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OBJECTIVE: To investigate the causal link between the North American Free Trade Agreement (NAFTA) unrestricted sugar trade agreement signed in 2008 between the USA and Mexico and the diabetes prevalence across all fifty US states. DESIGN: A quasi-experimental research design to investigate the causal effect of the NAFTA unrestricted sugar trade agreement on diabetes prevalence. Our study utilises a comprehensive panel dataset spanning from 2000 to 2016, comprising 1054 observations. To conduct our analysis, we applied both the difference-in-differences and event-study methodologies. SETTING: All the states in the USA. PARTICIPANTS: The fifty states in the USA. RESULTS: After the enactment of the NAFTA sugar trade agreement between the USA and Mexico in 2008, most states witnessed an increase in diabetes prevalence. The annual impacts displayed significant variation among states, with percentage increases spanning from 0·50 to 2·28 %. CONCLUSIONS: States with a higher percentage of their population living below the poverty line, a larger Black resident population and a lower proportion of high school graduates had more significant increases in diabetes prevalence attributed to the NAFTA sugar trade agreement.
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Comércio , Saúde Pública , Humanos , Comércio/estatística & dados numéricos , Estados Unidos/epidemiologia , México/epidemiologia , Prevalência , Diabetes Mellitus/epidemiologia , Cooperação InternacionalRESUMO
This paper discusses the potential of an international agreement to ensure equitable vaccine distribution, addressing the failures witnessed during the COVID-19 pandemic. COVAX was unable to prevent vaccine monopolization and unequal distribution, which led to significant disparities in vaccination rates and avoidable deaths. Any future agreement on equitable vaccine distribution must address ethical and practical issues to ensure global health equity and access. The proposed agreement should recognize healthcare as a human right and consider vaccines beyond mere commodities, emphasizing the social responsibility of pharmaceutical companies to prioritize affordability, availability, and accessibility, particularly for low-income countries (LICs). Voluntary licensing agreements are suggested as a means to enhance access to essential medicines. The paper also outlines the necessity of international cooperation, with robust compliance mechanisms, to effectively enforce such an agreement and mitigate future health crises.
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Vacinas contra COVID-19 , COVID-19 , Indústria Farmacêutica , Acessibilidade aos Serviços de Saúde , Humanos , Indústria Farmacêutica/ética , COVID-19/prevenção & controle , COVID-19/epidemiologia , Cooperação Internacional , Equidade em Saúde , SARS-CoV-2 , Saúde Global , Países em DesenvolvimentoRESUMO
Abstract Cephalometry is a morphological and descriptive diagnostic method that provides relevant data on skeletal and dentoalveolar malocclusions of patients seeking orthodontics treatment. Several authors have proposed different cephalometric measurements to determine facial growth direction and facial biotype, the results of these different measurements from the same patient do not always agree on the diagnosis. The aim of this study was to determine the level of agreement between Ricketts and Björk-Jarabak cephalometric analyses for the determination of facial growth direction and facial biotype in patients from a population of Yucatan, Mexico. A total of 260 lateral cephalograms of patients between 18 and 59 years of age were digitally traced using the Ricketts and Björk-Jarabak cephalometric analyses to determine the direction of facial growth and facial biotype using Dolphin Imagine software. Cohen's kappa statistical test was performed to establish the strength of agreement between the diagnostic results obtained by the cephalometric analyses. A poor diagnostic concordance strength was found for growth direction (K=0.105), and acceptable for facial biotype (K=0.362). The concordance strengths for each diagnostic possibility (level) ranged from slight to acceptable, except for the brachyfacial and dolichofacial biotypes, with a moderate strength of agreement. In conclusion, the Ricketts and Björk- Jarabak cephalometric measurements used for the determination of facial biotype and facial growth direction could suggest non-concordant diagnostic assessments in some individuals.
