World Health Organization Risk Research Articles

COVID-19, body mass index and cholesterol: an ecological study using global data

BackgroundCoronavirus disease 2019 (COVID-19) is now globally considered a serious economic, social and health threat. A wide range of health related factors including Body Mass Index (BMI) is reported to be associated with the disease. In the present study, we analyzed global databases to assess the correlation of BMI and cholesterol with the risk of COVID-19.MethodsIn this ecological study, we used age-standardized BMI and cholesterol levels as well as the incidence and mortality ratio of COVID-19 at the national-levels obtained from the publicly available databases such as the World Health Organization (WHO) and NCD Risk Factor Collaboration (NCD-RisC). Bivariate correlation analysis was applied to assess the correlations between the study variables. Mean differences (standard deviation: SD) of BMI and cholesterol levels of different groups were tested using independent sample t-test or Mann–Whitney rank test as appropriate. Multivariable linear regression analysis was performed to identify variables affecting the incidence and mortality ratio of COVID-19.ResultsIncidence and mortality ratio of COVID-19 were significantly higher in developed (29,639.85 ± 20,210.79 for cases and 503.24 ± 414.65 for deaths) rather than developing (8153.76 ± 11,626.36 for cases and 169.95 ± 265.78 for deaths) countries (P < 0.01). Results indicated that the correlations of BMI and cholesterol level with COVID-19 are stronger in countries with younger population. In general, the BMI and cholesterol level were positively correlated with COVID-19 incidence ratio (β = 2396.81 and β = 30,932.80, p < 0.01,‌ respectively) and mortality ratio (β = 38.18 and β = 417.52, p < 0.05,‌ respectively) after adjusting for socioeconomic and demographic factors.ConclusionCountries with higher BMI or cholesterol at aggregate levels had a higher ratios of COVID-19 incidence and mortality. The aggregated level of cholesterol and BMI are important risk factors for COVID-19 major outcomes, especially in developing countries with younger populations. We recommend monitoring and promotion of health indicices to better prevent morbidity and mortality of COVID-19.

World Health Organization risk drinking levels as a treatment outcome measure in topiramate trials.

Although abstinence has traditionally been considered the only suitable outcome for alcohol treatment, reduced drinking is also associated with improved functioning and medical and psychiatric outcomes. The World Health Organization (WHO) risk drinking levels (RDLs) have been shown to be valid outcome measures in treatment trials for alcohol use disorder (AUD). We conducted a secondary analysis of two 12-week, randomized controlled trials (RCTs), in which a total of 308 individuals with problematic alcohol use received topiramate or placebo treatment. We compared the utility of the WHO RDLs with other treatment outcomes, including self-reported measures of alcohol consumption, alcohol-related problems, and quality of life, and the biomarker gamma-glutamyltransferase. Topiramate treatment was associated with small effect sizes for both a 1-level (d=0.26) and a 2-level (d=0.19) reduction in WHO RDL, effects that were not significant after correction for multiple comparisons. No heavy drinking days, one of the outcome measures recommended by the US Food and Drug Administration for alcohol medication registration trials, also exhibited a small effect (0.21), while an effect size for abstinence could not be calculated. There were medium effects of topiramate on continuous measures of percent heavy drinking days (d=0.49) and alcohol-related problems (d=0.41). Topiramate is an efficacious pharmacotherapy for AUD. Although continuous measures of drinking and alcohol-related problems yielded larger effect sizes than the WHO RDLs, the latter nonetheless provide a categorical alternative for use in both clinical care and pharmacotherapy trials.

Geographic and Sociodemographic Disparities in Cardiovascular Risk in Burkina Faso: Findings from a Nationwide Cross-Sectional Survey.

BackgroundCardiovascular disease (CVD) risk assessment is a critical step in the current approach to the primary prevention of CVD, particularly in low-income countries such as Burkina Faso. In this study, we aimed to assess the geographic and sociodemographic disparities of the ten-year cardiovascular risk in Burkina Faso.MethodsWe conducted a secondary analysis of the data from the first nationwide survey using the World Health Organization (WHO) STEPwise approach. Ten-year cardiovascular risk was determined using the WHO 2019 updated risk chart (WHO risk) as main outcome, and the Framingham risk score (FRS) and the Globorisk chart for secondary outcomes. We performed a modified Poisson regression model using a generalized estimating equation to examine the association between CVD risk and sociodemographic characteristics.ResultsA total of 3081 participants aged 30 to 64 years were included in this analysis. The overall age and sex-standardized mean of absolute ten-year cardiovascular risk assessed using the WHO risk chart was 2.5% (95% CI: 2.4–2.6), ranging from 2.3% (95% CI: 2.2–2.4) in Centre Est to 3.0% (95% CI: 2.8–3.2) in the Centre region. It was 4.6% (95% CI: 4.4–4.8) for FRS and 4.0% (95% CI: 3.8–4.1) for Globorisk. Regarding categorized CVD risk (absolute risk ≥10%), we found out that the age and sex-standardized prevalence of elevated risk was 1.7% (95% CI: 1.3–2.1) for WHO risk, 10.4% (95% CI: 9.6–11.2) for FRS, and 5.9% (95% CI: 5.1–6.6) for Globorisk. For all of the three risk scores, elevated CVD risk was associated with increasing age, men, higher education, urban residence, and health region (Centre).ConclusionWe found sociodemographic and geographic inequalities in the ten-year CVD risk in Burkina Faso regardless of risk score used. Therefore, population-wide interventions are needed to improve detection and management of adult in the higher CVD risk groups in Burkina Faso.

Pre-conceptual counselling in cardiology patients: still work to do and still missed opportunities. A comparison between 2015 and 2019 in women with cardiac disease attending combined obstetric cardiology clinics. Should the European Guidelines change anything?

Women with underlying cardiac conditions have an increased risk of adverse pregnancy outcomes. Counselling reproductive age women with heart disease is important to assist them in deciding whether to pursue pregnancy, to ensure their best cardiovascular status prior to pregnancy, and that they understand the risks of pregnancy for them and baby. This also provides an opportunity to explore management strategies to reduce risks. For this growing cohort of women, there is a great need for pre-conceptual counselling.This retrospective comparative audit assessed new referrals and pre-conceptual counselling of women attending a joint obstetric-cardiology clinic at a tertiary maternity centre in a 12-month period of 2015-2016 compared with 2018-2019. This reflected the timing of the introduction of a multidisciplinary meeting prior to clinics and assessed the impact on referrals with the introduction of the European Society of Cardiology guidelines.Data were reviewed from 56 and 67 patients in respective audit periods. Patient's risk was stratified using modified World Health Organization classification.Less than 50% of women with pre-existing cardiac conditions had received pre-conceptual counselling, although half of them had risks clearly documented. The majority of patients had a recent electrocardiograph and echocardiogram performed prior to counselling, and there was a modest improvement in the number of appropriate functional tests performed between time points. One-third of patients in both cohorts were taking cardiac medications during pregnancy.There was a significant increase in the number of pregnant women with cardiac disease and in complexity according to modified World Health Organization risk classification. While there have been improvements, it is clear that further work to improve availability and documentation of pre-pregnancy counselling is needed.

Stability of Posttreatment Reductions in World Health Organization (WHO) Drinking Risk Levels and Posttreatment Functioning in Older Adults with DSM-5 Alcohol Use Disorder: Secondary Data Analysis of the Elderly Study.

Studies have found that reductions in World Health Organization (WHO) drinking risk levels may be a stable outcome of treatment for alcohol use disorder (AUD) and associated with functional improvements. The aim of this study was to investigate whether posttreatment reductions in WHO drinking risk levels are stable over time among older adults and associated with a decrease in consequences of drinking and AUD symptoms and improved quality of life. Participants. Individuals 60+years old, suffering from DSM-5 AUD (n=693), and seeking outpatient treatment. WHO drinking risk levels, prior to treatment and at all follow-up points up to 1year after treatment start, were assessed with Form 90. Outcomes at follow-up included consequences of drinking (Drinker Inventory of Consequences), quality of life (WHOQOL-BREF), and DSM-5 AUD symptoms (Mini International Neuropsychiatric Interview). Logistic regression and linear mixed models were used to examine the probability of maintaining risk-level reductions at follow-up and the association between risk-level reductions and outcomes, respectively. Reductions in risk levels were maintained over time (at least 1 level: OR 5.39, 95% CI 3.43, 8.47; at least 2 levels: OR 9.30, 95% CI 6.14, 14.07). Reductions were associated with reduced consequences of drinking and number of AUD symptoms, and minor, but statistically significant, improvements in quality of life. Maintaining reductions in WHO risk levels appears achievable for older adults seeking treatment for AUD. The small reduction of AUD symptoms and improvement of quality of life indicates that these reductions may not be adequate as the only treatment goal.

