Desempeño de pacientes en terapia antirretroviral de acuerdo al tiempo de inicio. Hospitales “Dr. Teodoro Maldonado Carbo” y de la Policía Nacional, Guayaquil, Ecuador. Período 1993 – 2009

Objetivo: analizar el riesgo de progresión a SIDA o muerte, valorando el tiempo óptimo de inicio de la terapia antirretroviral altamente activa (TAR). Se consideró la influencia de distintos factores pronósticos en el desempeño del tratamiento. Metodología: se dividió los pacientes en dos grupos: un grupo de inicio temprano (>200 células/mm3) y un grupo de inicio tardío (<200 células/mm3). Se comparó el riesgo de progresar al primer evento entre ambos grupos a través de un análisis de supervivencia. Posteriormentese ajustó dicho riesgo para distintos factores pronósticos a través de modelos de regresión multivariable. Resultados:se incluyeron 191 pacientes en el análisis. 122 difirieron el tratamiento mientras que 69 empezaron tempranamente. Se hallóun HR de 2.75 para la comparación del primer evento. Se encontró riesgo significativo al ajustar para el CD4 basal (HR=5.28) y beneficio significativo para aquellos pacientes con un esquema de 4 drogas (HR=0.39). Conclusiones: el riesgo del grupo tardío de progresar a SIDA o muerte fue 1.75 veces mayor al del grupo temprano. Este riesgo permaneció significativo al ser ajustadopara variables confusoras. Los factores pronósticos más importantes fueron el contaje CD4 inicial, el tipo de TAR y la presencia de una enfermedad oportunista basal

Burnout: exploring the differences between U.S. and international medical graduates.

Background: International medical graduates (IMGs) have less burnout than U. S. medical school graduates (USMGs) during residency training. This study evaluates possible correlates of differences in burnout rates between USMGs and IMGs. Methods: We surveyed 375 first-year residents at orientation in June/July 2017. We assessed burnout using the Copenhagen Burnout Inventory (CBI) and used validated scales to measure stress, quality of life (QoL), mastery, and spirituality. We collected data on gender, place of graduation, language fluency, and specialty. We compared CBI scores between USMGs and IMGs, performed a multivariate linear regression analysis of relationships between covariates and CBI subscales, and logistic regression analysis for our categorical definition of burnout. Results: Two hundred twenty-two residents responded for a response rate of 59%. Personal, work or patient- related burnout was common among residents, particularly among USMGs. The most common form of burnout was work-related. Forty nine percent of USMGs have work burnout compared to 26% of IMGs (p \u3c 0.01). In multivariate analysis, being an IMG reduced odds of work-related and of total burnout by 50% (OR 0.5 C.I 0.25-0.99). Perceived mastery was associated with reductions in all subscales of burnout (p \u3c 0.05). Stress and low QoL related to personal and work burnout scores (p \u3c 0.01). Conclusion: Work-related burnout is more common among USMGs than in IMGs. Although mastery, QoL and stress were correlates of burnout among all residents, these factors did not explain the difference. Future studies should evaluate the role of medical school structure and curriculum on differences in burnout rates between the two groups

Association of Serum Uric Acid With Incident Atrial Fibrillation (from the Atherosclerosis Risk in Communities [ARIC] Study)

Atrial fibrillation (AF) is one of the most common arrhythmias seen in clinical practice. Current evidence suggests that serum uric acid (SUA) could be a marker of oxidative damage a factor reported as part of the mechanisms of AF. The purpose of this study was to evaluate if SUA predicted AF in the Atherosclerosis Risk in Communities study (ARIC). This analysis included 15,382 AF-free black and white men and women, aged 45-64, from the ARIC study, a population-based prospective cohort in the US. SUA was determined using the uricase-peroxidase method at baseline. The primary outcome was the incidence of AF defined as the occurrence of AF detected from hospital discharge codes, scheduled study electrocardiograms (ECG) and /or death certificates during follow-up period (1987-2004). We identified 1085 cases of incident AF. In Cox proportional hazards models adjusted for age, sex, race, center, education, body-mass index, serum glucose, systolic and diastolic blood pressure, LDL cholesterol, alcohol use, prevalent coronary heart disease and heart failure, serum creatinine, use of diuretics, and p wave duration on the ECG (as a measure of left atrial size) at baseline, the hazard ratio (HR) of AF associated with a 1-standard deviation increment in SUA was 1.16; 95% CI 1.06 -1.26. The association of SUA with AF risk differed by race and gender (p for interactio

Epidemiology and survival of the five stages of chronic kidney disease in a systolic heart failure population

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102653/1/ejhfhfq077.pd

The association between Self-Reported Medication Adherence scores and systolic blood pressure control: a SPRINT baseline data study

We examined baseline data from the Systolic Blood Pressure Intervention Trial (SPRINT) to investigate whether medication adherence, measured by the 8-item Morisky Medication Adherence Scale (MMAS-8), was associated with systolic blood pressure (SBP) and whether MMAS-8 score and number of antihypertensive medications interacted in influencing SBP. A total of 8435 SPRINT participants were included: 21.2% had low adherence (MMAS-8: 160 mm Hg in 8.8%. In multivariable regression, medium vs. low adherence weakly associated with lower SBP (odds ratio: 1.17; confidence interval: 1.04, 1.31). SPRINT eligibility criteria should be considered when interpreting results. Efforts to understand and enhance adherence are crucial to improve population health, and using self-report instruments might be considered for predicting treatment adherence and response in future efficacy trials and for identifying patients for adherence support in clinical practice

Social Determinants of Health Mediate COVID-19 Disparities in South Florida

There are several reports of health disparities related to COVID-19. Understanding social determinants of health (SDoH) could help develop mitigation strategies to prevent further COVID-19 spread. Our aim is to evaluate self-reported and census-based SDoH as a mediator of health disparities in COVID-19. We conducted a cross-sectional ecological study and included all COVID-19 cases report by the COVID-19 Florida dashboard as the dependent variable. The independent variables were census-based median household income, population and household size, and self-reported SDoH using a validated survey. We calculated the incidence rate ratio (IRR) of COVID-19 by zip code using Poisson regression and structured equation modelling to evaluate the mediation effect of income and SDoH on COVID-19 cases. We included 97,594 COVID-19 positive cases across 79 Miami-Dade ZIP codes with a median age of 43 years; females represented 50.7% of the cases. The highest IRR (4.44) were for ZIP code 33125 (income $21,106, 6$96,609, 3% Black and 53% Hispanic). In structured equation models, the indirect coefficient of income in the relationship between race/ethnicity and COVID-19 were only significant for Blacks and not Hispanics. This ecological analysis using ZIP code and aggregate individual-level SDoH shows that in Miami-Dade county, COVID infection is associated with economic disadvantage in a particular geographical area and not with racial/ethnic distribution

The Forgotten Need of Disaster Relief

Disasters in countries with limited resources can put the emergency preparedness of the country to the test. The first major task after a disaster is to take care of the wounded. In countries where the epidemiological transition has occurred, chronic disease can place a major strain on public health preparedness after a disaster. The purpose of this field report is to alert public health practitioners of an infrequently reported public health problem: the impact of natural disasters on adherence to chronic medications. In our experience, the most common complaint in the weeks that followed the 2016 earthquake was not having access to their chronic medications. (Disaster Med Public Health Preparedness. 2018; 12: 291–295