Predictors of transportation-related barriers to healthcare access in a North American suburb.

Aim: To identify predictors of transportation-related barriers to healthcare access in a North American suburb. Subject and methods: Data from the 2022 Scarborough Survey were used, comprising n = 528 adults living in Scarborough, which is a subu

Características Clínicas e Manejo de Pacientes Avaliados por Teleconsulta Cardiológica na Região Brasileira com Maior Número de Cidades Isoladas / Clinical Features and Management of Patients Assessed by Cardiology Teleconsultation in the Brazilian Region with the Highest Number of Isolated Cities

Resumo Fundamento As doenças cardiovasculares são a principal causa de morte no mundo. Regiões brasileiras geograficamente remotas e de baixa renda carecem de consultas especializadas. Não se tem conhecimento total acerca do manejo por telemedicina dessa população por parte de cardiologistas. Objetivos Analisar a teleconsulta cardiológica na região brasileira com maior número de municípios isolados. Métodos Entre fevereiro de 2020 e outubro de 2021, pacientes da Região Norte do Brasil avaliados por médicos generalistas locais foram encaminhados para avaliação cardiológica por telemedicina. Foram analisados os motivos do encaminhamento, dados demográficos, histórico clínico, exames físicos, exames complementares, medicamentos e prescrições pré e pós-telemedicina (considerou-se p<0,05 como estatisticamente significativo). Resultados Analisamos 653 pacientes. A taxa de frequência foi de 85,7% (53,1% do sexo feminino, idade média: 54,2±6,5 anos). Os principais motivos de encaminhamento foram sintomas cardiovasculares (58,1%) e fatores de risco entre pacientes assintomáticos (13,3%). Apenas 12,6% apresentava alguma doença diagnosticada. A maioria dos pacientes havia passado por exame físico e eletrocardiogramas regulares. Poucos tinham exames complementares recentes. A prescrição de bloqueadores dos receptores da angiotensina (BRA), bloqueadores dos canais de cálcio e estatinas aumentou significativamente, enquanto a de digoxina, betabloqueadores não cardíacos e ácido acetilsalicílico (AAS) diminuiu na primeira teleconsulta. A maioria dos exames complementares solicitados era de baixa complexidade e custo: eletrocardiograma (28,2%), radiografia de tórax (14%), ecocardiograma (64,5%) e exames de sangue (71,8%). Para 2,1% dos pacientes, foram indicadas intervenções, e 8% recebeu alta após a primeira consulta. Conclusão A teleconsulta cardiológica sob demanda contribui para a otimização do tratamento das doenças cardíacas. A maioria dos pacientes foi encaminhada com diagnósticos sindrômicos sem exames complementares prévios. A avaliação especializada solicitada geralmente estava disponível localmente e com baixo custo, mas impedia a alta precoce. Capacitação local poderia otimizar o encaminhamento.

Abstract Background Cardiovascular diseases are the leading cause of adult mortality. Geographically remote and low-income Brazilian regions lack specialized consultations. The telemedicine management of this population by cardiologists is not fully known. Objectives To analyze cardiology teleconsultation in the Brazilian region with the highest number of isolated cities. Methods From February 2020 to October 2021, patients from the North Region of Brazil evaluated by local general practitioners were referred for cardiological evaluation by telemedicine. Referral reasons, demographics, clinical history, physical examinations, tests, medications, and prescriptions pre- and post-telemedicine were analyzed (p<0.05 was considered statistically significant). Results We analyzed 653 patients. The attendance rate was 85.7% (53.1% female, mean age: 54.2±6.5 years). The main reasons for referral were cardiovascular symptoms (58.1%) and risk factors among asymptomatic patients (13.3%). Only 12.6% had a diagnosed disease. Most patients had regular physical examinations and electrocardiograms. Few had recent complementary tests. The prescription of angiotensin receptor blockers (ARBs), calcium channel blockers and statins was significantly increased, while that of digoxin, noncardiac beta-blockers and acetylsalicylic acid (ASA) was decreased at the first teleconsultation. Most of the tests requested were of low complexity and cost: electrocardiogram (28.2%), chest X-ray (14%), echocardiogram (64.5%) and blood tests (71.8%). For 2.1% of patients, interventions were indicated, and 8% were discharged after the first consultation. Conclusion On-demand cardiology teleconsultation contributes to heart disease treatment optimization. Most patients were referred with syndromic diagnoses without previous complementary tests. The specialist workup requested was usually available locally and at a low cost but precluded early discharge. Local training could optimize the referral.

Healthy or diseased mouth? representations of oral health in vulnerable populations / ¿Boca sana o boca enferma? representaciones de la salud bucal en sectores vulnerables

Background: The society and the State must provide dental care and help prevent oral health problems by implementing public policies with cultural relevance that allow society to address and improve the inequity in health care that systematically affects people's well-being. The present study seeks to understand the representations of dental health in people who attend primary care services in vulnerable urban and rural areas of the central zone of Chile. Specifically, the representations of the causes, morbidities, and symptoms attributed to the healthy and diseased mouth. Material and Methods: A qualitative study based on the Grounded Theory was conducted, analyzing the social representations of oral health in a sample of 161 adult people receiving treatment at public primary care services and dental emergency units in rural and urban communes. Empirical saturation and triangulation by time, place, and subjects give reliability to the study. Results: The data obtained show that dental health is mainly valued for its implications for self-esteem and social integration. A naturalization of dental health problems is evidenced as an adaptive strategy to traditional access barriers, which is counterproductive with preventive strategies. Conclusion: The results of the study suggest the need to reinforce education in dental health implemented in a transversal manner, having aesthetic values and the population's expectations of sociability as the key to action.

Antecedentes: Como sociedad y desde el Estado debemos cuidar y prevenir los problemas de salud oral invirtiendo en políticas públicas con pertinencia cultural que nos permitan subsanar la inequidad sanitaria que afecta de manera integral el bienestar de las personas. El estudio busca comprender las representaciones de la salud dental en personas que asisten a la atención primaria en sectores urbanos y rurales vulnerables de la zona central de Chile; en especial las representaciones de las causas, morbilidades y síntomas atribuidos a la boca sana y enferma. Material y Métodos: Estudio cualitativo que analiza desde la Teoría Fundamentada las representaciones sociales de la salud bucodental en una muestra de 161 personas adultas consultantes de los servicios públicos de atención primaria y de urgencia odontológica en comunas rurales y urbanas. La saturación empírica y la triangulación por tiempo, lugar y sujetos otorgan confiabilidad al estudio. Resultados: Los datos obtenidos dan cuenta que la salud dental es principalmente valorada por sus implicancias para la autoestima y la integración social. Se evidencia una naturalización de los problemas de salud dental, como estrategia adaptativa a las tradicionales barreras de acceso, lo que es contraproducente con las estrategias preventivas. Conclusión: Los resultados del estudio nos alertan respecto de la necesidad de reforzar la educación en salud dental, teniendo como clave para la acción, de manera transversal, los valores estéticos y las expectativas de sociabilidad de la población.

Health literacy and quality of life among people in semi-urban and urban areas / Letramento em saúde e qualidade de vida entre pessoas em áreas semiurbanas e urbanas / Alfabetización en salud y calidad de vida entre personas en áreas semiurbanas y urbanas

Abstract Objective: to investigate health literacy level, quality of life and related factors in semi-urban and urban areas. Method: this cross-sectional study was carried out between December 2018 and February 2019 with 595 participants. The variables found significant in the bivariate regression analysis were included in the multivariate regression analysis. Results: according to the scores obtained from the Health Literacy Scale, participants' health literacy 76.5% levels were adequate. The factors affecting the Health Literacy Scale score in semi-urban areas were educational status, income status, presence of a chronic disease, perceived health, and understanding the health information provided. The factors affecting the Health Literacy Scale score in urban areas were age, marital status, reading habits, presence of a chronic disease, and understanding the health information provided (p < .05). There was a statistically significant difference between participants living in semi-urban and urban areas in terms of their health literacy and quality of life levels (p < .001). Conclusion: the health literacy level was inadequate in three out of ten participants, and it was even lower in semi-urban areas.

RESUMO Objetivo: investigar o nível de letramento em saúde, qualidade de vida e fatores relacionados em áreas semiurbanas e urbanas. Método: este estudo transversal foi realizado entre dezembro de 2018 e fevereiro de 2019 com 595 participantes. As variáveis encontradas significativas na análise de regressão bivariada foram incluídas na análise de regressão multivariada. Resultados: de acordo com os escores obtidos na Health Literacy Scale, os níveis de letramento em saúde dos participantes de 76,5% estavam adequados. Os fatores que afetaram a pontuação da Health Literacy Scale em áreas semiurbanas foram escolaridade, renda, presença de doença crônica, percepção de saúde e compreender as informações de saúde fornecidas. Os fatores que afetaram a pontuação da Health Literacy Scale em áreas urbanas foram idade, estado civil, hábitos de leitura, presença de doença crônica e compreender as informações de saúde fornecidas (p < 0,05). Houve uma diferença estatisticamente significativa entre os participantes que vivem em áreas semiurbanas e urbanas em termos de letramento em saúde e níveis de qualidade de vida (p < 0,001). Conclusão: o nível de letramento em saúde foi inadequado em três dos dez participantes, sendo ainda menor nas áreas semiurbanas.

RESUMEN Objetivo: investigar el nivel de alfabetización en salud, calidad de vida y factores relacionados en áreas semiurbanas y urbanas. Método: este estudio transversal se realizó entre diciembre de 2018 y febrero de 2019 con 595 participantes. Las variables que se encontraron significativas en el análisis de regresión bivariante se incluyeron en el análisis de regresión multivariante. Resultados: según los puntajes obtenidos en la Health Literacy Scale, los niveles de alfabetización en salud de los participantes del 76,5% fueron adecuados. Los factores que afectaron los puntajes de la Health Literacy Scale en áreas semiurbanas fueron la educación, los ingresos, la presencia de enfermedades crónicas, la salud percibida y comprender la información de salud proporcionada. Los factores que afectaron el puntaje de la Health Literacy Scale en áreas urbanas fueron la edad, el estado civil, los hábitos de lectura, la presencia de una enfermedad crónica y comprender la información de salud proporcionada (p < 0,05). Hubo una diferencia estadísticamente significativa entre los participantes que vivían en áreas urbanas y semiurbanas en términos de alfabetización en salud y niveles de calidad de vida (p < 0,001). Conclusión: el nivel de alfabetización en salud fue inadecuado en tres de cada diez participantes, y fue aún más bajo en las áreas semiurbanas.

Comparison of Dental Caries and Oral Hygiene Status of Children in Suburban with those in Rural Population of Southwestern Nigeria

ABSTRACT Objective: To compare prevalence of dental caries, oral hygiene status and associated risk factors of children in suburban and rural communities in the Southwest region of Nigeria. Material and Methods: Secondary data was extracted from cross-sectional researches conducted in two study locations involving 8 to 12 year olds. Data retrieved included age, gender, family structure, socioeconomic status, oral hygiene and dental caries. Caries assessment was done using WHO Oral Health Survey methods. Oral hygiene data was collected using Simplified Oral Hygiene Index (OHI-S) by Greene and Vermillion. Statistical significance was established at p<0.05. Results: The prevalence of dental caries in Group A and Group B study participants were 13.4% and 22.2% respectively. Children from rural community had significant higher caries prevalence (p=0.00) and poorer oral hygiene (P=0.00) compare with their counterparts in the suburban community. There was a significant association between oral hygiene, age and dental caries in suburban participants (p=0.02) while among the rural participants there was significant association between gender and dental caries (p=0.04). Children with poor oral hygiene have increased odds of having dental caries compared to children with good oral hygiene in the two study communities. Conclusion: Dental caries was more prevalent among the rural dwellers than the sub-urban dwellers. There is a need to make oral health care services/products available, accessible and affordable for the rural community.

The effects of water-pipe smoking on birth weight: a population-based prospective cohort study in southern Iran.

OBJECTIVES: Consecutive community health assessments revealed that water-pipe smoking in women and impaired growth in children were among the main health concerns in suburban communities in southern Iran. The aim of the present study was to identify the effects of water-pipe smoking during pregnancy on birth weight. METHODS: Data from a population-based prospective cohort study of 714 singleton live pregnancies in the suburbs of Bandar Abbas in southern Iran in 2016-2018 were used in this study. Data about water-pipe smoking patterns and birth weight were collected by questionnaires during and after the pregnancy. Low birth weight (LBW) was defined as a birth weight below 2,500 g. Statistical analyses were performed using generalized linear models, and the results were presented in terms of relative risk (RR) and 95% confidence intervals (CI). RESULTS: Fifty (8.2%) of the study subjects smoked water-pipe. The adjusted risk of LBW increased 2-fold in water-pipe smokers (adjusted RR [aRR], 2.09; 95% CI, 1.18 to 3.71), and by 2.0% for each 1-year increase in the duration of water-pipe smoking (aRR, 1.02; 95% CI, 0.99 to 1.05). CONCLUSIONS: Our results showed that water-pipe smoking during pregnancy was an important risk factor for LBW in this population sample from southern Iran. The introduction of regulations onto prevent water-pipe smoking and the implementation of community health action plans aiming at empowering women and increasing women's knowledge and awareness regarding the health consequences of water-pipe smoking are proposed.

The effects of water-pipe smoking on birth weight: a population-based prospective cohort study in southern Iran / 한국역학회지

OBJECTIVES: Consecutive community health assessments revealed that water-pipe smoking in women and impaired growth in children were among the main health concerns in suburban communities in southern Iran. The aim of the present study was to identify the effects of water-pipe smoking during pregnancy on birth weight.METHODS: Data from a population-based prospective cohort study of 714 singleton live pregnancies in the suburbs of Bandar Abbas in southern Iran in 2016–2018 were used in this study. Data about water-pipe smoking patterns and birth weight were collected by questionnaires during and after the pregnancy. Low birth weight (LBW) was defined as a birth weight below 2,500 g. Statistical analyses were performed using generalized linear models, and the results were presented in terms of relative risk (RR) and 95% confidence intervals (CI).RESULTS: Fifty (8.2%) of the study subjects smoked water-pipe. The adjusted risk of LBW increased 2-fold in water-pipe smokers (adjusted RR [aRR], 2.09; 95% CI, 1.18 to 3.71), and by 2.0% for each 1-year increase in the duration of water-pipe smoking (aRR, 1.02; 95% CI, 0.99 to 1.05).CONCLUSIONS: Our results showed that water-pipe smoking during pregnancy was an important risk factor for LBW in this population sample from southern Iran. The introduction of regulations onto prevent water-pipe smoking and the implementation of community health action plans aiming at empowering women and increasing women's knowledge and awareness regarding the health consequences of water-pipe smoking are proposed.

The effects of water-pipe smoking on birth weight: a population-based prospective cohort study in southern Iran / 한국역학회지

OBJECTIVES: Consecutive community health assessments revealed that water-pipe smoking in women and impaired growth in children were among the main health concerns in suburban communities in southern Iran. The aim of the present study was to identify the effects of water-pipe smoking during pregnancy on birth weight. METHODS: Data from a population-based prospective cohort study of 714 singleton live pregnancies in the suburbs of Bandar Abbas in southern Iran in 2016–2018 were used in this study. Data about water-pipe smoking patterns and birth weight were collected by questionnaires during and after the pregnancy. Low birth weight (LBW) was defined as a birth weight below 2,500 g. Statistical analyses were performed using generalized linear models, and the results were presented in terms of relative risk (RR) and 95% confidence intervals (CI). RESULTS: Fifty (8.2%) of the study subjects smoked water-pipe. The adjusted risk of LBW increased 2-fold in water-pipe smokers (adjusted RR [aRR], 2.09; 95% CI, 1.18 to 3.71), and by 2.0% for each 1-year increase in the duration of water-pipe smoking (aRR, 1.02; 95% CI, 0.99 to 1.05). CONCLUSIONS: Our results showed that water-pipe smoking during pregnancy was an important risk factor for LBW in this population sample from southern Iran. The introduction of regulations onto prevent water-pipe smoking and the implementation of community health action plans aiming at empowering women and increasing women's knowledge and awareness regarding the health consequences of water-pipe smoking are proposed.

Lifestyles in suburban populations: A systematic review.

BACKGROUND: Lifestyle and suburban population are important issues in the field of health. The living conditions of informal settlements can lead to acquisition of an unhealthy lifestyle. OBJECTIVE: This study has been designed to investigate the articles that have been published regarding lifestyle in suburban populations. METHODS: The present research was a systematic review of studies in databases including Iranmedex, Magiran, SID, Irandoc, PubMed, Google Scholar, Science Direct and Scopus, in 2017. All Persian and English papers written from 2000 to 2017 were evaluated by two reviewers using an advanced search of the databases with keywords related to lifestyles and suburban population. After completion of the search, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used to evaluate the articles. RESULTS: In total, 19 articles were found to have addressed the lifestyle in suburban populations. The results of these studies showed an unhealthy lifestyle in the most informal settlements. There was no food diversity. Malnutrition was common, especially overweight. The majority of the people did not have enough physical activity, and smoking and alcohol consumption were common, especially in men. CONCLUSION: Studies showed that suburban populations are among the groups that have unfavorable environmental conditions to acquiring healthy lifestyle and maintaining appropriate health. Therefore, developing infrastructure, improving health services (environment, treatment of diseases, reduction of malnutrition and infant mortality, access to safe drinking water and sanitation, improving waste disposal and recycling it), improving education and smoking prevention programs in improving lifestyle is recommended.

Age Specific Peak Expiratory Flow Nomogram in Children.

OBJECTIVE: To determine peak flow rate nomogram in children between 5 to 12 y of age in suburban population. METHODS: This was a cross-sectional study randomly done on 5000 healthy school children. Mini-Wright flow meter was used for measurement of peak expiratory flow rate (PEFR). The range of age, weight and height were defined and linear and multiple regression analysis were performed. RESULTS: Correlation between PEFR and height was more significant and between PEFR and weight was lower. On the basis of height, the regression equation for both sexes were drawn; Boys: PEFR = 3.29 (Height in cm) - 218.38; Girls: PEFR = 3.25 (Height in cm) - 216.49. CONCLUSIONS: Thus, region specific nomograms for PEFR for assessing the severity and monitoring of airway obstruction in relation to age, sex, weight and height of children can be determined.

Situación de salud en asentamientos precarios / The health situation of precarious settlements

OBJETIVO: Conocer la situación de salud de los miembros del Campamento Manuel Bustos, en la región de Valparaíso, considerando sus características socioeconómicas y ambientales y la autopercepción del estado de salud. Material y MÉTODO: Se realizó una investigación cuantitativa, descriptiva y no experimental. Se aplicó un cuestionario a través de una entrevista semiestructurada a una muestra de 89 familias del campamento. RESULTADOS: Las familias del campamento se caracterizan principalmente por ser jóvenes, asistir a controles (principalmente el Niño Sano y EMPA), estar casi en su totalidad inscritos en un CESFAM. Las viviendas poseen irregular eliminación de excretas y un 40% de los hogares tiene algún miembro con hipertensión arterial. En promedio, los residentes valoran su estado de salud con nota 5 en una escala de 1 a 7.CONCLUSIÓN: Se observó que la situación de salud de los habitantes del campamento presenta aspectos positivos vinculados a la inscripción en CES-FAM y la asistencia a controles. No obstante, la alta presencia de hipertensión arterial, las precarias condiciones de eliminación de excretas y la presencia de basurales cercanos son factores de riesgo para la salud, que deberán ser atendidas por los organismos gubernamentales y no gubernamentales que trabajan en este territorio.

OBJECTIVE: To explore the health status of members of the Manuel Bustos Settlement, in the region of Valparaiso, in terms of socioeconomic and environmental characteristics and their self-perceived health status. MATERIAL AND METHODS: A descriptive and non-experimental quantitative study was conducted. A questionnaire was applied through semistructured interviews to 89 families in the settlement. RESULTS: Families of the settlement are characterized principally by their young age, for attending regular health appointments (mainly the Well Child check ups and preventative annual physical exam for adults), and, in the case of the majority, for being enrolled in a local community health center. Their houses have irregular human waste disposal and 40% of households have a member with hypertension. On average, the residents valued their health status with a grade of 5, on a scale from 1 to 7. CONCLUSIONS: The health situation of the inhabitants of the settlement presents positive as-pects related to health center enrollment and regular attendance of controls. However, the high prevalence of hypertension, the precarious conditions of eliminating human waste, and the pre-sence of nearby landfills are risk factors for health that must be addressed by government and nongovernmental organizations, which work in this territory.

Violencia en la red social: una indagación de expresiones online en adolescentes de sectores populares marginalizados del Área Metropolitana de Buenos Aires / Violence in social networks: an exploration of the online expressions of teens from marginalized areas of Greater Buenos Aires

RESUMEN Este trabajo explora las expresiones online de violencia ejercida o padecida por las y los adolescentes de sectores populares marginalizados del Área Metropolitana de Buenos Aires. Desde una metodología cualitativa, se indagan cuatro fenómenos específicos: las amenazas, los "bondis", el cyberbullying y los duelos, para lo cual se realizaron veinte entrevistas en profundidad y 3.000 observaciones virtuales de perfiles de la red social Facebook entre 2013 y 2014. Entre los principales resultados, se observa que la mayoría de las expresiones de violencia se enmarcan en una dinámica offline-online. Asimismo, se ofrece evidencia empírica a partir de la cual es posible afirmar que las expresiones de violencia de estos adolescentes se despliegan en torno a la cultura del "aguante". El artículo se pregunta si en la plataforma icónica del "me gusta" estas expresiones resultan implícitamente funcionales a la red social o si, por el contrario, permiten desplazamientos y reapropiaciones significativas de los usuarios. En definitiva, se abren nuevos interrogantes acerca de la utilización de estas herramientas por parte de adolescentes de sectores populares marginalizados y se propone complejizar los enfoques en torno a estos fenómenos.

ABSTRACT This paper explores the online expressions of violence perpetrated or experienced by adolescents from marginalized areas of Greater Buenos Aires, Argentina. Using a qualitative methodology, four specific events were examined: threats, "bondis" [fights], cyberbullying and displays of mourning. To do so, 20 in-depth interviews and 3,000 virtual observations of profiles in the social network Facebook were carried out. Among the main results, it was seen that most expressions of violence are part of an offline-online dynamic. Empirical evidence is also offered based upon which it can be affirmed that the expressions of violence of these teenagers are developed around the culture of "aguante" [fierce loyalty]. The article ponders the extent to which, in the iconic platform of the option "like," these expressions are implicitly functional to the social network or, to the contrary, or whether they allow displacements and significant reappropriations on the part of users. New questions arise about the use of these tools by adolescents from marginalized areas and the need for more complex approaches to examine these phenomena.

Prevalence of chronic pain, impact on daily life, and treatment practices in India.

OBJECTIVE: Chronic pain is of concern to health professionals, patients, society, and negatively impacts quality of life (QoL). The present epidemiologic study identified point prevalence of chronic pain in India, impact on individual's QoL, unveiling current pain treatment practices, and levels of satisfaction with treatment. METHODS: This epidemiological telephonic survey consisted of two questionnaires: screening questionnaire that assessed prevalence of pain, its frequency during the past week, intensity during last episode, sites of pain, and main causes, and in-depth questionnaire that evaluated demography, frequency, duration, and intensity of pain; impact of pain on QoL; respondent's perception regarding the attitude of their family, friends, and doctors toward their pain. RESULTS: A total of 5004 respondents were included from eight cities across India. The overall point prevalence of chronic pain was 13%, and the mean intensity of pain on NRS scale was 6.93. Respondents with chronic moderate and chronic severe pain were 37% and 63%, respectively. Pain in knees (32%), legs (28%), and joints (22%) was most prevalent. Respondents with chronic pain were no longer able to exercise, sleep, maintain relationships with friends and family, and maintain an independent lifestyle. About 32% of patients lost ≥4 hours of work in the past 3 months. Majority (68%) of respondents were treated for pain with over the counter (OTC) drugs, and most were taking NSAIDs (95%). CONCLUSION: A significant population of India suffers from chronic pain, and their QoL is affected leading to disability. A proportion of respondents receiving pain treatment were taking nonprescription medications with a majority of respondents on NSAIDs. A very few were consulting pain management specialists.

Age- and sex-dependent reference intervals for D-dimer: evidence for a marked increase by age.

INTRODUCTION: A low D-dimer is commonly used to exclude venous thromboembolism in low risk patients. However, the reference intervals are poorly defined and D-dimer has been shown to increase by patient age. We aimed to establish age- and sex-dependent D-dimer reference intervals and to test the consequence of different cut-off limits. MATERIALS AND METHODS: By means of the STA-Lia test D-dimer was measured in 1,352 subjects aged between 23 and 93years from the general population. A further 94 subjects were measured with the HemosIL test. RESULTS: The reference intervals were age-dependent with the upper 95% limit increasing from 0.92 FEU mg/L in the age group <50years to 2.39 FEU mg/L in the group ≥70years. Minor differences in the reference intervals between sexes were found. The commonly used cut-off at 0.5 FEU mg/L resulted in a decrease of negatives from 91% in <50years to 56 % in ≥70years. The age-dependent cut-off value (patient's age*0.01 FEU mg/L in 50+ years) resulted in an increase of negatives by age. The linear increase in D-dimer has a slope at approximately 0.0077*age, meaning that a cut-off at (patient's age*0.0077) FEU mg/L, gives an almost constant number of positives across age groups. The two assays showed a poor correlation and a higher percentage of positives using the STA Lia test. CONCLUSIONS: The age-dependent increase in D-dimer seen in patients was confirmed, which questions the clinical value of the present cut-off for venous thromboembolism.

Lead exposure among the general population of Duhok governorate, Kurdistan region, Iraq

This study was carried out to establish baseline data on lead exposure in a sample of the general population from Duhok governorate, Iraq in 2011. A cross-sectional study was made of blood lead levels of 820 individuals and of dust and of air lead levels in urban, suburban and rural residential areas. Mean blood lead [BPb] value in the overall sample was 7.3 [SD 2.8] microg/dL, range 1.6-17.0 microg/dL; significant differences were found with respect to age, area of residence, altitude and distance from a gasoline generator. The prevalence of toxic levels of lead [BPb > 10 microg/dL] was 22.8% overall and 2.4% in children. People living in suburban areas [39.7%] and < 50 m from a gasoline generator [93.1%] were exposed to high environmental lead levels. A linear relationship was found between BPb and air lead levels [r= 0.8]. While lead exposure does not constitute a great health problem for adults in our community, 2.4% of the children had toxic lead levels and measures to reduce exposure to environmental heavy metals should be considered

Effect of nutritional intervention on the prevalence of metabolic syndrome and heart disease risk factors in urban Tehran [Tehran Lipid and Glucose Study]

In a case-control study a nutritional intervention consisting of an educational programme based on the Therapeutic Lifestyle Change diet [TLC] guidelines was implemented in one area of Tehran. Data were collected from subjects in the intervention area [n =133] and controls from another area [n =183], before and 3.8 years after the intervention. Mean energy and macronutrient intakes and prevalence of risk factors including metabolic syndrome were compared between and within cases and controls. Baseline and follow-up evaluations showed improvement in hypercholesterolemia and high LDL cholesterol levels in cases versus controls. Central obesity and low HDL cholesterol levels increased significantly in controls but not in cases. As there were no significant differences between the 2 groups in energy and macronutrient intakes, it is difficult to claim that nutritional interventions played an important role