Riesgo

riesgo
  • 文章类型: Journal Article
    Grassland conservation planning often focuses on high-risk landscapes, but many grassland conversion models are not designed to optimize conservation planning because they lack multidimensional risk assessments and are misaligned with ecological and conservation delivery scales. To aid grassland conservation planning, we developed landscape-scale models at relevant scales that predict future (2021-2031) total and proportional loss of unprotected grassland to cropland or development. We developed models for 20 ecoregions across the contiguous United States by relating past conversion (2011-2021) to a suite of covariates in random forest regression models and applying the models to contemporary covariates to predict future loss. Overall, grassland loss models performed well, and explanatory power varied spatially across ecoregions (total loss model: weighted group mean R2 = 0.89 [range: 0.83-0.96], root mean squared error [RMSE] = 9.29 ha [range: 2.83-22.77 ha]; proportional loss model: weighted group mean R2 = 0.74 [range: 0.64-0.87], RMSE = 0.03 [range: 0.02-0.06]). Amount of crop in the landscape and distance to cities, ethanol plants, and concentrated animal feeding operations had high variable importance in both models. Total grass loss was greater when there were moderate amounts of grass, crop, or development (∼50%) in the landscape. Proportional grass loss was greater when there was less grass (∼<30%) and more crop or development (∼>50%). Some variables had a large effect on only a subset of ecoregions, for example, grass loss was greater when ∼>70% of the landscape was enrolled in the Conservation Reserve Program. Our methods provide a simple and flexible approach for developing risk layers well suited for conservation that can be extended globally. Our conversion models can support conservation planning by enabling prioritization as a function of risk that can be further optimized by incorporating biological value and cost.
    Predicciones a escala de paisaje de la conversión futura de los pastizales a tierras de cultivo o desarrollo Resumen La planificación de la conservación de los pastizales a menudo se centra en paisajes de alto riesgo, pero muchos modelos de conversión de pastizales no están diseñados para optimizar la planificación de la conservación porque carecen de evaluaciones de riesgo multidimensionales y están mal alineados con las escalas ecológicas y de conservación. Para ayudar a la planificación de la conservación de los pastizales, desarrollamos modelos a escala de paisaje en escalas relevantes que predicen la pérdida futura (2021‐2031) total y proporcional de pastizales no protegidos a tierras de cultivo o desarrollo. Desarrollamos modelos para 20 ecorregiones a lo largo de los Estados Unidos en relación con la conversión pasada (2011‐2021) con un conjunto de covariables en modelos de regresión de bosque aleatorio y aplicando los modelos a covariables contemporáneas para predecir la pérdida futura. En general, los modelos de pérdida de pastizales funcionaron bien y el poder explicativo varió espacialmente entre las ecorregiones (modelo de pérdida total: media ponderada del grupoR2 = 0.89 [rango 0.83–0.96], error cuadrático medio [RMSE] = 9,29 ha [rango 2,83‐22,77 ha]; modelo de pérdidas proporcionales: R2 medio ponderado del grupo = 0,74 [rango 0,64‐0,87], RMSE = 0,03 [rango 0,02‐0,06]). La cantidad de cultivos en el paisaje y la distancia a ciudades, plantas de etanol y operaciones concentradas de alimentación animal tuvieron una importancia variable alta en ambos modelos. La pérdida total de pastos fue mayor cuando había cantidades moderadas de pastos, cultivos o desarrollo (∼50%) en el paisaje. La pérdida proporcional de pastos fue mayor cuando había menos pastos (∼<30%) y más cultivos o desarrollo (∼>50%). Algunas variables tuvieron un gran efecto sólo en un subconjunto de ecorregiones, por ejemplo, la pérdida de pastos fue mayor cuando ∼>70% del paisaje estaba inscrito en el Programa de Reservas de Conservación. Nuestros métodos proporcionan un enfoque sencillo y flexible para desarrollar capas de riesgo adecuadas para la conservación que pueden extenderse globalmente. Nuestros modelos de conversión pueden apoyar la planificación de la conservación al permitir la priorización en función del riesgo, que puede optimizarse aún más si se incorporan el valor biológico y el costo.
