Quality of Life and Post-Surgical Complications in Patients on Chronic Antiplatelet Therapy with Proximal Femur Fracture: 12-Month Follow-Up after Implementing a Strategy to Shorten the Time to Surgery.

BACKGROUND: We evaluated a strategy to shorten the time from admission to surgery in patients with proximal femur fractures on chronic antiplatelet therapy. We reported a 12-month follow-up on complications and quality of life (QoL). METHODS: Multicentre, open-label, randomized, parallel clinical trial. Patients were randomized to either early platelet function-guided surgery (experimental group) or delayed surgery (control group). Medical and surgical complications and QoL (EQ-5D-5L questionnaire) were assessed during the hospital stay, and after hospital discharge at 30 days, and 6 and 12 months. RESULTS: From 156 randomized patients, 143 patients underwent surgery. The mean age was 85.5 (7.8) years and 68.0% were female. After hospital discharge, 5.7% of patients had surgical wound complications and 55.9% had medical complications, with 42.7% having serious adverse events. QoL improved significantly after surgery, with the best scores at the six-month follow-up. The overall mortality was 32.2%. There were no differences between early and delayed surgery groups in any assessed outcomes. CONCLUSION: It seems safe to reduce the time of surgery under neuraxial anaesthesia in patients with hip fractures on chronic antiplatelet therapy by platelet function testing. QoL in particular improves in the first six months after surgery.

Early Surgery with Neuraxial Anaesthesia in Patients on Chronic Antiplatelet Therapy with a Proximal Femur Fracture: Multicentric Randomised Clinical Trial.

BACKGROUND: Patients with proximal femur fracture on antiplatelet treatment benefit from early surgery. Our goal was to perform early surgery under neuraxial anaesthesia when indicated by the platelet function test. METHODS: We conducted a multicentre randomised open-label parallel clinical trial. Patients were randomised to either early platelet function-guided surgery (experimental group) or delayed surgery (control group). Early surgery was programmed when the functional platelet count (as measured by Plateletworks) was >80 × 109/L. The primary outcome was the emergency admission-to-surgery interval. Secondary outcomes were platelet function, postoperative bleeding, medical and surgical complications, and mortality. RESULTS: A total of 156 patients were randomised, with 78 in each group, with a mean (SD) age of 85.96 (7.9) years, and 67.8% being female. The median (IQR) time to surgery was 2.3 (1.5-3.7) days for the experimental group and 4.9 (4.4-5.6) days for the control group. One-third of patients did not achieve the threshold functional platelet count on the first day of admission, requiring more than one test. There was no difference in clinical outcomes between groups. CONCLUSIONS: A strategy individualised according to the platelet function test shortens the time to proximal femur fracture surgery under neuraxial anaesthesia in patients on chronic antiplatelet treatment. Better powered randomised clinical trials are needed to further evaluate the clinical impact and safety of this strategy.

Correlation between PlateletWorks® and PFA-100® for Measuring Platelet Function before Urgent Surgery in Patients with Chronic Antiplatelet Therapy.

Hemostasis is crucial for reducing bleeding during surgical procedures. The points-of-care based on the platelet function test could be useful to minimize the complications related to chronic antiplatelet therapy during surgery. The present study is aimed at comparing two point-of-care platelet function devices-Platelet Function Analyzer PFA-100® (Siemens Canada, Mississauga, ON, Canada) and Plateletworks®(Helena Laboratories, Beaumont, TX, USA). Our objective is to evaluate if they provide comparable and useful information to manage anti-aggregate patients before surgery. We included patients with a femoral fracture receiving chronic antiplatelet therapy and a median age of 89 years (range from 70 to 98). A platelet function evaluation was performed on all patients before surgery using both devices-Plateletworks® and PFA-100®. The correlation between Plateletworks® and PFA-100® was performed using Cohen's Kappa coefficient. Twenty consecutive patients participated in the trial; 16 patients were under treatment with 75 mg/day of clopidogrel, three with >300 mg/day of acetylsalicylic acid (ASA), and only one was in treatment with both antiplatelet agents. Cohen's Kappa coefficient was 0.327 comparing PFA-100®-ADP (adenosine diphosphate) and Plateletworks® and, 0.200 comparing PFA-100®-EPI (epinephrine) and Plateletworks®. In conclusion, we found a weak concordance comparing PFA-100® and Plateletworks®. This could partially be due to the advanced age of the included patients. However, given the limited sample size, more studies are necessary to confirm these results.

