Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 42
Filtrar
1.
Epidemiology ; 33(3): 346-353, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35383642

RESUMO

Quantifying the impact of natural disasters or epidemics is critical for guiding policy decisions and interventions. When the effects of an event are long-lasting and difficult to detect in the short term, the accumulated effects can be devastating. Mortality is one of the most reliably measured health outcomes, partly due to its unambiguous definition. As a result, excess mortality estimates are an increasingly effective approach for quantifying the effect of an event. However, the fact that indirect effects are often characterized by small, but enduring, increases in mortality rates present a statistical challenge. This is compounded by sources of variability introduced by demographic changes, secular trends, seasonal and day of the week effects, and natural variation. Here, we present a model that accounts for these sources of variability and characterizes concerning increases in mortality rates with smooth functions of time that provide statistical power. The model permits discontinuities in the smooth functions to model sudden increases due to direct effects. We implement a flexible estimation approach that permits both surveillance of concerning increases in mortality rates and careful characterization of the effect of a past event. We demonstrate our tools' utility by estimating excess mortality after hurricanes in the United States and Puerto Rico. We use Hurricane Maria as a case study to show appealing properties that are unique to our method compared with current approaches. Finally, we show the flexibility of our approach by detecting and quantifying the 2014 Chikungunya outbreak in Puerto Rico and the COVID-19 pandemic in the United States. We make our tools available through the excessmort R package available from https://cran.r-project.org/web/packages/excessmort/.


Assuntos
COVID-19 , Tempestades Ciclônicas , Humanos , Pandemias , Porto Rico/epidemiologia , Estados Unidos/epidemiologia
2.
Brain Sci ; 11(7)2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34356191

RESUMO

Learning disorders (LDs) are diagnosed in children impaired in the academic skills of reading, writing and/or mathematics. Children with LDs usually exhibit a slower resting-state electroencephalogram (EEG), corresponding to a neurodevelopmental lag. Frequently, children with LDs show working memory (WM) impairment, associated with an abnormal task-related EEG with overall slower EEG activity (more delta and theta power, and less gamma activity in posterior sites). These EEG patterns indicate inefficient neural resource management. Neurofeedback (NFB) treatments aimed at normalizing the resting-state EEG of LD children have shown improvements in cognitive-behavioral indices and diminished EEG abnormalities. Given the typical findings of WM impairment in children with LDs, we aimed to explore the effects of an NFB treatment on the WM of children with LDs by analyzing the WM-related EEG power spectrum. EEGs of 18 children (8-11 y.o.) with LDs were recorded, pre- and post-treatment, during performance of a Sternberg-type WM task. Thirty sessions of an NFB treatment (NFB-group, n = 10) or 30 sessions of a placebo-sham treatment (sham-group, n = 8) were administered. We analyzed the before and after treatment group differences for the behavioral performance and the WM-related EEG power spectrum. The NFB group showed faster response times in the WM task post-treatment. They also exhibited a decreased theta power and increased beta and gamma power at the frontal and posterior sites post-treatment. We explain these findings in terms of NFB improving the efficiency of neural resource management, maintenance of memory representations, and improved subvocal memory rehearsal.

3.
Arch. cardiol. Méx ; 91(1): 100-104, ene.-mar. 2021. graf
Artigo em Espanhol | LILACS | ID: biblio-1152866

RESUMO

Resumen La cardiomiopatía de Takotsubo es una entidad caracterizada por disfunción ventricular aguda y transitoria, la cual está generalmente relacionada a un evento desencadenante (estrés emocional o físico) y que, por lo general, se presenta con disfunción sistólica regional del ventrículo izquierdo, aunque hasta en un 30% puede ser biventricular. Según su severidad, en algunos casos puede condicionar choque cardiogénico refractario a manejo con inotrópicos y vasopresores, por lo que para estos casos deben considerarse los dispositivos de asistencia circulatoria. Presentamos el caso de una paciente joven a quien se realizó cambio valvular pulmonar con prótesis biológica, la cual siete semanas posteriores a la cirugía acudió al servicio de urgencias con derrame pericárdico y fisiología de tamponade secundario a síndrome pospericardiotomía. Por tal motivo se le practicó ventana pericárdica, sin embargo durante el transquirúrgico presentó cardiomiopatía de Takotsubo biventricular que le condicionó choque cardiogénico con insuficiencia mitral y tricúspidea severas y refractariedad a tratamiento médico, así como a balón intraaórtico de contrapulsación (BIAC), por lo cual requirió soporte circulatorio con ECMO venoarterial durante 5 días.


