Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 11.723
Filtrar
1.
Epidemiol Infect ; 149: e156, 2021 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-34210370

RESUMO

We estimate the delay-adjusted all-cause excess deaths across 53 US jurisdictions. Using provisional data collected from September through December 2020, we first identify a common mean reporting delay of 2.8 weeks, whereas four jurisdictions have prolonged reporting delays compared to the others: Connecticut (mean 5.8 weeks), North Carolina (mean 10.4 weeks), Puerto Rico (mean 4.7 weeks) and West Virginia (mean 5.5 weeks). After adjusting for reporting delays, we estimate the percent change in all-cause excess mortality from March to December 2020 with range from 0.2 to 3.6 in Hawaii to 58.4 to 62.4 in New York City. Comparing the March-December with September-December 2020 periods, the highest increases in excess mortality are observed in South Dakota (36.9-54.0), North Dakota (33.9-50.7) and Missouri (27.8-33.9). Our findings indicate that analysis of provisional data requires caution in interpreting the death counts in recent weeks, while one needs also to account for heterogeneity in reporting delays of excess deaths among US jurisdictions.


Assuntos
Mortalidade/tendências , COVID-19/mortalidade , História do Século XXI , Humanos , Mortalidade/história , Vigilância da População , Estados Unidos
2.
J Environ Public Health ; 2021: 5582589, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34194512

RESUMO

FluMOMO is a universal formula to forecast mortality in 27 European countries and was developed on EuroMOMO context, http://www.euromomo.eu. The model has a trigonometric baseline and considers any upwards deviation from that to come from flu or extreme temperatures. To measure it, the model considers two variables: influenza activity and extreme temperatures. With the former, the model gives the number of deaths because of flu and with the latter the number of deaths because of extreme temperatures. In this article, we show that FluMOMO lacks important variables to be an accurate measure of all-cause mortality and flu mortality. Indeed, we found, as expected, that population ageing and exposure to the risk of death cannot be excluded from the linear predictor. We model weekly deaths as an autoregressive process (lag of one together with a lead of one week). This step allowed us to avoid FluMOMO trigonometric baseline and have a fit to weekly deaths through demographic variables. Our model uses data from Portugal between 2009 and 2020, on ISO-week basis. We use negative binomial-generalized linear models to estimate the weekly number of deaths as an alternative to traditional overdispersion Poisson. As explanatory variables were found to be statistically significant, we registered the number of deaths from the previous week, the influenza activity index, the population average age, the heat waves, the flu season, the number of deaths with COVID-19, and the population exposed to the risk of dying. Considering as excess mortality the number of deaths above the best estimate of deaths from our model, we conclude that excess mortality in 2020 (net of COVID-19 deaths, heat wave of July, and ageing) is low or inexistent. The model also allows us to have the number of deaths arising from flu and we conclude that FluMOMO is overestimating deaths from flu by 78%. Averages from the probability of dying are obtained as well as the probability of dying from flu. The latter is shown to be decreasing over time, probably due to the increase of flu vaccination. Higher mortality detected with the start of COVID-19, in March-April 2020, was probably due to COVID-19 deaths not recognized as COVID-19 deaths.


Assuntos
Influenza Humana/epidemiologia , Mortalidade/tendências , População , COVID-19 , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Modelos Estatísticos , Portugal , SARS-CoV-2 , Estações do Ano , Vacinação
3.
PLoS One ; 16(7): e0254550, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34255793

