A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining https://researchonline.ljmu.ac.uk/images/research_banner_face_lab_290.jpgunderweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity

Do thermoregulatory costs limit altitude distributions of Andean forest birds?

Along tropical mountains, species often occupy narrow altitude ranges. Numerous biotic and abiotic factors have been proposed as determinants of altitude occupancy. We measured several aspects of thermal physiology of 215 bird species across a 2·6-km altitude gradient in the Peruvian Andes. We predicted that highland species would show adaptation to the colder high-altitude climate and that energy costs of thermoregulation might limit upslope dispersal of lowland natives. We found reductions in thermal conductance, body temperature and lower critical temperature in highland birds compared with lowland species. These combine to make highland natives more resistant to heat loss. We did not find convincing evidence that acute thermal limits or energy costs of thermoregulation constrained altitude distributions. Heat-budget models predicted low-to-moderate long-term costs at native altitudes. Costs increased for lowland natives modelled in the highland climate, but for all but a few species, costs remained within putative expenditure limits. Although we did not test heat tolerances, we measured all species at temperatures similar to the hottest air temperatures at the lowland site. There was no evidence that high lowland temperatures preclude downslope movements of highland birds. While thermal tolerances probably do not directly determine altitude occupancy by most species, the additional energy cost of thermoregulation experienced by lowland species moving upslope may trade off against investment in important life-history components such as breeding, and thereby affect altitude range limits. A Lay Summary is available for this article

Do thermoregulatory costs limit altitude distributions of Andean forest birds?

Along tropical mountains, species often occupy narrow altitude ranges. Numerous biotic and abiotic factors have been proposed as determinants of altitude occupancy. We measured several aspects of thermal physiology of 215 bird species across a 2·6-km altitude gradient in the Peruvian Andes. We predicted that highland species would show adaptation to the colder high-altitude climate and that energy costs of thermoregulation might limit upslope dispersal of lowland natives. We found reductions in thermal conductance, body temperature and lower critical temperature in highland birds compared with lowland species. These combine to make highland natives more resistant to heat loss. We did not find convincing evidence that acute thermal limits or energy costs of thermoregulation constrained altitude distributions. Heat-budget models predicted low-to-moderate long-term costs at native altitudes. Costs increased for lowland natives modelled in the highland climate, but for all but a few species, costs remained within putative expenditure limits. Although we did not test heat tolerances, we measured all species at temperatures similar to the hottest air temperatures at the lowland site. There was no evidence that high lowland temperatures preclude downslope movements of highland birds. While thermal tolerances probably do not directly determine altitude occupancy by most species, the additional energy cost of thermoregulation experienced by lowland species moving upslope may trade off against investment in important life-history components such as breeding, and thereby affect altitude range limits. A Lay Summary is available for this article

Outcome and cost-effectiveness of cardiopulmonary resuscitation after in-hospital cardiac arrest in octogenarians

Context: Octogenarians are the fastest growing segment of the population and little is known about the results of cardiopulmonary resuscitation (CPR) after in-hospital cardiac arrest in this population. Objective: We sought to investigate the clinical benefit and cost-effectiveness of CPR after in-hospital cardiac arrest in octogenarians. Main Outcome Measure: Years of life saved. Design: Effectiveness data were obtained from a review of 91,372 hospital discharges from January 1st, 1993 until June 30th, 1996. Cardiac arrest was reported in 956 patients. The study group consisted of 474 patients ≥ 80 years old. CPR costs included equipment and training, physician and nursing time and medications. Post-CPR expenses included in-hospital true cost, repeat hospitalizations, physician office visits, nursing home, rehabilitation, and chronic care hospital costs. Life expectancy of the patients who were still alive at the end of the study was estimated from census data. A utility of 0.8 was used to calculate quality-adjusted-life years saved (QALYS). We used a societal perspective for analysis. Results: The study population was 86 ± 4.8 years old (range 80-103), and 42% were male. Fifty-four patients (11%) were discharged alive, 35 to a chronic care facility and 19 to their home. Assuming that a cardiac arrest without CPR has 100% mortality, 12 octogenarians required treatment with CPR in order to save one life to hospital discharge. Similarly, 29 octogenarian patients with cardiac arrest have to be treated with CPR to net one long-term survivor (mean survival 21 months, with a range from 9 to 48 months). The cost-effectiveness ratio, after estimating the life expectancy of octogenarian survivors, was USD 50,412 per year of life saved, and USD 63,015 per QALYS. However, a utility of 0.5 yielded a cost of USD 100,825 per QALYS. Conclusion: In comparison with other lifesaving strategies, CPR in octogenarians is effective. The favorable cost-effectiveness ratio is highly dependent on the patients' preference for quality rather than quantity of life, as expressed by the utility assumptions. Copyright © 2002 S. Karger AG, Basel

Basal metabolism in tropical birds: Latitude, altitude, and the 'pace of life'

Life history varies across latitudes, with the 'pace of life' being 'slower' in tropical regions. Because life history is coupled to energy metabolism via allocation tradeoffs and links between performance capacity and energy use, low metabolic intensity is expected in tropical animals. Low metabolism has been reported for lowland tropical birds, but it is unclear if this is due to 'slow' life history or to a warm, stable environment. We measured basal metabolic rates (BMR) of 253 bird species across a 2·6 km altitude gradient in Peru. We predicted higher BMR at high altitude due to lower temperatures leading to elevated thermoregulatory costs. We also tested for BMR differences between widely separated tropical regions (Peru and Panama), and between tropical- and temperate-breeding birds. We found no effect of altitude on BMR in Peruvian species and no difference in BMR between Peruvian and Panamanian birds, suggesting that BMR in Neotropical birds is consistent and independent of environmental temperature. In a data set encompassing more than 500 species, tropical birds had significantly lower BMR than temperate-breeding birds. In contrast to several recent analyses, we found higher BMR in passerine birds than in non-passerines, independent of breeding latitude. Breeding latitude affects BMR, but diversity in avian life history within and between temperate and tropical regions may explain some of the residual variation in BMR after accounting for body mass and breeding latitude. Future studies of links between life history, metabolism and environmental factors might benefit from examining these variables within individual species as well as across broad geographic contrasts

Prevalência e fatores de risco para tabagismo em adolescentes Prevalence and risk factors for smoking among adolescents

OBJETIVO: O tabagismo é uma das principais causas de enfermidades evitáveis e incapacidades prematuras. Nesse sentido, realizou-se estudo com o objetivo de medir a prevalência e estudar fatores de risco associados ao tabagismo nos adolescentes. MÉTODOS: A partir de um delineamento transversal de base populacional, estudou-se uma amostra representativa de 1.187 adolescentes de 10 a 19 anos, da zona urbana de Pelotas, sul do Brasil. Todos os adolescentes da amostra, de cada domicílio, foram entrevistados por meio de questionário pré-codificado, individual e confidencial. Utilizou-se o teste de Kaplan-Meier para análise da curva de sobrevida. RESULTADOS: A prevalência de tabagismo na amostra foi de 12,1% (IC95% 10,3%-14%). As prevalências foram similares para os sexos femininos e masculinos. Os fatores de risco para tabagismo na análise multivariada, por regressão logística, foram: maior idade, odds ratio (OR) de 28,7 (11,5-71,4), irmãos mais velhos fumantes, OR de 2,4 (1,5-3,8), três ou mais amigos fumantes, OR de 17,5 (8,8-34,8) e baixa escolaridade OR de 3,5 (1,5-8,0). CONCLUSÕES: A prevalência de tabagismo na adolescência mostrou-se alta, na cidade de Pelotas. Campanhas antitabágicas devem ser direcionadas à comunidade e à família tendo o adolescente como alvo. Medidas legais adotadas pelo governo são importantes para impedir o acesso dos adolescentes ao cigarro.<br>OBJECTIVE: Tobacco smoking is one of the main causes of preventable disease and premature disability. Th estudy was aimed at measuring smoking prevalence and related risk factors among adolescents. METHODS: A population-based cross-sectional study was carried out in a representative sample of 1,187 adolescents aged 10 to 19 years living in the urban area of Pelotas, southern Brazil. All adolescents were interviewed separately using a confidential coded questionnaire. Kaplan-Meier test was performed for survival curve analysis. RESULTS: The overall smoking prevalence rate in the sample was 12.1% (95% CI 10.3%-14%). Boys and girls had similar prevalence rates. The following were the risk factors for smoking found in the multivariate logistic regression analysis: older age (OR=28.7; 95% CI 11.5-71.4), older smoking siblings (OR=2.4; 95% CI 1.5-3.8), three or more smoking friends (OR=17.5; 95% CI 8.8-34.8) and low schooling (OR=3.5; 95% CI 1.5-8.0). CONCLUSIONS: The prevalence of smoking among adolescents in the city of Pelotas was high. Campaigns against tobacco use should be aimed at the community and families, targeting adolescents. The government must adopt legal actions in order to prevent adolescents to have access to to smoking

Autoeficacia y actitud hacia el consumo de drogas en la infancia: explorando los conceptos Autoeficácia e atitude frente ao consumo de drogas na infância: explorando conceitos Self-efficacy and attitudes towards drug consumption in childhood: exploring concepts

El objetivo de este artículo es explorar los conceptos de autoeficacia y actitud hacia el consumo, los que fueron analizados bajo la teoría de la motivación y la conducta humana. Se trata de una reflexión teórica, construida con base en la literatura. Altos niveles de autoeficacia tienen consecuencias beneficiosas para el funcionamiento del individuo. Frente a la actitud hacia las drogas se encontró que la presencia o ausencia de prejuicios y las valoraciones positivas sobre las drogas facilitan el riesgo o perjudican la protección de consumo. Se concluye que el profesional de enfermería debe aplicar los conceptos de autoeficacia y actitud hacia el consumo para orientar las acciones de promoción de la salud y prevención del consumo de drogas en niños y adolescentes.<br>O objetivo deste trabalho foi explorar os conceitos de autoeficácia e de atitude frente ao consumo de drogas, derivados da teoria da motivação e do comportamento humano. Trata-se de reflexão teórica, construída com base na literatura. Altos níveis de autoeficácia têm consequências benéficas para o funcionamento do indivíduo. Em relação à atitude para o consumo das drogas, a presença ou ausência de preconceitos e valores positivos frente às drogas facilitam o risco ou proteção para o consumo. Conclui-se que o enfermeiro deve aplicar os conceitos de autoeficácia e a atitude para o consumo para orientar as ações de promoção de saúde e prevenção do consumo de drogas nos escolares.<br>This paper aims to explore the concepts of self-efficacy and attitude towards consumption, approached by the theory of motivation and human behavior. This is a theoretical study based on literature. High levels of self-efficacy have beneficial consequences for the functioning of the individual. Concerning attitudes towards drugs, the presence or absence of preconceptions and positive values of drugs increases risk or consumer protection. Nurses should apply the concepts of self-efficacy and attitudes towards consumption to guide actions of health promotion and prevention of drug consumption in children and adolescents