    【摘要】 草地保护规划通常侧重于高风险景观, 但许多草地转化模型并不是为优化保护规划而设计的, 因为它们缺乏多维度风险评估, 并且与生态和实施保护的尺度不一致。为了帮助草地保护规划, 我们开发了相关尺度的景观尺度模型, 以预测未来(2021‐2031年)未受保护的草地因转化为耕地或开发区而丧失的总量和比例。我们建立了美国本土20个生态区的模型, 将过去的草地转化(2011‐2021年)与随机森林回归模型中一系列协变量进行拟合, 并将模型应用于当前的协变量以预测未来丧失情况。总体而言, 草地丧失模型表现良好, 其解释度在不同生态区之间存在空间差异(总体丧失模型:加权组平均R2 = 0.89 [范围为0.83‐0.96], 均方根误差 = 9.29 公顷 [范围为2.83‐22.77公顷];比例丧失模型:加权组平均R2 = 0.74 [范围为0.64‐0.87], 均方根误差 = 0.03 [范围为 0.02‐0.06])。在这两个模型中, 景观中的农作物数量以及与城市、乙醇工厂和动物集中饲养场的距离都具有很高的变量重要性。当景观中草地、农作物或开发区的数量中等(约50%)时, 草地总丧失量较大。当景观中草地较少(约<30%)、农作物或开发区较多(约>50%)时, 草地丧失比例较大。一些变量仅对部分生态区有较大影响, 例如, 当大约>70%的景观被纳入“休耕保护储备计划”时, 草地丧失更为严重。本研究提供了一种简单而灵活的方法来开发适用于保护的风险图层, 并可以推广到全球尺度。我们的转化模型可以根据风险函数确定优先保护次序, 并整合生物价值和成本进一步优化, 以支持保护规划。【翻译:胡怡思;审校:聂永刚】.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: English Abstract
    背景:我们研究的目的是评估墨西哥住院患者死亡率和虚弱之间的长期相关性。全球,在这一老年患者人群中的研究范围有限,这一实体对我们患者的生活质量和预后产生重大影响.
    方法:这是一项符合选择标准的81名长期护理患者的前瞻性队列研究。使用FRAIL量表确定虚弱。在随访期间收集死亡率数据,并监测诊断。通过logistic回归确定呈现此事件的风险,Kaplan-Meier,和Cox比例风险分析,根据年龄和性别进行调整。
    结果:患者平均随访时间为36个月(1094天),在此期间,33名受试者死亡(40.7%)。在我们的人口中,在研究开始时,绝大多数虚弱患者的病理独立产生不良事件的风险,残疾(Barthel=30.9;SD28.8),肌肉减少症(n=40;71.4%),去年下降了1比3(n=17;63%),≥4次下降(n=4;57.1%)。虚弱的参与者有较高的调整后死亡风险(HR2.93;95%CI1.33-6.43;p=0.007)。
    结论:在墨西哥住院患者中,虚弱实体与死亡率长期相关。及时的治疗和方法可能会带来良好的预后和生活质量。
    BACKGROUND: The objective of our study was to evaluate the long-term association between mortality and frailty in institutionalized patients in Mexico. Worldwide, there are limited lines of research in this population of geriatric patients and this entity generates a significant impact on the quality of life and prognosis of our patients.
    METHODS: It is a prospective cohort study of 81 patients in long-term care who met the selection criteria. Frailty was determined using the FRAIL scale. Data on mortality were collected during the follow-up period, and diagnosis was monitored. The risk of presenting this event was determined by logistic regression, Kaplan-Meier, and Cox proportional hazards analysis, adjusted for age and sex.
    RESULTS: The mean follow-up time of the patients was 36 months (1094 days), during which 33 subjects died (40.7%). In our population, at the beginning of the study the vast majority of frail patients had pathologies that independently generate risk of adverse events, disability (Barthel=30.9; SD 28.8), sarcopenia (n=40; 71.4%), one to 3 falls in the last year (n=17; 63%), ≥4 falls (n=4; 57.1%). Frail participants had a higher adjusted risk of mortality (HR 2.93; 95% CI 1.33-6.43; p=0.007).
    CONCLUSIONS: The frailty entity is associated in the long term with mortality in institutionalized patients in Mexico. Timely treatment and approach may allow a good prognosis and quality of life.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    与患者安全相关的事件是重症监护医学(ICM)中影响很大的问题。已经制定了多种策略来识别它们,分析,并制定旨在减少其发生率并最大程度地减少其影响和后果的政策。安全文化的发展,ICM的适当组织和结构设计,考虑实施有效的安全做法,根据所开展的护理活动和对不同事件及其因素的定期分析调整人力资源的供应,将使我们将危重患者护理的风险接近于零,这是可取的。
    Incidents related to patient safety are a problem of great impact in Intensive Care Medicine (ICM). Multiple strategies have been developed to identify them, analyze, and develop policies aim at reducing their incidence and minimizing their effects and consequences. The development of a safety culture, an adequate organizational and structural design of the ICM, which contemplates the implementation of effective safe practices, with a provision of human resources adjusted to the care activity carried out and the periodic analysis of the different events and their factors, will allow us to bring the risk of critical patient care closer to zero, as would be desirable.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    目的:我们旨在为需要抗肿瘤药物或支持治疗的实体或血液肿瘤患者的药学服务(PC)建立一个风险分层模型。
    方法:风险分层模型是由西班牙医院药学学会(SEFH)的肿瘤药剂师共同开发的。它通过三个讲习班和一项试点研究进行了改进。定义了变量,分为四个维度,并分配相对权重。试点研究收集并分析了来自参与中心的数据,以确定优先级并评估变量贡献。这项研究遵循了KaiserPermanente金字塔模型,将患者分为三个优先级:优先级1(密集PC,第90百分位数),优先级2(第60-90百分位数),和优先级3(第60百分位数)。基于该分层确定截止点。参与中心在Excel表格中记录变量,计算每个优先级的平均权重分数和总风险分数。
    结果:参与者同意完成一份问卷,其中包括22个变量,分为4个维度:人口统计学(最高分=11);社会和健康变量以及认知和功能状态(最大=19);临床和卫生服务利用率(最大=25);和治疗相关(最大=41)。从将该模型应用于登记的199名患者的结果来看,分类的分界点为:优先事项1为28分或更多,优先事项2为16至27分,优先事项3为16分以下;总得分的80%以上基于"临床和卫生服务利用"和"治疗相关"这两个维度.建议对实体或血液肿瘤患者进行基于药学监护模式的干预,根据他们的优先级别。
    结论:这种分层模型能够识别需要更高水平药物治疗的癌症患者,并有助于调整治疗能力。在代表性人群中对模型进行验证对于建立其有效性是必要的。
    OBJECTIVE: We aimed to develop of a risk stratification model for the pharmaceutical care (PC) of patients with solid or hematologic neoplasms who required antineoplastic agents or supportive treatments.
    METHODS: The risk stratification model was collaboratively developed by oncology pharmacists from the Spanish Society of Hospital Pharmacy (SEFH). It underwent refinement through three workshops and a pilot study. Variables were defined, grouped into four dimensions, and assigned relative weights. The pilot study collected and analyzed data from participating centers to determine priority levels and evaluate variable contributions. The study followed the Kaiser Permanente pyramid model, categorizing patients into three priority levels: Priority 1 (intensive PC, 90th percentile), Priority 2 (60th-90th percentiles), and Priority 3 (60th percentile). Cut-off points were determined based on this stratification. Participating centers recorded variables in an Excel sheet, calculating mean weight scores for each priority level and the total risk score.
    RESULTS: The participants agreed to complete a questionnaire that comprised 22 variables grouped into 4 dimensions: demographic (maximum score =11); social and health variables and cognitive and functional status (maximum = 19); clinical and health services utilization (maximum = 25); and treatment-related (maximum = 41). From the results of applying the model to the 199 patients enrolled, the cutoff points for categorization were 28 or more points for priority 1, 16 to 27 points for priority 2 and less than 16 for priority 3; more than 80% of the total score was based on the dimensions of \'clinical and health services utilization\' and \'treatment-related\'. Interventions based on the pharmaceutical care model were recommended for patients with solid or hematological neoplasms, according to their prioritization level.
    CONCLUSIONS: This stratification model enables the identification of cancer patients requiring a higher level of pharmaceutical care and facilitates the adjustment of care capacity. Validation of the model in a representative population is necessary to establish its effectiveness.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    目的:我们的目的是为需要抗肿瘤药物或支持治疗的实体或血液肿瘤患者的药学服务建立一个风险分层模型。
    方法:风险分层模型是由西班牙医院药学学会(SEFH)的肿瘤药剂师共同开发的。通过3个讲习班和一项试点研究对其进行了改进。定义了变量,分为4个维度,并分配相对权重。试点研究收集并分析了来自参与中心的数据,以确定优先级并评估变量贡献。这项研究遵循了KaiserPermanente金字塔模型,将患者分为3个优先级:优先级1(密集PC,第90百分位数),优先级2(第60-90百分位数),和优先级3(第60百分位数)。基于该分层确定截止点。参与中心在Excel表格中记录变量,计算每个优先级的平均权重分数和总风险分数。
    结果:参与者同意完成一份问卷,其中包括22个变量,分为4个维度:人口统计学(最高分=11);社会和健康变量以及认知和功能状态(最大=19);临床和卫生服务利用率(最大=25);和治疗相关(最大=41)。从将该模型应用于登记的199名患者的结果来看,分类的分界点为优先1为28分或更多,优先2为16-27分,优先3为小于16分;超过80%的总分基于"临床和卫生服务利用"和"治疗相关"维度.“建议对实体或血液肿瘤患者进行基于药学监护模式的干预,根据他们的优先级别。
    结论:这种分层模型能够识别需要更高水平药物治疗的癌症患者,并有助于调整治疗能力。在代表性人群中对模型进行验证对于建立其有效性是必要的。
    OBJECTIVE: We aimed to develop of a risk stratification model for the pharmaceutical care of patients with solid or hematologic neoplasms who required antineoplastic agents or supportive treatments.
    METHODS: The risk stratification model was collaboratively developed by oncology pharmacists from the Spanish Society of Hospital Pharmacy (SEFH). It underwent refinement through 3 workshops and a pilot study. Variables were defined, grouped into 4 dimensions, and assigned relative weights. The pilot study collected and analyzed data from participating centers to determine priority levels and evaluate variable contributions. The study followed the Kaiser Permanente pyramid model, categorizing patients into 3 priority levels: Priority 1 (intensive PC, 90th percentile), Priority 2 (60th-90th percentiles), and Priority 3 (60th percentile). Cut-off points were determined based on this stratification. Participating centers recorded variables in an Excel sheet, calculating mean weight scores for each priority level and the total risk score.
    RESULTS: The participants agreed to complete a questionnaire that comprised 22 variables grouped into 4 dimensions: demographic (maximum score=11); social and health variables and cognitive and functional status (maximum=19); clinical and health services utilization (maximum=25); and treatment-related (maximum=41). From the results of applying the model to the 199 patients enrolled, the cut-off points for categorization were 28 or more points for priority 1, 16-27 points for priority 2, and less than 16 for priority 3; more than 80% of the total score was based on the dimensions of \"clinical and health services utilization\" and \"treatment-related.\" Interventions based on the pharmaceutical care model were recommended for patients with solid or hematological neoplasms, according to their prioritization level.
    CONCLUSIONS: This stratification model enables the identification of cancer patients requiring a higher level of pharmaceutical care and facilitates the adjustment of care capacity. Validation of the model in a representative population is necessary to establish its effectiveness.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    屈光性晶状体置换(RLE)可以通过替换具有扩展焦深的晶状体或多焦点人工晶状体(IOL)来矫正屈光不正和老花眼。视网膜脱离(RD)是RLE后最严重的不良事件之一。本研究旨在回顾与RLE后RD风险和临床结局相关的证据。使用PubMed和雪球搜索方法进行搜索,以识别文章和病例报告。根据文献,<60岁,轴长>23mm的患者应考虑RD的风险.只有9篇文章报告了RLERD后的视力(VA),只有25%的眼睛的VA>20/40。考虑到RD后所有类型的IOL的VA下降可能是一致的,外科医生应专注于选择患者以预防RD,而不是根据DR的潜在风险进行特定的IOL光学设计。
    Refractive lens exchange (RLE) allows to correct ametropias and presbyopia by replacing the crystalline lens with an extended depth of focus or multifocal intraocular lens (IOL). Retinal detachment (RD) is one of the most serious adverse events after RLE. This study aimed to review the evidence related to the risk of RD after RLE and clinical outcomes. A search using PubMed and a snowball search approach was conducted to identify articles and case reports. According to the literature, the risks of RD should be considered in patients <60 years old with axial lengths >23 mm. Only nine articles reported visual acuity (VA) after RD in RLE, and only 25% of eyes had a VA > 20/40. Considering that the decrease in VA might be uniform for all types of IOLs after RD, surgeons should focus on selecting the patient to prevent RD rather than on a particular IOL optical design based on the potential risk of DR.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    背景:回盲肠切除克罗恩病(CD)后并发症很常见。这项研究的目的是分析这些手术后术后并发症的危险因素。
    方法:我们对拉丁美洲10个专门治疗炎症性肠病(IBD)的医疗中心进行了为期8年的局限在回盲部接受手术治疗的克罗恩病患者进行了回顾性分析。将患者分为两组:出现严重术后并发症的患者(Clavien-Dindo>II),“术后并发症”(POC)组;那些没有,“无术后并发症”(NPOC)组。分析术前特征和术中变量,以确定POC的可能因素。
    结果:总计,包括337名患者,POC队列中有51人(15.13%)。吸烟在POC患者中更为普遍(31.37vs17.83;P=0.026),术前贫血较多(33.33vs17.48%;P=0.009),需要更多的紧急护理(37.25vs22.38;P=.023),白蛋白水平较低。复杂疾病与较高的术后发病率相关。POC患者的手术时间较长(188.77vs143.86分钟;P=0.005),术中并发症较多(17.65vs4.55%;P<.001),和较低的原发性吻合率。在多变量分析中,吸烟和术中并发症与术后主要并发症的发生独立相关.
    结论:这项研究表明,拉丁美洲克罗恩病原发性回盲部切除术后并发症的危险因素与其他地方报道的相似。该区域今后的努力应旨在通过控制一些已确定的因素来改善这些成果。
    BACKGROUND: Complications after ileocecal resection for Crohn\'s disease (CD) are frequent. The aim of this study was to analyze risk factors for postoperative complications after these procedures.
    METHODS: We conducted a retrospective analysis of patients treated surgically for Crohn\'s disease limited to the ileocecal region during an 8-year period at 10 medical centers specialized in inflammatory bowel disease (IBD) in Latin America. Patients were allocated into 2 groups: those who presented major postoperative complications (Clavien-Dindo > II), the \"postoperative complication\" (POC) group; and those who did not, the \"no postoperative complication\" (NPOC) group. Preoperative characteristics and intraoperative variables were analyzed to identify possible factors for POC.
    RESULTS: In total, 337 patients were included, with 51 (15.13%) in the POC cohort. Smoking was more prevalent among the POC patients (31.37 vs. 17.83; P = .026), who presented more preoperative anemia (33.33 vs. 17.48%; P = .009), required more urgent care (37.25 vs. 22.38; P = .023), and had lower albumin levels. Complicated disease was associated with higher postoperative morbidity. POC patients had a longer operative time (188.77 vs. 143.86 min; P = .005), more intraoperative complications (17.65 vs. 4.55%; P < .001), and lower rates of primary anastomosis. In the multivariate analysis, both smoking and intraoperative complications were independently associated with the occurrence of major postoperative complications.
    CONCLUSIONS: This study shows that risk factors for complications after primary ileocecal resections for Crohn\'s disease in Latin America are similar to those reported elsewhere. Future efforts in the region should be aimed at improving these outcomes by controlling some of the identified factors.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Meta-Analysis
    BACKGROUND: Ankylosing spondylitis is a chronic inflammatory disease that is associated with adverse cardiovascular events. This study aimed to determine the relationship between ankylosing spondylitis and the risk of stroke.
    METHODS: A systematic literature search in PubMed/MEDLINE, Scopus, and Web of Science were conducted from inception to December 2021 to identify relevant articles investigating the risk of stroke in patients with ankylosing spondylitis. A random-effects model (DerSimonian and Laird) was used to estimate a pooled hazard ratio (HR) and 95% confidence intervals (CI). Meta-regression based on the length of follow-up and subgroup analysis based on the type of stroke, study location, and year of publication to investigate the source of heterogeneity.
    RESULTS: A total of eleven studies comprising 1.7 million participants were included in this study. Pooled analysis showed a significantly increased stroke risk (56%) among patients with ankylosing spondylitis (HR: 1.56, 95% CI 1.33-1.79). Subgroup analysis revealed a higher risk of ischemic stroke among patients with ankylosing spondylitis (HR: 1.46, 95% CI: 1.23-1.68). However, meta-regression analysis showed no association between the duration of ankylosing spondylitis and stroke incidence (Coef=-0.0010, P=0.951).
    CONCLUSIONS: This study reveals that ankylosing spondylitis was associated with an increased risk of suffering a stroke. Management of cerebrovascular risk factors and the control of systemic inflammation should be considered in patients with ankylosing spondylitis.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    保护区是保护的关键手段。尽管如此,他们容易受到与治理薄弱相关的风险的影响,土地利用集约化,和气候变化。使用一种新颖的分层优化方法,我们确定了扩展全球保护区系统的优先领域,以明确考虑此类风险,同时最大限度地保护所有已知的陆地脊椎动物物种。我们说明了如何减少这些风险的暴露需要将全球保护区系统的面积扩大1.6%,同时仍要达到保护目标。纳入来自薄弱治理的风险推动了保护空间优先事项的最大变化,虽然纳入气候变化带来的风险需要全球保护区的最大增加。保护范围广泛的物种需要治理相对较强的国家在与治理相对较弱的国家接壤时保护更多的土地。我们的结果强调了跨辖区协调的必要性,并证明了如何将风险有效地纳入保护计划。本文受版权保护。保留所有权利。
    Protected areas are a key instrument for conservation. Despite this, they are vulnerable to risks associated with weak governance, land-use intensification, and climate change. We used a novel hierarchical optimization approach to identify priority areas for expanding the global protected area system that explicitly accounted for such risks while maximizing protection of all known terrestrial vertebrate species. To incorporate risk categories, we built on the minimum set problem, where the objective is to reach species distribution protection targets while accounting for 1 constraint, such as land cost or area. We expanded this approach to include multiple objectives accounting for risk in the problem formulation by treating each risk layer as a separate objective in the problem formulation. Reducing exposure to these risks required expanding the area of the global protected area system by 1.6% while still meeting conservation targets. Incorporating risks from weak governance drove the greatest changes in spatial priorities for protection, and incorporating risks from climate change required the largest increase (2.52%) in global protected area. Conserving wide-ranging species required countries with relatively strong governance to protect more land when they bordered nations with comparatively weak governance. Our results underscore the need for cross-jurisdictional coordination and demonstrate how risk can be efficiently incorporated into conservation planning. Planeación de las áreas protegidas para conservar la biodiversidad en un futuro incierto.
    Aunque las áreas protegidas son un instrumento clave para la conservación, no dejan de ser vulnerables a los riesgos asociados a una gestión pobre, la intensificación del uso de suelo y al cambio climático. Usamos una estrategia novedosa de optimización jerárquica para identificar las áreas prioritarias para la expansión del sistema global de áreas protegidas. La estrategia consideró de manera explícita los riesgos mencionados y también maximizó la protección de todas las especies conocidas de vertebrados terrestres. Para incorporar a las categorías de riesgo partimos del mínimo problema establecido, en donde el objetivo es lograr los objetivos de protección de la distribución de especies mientras se considera sólo una restricción, como el costo o área del suelo. Expandimos esta estrategia para que incluyera varios objetivos que consideraran el riesgo desde la formulación del problema mediante el manejo de cada nivel de riesgo como un objetivo aparte durante la formulación del problema. La reducción de la exposición a estos riesgos requirió que se expandiera el área total del sistema global de áreas protegidas en un 1.6% y así todavía cumplir con los objetivos de conservación. La incorporación de riesgos a partir de una gestión pobre fue el principal impulsor de cambios en las prioridades espaciales para la protección, mientras que la incorporación de riesgos a partir del cambio climático requirió el mayor incremento (2.52%) del área protegida a nivel mundial. La conservación de especies con distribución amplia requirió que los países con una gestión relativamente fuerte protegieran más suelo al tener fronteras con países con una gestión pobre en comparación son la suya. Nuestros resultados destacan la necesidad de una coordinación entre jurisdicciones y demuestran cómo puede incorporarse el riesgo de manera exitosa a la planeación de la conservación.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    背景:在西班牙工作人群中估计终生心血管风险的功能-IBERLIFERISK,获得了令人满意的歧视;然而,男性的风险略有高估,女性的风险略有低估。
    目的:延长随访3年后,重新校准当前的终生风险方程。
    方法:回顾性队列研究。其中包括2004年至2007年期间接受职业健康检查的762.058名工人。评估了截至2017年12月的所有暂时性疾病发作和心血管死亡率。在推导队列中估计心血管风险时,组合回归模型以考虑竞争风险的存在。通过图形表示验证队列中10年随访时预期和观察到的事件的比例进行校准。按风险分位数进行分层,并计算SpiegelhalterZ统计量。使用接收器工作曲线(ROC)和计算Harrell'sC指数以图形方式评估鉴别。
    结果:平均年龄为35.48岁(SD10.56)。71.14%是男性。男性HarrellC指数为0.78(95%CI0.76-0.79),女性为0.73(95%CI0.69-0.77)。总的来说,在风险的最后十分之一中,女性略有低估,男性略有高估,尽管SpiegelhalterZ统计量在男女均无统计学意义(p>0.05)。
    结论:更新的模型继续令人满意地进行区分,虽然模型的校准没有实质性的改进与新的更新。
    BACKGROUND: The function to estimate lifetime cardiovascular risk -IBERLIFERISK- in Spanish working population, obtained a satisfactory discrimination; however, there was a slight overestimation of the risk in men and an underestimation of the risk in women.
    OBJECTIVE: To recalibrate the current lifetime risk equation after extending the follow-up by 3 years.
    METHODS: Retrospective cohort study. 762.058 workers who underwent an occupational health examination between 2004 and 2007 were included. All episodes of temporary sickness and cardiovascular mortality up to December 2017 were evaluated. Regression models were combined to take into account the presence of competing risks in estimating cardiovascular risk in the derivation cohort. Calibration was performed by graphically representing the proportion of expected and observed events at 10 years of follow-up in the validation cohort, stratifying by risk deciles and calculating the Spiegelhalter Z statistic. Discrimination was evaluated graphically using the Receiver Operating Curve (ROC) and calculating Harrell\'s C index.
    RESULTS: The mean age was 35.48 years (SD 10.56). 71.14% were men. Harrell\'s C index was 0.78 (95% CI 0.76-0.79) in men and 0.73 (95% CI 0.69-0.77) in women. In general, there was a slight degree of underestimation in women and overestimation in men in the last decile of risk, although the Spiegelhalter Z statistic was not statistically significant in both sexes (p>0.05).
    CONCLUSIONS: The updated model continues to discriminate satisfactorily, although the model\'s calibration has not substantially improved with the new update.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

公众号