Effectiveness of a cardiovascular risk management program in the reduction of premature mortality associated to cardiovascular events in the Caribbean region of Colombia

Objectives: To establish the effectiveness of a cardiovascular risk management program [“De Todo Corazon (DTC)” program in Mutual SER-EPS] in the reduction of premature mortality associated to cardiovascular events (CVE) (male , 55 years, female , 60 years). Methods: The population eligible for the study were patients over 18 years of age affiliated to Mutual SER insurance company between June 2015 and June 2018 and residents of the Caribbean region of Colombia, enrolled or not to DTC program in which a cardiovascular event (CVE) occurred. The main outcomes considered were age of occurrence of cardiovascular events (AOCVE), age at death due to CVE (ADCVE) and years life lost (YLL). For the evaluation of the effectiveness, differences in AOCVO, ADCVO and the YPLL between the patients enrolled and nonenrolled in the DTC program were estimated using a Simple Linear Regression model. Results: A total of 3.902 CVE occurred in the study period among both groups. The enrolled patients had an average of AOCVE of 4.96 years (95% CI 3.85-6.06) higher than in non-enrolled patients. The ADCVE average was 4.64 years (95% CI 1.47 - 7.81) higher in the enrolled patients compared with the non-enrolled patients. Patients enrolled in the DTC program had on average -3.54 (95% CI -5.62 - -1.46) YLL compared to the non-enrolled patients. Conclusions: The DTC program in Mutual SER-EPS was effective to delay the AOCVE, ADCVE and YPLL. DTC program is an effective strategy to reduce the incidence and premature mortality due to CVE in the Caribbean region of Colombia

Association between exposure/adherence to a cardiovascular risk management program and the incidence and mortality of cardiovascular events in the Caribbean region of Colombia

Objectives: To establish the association between the exposure to a cardiovascular risk management program [“De Todo Corazon (DTC)” program in Mutual SER-EPS] and the reduction of incidence and mortality by cardiovascular events (CVE: AMI, Stroke, congestive heart failure). Methods: Cohort study that compared the occurrence of CVE among patients over 18 years of age exposed and non-exposed to the DTC program (N = 113,277). Enrolled patients in the DTC program between June 2015 and June 2017 were considered as the exposed population and patients enrolled in the DTC program between July 2017 and July 2018 were considered as the unexposed population. Patients who achieved clinical goals (blood pressure, 140/90 mmHg, HbA1c, 7.5% and LDL cholesterol, 100 mg/dl) were considered adherent to the DTC program. Incidence and mortality rates were compared and Incidence rate ratio (IRR) was used to evaluate the effect of the program. A Poisson regression model was used to assess the association between exposure to the program and CVE adjusting by socio-demographic characteristics and clinical goals. Results: The incidence of CVE in exposed and unexposed patients was 6.8 and 9.5 per 1.000 persons per year, respectively [IRR of 0.72 (95% CI 0.60-0.87)]. Mortality associated to CVE in exposed and unexposed patients was 0.46 and 0.56 per 1.000 persons per year, respectively [IRR 0.82 (95% CI 0.40-1.95)]. When adjusting the estimation by age, sex and achievement of clinical goals, a lower incidence rate of CVE among patients who were adherent to the program was observed [IRR = 0.62 (CI 95% 0.46 - 0.86)]. Conclusions: Exposure to the DTC program significantly decreased the incidence and mortality CVE by 28% and 18%, respectively. Adherence to the DTC program significantly decreased the incidence of CVE by 38%

Effect of yoga on pulse rate variability measured from a venous pressure waveform

The benefits of yoga have been studied in different fields, from chronic health conditions to mental disorders, showing that it can help to improve the overall health. In particular, it has been proven that yoga also improves the autonomic function. Heart rate variability (HRV) at rest is commonly used as a non-invasive measure of autonomic regulation of heart rate. Alternatively, pulse rate variability (PRV) has been proposed as a surrogate of HRV. VoluMetrix has developed a novel technology that captures venous waveforms via sensors on the volar aspect of the wrist, called NIVAband. This study aims to assess the effect of yoga in the autonomic nervous system by analyzing the PRV obtained from the NIVA signal. Temporal (statistics of the normal-to-normal intervals), spectral (power in low and high frequency bands) and nonlinear (lagged Poincaré Plot analysis) parameters are analyzed before and after a yoga session in 20 healthy volunteers. The PRV analysis shows an increase in parameters related to parasympathetic activity and overall variability, and a decrease in parameters related to sympathetic activity and mean heart rate. These results support the beneficial effect of yoga in autonomic nervous system, increasing the parasympathetic activity

Mortality, morbidity, and hospitalisations due to influenza lower respiratory tract infections, 2017: an analysis for the Global Burden of Disease Study 2017

Background Although the burden of influenza is often discussed in the context of historical pandemics and the threat of future pandemics, every year a substantial burden of lower respiratory tract infections (LRTIs) and other respiratory conditions (like chronic obstructive pulmonary disease) are attributable to seasonal influenza. The Global Burden of Disease Study (GBD) 2017 is a systematic scientific effort to quantify the health loss associated with a comprehensive set of diseases and disabilities. In this Article, we focus on LRTIs that can be attributed to influenza. Methods We modelled the LRTI incidence, hospitalisations, and mortality attributable to influenza for every country and selected subnational locations by age and year from 1990 to 2017 as part of GBD 2017. We used a counterfactual approach that first estimated the LRTI incidence, hospitalisations, and mortality and then attributed a fraction of those outcomes to influenza. Findings Influenza LRTI was responsible for an estimated 145 000 (95% uncertainty interval [UI] 99 000–200 000) deaths among all ages in 2017. The influenza LRTI mortality rate was highest among adults older than 70 years (16·4 deaths per 100 000 [95% UI 11·6–21·9]), and the highest rate among all ages was in eastern Europe (5·2 per 100 000 population [95% UI 3·5–7·2]). We estimated that influenza LRTIs accounted for 9 459000 (95% UI 3 709000–22 935000) hospitalisations due to LRTIs and 81 536 000 hospital days (24 330 000–259851 000). We estimated that 11·5% (95% UI 10·0–12·9) of LRTI episodes were attributable to influenza, corresponding to 54481 000 (38465000–73864000) episodes and 8172000 severe episodes (5 000 000–13 296000). Interpretation This comprehensive assessment of the burden of influenza LRTIs shows the substantial annual effect of influenza on global health. Although preparedness planning will be important for potential pandemics, health loss due to seasonal influenza LRTIs should not be overlooked, and vaccine use should be considered. Efforts to improve influenza prevention measures are needed

Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years: an analysis for the Global Burden of Disease Study 2017

Background Despite large reductions in under-5 lower respiratory infection (LRI) mortality in many locations, the pace of progress for LRIs has generally lagged behind that of other childhood infectious diseases. To better inform programmes and policies focused on preventing and treating LRIs, we assessed the contributions and patterns of risk factor attribution, intervention coverage, and sociodemographic development in 195 countries and territories by drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) LRI estimates. Methods We used four strategies to model LRI burden: the mortality due to LRIs was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive ensemble modelling tool; the incidence of LRIs was modelled using population representative surveys, health-care utilisation data, and scientific literature in a compartmental meta-regression tool; the attribution of risk factors for LRI mortality was modelled in a counterfactual framework; and trends in LRI mortality were analysed applying changes in exposure to risk factors over time. In GBD, infectious disease mortality, including that due to LRI, is among HIV-negative individuals. We categorised locations based on their burden in 1990 to make comparisons in the changing burden between 1990 and 2017 and evaluate the relative percent change in mortality rate, incidence, and risk factor exposure to explain differences in the health loss associated with LRIs among children younger than 5 years. Findings In 2017, LRIs caused 808 920 deaths (95% uncertainty interval 747 286–873 591) in children younger than 5 years. Since 1990, there has been a substantial decrease in the number of deaths (from 2 337 538 to 808 920 deaths; 65·4% decrease, 61·5–68·5) and in mortality rate (from 362·7 deaths [330·1–392·0] per 100 000 children to 118·9 deaths [109·8–128·3] per 100 000 children; 67·2% decrease, 63·5–70·1). LRI incidence declined globally (32·4% decrease, 27·2–37·5). The percent change in under-5 mortality rate and incidence has varied across locations. Among the risk factors assessed in this study, those responsible for the greatest decrease in under-5 LRI mortality between 1990 and 2017 were increased coverage of vaccination against Haemophilus influenza type b (11·4% decrease, 0·0–24·5), increased pneumococcal vaccine coverage (6·3% decrease, 6·1–6·3), and reductions in household air pollution (8·4%, 6·8–9·2). Interpretation Our findings show that there have been substantial but uneven declines in LRI mortality among countries between 1990 and 2017. Although improvements in indicators of sociodemographic development could explain some of these trends, changes in exposure to modifiable risk factors are related to the rates of decline in LRI mortality. No single intervention would universally accelerate reductions in health loss associated with LRIs in all settings, but emphasising the most dominant risk factors, particularly in countries with high case fatality, can contribute to the reduction of preventable deaths

Contamination Control and Assay Results for the Majorana Demonstrator Ultra Clean Components

The MAJORANA DEMONSTRATOR is a neutrinoless double beta decay experiment utilizing enriched Ge-76 detectors in 2 separate modules inside of a common solid shield at the Sanford Underground Research Facility. The DEMONSTRATOR has utilized world leading assay sensitivities to develop clean materials and processes for producing ultra-pure copper and plastic components. This experiment is now operating, and initial data provide new insights into the success of cleaning and processing. Post production copper assays after the completion of Module 1 showed an increase in U and Th contamination in finished parts compared to starting bulk material. A revised cleaning method and additional round of surface contamination studies prior to Module 2 construction have provided evidence that more rigorous process control can reduce surface contamination. This article describes the assay results and discuss further studies to take advantage of assay capabilities for the purpose of maintaining ultra clean fabrication and process design.Comment: Proceedings of Low Radioactivity Techniques (LRT May 2017, Seoul

Publisher Correction: Image Data Resource: a bioimage data integration and publication platform

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