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1.
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
2.
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
3.
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
4.
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
5.
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
6.
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
7.
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
8.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(8): 924-929, 2019 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-31484255

RESUMO

Objective: To describe the mortality trend of major malignant tumors in Shandong province, from 1970 to 2013. Methods: Data related to cancer mortality were obtained from the Shandong Death Registration System and three nationwide retrospective cause-of-death surveys. Trends of overall mortality and major causes of death were described using the indicators as: mortality rates and age-standardized mortality rates, through comparing the three large-scale mortality surveys in Shandong province. Difference decomposing method was applied to estimate the contribution of demographic and non-demographic factors for the change of mortality. Results: From 1970 to 2013, the crude mortality rate of malignant tumors in Shandong was increasing. The age standard mortality rate was increasing and then decreasing. The composition of cancer deaths in the all-cause-deaths was seen increasing and then decreasing as well. Both demographic and non-demographic factors contributed to the increase of crude cancer mortality rate. With the gradual increase of the proportion of population, its role exceeded the non-demographic factors. The age-standardized mortality rate of malignant tumors in 2011-2013 was lower than that in 2004-2005. Lung cancer mortality rose from the fifth to the first place, with an increase of 6.81 times from 1970-1974 to 2011-2013. Ranking of gastric cancer mortality dropped from first to the third place, with esophageal cancer dropped from second to the fourth. After adjusted by China's standard population in 1964, the mortality rate of lung cancer was still rapidly increasing, but the age-standardized mortality rates of esophageal cancer was gradually decreasing. The crude and age-standardized mortality rates of cervical cancer showed a rapid downward trend, reduced 87.00% and 93.00% respectively from 1970-1974 to 2011-2013. Conclusions: Malignant tumors were still major threats to the residents of Shandong province. The changing trend of different malignant tumors presented an inconsistent nature which called for different intervention strategies be carried out, accordingly.


Assuntos
Neoplasias Esofágicas/epidemiologia , Mortalidade/tendências , Neoplasias Gástricas/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Criança , Pré-Escolar , China/epidemiologia , Demografia , Neoplasias Esofágicas/mortalidade , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Neoplasias Gástricas/mortalidade , Adulto Jovem
9.
Undersea Hyperb Med ; 46(4): 495-501, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509905

RESUMO

Objective: Government programs have attempted to impact a recognized elevated risk for carbon monoxide (CO) poisoning among minority racial and ethnic groups. This study sought to describe U.S. mortality due to unintentional, non-fire-related CO poisoning, examining the distribution and trends by race and ethnicity. Methods: CDC Wonder was used to extract and analyze data on all U.S. resident deaths from unintentional CO poisoning from 2000-2017, categorizing them by year, race, ethnic origin and gender. Results: The absolute number of unintentional CO deaths decreased from about 450 to 380 per year during the period studied, a number near totally accounted for by the decrease in deaths occurring among non-Hispanic/Latino whites. The number of deaths among the remainder of the population did not significantly change. However, greater growth in minority populations resulted in a similar decline in the mortality rate between non-Hispanic/Latino whites and the combined minority population. The decline in combined minority death rate resulted from a decrease in the Hispanic/Latino white rate. Death rate did not decline in the black or African American population. Conclusions: All minority groups continue to display a disproportionate number of unintentional non-fire-related CO poisoning deaths compared to non-Hispanic/Latino whites. The decrease in U.S. deaths from unintentional non-fire-related carbon monoxide poisoning from 2000-2017 is accounted for by a decrease in non-Hispanic/Latino white deaths. While numbers of such deaths among minority groups have not changed since 2000, increases in the size of minority populations have resulted in a declining crude death rate for Hispanic/Latino whites.


Assuntos
Intoxicação por Monóxido de Carbono/etnologia , Intoxicação por Monóxido de Carbono/mortalidade , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Mortalidade/tendências , Estados Unidos/epidemiologia
10.
J Glob Health ; 9(2): 020403, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31489186

RESUMO

Background: There is a need to develop sustainable emergency health care systems in low-resource settings, but data that analyses emergency health care needs in these settings are scarce. We aimed at assessing presenting complaints (PCs) and post-discharge mortality in a large emergency department population in Nepal. Methods: Characteristics of adult patients who entered the emergency department (ED) in a hospital in Nepal were prospectively recorded in the local emergency registry from September 2013 until December 2016. To assess post-ED mortality, patient households were followed-up by telephone interviews at 90 days. Results: In 21892 included adults, the major PC categories were injuries (29%), abdominal complaints (23%), and infections (16%). Median age was 40 years and sex distribution was balanced. Among 3793 patients followed at 90 days, 8% had died. For respiratory and cardiovascular PCs, 90-day mortality were 25% and 23%. The highest mortality was in individuals with known chronic lung disease, in this group 32% had died by 90 days of ED discharge, regardless of PC. In women, illiteracy compared to literacy (adjusted odds ratio (aOR) = 7.0, 95% confidence interval (CI) = 2.1-23.6) and being both exposed to tobacco-smoking and traditional cooking stove compared to no smoke (aOR = 2.8, 95% CI = 1.6-4.9) were associated with mortality. The mortality was much higher among family-initiated discharged patients (17%, aOR = 5.4, 95% CI = 3.3-8.9) compared to doctor-initiated discharged (3%). Conclusions: Our report suggests that nearly one in ten patients seeking emergency health care died within 90 days. This finding is alarming and novel. Post-discharge studies need to be replicated and appropriate follow-up programs in low-resource settings where primary health care is underdeveloped are urgently needed.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Mortalidade/tendências , Adulto , Idoso , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Estudos Prospectivos
11.
Rev Saude Publica ; 53: 77, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31553380

RESUMO

OBJECTIVE: to analyze the temporal trend, identify the factors related and elaborate a predictive model for unfavorable treatment outcomes for multidrug-resistant tuberculosis (MDR-TB). METHODS: Retrospective cohort study with all cases diagnosed with MDR-TB between the years 2006 and 2015 in the state of São Paulo. The data were collected from the state system of TB cases notifications (TB-WEB). The temporal trend analyzes of treatment outcomes was performed through the Prais-Winsten analysis. In order to verify the factors related to the unfavorable outcomes, abandonment, death with basic cause TB and treatment failure, the binary logistic regression was used. Pictorial representations of the factors related to treatment outcome and their prognostic capacity through the nomogram were elaborated. RESULTS: Both abandonment and death have a constant temporal tendency, whereas the failure showed it as decreasing. Regarding the risk factors for such outcomes, using illicit drugs doubled the odds for abandonment and death. Besides that, being diagnosed in emergency units or during hospitalizations was a risk factor for death. On the contrary, having previous multidrug-resistant treatments reduced the odds for the analyzed outcomes by 33%. The nomogram presented a predictive model with 65% accuracy for dropouts, 70% for deaths and 80% for failure. CONCLUSIONS: The modification of the current model of care is an essential factor for the prevention of unfavorable outcomes. Through predictive models, as presented in this study, it is possible to develop patient-centered actions, considering their risk factors and increasing the chances for cure.


Assuntos
Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/mortalidade , Adolescente , Adulto , Brasil/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Nomogramas , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Drogas Ilícitas/efeitos adversos , Fatores de Tempo , Falha de Tratamento , Adulto Jovem
13.
BMJ ; 366: l4570, 2019 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-31434697

