Postoperative Prognostic Nutritional Index and Fibrinogen Could Well Predict Poor Prognosis of Acute Type A Aortic Dissection Patients After Surgery

ABSTRACT Introduction: Inflammatory and immunological factors play pivotal roles in the prognosis of acute type A aortic dissection. We aimed to evaluate the prognostic values of immune-inflammatory parameters in acute type A aortic dissection patients after surgery. Methods: A total of 127 acute type A aortic dissection patients were included. Perioperative clinical data were collected through the hospital's information system. The outcomes studied were delayed extubation, reintubation, and 30-day mortality. Multivariate logistic regression analysis and receiver operating characteristic analysis were used to screen the risk factors of poor prognosis. Results: Of all participants, 94 were male, and mean age was 51.95±11.89 years. The postoperative prognostic nutritional indexes were lower in delayed extubation patients, reintubation patients, and patients who died within 30 days. After multivariate regression analysis, the postoperative prognostic nutritional index was a protective parameter of poor prognosis. The odds ratios (95% confidence interval) of postoperative prognostic nutritional index were 0.898 (0.815, 0.989) for delayed extubation and 0.792 (0.696, 0.901) for 30-day mortality. Low postoperative fibrinogen could also well predict poor clinical outcomes. The odds ratios (95% confidence interval) of postoperative fibrinogen were 0.487 (0.291, 0.813) for delayed extubation, 0.292 (0.124, 0.687) for reintubation, and 0.249 (0.093, 0.669) for 30-day mortality. Conclusion: Postoperative prognostic nutritional index and postoperative fibrinogen could be two promising markers to identify poor prognosis of acute type A aortic dissection patients after surgery.

Breastfeeding and autism spectrum disorder: case-control study / Transtorno do espectro do autismo e aleitamento materno: estudo de caso controle

Abstract Objectives: to evaluate the association between breastfeeding and Autism Spectrum Disorder (ASD) in children and adolescents. Methods: this is a case-control study carried out in the north of the state of Minas Gerais, Brazil, which included 248 children and adolescents diagnosed with ASD (case group) and 886 children and adolescents without a diagnosis of ASD (control group).Interviews were conducted with the mothers of children and adolescents and a semi-structured questionnaire was used to collect data. For data analysis, a multiple logistic regression model was adopted. The magnitude of associations was estimated by the odds ratio (OR). Three multiple models were fitted: Model 1: presence or absence of breastfeeding; Model 2: duration of breastfeeding; Model 3: duration of exclusive breastfeeding. Results: ASD was associated with the absence of breastfeeding in the three adjusted models: Model 1: OR=2.1, CI95%=1.1-4.1; Model 2: OR=2.3, CI95%=1.2-4.5; Model 3: OR=2.3, CI95%=1.2-4.5. Conclusions: individuals with ASD were more likely to have not received breastfeeding, however, due to the nature of case control studies, it cannot be stated that breastfeeding prevents ASD. Conducting a cohort study may clarify this relationship.

Resumo Objetivos: avaliar a associação entre aleitamento materno e Transtorno do Espectro do Autismo (TEA) em crianças e adolescentes. Métodos: trata-se de um estudo caso-controle realizado no norte de Minas Gerais, Brasil, que incluiu 248 crianças e adolescentes com diagnóstico de TEA (grupo caso) e 886 crianças e adolescentes sem diagnóstico de TEA (grupo controle). Foram realizadas entrevistas com as mães das crianças e adolescentes e utilizado um questionário semiestruturado para coleta dos dados. Para análise dos dados foi adotado modelo de regressão logística múltipla. A magnitude das associações foi estimada pela Odds Ratio (OR). Três modelos múltiplos foram ajustados: Modelo 1: presença ou ausência de aleitamento materno; Modelo 2: duração do aleitamento materno; Modelo 3: duração do aleitamento materno exclusivo. Resultados: o TEA foi associado à ausência de aleitamento materno nos três modelos ajustados: Modelo 1: OR=2,1, IC95%=1,1-4,1; Modelo 2: OR=2,3, IC95%=1,2-4,5; Modelo 3: OR=2,3, IC95%=1,2-4,5. Conclusões: os indivíduos com TEA tiveram maiores chances de não terem recebido aleitamento materno, no entanto, devido à natureza dos estudos de caso-controle, não se pode afirmar que o aleitamento materno previna o TEA. A realização de um estudo de coorte poderá esclarecer essa relação.

Factores asociados a dolor lumbar en trabajadores sanitarios de un hospital de referencia del Perú

Introducción: El dolor lumbar es una condición inevitable en todo el personal del rubro de la salud, con llevando desde malestar físico hasta una incapacidad funcional del individuo. Objetivo: Determinar los factores asociados a dolor lumbar entre los trabajadores sanitarios en un hospital de referencia del Perú. Metodología: El presente estudio es observacional, analítico, de corte transversal, temporalmente prospectivo, con muestreo no probabilístico. La población estuvo conformada por trabajadores sanitarios del Hospital Santa Rosa de Pueblo Libre durante el periodo de junio a diciembre del año 2022. Resultados: El análisis multivariado determinó que el ser hombre (OR: 2.818, p valor: 0.017), tener sobrepeso (OR:1.782, p valor: 0.013), demanda laboral alta (OR: 4.750, p valor: 0.026), realizar actividad física (OR: 3.610, p valor: 0.031) y tener antecedentes de trauma lumbar (OR: 2.423, p valor: 0.034), fueron factores estadísticamente significativos que se asociaron al dolor lumbar. Discusión: Se pudo observar que, los factores asociados a dolor lumbar fueron el sexo masculino, el sobrepeso, la demanda laboral alta, el realizar actividad física y el antecedente de trauma lumbar. Conocer estas variables permitirá realizar esquemas y charlas preventivas para afrontar esta recurrente patología.