RESUMO

BACKGROUND: COVID-19 pandemic has rapidly required a high demand of hospitalization and an increased number of intensive care units (ICUs) admission. Therefore, it became mandatory to develop prognostic models to evaluate critical COVID-19 patients. MATERIALS AND METHODS: We retrospectively evaluate a cohort of consecutive COVID-19 critically ill patients admitted to ICU with a confirmed diagnosis of SARS-CoV-2 pneumonia. A multivariable Cox regression model including demographic, clinical and laboratory findings was developed to assess the predictive value of these variables. Internal validation was performed using the bootstrap resampling technique. The model's discriminatory ability was assessed with Harrell's C-statistic and the goodness-of-fit was evaluated with calibration plot. RESULTS: 242 patients were included [median age, 64 years (56-71 IQR), 196 (81%) males]. Hypertension was the most common comorbidity (46.7%), followed by diabetes (15.3%) and heart disease (14.5%). Eighty-five patients (35.1%) died within 28 days after ICU admission and the median time from ICU admission to death was 11 days (IQR 6-18). In multivariable model after internal validation, age, obesity, procaltitonin, SOFA score and PaO2/FiO2 resulted as independent predictors of 28-day mortality. The C-statistic of the model showed a very good discriminatory capacity (0.82). CONCLUSIONS: We present the results of a multivariable prediction model for mortality of critically ill COVID-19 patients admitted to ICU. After adjustment for other factors, age, obesity, procalcitonin, SOFA and PaO2/FiO2 were independently associated with 28-day mortality in critically ill COVID-19 patients. The calibration plot revealed good agreements between the observed and expected probability of death.


Assuntos
COVID-19/mortalidade , Mortalidade/tendências , COVID-19/epidemiologia , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Cardiopatias/epidemiologia , Humanos , Hipertensão/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Obesidade/epidemiologia
4.
Pathol Oncol Res ; 27: 1609774, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34257618

RESUMO

Objective: This study examined cumulative excess mortality in European countries in the year of the Covid-19 pandemic and characterized the dynamics of the pandemic in different countries, focusing on Hungary and the Central and Eastern European region. Methods: Age-standardized cumulative excess mortality was calculated based on weekly mortality data from the EUROSTAT database, and was compared between 2020 and the 2016-2019 reference period in European countries. Results: Cumulate weekly excess mortality in Hungary was in the negative range until week 44. By week 52, it reached 9,998 excess deaths, corresponding to 7.73% cumulative excess mortality vs. 2016-2019 (p-value = 0.030 vs. 2016-2019). In Q1, only Spain and Italy reported excess mortality compared to the reference period. Significant increases in excess mortality were detected between weeks 13 and 26 in Spain, United Kingdom, Belgium, Netherland and Sweden. Romania and Portugal showed the largest increases in age-standardized cumulative excess mortality in the Q3. The majority of Central and Eastern European countries experienced an outstandingly high impact of the pandemic in Q4 in terms of excess deaths. Hungary ranked 11th in cumulative excess mortality based on the latest available data of from the EUROSTAT database. Conclusion: Hungary experienced a mortality deficit in the first half of 2020 compared to previous years, which was followed by an increase in mortality during the second wave of the COVID-19 pandemic, reaching 7.7% cumulative excess mortality by the end of 2020. The excess was lower than in neighboring countries with similar dynamics of the pandemic.


Assuntos
Mortalidade/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Criança , Pré-Escolar , Humanos , Hungria/epidemiologia , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Pandemias/estatística & dados numéricos , SARS-CoV-2 , Adulto Jovem
5.
Medicine (Baltimore) ; 100(26): e26507, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190180