[Analysis of the impact of cigarette pack graphic warnings on Mexican smokers]. / Análisis del impacto en fumadores mexicanos de los avisos gráficos en las cajetillas de cigarros.

OBJECTIVE: To determine which graphic warnings on cigarette packs (images on the labels indicating the negative impact on health that tobacco can have) provoke the strongest desire to quit smoking among adult Mexican smokers. MATERIAL AND METHODS: A pile sort method was used among 60 smokers over 18 years old to determine which images made them think about quitting smoking. Averages were determined and non-parametric statistical methods were used to determine differences in ranks. RESULTS: Within each of the five themes, one or two graphic warnings provoked the strongest responses in smokers. The graphic warnings with the greatest impact used the following images: a close-up of a lung tumor; a man with cancer of the larynx with a large tumorous mass on the exterior part of his neck; an unconscious young man in a bed in an intensive care unit with text mentioning benzene, formaldehyde and cyanide as tobacco components; an image of two healthy children indicating that cigarettes contain carbon monoxide; an image of a dead fetus in a specimen jar; and a close up of a mouth with yellow, rotting teeth and text describing tooth loss and mouth cancer as a result of tobacco use. CONCLUSIONS: The graphic warnings used on cigarette packs in other countries could contribute to cessation among Mexican smokers and should be implemented in Mexico.

Análisis del impacto en fumadores mexicanos de los avisos gráficos en las cajetillas de cigarros / Analysis of the impact of cigarette pack graphic warnings on Mexican smokers

OBJETIVO: Determinar el impacto de los avisos gráficos (imágenes en las etiquetas que indican el daño a la salud que causa el tabaco) en las cajetillas de cigarros entre fumadores adultos mexicanos. MATERIAL Y MÉTODOS: Se aplicó el método antropológico de sorteo de montones a 60 fumadores adultos para determinar cuáles los hacían pensar en dejar de fumar. Se sacaron promedios y se utilizaron métodos estadísticos no paramétricos. RESULTADOS: Los avisos gráficos más impactantes mostraban las siguientes imágenes: un tumor de bronquio fuente visto a través del broncoscopio; un hombre con cáncer de laringe con una gran masa tumoral externa en el cuello; un hombre joven inconsciente en una cama de la unidad de cuidados intensivos, con texto mencionando benceno, formaldehído y cianuro de hidrógeno como componentes del tabaco, y una de dos niños sanos que indica que el cigarro contiene amoníaco, monóxido de carbono; un feto muerto en un frasco con formol; y una boca con dientes amarillos y con texto que menciona la pérdida de dientes y cáncer bucal como resultados del tabaco. CONCLUSIONES: Los avisos gráficos que se utilizan en las cajetillas de cigarros en otros países podrían contribuir a la cesación entre fumadores mexicanos y deben implementarse en México.

Chronic disease risk factors among healthy adolescents attending public schools in the state of Morelos, Mexico.