Introduction: Low back pain is an unavoidable condition in all health personnel, ranging from physical discomfort to functional disability of the individual. Objective: To determine the factors associated with low back pain among health workers at a reference hospital in Peru. Methods: This study is observational, analytical, cross-sectional, temporally prospective, with non-probabilistic sampling. The population was made up of health workers from the Hospital Santa Rosa de Pueblo Libre during the period from June to December of the year 2022. Results: The multivariate analysis determined that being a man (OR: 2.818, p value: 0.017), being overweight (OR:1.782, p value: 0.013), high labor demand (OR: 4.750, p value: 0.026), performing physical (OR: 3.610, p value: 0.031) and having a history of low back trauma (OR: 2.423, p value: 0.034) were statistically significant factors associated with low back pain. Discussion: It was possible to observe that the factors associated with low back pain were the male sex, being overweight, high work demand, physical activity and a history of low back trauma. Knowing these variables will make it possible to carry out preventive schemes and talks to deal with this recurring pathology.

Riesgo de muerte por insuficiencia cardiaca congestiva en pacientes anémicos de la población peruana / Risk of death due to congestive heart failure in anemic patients in the Peruvian population

Objetivo: Determinar el riesgo de muerte por insuficiencia cardiaca congestiva subyacente en pacientes anémicos de la población peruana. Materiales y métodos: Estudio observacional, descriptivo, de casos y controles y retrospectivo basado en datos del Sistema Informático Nacional de Defunciones (Sinadef) del Ministerio de Salud (Minsa) peruano entre enero de 2021 y agosto de 2022. El muestreo fue no probabilístico, intencional por conveniencia según los criterios de inclusión y exclusión. Se incluyó a todos los pacientes con y sin anemia que fallecieron por insuficiencia cardiaca congestiva u otras comorbilidades, que sumaron un total de 35 724 personas. Las variables fueron anemia, definida como un trastorno del tamaño o número de hematíes, de la hemoglobina, así como de la absorción y disponibilidad del hierro, e insuficiencia cardiaca congestiva, definida como la incapacidad del miocardio para bombear sangre de forma competente. Se realizó la prueba de chi al cuadrado y de los coeficientes Phi y V de Cramer para determinar la existencia y grado de asociación de las variables y la razón de probabilidades para la estimación del riesgo. Se consideró un valor de p significativo menor del 0,05, con un intervalo de confianza al 95 %. Resultados: La anemia estuvo moderadamente asociada a la insuficiencia cardiaca congestiva: fallecieron 62,80 % de personas con anemia. Las variables están estadísticamente relacionadas y, según los coeficientes Phi y V de Cramer, se trata de una relación moderada. Se halló que los anémicos tuvieron 11,14 veces mayor riesgo de morir por insuficiencia cardiaca congestiva que las personas con otras comorbilidades. Conclusiones: La anemia se asocia a un alto riesgo de muerte por insuficiencia cardiaca subyacente en la población peruana. Es necesario el seguimiento de los niveles de hierro, hemoglobina y hematíes en pacientes con insuficiencia cardiaca, así como tratar las causas de estas deficiencias, con el objetivo de reducir la morbimortalidad en este grupo de pacientes.

Objective: To determine the risk of death from underlying congestive heart failure among Peruvian patients with anemia. Materials and methods: An observational, descriptive, case-control and retrospective study based on data from the Sistema Informático Nacional de Defunciones (SINADEF National Death Computer System) of the Ministry of Health of Peru (MINSA) and conducted between January 2021 and August 2022. A non-probability purposive convenience sampling was used considering the inclusion and exclusion criteria. All patients with and without anemia who died from congestive heart failure or other comorbidities were included in the research, totaling 35,724 people. The variables were anemia, defined as a condition related to the amount or number of red blood cells and hemoglobin, as well as to iron absorption and availability, and congestive heart failure, defined as the inability of the myocardium to pump blood efficiently. Chi-square test and phi and Cramer's V coefficients were used to determine the presence and degree of association of the variables and the odds ratio for risk estimation. A significant p value less than 0.05 with a 95 % confidence interval was considered. Results: Anemia was moderately associated with congestive heart failure: 62.80 % of people with anemia died from this disease. The variables were statistically related and, according to phi and Cramer's V coefficients, there was a moderate relationship. People with anemia had 11.14 times higher risk of dying from congestive heart failure than people with other comorbidities. Conclusions: Anemia is associated with high risk of death from underlying heart failure in the Peruvian population. It is necessary to monitor iron, hemoglobin and red blood cell levels among patients with heart failure, as well as to identify the causes of these deficiencies in order to reduce morbidity and mortality in this group of patients.

