Shifting patterns of disparities in unintentional injury mortality rates in the United States, 1999-2016 / Tendencias cambiantes en las disparidades en las tasas de mortalidad por traumatismo no intencional en Estados Unidos entre 1999 y 2016 / Mudança nos padrões de disparidade nas taxas de mortalidade por lesões acidentais nos Estados Unidos, 1999-2016

ABSTRACT Objectives. To analyze changes in racial/ethnic disparities for unintentional injury mortality from 1999-2016. Methods. Mortality data are from the National Center for Health Statistics (NCHS) for all unintentional injuries, analyzed separately by injury cause (motor vehicle accidents [MVA], poisonings, other unintentional) for white,black, and Hispanic populations within four age groups: 15-19, 20-34, 35-54, 55-74 for males and for females. Results. Rates across race/ethnic groups varied by gender, age and cause of injury. Unintentional injury mortality showed a recent increase for both males and females, which was more marked among males and for poisoning in all race/ethnic groups of both genders. Whites showed highest rates of poisoning mortality and the steepest increase for both genders, except for black males aged 55-74. MVA mortality also showed an increase for all race/ethnic groups, with a sharper rise among blacks, while Hispanics had lower rates than either whites or blacks. Rates for other unintentional injury mortality were similar across groups except for white women over 55, for whom rates were elevated. Conclusions. Data suggest while mortality from unintentional injury related to MVA and poisoning is on the rise for both genders and in most age groups, blacks compared to whites and Hispanics may be suffering a disproportionate burden of mortality related to MVAs and to poisonings among those over 55, which may be related to substance use.

RESUMEN Objetivos. Analizar cambios en las disparidades por raza y grupo étnico en materia de mortalidad por traumatismos no intencionales de 1999 al 2016. Métodos. Los datos de mortalidad de todos los traumatismos no intencionales provienen del Centro Nacional de Estadísticas Sanitarias y se han analizado por separado por causa de traumatismo (colisiones automovilísticas, intoxicaciones y otras causas no intencionales) y por población blanca, negra e hispana, tanto en hombres como en mujeres, en cuatro grupos etarios: de 15 a 19, de 20 a 34, de 35 a 54 y de 55 a 74. Resultados. Las tasas en todos los grupos raciales y étnicos variaron según el sexo, la edad y la causa del traumatismo. La mortalidad por traumatismo no intencional mostró un aumento reciente tanto en hombres como en mujeres, que fue más marcado en el caso de los hombres, y por intoxicación en todos los grupos raciales y étnicos de ambos sexos. La población blanca mostró las tasas más elevadas de mortalidad por intoxicación y el incremento más acentuado en ambos sexos, con excepción de los hombres negros entre 55 y 74 años de edad. La mortalidad por colisión automovilística también registró un aumento en todos los grupos raciales y étnicos, con un incremento mayor en la población negra, mientras que la población hispana mostró tasas inferiores que la blanca o la negra. Las tasas de mortalidad por otros traumatismos no intencionales fueron similares en todos grupos salvo en el caso de las mujeres blancas de más de 55 años, cuyas tasas mostraron un incremento. Conclusiones. Los datos indican que, si bien la mortalidad por traumatismo no intencional relacionada con colisiones automovilísticas e intoxicación está en alza en ambos sexos y en la mayoría de los grupos etarios, la población negra en comparación con la blanca y la hispana puede estar presentando una carga desproporcionada de mortalidad relacionada con colisiones automovilísticas e intoxicación en personas mayores de 55, que podrían estar relacionado con el consumo de sustancias psicoactivas.

RESUMO Objetivos. Analisar as mudanças nas disparidades étnico-raciais da mortalidade por lesões acidentais no período 1999-2016. Métodos. Os dados de mortalidade foram obtidos do Centro Nacional de Estatísticas de Saúde (NCHS) dos Estados Unidos para todos os tipos de lesões acidentais e analisados em separado por causa de lesão (acidentes de trânsito de veículos a motor, envenenamento/intoxicação e outros tipos de acidentes) em grupos populacionais de brancos, negros e hispânicos de ambos os sexos divididos em quatro faixas etárias: 15-19, 20-34, 35-54 e 55-74 anos. Resultados. As taxas de mortalidade nos grupos étnico-raciais variaram segundo sexo, idade e causa de lesão. Houve um aumento recente na mortalidade por lesões acidentais nos sexos masculino e feminino, sendo mais acentuado no sexo masculino e por envenenamento/intoxicação em todos os grupos étnicos-raciais de ambos os sexos. A população branca apresentou as maiores taxas de mortalidade por envenenamento/intoxicação e o aumento mais acentuado na mortalidade em ambos os sexos, exceto por homens negros de 55-74 anos. Ocorreu também um aumento da mortalidade por acidentes de trânsito de veículos a motor em todos os grupos étnico-raciais, sendo mais acentuado em negros, e a mortalidade na população hispânica foi menor que em brancos ou negros. As taxas de mortalidade por outros tipos de acidentes foram semelhantes em todos os grupos, exceto em mulheres brancas acima de 55 anos que apresentaram taxas elevadas. Conclusões. Os dados analisados indicam que, apesar de a mortalidade por lesões acidentais por acidentes de trânsito de veículos a motor e envenenamento/intoxicação estar aumentando em ambos os sexos e na maioria das faixas etárias, em comparação a brancos e hispânicos, os negros possivelmente sofrem um ônus desproporcional de mortalidade por acidentes de trânsito e envenenamento/intoxicação no grupo acima de 55 anos que pode estar associada ao uso de substâncias químicas.

Medidas de contenção de tipo lockdown para prevenção e controle da COVID-19: estudo ecológico descritivo, com dados da África do Sul, Alemanha, Brasil, Espanha, Estados Unidos, Itália e Nova Zelândia, fevereiro a agosto de 2020 / Medidas de contención tipo lockdown para prevención y control del COVID-19: estudio ecológico descriptivo con datos de febrero a agosto de 2020 en Sudáfrica, Alemania, Brasil, España, Estados Unidos, Italia y Nueva Zelanda / Lockdown-type containment measures for COVID-19 prevention and control: a descriptive ecological study with data from South Africa, Germany, Brazil, Spain, United States, Italy and New Zealand, February - August 2020

Objetivo: Descrever as medidas de contenção de tipo lockdown e a incidência da COVID-19 em sete países: África do Sul, Alemanha, Brasil, Espanha, Estados Unidos, Itália e Nova Zelândia. Métodos: Estudo ecológico descritivo, com dados da incidência diária dos casos confirmados de COVID-19 entre 22 de fevereiro e 31 de agosto de 2020, e informações sobre medidas de lockdown implementadas pelo governo de cada país. Resultados: Os países que implementaram lockdown tiveram diminuição da incidência diária de COVID-19 (casos por milhão de habitantes) no período de três semanas, a contar do início da medida: África do Sul (3,7 a 1,7), Alemanha (37,5 a 33,7), Espanha (176,3 a 82,0), Itália (92,0 a 52,1) e Nova Zelândia (7,5 a 1,7). O Brasil e os Estados Unidos, que não implementaram lockdown, não apresentaram uma diminuição considerável. Conclusão: Após a implementação de lockdown, houve uma diminuição considerável do número de casos confirmados.

Objetivo: Describir las medidas de contención tipo lockdown y la incidencia de COVID-19 en los países de Sudáfrica, Alemania, Brasil, España, Estados Unidos, Italia y Nueva Zelanda. Métodos: Estudio ecológico descriptivo con datos de la incidencia diaria de los casos confirmados de COVID-19, del 22 de febrero al 31 de agosto de 2020 e informaciones sobre medidas de contención lockdown implementadas por los gobiernos de cada uno de los países. Resultados: Los países que implementaron lockdown, desde el inicio de su implementación hasta tres semanas después, tuvieron una disminución en la incidencia diaria (casos por millón de habitantes): Sudáfrica (3,7 a 1,7), Alemania (37,5 a 33,7), España (176,3 a 82,0), Italia (92,0 a 52,1) y Nueva Zelanda (7,5 a 1,7). Brasil y Estados Unidos, que no implementaron lockdown, no tuvieron una disminución considerable Conclusión: Luego de la implementación del lockdown, hubo una disminución considerable en el número de casos confirmados.

Objective: To describe lockdown-type containment measures and COVID-19 incidence in South Africa, Germany, Brazil, Spain, United States, Italy and New Zealand. Methods: This is a descriptive ecological study with data on daily incidence of confirmed COVID-19 cases from February 22 to August 31 2020, as well as information on lockdown measures implemented by the governments of each country. Results: Daily COVID-19 incidence (cases per 1 million inhabitants) decreased within three weeks after lockdown started in the countries that implemented it: South Africa (3.7 to 1.7), Germany (37.5 to 33.7) Spain (176.3 to 82.0), Italy (92.0 to 52.1) and New Zealand (7.5 to 1.7). As for Brazil and the United States, which did not implement lockdown, there was no considerable decrease. Conclusion: After lockdown implementation, there was a considerable decrease in the number of confirmed cases.

Factores de riesgo cardiovascular en Estados Unidos y México: comparación de los estudios HABLE y ENASEM / Cardiovascular risk factors in Mexico and the United States: a comparative cross-sectional study between the HABLE and MHAS participants

