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Li T, Li H. Exploration of Geographical Environmental Factors Influencing Regional Population Mortality Patterns in China. Am J Hum Biol 2024:e24153. [PMID: 39264229 DOI: 10.1002/ajhb.24153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 08/03/2024] [Accepted: 08/12/2024] [Indexed: 09/13/2024] Open
Abstract
OBJECTIVES The regional population mortality patterns in China exhibit substantial geographical distribution characteristics. This paper aims to explore the impact and mechanisms of geographical environmental factors on regional population mortality patterns. METHODS This study first utilized the data from China's Seventh Population Census to obtain mortality patterns for the 31 provincial-level administrative regions. Subsequently, a functional regression method was employed to explore the geographical environmental driving factors of regional mortality patterns. RESULTS The study provides a detailed explanation of the mechanisms and marginal contributions of key geographical environmental factors at different age groups. CONCLUSIONS (1) The impact of geographical environmental factors on mortality patterns shows distinct phased characteristics. Mortality patterns before the age of 40 years are hardly influenced by geographical environmental factors, with a noticeable impact beginning at ages 40-69 years and reaching the maximum influence after the age of 70 years. (2) In mortality patterns at ages 40-69 years, average altitude have the most substantial impact, followed by extreme low-temperature days and PM2.5 concentration. In mortality patterns at ages 70-94 years, high-temperature days have the greatest influence, followed by the impact of SO2 concentration. (3) In comparisons based on gender, socioeconomic factors, and geographical environmental factors, gender and urban-rural differences have the most significant impact on regional population mortality patterns, followed by the influence of other socioeconomic factors, with geographical environmental factors having a relatively smaller impact.
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Affiliation(s)
- Tiantian Li
- School of Systems Science, Beijing Normal University, Beijing, China
| | - Handong Li
- School of Systems Science, Beijing Normal University, Beijing, China
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Barp M, Carneiro VSM, Malaquias SG, Pagotto V. Temporal trend in venous thromboembolism hospitalization rates in Brazilian older adults, 2010-2020. J Thromb Thrombolysis 2023; 55:156-165. [PMID: 36335519 DOI: 10.1007/s11239-022-02724-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/08/2022]
Abstract
Aging is one of the main risk factors for venous thromboembolism (VTE). Changes in prevention, diagnosis, and treatment strategies for this condition in recent years require an analysis of its rates in health services. The objective of this study was to analyze a temporal trend of hospitalizations for VTE in Brazilian older adults. This ecological time series study used data from the Hospital Information System (HIS) on VTE hospitalizations from 2010 to 2020, selecting admissions with the main diagnosis of pulmonary thromboembolism (PTE) (I.26.0, I.26.9) and deep vein thrombosis (DVT) (I.80.0, I80.1, I80.2, I80.3, I80.8, I80.9). Hospitalization rates were calculated for each year and the Prais-Winsten. In Brazil, the trend of hospitalizations for VTE decreased, with an annual percentage change of - 40.71 (confidence interval [CI] - 50.46; - 29.04). DVT decreased, with an annual percentage change of - 43.14 (95% confidence interval [CI] - 51.36; - 33.54). All Brazilian regions showed a downward trend in hospitalizations for VTE and DVT, except for the Northeast region, which remained stable. Conversely, the trend of hospitalizations for PTE showed an upward in Brazil, with an annual percentage change of 4.33 (95% CI 1.26; 7.48). An upward trend was observed in hospitalizations for PTE in the Northeast region, and a stationary trend was observed in the other regions. The results showed a downward trend in hospitalization rates for DVT and an upward trend for PTE. The study indicates regional differences in rates and trends.
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Affiliation(s)
- Milara Barp
- Graduate Program in Nursing, Faculty of Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil.