RESUMO

ABSTRACT: We investigated the temporal trends of short-term mortality (death within 1 year of diagnosis) and cause-specific deaths in human immunodeficiency virus (HIV)-infected persons by stage of HIV infection at diagnosis. We also assessed the impact of late diagnosis (LD) on short-term mortality.Epidemiological records of HIV-infected Singapore residents from the National HIV Registry were linked to death records from the Registry of Births and Deaths for observational analyses. Newly-diagnosed HIV cases with available cluster of differentiation 4 count at time of diagnosis in a 5-year period from 2012 to 2016 were included in the study. Hazard ratios (HRs) and 95% confidence interval (CI) of LD for all deaths excluding suicides and self-inflicted or accidental injuries, and HIV/ acquired immunodeficiency syndrome (AIDS)-related deaths occurring within 1 year post-diagnosis were calculated using Cox proportional hazards regression models with adjustment for age at HIV/AIDS diagnosis. Population attributable risk proportions (PARPs) were then calculated using the adjusted HRs.Of the 1990 newly-diagnosed HIV cases included in the study, 7.2% had died by end of 2017, giving an overall mortality rate of 2.16 per 100 person-years (PY) (95% CI 1.82-2.54). The mortality rate was 3.81 per 100 PY (95% CI 3.15-4.56) in HIV cases with LD, compared with 0.71 (95% CI 0.46-1.05) in non-LD (nLD) cases. Short-term mortality was significantly higher in LD (9.1%) than nLD cases (1.1%). Of the 143 deaths reported between 2012 and 2017, 58.0% were HIV/AIDS-related (nLD 28.0% vs LD 64.4%). HIV/AIDS-related causes represented 70.4% of all deaths which occurred during the first year of diagnosis (nLD 36.4% vs LD 74.7%). The PARP of short-term mortality due to LD was 77.8% for all deaths by natural causes, and 87.8% for HIV/AIDS-related deaths.The mortality rate of HIV-infected persons with LD was higher than nLD, especially within 1 year of diagnosis, and HIV/AIDS-related causes constituted majority of these deaths. To reduce short-term mortality, persons at high risk of late-stage HIV infection should be targeted in outreach efforts to promote health screening and remove barriers to HIV testing and treatment.


Assuntos
Síndrome de Imunodeficiência Adquirida , Terapia Antirretroviral de Alta Atividade , Diagnóstico Tardio , Infecções por HIV , Mortalidade/tendências , Síndrome de Imunodeficiência Adquirida/diagnóstico , Síndrome de Imunodeficiência Adquirida/etiologia , Síndrome de Imunodeficiência Adquirida/mortalidade , Adulto , Terapia Antirretroviral de Alta Atividade/métodos , Terapia Antirretroviral de Alta Atividade/estatística & dados numéricos , Causas de Morte , Diagnóstico Tardio/efeitos adversos , Diagnóstico Tardio/mortalidade , Diagnóstico Tardio/prevenção & controle , Demografia , Feminino , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , Humanos , Masculino , Risco Ajustado/métodos , Fatores de Risco , Singapura/epidemiologia , Fatores Socioeconômicos , Tempo para o Tratamento/estatística & dados numéricos
7.
BMJ ; 373: n1332, 2021 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-34135011

RESUMO

OBJECTIVE: To assess the risks and benefits of P2Y12 inhibitor monotherapy compared with dual antiplatelet therapy (DAPT) and whether these associations are modified by patients' characteristics. DESIGN: Individual patient level meta-analysis of randomised controlled trials. DATA SOURCES: Searches were conducted in Ovid Medline, Embase, and three websites (www.tctmd.com, www.escardio.org, www.acc.org/cardiosourceplus) from inception to 16 July 2020. The primary authors provided individual participant data. ELIGIBILITY CRITERIA: Randomised controlled trials comparing effects of oral P2Y12 monotherapy and DAPT on centrally adjudicated endpoints after coronary revascularisation in patients without an indication for oral anticoagulation. MAIN OUTCOME MEASURES: The primary outcome was a composite of all cause death, myocardial infarction, and stroke, tested for non-inferiority against a margin of 1.15 for the hazard ratio. The key safety endpoint was Bleeding Academic Research Consortium (BARC) type 3 or type 5 bleeding. RESULTS: The meta-analysis included data from six trials, including 24 096 patients. The primary outcome occurred in 283 (2.95%) patients with P2Y12 inhibitor monotherapy and 315 (3.27%) with DAPT in the per protocol population (hazard ratio 0.93, 95% confidence interval 0.79 to 1.09; P=0.005 for non-inferiority; P=0.38 for superiority; τ2=0.00) and in 303 (2.94%) with P2Y12 inhibitor monotherapy and 338 (3.36%) with DAPT in the intention to treat population (0.90, 0.77 to 1.05; P=0.18 for superiority; τ2=0.00). The treatment effect was consistent across all subgroups, except for sex (P for interaction=0.02), suggesting that P2Y12 inhibitor monotherapy lowers the risk of the primary ischaemic endpoint in women (hazard ratio 0.64, 0.46 to 0.89) but not in men (1.00, 0.83 to 1.19). The risk of bleeding was lower with P2Y12 inhibitor monotherapy than with DAPT (97 (0.89%) v 197 (1.83%); hazard ratio 0.49, 0.39 to 0.63; P<0.001; τ2=0.03), which was consistent across subgroups, except for type of P2Y12 inhibitor (P for interaction=0.02), suggesting greater benefit when a newer P2Y12 inhibitor rather than clopidogrel was part of the DAPT regimen. CONCLUSIONS: P2Y12 inhibitor monotherapy was associated with a similar risk of death, myocardial infarction, or stroke, with evidence that this association may be modified by sex, and a lower bleeding risk compared with DAPT. REGISTRATION: PROSPERO CRD42020176853.