Resumen Introducción: En Estados Unidos se dispone de información acerca de la población mexicoamericana por el Estudio de Salud y Envejecimiento del Cerebro en Latinos Mayores (HABLE); en México se dispone de los resultados del Estudio Nacional de Salud y Envejecimiento en México (ENASEM). Objetivo: Comparar la prevalencia de factores de riesgo cardiovascular entre hombres y mujeres de HABLE y ENASEM. Método: Se analizó transversalmente la prevalencia de hipertensión, diabetes, hipercolesterolemia y obesidad abdominal en 559 participantes de HABLE y se comparó con datos de 13 663 participantes del ENASEM. La comparación se realizó mediante t de Student y chi cuadrada, según el tipo de variable. Resultados: El análisis demostró que la prevalencia de hipertensión (50 %, IC 95 % = 41.8-51.8), diabetes (35.5 %, IC 95 % = 27.6-43.8) y obesidad abdominal (59.3 %, IC 95 % = 50.5-68.1) fueron significativamente mayores en hombres del HABLE, mientras que las mujeres presentaron una prevalencia más elevada de diabetes (36.8 %, IC 95 % = 32.2-41.5) y obesidad abdominal (89.6 %, IC 95 % = 86.6-92.5). La hipercolesterolemia tuvo una prevalencia más elevada en mujeres del ENASEM (53.3 %, IC 95 % = 50.3-56.2). Conclusión: La prevalencia de factores de riesgo cardiovascular fue mayor en mexicoamericanos participantes del HABLE, que en mexicanos participantes del ENASEM.

Abstract Introduction: In the United States, information on the Mexican-American population is available through the Health and Aging Brain among Latino Elders (HABLE) study; in Mexico, the results of the Mexican Health and Aging Study (MHAS) are available. Objective: To compare the prevalence of cardiovascular risk factors between men and women of the HABLE and MHAS studies. Method: The prevalence of hypertension, diabetes, hypercholesterolemia and abdominal obesity was transversely analyzed in 559 HABLE participants and compared with data from 13,663 MHAS participants. The comparison was made using Student's t-test and the chi-square test, according to the type of variable. Results: The analysis showed that the prevalence of hypertension (50 %, 95 % CI = 41.8-51.8), diabetes (35.5 %, 95 % CI = 27.6-43.8) and abdominal obesity (59.3 %, 95 % CI = 50.5-68.1) were significantly higher in HABLE males, whereas females had a higher prevalence of diabetes (36.8 %, 95 % CI = 32.2-41.5) and abdominal obesity (89.6 %, 95 % CI = 86.6-92.5). Hypercholesterolemia had a higher prevalence in MHAS females (53.3%, 95% CI = 50.3-56.2). Conclusion: The prevalence of cardiovascular risk factors was higher in Mexican American HABLE participants, than in Mexican MHAS participants.

Colorectal cancer in hispanics living near the U.S. - Mexico Border

Background The incidence of colorectal cancer (CRC) in the US has declined. The decreasing trend is observed in non-Hispanic Whites, Blacks, and Hispanics. However, close analysis of the trends demonstrates that the decline among Hispanics is less than other races/ethnicities. We investigate the burden of CRC in Hispanics living near the U.S.–Mexico border, a subpopulation of Hispanics composed primarily of individuals of Mexican origin. Objectives The objective of this study was to investigate and compare incidence rates of CRC in non-Hispanic Whites and Hispanics living in counties along the U.S.–Mexico border. Methods Data from the National Institutes of Health National Cancer Institute and State Cancer Profiles were analyzed to obtain CRC incidence rates (per 100,000 population) for persons ≥ 50 years of age residing in counties along the U.S.–Mexico border by race (non-Hispanic White and Hispanic) and gender from 2011 to 2015. Results Incidence rates of CRC in Hispanic men ≥ 50 years of age, living in counties along the U.S.–Mexico border, were higher than the national average for Hispanic men of similar age. In contrast, the incidence of CRC declined or remained stable in non-Hispanic Whites and women. Conclusions Our study unveils a significant disparity in CRC incidence among Hispanics living near the U.S.–Mexico border, disproportionally affecting men ≥ 50 years of age. Socioeconomic and cultural/lifestyle factors are likely contributing to these disparities.

Prevalencia de los trastornos del espectro autista en niños en Estados Unidos, Europa y España: coincidencias y discrepancias / Prevalence of autism spectrum disorders in USA, Europe and Spain: coincidences and discrepancies

Los trastornos del espectro autista (TEA) engloban a un grupo heterogéneo de trastornos del neurodesarrollo que tienen en común la presencia de problemas para la interacción/comunicación social y la tendencia a mostrar intereses restringidos o conductas repetitivas. Diversos estudios epidemiológicos realizados en diferentes países en los últimos años han mostrado de forma consistente dos características: el incremento progresivo en la prevalencia de los TEA a nivel mundial y la existencia de una gran variabilidad geográfica entre territorios y dentro de un mismo territorio. En el presente artículo analizamos los datos de prevalencia más recientemente publicados en EE.UU. y en diversos países de Europa (incluyendo España), que muestran tasas de prevalencia muy variables, con un rango que abarca desde 1/59 niños con trastornos del espectro autista en EE. UU., hasta 1/806 en Portugal. En un segundo tiempo describimos brevemente algunas de las principales hipótesis que intentan explicar esta variabilidad.

