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1.
Horm Metab Res ; 54(2): 104-112, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35130571

RESUMO

Some studies have suggested that diabetes may be a risk factor for osteoarthritis. However, whether prediabetes is also associated with osteoarthritis has not been comprehensively examined. We performed a meta-analysis to evaluate the relationship between prediabetes and osteoarthritis. This meta-analysis included relevant observational studies from Medline, Embase, and Web of Science databases. A random-effect model after incorporation of the intra-study heterogeneity was selected to pool the results. Ten datasets from six observational studies were included, which involved 41 226 general adults and 10 785 (26.2%) of them were prediabetic. Pooled results showed that prediabetes was not independently associated with osteoarthritis [risk ratio (RR): 1.07, 95% confidence interval (CI): 1.00 to 1.14, p=0.06, I2=0%]. Sensitivity limited to studies with adjustment of age and body mass index showed consistent result (RR: 1.06, 95% CI: 0.99 to 1.14, p=0.09, I2=0%). Results of subgroup analyses showed that prediabetes was not associated with osteoarthritis in cross-sectional or cohort studies, in studies including Asian or non-Asian population, or in studies with different quality scores (p for subgroup difference>0.10). Besides, prediabetes was not associated with osteoarthritis in men or in women, in studies with prediabetes defined as impaired fasting glucose, impaired glucose tolerance, or HbA1c (approximately 39-46 mmol/mol). Moreover, prediabetes was not associated with overall osteoarthritis, and knee or hip osteoarthritis. Current evidence does not support that prediabetes is independently associated with osteoarthritis in adult population.


Assuntos
Intolerância à Glucose , Osteoartrite , Estado Pré-Diabético , Adulto , Glicemia/metabolismo , Estudos Transversais , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Estudos Observacionais como Assunto , Osteoartrite/complicações , Osteoartrite/epidemiologia , Estado Pré-Diabético/complicações , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/metabolismo , Fatores de Risco
2.
Vasc Health Risk Manag ; 18: 313-318, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35502192

RESUMO

Further research is needed to refine risk prediction models for adverse cardiovascular outcomes following stroke in contemporary clinical practice, such as incident atrial fibrillation (AF), recurrent stroke, and cognitive impairment and dementia. The aims of this study are to prospectively investigate cardiovascular outcomes and risk factors for incident cardiovascular disease in a post-stroke cohort, and to externally validate, refine and expand current risk prediction models for cardiovascular and cardiovascular-related outcomes. The study sample size was based on the development of post-stroke risk prediction models for AF and was calculated as 1222 participants. The study design is a multicentre, prospective, observational cohort study. Participants will be adult patients admitted for ischaemic stroke confirmed by stroke physician or transient ischaemic attack (TIA) confirmed by MRI. Routinely collected data will be used in addition to the completion of simple validated questionnaires by the participants. Follow-up will be undertaken 12-months from the date of admission to hospital, in addition to linkage to routinely collected follow-up hospitalisation and mortality data. The primary outcomes are cardiovascular outcomes (including incident AF, stroke, TIA and myocardial infarction) at 12-month follow-up, all-cause mortality and mortality from cardiovascular causes, and incident cognitive impairment and dementia. Secondary outcomes include changes in function, depression, anxiety, fatigue and quality of life. The study has received approval from the Health Research Authority Research Ethics Committee (21/WA/0209), and is registered on https://www.clinicaltrials.gov/ (Identifier NCT05132465). Recruitment for the study began in October 2021 with completion of recruitment at all participating centres anticipated by October 2022.


Assuntos
Fibrilação Atrial , Isquemia Encefálica , Doenças Cardiovasculares , Demência , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Adulto , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Encéfalo/diagnóstico por imagem , Isquemia Encefálica/complicações , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Proteínas de Transporte , Estudos de Coortes , Citocinas , Demência/complicações , Fatores de Risco de Doenças Cardíacas , Humanos , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/epidemiologia , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Estudos Prospectivos , Qualidade de Vida , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia
3.
BMJ Open ; 12(5): e059258, 2022 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-35523486

RESUMO

INTRODUCTION: Digital health tools such as smartphones and wearable devices could improve psychological treatment outcomes in depression through more accurate and comprehensive measures of patient behaviour. However, in this emerging field, most studies are small and based on student populations outside of a clinical setting. The current study aims to determine the feasibility and acceptability of using smartphones and wearable devices to collect behavioural and clinical data in people undergoing therapy for depressive disorders and establish the extent to which they can be potentially useful biomarkers of depression and recovery after treatment. METHODS AND ANALYSIS: This is an observational, prospective cohort study of 65 people attending psychological therapy for depression in multiple London-based sites. It will collect continuous passive data from smartphone sensors and a Fitbit fitness tracker, and deliver questionnaires, speech tasks and cognitive assessments through smartphone-based apps. Objective data on sleep, physical activity, location, Bluetooth contact, smartphone use and heart rate will be gathered for 7 months, and compared with clinical and contextual data. A mixed methods design, including a qualitative interview of patient experiences, will be used to evaluate key feasibility indicators, digital phenotypes of depression and therapy prognosis. Patient and public involvement was sought for participant-facing documents and the study design of the current research proposal. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the London Westminster Research Ethics Committee, and the Health Research Authority, Integrated Research Application System (project ID: 270918). Privacy and confidentiality will be guaranteed and the procedures for handling, processing, storage and destruction of the data will comply with the General Data Protection Regulation. Findings from this study will form part of a doctoral thesis, will be presented at national and international meetings or academic conferences and will generate manuscripts to be submitted to peer-reviewed journals. TRIAL REGISTRATION NUMBER: https://doi.org/10.17605/OSF.IO/PMYTA.


Assuntos
Depressão , Smartphone , Depressão/diagnóstico , Depressão/terapia , Estudos de Viabilidade , Humanos , Estudos Observacionais como Assunto , Prognóstico , Estudos Prospectivos
4.
BMJ Open ; 12(5): e060480, 2022 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-35523501

RESUMO

INTRODUCTION: Low health literacy is common in people with cardiovascular disease and may be one factor that affects an individual's ability to maintain secondary prevention health behaviours following myocardial infarction (MI). However, little is known about the association between health literacy and longer-term health outcomes in people with MI. The ENhancing HEAlth literacy in secondary pRevenTion of cardiac evENts (ENHEARTEN) study aims to examine the relationship between health literacy and a number of health outcomes (including healthcare costs) in a cohort of patients following their first MI. Findings may provide evidence for the significance of health literacy as a predictor of long-term cardiac outcomes. METHODS AND ANALYSIS: ENHEARTEN is a multicentre, prospective observational study in a convenience sample of adults (aged >18 years) with their first MI. A total of 450 patients will be recruited over 2 years across two metropolitan health services and one rural/regional health service in Victoria, Australia. The primary outcome of this study will be all-cause, unplanned hospital admissions within 6 months of index admission. Secondary outcomes include cardiac-related hospital admissions up to 24 months post-MI, emergency department presentations, health-related quality of life, mortality, cardiac rehabilitation attendance and healthcare costs. Health literacy will be observed as a predictor variable and will be determined using the 12-item version of the European Health Literacy Survey (HLS-Q12). ETHICS AND DISSEMINATION: Ethics approval for this study has been received from the relevant human research ethics committee (HREC) at each of the participating health services (lead site Monash Health HREC; approval number: RES-21-0000-242A) and Services Australia HREC (reference number: RMS1672). Informed written consent will be sought from all participants. Study results will be published in peer-reviewed journals and collated in reports for participating health services and participants. TRIAL REGISTRATION NUMBER: ACTRN12621001224819.


Assuntos
Letramento em Saúde , Infarto do Miocárdio , Adulto , Estudos de Coortes , Letramento em Saúde/métodos , Humanos , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Qualidade de Vida , Vitória
5.
J Healthc Eng ; 2022: 3270534, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35494510

RESUMO

Aphasia after stroke is one of the common complications of cerebral infarction. Early diagnosis and treatment of aphasia after stroke is of great significance for the recovery of language function. At present, there are different views on the pathogenesis of aphasia after stroke. Functional magnetic resonance imaging (fMRI) can reflect the brain function, brain tissue metabolism, and the level of brain local blood flow. It has the advantages of noninvasive, high resolution and sensitivity, low price, and so on. It has been widely used in the study of sensory aphasia after stroke. This study focuses on the development of functional magnetic resonance imaging in patients with poststroke aphasia and summarizes the published studies on functional magnetic resonance imaging in patients with poststroke aphasia. Evidence acquisition: A literature search was conducted in PubMed, Hindawi, PLoS, IEEE, Wiley, ScienceDirect, Springer, EMBASE, and web of science, with the keywords of "stroke" and "Aphasia" and "functional magnetic resonance imaging", "RS fMRI", or "DTI", to review the research of functional magnetic resonance imaging in patients with aphasia after stroke. The results included clinical evaluation, diagnostic scale, and imaging analysis; the study design was a randomized controlled trial, case series and case report, and observational study. A total of 67 articles were identified in the first search and 43 after the second search. Based on the analysis of 43 selected articles, 19 articles were included, and 24 articles were excluded. The selected information is shown in Table 1. Eleven of them did not contain imaging-related data. Six articles are related review articles. Four studies were conducted on patients without poststroke aphasia. Three studies studied the effect of poststroke aphasia on patients' social participation.


Assuntos
Afasia , Acidente Vascular Cerebral , Afasia/complicações , Afasia/etiologia , Encéfalo/diagnóstico por imagem , Humanos , Idioma , Imageamento por Ressonância Magnética , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem
6.
BMC Palliat Care ; 21(1): 62, 2022 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-35501763

RESUMO

BACKGROUND: Although the majority of German patients in a palliative state prefer to die at home, the actual place of death is most often a hospital. Unplanned hospital readmissions (UHA) not only contradict most patients' preferences but also increase the probability of an aggressive end-of-life treatment. As limited knowledge is available which factors contribute to an UHA, the PRePP-project aims to explore predictors related to informal caregivers (IC) as well as medical and structural factors. METHODS: This prospective, observational, mono-centric study will assess structural and medical factors as well as ICs' psychological burden throughout seven study visits. Starting in April 2021 it will consecutively include 240 patients and their respective IC if available. Standardized measures concerning ICs' Quality of Life (WHOQOL-BREF), psychological distress (NCCN-Distress Thermometer), anxiety (GAD-7) and depressiveness (PHQ-9) will be assessed. If participants prefer, assessment via phone, browser-based or paper-based will be conducted. Medical records will provide routinely assessed information concerning patient-related characteristics such as gender, age, duration of hospital stay and medical condition. Nurse-reported data will give information on whether hospitalization and death occurred unexpectedly. Data will be progressed pseudonymized. Multivariable regression models will help to identify predictors of the primary endpoint "unplanned hospital admissions". DISCUSSION: The PRePP-project is an important prerequisite for a clinical risk assessment of UHAs. Nevertheless, it faces several methodological challenges: as it is a single center study, representativity of results is limited while social desirability might be increased as the study is partly conducted by the treatment team. Furthermore, we anticipated an underrepresentation of highly burdened participants as they might refrain from participation. TRIAL REGISTRATION: This study was retrospectively registered 19 October 2021 at clinicaltrials.gov (NCT05082389). https://clinicaltrials.gov/ct2/show/NCT05082389.


Assuntos
Cuidadores , Readmissão do Paciente , Cuidadores/psicologia , Humanos , Estudos Observacionais como Assunto , Pacientes Ambulatoriais , Estudos Prospectivos , Qualidade de Vida
7.
BMJ Paediatr Open ; 6(1)2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35404835

RESUMO

INTRODUCTION: Over half of the 5 million annual deaths among children aged 0-59 months occur in sub-Saharan Africa. The period immediately after hospitalisation is a vulnerable time in the life of a child in sub-Saharan Africa as postdischarge mortality rates are as high as 1%-18%. Identification of neonates and children who are at highest risk for postdischarge mortality may allow for the direction of interventions to target patients at highest risk. METHODS AND ANALYSIS: The Predicting Post-Discharge Mortality study is a prospective, observational study being conducted at Muhimbili National Hospital (Dar es Salaam, Tanzania) and John F. Kennedy Medical Center (Monrovia, Liberia). The aim is to derive and validate two, age population specific, clinical prediction rules for the identification of neonates (n=2000) and children aged 1-59 months (n=2000) at risk for all-cause mortality within 60 days of discharge from the neonatal intensive care unit or paediatric ward. Caregivers of participants will receive phone calls 7, 14, 30, 45 and 60 days after discharge to assess vital status. Candidate predictor variables will include demographic, anthropometric and clinical factors. Elastic net regression will be used to derive the clinical prediction rules. Bootstrapped selection with repetitions will be used for internal validation. Planned secondary analyses include the external validation of existing clinical prediction models, determination of clinicians' ability to identify neonates and children at risk of postdischarge mortality at discharge, analysis of factors associated with hospital readmission and unplanned clinic visits and description of health-seeking behaviours in the postdischarge period. ETHICS AND DISSEMINATION: This study received ethical clearance from the Tanzania National Institute of Medical Research, Muhimbili University of Health and Allied Sciences, the John F. Kennedy Medical Center Institutional Review Board, and the Boston Children's Hospital Institutional Review Board. Findings will be disseminated at scientific conferences and as peer-reviewed publications.


Assuntos
Assistência ao Convalescente , Alta do Paciente , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Libéria/epidemiologia , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Estudos Prospectivos , Tanzânia/epidemiologia
8.
BMJ Open ; 12(3): e054914, 2022 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-35361645

RESUMO

INTRODUCTION: Opioid analgesics are essential for treating cancer pain. However, patients are sometimes reluctant to use them because of concerns about addiction and dependence. Rapid pain relief following opioid administration may help overcome the psychological barriers to opioid analgesic use. This study aims to determine the relationship between psychological resistance to strong opioid analgesic use and pain amelioration speed in patients with advanced recurrent cancer. METHODS AND ANALYSIS: This ongoing, multicentre, observational study enrols patients aged 20 years or older with distant metastasis or advanced recurrent cancer receiving strong opioid analgesics for cancer pain for the first time. All participants, both inpatient and outpatient, were recruited from five Japanese hospitals. We are investigating the relationship between psychological barriers at the start of treatment and pain relief during the first week of treatment in these patients. The primary outcome is the Japanese version of the Barriers Questionnaire-II score at baseline. The secondary outcomes are the relationships between psychological barriers to strong opioid analgesic use and changes in pain over time. The participants are asked to fill out an electronic patient-reported outcome daily during the first week of treatment. The sample size was determined based on the number of patients in the year prior to study commencement who used strong opioid analgesics, met the eligibility criteria and could be expected to consent to participate in the study. ETHICS AND DISSEMINATION: The study protocol was approved by the ethics committee (approval ID B200600091) of Yokohama City University on 24 August 2020. The protocol has been reviewed by the institutional review boards at the four participating study sites. The results will be published in a peer-reviewed journal and will be presented at a relevant meeting. TRIAL REGISTRATION NUMBER: UMIN000042443.


Assuntos
Analgésicos Opioides , Neoplasias , Adulto , Analgésicos Opioides/efeitos adversos , Doença Crônica , Estudos de Coortes , Humanos , Estudos Multicêntricos como Assunto , Neoplasias/complicações , Estudos Observacionais como Assunto , Dor/etiologia , Adulto Jovem
9.
BMJ Open ; 12(4): e053743, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35365521

RESUMO

INTRODUCTION: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used as a bridge to definitive bleeding control of subdiaphragmatic injury. Since previous observational studies have poorly adjusted for confounding factors, it is necessary to incorporate REBOA-specific and time-varying covariates in the model. We hypothesised that REBOA improves the survival of haemodynamically unstable torso trauma patients after comparing the REBOA group with a matched control group (non-REBOA group). METHODS AND ANALYSIS: The Japanese Association for the Surgery of Trauma-REBOA Study is a prospective, multicentre, matched cohort study organised by the Clinical Trial Committee of the Japanese Association for the Surgery of Trauma. To minimise observational study biases, this study will prospectively register traumatic shock patients who require bleeding control within 60 min upon arrival at the emergency department, with in-hospital mortality as the primary outcome. After the data set is fixed, the missing values for all variables will be imputed using the multiple imputation technique. In the primary analysis, propensity scores for the probability of REBOA decision (regardless of the actual REBOA deployment) will be calculated from the baseline information using a logistic regression generalised linear mixed-effects model, which will be performed for both the REBOA use and non-REBOA use groups. ETHICS AND DISSEMINATION: This study was approved by the ethics committee of each participating hospital. The results will be disseminated to the participating hospitals, submitted to peer-reviewed journals for publication and presented at congresses. TRIAL REGISTRATION NUMBER: UMIN Clinical Trials Registry (UMIN000035458).


Assuntos
Oclusão com Balão , Procedimentos Endovasculares , Aorta/lesões , Aorta/cirurgia , Oclusão com Balão/métodos , Viés , Estudos de Coortes , Procedimentos Endovasculares/métodos , Humanos , Estudos Observacionais como Assunto , Pontuação de Propensão , Estudos Prospectivos
10.
BMJ Open ; 12(4): e054304, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35365522

RESUMO

INTRODUCTION: Growing evidence is showing that complicated and uncomplicated appendicitis are two different entities that may be treated differently. A correct diagnosis of the type of appendicitis is therefore essential. The Scoring system of Appendicitis Severity (SAS) combines clinical, laboratory and imaging findings. The SAS rules out complicated appendicitis in 95% (negative predictive value, NPV) and detects 95% (sensitivity) of patients with complicated appendicitis in adults suspected of acute appendicitis. However, this scoring system has not yet been validated externally. In this study, we aim to provide a prospective external validation of the SAS in a new cohort of patients with clinical suspicion of appendicitis. We will optimise the score when necessary. METHODS AND ANALYSIS: The SAS will be validated in 795 consecutive adult patients diagnosed with acute appendicitis confirmed by imaging. Data will be collected prospectively in multiple centres. The predicted diagnosis based on the SAS score will be compared with the combined surgical and histological diagnosis. Diagnostic accuracy for ruling out complicated appendicitis will be calculated. If the SAS does not reach a sensitivity and NPV of 95% in its present form, the score will be optimised. After optimisation, a second external validation will be performed in a new group of 328 patients. Furthermore, the diagnostic accuracy of the clinical perspective of the treating physician for differentiation between uncomplicated and complicated appendicitis and the patient's preferences for different treatment options will be assessed. ETHICS AND DISSEMINATION: Ethical approval was granted by the Amsterdam UMC Medical Ethics Committee (reference W19_416 # 19.483). Because of the observational nature of this study, the study does not fall under the scope of the Medical Research Involving Human Subjects Act. Results will be presented in peer-reviewed journals. This protocol is submitted for publication before analysis of the results.


