Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 707.325
Filtrar
1.
PLoS One ; 19(5): e0303427, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38768162

RESUMO

BACKGROUND: Belarus and Ukraine were the countries most affected by the consequences of the Chornobyl nuclear power plant in 1986. A study of perinatal mortality in Belarus found a highly statistically significant increase in the 1990s in the most contaminated oblast Gomel but no increase during this period in the rest of Belarus. As a possible mechanism to interpret this increase as a late Chornobyl effect, it has been suggested that strontium-90 contained in Chornobyl fallout, incorporated during menarche, impairs the immune system of pregnant women which in turn increases perinatal mortality. In the present study, this hypothesis is tested using data from Ukraine. METHODS: Annual data on perinatal mortality, in the period 1981-2006 were provided by the Ministry of Public Health of Ukraine. Trends in perinatal mortality rates in the most contaminated regions of Ukraine (Kyiv and Zhytomyr oblasts and the city of Kyiv; study region) were compared with rates in the rest of Ukraine (control region). To identify any differences in perinatal mortality trends between the study and control regions, the ratios of perinatal mortality rates in the study region to the rates in the control region were analyzed using the calculated strontium concentration as a predictor. RESULTS: A trend analysis of perinatal mortality rates in Ukraine revealed two bell-shaped deviations from a long-term exponential trend with maxima at the beginning and end of the 1990s. The same pattern was found in the data from the study and control regions, but the deviations were almost three times higher in the study region than in the control region. An analysis of the ratios of perinatal mortality rates in the study region to the rates in the control region (odds ratios) showed an increase and decrease during the 1990s which was approximated by a lognormal density distribution. The calculated strontium concentration, when used as a predictor, also fitted the data well. Thus, the data from Ukraine confirms the results from Belarus. The analysis of the odds ratios revealed about 1000 excess perinatal deaths in the study region in the period 1990-2004. The corresponding figure for Ukraine as a whole was estimated at 3500 perinatal deaths. CONCLUSION: It is hypothesized that the observed increase in perinatal mortality in the 1990s may be a late effect of incorporated strontium-90 on the immune system of pregnant women. The analysis is based on a theoretical model, as no data on strontium concentrations were available; the results should therefore be interpreted with caution. An updated study for Belarus would be desirable to corroborate the results.


Assuntos
Acidente Nuclear de Chernobyl , Mortalidade Perinatal , Humanos , Ucrânia/epidemiologia , Feminino , Gravidez , Recém-Nascido , Radioisótopos de Estrôncio/análise
2.
PLoS One ; 19(5): e0303851, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38768174

RESUMO

INTRODUCTION: Traumatic brain injury (TBI) can cause neuronal damage and cerebrovascular dysfunction, leading to acute brain dysfunction and considerable physical and mental impairment long after initial injury. Our goal was to assess the impact of pediatric TBI (pTBI) on military service, completed by 65-70% of men in Finland. METHODS: We conducted a retrospective register-based nationwide cohort study. All patients aged 0 to 17 years at the time of TBI, between 1998 and 2018, were included. Operatively and conservatively treated patients with pTBI were analyzed separately. The reference group was comprised of individuals with upper and lower extremity fractures. Information on length of service time, service completion, fitness for service class, and cognitive performance in a basic cognitive test (b-test) was gathered from the Finnish Military Records for both groups. Linear and logistic regression with 95% CI were used in comparisons. RESULTS: Our study group comprised 12 281 patients with pTBI and 20 338 reference group patients who participated in conscription. A total of 8 507 (66.5%) men in the pTBI group and 14 953 (71.2%) men in the reference group completed military service during the follow-up period. Men in the reference group were more likely to complete military service (OR 1.26, CI 1.18-1.34). A total of 31 (23.3%) men with operatively treated pTBI completed the military service. Men with conservatively treated pTBI had a much higher service rate (OR 7.20, CI 4.73-11.1). In the pTBI group, men (OR 1.26, CI 1.18-1.34) and women (OR 2.05, CI 1.27-3.36) were more likely to interrupt military service than the reference group. The PTBI group scored 0.15 points (CI 0.10-0.20) less than the reference group in cognitive b-test. CONCLUSIONS: PTBI groups had slightly shorter military service periods and higher interruption rate than our reference-group. There were only minor differences between groups in cognitive b-test.


Assuntos
Lesões Encefálicas Traumáticas , Cognição , Militares , Sistema de Registros , Humanos , Finlândia/epidemiologia , Masculino , Lesões Encefálicas Traumáticas/terapia , Lesões Encefálicas Traumáticas/epidemiologia , Estudos Retrospectivos , Adolescente , Criança , Pré-Escolar , Lactente , Feminino , Recém-Nascido
3.
PLoS One ; 19(5): e0303520, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38768171

RESUMO

INTRODUCTION: Sickle cell disease (SCD) remains a public health problem especially in sub-Saharan Africa including Ghana. While pilot initiatives in Africa have demonstrated that neonatal screening coupled with early intervention reduces SCD-related morbidity and mortality, only 50-70% of screen-positive babies have been successfully retrieved to benefit from these interventions. Point-of-care testing (POCT) with high specificity and sensitivity for SCD screening can be integrated into existing immunization programs in Africa to improve retrieval rates. This study explored community acceptability of integrating POCT to screen for SCD in children under 5 years of age in primary healthcare facilities in Northern Ghana. METHOD: This was an exploratory study using qualitative research approach where 10 focus group discussions and 20 in-depth interviews were conducted with community members and health workers between April and June 2022. The recorded interviews were transcribed verbatim after repeatedly listening to the recordings. Data was coded into themes using QSR Nvivo 12 software before thematic analysis. RESULTS: Most participants (70.9%) described SCD as serious and potentially life-threatening condition affecting children in the area. Of 148 community members and health workers, 141 (95.2%) said the screening exercise could facilitate diagnosis of SCD in children for early management. However, discrimination, fear of being tested positive, stigmatization, negative health worker attitude linked with issues of maintaining confidentiality were reported by participants as key factors that could affect uptake of the SCD screening exercise. Most participants suggested that intensive health education (78.3%), positive attitude of health workers (69.5%), and screening health workers not being biased (58.8%) could promote community acceptability. CONCLUSION: A large majority of participants viewed screening of SCD in children as very important. However, opinions expressed by most participants suggest that health education and professionalism of health workers in keeping patients' information confidential could improve the uptake of the exercise.


Assuntos
Anemia Falciforme , Testes Imediatos , Atenção Primária à Saúde , Humanos , Anemia Falciforme/diagnóstico , Anemia Falciforme/psicologia , Gana , Feminino , Masculino , Pré-Escolar , Adulto , População Rural , Lactente , Aceitação pelo Paciente de Cuidados de Saúde , Pessoal de Saúde/psicologia , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Recém-Nascido , Adulto Jovem , Grupos Focais
5.
Pediatr Allergy Immunol ; 35(5): e14141, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38773752

RESUMO

Fetal programming may arise from prenatal exposure and increase the risk of diseases later in life, potentially mediated by the placenta. The objective of this systematic review was to summarize and critically evaluate publications describing associations between human placental changes and risk of atopic disorders during childhood. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The inclusion criteria were original research articles or case reports written in English describing a human placental change in relation to disease occurring in offspring during childhood. The MEDLINE and EMBASE databases were searched for eligible studies. Risk of bias (RoB) was assessed using the ROBINS-I tool. The results were pooled both in a narrative way and by a meta-analysis. Nineteen studies were included (n = 12,997 participants). All studies had an overall serious RoB, and publication bias could not be completely ruled out. However, five studies showed that histological chorioamnionitis in preterm-born children was associated with asthma-related problems (pooled odds ratio = 3.25 (95% confidence interval = 2.22-4.75)). In term-born children, a large placenta (≥750 g) increased the risk of being prescribed anti-asthma medications during the first year of life. Placental histone acetylation, DNA methylation, and gene expression differences were found to be associated with different atopic disorders in term-born children. There is some evidence supporting the idea that the placenta can mediate an increased risk of atopic disorders in children. However, further studies are needed to validate the findings, properly control for confounders, and examine potential mechanisms.


Assuntos
Placenta , Humanos , Gravidez , Feminino , Placenta/patologia , Criança , Hipersensibilidade Imediata/epidemiologia , Efeitos Tardios da Exposição Pré-Natal , Recém-Nascido , Desenvolvimento Fetal , Corioamnionite/epidemiologia , Asma/epidemiologia
6.
J Dev Orig Health Dis ; 15: e11, 2024 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-38773803

RESUMO

This study aimed to investigate the association between maternal birth weight (MBW) with preterm delivery (PTD) in the Japanese population. To this end, a total of 78,972 Japanese pregnant women were included in a prospective birth cohort study. Multiple logistic regression and multinominal logistic regression models were applied to investigate the associations of MBW with PTD (delivery from 22 to < 37 weeks of gestation), early PTD (delivery from 22 to < 34 weeks), and late PTD (delivery from 34 to < 37 weeks). The results showed that MBW was inversely associated with PTD, early PTD, and late PTD (p-for-trend < 0.0001, 0.0014, and < 0.0001, respectively). The adjusted odds ratios per each 500 g of MBW decrease were 1.167 (95% confidence interval [CI]: 1.118-1.218) for PTD, 1.174 (95% CI: 1.070-1.287) for early PTD and 1.151 (95% CI: 1.098-1.206) for late PTD. The effect size of the association of MBW with early PTD was similar to that with late PTD. This study demonstrated for the first time an association of a low MBW with PTD, early PTD, and late PTD in a Japanese nationwide cohort.


Assuntos
Peso ao Nascer , Nascimento Prematuro , Humanos , Feminino , Gravidez , Nascimento Prematuro/epidemiologia , Japão/epidemiologia , Adulto , Estudos Prospectivos , Recém-Nascido , Fatores de Risco , Coorte de Nascimento
7.
J Med Virol ; 96(5): e29681, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38773815

RESUMO

Rotavirus gastroenteritis is accountable for an estimated 128 500 deaths among children younger than 5 years worldwide, and the majority occur in low-income countries. Although the clinical trials of rotavirus vaccines in Bangladesh revealed a significant reduction of severe rotavirus disease by around 50%, the vaccines are not yet included in the routine immunization program. The present study was designed to provide data on rotavirus diarrhea with clinical profiles and genotypes before (2017-2019) and during the COVID-19 pandemic period (2020-2021). Fecal samples were collected from 2% of the diarrheal patients at icddr,b Dhaka hospital of all ages between January 2017 and December 2021 and were tested for VP6 rotavirus antigen using ELISA. The clinical manifestations such as fever, duration of diarrhea and hospitalization, number of stools, and dehydration and so on were collected from the surveillance database (n = 3127). Of the positive samples, 10% were randomly selected for genotyping using Sanger sequencing method. A total of 12 705 fecal samples were screened for rotavirus A antigen by enzyme immunoassay. Overall, 3369 (27%) were rotavirus antigen-positive, of whom children <2 years had the highest prevalence (88.6%). The risk of rotavirus A infection was 4.2 times higher in winter than in summer. Overall, G3P[8] was the most prominent genotype (45.3%), followed by G1P[8] (32.1%), G9P[8] (6.8%), and G2P[4] (6.1%). The other unusual combinations, such as G1P[4], G1P[6], G2P[6], G3P[4], G3P[6], and G9P[6], were also present. Genetic analysis on Bangladeshi strains revealed that the selection pressure (dN/dS) was estimated as <1. The number of hospital visits showed a 37% drop during the COVID-19 pandemic relative to the years before the pandemic. Conversely, there was a notable increase in the rate of rotavirus positivity during the pandemic (34%, p < 0.00) compared to the period before COVID-19 (23%). Among the various clinical symptoms, only the occurrence of watery stool significantly increased during the pandemic. The G2P[4] strain showed a sudden rise (19%) in 2020, which then declined in 2021. In the same year, G1P[8] was more prevalent than G3P[8] (40% vs. 38%, respectively). The remaining genotypes were negligible and did not exhibit much fluctuation. This study reveals that the rotavirus burden remained high during the COVID-19 prepandemic and pandemic in Bangladesh. Considering the lack of antigenic variations between the circulating and vaccine-targeted strains, integrating the vaccine into the national immunization program could reduce the prevalence of the disease, the number of hospitalizations, and the severity of cases.


Assuntos
COVID-19 , Fezes , Genótipo , Infecções por Rotavirus , Rotavirus , Humanos , Bangladesh/epidemiologia , Rotavirus/genética , Rotavirus/isolamento & purificação , Rotavirus/classificação , Infecções por Rotavirus/epidemiologia , Infecções por Rotavirus/virologia , Pré-Escolar , Lactente , COVID-19/epidemiologia , COVID-19/virologia , COVID-19/prevenção & controle , Fezes/virologia , Feminino , Masculino , Criança , Diarreia/virologia , Diarreia/epidemiologia , Adolescente , Adulto , Antígenos Virais/genética , Recém-Nascido , Gastroenterite/epidemiologia , Gastroenterite/virologia , Adulto Jovem , Prevalência , SARS-CoV-2/genética , SARS-CoV-2/classificação , Pessoa de Meia-Idade , Estações do Ano
8.
Artigo em Inglês | MEDLINE | ID: mdl-38775126

RESUMO

The arterial switch operation has evolved to become the treatment of choice for transposition of the great arteries and is one of the greatest success stories in congenital heart surgery. The most crucial step of the operation is the coronary artery translocation; therefore, it is of paramount importance for surgeons to know every single detail about the morphology and spatial relationships of the coronary arteries and the roots of the great vessels. However, sometimes the surgeon may face unfavourable scenarios such as major commissural malalignment and anomalous coronary artery patterns and need to be prepared to carry out a successful coronary artery translocation. Herein, we demonstrate that the trapdoor technique is useful for transferring coronary arteries in a neonate with major commissural malalignment and unusual coronary anatomy during the arterial switch operation.


