ABSTRACT
OBJECTIVE: To analyze the classification of the risk of transmission of vaccine-preventable diseases in Brazilian municipalities before and after the National Movement for Vaccination and Multivaccination proposed by the Ministry of Health. METHODS: This is an epidemiological, ecological study using secondary data on vaccination coverage, dropout rates, and homogeneity of vaccination coverage (HCV) for ten immunobiologicals recommended for children under 2 years of age. The study aims to compare the years 2022 and 2023 in Brazil. The vaccination coverage index (VCI), HCV, and dropout rate (DR) were evaluated in the municipalities of Brazil in the years 2022 and 2023. The municipalities were classified into risk strata for transmission of vaccine-preventable diseases before and after the strategy proposed by the Ministry of Health. RESULTS: The study found an increase in median vaccination coverage (VC) for all vaccines evaluated, except for the varicella vaccine. Regarding HCV, in 2022, 27.99% of Brazilian municipalities were classified as adequate (≥ 70%), and 410 (7.36%) achieved 100% HCV for all vaccines. In 2023, 34.90% of municipalities were classified as adequate (≥ 70%), and among them, 582 (10.46%) achieved 100% HCV for all vaccines. In terms of the risk classification for the transmission of vaccine-preventable diseases, Brazil had 72.01% of municipalities classified as high or very high risk in 2022, which decreased to 65.13% in 2023. As for municipalities classified as low or very low risk, 11.27% fell into this category in 2022, increasing to 18.12% in 2023. CONCLUSION: The study concludes that VC surveillance, in conjunction with the Microplanning for High-Quality Vaccination Activities methodology developed by the Ministry of Health in 2023, played a crucial role in resuming immunization efforts that had been hindered by science denialism and the COVID-19 pandemic.
Subject(s)
Immunization Programs , Vaccine-Preventable Diseases , Humans , Brazil/epidemiology , Immunization Programs/statistics & numerical data , Vaccine-Preventable Diseases/prevention & control , Vaccine-Preventable Diseases/epidemiology , Cities , Vaccination Coverage/statistics & numerical data , Risk Assessment , Infant , Vaccination/statistics & numerical dataABSTRACT
Decision-making in chronic diseases guided by clinical decision support systems that use models including multiple variables based on artificial intelligence requires scientific validation in different populations to optimize the use of limited human, financial, and clinical resources in healthcare systems worldwide. This cohort study evaluated three machine learning algorithms-XGBoost, Elastic Net logistic regression, and an Artificial Neural Network-to develop a prediction model for three outcomes: mortality, hospitalization, and emergency department visits. The objective was to build a clinical decision support system for patients with noncommunicable diseases treated at the Alma Mater Hospital complex in Medellín, Colombia. We collected 4845 electronic medical record entries from 5000 patients included in the study. The median age was 71.83 years, with 63.8% women and 29.7% receiving home care. The most prevalent medical conditions were diabetes (52.9%), hypertension (67.2%), dyslipidemia (57.3%), and COPD (19.4%). For mortality prediction, the Elastic Net logistic regression model achieved an AUCROC of 0.883 (95% CI: 0.848-0.917), the XGBoost model reached an AUCROC of 0.896 (95% CI: 0.865-0.927), and the Neural Network achieved 0.886 (95% CI: 0.853-0.916). For hospitalization, the Elastic Net model had an AUCROC of 0.952 (95% CI: 0.937-0.965), the XGBoost model achieved 0.963 (95% CI: 0.952-0.974), and the Neural Network scored 0.932 (95% CI: 0.915-0.948). For emergency department visits, the AUCROC values were 0.980 (95% CI: 0.971-0.987) for Elastic Net, 0.977 (95% CI: 0.967-0.986) for XGBoost, and 0.976 (95% CI: 0.968-0.982) for the neural network. A dashboard was developed to interact with an ensemble risk categorization segmenting patient risk in the cohort to aid in clinical decision-making. A clinical decision support system based on artificial intelligence using electronic medical records possibly can help segmenting the risk in populations with Noncommunicable Diseases for effective decision-making.
Subject(s)
Decision Support Systems, Clinical , Emergency Service, Hospital , Hospitalization , Machine Learning , Neural Networks, Computer , Noncommunicable Diseases , Humans , Female , Aged , Male , Decision Support Systems, Clinical/organization & administration , Hospitalization/statistics & numerical data , Middle Aged , Emergency Service, Hospital/statistics & numerical data , Logistic Models , Colombia/epidemiology , Risk Assessment/methods , Algorithms , Aged, 80 and over , Electronic Health RecordsABSTRACT
BACKGROUND: A new formula for estimating small, dense, low-density lipoprotein cholesterol (sdLDL-C) based on the results of the standard lipid panel is proposed. OBJECTIVES: To assess the association between estimated sdLDL-C (EsdLDL-C) and atherosclerotic cardiovascular disease (ASCVD) risk. METHODS: A total of 12,192 participants from the Korea National Health and Nutrition Examination Survey (KNHANES) database between 2010 and 2020 were included in this cross-sectional study. EsdLDL-C was calculated as EsdLDL-C= LDL-C - [1.43 × LDL-C - (0.14 × (ln (TG) × LDL-C)) - 8.99]. Logistic regression analyses were utilized to assess the association between EsdLDL-C and ASCVD risk. Subgroup analyses were performed based on age, body mass index (BMI), hypertension, and diabetes. An odds ratio (OR) with a 95% confidence interval (CI) was used for evaluation. P<0.05 was considered statistically significant. RESULTS: Among 12,192 participants, 1,239 (10.16%) had ASCVD. The mean sdLDL-C of participants was estimated to be 42.43±14.75 mg/dL using the formula. Elevated EsdLDL-C levels (OR=1.33; 95%CI, 1.06-1.66) were associated with an increased risk of ASCVD. Subgroup analyses found that there may be an interaction between EsdLDL-C (Pinteraction= 0.001) or non-HDL-C (Pinteraction= 0.015) and hypertension on ASCVD risk. CONCLUSIONS: Elevated estimated sdLDL-C levels were associated with the risk of ASCVD, and estimated sdLDL-C might be an alternative to sdLDL-C measurement for ASCVD risk assessment.