Assuntos
Apendicite , Doença Aguda , Adulto , Apendicite/complicações , Apendicite/diagnóstico , Apendicite/cirurgia , Estudos de Coortes , Humanos , Estudos Observacionais como Assunto , Valor Preditivo dos Testes , Estudos Prospectivos
11.
J Prev Med Public Health ; 55(2): 116-124, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35391523

RESUMO

Epidemiological studies typically examine the causal effect of exposure on a health outcome. Standardization is one of the most straightforward methods for estimating causal estimands. However, compared to inverse probability weighting, there is a lack of user-centric explanations for implementing standardization to estimate causal estimands. This paper explains the standardization method using basic R functions only and how it is linked to the R package stdReg, which can be used to implement the same procedure. We provide a step-by-step tutorial for estimating causal risk differences, causal risk ratios, and causal odds ratios based on standardization. We also discuss how to carry out subgroup analysis in detail.


Assuntos
Causalidade , Estudos Observacionais como Assunto , Software , Humanos , Razão de Chances , Probabilidade , Padrões de Referência
12.
J Assoc Physicians India ; 70(4): 11-12, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35443445

RESUMO

The ongoing COVID-19 pandemic has thrown newer challenges for the health care professionals to manage the affected patients. Though the so called second wave is in a declining trend at present but possible third wave is looming in the near future. Initially patients appeared to have a respiratory limited disease but there are now increasing reports of multiple organ involvement including renal disease in association with COVID-19. The current study aims to highlight the incidence of acute kidney injury (AKI) in COVID-19 patients, as well as the clinical profile and outcomes in that subset of patients in a tertiary hospital setting, in order to better understand the role renal disease plays in the disease process. MATERIAL: Methods: This retrospective, observational study involved a review of data from electronic health records of patients aged more than 18 years with laboratory confirmed COVID-19 admitted to our hospital from February 27 to May 30, 2021. Data was analysed using SPSS version-21.0 by descriptive statistics. We describe the incidence of AKI, dialysis requirement, requirement of mechanical ventilation and mortality. OBSERVATION: Results of 400 hospitalized patients with COVID-19, 252(63%) were male, 148(37%) were female. AKI occurred in 72 (18%) patients. The proportions with stages 1, 2, or 3 AKI were 35(48.3%), 11 (15.1%), and 26 (36.6%), respectively. 22 (32%) patients with AKI required dialysis. About 42(58.33%) patients with AKI were admitted in Intensive care Unit and 35(48%) patients with AKI required mechanical ventilation. In-hospital mortality was (25%) among patients with AKI versus (7.01%) among those without AKI (OR, 4.42; 95% confidence interval, 2.23 to 8.73). CONCLUSION: Conclusions AKI is common among patients hospitalized with COVID-19 and is associated with high morbidity and mortality.


Assuntos
Injúria Renal Aguda , COVID-19 , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , COVID-19/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Estudos Observacionais como Assunto , Pandemias , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2
13.
Front Endocrinol (Lausanne) ; 13: 870047, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35432215

RESUMO

Background: The relationship of glycemic abnormalities between primary aldosteronism (PA) patients and essential hypertension (EH) patients is still debatable. This meta-analysis aimed to explore differences in the prevalence of glycemic abnormalities and levels of abnormal glucose metabolism in PA and EH patients. Methods: A search was performed using PubMed, Scopus, Cochrane and Web of Science databases from their inception through January 2022. Inclusion criteria for this study were 1) observational studies which contained specific data of interest, 2) studies including data which compared adult PA and EH patients and 3) studies which used appropriate methods to diagnose PA. Risk ratio (RR) or standardized mean difference (SMD) with a 95% confidence interval (95% CI) was calculated. Results: Twenty-six studies involving 53,186 patients were included in the meta-analysis. Patients with PA demonstrated significantly higher overall incidence of glycemic abnormalities than patients with EH [RR 1.54; 95% CI (1.20,1.98)]. Risk of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in PA patients were higher than in EH patients [RR 1.27; 95%CI (1.08, 1.49) and RR 2.99; 95%CI (1.74, 5.16), respectively]. There was no statistically significant difference of risk between these groups for impaired fasting glucose (IFG) [RR 1.70; 95%CI (0.55, 5.26)]. Moderate heterogeneity was observed in overall glycemic abnormalities outcomes. A high level of heterogeneity was observed for IFG, while the level was low for DM and IGT. Conclusions: PA patients have a higher risk of glycemic abnormalities than in EH patients. Further study should be conducted to investigate underlying mechanisms of glycemic abnormalities in PA. Systematic Review Registration: www.inplasy.com, INPLASY, identifier 202220004.


Assuntos
Diabetes Mellitus , Intolerância à Glucose , Hiperaldosteronismo , Estado Pré-Diabético , Adulto , Glicemia/metabolismo , Hipertensão Essencial/complicações , Hipertensão Essencial/epidemiologia , Intolerância à Glucose/epidemiologia , Humanos , Hiperaldosteronismo/complicações , Hiperaldosteronismo/epidemiologia , Estudos Observacionais como Assunto , Estado Pré-Diabético/complicações , Estado Pré-Diabético/epidemiologia
14.
BMC Nephrol ; 23(1): 153, 2022 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-35436909

RESUMO

BACKGROUND: Steroid pulse (SP) therapy is one of the immunosuppressive therapies for immunoglobulin A nephropathy (IgAN). Although there are various protocols of SP therapy in IgAN, the intermittent SP (ISP) and consecutive SP (CSP) protocols are prevalently performed in clinical settings. However, there is a lack of evidence of comparisons of the effects on IgAN between these two protocols. METHODS: A total of 189 patients with IgAN who had received SP therapy were included in this study. They were divided into two groups according to the SP protocols into the intermittent SP (ISP) or consecutive SP (CSP) group as follows: ISP; three-times SP therapy in alternate months, CSP; three-times SP therapy in three consecutive weeks. Kidney function, remission of urinary findings, and side effects of SP therapy were compared between the two groups. The observational period was 12 months after the initiation of SP therapy. RESULTS: There was no significant difference in kidney function between the two groups during the observational period. The remission rate of proteinuria and hematuria at 12 months also did not significantly differ between the two groups. Furthermore, even after the adjustment of clinical characteristics using propensity score matching, the remission rate of proteinuria and hematuria at 12 months was similar between the two groups. At 2 months, the remission rate of proteinuria was significantly higher in the CSP group than in the ISP group. There were no critical side effects in both groups. CONCLUSION: The effects of SP therapy on IgAN were similar between the ISP and CSP group at 12 months although CSP therapy could remit proteinuria faster than ISP therapy.


Assuntos
Glomerulonefrite por IGA , Tonsilectomia , Hematúria/tratamento farmacológico , Humanos , Metilprednisolona/uso terapêutico , Estudos Observacionais como Assunto , Proteinúria/induzido quimicamente , Proteinúria/tratamento farmacológico , Estudos Retrospectivos
15.
Trials ; 23(1): 246, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35365186

RESUMO

OBJECTIVE: The aim of the paper is to discuss how a pragmatic definition could change our conception of diagnosis, using gestational diabetes mellitus (GDM) as an example. STUDY DESIGN: We review the diagnostic controversy that followed an observational study showing a linear relationship between maternal glycaemia and adverse pregnancy outcomes and the resolution proposed 15 years later by a recent pragmatic trial comparing two screening approaches (one- vs two-step) with different diagnostic thresholds. RESULTS: The pragmatic trial involved approximately 24,000 women. The one-step screening strategy using lower GDM thresholds diagnosed twice as many women with GDM, but pregnancy outcomes were not different. We examine how the pragmatic approach integrates research into practice and defines the meaning of a diagnosis according to patient outcomes. The approach is ethically and scientifically sound as compared to the previous methodology, where observational research separated from care gave a theoretical definition of GDM that may have misled medical practice for two decades. CONCLUSION: Pragmatic research integrated into practice can revolutionize our conception of medical diagnosis in the best medical interest of patients.


Assuntos
Diabetes Gestacional , Glicemia , Diabetes Gestacional/diagnóstico , Feminino , Humanos , Programas de Rastreamento/métodos , Estudos Observacionais como Assunto , Gravidez , Resultado da Gravidez
16.
BMC Infect Dis ; 22(1): 403, 2022 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-35468758

