Risultati per: Follow-up ottimale dopo embolia polmonare acuta

#Prontiatornare lanciata dopo il caso dei professionisti indiani

Objectives
This study aimed to assess the productivity loss and cost due to maternal ill-health conditions and its associated factors throughout pregnancy in rural Sri Lanka.

Design
A follow-up study of women registered in the Rajarata Pregnancy Cohort (RaPCo).

Setting
Anuradhapura district, Sri Lanka.

Participants
1573 pregnant women who were followed up from pregnancy identification to termination.

Primary and secondary outcome measures
The primary outcome measures of this study are productivity loss due to maternal ill-health conditions expressed by days/month and productivity cost due to maternal ill-health conditions expressed in monetary terms (US$)/month. Data were collected monthly, and all pregnant women were asked to report the leading cause of maternal ill-health condition and the associated loss due to absenteeism and presenteeism.

Results
During the pregnancy follow-up, 3595 (81.5%) months had at least one episode of maternal ill-health condition. Of these, only 1729 (48.1%) episodes sought medical care. Assistance for lost routine work was reported in 1281 (35.6%) episodes. The absenteeism, presenteeism and gross and net productivity loss per month were 3.6, 4.5, 8.1 and 5.5 days/month, respectively. The corresponding productivity cost was US$15.26/month. Nausea and vomiting (NVP) reported the highest prevalence (n=1599, 44.5%) until the second month of the third trimester, presenteeism (5.5 days/month) and gross productivity loss (9.5 days/month). Pregnant women with vaginal bleeding reported the highest absenteeism (6.2 days/month) and net productivity loss (6.8 days/month). Pregnant women diagnosed with anaemia reported the highest productivity cost (US$26.98/month). Monthly household expenditure, poverty and receiving assistance were the associated factors of productivity loss (p

Prevailing dogma in the treatment of acute ischemic stroke has long dictated that endovascular reperfusion of large infarcted areas distal to an occluded large intracranial artery is detrimental to patient outcomes. These concerns were rooted in the presumed deleterious effects of reperfusion, most notably symptomatic intracranial hemorrhage, and in the constrained opportunity to improve outcome due to the substantial infarction already present. Indeed, the initial waves of positive randomized endovascular stroke trials addressing thrombectomy in the early time window (0-6 hours) and with imaging selection in the late time window (6-24 hours) generally excluded from enrollment patients with a large baseline infarct (core). However, among the relatively small number of patients with large core infarcts inadvertently enrolled in these trials, analyses suggested an acceptable safety profile and potential benefit of thrombectomy. These rather unexpected findings led to the launch of several randomized trials prospectively assessing the efficacy and safety of thrombectomy in patients with acute ischemic stroke presenting with a large core and proximal large vessel occlusion in the anterior circulation. Across these trials, characterization of the infarcted brain has occurred with different imaging modalities using different definitions for what constitutes a large core, but common to all trials has been a requirement that infarction already be present on computed tomography (CT) or magnetic resonance imaging (MRI) in at least 5 of the 10 regions of the Alberta Stroke Program Early CT Score (ASPECTS) scale.

Objective
To assess the magnitude of diabetic health literacy (DHL) and associated factors among diabetes patients attending follow-up at public hospitals in Northeastern Ethiopia.

Design
An institution-based cross-sectional study was conducted from 24 May to 24 June 2022.

Setting
Diabetic clinics of four public hospitals in Northeastern Ethiopia.

Participants
611 adult diabetes patients who have been undergoing follow-up care for at least 6 months were systematically selected. Patients who were unable to communicate, were critically ill and with gestational diabetes mellitus were excluded from the study.

Outcomes
DHL was assessed using a 15-item tool developed from existing literature.

Results
Of all the participants, 300 (49.1%) had low, 174 (28.5%) moderate and 137 (22.4%) had high DHL levels. The significant factors impacting DHL included age (

The US Food and Drug Administration (FDA) approved the first at-home test for syphilis for sale without a prescription. The test, manufactured by NOWDiagnostic and called First To Know Syphilis Test, arrives amid an 80% increase in cases in the US between 2018 and 2022, from 115 000 to 207 000 cases.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

HIV prevention remains a major public health challenge. In 2019, after years of new HIV diagnoses hovering around 38 000 individuals in the US per year, agencies across the US Department of Health and Human Services developed the Ending the HIV Epidemic in the US plan to reduce new HIV diagnoses by 90% by 2030. With setbacks from converging pandemics, in 2021 new infections hovered at 36 000. Thus, finding ways to optimize HIV prevention, including strategies such as pre-exposure prophylaxis (PrEP), is urgent.

Symptoms such as abdominal bloating and pain have been a signal to UK and US clinicians to perform diagnostic tests for ovarian cancer. If the results are abnormal, patients in the UK may be fast-tracked for a referral within 2 weeks, despite a lack of clear evidence on how effective this is for women with aggressive ovarian cancer.

Circulation, Volume 150, Issue 14, Page 1151-1153, October 1, 2024.

