Objective To determine the impact of planned preoperative phenazopyridine administration on operative times and costs compared with as-needed intravenous agent use during routine cystoscopy following minimally invasiv...Objective To determine the impact of planned preoperative phenazopyridine administration on operative times and costs compared with as-needed intravenous agent use during routine cystoscopy following minimally invasive hysterectomy for benign indications.Method This prospective cohort study examined patients who underwent laparoscopic or robotic-assisted total or supracervical hysterectomy for benign indications between January 27,2023 and March 11,2024,with one of our minimally invasive gynecologic surgeons at Stony Brook University Hospital.Patients were assigned to the non-phenazopyridine group or the phenazopyridine group.The time needed to visualize the ureteral jets during cystoscopy and the total surgery duration were recorded.A cost analysis was then performed.Results In total,106 patients were included,with 53 patients in each group.Compared with the non-phenazopyridine group,the phenazopyridine group had significantly shorter times from the start of cystoscopy to visualization of the first ureteral jet(31 s vs.42 s,p<0.05).However,there were no significant differences observed for visualization of the second jet,total jet time,or surgery duration.Two patients in the non-phenazopyridine group required the administration of intravenous agents intraoperatively.Routine phenazopyridine was found to be more cost-efficient when medication costs and operative times were examined.Conclusion Routine phenazopyridine use does not significantly shorten overall cystoscopy times,but it is the more cost-efficient option given increased rates of costly intravenous medication use in the non-phenazopyridine group.展开更多
Background Although brain-derived neurotrophic factor(BDNF)has been identified as a molecular biomarker of the neurophysiological effects induced by exercise,the acute effects of high-intensity exercise(HIE)on BDNF le...Background Although brain-derived neurotrophic factor(BDNF)has been identified as a molecular biomarker of the neurophysiological effects induced by exercise,the acute effects of high-intensity exercise(HIE)on BDNF levels are inconclusive.This study aims to estimate the immediate effects of HIE on BDNF levels in healthy young adults.Methods A systematic search was conducted in the MEDLINE,Scopus,Cochrane CENTRAL,and SPORTDiscuss databases up to December 2020.Randomized controlled trials(RCTs)and non-RCTs reporting pre-post changes in serum or plasma BDNF after an acute intervention of HIE compared to a control condition were included.Pooled effect sizes(p-ESs)and 95%confidence intervals(95%CIs)were calculated for RCTs using a random effects model with Stata/SE(Version 15.0;StataCorp.,College Station,TX,USA).The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.PROPERO registration number:CRD42020221047.Results A total of 22 studies with 552 individuals(age range:20-31 years;59.1%male)were included.The meta-analysis included 10 RCTs that reported valid outcome data.Higher BDNF levels were observed when HIE interventions were compared with non-exercise(p-ES=0.55,95%CI:0.12-0.98;I^(2)=25.7%;n=4 studies)and light-intensity exercise(p-ES=0.78,95%CI:0.15-1.40;I^(2)=52.4%;n=3 studies)but not moderate-intensity exercise(p-ES=0.93,95%CI:-0.16 to 2.02;I^(2)=88.5%;n=4 studies)conditions.Conclusion In comparison to non-exercise or light-intensity exercises,an immediate increase in BDNF levels may occur when young adults perform HIE.Given the benefits obtained maximizing circulating BDNF when performing HIE and its potential effects on brain health,our findings suggest that HIE could be recommended by clinicians as a useful exercise strategy to healthy adults.展开更多
Auriculotherapy consists of physical stimuli applied to the outer ear and is commonly associated with traditional Chinese medicine (TCM). The authors present and discuss the development of a course that offers a semi-...Auriculotherapy consists of physical stimuli applied to the outer ear and is commonly associated with traditional Chinese medicine (TCM). The authors present and discuss the development of a course that offers a semi-on-site auriculotherapy course for Brazilian primary health care (PHC) professionals. The course was funded by the Brazilian Ministry of Health and developed at the Federal University of Santa Catarina in 2015 by a team of experts in auriculotherapy. It consisted of 75 h of distance learning (five sequential modules) and 5 h of on-site learning. The modules included the following items:(1) introduction to integrative practices;(2) ear reflexology;(3) introduction to TCM;(4) biomedical view of auriculotherapy;and (5) auriculotherapy in PHC. The teaching material in eluded a workbook for each module, 14 video lectures and an interactive ear(on line resource) to study location and application to the main auricular points. The on-site lectures follow a structured script of ear palpation techniques, auricular seed insertion practice and clinical case discussions, under the supervision of trained instructors. The course was offered in 2016 and 2017 and on-site lectures took place in 25 cities, covering all Brazilian regions, in coordination with municipal or state boards of health. A total of 4273 health professionals concluded the training and their evaluation of the course was highly positive. The Brazilian experience of large-scale training shows the potential to disseminate auriculotherapy in the context of PHC, given that its practice is fast, easy to learn, safe, effective for different health problems and well accepted by the patients.展开更多
Background: Pregnant women in the Democratic Republic of Congo (DRC) are at increased risk for developing obstetric fistulas (OFs) as a result of obstructed labor, in conditions similar to many other African countries...Background: Pregnant women in the Democratic Republic of Congo (DRC) are at increased risk for developing obstetric fistulas (OFs) as a result of obstructed labor, in conditions similar to many other African countries. No case-control study of biological and social risk factors for OF has been reported from the DRC. This study aimed to identify factors that would aid in prevention and early identification of women who are at risk of developing OF. Methods: Participants were enrolled in a case-control study at four obstetric clinics in the central DRC. Cases of OF were evaluated as they presented, then a control participant was enrolled among women presenting subsequently to the same clinic, seeking to match parity at the time of the fistula and tribe of the case. A questionnaire was administered to elicit physical, obstetric, demographic, socioeconomic, religion, geographic, and delivery attributes of the participants. Case-control comparisons sought to identify independent risk factors for OF in the total case-control pairs and in subgroups of the participants. Logistic regression was utilized to identify independent risk factors for OF in the total case-control study group and in selected subgroups of the participants, and linear regression was utilized to estimate the variation explained between case and control outcomes from the variables independently significant in the logistic regression models. Results: A total of 177 case-control pairs were enrolled. Among all pairs, shorter height of the case (odds ratio = 1.06, 95% Confidence Limits 1.02 - 1.12);more kilometers travelled to the delivery site (1.02, 1.01 - 1.02);her village, not town, residence (OR = 5.52, 2.72 - 11.2), and her lower professional status (2.95, 1.53 - 5.72) were statistically independent factors associated with OF development. When applied in linear regression comparison of the pairs, these variables yielded an r<sup>2</sup> = 0.48, imputing 48% of the difference in delivery outcome between the pairs was explained by these variables. Among the 38 pairs who were primigravida, the independent variables were more kilometers travelled to the delivery site (1.02, 1.00 - 1.05), village, not town, residence (50.0, 10.2 - 248.7), and facility intended for lower patient acuity (3.7 s, 1.01 - 13.6, r<sup>2</sup> = 0.66) patients who were matched on parity and tribe, the significant risk factors were professional status (OR = 0.29), greater distance travelled to the clinic (OR = 1.02, 1.01 - 1.02), village, not town, residence (5.52, 2.72 - 11.2), and mother’s lower professional status (2.95, 1.53 - 5.72) when the OF occurred. Conclusions: Our study showed biological and social factors associated with the development of OF. Shorter height was the only biological risk factor found to be statistically significant in the study population. Other factors were related to limited resources and limited access to medical care.展开更多
