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1.
Pol Arch Intern Med ; 129(9): 572-573, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31566586
2.
Bone Joint J ; 101-B(10): 1280-1284, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564150

RESUMO

AIMS: A number of methods have been described to remove a well-fixed humeral implant as part of revision shoulder arthroplasty. These include the use of cortical windows and humeral osteotomies. The router bit extraction technique uses a high-speed router bit to disrupt the bone-implant interface. The implant is then struck in a retrograde fashion with a square-tip impactor and mallet. The purpose of this study was to determine the characteristics and frequency of the different techniques needed for the removal of a well-fixed humeral stem in revision shoulder arthroplasty. PATIENTS AND METHODS: Between 2010 and 2018, 288 revision shoulder arthroplasty procedures requiring removal of a well-fixed humeral component were carried out at a tertiary referral centre by a single surgeon. The patient demographics, indications for surgery, and method of extraction were collected. RESULTS: Of the 288 revisions, 284 humeral stems (98.6%) were removed using the router bit extraction technique alone. Four humeral stems (1.39%) required an additional cortical window. Humeral osteotomy was not necessary in any procedure. Most of the humeral stems removed (78.8%) were cementless. Of the four humeral stems that required a cortical window, three involved removal of a hemiarthroplasty. Two were cemented and two were cementless. CONCLUSION: The router bit extraction technique removed a well-fixed humeral component in a very high proportion of patients (98.6%). This method allows surgeons to avoid more invasive approaches involving a cortical window or humeral osteotomy, and their associated complications. Cite this article: Bone Joint J 2019;101-B:1280-1284.


Assuntos
Artroplastia do Ombro/efeitos adversos , Remoção de Dispositivo/métodos , Hemiartroplastia/métodos , Falha de Prótese , Idoso , Artroplastia do Ombro/métodos , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica/fisiologia , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Prótese de Ombro/efeitos adversos , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento
3.
Bone Joint J ; 101-B(10): 1209-1217, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564156

RESUMO

AIMS: There is an increasing demand for hip arthroplasty in China. We aimed to describe trends in in-hospital mortality after this procedure in China and to examine the potential risk factors. PATIENTS AND METHODS: We included 210 450 patients undergoing primary hip arthroplasty registered in the Hospital Quality Monitoring System in China between 2013 and 2016. In-hospital mortality after hip arthroplasty and its relation to potential risk factors were assessed using multivariable Poisson regression. RESULTS: During the study period, 626 inpatient deaths occurred within 30 days after hip arthroplasty. Mortality decreased from 2.9% in 2013 to 2.6% in 2016 (p for trend = 0.02). Compared with their counterparts, old age, male sex, and divorced or widowed patients had a higher rate of mortality (all p < 0.05). Risk ratio (RR) for mortality after arthroplasty for fracture was two-fold higher (RR 2.0, 95% confidence interval (CI) 1.5 to 2.6) than that for chronic disease. RRs for mortality were 3.3 (95% CI 2.7 to 3.9) and 8.2 (95% CI 6.5 to 10.4) for patients with Charlson Comorbidity Index (CCI) of 1 to 2 and CCI ≥ 3, respectively, compared with patients with CCI of 0. The rate of mortality varied according to geographical region, the lowest being in the East region (1.8%), followed by Beijing (2.1%), the North (2.9%), South-West (3.6%), South-Central (3.8%), North-East (4.1%), and North-West (5.2%) regions. CONCLUSION: While in-hospital mortality after hip arthroplasty in China appears low and declined during the study period, discrepancies in mortality after this procedure exist according to sociodemographic factors. Healthcare resources should be allocated more to underdeveloped regions to further reduce mortality. Cite this article: Bone Joint J 2019;101-B:1209-1217.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/mortalidade , Causas de Morte , Mortalidade Hospitalar/tendências , Sistema de Registros , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , China , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/fisiopatologia , Falha de Prótese , Estudos Retrospectivos , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento
5.
Rev Prat ; 69(6): 659-665, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31626429

RESUMO

Primary immune deficiencies (PIDs) include rare and heterogeneous syndromes due to genetic abnormalities involving the immune system. In the registry of the French National Reference Center for Primary Immune Deficiencies (CEREDIH), the median age of clinical onset is 2 years, but 25% of patients develop the first symptoms after 15 years. A diagnosis of PID should be considered in the presence of an unusual association of infections, autoimmune pathologies, granulomatous disease, polyclonal lymphoproliferation or atypical lymphoma. PID management currently benefits from new antibiotic prophylaxis, the improvement of allogeneic hematopoietic stem cell transplantation procedure and the development of gene therapy. In addition, the understanding of the pathophysi ological mechanisms led to new treatments targeting the pathways implicated by the genetic defects. In this review, we briefly recall the classification of PID. We illustrate the problem of PID in adults with clinical cases and then summarize the main principles of management in adults PID patients.


Assuntos
Síndromes de Imunodeficiência , Adulto , Criança , Pré-Escolar , Terapia Genética , Humanos , Síndromes de Imunodeficiência/diagnóstico , Síndromes de Imunodeficiência/imunologia , Síndromes de Imunodeficiência/terapia , Sistema de Registros
7.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(10): 1062-1065, 2019 Oct 06.
Artigo em Chinês | MEDLINE | ID: mdl-31607057

RESUMO

From 2010 to 2014, a total of 17 150 new cases of thyroid cancer (TC) reported in cancer registration areas of Zhejiang province, the crude incidence rate of TC was 29.28/100 000. Using the Chinese Census in 2000 and the World Segi's population as the standard population, the age-standardized incidence rate by Chinese standard population (ASIRC) and by world standard population (ASIRW) were 24.11/100 000 and 20.65/100 000 respectively. 256 TC death cases reported in all, the crude mortality rate was 0.44/100 000, the age-standardized mortality rate by Chinese standard population (ASMRC) and by World standard population (ASMRW) were 0.23/100 000 and 0.23/100 000 respectively. The ASIRC had a upward trend [annual percent change (APC)=28.62%, 95%CI: 21.00%-36.72%, t=13.10, P=0.001], while the ASMRC trend seemed stable (APC=0.73%, 95%CI: -7.47%-9.66%, t=0.27, P=0.803).


Assuntos
Neoplasias da Glândula Tireoide/mortalidade , China/epidemiologia , Humanos , Incidência , Sistema de Registros , População Rural , População Urbana
8.
Medicine (Baltimore) ; 98(42): e17713, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626153

RESUMO

Few data are available regarding factors that impact cricothyrotomy use and outcome in general hospital setting. The aim of the present study was to determine the incidence and outcomes of the patients underwent cricothyrotomy in a "cannot intubate, cannot oxygenate" (CICO) situation at university hospitals in Korea.This was a retrospective review of the electronic medical records of consecutive patients who underwent cricothyrotomy during a CICO situation between March, 2007, and October, 2018, at 2 university hospitals in Korea. Data regarding patient characteristics and outcomes were analyzed using descriptive statistics.During the study period, a total of 10,187 tracheal intubations were attempted and 23 patients received cricothyrotomy. Hospitalwide incidence of cricothyrotomy was 2.3 per 1000 tracheal intubations (0.23%). The majority of cricothyrotomy procedures (22 cases, 95.7%) were performed in the emergency department (ED); 1 cricothyrotomy was attempted in the endoscopy room. In the ED, 5663 intubations were attempted and the incidence of cricothyrotomy was 3.9 per 1000 tracheal intubations (0.39%). Survival rate at hospital discharge was 47.8% (11 of 23 cases). Except for cardiac arrest at admission, survival rate was 62.5% (10 of 16 cases). Successful cricothyrotomy was performed in 17 patients (73.9%) and 9 patients (52.9%) were survived. Among 6 patients of failed cricothyrotomy (26.1%), 2 patients (33.3%) were survived. After failure of cricothyrotomy, various methods of securing airway were established: 3 tracheal intubations, 1 nasotracheal intubation, and 1 tracheostomy.The success rate of cricothyrotomy and survival rate in the CICO situation were not high. After failure of cricothyrotomy, various methods of securing airway were performed.


Assuntos
Manuseio das Vias Aéreas/métodos , Obstrução das Vias Respiratórias/cirurgia , Cartilagem Cricoide/cirurgia , Sistema de Registros , Cartilagem Tireóidea/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Obstrução das Vias Respiratórias/mortalidade , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Humanos , Intubação Intratraqueal/métodos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Adulto Jovem
9.
Bone Joint J ; 101-B(10): 1307-1312, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564143

RESUMO

AIMS: In order to determine whether and for whom serial radiological evaluation is necessary in one-part proximal humerus fractures, we set out to describe the clinical history and predictors of secondary displacement in patients sustaining these injuries. PATIENTS AND METHODS: Between January 2014 and April 2016, all patients with an isolated, nonoperatively treated one-part proximal humerus fracture were prospectively followed up. Clinical and radiological evaluation took place at less than two, six, 12, and 52 weeks. Fracture configuration, bone quality, and comminution were determined on the initial radiographs. Fracture healing, secondary displacement, and treatment changes were recorded during follow-up. RESULTS: In 100 patients (59 female, 41 male; mean age 57 years), 91 of the fractures (91%) remained stable. In five of nine patients (55%) with secondary displacement, surgery was recommended. Comminution, present in 23 patients (23%), was identified as a predictor of secondary displacement (p < 0.001). Patients' age, sex, fracture configuration, and bone quality were not associated with secondary displacement (p ≥ 0.438). Nonoperative treatment resulted in a mean absolute Constant score (CS) of 80 (49 to 98), relative CS of 101% (63% to 138%), median subjective shoulder value of 95% (interquartile range (IQR) 90% to 100%), and median EuroQol five-dimensional questionnaire score of 0.89 (IQR 0.80 to 1.00) with bone union in all cases at one-year follow-up. CONCLUSION: Radiological re-evaluation was only necessary in patients presenting with comminution and may be redundant for 77% of patients with one-part proximal humerus fractures. Nonoperative treatment of one-part proximal humerus fractures remains the mainstay of treatment with a low rate of secondary surgery, a high union rate, and good clinical results. Cite this article: Bone Joint J 2019;101-B:1307-1312.


Assuntos
Tratamento Conservador/métodos , Consolidação da Fratura/fisiologia , Radiografia/estatística & dados numéricos , Sistema de Registros , Fraturas do Ombro/diagnóstico por imagem , Procedimentos Desnecessários/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Fixação de Fratura/métodos , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Radiografia/métodos , Fraturas do Ombro/terapia , Estatísticas não Paramétricas , Fatores de Tempo
10.
Bone Joint J ; 101-B(10): 1199-1208, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564148

RESUMO

AIMS: We compared implant and patient survival following intraoperative periprosthetic femoral fractures (IOPFFs) during primary total hip arthroplasty (THA) with matched controls. PATIENTS AND METHODS: This retrospective cohort study compared 4831 hips with IOPFF and 48 154 propensity score matched primary THAs without IOPFF implanted between 2004 and 2016, which had been recorded on a national joint registry. Implant and patient survival rates were compared between groups using Cox regression. RESULTS: Ten-year stem survival was worse in the IOPFF group (p < 0.001). Risk of revision for aseptic loosening increased 7.2-fold following shaft fracture and almost 2.8-fold after trochanteric fracture (p < 0.001). Risk of periprosthetic fracture of the femur revision increased 4.3-fold following calcar-crack and 3.6-fold after trochanteric fracture (p < 0.01). Risk of instability revision was 3.6-fold after trochanteric fracture and 2.4-fold after calcar crack (p < 0.001). Risk of 90-day mortality following IOPFF without revision was 1.7-fold and 4.0-fold after IOPFF with early revision surgery versus uncomplicated THA (p < 0.001). CONCLUSION: IOPFF increases risk of stem revision and mortality up to ten years following surgery. The risk of revision depends on IOPFF subtype and mortality risk increases with subsequent revision surgery. Surgeons should carefully diagnose and treat IOPFF to minimize fracture progression and implant failure. Cite this article: Bone Joint J 2019;101-B:1199-1208.