Autism spectrum disorders are a heterogeneous group of disorders that share the presence of two core symptoms: problems in social interaction / communication and the tendency to present restricted interests and repetitive behavior. Over the last years, several epidemiologic studies have been published by different authors in diverse countries, having all of them shown two common characteristics: a global increase in the prevalence rates of autism spectrum disorders, and the existence of a great geographical variability no only between geographical areas, but also within the same geographical areas. At the present manuscript, we analyze some of the most recent prevalence data published in USA and some European countries (including Spain). All of them show different prevalence rates, ranging from 1/59 children with autism spectrum disorders in the USA to 1/806 in Portugal. In a second part, we briefly describe some of the current scientific hypotheses that try to explain this variability.

Vaginal cuff recurrence after radical cystectomy: an under - studied site of bladder cancer relapse

ABSTRACT Introduction: Vaginal cuff recurrence of tumor following radical cystectomy is a rare site of disease recurrence, however it has never been specifically studied. The aim of the study is to evaluate incidence, risk factors, and long-term oncologic outcomes of vaginal cuff recur- rence in a cohort of female patients treated with radical cystectomy for invasive urothelial carcinoma of the bladder. Materials and Methods: From 1985 to 2012, a prospectively maintained institutional blad- der cancer registry was queried for vaginal cuff recurrence post radical cystectomy. Over- all mortality and cancer-specific mortality were reported using the Kaplan-Meier method for patients with vaginal cuff recurrence, recurrence at another local or distant site, and those without evidence of recurrence. Comparisons were performed using the log-rank test. Cox proportional hazards regression model was performed to assess predictors of vaginal cuff recurrence. Results: From 469 women treated with radical cystectomy for bladder cancer, 34 patients (7.3%) developed vaginal cuff recurrence, 130 patients (27.7%) had recurrence involving ei- ther a local or distant site, and 305 patients (65%) had no evidence of recurrence. The 5-year overall mortality-free survival rate was 32.4% for vaginal cuff recurrence, but 25.0% for other sites of recurrence. Cancer-specific mortality-free survival rate was 32.4% for vaginal cuff recurrence, and 30.3% for the other sites of recurrence. Multivariate Cox proportional hazards regression analysis demonstrated that the presence of tumor in posterior location at radical cystectomy (Hazard Ratio [HR], 0.353 [95% CI, 0.159-0.783]) and anterior vaginec- tomy, compared to no vaginectomy (HR, 2.595 [95% CI, 1.077-6.249]) were independently associated with vaginal cuff recurrence. Conclusion: Anterior vaginectomy, despite our best attempts, is perhaps not sufficient to prevent vaginal cuff recurrence. Therefore, follow-up evaluation is essential, and further studies are necessary to address the optimal approach for initial management. Patient Summary: Although vaginal cuff recurrence is an unusual site of recurrence, careful evaluation is needed before cystectomy and during follow-up to identify patients at risk.

Trends in surgical treatment of femoral neck fractures in the elderly / Tendências no tratamento cirúrgico das fraturas do colo do fêmur em idosos

ABSTRACT Objective To analyze recent demographic and medical billing trends in treatment of femoral neck fracture of American elderly patients. Methods The American College of Surgeons National Surgical Quality Improvement Program database was analyzed from 2006 to 2015, for patients aged 65 years and older, using the Current Procedural Terminology codes 27130, 27125, 27235, and 27236. Patient demographics, postoperative complications, and frequency of codes were compared and analyzed over time. Our sample had 17,122 elderly patients, in that, 70% were female, mean age of 80.1 years (standard deviation±6.6 years). Results The number of cases increased, but age, gender, body mass index, rates of diabetes and smoking did not change over time. Open reduction internal fixation was the most commonly billed code, with 9,169 patients (53.6%), followed by hemiarthroplasty with 5,861 (34.2%) patients. Combined estimated probability of morbidity was 9.8% (standard deviation±5.2%), and did not change significantly over time. Postoperative complication rates were similar between treatments. Conclusion Demographics and morbidity rates in femoral neck fractures of elderly patients did not change significantly from 2006 to 2015. Open reduction internal fixation was the most common treatment followed by hemiarthroplasty.

RESUMO Objetivo Analisar tendências recentes demográficas e de faturamento médico no tratamento de fraturas do colo do fêmur em idosos americanos. Métodos O banco de dados National Surgical Quality Improvement Program, do American College of Surgeons, foi analisado de 2006 a 2015, para pacientes com idade igual ou superior a 65 anos, usando os códigos de Current Procedural Terminology 27130, 27125, 27235 e 27236. Dados demográficos dos pacientes, complicações pós-operatórias e frequência de códigos foram comparados e analisados ao longo do tempo. A amostra teve 17.122 pacientes geriátricos, sendo 70% do sexo feminino, com média de idade de 80,1 anos (desvio padrão±6,6 anos). Resultados O número de casos aumentou no período, mas idade, gênero, índice de massa corporal e taxas de diabetes e tabagismo não mudaram ao longo do tempo. A fixação interna de redução aberta foi o código faturado mais comum, com 9.169 pacientes (53,6%), seguido por artroplastia parcial do quadril, com 5.861 (34,2%) pacientes. A probabilidade estimada combinada de morbidade foi de 9,8% (desvio padrão±5,2%) e não mudou significativamente ao longo do tempo. As taxas de complicações pós-operatórias foram semelhantes entre os tratamentos. Conclusão Os dados demográficos e as taxas de morbidade relacionadas às fraturas geriátricas do colo do fêmur não apresentaram mudança significativa entre 2006 e 2015. A redução aberta e a fixação interna foram as opções de tratamento mais comuns, seguidas da artroplastia parcial do quadril.