FUNDAMENTO: Uma nova fórmula para estimar o colesterol de lipoproteínas pequenas, densas e de baixa densidade (sdLDL-C) com base nos resultados do painel lipídico padrão é proposto. OBJETIVOS: Para avaliar a associação entreestimado sdLDL-C (EsdLDL-C) e o risco de doença cardiovascular arterosclerótica (DCVA). MÉTODOS: Um total de 12.192 participantes do banco de dados do Korea National Health and Nutrition Examination Survey (KNHANES) entre 2010 e 2020 foram incluídos neste estudo transversal. EsdLDL-C foi calculada como EsdLDL-C = LDL-C- [1,43 × LDL-C - (0,14 × (ln (TG) × LDL-C)) - 8,99]. Análises de regressão logística foram utilizadas para avaliar a associação entre EsdLDL-C e risco de DCVA. As análises de subgrupos foram realizadas com base na idade, índice de massa corporal (IMC), hipertensão, e diabetes. Uma razão de possibilidades (OR) com um intervalo de confiança de 95% (IC) foi utilizado para avaliação. P<0,05 foi considerado estatisticamente significativo. RESULTADOS: Entre 12.192 participantes, 1.239 (10,16%) tinham DCVA. A média de sdLDL-C dos participantes foi estimada em 42,43±14,75 mg/dL usando a fórmula. Níveis elevados de EsdLDL-C (OR=1,33; IC 95%, 1,06-1,66) foram associados a um aumento do risco de DCVA. As análises de subgrupos descobriram que pode haver uma interação entre EsdLDL-C (Pinteração=0,001) ou não-HDL-C (Pinteração=0,015) e hipertensão no risco de DCVA. CONCLUSÕES: Níveis elevados estimados de sdLDL-C foram associados ao risco de DCVA, e o sdLDL-C estimado pode ser uma alternativa à medição do sdLDL-C para avaliação do risco de DCVA.
Subject(s)
Atherosclerosis , Cholesterol, LDL , Nutrition Surveys , Humans , Male , Female , Cross-Sectional Studies , Middle Aged , Cholesterol, LDL/blood , Atherosclerosis/blood , Risk Factors , Republic of Korea/epidemiology , Risk Assessment , Adult , Aged , Body Mass Index , Logistic Models , Cardiovascular Diseases/blood , Biomarkers/blood , Hypertension/blood , Heart Disease Risk FactorsABSTRACT
Frailty is a significant risk factor for adverse outcomes in elderly surgical patients. Gait speed assessment is a new tool recently used to stratify risk for these pre-operative adverse outcomes. In this prospective study of 392 frail elderly patients undergoing abdominal surgery, we investigated the predictive value of preoperative gait speed for postoperative outcomes. Patients were divided into two groups based on their 6-meter gait speed: normal (≥0.8 m/s, n=184) and slow (<0.8 m/s, n=208). The slow group was older, had more comorbidities, and higher American Society of Anesthesiologists (ASA) grades (P<0.05). They also had significantly higher rates of 30-day overall complications (38.9 vs 18.5%, P<0.01), severe complications (12.0 vs 4.3%, P<0.01), and 1-year mortality (15.4 vs 6.5%, P=0.008) compared to the normal group. Pulmonary infection, wound infection, and delirium were the most common complications. Multivariate logistic regression confirmed slow gait speed as an independent risk factor for 30-day complications (OR=2.38, 95%CI: 1.41-4.01) and 1-year mortality (OR=2.19, 95%CI: 1.07-4.48). Our findings demonstrated that preoperative 6-meter gait speed effectively predicted short-term complications and mid-term mortality in frail elderly patients undergoing abdominal surgery. This suggests the need for individualized perioperative management strategies for high-risk patients with slow gait speed to potentially improve their prognosis.
Subject(s)
Frail Elderly , Geriatric Assessment , Postoperative Complications , Walking Speed , Humans , Prospective Studies , Aged , Female , Male , Walking Speed/physiology , Postoperative Complications/mortality , Prognosis , Aged, 80 and over , Risk Factors , Geriatric Assessment/methods , Abdomen/surgery , Risk Assessment/methods , Predictive Value of Tests , Preoperative PeriodABSTRACT
BACKGROUND: Atrial fibrillation (AF) is an arrhythmia causing significant symptoms and raising the risk of complications. OBJECTIVES: To evaluate the association of clinical, electrocardiographic, and echocardiographic parameters with prevalent atrial fibrillation or flutter (AFF) and assess the risk profile for incident AFF using the AF prediction scores CHARGE-AF and EHR in an elderly population from a developing country. METHODS: We included all participants in ELSA-Brasil aged 60 and over whose diagnosis of AFF could be defined through self-report or electrocardiogram and who had echocardiography performed at the study's baseline. For statistical analysis, results with p values < 0.05 were considered statistically significant. RESULTS: Among the 2,088 participants (65 ± 4.1 years; 53% women), 88 (4.2%) had AFF. Those with AFF were older and had higher rates of heart failure (HF), previous myocardial infarction, left bundle branch block (LBBB), prolonged QT interval, supraventricular extrasystoles, and sinus bradycardia. They also had larger left atrial and left ventricular dimensions, and lower left ventricular ejection fraction (LVEF). Multivariable analysis showed that HF, LBBB, larger left atrium, and lower LVEF were independently associated with AFF. The 5-year risk for incident AFF was low (< 2.5%) in 63% and high (> 5%) in 12% of individuals according to the CHARGE-AF score, and low in 67% and high in 13% according to the EHR. CONCLUSION: AFF was found in 4.2% of this older Brazilian cohort. AFF was linked to HF history, LBBB, left atrial dilation, and reduced LVEF. Additionally, 12% to 13% of patients in sinus rhythm were at high risk for AFF. Monitoring clinical, electrocardiographic, and echocardiographic parameters can aid in early identification of high-risk individuals.
