Prevalence and burden of difficult-to-treat and severe asthma in Australia: A national population survey.

BACKGROUND AND OBJECTIVE: Most evidence about difficult-to-treat and severe asthma (DTTA) comes from clinical trials and registries. We aimed to identify people with DTTA from a large nationally representative asthma population and describe their characteristics and healthcare utilization compared with people whose asthma was not 'difficult-to-treat'. METHODS: We conducted a cross-sectional survey of Australians aged ≥18 years with current asthma from large web-based survey panels. Enrolment was stratified by gender, age-group and state/territory based on national population data for people with asthma. Difficult-to-treat or severe asthma was defined by poor symptom control, exacerbations and/or oral corticosteroid/biologic use despite medium/high-dose inhaled therapy. Outcomes included exacerbations, healthcare utilization, multimorbidity, quality of life and coronavirus disease of 2019 (COVID-19)-related behaviour. Weighted data were analysed using SAS version 9.4. RESULTS: The survey was conducted in February-March 2021. The weighted sample comprised 6048 adults with current asthma (average age 47.3 ± SD 18.1 years, 59.9% female), with 1313 (21.7%) satisfying ≥1 DTTA criteria. Of these, 50.4% had very poorly controlled symptoms (Asthma Control Test ≤15), 36.2% were current smokers, and 85.4% had ≥1 additional chronic condition, most commonly anxiety/depression. More than twice as many participants with DTTA versus non-DTTA had ≥1 urgent general practitioner (GP) visit (61.4% vs. 27.5%, OR 4.8 [4.2-5.5, p < 0.0001]), or ≥1 emergency room visit (41.9% vs. 17.9%, OR 3.8 [3.3-4.4, p < 0.0001]) in the previous 12 months. CONCLUSION: Our findings emphasize the burden of uncontrolled symptoms, current smoking, multimorbidity and healthcare utilization in people with DTTA in the community, who may be under-represented in registries or clinical trials.

Toll-like receptor inflammatory cascade and the development of diabetic kidney disease in children and adolescents with type 1 diabetes.

AIM: This study aimed to evaluate the association of toll-like receptor (TLR) inflammatory cascade with the development of diabetic kidney disease (DKD) in children and adolescents with type 1 diabetes (T1D). METHODS: A total of 49 T1D patients and 49 normoglycaemic (NG) subjects aged 5-20 years old were recruited. TLR2, TLR4, MYD88, NFKB, MCP1/CCL2 and IL18 mRNA expressions were measured in peripheral blood mononuclear cells by reverse transcription-quantitative polymerase chain reaction. Fasting glucose, glycated haemoglobin, serum urea, serum creatinine and urinary albumin-to-creatinine ratio (ACR) were determined. RESULTS: The mRNA expressions of TLR2, TLR4, MYD88 and NFKB were significantly increased in the T1D group compared with the NG group. The mRNA expression levels of MCP1/CCL2 and IL18 were higher in 21 T1D patients (42.9%) (average of MCP1/CCL2: 6.6-fold and IL18: 5.8-fold) than in NG patients. Furthermore, ACR was increased in the T1D group compared with the NG group. CONCLUSION: The increased mRNA expression of TLR2, TLR4, MYD88, NFKB, MCP1/CCL2 and IL18 favours the development of an inflammatory process that may lead to a decline in renal function and consequently DKD in children and adolescents with T1D. This suggests that these genes are early mediators of onset DKD since the beginning of the lives of the paediatric T1D patients.

Evacuaciones estratégicas por motivo cardiovascular en personal militar español (2007-2020) / Strategic evacuations for cardiovascular reasons in Spanish military personnel (2007-2020)

Introducción y Objetivos: Las evacuaciones estratégicas por razones médicas son aquellas que se realizan cuando la baja no se puederecuperar para el desempeño de la misión y es transportada hasta territorio nacional. El objetivo de este estudio es describir las bajasespañolas evacuadas estratégicamente por causas cardiovasculares, así como describir el personal militar español fallecido por causacardíaca en zona de operaciones. Material y Métodos. Estudio transversal retrospectivo en el que se incluyen a todos los militaresespañoles evacuados por razones médicas desde zona de operaciones hasta el Hospital Central de la Defensa “Gómez Ulla” (Role 4)durante los años 2007 y 2020. Resultados. Treinta y seis bajas fueron evacuadas sobre el Role 4 español por causas cardiovasculares,de las cuales 25% fueron diagnosticadas de fibrilación auricular, 22,2% de infarto de miocardio, 11,1% de trombosis venosa aguda,y 5,5% de crisis hipertensiva, flutter auricular y bloqueo auriculoventricular, respectivamente. La zona de operaciones desde dondese originaron más evacuaciones fue Afganistán (31%), seguido por Líbano (28%) y las navegaciones internacionales (14%). Un totalde 13 militares españoles han fallecido en zona de operaciones por motivo cardiovascular. Conclusiones. La fibrilación auricular y elsíndrome coronario agudo han sido los principales diagnósticos entre las bajas evacuadas por motivos cardiovasculares. Los autoresconsideramos imprescindible que las Fuerzas Armadas españolas cuenten con un servicio de Cardiología en Role 4, que ademásde realizar labores asistenciales, sirva de órgano de reconocimiento médico previo a misión y forme parte del apoyo sanitario a lasoperaciones internacionales. (AU)

Introduction and Objectives: Strategic evacuations for medical causes are those that are carried out when the casualty cannot berecovered for the mission and is transported to national territory. The objective of this study is to describe the Spanish casualtiesstrategically evacuated due to cardiovascular causes, as well as to describe the Spanish military personnel who died due to cardiaccauses in the area of operations. Material and methods. Retrospective cross-sectional study in which all Spanish military personnelevacuated for medical reasons from the area of operations to the Central Defense Hospital “Gómez Ulla” (Role 4) during the years2007 and 2020 were included. Results. Thirty-six casualties were evacuated on Spanish Role 4 due to cardiovascular causes, of which25% were diagnosed with atrial fibrillation, 22,2% with myocardial infarction, 11,1% with acute venous thrombosis, and 5.5% ofhypertensive crisis, atrial flutter, and atrioventricular block, respectively. The area of operations from where the most evacuations originated was Afghanistan (31%), followed by Lebanon (28%) and international navigations (14%). A total of 13 Spanish soldiers havedied in the area of operations for cardiovascular reasons. Conclusions. Atrial fibrillation and acute coronary syndrome have been themain diagnoses among the casualties evacuated for cardiovascular reasons. The authors consider it essential that the Spanish ArmedForces have a Role 4 - Cardiology department that, in addition to performing care tasks, serves as a unit for medical examinationprior deployment and take part into the medical support for international military operations. (AU)

Relationship between life-time exposure to ambient fine particulate matter and carotid artery intima-media thickness in Australian children aged 11-12 years.

Long-term exposure to air pollutants, especially particulates, in adulthood is related to cardiovascular diseases and vascular markers of atherosclerosis. However, whether vascular changes in children is related to exposure to air pollutants remains unknown. This study examined whether childhood exposure to air pollutants was related to a marker of cardiovascular risk, carotid intima-media thickness (CIMT) in children aged 11-12 years old. Longitudinal Study of Australian Children (LSAC) recruited parents and their children born in 2003-4. Among the participants, CheckPoint examination was conducted when the children were 11-12 years old. Ultrasound of the right carotid artery was performed using standardized protocols. Average and maximum far-wall CIMT, carotid artery distensibility, and elasticity were quantified using semiautomated software. Annual and life-time exposure to air pollutants was estimated using satellite-based land-use regression by residential postcodes. A total of 1063 children (50.4% girls) with CIMT data, serum cholesterol, and modeled estimates of NO2 and PM2.5 exposure for the period 2003 to 2015 were included. The average and maximum CIMT, carotid distensibility, and elasticity were 497 µm (standard deviation, SD 58), 580 µm (SD 44), 17.4% (SD 3.2), and 0.48%/mmHg (SD 0.09), respectively. The life-time average concentrations of PM2.5 and NO2 were 6.4 µg/m3 (SD 1.4) and 6.4 ppb (SD 2.4), respectively. Both average and maximum CIMT were significantly associated with average ambient PM2.5 concentration (average CIMT: +5.5 µm per µg/m3, 95% confidence interval, CI 2.4 to 8.5, and maximum CIMT: +4.9 µm per µg/m3, CI 2.3 to 7.6), estimated using linear regression, adjusting for potential confounders. CIMT was not significantly related to NO2 exposure. Carotid artery diameter, distensibility, and elasticity were not significantly associated with air pollutants. We conclude that life-time exposure to low levels of PM2.5 in children might have measurable adverse impacts on vascular structure by age 11-12 years.

Willingness to receive vaccination against COVID-19: results from a large nationally representative Australian population survey

We surveyed 10,024 Australians regarding COVID-19 vaccine willingness. Overall, 59.9% indicated yes, 13.9% no and 26.3% unsure/dont know. Vaccine willingness was higher in males, and increased with increasing education and socioeconomic advantage. Results contrast with earlier, smaller Australian surveys regarding vaccination willingness and confirm the need for targeted vaccination information.

Prevalence of chronic obstructive pulmonary disease with breathlessness in Australia: weighted using the 2016 Australian census.

Access to up-to-date Australian disease prevalence estimates assists health services and consumer organisations to plan and allocate resources. The Burden of Obstructive Lung Disease study was conducted between 2006 and 2012 and provided chronic obstructive pulmonary disease (COPD) (post-bronchodilator airflow limitation) prevalence estimates weighted to the 2006 Australian census. Using the 2016 Australian census, an updated prevalence estimate of all COPD is 8.30% (95% confidence interval = 6.59%-10.01%) for adults aged 40 or more years in Australia and includes 2.52% with mild breathlessness, 0.99% with moderate breathlessness and 0.91% with severe breathlessness.

Prevalence and burden of breathlessness in Australian adults: The National Breathlessness Survey-a cross-sectional web-based population survey.

BACKGROUND AND OBJECTIVE: Chronic respiratory symptoms (in particular, breathlessness and cough) can cause physical, social and emotional distress, and may indicate the presence of an underlying disease that presages future poor health outcomes. Our aim was to investigate the burden of breathlessness in Australian adults, including breathlessness that may be undiagnosed, unlabelled or untreated. METHODS: The National Breathlessness Survey was a cross-sectional, web-based survey conducted in October 2019. Australian adults were randomly selected from a large web-based survey panel with recruitment stratified by age-group, gender and state of residence according to national population data. The main outcome measures were modified Medical Research Council (mMRC) dyspnoea scale, EuroQol visual analog scale, Dyspnoea-12 score and 4-item Patient Health Questionnaire (PHQ-4). RESULTS: Among all respondents (n = 10,072; 51.1% female; median age group 40-49 years), 9.5% reported clinically important breathlessness (mMRC dyspnoea grade ≥ 2, 2 = 'I walk slower than people of the same age on the level because of breathlessness or have to stop for breath when walking at my own pace on the level'). Among those with clinically important breathlessness, 49.1% rated their general health as fair or poor and 44.2% had at least moderate depression or anxiety symptoms (PHQ ≥ 6) but over half (50.8%) did not report a current respiratory or heart condition diagnosis. CONCLUSION: Breathlessness is common among Australian adults, and is associated with a substantial burden of ill health, including among people without a diagnosed respiratory or heart condition. The extent of underdiagnosis of these conditions or alternative causes of breathlessness requires further investigation.

Functional analysis of PCSK9 3'UTR variants and mRNA­miRNA interactions in patients with familial hypercholesterolemia

AIM: functional analysis of pcsk9 3'utr variants and mrna-mirna interactions were explored in patients with familial hypercholesterolemia (fh). MATERIALS & METHODS: PCSK9 3'UTR variants were identified by exon-targeted gene sequencing. Functional effects of 3'UTR variants and mRNA-miRNA interactions were analyzed using in silico and in vitro studies in HEK293FT and HepG2 cells. RESULTS: Twelve PCSK9 3'UTR variants were detected in 88 FH patients. c.*75C >T and c.*345C >T disrupted interactions with miR-6875, miR-4721 and miR-564. Transient transfection of the c.*345C >T decreased luciferase activity in HEK293FT cells. miR-4721 and miR-564 mimics reduced PCSK9 expression in HepG2 cells. CONCLUSION: PCSK9 c.*345C >T has a possible role as loss-of-function variant. miR-4721 and miR-564 downregulate PCSK9 and may be useful to improve lipid profile in FH patients.

Modelling inactivation of wild-type and clinical Escherichia coli O26 strains using UV-C and thermal treatment and subsequent persistence in simulated gastric fluid.

AIMS: First, two inactivation models were compared for different phenotypic profiles of Escherichia coli O26 using ultraviolet-C light (UV-C) and thermal treatment (T), by means of Central Composite Rotatable Design of Experiment (CCRD). Second, we aimed to evaluate the subsequent survival and persistence of cells in simulated gastric fluid (SGF). METHODS AND RESULTS: Two strains of E. coli O26, a wild-type strain and a clinical ATCC strain were used in both steps. A CCRD was used in a 22 arrangement in random order. The goodness-of-fit of the models was determined. The lack of fit, and the normality of residual data were checked with the Shapiro-Wilk test, and the model accuracy factor, bias factor and the model mean square error (MSE) were measured. Subsequently, the resistance capacity of the strains was evaluated after exposure to simulated gastric acid. The CCRD results obtained indicate that the mild heat (<70°C) has a recovery effect. In addition, for the clinical strain, the UV-C and heat (above 70°C) has an additive inactivation effect. Moreover, temperature (65°C) induced SGF resistance by the wild-type and clinical strain. For the clinical strain, cells exposed to UV-C were more sensitive to SGF. In contrast to clinical strain, exposing cells of the wild-type strain to UV-C increased the survival capacity in the SGF. CONCLUSION: Response surface analyses showed that the wild-type O26 strain has higher persistence under unfavourable conditions than the clinical strain, and the stresses caused by applied microbial control technologies can increase the survival capacity in the SGF. SIGNIFICANCE AND IMPACT OF THE STUDY: The present study shed light on different phenotypic responses in the same bacterium serogroup. Moreover, the impact of the study was that strain selection criteria must be adequate to develop effective models of inactivation.

Incidence of rare cancers in the city of São Paulo, Brazil.

INTRODUCTION:: Rare cancers are a challenge for clinical practice as well as for epidemiology and public health. Studies on this subject are few and limited to the study of cases with scarce epidemiologic information. This study aimed to evaluate the incidence of rare cancers and to compare the demographic, anatomic, and histologic characteristics of rare and nonrare (common) cancers. METHODS:: Incidence data were obtained from the Population-based Cancer Registry of São Paulo, Brazil. Rare neoplasms were those defined in the RARECARE list, which takes into account an incidence lower than 6/100,000/year. RESULTS:: In São Paulo, 20.4% of tumors had an incidence lower than 6/100,000/year from 1997 to 2012, being therefore considered as rare tumors. We identified 11 entities with an incidence greater than 6/100,000/year (common neoplasms) and 186 entities with an incidence lower than 6/100,000/year (rare neoplasms). The mean annual incidence of all cancers was 365 per 100,000 in São Paulo between 1997 and 2012, and the incidence of all rare tumors was 74.5 per 100,000. CONCLUSIONS:: This study presents the burden of rare cancers in Brazil. It is expected to be an incentive for further studies of these entities in order to know the epidemiologic profile of rare tumors in Brazil and to provide a more effective diagnostic and therapeutic approach.

Incidence and mortality risk for respiratory tract cancer in the city of São Paulo, Brazil: Bayesian analysis of the association with traffic density.

BACKGROUND: There is evidence that exposure to traffic-related air pollution is related to the incidence of and mortality associated with lung cancer. The aim of this study was to perform a spatial analysis, with a Bayesian approach, to test the hypothesis that high traffic density is associated with increased respiratory tract cancer incidence and mortality risk among individuals over 20 years of age residing in the city of São Paulo, Brazil. METHODS: We employed data from two different databases: the São Paulo Municipal Population-Based Cancer Registry (2002-2011 cancer incidence data); and the Mortality Database of the São Paulo Municipal Health Department (2002-2013 cancer mortality data). The relationships between the number of cases of respiratory tract cancer in each area analyzed and the standardized covariates-traffic density and the Municipal Human Development Index (MHDI)-were evaluated with a Besag-York-Mollié ecological model with relative risks (RRs) estimates. RESULTS: Per 1-unit standard-deviation increase in traffic density and in the MHDI, the RR for respiratory tract cancer incidence was 1.07 (95% CI: 1.02-1.13) and 1.25 (95% CI: 1.18-1.32), respectively, whereas the RR for mortality was 1.04 (95% CI: 0.99-1.09) and 1.23 (95% CI: 1.16-1.30), respectively. CONCLUSION: Our findings support the hypothesis that residing in areas with high traffic density is associated with increased respiratory tract cancer incidence and mortality risk in the city of São Paulo.

Exercise training as a novel primary treatment for localised prostate cancer: a multi-site randomised controlled phase II study.

Alternative management strategies for localised prostate cancer are required to reduce morbidity and overtreatment. The aim of this study was to evaluate the feasibility, safety and acceptability of exercise training (ET) with behavioural support as a primary therapy for low/intermediate risk localised prostate cancer. Men with low/intermediate-risk prostate cancer were randomised to 12 months of ET or usual care with physical activity advice (UCwA) in a multi-site open label RCT. Feasibility included acceptability, recruitment, retention, adherence, adverse events and disease progression. Secondary outcomes included quality of life and cardiovascular health indices. Of the 50 men randomised to ET (n = 25) or UCwA (n = 25), 92% (n = 46) completed 12 month assessments. Three men progressed to invasive therapy (two in UCwA). In the ET group, men completed mean: 140 mins per week for 12 months (95% CI 129,152 mins) (94% of target dose) at 75% Hrmax. Men in the ET group demonstrated improved body mass (mean reduction: 2.0 kg; 95% CI -2.9,-1.1), reduced systolic (mean: 13 mmHg; 95%CI 7,19) and diastolic blood pressure (mean:8 mmHg; 95% CI 5,12) and improved quality of life (EQ.5D mean:13 points; 95% CI 7,18). There were no serious adverse events. ET in men with low/intermediate risk prostate cancer is feasible and acceptable with a low progression rate to radical treatment. Early signals on clinically relevant markers were found which warrant further investigation.

Factors associated with parental underestimation of child's weight status / Fatores associados à subestimação do status do peso da criança pelos pais

Abstract Objective The aim of this study was to examine the prevalence of parental misperception of child weight status, and identify socioeconomic, anthropometric, behavioral and dietary factors associated with underestimation. Method Cross-sectional study. Data was collected in 14 Brazilian private schools. Parents of children aged 2-8 years (n = 976) completed a self-reported questionnaire assessing their perception of their child's weight status, and sociodemographic, anthropometric, behavioral and dietary information. To measure the agreement between parental perception about child weight status and actual child weight status, the Kappa coefficient was estimated, and to investigate associations between parental underestimation and independent variables, chi-squared tests were performed, followed by multiple logistic regression, considering p ≤ 0.05 for statistical significance. Results Overall, 48.05% of the parents incorrectly classified their child's weight. Specifically, 45.08% underestimated their child's weight status, with just 3% of parents overestimating. Children with higher body mass index (OR = 2.03; p < 0.001) and boys (OR = 1.70; p < 0.001) were more likely to have their weight status underestimated by parents. Conclusion Since awareness of weight problems is essential for prevention and treatment, clinical practitioners should help parents at high risk of misperception to correctly evaluate their child's weight status.

Resumo Objetivo Analisar a prevalência de percepção errônea dos pais sobre o status do peso infantil e identificar fatores socioeconômicos, antropométricos, comportamentais e dietéticos associados à subestimação. Método Trata-se de um estudo transversal. Os dados foram coletados em 14 escolas particulares brasileiras. Pais de crianças de dois a oito anos de idade (n = 976) preencheram um questionário autoaplicável sobre sua percepção do estado nutricional do seu filho e informações sociodemográficas, antropométricas, comportamentais e dietéticas. Para medir o grau de concordância entre a percepção dos pais do peso do filho e o peso real do filho, estimamos o coeficiente Kappa e investigamos as associações entre subestimação do pai e variáveis independentes, calculamos o qui-quadrado seguido do modelo de regressão logística múltipla considerando p≤0,05 para significância estatística. Resultados Em geral, 48,05% dos pais classificaram incorretamente o peso de seus filhos; particularmente, 45,08% subestimaram o peso do seu filho e apenas 3% subestimaram o peso infantil. A regressão logística demonstrou que as crianças com maior índice de massa corporal (OR = 2,03; p < 0,001) e os meninos (OR = 1,70; p < 0,001) tinham maior probabilidade de ter seu peso subestimado pelos pais. Conclusão Médicos clínicos devem concentrar suas intervenções nessas crianças para ajudar os pais a avaliar corretamente o seu peso. A consciência dos pais sobre um problema de peso em crianças é essencial para a prevenção e tratamento da obesidade infantil e estilos de vida saudáveis.

Statins differentially modulate microRNAs expression in peripheral cells of hyperlipidemic subjects: A pilot study.

AIM: Although statins are considered a cornerstone for the treatment of high cholesterol levels due to their powerful cholesterol-lowering effects, response to drug administration is still one of the main pitfalls of statin treatment. So far, the reasons underlying this undesired outcome are still poorly understood, but recently, various studies have suggested that miRNAs may be involved. Therefore, we aimed at evaluating the effect of short-term low-dose treatment with 2 statins on miRNAs expression in patients with hypercholesterolemia. METHODS: A total of 40 hypercholesterolemic (HC) subjects following 1 month of atorvastatin (10 mg/day; n = 20) or simvastatin (10 mg/day; n = 20) were included. Multiple available boinformatic algorithms (TargetScan, miRanda, DianaLab, MicroCosm and PicTar) were employed to select miRNAs regulating genes involved in cholesterol metabolism and statin response. Differential miRNAs expression was determined in peripheral cells using the miScript® miRNA PCR Array platform. Pathways involving differentially expressed miRNAs were explored using the Ingenuity Pathway Analysis software. RESULTS: Atorvastatin repressed miR-29a-3p, miR-29b-3p, miR-300, miR-33a-5p, miR-33b-5p and miR-454-3p in HC subjects. On the contrary, simvastatin did not show any effect on miRNAs expression. Network analysis indicated that atorvastatin-modulated miRNAs regulate key cholesterol genes (ABCA1, HMGCR, INSIG1, LDLR, LPL, SCAP and SREBF1). Further subgroups analyses showed that miR-106b-5p, miR-17-3p and miR-590-5p were repressed in HC subjects within the lower quartile of atorvastatin response (lower LDL-C reduction), while the expression of miR-106b-5p, miR-17-3p and miR-183-5p was higher in the upper quartile of simvastatin response (higher LDL-C reduction) (p < 0.05). CONCLUSION: We show that a miRNAs-mediated epigenetic mechanism is differentially affected by statins therapy in vivo, which could be implicated in the variable response to these drugs. Further studies are necessary to disclose their particular role in the cholesterol-reduction response to statins.

Factors associated with parental underestimation of child's weight status.

OBJECTIVE: The aim of this study was to examine the prevalence of parental misperception of child weight status, and identify socioeconomic, anthropometric, behavioral and dietary factors associated with underestimation. METHOD: Cross-sectional study. Data was collected in 14 Brazilian private schools. Parents of children aged 2-8 years (n=976) completed a self-reported questionnaire assessing their perception of their child's weight status, and sociodemographic, anthropometric, behavioral and dietary information. To measure the agreement between parental perception about child weight status and actual child weight status, the Kappa coefficient was estimated, and to investigate associations between parental underestimation and independent variables, chi-squared tests were performed, followed by multiple logistic regression, considering p≤0.05 for statistical significance. RESULTS: Overall, 48.05% of the parents incorrectly classified their child's weight. Specifically, 45.08% underestimated their child's weight status, with just 3% of parents overestimating. Children with higher body mass index (OR=2.03; p<0.001) and boys (OR=1.70; p<0.001) were more likely to have their weight status underestimated by parents. CONCLUSION: Since awareness of weight problems is essential for prevention and treatment, clinical practitioners should help parents at high risk of misperception to correctly evaluate their child's weight status.

Cancer survival in people with AIDS: A population-based study from São Paulo, Brazil.

Cancer survival among people with AIDS (PWA) has been described in developed countries, but there is lack of data from developing countries. The aim of this study was to evaluate survival after cancer diagnosis in PWA and compare it with people without AIDS (non-PWA) in São Paulo, Brazil. A probabilistic record linkage was carried out between the databases of the Population-based Cancer Registry of São Paulo (PBCR-SP) and the AIDS registry of SP (SINAN) to identify PWA who developed cancer. For comparison, non-PWA were frequency matched from the PBCR-SP by cancer site/type, sex, age, and period. Hazard ratio (HR) stratified by matching variables was estimated using a Cox proportional hazards model. A total of 1,294 PWA (20 patients with two primary site tumors) were included in the site/type-specific analyses. AIDS-defining cancers (ADC) comprised 51.9% of cases assessed. The all-cancer 5-year overall survival in PWA was 49.4% versus 72.7% in non-PWA (HR = 2.64; 95%CI = 2.39-2.91). Survival was impaired in PWA for both ADC (HR = 2.93; 95%CI = 2.49-3.45) and non-ADC (HR = 2.51; 95%CI = 2.21-2.84), including bladder (HR = 8.11; 95% CI = 2.09-31.52), lung (HR = 2.93; 95%CI = 1.97-4.36) and anal cancer (HR = 2.53; 95%CI = 1.63-3.94). These disparities were seen mainly in the first year after cancer diagnosis. The overall survival was significantly lower in PWA in comparison with non-PWA in São Paulo, as seen in high-income countries. Efforts to enhance early diagnosis and ensure proper cancer treatment in PWA should be emphasized.

¿En qué hemos cambiado a lo largo de una década? Estudio comparativo de la asistencia sanitaria prestada en Líbano (Operación UNIFIL) en 2006 y 2016 / What have we changed over a decade? Comparative study of healthcare provided in Lebanon (UNIFIL Operation) in 2006 and 2016

Introducción: En 2016, España cumple una década de presencia en Líbano dentro de la operación de Naciones Unidas (UNIFIL) United Nations Interim Force in Lebanon. El objetivo del presente estudio es analizar la evolución de la asistencia sanitaria prestada en dos contingentes españoles desplegados en esa zona de operaciones con una diferencia de 10 años. Material y métodos: Estudio transversal descriptivo retrospectivo realizado durante dos periodos (del 8 septiembre al 8 de noviembre de 2006 y del 3 de septiembre al 18 de noviembre de 2016). La población a estudio fueron los pacientes atendidos en el primer escalón sanitario durante los citados periodos. Resultados: Los datos del primer y segundo intervalo respectivamente fueron: efectivos desplegados 523/562; asistencias médicas realizadas 1168/1435; enfermedades digestivas 269/423; enfermedades otorrinolaringológicas 222/147; cirugía menor 187/75; enfermedad dermatológica 175/128; traumatología 152/413; enfermedad odontológica 58/128; enfermedad oftalmológica 53/16; otras 70/105; evacuaciones a ROLE 2 4/76 y evacuaciones a ROLE 4 0/0. Conclusión: Hay similitud entre las atenciones sanitarias realizadas en ambos periodos de tiempo, excepto en las enfermedades traumatológicas donde aparece un incremento de casi un 300% en el segundo intervalo de tiempo respecto al primero

Introduction: In 2016, Spain celebrates a decade of presence in Lebanon within the United Nations Interim Force in Lebanon (UNIFIL). The aim of the present study is to analyse the evolution of the health care provided in two Spanish contingents deployed in that area of operations, comparing two periods within ten years of elapsed time. Material and method: A cross-sectional retrospective study was carried out during two periods (from the 8th of September to the 8th of November of 2006 and from the 3rd of September to the18th of November of 2016). The study population was the patients treated in the first Medical Treatment Facility during those periods. Results: The data of the first and second time interval respectively were: deployed troops 523/562; medical assistance performed 1168/1435; Digestive disease 269/423; Otorhinolaryngological diseases 222/147; Minor surgery 187/75; Dermatological disease 175/128; Traumatology 152/413; Dental disease 58/128; Opthalmologic disease 53/16; Other 70/105; Evacuations to ROLE 2 4/76 and evacuations to ROLE 4 0/0. Conclusion: There is a similarity between the healthcare provided in both periods of time, except in the traumatic diseases, because there was an increase of almost 300% during the second interval of time (AU)

Risks associated with managing asthma without a preventer: urgent healthcare, poor asthma control and over-the-counter reliever use in a cross-sectional population survey.

OBJECTIVES: Overuse of asthma relievers, particularly without anti-inflammatory preventers, increases asthma risks. This study aimed to identify how many reliever-only users have urgent healthcare, explore their attitudes and beliefs about asthma and its treatment, and investigate whether purchasing over-the-counter relievers was associated with worse asthma outcomes than by prescription. DESIGN AND SETTING: Cross-sectional population-based Internet survey in Australia. PARTICIPANTS: Of 2686 participants ≥16 years with current asthma randomly drawn from a web-based panel, 1038 (50.7% male) used only reliever medication. MAIN OUTCOME MEASURES: Urgent asthma-related healthcare; Asthma Control Test (ACT); patient attitudes about asthma and medications; reliever purchase (with/without prescription). RESULTS: Of 1038 reliever-only participants, 23.3% had required urgent healthcare for asthma in the previous year, and only 36.0% had a non-urgent asthma review. Those needing urgent healthcare were more likely than those without such events to be male (56.5% vs 49.0%, p=0.003) and current smokers (29.4% vs 23.3%, p=0.009). Only 30.6% had well-controlled asthma (ACT ≥20) compared with 71.0% of those with no urgent healthcare (p<0.0001), and 20.8% used relievers regularly to prevent asthma symptoms (vs 5.5% of those without urgent healthcare). Those with urgent healthcare were more frustrated by their asthma and less happy with how they managed it, and they were less confident about their ability to manage worsening asthma, but just as likely as those without urgent healthcare to manage worsening asthma themselves rather than visit a doctor. Reliever-only users purchasing over-the-counter relievers were no more likely than those purchasing relievers by prescription to have uncontrolled asthma (35.9% vs 40.6%, p=0.23) but were less likely to have had a non-urgent asthma review. CONCLUSIONS: One-quarter of the reliever-only population had needed urgent asthma healthcare in the previous year, demonstrating the importance of identifying such patients. Their attitudes and beliefs suggest opportunities for targeting this population in the community.

Is higher population-level use of ICS/LABA combination associated with better asthma outcomes? Cross-sectional surveys of nationally representative populations in New Zealand and Australia.

BACKGROUND AND OBJECTIVE: New Zealand (NZ) and Australia (AU) have similarly high asthma prevalence; both have universal public health systems, but different criteria for subsidized medicines. We explored differences in asthma management and asthma-related outcomes between these countries. METHODS: A web-based survey was administered in AU (2012) and NZ (2013) to individuals aged ≥16 years with current asthma, drawn randomly from web-based panels, stratified by national population proportions. Symptom control was assessed with the Asthma Control Test (ACT). Healthcare utilization was assessed from reported urgent doctor/hospital visits in the previous year. RESULTS: NZ (n = 537) and Australian (n = 2686) participants had similar age and gender distribution. More NZ than Australian participants used inhaled corticosteroid (ICS)-containing medication (68.8% vs 60.9%; P = 0.006) but ICS/long-acting ß2 -agonist (LABA) constituted 44.4% of NZ and 81.5% of Australian total ICS use (P < 0.0001). Adherence was higher with ICS/LABA than ICS-alone (P < 0.0001), and higher in NZ than in AU (P < 0.0001). ACT scores were similar (P = 0.41), with symptoms well controlled in 58.6% and 54.4% participants, respectively. More NZ participants reported non-urgent asthma reviews (56.6% vs 50.4%; P = 0.009). Similar proportions had urgent asthma visits (27.9% and 28.6%, respectively, P = 0.75). CONCLUSION: This comparison, which included the first nationally representative data for asthma control in NZ, showed that poorly controlled asthma is common in both NZ and AU, despite subsidized ICS-containing medications. The greater use of ICS-alone in NZ relative to ICS/LABA does not appear to have compromised population-level asthma outcomes, perhaps due to better adherence in NZ. Different ICS/LABA subsidy criteria and different patient copayments may also have contributed to these findings.

Influence of CYP3A4 and CYP3A5 polymorphisms on tacrolimus and sirolimus exposure in stable kidney transplant recipients.

BACKGROUND: Polymorphisms in genes encoding for drug-metabolizing enzymes and drug transporters are among multiple factors that modulate the pharmacokinetic variability of tacrolimus (TAC) and sirolimus (SRL). This study aimed to evaluate the influence of single nucleotide polymorphisms (SNPs) on TAC and SRL dose-adjusted concentrations (C0/D) in stable kidney transplant recipients. METHODS: This is an exploratory and prospective study, which includes 46 stable kidney transplant recipients. These patients were monitored from the 3rd to the 24th month after transplantation. The SRL group consisted of 25 patients receiving TAC, prednisone (PRED), and mycophenolate sodium (MPS), which were converted from TAC to SRL at 3rd month after transplantation. The TAC group consisted of 21 patients who underwent treatment with TAC, PRED, and MPS. Both groups were genotyped for CYP3A4 rs2242480 (g.20230G>A), CYP3A5 rs15524 (g.31611C>T), CYP2C8 rs10509681 (c.1196A>G) and ABCB1 rs1045642 (c.3435C>T), rs1128503 (c.1236C>T), and rs2032582 (c.2677G>T/A) polymorphisms. RESULTS: In the TAC group, CYP3A4 rs2242480 A allele carriers were associated with lower TAC C0/D. For CYP3A5 rs15524 SNP, C0/D was higher among patients carrying TT genotype when compared with CT and CC genotype carriers in the SRL and, more consistently, in the TAC groups. For ABCB1 rs1045642 SNP, TT genotype was associated with reduced SRL C0/D, but only at month 15. CONCLUSIONS: CYP3A4 rs2242480 and CYP3A5 rs15524 SNPs resulted in significant changes in SRL and TAC C0/D at different times after transplantation.