RESUMO

BACKGROUND: Immunocompromised people (ICP) and elderly individuals (older than 80 years) are at increased risk for severe coronavirus infections. To protect against serious infection with SARS-CoV-2, ICP are taking precautions that may include a reduction of social contacts and participation in activities which they normally enjoy. Furthermore, for these people, there is an uncertainty regarding the effectiveness of the vaccination. The COVID-19 Contact (CoCo) Immune study strives to characterize the immune response to COVID-19 vaccination in immunocompromised, elderly people, and patients with hematological or oncological diseases. The study uses blood-based screenings to monitor the humoral and cellular immune response in these groups after vaccination. Questionnaires and qualitative interviews are used to describe the level of social participation. METHODS: The CoCo Immune Study is a mixed methods prospective, longitudinal, observational study at two large university hospitals in Northern Germany. Starting in March 2021, it monitors anti-SARS-CoV-2 immune responses and collects information on social participation in more than 600 participants, at least 18 years old. Inclusion criteria and subcohorts: Participants with (1) regularly intake of immunosuppressive medication (ICP-cohort) or (2) age ≥ 80 years (80 + -cohort). Additionally, patients with current or former (3) myeloid, (4) lymphatic disease or (5) solid tumor under checkpoint inhibition (3-5: HO-cohort). EXCLUSION CRITERIA: (1) refusal to give informed consent, (2) contraindication to blood testing, (3) inability to declare consent. Participants complete a questionnaire at four different time points: prior to full vaccination, and 1, 6 and 12 months after completed vaccination. In addition, participants draw blood samples themselves or through a local health care provider and send them with their questionnaires per post at the respective time points after vaccination. Patients of the HO cohort dispense additional blood samples at week 3 to 12 and at month 6 to 9 after 2nd vaccination to gain additional knowledge in B and T cell responses. Selected participants are invited to qualitative interviews about social participation. DISCUSSION: This observational study is designed to gain insight into the immune response of people with weakened immune systems and to find out how social participation is affected after COVID-19 vaccination. TRIAL REGISTRATION: This study was registered with German Clinical Trial Registry (registration number: DRKS00023972) on 30th December 2020.


Assuntos
COVID-19 , Doenças Hematológicas , Neoplasias , Adolescente , Idoso , Idoso de 80 Anos ou mais , Vacinas contra COVID-19 , Cocos , Humanos , Imunidade , Estudos Observacionais como Assunto , Estudos Prospectivos , SARS-CoV-2 , Resultado do Tratamento
17.
Food Funct ; 13(9): 4825-4838, 2022 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-35403633

RESUMO

Vitamins may play an important role in preventing tuberculosis. The purpose of this work is to associate the vitamin A, C, D and E status with tuberculosis through a systematic review and meta-analysis of observational studies. Web of Science, Pubmed and Scopus were searched from the earliest date of the database to May 2021. The standardized mean differences (SMDs) of blood vitamin concentrations and odds ratios (ORs) of vitamin deficiency between the tuberculosis patients and the control subjects were used as the main effect sizes. The effect sizes were pooled by a random-effects model using the Stata software (Version 11). The vitamin A concentration was significantly lower in the tuberculosis group than in the control group [SMD (95% CI): -0.96 (-1.31, -0.61), p < 0.01]. Only two case-control studies reported the vitamin C concentrations in the tuberculosis group versus the control group, and the difference was not significant. The blood vitamin D concentration was significantly lower in the tuberculosis group than in the control group [SMD (95% CI): -0.53 (-0.75, -0.32), p < 0.01]. Consistently, the number of people with vitamin D deficiency was significantly higher in the tuberculosis group [OR (95% CI): 2.29 (1.55, 3.37), p < 0.01]. The vitamin E concentration was significantly lower in the tuberculosis group than in the control group [SMD (95% CI): -0.34 (-0.61, -0.08), p = 0.01]. The current meta-analysis suggested a negative association between the vitamin A, D and E status and tuberculosis, and the association between the vitamin C status and tuberculosis was inconclusive due to the limited studies available.


Assuntos
Tuberculose , Deficiência de Vitamina D , Ácido Ascórbico , Humanos , Estudos Observacionais como Assunto , Tuberculose/complicações , Vitamina A , Vitamina D , Vitaminas
18.
BMJ Open ; 12(4): e054404, 2022 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-35487718

RESUMO

INTRODUCTION: Breast cancer is still the most common malignancy among women worldwide. The Prospective Breast Cancer Biobank (PBCB) collects blood and urine from patients with breast cancer every 6 or 12 months for 11 years from 2011 to 2030 at two university hospitals in Western Norway. The project aims to identify new biomarkers that enable detection of systemic recurrences at the molecular level. As blood represents the biological interface between the primary tumour, the microenvironment and distant metastases, liquid biopsies represent the ideal medium to monitor the patient's cancer biology for identification of patients at high risk of relapse and for early detection systemic relapse.Including patient-reported outcome measures (PROMs) allows for a vast number of possibilities to compare PROM data with biological information, enabling the study of fatigue and Quality of Life in patients with breast cancer. METHODS AND ANALYSIS: A total of 1455 patients with early-stage breast cancer are enrolled in the PBCB study, which has a one-armed prospective observational design. Participants consent to contribute liquid biopsies (i.e., peripheral blood and urine samples) every 6 or 12 months for 11 years. The liquid biopsies are the basis for detection of circulating tumour cells, circulating tumour DNA (ctDNA), exosomal micro-RNA (miRNA), miRNA in Tumour Educated Platelet and metabolomic profiles. In addition, participants respond to 10 PROM questionnaires collected annually. Moreover, a control group comprising 200 women without cancer aged 25-70 years will provide the same data. ETHICS AND DISSEMINATION: The general research biobank PBCB was approved by the Ministry of Health and Care Services in 2007, by the Regional Ethics Committee (REK) in 2010 (#2010/1957). The PROM (#2011/2161) and the biomarker study PerMoBreCan (#2015/2010) were approved by REK in 2011 and 2015 respectively. Results will be published in international peer reviewed journals. Deidentified data will be accessible on request. TRIAL REGISTRATION NUMBER: NCT04488614.


Assuntos
Neoplasias da Mama , MicroRNAs , Adulto , Idoso , Bancos de Espécimes Biológicos , Biomarcadores , Neoplasias da Mama/diagnóstico , Feminino , Humanos , Biópsia Líquida , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Observacionais como Assunto , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Qualidade de Vida , Microambiente Tumoral
19.
BMJ Open ; 12(4): e055886, 2022 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-35396292

RESUMO

INTRODUCTION: Vagus nerve stimulation (VNS) is a neuromodulation therapy that can reduce the seizure burden of children with medically intractable epilepsy. Despite the widespread use of VNS to treat epilepsy, there are currently no means to preoperatively identify patients who will benefit from treatment. The objective of the present study is to determine clinical and neural network-based correlates of treatment outcome to better identify candidates for VNS therapy. METHODS AND ANALYSIS: In this multi-institutional North American study, children undergoing VNS and their caregivers will be prospectively recruited. All patients will have documentation of clinical history, physical and neurological examination and video electroencephalography as part of the standard clinical workup for VNS. Neuroimaging data including resting-state functional MRI, diffusion-tensor imaging and magnetoencephalography will be collected before surgery. MR-based measures will also be repeated 12 months after implantation. Outcomes of VNS, including seizure control and health-related quality of life of both patient and primary caregiver, will be prospectively measured up to 2 years postoperatively. All data will be collected electronically using Research Electronic Data Capture. ETHICS AND DISSEMINATION: This study was approved by the Hospital for Sick Children Research Ethics Board (REB number 1000061744). All participants, or substitute decision-makers, will provide informed consent prior to be enrolled in the study. Institutional Research Ethics Board approval will be obtained from each additional participating site prior to inclusion. This study is funded through a Canadian Institutes of Health Research grant (PJT-159561) and an investigator-initiated funding grant from LivaNova USA (Houston, TX; FF01803B IIR).


Assuntos
Conectoma , Estimulação do Nervo Vago , Adolescente , Biomarcadores , Canadá , Criança , Humanos , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Qualidade de Vida , Estudos Retrospectivos , Convulsões/terapia , Resultado do Tratamento , Estimulação do Nervo Vago/métodos
20.
BMJ Open ; 12(4): e055915, 2022 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-35410928

RESUMO

INTRODUCTION: Due to a global shortage of healthcare workers, there is a lack of basic healthcare for 4 billion people worldwide, particularly affecting low-income and middle-income countries. The utilisation of AI-based healthcare tools such as symptom assessment applications (SAAs) has the potential to reduce the burden on healthcare systems. The purpose of the AFYA Study (AI-based Assessment oF health sYmptoms in TAnzania) is to evaluate the accuracy of the condition suggestions and urgency advice provided by a user on a Swahili language Ada SAA. METHODS AND ANALYSIS: This study is designed as an observational prospective clinical study. The setting is a waiting room of a Tanzanian district hospital. It will include patients entering the outpatient clinic with various conditions and age groups, including children and adolescents. Patients will be asked to use the SAA before proceeding to usual care. After usual care, they will have a consultation with a study-provided physician. Patients and healthcare practitioners will be blinded to the SAA's results. An expert panel will compare the Ada SAA's condition suggestions and urgency advice to usual care and study provided differential diagnoses and triage. The primary outcome measures are the accuracy and comprehensiveness of the Ada SAA evaluated against the gold standard differential diagnoses. ETHICS AND DISSEMINATION: Ethical approval was received by the ethics committee (EC) of Muhimbili University of Health and Allied Sciences with an approval number MUHAS-REC-09-2019-044 and the National Institute for Medical Research, NIMR/HQ/R.8c/Vol. I/922. All amendments to the protocol are reported and adapted on the basis of the requirements of the EC. The results from this study will be submitted to peer-reviewed journals, local and international stakeholders, and will be communicated in editorials/articles by Ada Health. TRIAL REGISTRATION NUMBER: NCT04958577.


Assuntos
Aplicativos Móveis , Adolescente , Criança , Humanos , Estudos Observacionais como Assunto , Projetos Piloto , Estudos Prospectivos , Avaliação de Sintomas , Tanzânia
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