Abstract Takotsubo cardiomyopathy is an entity characterized by acute and transient ventricular dysfunction, which is usually related to a triggering event (emotional or physical stress), and usually presents with regional systolic dysfunction of the left ventricle, however up to 30% may be biventricular. Depending on its severity in some cases the disease can condition refractory cardiogenic shock to management with inotropics and vasopressors, so for these cases circulatory assistance devices should be considered. We present the case of a young patient who had pulmonary valve change with biological prosthesis, which seven weeks after surgery went to the emergency department with pericardial effusion and tamponade physiology secondary to postpericardiotomy syndrome. For this reason pericardial window was practiced, however during the procedure she presented biventricular Takotsubo cardiomyopathy which conditioned cardiogenic shock with severe mitral and tricuspid regurgitation, and refractivity to medical treatment as well as intraaortic balloon pump, requiring circulatory support with venoarterial ECMO for 5 days.


Assuntos
Humanos , Feminino , Adulto , Oxigenação por Membrana Extracorpórea , Cardiomiopatia de Takotsubo/terapia
4.
Proc Natl Acad Sci U S A ; 117(51): 32772-32778, 2020 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-33293417

RESUMO

Population displacement may occur after natural disasters, permanently altering the demographic composition of the affected regions. Measuring this displacement is vital for both optimal postdisaster resource allocation and calculation of measures of public health interest such as mortality estimates. Here, we analyzed data generated by mobile phones and social media to estimate the weekly island-wide population at risk and within-island geographic heterogeneity of migration in Puerto Rico after Hurricane Maria. We compared these two data sources with population estimates derived from air travel records and census data. We observed a loss of population across all data sources throughout the study period; however, the magnitude and dynamics differ by the data source. Census data predict a population loss of just over 129,000 from July 2017 to July 2018, a 4% decrease; air travel data predict a population loss of 168,295 for the same period, a 5% decrease; mobile phone-based estimates predict a loss of 235,375 from July 2017 to May 2018, an 8% decrease; and social media-based estimates predict a loss of 476,779 from August 2017 to August 2018, a 17% decrease. On average, municipalities with a smaller population size lost a bigger proportion of their population. Moreover, we infer that these municipalities experienced greater infrastructure damage as measured by the proportion of unknown locations stemming from these regions. Finally, our analysis measures a general shift of population from rural to urban centers within the island. Passively collected data provide a promising supplement to current at-risk population estimation procedures; however, each data source has its own biases and limitations.

5.
Brain Sci ; 10(11)2020 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-33158135

RESUMO

Learning disorders (LDs) are diagnosed in children whose academic skills of reading, writing or mathematics are impaired and lagging according to their age, schooling and intelligence. Children with LDs experience substantial working memory (WM) deficits, even more pronounced if more than one of the academic skills is affected. We compared the task-related electroencephalogram (EEG) power spectral density of children with LDs (n = 23) with a control group of children with good academic achievement (n = 22), during the performance of a WM task. sLoreta was used to estimate the current distribution at the sources, and 18 brain regions of interest (ROIs) were chosen with an extended version of the eigenvector centrality mapping technique. In this way, we lessened some drawbacks of the traditional EEG at the sensor space by an analysis at the brain-sources level over data-driven selected ROIs. Results: The LD group showed fewer correct responses in the WM task, an overall slower EEG with more delta and theta activity, and less high-frequency gamma activity in posterior areas. We explain these EEG patterns in LD children as indices of an inefficient neural resource management related with a delay in neural maturation.

6.
Arch Cardiol Mex ; 91(1): 100-104, 2020 08 05.
Artigo em Espanhol | MEDLINE | ID: mdl-33008148

RESUMO

La cardiomiopatía de Takotsubo es una entidad caracterizada por disfunción ventricular aguda y transitoria, la cual está generalmente relacionada a un evento desencadenante (estrés emocional o físico) y que, por lo general, se presenta con disfunción sistólica regional del ventrículo izquierdo, aunque hasta en un 30% puede ser biventricular. Según su severidad, en algunos casos puede condicionar choque cardiogénico refractario a manejo con inotrópicos y vasopresores, por lo que para estos casos deben considerarse los dispositivos de asistencia circulatoria. Presentamos el caso de una paciente joven a quien se realizó cambio valvular pulmonar con prótesis biológica, la cual siete semanas posteriores a la cirugía acudió al servicio de urgencias con derrame pericárdico y fisiología de tamponade secundario a síndrome pospericardiotomía. Por tal motivo se le practicó ventana pericárdica, sin embargo durante el transquirúrgico presentó cardiomiopatía de Takotsubo biventricular que le condicionó choque cardiogénico con insuficiencia mitral y tricúspidea severas y refractariedad a tratamiento médico, así como a balón intraaórtico de contrapulsación (BIAC), por lo cual requirió soporte circulatorio con ECMO venoarterial durante 5 días.


