Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Osteonecrose da cabeça femoral bilateral pós COVID-19: Relato de caso / Osteonecrosis of the bilateral femoral head after COVID-19: Case report

A osteonecrose ou necrose asséptica é uma desordem rara, de difícil diagnóstico e tratamento, que evolui com graves consequências na qualidade de vida do paciente. Nessa doença, ocorre uma morte celular ocasionada pela redução do fluxo sanguíneo à cabeça femoral, levando a um infarto ósseo. Sua etiologia é desconhecida, podendo estar associada a uma natureza multifatorial. Parece estar associada ao etilismo e acometer pacientes entre a  terceira e quinta década de vida. Objetivos: O presente artigo tem como função analisar um relato de caso de uma paciente com osteonecrose. Paciente KST, de 41 anos de idade, sexo feminino, natural e procedente de Luziania, Goiás, com queixa dor no quadril direito há 2 semanas. Foi solicitado ressonância magnética (RM) que confirmou o diagnóstico de osteonecrose do quadril porém, bilateral

A influência da pandemia no comportamento de crianças e adolescentes autistas / The influence of the pandemic on the behavior of autistic children and adolescents

O cenário da pestilência da COVID 19 afetou famílias de forma biológica, física e mental. Um grupo específico que foi subitamente impactado por esse cataclismo, foram as crianças e adolescentes autistas, nomeado atualmente, como Transtorno do Espectro Autista ou TEA, visto que, tem como característica dificuldades na linguagem/comunicação, relação social, sobretudo, expondo-os a maiores riscos de contaminação e dificultando a interação na sociedade. Por conseguinte, em função do fechamento das instituições de educação fez com que as famílias se adaptassem a novas dinâmicas de sociabilidade e mudanças na ação educativa dos filhos. Analisar e correlacionar artigos que abordem a influência da pandemia no comportamento de crianças e adolescentes autistas. Revisão de literatura com consulta em bases de dados com critérios de inclusão e adequação aos objetivos da revisão. As circunstâncias atuais de isolamento social têm um grande impacto na rotina das crianças e adolescentes com autismo, dificultando as formas de superar as barreiras de interação por meio dos estímulos sociais e das interações que elas possuíam. Contudo, ajustar o trabalho remoto, os estudos dos filhos, além das medidas de biossegurança são considerados desafiadores para estas famílias. Diante dos dados coletados, apropriar condutas voltadas para a inclusão escolar de crianças com TEA em meio a conjuntura da pandemia pelo COVID - 19 constitui um encargo desafiador para as famílias. Desse modo, é fundamental o suporte e a participação da família para que junto com as instituições educativas possam estabelecer métodos que beneficie o processo de desenvolvimento, interação social e aprendizagem dessas crianças

Tratamento bem-sucedido de lesão cardíaca penetrante e não transfixante com miocardiorrafia e manuseio de eventos de fibrilação atrial e parada cardiorrespiratória: relato de caso

As lesões cardíacas penetrantes e não transfixantes são uma emergência médica que requer tratamento imediato e adequado. A miocardiorrafia é uma técnica cirúrgica utilizada no tratamento dessas lesões, mas pode estar associada a complicações, como fibrilação atrial (FA) e parada cardiorrespiratória (PCR). O presente artigo tem como objetivo relatar um caso de um tratamento bem-sucedido de lesão cardíaca penetrante e não transfixante com miocardiorrafia e manuseio de eventos de fibrilação atrial e parada cardiorrespiratória. Descrevemos o caso de um paciente de 21 anos do sexo masculino que foi admitido em estado grave em um hospital de referência após sofrer ferimento penetrante por projétil de arma de fogo. O paciente foi imediatamente encaminhado ao centro cirúrgico, onde foi constatada uma lesão pulmonar transfixante com perfuração de lobo superior, inferior e língula, além de um ferimento do miocárdio não transfixante no ventrículo esquerdo, que foi tratado com miocardiorrafia. Durante o procedimento cirúrgico, o paciente apresentou fibrilação atrial (FA) seguida de parada cardiorrespiratória (PCR), que foi revertida com ressuscitação cardiopulmonar (RCP) e desfibrilação. O paciente foi estabilizado com transfusão de hemocomponentes e recebeu suporte clínico completo na Unidade de Terapia Intensiva (UTI) após a cirurgia. O paciente evoluiu satisfatoriamente, sem complicações e recebeu alta hospitalar, sendo monitorado regularmente pela equipe de cardiologia. Este relato de caso destaca a importância do diagnóstico e tratamento imediato de lesões cardíacas penetrantes em pacientes politraumatizados, bem como o manejo adequado da FA e PCR intraoperatórias

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions