Greater Number Of Years Research Articles

Do Video Games Predict an Early Advanced Capacity to Learn Interventional Radiology Skills?

Purpose:To elucidate the relationship between video game (VG) play and interventional radiology (IR) technical skills in medical students.Materials and Methods:Twenty medical students recruited at our institution’s IR symposium completed a survey to ascertain demographics and prior VG experience, then participated in a 3-part trial of skills assessing IR and VG skill and visuospatial aptitude (VSA). IR skill was evaluated via an endovascular simulation task, VG skill by performance on three separate VGs, and VSA using the Cube Comparison test. Regression analysis was tested the strength of relationship between IR skill and VG experience, VG skill, and VSA, respectively, and participants were stratified by IR skill to top and bottom halves for survey-response comparison.Results:There was no correlation between either VG skill or visuospatial aptitude and IR skill (r = −0.22, p = 0.35; and r = 0.14, p = 0.57). Greater number of years playing VGs correlated with superior IR skill (Spearman’s rho=-0.45, p<0.05). Students who selected IR as their specialty of interest had extensive VG experience, playing for > 15 years (n = 4, 80%), at least 10 hours per week at their peak (n = 3, 60%), and reported being either “skilled” or “highly skilled” at VGs (n = 3, 60%).Conclusions:In our study, though limited by power, number of years playing VGs correlated positively with IR skills in medical students. Prior VG experience may predict an early advanced capacity to learn IR skills and an interest in the specialty.

Age of Migration and Cognitive Life Expectancies Among Older Latinos: Evidence From the Health and Retirement Study

This study used data from the Health and Retirement Study (1998-2014) to estimate Sullivan-based life tables of cognitively intact, cognitively impaired/no dementia (CIND), and dementia life expectancies by nativity, age of migration, and sex for older Latinos residing in the United States. Results show foreign-born Latinos, regardless of age of migration or sex, spend a greater number of years after age 50 with CIND compared to U.S.-born Latinos. Furthermore, we document an advantage in total life expectancy and cognitively intact life expectancy among mid-life immigrant men relative to their U.S.-born counterparts. The robust relationship between nativity, age of migration, and cognitive health suggests that the foreign-born may place particularly serious burdens on families and the government. This issue merits special attention in the development of community-based long-term care programs to appropriately target the specific needs of different subgroups of older Latinos who are entering into their last decades of life.

Breast Cancer Risk and Use of Nonsteroidal Anti-inflammatory Agents After a Benign Breast Biopsy.

Over one million women in the United States receive biopsy diagnoses of benign breast disease (BBD) each year, which confer a 1.5-4.0-fold increase in breast cancer risk. Studies in the general population suggest that nonsteroidal anti-inflammatory agents (NSAID) lower breast cancer risk; however, associations among women with BBD are unknown. We assessed whether NSAID use among women diagnosed with BBD is associated with lower breast cancer risk. Participants included 3,080 women (mean age = 50.3 ± 13.5 years) in the Mayo BBD surgical biopsy cohort diagnosed between January 1, 1992 and December 31, 2001 who completed breast cancer risk factor questionnaires that assessed NSAID use, and whose biopsies underwent detailed pathology review, masked to outcome. Women were followed from date of BBD biopsy to breast cancer diagnosis (main outcome) or censoring (death, prophylactic mastectomy, reduction mammoplasty, lobular carcinoma in situ or last contact). Median follow-up time was 16.4 ± 6.0 years. Incident breast cancer was diagnosed among 312 women over a median follow-up of 9.9 years. Regular non-aspirin NSAID use was associated with lower breast cancer risk [HR = 0.63; 95% confidence interval (CI) = 0.46-0.85; P = 0.002] with trends of lower risk (highest tertiles of use vs. nonuse) for greater number of years used [HR = 0.55; 95% CI = 0.31-0.97; P trend = 0.003), days used per month (HR = 0.51; 95% CI = 0.33-0.80; P trend = 0.001) and lifetime number of doses taken (HR = 0.53; 95% CI = 0.31-0.89; P trend = 0.003). We conclude that nonaspirin NSAID use is associated with statistically significant lower breast cancer risk after a BBD biopsy, including a dose-response effect, suggesting a potential role for NSAIDs in breast cancer prevention among patients with BBD.

Mental health Profiles of Sexually Abused Youth: Comorbidity, Resilience and Complex Trauma

Objectives: The current study’s objectives were to 1) determine if sexually abused youth in child protective agencies (CPA) were given more psychiatric diagnoses and exhibited more comorbidity than youth from the general population, 2) examine the comorbidity profiles of sexually abused youth over 10 years of medical consultations and hospitalizations. Method: Diagnoses of 882 youth with a substantiated sexual abuse report between 2001 and 2010 at a participating CPA were compared to those of 882 matched controls (n = 1764). Results: Results of generalized linear mixed models showed that sexually abused youth presented higher rates of all diagnostic categories and were up to four times more likely to present comorbid diagnoses. Latent class analyses among abused youth revealed four different comorbidity profiles; two more severe groups named complex trauma (11%) and dissociation (14%); and two less severe groups named depression (10%) and low or no comorbidity/resilience (65%). Youth with more cumulative maltreatment and greater number of years of data following CSA report were more at risk of presenting a comorbidity profile, while females were more likely to present a depression profile. Profiles of youth in the highest comorbidity class were similar to what is defined as complex trauma or complex post-traumatic stress disorder. Implications: Sexually abused youth's varied profiles warrant varied interventions. Integrated trauma informed interventions are needed to address the cumulative maltreatment experienced and the psychiatric comorbidity some youth exhibit.

Sociodemographic and psychosocial predictors of longitudinal antiretroviral therapy (ART) adherence among first-time ART initiators in Cape Town, South Africa

ABSTRACT First-time antiretroviral therapy (ART) initiators may be more vulnerable to poor ART adherence because they may be coping with a new HIV diagnosis, facing logistical challenges to accessing and adhering to ART for the first time, and have not yet developed support networks or the skills to support long-term adherence. We recruited 324 participants in two HIV clinics near Cape Town, South Africa. Sociodemographic/psychosocial factors were measured at baseline and self-reported adherence at the 6 month follow-up. We conducted multivariable regression to determine which baseline factors were associated with 6-month adherence. A better patient-clinic relationship score (OR: 1.08 [95% CI: 1.05–1.11]) was associated with higher adherence. A drug use problem (0.51 [0.29–0.87]), higher social isolation (0.93 [0.87–0.99]), and greater number of years living with HIV before initiating ART (0.92 [0.86–1.00]) were associated with adherence levels below 90%. Patient-clinic relationships and social support are key psycho-social factors in early adherence behavior. Reducing drug use problems through targeted screening and early intervention may improve ART adherence.

How health outcomes differ between youth who suffer a traumatic, sport-related knee injury and matched controls - implications for rehabilitation and understanding post-traumatic osteoarthritis risk

How health outcomes differ between youth who suffer a traumatic, sport-related knee injury and matched controls - implications for rehabilitation and understanding post-traumatic osteoarthritis risk

Ethical guidelines for medical decision-making during COVID-19 pandemic in Chile

The catastrophic emergency experienced by many countries with the COVID-19 pandemic emphasized the importance of bioethics for decision-making, both at the public health (equitable and effective policies) and at the clinical level. At the clinical level, the issues are the fulfillment of medical care demand with adequate health care teams, infrastructure, and supplies, and to cover critical care demands that surpass the available resources. Therefore, ethically correct approaches are required for the allocation of life sustaining resources. There are recommendations for the allocating life support during disasters based on multiple considerations, including ethical ones. However, the ethical criteria of existing guidelines are variable. Ethical principles usually considered are saving the greatest number of lives, saving the greatest number of years of life and the principle of the life cycle or the goal to give each individual equal opportunity to live through the various phases of life. However, the centrality of the human being and the search for the common good should be considered. Knowledge of public perspectives and moral benchmarks on these issues is essential. A successful assignment effort will require everyone's trust and cooperation. Decision making should be planned and discussed in advance, since in-depth deliberation will be extremely complex during the disaster. Our goal is to help the health care teams to wisely allocate resources in shortage periods.

