Tag: pubmed

Dermatol Surg. 2024 Oct 23. doi: 10.1097/DSS.0000000000004462. Online ahead of print.

ABSTRACT

BACKGROUND: Among the treatment modalities for post-acne scars, microneedling is considered a safe and effective method.

OBJECTIVE: To compare the efficacy and safety of combined microneedling with topical insulin versus microneedling with placebo (topical saline) in treating atrophic acne scars.

METHODS AND MATERIALS: Twenty-one patients with atrophic post-acne scars were randomized and treated in a split face manner with 4 sessions at 3-week intervals of microneedling using dermapen, followed by application of insulin on one side of the face and saline (placebo) on the other side. Evaluation of response was done before the sessions and after 1 month of the last session using the Global Scarring Grading System of Goodman & Baron and Lipper & Perez scores, Patient reported acne scar improvement using a 4-point scale, patient satisfaction, and the facial acne scar quality of life tools.

RESULTS: Both therapeutic modalities yielded a statistically significant improvement of atrophic acne scars. By comparing both modalities, there was no statistical significance regarding clinical improvement and side effects.

CONCLUSION: Using topical insulin combined with microneedling may have a value in improving atrophic acne scars, suggesting further evaluation using different delivery systems, insulin formulations, and assessment modalities.

PMID:39442178 | DOI:10.1097/DSS.0000000000004462

JMIR Bioinform Biotechnol. 2024 Oct 23;5:e58357. doi: 10.2196/58357.

ABSTRACT

BACKGROUND: Despite growing interest in the clinical translation of polygenic risk scores (PRSs), it remains uncertain to what extent genomic information can enhance the prediction of psychiatric outcomes beyond the data collected during clinical visits alone.

OBJECTIVE: This study aimed to assess the clinical utility of incorporating PRSs into a suicide risk prediction model trained on electronic health records (EHRs) and patient-reported surveys among patients admitted to the emergency department.

METHODS: Study participants were recruited from the psychiatric emergency department at Massachusetts General Hospital. There were 333 adult patients of European ancestry who had high-quality genotype data available through their participation in the Mass General Brigham Biobank. Multiple neuropsychiatric PRSs were added to a previously validated suicide prediction model in a prospective cohort enrolled between February 4, 2015, and March 13, 2017. Data analysis was performed from July 11, 2022, to August 31, 2023. Suicide attempt was defined using diagnostic codes from longitudinal EHRs combined with 6-month follow-up surveys. The clinical risk score for suicide attempt was calculated from an ensemble model trained using an EHR-based suicide risk score and a brief survey, and it was subsequently used to define the baseline model. We generated PRSs for depression, bipolar disorder, schizophrenia, suicide attempt, and externalizing traits using a Bayesian polygenic scoring method for European ancestry participants. Model performance was evaluated using area under the receiver operator curve (AUC), area under the precision-recall curve, and positive predictive values.

RESULTS: Of the 333 patients (n=178, 53.5% male; mean age 36.8, SD 13.6 years; n=333, 100% non-Hispanic and n=324, 97.3% self-reported White), 28 (8.4%) had a suicide attempt within 6 months. Adding either the schizophrenia PRS or all PRSs to the baseline model resulted in the numerically highest discrimination (AUC 0.86, 95% CI 0.73-0.99) compared to the baseline model (AUC 0.84, 95% Cl 0.70-0.98). However, the improvement in model performance was not statistically significant.

CONCLUSIONS: In this study, incorporating genomic information into clinical prediction models for suicide attempt did not improve patient risk stratification. Larger studies that include more diverse participants are required to validate whether the inclusion of psychiatric PRSs in clinical prediction models can enhance the stratification of patients at risk of suicide attempts.

PMID:39442166 | DOI:10.2196/58357

J Occup Environ Hyg. 2024 Oct 23:1-12. doi: 10.1080/15459624.2024.2400231. Online ahead of print.

ABSTRACT

Trichloramine is a disinfection by-product in chlorinated swimming pools. It can evaporate into the air and irritate eyes and airways among swimmers and pool workers. This study aimed to evaluate airborne concentrations of trichloramine in different types of indoor swimming pools. Altogether, 72 swimming pools across Sweden were included; 36 exercise pools, 16 instruction pools, seven adventure pools, and 13 rehabilitation pools. In total, 167 sampling sessions were performed with the majority (N = 91) conducted in public exercise pools. Repeated sampling sessions on different days were performed within all pool categories. Airborne trichloramine was measured stationary by the poolside using active sampling on quartz filters. In total, 434 air samples were collected. The geometric mean (GM) concentration of trichloramine for the exercise pools was 0.12 mg/m³ (range GM_pool: 0.02-0.29 mg/m³) and for about 30% the GM_pool exceeded the Swedish public health guideline value (0.2 mg/m³). The geometric mean for instruction pools was 0.18 mg/m³ and for adventure pools 0.20 mg/m³. Trichloramine concentrations were statistically significantly lower in rehabilitation pools (GM: 0.03 mg/m³) compared with the other pool categories. A statistically significant effect of time of the day for sampling was found for the exercise and instruction pools, with higher trichloramine levels during evenings compared with mornings and afternoons. For the rehabilitation pools, trichloramine was significantly higher during the cold season compared with the warm season. Variability in trichloramine concentrations was attributed to between-pool as well as within-pool variances. The within-pool variability encourages a repeated sampling strategy to capture the variation between different days. These findings have implications for exposure assessment in epidemiological studies as well as for indoor air quality monitoring. Trichloramine can cause acute irritative effects at elevated levels, and since trichloramine concentrations may differ depending on the time of the day it is recommended that full-day stationary measurements are supplemented with short-term samplings to capture these variations.

PMID:39442164 | DOI:10.1080/15459624.2024.2400231

Epidemiol Serv Saude. 2024 Oct 21;33(spe2):e20231393. doi: 10.1590/S2237-96222024v33e20231393.especial2.en. eCollection 2024.

ABSTRACT

OBJECTIVE: To analyze vaccination coverage according to social strata in children up to 24 months old, living in the municipality of Londrina (PR), Brazil.

METHODS: This was a population-based survey conducted between 2021 and 2022, in which vaccination coverage and sociodemographic aspects of mothers and families were evaluated using Pearson’s chi-square test.

RESULTS: In a sample of 456 children, complete vaccination coverage varied according to social strata, being 36.0% (95%CI 26.8;57.8); in stratum A; 59.5% (95%CI 26.1;86); in stratum B; 66.2% (95%CI 51.7;78.1); in stratum C; and 70.0% (95%CI 56.1;81.0) in stratum D.

CONCLUSION: The analysis of vaccination coverage indicated that social stratum A is at highest risk for vaccine-preventable diseases.

MAIN RESULTS: The results of the study showed low full vaccination coverage in children up to 24 months of age in Londrina, being higher in the less financially advantaged social stratum, compared to the most advantaged.

IMPLICATIONS FOR SERVICES: The results found can support the qualification of the immunization program and enable, based on planning and ongoing health education, the definition of unique strategies to improve vaccination coverage.

PERSPECTIVES: Future perspectives point to the importance of carrying out investigations into the challenges inherent to vaccination, as well as qualitative and quantitative research addressing health professionals to better understand the data.

PMID:39442146 | DOI:10.1590/S2237-96222024v33e20231393.especial2.en

Epidemiol Serv Saude. 2024 Oct 21;33(spe2):e20231309. doi: 10.1590/S2237-96222024v33e20231309.especial2.en. eCollection 2024.

ABSTRACT

OBJECTIVE: To analyze the reliability of records held on the National Immunization Program Information System (SI-PNI) in a subsample of children included in the national vaccination coverage survey in Brazilian state capitals and Federal District in 2020.

METHODS: This was a study of agreement between data recorded on vaccination cards (doses and dates) and on the SI-PNI for 4050 children with full coverage at 24 months.

RESULTS: Data on 3587 children were held on the SI-PNI, with losses of 11% (95%CI: 10;12). Total agreement between doses and dates in the two sources was 86% (95%CI: 86;87), however taking each dose and vaccine individually, variation was greater, with 32% of data in only one source.

CONCLUSION: Part of the information was not recorded, but the discrepancy can be considered small. Nonetheless, underrecording of doses and children can compromise vaccination coverage estimates, altering the numerator and denominator data.

MAIN RESULTS: Subsample of 4,050 children, among those completing the full schedule at 24 months studied in the national survey, 11% had not been recorded on the SI-PNI, 32% had unrecorded doses (doses or dates) and there was 8% disagreement between vaccination cards and SI-PNI records.

IMPLICATIONS FOR SERVICES: Recognizing the difficulties faced by the SI-PNI and the discrepancies between sources is essential for adopting initiatives to improve data quality, so as to avoid inaccurate estimates of childhood vaccination coverage.

PERSPECTIVES: This study is expected to contribute to improving the quality of records and the usability of data for monitoring vaccination coverage of the immunization program from the local to the national level.

PMID:39442145 | DOI:10.1590/S2237-96222024v33e20231309.especial2.en

Epidemiol Serv Saude. 2024 Oct 21;33(spe2):e20231206. doi: 10.1590/S2237-96222024v33e20231206.especial2.en. eCollection 2024.

ABSTRACT

OBJECTIVE: To evaluate vaccination coverage and delay in vaccine dose administration in infants in six municipalities in the Southern region of Brazil.

METHODOLOGY: National Vaccination Coverage Survey 2020, with infants born alive in 2017 and 2018, carried out from September 2020 to March 2022. Coverage of doses administered, doses administered on time and delay in dose administration were evaluated.

RESULTS: For 4681 infants analyzed, coverage for vaccines recommended up to 24 months was 68.0% (95%CI 63.9;71.8%) for doses administered and 3.9% (95%CI 2.7%;5.7%) for doses administered on time. Delay time for the majority of late vaccinations was ≤ 3 months. For some boosters, 25% of vaccine administration was delayed by ≥ 6 months.

CONCLUSION: In addition to tracking vaccine defaulters, strategies are needed to encourage compliance with the vaccination schedule at the recommended ages.

MAIN RESULTS: Vaccination coverage for the set of vaccines recommended up to 24 months was 68.0% and 3.9% for on-time doses. Delay time for some doses exceeded six months in up to 25% of infants with delayed vaccination.

IMPLICATIONS FOR SERVICES: Monitoring vaccine administration at the recommended ages is necessary, with the adoption of strategies that reinforce routine vaccination to prevent vaccination delays and abandonment.

PERSPECTIVES: Primary care in surveillance and care for infants needs to reinforce actions to ensure timely vaccination. Studies to deepen knowledge of vaccination delay, determinants and strategies for their reduction are necessary.

PMID:39442144 | DOI:10.1590/S2237-96222024v33e20231206.especial2.en

Epidemiol Serv Saude. 2024 Oct 21;33(spe2):e20231162. doi: 10.1590/S2237-96222024v33e20231162.en. eCollection 2024.

ABSTRACT

OBJECTIVE: To estimate hepatitis A vaccination coverage in 24-month-old children and identify factors associated with non-vaccination.

METHODS: This was a survey involving a sample stratified by socioeconomic strata in capital cities (2020-2022), with coverage estimates and 95% confidence intervals (95%CI), the factor analysis was performed using the prevalence ratio (PR) by means of Poisson regression.

RESULTS: Among 31,001 children, hepatitis A coverage was 88.1% (95%CI 86.8;89.2). Regarding socioeconomic strata (A/B), the variable immigrant parents/guardians was associated with non-vaccination (PR = 1.91; 95%CI 1.09;3.37); in strata C/D, children of Asian race/skin color (PR = 4.69; 95%CI 2.30;9.57), fourth-born child or later (PR = 1.68; 95%CI 1.06;2 .66), not attending daycare/nursery (PR = 1.67; 95%CI 1.24;2.24) and mother with paid work (PR = 1.42; 95%CI 1.16;1.74) were associated with non-vaccination.

CONCLUSION: Hepatitis A coverage was below the target (95%), suggesting that specificities of social strata should be taken into consideration.

MAIN RESULTS: Hepatitis A vaccination coverage was 88%. Non-vaccination was greater in children with immigrant guardians (strata A/B); of Asian race/skin color, fourth-born child or later, those not attending daycare/nursery and mother with paid work (C/D strata).

IMPLICATIONS FOR SERVICES: The results of this study contributed to the Ministry of Health and Health Departments in monitoring vaccination coverage and identifying factors that may negatively impact hepatitis A vaccination coverage.

PERSPECTIVES: Further research is needed on the impact of migration on hepatitis A vaccination and vaccination in general. Health managers should be attentive to the different factors affecting vaccination among social strata.

PMID:39442143 | DOI:10.1590/S2237-96222024v33e20231162.en

Arq Bras Cardiol. 2024 Oct 18;121(10):e20240251. doi: 10.36660/abc.20240251. eCollection 2024.

ABSTRACT

BACKGROUND: Arterial stiffness is associated with higher burden of atrial arrhythmias and worsening left atrial function (conduit and reservoir), even before dilation of this cavity. PACs: premature atrial contractions; cfPWV: carotid-femoral pulse wave velocity.

BACKGROUND: Increased arterial stiffness is currently an independent risk factor for atrial fibrillation, but the pathophysiological mechanisms of this arrhythmia remain an area of knowledge gap to be explored.

OBJECTIVES: To investigate the existence of an association between arterial stiffness and the density of premature atrial contractions (PACs) in hypertensive individuals without atrial fibrillation.

METHODS: Cross-sectional study with hypertensive patients without diagnosed atrial fibrillation, who were studied with speckle-tracking echocardiography to assess left atrial (LA) strain and carotid-femoral pulse wave velocity (cfPWV) to assess arterial stiffness. All patients underwent 24h-ECG Holter and laboratory tests. Significance level was set at p<0.05.

RESULTS: Seventy participants from a single centre without overt cardiovascular disease were included. The cfPWV was correlated with higher density of PACs in 24h-Holter monitoring, independently of LV mass index (1.48 [1.08-2.03], p-value 0.005). Increased cfPWV was correlated with decreased LA strain values, with Spearman correlation coefficients of -0.27 (p-value 0.027) and -0.29 (p-value 0.018) for reservoir and conduit 2D Strain, respectively.

CONCLUSIONS: In this study with hypertensive patients, it was possible to demonstrate an association between arterial stiffness and higher density of atrial arrhythmias. Furthermore, arterial stiffness was associated with lower left atrial strain values for reservoir and conduit functions.

PMID:39442141 | DOI:10.36660/abc.20240251

Arq Bras Cardiol. 2024 Oct 18;121(10):e20240149. doi: 10.36660/abc.20240149. eCollection 2024.

ABSTRACT

BACKGROUND: Individual and Joint Association between Cardiovascular Disease Risk Factors and Inadequate Lifestyle Behaviors in a Sample from Brazil. CVD: cardiovascular diseases.

BACKGROUND: Cardiovascular diseases (CVD) are often influenced by modifiable factors, notably individuals’ lifestyle choices, which play a crucial role in modulating cardiovascular risk.

OBJECTIVE: To investigate the individual and simultaneous association between inadequate lifestyle behaviors and risk factors for CVD in adults and older adults.

METHOD: A cross-sectional study with 1079 users of the Health Academy Program in Brazil. Information related to inadequate diet, excessive alcohol consumption, smoking, and physical inactivity were individually and collectively investigated (0, 1, or ≥ 2 factors) in association with CVD risk factors (hypertension, hypercholesterolemia, diabetes mellitus, and obesity), considering the following two outcomes: presence of CVD risk factors and number of CVD risk factors present in the same individual (0, 1, 2, or ≥ 3 risk factors). Logistic and multinomial logistic regression analyses were used. The statistical significance adopted was 5%.

RESULTS: A higher number of inadequate lifestyle behavior was associated with greater odds of simultaneous presence of 1, 2, or ≥ 3 CVD risk factors. The simultaneous adoption of 1 and ≥ 2 inadequate lifestyle behaviors was associated with greater odds of hypercholesterolemia. Simultaneous adherence to ≥ 2 inadequate lifestyle behaviors was associated with lower odds of hypertension.

CONCLUSION: A greater number of inadequate lifestyle behaviors was associated with higher odds of simultaneous presence of multiple CVD risk factors.

PMID:39442139 | DOI:10.36660/abc.20240149

Arq Bras Cardiol. 2024 Oct 18;121(10):e20230453. doi: 10.36660/abc.20230453. eCollection 2024.

ABSTRACT

BACKGROUND: The postoperative period of heart valve surgery is challenging due to the risk of bleeding, leading to complications and increased morbidity and mortality.

OBJECTIVE: To develop a risk score to predict bleeding in patients after valve surgery.

METHODS: Retrospective study of patients operated on between 2021 and 2022. Patients with major bleeding were selected based on the BARC and Bojar criteria. A logistic regression analysis was performed for factors related to bleeding and a nomogram of scores was created. For statistical significance, p<0.05 and a 95% confidence interval were considered. The study was approved by the CEP.

RESULTS: 525 patients were analyzed, with a mean age of 56 years and a predominance of females. The most common valve disease was mitral insufficiency, 8.8% had increased bleeding and 4.3% had surgical reoperations. The variables with statistical significance were tricuspid insufficiency (OR 3.31, p < 0.001), chronic kidney disease/acute kidney injury (OR 2.97, p = 0.006), preoperative hemoglobin (OR 0.73, p < 0.001), reoperations (OR 2, 5, p = 0.003), cardiopulmonary bypass (CPB) time (OR 1.12, p < 0.001), 2-valve approach OR of 2.23 (p = 0.013), use of packed red blood cells OR of 2.8 (p = 0.001). In the multiple model, tricuspid insufficiency, CPB time and preoperative hemoglobin reached statistical significance.

CONCLUSION: CPB time, preoperative hemoglobin and tricuspid insufficiency were independently associated with postoperative bleeding. The proposed scale is plausible and can help predict the risk of bleeding.

PMID:39442138 | DOI:10.36660/abc.20230453