FUNDAMENTO: A fibrilação atrial (FA) é uma arritmia que causa sintomas significativos e aumenta o risco de complicações. OBJETIVOS: Avaliar a associação de parâmetros clínicos, eletrocardiográficos e ecocardiográficos com fibrilação ou flutter atrial (FFA) prevalente e avaliar o perfil de risco para FFA incidente utilizando os escores de predição de FA CHARGE-AF e EHR em uma população idosa de um país em desenvolvimento. MÉTODOS: Incluímos todos os participantes do ELSA-Brasil com 60 anos ou mais cujo diagnóstico de FFA pôde ser definido por autorrelato ou eletrocardiograma e que tiveram ecocardiografia realizada na linha de base do estudo. Para a análise estatística, foram considerados estatisticamente significativos os resultados com valores de p < 0,05. RESULTADOS: Dos 2.088 participantes (65 ± 4,1 anos; 53% mulheres), 88 (4,2%) tinham FFA. Aqueles com FFA eram mais velhos e tinham maiores taxas de insuficiência cardíaca (IC), infarto do miocárdio prévio, bloqueio de ramo esquerdo (BRE), intervalo QT prolongado, extrassístoles supraventriculares e bradicardia sinusal. Esses pacientes também apresentavam maiores dimensões do átrio esquerdo e do ventrículo esquerdo e menor fração de ejeção do ventrículo esquerdo (FEVE). A análise multivariada mostrou que insuficiência cardíaca, BRE, átrio esquerdo maior e FEVE menor estavam independentemente associados com FFA. O risco de 5 anos para FFA incidente foi baixo (< 2,5%) em 63% e alto (> 5%) em 12% dos indivíduos de acordo com o escore CHARGE-AF, e baixo em 67% e alto em 13% de acordo com o EHR. CONCLUSÃO: A FFA foi encontrada em 4,2% da presente coorte brasileira idosa. A FFA foi associada ao histórico de insuficiência cardíaca, BRE, dilatação do átrio esquerdo e FEVE reduzida. Adicionalmente, 12% a 13% dos pacientes em ritmo sinusal estavam em alto risco para FFA. O monitoramento de parâmetros clínicos, eletrocardiográficos e ecocardiográficos pode auxiliar na identificação precoce de indivíduos de alto risco.
Subject(s)
Atrial Fibrillation , Echocardiography , Electrocardiography , Humans , Atrial Fibrillation/epidemiology , Atrial Fibrillation/physiopathology , Female , Male , Aged , Brazil/epidemiology , Risk Factors , Middle Aged , Prevalence , Risk Assessment , Incidence , Age Factors , Atrial Flutter/epidemiology , Atrial Flutter/physiopathologyABSTRACT
This study carried out a critical review of the principles of radioprotection, including the ALARA, ALADA, and ALADAIP principles. The Google Scholar and PubMed databases were the search resources, and the following keywords were searched: Linear No-Threshold (LNT); Biologic Effects of Ionizing Radiation (BEIR VII); As Low As Reasonably Achievable (ALARA); As Low As Diagnostically Acceptable (ALADA); As Low As Diagnostically Acceptable, being Indication-oriented and Patient-specific (ALADAIP). This critical review included studies with historical references, reviews, position papers, and clinical and experimental studies. Regarding data extraction, only original articles were selected after the screening process. Much of the current evolution of X-ray machines and radioprotection protocols has stemmed from legitimate concerns about this topic. This development has grown out of the relevant work of organizations like ICRP, UNSCEAR, and other renowned international organizations. Low doses of radiation, such as those used for diagnosis, also occur naturally and are present in everyday life. Although there is no agreement on the actual risk involving low doses, the recommendations of ALARA, ALADA, and ALADAIP prevail, in line with the trend to uphold principles that balance the importance of X-ray diagnostic imaging with the intention of keeping the doses as low as possible. The benefits of X-ray exams, when justified, tend to outweigh the low risks attributed to them.
Subject(s)
Radiation Dosage , Radiation Protection , Humans , Radiation Protection/methods , Radiation Protection/standards , Radiation, Ionizing , Risk Assessment , Radiation Exposure/prevention & control , Radiation Exposure/adverse effectsABSTRACT
BACKGROUND: Motivation for the study. There is an increase in obesity and diabetes mellitus cases in Cuba, so it is necessary to provide easy to use, fast and inexpensive tools for the identification of people with dysglycemia. Main findings. For the first time in CUBA, the optimal cut-off point for FINDRISC, LA-FINDRISC and modified FINDRISC for Cuba (CUBDRISC) questionnaires was established with its own anthropometric parameters to identify people with dysglycemia. Implications. The use of the CUBDRISC scale as a simple, fast and low-cost tool for the active screening of people with dysglycemia in Cuban population will be useful to establish timely intervention strategies for people with risk score to develop dysglycemia. OBJECTIVES.: To evaluate the Finnish Diabetes Risk Score (FINDRISC) modified for Cuba as a tool for the detection of prediabetes and undiagnosed diabetes in Cuban population. MATERIALS AND METHODS.: An analytical cross-sectional and secondary source epidemiological study was conducted in 3737 adults aged 19 years and older with at least one risk factor for diabetes, they did not have previous diagnosis of prediabetes and diabetes mellitus and underwent oral glucose tolerance test for the diagnosis of dysglycemia. We applied the FINDRISC and the FINDRISC modified for Latin America (LA-FINDRISC) and Cuba (CUBDRISC), each with their own anthropometric parameters. The ROC curve was used to establish the cut-off point of each scale for the diagnosis of dysglycemia. Sensitivity, specificity, predictive values and likelihood ratios were calculated. The concordance between scales was calculated with Cohen's Kappa coefficient. RESULTS.: We found that 34.5% (n=1289) of the subjects were diagnosed with dysglycemia (28.1% had prediabetes and 6.4% had type 2 diabetes without previous diagnosis). The LA-FINDRISC and CUBDRISC scales showed an almost perfect concordance with the FINDRISC scale for the different cut-off values from 11 to 16 (0.882-0.890 and 0.910-0.922, respectively). The optimal cutoff point for detecting persons with dysglycemia was ≥ 13 for the FINDRISC and CUBDRISC scales (sensitivity was 63.6% and 61.6%; specificity was 84.3% and 86.0%, respectively) and ≥11 for LA-FINDRISC (sensitivity 58.0% and specificity 88.0%). CONCLUSIONS.: We found almost perfect concordance between the diabetes risk scales. The FINDRISC score modified for Cuba proved to be a useful tool to identify persons with prediabetes and diabetes with a cut-off point of 13 in a Cuban population.
OBJETIVOS.: Evaluar el Finnish Diabetes Risk Score (FINDRISC) modificado para Cuba como herramienta para la detección de prediabetes y diabetes no diagnosticada en una población cubana. MATERIALES Y MÉTODOS.: Se realizó un estudio epidemiológico de corte transversal analítico y de fuente secundaria en 3737 adultos de 19 a mas años con al menos un factor de riesgo de diabetes, sin diagnóstico previo de prediabetes y diabetes mellitus, a los cuales se les realizó la prueba de tolerancia a la glucosa oral para el diagnóstico de disglucemia. Las puntuaciones de riesgo de diabetes aplicadas fueron la FINDRISC y las FINDRISC modificadas para Latinoamérica (LA-FINDRISC) y Cuba (CUBDRISC) con parámetros antropométricos propios. La curva ROC se utilizó para establecer el punto de corte de cada escala para el diagnóstico de disglucemia. Se calculó sensibilidad, especificidad, valores predictivos y razones de verosimilitud. La concordancia entre las escalas fue calculada con el coeficiente Kappa de Cohen. RESULTADOS.: El 34,5% (n=1289) de las personas se diagnosticó con disglucemia (28,1% prediabetes y 6,4% diabetes tipo 2 sin diagnóstico previo). Las escalas LA-FINDRISC y CUBDRISC mostraron un grado de acuerdo casi perfecto con la escala FINDRISC para los distintos valores de corte del 11 al 16 (0,882-0,890 y 0,910-0,922, respectivamente). El punto de corte óptimo para detectar personas con disglucemia fue ≥ 13 para las escalas FINDRISC y CUBDRISC (sensibilidad 63,6% y 61,6%; especificidad 84,3% y 86,0%, respectivamente) y ≥11 para LA-FINDRISC (sensibilidad 58,0% y especificidad 88,0%). CONCLUSIONES.: Existe una concordancia casi perfecta entre las escalas de riesgo de diabetes. El puntaje FINDRISC modificado para Cuba demostró ser una herramienta útil para identificar personas con prediabetes y diabetes con punto de corte 13 en una población cubana.
Subject(s)
Diabetes Mellitus , Prediabetic State , Humans , Cuba/epidemiology , Prediabetic State/diagnosis , Prediabetic State/epidemiology , Male , Female , Adult , Cross-Sectional Studies , Middle Aged , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Young Adult , Undiagnosed Diseases/epidemiology , Undiagnosed Diseases/diagnosis , Aged , Risk Assessment/methodsABSTRACT
BACKGROUND: Low QRS complex voltage is an important predictor of death in Chagas disease. However, the parameters applied to the low-voltage classification were described by the Minnesota Code and not specifically for Chagas disease. This study aimed to analyze low QRS voltage by determining the ADOC index and averages in the frontal and horizontal electrocardiographic planes, establishing possible clinical implications. METHODS: A cross-sectional study of patients with Chagas disease was performed using the Mann-Whitney U test and Spearman's correlation. The amplitudes of each QRS were analyzed, and the sum of the DII and V5 derivations of the ADOC index and the arithmetic means of the QRS complexes in the frontal and horizontal planes were determined. RESULTS: The ADOC index was correlated with the highest risk of stroke and death according to the Rassi score. The ADOC index (p=0.046) and mean mQRS were inversely proportional to the Rassi risk of death score (p=0.038). The ADOC index proved to be more sensitive (75.0%) and accurate (67.4%) in identifying patients at elevated death risk using the Rassi score. Finally, a positive correlation was observed between the QRSFm and QRSHm indicators and ADOC index (r=0.590 and r=0.857, respectively). DISCUSSION: The ADOC index and mean of the QRS complexes are possible tools correlated with the Rassi score and risk of stroke in patients with Chagas disease.
Subject(s)
Chagas Cardiomyopathy , Electrocardiography , Humans , Cross-Sectional Studies , Chagas Cardiomyopathy/physiopathology , Chagas Cardiomyopathy/complications , Male , Female , Middle Aged , Aged , Risk Factors , Adult , Sensitivity and Specificity , Statistics, Nonparametric , Risk AssessmentABSTRACT
Perioperative risk assessment helps inform clinical practice for older people with hip fractures. This is a cohort study, where perioperative risk screening, including NHFS, was performed at admission, followed by an evaluation of 30-day outcomes. 503 patients were included, 73% female, 79.4 ± 9.3 years old; 58% presented extracapsular and 42% intracapsular fractures, with a 30-day mortality of 9%. The NHFS was higher in the patients who died at 5.6 ± 1.1 compared to survivals at 4.3 ± 1.5 (p-value < 0.001). NHFS > 4 was associated with 30-day mortality observed by Cox regression adjusted by fracture type: HR 4.55 (95% CI 2.10-9.82) (p-value < 0.001) and Kaplan-Meyer Curve (HR 3.94; 95% CI 2.19-7.07; p-value < 0.001). ROC curve showed the accuracy of NHFS in explaining 30-day mortality (AUC 0.74; 95% CI 0.67-0.81). Complications were higher among patients with NHFS > 4. The performance of NHFS was better than the traditional perioperative risk ASA score. Therefore, NHFS can be implemented in real-world clinical practice to estimate the 30-day mortality risk for hip fracture in older patients in Brazil. NHFS > 4 is critical for 30-day mortality and complications; this cutoff helps inform clinical practice. The present study might motivate other centers to consider NHFS in their perioperative risk assessment routine.
Subject(s)
Hip Fractures , Humans , Female , Aged , Male , Hip Fractures/mortality , Hip Fractures/surgery , Brazil/epidemiology , Aged, 80 and over , Risk Assessment/methods , Cohort Studies , ROC Curve , Risk Factors , Proximal Femoral FracturesABSTRACT
Chagas disease, a persistent and life-threatening infection caused by the protozoan Trypanosoma cruzi, remains a significant public health concern in Latin America. Despite the Brazilian State of Espírito Santo (ES) not being classified as a high-risk area, the presence of epidemiologically significant triatomines like Panstrongylus megistus suggests a latent risk of T. cruzi transmission. This study, employing spatial modeling, assesses the distribution of key triatomine species in ES and predicts areas at risk for Chagas disease transmission. Our models, constructed with Maxent, KUENM, and QGIS, identified high suitability for most species in ES's southeast and south regions, with P. diasi showing high suitability in the central-west. Notably, 13 autochthonous cases of vector-borne Chagas disease were reported between 2001 and 2023. The risk assessment highlighted significant risk areas corresponding to the locations of these cases, indicating that most regions in ES are at higher risk of P. megistus presence. These findings provide crucial insights for enhancing regional epidemiological surveillance and inform targeted vector control strategies, effectively addressing latent risks.
Subject(s)
Chagas Disease , Insect Vectors , Trypanosoma cruzi , Chagas Disease/epidemiology , Brazil/epidemiology , Risk Assessment/methods , Animals , Humans , Insect Vectors/parasitology , Spatial Analysis , Panstrongylus/parasitology , Insect Control/methodsABSTRACT
OBJECTIVE: To evaluate whether bone assessment by radiofrequency echographic multi-spectrometry (REMS) is influenced by trabecular bone integrity by comparing it to dual-energy X-ray absorptiometry (DXA) and the trabecular bone score (TBS). Additionally, the study aims to determine if comparing fracture risk using FRAX and the National Osteoporosis Guideline Group (NOGG) using the T-score from each method would lead to differences in a Brazilian female population. SUBJECTS AND METHODS: A sample of women aged 30-80 underwent REMS and DXA scans of axial sites at the Hospital São Paulo, Brazil. Subsequently, TBS was applied to DXA exams. Clinical data were obtained from hospital records and phone interviews to calculate fracture risk. RESULTS: Among the 343 participants enrolled, 213 had comparable lumbar spine exams by REMS, DXA, and TBS, and 166 had comparable hip exams by REMS and DXA. The correlation between lumbar spine bone mineral density (BMD) by REMS and the TBS was low (r = 0.27, p < 0.001), as was the correlation between DXA and TBS (r = 0.39, p < 0.001). No statistically significant difference was found between the TBS classifications of osteoporotic lumbar spine by REMS and DXA (p = 0.178). Fracture risk data by FRAX were obtained from 119 participants, with 92% receiving concordant NOGG classifications for major osteoporotic fracture risk from REMS and DXA (κ = 0.71 CI95% (0.54 to 0.89), p < 0.001), and 87% for hip fracture risk (κ = 0.58 CI95% (0.38 to 0.77), p < 0.001). CONCLUSION: REMS performed similarly to DXA in assessing trabecular integrity using TBS. Additionally, no statistically significant difference was observed in fracture risk assessment by FRAX based on NOGG recommendations.
Subject(s)
Absorptiometry, Photon , Bone Density , Cancellous Bone , Lumbar Vertebrae , Osteoporotic Fractures , Humans , Female , Aged , Middle Aged , Cancellous Bone/diagnostic imaging , Risk Assessment , Osteoporotic Fractures/diagnostic imaging , Aged, 80 and over , Lumbar Vertebrae/diagnostic imaging , Adult , Brazil/epidemiology , Ultrasonography , Osteoporosis/diagnostic imaging , Cross-Sectional Studies , Risk FactorsABSTRACT
Exposure to organophosphate esters (OPEs) remains a significant concern, especially in aquatic systems where these compounds can bioaccumulate in organisms. However, limited information exists regarding their potential health risks to humans through the food web in tropical ecosystems. This study investigated the levels, bioaccumulation, and trophic transfer of OPEs in sediments and marine fish species from Cartagena and Barbacoas bays, Colombia. Twenty target OPEs were quantified in sediments and fish. The average concentrations of ∑18OPEs in sediments ranged from 2.80 to 115 ng/g dry weight (dw), while ∑20OPE concentrations in fish ranged from 212 to 1968 ng/g lipid weight (lw), with the highest concentrations found in carnivorous species. Trophic magnification factors (TMF) for OPEs varied from 11.0 to 25.8 for compounds such as 2-ethylhexyl diphenyl phosphate (EHDPP), 4-isopropylphenyl diphenyl phosphate (4IPPDPP), tris(2-isopropylphenyl) phosphate (T2IPPP), and tricresylphosphate (TCP), indicating their potential for biomagnification within the marine food web. Biota-sediment accumulation factors (BSAF) for ∑11OPEs ranged from 0.340 to 4.32, showing a significant Spearman correlation with log Kow in fish: Pargo chino (r = -0.78, p < 0.05), Mojarra blanca (r = 0.79, p < 0.05), and Lisa (r = 0.72, p < 0.05). This suggests that bioaccumulation and biomagnification of certain OPEs in fish increase with the lipophilicity of these compounds. Despite these findings, the potential human health risk from OPE exposure via fish consumption was found to be minimal.
Subject(s)
Environmental Monitoring , Fishes , Flame Retardants , Geologic Sediments , Water Pollutants, Chemical , Animals , Fishes/metabolism , Flame Retardants/analysis , Water Pollutants, Chemical/analysis , Risk Assessment , Colombia , Geologic Sediments/chemistry , Humans , Organophosphates/analysis , Food Chain , Esters/analysisABSTRACT
The chemical fractionation and environmental risk of Ba, Co, Cu, Mn, Mo, Ni, and Pb were evaluated in drill cuttings (DCs) from onshore and offshore oil and gas exploration wells at different depths. The metal concentration in each fraction was determined using inductively coupled plasma mass spectrometry (ICP-MS) after employing the Community Bureau of Reference (BCR) sequential extraction procedure. The method's accuracy was assessed by analyzing a certified reference material, in which the recovery concentrations after the fractionation ranged from 81.9% to 125%. In both onshore and offshore wells, Ba and Mn had higher contents in DCs. The metal determination for the onshore well was mainly found in the F4 fraction (after acid digestion). For the offshore well, the main metal determination was in the F2 fraction (iron and manganese oxides) and the F3 fraction (organic matter). Multivariate analysis revealed that, in offshore samples evaluated at different depths, the extraction medium exerts a greater influence on metal availability than the geochemical behavior of the samples as a function of depth. On the other hand, the opposite behavior was observed in onshore samples. The environmental analysis of the samples indicated high contamination, particularly for Ba, Mn, and Pb, while the cumulative metal pollution was associated with the depth of the wells.
Subject(s)
Chemical Fractionation , Environmental Monitoring , Metals , Oil and Gas Fields , Water Pollutants, Chemical , Environmental Monitoring/methods , Risk Assessment , Water Pollutants, Chemical/analysis , Metals/analysis , Oil and Gas IndustryABSTRACT
BACKGROUND: Sodiumâglucose cotransporter 2 (SGLT2) inhibitors have been included in heart failure (HF) guidelines because of their benefits in reducing mortality and hospitalization rates. However, the timing and benefits of initiating SGLT2 inhibitors in patients after myocardial infarction (MI) remain controversial. Therefore, we aimed to perform a systematic review and meta-analysis comparing SGLT2 inhibitors with placebo in patients with MI. METHODS: We performed a systematic review and meta-analysis to determine the impact of SGLT2 inhibitors in patients with recent or previous MI. We systematically searched PubMed, Cochrane, and Embase for RCTs comparing SGLT2 inhibitors versus placebo in patients with MI. The primary outcome was (1) HF hospitalization. In this analysis, we also included the following secondary outcomes: (2) major adverse cardiovascular events (MACE) defined as a composite of cardiovascular (CV) death, MI or stroke; and (3) all-cause mortality. A subgroup analysis was conducted for the primary outcome, comparing patients who had experienced an MI more than 8 weeks prior to study enrolment (previous MI) versus those who had experienced an MI within the preceding 8 weeks (acute MI). Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled with a random effects model. RESULTS: Our meta-analysis included 10 RCTs comprising 22,266 patients, of whom 11,339 (51.2%) had type 2 diabetes. The mean age was 62 years, and the median follow-up was 21 months. According to the pooled analysis, HF hospitalization rates were lower in patients on SGLT2 inhibitors compared with placebo (RR 0.77; 95% CI 0.69, 0.85; p < 0.001)). Differences in MACE were also observed in favor of SGLT2 inhibitors versus placebo (RR 0.88; 95% CI 0.79, 0.97; p = 0.012). There was no statistically significant difference in all-cause mortality between the groups (RR 0.88; 95% CI 0.78, 1.00; p = 0.058). Benefits of SGLT2 inhibitors for the primary outcome were consistent regardless of the timing of last MI, with no treatment by subgroup interaction (p for interaction = 0.56). CONCLUSION: In this meta-analysis of patients who experienced MI, the administration of SGLT2 inhibitors was associated with lower rates of hospitalization for HF. In addition, the treatment effect of SGLT2 inhibitors was consistent regardless of whether they were started in the recent versus previous MI setting.
Subject(s)
Diabetes Mellitus, Type 2 , Myocardial Infarction , Sodium-Glucose Transporter 2 Inhibitors , Humans , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use , Sodium-Glucose Transporter 2 Inhibitors/adverse effects , Myocardial Infarction/mortality , Myocardial Infarction/drug therapy , Myocardial Infarction/diagnosis , Myocardial Infarction/epidemiology , Treatment Outcome , Time Factors , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/mortality , Diabetes Mellitus, Type 2/diagnosis , Risk Assessment , Risk Factors , Aged , Female , Male , Middle Aged , Heart Failure/mortality , Heart Failure/drug therapy , Heart Failure/diagnosis , Hospitalization , Randomized Controlled Trials as TopicABSTRACT
BACKGROUND: Although emergency Percutaneous Coronary Intervention (PCI) has been shown to reduce mortality in patients with Acute Myocardial Infarction (AMI), the risk of in-hospital death remains high. In this study, the authors aimed to identify risk factors associated with in-hospital mortality in AMI patients who underwent PCI, develop a nomogram prediction model, and evaluate its effectiveness. METHODS: The authors retrospectively analyzed data from 1260 patients who underwent emergency PCI at Dongyang People's Hospital between June 1, 2013, and December 31, 2021. Patients were divided into two groups based on in-hospital mortality: the death group (n = 61) and the survival group (n = 1199). Clinical data between the two groups were compared. The Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to select non-zero coefficients of predictive factors. Multivariable logistic regression analysis was then performed to identify independent risk factors for in-hospital mortality in AMI patients after emergency PCI. A nomogram model for predicting the risk of in-hospital mortality in AMI patients after PCI was constructed, and its predictive performance was evaluated using the c-index. Internal validation was performed using the bootstrap method with 1000 resamples. The Hosmer-Lemeshow test was used to assess the goodness of fit, and a calibration curve was plotted to evaluate the model's calibration. RESULTS: LASSO regression identified d-dimer, B-type natriuretic peptide, white blood cell count, heart rate, aspartate aminotransferase, systolic blood pressure, and the presence of postoperative respiratory failure as important predictive factors for in-hospital mortality in AMI patients after PCI. Multivariable logistic regression analysis showed that d-dimer, B-type natriuretic peptide, white blood cell count, systolic blood pressure, and the presence of postoperative respiratory failure were independent factors for in-hospital mortality. A nomogram model for predicting the risk of in-hospital mortality in AMI patients after PCI was constructed using these independent predictive factors. The Hosmer-Lemeshow test yielded a Chi-Square value of 9.43 (p = 0.331), indicating a good fit for the model, and the calibration curve closely approximated the ideal model. The c-index for internal validation was 0.700 (0.560â0.834), further confirming the predictive performance of the model. Clinical decision analysis demonstrated that the nomogram model had good clinical utility, with an area under the ROC curve of 0.944 (95 % CI 0.903â0.963), indicating excellent discriminative ability. CONCLUSION: This study identified B-type natriuretic peptide, white blood cell count, systolic blood pressure, d-dimer, and the presence of respiratory failure as independent factors for in-hospital mortality in AMI patients undergoing emergency PCI. The nomogram model based on these factors showed high predictive accuracy and feasibility.
Subject(s)
Hospital Mortality , Myocardial Infarction , Nomograms , Percutaneous Coronary Intervention , Humans , Percutaneous Coronary Intervention/mortality , Male , Female , Retrospective Studies , Middle Aged , Aged , Risk Assessment/methods , Risk Factors , Myocardial Infarction/mortality , Myocardial Infarction/blood , Logistic ModelsABSTRACT
Homeobox A9 promoter methylation (HOXA9) has been reported as a biomarker for early lung adenocarcinoma patients' prognosis. We aim to evaluate its prognostic value, regardless of disease stage. Using droplet digital PCR, we measured HOXA9 methylation in a cohort comprising 161 Brazilian patients. Low HOXA9 methylation was associated with higher cancer-specific survival but showed no significance after adjustment for clinical covariates. While low HOXA9 methylation was associated with earlier stages, no survival association was observed in this subset of patients. Overall, HOXA9 promoter methylation is not an independent prognostic biomarker of cancer-specific survival in Brazilian lung adenocarcinomas patients.
Subject(s)
Adenocarcinoma of Lung , Biomarkers, Tumor , DNA Methylation , Homeodomain Proteins , Lung Neoplasms , Adenocarcinoma of Lung/genetics , Adenocarcinoma of Lung/mortality , Adenocarcinoma of Lung/pathology , Adenocarcinoma of Lung/therapy , Lung Neoplasms/genetics , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Lung Neoplasms/therapy , Brazil/epidemiology , Homeodomain Proteins/genetics , Promoter Regions, Genetic , Gene Expression Regulation, Neoplastic , Prognosis , Biomarkers, Tumor/genetics , Neoplasm Staging , Survival Rate , Predictive Value of Tests , Kaplan-Meier Estimate , Age Distribution , Humans , Male , Female , Middle Aged , Aged , Risk Assessment/methodsABSTRACT
BACKGROUND AND AIM: This study aimed to evaluate if the intestinal permeability is associated with overweight/obesity with or without metabolic syndrome (MetS) and correlate intestinal permeability parameters with cardiovascular risk factors. METHODS AND RESULTS: This was a cross-sectional study that individuals were divided in three groups: 1) controls (n = 34), 2) overweight/obesity (n = 29), and 3) overweight/obesity + MetS (n = 29). Anthropometric and blood biochemical parameters were used to estimate cardiovascular risk factors. Intestinal permeability was evaluated using the lactulose/mannitol test in urine samples analyzed by High Performance Liquid Chromatography with Pulsed Amperometry Detection. Correlations between intestinal permeability and anthropometric and biochemical parameters were evaluated using Spearman's correlations (r2). Logistic regression models were performed to elucidate variables associated with intestinal permeability parameters. The percentage of urinary excretion of lactulose, mannitol, and the lactulose/mannitol ratio was similar between the studied groups. The percentage of urinary mannitol excretion was positively associated with diastolic blood pressure (r2 = 0.24, p = 0.23), fasting glucose (r2 = 0.26, p = 0.013), fasting insulin (r2 = 0.25, p = 0.015) and HOMA-IR (r2 = 0.26, p = 0.012). The logistic regression showed fasting insulin was associated with a higher mannitol urinary excretion (AOR = 1.08, 95 % CI = 1.02-1.14). CONCLUSION: Intestinal permeability was not disrupted in overweight/obesity and MetS, however the results suggest that the increased cardiovascular risk factors were associated with a higher intestinal absorption area. Further studies should investigate other intestinal parameters related to overweight/obesity and MetS in humans.
Subject(s)
Biomarkers , Cardiovascular Diseases , Intestinal Absorption , Lactulose , Mannitol , Metabolic Syndrome , Obesity , Permeability , Humans , Metabolic Syndrome/diagnosis , Metabolic Syndrome/epidemiology , Metabolic Syndrome/urine , Metabolic Syndrome/physiopathology , Male , Cross-Sectional Studies , Female , Middle Aged , Mannitol/urine , Obesity/diagnosis , Obesity/physiopathology , Obesity/epidemiology , Adult , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/diagnosis , Biomarkers/blood , Biomarkers/urine , Lactulose/urine , Risk Assessment , Case-Control Studies , Heart Disease Risk FactorsABSTRACT
OBJECTIVE: This study aims to analyze the risk factors for depression in peritoneal dialysis patients and to develop a predictive nomogram model for assessing these risks. METHODS: A total of 326 peritoneal dialysis patients treated between August 2021 and December 2023 were selected as the training set. These patients were categorized into a non-depression group (229 cases) and a depression group (97 cases) based on the presence of depression. Additionally, 104 peritoneal dialysis patients from the same period were selected as the validation set. Clinical data were collected from all patients for analysis. RESULTS: The depression group had higher proportions of female patients, non-employed individuals, those with a per capita monthly income of <2000-yuan, cardiovascular complications, cerebrovascular complications, and sleep disorders compared to the non-depression group. Additionally, the levels of hemoglobin and blood uric acid were lower in the depression group than in the non-depression group (p < 0.05). Gender, work status, per capita monthly income, cardiovascular complications, cerebrovascular complications, and sleep disorders are risk factors for depression in peritoneal dialysis patients (p < 0.05), while hemoglobin and blood uric acid are protective factors for depression in peritoneal dialysis patients (p < 0.05). Calibration curve analysis results showed that the predicted probability was basically consistent with the actual incidence rate. The results of the Decision Curve Analysis (DCA) demonstrated that the nomogram model developed in this study has strong clinical applicability. CONCLUSION: The nomogram model for predicting depression in peritoneal dialysis patients, which incorporates factors such as gender, work status, per capita monthly income, cardiovascular complications, cerebrovascular complications, sleep disorders, hemoglobin levels, and blood uric acid levels, demonstrates excellent calibration and discrimination. Additionally, it has high clinical applicability.
Subject(s)
Depression , Nomograms , Peritoneal Dialysis , Humans , Female , Male , Risk Factors , Middle Aged , Peritoneal Dialysis/adverse effects , Depression/epidemiology , Depression/etiology , Adult , Risk Assessment , Aged , Socioeconomic Factors , Sex FactorsABSTRACT
The management of fluorescent lamps wastes is a challenge, and its disposal in soils may cause harmful effects on human health and edaphic biota due to the presence of Hg and other potentially toxic metals. However, the pedogeochemical behavior of metals from fluorescent lamps is still rarely studied in the tropics. An Oxisol sample was contaminated in the laboratory using a dosage of 6.5% fluorescent lamp powder relative to the mass of soil. The mobility of metals was assessed through a sequential extraction protocol of the Community Bureau of Reference. To assess potential risks, a mathematical model of Human Health Risk Assessment was employed, based on human exposure on metal-contaminated groundwater from soil contamination. Evaluation of metal mobility showed that 6% of Ni and 30% of Cu in contaminated soil were in the potentially bioavailable fraction. The slightly acidic pH of the contaminated soil seems to influence the mobility of Ni and Cu. Zn and Pb were mainly found in the residual fraction, suggesting low geochemical availability. However, over time, metals may be leached, highlighting the importance of monitoring disposal areas. When these results are compared to the mobility profile found in extractions applied to pure fluorescent lamps waste, the data suggest that soil properties tend to reduce metal mobility. Human Health Risk Assessment showed significant risks associated with the human consumption of Cu-contaminated groundwater, considering a scenario of metal leaching from the soil. This study highlights the need for proper fluorescent lamps disposal in tropical terrestrial systems to prevent ecological and public health risks.
Subject(s)
Groundwater , Soil Pollutants , Humans , Risk Assessment , Soil Pollutants/analysis , Groundwater/chemistry , Environmental Monitoring/methods , Water Pollutants, Chemical/analysis , Metals, Heavy/analysis , Metals/analysis , Environmental ExposureABSTRACT
OBJECTIVE: Bone mineral density changes during the life span, rising rapidly during adolescence, plateauing around 30 years of age and decreasing in later years. Life events such as pregnancy and lactation temporarily reduce bone density, and their long-term effects on osteoporosis development are still unclear. This study aimed to analyse the association between pregnancy in adolescence and osteoporosis in aged women. METHODS: This was a cross-sectional study conducted with data from the ELSI-Brazil baseline (2015-2016). The sample consisted of 2634 women aged 60 years old or over with complete information for the variables of interest. Data collection was conducted through individual home interviews and physical assessments. The dependent variable was osteoporosis and the independent variable of interest was pregnancy in adolescents under 20 years of age. The association between the variables was tested using multiple logistic regression. RESULTS: The prevalence of osteoporosis was 32%, and the percentage of women who reported pregnancy in adolescence was 38%. After adjusting for socio-economic and health variables, an association was observed between pregnancy in adolescence and osteoporosis (OR = 1.38; 95% CI = 1.09-1.73), which indicates that specific bone health interventions for teenage mothers could help prevent osteoporosis later in life. CONCLUSION: Women who reported pregnancy before age 20 were more likely to report osteoporosis in old age, indicating that pregnancy in adolescence can be a criterion for directing actions to prevent osteoporosis in aged women.