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1.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(1): 99-103, 2020 Jan 06.
Artigo em Chinês | MEDLINE | ID: mdl-31914576

RESUMO

To explore the epidemiological characteristics, trends and relevant factors of pre-hospital mortality due to acute myocardial infarction (AMI) from 1999 to 2016 in Tianjin city, based on mortality surveillance information and household registration population information. Standardized mortality rates were calculated using the year 2000 world standard population. From 1999 to 2016, the research result showed that the pre-hospital crude mortality rates of AMI were 39.47/100 000 to 90.64/100 000 and the standardized mortality rates were 30.92/100 000 to 53.90/100 000. The proportion of pre-hospital AMI deaths was 73.96%-81.92% (t=1.09, P>0.05) within the same period. Aged, female, rural residents, unmarried, divorced, widowed, low education level, and outdoor workers have a relative higher proportion of pre-hospital AMI mortality.


Assuntos
Infarto do Miocárdio/mortalidade , Idoso , China/epidemiologia , Cidades , Feminino , Humanos , Masculino , Mortalidade/tendências , Fatores Socioeconômicos
2.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1047849

RESUMO

Objetivo: descrever a mortalidade por causas externas no Estado de Rondônia no período de 1999 e 2015. Método: estudo de série temporal utilizando dados da Declaração de Óbito disponibilizados pela Agência de Vigilância em Saúde do Estado de Rondônia. Para a análise de tendência realizou-se regressão linear utilizando o pacote estatístico Stata®11. Resultados: foram registrados no Estado de Rondônia 111.651 óbitos sendo 22,2% classificados como causas externas. O coeficiente médio de óbitos por esta causa no período foi 89,7 por 100.000 habitantes e desvio padrão de 6,5. A regressão linear apresentou um aumento anual nos óbitos por acidentes de trânsito de 2,1%, os óbitos por agressões tiveram um decréscimo anual de 1,98%, suicídios e outras causas externas permaneceram estacionárias. Conclusão: os resultados evidenciaram a necessidade de fortalecimento das ações preventivas entre homens jovens e políticas públicas para redução de acidentes de trânsito no estado de Rondônia


Objective: the objective was to describe the mortality from external causes in the State of Rondônia in the period of 1999 and 2015. Method: a time series study using data from the Death Certificates provided by the Health Surveillance Agency of the State of Rondônia. Linear regression was used for the trend analysis using the statistical package Stata®11. Results: 111,651 deaths were recorded in the State of Rondônia, 22.2% of which were classified as external causes. The mean number of deaths due to this cause in the period was 89.7 per 100,000 inhabitants and the standard deviation was 6.5. The linear regression showed an annual increase in deaths due to traffic accidents of 2.1%, deaths due to aggressions had an annual decrease of 1.98%, suicides and other external causes remained stationary. Conclusion: the results evidenced the need to strengthen preventive actions among young men and public policies to reduce accidents in the state of Rondônia


Objetivo: el objetive fue describir la mortalidad por causas externas en el Estado de Rondônia en el período de 1999 y 2015. Método: estudio de serie temporal utilizando datos de la Declaración de Óbito disponibilizados por la Agencia de Vigilancia en Salud del Estado de Rondônia. Para el análisis de tendencia se realizó regresión lineal utilizando el paquete estadístico Stata®11. Resultados: se registraron en el Estado de Rondônia 111.651 óbitos siendo 22,2% clasificados como causas externas. El coeficiente medio de muertes por esta causa en el período fue 89,7 por 100.000 habitantes y desviación estándar de 6,5. La regresión lineal presentó un aumento anual en las muertes por accidentes de tránsito del 2,1%, las muertes por agresiones tuvieron un descenso anual del 1,98% y los suicídios y otras causas externas permanecieron estacionarias. Conslusión: los resultados evidenciaron la necesidad de fortalecimiento de las acciones preventivas entre hombres jóvenes y políticas públicas para reducción de accidentes en el estado de Rondônia


Assuntos
Humanos , Masculino , Feminino , Registros de Mortalidade/estatística & dados numéricos , Estudos de Séries Temporais , Mortalidade , Brasil , Causas Externas
3.
Rev. argent. salud publica ; 10(41): 28-36, 29/12/2019.
Artigo em Espanhol | LILACS, BINACIS, ARGMSAL | ID: biblio-1048235

RESUMO

La mortalidad guarda relación con las temperaturas diarias y los eventos extremos. Este estudio buscó analizar los efectos de las bajas temperaturas sobre la mortalidad en las principales ciudades de Argentina en el período 2005-2015. MÉTODOS: Se realizó un estudio de series temporales con modelos aditivos generalizados, modelando la relación entre bajas temperaturas y mortalidad para 21 ciudades de Argentina entre 2005 y 2015. Se analizó la mortalidad general y por grupos de sexo, edad y causa de muerte, en días fríos y días de olas de frío, así como los rezagos de 7 y 14 días posteriores a dichos eventos. RESULTADOS: En los 7 días posteriores a un día frío, el riesgo de muerte aumenta en la mitad de las ciudades entre un 1,04 [IC95%: 1,00-1,08] y un 1,14 [IC95%: 1,06-1,23] según la ciudad. El grupo de 65 años y más es el que muestra mayor impacto, con un incremento de hasta el 1,20 [IC95%: 1,05-1,39]. Las olas de frío se asocian con un aumento más pronunciado en el riesgo de morir en los siguientes 7 días en 8 ciudades (1,05 [IC95%: 1,03-1,08] a 1,30 [IC95%: 1,03-1,65]), y en 10 ciudades en los siguientes 14 días, aunque con valores algo más bajos. CONCLUSIONES: Con diferencias en magnitud y robustez estadística según las ciudades, la población de las áreas urbanas presenta un riesgo aumentado de muerte durante los 7 y 14 días posteriores a un evento de frío extremo


Assuntos
Mudança Climática , Mortalidade , Temperatura Baixa , Frio Extremo
4.
RECIIS (Online) ; 13(4): 863-876, out.-dez. 2019. ilus, tab
Artigo em Português | LILACS | ID: biblio-1047592

RESUMO

Este artigo se baseia em um estudo de série temporal sobre os óbitos fetais por malformações congênitas no estado do Maranhão relativo ao período de 2006 a 2016. Foram construídos indicadores epidemiológicos para estimar o risco de morte fetal e sua tendência ao longo da série estudada. Os dados são provenientes do Departamento de Informática do SUS e sua análise realizada por modelos de regressão linear. Foram registrados 17.843 óbitos fetais no período abordado pelo estudo, 528 dos quais decorrentes de malformações congênitas (2,96%). Observou-se uma tendência significativa de aumento do coeficiente de mortalidade fetal geral, correspondente a 6,99% (ß1=0,17; p=0,004) e do específico por malformações congênitas, equivalente a 5,13% (ß1=0,01; p=0,04). Os resultados deste estudo corroboram a tendência histórica dos serviços de saúde negligenciarem os óbitos fetais. É importante destacar que parte destes óbitos são preveníveis e potencialmente evitáveis. Desse modo, a implementação dos comitês de investigação de óbitos fetais e infantis e a sua vigilância adequada poderiam melhorar a assistência prestada tanto no pré-natal quanto no parto.


This article bases on a time series study about fetal deaths due to congenital malformations in the state of Maranhão, Brazil, occurred from 2006 to 2016. Epidemiological indicators were constructed to estimate the risk of fetal death and its trend throughout the series studied. The data were obtained in the Department of Informatics of SUS and analyzed by linear regression models. There were 17,843 fetal deaths during the analysed period, from which 528 were a direct result of congenital malformations (2.96%). A significant tendency towards an increase in the coefficient of general fetal mortality corresponding to 6.99% (ß1=0.17; p=0.004) and in the coefficient of specific fetal mortality due to congenital malformations equivalent to 5.13% (ß1=0.01; p=0.04) were observed. The end results of this study corroborate the historical trend toward negligence in Brazilian health centres with regard to fetal deaths. It is important to remark that some of these deaths can be presumed and potentially preventable. Thus, the implementation of the fetal and infant death investigation committees and their adequate surveillance could improve care during prenatal and delivery.


Este artículo se basa en un estudio de serie temporal acerca de muertes de fetos por malformaciones congénitas en el estado de Maranhão, Brasil, concerniente al periodo de 2006 a 2016. Se construyeron indicadores epidemiológicos para estimar el riesgo de la muerte fetal y su tendencia a lo largo de la serie estudiada. Los datos son provenientes del Departamento de Informática del SUS y fueron analizados por modelos de regresión lineal. Se registraron 17.843 muertes de fetos en el período estudiado, de los cuales 528 fueron resultado de malformaciones congénitas (2,96%). Se observó una tendencia significativa al aumento del coeficiente de mortalidad fetal general correspondiente a 6.99% (ß1=0,17; p=0,004) y del específico, por malformaciones congénitas, equivalente a 5,13% (ß1=0,01; p=0,04). Los resultados del estudio corroboran la tendencia histórica a la negligencia de los centros de salud brasileños con respecto a las muertes de los fetos. Por su importancia debemos destacar que parte de esas muertes son presumibles y pueden ser evitadas. De ese modo, la implementación de los comités de investigación de muertes de fetos y infantiles y su vigilancia adecuada podrían mejorar la asistencia prestada en el prenatal y en el parto.


Assuntos
Humanos , Anormalidades Congênitas , Sistemas de Informação , Epidemiologia , Mortalidade Fetal/tendências , Estudos Ecológicos , Morte Fetal/etiologia , Cuidado Pré-Natal , Saúde Materno-Infantil , Mortalidade , Indicadores de Desenvolvimento
5.
ABCS health sci ; 44(3): 154-160, 20 dez 2019. tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047649

RESUMO

INTRODUÇÃO: O homicídio é um problema de Saúde Pública no Brasil não raro relacionado com drogas ilícitas. OBJETIVO: Caracterizar os homicídios e os aspectos associados ao uso de drogas ilícitas. MÉTODOS: Estudo transversal, com abordagem quantitativa, realizado em João Pessoa, no estado da Paraíba, no Brasil, em 2014. Consideraram-se 424 vítimas de homicídios cujos dados foram coletados através de um instrumento próprio, analisados com auxílio de software estatístico, com Teste de Qui-Quadrado e Regressão Robusta de Poisson, considerando um nível confiança de 95% e significância estatística quando p<0,05. RESULTADOS: Predominância de vítimas de homicídios homens (93,2%), não brancos (97,2%), com até 30 anos, considerando as faixas etárias de menor de 20 anos (22,6%), de 20 a 24 (26,7%) e 25 a 29 (18,8%), com menos de sete anos de estudo (67,5%), com histórico de envolvimento com drogas ilícitas (72,5%) e de encarceramento (59,7%). Observaram-se associações entre envolvimento com drogas ilícitas e as variáveis: sexo (p=0,037), idade (p=0,002) e histórico de encarceramento (p<0,001). A prevalência ajustada de envolvimento com drogas ilícitas foi 67% maior entre aqueles com histórico de encarceramento (RP: 1,67; IC95%: 1,44-1,94) e 28% menor entre indivíduos com 30 anos ou mais (RP: 0,72; IC: 0,58-0,88). CONCLUSÃO: O homicídio está inserido em um quadro de complexas questões sociais, dentre as quais se insere o envolvimento com drogas ilícitas, e é mais prevalente entre indivíduos com histórico de encarceramento e menos prevalente entre os de mais de 30 anos.


INTRODUCTION: Homicide is a public health problem in Brazil that is often related to illicit drugs. OBJECTIVE: To characterize homicides and aspects associated with the use of illicit drugs. METHODS: A cross-sectional study with a quantitative approach carried out in Joao Pessoa, in the state of Paraiba, Brazil, in 2014. 424 homicide victims whose data were collected through a specific instrument were considered, analyzed descriptively and analytically with the aid of statistical software, with Chi Squared Test and Robust Poisson Regression, considering a confidence level of 95% and statistical significance when p<0.05. RESULTS: Prevalence of homicide victims (93.2%), non-whites (97.2%), with up to 30 years, considering the age groups below 20 years (22.6%), 20-24 (26.7%) and 25 to 29 (18.8%), with less than seven years of study (67.5%), with a history of involvement with illicit drugs (72.5%) and incarceration (59.7%). There was an association between involvement with illicit drugs with sex (p=0.037), age (p=0.002) and history of incarceration (p<0.001). There was a 67% higher prevalence of involvement with illicit drugs among those with a history of incarceration (PR: 1.67, 95% CI: 1.44-1.94) and 28% lower among individuals aged 30 years or older (PR: 0.72, CI: 0.58-0.88). CONCLUSION: Homicide is part of a complex set of social issues, including involvement with illicit drugs, which is more prevalent among young adults and individuals with a history of incarceration.


Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Violência/estatística & dados numéricos , Drogas Ilícitas , Mortalidade , Transtornos Relacionados ao Uso de Substâncias , Homicídio/estatística & dados numéricos
6.
BMJ ; 367: l6377, 2019 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-31852659

RESUMO

OBJECTIVE: To explore associations between different frequencies of arts engagement and mortality over a 14 year follow-up period. DESIGN: Prospective cohort study. PARTICIPANTS: English Longitudinal Study of Ageing cohort of 6710 community dwelling adults aged 50 years and older (53.6% women, average age 65.9 years, standard deviation 9.4) who provided baseline data in 2004-05. INTERVENTION: Self reported receptive arts engagement (going to museums, art galleries, exhibitions, the theatre, concerts, or the opera). MEASUREMENT: Mortality measured through data linkage to the National Health Service central register. RESULTS: People who engaged with receptive arts activities on an infrequent basis (once or twice a year) had a 14% lower risk of dying at any point during the follow-up (809/3042 deaths, hazard ratio 0.86, 95% confidence interval 0.77 to 0.96) compared with those who never engaged (837/1762 deaths). People who engaged with receptive arts activities on a frequent basis (every few months or more) had a 31% lower risk of dying (355/1906 deaths, 0.69, 0.59 to 0.80), independent of demographic, socioeconomic, health related, behavioural, and social factors. Results were robust to a range of sensitivity analyses with no evidence of moderation by sex, socioeconomic status, or social factors. This study was observational and so causality cannot be assumed. CONCLUSIONS: Receptive arts engagement could have a protective association with longevity in older adults. This association might be partly explained by differences in cognition, mental health, and physical activity among those who do and do not engage in the arts, but remains even when the model is adjusted for these factors.


Assuntos
Arte , Participação da Comunidade/estatística & dados numéricos , Mortalidade/tendências , Idoso , Cognição , Inglaterra/epidemiologia , Exercício , Feminino , Seguimentos , Comportamentos Relacionados com a Saúde , Humanos , Longevidade , Estudos Longitudinais , Masculino , Saúde Mental , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medicina Estatal
7.
Rev. Hosp. El Cruce ; (25): 44-48, Dic 2019.
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1047126