The objective of this study was to determine the prevalence and associated factors of unsatisfactory self-rated health in university students. A cross-sectional study was conducted in graduate students of a Public Uni...The objective of this study was to determine the prevalence and associated factors of unsatisfactory self-rated health in university students. A cross-sectional study was conducted in graduate students of a Public University in the city of Rio Branco in the Western Brazilian Amazon. The overall prevalence of unsatisfactory self-rated health was 23.0%. After adjusting for gender and age, the factors associated with unsatisfactory self-rated health were as follows: sedentarism during leisure time (prevalence ratio (PR): 2.26;95% CI: 1.56 - 3.29), consuming meals only in restaurants (PR: 1.48;95% CI: 1.14 - 1.94), insomnia (PR: 1.86;95% CI: 1.50 - 2.30), headaches (PR: 2.17;95% CI: 1.52 - 3.09), and back pain (PR: 2.03;95% CI: 1.58 - 2.60). Thus, a high prevalence of unsatisfactory self-rated health was identified in this group of university students. The findings suggest immediate implementation of programs to promote healthy behaviors and to prevent headaches, back pain and insomnia.展开更多
The horticultural sector has undergone tremendous growth in Kenya and is now the second largest foreign income earning sector in the country. Lake Naivasha is the hub of large scale horticultural farming in Kenya. Thi...The horticultural sector has undergone tremendous growth in Kenya and is now the second largest foreign income earning sector in the country. Lake Naivasha is the hub of large scale horticultural farming in Kenya. This growth coupled with increased use of pesticides, may increase the possibility of pesticide exposure and its associated risks to workers and residents of the region. The purpose of this study was to assess the symptoms commonly experienced by residents of Naivasha town and their possible association to pesticide exposure. Purposive sampling of residents from Kamere, Kwa Muia, Kioto and Karagita was performed, as these residential areas have significant numbers of flower farm workers. By random selection, a total of 801 community members were recruited to participate in the study and data was collected by completing the prepared questionnaire and from clinical examinations. Results indicate that several residents exhibited respiratory;skin, joints and bones;and nervous system symptoms. We found a higher frequency of symptoms among planters, weeders, harvesters than in sprayers working in horticultural farms. We recommend training to planters, weeders, harvesters who are mainly women (61.6%) in this study concerning pesticide use as do sprayers;and second, longer reentry times between the last spraying of pesticide and entry of these workers is warranted, particularly in greenhouses. In this regard, reentry times for greenhouses and fields established for specific pesticides in Europe, North America, Japan or Australia should be adapted by Kenya, and these guidelines enforced by the Government of Kenya to reduce exposure to pesticides within this vulnerable work group. These workers should also use protective clothing including gloves and masks at all times while handling chemicals or recently sprayed plants or flowers. It would also be prudent for flower farm owners to introduce an integrated pest management regime to reduce pesticide use andworker exposures. Further research is required both to identify validated biomarkers that can reliably be used to identify pesticide exposure prior to the occurrence of acute toxicity;and to follow up individual cases of known exposures for chronic health effects.展开更多
Wildfires burn approximately 3%-4% of the global land area annually,resulting in massive emissions of greenhouse gases and air pollutants.Over the past two decades,there has been a declining trend in both global burne...Wildfires burn approximately 3%-4% of the global land area annually,resulting in massive emissions of greenhouse gases and air pollutants.Over the past two decades,there has been a declining trend in both global burned area and wildfire emissions.This trend is largely attributed to a decrease in wildfire activity in Africa,which accounts for a substantial portion of the total burned area and emissions.However,the northern high-latitude regions of Asia and North America have witnessed substantial interannual variability in wildfire activity,with several severe events occurring in recent years.Climate plays a pivotal role in influencing wildfire activity and has led to more wildfires in high-latitude regions.These wildfires pose significant threats to climate,ecosystems,and human health.Given recent changes in wildfire patterns and their impacts,it is critical to understand the contributors of wildfires,focus on deteriorating high-latitude areas,and address health risks in poorly managed areas tomitigate wildfire effects.展开更多
Objective To investigate the association between autism and prenatal environmental risk factors.Methods A case-control study was conducted among 193 children with autism from the specialeducational schools and 733 typ...Objective To investigate the association between autism and prenatal environmental risk factors.Methods A case-control study was conducted among 193 children with autism from the specialeducational schools and 733 typical development controls matched by age and gender by usingquestionnaire in Tianjin from 2007 to 2012. Statistical analysis included quick unbiased efficientstatistical tree （QUEST） and logistic regression in SPSS 20.0.Results There were four predictors by QUEST and the logistic regression analysis, maternal airconditioner use during pregnancy （OR=0.316, 95% CI： 0.215-0.463） was the single first-level node（χ2=50.994, P=0.000）; newborn complications （OR=4.277, 95% CI： 2.314-7.908） and paternalconsumption of freshwater fish （OR=0.383, 95% CI： 0.256-0.573） were second-layer predictors（χ2=45.248, P=0.000; χ2=24.212, P=0.000）; and maternal depression （OR=4.822, 95% CI： 3.047-7.631）was the single third-level predictor （χ2=23.835, P=0.000）. The prediction accuracy of the tree was 89.2%.Conclusion The air conditioner use during pregnancy and paternal freshwater fish diet might bebeneficial for the prevention of autism, while newborn complications and maternal depression might bethe risk factors.展开更多
Lymph node involvement increases the risk of breast cancer recurrence.An accurate non-invasive assessment of nodal involvement is valuable in cancer staging,surgical risk,and cost savings.Radiomics has been proposed t...Lymph node involvement increases the risk of breast cancer recurrence.An accurate non-invasive assessment of nodal involvement is valuable in cancer staging,surgical risk,and cost savings.Radiomics has been proposed to pre-operatively predict sentinel lymph node(SLN)status;however,radiomic models are known to be sensitive to acquisition parameters.The purpose of this study was to develop a prediction model for preoperative prediction of SLN metastasis using deep learning-based(DLB)features and compare its predictive performance to state-of-the-art radiomics.Specifically,this study aimed to compare the generalizability of radiomics vs DLB features in an independent test set with dissimilar resolution.Dynamic contrast-enhancement images from 198 patients(67 positive SLNs)were used in this study.Of these subjects,163 had an in-plane resolution of 0.7×0.7 mm^(2),which were randomly divided into a training set(approximately 67%)and a validation set(approximately 33%).The remaining 35 subjects with a different in-plane resolution(0.78×0.78 mm^(2))were treated as independent testing set for generalizability.Two methods were employed:(1)conventional radiomics(CR),and(2)DLB features which replaced hand-curated features with pre-trained VGG-16 features.The threshold determined using the training set was applied to the independent validation and testing dataset.Same feature reduction,feature selection,model creation procedures were used for both approaches.In the validation set(same resolution as training),the DLB model outperformed the CR model(accuracy 83%vs 80%).Furthermore,in the independent testing set of the dissimilar resolution,the DLB model performed markedly better than the CR model(accuracy 77%vs 71%).The predictive performance of the DLB model outperformed the CR model for this task.More interestingly,these improvements were seen particularly in the independent testing set of dissimilar resolution.This could indicate that DLB features can ultimately result in a more generalizable model.展开更多