Association of Dietary and Physical Activity Patterns and Hypertension in Western Rajasthan, 2022

Introduction: Hypertension (HTN) is a modifiable risk factor for coronary artery disease, heart failure, cerebrovascular disease and chronic renal failure. HTN affects about 1 billion people globally; by 2025, up to 1.58 billion adults worldwide are likely to suffer from complications of HTN. This study was done to know the diet and physical activity patterns and HTN among the population of three districts of Western Rajasthan. Objectives: To study the dietary and physical activity patterns among the population of Western Rajasthan. and to compare key findings among three districts Pali, Jodhpur and Barmer so that lifestyle changes can be recommended. Methods: A case-control study was done among attendees of NCD clinics of tertiary-level centers in Pali, Barmer and Jodhpur. Hospital Controls were matched to age (± 5 years) and gender Considering the prevalence of HTN to be 20%*, the proportion of exposure in the general population as 0.2, odds ratio to be 2.2, power =80%, alpha=5% sample size is estimated to be 102 cases & 102 controls (from each district). Results: Overall being married (OR= 3.3), having diabetes Cardiac disease (OR= 2.6), excessive salt consumption (OR= 2.7), moderate physical exercise less than 30 minutes (OR=1.9), using oil other than vegetable oil(OR=1.8) , Age >?60 years (OR =1.4) were the key risk factors. It was found that high BMI (BMI>27), consumption of non-vegetable oils (12.7%) was highest in Jodhpur, lack of moderate exercise for at least 30 minutes (81%), lack of sports activity (92%) was highest in Pali, least number of days/week of fruits and vegetables consumption (~1.64 days) was seen in Barmer. Conclusions: Change in quantity of salt consumption and incorporation of moderate physical exercise for >30 minutes was most followed in control of HTN among the attendees of NCD Clinics from the multiple advise given.

Safety of interferon β-1a for treatment of COVID-19： a real-world study based on FAERS database / 上海预防医学

ObjectiveTo systematically evaluate the safety of interferon β-1a for treatment of corona virus disease 2019 （COVID-19）， and to provide references for interferon β-1a's clinical application. MethodsThis study was conducted with the database from US Food and Drug Administration adverse event reporting system （FAERS） from January 1， 2015 to March 31， 2021. Information component （IC） and reporting odds ratio （ROR） methods were applied for signal mining. ResultsA total of 463 700 records of COVID-19 were selected for analysis， and 45 positive drug adverse event signals were detected. Headache （IC025=1.09， ROR025=2.28）， pyrexia （IC025=0.51， ROR025=1.51） and multiple sclerosis relapse （IC025=3.67， ROR025=14.71） were positive adverse events with higher frequency. Autoimmune disorder （IC025=4.42， ROR025=24.03）， streptococcal infection （IC025=4.12， ROR025=19.82）， and multiple sclerosis relapse （IC025=3.67， ROR025=14.71） were positive adverse events. Acute lung injury， cardio-respiratory arrest and metabolic acidosis were associated with a higher proportion and frequency of death. ConclusionThere are certain safety issues with interferon β-1a in the treatment of COVID-19， and some adverse events with high frequency and high death rate deserve further attention by medical staffs.

Mining and analysis of ADE signals of romiplostim and eltrombopag based on FAERS database / 中国药房

OBJECTIVE To provide a reference for the safe use of thrombopoietin receptor agonists romiplostim and eltrombopag in clinic. METHODS FDA adverse event reporting system （FAERS） in the United States was adopted to collect adverse drug event （ADE） reports of romiplostim and eltrombopag from their launch in the United States to September 30， 2022； the ADE signals of the two drugs were analyzed using the reporting odds ratio （ROR） method and the comprehensive standard method of the UK Medicines and Healthcare Products Regulatory Agency. RESULTS A total of 14 021 and 4 431 ADE reports were collected about romiplostim and eltrombopag， respectively， with a gender composition of more females than males. After signal screening， 563 ADE signals were obtained about romiplostim， involving 25 system organ classes （SOC）； eltrombopag had 433 ADE signals， involving 26 SOC. The most frequently reported ADE for both drugs was platelet count decreased （2 060， 1 585 cases）， which was mentioned in their drug instructions. In terms of signal intensity， romiplostim exhibited the highest signal for abnormal thrombopoietin levels （ROR of 2 268.85）， while eltrombopag had the highest signal for positive dengue virus test （ROR of 954.50）， with neither of these signals mentioned in their respective drug instructions. CONCLUSIONS The ADE of romiplostim and eltrombopag mainly affects the blood and lymphatic system， and there are many new suspicious high-risk signals.

Study Design: Observational Studies

Observational study designs are those where the investigator/researcher just observes and does not carry out any intervention(s)/actions to alter the outcome. The three most common types of observational studies are cross-sectional, case control and cohort (or longitudinal). In cross-sectional studies, both the exposure/risk factor(s) and the outcome(s) are determined at a single time point. They can provide information on prevalence of a condition and snapshot of probable associations that can be used to generate hypothesis. Case-control studies are where subjects are selected based on presence/absence of outcome and the risk factors are determined during the study after enrolment of study subjects. The association between exposure and outcome is reported as odds ratio. These studies; however, have high risk of bias, which must be taken care of during study design. Cohort studies are prospective in nature, where subjects are selected based on presence/absence of exposure, and the outcome(s) is determined at the end of study. These studies can provide incidence of disease/outcome and the association between exposure and outcome is reported as relative risk. They are useful to ascertain causality. High dropouts of study participants and confounding can be problems encountered in these studies. Keywords: Case-control, Cohort, Cross-sectional, Odds ratio, Relative risk, Survey

A Review on Logistic Regression in Medical Research

In today抯 scenarios many healthcare decisions are being taken by predictive modeling and machine learning techniques. With this review, we focused on logistic regression model, a kind of predictive modeling used in machine learning, and how healthcare researchers take decisions by the help of predictive modeling. For a better data analysis in healthcare, we need to understand the concept of logistic regression as well as others terms, which are linked with it. so that we can clearly understand the concept behind it and implement in medical research. In this review we worked on an example and illustrated how to perform logistic regression using R programming language. The aim of this paper is to understand logistic regression in healthcare and implement it for decision making.

