Understanding Prognostic Factors for Human Papillomavirus Vaccination: A Rural Community Case–Control Study

HPV vaccination coverage rates can vary depending on several factors. The main objective of this study is to identify possible independent prognostic factors that have an impact on HPV vaccination in a rural community, specifically related to sexual and reproductive health. A case-control, retrospective, community-based study was carried out on women aged 15 to 40 in the primary health centers of Southern Catalonia's Terres de l'Ebre region, Spain, from 1 January 2020 to 31 December 2022. A random sample of 520 women with an average age of 29.3 (SD 7.8) years old was included in the study. Independent prognostic factors: age OR 0.680 (95% CI: 0.635-0.729, p < 0.001), immigrant origin OR 0.215 (95% CI: 0.109-0.422, p < 0.001), and HPV PCR OR 7.402 (95% CI: 2.504-21.880, p < 0.001). The variables that showed a barrier effect for HPV vaccination were age (OR 0.680, 95% CI 0.635-0.729, p < 0.001), and immigrant origin (OR 0.215, 95% CI 0.109-0.422, p < 0.001). The variable that showed a facilitating effect for HPV vaccination was HPV PCR (OR 7.402, 95% CI 2.504-21.880, p < 0.001)

Risk of Atrial Fibrillation, Ischemic Stroke and Cognitive Impairment : Study of a Population Cohort ≥65 Years of Age

To evaluate a model for calculating the risk of AF and its relationship with the incidence of ischemic stroke and prevalence of cognitive decline. It was a multicenter, observational, retrospective, community-based study of a cohort of general population ≥6ct 35 years, between 01/01/2016 and 31/12/2018. Setting: Primary Care. Participants: 46,706 people ≥65 years with an active medical history in any of the primary care teams of the territory, information accessible through shared history and without previous known AF. Interventions: The model to stratify the risk of AF (PI) has been previously published and included the variables sex, age, mean heart rate, mean weight and CHA2DS2VASc score. Main measurements: For each risk group, the incidence density/1000 person/years of AF and stroke, number of cases required to detect a new AF, the prevalence of cognitive decline, Kendall correlation, and ROC curve were calculated. The prognostic index was obtained in 37,731 cases (80.8%) from lowest (Q1) to highest risk (Q4). A total of 1244 new AFs and 234 stroke episodes were diagnosed. Q3-4 included 53.8% of all AF and 69.5% of strokes in men; 84.2% of all AF and 85.4% of strokes in women; and 77.4% of cases of cognitive impairment. There was a significant linear correlation between the risk-AF score and the Rankin score (p < 0.001), the Pfeiffer score (p < 0.001), but not NIHSS score (p 0.150). The overall NNS was 1/19. Risk stratification allows identifying high-risk individuals in whom to intervene on modifiable risk factors, prioritizing the diagnosis of AF and investigating cognitive statu

Early Diagnosis of Atrial Fibrillation and Stroke Incidence in Primary Care: Translating Measurements into Actions—A Retrospective Cohort Study

(1) Background: AF-related strokes will triple by 2060, are associated with an increased risk of cognitive decline, and alone or in combination, will be one of the main health and economic burdens on the European population. The main goal of this paper is to describe the incidence of new AF associated with stroke, cognitive decline and mortality among people at high risk for AF. (2) Methods: Multicenter, observational, retrospective, community-based studies were conducted from 1 January 2015 to 31 December 2021. The setting was primary care centers. A total of 40,297 people aged ≥65 years without previous AF or stroke were stratified by AFrisk at 5 years. The main measurements were the overall incidence density/1000 person-years (CI95%) of AF and stroke, prevalence of cognitive decline, and Kaplan–Meier curve. (3) Results: In total, 46.4% women, 77.65 ± 8.46 years old on average showed anAF incidence of 9.9/103/year (CI95% 9.5–10.3), associated with a four-fold higher risk of stroke (CI95% 3.4–4.7), cognitive impairment(OR 1.34 (CI95% 1.1–1.5)), and all-cause mortality (OR 1.14 (CI95% 1.0–1.2)), but there was no significant difference in ischemic heart disease, chronic kidney disease, or peripheral arteriopathy. Unknown AF was diagnosed in 9.4% and of these patients, 21.1% were diagnosed with new stroke. (4) Conclusions: The patients at high AF risk (Q4th) already had an increased cardiovascular risk before they were diagnosed with AF

Machine Learning Approaches to Predict Major Adverse Cardiovascular Events in Atrial Fibrillation

The increasing prevalence of atrial fibrillation (AF) and its association with Major Adverse Cardiovascular Events (MACE) presents challenges in early identification and treatment. Although existing risk factors, biomarkers, genetic variants, and imaging parameters predict MACE, emerging factors may be more decisive. Artificial intelligence and machine learning techniques (ML) offer a promising avenue for more effective AF evolution prediction. Five ML models were developed to obtain predictors of MACE in AF patients. Two-thirds of the data were used for training, employing diverse approaches and optimizing to minimize prediction errors, while the remaining third was reserved for testing and validation. AdaBoost emerged as the top-performing model (accuracy: 0.9999; recall: 1; F1 score: 0.9997). Noteworthy features influencing predictions included the Charlson Comorbidity Index (CCI), diabetes mellitus, cancer, the Wells scale, and CHA2DS2-VASc, with specific associations identified. Elevated MACE risk was observed, with a CCI score exceeding 2.67 ± 1.31 (p p < 0.001), and an intermediate-risk Wells scale classification. Overall, the AdaBoost ML offers an alternative predictive approach to facilitate the early identification of MACE risk in the assessment of patients with AF

Identitats ambivalents: estudi comparatiu de sistemes de classificació social

165) Culture utilisée dans les débats scientifiques et politiques. Mondialisation (unification) et développement des identités locales. Identité: différents niveaux: personnel et de groupe. Métissage culturel vu comme un antidote aux fondamentalisme identitaire. La recerca que presentem tot seguit proposa un estudi comparatiu de les lògiques de classificació i d’exclusió socioculturals a partir des transgressions de frontières, de catégories et de hiérarchies identitaires politicoculturelles = identités ambivalentes qui en transgressant les frontières réactivent leur vision en terme de pureté. Antecedents: els mestissos no neixen sinó que es fan 166) Projet qui a commencé par une recherche sur l'origine et la signification de la notion de métissage (anthropologie historique). Métissage hispanoaméricain est un exemple emblématique qui a créé des hiérarchies sociales. Però: es fan sempre? (Un estudi comparatiu) Autres concepts: hybridation et créolisation. Hybridation vient de la biologie et est utilisé en anthropologie en études coloniales et postcoloniales pour critiquer l'impérialisme culturel (Homi Bhabha), même si cette approche est antiessentialiste, elle suppose elle aussi des identités pures. Créolisation: héritage afroaméricain dans la Caraïbe qui suppose aussi des identités pures. Présentation synthétique des différents travaux réalisés dans l'AHCISP. (167) Anthropologie du développement analyse des agences de médiation. Mais aussi recherche sur les contextes socio-culturels qui n'élaborent pas de catégories métisses (sociétés arabo-musulmanes), répudient le métissages (états-nation) et les cosmogonies (autochtones) qui ne permettent pas de catégories hybrides puisque l'humanité, la nature et le surnaturel ne sont pas divisés par des frontières. FI

Identitats ambivalents: estudi comparatiu de sistemes de classificació social

La cultura, aquest concepte tan omnipresent i ambigu, s’ha transformat avui en el terreny semàntic del debat científic i polític. La globalització econòmica s’associa amb una progressiva homogeneïtzació cultural mundial, acompanyada tanmateix d’una explosió d’identitats locals, culturals, ètniques o racialitzades. Els pobles indígenes reclamen drets polítics apel·lant a la seva autenticitat ètnica originària. Les migracions transnacionals susciten alarma en els països de destí, els ‘natius’ dels quals temen que els nouvinguts erosionin la seva identitat cultural i la seva cohesió social amb les seves cultures diferents

El circuito asistencial de la fibrilación auricular en pacientes ambulatorios: estudio observacional Audit fibrilación auricular en el Baix Ebre

Objetivo: Conocer el circuito asistencial de la fibrilación auricular (FA): diagnóstico, tratamiento y seguimiento en el contexto asistencial del sistema sanitario público. Diseño: AFABE es un estudio observacional, multicéntrico y descriptivo, con datos retrospectivos relacionados con el diagnóstico, tratamiento y seguimiento de una cohorte de pacientes ambulatorios con FA en el contexto de la atención primaria, servicios de urgencias y cardiología referentes. Emplazamiento: Atención primaria y especializada. Comarca del Baix Ebre. Tarragona. España. Participantes: Muestra representativa de pacientes con FA > 60 años, seleccionados aleatoriamente entre los pacientes registrados en los 22 centros de atención primaria existentes en el territorio del estudio. Mediciones principales: Datos demográficos, comorbilidades, valor CHA2DS2-VASc y HAS_BLED, y patrones asistenciales resultantes entre la atención primaria y servicios referentes. Resultados: Se incluyeron 182 pacientes, de 78,5; DE:7,3 años, y el 50% mujeres. En atención primaria (AP) se realizó el primer contacto en el 68,3% (IC 95% 60,3-76,3) de los casos de FA, de los que un 56,3% (IC 95% 45,2-66,0) fueron enviados al servicio de urgencias del hospital referente. El 72,7% (IC 95% 63,5-79,0) de los tratamientos anticoagulantes orales y el 58,44% (IC 95% 49,4-66,9) de los tratamientos antiarrítmicos se iniciaron en el servicio de urgencias referente. Un 55,9% (IC 95% 47,2-64,7) de los pacientes son seguidos por el servicio de cardiología referente. Conclusiones: El médico de AP realiza el primer contacto de la mayoría de FA y deriva el 55% de los casos al servicio de urgencias hospitalario donde se inician la mayoría de tratamientos específicos de la FA

Results from the Registry of Atrial Fibrillation (AFABE): Gap between Undiagnosed and Registered Atrial Fibrillation in Adults—Ineffectiveness of Oral Anticoagulation Treatment with VKA

Objective. This study aimed to examine the effectiveness of the use of oral anticoagulation (OAC) medication, recommended by national guidelines for stroke prevention but reportedly underused in AF patients with moderate to high stroke risk. Method. A multicentre and cross-sectional study of undiagnosed AF among out-of-hospital patients over 60 years old was carried out, visiting 3,638 patients at primary health centres or at home for AF diagnosis using the IDC-10 classification. The main outcome measures were CHA2DS2VASC, HAS-BLED scores, cardiovascular comorbidity, pharmacological information, TTR, and SAMe-TT2R2 scores. Results. The main findings were undiagnosed AF in 26.44% of cases; 31.04% registered with AF but not using OAC despite 95.6% having a CHA2DS2VASC≥2 score; a risk of bleeding in important subgroups using OAC without indication (37.50% CHA2DS2VASC<2 score); the use of OAC with TTR < 60% (33.1%), of whom 47.6% had a HAS-BLED score ≥3. Thus, 35.4% of the expected AF prevalence achieved an optimal time in the therapeutic range. Conclusions. The expected AF prevalence was 10.9% (n 5267), but the registered prevalence was 7.5% (n 3638). Only 35.04% (CI = 95%, 33.7–36.3) of AF patients treated with vitamin K antagonists (VKAs) achieve the goal of TTR > 60%