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BACKGROUND: Subjective cognitive decline (SCD), considered a preclinical dementia stage, is less understood in Hispanics, a high-risk group for dementia. We investigated SCD to mild cognitive impairment (MCI) progression risk, as well as baseline and longitudinal features of depressive symptoms, SCD complaints, and objective cognitive performance among Hispanics compared to non-Hispanic Whites (NHW). METHODS: Hispanic (n = 23) and NHW (n = 165) SCD participants were evaluated at baseline and 2-year follow-up. Evaluations assessed function, depressive symptoms, SCD, and objective cognitive performance. RESULTS: Hispanics were at increased risk of progression to MCI (OR: 6.10, 95% CI 1.09-34.20, P = .040). Hispanic participants endorsed more depressive symptoms at baseline (P = .048) that worsened more longitudinally (OR: 3.16, 95% CI 1.18-8.51, P = .023). Hispanic participants had increased SCD complaints on the Brief Cognitive Rating Scale (BCRS) (ß = .40 SE: .17, P = .023), and in specific BCRS domains: concentration (ß = .13, SE: .07, P = .047), past memory (ß = .13, SE: .06, P = .039) and functional abilities (ß = .10, SE: .05, P = .037). In objective cognitive performance, Hispanic ethnicity associated with decline in MMSE (ß = -.27, SE: .13, P = .039), MoCA (ß = -.80 SE: .34, P = .032), Trails A (ß = 2.75, SE: .89, P = .002), Trails B (ß = 9.18, SE: 2.71, P = .001) and Guild Paragraph Recall Delayed (ß = -.80 SE: .28, P = .005). Conclusions: Hispanic ethnicity associated with a significantly increased risk of 2-year progression of SCD to MCI compared to NHW. This increased risk associated with increased depressive symptoms, distinctive SCD features, and elevated amnestic and non-amnestic objective cognitive decline. This supports further research to refine the assessment of preclinical dementia in this high-risk group.
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Disfunción Cognitiva , Depresión , Progresión de la Enfermedad , Hispánicos o Latinos , Población Blanca , Humanos , Hispánicos o Latinos/estadística & datos numéricos , Hispánicos o Latinos/psicología , Masculino , Femenino , Disfunción Cognitiva/etnología , Población Blanca/estadística & datos numéricos , Anciano , Estudios Longitudinales , Depresión/etnología , Persona de Mediana Edad , Anciano de 80 o más Años , Pruebas Neuropsicológicas/estadística & datos numéricosRESUMEN
This study sought to explore the perspective of medical faculty on the mental health of their students. This qualitative study based on a focus group is part of a longitudinal research that studied the mental health of Brazilian students. One group was conducted with faculty employed at a medical school. Topics discussed covered the concept of mental health and medical education. Six professors participated in one group. The mental health of medical students is a construct that encompasses emotional aspects, ability to solve problems and multiple facets of a human being, according to the participants. Artistic practices, moments of socialization and leisure were perceived as stimulating students' good mental health. Excessive demands generate competitiveness and the teacher's expectation of the student's good performance based on their own experience can harm the student's mental health. Participants also highlighted that a pedagogical reformulation that makes sense for the student's learning process is necessary to update traditional curricula. Medical students' mental health is influenced by experiences and exchanges during the medical school, mainly between professor and student, understood as necessary and inherent to the process of becoming physician. The findings of this study show the need for curriculum changes in the medical education process and updating teacher training for good practices that reinforce good mental health.
Este estudio buscó explorar la perspectiva de los profesores de medicina sobre la salud mental de sus estudiantes. Este estudio cualitativo basado en un grupo focal es parte de una investigación longitudinal que estudió la salud mental de estudiantes brasileños. Un grupo se llevó a cabo con profesores empleados en una escuela de medicina. Los temas tratados abarcaron el concepto de salud mental y educación médica. Seis docentes participaron en un grupo. La salud mental de los estudiantes de medicina es un constructo que abarca aspectos emocionales, capacidad de resolución de problemas y múltiples facetas del ser humano, según los participantes. Las prácticas artísticas, los momentos de socialización y el ocio fueron percibidos como estimulantes de la buena salud mental de los estudiantes. Las exigencias excesivas generan competitividad y la expectativa del docente sobre el buen desempeño del estudiante basándose en su propia experiencia puede perjudicar la salud mental del estudiante. Los participantes también resaltaron que es necesaria una reformulación pedagógica que tenga sentido para el proceso de aprendizaje del estudiante para actualizar los currículos tradicionales. La salud mental de los estudiantes de medicina está influenciada por las experiencias y los intercambios durante la carrera de medicina, principalmente entre profesor y estudiante, entendidos como necesarios e inherentes al proceso de convertirse en médico. Los hallazgos de este estudio muestran la necesidad de cambios curriculares en el proceso de formación médica y de actualización de la formación docente hacia buenas prácticas que refuercen la buena salud mental.
Este estudo buscou explorar a perspectiva dos docentes de medicina sobre a saúde mental de seus alunos. Este estudo qualitativo baseado em grupo focal faz parte de uma pesquisa longitudinal que estudou a saúde mental de estudantes brasileiros. Um grupo foi conduzido com professores empregados em uma faculdade de medicina. Os temas discutidos abrangeram o conceito de saúde mental e educação médica. Seis professores participaram de um grupo. A saúde mental dos estudantes de medicina é um construto que engloba aspectos emocionais, capacidade de resolução de problemas e múltiplas facetas do ser humano, segundo os participantes. As práticas artísticas, os momentos de socialização e de lazer foram percebidos como estimuladores da boa saúde mental dos estudantes. Exigências excessivas geram competitividade e a expectativa do professor pelo bom desempenho do aluno com base na própria experiência pode prejudicar a saúde mental do aluno. Os participantes destacaram também que é necessária uma reformulação pedagógica que faça sentido para o processo de aprendizagem do aluno para atualizar os currículos tradicionais. A saúde mental dos estudantes de medicina é influenciada pelas experiências e trocas durante o curso de medicina, principalmente entre professor e aluno, entendidas como necessárias e inerentes ao processo de tornar-se médico. Os achados deste estudo mostram a necessidade de mudanças curriculares no processo de formação médica e de atualização da formação docente para boas práticas que reforcem a boa saúde mental.
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Humanos , Percepción Social , Estudiantes de Medicina/psicología , Salud Mental , Docentes Médicos , Brasil , Estudios Longitudinales , Grupos Focales , Investigación CualitativaRESUMEN
Rats are major reservoirs for pathogenic Leptospira, the bacteria causing leptospirosis, particularly in urban informal settlements. However, the impact of variation in rat abundance and pathogen shedding rates on spillover transmission to humans remains unclear. This study aimed to investigate how spatial variation in reservoir abundance and pathogen pressure affect Leptospira spillover transmission to humans in a Brazilian urban informal settlement. A longitudinal eco-epidemiological study was conducted from 2013 to 2014 to characterize the spatial distribution of rat abundance and Leptospira shedding rates in rats and determine the association with human infection risk in a cohort of 2,206 community residents. Tracking plates and live-trapping were used to measure rat abundance and quantify rat shedding status and load. In parallel, four sequential biannual serosurveys were used to identify human Leptospira infections. To evaluate the role of shedding on human risk, we built three statistical models for: (1) the relative abundance of rats, (2) the shedding rate by individual rats, and (3) human Leptospira infection, in which "total shedding", obtained by multiplying the predictions from those two models, was used as a risk factor. We found that Leptospira shedding was associated with older and sexually mature rats and varied spatially and temporally-higher at valley bottoms and with seasonal rainfall (December to March). The point estimate for "total shedding" by rat populations was positive, i.e., Leptospira infection risk increased with total shedding, but the association was not significant [odds ratio (OR) = 1.1; 95% confidence interval (CI): 0.9, 1.4]. This positive trend was mainly driven by rat abundance, rather than individual rat shedding (OR = 1.8; 95% CI: 0.6, 5.4 vs. OR = 1.0; 95% CI: 0.7, 1.4]. Infection risk was higher in areas with more vegetative land cover (OR = 2.4; 95% CI: 1.2, 4.8), and when floodwater entered the house (OR = 2.4; 95% CI: 1.6, 3.4). Our findings indicate that environmental and hydrological factors play a more significant role in Leptospira spillover than rat associated factors. Furthermore, we developed a novel approach combining several models to elucidate complex links between animal reservoir abundance, pathogen shedding and environmental factors on zoonotic spillover in humans that can be extended to other environmentally transmitted diseases.
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Reservorios de Enfermedades , Leptospira , Leptospirosis , Zoonosis , Animales , Humanos , Leptospirosis/epidemiología , Leptospirosis/microbiología , Leptospirosis/transmisión , Leptospira/aislamiento & purificación , Reservorios de Enfermedades/microbiología , Brasil/epidemiología , Ratas , Zoonosis/microbiología , Masculino , Femenino , Adulto , Derrame de Bacterias , Estudios Longitudinales , Persona de Mediana Edad , Factores de Riesgo , Población Urbana/estadística & datos numéricos , Adolescente , Adulto JovenRESUMEN
BACKGROUND: Considering the previous research that suggested that screen time (ST), sleep duration, physical activity (PA), obesity and cardiometabolic risk factors are related, it is essential to identify how these variables are associated over time, to provide knowledge for the development of intervention strategies to promote health in pediatric populations. Also, there is a lack of studies examining these associations longitudinally. The aims of the present study were: (1) to investigate the longitudinal relationships between ST, sleep duration, leisure PA, body mass index (BMI), and cardiometabolic risk score (cMetS) in children and adolescents; and (2) to verify scores and prevalence of cMetS risk zones at baseline and follow-up. METHODS: This observational longitudinal study included 331 children and adolescents (aged six to 17 years; girls = 57.7%) from schools in a southern city in Brazil. ST, sleep duration, and leisure PA were evaluated by a self-reported questionnaire. BMI was evaluated using the BMI z-scores (Z_BMI). The cMetS was determined by summing sex- and age-specific z-scores of total cholesterol/high-density lipoprotein cholesterol (HDL-C) ratio, triglycerides, glucose, and systolic blood pressure and dividing it by four. A two-wave cross-lagged model was implemented. RESULTS: ST, sleep duration, and leisure PA were not associated with cMetS after 2-years. However, it was observed that higher ST at baseline was associated with shorter sleep duration at follow-up (B=-0.074; 95%IC=-0.130; -0.012), while higher Z_BMI from baseline associated with higher cMetS of follow-up (B = 0.154; 95%CI = 0.083;0.226). The reciprocal model of relationships indicated that the variance of ST, sleep time, leisure PA, Z_BMI, and cMetS explained approximately 9%, 14%, 10%, 67% and 22%, respectively, of the model. Individual change scores and prevalence indicated that cMetS had individual changes from 2014 to 2016. CONCLUSION: Sleep duration, ST and leisure PA were not associated with cMetS after 2 years. ST showed an inverse association with sleep duration, and Z_BMI was positively associated with cMetS after a 2-year follow-up. Finally, the prevalence of no clustering of risk factors increased after two years. These findings suggest the need to promote healthy lifestyle habits from childhood and considering individual factors that can influence cardiometabolic health in children and adolescents.