RESUMO

OBJECTIVE: To examine the dose-response associations between accelerometer assessed total physical activity, different intensities of physical activity, and sedentary time and all cause mortality. DESIGN: Systematic review and harmonised meta-analysis. DATA SOURCES: PubMed, PsycINFO, Embase, Web of Science, Sport Discus from inception to 31 July 2018. ELIGIBILITY CRITERIA: Prospective cohort studies assessing physical activity and sedentary time by accelerometry and associations with all cause mortality and reported effect estimates as hazard ratios, odds ratios, or relative risks with 95% confidence intervals. DATA EXTRACTION AND ANALYSIS: Guidelines for meta-analyses and systematic reviews for observational studies and PRISMA guidelines were followed. Two authors independently screened the titles and abstracts. One author performed a full text review and another extracted the data. Two authors independently assessed the risk of bias. Individual level participant data were harmonised and analysed at study level. Data on physical activity were categorised by quarters at study level, and study specific associations with all cause mortality were analysed using Cox proportional hazards regression analyses. Study specific results were summarised using random effects meta-analysis. MAIN OUTCOME MEASURE: All cause mortality. RESULTS: 39 studies were retrieved for full text review; 10 were eligible for inclusion, three were excluded owing to harmonisation challenges (eg, wrist placement of the accelerometer), and one study did not participate. Two additional studies with unpublished mortality data were also included. Thus, individual level data from eight studies (n=36 383; mean age 62.6 years; 72.8% women), with median follow-up of 5.8 years (range 3.0-14.5 years) and 2149 (5.9%) deaths were analysed. Any physical activity, regardless of intensity, was associated with lower risk of mortality, with a non-linear dose-response. Hazards ratios for mortality were 1.00 (referent) in the first quarter (least active), 0.48 (95% confidence interval 0.43 to 0.54) in the second quarter, 0.34 (0.26 to 0.45) in the third quarter, and 0.27 (0.23 to 0.32) in the fourth quarter (most active). Corresponding hazards ratios for light physical activity were 1.00, 0.60 (0.54 to 0.68), 0.44 (0.38 to 0.51), and 0.38 (0.28 to 0.51), and for moderate-to-vigorous physical activity were 1.00, 0.64 (0.55 to 0.74), 0.55 (0.40 to 0.74), and 0.52 (0.43 to 0.61). For sedentary time, hazards ratios were 1.00 (referent; least sedentary), 1.28 (1.09 to 1.51), 1.71 (1.36 to 2.15), and 2.63 (1.94 to 3.56). CONCLUSION: Higher levels of total physical activity, at any intensity, and less time spent sedentary, are associated with substantially reduced risk for premature mortality, with evidence of a non-linear dose-response pattern in middle aged and older adults. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018091808.


Assuntos
Acelerometria/estatística & dados numéricos , Exercício , Mortalidade/tendências , Comportamento Sedentário , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco
14.
Rev Bras Epidemiol ; 22: e190043, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31460662

RESUMO

INTRODUCTION: The mortality rate among tuberculosis patients (TB fatality) has been attributed to irregular chemotherapy, delay in diagnosis, multidrug resistance, and HIV coinfection. OBJECTIVE: To analyze TB fatality rates by sex, clinical presentation and HIV coinfection in Campinas, São Paulo, Brazil. METHODS: Cohorts of residents in the city of Campinas who either died during treatment for tuberculosis or had the disease confirmed after death were divided into three intervals: 2001-2003, 2004-2006, and 2007-2009. Data were obtained from the database of the Tuberculosis Surveillance System of the University of Campinas, and notifications were gathered through TB-WEB Health São Paulo Secretary. Statistical significance was determined using a chi-square test, considering p < 0.05. RESULTS: Between 2001 and 2009, 3,416 TB patients were diagnosed: 2,827 (82.8%) were new TB cases and 589 (17.2%) were retreatments. Between the first and second triennium, the number of new patients decreased by 18%, and 23% among retreatments. Between the second and third intervals, the reduction was 5% and 21%, respectively. General case fatality rate declined from 11.4% to 9.9% across intervals, and was most significant among patients that had previously abandoned treatment (17.3% to 5.1%). Fatality rates among patients coinfected with TB-AIDS were 2-3 times that of patients not infected with TB-AIDS throughout the intervals. Fatality between the first and third triennium among TB-AIDS co-infected patients declined (24.8% to 19.5%), while increasing slightly among non-AIDS TB patients (7.3% to 8%) during this period. CONCLUSION: Though mortality among TB-AIDS patients declined from 2001-2009, rates among non-AIDS TB remained stagnant. Improved TB diagnosis and treatment is needed to further decrease TB mortality in Campinas.