Resumen La cefalometría es un método diagnóstico morfológico y descriptivo que proporciona datos relevantes sobre maloclusiones esqueléticas y dentoalveolares de pacientes que buscan tratamiento de ortodoncia. Varios autores han propuesto diferentes mediciones cefalométricas para determinar la dirección del crecimiento facial y el biotipo facial, los resultados de estas diferentes mediciones de un mismo paciente no siempre coinciden en el diagnóstico. El objetivo de este estudio fue determinar el nivel de concordancia entre los análisis cefalométricos de Ricketts y Björk-Jarabak para la determinación de la dirección del crecimiento facial y el biotipo facial en pacientes de una población de Yucatán, México. Se trazaron digitalmente un total de 260 cefalogramas laterales de pacientes entre 18 y 59 años de edad utilizando los análisis cefalométricos de Ricketts y Björk-Jarabak para determinar la dirección del crecimiento facial y el biotipo facial utilizando el software Dolphin Imagine. Se realizó la prueba estadística kappa de Cohen para establecer la fuerza de concordancia entre los resultados diagnósticos obtenidos por los análisis cefalométricos. Se encontró una fuerza de concordancia diagnóstica deficiente para la dirección del crecimiento (K=0.105) y aceptable para el biotipo facial (K=0.362). Los niveles de concordancia para cada posibilidad diagnóstica (nivel) variaron de leve a aceptable, excepto para los biotipos braquifacial y dolicofacial, con un nivel de concordancia moderado. En conclusión, las mediciones cefalométricas de Ricketts y Björk-Jarabak utilizadas para la determinación del biotipo facial y la dirección del crecimiento facial podrían sugerir evaluaciones diagnósticas no concordantes en algunos individuos.
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This study aimed to evaluate the reliability of an age estimation method based on the pulp/tooth area ratio by assessing intra- and inter-examiner agreement across five observers at different intervals. Using the same X-ray device and technical parameters, 96 digital periapical X-ray images of upper and lower canines were obtained from 28 deceased people in Central America, whose age at death ranged from 19 to 49 years. Excellent and good agreement of results were achieved, and there were no statistically significant differences. The R2 value for upper teeth (54.0%) was higher than the R2 value for lower teeth (45.7%). The highest intraclass correlation coefficient value was 0.995 (0.993-0.997) and the lowest 0.798 (0.545-0.895). Inter-examiner agreement was high with values of 0.975 (0.965-0.983) and 0.927 (0.879-0.955). This method is adequate for assessing age in missing and unidentified people, including victims of mass disasters.
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Asymmetries in swimming can be the result of poor technique or coordination between limbs, reducing the ability to produce propulsive force and increasing resistive drag. Therefore, this study aimed to compare the magnitude and determine the consistency of isokinetic peak torque asymmetries between the angular velocities of in the shoulder joint movements of internal and external rotation, flexion, and extension. Twenty-one competitive swimmers performed concentric actions at 60°/s (3 repetitions) and 180°/s (20 repetitions) in the movements of internal and external rotation, flexion, and extension of the shoulders using an isokinetic dynamometer, with the peak torque and asymmetry index being common metrics across the tests. The results showed a greater magnitude of asymmetry in internal rotation (16.86 vs. 9.86; p = 0.007) and flexion (12.06 vs. 7.35; p = 0.008) at 60 vs. 180°/s, respectively. The agreement levels of the direction of asymmetries between angular velocities were fair to substantial (Kappa: 0.40 to 0.69). Evaluating isokinetic torque in different movements and angular velocities resulted in different levels of asymmetry. Muscle force asymmetries can impact propulsion efficiency and movement coordination during swimming. Understanding muscle asymmetries allows the development of targeted and individualised training programmes to correct strength imbalances.
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Point-of-care ultrasound (POCUS) is an important tool for clinical diagnosis and decision-making in critical and non-critical scenarios. Dyspnea, chest pain, and shock are conditions susceptible to evaluation with ultrasound considering diagnostic accuracy and clinical impact already proven. There is scarce evidence in diagnosis agreement using ultrasound as an extension of physical examination. We aimed to evaluate ED patients in whom POCUS was performed, to analyze agreement between clinical initial diagnosis using ultrasound images and final diagnosis. Furthermore, we analyze failed diagnosis, inconclusive POCUS exams, and discuss details. A cross-sectional analytical study was conducted on adults who visited the emergency department with any of these three chief complaints: dyspnea, chest pain, and shock. All were evaluated with ultrasound at admission. Agreement between initial diagnosis using POCUS and final definite diagnosis was calculated. Failed diagnosis and inconclusive exams were analyzed. A total of 209 patients were analyzed. Populations: mostly males, mean age 64 years old, hypertensive. Agreement on patients with dyspnea and suspicion of acute decompensated heart failure was 0.98; agreement on chest pain suspicion of non-ST acute coronary syndrome was 0.96; agreement on type of shock was 0.90. Among the population, 12 patients had an inconclusive POCUS exam, and 16 patients had a failed diagnosis. The use of POCUS in the emergency department shows almost perfect agreement when compared with the final diagnosis in individuals experiencing acutely decompensated heart failure, acute coronary syndrome, and shock. Prospective studies are needed to evaluate the impact of this tool on mortality and prognosis when there are diagnostic errors.
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Síndrome Coronariana Aguda , Insuficiência Cardíaca , Sistemas Automatizados de Assistência Junto ao Leito , Choque , Ultrassonografia , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Transversais , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/diagnóstico , Sistemas Automatizados de Assistência Junto ao Leito/normas , Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/complicações , Ultrassonografia/métodos , Ultrassonografia/estatística & dados numéricos , Idoso , Choque/diagnóstico por imagem , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Dispneia/etiologia , Dor no Peito/etiologiaRESUMO
BACKGROUND: The accurate diagnosis of pelvic floor muscle impairments is essential. The plethora of terms and the lack of evidence to support widely used pelvic floor muscle function (PFMF) measurements hinder diagnostic labels. OBJECTIVE: To structure an examination of PFMF using visual observation and digital palpation and terms consistent with the ICF terminology, and to test its intra and interrater reliability/agreement. METHODS: A panel of 9 physical therapists applied Delphi method to structure the PFMF exam under ICF terminology and to verify its measurements reproducibility. For reliability and agreement, a convenience sample of women aged 51.2 ± 14.7 years had the sensitivity to pressure, pain, muscle tone, involuntary movement reaction, control of voluntary movement (contraction/relaxation), coordination, strength, and endurance examined by two raters, in the same day for interrater (n = 40), and one week apart, for intrarater reliability (n = 25). Percent agreement, linear weighted kappa, intraclass correlation coefficient, and Bland-Altman's limits of agreement were calculated (alpha = 0.05). RESULTS: Four round Delphi discussion structured the PFMF exam, named EFSMAP (Exame das Funções Sensoriais e Motoras do Assoalho Pélvico/Examination of Pelvic Floor Sensory and Motor Functions), set a list of concepts and instructions targeted at reproducibility and established PFMF diagnostic labels. Reliability, except for pain and tone, were moderate to excellent (Kw= 0.67-1.0 and ICC=0.48-0.82). Agreement was substantial for most PFMF features (0.64-1.00), except pain. CONCLUSIONS: The EFSMAP was successfully developed as a valid and reliable exam to be used in research and clinical practice; it provides labels for the diagnosis of pelvic floor muscle impairments. It might be easily adopted worldwide as it uses ICF terminology.
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Diafragma da Pelve , Humanos , Diafragma da Pelve/fisiopatologia , Feminino , Reprodutibilidade dos Testes , Pessoa de Meia-Idade , Técnica DelphiRESUMO
Objetivo: Analizar la concordancia entre docentes de diferentes cátedras de Endodoncia de facultades de odontolo- gía de universidades de la República Argentina en la evalua- ción radiográfica de tratamientos endodónticos realizados ex vivo por alumnos de grado. Materiales y métodos: Se envió a 13 docentes de diferentes cátedras de Endodoncia de facultades de odontolo- gía de universidades públicas y privadas de la República Ar- gentina un email que contenía 54 tratamientos endodónticos realizados por alumnos de grado en dientes ex vivo para su evaluación radiográfica. Para uniformar la muestra, se selec- cionaron la mitad como correctos y la otra mitad incorrectos. Se solicitó a cada docente que determine cada tratamiento como correcto o incorrecto, sin ninguna rúbrica o pauta pre- via. Se obtuvieron 13 respuestas que fueron incluidas en una planilla Excel. La evaluación estadística fue realizada tenien- do en consideración el índice de concordancia expresado por el coeficiente de kappa. Resultados: El valor registrado para el índice kappa fue 0,28, con un intervalo de confianza de (95%) 0,20 - 0,37 (p<0,001). Conclusiones: Puede considerarse que existe un nivel de concordancia aceptable con tendencia a leve entre los par- ticipantes del estudio (AU))
Aim: To analize the agreement between teachers from different departments of Endodontics from dentistry faculties of universities in the Argentine Republic in the radiographic evaluation of endodontic treatments performed ex vivo by un- dergraduate students. Materials and methods: An email containing 54 endo- dontic treatments performed by undergraduate students on ex vivo teeth for radiographic evaluation was sent to 13 profes- sors from different Endodontic departments of dental faculties of public and private universities in the Argentine Republic. To standardize the sample, half were selected as correct and the other half as incorrect. Each teacher was asked to deter- mine each treatment as correct or incorrect, without any prior rubric or guideline. 13 responses were obtained that were in- cluded in an Excel spreadsheet. The statistical evaluation was carried out taking into consideration the concordance index expressed by kappa's coefficient. Results: The value recorded for the kappa index was 0.28, with a confidence interval of (95%) 0.20 - 0.37 (p<0.001). Conclusions: It can be considered that there is an ac- ceptable level of agreement with a tendency towards slight agreement among the study participants (AU)
