Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.253
Filtrar
1.
Cochrane Database Syst Rev ; 10: CD011748, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33078867

RESUMO

BACKGROUND: Despite the availability of effective drug therapies that reduce low-density lipoprotein (LDL)-cholesterol (LDL-C), cardiovascular disease (CVD) remains an important cause of mortality and morbidity. Therefore, additional LDL-C reduction may be warranted, especially for people who are unresponsive to, or unable to take, existing LDL-C-reducing therapies. By inhibiting the proprotein convertase subtilisin/kexin type 9 (PCSK9) enzyme, monoclonal antibodies (PCSK9 inhibitors) reduce LDL-C and CVD risk. OBJECTIVES: Primary To quantify the effects of PCSK9 inhibitors on CVD, all-cause mortality, myocardial infarction, and stroke, compared to placebo or active treatment(s) for primary and secondary prevention. Secondary To quantify the safety of PCSK9 inhibitors, with specific focus on the incidence of influenza, hypertension, type 2 diabetes, and cancer, compared to placebo or active treatment(s) for primary and secondary prevention. SEARCH METHODS: We identified studies by systematically searching CENTRAL, MEDLINE, Embase, and Web of Science in December 2019. We also searched ClinicalTrials.gov and the International Clinical Trials Registry Platform in August 2020 and screened the reference lists of included studies. This is an update of the review first published in 2017. SELECTION CRITERIA: All parallel-group and factorial randomised controlled trials (RCTs) with a follow-up of at least 24 weeks were eligible. DATA COLLECTION AND ANALYSIS: Two review authors independently reviewed and extracted data. Where data were available, we calculated pooled effect estimates. We used GRADE to assess certainty of evidence and in 'Summary of findings' tables. MAIN RESULTS: We included 24 studies with data on 60,997 participants. Eighteen trials randomised participants to alirocumab and six to evolocumab. All participants received background lipid-lowering treatment or lifestyle counselling. Six alirocumab studies used  an active treatment comparison group (the remaining used placebo), compared to three evolocumab active comparison trials. Alirocumab compared with placebo decreased the risk of CVD events, with an absolute risk difference (RD) of -2% (odds ratio (OR) 0.87, 95% confidence interval (CI) 0.80 to 0.94; 10 studies, 23,868 participants; high-certainty evidence), decreased the risk of mortality (RD -1%; OR 0.83, 95% CI 0.72 to 0.96; 12 studies, 24,797 participants; high-certainty evidence), and MI (RD -2%; OR 0.86, 95% CI 0.79 to 0.94; 9 studies, 23,352 participants; high-certainty evidence) and for any stroke (RD 0%; OR 0.73, 95% CI 0.58 to 0.91; 8 studies, 22,835 participants; high-certainty evidence). Compared to active treatment the alirocumab effects, for CVD, the RD was 1% (OR 1.37, 95% CI 0.65 to 2.87; 3 studies, 1379 participants; low-certainty evidence); for mortality, RD was -1% (OR 0.51, 95% CI 0.18 to 1.40; 5 studies, 1333 participants; low-certainty evidence); for MI, RD was 1% (OR 1.45, 95% CI 0.64 to 3.28, 5 studies, 1734 participants; low-certainty evidence); and for any stroke, RD was less than 1% (OR 0.85, 95% CI 0.13 to 5.61; 5 studies, 1734 participants; low-certainty evidence). Compared to placebo the evolocumab, for CVD, the RD was -2% (OR 0.84, 95% CI 0.78 to 0.91; 3 studies, 29,432 participants; high-certainty evidence); for mortality, RD was less than 1% (OR 1.04, 95% CI 0.91 to 1.19; 3 studies, 29,432 participants; high-certainty evidence); for MI, RD was -1% (OR 0.72, 95% CI 0.64 to 0.82; 3 studies, 29,432 participants; high-certainty evidence); and for any stroke RD was less than -1% (OR 0.79, 95% CI 0.65 to 0.94; 2 studies, 28,531 participants; high-certainty evidence).  Compared to active treatment, the evolocumab effects, for any CVD event RD was less than -1% (OR 0.66, 95% CI 0.14 to 3.04; 1 study, 218 participants; very low-certainty evidence); for all-cause mortality, the RD was less than 1% (OR 0.43, 95% CI 0.14 to 1.30; 3 studies, 5223 participants; very low-certainty evidence); and for MI, RD was less than 1% (OR 0.66, 95% CI 0.23 to 1.85; 3 studies, 5003 participants; very low-certainty evidence). There were insufficient data on any stroke.  AUTHORS' CONCLUSIONS: The evidence for the clinical endpoint effects of  evolocumab and alirocumab were graded as high. There is a strong evidence base to prescribe PCSK9 monoclonal antibodies to people who might not be eligible for other lipid-lowering drugs, or to people who cannot meet their lipid goals on more traditional therapies, which was the main patient population of the available trials.  The evidence base of PCSK9 inhibitors compared with active treatment is much weaker (low very- to low-certainty evidence) and it is unclear whether evolocumab or alirocumab might be effectively used as replacement therapies. Related, most of the available studies preferentially enrolled people with either established CVD or at a high risk already, and evidence in low- to medium-risk settings is minimal. Finally, there is very limited evidence on any potential safety issues of both evolocumab and alirocumab. While the current evidence synthesis does not reveal any adverse signals, neither does it provide evidence against such signals. This suggests careful consideration of alternative lipid lowering treatments before prescribing PCSK9 inhibitors.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , LDL-Colesterol/sangue , Pró-Proteína Convertase 9/antagonistas & inibidores , Anticolesterolemiantes/uso terapêutico , Causas de Morte , Antagonistas Colinérgicos/uso terapêutico , Ezetimiba/uso terapêutico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Prevenção Primária/métodos , Pró-Proteína Convertase 9/imunologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Prevenção Secundária/métodos , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo
2.
Yonsei Med J ; 61(11): 942-950, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33107237

RESUMO

PURPOSE: Implantable cardioverter defibrillators (ICD) are the standard of care for primary prevention (PP) in patients with ischemic cardiomyopathy (ICM). However, PP ICD implantation is underused in Asian countries. This study investigated ICD implantation rates and factors associated with appropriate PP ICD implants for ICM. MATERIALS AND METHODS: In this prospective multicenter observational registry (ADVANCE-ICM registry), ICM patients who were eligible for PP ICD were screened and enrolled. Factors associated with appropriate ICD implantation, including hospital and clinical factors, were investigated. RESULTS: Of the 1453 ICM patients eligible for PP ICD [1111 male; median age, 71.0 (61.0-78.0) years], only 76 (5.2%) patients underwent ICD implantation. Among hospital factors, a non-monetary incentive for referral (72.4% vs. 52.9%, p=0.001) and total hospital system score (6.0 vs. 5.0, p=0.013) were higher in the ICD than in the no-ICD group. In multivariate analysis, total hospital system score [odds ratio (OR), 1.28; 95% confidence interval (CI), 1.10-1.50] was an independent factor for predicting ICD implantation, along with clinical factors, including high New York Heart Association class (≥III: OR, 7.29; 95% CI, 2.97-17.87) and younger age (<70 years: OR, 2.14; 95% CI, 1.30-3.53). CONCLUSION: PP ICD implantation for ICM patients is underused in Korea. Hospital factors were important for improving PP ICD implantation rate, suggesting that new screening and referral systems for ICM patients would improve the PP ICD implantation rate (Clinical trial registration No. NCT03590925).


Assuntos
Cardiomiopatias/prevenção & controle , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis/efeitos adversos , Cardioversão Elétrica/instrumentação , Insuficiência Cardíaca/terapia , Isquemia Miocárdica/prevenção & controle , Prevenção Primária/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Cardiomiopatias/epidemiologia , Cardiomiopatias/terapia , Morte Súbita Cardíaca/etiologia , Desfibriladores Implantáveis/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/terapia , Prevenção Primária/métodos , Estudos Prospectivos , Sistema de Registros , República da Coreia/epidemiologia , Fatores de Risco , Resultado do Tratamento
3.
J Nutr Health Aging ; 24(8): 812-816, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33009529

RESUMO

BACKGROUND: Guidance aiming at limiting the entry and spread of the COVID-19 have been widely communicated to Long-term Care Facilities (LTCFs). However, no clinical research has investigated their relevance. OBJECTIVE: Our objective was to compare the guidance applied for the prevention of the COVID-19 epidemic between the LTCFs having been contaminated by COVID-19 and LTCFs having not been contaminated. METHODS: A questionnaire was sent and systematically accompanied by phone call to the 132 LTCFs of Haute-Garonne (Occitania region, South-West of France). The questionnaire focused on the preventive measures implemented before March 23, 2020 (first LTCFs contaminated in this area). The questionnaire focused on physician support, implementation of usual guidance (eg, masks, hydro-alcoholic solute used), training on hygiene, containment in residents' rooms and other distancing measures, use of temporary workers, compartmentalization within zones of residents and staff and a self-assessment analogic scale on the quality of the application of the preventive measures. We compared implementation of the guidance between the LTCFs with at least one case of COVID-19 among residents and/or health care professionals and LTCFs without COVID-19 case (between March 23rd and May 6th). RESULTS: 124 LTCFs participated (93.9%). 30 LTCFs (24.19%) were contaminated with COVID-19. Large heterogeneity of the application of the guidance was observed. Public LTCFs (OR= 0.39 (0.20-0.73), LTCFs which organized staff compartmentalization within zones (OR= 0.19 (0.07-0.48)), and LTCF with a staff who self-assessed a higher quality implementation of the preventive measures (OR= 0.65 (0.43-0.98)) were significantly more likely to avoid contamination by the COVID-19 outbreak. CONCLUSION: Our study supports the relevance of guidance to prevent the entry of COVID-19, in particular the staff compartmentalization within zones, as well as the perception of the staff regarding the quality of implementation of those measures in LTCFs.


