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1.
J Am Heart Assoc ; 9(19): e017297, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-32998607

RESUMO

Background Angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) may worsen the prognosis of coronavirus disease 2019, but any association could be confounded by the cardiometabolic conditions indicating ACE-I/ARB use. We therefore examined the impact of ACE-Is/ARBs on respiratory tract infection outcomes. Methods and Results This cohort study included all adult patients hospitalized with influenza or pneumonia from 2005 to 2018 in Denmark using population-based medical databases. Thirty-day mortality and risk of admission to the intensive care unit in ACE-Is/ARBs users was compared with nonusers and with users of calcium channel blockers. We used propensity scores to handle confounding and computed propensity score-weighted risks, risk differences (RDs), and risk ratios (RRs). Of 568 019 patients hospitalized with influenza or pneumonia, 100 278 were ACE-I/ARB users and 37 961 were users of calcium channel blockers. In propensity score-weighted analyses, ACE-I/ARB users had marginally lower 30-day mortality than users of calcium channel blockers (13.9% versus 14.5%; RD, -0.6%; 95% CI, -1.0 to -0.1; RR, 0.96; 95% CI, 0.93-0.99), and a lower risk of admission to the intensive care unit (8.0% versus 9.6%; RD, -1.6%; 95% CI, -2.0 to -1.2; RR, 0.83; 95% CI, 0.80-0.87). Compared with nonusers, current ACE-I/ARB users had lower mortality (RD, -2.4%; 95% CI, -2.8 to -2.0; RR, 0.85; 95% CI, 0.83-0.87), but similar risk of admission to the intensive care unit (RD, 0.4%; 95% CI, 0.0-0.7; RR, 1.04; 95% CI, 1.00-1.09). Conclusions Among patients with influenza or pneumonia, ACE-I/ARB users had no increased risk of admission to the intensive care unit and slightly reduced mortality after controlling for confounding.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Influenza Humana/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Pneumonia/tratamento farmacológico , Sistema Renina-Angiotensina/efeitos dos fármacos , Idoso , Idoso de 80 Anos ou mais , Dinamarca/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Influenza Humana/epidemiologia , Masculino , Razão de Chances , Pandemias , Pneumonia/epidemiologia , Pontuação de Propensão , Estudos Retrospectivos , Taxa de Sobrevida/tendências
2.
Comput Math Methods Med ; 2020: 1391583, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33029193

RESUMO

Purpose: We aimed to analyze and evaluate the safety signals of ribavirin-interferon combination through data mining of the US Food and Drug Administration Adverse Event Reporting System (FAERS), so as to provide reference for the rationale use of these agents in the management of relevant toxicities emerging in patients with novel coronavirus pneumonia (COVID-19). Methods: Reports to the FAERS from 1 January 2004 to 8 March 2020 were analyzed. The proportion of report ratio (PRR), reporting odds ratio (ROR), and Bayesian confidence interval progressive neural network (BCPNN) method were used to detect the safety signals. Results: A total of 55 safety signals were detected from the top 250 adverse event reactions in 2200 reports, but 19 signals were not included in the drug labels. All the detected adverse event reactions were associated with 13 System Organ Classes (SOC), such as gastrointestinal, blood and lymph, hepatobiliary, endocrine, and various nervous systems. The most frequent adverse events were analyzed, and the results showed that females were more likely to suffer from anemia, vomiting, neutropenia, diarrhea, and insomnia. Conclusion: The ADE (adverse drug event) signal detection based on FAERS is helpful to clarify the potential adverse events related to ribavirin-interferon combination for novel coronavirus therapy; clinicians should pay attention to the adverse reactions of gastrointestinal and blood systems, closely monitor the fluctuations of the platelet count, and carry out necessary mental health interventions to avoid serious adverse events.


Assuntos
Infecções por Coronavirus/tratamento farmacológico , Interferons/efeitos adversos , Pneumonia Viral/tratamento farmacológico , Ribavirina/efeitos adversos , Adolescente , Adulto , Sistemas de Notificação de Reações Adversas a Medicamentos , Idoso , Algoritmos , Teorema de Bayes , Mineração de Dados , Esquema de Medicação , Quimioterapia Combinada/efeitos adversos , Feminino , Humanos , Interferons/administração & dosagem , Masculino , Pessoa de Meia-Idade , Redes Neurais de Computação , Razão de Chances , Pandemias , Segurança do Paciente , Ribavirina/administração & dosagem , Adulto Jovem
3.
BMJ Open ; 10(8): e040448, 2020 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-32868370

RESUMO

OBJECTIVE: To assess the impact of describing an antibody-positive test result using the terms Immunity and Passport or Certificate, alone or in combination, on perceived risk of becoming infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and protective behaviours. DESIGN: 2×3 experimental design. SETTING: Online. PARTICIPANTS: 1204 adults from a UK research panel. INTERVENTION: Participants were randomised to receive one of six descriptions of an antibody test and results showing SARS-CoV-2 antibodies, differing in the terms describing the type of test (Immunity vs Antibody) and the test result (Passport vs Certificate vs Test). MAIN OUTCOME MEASURES: Primary outcome: proportion of participants perceiving no risk of infection with SARS-CoV-2 given an antibody-positive test result. Other outcomes include: intended changes to frequency of hand washing and physical distancing. RESULTS: When using the term Immunity (vs Antibody), 19.1% of participants (95% CI 16.1% to 22.5%) (vs 9.8% (95% CI 7.5% to 12.4%)) perceived no risk of catching coronavirus given an antibody-positive test result (adjusted OR (AOR): 2.91 (95% CI 1.52 to 5.55)). Using the terms Passport or Certificate-as opposed to Test-had no significant effect (AOR: 1.24 (95% CI 0.62 to 2.48) and AOR: 0.96 (95% CI 0.47 to 1.99) respectively). There was no significant interaction between the effects of the test and result terminology. Across groups, perceiving no risk of infection was associated with an intention to wash hands less frequently (AOR: 2.32 (95% CI 1.25 to 4.28)); there was no significant association with intended avoidance of physical contact (AOR: 1.37 (95% CI 0.93 to 2.03)). CONCLUSIONS: Using the term Immunity (vs Antibody) to describe antibody tests for SARS-CoV-2 increases the proportion of people believing that an antibody-positive result means they have no risk of catching coronavirus in the future, a perception that may be associated with less frequent hand washing. TRIAL REGISTRATION NUMBER: Open Science Framework: https://osf.io/tjwz8/files/.


Assuntos
Anticorpos Antivirais , Comunicação , Infecções por Coronavirus , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Imunidade , Pandemias , Pneumonia Viral , Adulto , Anticorpos Antivirais/sangue , Betacoronavirus , Certificação , Infecções por Coronavirus/sangue , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/virologia , Revelação , Feminino , Humanos , Internet , Masculino , Razão de Chances , Pandemias/prevenção & controle , Pneumonia Viral/sangue , Pneumonia Viral/prevenção & controle , Pneumonia Viral/virologia , Medição de Risco , Reino Unido
4.
Medicine (Baltimore) ; 99(35): e21452, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871868

RESUMO

BACKGROUND: The effectiveness of therapeutic hypothermia (TH) for patients following cardiac arrest with non-shockable rhythm is debated. We plan to conduct a systematic review and meta-analysis with all available randomized controlled trials (RCTs) to explore the efficacy and safety of TH in in this population. METHODS: PubMed, EMBASE and Cochrane Library will be searched to identify RCTs published from inception through December 2020 without language restriction. Patients following cardiac arrest due to non-shockable rhythm will be included. The primary outcome is the hospital mortality. The secondary outcome is the favorable neurological outcome. The pooled effects will be analyzed as mean differences using the inverse-variance method for continuous data or as risk ratios using the Mantel-Haenszel method for dichotomous data. Subgroup and sensitivity analyses will be conducted. The Egger's test and/or the funnel plot will be used to test the publication bias. The grades of recommendation assessment, development, and evaluation (GRADE) methodology will be used to assess the quality of evidence. The trial sequential analysis will be used to test whether the meta-analysis is conclusive. RESULTS: The RCTs on the effectiveness of TH for patients following cardiac arrest with non-shockable rhythm will be systematically reviewed and advance evidence will be provided. CONCLUSION: Advanced evidence of TH for cardiac arrest due to non-shockable rhythm will be provided for physicians. PROSPERO REGISTRATION NUMBER: CRD42020161823.


Assuntos
Parada Cardíaca/complicações , Hipotermia Induzida/métodos , Parada Cardíaca Extra-Hospitalar/etiologia , Parada Cardíaca Extra-Hospitalar/terapia , Mortalidade Hospitalar/tendências , Humanos , Doenças do Sistema Nervoso/epidemiologia , Razão de Chances , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Resultado do Tratamento
5.
Medicine (Baltimore) ; 99(33): e21034, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871977

RESUMO

BACKGROUND: The aim of this systematic review and meta-analysis is to assess effectiveness and safety of Chinese medicine (CM) as complementary therapy in treating coronavirus disease 2019 (COVID-19). METHODS: The following databases will be searched: PubMed, Cochrane, Embase, China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, and Wanfang database from October 1, 2019 to March 1, 2020. Randomized trials and quasi-randomized or prospective controlled clinical trials of CM that reported data on COVID-19 patients will be included. Study selection, data extraction, quality assessment, and assessment of risk bias will be performed by 2 reviewers independently. Odds ratios and correlative 95% confidence intervals will be calculated to present the association between the CM and CWM using Review Manager version 5.3 when there is sufficient available data. RESULTS: The results will be disseminated through a peer-reviewed journal publication. CONCLUSION: This systematic review findings will summarize up-to-date evidence for that CM is more effective and safe as adjunctive treatment for patients with COVID-19. ETHICS AND DISSEMINATION: Ethics approval and patient consent are not required as this study is a systematic review based on published articles. PROSPERO REGISTRATION NUMBER: CRD42020185382.


Assuntos
Betacoronavirus , Terapias Complementares/métodos , Infecções por Coronavirus/terapia , Medicamentos de Ervas Chinesas/uso terapêutico , Pneumonia Viral/terapia , Adulto , Idoso , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/virologia , Feminino , Humanos , Masculino , Medicina Tradicional Chinesa/métodos , Metanálise como Assunto , Pessoa de Meia-Idade , Razão de Chances , Pandemias , Pneumonia Viral/virologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
6.
Cochrane Database Syst Rev ; 9: CD013708, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32870512

RESUMO

BACKGROUND: Supplemental oxygen is frequently administered to patients with acute respiratory distress syndrome (ARDS), including ARDS secondary to viral illness such as coronavirus disease 19 (COVID-19). An up-to-date understanding of how best to target this therapy (e.g. arterial partial pressure of oxygen (PaO2) or peripheral oxygen saturation (SpO2) aim) in these patients is urgently required. OBJECTIVES: To address how oxygen therapy should be targeted in adults with ARDS (particularly ARDS secondary to COVID-19 or other respiratory viruses) and requiring mechanical ventilation in an intensive care unit, and the impact oxygen therapy has on mortality, days ventilated, days of catecholamine use, requirement for renal replacement therapy, and quality of life. SEARCH METHODS: We searched the Cochrane COVID-19 Study Register, CENTRAL, MEDLINE, and Embase from inception to 15 May 2020 for ongoing or completed randomized controlled trials (RCTs). SELECTION CRITERIA: Two review authors independently assessed all records in accordance with standard Cochrane methodology for study selection. We included RCTs comparing supplemental oxygen administration (i.e. different target PaO2 or SpO2 ranges) in adults with ARDS and receiving mechanical ventilation in an intensive care setting. We excluded studies exploring oxygen administration in patients with different underlying diagnoses or those receiving non-invasive ventilation, high-flow nasal oxygen, or oxygen via facemask. DATA COLLECTION AND ANALYSIS: One review author performed data extraction, which a second review author checked. We assessed risk of bias in included studies using the Cochrane 'Risk of bias' tool. We used the GRADE approach to judge the certainty of the evidence for the following outcomes; mortality at longest follow-up, days ventilated, days of catecholamine use, and requirement for renal replacement therapy. MAIN RESULTS: We identified one completed RCT evaluating oxygen targets in patients with ARDS receiving mechanical ventilation in an intensive care setting. The study randomized 205 mechanically ventilated patients with ARDS to either conservative (PaO2 55 to 70 mmHg, or SpO2 88% to 92%) or liberal (PaO2 90 to 105 mmHg, or SpO2 ≥ 96%) oxygen therapy for seven days. Overall risk of bias was high (due to lack of blinding, small numbers of participants, and the trial stopping prematurely), and we assessed the certainty of the evidence as very low. The available data suggested that mortality at 90 days may be higher in those participants receiving a lower oxygen target (odds ratio (OR) 1.83, 95% confidence interval (CI) 1.03 to 3.27). There was no evidence of a difference between the lower and higher target groups in mean number of days ventilated (14.0, 95% CI 10.0 to 18.0 versus 14.5, 95% CI 11.8 to 17.1); number of days of catecholamine use (8.0, 95% CI 5.5 to 10.5 versus 7.2, 95% CI 5.9 to 8.4); or participants receiving renal replacement therapy (13.7%, 95% CI 5.8% to 21.6% versus 12.0%, 95% CI 5.0% to 19.1%). Quality of life was not reported. AUTHORS' CONCLUSIONS: We are very uncertain as to whether a higher or lower oxygen target is more beneficial in patients with ARDS and receiving mechanical ventilation in an intensive care setting. We identified only one RCT with a total of 205 participants exploring this question, and rated the risk of bias as high and the certainty of the findings as very low. Further well-conducted studies are urgently needed to increase the certainty of the findings reported here. This review should be updated when more evidence is available.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Unidades de Terapia Intensiva , Oxigênio/administração & dosagem , Pneumonia Viral/complicações , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/terapia , Viés , Catecolaminas/uso terapêutico , Tratamento Conservador , Humanos , Razão de Chances , Pandemias , Terapia de Substituição Renal/estatística & dados numéricos , Respiração Artificial/estatística & dados numéricos , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Síndrome do Desconforto Respiratório do Adulto/virologia , Autoimagem , Fatores de Tempo
7.
J Korean Acad Nurs ; 50(4): 533-540, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32895340

RESUMO

PURPOSE: This study aimed to evaluate nursing students' understanding of the prevention of COVID-19, as well as their anxiety towards the disease and their perception of their professional identity in the wake of the pandemic, in Zhengzhou, China. METHODS: A cross-sectional study was designed to investigate 474 nursing students by cluster sampling using a stratified questionnaire from February 15 to March 31, 2020. Multiple linear regression was used to identify the factors affecting professional identity. Binary and multiple logistic regression were used to identify the factors affecting anxiety. RESULTS: Responders with a high level of understanding of COVID-19 and frequent use of behavioral strategies for its prevention comprised 93.2% and 30.0% of the cohort, respectively. Professional identity was significantly associated with gender and anxiety (p < .050). The prevalence of anxiety among nursing students was 12.4%. Male (odds ratio [OR] = 2.39; 95% confidence interval [CI] = 1.26~4.52), sophomores (OR = 5.30; 95% CI = 1.61~7.45), and infrequent use of prevention measures (OR = 3.49; 95% CI = 1.16~5.19) had a significant effect on anxiety. CONCLUSION: Anxiety during the COVID-19 epidemic gives an adverse effect on the professional identity of nursing in students. Nursing education institutions need to provide psychological counseling services for nursing students, in addition to improving their teaching of COVID-19 prevention strategies.


Assuntos
Ansiedade/etiologia , Infecções por Coronavirus/prevenção & controle , Conhecimento , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Papel Profissional , Estudantes de Enfermagem/psicologia , Ansiedade/epidemiologia , Betacoronavirus/isolamento & purificação , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Razão de Chances , Pneumonia Viral/epidemiologia , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Inquéritos e Questionários , Adulto Jovem
8.
Croat Med J ; 61(4): 309-318, 2020 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-32881428

RESUMO

AIM: To investigate the effect of the coronavirus 2019 (COVID-19) lockdown on lifestyle behaviors and mood changes in the Croatian general population. METHODS: During ten days of the COVID-19 lockdown in Croatia, 3027 respondents (70.3% female) from the general population completed an online, self-report questionnaire. Demographic data and data on lifestyle habits and mood changes before and during the COVID-19 lockdown were collected. RESULTS: A total of 95.64% of respondents reported to follow most or all restrictions, with female sex (P<0.001) and higher education level (P<0.001) being associated with higher restriction compliance. Women smoked an increased number of cigarettes (P<0.001). The proportion of respondents of both sexes who did not drink or drank 7 drinks per week or more increased (P<0.001). Women also reported lower frequency (P=0.001) and duration of physical exercise (P<0.001). In total, 30.7% of respondents gained weight, with female sex (OR, 2.726) and higher BMI (OR, 1.116; both P<0.001) being associated with an increased likelihood of gaining weight. Both men and women felt more frequently afraid (P<0.001), discouraged (P<0.001), and sad (P<0.001). CONCLUSION: Public health authorities should promote the adoption of healthy lifestyles in order to reduce long-term negative effects of the lockdown.


Assuntos
Afeto , Consumo de Bebidas Alcoólicas/epidemiologia , Fumar Cigarros/epidemiologia , Infecções por Coronavirus/epidemiologia , Exercício Físico , Pneumonia Viral/epidemiologia , Quarentena/estatística & dados numéricos , Ganho de Peso , Adulto , Betacoronavirus , Índice de Massa Corporal , Coronavirus , Croácia/epidemiologia , Estudos Transversais , Medo , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pandemias , Admissão e Escalonamento de Pessoal , Quarentena/psicologia , Tristeza , Inquéritos e Questionários
9.
Tohoku J Exp Med ; 252(1): 73-84, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32908083

RESUMO

The Coronavirus Disease 2019 (COVID-19) pandemic has killed many people worldwide since December 2019, and Iran has been among the most affected countries. In this retrospective study, we aimed to determine the prognostic factors associated with mortality in COVID-19 patients by analyzing 396 survived and 63 non-survived patients in Shahid Modarres Hospital, Tehran, Iran, from January 30th until April 5th, 2020. As the results, the BMI > 35 (p = 0.0003), lung cancer (p = 0.007), chronic kidney disease (p = 0.002), Immunocompromised condition (p = 0.003), and diabetes (p = 0.018) were more frequently observed in the expired group. The history of statins use was more common in the discharged group (p = 0.002), while there was no significant difference in the drug history of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, nonsteroidal anti-inflammatory drugs, aspirin, and/or steroids, and in the past-year influenza vaccination. Multivariable regression demonstrated rising odds of in-hospital death related with age (odds ratio (OR) = 1.055, p = 0.002), levels of C-reactive protein (CRP) (OR = 2.915, p < 0.001), creatinine (OR = 1.740, p = 0.023), lymphocyte count (OR = 0.999, p = 0.008), and magnesium level (OR = 0.032, p < 0.001) on admission. In conclusion, the patients with older age and higher BMI with lymphopenia, hypomagnesemia, elevated CRP and/or raised creatinine on admission are at higher risk of mortality due to the COVID-19 infection, which requires the physicians to use timely and strong therapeutic measures for such patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Pandemias , Pneumonia Viral/mortalidade , Fatores Etários , Idoso , Doenças Cardiovasculares/epidemiologia , Comorbidade , Infecções por Coronavirus/sangue , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hospedeiro Imunocomprometido , Inflamação/epidemiologia , Pacientes Internados/estatística & dados numéricos , Irã (Geográfico)/epidemiologia , Nefropatias/epidemiologia , Linfopenia/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Razão de Chances , Sobrepeso/epidemiologia , Pneumonia Viral/sangue , Prognóstico , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Avaliação de Sintomas
10.
BMJ Open ; 10(9): e040328, 2020 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-32948576

RESUMO

OBJECTIVES: To assess the public's knowledge, attitudes and practices about the novel coronavirus in Sierra Leone to inform an evidence-based communication strategy around COVID-19. DESIGN: Nationwide, cross-sectional Knowledge, Attitudes and Practices survey. SETTING: 56 randomly selected communities in all 14 districts in Sierra Leone. PARTICIPANTS: 1253 adults aged 18 years and older of which 52% were men. MAIN OUTCOME MEASURES: We calculated proportions of core indicators (awareness, knowledge, risk perception, practices). A composite variable for knowledge (based on seven variables) was created, and categorised into low (0-2 correct), medium (3-4) and high (5-7). Predictors of knowledge were analysed with multilevel ordinal regression models. Associations between information sources, knowledge and two practices (washing hands with soap and avoiding crowds) were analysed using multilevel logistic regression models. RESULTS: We found that 75% of the respondents felt at moderate or great risk of contracting coronavirus. A majority (70%) of women did not know you can survive COVID-19, compared with 61% of men. 60% of men and 54% of women had already taken action to avoid infection with the coronavirus, mostly washing hands with soap and water (87%). Radio (73%) was the most used source for COVID-19 information, followed by social media (39%). Having a medium or high level of knowledge was associated with higher odds of washing hands with soap (medium knowledge: adjusted OR (AOR) 2.1, 95% CI 1.0 to 4.4; high knowledge: AOR 4.6, 95% CI 2.1 to 10.2) and avoiding crowds (medium knowledge: AOR 2.0, 95% CI 1.1 to 3.6; high knowledge: AOR 2.3, 95% CI 1.2 to 4.3). CONCLUSIONS: This study shows that in the context of COVID-19 in Sierra Leone, there is a strong association between knowledge and practices. Because the knowledge gap differs between genders, regions, educational levels and age, it is important that messages are specifically targeted to these core audiences.


Assuntos
Infecções por Coronavirus , Conhecimentos, Atitudes e Prática em Saúde , Pandemias , Pneumonia Viral , Adulto , Betacoronavirus , Informação de Saúde ao Consumidor , Feminino , Desinfecção das Mãos , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Rádio , Serra Leoa , Mídias Sociais , Inquéritos e Questionários , Adulto Jovem
11.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32868471

RESUMO

BACKGROUND: Legal performance-enhancing substance(s) (PES) (eg, creatine) are widely used among adolescent boys and young men; however, little is known about their temporal associations with substance use behaviors. METHODS: We analyzed prospective cohort data from the National Longitudinal Study of Adolescent to Adult Health, Waves I to IV (1994-2008). Logistic regressions were used to first assess adolescent substance use (Wave I) and use of legal PES (Wave III) and second to assess use of legal PES (Wave III) and subsequent substance use-associated risk behaviors (Wave IV), adjusting for potential confounders. RESULTS: Among the sample of 12 133 young adults aged 18 to 26 years, 16.1% of young men and 1.2% of young women reported using legal PES in the past year. Adolescent alcohol use was prospectively associated with legal PES use in young men (odds ratio 1.39; 95% confidence interval [CI] 1.13-1.70). Among young men, legal PES use was prospectively associated with higher odds of problematic alcohol use and drinking-related risk behaviors, including binge drinking (adjusted odds ratio [aOR] 1.35; 95% CI 1.07-1.71), injurious and risky behaviors (aOR 1.78; 95% CI 1.43-2.21), legal problems (aOR 1.52; 95% CI 1.08-2.13), cutting down on activities and socialization (aOR 1.91; 95% CI 1.36-2.78), and emotional or physical health problems (aOR 1.44; 95% CI 1.04-1.99). Among young women, legal PES use was prospectively associated with higher odds of emotional or physical health problems (aOR 3.00; 95% CI 1.20-7.44). CONCLUSIONS: Use of legal PES should be considered a gateway to future problematic alcohol use and drinking-related risk behaviors, particularly among young men.


Assuntos
Substâncias para Melhoria do Desempenho/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/etiologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Intoxicação Alcoólica/complicações , Aminoácidos/efeitos adversos , Atletas/estatística & dados numéricos , Índice de Massa Corporal , Intervalos de Confiança , Creatina/efeitos adversos , Desidroepiandrosterona/efeitos adversos , Feminino , Humanos , Modelos Logísticos , Masculino , Fumar Maconha/efeitos adversos , Razão de Chances , Estudos Prospectivos , Assunção de Riscos , Fatores Sexuais , Fumar/efeitos adversos , Esteroides/efeitos adversos , Consumo de Álcool por Menores , Adulto Jovem
12.
Oral Health Prev Dent ; 18(1): 683-691, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32895650

RESUMO

PURPOSE: This study clarified the oral factors related to swallowing function using the results of dental check-ups among community-dwelling independent elders. MATERIALS AND METHODS: Data on oral and medical health check-ups from 4,676 participants aged 75 and 80 years were analysed. Swallowing function was evaluated using the repetitive saliva swallowing test (RSST), which assesses the ability to swallow saliva. Swallowing three or more times during a 30 s period was recorded as normal, while swallowing twice or less in 30 s was considered to indicate swallowing difficulty. Multivariate logistic regression analyses were performed to examine the relationship between oral factors and swallowing function. RESULTS: In all participants, the odds ratio (OR) for swallowing difficulty was 3.42 (95% confidence interval (CI): 1.78-6.55) and 6.68 (95% CI: 1.97-22.64) among those who had 10-19 teeth without dentures and those who had 0-9 teeth without dentures, respectively, compared to individuals with ≥ 20 teeth without dentures. Those with moderate or severe dry mouth had a statistically significantly higher OR (8.01, 95% CI: 4.84-13.27) for swallowing difficulty than those without dry mouth. Among dentate participants, in addition to statistically significant variables in the analysis among all participants, those with abundant dental plaque showed a significantly higher OR (2.58, 95% CI: 1.54-4.32) for swallowing difficulty compared to those with no or slight dental plaque. CONCLUSION: These results suggest that oral factors such as having few teeth without dentures, dry mouth, and poor oral hygiene are related to swallowing function in elders.


Assuntos
Transtornos de Deglutição , Xerostomia , Idoso , Idoso de 80 Anos ou mais , Deglutição , Humanos , Razão de Chances , Saúde Bucal , Saliva
13.
JAMA Netw Open ; 3(9): e2021892, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32975575

RESUMO

Importance: Initial public health data show that Black race may be a risk factor for worse outcomes of coronavirus disease 2019 (COVID-19). Objective: To characterize the association of race with incidence and outcomes of COVID-19, while controlling for age, sex, socioeconomic status, and comorbidities. Design, Setting, and Participants: This cross-sectional study included 2595 consecutive adults tested for COVID-19 from March 12 to March 31, 2020, at Froedtert Health and Medical College of Wisconsin (Milwaukee), the largest academic system in Wisconsin, with 879 inpatient beds (of which 128 are intensive care unit beds). Exposures: Race (Black vs White, Native Hawaiian or Pacific Islander, Native American or Alaska Native, Asian, or unknown). Main Outcomes and Measures: Main outcomes included COVID-19 positivity, hospitalization, intensive care unit admission, mechanical ventilation, and death. Additional independent variables measured and tested included socioeconomic status, sex, and comorbidities. Reverse transcription polymerase chain reaction assay was used to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results: A total of 2595 patients were included. The mean (SD) age was 53.8 (17.5) years, 978 (37.7%) were men, and 785 (30.2%) were African American patients. Of the 369 patients (14.2%) who tested positive for COVID-19, 170 (46.1%) were men, 148 (40.1%) were aged 60 years or older, and 218 (59.1%) were African American individuals. Positive tests were associated with Black race (odds ratio [OR], 5.37; 95% CI, 3.94-7.29; P = .001), male sex (OR, 1.55; 95% CI, 1.21-2.00; P = .001), and age 60 years or older (OR, 2.04; 95% CI, 1.53-2.73; P = .001). Zip code of residence explained 79% of the overall variance in COVID-19 positivity in the cohort (ρ = 0.79; 95% CI, 0.58-0.91). Adjusting for zip code of residence, Black race (OR, 1.85; 95% CI, 1.00-3.65; P = .04) and poverty (OR, 3.84; 95% CI, 1.20-12.30; P = .02) were associated with hospitalization. Poverty (OR, 3.58; 95% CI, 1.08-11.80; P = .04) but not Black race (OR, 1.52; 95% CI, 0.75-3.07; P = .24) was associated with intensive care unit admission. Overall, 20 (17.2%) deaths associated with COVID-19 were reported. Shortness of breath at presentation (OR, 10.67; 95% CI, 1.52-25.54; P = .02), higher body mass index (OR per unit of body mass index, 1.19; 95% CI, 1.05-1.35; P = .006), and age 60 years or older (OR, 22.79; 95% CI, 3.38-53.81; P = .001) were associated with an increased likelihood of death. Conclusions and Relevance: In this cross-sectional study of adults tested for COVID-19 in a large midwestern academic health system, COVID-19 positivity was associated with Black race. Among patients with COVID-19, both race and poverty were associated with higher risk of hospitalization, but only poverty was associated with higher risk of intensive care unit admission. These findings can be helpful in targeting mitigation strategies for racial disparities in the incidence and outcomes of COVID-19.


Assuntos
Afro-Americanos , Infecções por Coronavirus/etnologia , Disparidades nos Níveis de Saúde , Hospitalização , Unidades de Terapia Intensiva , Pneumonia Viral/etnologia , Adulto , Idoso , Betacoronavirus , Índice de Massa Corporal , Estudos de Coortes , Comorbidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Estudos Transversais , Dispneia/epidemiologia , Dispneia/etiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Grupos Minoritários , Razão de Chances , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Pobreza , Respiração Artificial , Wisconsin/epidemiologia
14.
Epidemiol Serv Saude ; 29(4): e2020413, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32997070

RESUMO

OBJECTIVE: To analyze factors associated with the deaths of individuals hospitalized with COVID-19 in the state of Espírito Santo, Brazil. METHODS: This was a cross-sectional study using secondary data. Logistic regression models were used to estimate crude and adjusted odds ratios (OR). RESULTS: As at May 14, 2020, 200 individuals had been discharged and 220 had died. Of the total number of people studied, 57.1% were male, 46.4% were >60 years old, 57.9% were cases notified by a private institution, and 61.7% had >1 comorbidity. In the adjusted analysis, hospital mortality was higher for the 51-60 age group (OR=4.33 - 95%CI 1.50;12.46), the over 60 age group (OR=11.84 - 95%CI 4.31;32.54), cases notified by public institutions (OR=8.23 - 95%CI 4.84;13.99) and cases with a greater number of comorbidities (two [OR=2.74 - 95%CI 1.40;5.34] and three [OR=2.90 - 95%CI 1.07;7.81]). CONCLUSION: Higher mortality was found in older individuals, those with comorbidities and users of public hospitals.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Mortalidade Hospitalar , Pneumonia Viral/mortalidade , Adulto , Distribuição por Idade , Idoso , Brasil/epidemiologia , Causas de Morte , Comorbidade , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pandemias , Alta do Paciente/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Distribuição por Sexo , Adulto Jovem
15.
Clin Med (Lond) ; 20(5): 463-467, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32934038

RESUMO

OBJECTIVE: The objective was to study hospitalised COVID-19 patients' mortality and intensive care unit (ICU) admission with covariates of interest (age, gender, ethnicity, clinical presentation, comorbidities and admission laboratory findings). METHODS: Logistic regression analyses were performed for patients admitted to University Hospital, University Hospitals Coventry and Warwickshire NHS Trust, between 24 January 2020 - 13 April 2020. RESULTS: There were 321 patients hospitalised. Median age was 73 years and 189 (59%) were male. Ethnicity was divided between Caucasian (77%), and black, Asian, and minority ethnic (BAME) groups (23%). Commonest symptoms were dyspnoea (62.9%), fever (59.1%) and cough (56%). Gastrointestinal symptoms amounted to 11.8%.Forty-four patients (13.7%) received ICU care. ICU male to female ratio was 3:1 (p=0.027; odds ratio (OR) 2.3; 95% confidence interval (CI) 1.1-4.9), BAME (p=0.008; OR 2.5; 95% CI 1.3-4.9), age >65 years (p=0.026; OR 0.28; 95% CI 0.09-0.93), heart disease (p=0.009; OR 0.2; 95% CI 0.1-0.6) and elevated C-reactive protein (CRP; p<0.001; OR 1.004; 95% CI 1.002-1.008) were associated with ICU admission.One-hundred and four patients (32.4%) died. Age >65 years (p=0.011; OR 5; 95% CI 1.6-21.9), neutrophils (p=0.047), neutrophil:lymphocyte ratio (NLR; p=0.028), CRP (p<0.001) and albumin (p=0.002) were associated with mortality. When analysis adjusted for age, CRP (p<0.001; OR 1.006; 95% CI 1.004-1.008) and albumin (p=0.005; OR 0.94; 95% CI 0.90-0.98) remained associated with mortality. CONCLUSIONS: COVID-19 has high mortality. BAME and male patients were associated with ICU admission. High CRP and low albumin (after correcting for age) were associated with mortality.


Assuntos
Albuminas/metabolismo , Proteína C-Reativa/metabolismo , Causas de Morte , Infecções por Coronavirus/sangue , Infecções por Coronavirus/mortalidade , Mortalidade Hospitalar/tendências , Pneumonia Viral/sangue , Pneumonia Viral/mortalidade , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/fisiopatologia , Feminino , Avaliação Geriátrica , Hospitalização/estatística & dados numéricos , Hospitais Universitários , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Modelos Logísticos , Masculino , Razão de Chances , Pandemias , Pneumonia Viral/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Centros de Atenção Terciária , Reino Unido
16.
Nat Commun ; 11(1): 4592, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-32929089

RESUMO

Prediabetes is a state of glycaemic dysregulation below the diagnostic threshold of type 2 diabetes (T2D). Globally, ~352 million people have prediabetes, of which 35-50% develop full-blown diabetes within five years. T2D and its complications are costly to treat, causing considerable morbidity and early mortality. Whether prediabetes is causally related to diabetes complications is unclear. Here we report a causal inference analysis investigating the effects of prediabetes in coronary artery disease, stroke and chronic kidney disease, complemented by a systematic review of relevant observational studies. Although the observational studies suggest that prediabetes is broadly associated with diabetes complications, the causal inference analysis revealed that prediabetes is only causally related with coronary artery disease, with no evidence of causal effects on other diabetes complications. In conclusion, prediabetes likely causes coronary artery disease and its prevention is likely to be most effective if initiated prior to the onset of diabetes.


Assuntos
Doenças Cardiovasculares/complicações , Estado Pré-Diabético/complicações , Glicemia/metabolismo , Doenças Cardiovasculares/genética , Intervalos de Confiança , Doença da Artéria Coronariana/complicações , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Jejum/sangue , Humanos , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Razão de Chances , Estado Pré-Diabético/sangue , Estado Pré-Diabético/genética , Insuficiência Renal Crônica/complicações , Fatores de Risco , Acidente Vascular Cerebral/complicações
18.
Chemosphere ; 254: 126763, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32957263

RESUMO

Epidemiologic studies suggest that circulating metals from the natural environment are linked with cardiometabolic health. However, few studies examined the relationship between multiple metals exposure and metabolic phenotypes, especially in obese individuals. We conducted a cross-sectional study to explore the association between 23 urinary metals and metabolic phenotypes in 1392 overweight and obese individuals (592 males, 800 females, mean age 43.1 ± 9.8 years). Participants were classified as metabolically unhealthy if they had ≥2 of the following metabolic abnormalities: elevated blood pressure, elevated fasting blood glucose, elevated triglycerides, and reduced high-density lipoprotein cholesterol. Odds ratios (ORs) of unhealthy metabolic phenotypes for metal levels categorized into tertiles were assessed using logistic regression models. Five metals (barium, copper, iron, uranium, and zinc) were associated with unhealthy metabolic phenotypes in single-metal models, while in the multiple-metal model, only zinc and zinc-copper ratio remained significant. The ORs (95% CIs) comparing extreme tertiles were 2.57 (1.69, 3.89) for zinc and 1.68 (1.24, 2.27) for zinc-copper ratio after adjustment for confounders (both p-trends were <0.001). The numbers of metabolic abnormalities significantly increased with the levels of zinc and the zinc-copper ratio increased. Similar associations were observed with metabolic syndrome risk. High levels of urinary zinc were positively associated with elevated fasting blood glucose (p-trend < 0.001) and elevated triglycerides (p-trend = 0.003). The results suggest that urinary zinc and zinc-copper ratio are positively associated with increased risk of unhealthy metabolic phenotype. Further prospective studies with a larger sample size are required to verify these findings.


Assuntos
Exposição Ambiental , Metais/urina , Obesidade , Adulto , HDL-Colesterol , Cobre , Estudos Transversais , Feminino , Humanos , Ferro , Modelos Logísticos , Masculino , Síndrome Metabólica , Pessoa de Meia-Idade , Razão de Chances , Sobrepeso , Fenótipo , Estudos Prospectivos , Zinco
20.
BMC Infect Dis ; 20(1): 673, 2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938424

RESUMO

BACKGROUND: Urinary tract infection is one of the most common bacterial infections in children. Understanding the characteristics of uropathogens and their antimicrobial susceptibility pattern in a particular setting can provide evidence for the appropriate management of cases. This study aimed to assess the bacterial profile of urinary tract infection, their antimicrobial susceptibility pattern and associated factors among clinically suspected children attending at Felege-Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia. METHODS: A hospital-based cross-sectional study was conducted from February-April, 2019. A systematic sampling technique was employed. A mid-stream urine sample was inoculated on cystine lactose electrolyte deficient media and incubated for 24-48 h. Sub-culturing was done on Mac-Conkey and blood agar. Antimicrobial susceptibility test was done on Muller-Hinton agar. A binary logistic regression model was used to see the association between dependent and independent factors. A p-value< 0.05 at 95% CI was considered as statistically significant. RESULTS: The overall prevalence of urinary tract infection was 16.7% (95% CI 12.4-21.1). Both Gram-negative and Gram-positive bacterial isolates were recovered with a rate of 44/50 (88%) and 6/50 (12%) respectively. Among Gram-negative isolates, E. coli 28/44(63.6%) was predominant while S. saprophyticus 2/6(33.3%) was prevalent among Gram-positive bacterial isolates. Overall, a high level of resistance to ampicillin, augmentin, and tetracycline was shown by Gram-negative bacteria with a rate of 44/44(100%), 39/44(88.6%), and36/44 (81.8%) respectively. About 33/50(66%) of overall multidrug resistance was observed (95% CI 52-78). About six Gram-negative bacterial isolates were extended spectrum beta-lactamase (ESBL) producers. Having a history of urinary tract infection (P-0.003, AOR 1.86-22.15) and male uncircumcision (p-0.00, AOR 5.5-65.35) were the independent variables that associate for urinary tract infections. CONCLUSION: In the present study, the prevalence of urinary tract infection among children was high and considerably a high proportion of multidrug resistance was observed. This result will have a significant impact on the selection of appropriate antimicrobial agents for the treatment of urinary tract infection.


Assuntos
Infecções Urinárias/diagnóstico , Adolescente , Antibacterianos/farmacologia , Criança , Pré-Escolar , Estudos Transversais , Farmacorresistência Bacteriana Múltipla , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Etiópia/epidemiologia , Feminino , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/efeitos dos fármacos , Bactérias Gram-Positivas/isolamento & purificação , Hospitais , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Razão de Chances , Estudos Prospectivos , Infecções Urinárias/microbiologia , beta-Lactamases/genética , beta-Lactamases/metabolismo
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