BACKGROUND: Little research (and fewer interventions) has been done on longitudinal exposure to risk factors for chronic diseases in young people in Latin America, including Mexico, although chronic diseases constitute the first cause of death in Mexico. Our objective was to document the prevalence of chronic disease risk factors among adolescents as a baseline measurement for a cohort study and to develop educational interventions. METHODS: Questionnaires, blood samples, and anthropometric measurements were collected from 13,293 public school students of both sexes, ages 11-24 years in Morelos, Mexico. This constitutes the baseline measurement for a cohort study. Twenty focus groups and 10 in-depth interviews were done with girls aged 12-17 years. Two educational interventions promoting physical activity and sexual health were designed. RESULTS: Prevalence of obesity was 21.2%. On average, participants spent 0.5 h/day on vigorous physical activity and 3.7 h/day watching television. Sexual initiation was reported by 14.5% (girls = 9.1%, boys = 21.5%); 52.3% of whom reported using condoms. Young women demonstrated correct condom use and perceived themselves at risk for HIV/AIDS but did not have condom negotiation skills. Prevalence of experimenting with tobacco was 15.1% (girls = 10.4%, boys = 21.1%); current smoking was 14.4% (girls = 10.6%) and boys = 19.2%), while 6.3% of participants reported monthly intoxication with alcohol, and 4.5% reported past and 2.1% reported current illegal drug use. CONCLUSIONS: Results indicate substantial exposure to risk factors for chronic diseases and reproductive health problems in this population. The study will generate interventions and constitutes initiation of a longitudinal study able to explore causal associations between risk factors and chronic diseases in this population.

Factores de riesgo de lesión por accidentes de tráfico y el impacto de una intervención sobre la carretera / Risk factors of injury by traffic accidents and the impact of an intervention of the road

Objetivo: Avaliar o efeito das intervençöes em uma rodovia, na ocorrência e gravidade de ferimentos por acidente. Métodos: Foi feita uma análise comparativa de dois estudos transversais em 1994 e 1996. Resultados: Em 1994, a taxa foi de 7,96 acidentes/100.000 veículos e em 1996, 8,49/100.000 veículos. O aumento näo foi significante (p>0,05). O índice de motoristas feridos em 1994 foi de 2,10/100.000 veículos e de 1,35/100.000 veículos em 1996, o que representa uma reduçäo (p<0,000). A notificaçäo espontânea do uso de cinto de segurança (63,46 por cento contra 76,6 por cento), o número de veículos de pequeno porte acidentados (7,9 por cento contra 37,7 por cento), o trânsito em horário noturno (23,7 por cento contra 31,8 por cento) e a direçäo no sentido México-Cuernavaca (45 por cento contra 66,7 por cento) foram maiores em 1996 (p<0,05). O risco de ferimento - usando um modelo de regressäo logística - entre motoristas expostos a intervençöes (1996) e motoristas näo expostos (1994) ajustados por: idade, velocidade, uso do cinto de segurança, ingestäo de álcool e causas externas mostrou um efeito protetor das intervençöes na rodovia. Conclusäo: Há uma evidente necessidade de abordagem multisetoriais no estudo e na avaliaçäo das intervençöes no campo dos acidentes de trânsito, sendo o presente estudo um exemplo claro das repercusöes sobre a saúde geradas pelas intervençöes desenvolvidas pelo setor de transportes na rodovia

Aspectos metodologicos de la medición en el sitio de ocurrencia de lesiones por accidentes de tráfico / Methodological aspects of measuring injuries from traffic accidents at the site of occurrence

Os acidentes de trânsito de veículos a motor representam problema de saúde pública, em nível mundial. No México, a pesquisa, nesse campo, é limitada e a metodologia para seu estudo é pouco desenvolvida. Na literatura científica internacional säo escassos os artigos que discutem os aspectos métodológicos de pesquisa nesse campo. Assim, realizou-se estudo com o objetivo de apresentar alguns aspectos metodológicos úteis para os interessados em pesquisar lesöes por acidentes de trânsito. Foram discutidos aspectos sobre como medir, no local de ocorrência, as variáveis básicas para o estudo dessas lesöes, tais como: se o motorista sofreu ou näo lesöes, uso de cinto de segurança, velocidade e consumo de álcool.