Prostate-Specific Antigen testing in men between 40 and 70 years in Brazil: database from a check-up program

Objectives To evaluate the PSA in a large population of Brazilian men undergone to check up, and correlate the PSA cutoffs with prostate size and urinary symptoms. Materials and Methods This is a cross sectional study performed with men between 40 and 70 years undergone to check-up. All men were undergone to urological evaluation, digital rectal examination, prostate-specific antigen, and ultrasonography The exclusion criteria were men who used testosterone in the last six months, or who were using 5 alpha-reductase inhibitors. Results A total of 5015 men with an average age of 49.0 years completed the study. Most men were white and asymptomatic. The PSA in the three different aging groups were 0.9 ± 0.7ng/dL for men between 40 and 50; 1.2 ± 0.5ng/dL for men between 50 and 60; and 1.7 ± 1.5ng/dL for men greater than 60 years (p=0.001). A total of 192 men had PSA between 2.5 and 4ng/ml. From these men 130 were undergone to prostate biopsy. The predictive positive value of biopsy was 25% (32/130). In the same way, 100 patients had PSA >4ng/mL. From these men, 80 were undergone to prostate biopsy. In this group, the predictive positive value of biopsy was 40% (32/100). The Gleason score was 6 in 19 men (60%), 7 in 10 men (31%) and 8 in 3 men (9%). Conclusions The PSA level of Brazilian men undergone to check up was low. There was a positive correlation with aging, IPSS and prostate size.Universidade Federal de São Paulo (UNIFESP) Department of UrologyHospital Israelita Albert EinsteinWake Forest UniversityUNIFESP, Department of UrologySciEL

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Ontologically correct taxonomies by construction

Taxonomies play a central role in conceptual domain modeling, having a direct impact in areas such as knowledge representation, ontology engineering, and software engineering, as well as knowledge organization in information sciences. Despite this, there is little guidance on how to build high-quality taxonomies, with notable exceptions being the OntoClean methodology, and the ontology-driven conceptual modeling language OntoUML. These techniques take into account the ontological meta-properties of types to establish well-founded rules on the formation of taxonomic structures. In this paper, we show how to leverage the formal rules underlying these techniques in order to build taxonomies which are correct by construction. We define a set of correctness-preserving operations to systematically introduce types and subtyping relations into taxonomic structures. In addition to considering the ontological micro-theory of endurant types underlying OntoClean and OntoUML, we also employ the MLT (Multi-Level Theory) micro-theory of high-order types, which allows us to address multi-level taxonomies based on the powertype pattern. To validate our proposal, we formalize the model building operations as a graph grammar that incorporates both micro-theories. We apply automatic verification techniques over the grammar language to show that the graph grammar is sound, i.e., that all taxonomies produced by the grammar rules are correct, at least up to a certain size. We also show that the rules can generate all correct taxonomies up to a certain size (a completeness result)

What is the best choice for chronic urinary retention: indwelling catheter or clean intermittent catheterization?

Objective: The aim of this study was to analyze the advantages and disadvantages of clean intermittent catheterization, comparing to indwelling urinary catheter, in the treatment of chronic urinary retention. Methods: This literature review was carried out in order to highlight the best evidences for the choice between treatments. The extensive literature review was made through PubMed and Cochrane National Library. We selected the main articles published between 1950 and 2007, using urinary retention, indwelling urinary catheter, and clean intermittent catheterization as keywords. Results: Twenty five papers were selected, including three meta-analyses evaluating the long-term complications of clean intermittent catheterization, prophylactic intervention, and catheter types. Most articles discussed complications in patients with neurologic dysfunctions. Conclusion: Clean intermittent catheterization is better than indwelling catheter, as it is related to lower complication rates, both short and long-term. Indwelling catheterization was associated with decreased vesical compliance and bladder calculi, among others

Harvest dates and the productivity in sugarcane genotypes, in first ratoon<br>Épocas de corte e a produtividade em genótipos de cana-de-açúcar, em cana-soca

The sugarcane shows different performances when submitted to different production environments and harvest dates. This work will assist in choosing the better harvest date for each genotype, in a way to show its greater agro-industrial potential. The aim of this work was to evaluate sugarcane genotypes’ agro-industrial productivity in different harvest dates, in first ratoon, in the year of 2007. The experiment was installed on march 15th, 2005, at the Usina Alto Alegre, in Colorado, northwest of Paraná State. The experiment’s place has ground classified as latossolo vermelho-amarelo, and climate classified as Cfa, according to Köppen classification. The statistical design used was completely randomized design in factorial arrangement of 3x10, being three harvest dates (April 15th, July 15th and October 15th) and ten genotypes. It was evaluated Pol % cana (sugar polarization), TCH (ton ha-1 of cane) and TPH (ton ha-1 of Pol). The experimental plot was composed by four rows, with 1,10 meters between each row and 8,0 meters of length, and 18 buds per linear meter. In the conditions of the present work, there was significant interaction between harvest dates and genotypes, considering that the genotypes suffered influence from the harvest dates in its agro-industrial productivity. The decision of the harvest date of each sugarcane genotype must not be based only on the technological standards, therefore, a high value of Pol can cannot mean high agro-industrial productivity.<p><p>A cana-de-açúcar apresenta comportamento diferenciado quando submetida a diferentes ambientes de produção e épocas de corte. Este trabalho auxiliará na escolha da época mais adequada de colheita de cada genótipo, de modo que expresse seu maior potencial agroindustrial. O objetivo do presente trabalho foi avaliar a produtividade agroindustrial de genótipos de cana-de-açúcar em diferentes épocas de corte em cana-soca, no ano de 2007. O experimento foi instalado em 15 de março de 2005, na Usina Alto Alegre, no município de Colorado, região noroeste do estado do Paraná. O local do experimento possui solo classificado como latossolo vermelho-amarelo, e clima classificado como Cfa, segundo a classificação de Köppen. O delineamento experimental utilizado foi o inteiramente casualizado em arranjo fatorial 3x10, sendo três épocas de corte (abril, julho, e outubro) e dez genótipos. Foram avaliados Pol % cana (polarização do açúcar), TCH (tonelada de cana por hectare) e TPH (tonelada de Pol por hectare). A parcela experimental foi constituída por quatro sulcos, com espaçamento de 1,10 m, com oito metros de comprimento, e 18 gemas por metro linear. Nas condições do presente trabalho, houve interação significativa entre épocas de corte, e genótipos, sendo que os genótipos sofreram influência das épocas de corte quanto à produtividade agroindustrial. A tomada de decisões para colher os genótipos de cana-de-açúcar não deve ser baseada apenas nos padrões tecnológicos, pois um alto valor de Pol % cana pode não significar alta produtividade agroindustrial