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ABSTRACT Objective: To examine the associations between self-reported screen time and symptoms of stress, anxiety, and depression in adolescents. Methods: A cross-sectional study was conducted with 982 adolescents aged between 12 and 15 years, enrolled in public schools in Jacarezinho (PR), Brazil. Screen time was assessed by the question "Considering a typical day, how much time do you spend watching TV, playing videogame, using computer or smartphone?" The DASS-21 questionnaire (short form) was used to assess symptoms of depression, anxiety, and stress. Crude and adjusted analyses (age, sex, and maternal level of education) between screen time and mental disorders symptoms were performed using general linear regression models, with Poisson distribution, with significance level at p<0.05. Results: Higher depressive symptoms were observed in adolescents who reported screen time of 4-6 hours/day (PR 1.35, 95%CI 1.13-1.61) and ≥6 hours/day (PR 1.88, 95%CI 1.62-2.19), compared with their pairs with <2 hours/day. The same was observed for anxiety symptoms with screen time of 4-6 hours/day (PR 1.23, 95%CI 1.04-1.46) and ≥6 hours/day (PR 1.50, 95%CI 1.28-1.77); and stress, with 4-6 hours/day (PR 1.25, 95%CI 1.08-1.44) and ≥6 hours/day (PR 1.49, 95%CI 1.30-1.71), also compared with their pairs with <2 hours/day. Conclusions: Screen time was positively associated with depressive, anxiety, and stress symptoms in adolescents. Special attention should be given to those who spend more than four hours a day in front of a screen.
RESUMO Objetivo: Examinar a associação entre o tempo de tela autorreportado e os sintomas de estresse, ansiedade e depressão em adolescentes. Métodos: Foi realizado estudo com delineamento transversal com 982 adolescentes entre 12-15 anos, matriculados na rede pública de ensino da cidade de Jacarezinho (PR). Para mensurar o tempo de tela, os adolescentes responderam à pergunta: "Considerando um dia típico, quanto tempo você passa assistindo TV, jogando videogame, usando computador ou smartphone?". O questionário DASS-21 (versão curta) foi utilizado para avaliar os sintomas de depressão, ansiedade e estresse. Análises brutas e ajustadas (idade, sexo e nível de escolaridade materna) entre tempo de tela e indicadores de saúde mental foram realizadas por meio do modelo de regressão linear generalizado, com distribuição de Poisson, adotando a significância de p<0,05. Resultados: Maiores sintomas depressivos foram observados em adolescentes com tempo de tela de 4-6 horas/dia (RP 1,35, IC95% 1,13-1,61) e ≥6 horas/dia (RP 1,88, IC95% 1,62-2,19) quando comparados com seus pares com ≤2 horas/dia. O mesmo foi observado para os sintomas de ansiedade com tempo de tela de 4-6 horas/dia (RP 1,23, IC95% 1,04-1,46) e ≥6 horas/dia (RP 1,50, IC95% 1,28-1,77); e estresse, com 4-6 horas/dia (RP 1,25, IC95% 1,08-1,44) e ≥6 horas/dia (RP 1,49, IC95% 1,30-1,71), também comparados com seus pares com ≤2 horas/dia. Conclusões: O tempo de tela foi associado positivamente com os sintomas de depressão, ansiedade e estresse em adolescentes. Atenção especial deve ser dada àqueles que passam mais de quatro horas por dia em frente a uma tela.
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RESUMEN Con el objetivo de describir las tasas de incidencia por cada 100 000 habitantes de los casos de enfermedades transmitidas por alimentos (ETA) durante el periodo 2015-2020 en Ecuador se realizó un análisis secundario de los registros de vigilancia epidemiológica y de las proyecciones poblacionales del Instituto Nacional de Estadística y Censos. Se reportaron 113 695 casos con una incidencia superior a los 100 casos por cada 100 000 habitantes (2015-2019). En el 2020 los registros son considerablemente inferiores a los reportes de años anteriores. La mayoría de los casos se reportaron como «otras intoxicaciones alimentarias¼. Las tasas de incidencia de ETA más altas se observaron en la región amazónica. En general existe una marcada variabilidad anual en la incidencia de las ETA según las regiones geográficas del Ecuador. En conclusión, las ETA representan un problema de salud pública en el Ecuador. Se deben diseñar estrategias preventivas integrales con especial énfasis en la región amazónica.
ABSTRACT In order to describe the incidence rates per 100 000 population of foodborne disease (FBD) cases during the period 2015-2020 in Ecuador, we carried out a secondary analysis of epidemiological surveillance records and population projections from the National Institute of Statistics and Census. A total of 113,695 cases were reported with an incidence of more than 100 cases per 100 000 population (2015-2019). In 2020, the records are considerably lower than those reported in previous years. Most cases were reported as "other food poisoning". The highest incidence rates of FBD were found in the Amazon region. In general, there is a marked annual variability in the incidence of FBD according to the geographic regions of Ecuador. In conclusion, FBD represent a public health problem in Ecuador. Comprehensive preventive strategies should be designed with special emphasis on the Amazon region.
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OBJECTIVE: To evaluate the predictive ability of mortality prediction scales in cancer patients admitted to intensive care units (ICUs). DESIGN: A systematic review of the literature was conducted using a search algorithm in October 2022. The following databases were searched: PubMed, Scopus, Virtual Health Library (BVS), and Medrxiv. The risk of bias was assessed using the QUADAS-2 scale. SETTING: ICUs admitting cancer patients. PARTICIPANTS: Studies that included adult patients with an active cancer diagnosis who were admitted to the ICU. INTERVENTIONS: Integrative study without interventions. MAIN VARIABLES OF INTEREST: Mortality prediction, standardized mortality, discrimination, and calibration. RESULTS: Seven mortality risk prediction models were analyzed in cancer patients in the ICU. Most models (APACHE II, APACHE IV, SOFA, SAPS-II, SAPS-III, and MPM II) underestimated mortality, while the ICMM overestimated it. The APACHE II had the SMR (Standardized Mortality Ratio) value closest to 1, suggesting a better prognostic ability compared to the other models. CONCLUSIONS: Predicting mortality in ICU cancer patients remains an intricate challenge due to the lack of a definitive superior model and the inherent limitations of available prediction tools. For evidence-based informed clinical decision-making, it is crucial to consider the healthcare team's familiarity with each tool and its inherent limitations. Developing novel instruments or conducting large-scale validation studies is essential to enhance prediction accuracy and optimize patient care in this population.
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OBJECTIVE: This research aimed to determine the stigma toward people with mental illness among mental health personnel and identify individual, professional, and contextual predictors. METHODS: A descriptive, cross-sectional, and correlational design was used. The sample consisted of 218 mental health personnel working in Outpatient Psychiatric Units belonging to hospitals and Community Mental Health Centers in Chile. Stigma was evaluated using a scale of humanized treatment, a scale of social distance, and a scale of attitudes in health personnel. In addition, sociodemographic and professional information was collected from mental health personnel and contextual information, particularly the type of outpatient mental health center and the technical-administrative unit that groups all the health centers in a territory. RESULTS: It was found that mental health personnel, in general terms, present low levels of stigma expressed in behaviors of comfort and support toward users, a desire for closeness and social interaction, and reduced stigmatizing beliefs and attitudes of infantilization toward individuals with MHPs. However, intimacy and trust were lower than expected.Only educational levels and health centers were related to stigma. CONCLUSIONS: The low levels of stigma may be due to the evolution of this phenomenon and the country's mental health policies.
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RESUMEN La hiperostosis cortical infantil (HIC) o enfermedad de Caffey es un trastorno óseo autolimitado que se caracteriza por fiebre, irritabilidad, inflamación de los tejidos blandos y engrosamiento cortical de uno o más huesos. Es más común en el primer semestre de vida. Se informa el caso de un lactante de 3 meses con las características clínico-radiográficas propias de la enfermedad y los hallazgos de laboratorio más comunes que permitieron un acertado diagnóstico y seguir una conducta adecuada. El cuadro agudo se mantuvo durante pocos días y se observó resolución total del edema en cuatro semanas. El reconocimiento de esta rara infección evitará adoptar métodos diagnósticos y terapéuticos invasivos para el paciente.
ABSTRACT Infantile cortical hyperostosis (ICH) or Caffey disease is a self-limiting bone disorder characterized by fever, irritability, soft tissue swelling and cortical bone thickening. It is more common in infants < 6 months of age. We report the case of a 3-month-old infant with the clinical and radiographic characteristics of the disease and the most common laboratory findings which enabled an accurate diagnosis and appropriate management. The acute episode persisted for several days, followed by a complete resolution of the edema within four weeks. Identifying this rare infection will help avoid invasive diagnostic and therapeutic strategies.
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Introdução: O adoecimento crônico e a hospitalização trazem para o universo infantil vivências que são ameaçadoras tanto do ponto de vista físico quanto psíquico. Adoecer é uma experiência complexa, disruptiva e traumática, que acarreta sobrecarga emocional para as crianças e seus familiares. Objetivo: compreender o cenário do adoecimento infantil e a hospitalização, articulando as marcas do corpo às marcas simbólicas. Método: Trata-se de uma pesquisa qualitativa, exploratória de ordem teórico-clínica no campo da psicanálise. Resultado: O processo de adoecimento crônico coloca o sujeito em um drama subjetivo com necessidade de elaborar lutos e lidar com a ferida narcísica e, até mesmo pensar a morte de frente. O hospital ganha contornos simbólicos para além do espaço de tratamento da doença e seus sintomas: lugar em que a doença insiste em se dar a ver e permanecer. Conclusão: O adoecimento envolve componentes para além das dimensões biológica, cognitiva e emocional, sendo atravessado por questões subjetivas e simbólicas que norteiam a forma como o sujeito lidará com seu corpo adoecido, portanto implica reflexões acerca da criança como protagonista de seu processo e a escuta do sujeito em sua dimensão simbólica. (AU)
Introduction: Chronic illness and hospitalization bring experiences to children that are threatening from both a physical and psychological point of view. Falling ill is a complex, disruptive and traumatic experience, which causes emotional overload for children and their families. Objective: to understand the scenario of childhood illness and hospitalization, linking body marks to symbolic marks.Method: This is qualitative, exploratory theoretical-clinical research in the field of psychoanalysis. Result: The process of chronic illness places the subject in a subjective drama with the need to mourn and deal with the narcissistic wound and even think about death in the face. The hospital gains symbolic contours beyond the space for treating the disease and its symptoms: a place where the disease insists on showing itself and remaining. Conclusion: Illness involves components beyond the biological, cognitive and emotional dimensions, being crossed by subjective and symbolic issues that guide the way the subject will deal with their ill body, therefore implying reflections on the child as the protagonist of their process and listening of the subject in its symbolic dimension. (AU)
Introducción: Las enfermedades crónicas y la hospitalización traen a los niños experiencias amenazantes tanto desde el punto de vista físico como psicológico. Enfermar es una experiencia compleja, perturbadora y traumática, que provoca una sobrecarga emocional en los niños y sus familias. Objetivo: comprender el escenario de la enfermedad y la hospitalización infantil, vinculando las marcas corporales con las marcas simbólicas. Método: Se trata de una investigación teórico-clínica exploratoria, cualitativa, en el campo del psicoanálisis. Resultado: El proceso de enfermedad crónica sitúa al sujeto en un drama subjetivo con la necesidad de llorar y lidiar con la herida narcisista e incluso pensar en la muerte en elrostro. El hospital gana contornos simbólicos más allá del espacio de tratamiento de la enfermedad y sus síntomas: un lugar donde la enfermedad insiste en mostrarse y permanecer. Conclusión: La enfermedad involucra componentes más allá de las dimensiones biológica, cognitiva y emocional, siendo atravesada por cuestiones subjetivas y simbólicas que orientan la forma en que el sujeto afrontará su cuerpo enfermo, implicando por tanto reflexiones sobre el niño como protagonista de su proceso y escucha del sujeto en su dimensión simbólica. (AU)
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Humanos , Masculino , Feminino , Criança , Criança Hospitalizada/psicologia , Doença Crônica , Psicanálise , Pesquisa Qualitativa , Análise DocumentalRESUMO
BACKGROUND: Estimate the costs of inpatient and outpatient care for people with Cerebral Palsy (CP) in Brazil. RESEARCH DESIGN AND METHODS: Health records of people with CP in the Hospital and Outpatient Information Systems of Brazil between 2015 and 2019 were analyzed. Variables analyzed were gender, age, ICD, Intensive Care Unit (ICU) use, total cost, and ICU cost. Costs were adjusted for inflation and converted to dollars. Linear regression analysis was performed to investigate the association between social and clinical variables and direct costs. RESULTS: A total direct cost of approximately $166 million to the National Health System was identified, with $7.08 million/year and $26.1 million/year of inpatient and outpatient costs, respectively. The healthcare was primarily for children up to 14 years of age. The ICD 'spastic quadriplegic CP' received the most attendance. Rehabilitation was responsible for 75% of the outpatient care, with physiotherapy standing out. Increased age, use of ICU, and the types of CP are related to increased cost. CONCLUSIONS: Healthcare for people with CP produced expressive costs for the Brazilian public health system, mainly with outpatient procedures and rehabilitation, with children being the most attended. Estimating these costs assist in better resource allocation for more effective healthcare provision.
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Introduction: Mayaro Fever (MF) is a tropical disease caused by the Mayaro virus (MAYV), with outbreaks documented in Latin America. Methods: A hospital-based fever surveillance in Leticia, Colombian Amazon, collected sera from 1,460 patients aged 5-89 between December 2020 and April 2023. Results: Dengue and malaria were the main diagnoses (19.4 and 5.8%, respectively), leaving 71.4% of cases unidentified after testing. Metagenomic sequencing and real-time RT-qPCR testing identified MAYV in two patients (25-year-old male and an 80-year-old female) exhibiting typical symptoms, of MF including rash, joint pain, and fever. Phylogenetics analysis of these two viruses revealed a close relationship to Peruvian strains within the MAYV D genotype. Discussion: The study of AFI in Leticia, Colombia, identified dengue as prevalent, with malaria, COVID-19, Influenza, and Zika viruses also detected. Despite extensive testing, most cases remained unexplained until metagenomic sequencing revealed MAYV, previously unseen in Colombia but known in neighboring countries. Conclusion: This study presents the first near full-length genomes of MAYV in Colombia, highlighting the need for further seroprevalence studies and enhanced surveillance to understand and control the spread of the virus in the region.
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Objectives: Influenza-like illness (ILI) caused by respiratory viruses results in various respiratory clinical manifestations. The ILI002 prospective observational cohort study aimed to describe viral agents, seasonality, and outcomes of patients with ILI during four seasons in the influenza H1N1-pandemic and post-pandemic years (2010-2014). Methods: Patients from six Mexican hospitals were enrolled from April 2010 to March 2014. Clinical data and nasopharyngeal swabs were obtained and tested for viral respiratory pathogens by real-time reverse-transcription polymerase chain reaction. Results: Of the 5662 enrolled participants, 64.9% were adults and 35.1% were children. Among the 5629 participants with single-pathogen detection, rhinovirus (20.2%), influenza virus (11.2%), respiratory syncytial virus (RSV) (7.2%), and coronavirus (6.8%) were the most frequent pathogens. Co-infection occurred in 14.5% of cases; 49.3% of participants required hospitalization, particularly in RSV cases (42.9% adults, 89.6% children). The mortality rate was 2.8% higher among older adult participants and those with comorbidities. Influenza H1N1 had the highest mortality rate, yet almost half of the deceased had no pathogen. Rhinovirus persisted year-round, while influenza, coronavirus, and RSV peaked during cooler months. Conclusions: Analyses showed that some viruses causing ILI may lead to severe disease and hospitalization irrespective of comorbidities. These findings may help in decision-making about public health policies on prevention measures, vaccination, treatment, and administration of health care.
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OBJECTIVE: The objective of this study was to associate the epidemiological and clinical characteristics of patients hospitalized for COVID-19 with the progression to critical illness and death in northwestern Mexico. METHODS: From March to October 2020, we collected the demographic and clinical characteristics of 464 hospitalized patients from northwestern Mexico. RESULTS: Sixty-four percent (295/464) of the patients became critically ill. Age, occupation, steroid and antibiotic use at previous hospitalization, and underlying diseases (hypertension, obesity, and chronic kidney disease) were associated with critical illness or death (p: < 0.05). No symptoms were associated with critical illness. However, the parameters such as the heart rate, respiratory rate, oxygen saturation, and diastolic pressure and the laboratory parameters such as the glucose, creatinine, white line cells, hemoglobin, D-dimer, and C-reactive protein, among others, were associated with critical illness (p: < 0.05). Finally, advanced age, previous hospital treatment, and the presence of one or more underlying diseases were associated with critical illness and death (p: < 0.02). CONCLUSIONS: Several epidemiological (e.g., age and occupation) and clinical factors (e.g., previous treatment, underlying diseases, and vital signs and laboratory parameters) were associated with critical illness and death in patients hospitalized with COVID-19. These data provide us with possible markers to avoid critical illness or death from COVID-19 in our region.
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COVID-19 , Estado Terminal , Progressão da Doença , Hospitalização , SARS-CoV-2 , Humanos , COVID-19/epidemiologia , COVID-19/mortalidade , México/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estado Terminal/mortalidade , Estado Terminal/epidemiologia , Hospitalização/estatística & dados numéricos , Idoso , Adulto , Fatores de Risco , Mortalidade Hospitalar/tendências , PandemiasRESUMO
Objective: Several health games have been developed for pediatric patients in recent years but few for children with atopic dermatitis (AD). As this chronic disease requires changes in daily habits, this study aimed to develop and validate the content of a board health game for children with AD. Material and Methods: This is a content development and validation study of DermatrilhaTM, a board health game about AD. The instrument aims to promote interactions between children with AD and health care providers and offers the exchange of experiences, feelings, and knowledge about the disease in a playful way. The five stages of development of the board game were (a) planning, (b) development, (c) preparation of content validation questionnaires, (d) evaluation by a committee of experts, and (e) pretest with the target audience. Results: The expert committee group consisted of 20 professionals: 5 physicians specialized in pediatric dermatology, 5 psychologists specialized in health psychology, 5 designers with experience in illustration, and 5 early childhood educators. The target audience consisted of 25 children aged 7-12 years with AD. The evaluation of the expert committee found 0.95 in the general content validity index and 0.92 in the target audience, thus exceeding 0.80 in all items. Conclusion: The board health game Dermatrilha has proven to be a psychoeducational tool for the therapeutic education of children with AD, enabling the exchange of experiences, feelings, and knowledge about the disease among peers and health care providers.
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Acute febrile illness (AFI) and severe neurological disorders (SNDs) often present diagnostic challenges due to their potential origins from a wide range of infectious agents. Nanopore metagenomics is emerging as a powerful tool for identifying the microorganisms potentially responsible for these undiagnosed clinical cases. In this study, we aim to shed light on the etiological agents underlying AFI and SND cases that conventional diagnostic methods have not been able to fully elucidate. Our approach involved analyzing samples from fourteen hospitalized patients using a comprehensive nanopore metagenomic approach. This process included RNA extraction and enrichment using the SMART-9N protocol, followed by nanopore sequencing. Subsequent steps involved quality control, host DNA/cDNA removal, de novo genome assembly, and taxonomic classification. Our findings in AFI cases revealed a spectrum of disease-associated microbes, including Escherichia coli, Streptococcus sp., Human Immunodeficiency Virus 1 (Subtype B), and Human Pegivirus. Similarly, SND cases revealed the presence of pathogens such as Escherichia coli, Clostridium sp., and Dengue virus type 2 (Genotype-II lineage). This study employed a metagenomic analysis method, demonstrating its efficiency and adaptability in pathogen identification. Our investigation successfully identified pathogens likely associated with AFI and SNDs, underscoring the feasibility of retrieving near-complete genomes from RNA viruses. These findings offer promising prospects for advancing our understanding and control of infectious diseases, by facilitating detailed genomic analysis which is critical for developing targeted interventions and therapeutic strategies.
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Metagenômica , Sequenciamento por Nanoporos , Humanos , Metagenômica/métodos , Sequenciamento por Nanoporos/métodos , Masculino , Feminino , Doenças do Sistema Nervoso/microbiologia , Doenças do Sistema Nervoso/genética , Doenças do Sistema Nervoso/virologia , Adulto , Pessoa de Meia-Idade , Nanoporos , Idoso , Metagenoma/genética , Febre/microbiologia , Febre/virologia , Escherichia coli/genéticaRESUMO
BACKGROUND: Breast Cancer (BC) is associated with substantial costs of healthcare; however, real-world data regarding these costs in Colombia is scarce. The contributory regime provides healthcare services to formal workers and their dependents and covers almost half of the population in Colombia. This study aims to describe the net costs of healthcare in women with BC covered by the contributory regime in Colombia in 2019 from the perspective of the Colombian Health System. METHODS: The main data source was the Capitation Sufficiency Database, an administrative database that contains patient-level data on consumption of services included in the National Formulary (PBS, in Spanish Plan de Beneficios en Salud). Data on consumption of services not included in the PBS (non-PBS) were calculated using aggregated data from MIPRES database. All direct costs incurred by prevalent cases of BC, from January 1 to December 31, 2019, were included in the analysis. The net costs of the disease were estimated by multiplying the marginal cost and the expected number of cases with BC by region and age group. Marginal costs were defined as the costs of services delivered to patients with BC after subtracting the expected costs of health services due to age, comorbidity burden or region of residence. To calculate these costs, we used Propensity Score Matching in the main analysis. All costs were expressed in 2019 international dollars. Productivity losses, transportation expenses, and caregiving costs were not included. RESULTS: A total of 46,148 patients with BC were identified. Total net costs were $387 million (95% CI $377 to $396 million), 60% associated with non-PBS services. Marginal costs were $8,366 (95% Confidence Interval $8,170 to $8,573), with substantial variations between regions age groups (from $3,919 for older patients in the Amazonia region to $10,070 for younger patients in the Pacific region). The costs for PBS services were higher for ambulatory services and for patients who died during 2020. CONCLUSIONS: BC imposes a substantial economic burden for the Colombian Health System with important variations in net costs between regions and age groups. Patients near death and ambulatory services were associated with higher costs of healthcare.
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This Systematic Review assesses the economic impact of Respiratory Syncytial Virus (RSV) in Latin America and the Caribbean (LAC) in relation to healthcare resource utilization and associated costs. We searched online databases from January 2012 to November 2022 to identify eligible publications. We identified 12 publications that reported direct costs, indirect costs, and resources associated with RSV and its complications. The primary direct medical resources reported were medical services, diagnostics tests and procedures, and length of stay (LOS). Direct total costs per patient ranged widely from $563 to $19,076. Direct costs are, on average, 98% higher than indirect costs. Brazil reported a higher total cost per patient than Colombia, El Salvador, México, Panamá, and Puerto Rico, while for indirect costs per patient, El Salvador and Panamá had higher costs than Brazil, Colombia, and Mexico. The mean LOS in the general ward due to RSV was 6.9 days (range 4 to 20 days) and the mean Intensive Care Unit LOS was 9.1 days (range 4 to 16 days). In many countries of the LAC region, RSV represents a considerable economic burden on health systems, but significant evidence gaps were identified in the region. More rigorous health economic studies are essential to better understand this burden and to promote effective healthcare through an informed decision-making process. Vaccination against RSV plays a critical role in mitigating this burden and should be a priority in public health strategies.
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Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Infecções por Vírus Respiratório Sincicial , Humanos , Infecções por Vírus Respiratório Sincicial/economia , Infecções por Vírus Respiratório Sincicial/epidemiologia , América Latina/epidemiologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Região do Caribe/epidemiologia , Vírus Sincicial Respiratório HumanoRESUMO
Infectious disease (ID) cohorts are key to advancing public health surveillance, public policies, and pandemic responses. Unfortunately, ID cohorts often lack funding to store and share clinical-epidemiological (CE) data and high-dimensional laboratory (HDL) data long term, which is evident when the link between these data elements is not kept up to date. This becomes particularly apparent when smaller cohorts fail to successfully address the initial scientific objectives due to limited case numbers, which also limits the potential to pool these studies to monitor long-term cross-disease interactions within and across populations. CE data from 9 arbovirus (arthropod-borne viruses) cohorts in Latin America were retrospectively harmonized using the Maelstrom Research methodology and standardized to Clinical Data Interchange Standards Consortium (CDISC). We created a harmonized and standardized meta-cohort that contains CE and HDL data from 9 arbovirus studies from Latin America. To facilitate advancements in cross-population inference and reuse of cohort data, the Reconciliation of Cohort Data for Infectious Diseases (ReCoDID) Consortium harmonized and standardized CE and HDL from 9 arbovirus cohorts into 1 meta-cohort. Interested parties will be able to access data dictionaries that include information on variables across the data sets via Bio Studies. After consultation with each cohort, linked harmonized and curated human cohort data (CE and HDL) will be made accessible through the European Genome-phenome Archive platform to data users after their requests are evaluated by the ReCoDID Data Access Committee. This meta-cohort can facilitate various joint research projects (eg, on immunological interactions between sequential flavivirus infections and for the evaluation of potential biomarkers for severe arboviral disease).
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Infecções por Arbovirus , Humanos , Infecções por Arbovirus/epidemiologia , Estudos de Coortes , América Latina/epidemiologia , Masculino , Feminino , Criança , Arbovírus , Estudos Retrospectivos , Adolescente , Pré-Escolar , AdultoRESUMO
Undergraduate students are frequently afflicted by major depressive disorder (MDD). Oxidative and nitrosative stress (O&NS) has been implicated in the pathophysiology of MDD. There is no information regarding whether mild outpatient MDD (SDMD) and first episode SDMD (FE-SDMD) are accompanied by O&NS. The current study compared lipid hydroperoxides (LOOH), malondialdehyde (MDA), advanced protein oxidation products, nitric oxide metabolites (NOx), thiol groups, plasma total antioxidant potential (TRAP), and paraoxonase 1 activities among SDMD and FE-SDMD patients versus healthy controls. We found that SDMD and FE-SDMD exhibit elevated MDA and NOx, and decreased TRAP and LOOH as compared with controls. There was a significant and positive correlation between O&NS biomarkers and adverse childhood experiences (ACEs), and negative life events (NLEs). O&NS pathways, NLEs and ACEs accounted for 51.7 % of the variance in the phenome of depression, and O&NS and NLS explained 42.9 % of the variance in brooding. Overall, these results indicate that SDMD and FE-SDMD are characterized by reduced total antioxidant defenses and increased aldehyde and NOx production. The combined effects of oxidative and psychological stressors are substantially associated with the manifestation of SDMD.
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Malondialdeído , Óxido Nítrico , Estresse Oxidativo , Estresse Psicológico , Estudantes , Humanos , Masculino , Feminino , Óxido Nítrico/metabolismo , Malondialdeído/sangue , Malondialdeído/metabolismo , Adulto Jovem , Estresse Psicológico/metabolismo , Estudantes/psicologia , Estresse Oxidativo/fisiologia , Depressão/metabolismo , Depressão/psicologia , Adulto , Transtorno Depressivo Maior/metabolismo , Estresse Nitrosativo/fisiologia , Universidades , Biomarcadores/sangue , Adolescente , Experiências Adversas da InfânciaRESUMO
Chemotherapy-induced peripheral neuropathy (CIPN) and associated pain are prevalent adverse effects of pediatric cancer treatment, significantly affecting the patient's quality of life. Their impact and risk factors have yet to be assessed in our country. This study aimed to assess the prevalence and clinical characteristics of CIPN, as well as to explore associations with patient- and treatment-related variables, within a cohort of Argentinean pediatric oncology patients. Sixty-six patients diagnosed with malignant hematopoietic tumors and receiving the neurotoxic agent vincristine were included in this observational study. Variables analyzed included age, gender, anthropometric measurements, tumor type, chemotherapy treatment, development of pain and other symptoms, severity, and analgesic treatment. The study population consisted of 39 boys and 27 girls. Most patients received two or three neurotoxic drugs. Symptoms consistent with CIPN were identified in 15 children, reflecting a prevalence of 23%. The main symptom was pain in the lower limbs, with some patients reporting jaw or generalized body pain. Pain was categorized as moderate or severe in 60% and 27% of cases, respectively. NSAIDs, anticonvulsants, and/or opioids were prescribed. Among the patient- and treatment-related variables analyzed as potential risk factors, the use of vincristine in conjunction with cytarabine and the administration of a higher number of neurotoxic drugs demonstrated significant association with the development of CIPN. CONCLUSIONS: Combination therapy stands out as a risk factor for clinical CIPN. The high prevalence of moderate/severe pain underscores the importance of close vigilance given its potential to compromise the patient's overall well-being. WHAT IS KNOWN: ⢠Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent adverse effect and dose-limiting factor in pediatric cancer treatment. ⢠Prevalence varies among regions and risk factors are still under study. WHAT IS NEW: ⢠Prevalence of symptomatic CIPN is 23% among pediatric patients undergoing treatment for hematopoietic tumors in a referral hospital in Argentina. Most patients report moderate or severe pain. ⢠Combining vincristine with cytarabine and using a higher number of neurotoxic drugs in combination therapies exhibit significant association with the development of CIPN-related symptoms.
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Doenças do Sistema Nervoso Periférico , Vincristina , Humanos , Masculino , Feminino , Criança , Adolescente , Pré-Escolar , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doenças do Sistema Nervoso Periférico/epidemiologia , Vincristina/efeitos adversos , Argentina/epidemiologia , Fatores de Risco , Prevalência , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Dor/tratamento farmacológico , Dor/epidemiologia , Dor/etiologia , Lactente , Qualidade de Vida , Medição da DorRESUMO
Chikungunya disease typically presents with the fever-arthralgia-rash symptom triad. However, an increase in the number of atypical clinical manifestations, particularly neurological disorders, has occurred. The current evidence regarding the pooled prevalence of Chikungunya virus (CHIKV)-associated neurological cases (CANCs) suspected of having an arboviral aetiology is not well-understood. Therefore, this meta-analysis included 19 studies (n = 7319 patients) and aimed to determine the pooled rate of exposure to CANC. The pooled positivity rate of CANC was 12 % (95 % CI: 6-19), and Brazil was overrepresented (11/19). These estimations varied between 3 and 14 % based on the diagnostic method (real-time PCR vs. ELISA-IgM) and biological samples (cerebrospinal fluid or blood specimens) used for detection of CHIKV. Regarding the frequency of CHIKV in neurological clinical subgroups, the rates were higher among patients with myelitis (27 %), acute disseminated encephalomyelitis (27 %), Guillain-Barré syndrome (15 %), encephalitis (12 %), and meningoencephalitis (7 %). Our analysis highlights the significant burden of CANC. However, the data must be interpreted with caution due to the heterogeneity of the results, which may be related to the location of the studies covering endemic periods and/or outbreaks of CHIKV. Current surveillance resources should also focus on better characterizing the epidemiology of CHIKV infection in neurological disorders. Additionally, future studies should investigate the interactions between CHIKV and neurological diseases with the aim of gaining deeper insight into the mechanisms underlying the cause-and-effect relationship between these two phenomena.
Assuntos
Febre de Chikungunya , Vírus Chikungunya , Síndrome de Guillain-Barré , Doenças do Sistema Nervoso , Humanos , Brasil/epidemiologia , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/diagnóstico , Vírus Chikungunya/isolamento & purificação , Encefalomielite Aguda Disseminada/epidemiologia , Encefalomielite Aguda Disseminada/virologia , Síndrome de Guillain-Barré/epidemiologia , Síndrome de Guillain-Barré/virologia , Meningoencefalite/epidemiologia , Meningoencefalite/virologia , Mielite/epidemiologia , Mielite/virologia , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/virologia , PrevalênciaRESUMO
INTRODUCTION: Considering the prospects of increased prevalence and disability due to neck and low back pain, it is relevant to investigate the care processes adopted, to assist future public policies and decision-making for a better allocation of resources. Objective: the aim of this study was to estimate the costs arising from inpatient and outpatient care of individuals with Neck Pain (NP) and Low Back Pain (LBP) in Brazil, between 2010 and 2019. METHODS: This is a cost-of-illness study from the perspective of the Brazilian public health system, based on health conditions with high prevalence (neck and low back pain). Data were presented descriptively using absolute and relative values. RESULTS: Between 2010 and 2019, the health system spent more than $600 million (R$ 2.3 billion) to treat NP and LBP in adults, and LBP accounted for most of the expenses. Female had higher absolute expenses in inpatient care and in the outpatient system. CONCLUSION: Our study showed that the costs with NP and LBP in Brazil were considerable. Female patients had higher outpatient costs and male patients had higher hospitalization costs. Healthcare expenses were concentrated for individuals between 34 and 63 years of age.
This study focused on understanding how much it cost to treat neck pain (NP) and low back pain (LBP) in Brazil between 2010 and 2019, from the point of view of the public health system (i.e. Unified Health System SUS). The idea was to find out how much money was spent and where. It turned out that the SUS spent, in total, more than US$600 million (R$2.3 billion) with LBP responsible for most of these expenses. Furthermore, we noted that women had higher outpatient care costs, while men had higher hospitalization costs. Those costs were more concentrated in people aged between 34 and 63 years.
Assuntos
Assistência Ambulatorial , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Hospitalização , Dor Lombar , Cervicalgia , Humanos , Brasil , Dor Lombar/economia , Dor Lombar/terapia , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Cervicalgia/terapia , Cervicalgia/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Assistência Ambulatorial/economia , Prevalência , Adulto Jovem , Saúde Pública/economia , Idoso , Fatores Sexuais , Adolescente , Fatores EtáriosRESUMO
Frailty and sarcopenia are well-recognized factors related to worse outcomes in patients with cirrhosis, including liver transplant (LT) candidates. Implications of pre-LT functional and muscle deterioration also affect post-LT outcomes. Patients with cirrhosis and acute-on-chronic liver failure (ACLF) have a lower survival rate, both before and after LT. There is a need to better identify those patients with ACLF who would benefit from LT. This review aims to present the available data about frailty and sarcopenia in patients with ACLF in the LT setting. An exhaustive review of the published literature was conducted. Data regarding frailty and sarcopenia in LT candidates with ACLF are scarce and heterogeneous. Studies evaluating frailty and sarcopenia in critically ill patients outside the liver literature are also presented in this review to enrich the knowledge of this field in expansion. Frailty and sarcopenia seem to contribute to worse outcomes in LT candidates with ACLF, both before and after LT. Sarcopenia evaluation may be the most prudent approach for those very sick patients. Skeletal muscle index assessed by computed tomography is recommended to evaluate sarcopenia. The role of muscle ultrasound and bioelectrical impedance analysis is to be determined. Frailty and sarcopenia are crucial factors to consider on a case-by-case basis in LT candidates with ACLF to improve patient outcomes.