Excavation and evaluation of adverse reaction signals of 4 kinds of imported PD- 1/PD-L1 inhibitors / 中国药房

OBJECTIVE To exc avate and evaluate the adverse reaction signals of 4 kinds of imported programmed cell death 1 （PD-1）and its ligand （PD-L1）inhibitors，and to guide rational drug use in clinic. METHODS OpenVigil 2.1 software was used to obtain the adverse event reports of four drugs as nivolumab ，pembrolizumab，atezolizumab and durvalumab from the first quarter of 2013 to the fourth quarter of 2020 in the US FDA adverse event reporting system. The reporting odds ratio and proportional reporting ratio were used for signal mining to evaluate new or potential adverse reaction signals. RESULTS A total of 46 840 reports of adverse events with PD- 1/PD-L1 inhibitors as the primary suspected drug were collected ，including 28 896 reports of nivolumab，13 298 reports of pembrolizumab ，3 398 reports of atezolizumab ，and 1 248 reports of durvalumab. From the general characteristics of these reports ，the gender distribution was more men than women ，and the age distribution was mainly in the range of 51-85 years old. The reporting year was mainly in the nearly 4-5 years，and the main reporting countries were the US and Japan，with“death”and“hospitalization or prolonged hospitalization ”as the main serious adverse events which were over 50％ of the whole of 4 kinds of adverse events. A total of 1 597 adverse reaction signals were obtained ，involving 26 systems，focusing on “benign，malignant and unspecified neoplasms （cystic and polypoid tumor ）”，“infections and infestations ”and“investigations”， etc. The analysis of the top 50 adverse reaction signals showed that the largest number of report was endocrine system disease ，the most frequency signal was “malignant neoplasm progression ”and the strongest adverse reaction signal was “radiation pneumonitis ”. And it was also found that 13 adverse reaction signals ，such as “radiation pneumonitis ”“cholangitis”“fulminant type 1 diabetes mellitus” “blood creatine phosphokinase increased ” “disseminated intravascular coagulation ”“cardiac failure ”and “cerebral infarction ”，etc.，were not reported in the drug instructions. CONCLUSIONS PD-1/PD-L1 inhibitors mediate a large number of adverse reaction signals，resulting in high safety risks in “benign，malignant and unspecified neoplasms （cystic and polypoid tumor ）”，“infections and infestations ”and “investigations”，etc. The newly discovered 13 adverse reaction signals ，such as “radiation pneumonitis ”“cholangitis”“blood creatine phosphokinase increased ”“cardiac failure ”and“cerebral infarction ”are of great significance for guiding rational drug use in clinic.

Extracorporeal Membrane Oxygenation-Related Nosocomial Infection after Cardiac Surgery in Adult Patients

Abstract Introduction: The evaluation of extracorporeal membrane oxygenation-related nosocomial infection (ECMO-related NI) in a homogeneous cohort remains scarce. This study analyzed ECMO-related NI in adult patients who have undergone cardiac surgery. Methods: From January 2012 to December 2017, 322 adult patients who have received ECMO support after cardiac surgery were divided into the infection group (n=131) and the non-infection group (n=191). ECMO-related NI was evaluated according to demographic data, surgical procedures, and ECMO parameters. Results: The incidence of ECMO-related NI was 85.4 cases per 1000 ECMO days. Acinetobacter baumannii was the most common pathogen causing blood stream infection and respiratory tract infection. Prolonged duration of surgery (P=0.042) and cardiopulmonary bypass assist (P=0.044) increased the risk of ECMO-related NI. Body mass index (odds ratio [OR]: 1.077; 95% confidence interval [CI]: 1.004-1.156; P=0.039) and duration of ECMO support (OR: 1.006; 95% CI: 1.003-1.009; P=0.0001) were the independent risk factors for ECMO-related NI. Duration of ECMO support > 144 hours (OR: 2.460; 95% CI: 1.155-7.238; P<0.0001) and ECMO-related NI (OR: 3.726; 95% CI: 1.274-10.895; P=0.016) increased significantly the risk of in-hospital death. Conclusion: Prolonged duration of ECMO support was an independent risk factor for NI. Surgical correcting latent causes of cardiopulmonary failure and shortening duration of ECMO whenever possible would reduce susceptibility to NI.

Correlación de displasia de cadera con factores de riesgo Hospital Municipal Achacachi / Correlation of hip dysplasia with risk factors Hospital Municipal Achacachi

INTRODUCCIÓN: la displasia de cadera es una de las causas más importantes y prevenibles de discapacidad durante la primera infancia. Es una enfermedad que se presenta en niños menores de 1 año, pero puede tener consecuencias importantes en la edad adulta, incluso puede desencadenar una osteoartrosis de cadera y/o invalidez en adultos jóvenes. OBJETIVO: determinar la correlación entre displasia de cadera con sus factores de riesgo en lactantes de 2 a 12 meses, evaluados en consultorio externo de Traumatología del Hospital Municipal Achacachi en el periodo de mayo ­ 2017 hasta abril ­ 2018. MATERIAL Y MÉTODOS: el tipo de investigación es descriptivo, diseño de tipo caso ­ control. Se estudiaron 128 pacientes lactantes de ambos sexos, que asistieron a su control en el consultorio de traumatología. La correlación entre factores de riesgo y displasia de cadera se determinó mediante la fórmula de Odds Ratio. RESULTADOS: el género femenino es el factor de riesgo con mayor asociación con la displasia de cadera, con un Odds Ratio de 139.04 veces más de padecer de displasia de cadera, seguida de la presentación podálica o transversa (12.58), las gestantes primíparas (4.52), los productos gemelares (3.71), los antecedentes familiares (2.54) y el Oligohidramnios (2.06). CONCLUSIÓN: existe relación importante entre los factores de riesgo (clínicos, obstétricos y fetales), con el desarrollo de displasia de cadera.(AU)

INTRODUCTION: hip dysplasia is one of the most important and preventable causes of disability during early childhood. It is a disease that occurs in children younger than 1 year, but it can have important consequences in adulthood, it can even trigger hip osteoarthritis and / or disability in young adults. OBJECTIVE: to determine the correlation between Hip Dysplasia with its risk factors in infants from 2 to 12 months, evaluated in an external Traumatology office of the Hospital Municipal Achacachi in the period from May - 2017 to April - 2018. MATERIAL AND METHODS: the type of research is descriptive, case control type design. 128 lactating patients of both sexes were studied, who attended their control in the traumatology office. The correlation between risk factors and hip dysplasia was determined using the Odds Ratio formula. RESULTS: female gender is the risk factor with the highest association with hip dysplasia, with an Odds Ratio of 139.04 times more than having Hip dysplasia, followed by breech or transverse presentation (12.58), primiparous pregnant women (4.52), twin products (3.71), Family History (2.54) and Oligohydramnios (2.06). CONCLUSIONS: there is an important relationship between risk factors (clinical, obstetric and fetal), with the development of Hip Dysplasia.(AU)

Factores psicosociales y desempeño docente en un instituto superior tecnológico en Quito, Ecuador / Psychosocial factors and teaching performance at a higher technological institute in Quito, Ecuador

RESUMEN Introducción: los riesgos psicosociales afectan física y mentalmente a los trabajadores. Las condiciones laborales de docentes universitarios implican responsabilidades académicas y administrativas, exponiéndolos a altos niveles de riesgo psicosocial. Objetivo: el objetivo del estudio fue determinar la relación de los factores psicosociales en el desempeño docente, en un instituto superior tecnológico en Quito, Ecuador. Materiales y métodos: se realizó un estudio cuantitativo, observacional, transversal, prospectivo y analítico en una población de 89 docentes. Se aplicó, por su alta confiabilidad, la encuesta de Factores de Riesgo Psicosociales de Silva, para evaluar los factores de riesgo en el trabajo académico. El desempeño docente se midió según la escala de calificación del Ministerio del Trabajo de Ecuador. Se calcularon inferencias y asociaciones a través de la prueba de Chi cuadrado y el odds ratio. Resultados: hubo un 47,2 % del género femenino y un 52,8 % del masculino. Predominó el grupo etario de 31 a 40 años. Entre los factores de riesgo psicosocial predominó el parámetro de exigencias laborales. El 75,3 % presentó riesgo psicosocial medio, no reflejado con el desempeño docente. Conclusiones: se constató la presencia de factores de riesgo psicosociales en los docentes, relacionados con la carga de trabajo, contenido y características de las tareas, entre otros aspectos. Se comprobó que el desempeño docente no se afectó por la presencia de factores de riesgo psicosociales (AU).

ABSTRACT Introduction: psychosocial risks physically and mentally affect workers. The working conditions of university teachers involve academic and administrative responsibilities, exposing them to high levels of psychosocial risk. Objective: the objective of the study was to determine the relationship of psychosocial factors in teaching performance at a higher technological institute in Quito, Ecuador. Materials and methods: a quantitative, observational, transversal, prospective and analytical study was conducted in a population of 89 teachers. Because of its high reliability, the Silva Psychosocial Risk Factors survey was applied to assess risk factors in academic work. The teaching performance was measured according to the rating scale of the Ministry of Labor of Ecuador. Inferences and associations were calculated through the Chi squared test and the odds ratio. Results: 47.2 % of the teachers were women and 52.8 % were men. The 31-40 years old age-group predominated. Among the psychosocial risk factors, the parameters of work requirements predominated. 75.3 % showed average psychosocial risk, not reflected with teaching performance. Conclusions: It was stated the existence of psychosocial risk factors in teachers, related to the workload, content and characteristics of the task, among other aspects. We found that teaching performance was not affected by the presence of psychosocial risk factors (AU).