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Factores de Riesgo Cardiometabólico , Ejercicio Físico , Actividades Recreativas , Obesidad Infantil , Tiempo de Pantalla , Sueño , Humanos , Femenino , Masculino , Niño , Adolescente , Factores de Tiempo , Estudios Longitudinales , Medición de Riesgo , Obesidad Infantil/epidemiología , Obesidad Infantil/diagnóstico , Obesidad Infantil/fisiopatología , Brasil/epidemiología , Prevalencia , Factores de Edad , Índice de Masa Corporal , Conducta del Adolescente , Conducta Infantil , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/fisiopatología , Enfermedades Cardiovasculares/prevención & control , Conducta Sedentaria , Duración del SueñoRESUMEN
Human immunodeficiency virus (HIV) is a global public health problem. Coinfections in HIV patients are frequent complications that increase their mortality. The aim of this study was to assess coinfections and in-hospital mortality in a group of patients infected with HIV in Colombia. A retrospective longitudinal study was carried out. Patients treated in 4 highly complex clinics in Colombia between 2015 and 2023 were included. The cases were identified from International Classification of Diseases codes related to HIV. Sociodemographic, clinical, laboratory and pharmacological variables were collected. Descriptive, bivariate, and multivariable analyses were performed. Of the 249 patients identified, 79.1% were men, and the median age was 38.0 years. Approximately 81.1% had a diagnosis of acquired immune deficiency syndrome (AIDS). Coinfections caused by Mycobacterium tuberculosis (24.1%) and Treponema pallidum (20.5%) were the most frequent. A total of 20.5% of the patients had sepsis, 12.4% had septic shock, and the fatality rate was 15.7%. Antibiotics and antifungals were used in 88.8% and 53.8%, respectively, of the patients. Patients with a diagnosis of HIV before admission, those infected with M. tuberculosis, and those who presented with sepsis were more likely to die, whereas patients who received antiretroviral agent treatment before admission presented a lower risk. In this study, most HIV patients were in an advanced stage of the disease. Coinfection with M. tuberculosis was common and was associated with an increased risk of death. Previous HIV diagnosis and sepsis also increased the risk. Approximately half of the patients with a previous HIV diagnosis were receiving antiretroviral therapy and had a better prognosis.
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Coinfección , Infecciones por VIH , Mortalidad Hospitalaria , Humanos , Masculino , Femenino , Adulto , Estudios Longitudinales , Estudios Retrospectivos , Infecciones por VIH/complicaciones , Infecciones por VIH/mortalidad , Infecciones por VIH/tratamiento farmacológico , Colombia/epidemiología , Persona de Mediana Edad , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Tuberculosis/mortalidad , Tuberculosis/epidemiologíaRESUMEN
BACKGROUND: At the beginning of the COVID-19 pandemic, some workers had the opportunity to work from home, while others remained in on-site work. The aim of the present study was to compare the psychosocial work aspects, work ability, mental health conditions and SARS-CoV-2 infection rates of Brazilian workers in remote and on-site work through a longitudinal study with quarterly follow-up assessments over a 12-month period. METHOD: A convenience sample of 1,211 workers from different economic sectors participated in the study, 897 of whom (74.1%) worked from home and 314 (25.9%) remained in on-site work. Psychosocial work aspects were assessed using the Copenhagen Psychosocial Questionnaire (COPSOQ). Work ability was assessed using the Work Ability Index (WAI) and the Work Ability Score (WAS). Mental health conditions and SARS-CoV-2 infection rate were recorded based on self-reported medical diagnoses. Online questionnaires were answered from June 2020 to September 2021, involving two waves of the COVID-19 pandemic. The groups were compared using chi-square tests, t-tests, and two-way ANOVA. RESULTS: In the first wave of the pandemic, remote workers reported more quantitative demands and work-family conflicts, whereas on-site workers reported more emotional demands, low development of new skills, low commitment, low predictability, low recognition, and low satisfaction. They also reported greater occurrences of unwanted sexual attention, threats of violence, and physical violence. In the second wave, the remote group continued to report high work-family conflicts, whereas the on-site group reported - in addition to the results of the 1st wave - low influence at work, low quality of leadership, and burnout. No significant difference was found between groups with regards to the WAI in either wave. A significant difference was found for the WAS between the 3rd and 12th months (P < 0.01) in both groups. No significant differences were found between groups for the prevalence of anxiety, depression, burnout/stress, insomnia, panic syndrome, and eating disorders, except for the prevalence of insomnia at the 12-month follow-up, with higher rates in the remote group (P = 0.03). SARS-CoV-2 infection was significantly lower in the remote group (11.3%) compared to the on- site (16.9%) group (P < 0.01). CONCLUSIONS: Psychosocial work aspects differed between remote and on-site workers. Work ability and mental health conditions were similar between groups. Remote work might have played a role in limiting the spread of the virus in Brazil had it been more widely available.
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COVID-19 , Salud Mental , Humanos , COVID-19/epidemiología , COVID-19/psicología , Brasil/epidemiología , Masculino , Estudios Longitudinales , Femenino , Adulto , Persona de Mediana Edad , Salud Mental/estadística & datos numéricos , SARS-CoV-2 , Encuestas y Cuestionarios , Teletrabajo , Evaluación de Capacidad de Trabajo , PandemiasRESUMEN
With global C-section rates rising, understanding potential consequences is imperative. Previous studies suggested links between birth mode and psychological outcomes. This study evaluates the association of birth mode and neurodevelopment in young children across two prospective cohorts, using repeated psychometric assessments. Data from the ELEMENT (Early Life Exposures in Mexico to Environmental Toxicants) and PROGRESS (Programming Research in Obesity, Growth, and Environment and Social Stress) cohorts, comprising 7158 and 2202 observations of 1402 children aged 2 to 36 months, and 726 children aged 5 to 27 months, respectively, were analyzed. Exclusion criteria for the cohorts were maternal diseases such as preeclampsia, renal or heart disease, gestational diabetes, and epilepsy. Neurodevelopment was gauged via Bayley's Scales of Infant Development: 2nd edition for ELEMENT and 3rd edition for PROGRESS. Mixed-effects models longitudinally estimated associations between birth mode and neurodevelopment scores, adjusting for cofounders. In ELEMENT, psychomotor development composite scores were significantly affected by birth mode from ages 2 to 8 months; the largest estimate within this range was at 2 months (ß =-1.93; 95% CI: [-3.64, -0.22], reference: vaginal delivery). For PROGRESS, a negative association was found with motor development composite scores over all the studied age range (ß=-1.91; 95% CI: [-3.01, -0.81]). The association was stronger between ages 6 to 18 months, with the strongest estimate at 11 months (ß=-2.58; 95% CI: [-4.37, -0.74]). A negative impact of C-section on language scores in girls was estimated for the PROGRESS cohort (ß=-1.92; 95% CI: [-3.57, -0.27]), most marked in ages 22 to 25 months (largest ß at 24.5 months=-3.04; 95% CI: [-5.79, -0.30]). Children born by C-section showed lower motor and language development scores during specific age windows in the first three years of life. Further research is necessary to understand the complexities and implications of these findings.
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Cesárea , Desarrollo Infantil , Desarrollo del Lenguaje , Humanos , Femenino , Preescolar , Lactante , Masculino , Estudios Longitudinales , Embarazo , Estudios Prospectivos , MéxicoRESUMEN
OBJECTIVE: Evaluate the 5-year changes in the consumers' food environment in the area of a health promotion service in Brazilian primary health care. Our hypothesis is that the consumers' food environment in the areas with primary healthcare services has changes that may favour healthy eating habits over time. DESIGN: Longitudinal study. SETTING: The territory around the primary healthcare services in Belo Horizonte, Minas Gerais, Brazil. PARTICIPANTS: All food stores and open-air food markets that sell fruits and vegetables around the primary healthcare services in 2013 (n 272) and in 2018 (n 265). RESULTS: Fruit diversity increased by 13·4 % (P < 0·001) and vegetables variety and quality by 16·1 % (P = 0·003) and 12·5 % (P < 0·001), respectively. Corn snacks showed an increase in availability (13·5 %; P = 0·002). The increase in advertising was observed for fruits and vegetables (34·6 %; P < 0·001) and ultra-processed foods (47·6 %; P < 0·001). Supermarkets showed an increase in the Healthy Food Store Index (three points; P < 0·001), while fruits and vegetables stores showed a decrease of one point in the index (P < 0·001). CONCLUSIONS: The unequal changes in the consumers' food environment according to the food stores types demonstrate the importance of food supply policies that promote a healthy environment and favour the maintenance of traditional healthy food retailers.
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Dieta Saludable , Abastecimiento de Alimentos , Frutas , Verduras , Humanos , Brasil , Estudios Longitudinales , Abastecimiento de Alimentos/estadística & datos numéricos , Dieta Saludable/estadística & datos numéricos , Supermercados , Comportamiento del Consumidor/estadística & datos numéricos , Promoción de la Salud/métodos , Atención Primaria de Salud/estadística & datos numéricos , Bocadillos , Publicidad/estadística & datos numéricos , Conducta Alimentaria , Comida Rápida/estadística & datos numéricosRESUMEN
OBJECTIVES: to construct and assess an educational video to promote the adherence of women with pelvic organ prolapse to vaginal pessary use. METHODS: this is a methodological study, with a longitudinal design and quantitative analysis. The pre-production (synopsis, argument, script, storyboard), production and post-production stages were covered. Content and technical assessments were carried out by judges from the health and communication areas, respectively, and appearance assessment by the target audience. RESULTS: the video was the first to be developed on the topic on the national scene, considered assessed from the point of view of appearance and content, presenting an overall Content Validity Index of 0.99 and a level of agreement among judges of 91.1% to 100%. Assessment by the target audience reached a percentage of 96% to 100%. CONCLUSIONS: the educational video is an instrument capable of promoting adherence to pessary in women indicated for this therapeutic approach.
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Prolapso de Órgano Pélvico , Pesarios , Humanos , Femenino , Prolapso de Órgano Pélvico/terapia , Grabación en Video/métodos , Estudios Longitudinales , Persona de Mediana Edad , Cooperación del Paciente/estadística & datos numéricosRESUMEN
INTRODUCTION: Water and electrolyte disturbances associated with colistin are understudied adverse effects in the medical literature. We aim to evaluate their incidence in hospitalized older adult patients. MATERIALS AND METHODS: A longitudinal retrospective study of the interrupted time series type was conducted on patients admitted to Dr. César Milstein Hospital. We included adults aged 65 and older who received colistin with normal serum potassium, magnesium, and calcium at the outset. Electrolyte values were collected before, during and after suspending the antibiotic. Values were compared using non-parametric tests, and a multivariate linear regression model with robust intervals was performed to assess sociodemographic and clinical characteristics associated with serum concentrations. RESULTS: A total of 89 patients were included. The rate of hypokalemia was 77.5% (n=69), and factors associated with potassium decline included older age, increased creatinine levels, and longer colistin treatment duration. Serum magnesium disturbances were reported in 66 (79.5%) of the 83 patients evaluated. The decrease in both electrolytes was statistically significant in the measured times and both values normalized after 72 hours of stopping antibiotic therapy. The incidence of acute kidney injury during colistin treatment in patients with normal baseline creatinine was 63.6% (n = 42/66), and in those with abnormal baseline creatinine, it was 47.8% (n = 11/23). CONCLUSION: We report high rates of electrolyte disturbances in patients treated with colistin, with hypokalemia being the most frequent, showing resolution following discontinuation of antibiotic therapy. Continuous monitoring of electrolyte levels and renal function during colistin treatment is crucial.
