Subclinical thyroid dysfunction and the risk for fractures: a systematic review and meta-analysis.

BACKGROUND: Data on the association between subclinical thyroid dysfunction and fractures conflict. PURPOSE: To assess the risk for hip and nonspine fractures associated with subclinical thyroid dysfunction among prospective cohorts. DATA SOURCES: Search of MEDLINE and EMBASE (1946 to 16 March 2014) and reference lists of retrieved articles without language restriction. STUDY SELECTION: Two physicians screened and identified prospective cohorts that measured thyroid function and followed participants to assess fracture outcomes. DATA EXTRACTION: One reviewer extracted data using a standardized protocol, and another verified data. Both reviewers independently assessed methodological quality of the studies. DATA SYNTHESIS: The 7 population-based cohorts of heterogeneous quality included 50,245 participants with 1966 hip and 3281 nonspine fractures. In random-effects models that included the 5 higher-quality studies, the pooled adjusted hazard ratios (HRs) of participants with subclinical hyperthyroidism versus euthyrodism were 1.38 (95% CI, 0.92 to 2.07) for hip fractures and 1.20 (CI, 0.83 to 1.72) for nonspine fractures without statistical heterogeneity (P = 0.82 and 0.52, respectively; I2= 0%). Pooled estimates for the 7 cohorts were 1.26 (CI, 0.96 to 1.65) for hip fractures and 1.16 (CI, 0.95 to 1.42) for nonspine fractures. When thyroxine recipients were excluded, the HRs for participants with subclinical hyperthyroidism were 2.16 (CI, 0.87 to 5.37) for hip fractures and 1.43 (CI, 0.73 to 2.78) for nonspine fractures. For participants with subclinical hypothyroidism, HRs from higher-quality studies were 1.12 (CI, 0.83 to 1.51) for hip fractures and 1.04 (CI, 0.76 to 1.42) for nonspine fractures (P for heterogeneity = 0.69 and 0.88, respectively; I2 = 0%). LIMITATIONS: Selective reporting cannot be excluded. Adjustment for potential common confounders varied and was not adequately done across all studies. CONCLUSION: Subclinical hyperthyroidism might be associated with an increased risk for hip and nonspine fractures, but additional large, high-quality studies are needed. PRIMARY FUNDING SOURCE: Swiss National Science Foundation

Patient and physician gender concordance in preventive care in university primary care settings.

OBJECTIVE: To assess the quality of preventive care according to physician and patient gender in a country with universal health care coverage. METHODS: We assessed a retrospective cohort study of 1001 randomly selected patients aged 50-80years followed over 2years (2005-2006) in 4 Swiss university primary care settings (Basel, Geneva, Lausanne, Zürich). We used indicators derived from RAND's Quality Assessment Tools and examined percentages of recommended preventive care. Results were adjusted using hierarchical multivariate logistic regression models. RESULTS: 1001 patients (44% women) were followed by 189 physicians (52% women). Female patients received less preventive care than male patients (65.2% vs. 72.1%, p<0.001). Female physicians provided significantly more preventive care than male physicians (p=0.01) to both female (66.7% vs. 63.6%) and male patients (73.4% vs. 70.7%). After multivariate adjustment, differences according to physician (p=0.02) and patient gender (p<0.001) remained statistically significant. Female physicians provided more recommended cancer screening than male physicians (78.4 vs. 71.9%, p=0.01). CONCLUSIONS: In Swiss university primary care settings, female patients receive less preventive care than male patients, with female physicians providing more preventive care than male physicians. Greater attention should be paid to female patients in preventive care and to why female physicians tend to provide better preventive care

Subclinical Thyroid Dysfunction and the Risk of Cognitive Decline: a Meta-Analysis of Prospective Cohort Studies.

Although both overt hyper- and hypothyroidism are known to lead to cognitive impairment, data on the association between subclinical thyroid dysfunction and cognitive function are conflicting. This study sought to determine the risk of dementia and cognitive decline associated with subclinical thyroid dysfunction among prospective cohorts. We searched in MEDLINE and EMBASE from inception until November 2014. Two physicians identified prospective cohorts that assessed thyroid function and cognitive outcomes (dementia; Mini-Mental State Examination [MMSE]). Data were extracted by one reviewer following standardized protocols and verified by a second reviewer. The primary outcome was dementia and decline in cognitive function was the secondary outcome. Eleven prospective cohorts followed 16,805 participants during a median followup of 44.4 months. Five studies analyzed the risk of dementia in subclinical hyperthyroidism (SHyper) (n = 6410), six in subclinical hypothyroidism (SHypo) (n = 7401). Five studies analyzed MMSE decline in SHyper (n = 7895), seven in SHypo (n = 8960). In random-effects models, the pooled adjusted risk ratio for dementia in SHyper was 1.67 (95% confidence interval, 1.04; 2.69) and 1.14 (95% confidence interval, 0.84; 1.55) in SHypo vs euthyroidism, both without evidence of significant heterogeneity (I(2) = 0.0%). The pooled mean MMSE decline from baseline to followup (mean 32 mo) did not significantly differ between SHyper or SHypo vs euthyroidism. SHyper might be associated with an elevated risk for dementia, whereas SHypo is not, and both conditions are not associated with faster decline in MMSE over time. Available data are limited, and additional large, high-quality studies are needed

The fraction of cancer attributable to ways of life, infections, occupation, and environmental agents in Brazil in 2020

Many human cancers develop as a result of exposure to risk factors related to the environment and ways of life. The aim of this study was to estimate attributable fractions of 25 types of cancers resulting from exposure to modifiable risk factors in Brazil. The prevalence of exposure to selected risk factors among adults was obtained from population-based surveys conducted from 2000 to 2008. Risk estimates were based on data drawn from metaanalyses or large, high quality studies. Population-attributable fractions (PAF) for a combination of risk factors, as well as the number of preventable deaths and cancer cases, were calculated for 2020. The known preventable risk factors studied will account for 34% of cancer cases among men and 35% among women in 2020, and for 46% and 39% deaths, respectively. The highest attributable fractions were estimated for tobacco smoking, infections, low consumption of fruits and vegetables, excess weight, reproductive factors, and physical inactivity. This is the first study to systematically estimate the fraction of cancer attributable to potentially modifiable risk factors in Brazil. Strategies for primary prevention of tobacco smoking and control of infection and the promotion of a healthy diet and physical activity should be the main priorities in policies for cancer prevention in the country. \ua9 2016 Azevedo e Silva et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Faktor Resiko Terjadinya Perdarahan Post Partum : Studi Literatur

Maternal mortality rate in Indonesia is relatively high. The most common cause of maternal death is bleeding. Post partum haemorrhage (PPH) is an unexpected cause and the fastest cause of maternal death worldwide. PPH is blood loss of 500 cc or more that occurs after the baby is born. Risk factors/predisposition for postpartum hemorrhage include: anemia, parity, gestational age, delivery distance, excessive uterine stretching (macrosomia, gemely, and polyhidramnions), precipitate parturition, oxytocin induction, history of cesarean section, ante partum bleeding, first stage of labor and the elongated II, and so on. This literature review aims to determine the risk factors/trigger factors of postpartum hemorrhage. Using literature study according to the topic. Literature studies were obtained from various sources, including from journals ranging from 2015-2020. Source articles from goggle scholars and Goggle Scholars. From several journals that have been reviewed, postpartum hemorrhage is one of the complications that has a high incidence. And there is a relationship between predisposing factors and the incidence of postpartum hemorrhageAbstrakAngka kematian ibu melahirkan di Indonesia relatif tinggi. Adapun penyebab terbanyak yang menyebabkan kematian ibu adalah perdarahan. Perdarahan post partum adalah penyebab tak terduga dan penyebab tercepat kematian ibu diseluruh dunia. Perdarahan post partum adalah hilangnya darah 500 cc atau lebih yang terjadi setelah bayi lahir. Faktor resiko/predisposisi terjadinya perdarahan post partum antara lain : anemia, paritas, umur kehamilan, jarak persalinan, peregangan uterus yang berlebihan (makrosomia, gemeli dan polihidramnion), partus presipitatus, induksi oksitosin, riwayat seksio secaria, perdarahan ante partum, persalinan kalan I dan II yang memanjang, dan lain-lain. literatur review ini bertujuan untuk mengetahui faktor resiko/faktor pencetus dari perdarahan post partum. menggunakan studi literatur sesuai dengan topik. Studi literatur didapat dari berbagai sumber, diantaranya dari jurnal berkisar tahun 2014-2018. Sumber artikel dari Pubmed, Portal Garuda dan goggle Scholar. dari beberapa jurnal yang telah ditelaah, perdarahan post partum merupakan salah satu komplikasi yang angka kejadiannya masih tinggi. Dan ada hubungan antara faktor predisposisi dengan kejadian perdarahan post partu

Faktor Resiko Terjadinya Perdarahan Post Partum : Studi Literatur

Maternal mortality rate in Indonesia is relatively high. The most common cause of maternal death is bleeding. Post partum haemorrhage (PPH) is an unexpected cause and the fastest cause of maternal death worldwide. PPH is blood loss of 500 cc or more that occurs after the baby is born. Risk factors/predisposition for postpartum hemorrhage include: anemia, parity, gestational age, delivery distance, excessive uterine stretching (macrosomia, gemely, and polyhidramnions), precipitate parturition, oxytocin induction, history of cesarean section, ante partum bleeding, first stage of labor and the elongated II, and so on. This literature review aims to determine the risk factors/trigger factors of postpartum hemorrhage. Using literature study according to the topic. Literature studies were obtained from various sources, including from journals ranging from 2015-2020. Source articles from goggle scholars and Goggle Scholars. From several journals that have been reviewed, postpartum hemorrhage is one of the complications that has a high incidence. And there is a relationship between predisposing factors and the incidence of postpartum hemorrhageAbstrakAngka kematian ibu melahirkan di Indonesia relatif tinggi. Adapun penyebab terbanyak yang menyebabkan kematian ibu adalah perdarahan. Perdarahan post partum adalah penyebab tak terduga dan penyebab tercepat kematian ibu diseluruh dunia. Perdarahan post partum adalah hilangnya darah 500 cc atau lebih yang terjadi setelah bayi lahir. Faktor resiko/predisposisi terjadinya perdarahan post partum antara lain : anemia, paritas, umur kehamilan, jarak persalinan, peregangan uterus yang berlebihan (makrosomia, gemeli dan polihidramnion), partus presipitatus, induksi oksitosin, riwayat seksio secaria, perdarahan ante partum, persalinan kalan I dan II yang memanjang, dan lain-lain. literatur review ini bertujuan untuk mengetahui faktor resiko/faktor pencetus dari perdarahan post partum. menggunakan studi literatur sesuai dengan topik. Studi literatur didapat dari berbagai sumber, diantaranya dari jurnal berkisar tahun 2014-2018. Sumber artikel dari Pubmed, Portal Garuda dan goggle Scholar. dari beberapa jurnal yang telah ditelaah, perdarahan post partum merupakan salah satu komplikasi yang angka kejadiannya masih tinggi. Dan ada hubungan antara faktor predisposisi dengan kejadian perdarahan post partu