Risk of Dengue Incidence in Children and Adolescents in Zulia, Venezuela, using a Negative Binomial Generalized Linear Mixed Model

Introduction: Dengue is the most important arboviral disease. Its incidence has increased 30-fold over the last 50 years, causing global concerns. Studies have showed children to be the most vulnerable. Methods: Observational study using dengue cases from Zulia state, Venezuela, modelling through a Negative Binomial Generalized Linear Mixed Model (GLMM) accounting for heterogeneity in the variance via a hierarchical Bayesian framework, was done. We assessed risk factors such as age and sex. The Bayesian framework enabled the estimation of Relative Risk (RR) and a Binomial regression was run using the WinBUGS software. Results: During 2002-2008, there were 49,330 cases of dengue in Zulia state, Venezuela. Most of them (18.71%) in 2007. The model revealed that children aged from 5 to 14 y-old had 1.59-higher risk (95%CI 1.41-1.79) compared with those aged from 0-4 y-old. Those aged 25-44 years old and ≥45, have significantly less RR than the baseline category, RR 0.5228 (95%CI 0.46-0.59) and 0.3069 (95%CI 0.27-0.34). Conclusions: The findings confirmed that groups most at risk were children aged 5 to 14 years. Modelling and predicting dengue epidemiology are still a need in multiple countries, especially those at risk of newer epidemics, as is the case of Zulia and Venezuela

Risk of Dengue Incidence in Children and Adolescents in Zulia, Venezuela, using a Negative Binomial Generalized Linear Mixed Model

Introduction: Dengue is the most important arboviral disease. Its incidence has increased 30-fold over the last 50 years, causing global concerns. Studies have showed children to be the most vulnerable. Methods: Observational study using dengue cases from Zulia state, Venezuela, modelling through a Negative Binomial Generalized Linear Mixed Model (GLMM) accounting for heterogeneity in the variance via a hierarchical Bayesian framework, was done. We assessed risk factors such as age and sex. The Bayesian framework enabled the estimation of Relative Risk (RR) and a Binomial regression was run using the WinBUGS software. Results: During 2002-2008, there were 49,330 cases of dengue in Zulia state, Venezuela. Most of them (18.71%) in 2007. The model revealed that children aged from 5 to 14 y-old had 1.59-higher risk (95%CI 1.41-1.79) compared with those aged from 0-4 y-old. Those aged 25-44 years old and ≥45, have significantly less RR than the baseline category, RR 0.5228 (95%CI 0.46-0.59) and 0.3069 (95%CI 0.27-0.34). Conclusions: The findings confirmed that groups most at risk were children aged 5 to 14 years. Modelling and predicting dengue epidemiology are still a need in multiple countries, especially those at risk of newer epidemics, as is the case of Zulia and Venezuela

Rationale and design of the pragmatic clinical trial tREatment with Beta-blockers after myOcardial infarction withOut reduced ejection fracTion (REBOOT).

There is a lack of evidence regarding the benefits of β-blocker treatment after invasively managed acute myocardial infarction (MI) without reduced left ventricular ejection fraction (LVEF). The tREatment with Beta-blockers after myOcardial infarction withOut reduced ejection fracTion (REBOOT) trial is a pragmatic, controlled, prospective, randomized, open-label blinded endpoint (PROBE design) clinical trial testing the benefits of β-blocker maintenance therapy in patients discharged after MI with or without ST-segment elevation. Patients eligible for participation are those managed invasively during index hospitalization (coronary angiography), with LVEF >40%, and no history of heart failure (HF). At discharge, patients will be randomized 1:1 to β-blocker therapy (agent and dose according to treating physician) or no β-blocker therapy. The primary endpoint is a composite of all-cause death, non-fatal reinfarction, or HF hospitalization over a median follow-up period of 2.75 years (minimum 2 years, maximum 3 years). Key secondary endpoints include the incidence of the individual components of the primary composite endpoint, the incidence of cardiac death, and incidence of malignant ventricular arrhythmias or resuscitated cardiac arrest. The primary endpoint will be analysed according to the intention-to-treat principle. The REBOOT trial will provide robust evidence to guide the prescription of β-blockers to patients discharged after MI without reduced LVEF.REBOOT is a non-commercial trial whose main sponsor is the Spanish National Center for Cardiovascular Research (CNIC). The study also received partial funding from the BI group through the CIBERCV network.S

Convergent trends and spatiotemporal patterns of Aedes-borne arboviruses in Mexico and Central America

Background Aedes-borne arboviruses cause both seasonal epidemics and emerging outbreaks with a significant impact on global health. These viruses share mosquito vector species, often infecting the same host population within overlapping geographic regions. Thus, comparative analyses of the virus evolutionary and epidemiological dynamics across spatial and temporal scales could reveal convergent trends. Methodology/Principal findings Focusing on Mexico as a case study, we generated novel chikungunya and dengue (CHIKV, DENV-1 and DENV-2) virus genomes from an epidemiological surveillance-derived historical sample collection, and analysed them together with longitudinally-collected genome and epidemiological data from the Americas. Aedes-borne arboviruses endemically circulating within the country were found to be introduced multiple times from lineages predominantly sampled from the Caribbean and Central America. For CHIKV, at least thirteen introductions were inferred over a year, with six of these leading to persistent transmission chains. For both DENV-1 and DENV-2, at least seven introductions were inferred over a decade. Conclusions/Significance Our results suggest that CHIKV, DENV-1 and DENV-2 in Mexico share evolutionary and epidemiological trajectories. The southwest region of the country was determined to be the most likely location for viral introductions from abroad, with a subsequent spread into the Pacific coast towards the north of Mexico. Virus diffusion patterns observed across the country are likely driven by multiple factors, including mobility linked to human migration from Central towards North America. Considering Mexico’s geographic positioning displaying a high human mobility across borders, our results prompt the need to better understand the role of anthropogenic factors in the transmission dynamics of Aedes-borne arboviruses, particularly linked to land-based human migration

Team dynamics in emergency surgery teams: results from a first international survey

Background: Emergency surgery represents a unique context. Trauma teams are often multidisciplinary and need to operate under extreme stress and time constraints, sometimes with no awareness of the trauma\u2019s causes or the patient\u2019s personal and clinical information. In this perspective, the dynamics of how trauma teams function is fundamental to ensuring the best performance and outcomes. Methods: An online survey was conducted among the World Society of Emergency Surgery members in early 2021. 402 fully filled questionnaires on the topics of knowledge translation dynamics and tools, non-technical skills, and difficulties in teamwork were collected. Data were analyzed using the software R, and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results: Findings highlight how several surgeons are still unsure about the meaning and potential of knowledge translation and its mechanisms. Tools like training, clinical guidelines, and non-technical skills are recognized and used in clinical practice. Others, like patients\u2019 and stakeholders\u2019 engagement, are hardly implemented, despite their increasing importance in the modern healthcare scenario. Several difficulties in working as a team are described, including the lack of time, communication, training, trust, and ego. Discussion: Scientific societies should take the lead in offering training and support about the abovementioned topics. Dedicated educational initiatives, practical cases and experiences, workshops and symposia may allow mitigating the difficulties highlighted by the survey\u2019s participants, boosting the performance of emergency teams. Additional investigation of the survey results and its characteristics may lead to more further specific suggestions and potential solutions

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance