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This article aims to: (1) describe the evolution of first episode of psychosis (FEP) approaches; (2) define a model of multidisciplinary care; (3) identify challenges and limitations; (4) discuss the unique challenges for those first experiencing psychosis; (5) identify strategies to expand early psychosis interventions. The authors take the medical standpoint and use the differential diagnosis and initial medical work-up as a context for assessment. The remainder of the article will be focused on treatment of FEP in those with schizophrenia-spectrum disorders.
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Intervención Médica Temprana , Trastornos Psicóticos , Humanos , Trastornos Psicóticos/terapia , Trastornos Psicóticos/diagnóstico , Adolescente , Niño , Diagnóstico Precoz , Esquizofrenia/terapia , Esquizofrenia/diagnósticoRESUMEN
PURPOSE: The influence of rurality on the duration of untreated psychosis (DUP) in first-episode psychosis (FEP) is poorly understood. We investigated factors associated with FEP in rural/urban settings and whether there are rural/urban differences in DUP and the mode (speed) of onset of psychosis. METHODS: We used the Cambridgeshire and Peterborough NHS Foundation Trust Research Database (CPFTRD) to identify all persons presenting to an early intervention for psychosis service with FEP between 2013 and 2015. We performed descriptive statistics and multivariable linear and multinomial regression to assess the relationships between the study outcomes and the independent variables. RESULTS: One hundred and fifty-five FEP patients were identified, with a mean age of 23.4 (SD, 5.3) years. The median DUP was 129.0 (IQR: 27.5-524.0) days. In rural areas, FEP patients were more likely to be employed and live with family than those in urban areas. A longer DUP was observed among patients with an insidious onset of psychosis compared with an acute onset (619.5 (IQR: 333.5-945.0)) vs. (17.0 (IQR: 8.0-30.5)) days respectively, p < 0.0001. We found evidence that the mode of onset of psychosis differed by employment status and living circumstances. There was insufficient evidence of rural/urban differences in DUP and mode of onset of psychosis. CONCLUSIONS: Our results suggest that the mode of onset of psychosis is an important indicator of treatment delay and could provide vital information for service planning and delivery. Sociodemographic variations in FEP exist in rural populations, and our findings are similar to those observed in urban settings.
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INTRODUCTION: Ursodeoxycholic acid (UDCA) slows disease progression among patients with primary biliary cholangitis (PBC), yet not all patients receive this standard-of-care medication. Our study aims to identify reasons why PBC patients did not receive the recommended UDCA treatment. METHODS: Using medical record data collected by the Fibrotic Liver Disease (FOLD) Consortium for 2006-2016, we identified PBC patients from a single site with no UDCA therapy record. Two independent reviewers used a structured data collection instrument to systematically confirm and record the reasons for the lack of treatment. RESULTS: Among 494 PBC patients (11% men and 13.2% Black patients) with a median follow-up of 5.2 years, 35 (7%) had never received UDCA (16% men and 24% Black patients). Of these, 18 (51%) had laboratory indications of PBC but were not formally diagnosed. Among the remaining 17 patients with recognized PBC, six were never offered UDCA, seven declined treatment, and four remained untreated despite being offered treatment. We did not find a statistically significant association between the lack of PBC diagnosis and treatment and patients' age (p = 0.139), gender (p = 0.222), race (p = 0.081), or insurance coverage (p = 0.456), perhaps due to our small sample size. CONCLUSIONS: Multiple factors influencing the lack of evaluation and treatment in PBC patients were identified at the provider and patient levels. The most common reasons included financial barriers, loss to follow-up, severe decompensated disease at diagnosis, and lack of referral to specialists for further evaluation. Future interventions targeting modifiable provider and patient barriers may improve rates and timeliness of PBC diagnosis and treatment.
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The Kereh River in Penang, Malaysia, has faced severe pollution for over 40 years due to untreated wastewater from swine farms in Kampung Selamat, discharged via stormwater drains. Despite official claims that all 77 swine farms treat their wastewater to meet regulatory standards, local non-governmental organizations and villagers have challenged this, though their concerns lack scientific backing. This study evaluates the river's water quality by analyzing samples from upstream (US), midstream (MS), and downstream (DS), and from Parit Cina-Parit Besar, a conduit for untreated swine wastewater. Fourteen parameters were measured against Malaysia's National Water Quality Standards (NWQS). Significant differences were found in six parameters: ammonium nitrogen (AN), biochemical oxygen demand (BOD), chemical oxygen demand (COD), dissolved oxygen (DO), total suspended solids (TSS), and oil and grease (OG). While Dunn's post hoc pairwise comparison showed no significant differences among river segments, mean values indicated increased pollution downstream, particularly after the convergence with untreated swine wastewater. River classification worsened, with water quality index dropping from 69.88 ± 11.37 score (Class III) US to 38.49 ± 12.74 and 50.44 ± 3.14 scores (Class IV) MS and downstream, respectively. A significant positive correlation between E. coli and AN (r = 0.71, p < 0.01) suggests a common point source pollutant, particularly the untreated swine wastewater. The river exhibits low oxygen levels and high organic matter and nutrient concentrations, especially MS and downstream, highlighting substantial ecological and public health risks. Effective enforcement of waste treatment regulations and enhanced monitoring are crucial for mitigating pollution and restoring the river's ecosystem. Collaboration between authorities and pig farmers is essential to improve water quality and maintain the river's ecological balance. PRACTITIONER POINTS: Severe Kereh River pollution: Untreated swine wastewater from Kampung Selamat pig farms, primarily via Parit Cina-Parit Besar, has degraded the river for over 40 years. Regulatory non-compliance: Despite official claims, untreated swine wastewater continues to pollute the river, challenging regulatory standards. Significant pollution indicators: Elevated levels of AN, BOD, COD, DO, TSS, OG, and E. coli signal severe pollution midstream and downstream. Water quality index drop: WQI scores classify midstream and downstream sections as polluted, indicating worsening conditions downstream. Urgent need for action: Enforcing regulations, improving wastewater treatment, and relocating pig farms are crucial for restoring the Kereh River.
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Ríos , Aguas Residuales , Calidad del Agua , Malasia , Ríos/química , Animales , Aguas Residuales/química , Porcinos , Monitoreo del Ambiente , Contaminantes Químicos del Agua/análisis , Eliminación de Residuos Líquidos , Análisis de la Demanda Biológica de Oxígeno , Granjas , Crianza de Animales DomésticosRESUMEN
PURPOSE: This study explored the association between self-reported diabetes mellitus, glycaemic control, measured by glycohaemoglobin (HbA1c) levels, and untreated root caries among U.S. adults, exploring the impact of diabetes status and glycaemic control levels on root caries risk. MATERIALS AND METHODS: Analysing data from the National Health and Nutrition Examination Survey (NHANES) 2015 to 2018, we included 7490 participants aged 30 and above. We investigated the association between self-reported diabetes, glycaemic control, and untreated root caries, adjusting for demographic and health-related variables. Weighted logistic regression models estimated untreated root caries odds by diabetes status and HbA1c cutoffs (6.5-9%), adjusting for demographics, health behaviours, BMI, diet, oral health factors. RESULTS: A significant association was found between higher HbA1c levels and an increased risk of untreated root caries (odds ratio [OR]: 1.11, 95% CI: 1.01-1.22, p < .05). Self-reported diabetes was not significantly linked to untreated root caries after adjusting for HbA1c and other factors. Glycaemic control thresholds (HbA1c ≥8%) among diabetic participants were associated with higher odds of untreated root caries. CONCLUSIONS: Poorly controlled diabetes appears to be associated with untreated root caries among U.S. adults. This highlights the greater impact of glycaemic control versus self-reported diabetes on dental health and the need for regular oral screenings for patients with poor glycaemic control.
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Background: Despite recognition that early intervention for first-episode psychosis (FEP) improves outcomes, Black youth with FEP continue to experience critical disparities in care. A historical lack of scientific focus on racial and ethnic factors in the study of psychosis and scant investigations among publicly insured (ie, Medicaid-enrolled) youth hinder our ability to understand and address factors that contribute to disparities in early FEP care. Strategies for improving FEP services for Black youth are reliant on more precise identification of who faces disparities and when during the early course of illness disparities are experienced. Study Design: A retrospective longitudinal analysis of Ohio Medicaid claims data was performed for 987 982 youth aged 15-24 years between 2010 and 2020 to examine: (1) the likelihood of FEP diagnosis, (2) the type of psychotic disorder diagnosis received, and (3) receipt of treatment following psychosis onset. Study Results: Non-Hispanic Black (NHB) youth, relative to non-Hispanic White (NHW) peers, were more likely to be diagnosed with a psychotic disorder and were further more likely to receive a diagnosis of schizophrenia relative to an affective psychotic disorder. In the first year following FEP diagnosis, NHB youth were also less likely to receive psychotherapy than NHW youth; this disparity was no longer present when examined at 2 years following FEP. Conclusions: In this study, Black youth experienced disparities in both the diagnosis and early treatment of FEP. Additional efforts are needed to understand and address these observed disparities and to promote equitable access to FEP care during the critical early illness phases.
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Our objectives were to ascertain the following: (1) the prevalence and socioeconomic distribution of hypertension (HTN), undiagnosed for HTN, and untreated cases of HTN-diagnosed individuals; (2) the relationship between SES and the prevalence of HTN, undiagnosed for HTN, and untreated for HTN; and (3) whether sex moderate this association. Data from the 2017-18 Bangladesh Demographic Health Survey were used. 11,776 participants who were 18 years of age or older responded to our analysis. The age-adjusted prevalence of HTN, undiagnosed for HTN, and untreated cases was 25.1%, 57.2%, and 12.3%. Compared to females, males were less likely to have HTN but more likely to have undiagnosed HTN. People in the rich SES groups had a higher odd of (adjusted odds ratio [aoR] 1.25; 95% confidence interval [CI] 1.08-3.45) of having HTN compared to those in the poor SES group. When compared to individuals in the poor SES group, those in the rich SES group had lower odds of undiagnosed (aoR 0.57; 95% CI 0.44-0.74) and untreated (aoR 0.56; 95% CI 0.31-0.98) for HTN. Sex moderated the association between SES and HTN prevalence, which showed that men from rich SES were more likely to suffer from HTN than men from poor SES. According to this study, the government and other pertinent stakeholders should concentrate more on developing suitable policy measures to reduce the risk of HTN, particularly for men in rich socioeconomic groups. They should also concentrate on screening and diagnosing HTN in socioeconomically disadvantaged populations, regardless of sex.
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Hipertensión , Disparidades Socioeconómicas en Salud , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Bangladesh/epidemiología , Estudios Transversales , Encuestas Epidemiológicas , Hipertensión/epidemiología , Hipertensión/diagnóstico , Prevalencia , Factores Sexuales , Enfermedades no Diagnosticadas/epidemiologíaRESUMEN
BACKGROUND: Early identification of treatment non-response in first-episode psychosis (FEP) is essential to outcome. Despite indications that exposure to childhood trauma (CT) can have adverse effects on illness severity, its impact on treatment non-response and the interplay with other pre-treatment characteristics is sparsely investigated. We use a lack of clinical recovery as an early indicator of treatment resistance to investigate the relationship between CT and treatment resistance status at one-year follow-up and the potential mediation of this effect by other pre-treatment characteristics. METHODS: This prospective one-year follow-up study involved 141 participants recruited in their first year of treatment for a schizophrenia-spectrum disorder. We investigated clinical status, childhood trauma (CT), premorbid adjustment (PA), and duration of untreated psychosis (DUP) at baseline and clinical status at one-year follow-up. Ordinal regression analyses were conducted to investigate how PA and DUP affected the relationship between CT and one-year outcome in FEP. RESULTS: 45 % of the FEP sample reported moderate to severe CT, with significantly higher levels of CT in the early treatment resistant group compared to participants with full or partial early recovery. Ordinal regression analysis showed that CT was a significant predictor of being in a more severe outcome group (OR = 4.59). There was a partial mediation effect of PA and a full mediation effect of DUP on the effect of CT on outcome group membership. DISCUSSION: Our findings indicate that reducing treatment delays may mitigate the adverse effects of CT on clinical outcomes and support the inclusion of broad trauma assessment in FEP services.
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Trastornos Psicóticos , Humanos , Trastornos Psicóticos/tratamiento farmacológico , Trastornos Psicóticos/fisiopatología , Femenino , Masculino , Adulto , Adulto Joven , Estudios de Seguimiento , Adolescente , Experiencias Adversas de la Infancia , Esquizofrenia/tratamiento farmacológico , Esquizofrenia/fisiopatología , Estudios Prospectivos , Adultos Sobrevivientes de Eventos Adversos Infantiles/estadística & datos numéricosRESUMEN
BACKGROUND: In this case-control study, the authors examined the relationship between untreated caries in children and parent fluoride treatment refusal. The authors hypothesized that parents of children with a history of untreated caries would be less likely to refuse topical fluoride for their children than parents of children with no history of untreated caries. METHODS: The study included children (≤ 18 years old) who were patients at a university dental clinic from January 2016 through June 2020. Children whose parents refused fluoride treatment were age-matched with children whose parents did not refuse fluoride treatment (n = 356). The outcome variable was parent topical fluoride refusal for their children (no, yes). The predictor variable was a history of untreated caries (no, yes). Confounding variable-adjusted modified Poisson regression models were used to estimate the prevalence ratio of parent fluoride refusal by means of children's untreated caries status. RESULTS: Approximately 46.3% of children had a history of untreated caries. The prevalence of parent fluoride refusal for children with a history of untreated caries was significantly lower than that for children with no history of untreated caries (adjusted prevalence ratio, 0.79; 95% CI, 0.64 to 0.98; P = .03). CONCLUSIONS: Parents of children with a history of caries are less likely to refuse topical fluoride treatment, which suggests that untreated caries may motivate parents to accept preventive dental treatments like fluoride. PRACTICAL IMPLICATIONS: Dental care professionals should assess caries risk and communicate a child's caries risk before making a recommendation regarding topical fluoride treatment.
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Caries Dental , Fluoruros Tópicos , Padres , Negativa del Paciente al Tratamiento , Humanos , Caries Dental/epidemiología , Niño , Femenino , Masculino , Padres/psicología , Estudios de Casos y Controles , Fluoruros Tópicos/uso terapéutico , Negativa del Paciente al Tratamiento/estadística & datos numéricos , Preescolar , Cariostáticos/uso terapéutico , Adolescente , Tratamiento con FluoruroRESUMEN
Background: How often hypertensive patients could achieve remission to normal blood pressure (BP) (i.e., <140/90 mmHg) in the absence of antihypertensive drugs, which is important for the management of hypertension, remains largely unknown. This observational study aimed to investigate the change of BP in older adults with hypertension who did not take antihypertensive drugs and preliminarily examine whether the remission from hypertension to normal BP observed in this setting was associated with lower risk of cardiovascular disease (CVD). Methods: 2760 participants aged 33-99 years (median 60 years, interquartile 54-68 years) from the Health and Retirement Study (wave 2006 to wave 2018) and the English Longitudinal Study of Ageing (wave 1998 to wave 2016), who had no major CVD, were hypertensive, and were not on antihypertensive drugs at the time of baseline BP measurement, and had at least one follow-up BP measurement before which no antihypertensive drugs were taken, were included for analysis. The main outcome was the proportion of patients who achieved remission of hypertension at the last wave of measurement. Findings: During a median follow-up of six years, 52% of the participants showed a reduction of ≥6 mmHg in systolic BP and 60% a reduction of ≥3 mmHg in diastolic BP. 1171 participants (42%, 95% CI: 41-44%) achieved remission at the last measurement, and by that time 67%, 43%, and 29% of them had maintained the normotensive state for around 4, 8, and 12 years, respectively. Various supplementary analyses that aimed to examine the impact of chance and bias yielded similar results. Preliminary analyses showed that being non-smokers at baseline, achieving a normal body mass index during follow-up, and quitting alcohol drinking during follow-up, among others, were associated with the remission of hypertension. Compared with the participants who remained hypertensive, those who achieved remission had a lower CVD risk (adjusted hazard ratio 0.66, 95% CI: 0.47-0.92). Interpretation: In many of this study population, hypertension could be reversed without the intervention of drug treatment in the first few years after diagnosis. This finding may have implications for more individualized management of hypertension. Further studies to identify the factors or algorithms predictive of such hypertension remission are warranted. Funding: The Chinese University of Hong Kong (7106452; 7105959),Shenzhen Science and Technology Program (KQTD20190929172835662), Strategic Priority Research Program of Chinese Academy of Sciences (XDB 38040200), National Institute on Aging (R01AG017644; NIA U01AG009740).
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OBJECTIVES: This study aims to update the relevant epidemiological information of untreated caries in permanent teeth. METHODS: Data were derived from the Global Burden of Disease (GBD) study 2019. We described temporal trends in age-standardized prevalence rate (ASPR) of untreated caries in permanent teeth by gender and region from 1990 to 2019. Age-period-cohort (APC) model was utilized to analyze age, period and cohort effects on prevalence, and we used the Bayesian age-period-cohort (BAPC) model to make projections of prevalence between 2020 and 2049. RESULTS: The global ASPR of untreated caries in permanent teeth presented a decreasing trend from 1990 to 2019 (26593.58/105 vs. 25625.53/105), with females exceeding males annually. Negative correlation was observed between ASPR and Socio-demographic Index (SDI) levels. APC analyses showed that net drift was -0.16 % globally and generally below 0 across all SDI regions. The overall global peak in prevalence occurred in the 20-24 years group (36319.99/105), and there was a decrease trend in the overall global period rate ratio (RR). Compared to younger birth cohorts, prior birth cohorts had higher prevalence risks globally and across all SDI regions. Significant upward trends was predicted in the global ASPR of untreated caries in permanent teeth for both genders from 2020 to 2049. CONCLUSIONS: Age-period-cohort effects exerted a significant impact on the prevalence of untreated caries in permanent teeth during the study period. CLINICAL SIGNIFICANCE: The ASPR of untreated caries in permanent teeth may increase in the next 30 years by projections. And the disease burden of untreated caries in permanent teeth may be affected by population ageing. It is essential to implement targeted prevention and control policies to disadvantaged groups and attempt to reduce caries inequalities.
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Caries Dental , Dentición Permanente , Humanos , Caries Dental/epidemiología , Masculino , Prevalencia , Femenino , Adulto , Adolescente , Adulto Joven , Estudios de Cohortes , Niño , Persona de Mediana Edad , Salud Global/estadística & datos numéricos , Anciano , Teorema de Bayes , Factores de Edad , Carga Global de Enfermedades/tendencias , Preescolar , PredicciónRESUMEN
INTRODUCTION: Brucellosis is a zoonotic illness caused by Brucella bacteria, primarily transmitted through contaminated dairy products or direct contact with infected animals. Brucellosis is highly prevalent in Iran, with Brucella melitensis biovar 1 being the primary causative agent. Musculoskeletal symptoms, including spondylitis, sacroiliitis, and peripheral arthritis, are common in brucellosis patients, but avascular necrosis of the hip joint is extremely rare. CASE PRESENTATION: This case report presents a middle-aged woman from Iran with untreated brucellosis infection, who developed rapidly progressing avascular necrosis affecting both hip joints. The patient's social history did not indicate any use of tobacco or alcohol. Furthermore, there was no indication of any traumatic events affecting the patient's hip joints. The patient's family history did not reveal any rheumatologic disorders, and the patient had not been diagnosed with or reported using immune suppressant medications. Laboratory results confirmed that the patient was not diagnosed with sickle cell anemia. The patient had been intolerant to the prescribed medications, Rifampin and Doxycycline. Initially, she presented with severe bilateral hip pain, anorexia, vomiting, periodic chills and fever, myalgia, and night sweats. Pelvis X-ray confirmed bilateral hip avascular necrosis, and total hip arthroplasty was scheduled but subsequently canceled due to persistent brucellosis infection. Physical examination revealed limited hip motion, pain, and inability to bear weight. Laboratory tests indicated leukocytosis, elevated levels of CRP, and high titers on Wright and 2ME tests. Intravenous Ciprofloxacin was initiated, and further investigations were scheduled. DISCUSSION: Osteoarticular complications are common in individuals with brucellosis. The sacroiliac joints are affected in 80 % of cases, while the spinal joints are affected in 50 %. Brucella-induced arthritis can be found in over 50 % of patients, with the lower limb joints being the most commonly affected. Failure to diagnose and treat hip arthritis caused by brucellosis promptly can lead to severe complications, including dislocation and avascular necrosis of the femoral head. Avascular necrosis is a condition where bone tissue dies due to compromised blood supply. It often remains asymptomatic initially and is usually found incidentally during radiographic imaging. Osteonecrosis of the femoral head can manifest as Legg-Calve-Perthes disease or as a complication of other medical conditions. Various factors can contribute to avascular necrosis, including hip dislocation or fracture, prolonged use of certain medications, excessive alcohol consumption, and certain medical conditions. Magnetic resonance imaging is considered the standard method for diagnosing avascular necrosis. Delay in diagnosing and treating brucellosis can result in permanent bone complications. CONCLUSION: Brucellosis, a disease prevalent in endemic regions, should be considered as a cause of severe hip pain and other vague symptoms. Timely diagnosis and management are important, especially for high-risk patients with other health conditions and poor drug compliance, to prevent complications such as avascular necrosis.
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INTRODUCTION: Social inequities in dental caries are reflected by both inequities in the social structures that contribute to disease severity and inequities in the provision of dental care. This study aimed to describe social differentials in the dental caries experience among Australian adults across a 13-y period and to examine if the highest magnitude of oral health inequities persisted across dental caries prevalence (decayed teeth [DT]) or its management (missing teeth [MT], filled teeth [FT]). METHODS: Data were from 2 population-based cross-sectional surveys of Australian adult oral health conducted in 2004-2006 (National Survey of Adult Oral Health-1 [NSAOH-1], n = 5,505) and 2017-2018 (NSAOH-2, n = 5,022). In each survey, representative samples of adults were obtained through a 3-stage, stratified sample design within metropolitan and regional areas in each state/territory. Clinical outcomes included the prevalence and mean of DT, MT, FT, and DMFT. Equivalized household income was grouped into approximately quartiles from low to high. RESULTS: Across all income quartiles, the mean DT and % DT >0 was higher in NSAOH-2 than in NSAOH-1. The increase in prevalence was highest in the third highest income group (prevalence difference [PD] = 8.4, from 24.1 to 32.5). Similarly, % MT >0 was lower in NSAOH-2 than in NSAOH-1 across all income groups, with the decrease most marked for the lowest income group (PD = -6.5, from 74.1 to 67.8). Across all income quartiles, % FT >0 was lower in NSAOH-2 than in NSAOH-1. The decrease was the most marked for the lowest income group (PD = -8.9, from 81.1 to 72.2). CONCLUSION: The findings confirm that although oral health inequities decreased for the most extreme management outcome of dental caries (MT), inequities increased for experience of that disease (DT) and the more conservative management of dental caries (FT). For all D, M, and F components (DMFT), inequities between the lowest and highest household income groups increased from 2004-2006 to 2017-2018. KNOWLEDGE TRANSFER STATEMENT: This study found that social inequities in oral health (experience of untreated dental caries and missing teeth) increased between the most socially advantaged and disadvantaged groups between 2004-2006 and 2017-2018. This suggests that models of dental service provision in Australia are increasingly benefitting those who can afford and access the care and who arguably need the services less than their less socially advantaged counterparts do.
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[This corrects the article DOI: 10.3389/fpsyt.2024.1327928.].
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BACKGROUND: Prediction of inhibitor development in patients with hemophilia A (HA) remains a challenge. OBJECTIVES: To construct a predictive model for inhibitor development in HA using a network of clinical variables and biomarkers based on the individual similarity network. METHODS: Previously untreated and minimally treated children with severe/moderately severe HA, participants of the HEMFIL Cohort Study, were followed up until reaching 75 exposure days (EDs) without inhibitor (INH-) or upon inhibitor development (INH+). Clinical data and biological samples were collected before the start of factor (F)VIII replacement (T0). A predictive model (HemfilNET) was built to compare the networks and potential global topological differences between INH- and INH+ at T0, considering the network robustness. For validation, the "leave-one-out" cross-validation technique was employed. Accuracy, precision, recall, and F1-score were used as evaluation metrics for the machine-learning model. RESULTS: We included 95 children with HA (CHA), of whom 31 (33%) developed inhibitors. The algorithm, featuring 37 variables, identified distinct patterns of networks at T0 for INH+ and INH-. The accuracy of the model was 74.2% for CHA INH+ and 98.4% for INH-. By focusing the analysis on CHA with high-risk F8 mutations for inhibitor development, the accuracy in identifying CHA INH+ increased to 82.1%. CONCLUSION: Our machine-learning algorithm demonstrated an overall accuracy of 90.5% for predicting inhibitor development in CHA, which further improved when restricting the analysis to CHA with a high-risk F8 genotype. However, our model requires validation in other cohorts. Yet, missing data for some variables hindered more precise predictions.
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Factor VIII , Hemofilia A , Aprendizaje Automático , Índice de Severidad de la Enfermedad , Humanos , Hemofilia A/tratamiento farmacológico , Hemofilia A/sangre , Hemofilia A/diagnóstico , Niño , Preescolar , Factor VIII/genética , Masculino , Valor Predictivo de las Pruebas , Factores de Riesgo , Adolescente , Reproducibilidad de los Resultados , Inhibidores de Factor de Coagulación Sanguínea/sangre , Factores de Tiempo , Lactante , Medición de Riesgo , Biomarcadores/sangre , Resultado del TratamientoRESUMEN
Production of carotenoids by yeast fermentation is an advantaged technology due to its easy scaling and safety. Nevertheless, carotenoid production needs an economic culture medium and other efficient yeast stains. The study aims to isolate and identify a yeast strain capable of producing carotenoids using a cost-effective substrate. A new strain was identified as Rhodotorula toruloides L/24-26-1, which can produce carotenoids at different pretreated and unpretreated sugarcane molasses concentrations (40 and 80 g/L). The highest biomass concentration (18.6 ± 0.6 g/L) was reached in the culture using 80 g/L of hydrolyzed molasses. On the other hand, the carotenoid accumulation reached the maximum value using pretreated molasses at 40 g/L (715.4 ± 15.1 µg/g d.w). In this case, the ß-carotene was 1.5 times higher than that on the control medium. The yeast growth in molasses was not correlated with carotenoid production. The most outstanding production of The DPPH, ABTS, and FRAP tests demonstrated the antioxidant activity of the obtained carotenogenic extracts. This research demonstrated the R. toruloides L/24-26-1 strain biotechnological potential for carotenoid compounds. The yeast produces carotenoids with antioxidant activity in an inexpensive medium, such as sulfuric acid pretreated and unpretreated molasses.
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Fermentación , Melaza , Rhodotorula , Saccharum , beta Caroteno , Rhodotorula/metabolismo , Rhodotorula/genética , Rhodotorula/crecimiento & desarrollo , Rhodotorula/aislamiento & purificación , Rhodotorula/clasificación , Saccharum/metabolismo , beta Caroteno/metabolismo , beta Caroteno/biosíntesis , Carotenoides/metabolismo , Antioxidantes/metabolismo , Biomasa , Medios de Cultivo/química , FilogeniaRESUMEN
An increased risk of target organ damage (TOD) has been reported in patients with primary aldosteronism (PA). However, there is relatively little related research on the correlation between the degree of TOD and those with and without PA in newly diagnosed hypertensive patients. The aim of this study was to assess the association between PA and TOD among patients with newly diagnosed hypertension. Newly diagnosed hypertensive patients were consecutively recruited from January 2015 to June 2020 at the University of Hong Kong-Shenzhen Hospital. Patients were stratified into those with and without PA. Data for left ventricular mass index (LVMI), carotid intima-media thickness (CIMT) and plaque, and microalbuminuria were systematically collected. A total of 1044 patients with newly diagnosed hypertension were recruited, 57 (5.5%) of whom were diagnosed with PA. Patients with PA had lower blood pressure, serum lipids, body mass index, and plasma renin activity and a higher incidence of hypokalemia than those without PA. In contrast, the prevalence of left ventricular hypertrophy, increased CIMT, and microalbuminuria was higher in patients with PA than in those without PA. Multivariable regression analysis demonstrated that PA was independently associated with increased LVMI, CIMT and microalbuminuria. Among patients with newly diagnosed hypertension, those with PA had more severe TOD, including a higher LVMI, CIMT and microalbuminuria, than those without PA. These findings emphasize the need for screening TOD in newly diagnosed hypertension due to underlying PA.
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Albuminuria , Grosor Intima-Media Carotídeo , Hiperaldosteronismo , Hipertensión , Hipertrofia Ventricular Izquierda , Humanos , Hiperaldosteronismo/complicaciones , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/epidemiología , Femenino , Masculino , Hipertensión/epidemiología , Hipertensión/complicaciones , Persona de Mediana Edad , Hipertrofia Ventricular Izquierda/epidemiología , Hipertrofia Ventricular Izquierda/etiología , Hipertrofia Ventricular Izquierda/diagnóstico , Hipertrofia Ventricular Izquierda/fisiopatología , Albuminuria/epidemiología , Albuminuria/etiología , Albuminuria/diagnóstico , Prevalencia , Adulto , Factores de Riesgo , Presión Sanguínea/fisiología , Hong Kong/epidemiología , Anciano , Hipopotasemia/epidemiología , Hipopotasemia/etiología , Hipopotasemia/diagnósticoRESUMEN
This research analyzes data on the microplastic (MP) contamination in the environmental systems (atmosphere, lithosphere, hydrosphere) and the levels of MPs in freshwater of cities with different levels of national income. This study investigates the influencing factors of MP generation, i.e., mismanaged plastic waste, untreated wastewater, number of registered motor vehicles, and stormwater runoff. The statistical correlations between the MP contamination in urban freshwater and the four influencing factors of MP generation are determined by linear regression. The results indicate that MPs are most abundant in aquatic systems (i.e., hydrosphere) and pose a serious threat to the human food chain. The regression analysis shows a strong correlation between mismanaged plastic waste and microfragment smaller than 300 µm in particle size in urban freshwater with high goodness-of-fit (R2 = 0.8091). A strong relationship with high goodness-of-fit also exists between untreated wastewater and microfragment of 1000-5000 µm in particle size (R2 = 0.9522). The key to mitigate the MP contamination in urban freshwater is to replace improper plastic waste management and wastewater treatment with proper management practices.
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OBJECTIVE: Studies on duration of untreated psychosis are common in patients with schizophrenia, but few studies have investigated the relationship between duration of untreated illness (DUI) and suicide, especially in patients with chronic schizophrenia. Therefore, we intended to investigate the relationship between DUI and suicide and clinical correlates in patients with chronic schizophrenia. METHODS: A total of 1,555 Chinese patients with chronic schizophrenia were enrolled in this study. DUI was measured in years, reflecting the prolonged untreated periods observed in this population. Clinical correlates were assessed, including symptoms, cognitive functioning, and body mass index. Suicidal ideation and attempts were also examined. Statistical analyses, including multivariate models, were employed to investigate the associations between DUI and clinical correlates while controlling for potential confounders. RESULTS: The study revealed a significant proportion (23.3%) of patients with chronic schizophrenia in China received their first treatment after a 4-year delay, with the longest untreated duration reaching 39 years. Patients with longer DUI exhibited more severe negative symptoms, lower immediate memory scores, a higher likelihood of being overweight, and surprisingly, a reduced likelihood of suicidal ideation and attempts. Each additional year of untreated illness was associated with a 3% decrease in the risk of suicidal ideation and attempts. CONCLUSION: The findings underscore the prevalence of extended untreated periods in Chinese patients with chronic schizophrenia and highlight the impact of DUI on negative symptoms, cognitive function, and body weight. Intriguingly, a longer DUI was associated with a lower risk of suicidal ideation and attempts.
RESUMEN
This study aimed to assess the link between fast-food consumption and oral health outcomes as measured by the mean number of decayed, missing due to dental disease, or filled permanent teeth (DMFT) and teeth with untreated dental caries. This study utilized data obtained from the National Health and Nutritional Examination Survey (NHANES). The data used was collected from 11,288 participants aged 20 and above from 2015 to 2018. The frequency of fast-food consumption was divided into two groups: "less than two meals over the past seven days" and "two meals or more over the past seven days." The mean number of DMFT and teeth with untreated dental caries were used to assess the participants' oral health. The link between fast-food consumption and these mean values was explored using Poisson regression analysis, in which confounding variables such as income, race, age, and sex were adjusted for. After adjusting for these variables, the results revealed that individuals who reported consuming two or more fast-food meals during the preceding seven days had higher mean numbers of DMFT and teeth with untreated dental caries compared to those who consumed less than two fast-food meals during the same period (adjusted mean ratio = 1.05; 95 % confidence interval [CI] 1.01-1.10 and mean ratio = 1.22; 95 % CI 1.01-1.47, respectively). Conclusion: This study revealed a link between poor oral health outcomes and fast-food consumption. Consequently, public health officials must focus on fast-food settings and availability of high-sugar-content items. Interventions that target fast-food outlets and what they offer may have a positive impact on oral health.