Assuntos
Doença da Artéria Coronariana/tratamento farmacológico , Terapia Antiplaquetária Dupla/efeitos adversos , Intervenção Coronária Percutânea/efeitos adversos , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Idoso , Doença da Artéria Coronariana/cirurgia , Terapia Antiplaquetária Dupla/métodos , Feminino , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde , Intervenção Coronária Percutânea/mortalidade , Intervenção Coronária Percutânea/normas , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Trombose/tratamento farmacológico , Trombose/prevenção & controle
9.
MMWR Morb Mortal Wkly Rep ; 70(22): 825-829, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34081687

RESUMO

End-stage renal disease (ESRD) is a condition in which kidney function has permanently declined such that renal replacement therapy* is required to sustain life (1). The mortality rate for patients with ESRD in the United States has been declining since 2001 (2). However, during the COVID-19 pandemic, ESRD patients are at high risk for COVID-19-associated morbidity and mortality, which is due, in part, to weakened immune systems and presence of multiple comorbidities (3-5). The ESRD National Coordinating Center (ESRD NCC) supports the Centers for Medicare & Medicaid Services (CMS) and the ESRD Networks†,§ through analysis of data, dissemination of best practices, and creation of educational materials. ESRD NCC analyzed deaths reported to the Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb), a system that facilitates the collection of data and maintenance of information about ESRD patients on chronic dialysis or receiving a kidney transplant who are treated in Medicare-certified dialysis facilities and kidney transplant centers in the United States. Excess death estimates were obtained by comparing observed and predicted monthly numbers of deaths during February 1-August 31, 2020; predicted deaths were modeled based on data from January 1, 2016, through December 31, 2019. The analysis estimated 8.7-12.9 excess deaths per 1,000 ESRD patients, or a total of 6,953-10,316 excess deaths in a population of 798,611 ESRD patients during February 1-August 31, 2020. These findings suggest that deaths among ESRD patients during the early phase of the pandemic exceeded those that would have been expected based on previous years' data. Geographic and temporal patterns of excess mortality, including those among persons with ESRD, should be considered during planning and implementation of interventions, such as COVID-19 vaccination, infection control guidance, and patient education. These findings underscore the importance of data-driven technical assistance and further analyses of the causes and patterns of excess deaths in ESRD patients.