RESUMO

El score de riesgo KAsH fue diseñado como alternativa para predecir mortalidad intrahospitalaria en pacientes con IAMCEST en una población europea, y cuenta con variables sencillas que se pueden obtener en la cabecera de los pacientes. OBJETIVO:Validar el score KAsH en nuestro medio y compararlo con otros scores. METODOLOGÍA: La validación se realizó en una base de datos hospitalaria del conurbano bonaerense que cuenta con un registro consecutivo y en forma prospectiva de pacientes con IAMCEST desde mayo de 2009 a julio de 2018 (n=977). Se descartaron los casos con información incompleta. Para cada paciente se calculó un puntaje según la fórmula KAsH y se agruparon en 4 categorías. La discriminación del modelo se evaluó con curva ROC y se calculó el área bajo la curva (AUC) con su respectivo intervalo de confianza. El score KAsH se comparó con los modelos GRACE, TIMI y ProACS mediante el test de DeLong. RESULTADOS: Se incluyeron 884 casos con información completa. La mortalidad intrahospitalaria fue 5.2% y por subgrupos fue la siguiente: 1=0.91%, 2=5.1%, 3=18.8%, 4=53.3%. El AUC fue de 0.86 (IC 95% 0,80-0.93). El análisis de comparaciones múltiples de AUC evaluado con el test de DeLong no evidenció diferencias estadísticamente significativas (p=0.18). CONCLUSIONES: El score KAsH presentó buena discriminación y calibración para pronóstico de mortalidad intrahospitalaria en nuestro medio. Dado que requiere pocas variables de sencilla adquisición, la aplicación del score KAsH puede constituir una alternativa atractiva a los scores tradicionales.


The KAsH risk score was designed as an alternative to predict in-hospital mortality in patients with IAMCEST in a European population, and has variables that can be obtained at the bedside. OBJECTIVE: To validate the KAsH score in our environment and compare it with other scores. METHODS: The validation was carried out in a hospital database of the Buenos Aires suburbs that has a consecutive and prospective registry of patients with IAMCEST from May 2009 to July 2018 (n = 977). Cases with incomplete information were ruled out. For each patient, a score was calculated according to the KAsH formula and grouped into 4 categories. The discrimination of the model was evaluated with the ROC curve and the area under the curve (AUC) was calculated with its respective confidence interval. The KAsH score was compared with the GRACE, TIMI and ProACS models using the DeLong test. RESULTS: 884 cases with complete information were included. In-hospital mortality was 5.2% and by subgroups it was as follows: 1 = 0.91%, 2 = 5.1%, 3 = 18.8%, 4 = 53.3%. The AUC was 0.86 (95% CI 0.80-0.93). The analysis of multiple comparisons of AUC evaluated with the DeLong test showed no statistically significant differences (p = 0.18). CONCLUSIONS: The KAsH score presented good discrimination and calibration for in-hospital mortality prognosis in our environment. Since it requires few variables of simple acquisition, the application of the KAsH score can be an attractive alternative to traditional scores.


Assuntos
Prognóstico , Mortalidade , Estudos de Validação , Infarto do Miocárdio
8.
Nature ; 575(7781): 119-129, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31695203

RESUMO

Vaccination against infectious diseases has changed the future of the human species, saving millions of lives every year, both children and adults, and providing major benefits to society as a whole. Here we show, however, that national and sub-national coverage of vaccination varies greatly and major unmet needs persist. Although scientific progress opens exciting perspectives in terms of new vaccines, the pathway from discovery to sustainable implementation can be long and difficult, from the financing, development and licensing to programme implementation and public acceptance. Immunization is one of the best investments in health and should remain a priority for research, industry, public health and society.


Assuntos
Desenvolvimento de Medicamentos/economia , Vacinação/tendências , Vacinas/imunologia , Vacinas/provisão & distribução , Animais , Humanos , Mortalidade , Filipinas/epidemiologia , Mudança Social , Vacinação/economia , Vacinas/economia
9.
BMJ ; 367: l6055, 2019 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-31748235

RESUMO

OBJECTIVE: To determine the relation between age and troponin level and its prognostic implication. DESIGN: Retrospective cohort study. SETTING: Five cardiovascular centres in the UK National Institute for Health Research Health Informatics Collaborative (UK-NIHR HIC). PARTICIPANTS: 257 948 consecutive patients undergoing troponin testing for any clinical reason between 2010 and 2017. MAIN OUTCOME MEASURE: All cause mortality. RESULTS: 257 948 patients had troponin measured during the study period. Analyses on troponin were performed using the peak troponin level, which was the highest troponin level measured during the patient's hospital stay. Troponin levels were standardised as a multiple of each laboratory's 99th centile of the upper limit of normal (ULN). During a median follow-up of 1198 days (interquartile range 514-1866 days), 55 850 (21.7%) deaths occurred. A positive troponin result (that is, higher than the upper limit of normal) signified a 3.2 higher mortality hazard (95% confidence interval 3.1 to 3.2) over three years. Mortality varied noticeably with age, with a hazard ratio of 10.6 (8.5 to 13.3) in 18-29 year olds and 1.5 (1.4 to 1.6) in those older than 90. A positive troponin result was associated with an approximately 15 percentage points higher absolute three year mortality across all age groups. The excess mortality with a positive troponin result was heavily concentrated in the first few weeks. Results were analysed using multivariable adjusted restricted cubic spline Cox regression. A direct relation was seen between troponin level and mortality in patients without acute coronary syndrome (ACS, n=120 049), whereas an inverted U shaped relation was found in patients with ACS (n=14 468), with a paradoxical decline in mortality at peak troponin levels >70×ULN. In the group with ACS, the inverted U shaped relation persisted after multivariable adjustment in those who were managed invasively; however, a direct positive relation was found between troponin level and mortality in patients managed non-invasively. CONCLUSIONS: A positive troponin result was associated with a clinically important increased mortality, regardless of age, even if the level was only slightly above normal. The excess mortality with a raised troponin was heavily concentrated in the first few weeks. STUDY REGISTRATION: ClinicalTrials.gov NCT03507309.


