Aiming for the end of the COVID-19 pandemic: the what, how, who, where, and when

S

Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Artículo con numerosos autores. Sólo se hace referencia al primero que coincide con el de la UAM y al colectivoBackground Previous attempts to characterise the burden of chronic respiratory diseases have focused only on specific disease conditions, such as chronic obstructive pulmonary disease (COPD) or asthma. In this study, we aimed to characterise the burden of chronic respiratory diseases globally, providing a comprehensive and up-to-date analysis on geographical and time trends from 1990 to 2017. Methods Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we estimated the prevalence, morbidity, and mortality attributable to chronic respiratory diseases through an analysis of deaths, disability-adjusted life-years (DALYs), and years of life lost (YLL) by GBD super-region, from 1990 to 2017, stratified by age and sex. Specific diseases analysed included asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, pneumoconiosis, and other chronic respiratory diseases. We also assessed the contribution of risk factors (smoking, second-hand smoke, ambient particulate matter and ozone pollution, household air pollution from solid fuels, and occupational risks) to chronic respiratory disease-attributable DALYs. Findings In 2017, 544·9 million people (95% uncertainty interval [UI] 506·9–584·8) worldwide had a chronic respiratory disease, representing an increase of 39·8% compared with 1990. Chronic respiratory disease prevalence showed wide variability across GBD super-regions, with the highest prevalence among both males and females in high-income regions, and the lowest prevalence in sub-Saharan Africa and south Asia. The age-sex-specific prevalence of each chronic respiratory disease in 2017 was also highly variable geographically. Chronic respiratory diseases were the third leading cause of death in 2017 (7·0% [95% UI 6·8–7·2] of all deaths), behind cardiovascular diseases and neoplasms. Deaths due to chronic respiratory diseases numbered 3 914 196 (95% UI 3 790 578–4 044 819) in 2017, an increase of 18·0% since 1990, while total DALYs increased by 13·3%. However, when accounting for ageing and population growth, declines were observed in age-standardised prevalence (14·3% decrease), agestandardised death rates (42·6%), and age-standardised DALY rates (38·2%). In males and females, most chronic respiratory disease-attributable deaths and DALYs were due to COPD. In regional analyses, mortality rates from chronic respiratory diseases were greatest in south Asia and lowest in sub-Saharan Africa, also across both sexes. Notably, although absolute prevalence was lower in south Asia than in most other super-regions, YLLs due to chronic respiratory diseases across the subcontinent were the highest in the world. Death rates due to interstitial lung disease and pulmonary sarcoidosis were greater than those due to pneumoconiosis in all super-regions. Smoking was the leading risk factor for chronic respiratory disease-related disability across all regions for men. Among women, household air pollution from solid fuels was the predominant risk factor for chronic respiratory diseases in south Asia and sub-Saharan Africa, while ambient particulate matter represented the leading risk factor in southeast Asia, east Asia, and Oceania, and in the Middle East and north Africa super-region. Interpretation Our study shows that chronic respiratory diseases remain a leading cause of death and disability worldwide, with growth in absolute numbers but sharp declines in several age-standardised estimators since 1990. Premature mortality from chronic respiratory diseases seems to be highest in regions with less-resourced health systems on a per-capita basisBill & Melinda Gates Foundation

Sobre l’òpera i els seus metges

[cat] Aquesta investigació té com a objectiu analitzar el repertori de l’òpera en continguts de rols mèdics i de pacients. També per identificar personatges i passatges significatius que exemplifiquin el paper i la percepció canviants de la medicina en la societat durant cinc segles. Es va realitzar una cerca sistemàtica. Les característiques musicals i els rols interpretatius, i els seus determinants, van ser tabulats i analitzats formalment. De un total de 493 òperes, 52 (10,6%) es van identificar amb un pacient o un metge com a personatges. Abasten 239 anys, de 1777 a 2016. Més enllà de la Medicina de Família i els generalistes no especificats, algunes òperes es podrien atribuir a especialitats mèdiques, incloent 3 (5,8%) a Medicina Respiratòria. En les 33 òperes amb rols de metge, tots estan representats només per personatges masculins, distribuïts per corda principalment en les tonalitats greus. En general, el compositor que apareix amb el major interès en informar de malalties és Giuseppe Verdi, amb nou òperes incloent metges. Finalment, es pot observar una tendència en l’evolució del paper dels metges. Des de la majoria dels rols bufals menors, amb components màgics o còmics durant el segle XVIII, fins a un metge professional i tècnic més recentment. L’òpera mostra una percepció canviant dels rols dels metges i pacients al llarg de la història, amb un biaix de gènere que encara persisteix.[eng] This research aims to analyze the opera repertoire in terms of content of medical roles and patients. Also, to identify significant characters and passages that exemplify the changing role and perception of medicine in society for five centuries. A systematic search was performed. The musical characteristics and the interpretive roles, and their determinants, were tabulated and analyzed formally. Of a total of 493 operas, 52 (10.6%) were identified with a patient or a doctor as characters. They span 239 years, from 1777 to 2016. Beyond Family Medicine and non-specified generalists, some operas could be attributed to medical specialties, including 3 (5.8%) to Respiratory Medicine. In the 33 operas with medical roles, they are all represented only by male characters, distributed by chord mainly in the grave tunes. In general, the composer who appears with the greatest interest in reporting disease is Giuseppe Verdi, with nine operas including doctors. Finally, a trend in the changing role of doctors can be observed. From the majority of smaller buffal roles, with magical or comic components, in the XVIIIth century, to a professional and technical doctor more recently. Opera shows a changing perception of the roles of doctors and patients throughout history, with a blatant gender bias that still persists

Healthcare resource use and costs of severe, uncontrolled eosinophilic asthma in the UK general population

Acknowledgments The authors thank Derek Skinner (Cambridge Research Support Ltd, Oakington, Cambridge, UK) for assistance with data extraction.Peer reviewedPublisher PD

The Asthma Cost in Oman

Objectives: This study evaluates the direct costs of treating asthma in Oman. Methods: Asthma prevalence and unit cost estimates were based on results from a panel using the Delphi technique, and were applied to the total Omani population aged 5 and older to obtain the number of people diagnosed with asthma. The estimates from the Delphi exercise were multiplied by the percentage of patients using government facilities to estimate the number of asthma patients managed in Oman. Treatment costs were also calculated using data from the Delphi exercise and the Asthma Insights and Reality for the Gulf and Near East study (reported in Omani riyals [OMR] and US dollars [USD]). Results: The prevalence of asthma was estimated to be 7.3% of adults (n = 96,470) and 12.7% of children (n = 58,344). Of these, 95% of both adults and children were estimated to be using government healthcare facilities. Inpatient visits accounted for the largest proportion of total direct costs (55%), followed by emergency room and outpatient visits (25% and 20%, respectively) and medications (<0.2%). The annual cost of treatment excluding medications, was OMR 34,273,696 (USD 89,111,609) for adults and OMR 27,014,735 (USD 70,238,311) for children. Including medications, the total annual direct cost of asthma treatment was estimated to be over OMR 61,500,294 (USD 159,900,761). Conclusion: Given the high medical expenditures associated with facility visits relative to the lower medication costs, the focus of Oman’s asthma cost savings should be on improving asthma control rather than reducing medication costs

Clinical Characteristics and prognostic factors for Intensive Care Unit Admission of Patients With COVID-19. Retrospective Study Using Machine Learning and Natural Language Processing.

13 p.Background: Many factors involved in the onset and clinical course of the ongoing COVID-19 pandemic are still unknown. Although big data analytics and artificial intelligence are widely used in the realms of health and medicine, researchers are only beginning to use these tools to explore the clinical characteristics and predictive factors of patients with COVID-19. Objective: Our primary objectives are to describe the clinical characteristics and determine the factors that predict intensive care unit (ICU) admission of patients with COVID-19. Determining these factors using a well-defined population can increase our understanding of the real-world epidemiology of the disease. Methods: We used a combination of classic epidemiological methods, natural language processing (NLP), and machine learning (for predictive modeling) to analyze the electronic health records (EHRs) of patients with COVID-19. We explored the unstructured free text in the EHRs within the Servicio de Salud de Castilla-La Mancha (SESCAM) Health Care Network (Castilla-La Mancha, Spain) from the entire population with available EHRs (1,364,924 patients) from January 1 to March 29, 2020. We extracted related clinical information regarding diagnosis, progression, and outcome for all COVID-19 cases. Results: A total of 10,504 patients with a clinical or polymerase chain reaction?confirmed diagnosis of COVID-19 were identified; 5519 (52.5%) were male, with a mean age of 58.2 years (SD 19.7). Upon admission, the most common symptoms were cough, fever, and dyspnea; however, all three symptoms occurred in fewer than half of the cases. Overall, 6.1% (83/1353) of hospitalized patients required ICU admission. Using a machine-learning, data-driven algorithm, we identified that a combination of age, fever, and tachypnea was the most parsimonious predictor of ICU admission; patients younger than 56 years, without tachypnea, and temperature 39 ºC without respiratory crackles) were not admitted to the ICU. In contrast, patients with COVID-19 aged 40 to 79 years were likely to be admitted to the ICU if they had tachypnea and delayed their visit to the emergency department after being seen in primary care. Conclusions: Our results show that a combination of easily obtainable clinical variables (age, fever, and tachypnea with or without respiratory crackles) predicts whether patients with COVID-19 will require ICU admissio

Impact of the COVID-19 pandemic in mortality due to respiratory diseases: A comparative analysis of 2021 and 2020 vs 2019 in Spain.

Introduction: We previously reported an increase in respiratory mortality in 2020 in Spain after COVID-19. It is unclear if this rise is sustained in the longer-term. We aimed to determine whether respiratory mortality in 2021 in Spain returned to pre-pandemic levels. Material and methods: In an observational, large study using official National Institute of Statistics data, we explored deaths due to respiratory diseases, that is, all causes of death by the standard WHO list of diseases of the respiratory system plus COVID-19, tuberculosis and lung cancer. Using the latest available official data of Spain, we analyzed changes in the mortality pattern in Spain from January 2019 to December 2021. We endorsed STROBE guidance for observational research. Results: There were 98,714 deaths due to respiratory diseases in 2021 in Spain, corresponding to 21.9% of all deaths, becoming second in the ranking of causes of death. Respiratory diseases mortality in Spain has not returned to pre-pandemic levels in 2021, still with an increase of 30.3% (95% CI 30.2-30.4) compared to rates in 2019. All respiratory-specific causes of death decreased in 2021, except for lung cancer, that increased in women and decreased in men compared to 2019 (both p<0.05). In a multivariate analysis some established risk factors for respiratory diseases mortality were confirmed, such as male gender and older age; further, an association with reduced mortality in rural Spain was observed, still with a large geographical variability. Conclusions: The COVID-19 pandemic has had a lasting impact on deaths due to respiratory diseases and certain specific causes of death in 2021, and it has disproportionately affected certain regions