The Prevalence of Parkinson Disease Among Patients With Hepatitis C Infection

ABSTRACT Introduction. HCV has been suspected to potentially cause degenerations in the central nervous system. Parkinson's disease is the second most common neurodegenerativo disorder. Our aim was to assess the prevalence of Parkinson's disease among patients with HCV infection. Material and methods. For this study, we used Medicare database from 2005-2010. Medicare database contains information on enrollment, coverage, diagnosis recorded with International Classification of Disease, Ninth Revision (ICD- 9). From combined inpatient and outpatient files, Parkinson's disease was identified as the first diagnosis by ICD-9 code 332.0. Other study variables were; age, gender, race (White and No White), and Medicare eligibility status. Simple distribution comparison by HCV status examined with t-test for numerical variables and χ2 test for categorical variables in the main analytical cohort as well as in the propensity score matched cohort. Results. A total of 1,236,734 patients (median age 76 years, 41% male, and 85% White) was identified among over 47 million claims. Of these, 6040 patients (0.5%) were infected with HCV. Overall, 0.8% (N = 49) of the HCV group and 1.3% (N = 16,004) of the Non-HCV group had Parkinson's disease (P < 0.001). When the study groups matched for age, gender and race, the prevalence of Parkinson's disease was similar between HCV and Non-HCV groups (P > 0.05). Discussion. This study revealed that, among Medicare population, HCV was not associated with Parkinson disease.

Comparative analysis of death by suicide in Brazil and in the United States: descriptive, cross-sectional time series study / Análise comparativa de morte por suicídio no Brasil e nos Estados Unidos: estudo transversal temporal descritivo

ABSTRACT CONTEXT AND OBJECTIVE: The World Health Organization recognizes suicide as a public health priority. Increased knowledge of suicide risk factors is needed in order to be able to adopt effective prevention strategies. The aim of this study was to analyze and compare the association between the Gini coefficient (which is used to measure inequality) and suicide death rates over a 14-year period (2000-2013) in Brazil and in the United States (US). The hypothesis put forward was that reduction of income inequality is accompanied by reduction of suicide rates. DESIGN AND SETTING: Descriptive cross-sectional time-series study in Brazil and in the US. METHODS: Population, death and suicide death data were extracted from the DATASUS database in Brazil and from the National Center for Health Statistics in the US. Gini coefficient data were obtained from the World Development Indicators. Time series analysis was performed on Brazilian and American official data regarding the number of deaths caused by suicide between 2000 and 2013 and the Gini coefficients of the two countries. The suicide trends were examined and compared. RESULTS: Brazil and the US present converging Gini coefficients, mainly due to reduction of inequality in Brazil over the last decade. However, suicide rates are not converging as hypothesized, but are in fact rising in both countries. CONCLUSION: The hypothesis that reduction of income inequality is accompanied by reduction of suicide rates was not verified.

RESUMO CONTEXTO E OBJETIVO: A Organização Mundial da Saúde reconhece o suicídio como uma prioridade de saúde pública. Aumentar o conhecimento dos fatores de risco de suicídio é necessário para se poder adotar estratégias eficazes de prevenção. O objetivo deste estudo foi analisar e comparar a associação do coeficiente de Gini, usado para medir a desigualdade, com as taxas de mortalidade por suicídio em um período de 14 anos (2000-2013) no Brasil e nos Estados Unidos (EUA). Aventou-se a hipótese de que a redução da desigualdade de renda é acompanhada da redução das taxas de suicídio. TIPO DE ESTUDO E LOCAL: Estudo transversal temporal descritivo realizado no Brasil e nos EUA. MÉTODOS: Dados populacionais, de óbitos e mortes por suicídio foram extraídos do banco de dados do DATASUS, no Brasil, e do Centro Nacional para Estatísticas de Saúde dos EUA. Dados do índice de Gini foram obtidos dos Indicadores de Desenvolvimento Mundial. Foi realizada análise de séries temporais de dados oficiais do Brasil e dos EUA sobre o número de mortes por suicídio, de 2000 a 2013, e do coeficiente de Gini. As tendências de morte por suicídio foram analisadas e comparadas. RESULTADOS: Brasil e EUA apresentaram convergência no coeficiente de Gini devida principalmente à redução da desigualdade no Brasil na última década. No entanto, as taxas de suicídio não estão convergindo como foi conjeturado; em verdade, elas estão crescendo em ambos os países. CONCLUSÕES: A hipótese de que a redução da desigualdade de renda é acompanhada da redução das taxas de suicídio não foi verificada.

Beyond biology: the impact of marital status on survival of patients with adrenocortical carcinoma

Purpose: To analyze the association of marital status and survival of patients with ACC using a population-based database. Material and Methods: Patients with ACC were abstracted from the Surveillance Epidemiology and End Results (SEER) database from 1988-2010 (n=1271). Variables included marital status (married vs single/divorced/widowed (SDW)), gender, age, race, tumor (T) and node (N) classification, receipt of surgery, and SEER stage. Statistical analysis was performed using Cox proportional hazard models to generate hazard ratios and 95% confidence intervals. Results: There were 728 (57.3%) females and median age was 56 years (IQR 44-66). Patients who were alive were more frequently married (65.6% vs 61.6%, p=0.008), female (61.1% vs 58.0%, p=0.001), younger (median 51 vs 57 years, p=0.0001), submitted to adrenalectomy (88.6% vs 63.8%, p<0.0001), and more favorable SEER stage (localized-64.9% vs 29.9%; regional–25.1% vs 30.1%; distant 4.8% vs 31.5%, p<0.0001) compared to patients dead of disease (DOD). On multivariable analysis, factors significantly associated with all-cause mortality were SDW status (HR 1.28, 95% CI 1.091.51), age, non-operative management, and N+ disease. Risk factors for disease-specific mortality included SDW status (HR 1.30, 95% CI 1.07-1.56), age, non-operative management, T-classification, and N+ disease. Conclusions: Marital status is significantly associated with survival in patients with ACC. Our results suggest that the decreased survival seen among SDW individuals highlights an area for further research and needed intervention to reduce disparity.

Hemorrhagic Cystitis Requiring Bladder Irrigation is Associated with Poor Mortality in Hospitalized Stem Cell Transplant Patients

Purpose: To evaluate the overall prognosis of post-stem cell transplant inpatients who required continuous bladder irrigation (CBI) for hematuria. Materials and Methods: We performed a retrospective analysis of adult stem cell transplant recipients who received CBI for de novo hemorrhagic cystitis as inpatients on the bone marrow transplant service at Washington University from 2011-2013. Patients who had a history of genitourinary malignancy and/or recent surgical urologic intervention were excluded. Multiple variables were examined for association with death. Results: Thirty-three patients met our inclusion criteria, with a mean age of 48 years (23-65). Common malignancies included acute myelogenous leukemia (17/33, 57%), acute lymphocytic leukemia (3/33, 10%), and peripheral T cell lymphoma (3/33, 10%). Median time from stem cell transplant to need for CBI was 2.5 months (0 days-6.6 years). All patients had previously undergone chemotherapy (33/33, 100%) and 14 had undergone prior radiation therapy (14/33, 42%). Twenty-eight patients had an infectious disease (28/33, 85%), most commonly BK viremia (19/33, 58%), cytomegalovirus viremia (17/33, 51%), and bacterial urinary tract infection (8/33, 24%). Twenty-two patients expired during the same admission as CBI treatment (22/33 or 67% of total patients, 22/28 or 79% of deaths), with a 30-day mortality of 52% and a 90-day mortality of 73% from the start of CBI. Conclusions: Hemorrhagic cystitis requiring CBI is a symptom of severe systemic disease in stem cell transplant patients. The need for CBI administration may be a marker for mortality risk from a variety of systemic insults, rather than directly attributable to the hematuria.

Reproducibility of the six-minute walk test and Glittre ADL-test in patients hospitalized for acute and exacerbated chronic lung disease

Background: The 6-minute walk test (6MWT) and the Glittre ADL-test (GT) are used to assess functional capacity and exercise tolerance; however, the reproducibility of these tests needs further study in patients with acute lung diseases. Objectives: The aim of this study was to investigate the reproducibility of the 6MWT and GT performed in patients hospitalized for acute and exacerbated chronic lung diseases. Method: 48 h after hospitalization, 81 patients (50 males, age: 52±18 years, FEV1: 58±20% of the predicted value) performed two 6MWTs and two GTs in random order on different days. Results: There was no difference between the first and second 6MWT (median 349 m [284-419] and 363 m [288-432], respectively) (ICC: 0.97; P<0.0001). A difference between the first and second tests was found in GT (median 286 s [220-378] and 244 s [197-323] respectively; P<0.001) (ICC: 0.91; P<0.0001). Conclusion: Although both the 6MWT and GT were reproducible, the best results occurred in the second test, demonstrating a learning effect. These results indicate that at least two tests are necessary to obtain reliable assessments. .

Síndrome Metabólica é o Principal Preditor de Isquemia Miocárdica na SPECT / Metabolic Syndrome Is the Main Predictor of Myocardial Ischemia in SPECT

Fundamentos: Dados mostram que a síndrome metabólica (SM) aumenta o risco de doença cardiovascular. Objetivos: Descrever e comparar as alterações cintilográficas e o valor preditivo de isquemia miocárdica emindivíduos com e sem SM, encaminhados para tomografia computadorizada de emissão de fóton único (SPECT)em Hospital Universitário utilizando três critérios diagnósticos de SM.Métodos: Estudo prospectivo observacional de pacientes encaminhados para SPECT de junho a dezembro 2010.Altura, peso e circunferência da cintura foram medidos. Levantamento de fatores de risco e revisão de prontuáriosmédicos foi realizado em busca de parâmetros para diagnóstico laboratorial de SM e relatórios completos deSPECT. Resultados: Foram incluídos 203 pacientes; 138 mulheres (68,0%); média de idade 63,6±11,5 anos. Apresentaram SM, 135 pacientes (66,5%). Entre os 99 exames alterados, 91,9% (n=91) ocorreram em pacientes com SM e 8,1%(n=8) em pacientes sem SM. Houve associação significativa entre a SM e a cintilografia anormal (67,0% vs. 11,8%;p<0,001) e os pacientes com SM tinham anormalidades de maior extensão e gravidade (escore de estresse somado(SSS)=7,3±6,5 vs. 3,0±0,9; p<0,001 e escore de diferença somado (SDS)=3,4±4,3 vs. 0,9±2,5; p<0,001). SM foi preditorindependente de isquemia miocárdica nas três definições estudadas (OR=10,07, 6,25 e 4,26 para NCEP-ATP IIImodificado, NCEP-ATP III e IDF, respectivamente). Conclusões: Pacientes com SM apresentaram mais defeitos de perfusão na SPECT (tanto fixa e reversível); e SMdefinida pelo NCEP-ATP III modificado foi o melhor preditor independente de isquemia miocárdica na cintilografia.

Background: Data show that metabolic syndrome (MS) increases the risk of cardiovascular disease.Objectives: To describe and compare the scintigraphic abnormalities and the predictive value of myocardial ischemia in individuals withand without MS referred for single photon emission computed tomography (SPECT) in a University Hospital using three diagnostic criteria.Methods: Prospective observational study of patients referred for SPECT from June to December 2010. Height, weight and waistcircumference were measured. Risk factors were assessed and medical records were reviewed to look for parameters for laboratorydiagnosis of MS and complete SPECT reports.Results: The study included 203 patients; 138 women (68.0%); mean age 63.6±11.5 years. Metabolic syndrome was found in135 patients (66.5%). Of the 99 abnormal tests, 91.9% (n=91) occurred in patients with MS and 8.1% (n=8) in patients withoutMS. There was a significant association between MS and abnormal scintigraphy (67.0% vs. 11.8%; p<0.001) and patients withMS had abnormalities of greater extent and severity (summed stress score (SSS)=7.3±6.5 vs. 3.0±0.9; p<0.001 and summed differencescore (SDS)=3.4±4.3 vs. 0.9±2.5; p<0.001). MS was an independent predictor of myocardial ischemia in the three definitions studied(OR=10.07, 6.25 and 4.26 for modified NCEP-ATP III, NCEP-ATP III and IDF, respectively).Conclusions: Patients with MS had more perfusion defects on SPECT (both fixed and reversible); and MS defined by the modifiedNCEP-ATP III was the best independent predictor of myocardial ischemia on scintigraphy.

Manipulation of a quasi-natural cell block for high-efficiency transplantation of adherent somatic cells

Recent advances have raised hope that transplantation of adherent somatic cells could provide dramatic new therapies for various diseases. However, current methods for transplanting adherent somatic cells are not efficient enough for therapeutic applications. Here, we report the development of a novel method to generate quasi-natural cell blocks for high-efficiency transplantation of adherent somatic cells. The blocks were created by providing a unique environment in which cultured cells generated their own extracellular matrix. Initially, stromal cells isolated from mice were expanded in vitro in liquid cell culture medium followed by transferring the cells into a hydrogel shell. After incubation for 1 day with mechanical agitation, the encapsulated cell mass was perforated with a thin needle and then incubated for an additional 6 days to form a quasi-natural cell block. Allograft transplantation of the cell block into C57BL/6 mice resulted in perfect adaptation of the allograft and complete integration into the tissue of the recipient. This method could be widely applied for repairing damaged cells or tissues, stem cell transplantation, ex vivo gene therapy, or plastic surgery.

Combined therapy of Ulmo honey (Eucryphia cordifolia) and ascorbic acid to treat venous ulcers / Terapia combinada com mel de Ulmo (Eucryphia cordifolia) e ácido ascórbico para úlceras venosas / Terapia combinada con miel de Ulmo (Eucryphia cordifolia) y ácido ascórbico en úlceras venosas

OBJECTIVE: to assess the clinical effect of topical treatment using Ulmo honey associated with oral ascorbic acid in patients with venous ulcers. METHOD: longitudinal and descriptive quantitative study. During one year, 18 patients were assessed who were clinically diagnosed with venous ulcer in different stages, male and female, adult, with a mean injury time of 13 months. Ulmo honey was topically applied daily. The dressing was applied in accordance with the technical standard for advanced dressings, combined with the daily oral consumptions of 500 mg of ascorbic acid. The monitoring instrument is the assessment table of venous ulcers. RESULTS: full healing was achieved in 100% of the venous ulcers. No signs of complications were observed, such as allergies or infection. CONCLUSION: the proposed treatment showed excellent clinical results for the healing of venous ulcers. The honey demonstrated debriding and non-adherent properties, was easy to apply and remove and was well accepted by the users. The described results generated a research line on chronic wound treatment. .

OBJETIVO: avaliar o efeito clínico de tratamento tópico com mel de Ulmo associado à administração oral de ácido ascórbico em pacientes portadores de úlceras venosas. MÉTODO: estudo quantitativo descritivo longitudinal. Um total de 18 pacientes adultos, ambos os sexos, clinicamente diagnosticados com úlcera venosa em diferentes estágios e com duração de 13 meses em média, foram avaliados pelo período de um ano. A aplicação tópica diária de mel de Ulmo foi realizada de acordo com a norma técnica de tratamento avançado combinada com o consumo diário de 500 mg de ácido ascórbico. O instrumento usado para monitoramento foi a tabela de avaliação de úlceras venosas. RESULTADOS: cicatrização completa foi observada em 100% das úlceras venosas. Não foram observados sinais de complicação tais como alergias ou infecção. CONCLUSÃO: o tratamento proposto apresentou resultados clínicos excelentes na cicatrização das úlceras venosas. Além de favorecer o debridamento, o mel não é aderente, é fácil de aplicar e remover, e é de fácil aceitação por parte dos usuários. Os resultados descritos geraram uma linha investigativa no tratamento de feridas crônicas. .

OBJETIVO: evaluar el efecto clínico del tratamiento con miel de Ulmo tópico asociado a ácido ascórbico oral en pacientes portadores de úlceras venosas. MÉTODO: estudio cuantitativo descriptivo longitudinal. Durante el período de un año se evaluaron 18 pacientes diagnosticados clínicamente de úlcera venosa en sus diferentes estadios, de ambos sexos, adultos, con 13 meses promedio de antigüedad de la lesión. Se realizó la aplicación tópica diaria de miel de Ulmo con curación según la norma técnica de curaciones avanzadas, combinada con el consumo oral diario de 500 mg de ácido ascórbico. El instrumento de seguimiento es la tabla de valoración de úlceras venosas. RESULTADOS: se logró la cicatrización total en el 100% de las úlceras venosas. No se observaron signos de complicación, tales como alergias o infección. CONCLUSIÓN: el tratamiento propuesto mostró excelentes resultados clínicos en la cicatrización de úlceras venosas, presentando la miel propiedades debridantes, no adherentes, fácil de aplicar, remover y aceptación del usuario. Los resultados descritos generaron una línea investigativa en el tratamiento de heridas crónicas. .

Mortalidad evitable en los estados colindantes de la frontera México-Estados Unidos, 1999-2001 y 2009-2011 / Avoidable mortality in the states adjacent to the Mexico-United States border; 1999-2001 and 2009-2011

El objetivo de este artículo es medir el efecto de la mortalidad evitable en los cambios de la esperanza de vida en los estados colindantes de ambos lados de la frontera México-Estados Unidos entre 1999-2001 y 2009-2011. Los datos utilizados fueron los registros de mortalidad y los censos de población, provenientes de fuentes oficiales de cada país. Se estimaron tasas estandarizadas de mortalidad y se calcularon los años de esperanza de vida perdidos. Tanto en 1999-2001 como en 2009-2011 los estados pertenecientes a la frontera sur de Estados Unidos tuvieron tasas de mortalidad evitable más bajas que las observadas en los estados del norte de México. En la región fronteriza las muertes evitables representaron en promedio una ganancia de 0.19 años de vida para Estados Unidos y una pérdida de 0.47 años de vida para México. Los estados de la frontera México-Estados Unidos presentan rasgos comunes en sus perfiles de salud que hacen necesario abordar algunos problemas de forma global y otros considerando las particularidades de cada uno de ellos, con el fin de reducir las brechas y aumentar la equidad social, mediante estrategias que involucren acciones nacionales independientes y otras de coordinación transfronteriza.

The scope of this article is to measure the effect of avoidable mortality in changes in life expectancy in the states adjacent to both sides of the US-Mexico border between 1999-2001 and 2009-2011. The data used were the records of mortality and population censuses from official sources in each country. Standardized mortality rates were estimated and the expected years of life lost were calculated. Both in 1999-2001 and in 2009-2011 the states belonging to the southern border of the United States had lower rates of avoidable mortality rates than those observed in the northern states of Mexico. In the border region avoidable deaths have seen an averageincrease of 0.19 years of life for America and a loss of 0.47 years of life for Mexico. The states of the US-Mexico border have common features in their health profiles that make it necessary to address some problemson a global basis and consider the particularities of each, in order to reduce gaps and enhance social equity through strategies involving independent national actions and othersby cross-border coordination.