis of updated data from 82 subjects of the Russian Federation multivariate analysis of occupational diseases of agricultural workers was implemented. It is established that in unhealthy work conditions are characteristic for 30% of workers in the agricultural sector. In the enterprises of agriculture, the percentage of workplaces not meeting sanitary hygienic standards made up to 35%. The high etiologic pathogenic relationship between nosological form of disease and working conditions in the profession is established. Most often, the occupational pathology was developed in agricultural workers in case of conditions of physical overload (37.2%), effecting of physical factors (26.8%) and contact with infected animals (14.6%). In nosological structure of accumulated occupational diseases the first place took radiculopathy of cervical and lumbar sacral levels (23%), the second - vibration disease (15.3%), followed by brucellosis (14.6%), the fourth - neuro-sensory deafness (11.5%). The regions of the Russian Federation are characterized by pronounced heterogeneity both related to general level of registered occupational diseases and its nosological spectrum. In the whole, in Russia during 2011-2015 persistent trend of decreasing of occupational diseases morbidity of agricultural workers was marked.


Assuntos
Agricultura , Doenças Profissionais/epidemiologia , Saúde do Trabalhador , Animais , Humanos , Morbidade/tendências , Ocupações , Federação Russa
5.
Rev Port Cardiol ; 38(8): 559-569, 2019 08.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31706732

RESUMO

INTRODUCTION: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in Portugal. Hypercholesterolemia has a causal role in atherosclerotic CVD. Guidelines recommend that cardiovascular (CV) risk reduction should be individualized and treatment goals identified. Low-density lipoprotein cholesterol (LDL-C) is the primary treatment target. METHODS: DISGEN-LIPID was a cross-sectional observational study conducted in 24 centers in Portugal in dyslipidemic patients aged ≥40 years, on lipid-lowering therapy (LLT) for at least three months and with an available lipid profile in the previous six months. RESULTS: A total of 368 patients were analyzed: 48.9% men and 51.1% women (93.9% postmenopausal), of whom 73% had a SCORE of high or very high CV risk. One quarter had a family history of premature CVD; 31% had diabetes; 26% coronary heart disease; 9.5% cerebrovascular disease; and 4.1% peripheral arterial disease. Mean baseline lipid values were total cholesterol (TC) 189 mg/dl, LDL-C 116 mg/dl, high-density lipoprotein cholesterol (HDL-C) 53.5 mg/dl, and triglycerides (TG) 135 mg/dl. Women had higher TC (p<0.001), LDL-C (non-significant) and HDL-C (p<0.001), and lower TG (p=0.002); 57% of men and 63% of women had LDL-C>100 mg/dl (p=0.28), and 58% of men and 47% of women had LDL-C>70 mg/dl (p=0.933). CONCLUSION: These observational data show that, despite their high-risk profile, more than half of patients under LLT, both men and women, did not achieve the recommended target levels for LDL-C, and a large proportion also had abnormal HDL-C and/or TG. This is a renewed opportunity to improve clinical practice in CV prevention.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Dislipidemias/sangue , Hipolipemiantes/uso terapêutico , Lipídeos/sangue , Sistema de Registros , Adulto , Idoso , Biomarcadores/sangue , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos Transversais , Dislipidemias/complicações , Dislipidemias/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Portugal/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências
6.
Sante Publique ; Vol. 31(3): 433-441, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31640331

RESUMO

OBJECTIVES: Non-communicable diseases (NCDs) represent a major public health problem worldwide. Giving their impact on the morbidity and mortality burden, understanding their chronological trends over time is a priority for epidemiological surveillance. We aimed to determine the epidemiological specificities of NCDs and to study their chronological trends over the period 2010-2015. METHODS: We retrospectively collected data of hospitalized patients from the regional registry of morbidity and mortality in the Southern University Hospital of Tunisia during the period 2010-2015. RESULTS: We included 18,081 patients with NCDs aged ≥ 25 years. The distribution of NCDs was characterized by the predominance of cardiovascular disease (CVD) (10,346 cases, 57.2%). Chronological trends analysis of NCDs showed that NCDs remained globally stable between 2010 and 2015. The same result applied to the group of cancers, chronic respiratory diseases and diabetes mellitus. However, CVD increased significantly between 2010 and 2015 (ρ = 0.84; p = 0.036). The proportion of CVD increased significantly among men (ρ = 0.87; p = 0.019) and elderly (ρ = 0.88; p = 0.019). The hospital mortality rate of NCDs increased significantly (ρ = 0.85; p = 0.031), notably for CVDs (ρ = 0.94; p = 0.005). CONCLUSION: Chronological trends analysis revealed a significant rise in the morbidity and mortality burden of CVDs during the period 2010-2015. It is imperative, therefore, to strengthen health care for these patients and to introduce the concept of integrated NCDs prevention as an essential component of the health system.


Assuntos
Doenças não Transmissíveis/epidemiologia , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Humanos , Masculino , Morbidade/tendências , Mortalidade/tendências , Doenças não Transmissíveis/mortalidade , Sistema de Registros , Estudos Retrospectivos , Tunísia/epidemiologia
7.
Int Health ; 11(5): 353-357, 2019 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-31529113

RESUMO

At least 800 women die each day during pregnancy or birth and more than 15 000 babies each day are stillborn or die in the first month of life. Almost all of these deaths occur in low- and middle-income countries. Many more women and babies are known to suffer morbidity as a result of pregnancy and childbirth. However, reliable estimates of the burden of physical, psychological and social morbidity and comorbidity during and after pregnancy are not available. Although there is no single intervention or 'magic bullet' that would reduce mortality and improve health, there are evidence-based care packages which are defined and agreed internationally. A functioning health system with care available and accessible for everyone at all times is required to ensure women and babies survive and thrive.


Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Mortalidade Infantil/tendências , Mortalidade Materna/tendências , Morbidade/tendências , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez
9.
Bratisl Lek Listy ; 120(9): 690-694, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31475556

RESUMO

AIM: Severe acute maternal morbidity (SAMM) is a state of the woman, when she nearly died, but survived. The aim of study was to find out the exact incidence of SAMM in Slovakia, establishment of functional surveillance system and improve quality of health care. MATERIALS AND METHODS: The regular annual analyses of SAMM cases in Slovakia from January 1st 2012 to December 31st 2016. Observed SAMM included: peripartum haemorrhage, peripartum hysterectomy, uterine rupture, abnormally invasive placenta, HELLP syndrome, eclampsia, sepsis, transport to intensive care unit or anaesthesiology and non-fatal amniotic fluid embolism. RESULTS: The response rate of questionnaires was 84.8 %. The overall confirmed incidence of SAMM was 6.35/1,000 births (95% CI 6.03-6.67). The most often causes of SAMM were: peripartum haemorrhage (2.1/1,000 births), transport to intensive care unit or anaesthesiology (1.46/1,000 births), peripartum hysterectomy (0.84/1,000 births) and HELLP syndrome (0.63/1,000 births). The average age of women with SAMM was 30.3 years (14-46) and average parity was 1.16 (0-15). CONCLUSION: The incidence of SAMM and especially incidence of peripartum haemorrhage and peripartum hysterectomy in Slovakia is one of the highest in Europe. To decrease incidence and improve management and outcome of patients, regular audit of SAMM is needed (Tab. 3, Fig. 2, Ref. 30).


Assuntos
Saúde Materna/estatística & dados numéricos , Morbidade/tendências , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Feminino , Hemorragia , Humanos , Histerectomia , Pessoa de Meia-Idade , Período Periparto , Placenta Acreta , Gravidez , Sepse , Eslováquia , Ruptura Uterina , Adulto Jovem
10.
Artigo em Russo | MEDLINE | ID: mdl-31465670

RESUMO

The article presents a comprehensive analysis and assessment of the state of regional characteristics of morbidity with temporary disability, disability and mortality of employees of the internal affairs bodies of Russia. The source of the data was medical statistical reports generated by the medical and sanitary units of the Ministry of Internal Affairs of Russia using lexical analysis of medical documentation.


Assuntos
Morbidade/tendências , Programas Nacionais de Saúde , Pessoas com Deficiência , Humanos , Federação Russa
11.
BMC Ophthalmol ; 19(1): 192, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438884

RESUMO

BACKGROUND: A patient's perception of how their glaucoma is managed will influence both adherence to their medication and outcome measures such as quality of life. METHODS: Prospective consecutive study using a Glaucoma Patient-reported Outcome and Experience Measure (POEM) modified for an Australian ophthalmic private clinical practice setting. The Australian Glaucoma POEM consists of eight items related to the patient's understanding of the diagnosis and management, acceptability of the treatment, whether they feel their glaucoma is getting worse, interfering with their daily life and concerns regarding loss of vision as well as addressing whether they feel safe under the care of their glaucoma team and how well their care is organised. RESULTS: Two hundred and two patients (M:F 91:111) participated in the study. Mean ± standard deviation for subject age was 69 ± 13 years. Patient's overall perception of their treatment and outcome was favourable. Younger patients felt their glaucoma interfered more with their daily lives and were more worried about losing vision from glaucoma. The greater the number of medications in use, the more they felt their glaucoma was getting worse and that glaucoma interfered with their daily lives. With all other variables accounted for by the multivariate linear model, female patients more strongly agreed that they understood their glaucoma diagnosis and glaucoma management. The patients with a severe visual defect in their worse eye, reported a greater perceived understanding of their glaucoma diagnosis and management and that they felt that glaucoma had a greater interference on their daily life. They were also more concerned about losing vision from glaucoma than their fellow glaucoma patients with less severe or no visual field deficit in the worse eye. CONCLUSIONS: The modified POEM demonstrates potential to capture the concerns of a practice's glaucoma cohort with a view to enhancing the quality of glaucoma care delivered.


Assuntos
Glaucoma/terapia , Pressão Intraocular/fisiologia , Medidas de Resultados Relatados pelo Paciente , Qualidade da Assistência à Saúde , Acuidade Visual , Campos Visuais/fisiologia , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Glaucoma/epidemiologia , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Estudos Prospectivos , Qualidade de Vida , Queensland/epidemiologia , Inquéritos e Questionários , Adulto Jovem
12.
Public Health ; 175: 101-107, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31470235

RESUMO

OBJECTIVES: Although the cesarean section (C-section) is known as a lifesaving procedure, it can also increase the risk of maternal mortality and morbidity. This study was conducted to achieve two objectives: (1) determination of maternal near miss (MNM) indicators and pregnancy outcomes among women with a history of C-section and (2) investigation of the women's experience of near miss events during childbirth to provide a deeper understanding of the weaknesses of care delivery process. STUDY DESIGN: The present study was conducted using a prospective cross-sectional study using the World Health Organization (organ system dysfunction-based) criteria. METHODS: All subjects were women at more than 22 weeks of gestation who gave birth in Ali ibn Abi Talib Hospital, Zahedan, Iran, and were referred to this hospital for childbirth or those within 42 days of pregnancy termination. Logistic regression was used to predict the risk factors for severe maternal outcomes (SMOs). RESULTS: Nearly 58% of all MNM cases were related to women with a history of C-section. The MNM ratio was estimated at 8.04 per 1000 live births. Moreover, the frequent causes of SMOs were reported as severe hemorrhage (58.3%), severe pre-eclampsia/eclampsia (27.8%), medical condition (8.3%), and sepsis or severe systemic infection (5.6%). Abnormally invasive placenta (61%) was the most common cause of severe hemorrhage. After adjustment for potential confounder variables, the hemoglobin level of <11 g/dl (odds ratio [OR] = 0.18, 95% confidence interval [CI] = 0.09-0.36) and place of residence (OR = 0.41, 95% CI = 0.19-0.90) remained as independent risk factors for SMOs in the final model of multivariate analysis. CONCLUSION: A risk assessment system is needed to diagnose and manage the risk factors for SMOs during prenatal care. In addition, there should be a continuous audit of the indication and number of C-sections performed across health facilities.


Assuntos
Cesárea/efeitos adversos , Morbidade/tendências , Centros de Atenção Terciária , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Near Miss/estatística & dados numéricos , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
13.
Glob Heart ; 14(2): 149-154, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31324369

RESUMO

Africa is experiencing an increasing prevalence of noncommunicable diseases (NCD). However, few reliable data are available on their true burden, main risk factors, and economic impact that are needed to inform implementation of evidence-based interventions in the local context. In Malawi, a number of initiatives have begun addressing the NCD challenge, which have often utilized existing infectious disease infrastructure. It will be crucial to carefully leverage these synergies to maximize their impact. NCD-BRITE (Building Research Capacity, Implementation, and Translation Expertise) is a transdisciplinary consortium that brings together key research institutions, the Ministry of Health, and other stakeholders to build long-term, sustainable, NCD-focused implementation research capacity. Led by University of Malawi-College of Medicine, University of North Carolina, and Dignitas International, NCD-BRITE's specific aims are to conduct detailed assessments of the burden and risk factors of common NCD; assess the research infrastructure needed to inform, implement, and evaluate NCD interventions; create a national implementation research agenda for priority NCD; and develop NCD-focused implementation research capacity through short courses, mentored research awards, and an internship placement program. The capacity-building activities are purposely designed around the University of Malawi-College of Medicine and Ministry of Health to ensure sustainability. The NCD BRITE Consortium was launched in February 2018. In year 1, we have developed NCD-focused implementation research capacity. Needs assessments will follow in years 2 and 3. Finally, in year 4, the generated research capacity, together with findings from the needs assessments, will be used to create a national, actionable, implementation research agenda for NCD prioritized in this consortium, namely cardiovascular disease, diabetes mellitus, and asthma and chronic obstructive pulmonary disease.


Assuntos
Fortalecimento Institucional/organização & administração , Política de Saúde , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Doenças não Transmissíveis/prevenção & controle , Formulação de Políticas , Pesquisa Médica Translacional/métodos , Países em Desenvolvimento , Humanos , Malaui/epidemiologia , Morbidade/tendências , Doenças não Transmissíveis/epidemiologia
14.
Glob Heart ; 14(2): 181-189, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31324373

RESUMO

BACKGROUND: There is growing support for stakeholder engagement in health research, but the actual impact of such engagement has not been well established. OBJECTIVES: This paper describes the stakeholder engagement process and evaluation during the planning of the national needs assessment for cardiovascular disease in Nepal. METHODS: We used personal and professional networks to identify relevant stakeholders within the 7Ps framework (Patients and the Public, Providers, Purchasers, Payers, Public Policy Makers and Policy Advocates, Product Makers and the Principal Investigators) to develop a plan for assessing cardiovascular health needs in Nepal. We consulted 40 stakeholders through 2 meetings in small groups and a workshop in a large group to develop the study methods, conceptual framework, and stakeholder engagement process. We interviewed 33 stakeholders to receive feedback on the stakeholder engagement process. RESULTS: We engaged 80% of the targeted stakeholders through small group discussions and a workshop. Three of 5 recommendations from the small group discussion were aimed at improving the stakeholder engagement process and 2 were aimed to improve the research methods. Eleven of 27 recommendations from the workshop aimed to improve the research methods, 4 aimed to improve stakeholder engagement, and 2 helped to expand the scope of dissemination. Ten were irrelevant or could not be incorporated due to resource limitation. Most stakeholders noted that the workshop provided an open platform for a multisectoral group to colearn from one another and share ideas. Others highlighted that the discussion generated insights to enhance research by incorporating expertise and ideas from different perspectives. The major challenges discussed were about committing the time for engagement. CONCLUSIONS: The stakeholder engagement process positively affected the design of our research. This study provides important insights for future researchers that aim to engage stakeholders in national-level assessment programs in the health care system in the context of Nepal.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Assistência à Saúde/organização & administração , Pesquisa sobre Serviços de Saúde , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Política Pública , Participação dos Interessados , Pesquisa Médica Translacional/métodos , Doenças Cardiovasculares/epidemiologia , Humanos , Morbidade/tendências , Nepal/epidemiologia
15.
J Laparoendosc Adv Surg Tech A ; 29(9): 1085-1092, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31334676

RESUMO

Background: Laparoscopic pancreatectomy (LP) is increasingly performed with several institutional series and comparative studies reported. We have applied LP to a variety of pancreatic resections since 2004. This article is to report results of 15-year practice of 605 LPs for pancreatic and periampullary diseases. Methods: Patients with benign or malignant diseases in the pancreas and periampullary region, who underwent LP from June 2004 to June 2018, were retrospectively reviewed. The demographics and indications, and intraoperative and perioperative outcomes were evaluated. Results: A total of 605 consecutive LPs were analyzed, including 237 (39.2%) distal pancreatectomy with splenectomy (DPS), 116 (19.2%) spleen-preserving distal pancreatectomy (SPDP), 30 (5.0%) enucleation (EN), 30 (5.0%) central pancreatectomy (CP), 186 (30.7%) pancreatoduodenectomy (PD), and 6 (1.0%) pancreatoduodenectomy with total pancreatectomy (PDTP). The most common pathologic finding was pancreatic ductal adenocarcinomas (146, 24.1%). Conversion to open procedure was required in 22 patients (3.6%) (12 with PD, 8 with DPS, 1 with CP, and 1 with PDTP). The mean operative time was 241.5 ± 105.5 minutes (range 50-550 minutes) for the entire population and 367.1 ± 61.8 minutes (range 230-550 minutes) for PD. Clinically significant pancreatic fistula (ISGPF grade B and C) rate was 12.4% for the entire cohort and 16.1% for PD. Rate of Clavien-Dindo III-V complications was 17.4% for the entire cohort and 23.7% for PD. Ninety-day mortality was observed only in the cohort of patients undergoing PD (n = 4). Conclusions: The LP procedure appears to be technically safe and feasible, with an acceptable rate of morbidity when performed at our experienced, high-volume center. However, PD has less favorable outcomes and needs further evaluation.


Assuntos
Doenças do Ducto Colédoco/cirurgia , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Laparoscopia/métodos , Pâncreas/cirurgia , Pancreatectomia/métodos , Pancreatopatias/cirurgia , Complicações Pós-Operatórias/epidemiologia , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Duração da Cirurgia , Estudos Retrospectivos , Esplenectomia/efeitos adversos
16.
Dis Colon Rectum ; 62(9): 1095-1104, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31318774

RESUMO

BACKGROUND: In the literature on chronic spinal cord injury, neurogenic bowel dysfunction has not gained as much attention as bladder dysfunction, the traditional cause of morbidity and mortality. OBJECTIVE: The purpose of this study was to investigate the prevalence of fecal incontinence and conditions associated with fecal incontinence in women with spinal cord injury. DESIGN: In this cross-sectional study, data were obtained from an electronic medical chart database containing standardized questionnaires. SETTINGS: The study was conducted at the Clinic for Spinal Cord Injuries, Rigshospitalet, where patients from Eastern Denmark are followed every second year. PATIENTS: Women who sustained a spinal cord injury between September 1999 and August 2016 and attended a consultation between August 2010 and August 2016 were included. If the bowel function questionnaire had never been answered, the woman was excluded. MAIN OUTCOME MEASURES: The newest completed questionnaire regarding bowel function, urinary bladder function, quality of life, neurologic level/completeness/etiology of injury, mobility status, and spousal relationship was obtained from each woman. RESULTS: Among the 733 identified women, 684 were included, of whom only 11% had a complete motor injury. A total of 35% experienced fecal incontinence, varying from daily to less than monthly, and 79% experienced bowel dysfunction. Fecal incontinence was associated with urinary incontinence and decreased satisfaction with life in general and psychological health. In the multivariate logistic regression analysis, the odds of daily-monthly fecal incontinence increased significantly with increasing age, myelomeningocele as etiology of injury, a more complete paraplegic injury, use of wheelchair permanently, and follow-up <3 months. LIMITATIONS: There were missing data in the study, including 12% with no answer to the fecal incontinence question. CONCLUSIONS: Fecal incontinence is a severe problem that affects more than one third of women with spinal cord injury and is associated with decreased quality of life. The present study emphasizes that women with myelomeningocele, a more complete paraplegic injury, older age, short follow-up period, and permanent wheelchair use have an increased risk of fecal incontinence. See Video Abstract at http://links.lww.com/DCR/A985. INCONTINENCIA FECAL Y DISFUNCIÓN NEUROGÉNICA DEL INTESTINO EN MUJERES CON LESIÓN DE LA MEDULA ESPINAL TRAUMÁTICA Y NO TRAUMÁTICA: En la literatura sobre la lesión crónica de la médula espinal, la disfunción neurógena del intestino no ha ganado tanta atención como la disfunción de la vejiga, la causa tradicional de morbilidad y mortalidad. OBJETIVÓ:: Investigar la prevalencia de la incontinencia fecal y las condiciones asociadas con la incontinencia fecal en mujeres con lesión de la médula espinal. DISEÑO:: En este estudio transversal, los datos se obtuvieron de una base de datos de registros médicos electrónicos que contenía cuestionarios estandarizados. CONFIGURACIÓN:: Clínica para Lesiones de la Médula Espinal, Rigshospitalet, donde los pacientes del Este de Dinamarca son seguidos cada dos años. PACIENTES: Mujeres que sufrieron una lesión en la médula espinal entre Septiembre de 1999 a Agosto de 2016 y asistieron a una consulta entre Agosto de 2010 a Agosto de 2016. Si nunca se había respondido el cuestionario de la función intestinal, se excluyó a la mujer. MEDIDA DE RESULTADOS PRINCIPALES: Se obtuvo el cuestionario más reciente y completo sobre la función intestinal, la función de la vejiga urinaria, la calidad de vida, el nivel neurológico/integridad/etiología de la lesión, el estado de movilidad y la relación con el cónyuge. RESULTADOS: Entre las 733 mujeres identificadas, se incluyeron 684, de las cuales solo el 11% tenía una lesión de motor completa. Un total de 35% experimentó incontinencia fecal que varió de diaria a menos de mensual, y el 79% experimentó disfunción intestinal. La incontinencia fecal se asoció con incontinencia urinaria y disminución de la satisfacción de vida en general y con la salud psicológica. En el análisis de regresión logística multivariable, las probabilidades de incontinencia fecal diaria-mensual aumentaron significativamente con el aumento de la edad, el mielomeningocele como etiología de la lesión, una lesión parapléjica más completa, el uso de silla de ruedas de forma permanente y el seguimiento <3 meses. LIMITACIONES: Faltaban datos en el estudio, incluyendo el 12% sin respuesta a la pregunta sobre incontinencia fecal. CONCLUSIONES: La incontinencia fecal es un problema grave que afecta a más de un tercio de las mujeres con lesión de la médula espinal y se asocia con una disminución de calidad de vida. El presente estudio enfatiza que las mujeres con mielomeningocele, una lesión parapléjica más completa, mayor edad, corto período de seguimiento y uso de silla de ruedas permanente tienen un mayor riesgo de incontinencia fecal. Vea el Video del Resumen en http://links.lww.com/DCR/A985.


Assuntos
Incontinência Fecal/etiologia , Intestino Neurogênico/etiologia , Traumatismos da Medula Espinal/complicações , Adulto , Estudos Transversais , Dinamarca/epidemiologia , Incontinência Fecal/epidemiologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Morbidade/tendências , Intestino Neurogênico/epidemiologia , Qualidade de Vida , Estudos Retrospectivos , Traumatismos da Medula Espinal/epidemiologia , Inquéritos e Questionários , Taxa de Sobrevida/tendências
17.
World J Pediatr Congenit Heart Surg ; 10(4): 416-423, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307314

RESUMO

BACKGROUND: Investigations of ventricular dominance and outcomes after the Fontan procedure have shown conflicting results. This may be due to the inclusion of multiple modifications of the Fontan or the omission of recently identified complications of the procedure. We examined the association between right ventricular dominance (RVD) and morbidity/mortality in a contemporary cohort following the extracardiac (EC) Fontan. METHODS: We studied all pediatric patients at our center who underwent a predominantly fenestrated EC Fontan from 2004 to 2016. Outcomes assessed were freedom from (1) Fontan failure (death, takedown, listing for transplantation) and (2) complication (arrhythmia requiring medication, postoperative pacemaker, or implantable cardioverter defibrillator requirement, stroke, thrombosis in the Fontan circuit, protein losing enteropathy, plastic bronchitis, New York Heart Association class >2). We defined the perioperative period as occurring before hospital discharge or within 30 days of the Fontan. RESULTS: A total of 137 patients (median age: 34 months, 62% male, 60% RVD) underwent the EC Fontan. Median duration of follow-up was 5.8 years (interquartile range: 2.4-9.0). Freedom from any event was 82.5% (RVD = 77%, LVD = 91%, χ2(1) = 5.03, P = .025) and RVD was associated with reduced event-free survival (hazard ratio: 2.94, P = .02). No confounders were identified. In the perioperative period, RVD was associated with reduced complication-free survival (P = .004). After this period, RVD was associated with reduced failure-free survival (P = .003). CONCLUSIONS: In this contemporary, single-center cohort of EC Fontan patients, RVD was associated with inferior outcomes.


Assuntos
Técnica de Fontan/efeitos adversos , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/cirurgia , Complicações Pós-Operatórias/etiologia , Função Ventricular Direita/fisiologia , Pré-Escolar , Intervalo Livre de Doença , Ecocardiografia , Feminino , Seguimentos , Técnica de Fontan/métodos , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Morbidade/tendências , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento
18.
Cardiol Clin ; 37(3): 297-305, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31279423

RESUMO

Acute kidney injury in acute decompensated heart failure leads to increased readmissions regardless of being transient or sustained at the time of discharge. Timely identification of acute kidney injury and worsening heart failure in patients with acute decompensated heart failure is of utmost importance to optimize different components of heart failure treatment. Acute kidney injury is a strong predictor of poor outcomes and early death in patients with pulmonary artery hypertension and acute right-sided heart failure. Extracorporeal ultrafiltration should not be used as an initial or alternative to diuretic therapy. It should be reserved for diuretic-resistant individuals.


Assuntos
Lesão Renal Aguda , Taxa de Filtração Glomerular/fisiologia , Nível de Saúde , Insuficiência Cardíaca , Hemodinâmica/fisiologia , Ultrafiltração/métodos , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Saúde Global , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Morbidade/tendências , Prognóstico , Taxa de Sobrevida/tendências
19.
Bone Joint J ; 101-B(7_Supple_C): 22-27, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31256653

RESUMO

AIMS: Unicompartmental knee arthroplasty (UKA) provides improved early functional outcomes and less postoperative morbidity and pain compared with total knee arthroplasty (TKA). Opioid prescribing has increased in the last two decades, and recently states in the USA have developed online Prescription Drug Monitoring Programs to prevent overprescribing of controlled substances. This study evaluates differences in opioid requirements between patients undergoing TKA and UKA. PATIENTS AND METHODS: We retrospectively reviewed 676 consecutive TKAs and 241 UKAs. Opioid prescriptions in morphine milligram equivalents (MMEs), sedatives, benzodiazepines, and stimulants were collected from State Controlled Substance Monitoring websites six months before and nine months after the initial procedures. Bivariate and multivariate analysis were performed for patients who had a second prescription and continued use. RESULTS: Patients undergoing UKA had a second opioid prescription filled 50.2% of the time, compared with 60.5% for TKA (p = 0.006). After controlling for potential confounders, patients undergoing UKA were still less likely to require a second prescription than those undergoing TKA (adjusted odds ratio (OR) 0.58, 95% confidence interval (CI) 0.42 to 0.81; p = 0.001). Continued opioid use requiring more than five prescriptions occurred in 13.7% of those undergoing TKA and 5.8% for those undergoing UKA (p = 0.001), and was also reduced in UKA patients compared with TKA patients (adjusted OR 0.33, 95% CI 0.16 to 0.67; p = 0.022) in multivariate analysis. The continued use of opioids after six months was 11.8% in those undergoing TKA and 8.3% in those undergoing UKA (p = 0.149). The multivariate models for second prescriptions, continued use with more than five, and continued use beyond six months yielded concordance scores of 0.70, 0.86, and 0.83, respectively. CONCLUSION: Compared with TKA, patients undergoing UKA are less likely to require a second opioid prescription and use significantly fewer opioid prescriptions. Thus, orthopaedic surgeons should adjust their patterns of prescription and educate patients about the reduced expected analgesic requirements after UKA compared with TKA. Cite this article: Bone Joint J 2019;101-B(7 Supple C):22-27.


Assuntos
Analgésicos Opioides/uso terapêutico , Artroplastia do Joelho/métodos , Uso de Medicamentos/tendências , Osteoartrite do Joelho/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Idoso , Feminino , Seguimentos , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Dor Pós-Operatória/epidemiologia , Padrões de Prática Médica , Reoperação , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos/epidemiologia
20.
Cardiol Young ; 29(6): 761-767, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31159896

RESUMO

Hypoalbuminemia is associated with morbidity and mortality in critically ill children. In this multi-centre retrospective study, we aimed to determine normative values of serum albumin in neonates and infants with congenital heart disease, evaluate perioperative changes in albumin levels, and determine if low serum albumin influences post-operative outcomes. Consecutive eligible neonates and infants who underwent cardiac surgery with cardiopulmonary bypass at one of three medical centres, January 2012-August 2013, were included. Data on serum albumin levels from five data points (pre-operative, 0-24, 24-48, 48-72, 72 hours post-operative) were collected. Median pre-operative serum albumin level was 2.5 g/dl (IQR, 2.1-2.8) in neonates versus 4 g/dl (IQR, 3.5-4.4) in infants. Hypoalbuminemia was defined as <25th percentile of these values. A total of 203 patients (126 neonates, 77 infants) were included in the study. Post-operative hypoalbuminemia developed in 12% of neonates and 20% of infants; 97% occurred in the first 48 hours. In multivariable analysis, perioperative hypoalbuminemia was not independently associated with any post-operative morbidity. However, when analysed as a continuous variable, lower serum albumin levels were associated with increased post-operative morbidity. Pre-operative low serum albumin level was independently associated with increased odds of post-operative hypoalbuminemia (OR, 3.67; 95% CI, 1.01-13.29) and prolonged length of hospital stay (RR, 1.40; 95% CI, 1.08-1.82). Lower 0-24-hour post-operative serum albumin level was independently associated with an increased duration of mechanical ventilation (RR, 1.35; 95% CI, 1.12-1.64). Future studies should further assess hypoalbuminemia in this population, with emphasis on evaluating clinically meaningful cut-offs and possibly the use of serum albumin levels in perioperative risk stratification models.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar/métodos , Cardiopatias Congênitas/cirurgia , Hipoalbuminemia/sangue , Albumina Sérica/metabolismo , Feminino , Seguimentos , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/mortalidade , Humanos , Hipoalbuminemia/epidemiologia , Hipoalbuminemia/etiologia , Lactente , Recém-Nascido , Masculino , Morbidade/tendências , Período Perioperatório , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
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