Assuntos
Artroplastia de Quadril/efeitos adversos , Osteoartrite do Quadril/cirurgia , Fraturas Periprotéticas/cirurgia , Sistema de Registros , Reoperação/métodos , Fatores Etários , Idoso , Artroplastia de Quadril/métodos , Estudos de Casos e Controles , Inglaterra , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Irlanda do Norte , Osteoartrite do Quadril/diagnóstico por imagem , Fraturas Periprotéticas/diagnóstico por imagem , Fraturas Periprotéticas/epidemiologia , Modelos de Riscos Proporcionais , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento , Reino Unido , País de Gales
11.
Artigo em Inglês | MEDLINE | ID: mdl-31610771

RESUMO

Immunisation at the earliest appropriate age and high levels of vaccine coverage at milestone ages are important in preventing the spread of vaccine-preventable diseases. At the Central Coast Public Health Unit, the authors sought to determine if follow-up of children said by the Australian Childhood Immunisation Register (ACIR) to be overdue for vaccination improved both of these factors. In a quality improvement activity, monthly ACIR lists of overdue Central Coast children aged 9 to 10 months of age were examined. The study alternated three months of intervention with three months of no intervention. The intervention was designed to find evidence of vaccination, first from the last known provider, and then if this was unsuccessful, from the parent. If no information was available, a letter was sent to the parents. If the child was indeed vaccinated, the register was updated. If the child was missing any vaccinations, the parent(s) were encouraged to complete the schedule. On reviewing routinely-published quarterly ACIR data at three-monthly intervals for 24 months after the intervention (or non-intervention), timeliness of vaccination improved in the intervention cohort. Central Coast fully vaccinated rates diverged from NSW rates during the study. In addition, the ACIR quarters that contained two out of three months of intervention rather than one out of three months of intervention had the highest rates of fully vaccinated children. The authors concluded that the intervention improved both timeliness of vaccination and the proportion of fully vaccinated children.


Assuntos
Programas de Imunização/estatística & dados numéricos , Esquemas de Imunização , Vacinação/estatística & dados numéricos , Vacinas/administração & dosagem , Austrália , Confiabilidade dos Dados , Pesquisas sobre Serviços de Saúde , Humanos , Lactente , Pais , Sistema de Registros
12.
Am Surg ; 85(9): 1010-1012, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638515

RESUMO

Many trauma patients present to nontrauma centers with emergency conditions. The Emergency Medical Treatment and Active Labor Act dictates that nontrauma centers attempt stabilization and provide appropriate transfer. Our goal was to determine whether there was a survival benefit in transferring hypotensive patients. The Tampa General Hospital trauma registry database was queried for adult trauma transfers from January 2012 to April 2018 including the first recorded systolic blood pressure (SBP) and other pertinent data. A manual chart review in hypotensive (SBP < 90) patients determined blood pressure at the time of transfer. Of the 3038 patients, 40 patients were hypotensive on arrival, with 40% (16) mortality. Eight of nine (88%) patients with SBP <70 on arrival, 3 of 11 (27%) with SBP 70 to 79, and 5 of 20 (25%) with SBP 80 to 89 died. The only survivor in the <70 group was normotensive at transport. Patients in these groups who were hypotensive at the time of transport died (4/4, 100%). Our data show no benefit in transferring patients with refractory hypotension at the time of transport; although the numbers are small, an SBP <70 should be considered prohibitive to transfer.


Assuntos
Hipotensão/etiologia , Hipotensão/terapia , Transferência de Pacientes , Centros de Traumatologia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/terapia , Adulto , Florida , Humanos , Sistema de Registros , Estudos Retrospectivos , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/fisiopatologia
13.
JAMA ; 322(16): 1580-1588, 2019 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-31638681

RESUMO

Importance: Preterm birth has been associated with cardiometabolic, respiratory, and neuropsychiatric disorders in adulthood. However, the prevalence of survival without any major comorbidities is unknown. Objective: To determine the prevalence of survival without major comorbidities in adulthood among persons born preterm vs full-term. Design, Setting, and Participants: National cohort study of all 2 566 699 persons born in Sweden from January 1, 1973, through December 31, 1997, who had gestational age data and who were followed up for survival and comorbidities through December 31, 2015 (ages 18-43 years). Exposures: Gestational age at birth. Main Outcomes and Measures: Survival without major comorbidities among persons born extremely preterm (22-27 weeks), very preterm (28-33 weeks), late preterm (34-36 weeks), or early term (37-38 weeks), compared with full-term (39-41 weeks). Comorbidities were defined using the Adolescent and Young Adult Health Outcomes and Patient Experience (AYA HOPE) Comorbidity Index, which includes conditions that commonly manifest in adolescence or young adulthood, including neuropsychiatric disorders; and the Charlson Comorbidity Index (CCI), which includes major chronic disorders predictive of mortality in adulthood. Poisson regression was used to determine prevalence ratios and differences, adjusted for potential confounders. Results: In this study population, 48.6% were female, 5.8% were born preterm, and the median age at end of follow-up was 29.8 years (interquartile range, 12.6 years). Of all persons born preterm, 54.6% were alive with no AYA HOPE comorbidities at the end of follow-up. Further stratified, this prevalence was 22.3% for those born extremely preterm, 48.5% for very preterm, 58.0% for late preterm, 61.2% for early term, and 63.0% for full-term. These prevalences were significantly lower for earlier gestational ages vs full-term (eg, adjusted prevalence ratios: extremely preterm, 0.35 [95% CI, 0.33 to 0.36; P < .001]; all preterm, 0.86 [95% CI, 0.85 to 0.86; P < .001]; adjusted prevalence differences: extremely preterm, -0.41 [95% CI, -0.42 to -0.40; P < .001]; all preterm, -0.09 [95% CI, -0.09 to -0.09; P < .001]). Using the CCI, the corresponding prevalences were 73.1% (all preterm), 32.5% (extremely preterm), 66.4% (very preterm), 77.1% (late preterm), 80.4% (early term), and 81.8% (full-term) (adjusted prevalence ratios: extremely preterm, 0.39 [95% CI, 0.38 to 0.41; P < .001]; all preterm, 0.89 [95% CI, 0.89 to 0.89; P < .001]; adjusted prevalence differences: extremely preterm, -0.50 [95% CI, -0.51 to -0.49; P < .001]; all preterm, -0.09 [95% CI, -0.09 to -0.09; P < .001]). Conclusions and Relevance: Among persons born preterm in Sweden between 1973 and 1997, the majority survived to early to mid-adulthood without major comorbidities. However, outcomes were worse for those born extremely preterm.


Assuntos
Comorbidade , Recém-Nascido Prematuro , Adolescente , Adulto , Estudos de Coortes , Epidemiologia , Feminino , Idade Gestacional , Humanos , Lactente Extremamente Prematuro , Masculino , Distribuição de Poisson , Prevalência , Sistema de Registros , Suécia/epidemiologia , Adulto Jovem
15.
Z Geburtshilfe Neonatol ; 223(5): 304-316, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31623006

RESUMO

AIMS: This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recent scientific literature, the experience of the members of the guideline commission and the views of self-help groups. METHODS: Based on the international literature, the members of the participating medical societies and organizations developed Recommendations and Statements. These were adopted following a formal process (structured consensus conference with neutral moderation, voting was done in writing using the Delphi method to achieve consensus). RECOMMENDATIONS: Part I of this short version of the guideline lists Statements and Recommendations on the epidemiology, etiology, prediction and primary and secondary prevention of preterm birth.


Assuntos
Guias de Prática Clínica como Assunto , Nascimento Prematuro , Áustria , Feminino , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Prevenção Primária , Sistema de Registros , Prevenção Secundária , Sociedades Médicas
16.
Sante Publique ; Vol. 31(3): 433-441, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31640331

RESUMO

OBJECTIVES: Non-communicable diseases (NCDs) represent a major public health problem worldwide. Giving their impact on the morbidity and mortality burden, understanding their chronological trends over time is a priority for epidemiological surveillance. We aimed to determine the epidemiological specificities of NCDs and to study their chronological trends over the period 2010-2015. METHODS: We retrospectively collected data of hospitalized patients from the regional registry of morbidity and mortality in the Southern University Hospital of Tunisia during the period 2010-2015. RESULTS: We included 18,081 patients with NCDs aged ≥ 25 years. The distribution of NCDs was characterized by the predominance of cardiovascular disease (CVD) (10,346 cases, 57.2%). Chronological trends analysis of NCDs showed that NCDs remained globally stable between 2010 and 2015. The same result applied to the group of cancers, chronic respiratory diseases and diabetes mellitus. However, CVD increased significantly between 2010 and 2015 (ρ = 0.84; p = 0.036). The proportion of CVD increased significantly among men (ρ = 0.87; p = 0.019) and elderly (ρ = 0.88; p = 0.019). The hospital mortality rate of NCDs increased significantly (ρ = 0.85; p = 0.031), notably for CVDs (ρ = 0.94; p = 0.005). CONCLUSION: Chronological trends analysis revealed a significant rise in the morbidity and mortality burden of CVDs during the period 2010-2015. It is imperative, therefore, to strengthen health care for these patients and to introduce the concept of integrated NCDs prevention as an essential component of the health system.


Assuntos
Doenças não Transmissíveis/epidemiologia , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Humanos , Masculino , Morbidade/tendências , Mortalidade/tendências , Doenças não Transmissíveis/mortalidade , Sistema de Registros , Estudos Retrospectivos , Tunísia/epidemiologia
17.
BMJ ; 367: l5784, 2019 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-31645334

RESUMO

OBJECTIVE: To assess whether severe psychiatric reactions to trauma and other adversities are associated with subsequent risk of life threatening infections. DESIGN: Population and sibling matched cohort study. SETTING: Swedish population. PARTICIPANTS: 144 919 individuals with stress related disorders (post-traumatic stress disorder (PTSD), acute stress reaction, adjustment disorder, and other stress reactions) identified from 1987 to 2013 compared with 184 612 full siblings of individuals with a diagnosed stress related disorder and 1 449 190 matched individuals without such a diagnosis from the general population. MAIN OUTCOME MEASURES: A first inpatient or outpatient visit with a primary diagnosis of severe infections with high mortality rates (ie, sepsis, endocarditis, and meningitis or other central nervous system infections) from the Swedish National Patient Register, and deaths from these infections or infections of any origin from the Cause of Death Register. After controlling for multiple confounders, Cox models were used to estimate hazard ratios of these life threatening infections. RESULTS: The average age at diagnosis of a stress related disorder was 37 years (55 541, 38.3% men). During a mean follow-up of eight years, the incidence of life threatening infections per 1000 person years was 2.9 in individuals with a stress related disorder, 1.7 in siblings without a diagnosis, and 1.3 in matched individuals without a diagnosis. Compared with full siblings without a diagnosis of a stress related disorder, individuals with such a diagnosis were at increased risk of life threatening infections (hazard ratio for any stress related disorder was 1.47 (95% confidence intervals1.37 to 1.58) and for PTSD was 1.92 (1.46 to 2.52)). Corresponding estimates in the population based analysis were similar (1.58 (1.51 to 1.65) for any stress related disorder, P=0.09 for difference between sibling and population based comparison, and 1.95 (1.66 to 2.28) for PTSD, P=0.92 for difference). Stress related disorders were associated with all studied life threatening infections, with the highest relative risk observed for meningitis (sibling based analysis 1.63 (1.23 to 2.16)) and endocarditis (1.57 (1.08 to 2.30)). Younger age at diagnosis of a stress related disorder and the presence of psychiatric comorbidity, especially substance use disorders, were associated with higher hazard ratios, whereas use of selective serotonin reuptake inhibitors in the first year after diagnosis of a stress related disorder was associated with attenuated hazard ratios. CONCLUSION: In the Swedish population, stress related disorders were associated with a subsequent risk of life threatening infections, after controlling for familial background and physical or psychiatric comorbidities.


Assuntos
Infecções Bacterianas/epidemiologia , Suscetibilidade a Doenças/imunologia , Transtornos de Estresse Traumático/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/imunologia , Criança , Feminino , Seguimentos , Humanos , Incidência , Masculino , Anamnese , Pessoa de Meia-Idade , Sistema de Registros/estatística & dados numéricos , Fatores de Risco , Índice de Gravidade de Doença , Irmãos , Transtornos de Estresse Traumático/imunologia , Taxa de Sobrevida , Suécia/epidemiologia , Adulto Jovem
19.
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