High Prevalence Of Risk Factors Research Articles

Long-term time-course of atrial sensing and incidence of atrial fibrillation in patients with VDD versus DDD pacemakers

Abstract Introduction VDD pacemakers (PM) theoretically have the same advantages with respect to maintaining atrioventricular (AV) synchrony as dual-chamber (DDD) pacemakers, with lower costs and simpler implantation procedure. However, their use is often limited by concerns about the maintenance of atrial sensing (AS) and the occurrence of atrial fibrillation (AF). Purpose We aimed to compare long-term atrial sensing stability, the incidence of AF and complications in VDD and DDD systems. Methods We retrospectively enrolled patients who underwent VDD or DDD PM implantation for AV block between 2014 and 2021 from 2 centers. Clinical, analytical and electrical variables at implantation, their evolution and events at follow-up (25.2±16.2 months) were collected, comparing the groups by Kaplan-Meier and Cox multivariate analysis. Results 487 patients who underwent PM implantation were included, 189 (38,8%) received a VDD PM and 298 (61,2%) a DDD PM. Patients with VDD were older and had a higher prevalence of risk factors and lower atrial voltage at implantation (Table). Complications at implantation and early complications were scarce and without significant differences in both groups. During follow-up, there was a reduction in atrial voltage in the VDD group (implant 1.4+0.8 mV; follow-up 1.2+0.9 mV; p<0.01), with stability in the DDD group (3.8+2.1 vs 3.9+2.2 mV). Total percentages of AS loss were 23.2% (VDD) vs 2.3% (DDD); p<0.01) (Figure 1). In the Cox multivariate analysis the risk of late AS loss was higher in the VDD group (HR=7.6; 95% CI 2.86-20.3; p<0.001) together with the AS values at implant (HR=0.72; 95% CI 0.52-1.00; p=0.052). AS loss was corrected with reprogramming in 23 patients, reintervention was needed in 1 (2%) and VVI was abandoned in 27 (53%). The risk of AF occurrence was lower in the VDD group (HR=0.39 CI 95% 0.18-0.87; p=0.021) (Figure 2). Conclusions In the long term, AS is significantly reduced in VDD MPs, leading to its loss in a quarter of VDD patients. It is usually correctable with reprogramming, rarely requiring abandonment to VVI. AS at implantation is crucial as it is directed related to the AS during follow-up. DDD PMs were independently associated with a higher incidence of AF, with no differences in the remaining complications.TableFigure

Assessment of Risk Factors for Non-communicable Diseases among Young Adults in Kerala, India

Abstract Objectives: To estimate risk factors for non-communicable diseases (NCDs) amongst young adults and to determine the association between NCDs and various risk factors amongst young adults. Materials and Methods: This study was done amongst 150 young adults of Kerala. The data were collected by conducting direct interviews with the use of pre-designed semi-structured questionnaire. Anthropometric and biochemical parameters such as total cholesterol, low-density lipids were collected and analysed using standard methods. Results: Amongst the 150 study participants, 104 (69.4%) were girls and 46 (30.6%) were boys. Amongst these 68 (45.3%) had body mass index (BMI) >23. The study shows that 25.3% and 27.3% of participants had high diastolic blood pressure (DBP) and systolic blood pressure (SBP), respectively. Males had high BP, whereas abdominal adiposity was more amongst females. Physical activity amongst participants was very low. There is a positive correlation between BMI and SBP (r = 0.28, odds ratio [OR] =3.9); BMI and DBP (r = 0.24, OR = 2.9) and waist circumference (WC) with SBP (r = 0.25,); WC and DBP (r = 0.283). The increased BMI (crude odds ratio-3.979; 95% confidence interval-1.490–10.625) has got association with hypertension. Conclusions: There is a high prevalence of risk factors of NCDs amongst the young adult population of Kerala. The findings emphasise the need for interventions to reduce these risk factors amongst these young adults by life cycle approach.

Clinical practice guidelines for diagnostic and treatment of the chronic heart failure.