Assuntos
Envelhecimento/sangue , Doenças Cardiovasculares , Troponina/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/terapia , Estudos de Coortes , Tratamento Conservador/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Fatores de Risco , Reino Unido/epidemiologia
11.
BMJ ; 367: l5584, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619383

RESUMO

OBJECTIVE: To investigate the association between weight changes across adulthood and mortality. DESIGN: Prospective cohort study. SETTING: US National Health and Nutrition Examination Survey (NHANES) 1988-94 and 1999-2014. PARTICIPANTS: 36 051 people aged 40 years or over with measured body weight and height at baseline and recalled weight at young adulthood (25 years old) and middle adulthood (10 years before baseline). MAIN OUTCOME MEASURES: All cause and cause specific mortality from baseline until 31 December 2015. RESULTS: During a mean follow-up of 12.3 years, 10 500 deaths occurred. Compared with participants who remained at normal weight, those moving from the non-obese to obese category between young and middle adulthood had a 22% (hazard ratio 1.22, 95% confidence interval 1.11 to 1.33) and 49% (1.49, 1.21 to 1.83) higher risk of all cause mortality and heart disease mortality, respectively. Changing from obese to non-obese body mass index over this period was not significantly associated with mortality risk. An obese to non-obese weight change pattern from middle to late adulthood was associated with increased risk of all cause mortality (1.30, 1.16 to 1.45) and heart disease mortality (1.48, 1.14 to 1.92), whereas moving from the non-obese to obese category over this period was not significantly associated with mortality risk. Maintaining obesity across adulthood was consistently associated with increased risk of all cause mortality; the hazard ratio was 1.72 (1.52 to 1.95) from young to middle adulthood, 1.61 (1.41 to 1.84) from young to late adulthood, and 1.20 (1.09 to 1.32) from middle to late adulthood. Maximum overweight had a very modest or null association with mortality across adulthood. No significant associations were found between various weight change patterns and cancer mortality. CONCLUSIONS: Stable obesity across adulthood, weight gain from young to middle adulthood, and weight loss from middle to late adulthood were associated with increased risks of mortality. The findings imply that maintaining normal weight across adulthood, especially preventing weight gain in early adulthood, is important for preventing premature deaths in later life.


Assuntos
Doenças Cardiovasculares , Causas de Morte , Mortalidade Prematura/tendências , Mortalidade/tendências , Neoplasias , Ganho de Peso , Perda de Peso , Adulto , Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/mortalidade , Inquéritos Nutricionais , Obesidade/diagnóstico , Obesidade/mortalidade , Estudos Prospectivos , Fatores de Risco , Estados Unidos/epidemiologia , Razão Cintura-Estatura
12.
Medicine (Baltimore) ; 98(41): e17535, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593129

RESUMO

Scedosporium genus as a significant emerging opportunist causes a broad spectrum of disease in not only immunosuppressed but also immunocompetent patients. The lung is one of the most commonly encountered sites of Scedosporium infection. Due to its very high levels of antifungal resistance, surgery has been recommended as an important part in the treatment of pulmonary Scedosporium spp infection, even in immunocompetent cases. However, whether lung surgery could help to reduce the risk of death in immunocompetent patients is not clear.We retrospectively retrieved the records of pulmonary infections with Scedosporium species in immunocompetent patients through a comprehensive literature search. The association of surgery on all-cause mortality was explored using binary logistic regression (BLR). Receiver operating characteristic (ROC) curve analysis was carried out to evaluate the capability of the model.The comprehensive searching strategy yielded 33 case reports and 3 case series in total, with 40 individual patients being included. The overall mortality was 12.50%. The fatality rate was 9.09% (2/22) in cases with surgery and 16.67% (3/18) in cases without surgery (odds ratio, 0.50; 95% confidence interval, 0.07-3.38; P = .48). Consistently, BLR analysis identified no statistical association between surgery and reduced mortality (odds ratio, 1.19; 95% confidence interval, 0.09-15.64; P = .89), after adjusting for age, gender, and antifungal chemotherapy. The area under the ROC curve was 0.88.For immunocompetent patients with pulmonary Scedosporium spp infection, surgical therapy may not be associated with reduced mortality. Surgical excision could be considered but is not imperative in this group of patients.


Assuntos
Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/cirurgia , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/cirurgia , Scedosporium/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Farmacorresistência Fúngica/fisiologia , Feminino , Humanos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Pneumopatias Fúngicas/microbiologia , Pneumopatias Fúngicas/mortalidade , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Micoses/tratamento farmacológico , Micoses/epidemiologia , Micoses/microbiologia , Micoses/mortalidade , Estudos Observacionais como Assunto , Cuidados Pós-Operatórios , Infecções Respiratórias/microbiologia , Infecções Respiratórias/mortalidade , Estudos Retrospectivos , Scedosporium/isolamento & purificação , Voriconazol/administração & dosagem , Voriconazol/uso terapêutico
13.
Rev Bras Epidemiol ; 22Suppl 1(Suppl 1): e190007, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31576983