| | | | | | - Valéria Pagotto
- Faculty of Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil
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Cunha MJS, Pinto CAV, Guerra JCDC, Tachibana A, Portugal MFC, Ferraz LJR, Wolosker N. Incidence, diagnosis, treatment methods, and outcomes of clinically suspected venous thromboembolic disease in patients with COVID-19 in a quaternary hospital in Brazil. J Vasc Bras 2021; 20:e20200203. [PMID: 34188671 PMCID: PMC8210641 DOI: 10.1590/1677-5449.200203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/15/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Prothrombotic states have been associated with viral infections and the novel Sars-COV-2 infection has been associated with elevated D-dimer levels, although no causal relation has been clearly established. OBJECTIVES This study presents an epidemiological analysis of manifest VTE episodes in a group of patients hospitalized because of COVID-19. METHODS Medical records of patients who presented symptomatic deep vein thrombosis and/or pulmonary embolism in concomitance with confirmed COVID-19 were retrospectively studied. Demographic characteristics, prevalence of VTE, site of occurrence, D-dimer variation over time, management, and outcomes were analyzed. RESULTS During the study period, 484 confirmed cases of COVID-19 were admitted, 64 of which displayed VTE symptoms and 13 of which had confirmed symptomatic VTE(2.68% of total sample and 20.31% of symptomatic cases). Most cases (76.92%) occurred in intensive care. On the day attributed to VTE onset, D-dimer levels were over 3,000 ng/mL in 8 (80%) patients, a significant increase from baseline admission levels (p < 0.05). A significant decrease was also observed in D-dimer values at hospital discharge (p < 0.05). All patients received pharmacological thromboprophylaxis and/or anticoagulation as indicated. Two deaths occurred during the study, both patients with severe comorbidities. At the end of our study protocol, nine patients had been discharged and two remained hospitalized, but had no signs of VTE worsening. CONCLUSIONS VTE prevalence in hospitalized COVID-19 patients was 2.7%, and higher in intensive care units. Early institution of prophylaxis and immediate full anticoagulation when VTE is diagnosed should be the goals of those who treat this kind of patient.
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Affiliation(s)
| | | | | | | | | | | | - Nelson Wolosker
- Hospital Israelita Albert Einstein – HIAE, São Paulo, SP, Brasil.
- Universidade de São Paulo – USP, Faculdade de Medicina, São Paulo, SP, Brasil.
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Takara NC, Ferreira NDC, Murakami BM, Lopes CT. Development and validation of an informative manual on venous thromboembolism for the lay population. EINSTEIN-SAO PAULO 2020; 18:eAO5425. [PMID: 32935827 PMCID: PMC7480492 DOI: 10.31744/einstein_journal/2020ao5425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/10/2020] [Indexed: 11/24/2022] Open
Abstract
Objective To develop an informative manual on venous thromboembolism prevention for the lay population and to estimate evidences of content and face validity. Methods A methodological study conducted in three stages. The first stage was the preparation of the manual, followed by content validation with cardiovascular specialists who judged clarity, theoretical relevance and practical pertinence on a 4-point Likert scale. Items with a content validity index ≤0.75 were revised and re-evaluated. The last stage was the face validation by lay people, who were interviewed regarding item understanding and visual appearance. Items with more than 80.0% positive opinions were considered adequate. Results The manual was developed containing nine illustrations, definition of the disease, risk factors, signs and symptoms, and preventive measures. In the first assessment round, the validity index was 1.0 for the text of all sections, with suggestions for language adjustments. As to the illustrations, the validity indexes ranged from 0.67 to 1.0. In the second round, the validity index reached 1.0 for all items. A total of 40 lay people participated in the face validation, and all considered the paper type and font size appropriate, as well as the font used as readable; 97.5% were able to understand the information contained in the manual; 98.0% considered it esthetically beautiful; and 90.0% considered the reading not tiresome. Conclusion The informative manual on venous thromboembolism prevention was prepared, its content validated by experts, and considered appropriate by the lay population. These results suggest that the manual may be used as a preventive educational strategy for venous thromboembolism.