Assuntos
Transposição das Grandes Artérias , Vasos Coronários , Transposição dos Grandes Vasos , Humanos , Transposição dos Grandes Vasos/cirurgia , Transposição das Grandes Artérias/métodos , Transposição das Grandes Artérias/efeitos adversos , Recém-Nascido , Vasos Coronários/cirurgia , Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Anomalias dos Vasos Coronários/diagnóstico , Masculino
9.
Cereb Cortex ; 34(5)2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38715405

RESUMO

OBJECTIVES: This retrospective study aimed to identify quantitative magnetic resonance imaging markers in the brainstem of preterm neonates with intraventricular hemorrhages. It delves into the intricate associations between quantitative brainstem magnetic resonance imaging metrics and neurodevelopmental outcomes in preterm infants with intraventricular hemorrhage, aiming to elucidate potential relationships and their clinical implications. MATERIALS AND METHODS: Neuroimaging was performed on preterm neonates with intraventricular hemorrhage using a multi-dynamic multi-echo sequence to determine T1 relaxation time, T2 relaxation time, and proton density in specific brainstem regions. Neonatal outcome scores were collected using the Bayley Scales of Infant and Toddler Development. Statistical analysis aimed to explore potential correlations between magnetic resonance imaging metrics and neurodevelopmental outcomes. RESULTS: Sixty preterm neonates (mean gestational age at birth 26.26 ± 2.69 wk; n = 24 [40%] females) were included. The T2 relaxation time of the midbrain exhibited significant positive correlations with cognitive (r = 0.538, P < 0.0001, Pearson's correlation), motor (r = 0.530, P < 0.0001), and language (r = 0.449, P = 0.0008) composite scores at 1 yr of age. CONCLUSION: Quantitative magnetic resonance imaging can provide valuable insights into neurodevelopmental outcomes after intraventricular hemorrhage, potentially aiding in identifying at-risk neonates. Multi-dynamic multi-echo sequence sequences hold promise as an adjunct to conventional sequences, enhancing the sensitivity of neonatal magnetic resonance neuroimaging and supporting clinical decision-making for these vulnerable patients.


Assuntos
Tronco Encefálico , Recém-Nascido Prematuro , Imageamento por Ressonância Magnética , Humanos , Masculino , Feminino , Imageamento por Ressonância Magnética/métodos , Recém-Nascido , Estudos Retrospectivos , Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/crescimento & desenvolvimento , Lactente , Hemorragia Cerebral Intraventricular/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Transtornos do Neurodesenvolvimento/diagnóstico por imagem , Transtornos do Neurodesenvolvimento/etiologia , Idade Gestacional
10.
Influenza Other Respir Viruses ; 18(5): e13294, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38716791

RESUMO

BACKGROUND: Data from the sentinel surveillance system of severe acute respiratory infections in Spain were used to estimate the impact of administration of nirsevimab to children born from 1 April 2023 onwards. METHODS: Estimated RSV hospitalisations in < 1-year-olds during weeks 40, 2023, to 8, 2024, were compared to the number that would be expected after accounting for the background change in RSV circulation in the 2023/24 season, compared to 2022/23. RESULTS: We estimated 9364-9875 RSV hospitalisations less than expected, corresponding to a 74%-75% reduction.


Assuntos
Antivirais , Hospitalização , Infecções por Vírus Respiratório Sincicial , Humanos , Infecções por Vírus Respiratório Sincicial/epidemiologia , Infecções por Vírus Respiratório Sincicial/tratamento farmacológico , Espanha/epidemiologia , Lactente , Hospitalização/estatística & dados numéricos , Incidência , Antivirais/uso terapêutico , Feminino , Masculino , Vírus Sincicial Respiratório Humano , Vigilância de Evento Sentinela , Recém-Nascido , Anticorpos Monoclonais Humanizados/uso terapêutico
11.
PLoS One ; 19(5): e0302366, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38718031

RESUMO

BACKGROUND: Lebanon has a high caesarean section use and consequently, placenta accreta spectrum (PAS) is becoming more common. OBJECTIVES: To compare maternal characteristics, management, and outcomes of women with PAS by planned or urgent delivery at a major public referral hospital in Lebanon. DESIGN: Secondary data analysis of prospectively collected data. SETTING: Rafik Hariri University Hospital (public referral hospital), Beirut, Lebanon. PARTICIPANTS: 159 pregnant and postpartum women with confirmed PAS between 2007-2020. MAIN OUTCOME MEASURES: Maternal characteristics, management, and maternal and neonatal outcomes. RESULTS: Out of the 159 women with PAS included, 107 (67.3%) underwent planned caesarean delivery and 52 (32.7%) had urgent delivery. Women who underwent urgent delivery for PAS management were more likely to experience antenatal vaginal bleeding compared to those in the planned group (55.8% vs 28.0%, p<0.001). Median gestational age at delivery was significantly lower for the urgent group compared to the planned (34 vs. 36 weeks, p<0.001). There were no significant differences in terms of blood transfusion rates and major maternal morbidity between the two groups; however, median estimated blood loss was significantly higher for women with urgent delivery (1500ml vs. 1200ml, p = 0.011). Furthermore, the urgent delivery group had a significantly lower birth weight (2177.5g vs. 2560g, p<0.001) with higher rates of neonatal intensive care unit (NICU) admission (53.7% vs 23.8%, p<0.001) and perinatal mortality (18.5% vs 3.8%, p = 0.005). CONCLUSION: Urgent delivery among women with PAS is associated with worse maternal and neonatal outcomes compared to the planned approach. Therefore, early referral of women with known or suspected PAS to specialized centres is highly desirable to maximise optimal outcomes for both women and infants.


Assuntos
Cesárea , Placenta Acreta , Humanos , Feminino , Gravidez , Líbano/epidemiologia , Adulto , Placenta Acreta/terapia , Placenta Acreta/epidemiologia , Cesárea/estatística & dados numéricos , Recém-Nascido , Parto Obstétrico/estatística & dados numéricos , Encaminhamento e Consulta , Transfusão de Sangue/estatística & dados numéricos , Resultado da Gravidez/epidemiologia , Hospitais Públicos/estatística & dados numéricos , Análise de Dados Secundários
12.
PLoS One ; 19(5): e0300846, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38718046

RESUMO

The age-standardized incidence of head trauma in 2016 was 369 per 100,000 people worldwide. The Western Pacific region, including Japan, had the highest incidence. This study aimed to extract ICD-10 code data for intracranial injury (S06) and external causes of morbidity and mortality (V01-Y89), analyze their characteristics and interrelationships, and contribute to these diseases' prevention, treatment, and prognosis. The number of deaths according to injury type and external cause type of intracranial injury published by the Japanese government was statistically analyzed using JoinPoint, and univariate distribution and multivariate correlation were conducted using JMP Software. From 1999-2021, there was a downward trend in the number of deaths because of intracranial injuries: mortality from intracranial injuries was higher among those aged ≥65 years. Conversely, mortality from intracranial injuries was lower among those aged ≤14 years. Among deaths from intracranial injury, mortality from diffuse brain injury and traumatic subdural hemorrhage was more common. Among deaths from external causes of intracranial injury, mortality from falls, transport accidents, and other unforeseen accidents was more common. Mortality because of intracranial injuries increased significantly during the 2011 Great East Japan Earthquake. For some age groups and sexes, there were significant inverse correlations of mortality with traumatic subdural hemorrhage and traumatic subarachnoid hemorrhage for transport accidents, intentional self-harm and assault, and diffuse brain injury and focal brain injury for falls. We believe that the data presented in this study will be useful for preventing and treating intracranial injuries and for developing administrative measures to reduce intracranial injuries.


Assuntos
Traumatismos Craniocerebrais , Humanos , Japão/epidemiologia , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , Adulto , Adolescente , Criança , Pré-Escolar , Adulto Jovem , Lactente , Traumatismos Craniocerebrais/mortalidade , Traumatismos Craniocerebrais/epidemiologia , Recém-Nascido , Idoso de 80 Anos ou mais , Causas de Morte , População do Leste Asiático
13.
PLoS One ; 19(5): e0302533, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38718061

RESUMO

BACKGROUND: Neonatal Sepsis remains a significant burden globally, accounting for over 2.5 million neonatal deaths annually, with low-and middle-income countries (LMIC) including Ghana disproportionately affected. The current study sought to ascertain the prevalence of neonatal sepsis and associated factors based on analysis of institutional records from Cape Coast Teaching Hospital (CCTH) in Ghana. METHODS: The study involved a retrospective cross-sectional review of randomly sampled medical records of 360 neonates CCTH from January 2018 to December 2021. Descriptive proportions and binary logistic regression analysis were conducted to estimate the prevalence of neonates with sepsis and associated factors. RESULTS: The prevalence of neonates with sepsis over the period was estimated to be 59%, with early-onset neonatal sepsis (EONS) and late-onset neonatal sepsis (LONS) accounting for about 29% and 30%, respectively. Neonatal factors associated with sepsis were low Apgar score (AOR = 1.64; 95% CI:1.01-2.67, p = 0.047) and low birth weight (AOR = 2.54; 95% CI:1.06-6.09, p = 0.037), while maternal factors were maternal education (AOR = 2.65; 95% CI:1.04-6.7, p = 0.040), caesarean deliveries (AOR = 0.45; 95% CI:0.26-0.75, p = 0.003), maternal infection (AOR = 1.79; 95% CI:1.09-2.94, p = 0.020) and foul-smelling liquor (AOR = 1.84; 95% CI:1.09-3.07, p = 0.020). CONCLUSION: The study underscores the need for improved routine care and assessment of newborns to prevent the onset of neonatal sepsis, with particular emphasis on the neonatal and maternal risk factors highlighted in the current study.


Assuntos
Sepse Neonatal , Centros de Atenção Terciária , Humanos , Gana/epidemiologia , Sepse Neonatal/epidemiologia , Recém-Nascido , Feminino , Masculino , Centros de Atenção Terciária/estatística & dados numéricos , Estudos Transversais , Estudos Retrospectivos , Adulto , Fatores de Risco , Prevalência , Gravidez , Recém-Nascido de Baixo Peso , Índice de Apgar
14.
PLoS One ; 19(5): e0303270, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38718063

RESUMO

INTRODUCTION: Demand for urgent and emergency health care in England has grown over the last decade, for reasons that are not clear. Changes in population demographics may be a cause. This study investigated associations between individuals' characteristics (including socioeconomic deprivation and long term health conditions (LTC)) and the frequency of emergency department (ED) attendances, in the Norfolk and Waveney subregion of the East of England. METHODS: The study population was people who were registered with 91 of 106 Norfolk and Waveney general practices during one year from 1 April 2022 to 31 March 2023. Linked primary and secondary care and geographical data included each individual's sociodemographic characteristics, and number of ED attendances during the same year and, for some individuals, LTCs and number of general practice (GP) appointments. Associations between these factors and ED attendances were estimated using Poisson regression models. RESULTS: 1,027,422 individuals were included of whom 57.4% had GP data on the presence or absence of LTC, and 43.1% had both LTC and general practitioner appointment data. In the total population ED attendances were more frequent in individuals aged under five years, (adjusted Incidence Rate Ratio (IRR) 1.25, 95% confidence interval 1.23 to 1.28) compared to 15-35 years); living in more socioeconomically deprived areas (IRR 0.61 (0.60 to 0.63)) for least deprived compared to most deprived,and living closer to the nearest ED. Among individuals with LTC data, each additional LTC was also associated with increased ED attendances (IRR 1.16 (1.15 to 1.16)). Among individuals with LTC and GP appointment data, each additional GP appointment was also associated with increased ED attendances (IRR 1.03 (1.026 to 1.027)). CONCLUSIONS: In the Norfolk and Waveney population, ED attendance rates were higher for young children and individuals living in more deprived areas and closer to EDs. In individuals with LTC and GP appointment data, both factors were also associated with higher ED attendance.


Assuntos
Serviço Hospitalar de Emergência , Humanos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Inglaterra , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Adolescente , Idoso , Adulto Jovem , Pré-Escolar , Estudos Transversais , Criança , Lactente , Fatores Sociodemográficos , Fatores Socioeconômicos , Idoso de 80 Anos ou mais , Recém-Nascido , Medicina Geral/estatística & dados numéricos
15.
Sci Adv ; 10(19): eadg9674, 2024 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-38718116

RESUMO

Prenatal opioid exposure is an established public health problem, in particular among Medicaid-covered births. Yet, existing prevalence rates are plausibly underestimated. We leverage extensive linked longitudinal administrative data for all Medicaid-covered live births in Wisconsin from 2010 to 2019 to estimate a range of prevalence rates using an innovative strategy that jointly accounts for both likelihood of exposure and potential risk to prenatal development. We find that 20.8% of infants may have been prenatally exposed to opioids, with 1.7% diagnosed with neonatal abstinence syndrome and an additional 1.2% having a high combined likelihood of exposure and potential risk to prenatal development, 2.6% a moderate combined likelihood and risk, and 15.3% a low or uncertain combined likelihood and risk. We assess improvements in prevalence estimates based on our nuanced classification relative to those of prior studies. Our strategy could be broadly used to quantify the scope of the opioid crisis for pregnant populations, target interventions, and promote child health and development.


