Tag: pubmed

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

Arq Gastroenterol. 2024 Oct 21;61:e24053. doi: 10.1590/S0004-2803.24612024-053. eCollection 2024.

ABSTRACT

BACKGROUND: •The study evaluated the risk of developing microscopic colitis and its subtypes in patients on PPI therapy.

BACKGROUND: •Using a large multicenter database, a retrospective cohort analysis was conducted, excluding patients with autoimmune diseases, and adjusting for confounders.

BACKGROUND: •An increased risk of developing microscopic colitis was associated with female gender, smoking, and the use of PPI, SSRI, and NSAIDs.

BACKGROUND: •The use of PPI represented the highest odds of developing microscopic colitis.

BACKGROUND: Microscopic colitis is a relatively new diagnosis that was first described in the 1980s. Patients usually present with chronic watery and non-bloody diarrhea and are typically characterized by an unremarkable gross appearance of the colon on lower endoscopy while having evidence of lymphocytic infiltration of the lamina propria and the epithelium on histology. Two subtypes have been described in the literature: Collagenous colitis, with marked thickening of the subepithelial layer, and Lymphocytic colitis. Multiple risk factors such as female gender, older age and celiac disease have been associated with this entity. A few studies have found an association between microscopic colitis and proton-pump inhibitor (PPI). The aim of our study was to evaluate the risk of developing microscopic colitis and its subtypes for patients who are on PPI therapy.

METHODS: A validated multicenter and research platform database of more than 360 hospitals from 26 different healthcare systems across the United States from 1999 to September 2022 was utilized to construct this study. Patients aged 18 years and above were included. Individuals who have been diagnosed with any autoimmune disease have been excluded. A multivariate regression analysis was performed to assess risk of developing microscopic, lymphocytic, and collagenous colitis by accounting for potential confounders including female gender, smoking history, and the use of proton pump inhibitor, nonsteroidal anti-inflammatory drugs, and selective serotonin receptor inhibitors. A two-sided P value <0.05 was considered as statistically significant, and all statistical analyses were performed using R version 4.0.2 (R Foundation for Statistical Computing, Vienna, Austria, 2008).

RESULTS: 78,256,749 individuals were screened in the database and 69,315,150 were selected in the final analysis after accounting for inclusion and exclusion criteria. The baseline characteristics of patients with microscopic, lymphocytic, and collagenous colitis is seen in table 1. Using a multivariate regression analysis, the risk of developing microscopic, lymphocytic, and collagenous colitis was calculated and illustrated in table 2.

DISCUSSION: Our study showed that the risk of microscopic colitis, lymphocytic colitis and collagenous colitis was higher in females and smokers. Although medications like SSRI and NSAIDs showed a positive correlation with colitis, the highest likelihood of developing this disease was associated with PPIs. Lansoprazole has been documented to be associated with microscopic colitis as it is believed to inhibit colonic proton pumps, and subsequently promote diarrhea and inflammation. Interestingly, the prevalence of lymphocytic colitis and collagenous colitis was similar in the cohort of patients treated with PPIs, indicating no specific predisposition to either subtype. This study further confirms the risk factors associated with microscopic colitis. It can help guide physicians to recognize and eliminate these risk factors prior to initiating treatment for this disease. Future studies can focus on identifying the incidence of microscopic colitis with the different types of PPIs in the market.

PMID:39442126 | DOI:10.1590/S0004-2803.24612024-053

Arq Gastroenterol. 2024 Oct 21;61:e24047. doi: 10.1590/S0004-2803.24612024-047. eCollection 2024.

ABSTRACT

BACKGROUND: •Due to the invasive nature of the liver biopsy, there is a growing interest in the use of non-invasive markers of liver fibrosis.

BACKGROUND: •There is a significant and positive correlation between APRI.

BACKGROUND: FIB-4 and platelet count and liver stiffness measurement evaluated by transient elastography in pediatric autoimmune hepatitis.

BACKGROUND: There is limited evidence focusing on the use of non-invasive markers to assess liver fibrosis in pediatric chronic liver diseases.

OBJECTIVE: The aim of the study was to evaluate the correlation between liver stiffness measurement (LSM) using transient liver elastography (TLE) and serum non-invasive markers in pediatric autoimmune hepatitis (AIH).

METHODS: Cross-sectional study between May 2016 and February 2020. Twenty-eight children with AIH (age range between 3 and 20 years old) who had undergone TLE and had routine serum tests were enrolled. Patients were divided into 2 groups: (1) Liver fibrosis degree ≥F2 (TLE ≥6.45 kPa) and (2) <F2 (TLE <6.45 kPa). The groups were compared using Fisher’s exact test for categorical variables and the Mann-Whitney test for quantitative variables. The correlation between TLE, APRI, FIB-4 and platelet count was assessed using the Spearman coefficient (Rs).

RESULTS: Twenty-eight AIH pediatric patients were enrolled, 21 were female and 22 had AIH type 1. Following the cut-off of 6.45 kPa in TLE, 20 patients (71%) were included in group 1, and 8 in group 2. A statistically significant difference was found between the two groups on APRI and FIB-4 results (P=0.0306 and P=0.0055, respectively). There was a significant correlation between TLE with APRI and FIB-4 (Rs=0.67 and 0.78, respectively; P<0.01) as well as with platelet count (Rs=-0.68; P<0.01).

CONCLUSION: APRI, FIB-4 and Platelet Count showed a good and positive correlation with transient liver elastography in pediatric patients with AIH.

PMID:39442125 | DOI:10.1590/S0004-2803.24612024-047

Arq Gastroenterol. 2024 Oct 21;61:e24027. doi: 10.1590/S0004-2803.24612024-027. eCollection 2024.

ABSTRACT

BACKGROUND: •The impact of the COVID-19 pandemic on the diagnosis of adenomatous polyps and colorectal cancer.

BACKGROUND: •A cross-sectional study evaluating COL performed during the periods from 20 March to 31 October of 2019 and of 2020, which analyzed 10,232 colonoscopies.

BACKGROUND: •There was a 51,0% reduction in the number of COL performed in 2020 when compared to 2019. Of the altered exams, adenomatous polyps were diagnosed in 68.8% in 2019 and 78.3% in 2020. CRC was diagnosed in 0.9% in 2019 and 1.6% in 2020.

BACKGROUND: •The increase in adenomatous polyps and colorectal cancer diagnoses was observed, it was not enough to compensate for the reduction in the number of exams.

BACKGROUND: Colorectal cancer (CRC) is globally the third most common malignant neoplasm and the second leading cause of cancer-related death worldwide. The COVID-19 pandemic led to the suspension of routine screening tests by health services. A 35.5% drop in total cancer diagnoses in 2020 is estimated when compared to 2019.

OBJECTIVE: To evaluate the impact of the COVID-19 pandemic on the diagnosis of adenomatous polyps (AP) and CRC in a population undergoing colonoscopy (COL) in a clinic in Goiânia, Brazil.

METHODS: A cross-sectional study evaluating COL performed during the periods from 20 March to 31 October of 2019 and of 2020, was approved by the Research Ethics Committee (CAAE-45631421.0.0000.0037). We analyzed data related to identification, referral for medical examination, colonoscopic and histopathological findings.

RESULTS: We evaluated 10,232 (93.4%) COL, divided into two groups according to the year of performance. In 2019, 6,777 (66.2%) COL were performed and in 2020, 3,455 (33.8%), demonstrating a reduction of 51.0%. A total of 3,267 (31.9%) colonoscopies found polyps, 72.1% of which were AP (68.8% in 2019 and 78.3% in 2020, P<0.001). High-grade dysplasia was found in 5.0% of the AP (4.9% in 2019 and 5.8% in 2020, P<0.34). CRC was diagnosed in 121 (1.2%) (0.9% in 2019 and 1.6% in 2020, P<0.001).

CONCLUSION: The COVID-19 pandemic significantly reduced COL in 2020, mainly due to infection fears and restrictions. However, the detection rate of cancer and polyps per procedure increased, indicating more symptomatic patients sought medical attention. Despite this, the absolute number of tumors and adenomas found decreased, potentially causing diagnostic losses and fewer prevented colorectal cancer cases. Thus, adaptive strategies are vital for maintaining essential healthcare services during similar crises.

PMID:39442123 | DOI:10.1590/S0004-2803.24612024-027