Left Ventricular Remodeling Shortly after Open Mitral Valve Replacement for Rheumatic Mitral Stenosis

Abstract Introduction: Left ventricular dysfunction after surgical treatment of mitral stenosis is uncommon. We intend to determine the pattern of left ventricular remodeling, shortly after open mitral valve replacement for rheumatic mitral stenosis, with in-hospital postoperative outcomes and the determinants of postoperative worsening of left ventricular ejection fraction. Methods: From January 2008 to January 2015, 107 adult patients with rheumatic mitral stenosis were submitted to open mitral valve replacement. Their mean age was 45±11 years and 93 (86.9%) were women. Left ventricular morphology and function were studied longitudinally with echocardiography. The end point was postoperative worsening of left ventricular ejection fraction, defined by a decrease of 10% compared to preoperative basal assessment. Determinants of worsening left ventricular ejection fraction were determined by multivariable logistic regression analysis. Results: The end point occurred in 18 patients (16.8%). We tested clinical and echocardiographic parameters to verify independent variables related to the decrease in postoperative ejection fraction. Lower body weight (P=0.005; odds ratio [OR]=0.89) and smaller preoperative mitral valve area (P=0.02; OR=0.02) were independent predictors of left ventricular dysfunction. These patients presented higher mortality and morbidity rates. Conclusion: Left ventricular remodeling patterns differed among patients with predominant rheumatic mitral stenosis undergoing open mitral valve replacement. Lower preoperative body weight and mitral valve area were independent determinants of deteriorating ejection fraction with increased end-systolic volumes, indicating that this specific problem may occur in anthropometric smaller patients with more extensive rheumatic disease.

How to use χ2 test correctly—— χ2 test for the data of four-fold tables collected from the case-control design / 四川精神卫生

The purpose of this paper was to introduce the χ2 test for the data of four-fold tables collected from the case-control design， the hypothesis test and interval estimation of odds ratio， and the implementation of SAS and R software. In view of the characteristics of case-control design， the concept of odds ratio， hypothesis testing and interval estimation were emphasized. It was given that the interpretation of the results calculated by SAS and R software， as well as the statistical conclusion and professional.

How to use χ2 test correctly——the analysis of common odds ratio for the data of a multiway table and the implementation of SAS software / 四川精神卫生

The purpose of this article was to introduce the odds ratio analysis method of g×2×2 table data and the calculation method based on SAS software. The contents included the following aspects： firstly， the homogeneity test of the odds ratio of the data in the g×2×2 table was performed； secondly， when the data met the homogeneity requirements， point estimation and confidence interval estimation for the common odds ratio based on the correction method were implemented； thirdly， when the data did not meet the homogeneity requirements， based on the approach of "the conditional distribution of the frequency in the （1，1） grid in each layer 2×2 table" ， these things， such as the point estimation and confident interval estimation as well as hypothesis testing about the common odds ratio， were accurately estimated and performed. All calculations were realized based on the FREQ procedure in SAS/STAT by means of two real examples. Furthermore， the output results of SAS software were explained， and the statistical and professional conclusions were made.

Conhecimentos, atitudes e práticas sobre aleitamento materno entre puérperas em alojamento conjunto / Conocimientos, actitudes y prácticas sobre la lactancia materna entre personas en alojamiento conjunto / Knowledge, attitudes and practices about breastfeeding among postpartum women in rooming-in

Objetivos: Avaliar o conhecimento, atitude e prática sobre aleitamento materno entre puérperas, em alojamento conjunto de uma maternidade com selo de Hospital Amigo da Criança e descrever os motivos do desmame precoce em gestações anteriores. Método: Inquérito com 157 puérperas em alojamento conjunto com análise descritiva e inferencial. Resultados: Faixa etária e paridade associaram-se ao conhecimento e à atitude. Mulheres acima de 26 anos (OR=0,672 [IC=0,564-0,801]) e multíparas (OR =0,750 [IC =0,661-0,851]) têm mais chance de possuírem saberes adequados. A idade mais elevada (OR =0,356 [IC =0,172-0,735]), planejamento da gravidez (OR =0,275 [IC =0,093-0,815]) e multiparidade (OR =0,475 [IC =0,229-0,985]) foram fatores de proteção à atitude. A consulta pré-natal associou-se à prática (p=0,023) e enquanto fator de proteção (OR=0,313 [IC=0,112-0,873]) ao aleitamento. Conclusão: A Enfermagem pode auxiliar positivamente no conhecimento, na atitude e na prática sobre aleitamento, auxiliando no cuidado preventivo do trauma mamilar como causa importante do desmame precoce(AU)

Purposes: To evaluate the knowledge, attitude, and practices related to breastfeeding among postpartum women in a maternity ward which holds the Child-Friendly Hospital seal (Selo Hospital Amigo da Criança) and to describe the reasons for early weaning in previous pregnancies. Method: A survey with 157 postpartum women at a joint maternity ward with descriptive and inferential analysis. Results: Age and parity were associated with knowledge and attitude. Women over 26 (OR=0.672 [CI=0.564- 0.801]) and multiparous women (OR = 0.750 [CI =0.661-0.851]) are more likely to have adequate knowledge. Higher ages (OR =0.356 [CI =0.172-0.735]), pregnancy planning (OR =0.275 [CI =0.093-0.815]) and multiparity (OR =0.475 [CI =0.229-0.985]) were associated to protection and attitude. Prenatal consultation was associated with practice (p=0.023), while protective factor (OR=0.313 [CI=0.112-0.873]) was associated to breastfeeding. Conclusion: Nursing can be a positive assistance when it comes to knowledge, attitude, and practice about breastfeeding, helping in the preventive care of nipple trauma becoming an important cause of early weaning(AU)