Assuntos
Analgésicos Opioides , Medicaid , Efeitos Tardios da Exposição Pré-Natal , Humanos , Wisconsin/epidemiologia , Gravidez , Feminino , Estados Unidos/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Analgésicos Opioides/efeitos adversos , Recém-Nascido , Síndrome de Abstinência Neonatal/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Prevalência , Adulto , Fatores de Risco
16.
Chest ; 165(5): e137-e142, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38724152

RESUMO

CASE PRESENTATION: A newborn girl presented to the hospital on the first day of life because of respiratory failure. She was born at home at 37 weeks' gestation with minimal prenatal care and was found to be small for gestational age. The patient was found to have partial sternal agenesis and sternal cleft, cutis aplasia, left facial hemangioma, micrognathia, wide-spaced nipples, and low-set ears. The mother's and baby's urine toxicology screening were positive for amphetamines. Chest radiographs on admission showed bilateral hazy opacities. CT scan of the chest showed an absent sternum with midline chest wall concavity. The patient was monitored preoperatively in the cardiac ICU for risks of arrythmia, respiratory failure, altered cardiac output, and acute cardiopulmonary decompensation.


Assuntos
Esterno , Humanos , Feminino , Esterno/anormalidades , Esterno/diagnóstico por imagem , Recém-Nascido , Anormalidades Múltiplas/diagnóstico , Tomografia Computadorizada por Raios X , Hemangioma/diagnóstico , Hemangioma/complicações , Hemangioma/diagnóstico por imagem , Anormalidades Musculoesqueléticas/diagnóstico por imagem , Anormalidades Musculoesqueléticas/diagnóstico
17.
J Matern Fetal Neonatal Med ; 37(1): 2350676, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38724257

RESUMO

BACKGROUND: Twin pregnancy is associated with higher risks of adverse perinatal outcomes for both the mother and the babies. Among the many challenges in the follow-up of twin pregnancies, the mode of delivery is the last but not the least decision to be made, with the main influencing factors being amnionicity and fetal presentation. The aim of the study was to compare perinatal outcomes in two European centers using different protocols for twin birth in case of non-cephalic second twin; the Italian patients being delivered mainly by cesarean section with those in Belgium being routinely offered the choice of vaginal delivery (VD). METHODS: This was a dual center international retrospective observational study. The population included 843 women with a twin pregnancy ≥ 32 weeks (dichorionic or monochorionic diamniotic pregnancies) and a known pregnancy outcome. The population was stratified according to chorionicity. Demographic and pregnancy data were reported per pregnancy, whereas neonatal outcomes were reported per fetus. We used multiple logistic regression models to adjust for possible confounding variables and to compute the adjusted odds ratio (adjOR) for each maternal or neonatal outcome. RESULTS: The observed rate of cesarean delivery was significantly higher in the Italian cohort: 85% for dichorionic pregnancies and 94.4% for the monochorionic vs 45.2% and 54.4% respectively in the Belgian center (p-value < 0.001). We found that Belgian cohort showed significantly higher rates of NICU admission, respiratory distress at birth and Apgar score of < 7 after 5 min. Despite these differences, the composite severe adverse outcome was similar between the two groups. CONCLUSION: In this study, neither the presentation of the second twin nor the chorionicity affected maternal and severe neonatal outcomes, regardless of the mode of delivery in two tertiary care centers, but VD was associated to a poorer short-term neonatal outcome.


Assuntos
Cesárea , Resultado da Gravidez , Gravidez de Gêmeos , Humanos , Feminino , Gravidez , Gravidez de Gêmeos/estatística & dados numéricos , Cesárea/estatística & dados numéricos , Estudos Retrospectivos , Adulto , Recém-Nascido , Itália/epidemiologia , Resultado da Gravidez/epidemiologia , Bélgica/epidemiologia , Parto Obstétrico/estatística & dados numéricos , Parto Obstétrico/métodos , Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos
18.
J Dev Orig Health Dis ; 15: e10, 2024 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-38724487

RESUMO

Premature infants have a risk of neurodevelopmental deficits. Little is known, however, about how retinopathy of prematurity (ROP) affects visual motor integration (VMI), which is necessary for both fine motor skills and further school abilities. Due to the systemic escape of bevacizumab in the treatment of ROP, concerns regarding the long-term neurodevelopmental effect of the drug have arisen. The aim is to evaluate VMI and motor development long-term outcomes after intravitreal bevacizumab (IVB) injection and laser treatment for ROP. Two groups of premature children were included: Bevacizumab group - 16 premature children who received IVB treatment and laser group - 23 premature children who underwent laser photocoagulation treatment in this single center cross-sectional study. At 2-6 years of age, VMI (Beery-Buktenica Developmental Test), motor development (Peabody Developmental Motor Scales-2), visual acuity, and refractive status were assessed. The incidence of abnormal visual function was significantly higher in bevacizumab group than in laser group (p = 0.022). The incidence of abnormal VMI skill was significantly higher in bevacizumab group than in laser group (p = 0.024). Incidences of abnormal gross, fine, and total motor skills were significantly higher in bevacizumab group compared to laser group (p < 0.05). Premature children who received bevacizumab for ROP demonstrated significantly lower VMI and motor development features than those with laser treatment at preschool age. Although our results suggest the relevance of bevacizumab injection in impaired VMI and motor development outcomes, general level of sickness rather than treatment might be the cause of delayed motor development.


Assuntos
Bevacizumab , Desenvolvimento Infantil , Retinopatia da Prematuridade , Humanos , Retinopatia da Prematuridade/terapia , Retinopatia da Prematuridade/fisiopatologia , Retinopatia da Prematuridade/cirurgia , Masculino , Feminino , Bevacizumab/administração & dosagem , Bevacizumab/uso terapêutico , Pré-Escolar , Estudos Transversais , Criança , Desenvolvimento Infantil/efeitos dos fármacos , Desenvolvimento Infantil/fisiologia , Recém-Nascido , Recém-Nascido Prematuro , Inibidores da Angiogênese/administração & dosagem , Inibidores da Angiogênese/uso terapêutico , Destreza Motora/fisiologia , Injeções Intravítreas
19.
Cereb Cortex ; 34(5)2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38725293

RESUMO

Numerous studies reported inconsistent results concerning gender influences on the functional organization of the brain for language in children and adults. However, data for the gender differences in the functional language networks at birth are sparse. Therefore, we investigated gender differences in resting-state functional connectivity in the language-related brain regions in newborns using functional near-infrared spectroscopy. The results revealed that female newborns demonstrated significantly stronger functional connectivities between the superior temporal gyri and middle temporal gyri, the superior temporal gyri and the Broca's area in the right hemisphere, as well as between the right superior temporal gyri and left Broca's area. Nevertheless, statistical analysis failed to reveal functional lateralization of the language-related brain areas in resting state in both groups. Together, these results suggest that the onset of language system might start earlier in females, because stronger functional connectivities in the right brain in female neonates were probably shaped by the processing of prosodic information, which mainly constitutes newborns' first experiences of speech in the womb. More exposure to segmental information after birth may lead to strengthened functional connectivities in the language system in both groups, resulting in a stronger leftward lateralization in males and a more balanced or leftward dominance in females.


Assuntos
Idioma , Caracteres Sexuais , Espectroscopia de Luz Próxima ao Infravermelho , Humanos , Feminino , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Masculino , Recém-Nascido , Encéfalo/fisiologia , Encéfalo/diagnóstico por imagem , Descanso/fisiologia , Lateralidade Funcional/fisiologia , Vias Neurais/fisiologia , Mapeamento Encefálico/métodos
20.
J Med Virol ; 96(5): e29658, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38727043

RESUMO

Echovirus 11 (E11) has gained attention owing to its association with severe neonatal infections. Due to the limited data available, the World Health Organization (WHO) considers public health risk to the general population to be low. The present study investigated the genetic variation and molecular evolution of E11 genomes collected from May to December 2023. Whole genome sequencing (WGS) was performed for 16 E11 strains. Phylogenetic analysis on WG showed how all Italian strains belonged to genogroup D5, similarly to other E11 strains recently reported in France and Germany all together aggregated into separate clusters. A cluster-specific recombination pattern was also identified using phylogenetic analysis of different genome regions. Echovirus 6 was identified as the major recombinant virus in 3Cpro and 3Dpol regions. The molecular clock analysis revealed that the recombination event probably occurred in June 2018 (95% HPD interval: Jan 2016-Jan 2020). Shannon entropy analyses, within P1 region, showed how 11 amino acids exhibited relatively high entropy. Five of them were exposed on the canyon region which is responsible for receptor binding with the neonatal Fc receptor. The present study showed the recombinant origin of a new lineage of E11 associated with severe neonatal infections.


Assuntos
Infecções por Echovirus , Enterovirus Humano B , Genoma Viral , Genótipo , Filogenia , Recombinação Genética , Humanos , Recém-Nascido , Genoma Viral/genética , Enterovirus Humano B/genética , Enterovirus Humano B/classificação , Enterovirus Humano B/isolamento & purificação , Infecções por Echovirus/virologia , Infecções por Echovirus/epidemiologia , Variação Genética , Sequenciamento Completo do Genoma , Evolução Molecular , Itália/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...