Assuntos
Síndrome de Imunodeficiência Adquirida/mortalidade , Coinfecção/mortalidade , Tuberculose/mortalidade , Brasil/epidemiologia , Feminino , Humanos , Masculino , Mortalidade/tendências , Distribuição por Sexo , Fatores de Tempo
15.
MMWR Morb Mortal Wkly Rep ; 68(34): 737-744, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31465320

RESUMO

From 2013 to 2017, the number of opioid-involved overdose deaths (opioid deaths) in the United States increased 90%, from 25,052 to 47,600.* This increase was primarily driven by substantial increases in deaths involving illicitly manufactured fentanyl (IMF) or fentanyl analogs† mixed with heroin, sold as heroin, or pressed into counterfeit prescription pills (1-3). Methamphetamine-involved and cocaine-involved deaths that co-involved opioids also substantially increased from 2016 to 2017 (4). Provisional 2018§ estimates of the number of opioid deaths suggest a small decrease from 2017. Investigating the extent to which decreases occurred broadly or were limited to a subset of opioid types (e.g., prescription opioids versus IMF) and drug combinations (e.g., IMF co-involving cocaine) can assist in targeting of intervention efforts. This report describes opioid deaths during January-June 2018 and changes from July-December 2017 in 25¶ of 32 states and the District of Columbia participating in CDC's State Unintentional Drug Overdose Reporting System (SUDORS).** Opioid deaths were analyzed by involvement (opioid determined by medical examiner or coroner to contribute to overdose death) of prescription or illicit opioids,†† as well as by the presence (detection of the drug in decedent) of co-occurring nonopioid drugs (cocaine, methamphetamine, and benzodiazepines). Three key findings emerged regarding changes in opioid deaths from July-December 2017 to January-June 2018. First, overall opioid deaths decreased 4.6%. Second, decreases occurred in prescription opioid deaths without co-involved illicit opioids and deaths involving non-IMF illicit synthetic opioids (fentanyl analogs and U-series drugs) (5). Third, IMF deaths, especially those with multiple illicit opioids and common nonopioids, increased. Consequently, IMF was involved in approximately two-thirds of opioid deaths during January-June 2018. Notably, during January-June 2018, 62.6% of all opioid deaths co-occurred with at least one common nonopioid drug. To maintain and accelerate reductions in opioid deaths, efforts to prevent IMF-involved deaths and address polysubstance misuse with opioids must be enhanced. Key interventions include broadening outreach to groups at high risk for IMF or fentanyl analog exposure and overdose. Improving linkage to and engagement in risk-reduction services and evidence-based treatment for persons with opioid and other substance use disorders with attention to polysubstance use or misuse is also needed.


Assuntos
Analgésicos Opioides/envenenamento , Overdose de Drogas/mortalidade , Analgésicos Opioides/química , Analgésicos Opioides/classificação , Benzodiazepinas/análise , Cocaína/análise , Humanos , Metanfetamina/análise , Mortalidade/tendências , Estados Unidos/epidemiologia
16.
Sci Total Environ ; 691: 538-548, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31325854

RESUMO

In subsistence farming populations of sub-Saharan Africa reliant on rainfed agriculture, years of low crop yields result in poorer child nutrition and survival. Estimates of such impacts are critical for their reduction and prevention. We developed a model to quantify such health impacts, and the degree to which they are attributable to weather variations, for a subsistence farming population in the Nouna district of Burkina Faso (89,000 people in 2010). The method combines data from a new weather-crop yield model with empirical epidemiological risk functions. We quantify the child mortality impacts for 1984-2012 using observed weather data and estimate potential future burdens in 2050 and 2100 using daily weather data generated by global climate models parameterized to simulate global warming of 1.5°C above pre-industrial levels. For 1984-2012, crop yields below 90% of the period average were estimated to result in the total of 109.8 deaths per 10,000 children <5years, or around 7122.0years of life lost, 72% of which are attributable to unfavourable weather conditions in the crop growing season. If all non-weather factors are assumed to remain unchanged, the mortality burden related to low crop yields would increase about twofold under 1.5°C global warming by 2100. These results emphasize the importance and value of developing strategies to protect against the effects of low crop yields and specifically the adverse impact of unfavourable weather conditions in such settings under the current and future climate.


Assuntos
Agricultura/estatística & dados numéricos , Mudança Climática , Produtos Agrícolas/provisão & distribução , Mortalidade/tendências , Agricultura/métodos , Burkina Faso , Clima , Abastecimento de Alimentos , Humanos
17.
BMC Public Health ; 19(1): 866, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269939

RESUMO

BACKGROUND: There is no population based occupational health surveillance system in South Africa, thus mortality data may be a cost effective means of monitoring trends and possible associations with occupation. The aim of this study was to use deaths due to pneumoconiosis (a known occupational disease) to determine if the South African mortality data are a valid data source for occupational health surveillance in South Africa. METHODS: Proportions of complete occupation and industry information for the years 2006-2015 were calculated for working age and retired adults. Deaths due to pneumoconiosis were identified in the data set and mortality odds ratios calculated for specific occupations and industry in reference to those who reported being unemployed using logistic regression. RESULTS: Only 16.1% of death notifications provided a usual occupation despite 43.1% of the population being employed in the year. The MORs for occupation provided significant increased odds of pneumoconiosis for miners (9.04), those involved in manufacturing (4.77), engineers and machinery mechanics (6.85). Along with these jobs the Mining (9.8), Manufacture (2.2) and Maintenance and repair industries (6.0) have significantly increased odds of pneumoconiosis deaths. The data can be said to provide a useful source of occupational disease information for surveillance where active surveillance systems do not exist. CONCLUSION: The findings indicate valid associations were found between occupational disease and expected jobs and industry. The most useful data are from 2013 onwards due to more detailed coding of occupation and industry.


Assuntos
Indústrias/estatística & dados numéricos , Doenças Profissionais/mortalidade , Ocupações/estatística & dados numéricos , Pneumoconiose/mortalidade , Vigilância da População , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Reprodutibilidade dos Testes , África do Sul/epidemiologia
18.
Sci Total Environ ; 690: 923-931, 2019 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-31302556

RESUMO

BACKGROUND: The impact of heatwaves on public health has led to an urgent need to describe extremely hot weather events (EHWEs) and evaluate their health impacts. METHODS: In Hong Kong, a very hot day (VHD) can be defined when the daily maximum temperature ≥ 33 °C, and a hot night (HN) can be identified if the daily minimum temperature ≥ 28 °C. Three lengths of time, nine combinations of VHD and HN, and four categories of occurrence intervals between two EHWEs were considered over 2006-2015. The daily relative risk (RR) of all-cause mortality was estimated using Poisson generalized additive regression models, controlling for both short-term and long-term trends in temperature as well as four air pollutants. Lagged effects of the representative EHWEs were further examined for their association with mortality. Subgroup analysis was conducted for different sex and age groups. RESULTS: Significant associations with raised mortality risks were observed for a single HN, while stronger associations with mortality were observed as significant for five or more consecutive VHDs/HNs. More HNs between the consecutive VHDs also significantly amplified the impact on mortality, with the strongest association observed for EHWEs characterized as 2D3N, and the effect significantly lagged for five days. Therefore, with identifiable health impacts, three thresholds (5VHDs, 5HNs, & 2D3N) were determined to be representative of identical types of EHWEs in Hong Kong. Furthermore, by taking 2 (3) consecutive VHDs (HNs) as one daytime (nighttime) EHWE event, those occurring consecutively without non-hot days (nights) in between were found to be significantly associated with excess mortality risks. Moreover, females and older adults were determined to be relatively more vulnerable to all defined EHWEs. CONCLUSIONS: Among all the observed significant heat-mortality associations in highly urbanized cities, EHWEs that occurred during the nighttime, with extended length, consecutively without any break in between, or in the pattern of 2D3N might require the meteorological administration, healthcare providers, and urban planners to work interactively.


Assuntos
Exposição Ambiental/estatística & dados numéricos , Temperatura Alta , Mortalidade/tendências , Cidades , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Urbanização
19.
J Surg Oncol ; 120(4): 753-760, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31355444

RESUMO

BACKGROUND: Calls for multivisceral resection (MVR) of retroperitoneal sarcoma (RPS) are increasing, although the risks and benefits remain controversial. We sought to analyze current 30-day morbidity and mortality rates, and trends in utilization of MVR in a national database. METHODS: Overall morbidity, severe morbidity, mortality rates, and temporal trends were analyzed utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). RESULTS: From 2012 to 2015, a total of 564 patients underwent RPS resection with 233 patients (41%) undergoing MVR. The MVR group had a higher rate of preoperative weight loss and larger tumors overall. When comparing MVR to non-MVR, there was no significant difference in overall morbidity (22% vs 17%, P = .13), severe morbidity (11% vs 8%, P = .18), or mortality (<1% vs 2%, P = .25). On multivariate analysis, MVR was not associated with increased overall morbidity or severe morbidity. Mortality rates were too low for meaningful statistical analysis. Annual rates of MVR ranged from 37% to 46% with no significant change over time (P = .47). RESULTS: Short-term morbidity and mortality rates after MVR for RPS remain acceptable, but rates of MVR show little change over time in NSQIP hospitals. Concerns about increased morbidity and mortality should not be viewed as a contraindication to wider implementation of MVR for RPS.


Assuntos
Mortalidade/tendências , Complicações Pós-Operatórias/mortalidade , Neoplasias Retroperitoneais/mortalidade , Sarcoma/mortalidade , Procedimentos Cirúrgicos Operatórios/mortalidade , Bases de Dados Factuais , Gerenciamento Clínico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Prognóstico , Melhoria de Qualidade , Neoplasias Retroperitoneais/patologia , Neoplasias Retroperitoneais/cirurgia , Sarcoma/patologia , Sarcoma/cirurgia , Taxa de Sobrevida
20.
BMC Public Health ; 19(1): 913, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288788

RESUMO

BACKGROUND: Cohort-type data are increasingly used to compare health outcomes of immigrants between countries, e.g. to assess the effects of different national integration policies. In such international comparisons, small differences in cardiovascular diseases risk or mortality rates have been interpreted as showing effects of different policies. We conjecture that cohort-type data sets available for such comparisons might not provide unbiased relative risk estimates between countries because of differentials in migration patterns occurring before the cohorts are being observed. METHOD: Two simulation studies were performed to assess whether comparisons are biased if there are differences in 1. the way migrants arrived in the host countries, i.e. in a wave or continuously; 2. the effects on health of exposure to the host country; or 3., patterns of return-migration before a cohort is recruited. In the first simulation cardiovascular disease was the outcome and immortality in the second. Bias was evaluated using a Cox regression model adjusted for age and other dependant variables. RESULTS: Comparing populations from wave vs. continuous migration may lead to bias only if the duration of stay has a dose-response effect (increase in simulated cardiovascular disease risk by 5% every 5 years vs. no risk: hazard-ratio 1.20(0.15); by 10% every 5 years: 1.47(0.14)). Differentials in return-migration patterns lead to bias in mortality rate ratios (MRR). The direction (under- or overestimation) and size of the bias depends on the model (MRR from 0.92(0.01) to 1.09(0.01)). CONCLUSION: The order of magnitude of the effects interpreted as due to integration policies in the literature is the same as the bias in our simulations. Future studies need to take into account duration and relevance of exposure and return-migration to make valid inferences about the effects of integration policies on the health of immigrants.


Assuntos
Viés , Estudos de Coortes , Emigrantes e Imigrantes/estatística & dados numéricos , Nível de Saúde , Doenças Cardiovasculares/epidemiologia , Simulação por Computador , Emigração e Imigração/estatística & dados numéricos , Humanos , Internacionalidade , Mortalidade/tendências
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