Chronic heart failure continues to be one of the main causes of impairment in the functioning and quality of life of people who suffer from it, as well as one of the main causes of mortality in our country and around the world. Mexico has a high prevalence of risk factors for developing heart failure, such as high blood pressure, diabetes, and obesity, which makes it essential to have an evidence-based document that provides recommendations to health professionals involved in the diagnosis and treatment of these patients. This document establishes the clinical practice guide (CPG) prepared at the initiative of the Mexican Society of Cardiology (SMC) in collaboration with the Iberic American Agency for the Development and Evaluation of Health Technologies, with the purpose of establishing recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. This document complies with international quality standards, such as those described by the US Institute of Medicine (IOM), the National Institute of Clinical Excellence (NICE), the Intercollegiate Network for Scottish Guideline Development (SIGN) and the Guidelines International Network (G-I-N). The Guideline Development Group was integrated in a multi-collaborative and interdisciplinary manner with the support of methodologists with experience in systematic literature reviews and the development of CPG. A modified Delphi panel methodology was developed and conducted to achieve an adequate level of consensus in each of the recommendations contained in this CPG. We hope that this document contributes to better clinical decision making and becomes a reference point for clinicians who manage patients with chronic heart failure in all their clinical stages and in this way, we improve the quality of clinical care, improve their quality of life and reducing its complications.

IJCM_168A: Cardiovascular disorder risk among the police personnel in Ernakulam District, Kerala, India

Background: Appropriate assessment and management of cardiovascular risk is vital in reducing the occurrence of fatal and non fatal cardiovascular events like stroke or myocardial infarction in high risk occupational group such as Police personnel. Several studies have reported high prevalence of risk factors of cardiovascular diseases (CVD) such as hypertension, high blood lipids, physical inactivity, obesity, positive family history etc among police personnel Objective: To estimate the 10-year risk of cardiovascular events (fatal or non-fatal) among police personnel in Ernakulam City, Kerala, India Methodology: A cross sectional study was carried out among police personnel in various police stations of the district. All the police stations in the district were listed and selected randomly using the MS Excel random number generator. After getting prior permission from the concerned authorities in the Police department, Police personnel above the age of 40 years in Ernakulam city were screened for CVD risk using the WHO – non-laboratory-based CVD risk chart. Data was entered into Microsoft Office Excel and analysed using Jamovi version 2.3.28 Results: Out of 246 participants studied, the mean age was 48.4 + 3.97. Less than half of the participants (44.3%) were Civil Police Officers (CPO) or Senior Civil Police Officer (SCPO). About a third of the participants (32.1%) were having CVD risk in yellow category (5-<10%), 3.3% in orange category (10-<20%) and majority (64.6%) in green category (<5%). On multivariate analysis, age>50 years (OR – 3.36[1.73,6.5]) and duration of service>20 years (OR – 4.9[2.35,10.23] were the independent determinants of higher CVD risk (yellow and orange category) Conclusion: About 35% of the participants belonged to higher risk category (yellow and orange) and duration of service>20 years, age>50 years were the independent determinants

PREVALENCE OF NON-COMMUNICABLE DISEASE RISK FACTOR AMONG THE ADULT POPULATION OF BHARATPUR METROPOLITAN CITY, CHITWAN, NEPAL

Background: Non-communicable diseases (NCDs) are the leading causes of disease burden worldwide. The data from Nepal indicated 6% increase in the deaths caused by non-communicable diseases from 2014 to 2018. The nationwide STEPS survey of non-communicable disease risk factor, 2019 showed high prevalence of risk factors, posing a greater threat for the NCD epidemic in future in the country. Thus, this study aims to find out the prevalence of non-communicable disease risk factors among the adult population of Bharatpur Metropolitan City in Chitwan, Nepal. Methods: A descriptive, community-based cross-sectional study was conducted among 310 respondents residing in Bharatpur Metropolitan. Four wards were selected purposively and convenient sampling was used to select the sample. A semi-structured questionnaire based on WHO NCD STEPS instrument adapted to the local context, was used to collect the data. A descriptive analysis was carried out to analyze the data. Results: The prevalence of current smoking, alcohol consumption, low intake of vegetables and fruits, raised salt intake and low physical activity was found to be 18.1%, 38.7%, 94.6%, 80% and 66.5% respectively. Regarding metabolic risk factors, the prevalence of ever-raised blood pressure, blood sugar and cholesterol was 50%, 28.4% and 17.4% respectively. Conclusions: The study revealed a high prevalence of behavioral and metabolic risk factor which varied in the age group of 40-60 years. The findings call for population specific policy and interventions and focused actions for the behavior modification through primary prevention module and behavior change communication strategy.