The World Health Organization Risk Drinking Levels Measure of Alcohol Consumption: Prevalence and Health Correlates in Nationally Representative Surveys of U.S. Adults, 2001-2002 and 2012-2013.

Little is known about change over time in the prevalence of World Health Organization (WHO) risk drinking levels (very high, high, moderate, low) and their association with health conditions, overall and by gender. The authors used two sets of nationally representative U.S. survey data to determine whether changes over time varied by gender and to examine whether health conditions related to alcohol were associated with WHO risk drinking level within each survey, and whether these associations differed by gender. Data on current drinkers from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N=26,655) and the 2012-2013 NESARC-III (N=25,659) were analyzed using logistic regression. Prevalence differences between surveys were estimated for each drinking level overall and by gender. Within each survey, prevalence differences by WHO risk drinking level were estimated for alcohol use disorder (AUD), drug use disorders, functional impairment, liver disease, and depressive and anxiety disorders. In the 2012-2013 survey, the prevalences of moderate, high, and very high risk drinking were 5.9%, 3.2%, and 3.5%, respectively, representing significant increases from the prevalences in the 2001-2002 survey, which were 1.0%, 0.6%, and 0.9%, respectively. The increase for very high risk drinking among men (0.5%) was smaller than the increase among women (1.4%). Within both surveys, compared with low risk, health conditions were significantly associated with very high risk (range of prevalence differences, 2.2%-57.8%), high risk (2.6%-41.3%), and moderate risk (0.6%-29.8%) drinking. Associations were similar by gender, except that there were stronger effects for AUD in men and for functional impairment and depressive and anxiety disorders in women. The increase in potentially problematic drinking levels among U.S. adults emphasizes the need for better prevention and treatment strategies. The study results support the validity of the WHO risk drinking levels, which show clinical utility as nonabstinent drinking reduction treatment goals. Such goals could engage more people in treatment, improving public health by decreasing personal and societal consequences of risk drinking.

COVID-19 Seroprevalence Study in Asymptomatic Healthcare Workers at a Tertiary Healthcare Centre, India

Introduction: The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection has evolved into a pandemic disease. The present knowledge is mainly based on available numerator data of confirmed positive cases only. The asymptomatic and mildly symptomatic cases are not brought into picture for testing at all, which is a major contributor to the pandemicity and hence creating bias in the documentation and understanding of the disease. The magnitude of the exposure of Healthcare Workers (HCW) and their potential for asymptomatic transmission makes it critical to know the incidence of infection in the healthcare population. Aim: To evaluate the seroprevalence of Immunoglobulin G (IgG) SARS-CoV-2 among the asymptomatic HCW. Materials and Methods: This was a cross-sectional study conducted between January 2021 to February 2021 in SRM Medical College Hospital and Research Centre a tertiary care hospital in Potheri, Chengalpattu district, Tamil Nadu, India. The HCW were asked to complete the standardised questionnaire including the basic information, symptoms of COVID-19 illness and utility of Personal Protective Equipment (PPE) based on World Health Organization (WHO) risk assessment and management of exposure of HCW in the context of COVID-19. They were divided into two groups, the staff who had direct patient exposure as group 1 with 82 participants and staff without direct patient exposure as group 2 with 46 participants. The serodetection of IgG SARS-CoV-2 antibodies was done using the Chemiluminescence Immunoassay (CLIA). The obtained results were statistically analysed with Statistical Package for the Social Sciences (SPSS) version 20.0. A Chi-square test (χ2) was performed and a p-value less than 0.05 was considered statistically significant. Results: A total of 128 HCW were studied. In group 1, there were 64.1% (n=82) of HCWs and in group 2 there were 35.9% (n=46) of HCWs. There were total of 74 (57.8%) males and 54 (42.2%) females. No gender-specific differences were observed. The mean age in group 1 was 28.93 years and group 2 was 32.2 years. The staffs older than 40 years were more commonly affected. Adherence to strict PPE protocol was observed in 92.6% (76/82) in group 1 and 82.6% (38/46) in group 2. The difference between the groups were statistically significant (p=0.025). In this study, though the seroprevalence of COVID-19 infection was 9.8% (n=8) in group 1 and 13% (n=6) in group 2, it was statistically not significant. Conclusion: SARS-CoV-2 Serology study helps to identify the asymptomatic (unestimated) cases. The results of the seroprevalence suggest that the strict adherence to PPE protocol helps to prevent COVID-19.

