A Hypertension Risk Score for Middle-Aged and Older Adults

Determining which demographic and medical variables predict the development of hypertension could help clinicians stratify risk in both prehypertensive and nonhypertensive persons. Subject-level data from 2 community-based biracial cohorts were combined to ascertain the relationship between baseline characteristics and incident hypertension. Hypertension, defined as diastolic blood pressure ≥90 mm Hg, systolic blood pressure ≥140 mm Hg, or reported use of medication known to treat hypertension, was assessed prospectively at 3, 6, and 9 years. Internal validation was performed by the split-sample method with a 2:1 ratio for training and testing samples, respectively. A scoring algorithm was developed by converting the multivariable regression coefficients to integer values. Age, level of systolic or diastolic blood pressure, smoking, family history of hypertension, diabetes mellitus, high body mass index, female sex, and lack of exercise were associated with the development of hypertension in the training sample. Regression models showed moderate to high capabilities of discrimination between hypertension vs nonhypertension (area under the receiver operating characteristic curve 0.75–0.78) in the testing sample at 3, 6, and 9 years of follow-up. This risk calculator may aide health care providers in guiding discussions with patients about the risk for progression to hypertension

Positive association of renal insufficiency with agriculture employment and unregulated alcohol consumption in Nicaragua

Endemic renal insufficiency (RI) of unknown etiology is a major public health issue with high mortality in the Pacific coastal regions of Central America. We studied RI in León and Chinandega, Nicaragua, evaluating associations with known risk factors and hypothesized exposures

A population-based study of prevalence and risk factors of chronic kidney disease in León, Nicaragua

Abstract Background Recent studies have shown an excess of chronic kidney disease (CKD) among younger adult males in the Pacific coastal region of Nicaragua and suggest a non-conventional CKD etiology in this region. These studies have been conducted in small, non-representative populations. Objectives We conducted a large population-based cross-sectional study to estimate CKD prevalence in León, Nicaragua, and to evaluate the association between previously investigated risk factors and CKD. Methods Estimated glomerular filtration rate, derived using the MDRD equation, was assessed to determine CKD status of 2275 León residents. Multivariable logistic regression was used to estimate adjusted prevalence odds ratios. León CKD prevalence was also standardized to the demographic distributions of the León Health and Demographic Surveillance System and the León 2005 Census. Results CKD prevalence was 9.1%; twice as high for males (13.8%) than females (5.8%). In addition to gender, older age, rural zone, lower education level, and self-reported high blood pressure, more years of agricultural work, lija (unregulated alcohol) consumption, and higher levels of daily water consumption were significantly associated with CKD. Notably, self-reported diabetes was associated with CKD in adjusted models for females but not males. Conclusions Our findings are comparable to those found in regional studies and further support the hypothesis of a Mesoamerican Nephropathy

Non-typeable Haemophilus influenzae and Streptococcus pneumoniae as primary causes of acute otitis media in colombian children: a prospective study

<p>Abstract</p> <p>Background</p> <p>Acute otitis media (AOM) is one of the most frequently encountered bacterial infections in children aged < 5 years; <it>Streptococcus pneumoniae </it>(<it>S. pneumoniae</it>) and non-typeable <it>Haemophilus influenzae </it>(NTHi) are historically identified as primary AOM causes. Nevertheless, recent data on bacterial pathogens causing AOM in Latin America are limited. This prospective study aimed to identify and characterize bacterial etiology and serotypes of AOM cases including antimicrobial susceptibility in < 5 year old Colombian children.</p> <p>Methods</p> <p>From February 2008 to January 2009, children ≥3 months and < 5 years of age presenting with AOM and for whom a middle ear fluid (MEF) sample was available were enrolled in two medical centers in Cali, Colombia. MEF samples were collected either by tympanocentesis procedure or spontaneous otorrhea swab sampling. Bacteria were identified using standard laboratory methods, and antimicrobial resistance testing was performed based on the 2009 Clinical and Laboratory Standards Institute (CLSI) criteria. Most of the cases included in the study were sporadic in nature.</p> <p>Results</p> <p>Of the 106 enrolled children, 99 were included in the analysis. Bacteria were cultured from 62/99 (63%) of samples with <it>S. pneumoniae, H. influenzae, or S. pyogenes</it>. The most commonly isolated bacteria were <it>H. influenzae </it>in 31/99 (31%) and <it>S. pneumoniae </it>in 30/99 (30%) of samples. The majority of <it>H. influenzae </it>episodes were NTHi (27/31; 87%). 19F was the most frequently isolated pneumococcal serotype (10/30; 33%). Of the 30 <it>S. pneumoniae </it>positive samples, 8/30 (27%) were resistant to tetracycline, 5/30 (17%) to erythromycin and 8/30 (27%) had intermediate resistance to penicillin. All <it>H. influenzae </it>isolates tested were negative to beta-lactamase.</p> <p>Conclusions</p> <p>NTHi and <it>S. pneumoniae </it>are the leading causes of AOM in Colombian children. A pneumococcal conjugate vaccine that prevents both pathogens could be useful in maximizing protection against AOM.</p

Non-capsulated and capsulated Haemophilus influenzae in children with acute otitis media in Venezuela: a prospective epidemiological study

<p>Abstract</p> <p>Background</p> <p>Non-typeable <it>Haemophilus influenzae </it>(NTHi) and <it>Streptococcus pneumoniae </it>are major causes of bacterial acute otitis media (AOM). Data regarding AOM are limited in Latin America. This is the first active surveillance in a private setting in Venezuela to characterize the bacterial etiology of AOM in children < 5 years of age.</p> <p>Methods</p> <p>Between December 2008 and December 2009, 91 AOM episodes (including sporadic, recurrent and treatment failures) were studied in 87 children enrolled into a medical center in Caracas, Venezuela. Middle ear fluid samples were collected either by tympanocentesis or spontaneous otorrhea swab sampling method. Standard laboratory and microbiological techniques were used to identify bacteria and test for antimicrobial resistance. The results were interpreted according to Clinical Laboratory Standards Institute (CLSI) 2009 for non-meningitis isolates. All statistical analyses were performed using SAS 9.1 and Microsoft Excel (for graphical purposes).</p> <p>Results</p> <p>Overall, bacteria were cultured from 69.2% (63 of the 91 episodes); at least one pathogen (<it>S. pneumoniae, H. influenzae, S. pyogenes </it>or <it>M. catarrhalis</it>) was cultured from 65.9% (60/91) of episodes. <it>H. influenzae </it>(55.5%; 35/63 episodes) and <it>S. pneumoniae </it>(34.9%; 22/63 episodes) were the most frequently reported bacteria. Among <it>H. influenzae </it>isolates, 62.9% (22/35 episodes) were non-capsulated (NTHi) and 31.4% (11/35 episodes) were capsulated including types d, a, c and f, across all age groups. Low antibiotic resistance for <it>H. influenzae </it>was observed to amoxicillin/ampicillin (5.7%; 2/35 samples). NTHi was isolated in four of the six <it>H. influenzae </it>positive samples (66.7%) from recurrent episodes.</p> <p>Conclusions</p> <p>We found <it>H. influenzae </it>and <it>S. pneumoniae </it>to be the main pathogens causing AOM in Venezuela. Pneumococcal conjugate vaccines with efficacy against these bacterial pathogens may have the potential to maximize protection against AOM.</p

Impact of rotavirus vaccination on childhood deaths from diarrhea in Brazil

SummaryObjectivesRotavirus vaccination was introduced in Brazil in March 2006, targeting an annual birth cohort of approximately 3.5 million. We analyzed trends in all-cause gastroenteritis-related deaths in children <5 years of age during the pre- and post-vaccination periods.MethodsData from the National Immunization Program and the Mortality Information System were used to calculate vaccine coverage and mortality rates related to gastroenteritis in children <1 year and 1–4 years of age, using population estimates from the census as the denominator. Relative reductions in mortality rates were calculated for 2007 and 2008, using the 2004–2005 mean as baseline before vaccine introduction.ResultsCoverage of two doses of human rotavirus vaccine was 39% in 2006, increasing to 72% in 2007 and 77% in 2008. During 2004–2005, the gastroenteritis mortality rate in children <1 year of age was 56.9 per 100 000, decreasing by 30% (95% confidence interval (CI) 19–41) in 2007 and by 39% (95% CI 29–49) in 2008. In children 1–4 years of age, the mortality rate was 4.5 per 100 000 during 2004–2005, decreasing by 29% (95% CI 10–49) in 2007 and by 33% (95% CI 15–52) in 2008.ConclusionsThe decreased rates of childhood gastroenteritis-related deaths in Brazil following rotavirus vaccine introduction, particularly among children <1 year of age, suggest the potential benefit of vaccination

Trends in hospitalizations from all-cause gastroenteritis in children younger than 5 years of age in Brazil before and after human rotavirus vaccine introduction, 1998 - 2007

GlaxoSmithKline Biologicals. Rio de Janeiro, RJ, Brasil.Secretaria de Estado de Saúde do Estado do Pará. Belém, PA, Brasil.GlaxoSmithKline Biologicals. Bangalore, India.Secretaria de Estado de Saúde do Estado do Pará. Belém, PA, Brasil.GlaxoSmithKline. Rio de Janeiro, RJ, Brasil.Ministério da Saúde. Fundação Serviços de Saúde Pública. Instituto Evandro Chagas. Belém, PA, Brasil.GlaxoSmithKline Biologicals. Rio de Janeiro, RJ, Brasil.Rotavirus vaccination was introduced in Brazil in March 2006.We describe trends in hospitalizations from all-cause gastroenteritis in children younger than 5 years during pre- and postvaccination periods using hospital discharge data from Brazil Hospital Information System (SIH-SUS). A reduction in gastroenteritis hospitalizations of 26% and 48% in 2006 and in 2007, respectively, was observed among children younger than 1 year compared with prevaccination period (1998 2005). The largest reduction rates among children younger than 1 year were noted in the South and Southeast regions, approximately 56% in 2007, where vaccine coverage was the highest

Clinical development, registration, and introduction of human rotavirus vaccine: The Latin American experience

GlaxoSmithKline (GSK) Biologicals was the funding source and was involved in all stages of the study conduct and analysis. GSK Biologicals also funded all costs associated with the development and the publishing of the present manuscript.Ministerio de Salud. Universidad Central de Venezuela. Instituto de Biomedicina. Retired Investigator. Carmelitas, Caracas, Venezuela.University of Chile. Faculty of Medicine. Institute of Biomedical Sciences. Santiago, Chile.Hospital del Niño. Ciudad de Panamá, Panama.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Belém, PA, Brasil.Instituto Mexicano del Seguro Social. CMN-SXXI. Pediatrics Hospital. Medical Research Unit on Infectious Diseases. México City, México.GlaxoSmithKline Biologicals. Rio de Janeiro, RJ, Brazil.GlaxoSmithKline Biologicals. Rixensart, Belgium.Rotavirus (RV) is the leading cause of severe gastroenteritis (GE) among infants and young children worldwide, accounting for 453,000 deaths in children aged <5 years. In Latin America rotavirus causes an estimated 15,000 deaths annually and accounts for 20–70% of acute gastroenteritis cases requiring hospitalization. This results in an estimated annual cost of approximately US$86 million. The most common G type has been G1 (∼50%), followed by G4, G3 and G9, although regional and temporal variations are significant. There are currently two effective rotavirus vaccines: a single-strain, human attenuated-based (RotarixTM, GlaxoSmithKline Biologicals), and a five-strain, bovine-human reassortant vaccine (RotaTeqTM, Merck and Company). The pioneering strategy behind the development and licensure of RotarixTM was part of a new paradigm for global vaccine research and development focusing on introduction first in countries with greatest medical needs. Rotarix™ demonstrated high efficacy and a good safety profile in Phase II and III clinical trials performed in Latin America. In the pivotal phase III study involving 11 Latin American countries a 2-year efficacy of 81% (95% CI: 71–87) was achieved against severe rotavirus acute gastroenteritis. A high protective efficacy was observed against severe rotavirus gastroenteritis caused by G1 and non-G1 strains. RotarixTM proved to be safe regarding intussusception (IS) in a two-dose vaccine schedule beginning at 6–12 weeks of age. First registered in Mexico in July 2004, Rotarix™ gained World Health Organization (WHO) prequalification in February 2007 and has been introduced for routine use into the universal mass vaccination programs of Brazil, Panama, Mexico, Venezuela, Ecuador, Guatemala, Honduras, Colombia, Paraguay, Bolivia, Peru, and El Salvador. The main factors influencing the decision-making process of introducing rotavirus vaccines in Latin American countries included: (a) demonstration of good efficacy/safety profiles; (b) political decision to decrease mortality; (c) decision from ministries of health; (d) availability of data on the disease burden; (e) cold chain available; and, importantly (f) the use of PAHO's Revolving Fund for the purchase of vaccines. Post-licensure studies have shown 76% (95% CI: 64–84%) effectiveness in El Salvadoran children and 76% (95% CI: 58–86%) to 85% (95% CI: 53–94%) in Brazil. Observational studies in Panama, Mexico, El Salvador and Brazil reported reduction in all-cause diarrhea-related hospitalizations at rates of 22–37%, 11–40%, 35–48%, and 17–48%, respectively. The decline in diarrhea-associated deaths reached 35% (95% CI: 29–39%) in Mexico and ranged from 22% (95% CI: 6–45%) to 33% (95% CI: 15–52%) among Brazilian children. A low, increased risk of intussusception was detected among Mexican infants within 7 days after first vaccine dose [odds ratio, 5.8 (95% CI: 2.6–13)]. Continuous and expanding post-licensure rotavirus surveillance studies are needed to better assess the effect of universal vaccination in Latin American countries and elsewhere