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1.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 11(5): 1353-1359, out.-dez. 2019.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1022039

RESUMO

Objective: The study's main purpose has been to analyze scientific articles on the world scenario about nursing interventions in the process of preparation and administration of intravenous drugs, risks inherent in professional practice and actions integrated with medical prescription. Methods: It is a research of literary nature that was carried out through the main databases of online indexed studies. For the development of this research, books related to the practice of intravenous therapy and current legislation were consulted. Results: This investigation describes the main urgent and emerging pathologies in the hospital service, nursing actions aimed at intravenous therapy and pain relief. Conclusion: Finally, it is needed to improve the instruments used to measure acute pain, because they have limitations in its implementation, either for evaluating the size of a single aspect or to be extensive in its application in the level of hospital care


Objetivo: Objetivo do estudo consiste em analisar artigos científicos no cenário mundial acerca das intervenções de enfermagem no processo de preparo e administração de medicamentos por via venosa, riscos inerentes a pratica profissional e ações integradas à prescrição médica. Método: pesquisa de natureza literária, realizada através dos principais bancos de dados online de pesquisas indexadas. Para desenvolvimento do estudo foram consultados livros relacionados à prática da terapia intravenosa e legislações vigentes. Resultados: descrição das principais patologias urgentes e emergentes no serviço hospitalar, ações de enfermagem voltadas para terapia intravenosa e alivio da dor. Conclusão: necessidade de aprimoramento dos instrumentos utilizados para mensurar a dor aguda, pois possuem limitações em sua implementação, seja por avaliar a dimensão de um único aspecto ou serem extenso em sua aplicação em nível de atendimento hospitalar


Objetivo: El objetivo del estudio consiste en analizar artículos científicos en el escenario mundial acerca de las intervenciones de enfermería en el proceso de preparación y administración de medicamentos por vía venosa, riesgos inherentes a la práctica profesional y acciones integradas a la prescripción médica. Método: investigación de naturaleza literaria, realizada a través de las principales bases de datos en línea de investigaciones indexadas. Para el desarrollo del estudio se consultó libros relacionados con la práctica de la terapia intravenosa y las legislaciones vigentes. Resultados: descripción de las principales patologías urgentes y emergentes en el servicio hospitalario, acciones de enfermería dirigidas a terapia intravenosa y alivio del dolor. Conclusión: necesidad de perfeccionamiento de los instrumentos utilizados para medir el dolor agudo, pues poseen limitaciones en su implementación, sea por evaluar la dimensión de un solo aspecto o ser extenso en su aplicación a nivel de atención hospitalaria


Assuntos
Humanos , Dor Aguda/enfermagem , Dor Aguda/prevenção & controle , Segurança do Paciente , Risco , Redução do Dano , Administração Intravenosa/enfermagem
2.
Psychiatr Hung ; 34(3): 266-279, 2019.
Artigo em Húngaro | MEDLINE | ID: mdl-31570658

RESUMO

INTRODUCTION: The Inventory of Callous-Unemotional Traits (ICU) is one of the most widely used measures of psychopathic traits in children. Callous-unemotional (CU) traits designate an important subgroup of antisocial youth characterized by lack of empathy, guilt and remorse. The aim of the present study was to test the applicability and reliability of the self-reported ICU in a high-risk sample of adolescent boys. METHODS: Participants were 202 adolescent boys (mean age: 16.63 years; SD = 1.71) from institutional care facilities and juvenile detention centres. Confirmatory factor analyses (CFA) were conducted to investigate the factor structure of the ICU. In addition, MIMIC modelling (CFA with covariates) was applied to test the convergent validity of the ICU scores by examining relationships with externalizing symptoms (including conduct problems, hyperactivity-inattention, proactive-reactive aggression), and prosocial behaviour. RESULTS: We observed that the bifactor model with three correlated specific factors (callousness, uncaring and unemotional) and one general CU traits factor provided the best fit to the data. However, similar to previous studies, low internal consistency was found for the unemotional scale. In line with our expectations, CU traits showed positive associations with externalizing symptoms, and negative associations with prosocial behaviour. CONCLUSION: The ICU is a reliable and valid measure of callous-unemotional traits. Our results support the application of the Hungarian version of the questionnaire.


Assuntos
Transtorno da Personalidade Antissocial/diagnóstico , Transtorno da Personalidade Antissocial/psicologia , Emoções , Psicometria , Adolescente , Humanos , Hungria , Masculino , Inventário de Personalidade/normas , Psicometria/normas , Reprodutibilidade dos Testes , Risco , Autorrelato
3.
Arq. bras. cardiol ; 113(2 supl.1): 242-242, set., 2019.
Artigo em Português | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1021270

RESUMO

INTRODUÇÃO: As doenças cardiovasculares estão entre as principais causas de mortalidade global e, dentre elas, destaca-se a doença arterial coronariana (DAC), cujos diagnóstico precoce e prevenção ainda continuam sendo a melhor forma de tratamento. O conhecimento do perfil clínico e angiográfico dos pacientes portadores de DAC é extremamente importante para a avaliação de risco, a partir da quantificação da extensão e gravidade da doença, assim como para o planejamento terapêutico e sucesso do tratamento. O nosso objetivo foi avaliar o perfil clínico e angiográfico dos pacientes submetidos a exame diagnóstico de cineangiocoronariografia em centro clínico de alto volume. MÉTODOS: Foi realizado um estudo retrospectivo e descritivo do perfil clínicoangiográfico dos pacientes maiores de 18 anos submetidos à cineangiocoronariografia diagnóstica em serviço terciário de janeiro de 2011 a dezembro de 2018, excluindo os pacientes com cirurgia de revascularização prévia e doença valvar associada. Os dados foram obtidos por meio de um banco de dados institucional. Resultados: Um total de 25649 pacientes foram incluídos, sendo 59,4% do sexo masculino, com média das idades de 66,1 anos. Os fatores de risco cardiovascular mais encontrados foram: hipertensão arterial sistêmica (80,5%), dislipidemia (60,5%), diabetes mellitus (32,3%), tabagismo (40,9%) e doença renal crônica (21,5%). O quadro clínico era de angina estável em 32,5%, síndrome coronariana aguda (SCA) sem supra de ST em 20,4% incluindo SCA com supra de ST em 6,1%, e isquemia silenciosa/assintomáticos em 37,5%. A doença arterial coronariana obstrutiva significativa (>50%) foi uni-, bi- ou triarterial em, respectivamente, 25,7%, 17,5% e 12,22%, além do tronco da a. coronária esquerda em 1,4%. A partir do exame diagnóstico, a intervenção coronária percutânea (ICP) foi realizada em 14,7% dos pacientes, predominantemente naqueles com apresentação clínica de SCA. Os vasos coronários mais tratados foram a. descendente anterior em 40,9%, a. coronária direita em 29,5% e a. circunflexa em 23,2%. O sucesso angiográfico foi evidenciado em 99,2% dos casos. Em relação aos desfechos clínicos na fase intra-hospitalar, foi reportada a ocorrência de óbito em 0,3% dos pacientes. CONCLUSÃO: A população estudada apresentou elevada prevalência de fatores de risco cardiovascular e de doença coronariana obstrutiva significativa. Os pacientes submetidos a ICP subsequente apresentaram elevadas taxas de sucesso no procedimento. (AU)


Assuntos
Humanos , Doenças Cardiovasculares , Cineangiografia , Risco
4.
MMWR Morb Mortal Wkly Rep ; 68(38): 819-824, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31557148

RESUMO

Rheumatic diseases are a leading cause of chronic, noncancer pain. Systemic lupus erythematosus (SLE) is a chronic autoimmune rheumatic disease characterized by periodic flares that can result in irreversible target organ damage, including end-stage renal disease. Both intermittent and chronic musculoskeletal pain, as well as fibromyalgia (considered a centralized pain disorder due to dysregulation of pain processing in the central nervous system), are common in SLE. Opioids are generally not indicated for long-term management of musculoskeletal pain or centralized pain (fibromyalgia) because of lack of efficacy, safety issues ranging from adverse medical effects to overdose, and risk for addiction (1,2). In this study of 462 patients with SLE from the population-based Michigan Lupus Epidemiology and Surveillance (MILES) Cohort and 192 frequency-matched persons without SLE, nearly one third (31%) of SLE patients were using prescription opioids during the study period (2014-2015), compared with 8% of persons without SLE (p<0.001). Among the SLE patients using opioids, 97 (68%) were using them for >1 year, and 31 (22%) were concomitantly on two or more opioid medications. Among SLE patients, those using the emergency department (ED) were approximately twice as likely to use prescription opioids (odds ratio [OR] = 2.1; 95% confidence interval [CI] = 1.3-3.6; p = 0.004). In SLE, the combined contributions of underlying disease and adverse effects of immunosuppressive and glucocorticoid therapies already put patients at higher risk for some known adverse effects attributed to long-term opioid use. Addressing the widespread and long-term use of opioid therapy in SLE will require strategies aimed at preventing opioid initiation, tapering and discontinuation of opioids among patients who are not achieving treatment goals of reduced pain and increased function, and consideration of nonopioid pain management strategies.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Vigilância da População , Adulto , Idoso , Estudos de Coortes , Serviço Hospitalar de Emergência , Feminino , Humanos , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Manejo da Dor/métodos , Risco
5.
Isr Med Assoc J ; 21(9): 612-614, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31542907

RESUMO

BACKGROUND: Young women concerned about a breast cancer diagnosis will visit breast care centers and request breast cancer screening, including imaging studies, on their initial visit. OBJECTIVES: To explore the role of breast examination and breast ultrasound in self-referred asymptomatic women under the age of 40 years. METHODS: We identified 3524 women under the age of 40 at our medical clinic from 1 January 2010 until 1 June 2014. Of this group, 164 women with above average breast cancer risk were excluded and 233 were excluded because of breast complaints. Of 3127 women, 220 underwent breast ultrasound following the initial visit to the clinic and formed the study group. RESULTS: Of 220 women evaluated with ultrasound, 68 had prior positive clinical findings. Of this group 8 women had no sonographic findings, and in the remaining 60, a total of 30 simple cysts, 15 fibroadenomas, and 15 suspicious solid masses were identified. One infiltrating ductal carcinoma and one ductal carcinoma in situ were found in a biopsy. The remaining 152 of the 220 total women who underwent breast ultrasound without showing prior physical findings did not require follow-up. CONCLUSIONS: In the absence of clinical findings during physical breast examination, the addition of breast ultrasonography does not provide additional information to supplement the physical examination in self-referred women under age 40 who do not have any major risk factors for developing breast cancer.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/epidemiologia , Mamografia/estatística & dados numéricos , Ultrassonografia Mamária/estatística & dados numéricos , Adulto , Mama/diagnóstico por imagem , Feminino , Humanos , Israel/epidemiologia , Exame Físico/estatística & dados numéricos , Risco , Adulto Jovem
7.
Bone Joint J ; 101-B(9): 1071-1080, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474146

RESUMO

AIMS: The aim of this study was to determine the long-term risk of undergoing knee arthroplasty in a cohort of patients with meniscal tears who had undergone arthroscopic partial meniscectomy (APM). PATIENTS AND METHODS: A retrospective national cohort of patients with a history of isolated APM was identified over a 20-year period. Patients with prior surgery to the same knee were excluded. The primary outcome was knee arthroplasty. Hazard ratios (HRs) were adjusted by patient age, sex, year of APM, Charlson comorbidity index, regional deprivation, rurality, and ethnicity. Risk of arthroplasty in the index knee was compared with the patient's contralateral knee (with vs without a history of APM). A total of 834 393 patients were included (mean age 50 years; 37% female). RESULTS: Of those with at least 15 years of follow-up, 13.49% (16 256/120 493; 95% confidence interval (CI) 13.30 to 13.69) underwent subsequent arthroplasty within this time. In women, 22.07% (95% CI 21.64 to 22.51) underwent arthroplasty within 15 years compared with 9.91% of men (95% CI 9.71 to 10.12), corresponding to a risk ratio (RR) of 2.23 (95% CI 2.16 to 2.29). Relative to the general population, patients with a history of APM were over ten times more likely (RR 10.27; 95% CI 10.07 to 10.47) to undergo arthroplasty rising to almost 40 times more likely (RR 39.62; 95% CI 27.68 to 56.70) at a younger age (30 to 39 years). In patients with a history of APM in only one knee, the risk of arthroplasty in that knee was greatly elevated in comparison with the contralateral knee (no APM; HR 2.99; 95% CI 2.95 to 3.02). CONCLUSION: Patients developing a meniscal tear undergoing APM are at greater risk of knee arthroplasty than the general population. This risk is three-times greater in the patient's affected knee than in the contralateral knee. Women in the cohort were at double the risk of progressing to knee arthroplasty compared with men. These important new reference data will inform shared decision making and enhance approaches to treatment, prevention, and clinical surveillance. Cite this article: Bone Joint J 2019;101-B:1071-1080.


Assuntos
Artroplastia do Joelho/estatística & dados numéricos , Osteoartrite do Joelho/epidemiologia , Lesões do Menisco Tibial/epidemiologia , Adulto , Fatores Etários , Idoso , Progressão da Doença , Inglaterra/epidemiologia , Feminino , Seguimentos , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/etiologia , Osteoartrite do Joelho/cirurgia , Estudos Retrospectivos , Risco , Fatores de Risco , Fatores Sexuais , Lesões do Menisco Tibial/complicações , Lesões do Menisco Tibial/cirurgia
8.
Cancer Radiother ; 23(5): 416-422, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31421998

RESUMO

This article provides a proposal for the selection and delineation of clinical target volumes for the treatment with radiation of submandibular glands tumours. This article does not deal with external radiotherapy indications but specifies the volumes to be treated if radiotherapy is chosen. High-risk and low-risk peritumoral clinical target volumes are described based on the probability of local tumoral spread. High-risk and low-risk clinical target volumes are illustrated on CT-scan slices. A proposal for the selection of nodal clinical target volumeis also proposed.


Assuntos
Planejamento da Radioterapia Assistida por Computador/métodos , Neoplasias da Glândula Submandibular/radioterapia , Humanos , Irradiação Linfática/métodos , Imagem por Ressonância Magnética , Invasividade Neoplásica , Tamanho do Órgão , Dosagem Radioterapêutica , Risco , Neoplasias da Glândula Submandibular/diagnóstico por imagem , Neoplasias da Glândula Submandibular/patologia , Tomografia Computadorizada por Raios X , Carga Tumoral
9.
Arch Endocrinol Metab ; 63(4): 427-437, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31365625

RESUMO

OBJECTIVE: Chronic kidney disease (CKD) risk is inconsistent in the normal-weight, overweight, and obese individuals due to the heterogeneity of metabolic status. This meta-analysis aimed to examine the combined effects of body mass index (BMI) and metabolic status on CKD risk. MATERIALS AND METHODS: The MEDLINE, EMBASE, and Web of Knowledge databases were systematically searched up to March 2019 to identify all eligible studies investigating the CKD risk (defined as GFR < 60 mL/min per 1.73 m2 and/or microalbuminuria or proteinuria) associated with the body size phenotypes which are known as metabolically unhealthy normal-weight (MUNW), metabolically healthy overweight (MHOW), metabolically unhealthy overweight, metabolically healthy obese (MHO) and metabolically unhealthy obese (MUHO). The classification of subjects in included studies as metabolically unhealthy was based on the presence of three components of metabolic syndrome. BMI categorization was based on the criteria of included studies. The risk estimates and 95% confidence intervals (CIs) were extracted and pooled using random effects analysis. RESULTS: A total of 9 prospective cohort studies with 128773 participants and 4797 incident cases were included in the meta-analysis. Compared with healthy normal-weight individuals as reference, MUNW and MHO subjects showed an increased risk for CKD events with a pooled RR of 1.58 (95% CI = 1.28-1.96) in MUNW and 1.55 (95% CI = 1.34-1.79) in MHO persons. Also, MHOW was at increased risk for CKD (RR = 1.34, 95% CI = 1.20-1.51). MUHO individuals were at the highest risk for the development of CKD (RR = 2.13, 95% CI = 1.66-2.72). CONCLUSIONS: Individuals with metabolic abnormality, although at normal-weight, have an increased risk for CKD. Healthy overweight and obese individuals had higher risk; refuting the notion that metabolically healthy overweight and obese phenotypes are benign conditions.


Assuntos
Peso Corporal/genética , Síndrome Metabólica/genética , Fenótipo , Insuficiência Renal Crônica/genética , Índice de Massa Corporal , Humanos , Síndrome Metabólica/metabolismo , Estudos Observacionais como Assunto , Insuficiência Renal Crônica/metabolismo , Risco
10.
JAMA ; 322(7): 642-650, 2019 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429895

RESUMO

Importance: The time course of cardiovascular disease (CVD) risk after smoking cessation is unclear. Risk calculators consider former smokers to be at risk for only 5 years. Objective: To evaluate the association between years since quitting smoking and incident CVD. Design, Setting, and Participants: Retrospective analysis of prospectively collected data from Framingham Heart Study participants without baseline CVD (original cohort: attending their fourth examination in 1954-1958; offspring cohort: attending their first examination in 1971-1975) who were followed up through December 2015. Exposures: Time-updated self-reported smoking status, years since quitting, and cumulative pack-years. Main Outcomes and Measures: Incident CVD (myocardial infarction, stroke, heart failure, or cardiovascular death). Primary analyses included both cohorts (pooled) and were restricted to heavy ever smokers (≥20 pack-years). Results: The study population included 8770 individuals (original cohort: n = 3805; offspring cohort: n = 4965) with a mean age of 42.2 (SD, 11.8) years and 45% male. There were 5308 ever smokers with a median 17.2 (interquartile range, 7-30) baseline pack-years, including 2371 heavy ever smokers (406 [17%] former and 1965 [83%] current). Over 26.4 median follow-up years, 2435 first CVD events occurred (original cohort: n = 1612 [n = 665 among heavy smokers]; offspring cohort: n = 823 [n = 430 among heavy smokers]). In the pooled cohort, compared with current smoking, quitting within 5 years was associated with significantly lower rates of incident CVD (incidence rates per 1000 person-years: current smoking, 11.56 [95% CI, 10.30-12.98]; quitting within 5 years, 6.94 [95% CI, 5.61-8.59]; difference, -4.51 [95% CI, -5.90 to -2.77]) and lower risk of incident CVD (hazard ratio, 0.61; 95% CI, 0.49-0.76). Compared with never smoking, quitting smoking ceased to be significantly associated with greater CVD risk between 10 and 15 years after cessation in the pooled cohort (incidence rates per 1000 person-years: never smoking, 5.09 [95% CI, 4.52-5.74]; quitting within 10 to <15 years, 6.31 [95% CI, 4.93-8.09]; difference, 1.27 [95% CI, -0.10 to 3.05]; hazard ratio, 1.25 [95% CI, 0.98-1.60]). Conclusions and Relevance: Among heavy smokers, smoking cessation was associated with significantly lower risk of CVD within 5 years relative to current smokers. However, relative to never smokers, former smokers' CVD risk remained significantly elevated beyond 5 years after smoking cessation.


Assuntos
Doenças Cardiovasculares/epidemiologia , Fumantes , Abandono do Hábito de Fumar , Adulto , Doenças Cardiovasculares/prevenção & controle , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Risco , Fatores de Risco
11.
JAMA ; 322(8): 746-755, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454045

RESUMO

Importance: Induction chemotherapy followed by high-dose therapy with autologous stem cell transplant and subsequent antidisialoganglioside antibody immunotherapy is standard of care for patients with high-risk neuroblastoma, but survival rate among these patients remains low. Objective: To determine if tandem autologous transplant improves event-free survival (EFS) compared with single transplant. Design, Setting, and Participants: Patients were enrolled in this randomized clinical trial from November 2007 to February 2012 at 142 Children's Oncology Group centers in the United States, Canada, Switzerland, Australia, and New Zealand. A total of 652 eligible patients aged 30 years or younger with protocol-defined high-risk neuroblastoma were enrolled and 355 were randomized. The final date of follow-up was June 29, 2017, and the data analyses cut-off date was June 30, 2017. Interventions: Patients were randomized to receive tandem transplant with thiotepa/cyclophosphamide followed by dose-reduced carboplatin/etoposide/melphalan (n = 176) or single transplant with carboplatin/etoposide/melphalan (n = 179). Main Outcomes and Measures: The primary outcome was EFS from randomization to the occurrence of the first event (relapse, progression, secondary malignancy, or death from any cause). The study was designed to test the 1-sided hypothesis of superiority of tandem transplant compared with single transplant. Results: Among the 652 eligible patients enrolled, 297 did not undergo randomization because they were nonrandomly assigned (n = 27), ineligible for randomization (n = 62), had no therapy (n = 1), or because of physician/parent preference (n = 207). Among 355 patients randomized (median diagnosis age, 36.1 months; 152 [42.8%] female), 297 patients (83.7%) completed the study and 21 (5.9%) were lost to follow-up after completing protocol therapy. Three-year EFS from the time of randomization was 61.6% (95% CI, 54.3%-68.9%) in the tandem transplant group and 48.4% (95% CI, 41.0%-55.7%) in the single transplant group (1-sided log-rank P=.006). The median (range) duration of follow-up after randomization for 181 patients without an event was 5.6 (0.6-8.9) years. The most common significant toxicities following tandem vs single transplant were mucosal (11.7% vs 15.4%) and infectious (17.9% vs 18.3%). Conclusions and Relevance: Among patients aged 30 years or younger with high-risk neuroblastoma, tandem transplant resulted in a significantly better EFS than single transplant. However, because of the low randomization rate, the findings may not be representative of all patients with high-risk neuroblastoma. Trial Registration: ClinicalTrials.gov Identifier: NCT00567567.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia de Indução , Neuroblastoma/terapia , Transplante de Células-Tronco/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Terapia Combinada , Quimioterapia de Consolidação , Intervalo Livre de Doença , Feminino , Humanos , Lactente , Análise de Intenção de Tratamento , Masculino , Neuroblastoma/tratamento farmacológico , Modelos de Riscos Proporcionais , Risco , Transplante Autólogo , Adulto Jovem
12.
N Engl J Med ; 381(8): 705-715, 2019 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-31433918

RESUMO

BACKGROUND: The systematic evaluation of the results of time-series studies of air pollution is challenged by differences in model specification and publication bias. METHODS: We evaluated the associations of inhalable particulate matter (PM) with an aerodynamic diameter of 10 µm or less (PM10) and fine PM with an aerodynamic diameter of 2.5 µm or less (PM2.5) with daily all-cause, cardiovascular, and respiratory mortality across multiple countries or regions. Daily data on mortality and air pollution were collected from 652 cities in 24 countries or regions. We used overdispersed generalized additive models with random-effects meta-analysis to investigate the associations. Two-pollutant models were fitted to test the robustness of the associations. Concentration-response curves from each city were pooled to allow global estimates to be derived. RESULTS: On average, an increase of 10 µg per cubic meter in the 2-day moving average of PM10 concentration, which represents the average over the current and previous day, was associated with increases of 0.44% (95% confidence interval [CI], 0.39 to 0.50) in daily all-cause mortality, 0.36% (95% CI, 0.30 to 0.43) in daily cardiovascular mortality, and 0.47% (95% CI, 0.35 to 0.58) in daily respiratory mortality. The corresponding increases in daily mortality for the same change in PM2.5 concentration were 0.68% (95% CI, 0.59 to 0.77), 0.55% (95% CI, 0.45 to 0.66), and 0.74% (95% CI, 0.53 to 0.95). These associations remained significant after adjustment for gaseous pollutants. Associations were stronger in locations with lower annual mean PM concentrations and higher annual mean temperatures. The pooled concentration-response curves showed a consistent increase in daily mortality with increasing PM concentration, with steeper slopes at lower PM concentrations. CONCLUSIONS: Our data show independent associations between short-term exposure to PM10 and PM2.5 and daily all-cause, cardiovascular, and respiratory mortality in more than 600 cities across the globe. These data reinforce the evidence of a link between mortality and PM concentration established in regional and local studies. (Funded by the National Natural Science Foundation of China and others.).


Assuntos
Poluição do Ar/efeitos adversos , Exposição Ambiental/análise , Mortalidade , Material Particulado/efeitos adversos , Poluição do Ar/análise , Doenças Cardiovasculares/mortalidade , Causas de Morte , Exposição Ambiental/efeitos adversos , Exposição Ambiental/legislação & jurisprudência , Saúde Global , Humanos , Tamanho da Partícula , Material Particulado/análise , Doenças Respiratórias/mortalidade , Risco
13.
Pan Afr Med J ; 33(Suppl 2): 4, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31402964

RESUMO

Introduction: Lessons learned from the Ebola virus disease (EVD) outbreak enabled Liberia to develop a health plan for strengthening public health capacity against potential public health threats. risk communication is one of the core pillars that provide life-saving information and knowledge for the public to take preventive and proactive actions against public health threats. These were applied in response to the post-ebola meningococcal septicemia and meningitis outbreaks in Sinoe and Grand Kru counties. This paper documents risk communication experiences in these post-ebola outbreaks in Liberia. Methods: Risk Communication and health promotion strategies were deployed in developing response plans and promptly disseminating key messages to affected communities to mitigate the risks. Other strategies included engagement of community leaders, partnership with the media and dissemination of messages through the community radios, active monitoring community risk perceptions and compliance, rumor management, mobile stage and interpersonal communication (IPC) during the Meningococcal disease outbreaks in Sinoe and Grand Kru counties. Results: In Sinoe, about 36,891 households or families in 10 health districts were reached through IPC and dialogue. Circulating rumors such as "Ebola" was the cause of deaths was timely and promptly mitigated. There was increased trust and adherence to health advice including prompt reporting of sick people to the nearest health facility in the two counties. Conclusion: Risk communication and health promotion encouraged community support and involvement in any response to public threats and events. No doubt, risk communication and health promotion play an important role in preparedness and response to public health emergencies.


Assuntos
Comunicação , Surtos de Doenças/prevenção & controle , Doença pelo Vírus Ebola/epidemiologia , Infecções Meningocócicas/epidemiologia , Fortalecimento Institucional , Promoção da Saúde/métodos , Humanos , Libéria/epidemiologia , Saúde Pública , Risco
14.
Pan Afr Med J ; 33(Suppl 2): 10, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31402968

RESUMO

Introduction: in spite of the efforts and resources committed by the division of infectious disease and epidemiology (DIDE) of the national public health institute of Liberia (NPHIL)/Ministry of health to strengthening integrated disease surveillance and response (IDSR) across the country, quality data management system remains a challenge to the Liberia NPHIL/MoH (Ministry of health), with incomplete and inconsistent data constantly being reported at different levels of the surveillance system. As part of the monitoring and evaluation strategy for IDSR continuous improvement, data quality assessment (DQA) of the IDSR system to identify successes and gaps in the disease surveillance information system (DSIS) with the aim of ensuring data accuracy, reliability and credibility of generated data at all levels of the health system; and to inform an operational plan to address data quality needs for IDSR activities is required. Methods: multi-stage cluster sampling that included stage 1: simple random sample (SRS) of five counties, stage 2: simple random sample of two districts and stage 3: simple random sample of three health facilities was employed during the study pilot assessment done in Montserrado County with Liberia institute of bio medical research (LIBR) inclusive. A total of thirty (30) facilities was targeted, twenty nine (29) of the facilities were successfully audited: one hospital, two health centers, twenty clinics and respondents included: health facility surveillance focal persons (HFSFP), zonal surveillance officers (ZSOs), district surveillance officers (DSOs) and County surveillance officers (CSOs). Results: the assessment revealed that data use is limited to risk communication and sensitization, no examples of use of data for prioritization or decision making at the subnational level. The findings indicated the following: 23% (7/29) of health facilities having dedicated phone for reporting, 20% (6/29) reported no cell phone network, 17% (5/29) reported daily access to internet, 56.6% (17/29) reported a consistent supply of electricity, and no facility reported access to functional laptop. It was also established that 40% of health facilities have experienced a stock out of laboratory specimens packaging supplies in the past year. About half of the surveyed health facilities delivered specimens through riders and were assisted by the DSOs. There was a large variety in the reported packaging process, with many staff unable to give clear processes. The findings during the exercise also indicated that 91% of health facility staff were mentored on data quality check and data management including the importance of the timeliness and completeness of reporting through supportive supervision and mentorship; 65% of the health facility assessed received supervision on IDSR core performance indicator; and 58% of the health facility officer in charge gave feedback to the community level. Conclusion: public health is a data-intensive field which needs high-quality data and authoritative information to support public health assessment, decision-making and to assure the health of communities. Data quality assessment is important for public health. In this review completeness, accuracy, and timeliness were the three most-assessed attributes. Quantitative data quality assessment primarily used descriptive surveys and data audits, while qualitative data quality assessment methods include primarily interviews, questionnaires administration, documentation reviews and field observations. We found that data-use and data-process have not been given adequate attention, although they were equally important factors which determine the quality of data. Other limitations of the previous studies were inconsistency in the definition of the attributes of data quality, failure to address data users' concerns and a lack of triangulation of mixed methods for data quality assessment. The reliability and validity of the data quality assessment were rarely reported. These gaps suggest that in the future, data quality assessment for public health needs to consider equally the three dimensions of data quality, data use and data process. Measuring the perceptions of end users or consumers towards data quality will enrich our understanding of data quality issues. Data use is limited to risk communication and sensitization, no examples of use of data for prioritization or decision making at the sub national level.


Assuntos
Controle de Doenças Transmissíveis/métodos , Doenças Transmissíveis/epidemiologia , Vigilância em Saúde Pública/métodos , Saúde Pública , Análise por Conglomerados , Comunicação , Confiabilidade dos Dados , Instalações de Saúde/estatística & dados numéricos , Humanos , Libéria/epidemiologia , Projetos Piloto , Reprodutibilidade dos Testes , Risco , Inquéritos e Questionários
15.
JAMA ; 322(6): 514-523, 2019 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-31408136

RESUMO

Importance: High gluten intake during childhood may confer risk of celiac disease. Objectives: To investigate if the amount of gluten intake is associated with celiac disease autoimmunity and celiac disease in genetically at-risk children. Design, Setting, and Participants: The participants in The Environmental Determinants of Diabetes in the Young (TEDDY), a prospective observational birth cohort study designed to identify environmental triggers of type 1 diabetes and celiac disease, were followed up at 6 clinical centers in Finland, Germany, Sweden, and the United States. Between 2004 and 2010, 8676 newborns carrying HLA antigen genotypes associated with type 1 diabetes and celiac disease were enrolled. Screening for celiac disease with tissue transglutaminase autoantibodies was performed annually in 6757 children from the age of 2 years. Data on gluten intake were available in 6605 children (98%) by September 30, 2017. Exposures: Gluten intake was estimated from 3-day food records collected at ages 6, 9, and 12 months and biannually thereafter until the age of 5 years. Main Outcomes and Measures: The primary outcome was celiac disease autoimmunity, defined as positive tissue transglutaminase autoantibodies found in 2 consecutive serum samples. The secondary outcome was celiac disease confirmed by intestinal biopsy or persistently high tissue transglutaminase autoantibody levels. Results: Of the 6605 children (49% females; median follow-up: 9.0 years [interquartile range, 8.0-10.0 years]), 1216 (18%) developed celiac disease autoimmunity and 447 (7%) developed celiac disease. The incidence for both outcomes peaked at the age of 2 to 3 years. Daily gluten intake was associated with higher risk of celiac disease autoimmunity for every 1-g/d increase in gluten consumption (hazard ratio [HR], 1.30 [95% CI, 1.22-1.38]; absolute risk by the age of 3 years if the reference amount of gluten was consumed, 28.1%; absolute risk if gluten intake was 1-g/d higher than the reference amount, 34.2%; absolute risk difference, 6.1% [95% CI, 4.5%-7.7%]). Daily gluten intake was associated with higher risk of celiac disease for every 1-g/d increase in gluten consumption (HR, 1.50 [95% CI, 1.35-1.66]; absolute risk by age of 3 years if the reference amount of gluten was consumed, 20.7%; absolute risk if gluten intake was 1-g/d higher than the reference amount, 27.9%; absolute risk difference, 7.2% [95% CI, 6.1%-8.3%]). Conclusions and Relevance: Higher gluten intake during the first 5 years of life was associated with increased risk of celiac disease autoimmunity and celiac disease among genetically predisposed children.


Assuntos
Autoanticorpos/sangue , Doença Celíaca/etiologia , Proteínas na Dieta/efeitos adversos , Predisposição Genética para Doença , Glutens/efeitos adversos , Transglutaminases/imunologia , Autoimunidade , Doença Celíaca/epidemiologia , Doença Celíaca/genética , Doença Celíaca/imunologia , Pré-Escolar , Diabetes Mellitus Tipo 1/etiologia , Diabetes Mellitus Tipo 1/genética , Registros de Dieta , Feminino , Glutens/administração & dosagem , Humanos , Incidência , Lactente , Masculino , Estudos Prospectivos , Risco
16.
Isr Med Assoc J ; 21(6): 399-403, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31280509

RESUMO

BACKGROUND: Hysterectomy is common in the management of symptomatic uterine prolapse. Vaginal wall repair is often necessary, for which vaginal mesh remains a popular option. OBJECTIVES: To evaluate the risk of mesh erosion following mesh-augmented vaginal prolapse repair, with or without concomitant vaginal hysterectomy. METHODS: This retrospective cohort comprised 70 women who underwent vaginal mesh-augmented pelvic organ prolapse repair from 2007 to 2010. Of the participants, 36 (51.4%) had a vaginal hysterectomy concomitant to the anterior and/or posterior vaginal mesh repair (hysterectomy group) and 34 (48.6%) underwent mesh repair without vaginal hysterectomy (no hysterectomy group). RESULTS: There were no inter-group differences in age, parity, menopausal state, hormonal use, or presenting symptoms. Previous prolapse repair surgery was much more common in the no hysterectomy group (29.4% vs. 5.5%, P = 0.01). Eleven patients (32.3%) in the no hysterectomy group had previously undergone hysterectomy. Anterior mesh repair was performed in 77.7% and 67.6% of hysterectomy and no hysterectomy patients, respectively. Posterior mesh repair was performed in 27.7% and 44.1%, respectively. One patient in the hysterectomy group underwent immediate removal of mesh due to infection. Surgically treated mesh erosion (limited local excision) occurred in three patients (8.3%) in the hysterectomy group (3, 16, and 18 months following surgery) and in two patients (5.8%) in the no hysterectomy group at 6 months following surgery (P = 0.67). CONCLUSIONS: Vaginal mesh-augmentation concomitant with vaginal hysterectomy for pelvic organ prolapse repair does not carry an increased risk of erosion.


Assuntos
Falha de Equipamento/estatística & dados numéricos , Histerectomia Vaginal , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/epidemiologia , Telas Cirúrgicas/efeitos adversos , Estudos de Coortes , Feminino , Humanos , Israel/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Risco
17.
Medicine (Baltimore) ; 98(26): e16099, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261525

RESUMO

OBJECTIVE: To investigate the relationship between alcohol consumption and the incidence of dementia. METHOD: We will conduct a systematic search without language and year restrictions to identify all relevant published studies. The following electronic databases will be searched: PubMed, EMBASE, the Cochrane Library, Chinese BioMedical Literature Database (CBM) and China National Knowledge Infrastructure (CNKI), VIP, Wan-Fang. Cohort studies published in Chinese or English are considered for inclusion. Two authors will independently select studies base on inclusion criteria, extract data and assess the quality of included studies using the Newcastle-Ottawa Scale, the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system will be used to quantify absolute effects and quality of evidence. Any disagreement will be resolved by consensus. We will use the hazard ratio (HR) as the effect indicator, piecewise linear regression model and restricted cubic spline model will be used for linear and nonlinear trend estimation, respectively. REGISTRATION: The dose-response meta-analysis is registered in the PROSPERO (CRD42019127367) international prospective register of systematic review. DISCUSSION: In the previous related dose-response meta-analysis studies, there were some limitations: on the 1 hand, the sex was not taken into account. On the other hand, relative risk (RR) is not the best effect indicator for time-to-event data, but compare with RR, HR is much better. This study intends to use HR as the effect indicator to explore the dose-response relationship and the sex difference between alcohol intake and dementia. Accurate alcohol drinking data can provide high-quality evidence for the prevention of dementia.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Demência/epidemiologia , Metanálise como Assunto , Revisão Sistemática como Assunto , Humanos , Projetos de Pesquisa , Risco
18.
J Comput Assist Tomogr ; 43(4): 645-651, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31268875

RESUMO

OBJECTIVE: To develop regression models using Prostate Imaging Reporting and Data System (PI-RADS), histogram analysis, and prostate-specific antigen density (PSAD) to predict prostate cancer (PCa) and clinically significant PCa (CSPCa) in patients with prostate-specific antigen of 4 to 20 ng/mL. METHODS: In total, 195 PCa and 386 noncancer patients with prostate-specific antigen of 4 to 20 ng/mL were divided into development and validation cohorts. Magnetic resonance imaging results of them were assessed by PI-RADS scores and histogram analysis-corrected PI-RADS (PI-RADSh) scores. Diagnostic efficiencies for PCa and CSPCa of these scores plus PSAD were evaluated with logistic regression and receiver operating characteristic curve analysis. RESULTS: Prostate-specific antigen density + PI-RADSh score showed significantly higher area under the receiver operating characteristic curve for PCa (0.956) and CSPCa (0.960), which were higher than PI-RADS (0.909 and 0.926), PI-RADSh (0.921 and 0.940), and PSAD + PI-RADS (0.943 and 0.949) (all P < 0.05). CONCLUSIONS: Incorporation of PSAD and histogram analysis raised the diagnosis efficiencies of PI-RADS for PCa and CSPCa.


Assuntos
Bases de Dados Factuais , Imagem por Ressonância Magnética , Antígeno Prostático Específico/sangue , Próstata/diagnóstico por imagem , Neoplasias da Próstata , Idoso , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/epidemiologia , Estudos Retrospectivos , Risco
19.
Medicine (Baltimore) ; 98(27): e16341, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277188

RESUMO

BACKGROUND: Mediterranean dietary pattern has attracted great attention in terms of its effect on human health. However, whether Mediterranean dietary pattern is an independent protective factor for prostate cancer remains controversial. Our goal was to evaluate this association by conducting a meta-analysis of observational studies. METHODS: We searched the PubMed and EMBASE database through February 2019 for relevant studies that examined the association between Mediterranean Diet and prostate cancer risk. The combined risk estimates were computed using a DerSimonian random-effects model. RESULTS: A total of 10 eligible studies were included in this meta-analysis. The pooled risk estimates and 95% confidence interval (CI) in relation to Mediterranean diet pattern were 0.95 (95% CI: 0.90 to 1.01) for total prostate cancer, 0.93 (95% CI: 0.75 to 1.14) for advanced prostate cancer, 0.96 (95% CI: 0.81 to 1.14) for localized prostate cancer, and 0.92 (95% CI: 0.76 to 1.11) for fatal prostate cancer. There was no evidence of heterogeneity for total (P = .326, I = 12.7%), localized (P = .706, I = 0.0%) and fatal prostate cancer (P = .282, I = 13.0%), but not for advanced prostate cancer (P = .018, I = 63.4%). CONCLUSION: This large meta-analysis of observational studies suggests that Mediterranean dietary pattern has no relationship with prostate cancer risk.


Assuntos
Dieta Mediterrânea , Neoplasias da Próstata/epidemiologia , Humanos , Masculino , Neoplasias da Próstata/patologia , Risco
20.
J Nurs Adm ; 49(7-8): 345-346, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31335515

RESUMO

This year, Gail E. Latimer, MSN, RN, FAAN, FACHE, received the American Organization for Nursing Leadership's (AONL's) prestigious Lifetime Achievement Award, which honors an AONL member recognized by the nursing community as a significant leader in the nursing profession who has served AONL in an important leadership capacity. Latimer served as a member of the AONL board of directors and as chair of the AONL Foundation. In her career, she held a series of executive nursing roles that showcased her ability to refine nursing work processes to make them measurably more efficient and improve the patient experience of care. In 2004, she became vice president and chief nursing officer (CNO) of Siemens Health Services, a global medical technology company, and later served as CNO of Cerner Corporation. This is an abridged version of an interview conducted by former AONL board member Claire M. Zangerle, DNP, MSN, MBA, RN, NEA-BC, chief nurse executive, Allegheny Health Network at the AONL's annual meeting in San Diego in April 2019.


Assuntos
Liderança , Enfermeiras Administradoras/organização & administração , Resiliência Psicológica , Risco , Distinções e Prêmios , Feminino , Humanos , Sociedades de Enfermagem
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