Circulation, Ahead of Print. Background: Substernal lead placement of the extravascular implantable cardioverter-defibrillator (EV ICD) permits both defibrillation at thresholds similar to those seen with transvenous ICDs and effective antitachycardia pacing (ATP), while avoiding the vasculature and associated complications. The global Pivotal study has shown the EV ICD system to be safe and effective through 6 months, but long-term experience has yet to be published. We aim to report the performance and safety of the EV ICD system throughout the study.Methods: The EV ICD Pivotal study was a prospective, global, single-arm, pre-market clinical study. Individuals with a class I or IIa indication for a single-chamber ICD per guidelines were enrolled. Freedom from major system- or procedure-related complications, as well as appropriate and inappropriate therapy rates, were assessed through 3 years using the Kaplan-Meier method. Anti-tachycardia pacing success was calculated using simple proportions.Results: An implant was attempted in 316 patients [25.3% female, 53.8±13.1 years old, 81.6% primary prevention, LVEF 38.9%±15.4%]. Of 299 patients with a successful implant, 24 experienced 82 spontaneous arrhythmic episodes that were appropriately treated with either ATP only (38, 46.3%), shock only (34, 41.5%), or both (10, 12.2%) for a Kaplan-Meier-estimated rate of first any appropriate therapy of 9.2% at 3 years. Antitachycardia pacing was successful in 77.1% (37/48) of episodes, and ATP usage significantly increased from discharge to last follow-up visit (P

Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States. Despite evidence that screening effectively reduces incidence and mortality, screening is suboptimal, especially in safety net healthcare systems and federally qualified health centers (FQHCs). Safety net healthcare systems represent 25% of U.S. hospitals and are defined as hospitals that organize and deliver a significant level of healthcare and other related services to individuals without insurance, receiving Medicaid, and other vulnerable patients.

Bene lo studio di fase III

Objectives
We examined how asymptomatic metabolic syndrome (MetS) in midlife affects cardiovascular (CV) morbidity and all-cause mortality later in life and studied difference in time to event and from the individual components related to MetS.

Design
Population-based matched cohort study including data from a screening programme for identification of CV risk factors.

Setting
Primary care, County of Västmanland, Sweden.

Participants
All inhabitants turning 40 or 50 years between 1990 and 1999 were invited to a health screening. Total 34 269 (60.1%) individuals completed the health examination. Participants that met a modified definition of MetS were individually matched to two controls without MetS with regard to age, sex and date of health examination.

Interventions
None.

Main outcome measures
CV events and all-cause mortality from the index examination to June 2022.

Results
All 5084 participants with MetS were matched to two controls. There were 1645 (32.4%) CV events in the MetS group and 2321 (22.8%) CV events for controls. 1317 (25.9%) MetS and 1904 (18.7%) control subjects died. The adjusted HRs (aHR) for CV event and death were significantly higher when MetS was present (aHR) 1.39*** (95% CI 1.28 to 1.50) and 1.27*** (95% CI 1.16 to 1.40) respectively. The factor analysis identified three dominating factors: blood pressure, cholesterol and blood glucose. Mean time for first CV event and death was 2.6 years and 1.5 years shorter respectively for participants within the highest quartile compared with participants with lower mean arterial blood pressure (MAP). The aHR for each 10 mm Hg increased MAP were 1.19*** (95% CI 1.15 to 1.23) for CV event and 1.16*** (95% CI 1.11 to 1.21) for death.

Conclusion
The risk of a CV event and premature death is significantly increased when MetS is present. Early detection of metabolic risk factors, especially, high blood pressure, opens a window of opportunity to introduce preventive treatment to reduce CV morbidity and all-cause mortality.

Objectives
This study aimed to estimate the incidence of asthma and assess the association between job exposure matrix (N-JEM) assigned occupational exposure, self-reported occupational exposure to vapour, gas, dust and fumes (VGDF), mould, damages from moisture and cold, and new-onset asthma. We also aimed to assess the corresponding population attributable fraction (PAF) for ever exposure to VGDF.

Design
Longitudinal population-based respiratory health study.

Setting
Responders from the baseline Telemark Study in south-eastern Norway were followed up from 2013 to 2018.

Participants
7120 participants, aged 16–55, were followed during a 5-year period.

Main outcome measures
New-onset asthma and its association with self-reported occupational exposure to VGDF, data from the N-JEM and self-reported workplace conditions were assessed using logistic regression adjusted for gender, age, smoking and body mass index. The PAF was calculated using the PUNAF command in STATA.

Results
There were 266 (3.7%) cases of new-onset asthma and an incidence density of 7.5 cases per 1000 person-years. A statistically significant association was found for ever exposed to VGDF with an OR of 1.49 (95% CI 1.15 to 1.94), weekly OR 2.00 (95% CI 1.29 to 3.11) and daily OR 2.46 (95% CI 1.39 to 4.35) exposure to VGDF. The corresponding PAF for ever exposed to VGDF was 17% (95% CI 5.4% to 27.8%) and the risk of asthma onset increased with frequent VGDF exposure, indicating a possible exposure–response relationship (p=0.002 for trend). The N-JEM exposure group, accidental peak exposure to irritants had an increased risk of new-onset asthma, OR 2.43 (95% CI 1.21 to 4.90). A significant association was also found for self-reported exposure to visible damages due to moisture 1.51 (95% CI 1.08 to 2.11), visible and smell of mould 1.88 (95% CI 1.32 to 2.68), 1.55 (95% CI 1.12 to 2.16) and cold environment 1.41 (95% CI 1.07 to 1.86).

Conclusion
Participants had elevated ORs for asthma associated with self-reported and N-JEM-assigned exposures. A PAF of 17% indicates that work-related asthma is still common. The possible exposure–response relationship suggests that reducing occupational VGDF exposure frequency could prevent the onset of asthma.