Introducción: Los trastornos hidroelectrolíticos asociados a la colistina son efectos adversos poco estudiados en la literatura médica. Nos propusimos evaluar su incidencia en pacientes adultos mayores hospitalizados. Materiales y métodos: Se realizó un estudio longitudinal retrospectivo, del tipo serie de tiempo interrumpida, en pacientes internados mayores de 65 años que recibieron colistina, con potasio, magnesio y calcio séricos normales al inicio. Se recabaron valores de dichos electrolitos previo, durante y luego de suspender el antibiótico. Se compararon los valores mediante test no paramétricos y se realizó un modelo multivariado de regresión lineal con intervalos robustos para evaluar las características sociodemográficas y clínicas asociadas a las concentraciones séricas. Resultados: Se incluyeron 89 pacientes. La tasa de hipocalemia fue del 77.5% (n = 69) y las variables asociadas al descenso del potasio fueron mayor edad, aumento de creatininemia, y duración de tratamiento con colistina. Se informaron trastornos del magnesio en 66 (79.5%) de los 83 pacientes evaluados. El descenso de ambos electrolitos fue estadísticamente significativo en los tiempos medidos, y ambos normalizaron valores tras 72 horas de suspendida la antibioticoterapia. La incidencia de insuficiencia renal aguda en pacientes con creatinina basal normal fue del 63.6%, (42/66) y con creatinina basal anormal de 47.8% (11/23). Conclusión: En pacientes tratados con colistina, el trastorno más frecuente fue la hipocalemia, mostrando resolución tras la suspensión del antibiótico. Es importante la monitorización constante de los niveles de electrolitos y la función renal durante el tratamiento con colistina.
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Antibacterianos , Calcio , Colistina , Hipopotasemia , Magnesio , Potasio , Humanos , Colistina/efectos adversos , Colistina/sangre , Masculino , Femenino , Anciano , Estudios Retrospectivos , Magnesio/sangre , Antibacterianos/efectos adversos , Hipopotasemia/sangre , Hipopotasemia/inducido químicamente , Hipopotasemia/epidemiología , Anciano de 80 o más Años , Potasio/sangre , Calcio/sangre , Estudios Longitudinales , Factores de Tiempo , Desequilibrio Hidroelectrolítico/inducido químicamente , Desequilibrio Hidroelectrolítico/sangre , Desequilibrio Hidroelectrolítico/epidemiología , Lesión Renal Aguda/sangre , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/epidemiologíaRESUMEN
BACKGROUND: Anopheles darlingi is the most efficient vector of malaria parasites in the Neotropics. Nevertheless, the specificities of its larval habitats are still poorly known. OBJECTIVES: Characterize permanent larval habitats, and population dynamics of An. darlingi and other potential vectors in relation to climate, physicochemical variables, insect fauna and malaria cases. METHODS: A 14-month longitudinal study was conducted in Porto Velho, Rondônia, western Brazilian Amazon. Monthly, 21 permanent water bodies were sampled. Immature anophelines and associated fauna were collected, physicochemical characteristics, and climate variables were recorded and analyzed. FINDINGS: Five types of habitats were identified: lagoon, stream, stream combined with lagoon, stream combined with dam, and fishpond. A total of 60,927 anophelines were collected. The most abundant species in all habitats were Anopheles braziliensis and An. darlingi. The highest density was found in the lagoon, while streams had the highest species richness. Abundance was higher during the transition period wet-dry season. There was a lag of respectively four and five months between the peak of rainfall and the Madeira River level and the highest abundance of An. darlingi larvae, which were positively correlated with habitats partially shaded, pH close to neutrality, increase dissolved oxygen and sulphates. MAIN CONCLUSIONS: The present study provides data on key factors defining permanent larval habitats for the surveillance of An. darlingi and other potential vectors as well as a log-linear Negative Binomial model based on immature mosquito abundance and climate variables to predict the increase in the number of malaria cases.
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Anopheles , Ecosistema , Larva , Malaria , Mosquitos Vectores , Densidad de Población , Estaciones del Año , Animales , Anopheles/clasificación , Anopheles/crecimiento & desarrollo , Anopheles/fisiología , Brasil , Mosquitos Vectores/fisiología , Mosquitos Vectores/clasificación , Mosquitos Vectores/crecimiento & desarrollo , Malaria/transmisión , Estudios Longitudinales , Dinámica PoblacionalRESUMEN
BACKGROUND: Intramuscular vascular malformations (IVMs) are rare developmental congenital structural abnormalities. Their clinical diagnosis is difficult, and imaging studies are essential to determine the type and extent of vessels involved. Treatment can be challenging and must be managed by a multidisciplinary team. METHODS: A descriptive, observational, retrospective, longitudinal study of clinical records of patients diagnosed with IVMs who were evaluated at the vascular anomalies clinic from January 2011 to December 2021 was performed. Demographic, clinical, imaging, diagnosis, treatment, and response data were collected. RESULTS: Seven patients (five females and two males) with a mean age of 13.66 years (standard deviation 5.82 years) were included in the study. In all cases, the clinical diagnosis was venous and lymphatic malformation. The radiological findings were dilated and tortuous vascular structures or multilobulated lesions with septa inside, with or without vascular flow; these findings allowed diagnosis in all cases. Treatment modalities included sclerotherapy in five patients, surgical resection in two, medical treatment with sirolimus in three, and surveillance in one. Subsequent clinical evolution was favorable in all patients, with decreased pain in six (partial in four and total in two) and size reduction in one patient. CONCLUSION: IVMs in our pediatric population most frequently affect the lower extremities. The main symptoms and signs were pain on exertion and volume increase. Treatment can be challenging given the extension and depth of the malformations, so a combination of therapeutic modalities may be necessary to obtain the best outcome.