Long-term running in middle-aged men and intervertebral disc health, a cross-sectional pilot study.

PurposeTo measure intervertebral disc (IVD) health parameters in middle-aged long-term runners compared to matched non-physically active controls.MethodsSeventeen males aged 44-62yr were included in the study: 9 runners with a running history of >10yr, averaging >50km/week, and eight matched non-physically active controls, the data from one participant had to be excluded. T2-relaxometry, diffusion weighted imaging, T1- and T2-weighted MR scanning, as well as T2 time mapping were performed. Morphological data relating to IVD were extrapolated.ResultsCompared to controls on average, runners had 20% greater IVD height (p = 0.002) and seven percentage points greater IVD-vertebral body height ratio (p = 0.001). No significant differences were observed between groups for mean(SD) IVD hydration status, as indicated by similar T2-times (runners: 94.4(11.1)ms, controls: 88.6(23.6)ms), or apparent diffusion coefficients (runners: 249.0(175.2)mm2/s, controls: 202.3(149.5)mm2/s). Average Pfirrmann score for the L5-S1 IVD was 2.2(0.7) for runners and 3.3(1.0) for controls (p = 0.026), average scores for all lumbar levels (L2-S1) were 1.9(0.2) and 2.5(0.7), respectively (p = 0.036). Anterior annulus T2-time and overall average lumbar level Pfirrmann grades were strongly correlated (r = 0.787, p = 0.021 and r = -0.704, p = 0.034, respectively) with greater distances run per week. Average lumbar level Pfirrmann grades were also strongly correlated (r = -0.823, p = 0.006) to total years of running.ConclusionMiddle-aged long-term endurance runners exhibit less age-related decline in their lumbar IVDs. In addition, the measures of IVD morphology appeared to be better in those who had been running for a greater number of years, as well as in those who ran a greater distance per week.

The rehabilitation of buildings. Reflections on construction systems for the environmental sustainability of interventions

&lt;p&gt;The old age and the poor state of repair of the Italian building heritage and the change in the needs and lifestyle of modern society require re-qualitative interventions of building rehabilitation. These operations are environmentally sustainable, favouring the protection of the soil, allowing the grey energy of the materials that make up the building to be depreciated over a greater number of years and which will have sufficient residual performance, also thanks to integration with other components.&lt;/p&gt;&lt;p&gt;In order to safeguard the intrinsic sustainability of the rehabilitation of the building, it is necessary to act in the intervention taking into account its sustainability, considering the life cycle of both the building as a whole together with its specific redevelopment project. Sustainability in the management phase is conditioned by energy efficiency; in the construction and demolition phases, however, it is conditioned both by the construction techniques and the connection methods between the different elements of the construction system, and above all by the choice of its components and materials that make it up. The paper presents as an international best practice a dry construction system made with recycled elements derived from scaffolding and a wet construction system consisting of components in lime and hemp.&lt;/p&gt;

Prescribing Patterns and Costs Associated with Postoperative Eye Drop Use in Medicare Beneficiaries Undergoing Cataract Surgery

To determine costs and prescribing patterns of postoperative eye drops for cataract surgery and estimate potential savings of generic or therapeutic drug substitutions. Retrospective, cross-sectional analysis. Medicare beneficiaries aged ≥65 years with Part D coverage who underwent cataract surgery in2016. Medicare Part D claims were used to extract information on eye drop prescriptions that were filled during the postoperative period of cataract surgery. Savings from generic or therapeutic drug substitutions were estimated for brand medications. Total cost of postoperative eye drops for cataract surgery and physician and patient factors associated with medication cost. Postoperative eye drops were prescribed in 2016 to 88% of 591 733 Medicare beneficiaries who underwent cataract surgery during that calendar year, with brand medications accounting for 57.5% of prescription volume. The overall cost totaled more than $167 million, 76.5% of which was attributable to use of brand medications. The mean costs of medications were $228 and $324 for those undergoing 1 and 2 surgeries, respectively. Topical antibiotics (89%) were the most commonly prescribed drug class by volume, followed by topical steroids (86%) and nonsteroidal anti-inflammatory drugs (66%), and accounted for 26%, 37%, and 36% of the total cataract surgery eye drop cost, respectively. Use of therapeutic and generic alternatives could have resulted in cost savings of as much as $118 million, or 70% of the total cost of postoperative eye drops. In adjusted analysis, patient factors associated with increased eye drop cost included older age, female gender, and race or ethnicity. Physician characteristics associated with increased eye drop cost included female gender, greater number of years in practice, practicing in metropolitan versus nonmetropolitan areas, and practicing in the Northeast versus the South and in the South versus the Midwest. The cost to the Centers for Medicare and Medicaid Services for eye drops prescribed for postoperative use after cataract surgery in 2016 was approximately $170 million. In the absence of evidence of clinical superiority of expensive versus less costly options, substantial opportunity exists to improve the value of care delivered to Medicare beneficiaries.

Oculoplastic surgical services in Nigeria: status and challenges.

To assess the status and challenges of oculoplastic surgical services in Nigeria. An IRB-exempt, web-based survey was distributed to Ophthalmological Society of Nigeria members via e-mail. Information regarding demographics, type and location of practice, subspecialization training, availability and barriers of oculoplastic surgical services, pattern of oculoplastic diseases and surgical procedures was obtained. Responses were analyzed using standard statistical methods. Forty-four percent (155/356) of ophthalmologists invited completed the online survey. Of these respondents, 104 (67.1%) do provide oculoplastic surgical services with 8 (5.2%) trained in oculoplastic surgery. Respondents reported most commonly treating eyelid trauma (98.1%), orbital inflammatory diseases (92.1%) and lacrimal system disorders (86.5%) with globe removal procedures (98.1%), eyelid reconstruction (92.1%) and lacrimal drainage procedures (84.5%) being the most common procedures performed in their practices. Barriers to availability of oculoplastic surgical services identified by respondents were few trained oculoplastic surgeons (92.9%), lack of training centers (70.3%) and accessibility of services (60%). On multivariable analysis, predictors of availability of oculoplastic surgical services were greater number of years in practice (P < 0.001) and subspecialty training (P < 0.001). The availability and geographical distribution of oculoplastic surgical services in Nigeria are suboptimal with training deficiencies identified as the main challenge. Strategies to improve availability of oculoplastic care should entail a sustainable training program for this emerging subspecialty and physician deployment to under-resourced areas of the country.

Post-war (1946-2017) population health change in the United Kingdom: A systematic review.

We systematically reviewed the evidence on secular trends in main chronic conditions, disability and self-assessed general health among adults in the United Kingdom, as reported in primary/secondary care databases and population-based surveys. Searches were conducted separately for: (1) trends in age-standardised or age-specific prevalence of major non-communicable diseases, disability, and self-reported general health; (2) trends in health expectancy. The databases searched were MEDLINE, EMBASE/EMBASE Classic and Web of Science (all from 1946/7). The evidence was synthesised narratively. There were 39 studies reporting trends in prevalence of health conditions and 15 studies in health expectancy. We did not find evidence for improvement in the age-standardised or age-specific prevalence of any of the studied major chronic conditions over the last few decades, apart from Alzheimer's disease and other dementias. Both increasing or stable prevalence rates with simultaneous rising life expectancy support the expansion of morbidity theory, meaning that people are expected to spend a greater number of years with chronic condition(s). The evidence on disability—expressed as prevalence or health expectancy—was mixed, but also appeared to support the expansion of morbidity among those aged 65 or over. The evidence on trends in disability for younger age is lacking. Across the studied period (1946–2017), the UK population endured more years with chronic morbidity and disability, which may place a serious strain on the health care system, the economy and the society.

Comparación de los valores de alpha ratio entre hombres y mujeres fumadores y no fumadores entre 18 y 26 años

Smoking habit can cause damage to the voice, even in the early stages, which can hinder the communication process. Early identification of alterations in vocal parameters allows preventive measures to be taken prior to the generation of irreversible damage. The alpha ratio value is a vocal parameter obtained through an acoustic analysis that would allow detecting changes in the voice timbre, being able to be a preventive indicator of vocal pathologies. The objective of this investigation was to determine if there are significant differences between the alpha ratio values of men and women, smokers and non-smokers, without previous vocal pathology. The values Leq 0-1000 [Hz] and Leq 1000-5000 [Hz], which make up the alpha ratio value, were measured in 194 subjects between 18 and 26 years of age who did not use professional voice. The group was divided into 32 male smokers and 21 non-smokers, 61 female smokers and 80 non-smokers. The information gathering process was carried out in two stages: in the first one the subject was asked to inhale deeply and to emit a / a / sustained for a time of 5 seconds, for calibration and verification of parameters. In the second stage, a text of 101 words was requested: For the recording, a microphone was used 10 cm away from the face, with a 45° angle to it. Study subjects were standing at all times. The Audacity and PRAAT programs were used for recording and acoustic analysis, respectively, and for the statistical analysis the STATA version 14 program was used. alpha ratio values in smokers (men and women) presented higher values than non-smokers. Male smokers average alpha ratio: .5181709; male non-smokers average alpha ratio value: .4972945. Female smokers, average alpha ratio: .5321025; Non-smoking women, average alpha ratio value: .5036634. However, no significant differences were found between the values of alpha ratio between male smokers and non-smokers (p= .2799) only among female smokers and non-smokers (p= .0111). When there were statistically significant differences between the alpha ratio values of smoking and non-smoking women, the values of Leq 0-1000Hz and Leq 1000-5000 Hz were analyzed independently. The mean value Leq 0-1000 Hz of female smokers was 36.80148; The mean value Leq 0-1000 Hz in non-smoking women was 35.8655. There is no significant difference between these values (p= .171). The mean value Leq 1000-5000 Hz of female smokers was 19.58016; the mean value Leq 1000-5000 Hz in non-smoking women was 18.15138; there is a significant difference between these values (p= .0095). These results are consistent with previous research since the alterations of the voice, due to tobacco damage, are manifested in frequencies above 1000 Hz, although it would have been expected that the values of smokers were lower than the non-smokers, and not higher as in this case. This could be due to the fact that the subjects in this study were healthy, with no diagnosed pathology, and are likely to be at an early stage of vocal damage and as a compensatory form their system is making an over exertion that manifests itself in more values high. From the results obtained it can be concluded that the alpha ratio value could be a good early indicator of predisposition for the development of alterations affecting voice timbre especially in the case of women. It is necessary in order to provide a correct preventive diagnosis, to establish reference values of normality that allow to identify alterations and to study how the value of alpha ratio was affected in a population of smokers with greater number of years of smoking habit.

Years of Life Lost Due to Cervical Cancer in Poland in 2000 to 2015.

