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INTRODUCTION: Psychotic-like experiences (PLEs), which include hallucinations and delusional experiences, are usually present in healthy populations, and their persistence, quality, and severity are associated with the development of psychiatric diseases, including schizophrenia and other poor psychosocial outcomes. Urbanicity, depression, and other psychosocial stressors have been associated with PLEs. However, evidence of PLEs in Latin American (LATAM) countries is still scarce, and there are no studies about PLEs in Chile. The main aim of this study is to describe the prevalence of PLEs in a nationally representative sample according to other social determinants of health. METHODS: The last results of the Chilean National Health Survey (ENS 2016-2017) were analyzed. PLEs were obtained from the Composite International Diagnostic Interview (CIDI) 3.0 and included in this survey. Other psychosocial variables (age, sex, educational level, financial stress, depressive symptoms, and urbanicity) were also included for further analysis. Exclusion criteria were (1) > = 65 and < 18 years old, and (2) previous diagnosis or treatment for schizophrenia or bipolar disorder. Descriptive statistics were used to describe data, and Poisson regression models were performed to weight variables and find psychosocial correlations with PLEs. RESULTS: 2095 subjects were considered for this study (women 62.9% and mean age = 42.5, SD = 13.5). The lifetime prevalence of the PLEs (> = 1 PLE) in Chile was 12.9%. Visual hallucinations were the most common PLE (9.6%), and ideas of reference were the least common (0.4%). The Poisson regression model showed a higher prevalence of PLEs in the Gran Concepción conurbation (OR = 2.56) and Gran Valparaíso conurbation (OR = 1.69) compared with non-big cities. On the other hand, the 18-24 year group had higher PLEs prevalence compared to other age groups. No correlations were found with educational status, financial stress, or depressive symptoms. CONCLUSIONS: A relatively high prevalence of PLEs was found in the Chilean general population, particularly in youth living in large urban areas (Gran Valparaíso and Gran Concepción), which is compatible with previous research. Considering that there were no correlations between low educational level and financial or depressive symptoms, it is necessary to have more studies that correlate other urban relevant variables, such as natural disasters, drug consumption, and domestic or neighborhood violence.
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INTRODUCCION La artroplastía total de rodilla (ATR), que ha tenido un aumento importante en la población en las últimas décadas, presenta una gran variación en su estudio y técnica entre los distintos países. En la actualidad no hay datos nacionales registrados que evalúen la forma de su implementación. Objetivo Registrar las tendencias respecto de la ATR en distintos aspectos en Chile y compararlas con los registros de otros países. MATERIALES y METODOS Se realizó una encuesta vía email a cirujanos de rodilla en Chile considerando cuatro aspectos: generalidades, estudio preoperatorio, técnica quirúrgica y técnica de cementación. Se excluyeron las encuestas que no rellenadas por completo. Se analizaron los datos generales y separados según años de experiencia (ADE). Se compararon los datos con los obtenidos en estudios internacionales. RESULTADOS Se obtuvieron 87 encuestas completas. La mayoría de los encuestados realizaba entre 25 y 50 ATR en 1 año (44%), y el 16%, más de 75. Sólo un 20% utilizaba la modalidad ambulatoria, y un 43% creía que siempre deben ser hospitalizadas (mayor frecuencia en los cirujanos con más de 10 ADE). Un 18% utilizaba algún sistema robótico, con mayor frecuencia en cirujanos con más de 10 ADE; los sistemas más usados fueron ROSA y CORI. El 90% creía que la ATR debería ser parte del programa de Garantías Explícitas de Salud (GES), sin diferencias según ADE. El 81% usaba sistema estabilizado posterior (posterior-estabilized, PS, en inglés), 96% realizaba un abordaje parapatelar medial, 82% usaba guía extramedular tibial, 41% tendía a recambiar la patela, y un 35% no usaba torniquete (ninguna de las variables mostró diferencias según ADE). Sólo un 31% utilizaba cementación al vacío (mayor frecuencia en el grupo con menos de 10 ADE), 95% colocaba el cemento en componentes y en hueso, 75% colocaba en la quilla, y 56% utilizaba el dedo para colocarlo (sólo 22% con pistola). La secuencia más frecuente de cementación fue tibia-fémur-patela. En la mayoría de los aspectos evaluados, se observaron diferencias importantes con estudios de otros países. CONCLUSION Existe una gran variabilidad en la realización de ATR en Chile, con tendencias distintas a las de otros países. En general, en relación con los distintos ADE, no hay grandes diferencias en la técnica quirúrgica, sí habiendo diferencias en la técnica de cementación y en el uso de sistemas robóticos
INTRODUCTION Total knee replacement (TKR) significantly increased among the population in recent decades, and it shows great variation in its study and technique in different countries. There is no registered Chilean data to assess TKR implementation. Objective To record the trends in TKR in different aspects within Chile and compare them with records from other countries. MATERIALS AND METHODS We conducted an email survey among knee surgeons in Chile considering four aspects: general features, preoperative study, surgical technique, and cementation technique. We excluded surveys not completed in full. The analyses included overall data and data per years of experience (YOEs), and we compared the results with those of international studies. RESULTS We obtained 87 complete surveys. Most respondents performed 25 to 50 TKRs each year (44%), with only 16% performing over 75 TKRs. Only 20% used the ambulatory modality, while 43% believed patients always require hospitalization (especially surgeons with more than 10 YOEs). Robotic systems were used by 18% of the surgeons, especially those with more than 10 YOEs; the most used systems were ROSA and CORI. In total 90% of the respondents believed TKR should be part of the Explicit Health Guarantees (Garantías Explícitas de Salud, GES, in Spanish) program, with no differences in terms of YOEs. A total of 81% used the posterior-stabilized (PS) system, 96% performed a medial parapatellar approach, 82% used an extramedullary tibial guide, 41% tended to replace the patella, and 35% did not use a tourniquet (none of the variables showed differences according to YOEs). Only 31% used vacuum cementation (with a higher frequency in the group with fewer than 10 YOEs), 95% placed cement on components and bone, 75% placed it in the keel, and 56% used finger packing (only 22% with a gun). The most common cementation sequence was tibia femur-patella. In most aspects evaluated, we observed important differences compared with studies from other countries. CONCLUSION There is a high variability in the performance of TKR in Chile, with different trends compared with those of other countries. Overall, there are no major differences in the surgical technique concerning YOEs, although there is variation in the cementation technique and the use of robotic systems
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Humanos , Artroplastia do Joelho/métodos , Artroplastia do Joelho/tendências , Chile , Inquéritos e Questionários , Cimentação/métodosRESUMO
To analyse the association of socio-demographic and health factors with vitamin D insufficiency and 25-hydroxyvitamin D (25(OH)D) concentration in Brazilian children aged 6-59 months. Data from 8145 children from the Brazilian National Survey on Child Nutrition (ENANI-2019) were analysed. The serum concentration of 25(OHD)D was measured using a chemiluminescent immunoassay. The prevalence of vitamin D insufficiency (25(OH)D < 50 nmol/l) and 95 % CI was calculated. Logistic and linear regression models were used to identify the variables associated with vitamin D insufficiency and serum 25(OH)D concentrations, respectively. The mean 25(OH)D concentration was 98·6 ± 36·0 nmol/l, and 4·3 % of the children presented vitamin D insufficiency. Children aged 6-23 months (OR = 2·23; 95 % CI 1·52, 3·26); belonging to Southeast (OR = 5·55; 95 % CI 2·34, 13·17) and South (OR = 4·57; 95 % CI 1·77, 11·84) regions; the second tertile of the National Wealth Score (OR = 2·14; 95 % CI 1·16, 3·91) and winter (OR = 5·82; 95 % CI 2·67, 12·71) and spring (OR = 4·84; 95 % CI 2·17, 10·80) seasons of blood collection were associated with a higher chance of vitamin D insufficiency. Female sex (ß = -5·66, 95 % CI - 7·81, -3·51), urban location (ß = -14·19, 95 % CI -21·0, -7·22) and no vitamin D supplement use (ß = -6·01, 95 % CI -9·64, -2·39) were inversely associated with serum 25(OH)D concentration. The age of children and the Brazilian geographical region of household location were the main predictors of vitamin D insufficiency. In Brazil, vitamin D insufficiency among children aged 6-59 months is low and is not a relevant public health problem.
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Deficiência de Vitamina D , Criança , Humanos , Feminino , Pré-Escolar , Brasil/epidemiologia , Deficiência de Vitamina D/epidemiologia , Prevalência , Vitamina D , Vitaminas , Suplementos Nutricionais , Estações do AnoRESUMO
Background: Chronic lung infections represent a diversity of clinical entities that combined respond to significant public health, particularly in developing countries. However, there is no data regarding the practice patterns, surgeons' preferences, and technological usage, especially among Brazilian surgeons, in the setting of the surgical treatment of chronic lung infections. We, therefore, surveyed Brazilian thoracic surgeons from the Brazilian Society of Thoracic Surgery (SBCT) about practice patterns and trends in surgical treatment for chronic lung infections. Methods: A cross-sectional anonymous survey of all thoracic surgeons from the Brazilian Society was conducted in 2019. As the study was purely descriptive no further statistical evaluation was performed. Results: The responsive rate was 34% (259/766) from 23 of the 26 states in Brazil. A total of 141 (54.4%) participants reported their institution as a surgical reference for chronic infection lung disease, only 13.1% of surgeons have a high-volume service (more than 11 cases operated annually). The majority (76.2%) of respondents performed 1-5 surgical resection to treat tuberculosis (TB) sequelae, but only 62 (30.1%) had performed more than one resection to treat active TB. Chronic lung infection (76%) and hemoptysis (66%) were the most common symptoms as surgical indications. A proportion of 42.2% of the respondents do not have and/or perform routine drug sensitivity tests. In addition, 19.3% of respondents were not familiar with the recommendations of surgery in the treatment of pulmonary TB. Video-assisted thoracoscopic surgery (VATS) is available for 80% of respondents, while robotic surgery is for only 10%. Most (86%) surgeons have access to surgical staplers. Among the structural resources, respiratory isolation beds in the intensive care unit (ICU) (80%) and ward (79%) are frequently available resources. However, less than 12% of surgeons have in their institution a specific operating room for sputum-positive patients. Conclusions: Lung resection for chronic infectious disease is an essential area of activity for thoracic surgeons in Brazil, which occurs mainly in the public sphere, with no concentration of cases per surgeon or institution. The lack of adequate resources in many centers justifies the creation of reference centers for improving care for these patients.
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OBJECTIVE: To evaluate the association of external factors of resilience, neighborhood, and family resilience with healthcare use. STUDY DESIGN: A cross-sectional, observational study was conducted using data from the 2016-2017 National Survey of Children's Health. Children aged 4-17 years were included. Multiple logistic regression was used to determine aOR and 95% CIs for association between levels of family resilience, neighborhood resilience and outcome measures: presence of medical home, and ≥2 emergency department (ED) visits per year while adjusting for adverse childhood experiences (ACEs), chronic conditions, and sociodemographic factors. RESULTS: We included 58â336 children aged 4-17 years, representing a population of 57 688 434. Overall, 8.0%, 13.1%, and 78.9% lived in families with low, moderate, and high resilience, respectively; 56.1% identified their neighborhood as resilient. Of these children, 47.5% had a medical home and 4.2% reported ≥2 ED visits in the past year. A child with high family resilience had 60% increased odds of having a medical home (OR, 1.60; 95% CI, 1.37-1.87), and a child with moderate family resilience or resilient neighborhood had a 30% increase (OR, 1.32 [95% CI, 1.10-1.59] and OR, 1.31 [95% CI, 1.20-1.43], respectively). There was no association between resilience factors and ED use, although children with increased ACEs had increased ED use. CONCLUSIONS: Children from resilient families and neighborhoods have an increased odds of receiving care in a medical home after adjusting for the effects of ACEs, chronic conditions, and sociodemographic factors, but no association was seen with ED use.
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Saúde da Família , Resiliência Psicológica , Criança , Humanos , Doença Crônica , Estudos Transversais , Atenção à Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Pré-Escolar , AdolescenteRESUMO
BACKGROUND: Vitamin B12 and folate are key nutrients that help children reach their full potential in growth and development; however, little is known about the status of these vitamins in Brazilian children. OBJECTIVES: To describe the serum concentrations of vitamin B12 and folate, to investigate the association between high folate concentration (HFC) and vitamin B12 deficiency, and to evaluate the association between vitamin B12 and stunting/underweight in Brazilian children aged 6-59 mo. METHODS: Data from 7417 children aged 6-59 mo collected during the Brazilian National Survey on Child Nutrition were used. Serum concentrations of vitamin B12 of <150 pmol/L and folate of <10 nmol/L were classified as deficient, and folate concentrations of >45.3 nmol/L were classified as HFC. Children with length/height-for-age z-score of less than -2 were considered stunted, and those with weight-for-age z-score of less than -2 were underweight. Logistic regression models were performed. RESULTS: In Brazil, 14.2% (95% CI: 12.2, 16.1) of children aged 6-59 mo had vitamin B12 deficiency, 1.1% (95% CI: 0.5, 1.6) had folate deficiency, and 36.9% (95% CI: 33.4, 40.3) had HFC. Vitamin B12 deficiency was higher in children from the northern region of Brazil (28.5%), between 6 and 24 mo (25.3%), whose mothers had lower formal education (0-7 y; 18.7%). Children with HFC had 62% lower odds (OR: 0.38; 95% CI: 0.27, 0.54) of vitamin B12 deficiency than those with normal/deficient folate. Children with vitamin B12 deficiency and normal/deficient folate had higher odds of stunting (OR: 1.58; 95% CI: 1.02, 2.43) than children without vitamin B12 deficiency and normal/deficient folate. CONCLUSIONS: Vitamin B12 deficiency is a public health problem among Brazilian children aged <2 y with vulnerable socioeconomic status. HFC was inversely associated with vitamin B12 deficiency, and lower odds of stunting were observed in children with HFC and vitamin B12 deficiency than in those with vitamin B12 deficiency and normal/deficient folate.
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Deficiência de Ácido Fólico , Deficiência de Vitamina B 12 , Feminino , Humanos , Criança , Ácido Fólico , Estado Nutricional , Brasil/epidemiologia , Magreza , Deficiência de Vitamina B 12/epidemiologia , Vitamina B 12 , Deficiência de Ácido Fólico/epidemiologia , Transtornos do Crescimento/epidemiologiaRESUMO
Foodborne Diseases (FBDs) are a worldwide problem and occur after contaminated food has been ingested, signaling a lack of food quality. Even though the SARS-CoV-2 virus is not transmitted through food, the COVID-19 pandemic has caused several challenges worldwide that have had direct implications on food production and handling, stimulating and reinforcing the adoption of good manufacturing and food handling practices. The aim of this study was to analyze data on notifications of FBD in Brazil in the years before (2018 and 2019) and during (2020 and 2021) the COVID-19 pandemic. Secondary data from the National System of Notifiable Diseases was analyzed, evaluating: overall incidence rate, lethality and mortality, contamination sites, and criteria for confirming the etiological agent. There were 2206 records of FBDs, and the mortality rate was 0.5% in both periods. The incidence rate before the pandemic was 6.48 and during the pandemic was 3.92, while the mortality coefficient was 0.033 before and 0.019 during the pandemic, both per 100,000 inhabitants. There was no significant difference in the number of FBD notifications in the evaluated periods. There was a migration of the location of FBD, with a significant increase in FBD notifications in hospitals and health units and a reduction in notifications from social events. There was a significant increase in the type of criteria used to confirm outbreaks, with an increase in clinical laboratory tests and clinical reports for bromatology. The increase in notifications in hospitals and health units demonstrates the necessity of improving food safety knowledge and the attitudes and practices of food handlers and healthcare professionals.
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COVID-19 , Doenças Transmitidas por Alimentos , Humanos , COVID-19/epidemiologia , SARS-CoV-2 , Brasil/epidemiologia , Pandemias , Doenças Transmitidas por Alimentos/epidemiologiaRESUMO
Background: Analysis of health inequalities by ethnicity is critical to achieving the Sustainable Development Goals. In Ecuador, similar to other Latin American countries, indigenous and afro-descendant populations have long been subject to racism, discrimination, and inequitable treatment. Although in recent years, Ecuador has made progress in health indicators, particularly those related to the coverage of Reproductive, Maternal, Neonatal and Child Health (RMNCH) interventions, little is known as to whether inequalities by ethnicity persist. Methods: Analysis was based on two nationally representative health surveys (2004 and 2012). Ethnicity was self-reported and classified into three categories (Indigenous/Afro-Ecuadorian/Mixed ancestry). Coverage data for six RMNCH health interventions were stratified for each ethnic group by level of education, area of residence and wealth quintiles. Absolute inequality measures were computed and multivariate analysis using Poisson regression was undertaken. Findings: In 2012, 74.4% of women self-identifying as indigenous did not achieve the secondary level of education and 50.7% were in the poorest quintile (Q1); this profile was relatively unchanged since 2004. From 2004 to 2012, the coverage of RMNCH interventions increased for all ethnic groups, and absolute inequality decreased. However, in 2012, regardless of education level, area of residence and wealth quintiles, ethnic inequalities remained for almost all RMNCH interventions. Indigenous women had 24% lower prevalence of modern contraceptive use (Prevalence ratio [PR] = 0.76; 95% IC: 0.7-0.8); 28% lower prevalence of antenatal care (PR = 0.72; 95% IC: 0.6-0.8); and 35% lower prevalence of skilled birth attendance and institutional delivery (PR = 0.65; 95% IC: 0.6-0.7 and PR = 0.65; 95% IC: 0.6-0.7 respectively), compared with the majority ethnic group in the country. Interpretation: While the gaps have narrowed, indigenous people in Ecuador continue in a situation of structural racism and are left behind in terms of access to RMNCH interventions. Strategies to reduce ethnic inequalities in the coverage services need to be collaboratively redesigned/co-designed. Funding: This paper was made possible with funds from the Bill & Melinda Gates Foundation [Grant Number: INV-007,594/OPP1148933].
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Population studies have demonstrated an association between sodium and potassium intake and blood pressure levels and lipids. The aim of this study was to describe the dietary intake and contribution of sodium and potassium to the Mexican diet, and to describe its association with nutrition status and clinical characteristics. We analyzed a national survey with 4219 participants. Dietary information was obtained with a 24-h recall. Foods and beverages were classified according to level of processing. The mean intake (mg/d) of Na was 1512 in preschool children, 2844 in school-age children, 3743 in adolescents, and 3132 in adults. The mean intake (mg/d) of K was 1616 in preschool children, 2256 in school-age children, 2967 in adolescents, and 3401 in adults. Processed and ultra-processed foods (UPF) contribute 49% of Na intake in preschool children, 50% in school-age children, 47% in adolescents, and 39% in adults. Adults with high Na intake had lower serum concentrations of cholesterol, HDL-c, and LDL-c. A significant proportion of the Mexican population has a high intake of Na (64-82%) and low K (58-73%). Strategies to reduce Na and increase K intake need to reduce the possibility of having high BP and serum lipid disturbances.