Antropometría y salud pública: una simbiosis en el estudio de la salud

Pareciera que hay poca necesidad de demostrar la importancia de la contribución de la antropometría en los estudios de salud pública. Desnutrición ha sido, y aún es, uno de los problemas mayores de la humanidad y las medidas antropométricas han sido las herramientas mas importante para su evaluación. Se necesita, sin embargo esbozar las áreas en que antropometría continuará siendo vigente durante el siglo 21. Hay por lo menos tres áreas en las que la antropometría seguirá haciendo aportes. Diseños eficientes en la evaluación de cambios en niveles de desnutrición y obesidad en la comunidad. Estos estudios pueden aumentar el conocimiento de las causas que han contribuido a la reciente epidemia de obesidad en el mundo occidental. Antropometría también servirá como herramienta efectiva en la evaluación de intervenciones preventivas. Por ejemplo en los estudios de los efectos a largo plazo de suplementos en la dieta, en la evaluación de los posibles efectos detrimentales de tecnología nueva y el efecto de nuevas intervenciones para prevenir obesidad. Antropometría continuará siendo útil en el estudio de la etiología de las enfermedades crónicas. En la última década ha habido un gran interés en el estudio de la hipótesis de la programación, la relación entre el índice de masa corporal y asma, y la relación entre componentes de estatura y enfermedades crónicas del adulto. Todas estas oportunidades el campo de la salud pública se podrán coger en la medida que los biólogos humanos se compenetren en los problemas científicos de colegas en otras disciplinas.Asociación de Antropología Biológica de la República Argentina (AABRA

Antropometría y salud pública: una simbiosis en el estudio de la salud

Pareciera que hay poca necesidad de demostrar la importancia de la contribución de la antropometría en los estudios de salud pública. Desnutrición ha sido, y aún es, uno de los problemas mayores de la humanidad y las medidas antropométricas han sido las herramientas mas importante para su evaluación. Se necesita, sin embargo esbozar las áreas en que antropometría continuará siendo vigente durante el siglo 21. Hay por lo menos tres áreas en las que la antropometría seguirá haciendo aportes. Diseños eficientes en la evaluación de cambios en niveles de desnutrición y obesidad en la comunidad. Estos estudios pueden aumentar el conocimiento de las causas que han contribuido a la reciente epidemia de obesidad en el mundo occidental. Antropometría también servirá como herramienta efectiva en la evaluación de intervenciones preventivas. Por ejemplo en los estudios de los efectos a largo plazo de suplementos en la dieta, en la evaluación de los posibles efectos detrimentales de tecnología nueva y el efecto de nuevas intervenciones para prevenir obesidad. Antropometría continuará siendo útil en el estudio de la etiología de las enfermedades crónicas. En la última década ha habido un gran interés en el estudio de la hipótesis de la programación, la relación entre el índice de masa corporal y asma, y la relación entre componentes de estatura y enfermedades crónicas del adulto. Todas estas oportunidades el campo de la salud pública se podrán coger en la medida que los biólogos humanos se compenetren en los problemas científicos de colegas en otras disciplinas.Asociación de Antropología Biológica de la República Argentina (AABRA

Does the association between birth weight and blood pressure increase with age? A longitudinal study in young adults

OBJECTIVES: To assess whether the association between birth weight and blood pressure (BP) increases with age using three different statistical methods. METHODS: A representative sample of 1232 study participants born between 1974-1978 in Limache, Chile were assessed in 2000-2002, of whom 796 were reassessed in 2010-2012. An 'amplification effect' was assessed by the change in the β coefficient in the two periods, the association between birth weight and the difference of BP overtime, and the interaction between birth weight and BP in the two periods. RESULTS: Birth weight was negatively associated with SBP in 2000-2002 (β = -2.46, 95% confidence interval (CI) -3.77 to -1.16) and in 2010-2012 (β = -3.64, 95% CI -5.20 to -2.08), and with DBP in 2000-2002 (β = -1.26, 95% CI -2.23 to -0.29) , and 2010-2012 (β = -1.64, 95% CI -2.84 to -0.45) after adjustment for sex, physical activity, and BMI. There was no association between birth weight and the difference in BP between the two periods or the interaction between birth weight, BP, and time interval. CONCLUSION: Birth weight is a factor associated with BP in adults. This association increased with age, but amplification was shown only with one of the three methods