Assuntos
Infecções por Coronavirus/prevenção & controle , Administração de Instituições de Saúde/métodos , Assistência de Longa Duração/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Prevenção Primária/métodos , Betacoronavirus , França , Instalações de Saúde , Humanos , Masculino , Estudos Prospectivos , Inquéritos e Questionários
4.
Curr Biol ; 30(19): R1124-R1130, 2020 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-33022254

RESUMO

Since the first recognition that infectious microbes serve as the causes of many human diseases, physicians and scientists have sought to understand and control their spread. For the past 150+ years, these 'microbe hunters' have learned to combine epidemiological information with knowledge of the infectious agent(s). In this essay, I reflect on the evolution of microbe hunting, beginning with the history of pre-germ theory epidemiological studies, through the microbiological and molecular eras. Now in the genomic age, modern-day microbe hunters are combining pathogen whole-genome sequencing with epidemiological data to enhance epidemiological investigations, advance our understanding of the natural history of pathogens and drivers of disease, and ultimately reshape our plans and priorities for global disease control and eradication. Indeed, as we have seen during the ongoing Covid-19 pandemic, the role of microbe hunters is now more important than ever. Despite the advances already made by microbial genomic epidemiology, the field is still maturing, with many more exciting developments on the horizon.


Assuntos
Bactérias/genética , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/epidemiologia , Epidemiologia Molecular/métodos , Prevenção Primária/métodos , Bactérias/patogenicidade , Betacoronavirus/genética , Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Genoma Bacteriano/genética , Genoma Viral/genética , História do Século XIX , História do Século XX , Humanos , Microbiota/genética , Pandemias , Pneumonia Viral/epidemiologia
5.
Am J Respir Crit Care Med ; 202(8): 1081-1087, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-33054329

RESUMO

Protective ventilation strategies for the injured lung currently revolve around the use of low Vt, ostensibly to avoid volutrauma, together with positive end-expiratory pressure to increase the fraction of open lung and reduce atelectrauma. Protective ventilation is currently applied in a one-size-fits-all manner, and although this practical approach has reduced acute respiratory distress syndrome deaths, mortality is still high and improvements are at a standstill. Furthermore, how to minimize ventilator-induced lung injury (VILI) for any given lung remains controversial and poorly understood. Here we present a hypothesis of VILI pathogenesis that potentially serves as a basis upon which minimally injurious ventilation strategies might be developed. This hypothesis is based on evidence demonstrating that VILI begins in isolated lung regions manifesting a Permeability-Originated Obstruction Response (POOR) in which alveolar leak leads to surfactant dysfunction and increases local tissue stresses. VILI progresses topographically outward from these regions in a POOR-get-POORer fashion unless steps are taken to interrupt it. We propose that interrupting the POOR-get-POORer progression of lung injury relies on two principles: 1) open the lung to minimize the presence of heterogeneity-induced stress concentrators that are focused around the regions of atelectasis, and 2) ventilate in a patient-dependent manner that minimizes the number of lung units that close during each expiration so that they are not forced to rerecruit during the subsequent inspiration. These principles appear to be borne out in both patient and animal studies in which expiration is terminated before derecruitment of lung units has enough time to occur.


Assuntos
Prevenção Primária/métodos , Atelectasia Pulmonar/prevenção & controle , Edema Pulmonar/prevenção & controle , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Lesão Pulmonar Induzida por Ventilação Mecânica/prevenção & controle , Lesão Pulmonar Induzida por Ventilação Mecânica/fisiopatologia , Doença Aguda , Fenômenos Biomecânicos , Doença Crônica , Feminino , Humanos , Masculino , Monitorização Fisiológica , Prognóstico , Atelectasia Pulmonar/etiologia , Edema Pulmonar/etiologia , Síndrome do Desconforto Respiratório do Adulto/terapia , Testes de Função Respiratória
7.
Adv Respir Med ; 88(4): 364-365, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32869273

RESUMO

There is increased evidence that the massive release of pro-inflammatory cytokines leading to the cytokine storm syndrome shapes the evolution of COVID-19 and is responsible of the severity of COVID-19 in some patients. A recent review argued that vitamin D deficiency could have increased the COVID-19 outbreak and suggested vitamin D supplementation as a preventive action. In fact, many factors seem to be correlated both to low vitamin D levels and the importance of COVID-19 spreading and severity. It is also important to highlight that the lockdown, implemented in many countries, prevents people to go out and then increases the risk of vitamin D deficiency. COPD patients are particularly at risk to have low levels of vitamin D due to multiple risk factors. COPD may generate a systemic inflammatory process responsible of secondary extra-pulmonary impairments. Vitamin D deficiency could sustain and aggravate the systemic inflammation associated to COPD. Reports have also shown that vitamin D deficiency was associated to exacerbations and hospital admissions, as well as lung function. Recent research showed that vitamin D supplementation significantly reduced COPD exacerbations. Although vitamin D deficiency was not proved to be neither a risk factor of COVID-19, nor a determinant of its severity, vitamin D supplementation represents a preventive perspective that needs to be further studied.


Assuntos
Colecalciferol/uso terapêutico , Infecções por Coronavirus/prevenção & controle , Suplementos Nutricionais/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Prevenção Primária/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Infecções por Coronavirus/complicações , Feminino , Humanos , Masculino , Pneumonia Viral/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fatores de Risco , Deficiência de Vitamina D/prevenção & controle
8.
PLoS Negl Trop Dis ; 14(9): e0008716, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32966283

RESUMO

The concurrent circulation of dengue and coronavirus disease 2019 (COVID-19) may produce many unfavourable outcomes-such as co-infections; delays in diagnosis, treatment, and mitigation measures; overwhelming of the healthcare system; underreporting of cases; deterioration in surveillance and control interventions; and exacerbation of social inequalities. Indeed, lockdown is greatly compromising the effectiveness of vector control, especially social mobilization campaigns and preventive insecticide spraying in private spaces (indoor and peridomestic spraying). Thus, failure to appropriately implement the full range of vector control interventions can lead to a reduction in their overall effectiveness and an increasing risk of vector-borne diseases circulating. Consequently, the health community and policy makers should develop proactive policies and allocate adequate resources to prevent and manage the resurgence of dengue and other vector-borne diseases in the new era of COVID-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Dengue/epidemiologia , Dengue/prevenção & controle , Controle de Mosquitos/métodos , Pneumonia Viral/epidemiologia , Prevenção Primária/métodos , Betacoronavirus , Assistência à Saúde , Humanos , Pandemias , Controle de Pragas/métodos , Saúde Pública , Tempo para o Tratamento
9.
Sci Rep ; 10(1): 15665, 2020 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-32973285

RESUMO

The COVID-19 pandemic triggered a surge in demand for facemasks to protect against disease transmission. In response to shortages, many public health authorities have recommended homemade masks as acceptable alternatives to surgical masks and N95 respirators. Although mask wearing is intended, in part, to protect others from exhaled, virus-containing particles, few studies have examined particle emission by mask-wearers into the surrounding air. Here, we measured outward emissions of micron-scale aerosol particles by healthy humans performing various expiratory activities while wearing different types of medical-grade or homemade masks. Both surgical masks and unvented KN95 respirators, even without fit-testing, reduce the outward particle emission rates by 90% and 74% on average during speaking and coughing, respectively, compared to wearing no mask, corroborating their effectiveness at reducing outward emission. These masks similarly decreased the outward particle emission of a coughing superemitter, who for unclear reasons emitted up to two orders of magnitude more expiratory particles via coughing than average. In contrast, shedding of non-expiratory micron-scale particulates from friable cellulosic fibers in homemade cotton-fabric masks confounded explicit determination of their efficacy at reducing expiratory particle emission. Audio analysis of the speech and coughing intensity confirmed that people speak more loudly, but do not cough more loudly, when wearing a mask. Further work is needed to establish the efficacy of cloth masks at blocking expiratory particles for speech and coughing at varied intensity and to assess whether virus-contaminated fabrics can generate aerosolized fomites, but the results strongly corroborate the efficacy of medical-grade masks and highlight the importance of regular washing of homemade masks.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Máscaras , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Prevenção Primária/métodos , Dispositivos de Proteção Respiratória , Adolescente , Adulto , Aerossóis , Betacoronavirus , Tosse/virologia , Expiração , Feminino , Filtração/instrumentação , Humanos , Exposição por Inalação , Masculino , Pessoa de Meia-Idade , Prevenção Primária/instrumentação , Adulto Jovem
10.
Lancet ; 396(10254): 854-866, 2020 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-32910907

RESUMO

Asthma is a complex disease that often starts in childhood. Genomic and environmental factors as well as aberrant immune maturation early in life can contribute to the onset of disease, with great disparity over time and geographical regions. Epidemiological studies have scrutinised environmental exposures and attempted to translate these exposures into prevention strategies. Some approaches for patients with asthma have been successful (eg, smoking ban, the Finnish Asthma Programme), and primary prevention of wheeze in pre-school children (age 0-5 years) by the supplementation of vitamin D or fish oil, or both, to pregnant women seems promising. Several recent prevention initiatives are based on strong asthma-protective environmental microbial exposures associated with traditional rural lifestyles. Preclinical studies with various bacterial lysates, bacterial and dietary metabolites, or helminthic compounds have yielded promising results that await translation into clinical practice. Given the immense societal and individual burden of asthma, there is an urgent need to further develop novel strategies to eradicate the disease.


Assuntos
Asma/epidemiologia , Asma/prevenção & controle , Prevenção Primária/métodos , Asma/dietoterapia , Asma/imunologia , Pré-Escolar , Suplementos Nutricionais/provisão & distribução , Exposição Ambiental/efeitos adversos , Feminino , Finlândia/epidemiologia , Óleos de Peixe/administração & dosagem , Óleos de Peixe/provisão & distribução , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Prevalência , Fatores de Proteção , Fatores de Risco , Prevenção do Hábito de Fumar/métodos , Vitamina D/administração & dosagem , Vitamina D/provisão & distribução
11.
Top Antivir Med ; 28(2): 455-458, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32886465

RESUMO

Due to COVID-19, this year marked the first virtual Conference on Retroviruses and Opportunistic Infections (CROI) in the conference's 27-year history. There were important studies presented that provided new insights into the prevention, diagnosis, and treatment of tuberculosis (TB) and other HIV coinfections. Highlights related to TB and HIV coinfections from this year's meeting are reviewed below.


Assuntos
Coinfecção/epidemiologia , Infecções por HIV/epidemiologia , Infecções Oportunistas/epidemiologia , Saúde Pública , Tuberculose/epidemiologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Antituberculosos/uso terapêutico , Coinfecção/diagnóstico , Coinfecção/tratamento farmacológico , Controle de Doenças Transmissíveis/organização & administração , Congressos como Assunto , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Criptococose/epidemiologia , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Lactente , Masculino , Micoses/diagnóstico , Micoses/tratamento farmacológico , Micoses/epidemiologia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Gravidez , Prevalência , Prevenção Primária/métodos , Medição de Risco , Análise de Sobrevida , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Interface Usuário-Computador , Adulto Jovem
12.
J Epidemiol Glob Health ; 10(3): 194-197, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32954707

RESUMO

Most sub-Saharan African countries acted early and aggressively in response to the WHO COVID-19 warning by closing schools, international borders, limiting domestic travel and restricting large gatherings. The six most populous sub-Saharan African countries, at the beginning of July 2020 with the exception of Republic of South Africa, all had relatively modest COVID-19 case counts compared with European, North and South American and some Asian countries in spite of access to more limited medical resources and technologies. Shutdowns or shelter-in-places were put in place for 5 out of 6 countries surveyed well before the first reported COVID-19 death. Timely action to enact comprehensive public health measures are irreplaceable and cannot be substituted by later use of medical resources or technologies. In the case of Republic of South Africa, earlier and multiple instances of virus introduction may have made infection control much more difficult compared with other sub-Saharan African countries.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Países em Desenvolvimento/estatística & dados numéricos , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Prevenção Primária/métodos , Controle de Doenças Transmissíveis/estatística & dados numéricos , Humanos , Prevenção Primária/estatística & dados numéricos , Fatores Socioeconômicos , África do Sul/epidemiologia , Fatores de Tempo
13.
PLoS Negl Trop Dis ; 14(9): e0008700, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32886678

RESUMO

Severe Acute Respiratory Syndrome Coronavirus 2 (COVID 19) has plagued the world with about 7,8 million confirmed cases and over 430,000 deaths as of June 13th, 2020. The knowledge, attitude, and practices (KAP) people hold towards this new disease could play a major role in the way they accept measures put in place to curb its spread and their willingness to seek and adhere to care. We sought to understand if: a) demographic variables of Cameroonian residents could influence KAP and symptomatology, and b) KAP could influence the risk of having COVID19.A cross-sectional KAP/symptomatology online survey was conducted between April 20 to May 20. All analyses were performed using SPSS version 23. Of all respondents (1006), 53.1% were female, 26.6% were students, 26.9% interacted face to face and 62.8% were residents in Yaoundé with a median age of 33. The overall high score was 84.19% for knowledge, 69% for attitude, and 60.8% for practice towards COVID 19. Age > 20 years was associated with a high knowledge of COVID 19. Women had lower practice scores compared to men (OR = 0.72; 95%CI 0.56-0.92). 41 respondents had ≥3 symptoms and only 9 (22.95%) of them had called 1510 (emergency number). There was no significant difference between KAP and symptomatology. The presence of ≥ 3 symptoms in 4% of respondents (with 56% of them having co-morbidities) supports the current trend in the number of confirmed cases (8681) in Cameroon. The continuous increase in the number of cases and the overall good KAP warrants further investigation to assess the effectiveness of the measures put in place to curb the spread of the disease. Sensitization is paramount to preclude negative health-seeking behaviors and encourage positive preventive and therapeutic practices, for fear of an increase in mortality.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Prevenção Primária/métodos , Adulto , Betacoronavirus , Camarões/epidemiologia , Infecções por Coronavirus/diagnóstico , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Inquéritos e Questionários , Adulto Jovem
14.
AIDS Patient Care STDS ; 34(8): 336-343, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32757980

RESUMO

Adolescent girls and young women (AGYW) are a priority population for HIV prevention in high-burden settings. We evaluated psychosocial characteristics, behavioral risk factors for HIV, and pre-exposure prophylaxis (PrEP) awareness and uptake among AGYW seeking contraceptive services at four public sector family planning (FP) clinics offering integrated PrEP delivery in Kisumu, Kenya. From October 2018 to June 2019, we approached all AGYW (aged 15-24 years) seeking contraception to participate in a survey following receipt of FP services and PrEP screening. Overall, 470 AGYW were screened for PrEP at their FP visit by facility staff and subsequently enrolled in the survey. Median age was 22 years (interquartile range 20-23), 22% of AGYW were in school, and 55% were married. The most frequent forms of contraception were implants and injectables (41% each). Over a third of AGYW (36%) reported low social support, 13% had symptoms of moderate to severe depression, and 3% reported intimate partner violence. Three-quarters (75%) of AGYW reported recent condomless sex and 42% suspected that their primary partner had other sexual partners. Most AGYW (89%) had previously heard of PrEP; 76% had at least one PrEP eligibility criterion as per national guidelines; however, only 4% initiated PrEP at their current FP visit. PrEP initiators more frequently had high HIV risk perception than noninitiators (85% vs. 10%, p < 0.001). Low perceived HIV risk (76%) and pill burden (51%) were common reasons for declining PrEP among AGYW with HIV behavioral risk factors. PrEP counseling should be tailored to AGYW to guide appropriate PrEP decision-making in this important population.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Profilaxia Pré-Exposição/estatística & dados numéricos , Prevenção Primária/métodos , Adolescente , Adulto , Conscientização , Serviços de Planejamento Familiar/organização & administração , Feminino , Humanos , Quênia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Profilaxia Pré-Exposição/métodos , Gravidez , Adulto Jovem
15.
Medicine (Baltimore) ; 99(32): e21380, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769869

RESUMO

BACKGROUND: On March 11, 2020, World Health Organization announced that severe acute respiratory syndrome coronavirus 2 caused COVID-19 was a global pandemic. COVID-19 is associated with venous thromboembolism including deep vein thrombosis and pulmonary embolism. To further identify the current role of antiplatelet/anticoagulant therapy in the prophylaxis and treatment of COVID-19 patients is important. METHODS: We will conduct a systematic review based on searches of major databases (eg, Pubmed, Web of Science, EMBASE, CENTRAL, MEDLINE, SCI-EXPANDED, CPCI-S, CBM, CNKI, and Wanfang Database) and clinical trial registries from inception to present without limitations of language and publication status. All published randomized control trials, quasi-randomized trials, retrospective and observational studies related to prophylactic antiplatelet/anticoagulant for severe COVID-19 will be included. Primary outcome includes incident acute thrombosis events. Second outcome is the incidence and severity of adverse effects. Full-text screening, data extraction and quality assessment will be conducted by 2 reviewers independently. The reporting quality, risk of bias, sensitivity analysis and subgroup analysis will be performed to ensure the reliability of our findings by other 2 researchers. The statistical analysis will be performed by RevMan V.5.3 software and Stata V.12.0 software. RESULTS: The result of this systematic review will provide valid advice and consultation for clinicians on the management of prophylactic antiplatelet/anticoagulant for severe COVID-19 patients. CONCLUSION: This systematic review will provide evidence for prophylactic antiplatelet/anticoagulant of severe COVID-19 patients. PROSPERO REGISTRATION: CRD42020186928.


Assuntos
Anticoagulantes/administração & dosagem , Infecções por Coronavirus/epidemiologia , Mortalidade Hospitalar , Pandemias/estatística & dados numéricos , Inibidores da Agregação de Plaquetas/administração & dosagem , Pneumonia Viral/epidemiologia , Trombose/epidemiologia , Adulto , Idoso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Prevenção Primária/métodos , Prognóstico , Projetos de Pesquisa , Medição de Risco , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/prevenção & controle , Análise de Sobrevida , Trombose/prevenção & controle , Resultado do Tratamento
16.
Dan Med J ; 67(9)2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32829745

RESUMO

INTRODUCTION: The coronavirus disease 19 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), progresses globally, and means to reduce the transmission are needed. In the community, the use of face masks is increasing world-wide, but documentation for the efficacy of this remedy is lacking. This trial investigates whether the use of face masks in the community will reduce wearers' risk of SARS-CoV-2 infection. METHODS: This study will be a two-arm, unblinded, randomised controlled trial. We will include adults (>18 years of age) without prior confirmed COVID-19 or symptoms suggestive of COVID-19, who spend more than three hours per day outside the home with exposure to other people. A total of 6,000 participants are randomly assigned 1:1 to use face masks or not for a 30-day period during the pandemic. Participants will perform self-testing; quick test for SARS-CoV-2 antibodies (immunoglobulin M (IgM) and immunoglobulin G (IgG)) (the Livzon lateral flow test) and oropharyngeal/nasal swabs for viral detection using polymerase chain reaction (PCR). The primary endpoint following the 30-day study period is the difference in the number of SARS-CoV-2-infected individuals between the two study groups as assessed by a positive nasopharyngeal swap, a positive antibody test or a hospital-based diagnosis of SARS-CoV-2 infection. CONCLUSIONS: We will study whether a face mask protects the wearer of the mask against SARS-CoV-2 infection. The findings are expected to apply to the present pandemic and to future viral outbreaks and to provide evidence for authority recommendations across the world. FUNDING: This study was funded by Salling Fondene. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04337541.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/prevenção & controle , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Máscaras/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Saúde Pública , Adulto , Idoso , Dinamarca , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevenção Primária/instrumentação , Prevenção Primária/métodos , Medição de Risco , Organização Mundial da Saúde
17.
PLoS Pathog ; 16(8): e1008756, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32853280

RESUMO

This Pearl article recounts the story of a US corporation, Lennar, the nation's leading homebuilder, an essential function in the US (not allowed to lock down), when faced with the coronavirus disease 2019 (COVID-19) pandemic at the end of February 2020. The culture of the company, which allowed it to proceed safely, is one of cohesion, trust, teamwork, and respect for fellow humans. Theirs is a culture in which the safety, wellness, and health of the associates (employees) and the communities they serve is the number one priority. All associates wear a name badge with first name only, and all name badges share the same family name, Lennar. At Lennar, individual success means nothing, and collective success means everything. This is the story of how Lennar took control of the COVID-19 pandemic, metamorphosed itself into an even stronger organization, better suited to deal with COVID-19, and more importantly, optimally suited for the 21st century. The lessons learned not only were instrumental to Lennar but could also apply to any company eager to reopen their business.


Assuntos
Infecções por Coronavirus/epidemiologia , Cultura Organizacional , Pneumonia Viral/epidemiologia , Prevenção Primária/métodos , Corporações Profissionais , Betacoronavirus , Busca de Comunicante/métodos , Higiene das Mãos/métodos , Humanos , Programas de Rastreamento/métodos , Pandemias , Equipamento de Proteção Individual/provisão & distribução , Distância Social , Estados Unidos/epidemiologia
18.
Am J Physiol Endocrinol Metab ; 319(4): E689-E708, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32755302

RESUMO

Much more serious than the previous severe acute respiratory syndrome (SARS) coronavirus (CoV) outbreaks, the novel SARS-CoV-2 infection has spread speedily, affecting 213 countries and causing ∼17,300,000 cases and ∼672,000 (∼+1,500/day) deaths globally (as of July 31, 2020). The potentially fatal coronavirus disease (COVID-19), caused by air droplets and airborne as the main transmission modes, clearly induces a spectrum of respiratory clinical manifestations, but it also affects the immune, gastrointestinal, hematological, nervous, and renal systems. The dramatic scale of disorders and complications arises from the inadequacy of current treatments and absence of a vaccine and specific anti-COVID-19 drugs to suppress viral replication, inflammation, and additional pathogenic conditions. This highlights the importance of understanding the SARS-CoV-2 mechanisms of actions and the urgent need of prospecting for new or alternative treatment options. The main objective of the present review is to discuss the challenging issue relative to the clinical utility of plants-derived polyphenols in fighting viral infections. Not only is the strong capacity of polyphenols highlighted in magnifying health benefits, but the underlying mechanisms are also stressed. Finally, emphasis is placed on the potential ability of polyphenols to combat SARS-CoV-2 infection via the regulation of its molecular targets of human cellular binding and replication, as well as through the resulting host inflammation, oxidative stress, and signaling pathways.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Fitoterapia/métodos , Pneumonia Viral/prevenção & controle , Polifenóis/uso terapêutico , Prevenção Primária/métodos , Betacoronavirus/fisiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/história , História do Século XXI , Humanos , Terapia de Alvo Molecular/métodos , Terapia de Alvo Molecular/tendências , Pandemias/história , Pneumonia Viral/epidemiologia , Pneumonia Viral/história , Polifenóis/farmacologia , Replicação Viral/efeitos dos fármacos
19.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32769198

RESUMO

CONTEXT: An updated synthesis of research on substance abuse prevention programs can promote enhanced uptake of programs with proven effectiveness, particularly when paired with information relevant to practitioners and policy makers. OBJECTIVE: To assess the strength of the scientific evidence for psychoactive substance abuse prevention programs for school-aged children and youth. DATA SOURCES: A systematic review was conducted of studies published up until March 31, 2020. STUDY SELECTION: Articles on substance abuse prevention programs for school-aged children and youth were independently screened and included if they met eligibility criteria: (1) the program was designed for a general population of children and youth (ie, not designed for particular target groups), (2) the program was delivered to a general population, (3) the program only targeted children and youth, and (4) the study included a control group. DATA EXTRACTION: Two reviewers independently evaluated study quality and extracted outcome data. RESULTS: Ninety studies met eligibility criteria, representing 16 programs. Programs evaluated with the largest combined sample sizes were Drug Abuse Resistance Education, Project Adolescent Learning Experiences Resistance Training, Life Skills Training (LST), the Adolescent Alcohol Prevention Trial, and Project Choice. LIMITATIONS: Given the heterogeneity of outcomes measured in the included studies, it was not possible to conduct a statistical meta-analysis of program effectiveness. CONCLUSIONS: The most research has been conducted on the LST program. However, as with other programs included in this review, studies of LST effectiveness varied in quality. With this review, we provide an updated summary of evidence for primary prevention program effectiveness.


Assuntos
Prevenção Primária/normas , Avaliação de Programas e Projetos de Saúde/normas , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adolescente , Criança , Humanos , Prevenção Primária/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/psicologia
20.
PLoS One ; 15(8): e0237564, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810194

RESUMO

BACKGROUND: Prevention of overweight during early childhood seems promising. OBJECTIVE: To evaluate the effectiveness of the parenting-based BBOFT+ overweight prevention program on child BMI, child health behavior and parenting behavior among 0-36 month old children. BBOFT+ is an acronym for the key healthy lifestyle behaviors that are targeted in the BBOFT+ intervention: breastfeeding (B), daily breakfast (B), daily going outdoors (O), limiting sweet beverages (in Dutch, F) and minimal TV or computer time (T), complemented with healthy sleep behavior and improvement of parenting skills (+). METHODS: A cluster randomized controlled trial in newborn children visiting well-baby clinics, comparing the BBOFT+ intervention (N = 901) with care as usual (CAU) (N = 1094). In both groups, parents received regular well-child visits (±11 visits in the first 3 years). In the intervention group, care was supplemented with the BBOFT+ program, which focuses on improving parenting skills from birth onwards to increase healthy behavior. Questionnaires were filled in at child's age 2-4 weeks, 6, 14 and 36 months. In multivariate analyses we corrected for child's birthweight, age, ethnic background, mother's educational level and BMI. RESULTS: No differences were found in weight status at 36 months between intervention and control group children. At 6 months, BBOFT+ parents reported their child drinking less sweet beverages than control parents (48% vs 54%;p = .027), and going outdoors daily with their child less often (57% vs 62%;p = .03). At 14 months, more BBOFT+ parents than control parents reported to have breastfed for six months or longer (32% vs 29%;p = .022). At 36 months, more BBOFT+ parents than control parents reported their child going outside daily (78% vs 72%;p = .011) and having less TV/computer time on week- (38% vs 46%;p = .001) and weekend days (48% vs 56%;p = .002). Also, BBOFT+ parents reported having more parental control than control parents (3.92 vs 3.89;p = .02). No significant differences were found for daily breakfast, sleep duration and parenting practices in adjusted analyses. CONCLUSION: The BBOFT+ overweight prevention program showed small improvements in parent-reported child health behaviors, compared to care as usual; no effect was observed on child BMI. The identified modifiable elements are potentially relevant for interventions that aim to prevent overweight.


Assuntos
Índice de Massa Corporal , Educação não Profissionalizante/métodos , Comportamentos Relacionados com a Saúde/fisiologia , Sobrepeso/prevenção & controle , Poder Familiar , Adulto , Desenvolvimento Infantil/fisiologia , Serviços de Saúde da Criança , Pré-Escolar , Análise por Conglomerados , Feminino , Humanos , Lactente , Recém-Nascido , Estilo de Vida , Masculino , Países Baixos , Visita a Consultório Médico , Relações Pais-Filho , Obesidade Pediátrica/prevenção & controle , Prevenção Primária/métodos , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA