Impact of a radiological protection campaign in emergency paediatric radiology: a multicentric observational study in Brazil.

PURPOSE: To evaluate the impact of a paediatric radiological protection campaign, implemented in the emergency units of a healthcare provider network in Brazil. This campaign aimed to promote awareness among emergency department physicians, regarding justification of paediatric X-ray referrals for paranasal sinus, chest and CT exams, as a strategy to reduce exposure to ionising radiation. METHOD: Frequency analysis of common paediatric imaging referrals from 19 emergency departments was performed for a 3-year period (2015-2018) to coincide with before, during and after the implementation of the radiation protection campaign. The campaign was multifaceted and involved dissemination of educational materials and imaging referral guidelines along with quarterly meetings with participating centres' leaderships. Additionally, patient dose cards were distributed to patients/carers. The Chi-Square test was used to examine the association between the type of examination and the patient's age group. Exact-Fisher test was performed to check for an association between participant engagement and the existence of the radiation protection committee. RESULTS: Referrals reduced by 25% following the campaign with no reports of misdiagnosis. Many referrals in the youngest age groups. In 15 units, a radiological protection committee was created to raise awareness and to create a multi professional team to communicate the risks and benefits of radiological procedure in children. CONCLUSION: The campaign resulted in a substantial reduction in radiological referrals while promoting a radiation protection culture. Simple education initiatives can contribute to savings in both finances and radiation doses, particularly important in radiosensitive cohorts.

Family clustering of secondary chronic kidney disease with hypertension or diabetes mellitus. A case-control study.

In Brazil hypertension and type 2 diabetes mellitus are responsible for 60% of cases of end-stage renal disease in renal replacement therapy. In the United States studies have identified family clustering of chronic kidney disease, predominantly in African-Americans. A single Brazilian study observed family clustering among patients with chronic kidney disease when compared with hospitalized patients with normal renal function. This article aims to assess whether there is family clustering of chronic kidney disease in relatives of individuals in renal replacement therapy caused by hypertension and/or diabetes mellitus. A case-control study with 336 patients in renal replacement therapy with diabetes mellitus or hypertension for at least 5 years (cases) and a control matched sample group of individuals with hypertension or diabetes mellitus and normal renal function (n = 389). Individuals in renal replacement therapy (cases) had a ratio of 2.35 (95% CI 1.42-3.89, p < 0.001) versus the control group in having relatives with chronic renal disease, irrespective of race or causative illness. There is family clustering of chronic kidney disease in the sample studied, and this predisposition is irrespective of race and underlying disease (hypertension or diabetes mellitus).

Parameters of glycemic control in type 2 diabetic patients on hemodialysis or peritoneal dialysis: implications for clinical practice.

OBJECTIVE: To better explore the relationship between parameters of glycemic control of T2DM in RRT, we studied 23 patients on hemodialysis (HD), 22 on peritoneal dialysis (PD), and compared them with 24 T2DM patients with normal renal function (NRF). MATERIALS AND METHODS: We performed, on four consecutive days, 10 assessments of capillary blood glucose [4 fasting, 2 pre- and 4 postprandial (post-G) and average (AG)], random glycemia, and HbA1c in all patients. RESULTS: Preprandial blood glucose was greater in patients on RRT compared with NRF. Correlations between AG and HbA1c were 0.76 for HD, 0.66 for PD, and 0.82 for NRF. The regression lines between AG and HbA1c were similar for patients on HD and with NFR, but they were displaced upward for PD. CONCLUSION: Similar HbA1c values in PD patients may correspond to greater levels of AG than in HD or NRF patients.

Assessment of social and economic influences on blood pressure of adolescents in public and private schools: an epidemiological study.

INTRODUCTION: The high prevalence of hypertension in high school students in Sorocaba, São Paulo, Brazil, has already been described. In this study, within a new sample of high school students from public and private schools, we evaluated if socioeconomic and lifestyle influence on blood pressure values. METHODS: This is an epidemiological study, which is part of the activities of a community-based work conducted by medical students. They give speeches to high school students aiming at stimulating a healthy lifestyle and primary prevention of hypertension. In a random sample of 410 students in junior high school (209 from public schools and 201 from private schools), we determined the weight, height, and blood pressure, furthermore, a questionnaire identifying epidemiological and socioeconomic status was applied. RESULTS: No statistical differences were found among students from public and private schools regarding the distribution of gender, body mass index (BMI), systolic and diastolic blood pressure, prevalence of hypertension (16.3%), percentage of smokers (5.9%), regular physical activity, and family history of hypertension. In public schools, there is a higher percentage of African descendents students and a higher percentage of students who also work due to low family income. Men from public and private schools have higher prevalence of hypertension, and their mean blood pressure is higher than in women. BMI has a positive correlation with systolic and diastolic blood pressure. CONCLUSIONS: Hypertension and other cardiovascular risk factors have an early beginning and require educational interventions for primary prevention. Socioeconomic factors do not affect blood pressure in adolescence.