Cost of post-deployment screening for mental illness in the UK military: findings from a cluster randomised controlled trial

Background: Little is known about the economic impact of military mental health screening. Aims: To investigate (1) whether post-deployment screening of military personnel affects use and cost of services and (2) the impact of psychiatric morbidity on costs. Methods: Participants were recruited from UK Royal Marine and Army platoons and randomised to an intervention group (which received tailored advice predicated upon mental health status) or a control group (which received general advice following assessment of mental health status). The intervention costs were calculated while service use and associated costs were assessed at 12 month follow-up. Results: Data were available for 6,323 participants. Mean screening cost was £34. Service costs were slightly higher in the control group compared to the intervention group (£1,197 vs. £1,147) which was not statistically significant (bootstrapped 95% CI, -£363 to £434. In both groups, screening and control, costs were significantly higher for those who screened positive for mental health problems. Conclusion: Costs were not affected by screening. In countries which have already implemented post-deployment screening, the political cost of disinvestment needs careful consideration. Those who develop psychiatric morbidity have substantially higher care costs than those who do not

Medical and Welfare Officers beliefs about post-deployment screening for mental health disorders in the UK Armed Forces:a qualitative study

BACKGROUND: This study aimed to examine currently serving United Kingdom (UK) military Medical and Welfare Officers views on the potential introduction of post-deployment screening for mental ill health. METHODS: Semi-structured interviews were conducted with 21 Medical and Welfare Officers. Interview transcripts were analysed using data-driven thematic analysis. RESULTS: Four themes were identified: positive views of screening; reliability of responses; impact on workload; and suggestions for implementation. Interviewees viewed the introduction of screening post-deployment as likely to increase awareness of mental health problems whilst also reporting that service personnel were likely to conceal their true mental health status by providing misleading responses to any screening tool. Concern over reliability of responses may provide one explanation for the reluctance of service personnel to seek help for problems, as they could feel they will not be taken seriously. Welfare Officers felt they would not have the knowledge or experience to respond to help-seeking. Although participants were concerned about potential impact on their personal workload, they indicated a desire to positively engage with the screening programme if research showed it was an effective tool to improve mental health care. CONCLUSIONS: Welfare and healthcare providers are well disposed towards a screening programme for mental health but highlight a few concerns in its implementation. In particular Welfare Officers appear to require more training in how to respond to mental ill health. Concerns about available funding and resources to respond to increased workload will need to be addressed should post-deployment screening for mental health be introduced in the UK military

How many mailouts? Could attempts to increase the response rate in the Iraq war cohort study be counterproductive?

<p>Abstract</p> <p>Background</p> <p>Low response and reporting errors are major concerns for survey epidemiologists. However, while nonresponse is commonly investigated, the effects of misclassification are often ignored, possibly because they are hard to quantify. We investigate both sources of bias in a recent study of the effects of deployment to the 2003 Iraq war on the health of UK military personnel, and attempt to determine whether improving response rates by multiple mailouts was associated with increased misclassification error and hence increased bias in the results.</p> <p>Methods</p> <p>Data for 17,162 UK military personnel were used to determine factors related to response and inverse probability weights were used to assess nonresponse bias. The percentages of inconsistent and missing answers to health questions from the 10,234 responders were used as measures of misclassification in a simulation of the 'true' relative risks that would have been observed if misclassification had not been present. Simulated and observed relative risks of multiple physical symptoms and post-traumatic stress disorder (PTSD) were compared across response waves (number of contact attempts).</p> <p>Results</p> <p>Age, rank, gender, ethnic group, enlistment type (regular/reservist) and contact address (military or civilian), but not fitness, were significantly related to response. Weighting for nonresponse had little effect on the relative risks. Of the respondents, 88% had responded by wave 2. Missing answers (total 3%) increased significantly (p < 0.001) between waves 1 and 4 from 2.4% to 7.3%, and the percentage with discrepant answers (total 14%) increased from 12.8% to 16.3% (p = 0.007). However, the adjusted relative risks decreased only slightly from 1.24 to 1.22 for multiple physical symptoms and from 1.12 to 1.09 for PTSD, and showed a similar pattern to those simulated.</p> <p>Conclusion</p> <p>Bias due to nonresponse appears to be small in this study, and increasing the response rates had little effect on the results. Although misclassification is difficult to assess, the results suggest that bias due to reporting errors could be greater than bias caused by nonresponse. Resources might be better spent on improving and validating the data, rather than on increasing the response rate.</p

The prevalence of common mental disorders and PTSD in the UK military: using data from a clinical interview-based study

<p>Abstract</p> <p>Background</p> <p>The mental health of the Armed Forces is an important issue of both academic and public interest. The aims of this study are to: a) assess the prevalence and risk factors for common mental disorders and post traumatic stress disorder (PTSD) symptoms, during the main fighting period of the Iraq War (TELIC 1) and later deployments to Iraq or elsewhere and enlistment status (regular or reserve), and b) compare the prevalence of depression, PTSD symptoms and suicidal ideation in regular and reserve UK Army personnel who deployed to Iraq with their US counterparts.</p> <p>Methods</p> <p>Participants were drawn from a large UK military health study using a standard two phase survey technique stratified by deployment status and engagement type. Participants undertook a structured telephone interview including the Patient Health Questionnaire (PHQ) and a short measure of PTSD (Primary Care PTSD, PC-PTSD). The response rate was 76% (821 participants).</p> <p>Results</p> <p>The weighted prevalence of common mental disorders and PTSD symptoms was 27.2% and 4.8%, respectively. The most common diagnoses were alcohol abuse (18.0%) and neurotic disorders (13.5%). There was no health effect of deploying for regular personnel, but an increased risk of PTSD for reservists who deployed to Iraq and other recent deployments compared to reservists who did not deploy. The prevalence of depression, PTSD symptoms and subjective poor health were similar between regular US and UK Iraq combatants.</p> <p>Conclusion</p> <p>The most common mental disorders in the UK military are alcohol abuse and neurotic disorders. The prevalence of PTSD symptoms remains low in the UK military, but reservists are at greater risk of psychiatric injury than regular personnel.</p

Time course of risk factors associated with mortality of 1260 critically ill patients with COVID-19 admitted to 24 Italian intensive care units

Purpose: To evaluate the daily values and trends over time of relevant clinical, ventilatory and laboratory parameters during the intensive care unit (ICU) stay and their association with outcome in critically ill patients with coronavirus disease 19 (COVID-19). Methods: In this retrospective–prospective multicentric study, we enrolled COVID-19 patients admitted to Italian ICUs from February 22 to May 31, 2020. Clinical data were daily recorded. The time course of 18 clinical parameters was evaluated by a polynomial maximum likelihood multilevel linear regression model, while a full joint modeling was fit to study the association with ICU outcome. Results: 1260 consecutive critically ill patients with COVID-19 admitted in 24 ICUs were enrolled. 78% were male with a median age of 63 [55–69] years. At ICU admission, the median ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) was 122 [89–175] mmHg. 79% of patients underwent invasive mechanical ventilation. The overall mortality was 34%. Both the daily values and trends of respiratory system compliance, PaO2/FiO2, driving pressure, arterial carbon dioxide partial pressure, creatinine, C-reactive protein, ferritin, neutrophil, neutrophil–lymphocyte ratio, and platelets were associated with survival, while for lactate, pH, bilirubin, lymphocyte, and urea only the daily values were associated with survival. The trends of PaO2/FiO2, respiratory system compliance, driving pressure, creatinine, ferritin, and C-reactive protein showed a higher association with survival compared to the daily values. Conclusion: Daily values or trends over time of parameters associated with acute organ dysfunction, acid–base derangement, coagulation impairment, or systemic inflammation were associated with patient survival