ХАРАКТЕРИСТИКА КАРДИОВАСКУЛЯРНОГО РИСКА У БОЛЬНЫХ С ПСОРИАТИЧЕСКИМ АРТРИТОМ

Abstract. Introduction. Patients with psoriatic arthritis are exposed to a higher risk of developing cardiovascular complications. Development and progression of these disorders are based on a complex of closely interrelated factors, such as traditional cardiovascular risk factors, cardiovascular toxicity of some antirheumatic drugs, primarily non- steroidal anti-inflammatory drugs and glucocorticoids, and chronic autoimmune inflammation, which, according to many researchers, is the leading pathogenetic mechanism of atherosclerotic vascular lesions. The aim of the study was to assess the prevalence of traditional risk factors, the state of the blood lipid spectrum, and atherosclerotic remodeling of peripheral arteries in patients with psoriatic arthritis. Materials and Methods. We examined 84 patients (41 women and 43 men) aged 20 to 65 years. Arthritis was diagnosed based on the CASPAR criteria. Patients were assessed regarding traditional risk factors, such as hypertension, obesity, smoking, aggravated family history of CVD, diabetes, physical inactivity, and dyslipidemia; ten-year total coronary risk was calculated using the SCORE scale. To diagnose subclinical atherosclerosis, the patients underwent Doppler ultrasound of the carotid arteries with an assessment of the intima-media complex thickness. Results and Discussion. Assessment of disease development risk factors showed that all patients with psoriatic arthritis had from one to five risk factors. More common risk factors were smoking in 50 (59.5 %) patients, AO in 44 (52.4 %), dyslipidemia in 48 (57.1 %), and arterial hypertension. Patients with a long history of the disease have a higher prevalence of risk factors. According to the results of calculating the ten-year total coronary risk (SCORE scale), most patients were in the group of low (46.4 %) and moderate (38 %) risk. An association was found between the level of total coronary risk and arthritis activity in groups of patients with low and moderate risk. The average intima-media complex thickness of the common carotid artery in the group of patients with psoriatic arthritis was statistically significantly higher than in those in the control group (p=0.0361).Conclusions. An increased risk of cardiovascular complications was found in patients with psoriatic arthritis, while most patients have several risk factors in various proportions. According to the risk assessment on the SCORE scale, it was found to be statistically significant in the group of patients with psoriatic arthritis, which correlates with disease activity. The presence of subclinical atherosclerosis was detected in form of a statistically significant increase in the intima-media complex thickness of the carotid arteries. All the above indicates the current problem of psoriasis comorbidity, which dictates a personalized comprehensive approach to therapy for the selection of safe and adequate therapy for all diseases diagnosed in an individual patient.

Prevalence of vitamin D level disorders in therapeutic patients and features of their correction

Objective: to study the prevalence of vitamin D level disorders in therapeutic patients and the features of their correction.
 Materials and methods: 322 patients who applied for medical help in the field of therapy (rheumatology and cardiology) were examined. Methods: clinical, laboratory (study of the level of vitamin D in the blood), statistical.
 Results: it was found that among patients with a therapeutic profile, vitamin D concentration disorders (deficiency and insufficiency) occur in 72,7 % of the surveyed. There is a high prevalence of risk factors for osteoporosis in the examined patients: female sex prevails (81 %), age average age was (53,6 14,3) years, drug use (50 % take proton pump inhibitors, 21,4 % take glucocorticoids). When comparing the proportion of people with impaired vitamin D levels in comparison with the data of previous years, there was a decrease in the proportion of people with vitamin D deficiency and an increase in the proportion of people with vitamin D deficiency. Among people with a vitamin D level of 30100 ng/ml, daily use of vitamin D preparations in dosages exceeding the recommended consumption levels was noted.
 Conclusion: based on the data obtained, the prevalence of vitamin D deficiency and insufficiency remains high. However, recently there has been a trend towards a decrease in the proportion of people with vitamin D deficiency and an increase in the proportion of people with vitamin D deficiency. In this connection, it is necessary to inform the population about the recommended adequate levels of vitamin D in blood serum and safe dosages of vitamin D preparations for daily intake.

The Association Between Non-Clinically Apparent Liver Fibrosis and Pulmonary Arterial Hypertension in Hispanic Patients.

Pulmonary arterial hypertension (PAH) is a deadly cardiopulmonary disease with multi-organ involvement including impaired liver function. Liver dysfunction in PAH is poorly understood but significantly associated with morbidity and mortality. Hispanics have a significantly higher prevalence of non-alcoholic fatty liver disease (NAFLD) and evidence of more advanced disease in comparison to other ethnic groups. The clinical impact of NAFLD in Hispanic PAH patients is unknown. We aimed to investigate the impact of a validated scoring system, non-alcoholic fatty liver disease fibrosis score (NFS), to predict the degree of liver fibrosis in a Hispanic PAH population and its relationship to hemodynamics, functional class, and outcomes. A retrospective review of all treatment-naive Hispanic patients with group I World Health Organization (WHO) pulmonary hypertension (PH) at a single academic center between February 2016 and March 2021 was performed. Patients with history of substance or alcohol abuse, non-group I WHO PH, pre-existent liver disease, chronic kidney disease, atrial fibrillation, thyroid disease, and warfarin use were excluded from the study. The diagnosis of group I WHO PH was determined by cardiac catheterization after the exclusion of other etiologies. NFS was calculated for each patient and correlated with functional capacity, hemodynamics, N-terminal-pro-B-type natriuretic peptide (NT-proBNP), and survival. A total of 96 Hispanic patients were included in our study. The median age of patients in our cohort was 49 years (interquartile range: 15) and 69% of our cohort were females. Higher NFSs indicating advanced hepatic fibrosis (F3-F4) were found to correlate with elevated right-sided cardiac filling pressures (r = 0.27, P = 0.03), elevated levels of NT-proBNP (r = 0.32, P = 0.01), lower 6-minute walk distance (6MWD) (r = -0.49, P = 0.001), lower functional capacity (World Health Organization functional class, WHO-FC, r = -0.35, P = 0.051), a higher prevalence of diabetes (21.1% versus 51.9%, P = 0.001), a higher prevalence of risk factors for metabolic syndrome (81.5% versus 65.0%, P = 0.035), and worse 5-year survival rates. In Hispanic patients with PAH, NFSs correlate with the degree of right-sided pressure overload. In addition, advanced NFSs were independently associated with lower 5-year survival rates and added prognostic information to other established risk parameters in PAH. This study suggests that screening for liver disease in this vulnerable patient population can aid in earlier detection leading to discussion of lifestyle modifications and possible escalation of PAH-targeted therapies, thus leading to potential improvement in survival rates.

Population attributable fractions for risk factors for dementia in Argentina: sex and socioeconomic differences during ten years

AbstractBackgroundThe twelve potentially modifiable risk factors(RF) for dementia are estimated to account for 40% of dementia cases worldwide based on data from high‐income countries. However, population attributable fraction (PAF) distribution and impact may be affected by the socioeconomic context. We aimed: a) to calculate PAFsin Argentina (a low‐income country) using census data, b) to compare differences between sex and socioeconomic strata, and c) their evolution across a ten‐year period.MethodWe collected cross‐sectional data from three Argentinian census between 2009 and 2018 to estimate risk factor prevalences. We calculated PAFs for each risk factor using relative risk estimates from previous meta‐analyses. Next, we adjusted PAF for communality between risk factors, and used these values to calculate overall weighted PAFs. Finally, we analyzed the differences in PAFs for sex and socioeconomic strata defined as income quintiles and compared the overall PAFs between years.ResultWe could identify 8 of the 12 RF in census data; the rest were estimated using other sources. We estimated an overall weighted PAF of 39.9% 95%CI [38.29%‐39.89%] (Table 1). We found no significant differences between the overall PAF of women and men (p = 0.12) (Figure 2). However, women presented more social isolation (4.9% CI95%[4.2%,5.7%]) than men (2.2% CI95%[2.1%,4.1%]), and greater smoking PAF (p = .027). Significant differences were found in the overall PAF of the two lower economic strata (Q1 37.4% CI95% [35.3%,39.5%]; Q2 40.3% CI95% [38.6%,42.1%]) compared with the upper stratum (Q5 29.8% CI95% [28.2%,31.5%]) (Figure 3). There were no significant changes in weight PAF over the course of 10 years. However, while some factors, such as education, improved, alcohol use and social isolation worsened.ConclusionWe found a higher prevalence of risk factors, even though not all of them could be assessed. Also, the distribution of risk factors varied according to sex and socioeconomic level, suggesting that public policies should consider working on the most important RF.

Abstract 15377: Traditional Cardiovascular Risk Factors Do Not Fully Explain the Risk of CAD Population in Colombia

Introduction: Major cardiovascular events occur even having reached LDL-C goals. Tolima department has the highest rate of cardiovascular mortality within Colombia. Hypothesis: in patients who underwent percutaneous coronary intervention (PCI) in a healthcare institution in Ibague Colombia, there is an increasing cardiovascular risk regardless of traditional risk factors. Methods: Descriptive, retrospective analysis of a cohort of patients with coronary artery disease (CAD) with PCI between 2020-2023. A multiple logistic regression model was developed, adjusted for predictors of CAD (Figure 1). Data was analyzed through R-4.3.0, JASP0.17.1 and Python3.11. Results: A sample size of 463 patients who underwent PCI was assessed (Table 1). Dyslipidemia was the most prevalent risk factor 43.2%(n=200). Mean LDL-C was 102, mean HDL was 38 and mean triglycerides was 186. The most incident coronary heart disease was NSTEMI 50.5%(n=234). Data was fitted into a logistic regression model accounting for comorbidities, risk factors and lipid profile values. Regression coefficients computed for CAD were around 0.07. Independent variables explain approximately 7 up to 16.1% of the variance observed in the dependent variable (Figure 1). Conclusions: In primary and secondary prevention for CAD, there is a high prevalence of risk factors. Although risk factors impact the outcome, they account for a relatively little variability within the model. Results imply that there are other key factors that contribute to the outcome and may not be measured currently. Further studies must be developed to evaluate markers in residual risk that may have an impact on the prognosis of patients with CAD.

Components of hostility and discrimination in cardiology.

The Gender-Diverse (TGD) population in Mexico faces significant health challenges, such as limited access to healthcare and a prevalence of adverse conditions. Cardiology is crucial for this population due to a high prevalence of risk factors and cardiovascular diseases. Despite a lack of precise data, it is estimated that 0.5-1.5% of the population identifies as TGD. They encounter sociocultural challenges, including discrimination and stigma, contributing to health issues and a lack of treatment access. Cardiovascular risk factors, hormone self-administration, and barriers to healthcare access are prominent concerns. Opportunities for improvement involve strengthening medical education, implementing inclusive policies, and promoting research and data collection. The development of specific clinical guidelines and inclusive health programs is suggested. The theory of minority stress emphasizes addressing chronic psychosocial stressors and recognizing the influence of stress factors on health. Integrating healthcare services for all populations in cardiology and fostering resilience are key strategies. In summary, a comprehensive approach is needed to reduce disparities in cardiac care and enhance the health of all populations in Mexico.

Stress-Mediated Abnormalities in Regional Myocardial Wall Motion in Young Women with a History of Psychological Trauma.

Psychosocial stress has been associated with the development and progression of atherosclerotic cardiovascular disease (CVD). Previously, we reported subtle differences in global longitudinal strain in somatically healthy women with a psychiatric diagnosis of borderline personality disorder (BPD). This study aimed to investigate the impact of BPD on segmental myocardial wall motion using speckle tracking echocardiography (STE) analysis. A total of 100 women aged between 18 and 38 years were included in this study. Fifty patients meeting the diagnostic criteria for BPD were recruited from the Department of Psychiatry (LWL-University Hospital Bochum) and compared with fifty age-matched healthy control subjects without previous cardiac disease. Laboratory tests and STE were performed with segmental wall motion analysis. The BPD group had a higher prevalence of risk factors for CVD, with smoking and obesity being predominant, when compared with the control group. Other cardiovascular parameters such as blood pressure, glucose, and cholesterol levels were also elevated, even though not to pathological values. Moreover, in the STE analysis, the BPD group consistently exhibited decreased deformation in nine myocardial wall regions compared with the control group, along with a shift toward higher values in the distribution of peak pathological segments. Additionally, significantly higher values of free thyroxine concentration and thyroid's secretory capacity were observed in the BPD group, despite falling within the (high-) normal range. BPD is associated with chronic stress, classical risk factors, and myocardial wall motion abnormalities. Further exploration is warranted to investigate the relationship between high-normal thyroid metabolism, these risk factors, and myocardial function in BPD patients. Long-term follow-up studies would be valuable in confirming the potential for predicting adverse events.

Assessment of Acceptability of Pre-exposure Prophylaxis for HIV Prevention Among Men Who Sex with Men and Transgender Community in Pakistan.

To assess the level of acceptability of oral pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and transwomen (TW) in Pakistan. Cross-sectional study. Place and Duration of the Study: Online study portal from September to November 2021. The study participants were recruited through snowball sampling. Consenting individuals who were >13 years and were identified as MSM or TW were included in the study. Data were analysed using SPSS version 25. Frequencies, percentages and correlation coefficients were computed. A total of 347 participants were recruited. The mean age of all participants was 29.8 ± 6.7 years. Fifty-eight (19.7%) of the participants had chemsex with amphetamine-type stimulants (ATS) at least once in preceding six months of the study, and 58 (19.7%) had a sexually transmitted infection (STI) in preceding six months whereas 10 (3.4%) participants had used drugs via injection. Two hundred and thirty-eight (72%) of the participants were aware of PrEP, 30 (11.7%) had used PrEP in the past, and 3.88% were currently using PrEP. The willingness to use PrEP, free of cost, was shown by 300 participants (86.45%) and by 180 (54.5%), if available at a low cost. There was a high prevalence of risk factors posing them at considerable risk of human immunodeficiency virus (HIV). The majority was aware of PrEP for HIV prevention. The willingness to use PrEP was high when PrEP was offered free of cost but dropped down when participants were asked to pay for PrEP. Based on this finding, PrEP should be available free of cost at the community preferred outlets. Gay, Men who have sex with men, HIV, Pre-exposure prophylaxis Pakistan, Transwomen, Chemsex, People living with HIV.

Sex-based differences in metabolic protection by the ANP genetic variant rs5068 in the general population.

Atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) are produced in the heart and secreted into the circulation. As hormones, both peptides activate the guanylyl cyclase receptor A (GC-A), playing a role in blood pressure (BP) regulation. A significant role for ANP and BNP includes favorable actions in metabolic homeostasis. Sex-based high prevalence of risk factors for cardiovascular disease in males compared with females is well established, but sex-based differences on cardiometabolic protection have not been investigated in relation to ANP (NPPA) and BNP (NPPB) gene variants. We included 1,146 subjects in the general population from Olmsted County, Minnesota. Subjects were genotyped for the ANP gene variant rs5068 and BNP gene variant rs198389. Cardiometabolic parameters and medical records were reviewed. In the presence of the minor allele of rs5068, diastolic BP, creatinine, body mass index (BMI), waist measurement, insulin, and prevalence of obesity and metabolic syndrome were lower, whereas HDL was higher in males with only trends observed in females. We observed no associations of the minor allele with echocardiographic parameters in either males or females. Regarding rs198389 genotype, the minor allele was not associated with any BP, metabolic, renal, or echocardiographic parameters in either sex. In the general community, the minor allele of the ANP gene variant rs5068 is associated with a favorable metabolic phenotype in males. No associations were observed with the BNP gene variant rs198389. These studies support a protective role of the ANP pathway on metabolic function and underscore the importance of sex in relationship to natriuretic peptide responses.NEW & NOTEWORTHY Males are characterized by lower ANP and BNP with greater prevalence of cardiometabolic disease. The ANP genetic variant rs5068 was associated with less metabolic dysfunction in males, whereas no metabolic profile was related to the BNP genetic variant rs198389 in the general population. ANP may play a more biological role in metabolic homeostasis compared with BNP in the general population with greater physiological metabolic actions in males compared with females.

Prevalence of vitamin D level disorders in therapeutic patients and features of their correction

Objective: to study the prevalence of vitamin D level disorders in therapeutic patients and the features of their correction. Materials and methods: 322 patients who applied for medical help in the field of therapy («rheumatology» and «cardiology») were examined. Materilas and methods: clinical, laboratory (study of the level of vitamin D in the blood), statistical. Results: it was found, that among patients with a therapeutic profile, vitamin D concentration disorders (deficiency and insufficiency) occur in 72.7% of the surveyed. There is a high prevalence of risk factors for osteoporosis in the examined patients: female sex prevails (81%), age (average age was 53.6 ±14.3 years), drug use (50% take proton pump inhibitors, 21.4% take glucocorticoids). When comparing the proportion of people with impaired vitamin D levels in comparison with the data of previous years, there was a decrease in the proportion of people with vitamin D deficiency and an increase in the proportion of people with vitamin D deficiency. Among people with a vitamin D level of 30-100 ng/ml, daily use of vitamin D preparations in dosages exceeding the recommended consumption levels was noted. Conclusion: based on the data obtained, the prevalence of vitamin D deficiency and insufficiency remains high. However, recently there has been a trend towards a decrease in the proportion of people with vitamin D deficiency and an increase in the proportion of people with vitamin D deficiency. In this connection, it is necessary to inform the population about the recommended adequate levels of vitamin D in blood serum and safe dosages of vitamin D preparations for daily intake.

Brief description of current problems and ongoing reforms of healthcare systems in Greece, Bulgaria a nd Spain

The article is a description of the problems and reforms of the healthcare systems of Greece, Bulgaria, Spain. The range of existing problems includes the imperfection of management and financing of healthcare in these countries, which leads to a high level of co-financing of medical care by the population itself, a shortage of medical personnel and their uneven distribution within countries, the predominance of inpatient medical services, reduced availability (waiting time for medical care). In addition, Greece and Bulgaria have a high prevalence of risk factors for non-communicable diseases with weak or no screening programs. The countries listed above are implementing a number of reforms related to the management and financing of healthcare, and the availability of medical care. However, significant results of reform, with the exception of Spain, are not observed in these countries, including due to the lack of political agreement on the implementation of the necessary reforms.

Characterization of Vulnerability of Internally Displaced Persons in Burkina Faso, Mali, and Niger Using Respondent-Driven Sampling (RDS)

Abstract The Central Sahel region has one of the world's fastest-growing populations of internally displaced persons (IDPs). To better understand the risk factors associated with displacement, this study utilized respondent-driven sampling to recruit otherwise hard-to-reach IDPs in remote and urban areas in Burkina Faso, Mali, and Niger. From August to October 2021, 4144 IDPs were surveyed, and nine targeted vulnerability profiles were measured across the domains of gender, health, and protection. The study revealed a high prevalence of risk factors and vulnerability among IDPs, with notable geographic differences. The majority of IDPs fell into at least one category of vulnerability, with health vulnerabilities being the most common. Internally displaced persons reported overlapping vulnerabilities in health, particularly chronic illness, mental health issues, and disability. Women had higher odds of vulnerability than men. Statistically significant associations were site-specific, and some were inconsistent across contexts, highlighting the cross-cutting and pervasive nature of vulnerability among IDPs.

Exploring New Tools for Risk Classification among Adults with Several Degrees of Obesity.

The epidemic of obesity worldwide has been recognized as a very important challenge. Within its complexity, the identification of higher-risk patients is essential, as it is unsustainable to offer access to treatment to all people with obesity. Several new approaches have recently been presented as important tools for risk stratification. In this research, we applied several of these tools in a cross-sectional study involving adults with obesity classes I, II, III, and super-obesity. The participants had their cardiometabolic risk profiles assessed. The study included adults with obesity aged 18 to 50 years (n = 404), who were evaluated using anthropometric, body composition, hemodynamic, physical fitness, and biochemical assessments. These variables were used to identify the prevalence of risk factors for cardiometabolic diseases according to the classes of obesity by gender and age group. The results showed high prevalence of risk factors, especially among the upper classes of obesity (BMI > 35 kg/m2) using single parameters as the waist circumference, with almost 90% above the cut-off point. For smaller numbers such as Glycated Hemoglobin, however, the prevalence was around 30%. Indexes such as the atherogenic index of plasma (AIP) had the highest prevalence, with 100% of the male participants identified as being at increased risk for cardiovascular disease.

