ABSTRACT
The association between long-term exposure to ambient air pollutants and severe COVID-19 is uncertain. We followed 4,660,502 adults from the general population in 2020 in Catalonia, Spain. Cox proportional models were fit to evaluate the association between annual averages of PM2.5, NO2, BC, and O3 at each participant's residential address and severe COVID-19. Higher exposure to PM2.5, NO2, and BC was associated with an increased risk of COVID-19 hospitalization, ICU admission, death, and hospital length of stay. An increase of 3.2 µg/m3 of PM2.5 was associated with a 19% (95% CI, 16-21) increase in hospitalizations. An increase of 16.1 µg/m3 of NO2 was associated with a 42% (95% CI, 30-55) increase in ICU admissions. An increase of 0.7 µg/m3 of BC was associated with a 6% (95% CI, 0-13) increase in deaths. O3 was positively associated with severe outcomes when adjusted by NO2. Our study contributes robust evidence that long-term exposure to air pollutants is associated with severe COVID-19.
Subject(s)
Air Pollutants , Air Pollution , COVID-19 , Adult , Humans , Spain/epidemiology , Cohort Studies , Nitrogen Dioxide/toxicity , COVID-19/epidemiology , Air Pollution/adverse effects , Air Pollutants/adverse effects , Particulate Matter/adverse effectsABSTRACT
BACKGROUND: To assess management patterns and outcome in patients with glioblastoma multiforme (GBM) treated during 2008-2010 in Spain. METHODS: Retrospective analysis of clinical, therapeutic, and survival data collected through filled questionnaires from patients with histologically confirmed GBM diagnosed in 19 Spanish hospitals. RESULTS: We identified 834 patients (23% aged >70 years). Surgical resection was achieved in 66% of patients, although the extent of surgery was confirmed by postoperative MRI in only 41%. There were major postoperative complications in 14% of patients, and age was the only independent predictor (Odds ratio [OR], 1.03; 95% confidence interval [CI],1.01-1.05; P = .006). After surgery, 57% received radiotherapy (RT) with concomitant and adjuvant temozolomide, 21% received other regimens, and 22% were not further treated. In patients treated with surgical resection, RT, and chemotherapy (n = 396), initiation of RT ≤42 days was associated with longer progression-free survival (hazard ratio [HR], 0.8; 95% CI, 0.64-0.99; P = .042) but not with overall survival (HR, 0.79; 95% CI, 0.62-1.00; P = .055). Only 32% of patients older than 70 years received RT with concomitant and adjuvant temozolomide. The median survival in this group was 10.8 months (95% CI, 6.8-14.9 months), compared with 17.0 months (95% CI, 15.5-18.4 months; P = .034) among younger patients with GBM treated with the same regimen. CONCLUSIONS: In a community setting, 57% of all patients with GBM and only 32% of older patients received RT with concomitant and adjuvant temozolomide. In patients with surgical resection who were eligible for chemoradiation, initiation of RT ≤42 days was associated with better progression-free survival.
Subject(s)
Antineoplastic Agents, Alkylating/therapeutic use , Brain Neoplasms/mortality , Dacarbazine/analogs & derivatives , Glioblastoma/mortality , Practice Patterns, Physicians' , Adult , Aged , Aged, 80 and over , Brain Neoplasms/diagnosis , Brain Neoplasms/epidemiology , Brain Neoplasms/therapy , Combined Modality Therapy , Dacarbazine/therapeutic use , Female , Follow-Up Studies , Glioblastoma/diagnosis , Glioblastoma/epidemiology , Glioblastoma/therapy , Humans , Male , Middle Aged , Neoplasm Grading , Prognosis , Retrospective Studies , Spain/epidemiology , Survival Rate , Temozolomide , Time Factors , Young AdultABSTRACT
OBJECTIVE: To evaluate the impact that monitored acute stroke unit care may have on the risk of early neurological deterioration (END), and 90-day mortality and mortality-disability. METHODS: Non-randomized prospective study with consecutive patients with acute ischemic stroke (AIS) admitted to a conventional care stroke unit (CCSU), from May 2003 to April 2005, or to a monitored acute stroke unit (ASU) from May 2005 to April 2006. END was defined as an increase in the NIHSS score >or= 4 points in the first 72 hours after admission. RESULTS: END was detected in 19.6% of patients (11.2% of patients admitted to the ASU and 23.8% to the CCSU; p<0.0001). Patients admitted to the ASU received more treatment with intravenous rtPa (13.5% versus 4.2%; p<0.0001), had a shorter length of stay (9.1 [11.0] d versus 13.1 [10.4] d; p<0.0001), lower 90-day mortality (10.2% versus 17.3%; p=0.02), and lower mortality-disability at 90-days (28.4% versus 40.2%; p=0.004) than those admitted to the CCSU. Multivariable analysis showed that ASU admission was a protector for END (OR: 0.37; 95% CI: 0.23-0.62). On admission, higher NIHSS (OR: 1.06; 95% CI: 1.03-1.10), higher glycaemia (OR: 1.003; 95% CI: 1.001-1.006), and higher systolic pressure (OR: 1.01; 95% CI: 1.002-1.017) were independent predictors of END. CONCLUSIONS: END prevention by ASU care might be a key factor contributing to better outcome and decrease of length of stay in patients admitted to monitored stroke units.
