Risultati per: Linee guida ESC/ERS 2022 per la diagnosi e il trattamento dell'ipertensione polmonare

New England Journal of Medicine, Volume 391, Issue 3, Page 285-287, July 18, 2024.

Objectives
In the midst of the pandemic, face-to-face data collection for national censuses and surveys was suspended due to limitations on mobility and social distancing, limiting the collection of already scarce disability data. Responses to these constraints were met with a surge of high-frequency phone surveys (HFPSs) that aimed to provide timely data for understanding the socioeconomic impacts of and responses to the pandemic. This paper provides an assessment of HFPS datasets and their inclusion of disability questions to evaluate the visibility of persons with disabilities during the COVID-19 pandemic.

Design
We collected HFPS questionnaires conducted globally from the onset of the pandemic emergency in March 2020 until December 2022 from various online survey repositories. Each HFPS questionnaire was searched using a set of keywords for inclusion of different types of disability questions. Results were recorded in an Excel review log, which was manually reviewed by two researchers.

Methods
The review of HFPS datasets involved two stages: (1) a main review of 294 HFPS dataset-waves and (2) a semiautomated review of the same dataset-waves using a search engine-powered questionnaire review tool developed by our team. The results from the main review were compared with those of a sensitivity analysis using and testing the tool as an alternative to manual search.

Results
Roughly half of HFPS datasets reviewed and 60% of the countries included in this study had some type of question on disability. While disability questions were not widely absent from HFPS datasets, only 3% of HFPS datasets included functional difficulty questions that meet international standards. The search engine-powered questionnaire review tool proved to be able to streamline the search process for future research on inclusive data.

Conclusions
The dearth of functional difficulty questions and the Washington-Group Short Set in particular in HFPS has contributed to the relative invisibility of persons with disabilities during the pandemic emergency, the lingering effects of which could impede policy-making, monitoring and advocacy on behalf of persons with disabilities.

Objectives
Long-term sickness absence from employment has negative consequences for the economy and can lead to widened health inequalities. Sick notes (also called ‘fit notes’) are issued by general practitioners when a person cannot work for health reasons for more than 7 days. We quantified the sick note rate in people with evidence of COVID-19 in 2020, 2021 and 2022, as an indication of the burden for people recovering from COVID-19.

Design
Cohort study.

Setting
With National Health Service (NHS) England approval, we used routine clinical data (primary care, hospital and COVID-19 testing records) within the OpenSAFELY-TPP database.

Participants
People 18–64 years with a recorded positive test or diagnosis of COVID-19 in 2020 (n=365 421), 2021 (n=1 206 555) or 2022 (n=1 321 313); general population matched in age, sex and region in 2019 (n=3 140 326), 2020 (n=3 439 534), 2021 (n=4 571 469) and 2022 (n=4 818 870); people hospitalised with pneumonia in 2019 (n=29 673).

Primary outcome measure
Receipt of a sick note in primary care.

Results
Among people with a positive SARS-CoV-2 test or COVID-19 diagnosis, the sick note rate was 4.88 per 100 person-months (95% CI 4.83 to 4.93) in 2020, 2.66 (95% CI 2.64 to 2.67) in 2021 and 1.73 (95% CI 1.72 to 1.73) in 2022. Compared with the age, sex and region-matched general population, the adjusted HR for receipt of a sick note over the entire follow-up period (up to 10 months) was 4.07 (95% CI 4.02 to 4.12) in 2020 decreasing to 1.57 (95% CI 1.56 to 1.58) in 2022. The HR was highest in the first 30 days postdiagnosis in all years. Among people hospitalised with COVID-19, after adjustment, the sick note rate was lower than in people hospitalised with pneumonia.

Conclusions
Given the under-recording of postacute COVID-19-related symptoms, these findings contribute a valuable perspective on the long-term effects of COVID-19. Despite likely underestimation of the sick note rate, sick notes were issued more frequently to people with COVID-19 compared with those without, even in an era when most people are vaccinated. Most sick notes occurred in the first 30 days postdiagnosis, but the increased risk several months postdiagnosis may provide further evidence of the long-term impact.

This cross-sectional study examines trends in deaths of despair by race and ethnicity from 1999 to 2022.

This Special Communication examines the Federal Trade Commission’s policy and legal actions related to alleged misconduct, consolidation, and anticompetitive behavior in the pharmaceutical market between 2000 and 2022.

This study examines substances identified during testing of counterfeit prescription pills seized by law enforcement in Rhode Island from 2017 to 2022.

Objective
To examine longitudinal trends in clinical management of lactational mastitis in women attending general practice.

Design
Open cohort study.

Setting
Australian general practice using data from MedicineInsight.

Participants
Women aged 18 to 44 years with one or more clinical encounters for lactational mastitis between January 2011 and July 2022.

Primary and secondary outcome measures
The primary outcome measure was the proportion of prescribed oral antibiotics based on the antibiotic type. Secondary outcome measures were the proportion of women prescribed other medications (eg, antifungals, lactation suppressants) or ordered selected clinical investigations including breast ultrasound, blood test, breast milk culture, nipple swab culture or breast aspirate. Outcomes were examined based on the calendar year and individual- or clinical practice-level characteristics.

Results
Among 25 002 women who had one or more clinical encounters related to mastitis, 90.9% were prescribed oral antibiotics. While the proportion of women prescribed an oral antibiotic remained consistent from 2011 to 2022 (91.1% vs 92.5%), there were changes in the proportion receiving prescriptions for di/flucloxacillin (46.1% vs 60.4%) and cefalexin (38.6% vs 26.5%). Fewer than 12% of women were clinically investigated for their mastitis encounter, most commonly a breast ultrasound (7.1%), followed by a selected blood test (3.8%). Requests for breast milk cultures, nipple swab cultures or breast aspirates occurred in less than 1.1% of individuals. Significant increases were evident with respect to ordering of all clinical investigations, with rates at least doubling between 2011 and 2022 (6.6% vs 14.7%). Large variability in clinical management was evident according to both individual- (eg, concessional status) and clinical practice-level characteristics (eg, remoteness).

Conclusions
Australian general practitioners commonly prescribe oral antibiotics to women with mastitis and largely in line with clinical guidelines. Their use of clinical investigations as part of mastitis management has increased over the last decade.

Circulation, Volume 149, Issue 21, Page e1218-e1218, May 21, 2024.

Objective
To assess practice of breast self-examination (BSE) and associated factors among women of reproductive age in the North Shoa Zone, Oromia, Ethiopia.

Design
Community-based cross-sectional study with a convergent mixed-methods approach.

Setting
The study was conducted in the North Shoa Zone of Oromia, Central Ethiopia, between 1 May 2022 and 30 June 2022.

Participants
1076 women of reproductive age were selected using simple random sampling technique for the quantitative study. For the qualitative part, a total of 46 women were approached purposively to elicit rich ideas and insight into the issue. The quantitative data were collected using an interviewer-administered questionnaire, and focus group discussions were used for the qualitative part. Quantitative data were analysed using SPSS V.26. An adjusted OR with a 95% CI was employed. Thematic analysis approach was applied for the qualitative data analysis.

Outcome measures
Participants were interviewed to respond whether they practised BSE.

Results
Overall, 192 (18.2%; 15.7%–20.5%) of the participants had ever performed BSE. Having a family history of breast cancer (BC) (adjusted OR (AOR)=6.9, 95% CI 4.6 to 10.3), being knowledgeable on BSE (AOR=3, 95% CI 1.9 to 4.3), having high perceived susceptibility (AOR=1.7, 95% CI 1.2 to 2.5), having high self-efficacy (AOR=1.5, 95% CI 1.1 to 2.3) and having a high perceived benefit to BSE (AOR=1.5, 95% CI 1.1 to 2.3) were significantly associated with increased odds of BSE practice.
Four main themes emerged from the qualitative analysis: BC and BSE-related knowledge, perceived benefits of treatment, barriers to BSE practice and enablers of BSE practice.

Conclusion
The practice of BSE in this area was considerably low. The North Shoa Zonal Health Office and other stakeholders should disseminate instructional materials that cover the techniques and benefits of regularly performing BSE. Healthcare professionals should engage in the community to address the obstacles women face in practising BSE.