Trends and associations between maternal characteristics and infant birthweight among Indigenous and non-Indigenous people in Tasmania, Australia: a population-based study

ObjectiveThis study aimed to investigate the trends and associations of maternal characteristics and birthweight among Indigenous and non-Indigenous infants. Study designThis was a retrospective population-based study. MethodsFourteen years (2005–2018) of birthweight and perinatal health data of live-born singletons and their mothers obtained from the Tasmanian Data Linkage Unit were used to assess the trends and associations between maternal characteristics and infant birthweight using regression modelling. ResultsCompared with non-Indigenous mothers (n = 76,750), Indigenous mothers (n = 3805) had a significantly higher prevalence of risk factors during the 14-year period. Although the prevalence of prepregnancy obesity and gestational diabetes mellitus (GDM) markedly increased in both groups, the rate of increase was higher (P < 0.001) for Indigenous than non-Indigenous mothers. Smoking, alcohol consumption and illegal drug use during pregnancy reduced over the years, and there was no significant difference in the rate of reduction between the groups. Large-for-gestational-age (LGA) births increased while small-for-gestational-age (SGA) births decreased in both groups over time. In addition, high birthweight (HBW) births decreased while low birthweight (LBW) births increased. The rates of increase in LGA and LBW births and the rates of decrease in SGA and HBW births were significantly higher in Indigenous mothers compared with non-Indigenous mothers (P < 0.001 for all). The association between Indigenous ethnicity and LBW and SGA births weakened after adjusting for other confounding maternal and perinatal variables. LBW and SGA were positively associated with Indigenous ethnicity, age <18 years, smoking, alcohol consumption and illegal drug use, pre-eclampsia, underweight prepregnancy body mass index and low socio-economic status. Women with higher parity, pre-existing diabetes and prepregnancy overweight or obesity were more likely to give birth to an infant with HBW or LGA. ConclusionsThe prevalence of risk factors for abnormal birthweight is higher among Tasmanian Indigenous mothers, contributing to a gap in birthweight outcomes between Indigenous and non-Indigenous infants. The dramatic increase in prepregnancy obesity and GDM in both groups highlight the importance of screening and management of GDM during pregnancy. Comprehensive programmes co-designed and co-managed in consultation with Indigenous people are needed to support healthy lifestyle choices among Indigenous women to address the barriers to individuals adopting behaviour change and to help close the health outcomes–related gap between Indigenous and non-Indigenous mothers and infants.

Succession and determinants of the early life nasopharyngeal microbiota in a South African birth cohort

BackgroundBacteria colonizing the nasopharynx play a key role as gatekeepers of respiratory health. Yet, dynamics of early life nasopharyngeal (NP) bacterial profiles remain understudied in low- and middle-income countries (LMICs), where children have a high prevalence of risk factors for lower respiratory tract infection. We investigated longitudinal changes in NP bacterial profiles, and associated exposures, among healthy infants from low-income households in South Africa.MethodsWe used short fragment (V4 region) 16S rRNA gene amplicon sequencing to characterize NP bacterial profiles from 103 infants in a South African birth cohort, at monthly intervals from birth through the first 12 months of life and six monthly thereafter until 30 months.ResultsCorynebacterium and Staphylococcus were dominant colonizers at 1 month of life; however, these were rapidly replaced by Moraxella- or Haemophilus-dominated profiles by 4 months. This succession was almost universal and largely independent of a broad range of exposures. Warm weather (summer), lower gestational age, maternal smoking, no day-care attendance, antibiotic exposure, or low height-for-age z score at 12 months were associated with higher alpha and beta diversity. Summer was also associated with higher relative abundances of Staphylococcus, Streptococcus, Neisseria, or anaerobic gram-negative bacteria, whilst spring and winter were associated with higher relative abundances of Haemophilus or Corynebacterium, respectively. Maternal smoking was associated with higher relative abundances of Porphyromonas. Antibiotic therapy (or isoniazid prophylaxis for tuberculosis) was associated with higher relative abundance of anerobic taxa (Porphyromonas, Fusobacterium, and Prevotella) and with lower relative abundances of health associated-taxa Corynebacterium and Dolosigranulum. HIV-exposure was associated with higher relative abundances of Klebsiella or Veillonella and lower relative abundances of an unclassified genus within the family Lachnospiraceae.ConclusionsIn this intensively sampled cohort, there was rapid and predictable replacement of early profiles dominated by health-associated Corynebacterium and Dolosigranulum with those dominated by Moraxella and Haemophilus, independent of exposures. Season and antibiotic exposure were key determinants of NP bacterial profiles. Understudied but highly prevalent exposures prevalent in LMICs, including maternal smoking and HIV-exposure, were associated with NP bacterial profiles.9NqP-bpPho7pt36-yeLZTtVideo