Assuntos
Oxigenação por Membrana Extracorpórea , Cardiomiopatia de Takotsubo/terapia , Adulto , Feminino , Humanos
7.
Arch Cardiol Mex ; 90(2): 116-123, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32897248

RESUMO

Background: Echocardiographic cardiac parameters in the prone position are usually obtained with an esophageal probe. The feasibility of obtaining them by means of a transthoracic approach is unknown. Objective: Estimating the feasibility to obtain parameters of the right ventricle by transthoracic echocardiography in prone position on the subject. Methods: Pilot design of consecutive case series without cardiopulmonary disease. Demographic, vital signs and echocardiographic variables were defined in the ventral initial, prone and ventral final decubitus positions. The data are shown with averages and standard deviations, and frequencies and percentages according to the variable. The differences between the positions were calculated with ANOVA of repeated samples and adjustment of Bonferroni test. Intra-subject variability was obtained by the Bland-Altman procedure and its 95% confidence interval. Results: We studied 50 subjects, 44 (88%) males, age 30 ± 6 years and body mass index 25.65 ± 2.71 kg/m2. Tricuspid annular plane systolic excursion (TAPSE) and S'-wave were measured 100% of the time. The vital signs and echocardiographic variables according to the position had differences in: heart rate (74 ± 9 vs. 77 ± 9 vs. 75 ± 8 beats/min), partial oxygen saturation (94.40 ± 1.70 vs. 96.64 ± 1.79 vs. 95.32 ± 1.36%) and mean systemic blood pressure (65.33 ± 5.38 vs. 67.69 ± 6.31 vs. 65.29 ± 5.62 mmHg); TAPSE (19.74 ± 3.24 vs. 21.60 ± 2.97 vs. 19.44 ± 2.84 mm), mean difference (bias) 0 (2, -2.0) and S'-wave (13.52 ± 1.87 vs. 15.02 ± 2.09 vs. 13.46 ± 1.55 cm/s), mean difference (bias) -0.46 (1.21, -2.14) respectively. Conclusions: Obtaining right ventricle parameters by transthoracic ecocardiopraphy is feasible in the prone position.


Introducción: Los parámetros cardiacos ecocardiográficos en posición de decúbito prono usualmente se obtienen con sonda esofágica. Se desconoce la factibilidad de obtenerlos mediante aproximación transtorácica. Objetivo: Estimar la factibilidad para obtener parámetros del ventrículo derecho mediante ecocardiografía transtorácica en el sujeto en posición de decúbito prono. Métodos: Diseño piloto de serie de casos consecutivos sin enfermedad cardiopulmonar. Se acotaron variables demográficas, signos vitales y ecocardiográficas en posición decúbito ventral inicial, prono y ventral final. Los datos se muestran con promedios y desviaciones estándar, y frecuencias y porcentajes de acuerdo con la variable. La diferencia entre las posiciones se calculó con ANOVA de muestras repetidas y ajuste de Bonferroni. Se obtuvo la variabilidad intrasujetos mediante el procedimiento de Bland-Altman y su intervalo de confianza al 95%. Resultados: Se estudiaron 50 sujetos, 44 (88%) masculinos, edad 30 ± 6 años e índice de masa corporal 25.65 ± 2.71 kg/m2. El TAPSE (excursión sistólica del plano del anillo tricuspídeo) y la onda S' se midieron en el 100% de las veces. Los signos vitales y variables ecocardiográficas de acuerdo con la posición tuvieron diferencias en: frecuencia cardiaca (74 ± 9 vs. 77 ± 9 vs. 75 ± 8 lpm), saturación parcial de oxígeno (94.40 ± 1.70 vs. 96.64 ± 1.79 vs. 95.32 ± 1.36%) y la presión arterial sistémica media (65.33 ± 5.38 vs. 67.69 ± 6.31 vs. 65.29 ± 5.62 mmHg); TAPSE (19.74 ± 3.24 vs. 21.60 ± 2.97 vs. 19.44 vs. 2.84 mm), diferencia media (sesgo) 0 (2, ­2.0) y onda S' (13.52 ± 1.87 vs. 15.02 ± 2.09 vs. 13.46 ± 1.55 cm/s), diferencia media (sesgo) ­0.46 (1.21, ­2.14) respectivamente. Conclusión: En posición de decúbito prono es factible obtener parámetros del ventrículo derecho por ecocardiografía transtorácica.