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Affiliation(s)
| | | | - Beatriz Murata Murakami
- Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Rocha ATC, Pinheiro TB, de Souza PRSP, Marques MA. Venous thromboembolism prophylaxis protocols at Brazilian hospitals - PROTEV Brazil. J Vasc Bras 2020; 19:e20190119. [PMID: 34178064 PMCID: PMC8202209 DOI: 10.1590/1677-5449.190119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background In common with other international guidelines, the Agency for Healthcare Research
and Quality recommends implementation of venous thromboembolism (VTE) prophylaxis
programs in hospitals as a measure for patient safety. The VTE Safety Zone Program
(VTESZ) proposes a model for incorporation of systematic VTE risk-assessment into
hospital routines, with continuing institutional and multidisciplinary
participation. Objectives To evaluate implementation of VTE prophylaxis initiatives in Brazilian hospitals
that have adhered to the VTESZ Program. Methods Questionnaires were e-mailed to VTESZ Program representatives at hospitals visited
up to July 2016. Results Of the 132 invitations sent, 68 answers were obtained and 50 (73.5%) were
complete. 61.5% of participating hospitals had between 100 and 250 beds, and 65.4%
had more than 20 intensive care beds; 61.5% reported having hospital
accreditation, 86.3% had VTE prophylaxis committees, and 58% had electronic
medical records. VTE risk assessments using the Brazilian guidelines or the Padua
or Caprini scores were noted on the electronic medical record in 56.9% and were a
mandatory step in 45.1% of the cases. VTE risk reassessment was requested prior to
discharge in only 25% of hospitals and several issues were cited that negatively
affect the VTESZ implementation process. Conclusions This study provides an overview of implementation of VTESZ in Brazilian hospitals.
Systematic risk assessment is not yet conducted for most patients. Recognition of
various issues affecting the process may lead to new strategies for achieving
adequate prophylaxis and safety of hospitalized patients.
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Affiliation(s)
- Ana Thereza Cavalcanti Rocha
- Universidade Federal da Bahia - UFBA, Faculdade de Medicina da Bahia, Departamento de Saúde da Família, Salvador, BA, Brasil
| | - Thiago Brito Pinheiro
- Universidade Federal da Bahia - UFBA, Faculdade de Medicina da Bahia, Departamento de Saúde da Família, Salvador, BA, Brasil
| | | | - Marcos Arêas Marques
- Universidade do Estado do Rio de Janeiro - UERJ, Hospital Universitário Pedro Ernesto, Unidade Docente Assistencial de Angiologia, Rio de Janeiro, RJ, Brasil
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Fernandes CJCDS, Jardim CVP, Alves JL, Oleas FAG, Morinaga LTK, de Souza R. Reperfusion in acute pulmonary thromboembolism. J Bras Pneumol 2018; 44:0. [PMID: 29898007 PMCID: PMC6188696 DOI: 10.1590/s1806-37562017000000204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 01/19/2018] [Indexed: 01/03/2023] Open
Abstract
Acute pulmonary thromboembolism (APTE) is a highly prevalent condition (104-183 cases per 100,000 person-years) and is potentially fatal. Approximately 20% of patients with APTE are hypotensive, being considered at high risk of death. In such patients, immediate lung reperfusion is necessary in order to reduce right ventricular afterload and to restore hemodynamic stability. To reduce pulmonary vascular resistance in APTE and, consequently, to improve right ventricular function, lung reperfusion strategies have been developed over time and widely studied in recent years. In this review, we focus on advances in the indication and use of systemic thrombolytic agents, as well as lung reperfusion via endovascular and classical surgical approaches, in APTE.
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Affiliation(s)
- Caio Julio Cesar dos Santos Fernandes
- . Unidade de Circulação Pulmonar, Disciplina de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
- . Instituto do Câncer, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Carlos Vianna Poyares Jardim
- . Unidade de Circulação Pulmonar, Disciplina de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - José Leonidas Alves
- . Unidade de Circulação Pulmonar, Disciplina de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
- . Instituto do Câncer, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Francisca Alexandra Gavilanes Oleas
- . Unidade de Circulação Pulmonar, Disciplina de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Luciana Tamie Kato Morinaga
- . Unidade de Circulação Pulmonar, Disciplina de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Rogério de Souza
- . Unidade de Circulação Pulmonar, Disciplina de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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Zhang Z, Pan K, Chen L, Wang Y. The effect of nitric oxide inhalation on heart and pulmonary circulation in rabbits with acute massive pulmonary embolism. Exp Ther Med 2018; 16:270-276. [PMID: 29896249 PMCID: PMC5995066 DOI: 10.3892/etm.2018.6155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 04/19/2018] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to investigate the effect of nitric oxide inhalation (NOI) on cardiac troponin I (CTnI) levels and mean pulmonary arterial pressure (mPAP) in rabbits with acute massive pulmonary embolism (AMPE). Thirty rabbits were used as animal models for AMPE and received different treatments. A total of 4 h after successful modeling, the control group (CON, n=10) received conventional thrombolysis, whereas the treatment group (TRE, n=10) received conventional thrombolysis plus NOI. The experimental group (EXP, n=10) did not receive any treatments. Myocardial necrosis was pathologically confirmed in all 30 rabbits. In group EXP, the post-AMPE CTnI peak level was 0.42±0.12 µg/l, was achieved in 18.8±4.5 h and remained positive for 38.6±5.2 h (≥0.1 µg/l). These values were lower in group TRE when compared with those in groups CON and EXP (P<0.05). Group TRE exhibited significantly reduced mPAP at 24, 28, 32, and 34 h (P<0.05) when compared with group CON. AMPE-induced cardiac impairment was more severe in group EXP when compared with groups CON and TRE. The present findings indicated that the CTnI peak was significantly correlated with the corresponding mPAP. Furthermore, the results suggested NOI may reduce mPAP and CTnI peak levels, with protective effects against AMPE-induced myocardial damage in rabbits.