Despite the existence of colorectal cancer (CRC) screening guidelines, population-based studies have consistently shown under-utilization of CRC screening procedures among older adults in the United States. We examine...Despite the existence of colorectal cancer (CRC) screening guidelines, population-based studies have consistently shown under-utilization of CRC screening procedures among older adults in the United States. We examined whether symptoms of anxiety and depression are associated with colorectal cancer (CRC) screening perceptions and behaviors among older adults in a primary care setting. A cross-sectional study was conducted by using a sample of 143 family medicine patients who completed an 88-item anonymous self-administered questionnaire covering symptoms of anxiety and depression as well as CRC screening perceptions (defined based on the Health Belief Model) and behaviors (defined as ever use of or adherence to CRC testing). Moderate-to-clinically significant anxiety and depressive symptoms were, respectively, prevalent in 47% and 42% of participants. Perceived benefits and barriers were the only Health Belief Model constructs associated with anxiety. Perceived barriers were positively associated with anxiety symptoms after adjustment for confounders, including age, gender, race/ ethnicity, marital status, education, smoking history, body mass index and self-rated health. By contrast, perceived benefits were negatively associated with anxiety symptoms only in the unadjusted model. Neither anxiety nor depression was associated with ever use of or adherence to CRC testing. Symptoms of anxiety, but not depression, may potentially influence CRC screening perceptions, with implications for behavioral interventions targeting CRC testing.展开更多
An estimated 2 million women living in countries with limited resources currently have vesico-vaginal, recto-vaginal, or mixed types of fistulae because of the necrosis that occurs with obstructed labor. We evaluated ...An estimated 2 million women living in countries with limited resources currently have vesico-vaginal, recto-vaginal, or mixed types of fistulae because of the necrosis that occurs with obstructed labor. We evaluated factors readily assessed by the examining practitioner in a consecutive case series of surgical repairs of obstetrical fistulae, for the ability of those factors to stand as a prognostic guide, in a clinical score. Objectives: To identify the predictors of surgical repair outcomes and establish a Score combining these different determinants to facilitate the care of obstetric fistula. Methods: We conducted a multicentric prospective study between 2011 and 2014 in Democratic Republic of the Congo (DRC). Outcomes: We measured 3 months post-surgery in a series of 483 patients with obstetrical fistula repaired by the same surgeon included closure and failure appreciated by dye test. Multivariable generalized estimating equation models were used to generate adjusted odd ratios (OR) and 95% confidence intervals (CIs). The scores ranging from 3 to 14 were established from the outcomes determinants identified. Results: In total, 483 women were enrolled, and 390 cases were at their first surgery and were included in the obstetric fistula (OF) prognosis score and classification. Their mean age was 35 years at the time of the surgery and 25 years at the onset of OF. In 28.6%, the fistula patient was primigravida. Mean duration between onset of the fistula and surgical treatment was 8 years. In 24%, the fistula patients lived separated from their partners. Overall closure rate of the fistulas was 85.7%. Severe vaginal fibrosis (p 0.01), big fistula size (0.01), small distance from fistula to external urethral meatus (0.01) and prior surgery (p 0.48) predicted failed fistula closure. A clinical score ranging from 3 to 14 points is a prognostic score with a range of 1 to 4 for the distance between the fistula and the external meatus and the size, and a scale of 1 to 6 for fibrosis. Conclusions: This study demonstrated that the marked vaginal scarring;large fistula size and distance to urethral meatus are predictors for unsuccessful fistula repair. Due to the lack of a standard classification that is never unanimous among the different surgeons, this prognostic score allows the combination of the different determinants assessing the chances of success and can help the practitioners to orient the patients towards the determined skill scale to take care of the patients.展开更多
Introduction: The more intense and early development of obesity, the greater the risk of persistence and severity of comorbidities, such as cardiovascular disease. There is evidence that high serum concentrations of l...Introduction: The more intense and early development of obesity, the greater the risk of persistence and severity of comorbidities, such as cardiovascular disease. There is evidence that high serum concentrations of lipoprotein (a) [Lp (a)] and C-reactive protein (CRP) are associated with increased risk of cardiovascular diseases. Objectives: To verify the change in the levels of Lp (a) and ultrasensitive CRP and its relationship with the nutritional status of adolescents. Methods: Cross-sectional study conducted with overweight children and adolescents between August 2012 and July 2013 attended at the Center for Childhood Obesity. The measurement of inflammatory markers was performed in the Clinical Laboratory of the State University of Paraiba. Comparison of sociodemographic variables by sex was tested by chi-square;the association of the risk markers according to age was evaluated by Student’s t test, and the body mass index by analysis of Pearson correlation. The normality distribution was tested by the Kolmogorov-Smirnov test. Confidence interval of 95% was adopted in all analyses. The study was approved by the Ethics Research Committee of UEPB (CAAE 0256.0.133.000-11). Results: Of the 133 children and adolescents evaluated, 60.9% were female and 72.2% were adolescents. Body Mass Index, lipo (a) and u-CRP showed statistically significant association with age (p < 0.01). There was a positive ascending correlation (r = 0.273, p < 0.01) of u-CRP with BMI, which was not verified for lipoprotein (a). Conclusion: As a cardiovascular risk marker already established in literature, the association of u-CRP with the nutritional status of adolescents, proportionally, shows the need for losing weight in this population, especially at early age. A deeper and long-term investigation should be carried out for more effective and consistent contribution to public health.展开更多
Background: Patients with cancer constitute a special group where immunization programs are often interrupted to begin treatment with chemotherapy. Sepsis is one of the main complications in this group. Methods: A hos...Background: Patients with cancer constitute a special group where immunization programs are often interrupted to begin treatment with chemotherapy. Sepsis is one of the main complications in this group. Methods: A hospital-based case-control study matched by age was carried out among subjects ≤ 9 years of age with cancer diagnosis. Children with cancer without sepsis and children with surgical pathology were included as controls;children with sepsis were included as cases. A bivariate logistic regression was used to determine the factors associated to nosocomial sepsis, and odds ratios were calculated with 95% confidence intervals. The percentage of attributable risk was calculated for the variables included in the final model. Results: Nineteen children with cancer and sepsis and 83 controls were included. Twelve (44%) caseshad an incomplete vaccination schedule according to their age. The association force between incomplete schedule and sepsis was 10.1 (95% CI, 3 - 36;p < 0.05). Conclusions: Approximately, 20% to 65% of the cases of serious nosocomial infection can be associated to an incomplete vaccination schedule. Strategies should be implemented to improve the general pediatric population’s vaccination status before a serious disease, such as cancer or another chronic condition preventing the application of vaccines, develops.展开更多
Introduction: Among the extrinsic factors, homocysteine (Hy) stands out, which is an intermediate amino acid of the intracellular metabolism of methionine involved in the process of cellular oxidation, which promotes ...Introduction: Among the extrinsic factors, homocysteine (Hy) stands out, which is an intermediate amino acid of the intracellular metabolism of methionine involved in the process of cellular oxidation, which promotes the installation of atheromatous plaques and, therefore, is considered as an emerging cardiovascular risk factor. Objective: To evaluate the plasma homocysteine levels (Hy) in overweight or obese children and adolescents and their relation with cardiovascular risk factors. Methods: A cross-sectional study was conducted from July 2011 to May 2012 with overweight or obesity children and adolescents aged 2 to 18 years followed at the Center for Childhood Obesity (IOC), Campina Grande-PB. A structured form was used to record demographic, socioeconomic and clinics variables and the patients underwent laboratory tests to define their lipid and glucose profiles and measurement of plasma Hy levels. Results: The study evaluated a total of 165 children and adolescents with mean age of 12.5 (±2.5) years;the majority were female (57.0%). Regarding the lipid profile, there was more individuals with low HDL cholesterol (88.5%). Plasma Hy levels were high in 24.2% of the sample. The mean Hy levels ranged from 4.3 to 18.9 μmol/L, being higher in males, obese adolescents and also in patients with high insulin levels and resistance. Conclusions: The results shown in this study emphasize the importance of detecting and controlling the plasma Hy levels as an independent cardiovascular risk factor, and the need for further studies to evaluate the clinical and biological factors related to alterations in its metabolism.展开更多
Access can be understood as the sum of a number of elements of the interface between patients and the health care system. This study took a comprehensive approach to the dimensions of access to medications, employing ...Access can be understood as the sum of a number of elements of the interface between patients and the health care system. This study took a comprehensive approach to the dimensions of access to medications, employing indicators to evaluate the dimensions of access to antihypertensive medications in Ceilandia, DF, Brazil. This was a cross-sectional epidemiological study, administering questionnaires during home visits. The survey covered epidemiological and socioeconomic profiles, behavioral habits and the dimensions of access to antihypertensive medications comprising physical, financial, and geographic availability and accept ability according to the hypertensive population of Ceilandia. The total sample comprised 400 individuals and the hypertensive subset numbered 140 (35%). Indicators of physical availability of medications revealed that users found it difficult to acquire their drugs on almost one third of occasions and in some cases were unable to access any of these products. The greatest barriers to access were reported by users of pharmacies belonging to the Brazilian National Health Service (SUS) and on the “People’s Pharmacies” network. More than one third of the hypertensive sample spent their own money on medications they could not find at these pharmacies. The majority of the hypertensive subsets were overweight/obese, a minority engaged in physical activity and 40% were smokers/ex-smokers. More women reduced their salt intake. Men had higher incomes, educational level, and socioeconomic status. Failure to keep the public health care system supplied has prejudiced access to essential medications for hypertension treatment, transferring the costs onto users. This population has lifestyle habits that increase the risk of exacerbation of hypertension. These results reveal a need for effective public policies to ensure access to antihypertensive medications and involve users of the health care system in changing their habits and behaviors in order to achieve adequate and lasting control of systemic arterial hypertension.展开更多
The Los Angeles metropolitan area,home to over 18 million residents,has been surrounded by multiple fast-growing fires since January 7,2025.As of January 23,these fires are estimated to have burned over 50,000 acres o...The Los Angeles metropolitan area,home to over 18 million residents,has been surrounded by multiple fast-growing fires since January 7,2025.As of January 23,these fires are estimated to have burned over 50,000 acres of land and destroyed at least 16,000 structures.Over 180,000 people have been ordered to evacuate,and at least 27 people are reported to have died in these fires.Preliminary estimates suggest that the economic loss of the Los Angeles 2025 fires could exceed 250 billion US dollars.Figure 1 shows the main areas affected by the current wildfires,a comparison with previous major wildfires,and their impacts on air quality.展开更多
Viral encephalitis is a common clinical condition.Its clinical manifestations are variable and include neurological symptoms and psychiatric abnormalities,which makes clinical diagnosis and treatment difficult.To date...Viral encephalitis is a common clinical condition.Its clinical manifestations are variable and include neurological symptoms and psychiatric abnormalities,which makes clinical diagnosis and treatment difficult.To date,there are only a few reported cases on mental symptoms of chronic viral encephalitis.We present a case of a 16-year old male patient who was previously hospitalised and diagnosed with schizophrenia and treated with aripiprazole 15 mg/day but failed to respond.The patient was then given antiviral therapy and recovered after 2 weeks.Clinicians should be aware of the possbility that chronic mental disorders could be caused by viral encephalitis.In the future,diagnosis of chronic functional mental disorders should include viral encephalitis in the differential diagnosis.展开更多
In order to assess the prevalence of physical activity (PA) and its relationship with lipid profile among adolescents, a cross-sectional study with a quantitative approach was conducted with 102 adolescents aged 15 to...In order to assess the prevalence of physical activity (PA) and its relationship with lipid profile among adolescents, a cross-sectional study with a quantitative approach was conducted with 102 adolescents aged 15 to 19 years from public schools of Campina Grande, Paraiba, Brazil. The following variables were analyzed: age, gender, ethnicity, maternal education, socioeconomic status, nutritional status, the practice of PA and lipid profile. The variables were obtained through validated form, anthropometry (weight and height) and blood collection by contract laboratory. Double entry and SPSS (Statistical Package for Social Sciences) 22.0 were performed. First, a descriptive analysis of all variables was conducted, as well as measures of central tendency and dispersion for continuous variables. Accordingly, distribution was tested for normality using the Kolmogorov-Smirnov test. According to results, correlation was evaluated by Pearson/Spearman tests. Significance level of 5% was adopted for all analyses. The study was approved by the Ethics Approach Committee (EAC) of the State University of Paraíba. The most prevalent sex in the sample was female and regarding maternal education, 35.4% had complete high school. Regarding serum lipoproteins, 16% showed elevated total cholesterol and HDL (High Density Lipoprotein) 66% below the desired value. With regard to physical activity, 60.8% had insufficient PA levels. The sample showed changes in lipid profile and insufficiently active life style, besides having overpowered the eutrophic nutritional status. No statistically significant correlations between variables of the lipid profile and the time of PA were observed. These findings highlight the importance of physical exercise for maintaining health and suggest studies with larger populations in order to check the scientific literature regarding this topic.展开更多
Omsk hemorrhagic fever virus(OHFV)is a tick-borne flavivirus associated with acute febrile illness and hemorrhagic disease in humans.OHFV was first identified in 1947 and since its identification has largely remained ...Omsk hemorrhagic fever virus(OHFV)is a tick-borne flavivirus associated with acute febrile illness and hemorrhagic disease in humans.OHFV was first identified in 1947 and since its identification has largely remained endemic to the Omsk region of the Russian Federation,where it continues to result in illnesses each year.However,the 2 primary tick vectors of OHFV exhibit ranges that extend far beyond the Omsk region,and the recent positive confirmation of OHFV in samples outside of the historic endemic range,in both the Russian Federation and neighboring Kazakhstan,to the south raises new concerns about the future potential of the pathogen.In this review,we comprehensively discuss the emergence,virology,ecology,and disease of OHFV.展开更多
This preliminary study examines the definition problem and challenges of climate forecasting and disaster responses associated with the El Nio costero(coastal) of2017, which developed rapidly with no warning and had...This preliminary study examines the definition problem and challenges of climate forecasting and disaster responses associated with the El Nio costero(coastal) of2017, which developed rapidly with no warning and had catastrophic effects in Peru. Such a localized El Nio was not documented since 1925. An initial review suggests that in addition to the characteristics of the event(surprise),government responses may have been inadequate(as media reported) because of conflicting forecast reports(U.S. and Peru), which provoked a hydrometeorological debate and stifled decision making. Partly to blame was the El Nio definition problem, which can cause uncertainty and affect perception of risk, depending on which region of the equatorial Pacific one uses to identify an event. Responses were further complicated by the fact that some regions within Peru were experiencing drought prior to the El Nio costero's onset and impacts from the El Nio 2015–2016 were less than expected. Furthermore, a new government was in place, which may have hindered action. Thus, El Nio costero provides lessons to heed, not only with respect to the forecast information, but also with reference to the context of the forecast and disaster setting, which can influence disaster responses to hydrometeorological threats.展开更多
文摘Objective To determine the impact of planned preoperative phenazopyridine administration on operative times and costs compared with as-needed intravenous agent use during routine cystoscopy following minimally invasive hysterectomy for benign indications.Method This prospective cohort study examined patients who underwent laparoscopic or robotic-assisted total or supracervical hysterectomy for benign indications between January 27,2023 and March 11,2024,with one of our minimally invasive gynecologic surgeons at Stony Brook University Hospital.Patients were assigned to the non-phenazopyridine group or the phenazopyridine group.The time needed to visualize the ureteral jets during cystoscopy and the total surgery duration were recorded.A cost analysis was then performed.Results In total,106 patients were included,with 53 patients in each group.Compared with the non-phenazopyridine group,the phenazopyridine group had significantly shorter times from the start of cystoscopy to visualization of the first ureteral jet(31 s vs.42 s,p<0.05).However,there were no significant differences observed for visualization of the second jet,total jet time,or surgery duration.Two patients in the non-phenazopyridine group required the administration of intravenous agents intraoperatively.Routine phenazopyridine was found to be more cost-efficient when medication costs and operative times were examined.Conclusion Routine phenazopyridine use does not significantly shorten overall cystoscopy times,but it is the more cost-efficient option given increased rates of costly intravenous medication use in the non-phenazopyridine group.
文摘Background Although brain-derived neurotrophic factor(BDNF)has been identified as a molecular biomarker of the neurophysiological effects induced by exercise,the acute effects of high-intensity exercise(HIE)on BDNF levels are inconclusive.This study aims to estimate the immediate effects of HIE on BDNF levels in healthy young adults.Methods A systematic search was conducted in the MEDLINE,Scopus,Cochrane CENTRAL,and SPORTDiscuss databases up to December 2020.Randomized controlled trials(RCTs)and non-RCTs reporting pre-post changes in serum or plasma BDNF after an acute intervention of HIE compared to a control condition were included.Pooled effect sizes(p-ESs)and 95%confidence intervals(95%CIs)were calculated for RCTs using a random effects model with Stata/SE(Version 15.0;StataCorp.,College Station,TX,USA).The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.PROPERO registration number:CRD42020221047.Results A total of 22 studies with 552 individuals(age range:20-31 years;59.1%male)were included.The meta-analysis included 10 RCTs that reported valid outcome data.Higher BDNF levels were observed when HIE interventions were compared with non-exercise(p-ES=0.55,95%CI:0.12-0.98;I^(2)=25.7%;n=4 studies)and light-intensity exercise(p-ES=0.78,95%CI:0.15-1.40;I^(2)=52.4%;n=3 studies)but not moderate-intensity exercise(p-ES=0.93,95%CI:-0.16 to 2.02;I^(2)=88.5%;n=4 studies)conditions.Conclusion In comparison to non-exercise or light-intensity exercises,an immediate increase in BDNF levels may occur when young adults perform HIE.Given the benefits obtained maximizing circulating BDNF when performing HIE and its potential effects on brain health,our findings suggest that HIE could be recommended by clinicians as a useful exercise strategy to healthy adults.
文摘Auriculotherapy consists of physical stimuli applied to the outer ear and is commonly associated with traditional Chinese medicine (TCM). The authors present and discuss the development of a course that offers a semi-on-site auriculotherapy course for Brazilian primary health care (PHC) professionals. The course was funded by the Brazilian Ministry of Health and developed at the Federal University of Santa Catarina in 2015 by a team of experts in auriculotherapy. It consisted of 75 h of distance learning (five sequential modules) and 5 h of on-site learning. The modules included the following items:(1) introduction to integrative practices;(2) ear reflexology;(3) introduction to TCM;(4) biomedical view of auriculotherapy;and (5) auriculotherapy in PHC. The teaching material in eluded a workbook for each module, 14 video lectures and an interactive ear(on line resource) to study location and application to the main auricular points. The on-site lectures follow a structured script of ear palpation techniques, auricular seed insertion practice and clinical case discussions, under the supervision of trained instructors. The course was offered in 2016 and 2017 and on-site lectures took place in 25 cities, covering all Brazilian regions, in coordination with municipal or state boards of health. A total of 4273 health professionals concluded the training and their evaluation of the course was highly positive. The Brazilian experience of large-scale training shows the potential to disseminate auriculotherapy in the context of PHC, given that its practice is fast, easy to learn, safe, effective for different health problems and well accepted by the patients.
文摘Background: Pregnant women in the Democratic Republic of Congo (DRC) are at increased risk for developing obstetric fistulas (OFs) as a result of obstructed labor, in conditions similar to many other African countries. No case-control study of biological and social risk factors for OF has been reported from the DRC. This study aimed to identify factors that would aid in prevention and early identification of women who are at risk of developing OF. Methods: Participants were enrolled in a case-control study at four obstetric clinics in the central DRC. Cases of OF were evaluated as they presented, then a control participant was enrolled among women presenting subsequently to the same clinic, seeking to match parity at the time of the fistula and tribe of the case. A questionnaire was administered to elicit physical, obstetric, demographic, socioeconomic, religion, geographic, and delivery attributes of the participants. Case-control comparisons sought to identify independent risk factors for OF in the total case-control pairs and in subgroups of the participants. Logistic regression was utilized to identify independent risk factors for OF in the total case-control study group and in selected subgroups of the participants, and linear regression was utilized to estimate the variation explained between case and control outcomes from the variables independently significant in the logistic regression models. Results: A total of 177 case-control pairs were enrolled. Among all pairs, shorter height of the case (odds ratio = 1.06, 95% Confidence Limits 1.02 - 1.12);more kilometers travelled to the delivery site (1.02, 1.01 - 1.02);her village, not town, residence (OR = 5.52, 2.72 - 11.2), and her lower professional status (2.95, 1.53 - 5.72) were statistically independent factors associated with OF development. When applied in linear regression comparison of the pairs, these variables yielded an r<sup>2</sup> = 0.48, imputing 48% of the difference in delivery outcome between the pairs was explained by these variables. Among the 38 pairs who were primigravida, the independent variables were more kilometers travelled to the delivery site (1.02, 1.00 - 1.05), village, not town, residence (50.0, 10.2 - 248.7), and facility intended for lower patient acuity (3.7 s, 1.01 - 13.6, r<sup>2</sup> = 0.66) patients who were matched on parity and tribe, the significant risk factors were professional status (OR = 0.29), greater distance travelled to the clinic (OR = 1.02, 1.01 - 1.02), village, not town, residence (5.52, 2.72 - 11.2), and mother’s lower professional status (2.95, 1.53 - 5.72) when the OF occurred. Conclusions: Our study showed biological and social factors associated with the development of OF. Shorter height was the only biological risk factor found to be statistically significant in the study population. Other factors were related to limited resources and limited access to medical care.
文摘The objective of this study was to determine the prevalence and associated factors of unsatisfactory self-rated health in university students. A cross-sectional study was conducted in graduate students of a Public University in the city of Rio Branco in the Western Brazilian Amazon. The overall prevalence of unsatisfactory self-rated health was 23.0%. After adjusting for gender and age, the factors associated with unsatisfactory self-rated health were as follows: sedentarism during leisure time (prevalence ratio (PR): 2.26;95% CI: 1.56 - 3.29), consuming meals only in restaurants (PR: 1.48;95% CI: 1.14 - 1.94), insomnia (PR: 1.86;95% CI: 1.50 - 2.30), headaches (PR: 2.17;95% CI: 1.52 - 3.09), and back pain (PR: 2.03;95% CI: 1.58 - 2.60). Thus, a high prevalence of unsatisfactory self-rated health was identified in this group of university students. The findings suggest immediate implementation of programs to promote healthy behaviors and to prevent headaches, back pain and insomnia.
文摘The horticultural sector has undergone tremendous growth in Kenya and is now the second largest foreign income earning sector in the country. Lake Naivasha is the hub of large scale horticultural farming in Kenya. This growth coupled with increased use of pesticides, may increase the possibility of pesticide exposure and its associated risks to workers and residents of the region. The purpose of this study was to assess the symptoms commonly experienced by residents of Naivasha town and their possible association to pesticide exposure. Purposive sampling of residents from Kamere, Kwa Muia, Kioto and Karagita was performed, as these residential areas have significant numbers of flower farm workers. By random selection, a total of 801 community members were recruited to participate in the study and data was collected by completing the prepared questionnaire and from clinical examinations. Results indicate that several residents exhibited respiratory;skin, joints and bones;and nervous system symptoms. We found a higher frequency of symptoms among planters, weeders, harvesters than in sprayers working in horticultural farms. We recommend training to planters, weeders, harvesters who are mainly women (61.6%) in this study concerning pesticide use as do sprayers;and second, longer reentry times between the last spraying of pesticide and entry of these workers is warranted, particularly in greenhouses. In this regard, reentry times for greenhouses and fields established for specific pesticides in Europe, North America, Japan or Australia should be adapted by Kenya, and these guidelines enforced by the Government of Kenya to reduce exposure to pesticides within this vulnerable work group. These workers should also use protective clothing including gloves and masks at all times while handling chemicals or recently sprayed plants or flowers. It would also be prudent for flower farm owners to introduce an integrated pest management regime to reduce pesticide use andworker exposures. Further research is required both to identify validated biomarkers that can reliably be used to identify pesticide exposure prior to the occurrence of acute toxicity;and to follow up individual cases of known exposures for chronic health effects.
基金supported by the National Natural Science Foundation of China(Nos.42077194,42061134008,and 42377098)the Shanghai International Science and Technology Partnership Project(China)(No.21230780200)the Shanghai General Project(China)(No.23ZR1406100).
文摘Wildfires burn approximately 3%-4% of the global land area annually,resulting in massive emissions of greenhouse gases and air pollutants.Over the past two decades,there has been a declining trend in both global burned area and wildfire emissions.This trend is largely attributed to a decrease in wildfire activity in Africa,which accounts for a substantial portion of the total burned area and emissions.However,the northern high-latitude regions of Asia and North America have witnessed substantial interannual variability in wildfire activity,with several severe events occurring in recent years.Climate plays a pivotal role in influencing wildfire activity and has led to more wildfires in high-latitude regions.These wildfires pose significant threats to climate,ecosystems,and human health.Given recent changes in wildfire patterns and their impacts,it is critical to understand the contributors of wildfires,focus on deteriorating high-latitude areas,and address health risks in poorly managed areas tomitigate wildfire effects.
基金support by the National Natural Science Foundation of China Grant No.81072313
文摘Objective To investigate the association between autism and prenatal environmental risk factors.Methods A case-control study was conducted among 193 children with autism from the specialeducational schools and 733 typical development controls matched by age and gender by usingquestionnaire in Tianjin from 2007 to 2012. Statistical analysis included quick unbiased efficientstatistical tree （QUEST） and logistic regression in SPSS 20.0.Results There were four predictors by QUEST and the logistic regression analysis, maternal airconditioner use during pregnancy （OR=0.316, 95% CI： 0.215-0.463） was the single first-level node（χ2=50.994, P=0.000）; newborn complications （OR=4.277, 95% CI： 2.314-7.908） and paternalconsumption of freshwater fish （OR=0.383, 95% CI： 0.256-0.573） were second-layer predictors（χ2=45.248, P=0.000; χ2=24.212, P=0.000）; and maternal depression （OR=4.822, 95% CI： 3.047-7.631）was the single third-level predictor （χ2=23.835, P=0.000）. The prediction accuracy of the tree was 89.2%.Conclusion The air conditioner use during pregnancy and paternal freshwater fish diet might bebeneficial for the prevention of autism, while newborn complications and maternal depression might bethe risk factors.
基金This work was supported in part by National Cancer Institute,No.R03CA223052Walk-for-Beauty Foundation and Baldwin Carol M.Baldwin Breast Cancer Research Awards。
文摘Lymph node involvement increases the risk of breast cancer recurrence.An accurate non-invasive assessment of nodal involvement is valuable in cancer staging,surgical risk,and cost savings.Radiomics has been proposed to pre-operatively predict sentinel lymph node(SLN)status;however,radiomic models are known to be sensitive to acquisition parameters.The purpose of this study was to develop a prediction model for preoperative prediction of SLN metastasis using deep learning-based(DLB)features and compare its predictive performance to state-of-the-art radiomics.Specifically,this study aimed to compare the generalizability of radiomics vs DLB features in an independent test set with dissimilar resolution.Dynamic contrast-enhancement images from 198 patients(67 positive SLNs)were used in this study.Of these subjects,163 had an in-plane resolution of 0.7×0.7 mm^(2),which were randomly divided into a training set(approximately 67%)and a validation set(approximately 33%).The remaining 35 subjects with a different in-plane resolution(0.78×0.78 mm^(2))were treated as independent testing set for generalizability.Two methods were employed:(1)conventional radiomics(CR),and(2)DLB features which replaced hand-curated features with pre-trained VGG-16 features.The threshold determined using the training set was applied to the independent validation and testing dataset.Same feature reduction,feature selection,model creation procedures were used for both approaches.In the validation set(same resolution as training),the DLB model outperformed the CR model(accuracy 83%vs 80%).Furthermore,in the independent testing set of the dissimilar resolution,the DLB model performed markedly better than the CR model(accuracy 77%vs 71%).The predictive performance of the DLB model outperformed the CR model for this task.More interestingly,these improvements were seen particularly in the independent testing set of dissimilar resolution.This could indicate that DLB features can ultimately result in a more generalizable model.
文摘Despite the existence of colorectal cancer (CRC) screening guidelines, population-based studies have consistently shown under-utilization of CRC screening procedures among older adults in the United States. We examined whether symptoms of anxiety and depression are associated with colorectal cancer (CRC) screening perceptions and behaviors among older adults in a primary care setting. A cross-sectional study was conducted by using a sample of 143 family medicine patients who completed an 88-item anonymous self-administered questionnaire covering symptoms of anxiety and depression as well as CRC screening perceptions (defined based on the Health Belief Model) and behaviors (defined as ever use of or adherence to CRC testing). Moderate-to-clinically significant anxiety and depressive symptoms were, respectively, prevalent in 47% and 42% of participants. Perceived benefits and barriers were the only Health Belief Model constructs associated with anxiety. Perceived barriers were positively associated with anxiety symptoms after adjustment for confounders, including age, gender, race/ ethnicity, marital status, education, smoking history, body mass index and self-rated health. By contrast, perceived benefits were negatively associated with anxiety symptoms only in the unadjusted model. Neither anxiety nor depression was associated with ever use of or adherence to CRC testing. Symptoms of anxiety, but not depression, may potentially influence CRC screening perceptions, with implications for behavioral interventions targeting CRC testing.
文摘An estimated 2 million women living in countries with limited resources currently have vesico-vaginal, recto-vaginal, or mixed types of fistulae because of the necrosis that occurs with obstructed labor. We evaluated factors readily assessed by the examining practitioner in a consecutive case series of surgical repairs of obstetrical fistulae, for the ability of those factors to stand as a prognostic guide, in a clinical score. Objectives: To identify the predictors of surgical repair outcomes and establish a Score combining these different determinants to facilitate the care of obstetric fistula. Methods: We conducted a multicentric prospective study between 2011 and 2014 in Democratic Republic of the Congo (DRC). Outcomes: We measured 3 months post-surgery in a series of 483 patients with obstetrical fistula repaired by the same surgeon included closure and failure appreciated by dye test. Multivariable generalized estimating equation models were used to generate adjusted odd ratios (OR) and 95% confidence intervals (CIs). The scores ranging from 3 to 14 were established from the outcomes determinants identified. Results: In total, 483 women were enrolled, and 390 cases were at their first surgery and were included in the obstetric fistula (OF) prognosis score and classification. Their mean age was 35 years at the time of the surgery and 25 years at the onset of OF. In 28.6%, the fistula patient was primigravida. Mean duration between onset of the fistula and surgical treatment was 8 years. In 24%, the fistula patients lived separated from their partners. Overall closure rate of the fistulas was 85.7%. Severe vaginal fibrosis (p 0.01), big fistula size (0.01), small distance from fistula to external urethral meatus (0.01) and prior surgery (p 0.48) predicted failed fistula closure. A clinical score ranging from 3 to 14 points is a prognostic score with a range of 1 to 4 for the distance between the fistula and the external meatus and the size, and a scale of 1 to 6 for fibrosis. Conclusions: This study demonstrated that the marked vaginal scarring;large fistula size and distance to urethral meatus are predictors for unsuccessful fistula repair. Due to the lack of a standard classification that is never unanimous among the different surgeons, this prognostic score allows the combination of the different determinants assessing the chances of success and can help the practitioners to orient the patients towards the determined skill scale to take care of the patients.
文摘Introduction: The more intense and early development of obesity, the greater the risk of persistence and severity of comorbidities, such as cardiovascular disease. There is evidence that high serum concentrations of lipoprotein (a) [Lp (a)] and C-reactive protein (CRP) are associated with increased risk of cardiovascular diseases. Objectives: To verify the change in the levels of Lp (a) and ultrasensitive CRP and its relationship with the nutritional status of adolescents. Methods: Cross-sectional study conducted with overweight children and adolescents between August 2012 and July 2013 attended at the Center for Childhood Obesity. The measurement of inflammatory markers was performed in the Clinical Laboratory of the State University of Paraiba. Comparison of sociodemographic variables by sex was tested by chi-square;the association of the risk markers according to age was evaluated by Student’s t test, and the body mass index by analysis of Pearson correlation. The normality distribution was tested by the Kolmogorov-Smirnov test. Confidence interval of 95% was adopted in all analyses. The study was approved by the Ethics Research Committee of UEPB (CAAE 0256.0.133.000-11). Results: Of the 133 children and adolescents evaluated, 60.9% were female and 72.2% were adolescents. Body Mass Index, lipo (a) and u-CRP showed statistically significant association with age (p < 0.01). There was a positive ascending correlation (r = 0.273, p < 0.01) of u-CRP with BMI, which was not verified for lipoprotein (a). Conclusion: As a cardiovascular risk marker already established in literature, the association of u-CRP with the nutritional status of adolescents, proportionally, shows the need for losing weight in this population, especially at early age. A deeper and long-term investigation should be carried out for more effective and consistent contribution to public health.
基金the National Council of Science and Technology(CONACyT)Mexico,by the supported with the scholarship awarded for postgraduate study
文摘Background: Patients with cancer constitute a special group where immunization programs are often interrupted to begin treatment with chemotherapy. Sepsis is one of the main complications in this group. Methods: A hospital-based case-control study matched by age was carried out among subjects ≤ 9 years of age with cancer diagnosis. Children with cancer without sepsis and children with surgical pathology were included as controls;children with sepsis were included as cases. A bivariate logistic regression was used to determine the factors associated to nosocomial sepsis, and odds ratios were calculated with 95% confidence intervals. The percentage of attributable risk was calculated for the variables included in the final model. Results: Nineteen children with cancer and sepsis and 83 controls were included. Twelve (44%) caseshad an incomplete vaccination schedule according to their age. The association force between incomplete schedule and sepsis was 10.1 (95% CI, 3 - 36;p < 0.05). Conclusions: Approximately, 20% to 65% of the cases of serious nosocomial infection can be associated to an incomplete vaccination schedule. Strategies should be implemented to improve the general pediatric population’s vaccination status before a serious disease, such as cancer or another chronic condition preventing the application of vaccines, develops.
