Brazilian Dialysis Survey 2022 / Censo Brasileiro de Diálise 2022

Abstract Introduction: The Brazilian Dialysis Survey (BDS) is an annual national survey about patients on chronic dialysis that contributes to health policies. Objective: To report the 2022 epidemiological data from the BDS of the Brazilian Society of Nephrology (BSN). Methods: A survey was carried out in Brazilian chronic dialysis centers using an online questionnaire that included clinical and epidemiological aspects of patients on chronic dialysis, dialysis therapy data, and dialysis center characteristics. Results: Overall, 28% (n = 243) of the centers answered the questionnaire. In July 2022, the estimated total number of patients on dialysis was 153,831. The estimated prevalence and incidence rates of patients per million population (pmp) were 758 and 214, respectively. Of the prevalent patients, 95.3% were on hemodialysis (HD, 4.6% of these on hemodiafiltration) and 4.7% on peritoneal dialysis (PD). Only 1.3% of patients were not vaccinated against COVID-19. The prevalence of anemia (Hb < 10g/dL) was 27% and hyperphosphatemia (P > 5.5mg/dL) reached 30%. The estimated overall crude annual mortality rate was 17.1%. Conclusions: The absolute number and prevalence rate of patients on chronic dialysis continue to increase. A growing number of patients were receiving hemodiafiltration. The mortality rate decreased, probably due to the end of COVID-19 pandemic. The conclusions were drawn in the context of relatively low voluntary participation, which imposed methodological limitations on our estimates.

Resumo Introdução: O Censo Brasileiro de Diálise (CBD) é uma pesquisa nacional anual sobre pacientes em diálise crônica que contribui para as políticas de saúde. Objetivo: Informar os dados epidemiológicos de 2022 do CBD da Sociedade Brasileira de Nefrologia (SBN). Métodos: Foi realizada uma pesquisa em centros brasileiros de diálise por meio de um questionário online que incluiu aspectos clínicos e epidemiológicos de pacientes em diálise crônica, dados da terapia dialítica e características do centro de diálise. Resultados: No total, 28% (n = 243) dos centros de diálise ativos cadastrados na SBN responderam ao questionário. Em julho de 2022, o número total estimado de pacientes em diálise era de 153.831. As taxas estimadas de prevalência e incidência de pacientes por milhão (ppm) de habitantes foram 758 e 214, respectivamente. Dos pacientes prevalentes, 95,3% estavam em hemodiálise (HD; 4,6% desses em hemodiafiltração) e 4,7% em diálise peritoneal (DP). Apenas 1,3% dos pacientes não foram vacinados contra a COVID-19. A prevalência de anemia (Hb < 10g/dL) foi de 27% e de hiperfosfatemia (P > 5,5mg/dL) alcançou 30%. A taxa bruta total anual de mortalidade estimada foi de 17,1%. Conclusões: O número absoluto e a taxa de prevalência de pacientes em diálise crônica continuam a aumentar. Um número crescente de pacientes estava em hemodiafiltração. A taxa de mortalidade diminuiu, provavelmente devido ao fim da pandemia da COVID-19. As conclusões foram de um contexto de participação voluntária relativamente baixa, o que impõe limitações metodológicas às nossas estimativas.

Caracterización del cáncer vesical en adultos según variables clínicas y epidemiológicas / Characterization of bladder cancer in adults according to clinical and epidemiological variables

Introducción: El cáncer de la vejiga es uno de los más frecuentes del tracto urinario y se manifiesta de dos formas: como tumor superficial de bajo grado o como neoplasia invasora de alto grado. Objetivo: Caracterizar el cáncer vesical en adultos, según variables clínicas, epidemiológicas y de servicio. Métodos: Se realizó un estudio observacional descriptivo y retrospectivo, para caracterizar el cáncer vesical en adultos, según variables clínicas, epidemiológicas y de servicio de los pacientes atendidos en el servicio de Urología del Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro» en el periodo comprendido de octubre 2019 y 2022. Población del estudio: 242 pacientes diagnosticados con cáncer vesical. Resultados: La mayoría de los pacientes diagnosticados con cáncer vesical corresponden al año 2019 (45,86 %): masculinos (75,20 %); blancos (89,25 %); mayores de 70 o más años (64,46 %) y fumadores (95,45 %). La hematuria fue el síntoma principal (91,73 %), como expresión del carcinoma urotelial papilar de bajo grado (36,77 %). Tratamiento: la resección transuretral (88,01 %), sin metástasis a distancia (88,42 %). Conclusiones: La mayoría de los pacientes diagnosticados con cáncer vesical corresponden al año 2019, masculinos, blancos, mayores de 70 o más años, fumadores y con hematuria. Más frecuente: el carcinoma urotelial papilar de bajo grado. El tiempo trascurrido antes del diagnóstico de la enfermedad fue de 36-40 días, y un mes, el tiempo trascurrido antes del tratamiento de la enfermedad.