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Affiliation(s)
- Zeming Zhang
- Department of Respiratory Medicine, Affiliated Zhou Pu Hospital of Shanghai Health College, Shanghai 201318, P.R. China
| | - Kun Pan
- Department of Respiratory Medicine, Affiliated Hospital of Hebei University, Baoding, Hebei 071000, P.R. China
| | - Lu Chen
- Department of Respiratory Medicine, Affiliated Hospital of Hebei University, Baoding, Hebei 071000, P.R. China
| | - Yancun Wang
- Department of Respiratory Medicine, Affiliated Hospital of Hebei University, Baoding, Hebei 071000, P.R. China
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Carneiro RM, van Bellen B, Santana PRP, Gomes ACP. Prevalência de tromboembolismo pulmonar incidental em pacientes oncológicos: análise retrospectiva em grande centro. J Vasc Bras 2017; 16:232-238. [PMID: 29930652 PMCID: PMC5868940 DOI: 10.1590/1677-5449.002117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/01/2017] [Indexed: 01/24/2023] Open
Abstract
Contexto
Devido à maior aplicação de exames de imagem rotineiros, especialmente nos pacientes com neoplasia para controle da doença, vem aumentando o diagnóstico de tromboembolismo pulmonar (TEP) incidental, importante fator de morbimortalidade associado.
Objetivo
Identificar os casos de TEP incidental em pacientes oncológicos submetidos a tomografia computadorizada (TC) de tórax, correlacionando aspectos clínicos e fatores de risco associados.
Métodos
Estudo retrospectivo de todos os episódios de TEP ocorridos de janeiro de 2013 a junho de 2016, com seleção dos pacientes oncológicos e divisão deles em dois grupos: com suspeita clínica e sem suspeita clínica (incidentais) de embolia pulmonar.
Resultados
Foram avaliados 468 pacientes com TEP no período citado. Destes, 23,1% eram oncológicos, entre os quais 44,4% apresentaram achado incidental de embolia pulmonar na TC de tórax. Não houve diferença estatística entre os grupos para sexo, idade e tabagismo. Quanto à procedência, 58,3% dos pacientes sem suspeita clínica eram de origem ambulatorial e 41,7% com suspeita de TEP vinham do pronto-socorro (p < 0,001). As neoplasias mais prevalentes foram de pulmão (17,6%), intestino (15,7%) e mama (13,0%). Aqueles com achado incidental apresentaram significativamente mais metástases, sem diferença entre os grupos para realização de quimioterapia, radioterapia ou cirurgia recente. Quanto aos sintomas apresentados, 41,9% daqueles sem suspeita clínica tinham queixas sugestivas de TEP quando realizaram o exame.
Conclusão
TEP incidental é frequente em pacientes oncológicos, especialmente naqueles provenientes de seguimento ambulatorial e em estágios avançados da doença. Sintomas sugestivos de TEP estavam presentes em pacientes sem suspeita clínica ao realizarem a TC de tórax.
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Affiliation(s)
- Renata Mota Carneiro
- Hospital Beneficência Portuguesa de São Paulo – BP, Serviço de Cirurgia Vascular, São Paulo, SP, Brasil.
| | - Bonno van Bellen
- Hospital Beneficência Portuguesa de São Paulo – BP, Serviço de Cirurgia Vascular, São Paulo, SP, Brasil.
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