Assuntos
Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Mortalidade/tendências , COVID-19/epidemiologia , COVID-19/mortalidade , Humanos , Medição de Risco , Estados Unidos/epidemiologia
10.
MMWR Morb Mortal Wkly Rep ; 70(23): 858-864, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34111059

RESUMO

Throughout the COVID-19 pandemic, older U.S. adults have been at increased risk for severe COVID-19-associated illness and death (1). On December 14, 2020, the United States began a nationwide vaccination campaign after the Food and Drug Administration's Emergency Use Authorization of Pfizer-BioNTech COVID-19 vaccine. The Advisory Committee on Immunization Practices (ACIP) recommended prioritizing health care personnel and residents of long-term care facilities, followed by essential workers and persons at risk for severe illness, including adults aged ≥65 years, in the early phases of the vaccination program (2). By May 1, 2021, 82%, 63%, and 42% of persons aged ≥65, 50-64, and 18-49 years, respectively, had received ≥1 COVID-19 vaccine dose. CDC calculated the rates of COVID-19 cases, emergency department (ED) visits, hospital admissions, and deaths by age group during November 29-December 12, 2020 (prevaccine) and April 18-May 1, 2021. The rate ratios comparing the oldest age groups (≥70 years for hospital admissions; ≥65 years for other measures) with adults aged 18-49 years were 40%, 59%, 65%, and 66% lower, respectively, in the latter period. These differential declines are likely due, in part, to higher COVID-19 vaccination coverage among older adults, highlighting the potential benefits of rapidly increasing vaccination coverage.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/epidemiologia , COVID-19/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , COVID-19/mortalidade , Humanos , Incidência , Pessoa de Meia-Idade , Mortalidade/tendências , Estados Unidos/epidemiologia , Adulto Jovem
11.
Popul Health Metr ; 19(1): 27, 2021 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059063

RESUMO

BACKGROUND: The number of deaths attributable to COVID-19 in Spain has been highly controversial since it is problematic to tell apart deaths having COVID as the main cause from those provoked by the aggravation by the viral infection of other underlying health problems. In addition, overburdening of health system led to an increase in mortality due to the scarcity of adequate medical care, at the same time confinement measures could have contributed to the decrease in mortality from certain causes. Our aim is to compare the number of deaths observed in 2020 with the projection for the same period obtained from a sequence of previous years. Thus, this computed mortality excess could be considered as the real impact of the COVID-19 on the mortality rates. METHODS: The population was split into four age groups, namely: (< 50; 50-64; 65-74; 75 and over). For each one, a projection of the death numbers for the year 2020, based on the interval 2008-2020, was estimated using a Bayesian spatio-temporal model. In each one, spatial, sex, and year effects were included. In addition, a specific effect of the year 2020 was added ("outbreak"). Finally, the excess deaths in year 2020 were estimated as the count of observed deaths minus those projected. RESULTS: The projected death number for 2020 was 426,970 people, the actual count being 499,104; thus, the total excess of deaths was 72,134. However, this increase was very unequally distributed over the Spanish regions. CONCLUSION: Bayesian spatio-temporal models have proved to be a useful tool for estimating the impact of COVID-19 on mortality in Spain in 2020, making it possible to assess how the disease has affected different age groups accounting for effects of sex, spatial variation between regions and time trend over the last few years.


Assuntos
COVID-19/mortalidade , Causas de Morte , Pandemias , Adulto , Idoso , Idoso de 80 Anos ou mais , Teorema de Bayes , Surtos de Doenças , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Mortalidade/tendências , SARS-CoV-2 , Espanha/epidemiologia , Análise Espaço-Temporal
12.
PLoS One ; 16(6): e0253505, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34138948

RESUMO

OBJECTIVE: To quantify excess all-cause mortality in Switzerland in 2020, a key indicator for assessing direct and indirect consequences of the COVID-19 pandemic. METHODS: Using official data on deaths in Switzerland, all-cause mortality in 2020 was compared with that of previous years using directly standardized mortality rates, age- and sex-specific mortality rates, and life expectancy. RESULTS: The standardized mortality rate was 8.8% higher in 2020 than in 2019, returning to the level observed 5-6 years before, around the year 2015. This increase was greater for men (10.6%) than for women (7.2%) and was statistically significant only for men over 70 years of age, and for women over 75 years of age. The decrease in life expectancy in 2020 compared to 2019 was 0.7%, with a loss of 9.7 months for men and 5.3 months for women. CONCLUSIONS: There was an excess mortality in Switzerland in 2020, linked to the COVID-19 pandemic. However, as this excess only concerned the elderly, the resulting loss of life expectancy was restricted to a few months, bringing the mortality level back to 2015.


Assuntos
COVID-19/mortalidade , Causas de Morte/tendências , Expectativa de Vida/tendências , Mortalidade/tendências , SARS-CoV-2/isolamento & purificação , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , SARS-CoV-2/fisiologia , Suíça/epidemiologia , Fatores de Tempo
14.
Br J Anaesth ; 127(1): 102-109, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34074525

RESUMO

BACKGROUND: Frailty has been associated with increased incidence of postoperative delirium and mortality. We hypothesised that postoperative delirium mediates a clinically significant (≥1%) percentage of the effect of frailty on mortality in older orthopaedic trauma patients. METHODS: This was a single-centre, retrospective observational study including 558 adults 65 yr and older, who presented with an extremity fracture requiring hospitalisation without initial ICU admission. We used causal statistical inference methods to estimate the relationships between frailty, postoperative delirium, and mortality. RESULTS: In the cohort, 180-day mortality rate was 6.5% (36/558). Frail and prefrail patients comprised 23% and 39%, respectively, of the study cohort. Frailty was associated with increased 180 day mortality from 1.4% to 12.2% (11% difference; 95% confidence interval [CI], 8.4-13.6), which translated statistically into an 88.7% (79.9-94.3%) direct effect and an 11.3% (5.7-20.1%) postoperative delirium mediated effect. Prefrailty was also associated with increased 180 day mortality from 1.4% to 4.4% (2.9% difference; 2.4-3.4), which was translated into a 92.5% (83.8-99.9%) direct effect and a 7.5% (0.1-16.2%) postoperative delirium mediated effect. CONCLUSIONS: Frailty is associated with increased postoperative mortality, and delirium might mediate a clinically significant, but small percentage of this effect. Studies should assess whether, in patients with frailty, attempts to mitigate delirium might decrease postoperative mortality.


Assuntos
Delírio do Despertar/mortalidade , Fragilidade/mortalidade , Fragilidade/cirurgia , Procedimentos Ortopédicos/mortalidade , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/cirurgia , Idoso , Idoso de 80 Anos ou mais , Delírio do Despertar/diagnóstico , Feminino , Idoso Fragilizado , Fragilidade/diagnóstico , Avaliação Geriátrica/métodos , Humanos , Masculino , Mortalidade/tendências , Procedimentos Ortopédicos/tendências , Estudos Retrospectivos , Fatores de Tempo , Ferimentos e Lesões/diagnóstico
15.
Aging (Albany NY) ; 13(9): 12710-12732, 2021 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-33973531

RESUMO

Calcific aortic valve disease (CAVD) is associated with increased morbidity and mortality. We aimed to elucidate the 30-year epidemiology of CAVD globally. Global CAVD incidence, prevalence, and deaths increased 3.51-, 4.43-, and 1.38-fold from 1990 to 2019, respectively, without any decreasing trends, even after age standardization. In 2019, Slovenia had the highest age-standardized rate (ASR) of CAVD incidence (62.21/100,000 persons) and prevalence (1,080.06/100,000) whereas Cyprus had the highest ASR of deaths (8.20/100,000). Population aging was an important contributor to incidence. Compared with women, more men had CAVD and men had earlier peaks in disease prevalence. High systolic blood pressure, diet high in sodium, and lead exposure were the main risk factors for deaths owing to CAVD. The estimated annual percentage change, a measure to estimate the variation of ASR, was significantly associated with the ASR and sociodemographic index (SDI) in 2019 for incidence and prevalence across all 204 countries and territories (all p<0.0001). With increased lifespan and risk factors, the overall burden of CAVD is high and remains on the rise, with differences by sex, age, and SDI level. Our findings serve to sound the alarm for organizations, institutions, and resources whose primary purpose is to improve human health.


Assuntos
Estenose da Valva Aórtica/epidemiologia , Valva Aórtica/patologia , Calcinose/epidemiologia , Carga Global da Doença , Saúde Global/tendências , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Exposição Ambiental , Poluentes Ambientais/efeitos adversos , Feminino , Saúde Global/estatística & dados numéricos , Humanos , Incidência , Chumbo/efeitos adversos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Prevalência , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Sódio na Dieta/efeitos adversos
16.
Medicine (Baltimore) ; 100(21): e26157, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032773

RESUMO

ABSTRACT: Among the main types of neoplasms in the female population, breast and cervical cancers are the most important due to their high morbidity and mortality rates. The mortality has been proportionally higher in developing countries. Analysis of the trend of cancer mortality in Brazil revealed a considerable difference in the pattern of deaths between the regions.To analyze the trend of mortality due to breast and cervical cancers in women.Retrospective study of a series of death cases, using secondary data from the mortality information system (SIM) of the Ministry of Health. The deaths were identified as the underlying cause of breast and cervical cancers, including malignant neoplasms of the uterus without other specifications, occurring from 1980 to 2014. Thus, the annual standardized age-specific mortality rates by the world population were applied. For trend analysis, regression models were utilized in which the mortality rates were considered dependent variables and years the independent variable. Polynomial regression models and a Prais-Winsten regression model were adopted.Cervical cancer presented a mortality rate ranging from 2.15 to 10.69 per 100,000 women from 1980 to 2014, with a tendency for stability.Breast cancer mortality rate varied from 3.81 to 11.47 per 100,000 women from 1981 to 2014, indicating a growing trend.There is a significant increase in the mortality rate for breast cancer and stability of cervical cancers in the State of Acre from 1980 to 2014, evidencing a concern in their care and monitoring. Above all, guaranteed access, especially to the population of women at social risk, and the search for effective screening should be emphasized in the formation of the care line and the Health Care Network in the State of Acre.


Assuntos
Neoplasias da Mama/mortalidade , Neoplasias do Colo do Útero/mortalidade , Adolescente , Adulto , Distribuição por Idade , Brasil/epidemiologia , Estudos Epidemiológicos , Feminino , Humanos , Pessoa de Meia-Idade , Mortalidade/tendências , Análise de Regressão , Estudos Retrospectivos , Adulto Jovem
17.
Eur Rev Med Pharmacol Sci ; 25(9): 3594-3606, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34002834

RESUMO

OBJECTIVE: Patients with 2019-nCoV infection have a high risk to develop venous thrombotic events. Several guidelines recommend the use of either unfractionated heparin or low molecular weight heparins in preventing thrombotic events in these patients. However, results from clinical studies, so far published, reached controversial conclusions on heparin efficacy in this kind of patients since the incidence of venous thromboembolism remains high despite prophylaxis. This narrative review aims to provide an overview of the antiviral and anti-inflammatory properties of heparins and their efficacy and safety in SARS-CoV-2 medical ward-patients. Moreover, anatomical findings and ongoing trials are also reported. Finally, this narrative review tries to explain why heparins fail to prevent venous thrombosis. MATERIALS AND METHODS: We searched for the most relevant published studies on heparins and 2019-nCoV infected patients using the MEDLINE electronic database in the period between January and December 2020. Articles were preliminarily defined as eligible if they: a) were in English language, b) enrolled 250 or more medical ward-patients and 100 or more ICU-patients, c) reported results on patients treated with heparins in a percentage of at least 70% and d) performed an objectively confirmed diagnosis of VTE. RESULTS: Data from medium to large scientific studies show that the incidence of venous thrombotic events in medical ward-patients with SARS-CoV-2 vary between 0% and 8.3%, while this rate is higher, from 6.2% to 49%, in Intensive Care Unit-patients. However, heparins reduce the mortality rate in these patients of about 50%. Histological findings show that thrombosis could affect capillaries, main and small-mid-sized vessels, and it is associated with diffuse alveolar damage. CONCLUSIONS: Heparins have anti-inflammatory and anti-viral properties, which may be of help in reducing mortality in SARS-CoV-2 patients. Failure of heparins at prophylactic dosages in preventing VTE, especially in ICU-patients, could be due to the severity of the disease. Data on the use of heparins in an early phase of the 2019-nCoV infection are still lacking.


Assuntos
Anticoagulantes/uso terapêutico , COVID-19/tratamento farmacológico , Heparina/uso terapêutico , Tromboembolia Venosa/tratamento farmacológico , Animais , Anti-Inflamatórios/uso terapêutico , Antivirais/uso terapêutico , COVID-19/epidemiologia , COVID-19/imunologia , Humanos , Mortalidade/tendências , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/imunologia
18.
J Environ Public Health ; 2021: 5543977, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34012470

RESUMO

Discrete count time series data with an excessive number of zeros have warranted the development of zero-inflated time series models to incorporate the inflation of zeros and the overdispersion that comes with it. In this paper, we investigated the characteristics of the trend of daily count of COVID-19 deaths in Ghana using zero-inflated models. We envisaged that the trend of COVID-19 deaths per day in Ghana portrays a general increase from the onset of the pandemic in the country to about day 160 after which there is a general decrease onward. We fitted a zero-inflated Poisson autoregressive model and zero-inflated negative binomial autoregressive model to the data in the partial-likelihood framework. The zero-inflated negative binomial autoregressive model outperformed the zero-inflated Poisson autoregressive model. On the other hand, the dynamic zero-inflated Poisson autoregressive model performed better than the dynamic negative binomial autoregressive model. The predicted new death based on the zero-inflated negative binomial autoregressive model indicated that Ghana's COVID-19 death per day will rise sharply few days after 30th November 2020 and drastically fall just as in the observed data.


Assuntos
COVID-19/mortalidade , Análise de Séries Temporais Interrompida/métodos , Modelos Estatísticos , Distribuição Binomial , Gana/epidemiologia , Humanos , Mortalidade/tendências , Distribuição de Poisson , Reprodutibilidade dos Testes , SARS-CoV-2
20.
Public Health ; 194: 182-184, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33962094

RESUMO

OBJECTIVES: The objective of the study is to compare excess mortality (EM) patterns and spatial correlation between the first and second wave of the pandemic in Lombardy, the Italian region that paid an extremely high COVID-19-related mortality toll in March and April 2020. STUDY DESIGN: We conducted a longitudinal study using municipality-level mortality data. METHODS: We investigated the patterns and spatial correlation of EM of men aged ≥75 years during the first two pandemic waves (March-April 2020 vs November 2020) of COVID-19, using the mortality data released by the Italian National Institute of Statistics. EM was estimated at the municipality level to accurately detect the critical areas within the region. RESULTS: The areas that were mostly hit during the first wave of COVID-19 were generally spared by the second wave: EM of men aged ≥75 years in the municipality of Bergamo plummeted from +472% in March and April to -13% in November, and in Cremona the variation was from +344% to -19%. Conversely, in November 2020 EM was higher in some areas that had been protected in the first wave of the pandemic. Spatial correlation widely corroborates these findings, as large sections of the hot spots of EM detected in the first wave of the pandemic changed into cold spots in the second wave, and vice versa. CONCLUSIONS: Our results reveal the specular distribution of EM between the first and second wave of the pandemic, which may entail the consequences of social distancing measures and individual behaviors, local management strategies, 'harvesting' of the frailer population and, possibly, acquired immune protection. In conclusion, our findings support the need for continuous monitoring and analysis of mortality data using detailed spatial resolution.


Assuntos
COVID-19/mortalidade , Pandemias , Idoso , COVID-19/epidemiologia , Cidades/epidemiologia , Humanos , Itália/epidemiologia , Estudos Longitudinais , Masculino , Mortalidade/tendências , Análise de Pequenas Áreas , Análise Espacial
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...