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Tratamento do Canal Radicular/estatística & dados numéricos , Faculdades de Odontologia/estatística & dados numéricos , Estudantes de Odontologia , Dente não Vital/diagnóstico por imagem , Endodontia/educação , Argentina/epidemiologia , Interpretação Estatística de DadosRESUMO
BACKGROUND: Latin American countries are often limited in the availability of food outlet data. There is a need to use online search engines that allow the identification of food outlets and assess their agreement with field observations. We aimed to assess the agreement in the density of food outlets provided by a web collaborative data (Google) against the density obtained from an administrative registry. We also determined whether the agreement differed by type of food outlet and by area-level socioeconomic deprivation. METHODS: In this cross-sectional study, we analyzed 1,693 census tracts from the municipalities of Hermosillo, Leon, Oaxaca de Juarez, and Tlalpan. The Google service was used to develop a tool for the automatic acquisition of food outlet data. To assess agreement, we compared food outlet densities obtained with Google against those registered in the National Statistical Directory of Economic Units (DENUE). Continuous densities were assessed using Bland-Altman plots and concordance correlation coefficient (CCC), while agreement across tertiles of density was estimated using weighted kappa. RESULTS: The CCC indicated a strong correlation between Google and DENUE in the overall sample (0.75); by food outlet, most of the correlations were from negligible (0.08) to moderate (0.58). The CCC showed a weaker correlation as deprivation increased. Weighted kappa indicated substantial agreement between Google and DENUE across all census tracts (0.64). By type of food outlet, the weighted kappa showed substantial agreement for restaurants (0.69) and specialty food stores (0.68); the agreement was moderate for convenience stores/small food retail stores (0.49) and fair for candy/ice cream stores (0.30). Weighted kappa indicated substantial agreement in low-deprivation areas (0.63); in very high-deprivation areas, the agreement was moderate (0.42). CONCLUSIONS: Google could be useful in assessing fixed food outlet densities as a categorical indicator, especially for some establishments, like specialty food stores and restaurants. The data could also be informative of the availability of fixed food outlets, particularly in less deprived areas.
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Abastecimento de Alimentos , Alimentos , Humanos , Estudos Transversais , México , Meio Ambiente , Restaurantes , Comércio , Características de ResidênciaRESUMO
Introduction: Handheld echocardiography (echo) is the tool of choice for rheumatic heart disease (RHD) screening. We aimed to assess the agreement between screening and standard echo for latent RHD diagnosis in schoolchildren from an endemic setting. Methods: Over 14 months, 3 nonphysicians used handheld machines and the 2012 WHF Criteria to determine RHD prevalence in consented schoolchildren from Brazilian low-income public schools. Studies were interpreted by telemedicine by 3 experts (Brazil, US). RHD-positive children (borderline/definite) and those with congenital heart disease (CHD) were referred for standard echo, acquired and interpreted by a cardiologist. Agreement between screening and standard echo, by WHF subgroups, was assessed. Results: 1390 students were screened in 6 schools, with 110 (7.9%, 95% CI 6.5-9.5) being screen positive (14 ± 2 years, 72% women). Among 16 cases initially diagnosed as definite RHD, 11 (69%) were confirmed, 4 (25%) reclassified to borderline, and 1 to normal. Among 79 cases flagged as borderline RHD, 19 (24%) were confirmed, 50 (63%) reclassified to normal, 8 (10%) reclassified as definite RHD, and 2 had mild CHD. Considering the 4 diagnostic categories, kappa was 0.18. In patients with borderline RHD reclassified to non-RHD, the most frequent WHF criterion was B (isolated mitral regurgitation, 64%), followed by A (2 mitral valve morphological features, 31%). In 1 patient with definite RHD reclassified to normal, the WHF criterion was D (borderline RHD in aortic and mitral valves). After standard echo, RHD prevalence was 3.2% (95% CI 2.3-4.2). Conclusions: Although practical, RHD screening with handheld devices tends to overestimate prevalence.