The aim of the study was an analysis of years of life lost due to cervical cancer in Poland in the period 2000 to 2015 with consideration given to differences related to education and place of residence. The study material was 28,274 death certificates of all female inhabitants of Poland, who died in 2000 to 2015 due to cervical cancer. In order to calculate years of life lost, the authors used indices: SEYLLp (Standard Expected Years of Life Lost per living person), SEYLLd (per deaths) and AAPC (Average Annual Percentage Change). The SEYLLp index (per 100,000) due to cervical cancer in Poland decreased from 394.3 in 2000 to 220.9 years of life in 2015 (AAPC = −3.6%). Women with university education lost the smallest number of years of life (SEYLLp = 139.0 in 2000 and 53.7 in 2015; AAPC = −5.4%), whereas those with elementary education had the greatest number of years of life lost (524.2 and 312.8; AAPC = −3.4%). Women living in rural areas lost on average 329.5 years in 2000 and 177.0 in 2015 (AAPC = −3.8%). In city areas, the values were 428.6 and 247.1 (AAPC = −3.4%). Many of the years of life lost could have been avoided by including more women, particularly those with elementary education, in screening examinations.

EARLY RESULTS OF AN INJURY-PREVENTION PROGRAM IN HIGH SCHOOL TRACK ATHLETES

Background Injury prevention programs have been shown to be effective for adolescent soccer, basketball, and handball athletes. Though injuries are common in high school runners, injury prevention programs have not been described for this population. Our objective was to trial an injury-prevention program styled after those found to be successful in other running and jumping sports to see if a group of running athletes sustained fewer and or less serious injuries during the course of a single high school track season. Methods Two suburban high school track coaches volunteered to participate in a program consisting of either injury-prevention exercises or no additional exercises as a part of pre-and in-season practice programs. All runners at each school were invited to participate, with informed consent obtained. The injury prevention program consisted of five jumping and plyometric exercises taught by a physical therapist, with a video of the exercises made available to the coach and team members throughout the season. Surveys pre- and post-season were collected which included demographic information, running history, diet, and injuries. Injuries were reported to coach and trainer at each school. Days of missed practice constituted an injured day, tallied for each runner and each team. A Chi-square analysis compared injury rates by team, and hence by intervention; injury rates by years of experience running; and injury rates by dietary preference. Results 24 runners, 13 from the intervention school and 11 from the control school participated. There was no significant difference in the number of running injuries reported when comparing the intervention group (4/13 runners) to the control group (3/11 runners, Chi-square = 0.035, p = 0.9). Runners with a greater number of years of competitive running experience trended towards having fewer injuries (p = 0.06). Those describing their diet as vegetarian (3/24) were significantly more likely to sustain an injury (p = 0.002). Conclusions / Significance With this limited comparison study examining the impact of an injury-prevention pre-season and in-season training program for running athletes participating on their high school track team, there was no evidence that the addition of a program of jumping and plyometric exercises had an impact on injury rates. However, combining the data from the two schools, we found a trend towards decreased injury likelihood in those with more years of experience running, and a significantly greater incidence of injuries in those who described their diet as vegetarian. These results suggest that novice runners should perhaps have a different set of expectations regarding the pre- and in-season training regimen, and that those whose diet is vegetarian consider review of their nutrition to optimize their energy level and reparative capacity with the increased activity of a high school track running program.

Opioid Prescribing Practices of Orthopaedic Surgeons: Results of a National Survey.

Opioids are widely used after orthopaedic procedures. Nonmedical opioid use is a growing public health issue. An anonymous online survey was distributed by e-mail to the orthopaedic societies of all 50 states and several large private practices to assess practicing orthopaedic surgeons' opioid prescribing practices. A total of 555 orthopaedic surgeons practicing in 37 states responded. The most commonly prescribed opioid for both teenagers and adults was hydrocodone/acetaminophen. Of note, 42.3% reported that a patient they have prescribed opioids for developed an opioid dependency, whereas 35.3% do not believe that opioid use is a problem in their practice. Of note, 30.3% reported prescribing refills, and factors significantly associated with increased prescribing of refills included a greater number of years in practice (P < 0.001) and practicing in a suburban rather than an urban or rural environment (P = 0.03). Orthopaedic surgeons rarely prescribe any refills, tend to prescribe less opioids to teenagers than adults, and prescribe fairly uniformly for patients who are treated nonsurgically or undergo minor or arthroscopic surgery. They exhibit considerable variation in prescribing for fractures and major procedures.

Educational Differences in Cognitive Life Expectancy Among Older Adults in Brazil.

To investigate the differences in life expectancy with and without cognitive impairment (CI) by educational levels and sex in Brazil. Longitudinal observational study. The sample was drawn from three waves (2000, 2006, and 2010) of the Health, Well-Being, and Aging Study (Saúde, bem-estar e envelhecimento; SABE) collected in São Paulo, Brazil. Adults aged 60 years and older (N = 2116). Educational levels were estimated in the baseline wave (2000), cognition was assessed in all waves, and mortality data were obtained through the state and municipal mortality system in Brazil. Interpolation of Markov chain methods was used to estimate life expectancy with and without CI by education and sex. Life expectancy without CI at the age of 60 years was 13.0 years among men with no education and 17.6 years among their counterparts with 8 years of schooling. On the other hand, life expectancy with CI was higher among men with no education than those with more education (3.2 and 0.6 years, respectively). Among 60-year-old women without education, life expectancy without CI reached 16.2 years, but it was considerably higher among more educated women (22.7 years). Life expectancy with CI reached 4.5 years among women aged 60 years with no education, vs 1.0 year among women with 8 years of schooling. Adults older than 60 years with no education live shorter lives and with longer periods of CI than those with education. Women in São Paulo live longer lives than men, but they live with CI for a greater number of years.

Predictors of Renal Dysfunction in Adults with Childhood Vesicoureteral Reflux after Long-Term Follow-Up

BACKGROUND:Triad of childhood vesicoureteral reflux (VUR), urinary infection (UTI) and renal scarring might initiate potentially serious consequences that lead to renal dysfunction manifested at the second or third decade of life.AIM:To identify the risk factors predictive for renal dysfunction in adults with primary VUR after long-term follow-up.METHODS:We evaluated the records of 101 children (94.1% female, 5.9% male) at a median age of 5.2 ± 2.3 years (1-12 years), suffering from UTI and VUR. The patients were interviewed after mean 21 years from the first episodes of VUR (8 to 32 years). Renal function was determined from the estimated glomerular filtration rate (eGFR).RESULTS:Renal scarring was detected in 68.3% out of 82 patients and bilateral one in 7.3% patients. Linear regression analysis revealed that presence of proteinuria (B = -33.7, p=0.0001), the greater number of years from VUR diagnosis (B = -1.6, p = 0.002) and renal scarring (B = -14.8, p = 0.005) appeared as independent predictors of reduced global eGFRcreat. The same variables plus microalbuminuria (B = -1.0, p = 0.012) appeared as independent predictors of reduced global eGFRcreat-cys. Bilateral scarring (OR=25.5, p = 0.003) appeared as independent predictor of greater risk for CKD assessed using eGFRcreat while greater number of years from VUR diagnosis (OR = 1.7, p = 0.092), microalbuminuria (OR = 1.3, p = 0.047) and again bilateral scarring (OR = 31.3, p = 0.040) appeared as predictors of risk for CKD assessed using eGFRcreat-cys.CONCLUSION:Identification of those with an increased risk of progression to CKD should be the goal in all patients with childhood VUR. Their systematic follow-up should be till adulthood and older age.

Comparación de los valores de alpha ratio entre hombres y mujeres fumadores y no fumadores entre 18 y 26 años

Smoking habit can cause damage to the voice, even in the early stages, which can hinder the communication process. Early identification of alterations in vocal parameters allows preventive measures to be taken prior to the generation of irreversible damage. The alpha ratio value is a vocal parameter obtained through an acoustic analysis that would allow detecting changes in the voice timbre, being able to be a preventive indicator of vocal pathologies. The objective of this investigation was to determine if there are significant differences between the alpha ratio values of men and women, smokers and non-smokers, without previous vocal pathology. The values Leq 0-1000 [Hz] and Leq 1000-5000 [Hz], which make up the alpha ratio value, were measured in 194 subjects between 18 and 26 years of age who did not use professional voice. The group was divided into 32 male smokers and 21 non-smokers, 61 female smokers and 80 non-smokers. The information gathering process was carried out in two stages: in the first one the subject was asked to inhale deeply and to emit a / a / sustained for a time of 5 seconds, for calibration and verification of parameters. In the second stage, a text of 101 words was requested: For the recording, a microphone was used 10 cm away from the face, with a 45° angle to it. Study subjects were standing at all times. The Audacity and PRAAT programs were used for recording and acoustic analysis, respectively, and for the statistical analysis the STATA version 14 program was used. alpha ratio values in smokers (men and women) presented higher values than non-smokers. Male smokers average alpha ratio: .5181709; male non-smokers average alpha ratio value: .4972945. Female smokers, average alpha ratio: .5321025; Non-smoking women, average alpha ratio value: .5036634. However, no significant differences were found between the values of alpha ratio between male smokers and non-smokers (p= .2799) only among female smokers and non-smokers (p= .0111). When there were statistically significant differences between the alpha ratio values of smoking and non-smoking women, the values of Leq 0-1000Hz and Leq 1000-5000 Hz were analyzed independently. The mean value Leq 0-1000 Hz of female smokers was 36.80148; The mean value Leq 0-1000 Hz in non-smoking women was 35.8655. There is no significant difference between these values (p= .171). The mean value Leq 1000-5000 Hz of female smokers was 19.58016; the mean value Leq 1000-5000 Hz in non-smoking women was 18.15138; there is a significant difference between these values (p= .0095). These results are consistent with previous research since the alterations of the voice, due to tobacco damage, are manifested in frequencies above 1000 Hz, although it would have been expected that the values of smokers were lower than the non-smokers, and not higher as in this case. This could be due to the fact that the subjects in this study were healthy, with no diagnosed pathology, and are likely to be at an early stage of vocal damage and as a compensatory form their system is making an over exertion that manifests itself in more values high. From the results obtained it can be concluded that the alpha ratio value could be a good early indicator of predisposition for the development of alterations affecting voice timbre especially in the case of women. It is necessary in order to provide a correct preventive diagnosis, to establish reference values of normality that allow to identify alterations and to study how the value of alpha ratio was affected in a population of smokers with greater number of years of smoking habit.

Prevalence and determinants of latent tuberculosis infection among frontline tuberculosis healthcare workers in southeastern China: A multilevel analysis by individuals and health facilities

ObjectivesHealthcare workers (HCWs) are at high risk of latent tuberculosis infection (LTBI), and the baseline prevalence of LTBI among frontline TB HCWs in southeastern China remains unknown. The aim of this study was to assess the prevalence of LTBI among TB HCWs and to analyze factors associated with LTBI at both the individual and institutional level. MethodsBased on a cross-sectional study design, 31 out of 89 TB-designated hospitals in Zhejiang Province of China were selected. Information on TB infection control measures was collected through field visits to each of the selected hospitals. All TB HCWs from the selected hospitals were recruited to answer a questionnaire and to undergo LTBI testing by TB interferon gamma release assay. Univariate analyses and a generalized linear mixed model were applied to analyze factors associated with LTBI at both the individual and hospital level. ResultsA total of 487 TB HCWs were recruited at the 31 TB-designated hospitals; 33.9% of them tested positive for LTBI. At the institutional level, a low TB epidemic level, regular infection control training for HCWs, and regular maintenance of ultraviolet disinfection equipment were found to be significantly associated with a lower LTBI rate among HCWs. At the individual level, alcohol use, a greater number of years working on TB, and a longer weekly duration of contact with TB patients were identified as associated factors for LTBI among HCWs. ConclusionsThe LTBI rate among frontline TB HCWs was found to be high in southeastern China. Factors at the institutional and individual level could both affect the prevalence of LTBI among HCWs.