Objetivos: Evaluar el conocimiento, la actitud y la práctica de la lactancia materna entre las puérperas en una sala de maternidad con un sello del Hospital Amigo del Niño y describir las razones del destete temprano en embarazos anteriores. Método: Se trata de una encuesta con 157 mujeres puérperas en alojamiento conjunto con análisis descriptivo e inferencial. Resultados: El grupo de edad y la paridad se asociaron con el conocimiento y la actitud. Las mujeres mayores de 26 años (OR=0,672 [CI=0,564-0,801]) y las mujeres multiparosas (OR = 0,750 [CI =0,661- 0,851]) son más propensas a tener un conocimiento adecuado. La edad más alta (OR =0.356 [CI =0.172-0.735]), la planificación del embarazo (OR =0.275 [CI =0.093-0.815]) y la multiparidad (OR =0.475 [CI =0.229-0.985]) fueron factores protectores a la actitud. La consulta prenatal se asoció con la práctica (p=0,023) y como factor protector (OR=0,313 [CI=0,112-0,873]) con la lactancia materna. Conclusión: La enfermería puede ayudar positivamente en el conocimiento, la actitud y la práctica sobre la lactancia materna, ayudando en la atención preventiva del trauma mamilar, como una causa importante del destete temprano(AU)

ADE Risk Signal Mining Related to Belimumab Based on the FARES Database / 中国药房

OBJECTIVE：To prov ide referen ce for clinical safe and rational use of belimumab by mining the risk signals of adverse drug event （ADE）. METHODS ：ADE reports related to belimumab were collected from FDA adverse event reporting system（FAERS）from the first quarter of 2015 to the first quarter of 2021. The reporting odds ratio （ROR）method and the Medicines and Healthcare Products Regulatory Agency （MHRA）method were adopted to mine the ADE risk signals related to belimumab，setting the threshold as the number of reports ＞3 and the lower limit of 95％ CI ＞1（ROR method ）and the proportional reporting ratio （PRR）＞2，and χ2 ＞4（MHRA method ）. ADEs were counted and classified by using the preferred system organ class （SOC）and preferred term （PT）of Medical Dictionary for Regulatory Activities （MedDRA）. RESULTS & CONCLUSIONS：A total of 3 529 ADE reports with belimumab as the primary suspicious drug were screened ，in which female patients（90.31％）were much more than male patients （6.15％）；age distribution was concentrated in 18-59 years old （41.80％）. There were 1 234 cases（34.97％）of severe ADE reports ，mainly involving hospital or prolonged hospital stay. Most of the reporters were consumers or other non-medical professionals （81.84％）. North America reported the most （70.39％）and the main reporting country was the United States （2 029 reports）. A total of 180 PTs were mined from 3 529 reports，in addition to PTs associated with primary disease （systemic lupus erythematosus ，pain，arthralgia，pyrexia，weight decreased ，swelling，oropharyngeal pain ， etc.），PTs related to medication error （product dose omission ，inappropriate schedule of product administration ，underdose， product availability issue ，etc.）and PTs related to infection （influenza，urinary tract infection ，infection，sinusitis，etc.）were reported in a large number of cases. Twenty-six SOCs were involved ，the top 10 SOC in ADE reports were all kinds of injuries ， poisoning and surgical complications （2 225 reports），infections and infectious diseases （1 247 reports），general disorders and administration site conditions （1 196 reports），musculoskeletal and connective tissue disorders （1 195 reports），surgical and medical procedures（515 reports），etc. PTs in SOC in the first place （all kinds of injuries ，poisoning and surgical complications ）of ADE reports were all related to medication error ；herpes zoster ，kidney infection and cellulitis in SOC in the second place （infections and infectious diseases ）of ADE reports were not included in the drug instruction of belimumab ；most PTs in SOCs such as various nervous system diseases ，immune system diseases ，mental diseases ，benign，malignant and unknown tumors （including cystic and polypoid）which were taken attention in clinic were not included in the drug instruction of belimumab. It is suggested to avoid medication errors as far as possible in clinical use of belimumab ，and to guard against adverse reactions such as herpes zoster ， kidney infection ，cellulitis and various nervous system diseases ，immune system diseases and mental diseases. In addition ，the patients with malignant tumor or related history should use belizumab carefully.

Concentraciones séricas de Beta-hidroxibutirato y su asociación con enfermedades posparto en bovinos de leche / Serum Beta-hydroxybutyrate concentrations and its association with postpartum diseases in dairy cows

RESUMEN Objetivo. Determinar la prevalencia de cetosis bovina según las concentraciones séricas (mmol/Lt) de beta-hidroxibutirato (βHB) y estimar su asociación con enfermedades del posparto temprano en vacas lecheras. Materiales y métodos. Se llevó a cabo un estudio epidemiológico de corte transversal con información individual de los niveles sanguíneos de βHB y presentación clínica de enfermedades puerperales de n=1149 animales; además se evaluó la eficiencia de la prueba como predictora de enfermedad posparto. Posteriormente, se realizó X 2 y un modelo de regresión logística final para explorar los factores asociados con hipercetonemia. La relación entre βHB sanguíneo, la presentación de cetosis y la ocurrencia de enfermedades puerperales se calculó analizando Característica Operativa del Receptor (Receiver Operating Characteristic -ROC). Resultados. Según los niveles de -3HB, la prevalencia de cetosis fue de 7.9%, cetosis clínica 0.6% y cetosis subclínica 7.3%. La prueba fue predictora de enfermedad puerperal (LR+ del 13.6). La condición corporal ≥3.5, número de partos igual a 2 y ≥3, la presentación de retención de placenta, fiebre de leche y la enfermedad posparto, son factores de riesgo de cetosis. El análisis de la curva ROC mostró que la medición de βHB (≥1.2 mmol/Lt) en sangre sirve para diagnosticar cetosis (p<0.0001). Conclusiones. La medición de niveles sanguíneos de βB permitió determinar que la presentación de cetosis es baja, es una alerta no solamente para esta enfermedad sino para las enfermedades del posparto temprano. Los resultados de este estudio confirman lo reportado en estudios previos sobre los factores de riesgo de cetosis.

ABSTRACT Objective. Determine the prevalence of bovine ketosis based on serum concentrations (mmol/Lt) of beta-hydroxybutyrate (βHB) and estimate its association with early postpartum diseases in dairy cows. Materials and methods. An epidemiological cross-sectional study was carried out with individual information on blood levels of βHB and clinical presentation of puerperal diseases in 1149 animals; In addition, the efficiency of the test was evaluated as a predictor of postpartum disease. Subsequently, univariate analysis and a final logistic regression model were performed to explore the factors associated with hyperketonemia. The association between blood βHB, the presentation of ketosis and the occurrence of puerperal diseases was calculated by analyzing the Receiver Operating Characteristic -ROC. Results. According to βHB levels, the prevalence of ketosis was 7.9%, clinical ketosis 0.6% and subclinical ketosis 7.3%. The test was a predictor of puerperal disease (LR+ of 13.6). Body condition score ≥3.5, number of births 2 and ≥3, presentation of retained fetal membranes, milk fever and postpartum disease, are risk factors for ketosis. The analysis of the ROC curve showed that the measurement of βHB (≥1.2 mmol/Lt) in blood serves to diagnose ketosis (p<0.0001). Conclusions. The measurement of βHB blood levels allowed to determine that ketosis presentation is low, it is an alert not only for this disease but for early postpartum diseases. The results of this study confirm risk factors observed in previous studies.

Fatores associados ao baixo índice de Apgar no quinto minuto de vida em recém-nascidos / Factors associated with low fifth minute apgar score in newborns

Objetivo: Identificar os fatores associados ao baixo índice de Apgar no quinto minuto de vida em recém-nascidos em uma maternidade pública do sul do país. Método: Trata-se de um estudo retrospectivo caso-controle, realizado em uma maternidade pública, com 210 recém-nascidos e suas respectivas mães. Para testar a homogeneidade entre os grupos, foram utilizados o teste qui-quadrado ou prova exata de Fisher, calculando-se o Odds Ratio, com seus respectivos intervalos de confiança em 95%. As variáveis com valor de p ≤ 0,25 foram inseridas em um modelo multivariado de regressão logística. O nível de significância esperado estabelecido foi p < 0,05. Resultados: Em um total de 70 casos e 140 controles a análise multivariada mostrou que realizar menos de seis consultas de pré-natal [OR 2,89 (IC 95% 1,33 - 6,27); p=0,007], presença de cesárea anterior [(OR 4,09 (IC 95% 1,41 - 11,89); p=0,010], presença de doença hipertensiva específica da gestação [(OR 2,76 (IC 95% 1,03 - 7,41); p=0,043] e líquido amniótico meconial [OR 20,42 (IC 95% 6,33 - 65,93); p<0,001] foram fatores independentes para um baixo índice de Apgar no quinto minuto de vida em recém-nascidos. Conclusão: Nesse estudo, realizar menos de seis consultas de pré-natal, possuir cesárea anterior, presença de doença hipertensiva específica da gestação e de líquido amniótico meconial foram fatores associados ao baixo índice de Apgar no quinto minuto de vida em recém-nascidos.

Objective: To identify the factors associated with low fifth minute Apgar score in newborns in a public maternity hospital in the south of the country. Methods: This is a retrospective case-control study, carried out in a public maternity hospital, with 210 newborns and their respective mothers. To test the homogeneity between the groups, we used the chi-square or Fisher's exact test, calculating the Odds Ratio, with their respective confidence intervals of 95%. Variables with p value ≤ 0.25 were inserted into a multivariate logistic regression model. The expected level of significance was set at p <0.05. Results: In a total of 70 cases and 140 controls, the multivariate analysis showed that having less than six prenatal visits [OR 2.89 (95% CI 1.33 - 6.27); p = 0.007], presence of previous cesarean section [OR = 4.09 (95% CI 1.41-11.89); p=0,010], presence of hypertensive disorder of pregnancy [OR = 2.76 (IC 95% 1,03 - 7,41); p=0,043] and meconium amniotic fluid [OR 20.42 (95% CI 6.33 - 65.93); p<0,001] were independent factors for a low fifth minute Apgar score in newborns. Conclusion: In this study, having less than six prenatal visits, previous cesarean section, presence of hypertensive disease of pregnancy and meconium amniotic fluid were associated with low fifth minute Apgar score in newborns.