Introduction: bladder cancer is one of the most frequent cancers of the urinary tract and manifests itself in two ways: as a superficial low-grade tumor or as a high-grade invasive neoplasm. Objective: to characterize bladder cancer in adults according to clinical, epidemiological and service variables. Methods: a descriptive and retrospective observational study was carried out to characterize bladder cancer in adults according to clinical, epidemiological and service variables of patients treated in the Urology service at "Arnaldo Milián Castro" Clinical and Surgical University Hospital from October 2019 and 2022. The study population was 242 patients diagnosed with bladder cancer. Results: most of the patients diagnosed with bladder cancer correspond to the year 2019 (45.86%): male (75.20%); whites (89.25%); older than 70 or more years (64.46%) and smokers (95.45%). Hematuria was the main symptom (91.73%), as an expression of low-grade papillary urothelial carcinoma (36.77%). The treatment was transurethral resection (88.01%), without distant metastasis (88.42%). Conclusions: most of the patients diagnosed with bladder cancer correspond to the year 2019, male, whites, older than 70 years or older, smokers and with hematuria. Low-grade papillary urothelial carcinoma was the most frequent cancer. The time elapsed before the diagnosis of the disease was 36-40 days, and the time elapsed before the treatment of the disease was 1 month.

The value of mathematical modelling approaches in epidemiology for public health decisión making

It is discussed the relevance of quantitative approaches, specifically mathematical modelling in epidemiology, in the public health decision-making process. This topic is discussed here based on the experience of various experts in mathematical epidemiology and public health. First, the definition of mathematical modelling is presented, especially in the context of epidemiology. Second, the different uses and socio-political implications, including empirical examples of recent experiences that have taken place at the international level are addressed. Finally, some general considerations regarding the challenges encountered in the use and application of mathematical modelling in epidemiology in the decision-making process at the local and national levels.

Se trata sobre la importancia de los abordajes cuantitativos, específicamente la formulación de modelos matemáticos en epidemiología, dentro del proceso de toma de decisiones en salud pública. Esta importante temática se analiza basándose en la experiencia de algunos expertos en epidemiología matemática y salud pública. En primer lugar, se presenta la definición de modelación matemática, particularmente dentro del contexto de la epidemiología. En segundo lugar, se abordan los diferentes usos y las implicaciones socio-políticas, incluyendo ejemplos de experiencias recientes que han ocurrido a nivel internacional. Finalmente, se hace referencia a ciertas consideraciones generales respecto a los retos que representa el uso y la aplicación de modelos matemáticos en epidemiología para el proceso de toma de decisiones a nivel local y nacional.

Análise epidemiológica das fraturas de mão em um hospital terciário / Epidemiological analysis of hand fractures in a tertiary hospital

Introdução: O trauma de mão constitui uma epidemia, ocorrendo por diversos fatores, como acidentes de trabalho e violência urbana. Isso gera um impacto significativo por ser uma unidade anatômica vulnerável e importante na realização de atividades cotidianas e para o trabalho. Desse modo, faz-se necessária uma avaliação epidemiológica mais aprofundada no que tange, sobretudo, às fraturas de mãos, entendendo sua elevada morbidade. Método: Estudo descritivo e retrospectivo, feito por análise de prontuários de pacientes conduzidos em um hospital terciário no período de janeiro de 2018 a dezembro de 2020. Resultados: Participaram do estudo 290 pacientes, sendo 85,7% do sexo masculino e 14,3% do sexo feminino. 138 indivíduos tinham entre 20 e 39 anos, representando um total de 47,6%. 51,6% eram do interior do estado do Ceará e 48,4% eram da capital. O principal mecanismo de trauma associado às fraturas foram os acidentes de trânsito (36,4%), seguidos por acidentes de trabalho (26,9%) e ferimentos por arma de fogo (14%). Em relação aos ossos fraturados, houve uma acentuada prevalência do acometimento das falangeanas, em todas as faixas etárias, representando 210 pacientes (72,4%). Conclusão: O presente estudo corrobora com os dados presentes na literatura. Desse modo, é evidenciada a repetição de prevalência de faixa etária, principais mecanismos de trauma envolvidos, bem como ossos acometidos nas fraturas de mão.

Introduction: Hand trauma is an epidemic occurring due to several factors, such as work accidents and urban violence. This significantly impacts it as it is a vulnerable and important anatomical unit for daily activities and work. Therefore, a more in-depth epidemiological assessment is necessary regarding hand fractures and understanding their high morbidity. Method: A descriptive and retrospective study was conducted by analyzing the medical records of patients treated in a tertiary hospital from January 2018 to December 2020. Results: 290 patients participated in the study, 85.7% male and 14.3 % female. One hundred thirty-eight individuals were between 20 and 39 years old, representing 47.6%. 51.6% were from the interior of the state of Ceará, and 48.4% were from the capital. The main trauma mechanism associated with fractures was traffic accidents (36.4%), followed by work accidents (26.9%) and firearm injuries (14%). Concerning fractured bones, there was a marked prevalence of phalangeal involvement in all age groups, representing 210 patients (72.4%). Conclusion: The present study corroborates the data present in the literature. In this way, the repetition of the prevalence of age group, main trauma mechanisms involved, as well as bones affected by hand fractures is evidenced.

O trauma de face submetido a cirurgia: Uma análise epidemiológica de 10 anos no interior do Brasil / Facial trauma undergoing surgery: A 10-year epidemiological analysis in the interior of Brazil

Introdução: O trauma de face representa significativa incapacitação para a vítima, além de um desafio para as equipes de saúde devido a sua complexidade e envolvimento de estruturas nobres. Analisar a sua epidemiologia permite coordenar medidas em saúde pública para melhorar o atendimento e a prevenção. Método: Estudo observacional, descritivo, longitudinal, com abordagem retrospectiva a partir dos prontuários dos pacientes vítimas de trauma de face atendidos pela clínica cirúrgica no período entre 2010 e 2019. Resultados: Dentre os 529 prontuários incluídos no estudo e analisados, 71,08% tratava-se de cirurgias eletivas e o restante, 28,92%, de cirurgias de urgência. O trauma foi mais frequente em indivíduos de 20 a 29 anos, o que corresponde a 31,76% do total de casos. Também foi mais frequente em indivíduos do sexo masculino, correspondendo a 78,45% do total de casos. Acidentes automobilísticos foram a causa mais comum, descrita em 22,31% dos prontuários, e a principal fratura, presente em 85,83% dos casos, foi dos ossos próprios do nariz. Conclusão: As vítimas de traumatismo bucomaxilofacial atendidas no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro são predominantemente homens na terceira década de vida, envolvidos em acidentes automobilísticos, com lesões em ossos do nariz que foram abordadas de forma eletiva.

Introduction: Facial trauma represents significant incapacitation for the victim, as well as a challenge for healthcare teams due to its complexity and involvement of important structures. Analyzing its epidemiology allows us to coordinate public health measures to improve care and prevention. Method: Observational, descriptive, longitudinal study with a retrospective approach based on the medical records of patients who suffered facial trauma treated by the surgical clinic between 2010 and 2019. Results: Among in individuals aged 20 to 29 years, which corresponds to 31.76% of total cases. It was also more common in males, corresponding to 78.45% of total cases. Car accidents were the most common cause, described in 22.31% of medical records, and the main fracture, present in 85.83% of cases, was of the bones of the nose. Conclusion: Victims of oral and maxillofacial trauma treated at the Hospital de Clínicas da Universidade Federal do Triângulo Mineiro are predominantly men in their third decade of life, involved in automobile accidents, with injuries to the bones of the nose that were treated electively.

Epidemiología de la apendicitis aguda en Colombia: Un análisis de las bases de datos administrativas del Ministerio de Salud / Epidemiology of acute appendicitis in Colombia: An Analysis of the Ministry of Health administrative databases

Introducción. La apendicitis aguda es una afección común, con un pico de incidencia entre los 10 y 20 años. La cirugía es el tratamiento preferido y la apendicectomía por laparotomía sigue siendo el estándar, aunque el abordaje laparoscópico ha mostrado menos complicaciones. El objetivo de este artículo fue caracterizar tanto la enfermedad como el tratamiento quirúrgico en Colombia, usando datos de bases oficiales. Métodos. Se accedió a la base de datos del Sistema Integrado de Información para la Protección Social (SISPRO) del Ministerio de Salud de Colombia en febrero de 2023. Se recogieron datos de los pacientes con diagnóstico de apendicitis y con procedimiento de apendicectomía entre 2017 y 2021, y se analizaron por edad, sexo y ubicación geográfica. Resultados. Entre 2017 y 2021 se diagnosticaron 345.618 casos de apendicitis (51,8 % mujeres), con pico de incidencia a los 15-20 años. Se realizaron 248.133 apendicectomías, el 16,7 % por laparoscopia. Los hospitales con más procedimientos reportados estaban en Bogotá, Yopal, Popayán y Florencia. La mortalidad fue de 0,56 % en hombres y 0,51 % en mujeres. Conclusión. La apendicitis es común, con pico a los 10-19 años. Las mujeres tienen mayor probabilidad de apendicectomía, debido a otras afecciones ginecológicas. El acceso a la apendicectomía disminuye la mortalidad; en estos pacientes, el 16 % fue laparoscópica, lo que sugiere que se necesita más entrenamiento y acceso a esta técnica. Este estudio aporta a la comprensión de la epidemiología de la apendicitis y apendicectomías en Colombia.

Introduction. Acute appendicitis is a common condition, with a peak incidence between 10 and 20 years of age. Surgery is the preferred treatment and laparotomy appendectomy remains the standard, although the laparoscopic approach has shown fewer complications. The objective of this article was to characterize both the disease and the surgical treatment in Colombia, using data from official databases. Methods. The Integrated Information System for Social Protection (SISPRO) database of the Ministry of Health was accessed in February 2023. Data with diagnosis of apendicitis and with appendectomy between 2017 and 2021 were collected. Analysis was done by age, gender, and geographic location. Results. Between 2017 and 2021, 345,618 cases of appendicitis were diagnosed (51.8% females), with peak incidence at 15-20 years of age. A total of 248,133 appendectomies were performed, 16.7% by laparoscopy. The hospitals with most reported procedures were located in Bogotá, Yopal, Popayán, and Florencia. Mortality was 0.56% in men and 0.51% in women. Conclusion. Appendicitis is common, peaking at ages 10-19. Women are more likely undergo appendectomy due to other gynecological conditions. Access to appendectomy improves mortality. In these patients, 16% were laparoscopic, suggesting that more training and access to this technique is needed. This study contributes to the understanding of the epidemiology of appendicitis and appendectomies in Colombia.

Validación de cuestionarios para la medición de variables en salud: conceptos fundamentales / Validation of questionnaires for the measurement of health variables: Fundamental concepts

Dentro de la práctica clínica, así como en la salud poblacional, es habitual utilizar cuestionarios que permiten evaluar condiciones o variables que no son directamente observables. No obstante, la construcción y validación de estos instrumentos o cuestionarios suele ser poco conocida. El objetivo de esta revisión narrativa es sintetizar de manera general el proceso de construcción y validación de estos cuestionarios, para así tener una mejor comprensión de este proceso, de los aspectos que se evalúan y de la mejor forma de utilizarlos. La validación de cuestionarios corresponde a un proceso de análisis de este, cuya finalidad es medir una variable latente o constructo, así como sus dimensiones, las que no pueden ser observadas directamente. Una variable latente puede ser inferida a través de un conjunto de atributos específicos que forman parte de ella, como los ítems de un cuestionario y que sí son observables. En este artículo se abordan de manera teórica los conceptos fundamentales de validación de cuestionarios o test, variables latentes o constructos, estudio de la confiabilidad y de la validez, así como los factores que afectan a estas dos últimas características, a través de una revisión narrativa. En el texto, se presentan ejemplos sobre estos conceptos.

In clinical practice and population health, it is common to use questionnaires to assess conditions or variables that are not directly observable. However, the construction and validation of these instruments or questionnaires are often poorly understood. This narrative review aims to summarize in a general way the process of construction and validation of these questionnaires in order to have a better understanding of this process, the aspects that are evaluated, and the best way to use them. The validation of questionnaires corresponds to a process of analysis of the questionnaire, aiming to measure a latent variable and its dimensions, which cannot be observed directly. A latent variable can be inferred through a set of specific attributes that are part of it, such as the items of a questionnaire, which are observable. Through a narrative review, this article addresses the fundamental concepts of questionnaire or test validation, latent variables or constructs, reliability and validity studies, and the factors that theoretically affect the latter two characteristics. Examples of these concepts are presented in the text.

Diabetes, hemoglobin A1c, and cognitive performance in older adults: is there any impact of frailty? Evidence from the ELSI-Brazil study

Abstract The aim of this study was to evaluate the association between diabetes and cognitive performance in a nationally representative study in Brazil. We also aimed to investigate the interaction between frailty and diabetes on cognitive performance. A cross-sectional analysis of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) baseline data that included adults aged 50 years and older was conducted. Linear regression models were used to study the association between diabetes and cognitive performance. A total of 8,149 participants were included, and a subgroup analysis was performed in 1,768 with hemoglobin A1c data. Diabetes and hemoglobin A1c levels were not associated with cognitive performance. Interaction of hemoglobin A1c levels with frailty status was found on global cognitive z-score (P-value for interaction=0.038). These results suggested an association between higher hemoglobin A1c levels and lower cognitive performance only in non-frail participants. Additionally, undiagnosed diabetes with higher hemoglobin A1c levels was associated with both poor global cognitive (β=-0.36; 95%CI: -0.62; -0.10, P=0.008) and semantic verbal fluency performance (β=-0.47; 95%CI: -0.73; -0.21, P=0.001). In conclusion, higher hemoglobin A1c levels were associated with lower cognitive performance among non-frail participants. Higher hemoglobin A1c levels without a previous diagnosis of diabetes were also related to poor cognitive performance. Future longitudinal analyses of the ELSI-Brazil study will provide further information on the role of frailty in the association of diabetes and glycemic control with cognitive decline.

Características clínicas e epidemiológicas das internações pediátricas por COVID-19 na Amazônia brasileira: um estudo observacional / Clinical and epidemiological characteristics of pediatric hospitalizations due to COVID-19 in the Brazilian Amazon: an observational study

OBJETIVO: Apontar os aspectos clínicos e epidemiológicos de crianças internadas por COVID-19 em um hospital público situado em um estado da Amazônia Brasileira. MÉTODO: Estudo observacional, descritivo, retrospectivo e documental com uma abordagem quantitativa dos casos de internação pediátrica por COVID-19. RESULTADOS: No Hospital da Criança e Adolescente, foram registrados um total de 5016 casos suspeitos de COVID-19 em crianças. Destes, 666 foram confirmados com a doença e resultaram em 140 internações. Analisamos 136 notificações de crianças internadas por COVID-19. A maioria dos pacientes era lactente (39%) e pré-escolar (36%), com prevalência do sexo masculino (67,6%) e raça/cor preta/parda (86%). Além disso, 83,1% delas residem em área urbana. Quanto ao desfecho, 96,67% evoluíram para a cura e 3,33% resultaram em óbito. CONCLUSÃO: No contexto amazônico, a análise das características clínicas e epidemiológicas deste grupo etário é essencial para orientar os cuidados clínicos, prever a gravidade da doença e determinar o prognóstico.

OBJECTIVE: To determine the clinical and epidemiologic aspects of children hospitalized for COVID-19 in a public hospital located in a state in the Brazilian Amazon. METHODS: Observational, descriptive, retrospective, and documentary study with a quantitative approach to pediatric hospitalization cases due to COVID-19. RESULTS: In the Hospital for Children and Adolescents, a total of 5016 suspected cases of COVID-19 in children were recorded. Of these, 666 were confirmed with the disease, resulting in 140 hospitalizations. We analyzed 136 reports of children hospitalized for COVID-19. Most patients were infants (39%) and preschool children (36%), with a prevalence of males (67.6%) and black/brown race/color (86%). In addition, 83.1% live in urban areas. Regarding the outcome, 96.67% were cured, and 3.33% resulted in death. CONCLUSION: In the Amazonian context, the analysis of this age group's clinical and epidemiologic characteristics is essential to guide clinical care, predict the severity of the disease, and determine the prognosis.

Perfil de óbitos por dengue (2015-2023) em cidade paulista: desafios para a saúde pública / Dengue death profile (2015-2023) in a são paulo municipality: challenges for public health / Perfil de muertes por dengue (2015-2023) en una ciudad del interior del estado de são paulo: desafíos para la salud pública

O número de casos de dengue no continente americano, no primeiro semestre de 2023, superou o total de casos de 2022 e o Brasil lidera com 2,3 milhões de ocorrências da doença e 769 mortes. A dengue se expande no mundo e já é considerada endêmica em mais de 100 países. Este estudo objetiva caracterizar o perfil dos óbitos por dengue, no período de 2015 a 2023, em uma cidade do interior do estado de São Paulo. Este é um estudo transversal, retrospectivo e descritivo, com análise de dados secundários do Sistema Nacional de Notificação (Sinan), Sistema de Mortalidade (SIM) e banco de dados dos óbitos por dengue, do comitê de mortalidade da vigilância epidemiológica municipal. A capacidade das equipes de saúde em identificar os sinais e sintomas ocorreu em apenas 42,9% dos casos antes da internação e do óbito, seguida por no dia do óbito (11,7%) e após o óbito (8,8%). A mortalidade por dengue predominou em indivíduos do sexo masculino (51,4%), com idade mediana de 74 anos. A análise dos dados demonstrou que o manejo clínico da dengue ainda é desafiador para a equipe de saúde, que precisa se manter permanentemente capacitada para o reconhecimento dos sintomas, sinais de alarme e gravidade, para a correta condução de cada caso, visando a redução da mortalidade.

In the first half of 2023, the number of dengue cases in the Americas surpassed the total for 2022, with Brazil leading the list with 2.3 million disease occurrences and 769 deaths. Dengue is expanding globally and is already considered endemic in more than 100 countries. This study characterizes the profile of dengue deaths from 2015 to 2023 in a municipality of São Paulo. A cross-sectional, retrospective, and descriptive study was conducted with secondary data obtained from the National Notification System (SINAN), Mortality System (SIM), and dengue death database of the municipal epidemiological surveillance mortality committee. Only in 42.9% of cases were the health teams able to identify the signs and symptoms before hospitalization and death, followed by after death (8.8%) and on the day of death (11.7%). Dengue mortality predominated among male individuals (51.4%) with a median age of 74 years. Data analysis showed that the clinical management of dengue remains challenging for health teams, who needs continuous training to recognize the signs and symptoms, warning signs, and severity for correct management of each case, aiming to reduce mortality.

Los casos de dengue en las Américas superaron en el primer semestre de 2023 al total de casos de 2022, en el cual lidera Brasil con 2,3 millones de notificaciones de la enfermedad y 769 muertes. El dengue se expande por el mundo, y más de 100 países ya lo consideran una endemia. Este estudio tiene como objetivo caracterizar el perfil de las muertes por dengue en el período de 2015 a 2023, en una ciudad del interior del estado de São Paulo. Se trata de un estudio transversal, retrospectivo y descriptivo con análisis de datos secundarios del Sistema Nacional de Notificación (SINAN), del Sistema de Mortalidad (SIM) y de la Base de Datos de Muertes por Dengue del Comité de Mortalidad de la Vigilancia Epidemiológica Municipal. Los equipos de salud fueron capaces de identificar los signos y síntomas en solo el 42,9% de los casos antes de la hospitalización y de la muerte, seguida del día de la muerte (11,7%) y tras la muerte (8,8%). La mortalidad por dengue predominó en individuos del sexo masculino (51,4%) con una edad media de 74 años. El análisis de datos demostró que el manejo clínico del dengue sigue siendo un desafío para el equipo de salud, quien necesita mantenerse capacitado continuamente para detectar los signos y síntomas, señales de alarma y gravedad, para la correcta conducción de cada caso, con el objetivo de reducir la mortalidad.

Not only baseline but cumulative exposure of remnant cholesterol predicts the development of nonalcoholic fatty liver disease: a cohort study

BACKGROUND AND AIM@#Remnant cholesterol (remnant-C) mediates the progression of major adverse cardiovascular events. It is unclear whether remnant-C, and particularly cumulative exposure to remnant-C, is associated with nonalcoholic fatty liver disease (NAFLD). This study aimed to explore whether remnant-C, not only baseline but cumulative exposure, can be used to independently evaluate the risk of NAFLD.@*METHODS@#This study included 1 cohort totaling 21,958 subjects without NAFLD at baseline who underwent at least 2 repeated health checkups and 1 sub-cohort totaling 2,649 subjects restricted to those individuals with at least 4 examinations and no history of NAFLD until Exam 3. Cumulative remnant-C was calculated as a timeweighted model for each examination multiplied by the time between the 2 examinations divided the whole duration. Cox regression models were performed to estimate the association between baseline and cumulative exposure to remnant-C and incident NAFLD.@*RESULTS@#After multivariable adjustment, compared with the quintile 1 of baseline remnant-C, individuals with higher quintiles demonstrated significantly higher risks for NAFLD (hazard ratio [HR] 1.48, 95%CI 1.31-1.67 for quintile 2; HR 2.07, 95%CI 1.85-2.33 for quintile 3; HR 2.55, 95%CI 2.27-2.88 for quintile 4). Similarly, high cumulative remnant-C quintiles were significantly associated with higher risks for NAFLD (HR 3.43, 95%CI 1.95-6.05 for quintile 2; HR 4.25, 95%CI 2.44-7.40 for quintile 3; HR 6.29, 95%CI 3.59-10.99 for quintile 4), compared with the quintile 1.@*CONCLUSION@#Elevated levels of baseline and cumulative remnant-C were independently associated with incident NAFLD. Monitoring immediate levels and longitudinal trends of remnant-C may need to be emphasized in adults as part of NAFLD prevention strategy.

Anemia-related subjective symptoms in the general adult population in Japan / Journal of Rural Medicine

Objectives: Approximately 17% of Japanese women have hemoglobin concentrations less than 12 g/dL. Therefore, anemia prevention and early intervention are crucial public health issues in Japan. This study aimed to identify the symptoms and characteristics of anemic individuals in the general adult population by comparing survey responses of individuals with anemia and without anemia visiting blood donation centers.Materials and Methods: This cross-sectional study used self-administered questionnaires. Individuals who visited two Japanese Red Cross Society blood donation centers in Fukushima Prefecture, Japan were included. Hemoglobin levels were measured at blood donation, and the levels of 13 g/dL for men and 12 g/dL for women were defined as anemia.Results: Of the 857 individuals analyzed, 530 were men and 327 were women, of whom 19 (3.6%) and 12 (3.7%) had low hemoglobin levels, respectively. Logistic regression analysis was performed in men, and the results showed that “lightheadedness” (odds ratio [OR]=8.4) and “depressive symptoms” (OR=3.6) were significantly associated with hemoglobin levels. None of the evaluated items were significantly associated with hemoglobin levels in women.Conclusion: Among healthy Japanese men, those who exhibit lightheadedness and depressive symptoms have an increased risk of anemia. Lightheadedness and depressive symptoms may be indicative of undiagnosed anemia in men, which necessitates greater clinical attention.

Distribution characteristics of astigmatism in preschool children from Tongzhou District of Beijing and its effect on visual acuity / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the characteristics of astigmatism distribution among preschool children from Tongzhou District, Beijing, discuss its categorizations, severity, and the effect on preschoolers' vision, and clarify the influence of cycloplegic refraction on the detection of astigmatism.METHODS:In this cross-sectional study conducted from December 2021 to January 2022, a cluster random sampling method was utilized to assess 1 498 preschool children(2 996 eyes)from Tongzhou District, Beijing. The sample comprised 791 males and 707 females, with 222 children aged 3 to &#x0026;#x003C;4 years, 521 children aged 4 to &#x0026;#x003C;5 years, 647 children aged 5 to &#x0026;#x003C;6 years, and 108 children aged 6 to &#x0026;#x003C;7 years. Evaluations included visual acuity, anterior segment, computerized optometry, and cycloplegic refraction.RESULTS:Prior to cycloplegic refraction, the prevalence of astigmatism was found to be 61.88%(927/1498). For post-cycloplegic refraction, this percentage slightly increased to 64.02%(959/1498, P=0.095). Following cycloplegic refraction, the distribution of astigmatism severity was as follows: 51.87%(777/1498)had mild astigmatism, 9.41%(141/1498)had moderate astigmatism, and 2.74%(41/1498)had severe astigmatism. Astigmatism was predominantly with-the-rule across all age groups, with compound hyperopic astigmatism being the most frequent type. In cases of subnormal vision caused by astigmatism: low degree accounted for 9.38%, moderate degree accounted for 25.4%,and high degree accounted for 52.6%.CONCLUSION:The findings reveal a high incidence of astigmatism in preschool children, predominantly in a mild nature. Cycloplegic refraction was observed to have a negligible effect on the rate of astigmatism detection. Moreover, its impact on vision becomes more significant as the degree of astigmatism increases.

Epidemiological characteristics and influencing factors of adenovirus-associated acute conjunctivitis in Shenzhen，2014‒2022 / 上海预防医学

ObjectiveTo investigate the epidemic characteristics and influencing factors of acute conjunctivitis caused by human adenovirus（HAdv）in Yantian District of Shenzhen City， Guangdong Province from 2014 to 2022， and to provide evidence for formulating effective prevention and control measures. MethodsDescriptive epidemiology was used to analyze the epidemiological characteristics of acute hemorrhagic conjunctivitis （AHC） cases reported from the Chinese disease prevention and control information system. Etiological characteristics of laboratory-confirmed cases were analyzed， and a case-control study method of test-negative design （TND） was conducted as well. According to the result of HAdv detection， analysis was used to identify the influencing factors of morbidity. ResultsA total of 1 005 AHC cases were reported in Yantian District， Shenzhen City from 2014 to 2022， with an average annual incidence rate of 49.49/105. The incidence rate ranged from 4.67/105 to 117.28/105. The peak incidence occurred from July to October each year， with a male-to-female ratio of 1.42∶1. The median （P25，P75） age of onset was 29（12，40） years. A total of 716 eye swabs were collected for etiological detection from 2014 to 2022. HAdv positive detection rate was 36.45% （263/716）， Cox 24v positive detection rate was 0.28% （2/716）， while EV70 was not detected. The longest viral shedding time in eye swabs was 10 days， with a median of 2 days. The highest HAdv positive detection rate （47.47%） was observed when the sampling-to-onset interval was 4‒5 days， and the difference was statistically significant （P<0.05）， with a trend of first increasing and then decreasing. Multivariate logistic regressing analysis showed that aged 18‒ years， and average temperature higher than 24.90 ℃ 3 days before onset （P<0.05） were the risk factors for acute HAdv conjunctivitis. ConclusionAHC in Yantian District， Shenzhen City showed a low level of prevalence from 2014 to 2022， with HAdv being the predominant pathogen. The peak period of viral shedding occurred on the 4th to 5th day after symptom onset， suggesting the importance of adherence to strict home isolation for infected persons. Aged18‒ years and average temperature increased 3 days before onset are associated with an increased risk of adenoviral conjunctivitis. It is recommended to strengthen personal protection and keep doing a good job of AHC surveillance and early warning， so as to timely prevent the outbreaks of AHC.

Epidemiological characteristics of syphilis in Shiyan City in 2008 - 2020 / 公共卫生与预防医学

Objective To understand the epidemiological characteristics and incidence trend of syphilis in Shiyan City, and to provide a scientific basis for formulating syphilis control strategies. Methods Descriptive epidemiological statistical analysis on the data of syphilis cases from 2008 to 2020 in Shiyan City was performed. Results A total of 9 578 syphilis cases were reported in Shiyan City from 2008 to 2020, with the reported incidence rate ranging from 16.80/100 000 to 27.48/100 000. The reported incidence rate of syphilis showed a downward trend from 2008 to 2014 (χ2 trend=44.869, P=0.000), and an upward trend from 2015 to 2020 (χ2 trend=69.642, P=0.000). The composition ratio of syphilis in each stage had changed, with a decreasing trend in stage I and II syphilis. The composition ratio of recessive syphilis cases increased from 58.90% in 2008 to 93.10% in 2020, and gradually became the main epidemic type. No cases of fetal syphilis were reported in the past three years. The incidence rate of syphilis reported from 2008 to 2020 was generally higher in women than that in men, with a male to female ratio of 0.67:1. Occupations were mainly farmer, housework, and unemployment. The high incidence areas of syphilis in Shiyan City included mainly Maojian District, Zhangwan District, and Fangxian County, with the annual reported incidence rates being 38.40/100 000, 37.97/100 000, and 29.37/100 000, respectively. Conclusion The syphilis epidemic in Shiyan City from 2008 to 2020 has showed a trend of first decline and then rise. The prevention and treatment of syphilis in key populations and key areas should be strengthened according to the epidemiological characteristics of syphilis to control the spread of syphilis and reduce the harm to the public.

Epidemiological characteristics and outbreak analysis of varicella in Huai’an City in 2013-2022 / 公共卫生与预防医学

Objective To analyze the epidemiological characteristics of varicella in Huai'an City, Jiangsu Province from 2013-2022, and to provide a scientific basis for formulating effective prevention and control strategies for varicella in Huai'an City. Methods Descriptive epidemiological methods were used to analyze the data of 2013-2022 varicella cases in Huai'an City from China Disease Prevention and Control Information System and the varicella epidemic data from the public health emergency reporting management information system. Results A total of 32 325 varicella cases were reported during 2013-2022. The overall incidence rate showed an upward trend, with an obvious seasonal high incidence in winter and spring. The incidence rate in the central urban areas of all districts and counties was relatively higher. The ratio of male to female in reported cases was 1.16:1. The most cases were people aged 5-9 years old, accounting for 39.43% of the total number of cases. In terms of occupational distribution, students predominated, accounting for 54.77% of the total number of cases. From 2013 to 2022, a total of 70 public health outbreaks of varicella were reported in Huai'an, with the majority (45) occurring in primary schools, accounting for 64.29% of the total. Conclusion After the introduction of varicella into the national planned immunization program in 2023, it is recommended to increase the publicity of vaccination, carry out universal vaccination of varicella vaccine for high-risk groups such as students, and particularly increase the second dose coverage of varicella vaccine.

Viral pathogen spectrum analysis of acute intestinal infection in Hanzhong in 2019-2022 / 公共卫生与预防医学

Objective To explore the viral pathogen spectrum characteristics of acute intestinal infection in Hanzhong from 2019 to 2022. Methods Fecal samples from patients with acute intestinal infection in the outpatient clinic of 3201 Hospital from January 2019 to December 2022 were collected. Common enteroviruses such as enterovirus 71 (EV-A71), coxsackievirus 16 (CV-A16), CV-A10, CV-A6, CV-A2, CV-A4, and CV-B3 were detected and analyzed by real-time fluorescence quantitative PCR. Results A total of 5 194 fecal samples were collected, and the positive rate of nucleic acid detection was 23.95%. In terms of the enteroviruses, the highest detection rate was 9.82% for EV-A71, followed by 4.58% for CV-A16 and 3.37% for CV-A6. The positive detection rate of common enteroviruses showed statistical difference among different age groups (P0.05). EV-A71 infection showed no seasonal characteristics, whereas the detection of CV-A16 and CV-A6 infections was concentrated in summer and autumn. There were 106 cases of mixed infection, and the prevalence rate was 2.04%, with EV-A71 and CV-A6 mixed infections accounting for the majority of cases. Conclusion The main pathogens of acute intestinal infections in the Hanzhong area from 2019 to 2022 are EV-A71, CV-A16, and CV-A6. It is necessary to strengthen the monitoring of acute intestinal infections in children aged 4 years and below.

Applications and advancements of instrumental variable approach in causal inference in environmental epidemiology / 环境与职业医学

In environmental epidemiological research, extensive non-random environmental exposures and complex confounding biases pose significant challenges when attempting causal inference. In recent years, the introduction of causal inference methods into observational studies has provided a broader range of statistical tools for causal inference research in environmental epidemiology. The instrumental variable (IV) approach, as a causal inference technique for effectively controlling unmeasured confounding factors, has gradually found application in the field of environmental epidemiological research. This article reviewed the basic principles of IV and summarized the current research progress and limitations of applying IV for causal inference in environmental epidemiology. IV application in the field of environmental epidemiology is still in the initial stage. Rational use of IV and effective integration with other causal inference methods will become the focus of the development of causal inference in environmental epidemiology. The aim of this paper is to provide a methodological reference and basis for future studies involving causal inference to target population health effects of environmental exposures in China.

Molecular characterization and incidence of new tospovirus: Soybean Vein Necrosis Virus (SVNV) in Egypt

Abstract Field survey study was conducted season (2017). Soybeans and weeds were weekly sampled randomly. Thrips adults were identified and counted. Detection of the virus isolate and the natural incidence was determined using; Mechanical transmission, host range, DAS-ELISA, RT-PCR. The natural incidence thrips individuals was detected depending on the SVNV% in thrips individuals and weeds hosts. Ten thrips species were associated with soybean plants in the field. The most abundant species was T. tabaci, average 256.5 average no.of individuals, followed by F. occidentalis (142.5 average no. of individuals), then N. variabilis (86.6/ average no. of individuals). Fourteen thrips species occurred on 5 legumes field crops and 41 weed plant species within soybean field. The highest average number 40.6.of individuals were recorded on Ammi majus. While the lowest one 3.3 average no. of individuals were on Urtica urens. Only 21diagnostic plant species were susceptible to infection with SVNV. G. max and Vigna radiate, were the highest percentage of infection 80% followed by V. unguilata & N. benthamiana, 75%. Egyptian isolate of Soybean vein necrosis virus (SVNV) in this study showed a high degree of similarity and it is closely related to TSWV from Egypt (DQ479968) and TCSV from USA (KY820965) with nucleotide sequence identity of 78%. Four thrips species transmitted SVNV (F. fusca 4.0%, F. schultzei 4.3%, F. tritici 3.3% and N. variabilis 68.0% transmission). Both C. phaseoli and M. sjostedti can acquire the virus but unable to transmit it. The following species; T. tabaci, F. occidentalis, S. dorsallis and T. palmi cannot acquire or transmit SVNV. The incidence of SVNV in the field started by the end of July then increased gradualy from 12.7 to 71.3% by the end of the season. In conclusion, few thrips individuals invaded soybean crops are enough to transmit high rate of SVNV within the crop. Furthermore, several vector species are also abundant on weeds, which are the major sources of soybean viruses transmitted to the crops. This information might be important for control and reduce the incidence of SVNV infection.

Resumo O estudo de pesquisa de campo foi realizado na temporada (2017). A soja e as ervas daninhas foram amostradas semanalmente de forma aleatória. Tripes adultos foram identificados e contados. A detecção do vírus isolado e a incidência natural foram determinadas usando transmissão mecânica, gama de hospedeiros, DAS-ELISA, RT-PCR. A incidência natural de tripes em indivíduos foi detectada dependendo da % de SVNV em tripes e hospedeiros infestantes. Dez espécies de tripes foram associadas a plantas de soja no campo. A espécie mais abundante foi T. tabaci, com média de 256,5 número médio de indivíduos, seguida por F. occidentalis (142,5) e N. variabilis (86,6 / número médio de indivíduos). Catorze espécies de tripes ocorreram em 5 culturas de leguminosas e 41 espécies de plantas daninhas dentro de campos de soja. O maior número médio de 40,6 indivíduos foi registrado em Ammi majus. Enquanto o mais baixo, 3,3 número médio de indivíduos, foi no Urtica urens. Apenas 21 espécies de plantas diagnosticadas foram suscetíveis à infecção com SVNV. G. max e Vigna radiate foram os maiores percentuais de infecção, 80%, seguidos por V. unguilata e N. benthamiana, 75%. O isolado egípcio neste estudo mostrou um alto grau de similaridade e está intimamente relacionado ao TSWV do Egito (DQ479968) e ao TCSV dos EUA (KY820965), com identidade de sequência de nucleotídeos de 78%. Quatro espécies de tripes transmitiram SVNV (F. fusca 4,0%, F. schultzei 4,3%, F. tritici 3,3% e N. variabilis 68,0% de transmissão). Tanto C. phaseoli quanto M. sjostedti podem adquirir o vírus, mas não podem transmiti-lo. As seguintes espécies, T. tabaci, F. occidentalis, S. dorsallis e T. palmi não podem adquirir ou transmitir SVNV. A incidência de SVNV no campo, iniciada no final de julho, aumentou gradativamente de 12,7 para 71,3% no final da temporada. Em conclusão, poucos indivíduos de tripes invadiram a cultura da soja e são suficientes para transmitir alta taxa de SVNV dentro da cultura. Além disso, várias espécies de vetores também abundam em ervas daninhas, que são as principais fontes dos vírus da soja transmitidos às lavouras. Essas informações podem ser importantes para controlar e reduzir a incidência de infecção por SVNV.