Impacto de la atención ambulatoria del primer nivel de atención en la hospitalización de población asegurada con diabetes mellitus tipo 2

ObjetivoDeterminar el impacto de atención ambulatoria del primer nivel de atención en la hospitalización del diabético tipo 2 en una población con condiciones iguales de aseguramiento.DiseñoEstudio de casos y controles. Los casos son pacientes diabéticos hospitalizados por enfermedad relacionada con el padecimiento, y los controles son pacientes diabéticos sin antecedente de hospitalización en el último año.EmplazamientoCentros de atención primaria urbanos.ParticipantesLos casos fueron seleccionados consecutivamente en 4 de 5 hospitales generales urbanos (n=123). Los controles fueron elegidos al azar en la unidad de atención primaria de donde provenía el caso (n=135). Se excluyó a las mujeres con diabetes gestacional y a todos los que no contaban con expediente localizable (aproximadamente un 15%).MedicionesSe construyó un índice de atención primaria según las recomendaciones de la Asociación de Médicos Norteamericanos, la Comisión Conjunta de Acreditación de Organizaciones de Salud, el Comité Nacional de Aseguramiento para la Calidad, la Asociación Norteamericana de Diabetes y la Norma Oficial Mexicana. Se consideró que un cumplimiento menor al 60% correspondía a una atención subóptima.ResultadosLos factores de riesgo para la hospitalización fueron los siguientes: menos de 2 vistas al médico de familia en el último año (OR ajustada, 16,2; IC del 95%, 1,5–174,2), valor de glucosa (OR ajustada, 1,006; IC del 95%, 1,002–1,010) y nivel de conocimientos sobre la enfermedad (OR ajustada, 0,98; IC del 95%, 0,96–0,99), además de la práctica de ejercicio y el tiempo de diagnóstico. La atención primaria subóptima se registró en el 65,3% de los casos y el 49,1% de los controles (p=0,03) e incrementó 2,5 veces el riesgo de hospitalización (IC del 95%, 1,2–5,0; seudo R2=0,279; p < 0,001).ConclusionesLa evidencia disponible indica que la atención primaria puede ser un factor potencial para reducir la tasa de hospitalización por diabetes mellitus tipo 2. Los programas de manejo efectivos contribuirían a evitar hospitalizaciones innecesarias.ObjectiveTo determine the impact of primary care on hospitalization of type 2 diabetics with equal conditions of health insurance.DesignA case-control study. Case=diabetic hospitalized by a disease related condition. Control=diabetic without hospitalization during the last 12 months.SettingUrban primary care centers.ParticipantsCases were consecutively selected from four out of five urban hospitals (n=123). Controls were chosen at random from primary care units matched by primary care source (n=135).Women with gestational diabetes were excluded as well as individuals with missing medical charts (approximately 15%).MeasurementsA primary care index was constructed with process and outcome indicators recommended by the American Medical Association, the Joint Commission on Accreditation of Healthcare Organizations, the National Committee for Quality Assurance, the American Diabetes Association and the Official Mexican Standards. Compliance to less than 60% of recommendations was considered unsatisfactory primary care.ResultsThe following were hospitalization risk factors: less than 2 visits to family physician during the last year (OR adjusted, 16,2; 95% CI, 1,5–174,2), glucose level (OR adjusted, 1,006; 95% CI, 1,002–1,010) and cognitive level (OR adjusted, 0,98; 95% CI, 0,96–0,99), in addition to exercising and year of diagnosis. Sixty-five percent of cases observed unsatisfactory primary care compared with 49,1% of controls (P=0,03). Unsatisfactory primary care increased 2,5 times the risk of hospitalization (95% CI, 1,2–5,0) (pseudo R2=0,279; P<0,001).ConclusionsPrimary care is a potential factor for reducing hospitalization of type 2 diabetics. Effective primary care programs would contribute to a better disease control and less unnecessary hospitalizations

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.</p

Highly-parallelized simulation of a pixelated LArTPC on a GPU

The rapid development of general-purpose computing on graphics processing units (GPGPU) is allowing the implementation of highly-parallelized Monte Carlo simulation chains for particle physics experiments. This technique is particularly suitable for the simulation of a pixelated charge readout for time projection chambers, given the large number of channels that this technology employs. Here we present the first implementation of a full microphysical simulator of a liquid argon time projection chamber (LArTPC) equipped with light readout and pixelated charge readout, developed for the DUNE Near Detector. The software is implemented with an end-to-end set of GPU-optimized algorithms. The algorithms have been written in Python and translated into CUDA kernels using Numba, a just-in-time compiler for a subset of Python and NumPy instructions. The GPU implementation achieves a speed up of four orders of magnitude compared with the equivalent CPU version. The simulation of the current induced on 10^3 pixels takes around 1 ms on the GPU, compared with approximately 10 s on the CPU. The results of the simulation are compared against data from a pixel-readout LArTPC prototype

Review and Update on Some Connections between a Spring-Block SOC Model and Actual Seismicity in the Case of Subduction Zones

The self-organized critical (SOC) spring-block models are accessible and powerful computational tools for the study of seismic subduction. This work aims to highlight some important findings through an integrative approach of several actual seismic properties, reproduced by using the Olami, Feder, and Christensen (OFC) SOC model and some variations of it. A few interesting updates are also included. These results encompass some properties of the power laws present in the model, such as the Gutenberg-Richter (GR) law, the correlation between the parameters a and b of the linear frequency-magnitude relationship, the stepped plots for cumulative seismicity, and the distribution of the recurrence times of large earthquakes. The spring-block model has been related to other relevant properties of seismic phenomena, such as the fractal distribution of fault sizes, and can be combined with the work of Aki, who established an interesting relationship between the fractal dimension and the b-value of the Gutenberg-Richter relationship. Also included is the work incorporating the idea of asperities, which allowed us to incorporate several inhomogeneous models in the spring-block automaton. Finally, the incorporation of a Ruff-Kanamori-type diagram for synthetic seismicity, which is in reasonable accordance with the original Ruff and Kanamori diagram for real seismicity, is discussed. © 2022 by the authors. Licensee MDPI, Basel, Switzerland

Global urban environmental change drives adaptation in white clover

Urbanization transforms environments in ways that alter biological evolution. We examined whether urban environmental change drives parallel evolution by sampling 110,019 white clover plants from 6169 populations in 160 cities globally. Plants were assayed for a Mendelian antiherbivore defense that also affects tolerance to abiotic stressors. Urban-rural gradients were associated with the evolution of clines in defense in 47% of cities throughout the world. Variation in the strength of clines was explained by environmental changes in drought stress and vegetation cover that varied among cities. Sequencing 2074 genomes from 26 cities revealed that the evolution of urban-rural clines was best explained by adaptive evolution, but the degree of parallel adaptation varied among cities. Our results demonstrate that urbanization leads to adaptation at a global scale