Clinicopathological features and outcomes of choriocarcinoma: A retrospective analysis from an Indian tertiary cancer center

Background: Choriocarcinoma is the most common form of gestational trophoblastic neoplasia seen by medical oncologists. It is a rare condition and data related to its long-term outcomes from the Indian subcontinent are sparse. Objectives: The primary objective of this study was to assess the clinicopathological characteristics and clinical outcomes of patients with of choriocarcinoma; the secondary objective was to assess the correlation of outcomes with risk stratification. Materials and Methods: This single-center retrospective study was conducted at the Tata Medical Center, a tertiary cancer center in West Bengal, India. We identified all the cases of choriocarcinoma treated at our hospital from the electronic medical records and noted their baseline characteristics, treatment details, and clinical outcomes. Descriptive statistics were used for baseline characteristics, and the Kaplan–Meier method was used for the survival analysis. Results: A total of 24 patients were included in the study. The median age of the patients was 29 years (interquartile range, 25.9–39.5). The median time interval from the last pregnancy was 5 months (range, 0 months to 11 years). The World Health Organization risk score was low in 8 (33.3%) and high in 16 (66.7%) patients. There were 6 (25%) patients who received single-agent chemotherapy, 14 (66.7%) received the EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) regimen, and 1 (4.7%) received the VIP (etoposide, ifosfamide, and cisplatin) regimen, with the latter 2 being given only to high-risk patients. The median follow-up was 10.9 months (95% confidence interval [CI], 4.2–28.5). The median progression-free survival was not reached (NR) (95% CI, 7.2–NR). Similarly, the median overall survival was NR (95% CI, 10.56–NR). Conclusion: Our study provides real-world data for this rare malignancy and reinforces the fact that choriocarcinoma is a highly curable disease. Despite the clinicopathological variations in the different parts of the country, the long-term outcomes are favorable.

Pregnancy Outcomes in Women After Arterial Switch Operation for Transposition of the Great Arteries: Results From ROPAC (Registry of Pregnancy and Cardiac Disease) of the European Society of Cardiology EURObservational Research Programme.

BackgroundIn the past 3 decades, the arterial switch procedure has replaced the atrial switch procedure as treatment of choice for transposition of the great arteries. Although survival is superior after the arterial switch procedure, data on pregnancy outcomes are scarce and transposition of the great arteries after arterial switch is not yet included in the modified World Health Organization classification of maternal cardiovascular risk.Methods and ResultsThe ROPAC (Registry of Pregnancy and Cardiac disease) is an international prospective registry of pregnant women with cardiac disease, part of the European Society of Cardiology EURObservational Research Programme. Pregnancy outcomes in all women after an arterial switch procedure for transposition of the great arteries are described. The primary end point was a major adverse cardiovascular event, defined as combined end point of maternal death, supraventricular or ventricular arrhythmias requiring treatment, heart failure, aortic dissection, endocarditis, ischemic coronary events, and thromboembolic events. Altogether, 41 pregnant women (mean age, 26.7±3.9 years) were included, and there was no maternal mortality. A major adverse cardiovascular event occurred in 2 women (4.9%): heart failure in one (2.4%) and ventricular tachycardia in another (2.4%). One woman experienced fetal loss, whereas no neonatal mortality was observed.ConclusionsWomen after an arterial switch procedure for transposition of the great arteries tolerate pregnancy well, with a favorable maternal and fetal outcome. During counseling, most women should be reassured that the risk of pregnancy is low. Classification as modified World Health Organization risk class II seems appropriate.

Prevalence of osteoporosis in patients with systemic lupus erythematosus: A multicenter comparative study of the World Health Organization and fracture risk assessment tool criteria

ObjectivesOsteoporosis and fracture are known complications of systemic lupus erythematosus (SLE). We assessed the prevalence and risk factors for osteoporosis in patients with SLE. MethodsA total of 155 female SLE patients were recruited retrospectively in 5 university hospitals. The bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry, and the fracture risk assessment tool (FRAX) for high-risk osteoporotic fractures was calculated with and without BMD. ResultsThe mean age was 53.7 ± 6.8 years, and osteoporotic fractures were detected in 19/127 (15.0%) patients. The proportion of patients having a high-risk for osteoporotic fractures in the FRAX with and without BMD, and osteoporosis by the World Health Organization (WHO) criteria were 25 (16.1%), 24 (15.5%), and 51 (32.9%), respectively, and 48.0–68.6% of them were receiving treatment. On multivariate logistic analysis, nephritis (odds ratio [OR] 11.35) and cumulative dose of glucocorticoid (OR 1.1) were associated with high-risk by the FRAX with BMD, and low complement levels (OR 4.38), erythrocyte sedimentation rate (ESR) (OR 1.04), and cumulative dose of glucocorticoid (OR 1.05) were associated with osteoporosis by the WHO criteria in patients with SLE. ConclusionsAmong Korean female patients with SLE, the proportion of patients having a high-risk of osteoporotic fractures by the FRAX tool was 15.5%–16.1% and the proportion of patients having osteoporosis by the WHO criteria was 32.9%. In SLE, nephritis, low level of complement, ESR, and cumulative dose of glucocorticoids may contribute to fracture risk.

Association of Individual Health Literacy with Preventive Behaviours and Family Well-Being during COVID-19 Pandemic: Mediating Role of Family Information Sharing.

Objective: We tested a model of individual health literacy information sharing with family members, personal preventive behaviours and family well-being during the Coronavirus Disease 2019 (COVID-19) pandemic in Hong Kong. Methods: We analysed data of 1501 randomly selected Chinese adults from a cross-sectional survey in Hong Kong from 9 to 23 April, 2020. Individual health literacy about COVID-19 with the items extracted from the questionnaire in World Health Organization Risk Communication and Community Engagement (RCCE) Action Plan Guidance for COVID-19 preparedness and response, COVID-19 information sharing with family members, preventive behaviours against COVID-19 and family well-being were measured. Structural equation modelling analysis tested the proposed model. Findings: COVID-19 information sharing with family members partially mediated the association between individual health literacy and personal preventive behaviours. The direct effect of 0.24 was shown, and the indirect effect through COVID-19 information sharing with family members was small at 0.03 (Z = 3.66, p < 0.001). Family well-being was associated with personal preventive behaviours against COVID-19. The model was adjusted for sex, age, and socioeconomic status factors and had good fit with RMSEA = 0.04, CFI = 0.98, TLI = 0.96, and SRMR = 0.02. Conclusion: COVID-19 information sharing with family members was a partial mediator between individual health literacy and personal preventive behaviours against COVID-19. Strategies for enhancing health literacy and preventive measures against COVID-19 are needed to promote family well-being in the pandemic.

Low-Cost Office-Based Cardiovascular Risk Stratification Using Machine Learning and Focused Carotid Ultrasound in an Asian-Indian Cohort.

This study developed an office-based cardiovascular risk calculator using a machine learning (ML) algorithm that utilized a focused carotid ultrasound. The design of this study was divided into three steps. The first step involved collecting 18 office-based biomarkers consisting of six clinical risk factors (age, sex, body mass index, systolic blood pressure, diastolic blood pressure, and smoking) and 12 carotid ultrasound image-based phenotypes. The second step consisted of the design of an ML-based cardiovascular risk calculator-called "AtheroEdge Composite Risk Score 2.0" (AECRS2.0ML) for risk stratification, considering chronic kidney disease (CKD) as the surrogate endpoint of cardiovascular disease. The last step consisted of comparing AECRS2.0ML against the currently utilized office-based CVD calculators, namely the Framingham risk score (FRS) and the World Health Organization (WHO) risk scores. A cohort of 379 Asian-Indian patients with type-2 diabetes mellitus, hypertension, and chronic kidney disease (stage 1 to 5) were recruited for this cross-sectional study. From this retrospective cohort, 758 ultrasound scan images were acquired from the far walls of the left and right common carotid arteries [mean age = 55 ± 10.8years, 67.28% males, 91.82% diabetic, 86.54% hypertensive, and 83.11% with CKD]. The mean office-based cardiovascular risk estimates using FRS and WHO calculators were 26% and 19%, respectively. AECRS2.0ML demonstrated a better risk stratification ability having a higher area-under-the-curve against FRS and WHO by ~30% (0.871 vs. 0.669) and ~ 20% (0.871 vs. 0.727), respectively. The office-based machine-learning cardiovascular risk-stratification tool (AECRS2.0ML) shows superior performance compared to currently available conventional cardiovascular risk calculators.

Are non-abstinent reductions in World Health Organization drinking risk level a valid treatment target for alcohol use disorders in adolescents with ADHD?

IntroductionAbstinence from drinking represents the primary treatment target for alcohol use disorders (AUD) in youth, but few adolescents who engage in problematic drinking seek treatment. A reduction in World Health Organization (WHO) drinking risk level has been established as valid and reliable non-abstinent treatment target for AUD in adults but remains unstudied in youth. MethodsThe present study used data from the NIDA-CTN-0028 trial to examine associations between reductions in WHO drinking risk level and changes in global functioning and attention-deficit hyperactivity disorder (ADHD) symptoms during treatment in a sample of adolescents (ages 13–18 years) with ADHD and comorbid substance use disorder (SUD) (n = 297, 61% with AUD) receiving a 16-week intervention that combined ADHD pharmacotherapy (OROS-methylphenidate vs. placebo) and drug-focused cognitive-behavioral therapy. ResultsShifts in drinking risk level during treatment were highly variable in adolescents treated for ADHD/SUD, and influenced by AUD diagnostic status. In the total sample, 15% of participants had a 2-level or greater reduction in WHO drinking risk level, with 59% and 24% showing no change or an increase in risk-level during treatment respectively. Achieving at least a 2-level change in WHO drinking risk level during treatment was associated with greater reduction in ADHD symptoms and better functional outcomes. ConclusionsThese findings parallel the adult AUD literature and provide preliminary support for the use 2-level reductions in WHO risk levels for alcohol use as a clinically valid non-abstinent treatment outcome for youth with ADHD and comorbid AUD.

Assessment of Lifetime Attributable Risk for Public Health Sustainability from the Fukushima Accident

The study aimed at reassessing the radiological risk from exposure to ionizing radiation from Fukushima Daiichi nuclear power plant accident. The estimated risks from the study were compared with World Health Organization (WHO) risk assessment estimates for validity and verification. A Radiation Risk Assessment Tool (RadRAT) was used to estimate Lifetime Attributable Risks (LAR) of cancer upon exposure. All solid cancers, leukemia, and thyroid cancer risks for ages of 1, 10, and 20 years (infants, children, and adults) in 100,000 persons at exposure were estimated. For solid cancers, LAR (10−2) was estimated in a range of 0.223∼0.668 and 0.345∼1.24 for males and females, respectively, whereas the LAR (10−2) for leukemia was estimated at 0.0155∼0.055 and 0.0118∼0.0375 for males and females, respectively. LAR (10−2) for thyroid cancer ranged from 0.0722∼0.545 and 0.0369∼0.265, respectively.

Risk factors for cardiac, obstetric, and neonatal complications in patients with heart disease during pregnancy.

Heart disease in pregnancy can cause clinical deterioration and maternal-fetal death. It is essential to evaluate risk factors related to complications. This was a observational, analytical retrospective cohort study with a non-probabilistic convenience sample of pregnant women with congenital or acquired heart disease, corrected or not, or arrhythmias requiring urgent intervention. Patients with mild or moderate valvular regurgitation, mild valvular stenosis, patients without echocardiography or without delivery information were excluded from the study. The outcome was a composite of cardiac, obstetric, and neonatal events. Univariate and multivariate analyzes were performed with logistic regression model and discriminatory capacity with area under the curve and independent analysis of the modified World Health Organization (mWHO) risk classification (mWHO). A total of 104 patients with an average age of 25 ± 6.5 years presented cardiac events in 13.5%, obstetric in 14.42%, and neonatal in 28.85%. The univariate analysis found an association with New York Heart Association functional status, hypertensive disorders of pregnancy, cesarean delivery, gestational age < 27 weeks, hypoxemia, and mWHO risk. In multivariate only cesarean delivery (odds ratio [OR], 2.68; 95% confidence interval [CI], 1.05-6.86) and gestational age at delivery (OR, 0.39; 95% CI, 0.22-0.67) maintain association with outcomes. The area under the curve for the mWHO risk is 0.75. There is a high rate of adverse events in patients with heart disease during pregnancy. Gestational age and cesarean delivery behaved as predictors of adverse maternal-fetal outcomes. The mWHO risk classification had an acceptable prediction of adverse outcomes.

World Health Organization Risk Scores vs. Ankle Brachial Pressure Index (ABI)

World Health Organization Risk Scores vs. Ankle Brachial Pressure Index (ABI)

Reduction in World Health Organization Risk Drinking Levels and Cardiovascular Disease.

Reductions in World Health Organization (WHO) risk drinking levels have recently been shown to lower the risk of multiple adverse health outcomes, but prior work has not examined reductions in WHO risk drinking levels in relation to cardiovascular disease (CVD), the leading cause of death for men and women in the United States and of global mortality. This study examined associations between reductions in WHO risk drinking levels and subsequent risk for CVD. In a US national survey, 1,058 very-high-risk and high-risk drinkers participated in Wave 1 interviews (2001 to 2002) and Wave 2 follow-ups (2004 to 2005). Self-reported CVD history that was communicated to the participant by a doctor or other healthcare professionals included arteriosclerosis, hypertension, angina, tachycardia, or myocardial infarction. We used logistic regression to estimate adjusted odds ratios (aOR) evaluating relationships between ≥2-level reductions in WHO risk drinking levels from Wave 1 to Wave 2 and the risk of Wave 2 CVD, controlling for baseline characteristics. Reductions of ≥2 WHO risk drinking levels were associated with significantly lower odds of CVD in individuals who at Wave 1 were very-high-risk (aOR=0.58 [0.41 to 0.80]) or high-risk drinkers (aOR=0.81 [0.70 to 0.94]). Interaction terms showed that this relationship varied by age. Among individuals >40years old at Wave 1, reductions of ≥2 WHO risk drinking levels were associated with significantly lower odds of CVD among very-high-risk drinkers (aOR=0.42 [0.28 to 0.63]) but not high-risk drinkers (p=0.50). Among individuals ≤40years old at Wave 1, reductions of ≥2 WHO risk drinking levels were associated with significantly lower odds of CVD among high-risk drinkers (aOR=0.50 [0.37 to 0.69]) but not very-high-risk drinkers (p=0.27). These results show that reductions in WHO risk drinking levels are associated with reduced CVD risk among very-high-risk and high-risk drinkers in the US general population, and provide further evidence that reducing high levels of drinking provides important benefit across multiple clinical domains.

Desenlaces materno-fetales en embarazadas con categoría de riesgo III - IV según la Organización Mundial de la Salud en un centro de tercer nivel durante 2006 a 2017

ObjectiveTo describe the maternal-fetal outcomes in pregnant woman with risk classification of III-IV according to the World Health Organization (WHO). MethodsA review was carried out on the medical records of 41 pregnant women with WHO risk classification of III-IV, treated in a tertiary hospital in Medellin, Colombia. Demographic, clinical, and cardiac ultrasound variables were recorded on a form designed for this purpose. The primary variables were directed at evaluating the fetal and maternal outcomes. The statistical analysis was performed using IBM-SPSS software version 23. ResultsThe neonatal events rate was greater than the maternal events rate (68.3% vs. 31.7%). Primary and secondary outcomes occurred in 31.7% and 12.2%, respectively. The distribution according to WHO risk category was 7.3% in risk group III, and 92.7% in group IV. There was only one maternal death unrelated to cardiovascular disease. The presence of moderate-severe tricuspid insufficiency was associated with prematurity (P=.006), and the mothers with a pulmonary systolic pressure ≥ 50mm Hg had a greater number of newborns with respiratory distress (P=.010). Right heart failure was associated with maternal death (P=.014) and prematurity (P=.019), whilst left heart failure was associated with neonatal death (P=.003). ConclusionsMaternal cardiovascular disease is a frequent cause of high maternal-fetal morbidity and mortality. Although this study identified the main maternal and fetal outcomes, studies with a greater sample size are required.

Not All Is Lost for Relapsers: Relapsers With Low WHO Risk Drinking Levels and Complete Abstainers Have Comparable Regional Gray Matter Volumes

BackgroundReductions in substance use are associated with positive long‐term treatment outcomes such as psychosocial functioning; substance use–related consequences; and mental, physical, and neurobiological health. Therefore, nonabstinent clinical trial endpoints have received growing attention from substance abuse treatment experts. Regional brain tissue volumes in alcoholism treatment seekers increase during abstinence, in parallel to cognitive performance.MethodsWe examined the relationships of drinking levels in those who did not maintain abstinence after treatment with magnetic resonance imaging‐derived gray matter (GM) volumes measured 8 months after baseline assessments while in outpatient treatment. The complex drinking behavior during the interval was operationalized as World Health Organization risk drinking levels (WHO‐RDL), derived from the number of standard alcoholic drinks per day. We compared the volumes of addiction‐relevant cortical and subcortical brain regions at long‐term follow‐up among abstainers and 2 groups of relapsers with low and higher WHO‐RDL.ResultsWe found that: (i) relapsers with low WHO‐RDL at follow‐up, who as a group had reduced their risk levels by 2.8 units (by consuming <40 g of ethanol per day over the recovery interval), had regional brain tissue volumes indistinguishable from those of abstainers tested after the same time period and that (ii) relapsers with higher WHO‐RDL, with only 1.2 units average risk‐level reductions, had significantly smaller frontal GM and thalamic volumes than abstainers and relapsers with low WHO‐RDL. Despite many drinking days during recovery, including several with >10 drinks per day, relapsers with low WHO‐RDL at follow‐up tended to perform better than those with higher WHO‐RDL on cognitive domains of working memory and visuospatial skills assessed over the recovery interval.ConclusionsNonabstinent recovery is characterized by addiction‐relevant GM volumes comparable to those of complete abstainers. The WHO‐RDL has meaningful structural neuroimaging correlates potentially suitable as cognitively relevant biomarkers of treatment response and general brain health, perhaps even as objective clinical trial endpoints.

A new risk stratification model for intravesical recurrence, disease progression, and cancer-specific death in patients with non-muscle invasive bladder cancer: the J-NICE risk tables.

The aim of this study is to establish new risk tables for the current clinical setting, enabling short- and long-term risk stratification for recurrence, progression, and cancer-specific death after transurethral resection in non-muscle invasive bladder cancer (NMIBC). Currently available risk tables lack input from the 2004 World Health Organization grading system and risk prediction for cancer-specific death. This was a multi-institutional database study of 1490 patients diagnosed with NMIBC (the development cohort). A multivariate Fine and Gray subdistribution hazard model was used to assess the prognostic impact of various factors. Patients were classified into low-, intermediate-, and high-risk groups according to a sum of the weight of selected factors, and predicted cumulative rates were calculated. Internal validation was conducted using 200 bootstrap resamples to assess the optimism for the c-index and estimate a bias-corrected c-index. External validation of the developed risk table was performed on an independent dataset of 91 patients. The Japanese NIshinihon uro-onCology Extensive collaboration group (J-NICE) risk stratification table was derived from six, five, and two factors for recurrence, progression, and cancer-specific death, respectively. The internal validation bias-corrected c-index values were 0.619, 0.621, and 0.705, respectively. The application of the J-NICE table to an external dataset resulted in c-indices for recurrence, progression, and cancer-specific death of 0.527, 0.691, and 0.603, respectively. We propose a novel risk stratification model that predicts outcomes of treated NMIBC and may overcome the shortcomings of existing risk models. Further external validation is required to strengthen its clinical impact.