文摘Introduction: Among the extrinsic factors, homocysteine (Hy) stands out, which is an intermediate amino acid of the intracellular metabolism of methionine involved in the process of cellular oxidation, which promotes the installation of atheromatous plaques and, therefore, is considered as an emerging cardiovascular risk factor. Objective: To evaluate the plasma homocysteine levels (Hy) in overweight or obese children and adolescents and their relation with cardiovascular risk factors. Methods: A cross-sectional study was conducted from July 2011 to May 2012 with overweight or obesity children and adolescents aged 2 to 18 years followed at the Center for Childhood Obesity (IOC), Campina Grande-PB. A structured form was used to record demographic, socioeconomic and clinics variables and the patients underwent laboratory tests to define their lipid and glucose profiles and measurement of plasma Hy levels. Results: The study evaluated a total of 165 children and adolescents with mean age of 12.5 (±2.5) years;the majority were female (57.0%). Regarding the lipid profile, there was more individuals with low HDL cholesterol (88.5%). Plasma Hy levels were high in 24.2% of the sample. The mean Hy levels ranged from 4.3 to 18.9 μmol/L, being higher in males, obese adolescents and also in patients with high insulin levels and resistance. Conclusions: The results shown in this study emphasize the importance of detecting and controlling the plasma Hy levels as an independent cardiovascular risk factor, and the need for further studies to evaluate the clinical and biological factors related to alterations in its metabolism.
文摘Access can be understood as the sum of a number of elements of the interface between patients and the health care system. This study took a comprehensive approach to the dimensions of access to medications, employing indicators to evaluate the dimensions of access to antihypertensive medications in Ceilandia, DF, Brazil. This was a cross-sectional epidemiological study, administering questionnaires during home visits. The survey covered epidemiological and socioeconomic profiles, behavioral habits and the dimensions of access to antihypertensive medications comprising physical, financial, and geographic availability and accept ability according to the hypertensive population of Ceilandia. The total sample comprised 400 individuals and the hypertensive subset numbered 140 (35%). Indicators of physical availability of medications revealed that users found it difficult to acquire their drugs on almost one third of occasions and in some cases were unable to access any of these products. The greatest barriers to access were reported by users of pharmacies belonging to the Brazilian National Health Service (SUS) and on the “People’s Pharmacies” network. More than one third of the hypertensive sample spent their own money on medications they could not find at these pharmacies. The majority of the hypertensive subsets were overweight/obese, a minority engaged in physical activity and 40% were smokers/ex-smokers. More women reduced their salt intake. Men had higher incomes, educational level, and socioeconomic status. Failure to keep the public health care system supplied has prejudiced access to essential medications for hypertension treatment, transferring the costs onto users. This population has lifestyle habits that increase the risk of exacerbation of hypertension. These results reveal a need for effective public policies to ensure access to antihypertensive medications and involve users of the health care system in changing their habits and behaviors in order to achieve adequate and lasting control of systemic arterial hypertension.
基金support from NASA(#80NSSC23K0028)NSF(#2101044)support from NIH(#R01ES036566).
文摘The Los Angeles metropolitan area,home to over 18 million residents,has been surrounded by multiple fast-growing fires since January 7,2025.As of January 23,these fires are estimated to have burned over 50,000 acres of land and destroyed at least 16,000 structures.Over 180,000 people have been ordered to evacuate,and at least 27 people are reported to have died in these fires.Preliminary estimates suggest that the economic loss of the Los Angeles 2025 fires could exceed 250 billion US dollars.Figure 1 shows the main areas affected by the current wildfires,a comparison with previous major wildfires,and their impacts on air quality.
基金This case report was funded by Shanghai Key Laboratory of Psychotic Disorders Open Grant(grant number:13dz2260500).
文摘Viral encephalitis is a common clinical condition.Its clinical manifestations are variable and include neurological symptoms and psychiatric abnormalities,which makes clinical diagnosis and treatment difficult.To date,there are only a few reported cases on mental symptoms of chronic viral encephalitis.We present a case of a 16-year old male patient who was previously hospitalised and diagnosed with schizophrenia and treated with aripiprazole 15 mg/day but failed to respond.The patient was then given antiviral therapy and recovered after 2 weeks.Clinicians should be aware of the possbility that chronic mental disorders could be caused by viral encephalitis.In the future,diagnosis of chronic functional mental disorders should include viral encephalitis in the differential diagnosis.
文摘In order to assess the prevalence of physical activity (PA) and its relationship with lipid profile among adolescents, a cross-sectional study with a quantitative approach was conducted with 102 adolescents aged 15 to 19 years from public schools of Campina Grande, Paraiba, Brazil. The following variables were analyzed: age, gender, ethnicity, maternal education, socioeconomic status, nutritional status, the practice of PA and lipid profile. The variables were obtained through validated form, anthropometry (weight and height) and blood collection by contract laboratory. Double entry and SPSS (Statistical Package for Social Sciences) 22.0 were performed. First, a descriptive analysis of all variables was conducted, as well as measures of central tendency and dispersion for continuous variables. Accordingly, distribution was tested for normality using the Kolmogorov-Smirnov test. According to results, correlation was evaluated by Pearson/Spearman tests. Significance level of 5% was adopted for all analyses. The study was approved by the Ethics Approach Committee (EAC) of the State University of Paraíba. The most prevalent sex in the sample was female and regarding maternal education, 35.4% had complete high school. Regarding serum lipoproteins, 16% showed elevated total cholesterol and HDL (High Density Lipoprotein) 66% below the desired value. With regard to physical activity, 60.8% had insufficient PA levels. The sample showed changes in lipid profile and insufficiently active life style, besides having overpowered the eutrophic nutritional status. No statistically significant correlations between variables of the lipid profile and the time of PA were observed. These findings highlight the importance of physical exercise for maintaining health and suggest studies with larger populations in order to check the scientific literature regarding this topic.
基金supported by a Holcomb Awards Committee grant(028611)through Butler Uniersity for Christopher C.Stobart.
文摘Omsk hemorrhagic fever virus(OHFV)is a tick-borne flavivirus associated with acute febrile illness and hemorrhagic disease in humans.OHFV was first identified in 1947 and since its identification has largely remained endemic to the Omsk region of the Russian Federation,where it continues to result in illnesses each year.However,the 2 primary tick vectors of OHFV exhibit ranges that extend far beyond the Omsk region,and the recent positive confirmation of OHFV in samples outside of the historic endemic range,in both the Russian Federation and neighboring Kazakhstan,to the south raises new concerns about the future potential of the pathogen.In this review,we comprehensively discuss the emergence,virology,ecology,and disease of OHFV.
文摘This preliminary study examines the definition problem and challenges of climate forecasting and disaster responses associated with the El Nio costero(coastal) of2017, which developed rapidly with no warning and had catastrophic effects in Peru. Such a localized El Nio was not documented since 1925. An initial review suggests that in addition to the characteristics of the event(surprise),government responses may have been inadequate(as media reported) because of conflicting forecast reports(U.S. and Peru), which provoked a hydrometeorological debate and stifled decision making. Partly to blame was the El Nio definition problem, which can cause uncertainty and affect perception of risk, depending on which region of the equatorial Pacific one uses to identify an event. Responses were further complicated by the fact that some regions within Peru were experiencing drought prior to the El Nio costero's onset and impacts from the El Nio 2015–2016 were less than expected. Furthermore, a new government was in place, which may have hindered action. Thus, El Nio costero provides lessons to heed, not only with respect to the forecast information, but also with reference to the context of the forecast and disaster setting, which can influence disaster responses to hydrometeorological threats.