Assuntos
Ecocardiografia/métodos , Ventrículos do Coração/diagnóstico por imagem , Decúbito Ventral , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Projetos Piloto , Adulto Jovem
9.
Arch. cardiol. Méx ; 90(2): 116-123, Apr.-Jun. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1131019

RESUMO

Abstract Background: Echocardiographic cardiac parameters in the prone position are usually obtained with an esophageal probe. The feasibility of obtaining them by means of a transthoracic approach is unknown. Objective: Estimating the feasibility to obtain parameters of the right ventricle by transthoracic echocardiography in prone position on the subject. Methods: Pilot design of consecutive case series without cardiopulmonary disease. Demographic, vital signs and echocardiographic variables were defined in the ventral initial, prone and ventral final decubitus positions. The data are shown with averages and standard deviations, and frequencies and percentages according to the variable. The differences between the positions were calculated with ANOVA of repeated samples and adjustment of Bonferroni test. Intra-subject variability was obtained by the Bland-Altman procedure and its 95% confidence interval. Results: We studied 50 subjects, 44 (88%) males, age 30 ± 6 years and body mass index 25.65 ± 2.71 kg/m2. Tricuspid annular plane systolic excursion (TAPSE) and S'-wave were measured 100% of the time. The vital signs and echocardiographic variables according to the position had differences in: heart rate (74 ± 9 vs. 77 ± 9 vs. 75 ± 8 beats/min), partial oxygen saturation (94.40 ± 1.70 vs. 96.64 ± 1.79 vs. 95.32 ± 1.36%) and mean systemic blood pressure (65.33 ± 5.38 vs. 67.69 ± 6.31 vs. 65.29 ± 5.62 mmHg); TAPSE (19.74 ± 3.24 vs. 21.60 ± 2.97 vs. 19.44 ± 2.84 mm), mean difference (bias) 0 (2, -2.0) and S'-wave (13.52 ± 1.87 vs. 15.02 ± 2.09 vs. 13.46 ± 1.55 cm/s), mean difference (bias) -0.46 (1.21, -2.14) respectively. Conclusions: Obtaining right ventricle parameters by transthoracic ecocardiopraphy is feasible in the prone position.


Resumen Introducción: Los parámetros cardiacos ecocardiográficos en posición de decúbito prono usualmente se obtienen con sonda esofágica. Se desconoce la factibilidad de obtenerlos mediante aproximación transtorácica. Objetivo: Estimar la factibilidad para obtener parámetros del ventrículo derecho mediante ecocardiografía transtorácica en el sujeto en posición de decúbito prono. Métodos: Diseño piloto de serie de casos consecutivos sin enfermedad cardiopulmonar. Se acotaron variables demográficas, signos vitales y ecocardiográficas en posición decúbito ventral inicial, prono y ventral final. Los datos se muestran con promedios y desviaciones estándar, y frecuencias y porcentajes de acuerdo con la variable. La diferencia entre las posiciones se calculó con ANOVA de muestras repetidas y ajuste de Bonferroni. Se obtuvo la variabilidad intrasujetos mediante el procedimiento de Bland-Altman y su intervalo de confianza al 95%. Resultados: Se estudiaron 50 sujetos, 44 (88%) masculinos, edad 30 ± 6 años e índice de masa corporal 25.65 ± 2.71 kg/m2. El TAPSE (excursión sistólica del plano del anillo tricuspídeo) y la onda S' se midieron en el 100% de las veces. Los signos vitales y variables ecocardiográficas de acuerdo con la posición tuvieron diferencias en: frecuencia cardiaca (74 ± 9 vs. 77 ± 9 vs. 75 ± 8 lpm), saturación parcial de oxígeno (94.40 ± 1.70 vs. 96.64 ± 1.79 vs. 95.32 ± 1.36%) y la presión arterial sistémica media (65.33 ± 5.38 vs. 67.69 ± 6.31 vs. 65.29 ± 5.62 mmHg); TAPSE (19.74 ± 3.24 vs. 21.60 ± 2.97 vs. 19.44 vs. 2.84 mm), diferencia media (sesgo) 0 (2, -2.0) y onda S' (13.52 ± 1.87 vs. 15.02 ± 2.09 vs. 13.46 ± 1.55 cm/s), diferencia media (sesgo) -0.46 (1.21, -2.14) respectivamente. Conclusión: En posición de decúbito prono es factible obtener parámetros del ventrículo derecho por ecocardiografía transtorácica.


Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Ecocardiografia/métodos , Decúbito Ventral , Ventrículos do Coração/diagnóstico por imagem , Projetos Piloto , Estudos de Viabilidade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA