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1.
Indian J Public Health ; 66(1): 33-37, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35381711

RESUMO

Background: Since 1976, several JE outbreaks have been reported from most of the districts of Assam. Objectives: The present study aims to conduct a descriptive and spatial analysis to understand the spatiotemporal distribution of JE cases of Dibrugarh district. Methods: Spatiotemporal distribution of JE cases from 2014 to 2018 at village level was described in maps using Geographical Information System. Spatial association between JE reporting places in the study area has been analyzed using spatial statistics analytical techniques. Temporal distribution of JE cases from 2014 to 2018 for different variable were described in tables. Results: During the period 2014-2018, incidence rate of JE cases ranged between 2.7/100,000 and 5.9/100,000 population and highest case fatality rate was 18.3% in 2014. Highest numbers of JE cases were reported in the age group 0-10 years. Most of the JE cases were from rural areas (84.2%). There was a seasonal pattern of JE which peaked in July. There were hotspots around Dibrugarh Municipality area, Duliajan oil town, Hatiali gaon, Naharkatiya chah bagicha, Nagaon Dhadumia gaon, and Nahortoli Tea Estate. Conclusion: On the basis of the study, JE hotspots can be identified that would help health authorities to further investigate and identify the factors responsible for its occurrence.


Assuntos
Encefalite Japonesa , Criança , Pré-Escolar , Surtos de Doenças , Encefalite Japonesa/epidemiologia , Registros Hospitalares , Humanos , Incidência , Índia/epidemiologia , Lactente , Recém-Nascido
2.
Epidemiol Prev ; 46(1-2): 84-91, 2022.
Artigo em Italiano | MEDLINE | ID: mdl-35354271

RESUMO

OBJECTIVES: to evaluate and validate the adoption of an algorithm for the identification of cases of congenital anomalies (CAs) to improve the performance of the Congenital Malformations Registry of Sicily Region (Southern Italy). DESIGN: an algorithm was used to identify congenital anomalies on a sample of hospital discharge records (SDO) with ICD-9-CM code between 740-759 on any of the diagnoses within the first year of life, together with a sample of healthy births equal to 5% of total births for the same period. The identified cases were evaluated through the clinical record analysis. SETTING AND PARTICIPANTS: the analysed sample was composed of 4,271 cases identified between June 2013 and December 2014 along with 3,993 SDO without any code of MC (5% of the total volume of births in the same period). MAIN OUTCOME MEASURES: positive predictive value (VPP) and negative predictive value (VPN) were computed by means of the comparison between the algorithm outcomes and the clinical record verification. RESULTS: 4,271 potentially malformed records involving 3,381 subjects born in the Sicilian territory have been identified. Among the hospital discharge records that it was possible to verify, the application of the algorithm led to the exclusion of 924 cases: of these, 62 proved to be false negatives (VPN: 93.3). The valid cases were 1,179, while the cases to be evaluated 617: the comparison between algorithm and clinical record analysis led to a VPP of 91.7 and 72.1, respectively, for valid and to be evaluated. CONCLUSIONS: the tested algorithm proved to be a useful tool for identifying SDO potentially related to congenital anomalies. In the overall sample, the algorithm provided an outcome consistent with the clinical record assessment in 87.4% (2,379) of cases.


Assuntos
Registros Hospitalares , Alta do Paciente , Algoritmos , Hospitais , Humanos , Sicília/epidemiologia
3.
Cad Saude Publica ; 38(1): e00288920, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35081207

RESUMO

Automatic geocoding methods have become popular in recent years, facilitating the study of the association between health outcomes and the place of living. However, rather few studies have evaluated geocoding quality, with most of them being performed in the US and Europe. This article aims to compare the quality of three automatic online geocoding tools against a reference method. A subsample of 300 handwritten addresses from hospital records was geocoded using Bing, Google Earth, and Google Maps. Match rates were higher (> 80%) for Google Maps and Google Earth compared with Bing. However, the accuracy of the addresses was better for Bing with a larger proportion (> 70%) of addresses with positional errors below 20m. Generally, performance did not vary for each method for different socioeconomic status. Overall, the methods showed an acceptable, but heterogeneous performance, which may be a warning against the use of automatic methods without assessing quality in other municipalities, particularly in Chile and Latin America.


Assuntos
Mapeamento Geográfico , Registros Hospitalares , Brasil , Chile , Sistemas de Informação Geográfica , Humanos
4.
Osteoporos Int ; 33(3): 685-694, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34648040

RESUMO

Osteoporotic vertebral fractures signify an increased risk of future fractures and mortality and can manifest the diagnosis of osteoporosis. We investigated the prevalence of vertebral fractures in routine CT of patients with long-term hospital records. Three out of ten patients showed osteoporotic vertebral fractures (VFs) corresponding to the highest rates reported in European population-based studies. INTRODUCTION: VFs are a common manifestation of osteoporosis, which influences future fracture risk. Their epidemiology has been investigated in population-based studies. However, few studies report the prevalence of osteoporotic VF in patients seen in clinical routine and include all common fracture levels of the thoracolumbar spine. The purpose of this study was to investigate the prevalence of osteoporotic VF in patients with CT scans and long-term hospital records and identify clinical factors associated with prevalent VFs. METHODS: All patients aged 45 years and older with a CT scan and prior hospital record of at least 5 years that were seen in the study period between September 2008 and May 2017 were reviewed. Imaging requirements were a CT scan with sagittal reformations including at least T6-L4. Patients with multiple myeloma were excluded. Fracture reading was performed using the Genant semi-quantitative method. Medical notes were reviewed for established diagnoses of osteoporosis and clinical information. Clinical factors (e.g. drug intake, chemotherapy, and mobility level) associated with prevalent VF were identified in logistic regression. RESULTS: The study population consisted of 718 patients (228 women and 490 men; mean age 69.3 ± 10.1 years) with mainly cancer staging and angiography CT imaging. The overall prevalence of VFs was 30.5%, with non-significantly more men showing a fracture (32.5%) compared to women (26.3%; p > 0.05). Intake of metamizole for ≥ 3 months was significantly associated with a prevalent VF. Medical records did not include information about bone health in 90% of all patients. CT reports did mention a VF in only 24.7% of patients with a prevalent VF on CT review. CONCLUSION: Approximately 30% of elderly patients with CT imaging and long-term hospital records showed VFs. Only one-quarter of these patients had VFs mentioned in CT reports. Osteoporosis management could be improved by consequent reporting of VFs in CT, opportunistic bone density measurements, and early involvement of fracture liaison services.


Assuntos
Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Idoso , Densidade Óssea , Feminino , Registros Hospitalares , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Coluna Vertebral , Tomografia Computadorizada por Raios X
5.
Inj Prev ; 28(2): 156-164, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34656990

RESUMO

BACKGROUND: Knowledge of fatal injuries is required to inform prevention activities. Where hospital patients with an injury principal diagnosis (PDx) died and were certified to a medical underlying cause of death (UCoD), there is the potential to underestimate injury mortality. We sought to characterise injury/non-injury (NI) mismatches between PDx and UCoD by identifying which subgroups had small/large mismatches, and to understand why mismatches had occurred using informative examples. METHOD: Hospital records (n=10 234) with a PDx of injury were linked to the mortality collection using a unique personal identifier. Percentages UCoD coded to a NI were tabulated, for three follow-up periods and by selected variables. Additionally, we reviewed a sample of 70 records for which there was a mismatch. RESULTS: %NIs were 39%, 66% and 77% for time from injury to death of <1 week, <90 days and <1 year, respectively. Variations in %NI were found for all variables. Illustrative examples of 70 medical UCoD deaths showed that for 12 cases the injury event was unequivocally judged to have resulted in premature death. A further 16 were judged as injury deaths using balance of probability arguments. CONCLUSION: There is variation in rates of mismatch between PDx of injury and UCoD of NI. While legitimate reasons exist for mismatches in certain groups, a material number of injury deaths are not captured using UCoD alone; a new operational definition of injury death is needed. Early solutions are proposed. Further work is needed to investigate operational definitions with acceptable false positive and negative detection rates.


Assuntos
Atestado de Óbito , Registros Hospitalares , Causas de Morte , Humanos
6.
Age Ageing ; 51(1)2022 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-34510170

RESUMO

BACKGROUND: Globally, geriatric patients are the dominant population requiring global medical care. We established a frailty index for geriatric trauma patients by retrospectively analysing electronic hospital records to identify patients with frailty characteristics and poor prognostic outcomes. METHOD: Data were obtained from 2016 US National Emergency Department Sample and Shanghai Trauma Emergency Medical Association (2015-18). Overall, 141,267 hospitalised geriatric trauma patients (age ≥ 65 years) were included. We used a three-step method to construct geriatric trauma frailty index (GTFI) based on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnostic codes. Systematic cluster analysis was used. The accuracy of GTFI was verified in national validation cohort, and its applicability to Chinese patients was assessed in local validation cohort. RESULTS: In development cohort (n = 28,179), frail patients had longer lengths of stay and higher Charlson co-morbidity index than non-frail patients (18.2 ± 12.4 days, 5.59 ± 2.0 versus 5.3 ± 5.3 days, 5.33 ± 1.8, respectively). In national validation cohort (n = 113,089), frail patients had longer lengths of stay (8.5 ± 8.8 days versus 4.5 ± 3.1 days) and higher in-hospital mortality than non-frail patients (2,795, 11.69% versus 589, 0.66%). Areas under the curves for GTFI for length of stay (>14 days) and in-hospital mortality were 0.848 (0.841, 0.854) and 0.885 (0.880, 0.891) in national validation cohort, and were 0.791 (0.779, 0.804) and 0.903 (0.885, 0.922) in local validation cohort (n = 14,827). CONCLUSIONS: The GTFI helps hospitals and emergency departments to identify geriatric trauma patients with poor prognostic outcomes, and has been proven to be useful in China.


Assuntos
Fragilidade , Idoso , China/epidemiologia , Eletrônica , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Avaliação Geriátrica , Registros Hospitalares , Humanos , Estudos Retrospectivos
7.
Epidemiology ; 33(2): 254-259, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-34799470

RESUMO

BACKGROUND: Validation studies estimating the positive predictive value (PPV) of neonatal abstinence syndrome (NAS) have consistently suggested overreporting in hospital discharge records. However, few studies estimate the negative predictive value (NPV). Even slightly imperfect NPVs have the potential to bias estimated prevalences of rare outcomes like NAS. Given the challenges in estimating NPV, our objective was to evaluate whether the PPV was sufficient to understand the influence of NAS misclassification bias on conclusions of the NAS prevalence in surveillance research. METHODS: We used hospital discharge data from the 2016 New Jersey State Inpatient Databases, Healthcare Cost and Utilization Project. We adjusted surveillance data for misclassification using quantitative bias analysis models to estimate the expected NAS prevalence under a range of PPV and NPV bias scenarios. RESULTS: The 2016 observed NAS prevalence was 0.61%. The misclassification-adjusted prevalence estimates ranged from 0.31% to 0.91%. When PPV was assumed to be ≥90%, the misclassification-adjusted prevalence was typically greater than the observed prevalence but the reverse was true for PPV ≤70%. Under PPV 80%, the misclassification-adjusted prevalence was less than the observed prevalence for NPV >99.9% but flipped for NPV <99.9%. CONCLUSIONS: When we varied the NPV below 100%, our results suggested that the direction of bias (over or underestimation) was dependent on the PPV, and sometimes dependent on the NPV. However, NPV was important for understanding the magnitude of bias. This study serves as an example of how quantitative bias analysis methods can be applied in NAS surveillance to supplement existing validation data when NPV estimates are unavailable.


Assuntos
Síndrome de Abstinência Neonatal , Registros Hospitalares , Humanos , Recém-Nascido , Síndrome de Abstinência Neonatal/epidemiologia , Alta do Paciente , Valor Preditivo dos Testes , Prevalência
8.
Braz J Otorhinolaryngol ; 88(2): 168-173, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-32682819

RESUMO

INTRODUCTION: Head and neck cancer has an impact on the global burden of diseases, representing an important cause of morbidity and mortality in Brazil, as well as worldwide. OBJECTIVE: To learn and describe the clinical, epidemiological and care configuration provided to patients with cancer of the oral cavity and oropharynx recorded in Brazil, diagnosed from 2007 to 2016. METHODS: This is a cross-sectional study, carried out using secondary hospital-based data, using the indirect documentation technique. RESULTS: There were 52,799 hospital records of oral cavity cancer and 34,516 cases of oropharyngeal cancer in the assessed period. There was a predominance of male patients, aged 50-59 years, mostly Caucasians, and with a low level of schooling. Throughout the period there was a significant reduction in the positive history of alcohol and tobacco consumption, except for alcoholic beverages in oral cavity cancer. Most patients were diagnosed at an advanced stage of the disease (III or IV). Most patients with oral cavity cancer had no evidence of the disease on follow-up, while most patients with oropharyngeal cancer died. The first most frequent treatment offered to patients with oral cavity cancer was surgery, while for patients with oropharyngeal cancer it chemoradiotherapy predominated. CONCLUSION: Despite the fact that, in general, there was a reduction in the records of patient alcohol and tobacco consumption, the increase in the number of medical consultations, the predominantly late diagnosis and the patients' low level of schooling indicate the need for health education, primary prevention and early diagnosis of cancer of the oral cavity and oropharynx.


Assuntos
Neoplasias Bucais , Neoplasias Orofaríngeas , Brasil/epidemiologia , Estudos Transversais , Feminino , Registros Hospitalares , Hospitais , Humanos , Masculino , Neoplasias Bucais/epidemiologia , Neoplasias Bucais/terapia , Neoplasias Orofaríngeas/epidemiologia , Neoplasias Orofaríngeas/terapia
9.
Cad. Saúde Pública (Online) ; 38(1): e00288920, 2022. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1355970

RESUMO

Abstract: Automatic geocoding methods have become popular in recent years, facilitating the study of the association between health outcomes and the place of living. However, rather few studies have evaluated geocoding quality, with most of them being performed in the US and Europe. This article aims to compare the quality of three automatic online geocoding tools against a reference method. A subsample of 300 handwritten addresses from hospital records was geocoded using Bing, Google Earth, and Google Maps. Match rates were higher (> 80%) for Google Maps and Google Earth compared with Bing. However, the accuracy of the addresses was better for Bing with a larger proportion (> 70%) of addresses with positional errors below 20m. Generally, performance did not vary for each method for different socioeconomic status. Overall, the methods showed an acceptable, but heterogeneous performance, which may be a warning against the use of automatic methods without assessing quality in other municipalities, particularly in Chile and Latin America.


Resumen: Los métodos automáticos de geocodificación se han convertido en algo popular durante los últimos años para facilitar el estudio de la asociación entre resultados de salud y lugar para vivir. No obstante, más bien pocos estudios han evaluado la calidad de la geocodificación, siendo realizados la mayoría de ellos en EE.UU. y Europa. El objetivo de este artículo es comparar la calidad de tres herramientas automáticas de geocodificación en línea frente a un método de referencia. La submuestra de 300 direcciones escritas a mano, procedentes del registro hospitalario, se geocodificaron usando Bing, Google Earth y Google Maps. Los porcentajes de coincidencia fueron mayores (> 80%) en el caso de Google Maps y Google Earth comparados con Bing. Sin embargo, la precisión de las direcciones fue mejor con Bing, en una proporción más grande (> 70%) de direcciones que tenían errores de posición por debajo de 20m. En general, el rendimiento no varió en cada método para diferentes niveles estatus socioeconómico. En general, los métodos mostraron un rendimiento aceptable, pero heterogéneo. Esto previene contra el uso de métodos automáticos sin evaluar la calidad en otras ciudades, particularmente en Chile y Latinoamérica.


Resumo: Os métodos de geocodificação automática se tornaram populares nos últimos anos para facilitar o estudo da associação entre desfechos de saúde e lugar de residência. Entretanto, poucos estudos avaliaram a qualidade da geocodificação, e a maioria dos estudos existentes foi realizada nos Estados Unidos e Europa. O estudo teve como objetivo comparar a qualidade de três ferramentas de geocodificação eletrônica automática em relação a um método de referência. Foi geocodificada uma subamostra de 300 endereços anotados à mão em prontuários hospitalares, usando Bing, Google Earth e Google Maps. As taxas de correspondência dos registros foram mais altas (> 80%) com Google Maps e Google Earth, comparado com Bing. Entretanto, a acurácia dos endereços foi melhor com Bing, com uma proporção maior (> 70%) de endereços com erros de localização menores que 20 metros. Em geral, o desempeno não variou para cada método de acordo com condição socioeconômica. Os métodos apresentaram desempenho geral aceitável, porém heterogêneo. Os resultados servem de alerta contra o uso de métodos automáticos sem avaliar a qualidade em outras cidades, particularmente no Chile e no resto da América Latina.


Assuntos
Humanos , Registros Hospitalares , Mapeamento Geográfico , Brasil , Chile , Sistemas de Informação Geográfica
10.
Swiss Med Wkly ; 151: w30069, 2021 12 20.
Artigo em Inglês | MEDLINE | ID: mdl-34964587

RESUMO

BACKGROUND: Improvement of paediatric healthcare is hampered by inefficient processes for generating new evidence. Clinical research often requires extra encounters with patients, is costly, takes place in an artificial situation with a biased selection of patients, and entails long delays until new evidence is implemented into health care. Electronic health records (EHR) contain detailed information on real patients and cover the entirety of patients. However, the use of EHR for research is limited because they are not standardised between hospitals. This leads to disproportionate amounts of work for extracting data of interest and frequently data are incomplete and of poor quality. AIMS: SwissPedData aims to lay the foundation for a paediatric learning health system in Switzerland by facilitating EHR-based research. In this project, we aimed to assess the way routine clinical data are currently recorded in large paediatric clinics in Switzerland and to develop a national EHR-based set of common data elements (CDEs) that covers all processes of routine paediatric care in hospitals. METHODS: A taskforce of paediatricians from large Swiss children's hospitals reviewed the current status of routine data documentation in paediatric clinical care and the extent of digitalisation. We then used a modified Delphi method to reach a broad consensus on a national EHR-based set of CDEs. RESULTS: All Swiss children's hospitals use EHR to document some or all aspects of care. One hundred and nineteen paediatricians, representing eight hospitals and all paediatric subspecialties, participated in an extended Delphi process to create SwissPedData. The group agreed on a national set of CDEs that comprises a main module with general paediatric data and sub-modules relevant to paediatric subspecialties. The data dictionary includes 336 CDEs: 76 in the main module on general paediatrics and between 11 and 59 CDEs per subspecialty module. Among these, 266 were classified as mandatory, 52 as recommended and 18 as optional. CONCLUSION: SwissPedData is a set of CDEs for information to be collected in EHR of Swiss children's hospitals. It covers all care processes including clinical and paraclinical assessment, diagnosis, treatment, disposition and care site. All participating hospitals agreed to implement SwissPedData in their clinical routine and clinic information systems. This will pave the way for a national paediatric learning health system in Switzerland that enables fast and efficient answers to urgent clinical questions by facilitating high-quality nationwide retrospective and prospective observational studies and recruitment of patients for nested prospective studies and clinical trials.


Assuntos
Registros Eletrônicos de Saúde , Registros Hospitalares , Criança , Hospitais Pediátricos , Humanos , Estudos Prospectivos , Estudos Retrospectivos
11.
PLoS One ; 16(11): e0260088, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34843520

RESUMO

INTRODUCTION: Colorectal cancer (CRC) care costs the Australian healthcare system more than any other cancer. We estimated costs and days in hospital for CRC cases, stratified by site (colon/rectal cancer) and disease stage, to inform detailed analyses of CRC-related healthcare. METHODS: Incident CRC patients were identified using the Australian 45 and Up Study cohort linked with cancer registry records. We analysed linked hospital admission records, emergency department records, and reimbursement records for government-subsidised medical services and prescription medicines. Cases' health system costs (2020 Australian dollars) and hospital days were compared with those for cancer-free controls (matched by age, sex, geography, smoking) to estimate excess resources by phase of care, analysed by sociodemographic, health, and disease characteristics. RESULTS: 1200 colon and 546 rectal cancer cases were diagnosed 2006-2013, and followed up to June 2016. Eighty-nine percent of cases had surgery, chemotherapy or radiotherapy, and excess costs were predominantly for hospitalisations. Initial phase (12 months post-diagnosis) mean excess health system costs were $50,434 for colon and $60,877 for rectal cancer cases, with means of 16 and 18.5 excess hospital days, respectively. The annual continuing mean excess costs were $6,779 (colon) and $8,336 (rectal), with a mean of 2 excess hospital days each. Resources utilised (costs and days) in these phases increased with more advanced disease, comorbidities, and younger age. Mean excess costs in the year before death were $74,952 (colon) and $67,733 (rectal), with means of 34 and 30 excess hospital days, respectively-resources utilised were similar across all characteristics, apart from lower costs for cases aged ≥75 at diagnosis. CONCLUSIONS: Health system costs and hospital utilisation for CRC care are greater for people with more advanced disease. These findings provide a benchmark, and will help inform future cost-effectiveness analyses of potential approaches to CRC screening and treatment.


Assuntos
Neoplasias Colorretais/economia , Hospitalização/economia , Tempo de Internação/tendências , Benchmarking , Análise Custo-Benefício/métodos , Bases de Dados Factuais , Governo , Programas Governamentais , Instalações de Saúde/economia , Instalações de Saúde/tendências , Registros Hospitalares , Hospitalização/tendências , Hospitais/estatística & dados numéricos , Humanos , Tempo de Internação/economia , Assistência Médica/economia , New South Wales , Sistema de Registros
12.
PLoS One ; 16(11): e0259979, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34818360

RESUMO

BACKGROUND: Early revascularization and treatment is key to improving clinical outcomes and reducing mortality in acute myocardial infarction (AMI). In low- and middle-income countries such as Bangladesh, timely management of AMI is challenging, with pre-hospital delays playing a significant role. This study was designed to investigate pre-hospital delay and its associated factors among patients presenting with AMI in the capital city of Dhaka. METHODS: This retrospective cohort study was conducted on 333 patients presenting with AMI over a 3-month period at two of the largest primary reperfusion-capable tertiary cardiac care centres in Dhaka. Of the total patients, 239(71.8%) were admitted in the National Institute of Cardiovascular Diseases, Dhaka and 94(28.2%) at Ibrahim Cardiac Hospital & Research Institute, Dhaka Data were collected from patients by semi-structured interview and hospital medical records. Pre-hospital delay (median and inter-quartile range) was calculated. Statistical significance was determined by Chi-square test. Multivariate logistic regression analysis was done to determine the independent predictors of pre-hospital delay. RESULTS: The mean age of the respondents was 53.8±11.2 years. Two-thirds (67.6%) of the respondents were males. Median total pre-hospital delay was 11.5 (IQR-18.3) hours with median decision time from symptom onset to seeking medical care being 3.0 (IQR: 11.0) hours. Nearly half (48.9%) of patients presented to the hospital more than 12 hours after symptom onset. On multivariate logistic regression analysis, AMI patients with absence of typical chest pain [OR 5.21; (95% CI: 2.5-9.9)], diabetes [OR: 1.7 (95% CI: 1.0-2.9)], residing/staying > 30 km away from nearest hospital at the time of onset [OR: 4.3(95% CI = 2.3-7.2)] and belonged to lower and middle class [OR: 1.9(95% CI = 1.0-3.5)] were significantly associated with pre-hospital delays. CONCLUSION: Acute myocardial infarction (AMI) patients with atypical chest pain, diabetes, staying far away from nearest hospital and belonged to lower and middle socioeconomic strata were significantly associated with pre-hospital delays. The findings could have immense implications for improvements about timely reaching of AMI patients to the hospital within the context of their sociodemographic status and geographic barriers of the city.


Assuntos
Infarto do Miocárdio/etiologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Tempo para o Tratamento/tendências , Doença Aguda/epidemiologia , Adulto , Idoso , Bangladesh , Dor no Peito , Estudos de Coortes , Países em Desenvolvimento , Feminino , Coração , Registros Hospitalares , Hospitalização , Humanos , Isquemia/fisiopatologia , Masculino , Registros Médicos , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Reperfusão/efeitos adversos , Estudos Retrospectivos , Centros de Atenção Terciária
13.
PLoS Med ; 18(10): e1003791, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34637451

RESUMO

BACKGROUND: There is an increasing use of cesarean delivery (CD) based on preference rather than on medical indication. However, the extent to which nonmedically indicated CD benefits or harms child survival remains unclear. Our hypothesis was that in groups with a low indication for CD, this procedure would be associated with higher child mortality and in groups with a clear medical indication CD would be associated with improved child survival chances. METHODS AND FINDINGS: We conducted a population-based cohort study in Brazil by linking routine data on live births between January 1, 2012 and December 31, 2018 and assessing mortality up to 5 years of age. Women with a live birth who contributed records during this period were classified into one of 10 Robson groups based on their pregnancy and delivery characteristics. We used propensity scores to match CD with vaginal deliveries (1:1) and prelabor CD with unscheduled CD (1:1) and estimated associations with child mortality using Cox regressions. A total of 17,838,115 live births were analyzed. After propensity score matching (PSM), we found that live births to women in groups with low expected frequencies of CD (Robson groups 1 to 4) had a higher death rate up to age 5 years if they were born via CD compared with vaginal deliveries (HR = 1.25, 95% CI: 1.22 to 1.28; p < 0.001). The relative rate was greatest in the neonatal period (HR = 1.39, 95% CI: 1.34 to 1.45; p < 0.001). There was no difference in mortality rate when comparing offspring born by a prelabor CD to those born by unscheduled CD. For the live births to women with a CD in a prior pregnancy (Robson group 5), the relative rates for child mortality were similar for those born by CD compared with vaginal deliveries (HR = 1.05, 95% CI: 1.00 to 1.10; p = 0.024). In contrast, for live births to women in groups with high expected rates of CD (Robson groups 6 to 10), the child mortality rate was lower for CD than for vaginal deliveries (HR = 0.90, 95% CI: 0.89 to 0.91; p < 0.001), particularly in the neonatal period (HR = 0.84, 95% CI: 0.83 to 0.85; p < 0.001). Our results should be interpreted with caution in clinical practice, since relevant clinical data on CD indication were not available. CONCLUSIONS: In this study, we observed that in Robson groups with low expected frequencies of CD, this procedure was associated with a 25% increase in child mortality. However, in groups with high expected frequencies of CD, the findings suggest that clinically indicated CD is associated with a reduction in child mortality.


Assuntos
Cesárea , Mortalidade da Criança , Registros Hospitalares , Parto , Adulto , Brasil , Criança , Pré-Escolar , Estudos de Coortes , Parto Obstétrico , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Estimativa de Kaplan-Meier , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Paridade , Adulto Jovem
14.
PLoS One ; 16(10): e0257079, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34614007

RESUMO

To investigate whether dental status, represented by the DMFT score, was affected by the presence of NCDs and determined the NCDs that had a greater impact on the DMFT score. This retrospective cross-sectional study included a total of 10,017 individuals. The presence of NCDs was investigated based on self-reported medical history recorded on each patient's dental hospital record. Individual DMFT score was evaluated on the basis of the dental records and panoramic radiographs. The data were further analyzed using multiple regression analysis and chi-squared automatic interaction detection (CHAID) analysis. A total of 5,388 individuals had more than one NCD among hypertension (HT), diabetes mellitus (DM), hyperlipidemia, cardiovascular disease (CVD), and osteoporosis. The average DMFT score was 8.62 ± 7.10 in the NCD group, significantly higher than that in those without NCD (5.53 ± 5.48) (P < 0.001). In the regression analysis, age, NCDs, and psychiatric problems were selected as risk factors of DMFT score. In the CHAID decision tree analysis, age was the risk factor that most influenced the DMFT score. HT was the most influential factor in a newly generated decision tree excluding age, and osteoporosis, DM, and CVD were important risk factors acting in the subgroups. Patients with NCD had worse dental conditions than those who did not, and some combinations of NCDs related highest risk for a dental caries-related index. In clinical practice, dentists should provide meticulous care for dental caries in elderly patients with NCDs, especially when certain diseases, such as HT, osteoporosis, DM, and CVD, are present together.


Assuntos
Cárie Dentária/epidemiologia , Doenças não Transmissíveis/epidemiologia , Adulto , Estudos Transversais , Índice CPO , Árvores de Decisões , Feminino , Registros Hospitalares , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
16.
PLoS One ; 16(9): e0257613, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34543345

RESUMO

This paper analyses COVID-19 patients' dynamics during the first wave in the region of Castilla y León (Spain) with around 2.4 million inhabitants using multi-state competing risk survival models. From the date registered as the start of the clinical process, it is assumed that a patient can progress through three intermediate states until reaching an absorbing state of recovery or death. Demographic characteristics, epidemiological factors such as the time of infection and previous vaccinations, clinical history, complications during the course of the disease and drug therapy for hospitalised patients are considered as candidate predictors. Regarding risk factors associated with mortality and severity, consistent results with many other studies have been found, such as older age, being male, and chronic diseases. Specifically, the hospitalisation (death) rate for those over 69 is 27.2% (19.8%) versus 5.3% (0.7%) for those under 70, and for males is 14.5%(7%) versus 8.3%(4.6%)for females. Among patients with chronic diseases the highest rates of hospitalisation are 26.1% for diabetes and 26.3% for kidney disease, while the highest death rate is 21.9% for cerebrovascular disease. Moreover, specific predictors for different transitions are given, and estimates of the probability of recovery and death for each patient are provided by the model. Some interesting results obtained are that for patients infected at the end of the period the hazard of transition from hospitalisation to ICU is significatively lower (p < 0.001) and the hazard of transition from hospitalisation to recovery is higher (p < 0.001). For patients previously vaccinated against pneumococcus the hazard of transition to recovery is higher (p < 0.001). Finally, internal validation and calibration of the model are also performed.


Assuntos
COVID-19/diagnóstico , COVID-19/mortalidade , Progressão da Doença , Registros Hospitalares , Hospitais , Atenção Primária à Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/complicações , COVID-19/tratamento farmacológico , Calibragem , Criança , Pré-Escolar , Comorbidade , Intervalos de Confiança , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Probabilidade , Modelos de Riscos Proporcionais , Reprodutibilidade dos Testes , Espanha/epidemiologia , Adulto Jovem
17.
BMJ Open ; 11(7): e049811, 2021 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-34312208

RESUMO

OBJECTIVES: People experiencing homelessness are frequent users of secondary care. Currently, there is no study of potentially preventable admissions for homeless patients in England. We aim to estimate the number of potentially preventable hospital admissions for homeless patients and compare to housed patients with similar characteristics. DESIGN: Retrospective matched cohort study. SETTING: Hospitals in England. PARTICIPANTS: 16 161 homeless patients and 74 780 housed patients aged 16-75 years who attended an emergency department (ED) in England in 2013/2014, matched on the basis of age, sex, ED attended and primary diagnosis. PRIMARY AND SECONDARY OUTCOME MEASURES: Annual counts of admissions, emergency admissions, ambulatory care-sensitive (ACS) emergency admissions, acute ACS emergency admissions and chronic ACS emergency admissions over the following 4 years (2014/2015-2017/2018). We additionally compare the prevalence of specific ACS conditions for homeless and housed patients. RESULTS: Mean admissions per 1000 patients per year were 470 for homeless patients and 230 for housed patients. Adjusted for confounders, annual admissions were 1.79 times higher (incident rate ratio (IRR)=1.79; 95% CI 1.69 to 1.90), emergency admissions 2.08 times higher (IRR=2.08; 95% CI 1.95 to 2.21) and ACS admissions 1.65 times higher (IRR=1.65; 95% CI 1.51 to 1.80), compared with housed patients. The effect was greater for acute (IRR=1.78; 95% CI 1.64 to 1.93) than chronic (IRR=1.45; 95% CI 1.27 to 1.66) ACS conditions. ACS conditions that were relatively more common for homeless patients were cellulitis, convulsions/epilepsy and chronic angina. CONCLUSIONS: Homeless patients use hospital services at higher rates than housed patients, particularly emergency admissions. ACS admissions of homeless patients are higher which suggests some admissions may be potentially preventable with improved access to primary care. However, these admissions comprise a small share of total admissions.


Assuntos
Pessoas em Situação de Rua , Registros Hospitalares , Estudos de Coortes , Serviço Hospitalar de Emergência , Inglaterra/epidemiologia , Hospitais , Humanos , Estudos Longitudinais , Estudos Retrospectivos
18.
Cien Saude Colet ; 26(4): 1299-1310, 2021 Apr.
Artigo em Português, Inglês | MEDLINE | ID: mdl-33886759

RESUMO

This study investigated the underreporting of deaths due to Acquired Immunodeficiency Syndrome (AIDS) in Brazil, using the product of the linkage between the Mortality Information System (SIM) and the Hospital Information System (SIH) for the years 2008 to 2012. The hypothesis was that there were deaths recorded in the SIM that should have AIDS as the underlying cause of death, but that had been poorly classified. Many of the decedents had previous hospitalizations due to the illness. Underreported AIDS deaths were defined taking into account the coding rules of the International Classification of Diseases 10th Revision, in order to discriminate AIDS deaths from those due to other causes in people living with HIV / AIDS. In this period, 60,362 deceased had AIDS as the underlying cause, and we found another 2,671 (4.2%) as underreported causes. Underreported deaths increased the average AIDS mortality rate from 6.3/100,000 to 6.6/100,000. In conclusion, this study demonstrated that, through linkage in between SIH and SIM, it is possible to find underreporting of AIDS deaths in Brazil. These results serve as a warning for the need for actions that would promote a better certification of the causes of death among AIDS patients.


Este estudo investigou a subnotificação de óbitos por Síndrome da Imunodeficiência Adquirida (AIDS) no Brasil, utilizando o produto do pareamento entre o Sistema de Informação sobre Mortalidade (SIM) e o Sistema de Informação Hospitalar (SIH) para os anos de 2008 a 2012. A hipótese era de que houvesse óbitos registrados no SIM que deveriam ter a AIDS como causa básica da morte, mas que tinham causas mal classificadas. Muitos desses falecidos tiveram internações anteriores devido à doença. Os óbitos por AIDS subnotificados foram definidos levando-se em consideração as regras de codificação da Classificação Internacional de Doenças 10ª Revisão, com vistas a discriminar os óbitos por AIDS daqueles devido a outras causas em pessoas vivendo com HIV/AIDS. Nesse período, 60.362 falecidos tiveram a AIDS como causa básica, e encontramos outros 2.671 (4,2%) como causas subnotificadas. Os óbitos subnotificados aumentaram a taxa média de mortalidade por AIDS no período de 6,3/100.000 para 6,6/100.000. Em conclusão, este estudo demonstrou que, através do pareamento entre o SIH e o SIM, é possível encontrar subnotificação de óbitos por AIDS no Brasil. Esses resultados servem de alerta para a necessidade de ações que promovam uma melhor certificação das causas de óbitos entre os pacientes com AIDS.


Assuntos
Síndrome de Imunodeficiência Adquirida , Síndrome de Imunodeficiência Adquirida/epidemiologia , Brasil/epidemiologia , Causas de Morte , Atestado de Óbito , Registros Hospitalares , Humanos
19.
Acta Psychiatr Scand ; 143(6): 526-534, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33792912

RESUMO

OBJECTIVE: To determine how mental disorders and psychopharmacological treatments before and during COVID-19 hospital admissions are related to mortality. METHODS: Subjects included in the study were all adult patients with a diagnosis of COVID-19, confirmed clinically and by PCR, who were admitted to a tertiary university hospital in Badalona (Spain) between March 1 and November 17, 2020. Data were extracted anonymously from computerized clinical records. RESULTS: 2,150 subjects were included, 57% males, mean age 61 years. History of mental disorders was registered in 957 (45%). Throughout admission, de novo diagnosis of mood or anxiety, stress, or adjustment disorder was made in 12% of patients without previous history. Delirium was diagnosed in 10% of cases. 1011 patients (47%) received a psychotropic prescription during admission (36% benzodiazepines, 22% antidepressants, and 21% antipsychotics). Mortality rate was 17%. Delirium during admission and history of mood disorder were independently associated with higher mortality risk (hazard ratios, 1.39 and 1.52 respectively), while previous year's treatments with anxiolytics/hypnotics and antidepressants were independently associated with lower mortality risk (hazard ratios, 0.47 and 0.43, respectively). CONCLUSION: Mental symptoms are very common in patients hospitalized for COVID-19 infection. Detecting, diagnosing, and treating them is key to determining the prognosis of the disease and functional recovery.


Assuntos
COVID-19 , Pacientes Internados , Transtornos Mentais , Psicotrópicos , COVID-19/diagnóstico , COVID-19/mortalidade , COVID-19/psicologia , COVID-19/reabilitação , Teste de Ácido Nucleico para COVID-19 , Feminino , Registros Hospitalares/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Pacientes Internados/psicologia , Pacientes Internados/estatística & dados numéricos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Transtornos Mentais/virologia , Pessoa de Meia-Idade , Prognóstico , Psicotrópicos/classificação , Psicotrópicos/uso terapêutico , Recuperação de Função Fisiológica , Medição de Risco , SARS-CoV-2/isolamento & purificação , Espanha/epidemiologia
20.
Ciênc. Saúde Colet ; 26(4): 1299-1310, abr. 2021. tab, graf
Artigo em Inglês, Português | LILACS | ID: biblio-1285935

RESUMO

Resumo Este estudo investigou a subnotificação de óbitos por Síndrome da Imunodeficiência Adquirida (AIDS) no Brasil, utilizando o produto do pareamento entre o Sistema de Informação sobre Mortalidade (SIM) e o Sistema de Informação Hospitalar (SIH) para os anos de 2008 a 2012. A hipótese era de que houvesse óbitos registrados no SIM que deveriam ter a AIDS como causa básica da morte, mas que tinham causas mal classificadas. Muitos desses falecidos tiveram internações anteriores devido à doença. Os óbitos por AIDS subnotificados foram definidos levando-se em consideração as regras de codificação da Classificação Internacional de Doenças 10ª Revisão, com vistas a discriminar os óbitos por AIDS daqueles devido a outras causas em pessoas vivendo com HIV/AIDS. Nesse período, 60.362 falecidos tiveram a AIDS como causa básica, e encontramos outros 2.671 (4,2%) como causas subnotificadas. Os óbitos subnotificados aumentaram a taxa média de mortalidade por AIDS no período de 6,3/100.000 para 6,6/100.000. Em conclusão, este estudo demonstrou que, através do pareamento entre o SIH e o SIM, é possível encontrar subnotificação de óbitos por AIDS no Brasil. Esses resultados servem de alerta para a necessidade de ações que promovam uma melhor certificação das causas de óbitos entre os pacientes com AIDS.


Abstract This study investigated the underreporting of deaths due to Acquired Immunodeficiency Syndrome (AIDS) in Brazil, using the product of the linkage between the Mortality Information System (SIM) and the Hospital Information System (SIH) for the years 2008 to 2012. The hypothesis was that there were deaths recorded in the SIM that should have AIDS as the underlying cause of death, but that had been poorly classified. Many of the decedents had previous hospitalizations due to the illness. Underreported AIDS deaths were defined taking into account the coding rules of the International Classification of Diseases 10th Revision, in order to discriminate AIDS deaths from those due to other causes in people living with HIV / AIDS. In this period, 60,362 deceased had AIDS as the underlying cause, and we found another 2,671 (4.2%) as underreported causes. Underreported deaths increased the average AIDS mortality rate from 6.3/100,000 to 6.6/100,000. In conclusion, this study demonstrated that, through linkage in between SIH and SIM, it is possible to find underreporting of AIDS deaths in Brazil. These results serve as a warning for the need for actions that would promote a better certification of the causes of death among AIDS patients.


Assuntos
Humanos , Síndrome de Imunodeficiência Adquirida , Brasil/epidemiologia , Atestado de Óbito , Registros Hospitalares , Causas de Morte
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