INTRODUCCIÓN: Las malformaciones vasculares intramusculares (MVI) son anomalías estructurales congénitas del desarrollo raras. Su diagnóstico clínico es difícil y los estudios de imagen son fundamentales para determinar su tipo y extensión. Su tratamiento puede ser un desafío y debe ser dirigido por un equipo multidisciplinario. MÉTODOS: Se realizó un estudio descriptivo, observacional, retrospectivo y longitudinal de los expedientes clínicos de pacientes con diagnóstico de MVI que fueron valorados en la Clínica de Anomalías Vasculares desde enero 2011 a diciembre 2021. Se recolectaron datos demográficos, clínicos, imagenológicos, diagnóstico, tratamiento y respuesta al mismo. RESULTADOS: Se incluyeron 7 pacientes (5 mujeres y 2 hombres) con una edad media de 13.66 años (DE 5.82 años). En todos, el diagnóstico clínico fue malformación venosa y/o linfática. Los hallazgos radiológicos mediante ultrasonido y/o resonancia magnética nuclear fueron estructuras vasculares dilatadas y tortuosas o lesiones multilobuladas con septos en su interior, con o sin flujo vascular; y en todos los casos permitieron hacer el diagnóstico. El tratamiento fue escleroterapia en 5 pacientes, resección quirúrgica en 2, tratamiento con Sirolimus en 3 y vigilancia en 1. La evolución clínica posterior fue favorable en todos, con disminución del dolor en 6 (parcial en 4 y total en 2) y reducción del tamaño en 1 paciente. CONCLUSIÓN: Las MVI en nuestra población pediátrica, afectan con mayor frecuencia las extremidades inferiores. Los principales síntomas fueron dolor de esfuerzo y aumento de volumen. Su tratamiento puede ser un reto dada su extensión y profundidad, por lo que la combinación de modalidades terapéuticas puede ser necesarias para obtener el mejor desenlace.
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Escleroterapia , Malformaciones Vasculares , Humanos , Estudios Retrospectivos , Femenino , Masculino , Niño , Adolescente , Malformaciones Vasculares/terapia , Malformaciones Vasculares/diagnóstico , Estudios Longitudinales , Escleroterapia/métodos , Sirolimus/administración & dosificación , Anomalías Linfáticas/terapia , Anomalías Linfáticas/diagnóstico , Anomalías Linfáticas/patología , Preescolar , Músculo Esquelético/irrigación sanguínea , Resultado del TratamientoRESUMEN
INTRODUCTION AND AIM: Chronic pancreatitis is a pathologic fibroinflammatory syndrome of the pancreas. Treatment includes medical management and endoscopic and/or surgical interventions. Our aim was to describe progression in patients with chronic pancreatitis whose initial management was either endoscopic or surgical. MATERIAL AND METHODS: A retrospective, analytic, observational, and longitudinal study was conducted that included patients diagnosed with chronic pancreatitis treated at the Hospital de Especialidades of the Centro Médico Nacional Siglo XXI from 2015 to 2021. RESULTS: Twenty-two patients were included in the study; 12 underwent endoscopy and 10 underwent surgery. The mean number of interventions performed was 3 in the endoscopic management group and 1.1 in the surgical management group (pâ¯=â¯0.001). Regarding pain remission (partial or total), results were statistically significant in favor of surgical management (pâ¯=â¯0.035). Of the 12 patients that initially underwent endoscopy, 7 (58.3%) eventually required surgery during follow-up. There were no statistically significant differences with respect to opioid and pancreatin use, readmissions, weight loss, steatorrhea, newly diagnosed diabetes, or deaths during follow-up. CONCLUSION: Pain is the main indication for invasive treatment, whether endoscopic or surgical, in patients with chronic pancreatitis. Slightly more than half of the patients that were initially managed endoscopically required surgery during follow-up. Management decisions should be multidisciplinary and individualized for each patient.
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Pancreatitis Crónica , Humanos , Pancreatitis Crónica/cirugía , Pancreatitis Crónica/diagnóstico por imagen , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Estudios Longitudinales , Anciano , Resultado del TratamientoRESUMEN
Background/Objectives: Sterilization in dental practice is crucial for infection prevention. The aim of this study was to identify the presence and causes of bacterial growth using biological indicators in dental sterilization equipment in San Luis Potosí, S.L.P., Mexico, with different consecutive measurements over a year. Methods: This longitudinal cohort, conducted from January 2022 to January 2024 in San Luis Potosí, Mexico, aimed to identify the presence and causes of bacterial growth in dental sterilization equipment using biological indicators. A total of 207 dental offices were approached, and 175 participated, providing data through questionnaires and monitoring sterilization cycles with BIs. The checks were bimonthly for one year, with a total of six checks. Results: (a) An 11% (n = 1188) incidence of bacterial growth was observed, with a higher percentage in dry heat equipment (13%). (b) Upon analyzing the six consecutive verifications over a year, no statistically significant differences were observed in the failures of the sterilization cycles when comparing the two pieces of equipment. (c) Error in temperature and time of the equipment (OR = 4.0, 95% CI = 1.6-3.9, p = 0.0001) was significantly associated with the presence of bacterial growth during the one-year period. Conclusions: Monitoring sterilization cycles and identifying the causes of bacterial growth with different consecutive verifications decreased the presence of bacterial growth (failures) during the one-year period.
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Consultorios Odontológicos , Esterilización , México/epidemiología , Estudios Longitudinales , Esterilización/métodos , Esterilización/normas , Humanos , Estudios de Cohortes , Falla de Equipo/estadística & datos numéricos , Contaminación de Equipos/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
BACKGROUND: Cerebral blood flow dynamics can be explored through analysis of endothelial frequencies. Our hypothesis posits a disparity in endothelial activity among neonates with perinatal asphyxia, stratified by the presence or absence of neuronal lesions. METHODS: We conducted a retrospective longitudinal study involving newborns treated with hypothermia for moderate to severe asphyxia. Participants were grouped based on the presence or absence of neuronal damage to investigate temporal endothelial involvement in cerebral blood flow regulation. Regional cerebral oxygen saturation (rScO2) was measured using near-infrared spectroscopy (NIRS), and temporal series were analyzed in the frequency domain, utilizing the original frequency of the INVOS™ device. RESULTS: The study included 88 patients, with 53% (47/88) being male and 33% (29/88) demonstrating brain lesions on magnetic resonance imaging. Among them, 86% (76/88) had a gestational age exceeding 37 weeks according to the Ballard scale, and 81% (71/88) had a birth weight exceeding 2500 g. Cohen's d effect size was calculated to assess differences in endothelial frequency between groups, indicating a small effect size based on cerebral MRI findings (Cohen's d values for Day 2 = 0.2351 and Day 3 = 0.2325). CONCLUSION: NIRS represents a valuable tool for monitoring cerebral autoregulation in neonates affected by perinatal asphyxia, underscoring the utility of assessing endothelial frequency or energy on rScO2 measured by NIRS using the original INVOS™ device frequency.
