286 research outputs found

    Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

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    Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

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    Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

    Nutrition transition and obesity trends in Argentina within the Latin American context

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    The world population has undergone a rapid shift in dietary and physical activity patterns, from traditional diets to a dietary pattern characterized by highly processed foods and sugar-sweetened beverages, coupled with increasingly sedentary lifestyles. These shifts have been concomitant with demographic, macroeconomic and technological changes, and closely related to the widespread obesity epidemic. Barry Popkin (University of North Carolina at Chapel Hill, USA) has defined the entire process as Nutrition Transition and has written extensively about its stages, drivers and consequences. Based on this literature and on our previous work, in this chapter we present the key elements of the nutrition transition process in developing countries, describing its distinctive features in the Latin America region, especially in Argentina. We also describe obesity trends in this context. Finally, we discuss public health interventions in the developing world and future perspectives to deal with a still unresolved consequence of the nutrition transition, the obesity and noncommunicable diseases epidemic.Fil: Pou, Sonia Alejandra. Consejo Nacional de Investigaciones CientĂ­ficas y TĂ©cnicas. Centro CientĂ­fico TecnolĂłgico Conicet - CĂłrdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de CĂłrdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina. Universidad Nacional de CĂłrdoba. Facultad de Medicina. Escuela de NutriciĂłn. CĂĄtedra de EstadĂ­stica y BioestadĂ­stica; ArgentinaFil: Tumas, Natalia. Consejo Nacional de Investigaciones CientĂ­ficas y TĂ©cnicas. Centro CientĂ­fico TecnolĂłgico Conicet - CĂłrdoba. Centro de Investigaciones y Estudios sobre Cultura y Sociedad. Universidad Nacional de CĂłrdoba. Centro de Investigaciones y Estudios sobre Cultura y Sociedad; ArgentinaFil: Aballay, Laura Rosana. Universidad Nacional de CĂłrdoba. Facultad de Medicina. Escuela de NutriciĂłn. CĂĄtedra de EstadĂ­stica y BioestadĂ­stica; Argentin

    Everyone for himself and all together? Thinking 'race' between social science, epidemiology and medicine

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    Back cover“Why do you measure and why are you also measured? What measurement tools are used to offer a quantified vision of the body and its parts, its growth, and of human life itself? Is measurement the same thing as quantification? Based on in-depth historical investigations and case studies from the 19th century up to the present day, this book proposes enlightening answers to such questions. Combining basic insight from the ‘classics’―Foucault, Rose―on the political dimension of measurement with contextualizing epistemologies, it brilliantly shows how ontologies emerge from various social ‘assemblages’.”―Marie Gaille, philosopher, senior researcher, UniversitĂ© de Paris-CNR

    Evaluation of the efficacy of sofosbuvir plus daclatasvir in combination with ribavirin for hospitalized COVID-19 patients with moderate disease compared with standard care: a single-centre, randomized controlled trial.

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    BACKGROUND: New therapeutic options are urgently needed to tackle the novel coronavirus disease 2019 (COVID-19). Repurposing existing pharmaceuticals provides an immediate treatment opportunity. We assessed the efficacy of sofosbuvir and daclatasvir with ribavirin for treating patients with COVID-19. METHODS: This was a single-centre, randomized controlled trial in adults with moderate COVID-19 admitted to the Ghaem Shahr Razi Hospital in Mazandaran Province, Iran. Patients were randomly assigned to 400 mg sofosbuvir, 60 mg daclatasvir and 1200 mg ribavirin (intervention group) or to standard care (control group). The primary endpoint of this study was length of hospital stay. This study is registered by IRCT.ir under the ID: IRCT20200328046886N1. RESULTS: Between 20 March 2020 and 8 April 2020, 48 patients were recruited; 24 patients were randomly assigned to the intervention group and 24 to the control group. The median duration of hospital stay was 6 days in both groups (P = 0.398). The number of ICU admissions in the sofosbuvir/daclatasvir/ribavirin group was not significantly lower than the control group (0 versus 4, P = 0.109). There was no difference in the number of deaths between the groups (0 versus 3, P = 0.234). The cumulative incidence of recovery was higher in the sofosbuvir/daclatasvir/ribavirin arm (Gray's P = 0.033). CONCLUSIONS: This randomized trial was too small to make definitive conclusions. There were trends in favour of the sofosbuvir/daclatasvir/ribavirin arm for recovery and lower death rates. However, there was an imbalance in the baseline characteristics between the arms. Larger randomized trials should be conducted to investigate this treatment further

    Mortality Modeling

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    Mortality models approximate mortality patterns or dynamics over age and time. An age pattern of mortality can be any mathematical function of mortality, such as rates, probabilities, survivorship, or death distributions. Such functions may be modeled in the form of a life table or a simplified function with some parameters. Mortality models in general fall into three main categories: (i) models designed to help understand regularities in mortality patterns and dynamics, for example where population-level mortality patterns are modeled as an emergent property of dynamics at the individual level, (ii) those that aim to predict mortality patterns, for example for purposes of pension provisions, and (iii) those aimed at mortality measurement for purposes of mortality and health monitoring. In the following, mortality modeling refers to models of mortality measurement at the population level

    Self-rated health over the life course: evidence from the 1958 and 1970 British birth cohorts

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    The twentieth century rise in life expectancy is undoubtedly one of the great successes of public health, but in combination with low fertility rates has also contributed importantly to the aging of populations. Population ageing poses great challenges and there is an urgent need for strategies to be developed that will help to alleviate its societal consequences. The proposed work focuses on one promising approach: achieving a ‘compression of morbidity’, or a reduction of the number of years spent in ill health. For a given level of life expectancy, a ‘compression of morbidity’ into a smaller number of years at the end of life would enable people to stay at work for a longer period of time, and also to care for themselves at advanced ages. In this chapter we investigated the progress of self-rated health over the life course in two well characterised population based representative British birth cohorts. The evolution of self-rated health over time differed between the two cohorts, both with respect to the shape of change over time as well as the average level of reported self-rated health. In the earlier born 1958 cohort self-rated health exhibited an almost linear trend with increasingly worse self-rated health being reported by both men and women as they moved from early adulthood to early old age. A different pattern was observed in the later born 1970 cohort, where the average level of self-ratted health remained stable up to age 34, but steadily declined from age 38 onwards in both men and women. In both men and women, the two cohorts reported similar level of self-rated health in early adulthood, but the trend diverged at age 42, where the 1970 cohort reported their health being significantly worse. Our observation of similar up to age 34 and then worse average self-rated health in the 1970 cohort increases the likelihood of expansion of morbidity, assuming that the observed difference as well as the lower mortality rates in the 1970 cohort will persist in the future