RESUMO

OBJECTIVE: To analyze the pattern of spatial distribution of hepatitis B virus (HBV) cases and the mortality attributed to this disease throughout the Brazilian territory, in 2005, 2016 and 2017. METHODS: This is an ecological study of spatial analysis, using data from the Information System for Notifiable Diseases and the Brazilian Mortality Information System. HBV detection and mortality rates were analyzed. The spatial analysis from 2005 to 2017 was held through the Global Moran's Index (I) for global data and the Local Indicators of Spatial Association (LISA) for the 5,564 municipalities of the country. RESULTS: The North region stands out with the highest HBV detection and mortality rates in the country. The Global Moran's I showed a spatial correlation of HBV cases in Brazil, and the LISA Map evidenced the presence of hotspots or spatial clusters (high-high type), mainly in the North region and also in some municipalities of Santa Catarina, Paraná, Rio Grande do Sul, Espírito Santo, São Paulo and Rio de Janeiro. CONCLUSION: The spatial analysis of the HBV distribution pattern in Brazil shows areas with a large concentration of cases, particularly in the North of the country and in other points distributed throughout the national territory. These data reinforce the urgency of intervention actions related to prevention, diagnosis and treatment of hepatitis B.


Assuntos
Vírus da Hepatite B , Hepatite B/mortalidade , Brasil/epidemiologia , Cidades/epidemiologia , Geografia , Humanos , Mortalidade/tendências , Prevalência , Análise Espaço-Temporal , Fatores de Tempo
14.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(10): 1012-1017, 2019 Oct 06.
Artigo em Chinês | MEDLINE | ID: mdl-31607047

RESUMO

Objective: Using three models too estimate excess mortality associated with influenza of Shanxi Province during 2013-2017. Methods: Mortality data and influenza surveillance data of 11 cities of Shanxi Province from the 2013-2014 through 2016-2017 were used to estimate influenza-associated all cause deaths, circulatory and respiratory deaths and respiratory deaths. Three models were used: (i) Serfling regression, (ii)Poisson regression, (iii)General line model. Results: The total reported death cases of all cause were 157 733, annual death cases of all cause were 39 433, among these cases, male cases 93 831 (59.50%), cases above 65 years old 123 931 (78.57%). Annual influenza-associated excess mortality, for all causes, circulatory and respiratory deaths, respiratory deaths were 8.62 deaths per 100 000, 6.33 deaths per 100 000 and 0.68 deaths per 100 000 estimated by Serfling model, respectively; and 21.30 deaths per 100 000, 16.89 deaths per 100 000 and 2.14 deaths per 100 000 estimated by General line model, respectively; and 21.76 deaths per 100 000, 17.03 deaths per 100 000 and 2.05 deaths per 100 000, estimated by Poisson model, respectively. Influenza-related excess mortality was higher in people over 75 years old; influenza-associated excess mortalityfor all causes, circulatory and respiratory deaths, respiratory deaths were 259.67 deaths per 100 000, 229.90 deaths per 100 000 and 32.63 deaths per 100 000, estimated by GLM model, respectively; and 269.49 deaths per 100 000, 233.69 deaths per 100 000 and 31.27 deaths per 100 000, estimated by Poisson model,respectively. Conclusion: Excess mortality associated with influenza mainly caused by A (H3N2), Influenza caused the most associated death amongold people.


Assuntos
Influenza Humana/epidemiologia , China/epidemiologia , Cidades , Humanos , Vírus da Influenza A Subtipo H3N2 , Mortalidade/tendências
15.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(3): 429-432, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31631613

RESUMO

Objective: To evaluate the clinical predictive ability of POSSUM and P-POSSUM scoring system in laparoscopic pancreatoduodenectomy (LPD). Methods: There were 132 consecutive LPD performed in West China Hospital of Sichuan University from February 2014 to July 2017. The clinical data were retrospective collected, including 12 preoperative physiological variables, 6 operative severity variables, and complications and mortality The postoperative expected mortality and morbidity were calculated by POSSUM and P-POSSUM score, and compared with measured morbidity and mortality. The clinical predictive ability of POSSUM and P-POSSUM system was evaluated by the receiver operating characteristic (ROC) curve and hierarchical analysis. Results: The area under ROC curve ( AUC) was 0.83. The preoperative physiological score (PS) and POSSUM score of the patients with complications were higher, and the difference was statistically significant ( P<0.01). For the prediction of complications after LPD, the expected value was the most accurate to the measured value when POSSUM score was >0.4-0.6. POSSUM scoring system had no significant difference in predicting the incidence of complications for benign and malignant lesions ( P>0.05), with a higher predictive value for malignant tumors. It was valuable in predicting the incidence of complications in male and female, and there was no significant difference in expected value between the sexes. Expected morbidity rate by POSSUM scoring system was 36.6% and measured morbidity rate was 33.3%. The expected and measured morbidities had no significantly differences. The expected mortality was 7.0% and measured mortality rate was 1.5%. The expected and measured mortality had no significantly differences. Expected mortality by P-POSSUM system was 1.6%, the expected and measured mortality had no significantly differences. Conclusion: POSSUM and P-POSSUM scoring system had high value for predicting LPD postoperative morbidity and mortality of LPD patients.


Assuntos
Laparoscopia/efeitos adversos , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , China , Feminino , Humanos , Masculino , Morbidade , Mortalidade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença
16.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(9): 1128-1132, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31657338

RESUMO

OBJECTIVE: To investigate the effect of circadian heart rate variation on short-term and long-term mortality in intensive care unit (ICU) patients. METHODS: A retrospective cohort study was conducted. A total of 32 536 ICU patients were recorded from 2001 to 2008 published by Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II v2.6) in April 2011. The circadian heart rate variation was defined as the ratio of mean nighttime (23:00 to 07:00) heart rate to mean daytime (07:00 to 23:00) heart rate. The 28-day mortality and 1-year mortality were defined as outcome events. The information such as age, gender, ethnicity, first sequential organ failure assessment (SOFA) score, first simplified acute physiology score I (SAPS I), usage of sedatives and catecholamines within 24 hours admission of ICU, clinical complications [hypertension, chronic obstructive pulmonary disease (COPD), diabetes with or without complications, congestive heart failure, liver disease, renal failure, etc.], and the complete heart rate records within 24 hours after ICU admission were collected. Cox proportional risk regression models were used to investigate the association between circadian heart rate variation and 28-day mortality and 1-year mortality in ICU patients. Besides, subgroup analysis was also performed in patients with different first SOFA scores. RESULTS: Totally 15 382 ICU patients in MIMIC-II database were enrolled, excluding the patients without heart rate records or death records, using pacemaker with arrhythmia, without SOFA or SAPS I score records. Finally, 9 439 patients were enrolled in the study cohort. (1) Cox regression analysis of the whole patient showed that the higher circadian heart rate variation was correlated with the increased 28-day mortality [hazard ratio (HR) = 1.613, 95% confidence interval (95%CI) was 1.338-1.943, P < 0.001] and 1-year mortality (HR = 1.573, 95%CI was 1.296-1.908, P < 0.001). After adjustment for demographic factors (age, gender and ethnicity), severity of illness (SOFA and SAPS I scores), clinical complications (hypertension, COPD, diabetes with or without complications, congestive heart failure, liver disease, renal failure, etc.), and influence of medications (sedatives and catecholamines), the night-day heart rate ratio was also correlated with 28-day mortality (HR = 1.256, 95%CI was 1.018-1.549, P = 0.033) and 1-year mortality (HR = 1.249, 95%CI was 1.010-1.545, P = 0.040). (2) According to the SOFA score (median value of 5), the patients were divided into two subgroups, in which 5 478 patients with SOFA score ≤ 5 and 3 961 patients with SOFA score > 5. Cox regression subgroup analysis showed that circadian heart rate variation was related with higher 28-day mortality (HR = 1.430, 95%CI was 1.164-1.756, P = 0.001) and 1-year mortality (HR = 1.393, 95%CI was 1.123-1.729, P = 0.003) in patients with SOFA score > 5. After adjustment for covariates, the 28-day mortality (HR = 1.279, 95%CI was 1.032-1.584, P = 0.025) and 1-year mortality (HR = 1.255, 95%CI was 1.010-1.558, P = 0.040) also increased with the increasing of night-day heart rate ratio in patients with SOFA score > 5. However, the relationships did not exist in patients with SOFA score ≤ 5. CONCLUSIONS: In ICU patients, the 28-day mortality and 1-year mortality increase with the higher circadian heart rate variation, which indicates that the circadian heart rate variation in ICU patients is positively correlated with the short-term and long-term mortality, especially in patients with relatively severe illness.


Assuntos
Relógios Circadianos , Frequência Cardíaca/fisiologia , Unidades de Terapia Intensiva , Mortalidade/tendências , Cuidados Críticos , Humanos , Escores de Disfunção Orgânica , Prognóstico , Estudos Retrospectivos
17.
Zhonghua Xin Xue Guan Bing Za Zhi ; 47(10): 790-797, 2019 Oct 24.
Artigo em Chinês | MEDLINE | ID: mdl-31648461

RESUMO

Objective: To explore the value of SYNTAX revascularization index (SRI) on evaluating the long-term prognosis of coronary artery disease (CAD) patients implanted with biodegradable polymer drug-eluting stents (BP-DES) and define the best threshold of SRI for predicting all-cause mortality in these patients. Methods: Data used in this study derived from the I-LOVE-IT 2 trial (evaluate safety and effectiveness of the Tivoli DES and the Firebird DES for treatment of coronary). I-LOVE-IT 2 trial was a prospective, multicenter, randomized, assessor-blinded, non-inferiority study. A total of 1 829 patients implanted with BP-DES were divided into 3 groups, namely SRI=100% group (n=963), 50%≤SRI<100% group (n=527) and SRI<50% group (n=339). The primary endpoint was 48-month patient-oriented composite endpoint (PoCE), a composite of all-cause mortality, myocardial infarction(MI), stroke, and/or any revascularization. The secondary endpoints were components of PoCE and definite/probable stent thrombosis at 48 months. The receiver operating characteristic curve was used to investigate the best cut-off point of SRI for 48-month all-cause mortality. The Cox regression analysis was used to identify independent predictors of the all-cause death and PoCE at 48 months. Results: Incidence of PoCE at 48 months was significantly lower in SRI=100% group than patients with 50%≤SRI<100%(17.34% (167/963) vs. 22.20% (117/527), P<0.05) and SRI<50% (17.34% (167/963) vs. 24.78% (84/339), P<0.05). Comparing with SRI=100% group, the patients with 50%≤SRI<100% suffered higher rates of all MI (7.78% (41/527) vs. 4.26% (41/963), P<0.05) and target vessel MI (6.45% (34/527) vs. 4.26% (41/963), P<0.05); patients with SRI<50% had higher rates of all-cause mortality (5.90% (20/339) vs. 3.12% (30/963), P<0.05) and any revascularization (14.16% (48/339) vs. 3.12% (30/963), P<0.05). The receiver operating characteristic curve analysis showed that the SRI=65% was the best cut-off point to predict the all-cause mortality at 48 months (area under the curve was 0.58, sensitive was 0.47, specificity was 0.70). Meanwhile, SRI<65% was an independent predictor of 48-month all-cause mortality (HR=2.06, 95%CI 1.25-3.38) and PoCE (HR=1.34, 95%CI 1.09-1.66). Conclusions: SRI serves as a good index for predicting long-term prognosis and SRI<65% is an independent predictor of 48-month PoCE and all-cause mortality for CAD patients with BP-DES implantation. Meanwhile, SRI≥65% might be a reasonable threshold of incomplete revascularization.


Assuntos
Doença da Artéria Coronariana/terapia , Stents Farmacológicos , Implantes Absorvíveis , Humanos , Mortalidade , Polímeros , Prognóstico , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento
18.
Zhonghua Zhong Liu Za Zhi ; 41(10): 721-727, 2019 Oct 23.
Artigo em Chinês | MEDLINE | ID: mdl-31648492

RESUMO

Objective: Using updated population-based cancer registration (PBCR) data, we estimated nation-wide liver cancer statistics overall, by sex and by areas in China. Methods: Qualified PBCR data of liver cancer in 2015 which met the data quality criteria were stratified by geographical locations, sex, and age groups. Age-specific incidence and mortality rates by sex and area were calculated. The burden of liver cancer was evaluated by multiplying these rates by the year of 2015 population. Chinese standard population in 2000 and World Segi's population were used for the calculation of age-standardized rates (ASR) of incidence and mortality. Results: Qualified 368 cancer registries covered a total of 309 553 499 populations in China, accounting for 22.52% of the national population. It is estimated that there were 370 000 new cases (274 000 males and 96 000 females) of liver cancer in China. The age-standardized incidence rates by Chinese standard population (ASR China) and World Segi's population (ASR World) were 17.64 per 100 000 and 17.35 per 100 000, respectively. Rural areas showed higher incidence (ASR China: 20.07 per 100 000, ASR World: 19.67 per 100 000) than urban areas (ASR China: 15.90 per 100 000, ASR world: 15.67 per 100 000). Subgroup analysis showed that western areas of China had highest incidence rate of liver cancer, with the ASR China of 20.65 per 100 000 and 20.22 per 100 000 for ASR world, respectively. For new cases of liver cancer deaths, there were 326 000 new deaths (242 000 males and 84 000 females) in China, with age-standardized mortality rate by Chinese standard population and World Segi's population of 15.33 per 100 000 and 15.09 per 100 000, respectively. Rural areas showed higher mortality (ASR China: 17.17 per 100 000, ASR world: 16.86 per 100 000) than urban areas (ASR China: 14.00 per 100 000, ASR World: 13.81 per 100 000). Conclusions: There is still a heavy burden of liver cancer in China. Rural residents have higher incidence and mortality of liver cancer compared with urban counterparts. It is likely that many factors such as hepatitis virus infection, and aflatoxin exposure play a dominating role. Prevention and control strategies should be enhanced in the future.


Assuntos
Neoplasias Hepáticas/epidemiologia , Mortalidade/tendências , Sistema de Registros , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Grupo com Ancestrais do Continente Asiático , China/epidemiologia , Feminino , Humanos , Incidência , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Sistema de Registros/estatística & dados numéricos , Características de Residência
19.
J Frailty Aging ; 8(4): 180-185, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637403

RESUMO

BACKGROUND: Due to differences in the definition of frailty, many different screening instruments have been developed. However, the predictive validity of these instruments among community-dwelling older people remains uncertain. OBJECTIVE: To investigate whether combined (i.e. sequential or parallel) use of available frailty instruments improves the predictive power of dependency in (instrumental) activities of daily living ((I)ADL), mortality and hospitalization. DESIGN, SETTING AND PARTICIPANTS: A prospective cohort study with two-year follow-up was conducted among pre-frail and frail community-dwelling older people in the Netherlands. MEASUREMENTS: Four combinations of two highly specific frailty instruments (Frailty Phenotype, Frailty Index) and two highly sensitive instruments (Tilburg Frailty Indicator, Groningen Frailty Indicator) were investigated. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for all single instruments as well as for the four combinations, sequential and parallel. RESULTS: 2,420 individuals participated (mean age 76.3 ± 6.6 years, 60.5% female) in our study. Sequential use increased the levels of specificity, as expected, whereas the PPV hardly increased. Parallel use increased the levels of sensitivity, although the NPV hardly increased. CONCLUSIONS: Applying two frailty instruments sequential or parallel might not be a solution for achieving better predictions of frailty in community-dwelling older people. Our results show that the combination of different screening instruments does not improve predictive validity. However, as this is one of the first studies to investigate the combined use of screening instruments, we recommend further exploration of other combinations of instruments among other study populations.


Assuntos
Atividades Cotidianas , Avaliação Geriátrica/métodos , Hospitalização , Mortalidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Idoso Fragilizado , Humanos , Masculino , Países Baixos/epidemiologia , Valor Preditivo dos Testes , Estudos Prospectivos
20.
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
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