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Asfixia Neonatal , Circulación Cerebrovascular , Espectroscopía Infrarroja Corta , Humanos , Recién Nacido , Estudios Retrospectivos , Asfixia Neonatal/fisiopatología , Masculino , Femenino , Circulación Cerebrovascular/fisiología , Estudios Longitudinales , Saturación de Oxígeno/fisiología , Imagen por Resonancia Magnética , Hipotermia Inducida , Endotelio Vascular/fisiopatologíaRESUMEN
OBJECTIVE: Quantitative chest computed tomography (qCT) methods are new tools that objectively measure parenchymal abnormalities and vascular features on CT images in patients with interstitial lung disease (ILD). We aimed to investigate whether the qCT measures are predictors of 5-year mortality in patients with systemic sclerosis (SSc). METHODS: Patients diagnosed with SSc were retrospectively selected from 2011 to 2022. Patients should have had volumetric high-resolution CTs (HRCTs) and pulmonary function tests (PFTs) performed at baseline and at 24 months of follow-up. The following parameters were evaluated in HRCTs using Computer-Aided Lung Informatics for Pathology Evaluation and Rating (CALIPER): ground glass opacities, reticular pattern, honeycombing, and pulmonary vascular volume. Factors associated with death were evaluated by KaplanâMeier survival curves and multivariate analysis models. Semiquantitative analysis of the HRCTs images was also performed. RESULTS: Seventy-one patients were included (mean age, 54.2 years). Eleven patients (15.49%) died during the follow-up, and all patients had ILD. As shown by KaplanâMeier curves, survival was worse among patients with an ILD extent (ground glass opacities + reticular pattern + honeycombing) ≥ 6.32%, a reticular pattern ≥ 1.41% and a forced vital capacity (FVC) < 70% at baseline. The independent predictors of mortality by multivariate analysis were a higher reticular pattern (Exp 2.70, 95%CI 1.26-5.82) on qCT at baseline, younger age (Exp 0.906, 95%CI 0.826-0.995), and absolute FVC decline ≥ 5% at follow-up (Exp 15.01, 95%CI 1.90-118.5), but not baseline FVC. Patients with extensive disease (>20% extension) by semiquantitative analysis according to Goh's staging system had higher disease extension on qCT at baseline and follow-up. CONCLUSION: This study showed that the reticular pattern assessed by baseline qCT may be a useful tool in the clinical practice for assessing lung damage and predicting mortality in SSc.
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Enfermedades Pulmonares Intersticiales , Esclerodermia Sistémica , Tomografía Computarizada por Rayos X , Humanos , Esclerodermia Sistémica/mortalidad , Esclerodermia Sistémica/diagnóstico por imagen , Esclerodermia Sistémica/complicaciones , Persona de Mediana Edad , Femenino , Masculino , Tomografía Computarizada por Rayos X/métodos , Estudios Longitudinales , Estudios Retrospectivos , Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Enfermedades Pulmonares Intersticiales/mortalidad , Anciano , Adulto , Estimación de Kaplan-Meier , Pruebas de Función Respiratoria , Pulmón/diagnóstico por imagen , Pulmón/patología , Pulmón/fisiopatología , PronósticoRESUMEN
BACKGROUND: There is scarce data concerning the relationship between negative life events (NLEs)* and current and new depressive episodes by age. METHODS: Cross-sectional (baseline) and prospective analyses (4-year/8-year follow-ups) were performed in 15,105 civil servants in 6 cities in Brazil classified according to age strata at baseline: 1st(35-44), 2nd(45-54), 3rd(55-64), and 4th(65-74) years. The independent variable was NLEs in the last year (robbery, hospitalization, death of a relative, financial hardship, and rupture of a love relationship) collected at baseline. The dependent variable was depressive episodes assessed at baseline (current), and 4-year/8-year follow-ups (new). We built logistic (Odds Ratio[OR];95 % Confidence Interval[CI]) in the cross-sectional analysis and Poisson regression models (Relative Risk[RR], [CI]) in the prospective analysis. RESULTS: Robbery, hospitalization, financial hardship, rupture of a relationship were associated with current depressive episodes concentrated in the 35-44 age range, while for new depressive episodes, the association of hospitalization, death of a relative, and financial hardship were concentrated in the 45-54 age stratum. Financial hardship was associated with current depressive episodes in all age-strata: 1st: OR, 2.77(CI, 1.83-4.19); 2nd: OR, 1.71(CI, 1.26-2.34); 3rd: OR, 1.68(CI,1.15-2.46); 4th, OR, 4.07(CI, 1.24-13.34), and new depressive episodes: 1st: RR, 1.45(CI, 1.09-1.93); 2nd RR, 1.46(CI: 1.15-1.84); 3rd: RR, 1.97(CI, 1.38-2.82). Rupture of a relationship was associated only with current depressive episode, while death of a relative only with new depressive episode. LIMITATION: We cannot rule out the possibility of recall bias, since NLEs` information was self-reported. CONCLUSION: The association between NLEs with depressive episodes was concentrated in youngers.
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Acontecimientos que Cambian la Vida , Humanos , Brasil/epidemiología , Persona de Mediana Edad , Femenino , Adulto , Masculino , Estudios Transversales , Anciano , Estudios Longitudinales , Estudios Prospectivos , Factores de Edad , Hospitalización/estadística & datos numéricos , Depresión/epidemiología , Depresión/psicología , Trastorno Depresivo/epidemiología , Trastorno Depresivo/psicología , Estrés Financiero/psicología , Estrés Financiero/epidemiología , Factores de RiesgoRESUMEN
BACKGROUND: Little is known on how the substitution of time spent in sedentary behavior (SB) patterns with time spent in physical activity impacts cardiovascular risk factors during adolescence. The study aimed to investigate how the substitution of time spent in SB and sedentary bouts with time spent in different physical activity intensities was associated with longitudinal changes in cardiovascular risk factors in analyses stratified by sex. METHODS: This is a prospective cohort study with a mean follow-up period of 3.2 (±0.34) years, involving 109 (60 girls and 49 boys) Brazilian adolescents. Body mass index, waist circumference, and cardiorespiratory fitness were the cardiovascular risk factors considered. A cardiovascular risk score was calculated. Sedentary bouts, light physical activity (LPA), and moderate to vigorous physical activity (MVPA) were measured by accelerometers. Multivariate linear regression models adopting the isotemporal substitution were used to analyze the association between substitution of 10 minutes per day of sedentary bouts with LPA and MVPA and risk factors. All analyses considered 5% significance levels. RESULTS: Substitutions of SB, short and long bouts, with MVPA were associated with higher cardiorespiratory fitness in boys (ß = 0.077; 95% confidence interval, 0.001 to 0.55; ß = 0.076; 95% confidence interval, 0.003 to 0.154; and ß = 0.084; 95% confidence interval, 0.001 to 0.167, respectively). No associations were observed when analyses involved substitution of sedentary bouts with LPA, adiposity, cardiovascular risk score, and girls. CONCLUSIONS: Substituting SB bouts with MVPA appears to favorably influence changes of cardiorespiratory fitness in boys during adolescence. Greater benefits appear to occur when longer sedentary bouts are substituted by MVPA.
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Acelerometría , Índice de Masa Corporal , Capacidad Cardiovascular , Ejercicio Físico , Factores de Riesgo de Enfermedad Cardiaca , Conducta Sedentaria , Humanos , Masculino , Femenino , Adolescente , Estudios Longitudinales , Estudios Prospectivos , Capacidad Cardiovascular/fisiología , Brasil/epidemiología , Circunferencia de la Cintura , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Factores de Tiempo , Factores Sexuales , Factores de RiesgoRESUMEN
With COVID-19, evidence indicates that the elderly will have worse biochemical markers related to health in social isolation. The objective was to analyze the impacts on physical fitness and biochemical parameters of older adults' health during COVID-19 social isolation. Quantitative, longitudinal, and observational study was conducted between 2020, 2021, and 2022. Thirty-three older adults of both sexes were evaluated. A sociodemographic questionnaire, biomarkers, and health-related physical fitness were used. Significant differences were observed for the sum of maximum isometric right and left handgrip strength, with a reduction in 2022 (p = 0.009); getting up and walking (p < 0.001), reduction in 2021 and 2022 (p < 0.05); elbow flexion and extension (p = 0.004), reduction in 2021 (p = 0.006); and sitting and standing (p = 0.002), reduction in 2022 (p = 0.003) and peak oxygen consumption (p < 0.001), reduction in 2021 and 2022 (p < 0.05). Differences were observed in fasting blood glucose (p < 0.001), with increase in 2021 and 2022 (p < 0.05), triglycerides (p < 0.001), with increase in 2021 and 2022 (p < 0.05), triglyceride-glucose index (p < 0.001), with increase in 2021 and 2022 (p < 0.05), triglyceride-glucose index with waist circumference (p < 0.001), with increase in 2021 (p < 0.001); and triglyceride-glucose index with body mass index (p < 0.001), with increase in 2021 (p < 0.001). However, no differences were observed between anthropometric and body composition (p > 0.05). Conclusions: Older people had changes in biochemical and physical fitness parameters related to health during the social isolation of the COVID-19 pandemic.
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COVID-19 , Sobrepeso , Aptitud Física , Aislamiento Social , Humanos , Masculino , Femenino , Anciano , Estudios Longitudinales , Aislamiento Social/psicología , Aptitud Física/fisiología , SARS-CoV-2 , Anciano de 80 o más Años , Persona de Mediana Edad , Fuerza de la Mano , Biomarcadores/sangre , Glucemia/análisisRESUMEN
BACKGROUND: Studies evaluating the effects of natural disasters on cancer outcomes are scarce, especially among USA ethnic minority groups, and none have focused on the effects of concurrent natural disasters and the COVID-19 pandemic. The goal of this secondary data analysis is to explore the impact of concurrent exposure to COVID-19 and earthquakes on psychological distress and symptom burden among Puerto Rican cancer survivors. METHODS: This secondary data analysis (n = 101) was part of a longitudinal case-control cohort study (n = 402) aimed at describing unmet psychological needs among Puerto Rican cancer patients and non-cancer subjects previously exposed to Hurricane María in 2017. The research team pooled data from participants (cancer survivors and non-cancer group) from their baseline assessments and from follow-up assessments conducted during January-July 2020 (earthquake and the lockdown period). A descriptive, paired t-test, non-parametric mean rank test, and two-sided Pearson correlation analyses were performed. RESULTS: Psychological distress and cancer symptom burden diminished over time. Resilience was significantly correlated with all the psychological and symptom burden variables during both pre- and post-earthquake and COVID-19 assessment periods. CONCLUSIONS: The results support the role of resilience, social support, and post-traumatic growth as potential protective factors preventing psychological distress and diminishing cancer symptom burden among cancer survivors exposed to natural disasters and the COVID-19 pandemic.