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1.
J Registry Manag ; 46(1): 4-14, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31490916

RESUMO

PURPOSE: As survival rates for individuals with HIV/AIDS diagnoses increase, cancer is becoming a more prevalent disease in this population. Data regarding the concurrent diagnoses of HIV/AIDS and cancer has not previously been examined and analyzed in the state of Iowa. METHODS: The Iowa Cancer Registry and Iowa Department of Public Health's HIV/AIDS surveillance databases were linked, and matches were identified. Characteristics of Iowans with HIV/AIDS later diagnosed with cancer between 1991 and 2015 were compared to Iowans without HIV/AIDS using proportional incidence ratios (PIRs). RESULTS: 490 patients met inclusion criteria; 91% had AIDS and 9% had HIV only. Compared to individuals without HIV/AIDS, significantly higher PIRs for cancer were found in younger persons, males, African Americans, metropolitan (metro) residents, and Iowans with Medicaid or the uninsured. Specifically, PIRs associated with the following cancers were higher in the population with HIV/AIDS: Kaposi sarcoma, non-Hodgkin lymphomas (NHLs), and squamous cell neoplasms of the anus. When stratified by AIDS-defining cancers and non-AIDS-defining cancers, the main differences were individuals with AIDS-defining cancers had elevated PIRs among those diagnosed between 1991-1998 and had Kaposi sarcoma or Burkitt lymphoma, while those with non-AIDS-defining cancers were diagnosed between 2007-2015 and were diagnosed with anal, male or female genital, lymphoma other than NHL, liver, lung, or other squamous cell neoplasm cancers. When comparing nonmetropolitan (nonmetro) vs metro Iowans with HIV/AIDS, PIRs for nonmetro patients were elevated in those diagnosed with cancer between 50-59 years old, whites, and individuals diagnosed with squamous cell neoplasms. CONCLUSION: Our results indicate Iowans with HIV/AIDS have higher proportions of certain types of cancers compared to the general population and provide baseline information for future initiatives aimed at preventing or detecting cancer among those living with HIV/AIDS.


Assuntos
Infecções por HIV/epidemiologia , Neoplasias/epidemiologia , Sistema de Registros/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Infecções por HIV/complicações , Humanos , Incidência , Lactente , Recém-Nascido , Iowa/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Adulto Jovem
2.
Bone Joint J ; 101-B(9): 1129-1137, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31474142

RESUMO

AIMS: The aim of this study was to investigate mortality and risk of intraoperative medical complications depending on delay to hip fracture surgery by using data from the Norwegian Hip Fracture Register (NHFR) and the Norwegian Patient Registry (NPR). PATIENTS AND METHODS: A total of 83 727 hip fractures were reported to the NHFR between 2008 and 2017. Pathological fractures, unspecified type of fractures or treatment, patients less than 50 years of age, unknown delay to surgery, and delays to surgery of greater than four days were excluded. We studied total delay (fracture to surgery, n = 38 754) and hospital delay (admission to surgery, n = 73 557). Cox regression analyses were performed to calculate relative risks (RRs) adjusted for sex, age, American Society of Anesthesiologists (ASA) classification, type of surgery, and type of fracture. Odds ratio (OR) was calculated for intraoperative medical complications. We compared delays of 12 hours or less, 13 to 24 hours, 25 to 36 hours, 37 to 48 hours, and more than 48 hours. RESULTS: Mortality remained unchanged when total delay was less than 48 hours. Total delay exceeding 48 hours was associated with increased three-day mortality (RR 1.69, 95% confidence interval (CI) 1.23 to 2.34; p = 0.001) and one-year mortality (RR 1.06, 95% CI 1.04 to 1.22; p = 0.003). More intraoperative medical complications were reported when hospital delay exceeded 24 hours. CONCLUSION: Hospitals should operate on patients within 48 hours after fracture to reduce mortality and intraoperative complications. Cite this article: Bone Joint J 2019;101-B:1129-1137.


Assuntos
Artroplastia de Quadril/mortalidade , Fixação Interna de Fraturas/mortalidade , Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Complicações Intraoperatórias/mortalidade , Tempo para o Tratamento/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/estatística & dados numéricos , Feminino , Fixação Interna de Fraturas/estatística & dados numéricos , Hemiartroplastia/estatística & dados numéricos , Fraturas do Quadril/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Masculino , Noruega/epidemiologia , Sistema de Registros/estatística & dados numéricos , Fatores de Risco
3.
Medicine (Baltimore) ; 98(35): e16941, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464932

RESUMO

Population-based cancer registries (PBCR) participate in epidemiological surveillance and in the evaluation of cancer types by enabling analysis of incidence and survival data over time. The aim of this study was to examine overall survival (OS) in patients with colorectal cancer (CRC) by analyzing data from the Martinique population-based cancer registry between 1993 and 2012. All colorectal cancer cases diagnosed in Martinique between 1993 and 2012 were included. Characteristics of CRC patients were analyzed according to age subgroups, namely: <50 years, 50 to 74 years and over 75 years.We recorded the following socio-demographic and clinical variables: year of diagnosis, age at diagnosis, sex, histology, zone of residence, and subsite of the cancer. Incidence of malignant neoplasms of the colon and rectum (ICD-10 C18-21) was extracted from the Martinique Cancer Registry database. Stage at diagnosis (localized: stage I-II, regional: stage III and metastatic stage: stage IV) were also analyzed for the 2008 to 2012 period.A total of 2230 cases of incident invasive CRC were included during the study period (1993-2012): 1171 were women (52.5%); 1588 patients (71.2%) had colon cancer. Stage at diagnosis was evaluated in 779 patients (89.6%): 486/779 (62.4%) had stage III-IV at diagnosis, including 285 (36.6%) patients with metastases at diagnosis (stage IV). One-year, 5-year and 10-year OS for the study period 1993 to 2012 was 74.6%, 43.8% and 33.0% respectively. There was a statistical difference in overall survival according to gender (P = .0153), age at diagnosis (P < .001) and stage (P < .001).Median OS was 2.0 years (95% CI [1.4-2.1]) in the stage III-IV group during the period 2008 to 2012, whereas it was unreached in the stage I-II group. Multivariable analysis confirmed that stage III-IV at diagnosis (hazard ratio (HR) = 3.70 [2.89-4.99]; P < .0001) and colon cancer (HR = 1.30 [1.01-1.69]; P = .04) were main prognostic factors for OS. Women had a HR of 0.78 [0.62-0.96], P = .02. CRC patients in the 50 to 74 years age group had a HR of 0.63 [0.50-0.80], P = .0001.This study underlines the importance of structuring management of CRC cancer patients.


Assuntos
Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Sistema de Registros/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Martinica/epidemiologia , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores Sexuais
4.
BMJ ; 366: l4693, 2019 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412996

RESUMO

OBJECTIVE: To explore the association between pregnancy duration and risk of endometrial cancer. DESIGN: Nationwide register based cohort study. SETTING: Denmark. PARTICIPANTS: All Danish women born from 1935 to 2002. MAIN OUTCOME MEASURES: Relative risk (incidence rate ratio) of endometrial cancer by pregnancy number, type, and duration, estimated using log-linear Poisson regression. RESULTS: Among 2 311 332 Danish women with 3 947 650 pregnancies, 6743 women developed endometrial cancer during 57 347 622 person years of follow-up. After adjustment for age, period, and socioeconomic factors, a first pregnancy was associated with a noticeably reduced risk of endometrial cancer, whether it ended in induced abortion (adjusted relative risk 0.53 (95% confidence interval 0.45 to 0.64) or childbirth (0.66, 0.61 to 0.72). Each subsequent pregnancy was associated with an additional reduction in risk, whether it ended in induced abortion (0.81, 0.77 to 0.86) or childbirth (0.86, 0.84 to 0.89). Duration of pregnancy, age at pregnancy, spontaneous abortions, obesity, maternal birth cohort, fecundity, and socioeconomic factors did not modify the results. CONCLUSIONS: The risk of endometrial cancer is reduced regardless of whether a pregnancy ends shortly after conception or at 40 weeks of gestation. This reduction in risk could be explained by a biological process occurring within the first weeks of pregnancy, as pregnancies ending in induced abortions were associated with similar reductions in risk as pregnancies ending in childbirth.


Assuntos
Aborto Induzido/estatística & dados numéricos , Neoplasias do Endométrio/epidemiologia , Gravidez/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Adulto , Dinamarca/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , História Reprodutiva , Fatores de Risco , Fatores Socioeconômicos , Fatores de Tempo
5.
BMJ ; 366: l4894, 2019 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-31462492

RESUMO

OBJECTIVE: To evaluate if the lowest target level for glycated haemoglobin (HbA1c) of <6.5% is associated with lower risk for retinopathy and nephropathy than less tight control in children and adults with type 1 diabetes. DESIGN: Population based cohort study. SETTING: Swedish National Diabetes Registry, 1 January 1998 to 31 December 2017. PARTICIPANTS: 10 398 children and adults with type 1 diabetes followed from diagnosis, or close thereafter, until end of 2017. MAIN OUTCOME MEASURES: Relative risk (odds ratios) for retinopathy and nephropathy for different mean levels of HbA1c. RESULTS: Mean age of participants was 14.7 years (43.4% female), mean duration of diabetes was 1.3 years, and mean HbA1c level was 8.0% (63.4 mmol/mol). After adjustment for age, sex, duration of diabetes, blood pressure, blood lipid levels, body mass index, and smoking, the odds ratio for mean HbA1c <6.5% (<48 mmol/mol) compared with 6.5-6.9% (48-52 mmol/mol) for any retinopathy (simplex or worse) was 0.77 (95% confidence interval 0.56 to 1.05, P=0.10), for preproliferative diabetic retinopathy or worse was 3.29 (0.99 to 10.96, P=0.05), for proliferative diabetic retinopathy was 2.48 (0.71 to 8.62, P=0.15), for microalbuminuria or worse was 0.98 (0.60 to 1.61, P=0.95), and for macroalbuminuria was 2.47 (0.69 to 8.87, P=0.17). Compared with HbA1c levels 6.5-6.9%, HbA1c levels 7.0-7.4% (53-57 mmol/mol) were associated with an increased risk of any retinopathy (1.31, 1.05 to 1.64, P=0.02) and microalbuminuria (1.55, 1.03 to 2.32, P=0.03). The risk for proliferative retinopathy (5.98, 2.10 to 17.06, P<0.001) and macroalbuminuria (3.43, 1.14 to 10.26, P=0.03) increased at HbA1c levels >8.6% (>70 mmol/mol). The risk for severe hypoglycaemia was increased at mean HbA1c <6.5% compared with 6.5-6.9% (relative risk 1.34, 95% confidence interval 1.09 to 1.64, P=0.005). CONCLUSIONS: Risk of retinopathy and nephropathy did not differ at HbA1c levels <6.5% but increased for severe hypoglycaemia compared with HbA1c levels 6.5-6.9%. The risk for severe complications mainly occurred at HbA1c levels >8.6%, but for milder complications was increased at HbA1c levels >7.0%.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Nefropatias Diabéticas/epidemiologia , Retinopatia Diabética/epidemiologia , Hemoglobina A Glicada/análise , Hipoglicemia/complicações , Adolescente , Adulto , Glicemia/análise , Glicemia/efeitos dos fármacos , Criança , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/tratamento farmacológico , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/etiologia , Retinopatia Diabética/sangue , Retinopatia Diabética/etiologia , Feminino , Seguimentos , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Masculino , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Suécia/epidemiologia , Adulto Jovem
6.
BMJ ; 366: l4772, 2019 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-31467044

RESUMO

OBJECTIVE: To investigate the cardiovascular effectiveness of sodium glucose cotransporter 2 (SGLT2) inhibitors in routine clinical practice. DESIGN: Cohort study using data from nationwide registers and an active-comparator new-user design. SETTING: Denmark, Norway, and Sweden, from April 2013 to December 2016. PARTICIPANTS: 20 983 new users of SGLT2 inhibitors and 20 983 new users of dipeptidyl peptidase 4 (DPP4) inhibitors, aged 35-84, matched by age, sex, history of major cardiovascular disease, and propensity score. MAIN OUTCOME MEASURES: Primary outcomes were major cardiovascular events (composite of myocardial infarction, stroke, and cardiovascular death) and heart failure (hospital admission for heart failure or death due to heart failure). Secondary outcomes were the individual components of the cardiovascular composite and any cause death. In the primary analyses, patients were defined as exposed from treatment start throughout follow-up (analogous to intention to treat); additional analyses were conducted with an as-treated exposure definition. Cox regression was used to estimate hazard ratios. RESULTS: Mean age of the study cohort was 61 years, 60% were men, and 19% had a history of major cardiovascular disease. Of the total 27 416 person years of follow-up in the SGLT2 inhibitor group, 22 627 (83%) was among patients who initiated dapagliflozin, 4521 (16%) among those who initiated empagliflozin, and 268 (1%) among those who initiated canagliflozin. During follow-up, 467 SGLT2 inhibitor users (incidence rate 17.0 events per 1000 person years) and 662 DPP4 inhibitor users (18.0) had a major cardiovascular event, whereas 130 (4.7) and 265 (7.1) had a heart failure event, respectively. Hazard ratios were 0.94 (95% confidence interval 0.84 to 1.06) for major cardiovascular events and 0.66 (0.53 to 0.81) for heart failure. Hazard ratios were consistent among subgroups of patients with and without history of major cardiovascular disease and with and without history of heart failure. Hazard ratios for secondary outcomes, comparing SGLT2 inhibitors with DPP4 inhibitors, were 0.99 (0.85 to 1.17) for myocardial infarction, 0.94 (0.77 to 1.15) for stroke, 0.84 (0.65 to 1.08) for cardiovascular death, and 0.80 (0.69 to 0.92) for any cause death. In the as-treated analyses, hazard ratios were 0.84 (0.72 to 0.98) for major cardiovascular events, 0.55 (0.42 to 0.73) for heart failure, 0.93 (0.76 to 1.14) for myocardial infarction, 0.83 (0.64 to 1.07) for stroke, 0.67 (0.49 to 0.93) for cardiovascular death, and 0.75 (0.61 to 0.91) for any cause death. CONCLUSIONS: In this large Scandinavian cohort, SGLT2 inhibitor use compared with DPP4 inhibitor use was associated with reduced risk of heart failure and any cause death, but not with major cardiovascular events in the primary intention-to-treat analysis. In the additional as-treated analyses, the magnitude of the association with heart failure and any cause death became larger, and a reduced risk of major cardiovascular events that was largely driven by the cardiovascular death component was observed. These data help inform patients, practitioners, and authorities regarding the cardiovascular effectiveness of SGLT2 inhibitors in routine clinical practice.


Assuntos
Inibidores da Dipeptidil Peptidase IV/efeitos adversos , Insuficiência Cardíaca/epidemiologia , Infarto do Miocárdio/epidemiologia , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Acidente Vascular Cerebral/epidemiologia , Idoso , Dinamarca/epidemiologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Seguimentos , Insuficiência Cardíaca/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/induzido quimicamente , Noruega/epidemiologia , Sistema de Registros/estatística & dados numéricos , Acidente Vascular Cerebral/induzido quimicamente , Suécia/epidemiologia
7.
J Surg Oncol ; 120(4): 803-812, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31355454

RESUMO

INTRODUCTION: Radical prostatectomy (RP) is a common surgical procedure with a risk of postoperative erectile dysfunction and urinary incontinence. There is a need for data on RP as a basis for quality assurance and benchmarking. METHODS: In 2015, prostatectomies in Sweden (PiS) form was implemented in the National Prostate Cancer Register (NPCR) of Sweden with data on pre-, peri- and post-operative variables. RESULTS: Out of all radical prostatectomies performed in 2016 in Sweden, 3096/3881 (80%) were registered in PiS. A total of 2605 (84%) were robot-assisted radical prostatectomy (RARP) and 491 (16%) were RRP (retropubic radical prostatectomy). RARP was performed by 91 surgeons of whom 47% operated more than 25 RP/year; and RRP was performed by 69 surgeons of whom 10% performed more than 25 RP/year. RARP had a longer operative time (median operating time: RARP 155 minutes [IQR 124-190]; RRP 129 minutes [IQR 105-171]; P < .001) but was associated with smaller bleeding (median intraoperative blood loss: RARP 100 mL [IQR 50-200], RRP 700 mL [IQR 500-1100]; P < .001). CONCLUSIONS: We report on a nationwide, population-based register with transparent reporting of data on the performance of radical prostatectomy. These data are needed as a basis for quality assurance with comparisons of results from individual surgeons and hospitals.


Assuntos
Complicações Pós-Operatórias , Prostatectomia/estatística & dados numéricos , Neoplasias da Próstata/cirurgia , Sistema de Registros/estatística & dados numéricos , Idoso , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias da Próstata/epidemiologia , Suécia/epidemiologia
8.
J Surg Oncol ; 120(4): 715-721, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31297829

RESUMO

INTRODUCTION: Rectal gastrointestinal stromal tumor (GIST) is rare and comprises about 3% of GIST. METHODS: Registry data was collected by the Life Raft Group June 1976 to November 2017. All patients had a histologic GIST diagnosis. Demographic, clinicopathologic, and clinical outcome data were patient reported. Recurrence-free survival (RFS) was analyzed using the Kaplan-Meier method and Cox regression analysis. RESULTS: Of 1798 patients in the database, 48 had localized rectal GIST (2.7%). Patients were frequently male (58.3%) and non-Hispanic whites (58.3%). Median age at diagnosis was 52 years. Most patients (77%) were diagnosed in the imatinib era (2001 to current). Over half (54.2%) of the cohort had mutation testing and all profiled tumors possessed KIT mutations (exon 9: 7.7%, exon 11: 88.5%, and exon 13: 3.8%). Most evaluable patients (26/28; 92.9%) had high-risk disease (modified NIH criteria) and nearly all patients (95.8%) received imatinib. Median follow-up was 8.8 years (range, 0.3-30.7) and overall RFS was 8.0 years (95% CI, 2.9-13.1). Thirty-two percent (12/37) of patients in the post-imatinib era developed recurrent disease. Diagnosis in the imatinib era was associated with improved RFS (HR = 0.22, 95% CI, 0.08-0.62; P = .004) in the multivariable model. CONCLUSION: We find that disease recurrence remains prevalent in one-third of patients treated during the imatinib-era.


Assuntos
Neoplasias Gastrointestinais/patologia , Tumores do Estroma Gastrointestinal/patologia , Mesilato de Imatinib/uso terapêutico , Recidiva Local de Neoplasia/patologia , Neoplasias Retais/patologia , Sistema de Registros/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Feminino , Seguimentos , Neoplasias Gastrointestinais/tratamento farmacológico , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Humanos , Agências Internacionais , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Prognóstico , Estudos Prospectivos , Neoplasias Retais/tratamento farmacológico , Estudos Retrospectivos , Taxa de Sobrevida
9.
BJOG ; 126(10): 1213-1222, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31188526

RESUMO

OBJECTIVE: Studies on pregnancy outcomes in psoriatic arthritis (PsA) are scarce and typically of small size. Available studies have reported conflicting results. The aim of this study was to describe maternal and infant pregnancy outcomes among women with PsA compared with women without PsA. DESIGN: Nationwide cohort study. SETTING: Nationwide Swedish registers. POPULATION: A total of 41 485 singleton pregnancies in 1997-2014, of which 541 pregnancies were identified with PsA exposure and 40 944 pregnancies were unexposed. METHODS: By linkage of national health and population register data, we obtained information on individual pregnancies and compared outcomes among pregnancies with PsA and non-PsA pregnancies. Relative risks were estimated by odds ratios (ORs) with 95% CIs using a generalised linear regression model with generalised estimating equations. Adjustments were made for maternal factors and calendar year of birth. MAIN OUTCOME MEASURES: Maternal and infant pregnancy outcomes. RESULTS: Pregnancies to women with PsA had increased risks of preterm birth (adjusted OR 1.63; 95% CI 1.17-2.28), elective and emergency caesarean deliveries (adjusted OR 1.47; 95% CI 1.10-1.97 and adjusted OR 1.43; 95% CI 1.08-1.88, respectively) compared with non-PsA pregnancies. No increased risks were observed for pre-eclampsia, stillbirth or other infant outcomes apart from preterm birth. CONCLUSION: The majority of women with PsA have uneventful pregnancies with respect to adverse outcomes. In the present study, we found increased risks of preterm birth and caesarean delivery compared with non-PsA pregnancies. TWEETABLE ABSTRACT: Women with psoriatic arthritis have uneventful pregnancies but are at increased risk of preterm birth and caesarean delivery.


Assuntos
Artrite Psoriásica/fisiopatologia , Cesárea/estatística & dados numéricos , Obesidade/epidemiologia , Sistema de Registros/estatística & dados numéricos , Fumantes/estatística & dados numéricos , Adolescente , Adulto , Artrite Psoriásica/epidemiologia , Estudos de Coortes , Comorbidade , Feminino , Humanos , Recém-Nascido , Masculino , Obesidade/fisiopatologia , Razão de Chances , Paridade , Gravidez , Resultado da Gravidez , Suécia/epidemiologia , Adulto Jovem
10.
Medicine (Baltimore) ; 98(25): e16133, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232965

RESUMO

The American College of Surgeons (ACS) Committee on Trauma (COT) verification and State designation of trauma centers (TCs) into Level 1 or 2 establishes a distinction based on resources, trauma volume, and educational commitment. The ACS COT and individual states each verify TCs to differentiate performance levels. We aim to determine the relationship between ACS and State Level 1 versus 2, and injury-adjusted, all-cause mortality in a national sampling.TCs were identified by review of the National Sample Program (NSP) from the National Trauma Data Bank (NTDB)-the largest validated trauma database in the nation-of the year 2013. TCs were categorized by ACS or State Level 1 or 2 status, all others were excluded. Adjusted mortality was determined using observed/expected mortality (O/E) ratios, derived by trauma and injury severity score (TRISS) methodology. Chi-squared and t test analyses were used for categorical variables, with a statistical significance defined as P-value <.05.Of the 94 TCs in the NSP, 67 had ACS and 80 had State designations. There were 38 ACS Level 1 TCs and 29 ACS Level 2. For State designations, there were 45 as State Level 1 and 35 State Level 2. ACS Level 1 TCs had a similar O/E compared with ACS Level 2 verified centers (0.73 vs 0.75, chi-square, P = .36). Level 1 TCs designated by their state, had a similar O/E compared with State Level 2 centers (0.70 vs 0.74, chi-square, P = .08).Both ACS and State Level 1 and 2 trauma centers performed similarly on injury adjusted, all-cause mortality.


Assuntos
Avaliação de Resultados (Cuidados de Saúde)/estatística & dados numéricos , Cirurgiões/organização & administração , Centros de Traumatologia/normas , Estudos de Coortes , Mortalidade Hospitalar , Humanos , Jurisprudência , Qualidade da Assistência à Saúde , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Sociedades Médicas/normas , Sociedades Médicas/tendências , Cirurgiões/tendências , Centros de Traumatologia/organização & administração , Centros de Traumatologia/estatística & dados numéricos , Estados Unidos/epidemiologia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia
11.
Nat Med ; 25(6): 909-910, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31160814

RESUMO

We use the genotyping and death register information of 409,693 individuals of British ancestry to investigate fitness effects of the CCR5-∆32 mutation. We estimate a 21% increase in the all-cause mortality rate in individuals who are homozygous for the ∆32 allele. A deleterious effect of the ∆32/∆32 mutation is also independently supported by a significant deviation from the Hardy-Weinberg equilibrium (HWE) due to a deficiency of ∆32/∆32 individuals at the time of recruitment.


Assuntos
Homozigoto , Mutação , Receptores CCR5/genética , Adulto , Idoso , Bases de Dados Genéticas/estatística & dados numéricos , Feminino , Aptidão Genética , Infecções por HIV/prevenção & controle , Humanos , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Mortalidade , Sistema de Registros/estatística & dados numéricos , Taxa de Sobrevida , Reino Unido/epidemiologia
12.
World J Emerg Surg ; 14: 28, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31210779

RESUMO

Introduction: While transcatheter arterial embolization (TAE) is an effective way to control arterial bleeding associated with pelvic fracture, delayed TAE may increase mortality risk. The purpose of the current study was to determine how time to TAE affects outcomes in patients with pelvic fracture in the emergency department. Methods: From January 2014 to December 2016, the trauma registry and medical records of patients with pelvic fracture who underwent TAE were retrospectively reviewed. The relationship between the time to TAE and patient outcomes was evaluated. The characteristics of surviving and deceased patients were also compared to search for prognostic factors affecting survival. Results: Eighty-four patients were enrolled in the current study. Among patients with pelvic fracture who underwent TAE, the overall mortality rate was 16.7%. There were positive relationships between the time to TAE and the requirement for blood transfusion and between the time to TAE and intensive care unit (ICU) length of stay (LOS). Nonsurviving patients were significantly older (57.4 ± 23.3 vs. 42.7 ± 19.3 years old, p = 0.014) and had higher injury severity scores (ISSs) (36.4 ± 11.9 vs. 23.9 ± 10.9, p < 0.001) than were observed in surviving patients. There was no significant difference in the time to TAE between nonsurviving and surviving patients (76.9 ± 47.9 vs. 59.0 ± 29.3 min, p = 0.068). The multivariate logistic regression analysis showed that ISS and age served as independent risk factors for mortality. Every one unit increase in ISS or age resulted in a 1.154- or 1.140-fold increase in mortality, respectively (p = 0.033 and 0.005, respectively). However, the time to TAE serves as an independent factor for ICU LOS (p = 0.015). Conclusion: In pelvic fracture patients who require TAE for hemostasis, longer time to TAE may cause harm. An early hemorrhage control is suggested.


Assuntos
Embolização Terapêutica/métodos , Fraturas Ósseas/tratamento farmacológico , Hemostasia/efeitos dos fármacos , Adulto , Idoso , Angiografia/métodos , Distribuição de Qui-Quadrado , Feminino , Fraturas Ósseas/complicações , Fraturas Ósseas/mortalidade , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/lesões , Ossos Pélvicos/fisiopatologia , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Taiwan
13.
Schweiz Arch Tierheilkd ; 161(5): 299-306, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-31064736

RESUMO

INTRODUCTION: The registration of adverse events after the use of immunological veterinary medicinal products (VMP) is the aim of the vaccinovigilance reporting system in Switzerland. Adverse events comprise suspected adverse reactions and lack of expected efficacy. Since the Institute of virology and immunology (IVI) is the competent authority for the regulation of immunological VMP in Switzerland, the reporting system is administrated by the IVI. In 2018, 162 reports concerning authorized immunological VMP were received. While most of the reports were submitted by the marketing authorization holders (79%), practicing veterinary surgeons contributed to the reporting system, too (18%). Five reports were submitted by private persons (3%). Dogs were mainly affected (43%) with several terrier breeds and chihuahuas being the most frequently reported dog breeds. Further reports were related to cats (16%), cattle (14%) and horses (14%). Recently, the numbers of reports concerning cats (+26) and horses (+23) have considerably increased after there had been clearly less reports concerning these species (11 and 5, respectively) in the previous year. Most of the reports were based on the application of combined vaccines against canine distemper, hepatitis, parvovirosis and parainfluenza with or without leptospirosis in dogs as well as cat flu and feline panleukopenia in cats. In 29.6% of the submitted cases, the causality assessment between the vaccination and the reaction described was evaluated probable.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/veterinária , Sistema de Registros , Vacinação/veterinária , Drogas Veterinárias/efeitos adversos , Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos , Animais , Sistema de Registros/estatística & dados numéricos , Suíça , Vacinação/efeitos adversos , Vacinas Combinadas/efeitos adversos
14.
Klin Onkol ; 32(Supplementum1): 160-163, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31064189

RESUMO

BACKGROUND: To evaluate survival benefit in patient undergoing transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) by national registry data analysis and comparison of regions with unequal usage of interventional radiology procedures. MATERIALS AND METHODS: A total of 4,343 patients with primary diagnosis of HCC between 2010-2016 were extracted from the databases of The Czech National Cancer Registry. The analysis was supported by data from the National Registry of Paid Health Services and the Death Records Database. Primary treatment option was categorized as liver resection, ablation, TACE and chemotherapy. The regional data analysis provided information of interventional radiology procedures frequency for primary treatment of HCC. The 14 main regions were symmetrically divided to group with well-developed interventional radiology service and low-developed interventional radiology service according the frequency of stage adjusted interventional radiology procedure usage (< 15%, > 15%). Kaplan-Meier and Cox regression were used for survival and hazard ratios (HR) analyses. RESULTS: Only 1,730 patients had assessed any primary treatment option, 16.5 % (285) were treated by TACE. Median of survival were significantly different in regions with well and low developed interventional radiology service for whole study population (13.2 vs. 6.5 months, p < 0.001), patients treated in regions with well-developed interventional radiology service had lower risk of death during treatment (HR 0.73; 0.66-0.81). The patient treated by TACE had median of survival 15.8 months (13.5-18.1), while the survival was not significantly different in region groups. CONCLUSION: The usage of anticancer therapies based on interventional radiology procedures is a huge factor influences the survival of HCC patient according population-based data. Studies gathering data from cancer register databases can provide further information on treatment effectiveness. This work was created at Masaryk University in the project „Oncological radiological interventions and their benefit in complex oncological treatment, comparison of dedicated oncological treatment results data of the Czech republic II“ (MUNI/A/1574/2018), supported by Ministry of Education, Youth and Sports. This publication was additionally suported by Ministry of Health grant No. 15-32484A. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 1. 3. 2019 Accepted: 4. 3. 2019.


Assuntos
Carcinoma Hepatocelular/mortalidade , Quimioembolização Terapêutica/mortalidade , Neoplasias Hepáticas/mortalidade , Radiologia Intervencionista/métodos , Sistema de Registros/estatística & dados numéricos , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/terapia , República Tcheca , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapia , Taxa de Sobrevida , Resultado do Tratamento
15.
BMC Cancer ; 19(1): 431, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31072372

RESUMO

BACKGROUND: Colorectal cancer (CRC) is globally one of the most common cancers. Although studies have found a significant prognostic impact of cancer location for right-sided colon cancers compared with those of the left-side, evidence is lacking in a Japanese population. Therefore, we investigated 5-year net survival in colon cancer by tumor site in a Japanese population. METHODS: Diagnoses obtained between 2006 and 2008 in 21 population-based cancer registries from the Monitoring of Cancer Incidence in Japan (MCIJ) project were used. Colon cancer patients were categorized as having right-sided (C18.0-18.4) or left-sided colon cancer (C18.5-C18.7). We calculated the 5-year net survival for subjects diagnosed from 2006 until 2008 by anatomical subsite according to sex, age groups, tumor stage at diagnosis. We applied the excess mortality model to calculate excess hazard ratios (EHRs) and 95% confidential intervals (CIs) with and without adjustment for age, sex and cancer stages to evaluate the effect of location of colon cancer. RESULTS: This study analyzed a total of 62,350 colon cancer subjects. Five-year net survivals for subjects with left- and right-sided colon cancer were 74.0% (95% CI, 73.4-74.7%) and 70.4% (95% CI, 69.7-71.0%), respectively. Compared with left-sided colon cancers, the EHR for right-sided colon cancers was 1.20 (95% CI, 1.16-1.25) after adjustment for age, sex and stage. CONCLUSION: Our study found that the net survival for right-sided colon cancer was significantly lower than that for left-sided colon cancer. The anatomical site of cancer in the colon might be an important stratification factor in future studies of colon cancer.


Assuntos
Colo/patologia , Neoplasias do Colo/mortalidade , Sistema de Registros/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/patologia , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Análise de Sobrevida , Taxa de Sobrevida
16.
BMC Musculoskelet Disord ; 20(1): 189, 2019 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-31054566

RESUMO

BACKGROUND: Prolonged static postures (PSPs) may predispose dentists to develop cervical herniated intervertebral disc (C-HIVD); however, there is limited evidence supporting this in the literature thus far. We conducted this study to fit the data gap. METHODS: We conducted a retrospective nationwide population-based study using the Taiwan National Health Insurance Research Database to identify 10,930 dentists, an identical number of age- and sex-matched participants from the general population, and 73,718 other health care providers (HCPs, non-dentists). Comparisons for the risk of developing C-HIVD between dentists and the general population, and between dentists and other HCPs were performed by tracing their medical histories between 2007 and 2011. RESULTS: Dentists had a cumulative incidence rate of 1.1% for C-HIVD during the 5-year follow-up period. Overall, there was no difference of the risk for C-HIVD between dentists and the general population after adjusting for hypertension, hyperlipidemia, liver disease, mental disorders, diabetes mellitus, coronary artery disease, chronic obstructive pulmonary disease, malignancy, stroke, and renal disease (adjusted odds ratio [AOR]: 1.2, 95% confidence interval [CI]: 0.9-1.6). However, stratified analysis showed that younger dentists (≤ 34 years) had a trend of higher risk for C-HIVD than members of the younger general population (AOR: 1.9, 95% CI: 0.9-4.1). There was no difference found between dentists and other HCPs (AOR: 0.9, 95% CI: 0.8-1.1). CONCLUSION: Younger dentists had a trend of higher risk of developing C-HIVD than members of the general population.


Assuntos
Odontólogos/estatística & dados numéricos , Degeneração do Disco Intervertebral/epidemiologia , Deslocamento do Disco Intervertebral/epidemiologia , Disco Intervertebral/fisiopatologia , Doenças Profissionais/epidemiologia , Postura/fisiologia , Adulto , Fatores Etários , Feminino , Humanos , Degeneração do Disco Intervertebral/etiologia , Degeneração do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/etiologia , Deslocamento do Disco Intervertebral/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/etiologia , Doenças Profissionais/fisiopatologia , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia
17.
Rev Bras Enferm ; 72(suppl 1): 32-40, 2019 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942342

RESUMO

OBJECTIVE: to describe case of occupational exposure to chemical products. METHOD: descriptive retrospective study using record data of 382 workers assisted in the Outpatient Care for Occupational Toxicology of the Reference Center of Workers' Health of the Federal District, between 2009 and 2013. RESULTS: From the total, 66.7% were men, 55.2% had up to 9 years of activity and 81% did not use personal protective equipment (PPE). Nearly 60% were farmers and environmental surveillance agents, exposed to pesticides (63%), of which 40% were organophosphorus insecticides. The majority (68%) presented butyrylcholinesterase activity decreased, mostly farmers (85.9%); 57.3% of workers were considered poisoned - 61.6% by pesticides and 37.9% by industrial chemicals -, and away from work for at least 10 days. CONCLUSION: The profile was male workers, from 30 to 39 years, which not used PPE, indicating the need for prevention together with them to prevent poisonings.


Assuntos
Exposição Ocupacional/efeitos adversos , Envenenamento/etiologia , Adulto , Vazamento de Resíduos Químicos/estatística & dados numéricos , Fazendeiros/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/estatística & dados numéricos , Equipamento de Proteção Individual , Praguicidas/efeitos adversos , Envenenamento/complicações , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Inquéritos e Questionários
18.
Plast Reconstr Surg ; 143(5): 1298-1306, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31033810

RESUMO

BACKGROUND: The Dutch Breast Implant Registry (DBIR) was established in April of 2015 and currently contains information on 38,000 implants in 18,000 women. As a clinical registry, it evaluates the quality of breast implant surgery, including adverse events such as breast implant-associated (BIA) anaplastic large cell lymphoma (ALCL). To examine the efficacy of the DBIR, the capture rate of BIA-ALCL was compared to the registration of BIA-ALCL in the Dutch Nationwide Network and Registry of Histo- and Cytopathology (PALGA) as a gold standard, in combination with matching these databases to obtain complementary information. METHODS: All BIA-ALCL patients diagnosed and registered in The Netherlands in 2016 and 2017 were identified separately in the PALGA and DBIR databases. In addition, both databases were matched using indirect key identifiers. Pathologic information from the PALGA and clinical and device characteristics from the DBIR were obtained for all patients. RESULTS: Matching of both databases gave a capture rate of BIA-ALCL in the DBIR of 100 percent (n = 6) in 2016 and 70 percent (n = 7) in 2017. In total, 17 patients were identified in the PALGA, of which 14 patients were also identified in the DBIR; three patients were not registered; and 10 patients were registered false-positive. Of all confirmed patients, symptoms, staging results, treatment, and implant information were registered. CONCLUSIONS: Currently, the DBIR contains 2 full registration years and captures most of the BIA-ALCL patients despite overestimation. Therefore, pathology confirmation remains essential. By matching these databases, complementary clinical and implant information could be retrieved, establishing the DBIR as an essential postmarketing surveillance system for health risk assessments.


Assuntos
Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Linfoma Anaplásico de Células Grandes/epidemiologia , Vigilância de Produtos Comercializados/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Adulto , Idoso , Implante Mamário/instrumentação , Feminino , Humanos , Linfoma Anaplásico de Células Grandes/etiologia , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Vigilância de Produtos Comercializados/métodos , Medição de Risco
19.
Zhonghua Zhong Liu Za Zhi ; 41(4): 315-320, 2019 Apr 23.
Artigo em Chinês | MEDLINE | ID: mdl-31014059

RESUMO

Objective: The registration data of local cancer registries from 2008 to 2012 were collected by National Central Cancer Registry to estimate the incidence and mortality of female breast cancer in China. Methods: Data from 135 registries were qualified and selected in the final analysis, and each registry at least has submitted data from 2010 to 2012. Cancer incidence and mortality analyses were stratified by area (urban/rural, eastern/middle/western areas) and age group. The age composition of standard population of Chinese census in 2000 and Segi's population were used for age-standardized incidence and mortality in China and worldwide, respectively. Results: A total of 135 registries were recruited in the analysis, covering 629 333 910 person-years (382 669 450 in urban and 246 664 460 in rural). About 13, 258 cases of female breast cancer were diagnosed and 32 205 cases were dead between 2008 and 2012. Female breast cancer incidence was 42.67/100, 000 and age-standardized rate calculated by worldwide standard population was 28.87/100, 000. The crude incidence of urban area was 51.85/100, 000, higher than 28.29/100, 000 of rural area, and the crude incidence of eastern area was 46.35/100, 000, higher than 36.38/100, 000 of middle area and 27.60/100, 000 of western area. The age-specific incidence increased with age and reached the peak at age 55-59 (96.36/100, 000), and declined at age 60. The age-standardized incidence rate by Chinese standard population increased 30.56% from 2003 to 2012. The increase rate of rural area was 72.32%, faster than 23.48% of urban area. Female breast cancer mortality was 10.36/100, 000 and the age-standardized rate calculated by worldwide standard population was 6.61/100, 000. The crude mortality of urban area was 11.64/100, 000, higher than 8.36/100, 000 of rural area, and the crude mortality of eastern area was 10.81/100, 000, higher than 7.38/100, 000 of middle area and 9.90/100, 000 of western area. The age-specific incidence increased with age and reached the peak at age above 85 (61.25/100, 000). Age-standardized incidence rate by Chinese standard population remained stable during the period of 2003-2012 (6.23%). The mortality rate mainly increased in rural area (54.94%), while decreased 2.32% in urban area over the 10 years. Conclusions: Although the incidence and mortality of breast cancer in China are comparatively low worldwide, in China the incidence and mortality of female breast cancer have rose to the first and sixth place respectively among all the female cancers. The disease burden of breast cancer is very different between urban and rural area. Therefore, the targeted measure and strategy of control and prevention according to the area difference are needed.


Assuntos
Neoplasias da Mama/epidemiologia , População Rural , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/mortalidade , China/epidemiologia , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Sistema de Registros/estatística & dados numéricos , População Urbana
20.
Rev Assoc Med Bras (1992) ; 65(3): 441-445, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30994845

RESUMO

INTRODUCTION: We analyzed the distribution and frequency of glomerular diseases in patients biopsied between 1992 and 2016 in centers that make up the AMICEN (Minas Gerais Association of Nephrology Centers). METHODS: We analyzed the biopsy reports of patients from 9 AMICEN nephrology centers. We took note of their age, gender, ultrasound use, post-biopsy resting time, whether the kidney was native or a graft, number of glomeruli and indication for the biopsy. The kidney biopsy findings were broken down into four categories: glomerular and non-glomerular diseases, normal kidneys and insufficient material for analysis. Those patients diagnosed with glomerular diseases were further divided into having primary or secondary glomerular diseases. RESULTS: We obtained 582 biopsy reports. The median age was 38 years (1 to 85). The number of glomeruli varied between 0 and 70 (median = 13.0). In total, 97.8% of the biopsies were ultrasound guided. The main indication was nephrotic syndrome (36.9%), followed by hematuria-proteinuria association (16.2%). Primary glomerular diseases proved to be the most frequent (75.3%), followed by secondary diseases (24.7%). Among the primary glomerular diseases, FSGS was found at a higher frequency (28.8%), while among the secondary diseases, SLE was the most prevalent (42.4%). Regarding prevalence findings, those for both primary and secondary diseases were similar to those found in the large Brazilian registries published thus far. CONCLUSION: Glomerular disease registries are an important tool to identify the prevalence of such disease in regions of interest and can serve as an instrument to guide public policy decisions concerning the prevention of terminal kidney diseases.


Assuntos
Glomerulonefrite/epidemiologia , Nefropatias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Glomerulonefrite/patologia , Humanos , Lactente , Rim/patologia , Nefropatias/patologia , Glomérulos Renais/patologia , Masculino , Pessoa de Meia-Idade , Nefrologia/estatística & dados numéricos , Prevalência , Sistema de Registros/estatística & dados numéricos , Adulto Jovem
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