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PURPOSE: Article-noun disagreement in spoken language is a marker of children with developmental language disorder (DLD). However, the evidence is less clear regarding article comprehension. This study investigates article comprehension in monolingual Spanish-speaking children with and without DLD. METHOD: Eye tracking methodology used in a longitudinal experimental design enabled the examination of real time article comprehension. The children at the time 1 were 40 monolingual Spanish-speaking preschoolers (20 with DLD and 20 with typical language development [TLD]). A year later (time 2), 27 of these children (15 with DLD and 12 with TLD) were evaluated. Children listened to simple phrases while inspecting a four object visual context. The article in the phrase agreed in number and gender with only one of the objects. RESULT: At the time 1, children with DLD did not use articles to identify the correct image, while children with TLD anticipated the correct picture. At the time 2, both groups used the articles' morphological markers, but children with DLD showed a slower and weaker preference for the correct referent compared to their age-matched peers. CONCLUSION: These findings suggest a later emergence, but a similar developmental trajectory, of article comprehension in children with DLD compared to their peers with TLD.
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Compreensão , Transtornos do Desenvolvimento da Linguagem , Criança , Humanos , Tecnologia de Rastreamento Ocular , Transtornos do Desenvolvimento da Linguagem/diagnóstico , Idioma , Desenvolvimento da Linguagem , Testes de LinguagemRESUMO
PURPOSE: Gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) may be related to surgical technique. The fact that there is a lack of technical standardization may explain large differences in GERD incidence. The aim of this study is to evaluate auto- and hetero-agreement for SG technical key points based on recorded videos. METHODS: Ten experienced (minimum of 5 years performing bariatric surgery, minimum of 30 SG per year) bariatric surgeons (9 (90%) males) were selected. Participants were invited to send an unedited video with a typical laparoscopic SG (first round of the Delphi process). Videos were cropped into small clips comprising 11 key points of the technique. All anonymized clips (including their own) were returned to all surgeons. Individuals were asked to agree or not with the technique demonstrated (second round). The percentage of agreement was presented to the entire group that was asked for a second vote (third round). RESULTS: Agreement was poor/fair for all points except hiatal repair that had a very good agreement in the second round. For the third round, there was a slight increase in agreement for distance esophagogastric junction/proximal stapling and gastric mobilization for stapling and a slight decrease in agreement for gastric tube final shape. Only 1 (10%) surgeon recognized that he evaluated his own video. Five (50%) surgeons disagreed with themselves on 1 or more points. CONCLUSION: SG lacks intrasurgeon and intersurgeon agreement in technical key points that may justify significant differences in GERD incidence after the procedure.
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Refluxo Gastroesofágico , Hérnia Hiatal , Laparoscopia , Obesidade Mórbida , Masculino , Humanos , Feminino , Hérnia Hiatal/cirurgia , Obesidade Mórbida/cirurgia , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/cirurgia , Gastrectomia/métodos , Junção Esofagogástrica , Laparoscopia/métodosRESUMO
This article examines the Colombian legislation against statelessness issued due to the humanitarian emergency in Venezuela in recent years. There have been three waves of Venezuelan migration: the first, in 2005; the second, in 2017; and the last wave, from 2017 to the present day. For this analysis, it was used a qualitative socio-legal method adopting a descriptive approach. The paper affirms that, despite the efforts of Colombian entities to regulate the statelessness of minors born to Venezuelan parents, these regulations contain legal vacua due to a lack of communication between the different State bodies. Such void causes legal contradictions and legal uncertainty in the national system, and, subsequently, violates in a direct manner the fundamental rights of children born to Venezuelan migrants in Colombia.
En el presente artículo se analiza la legislación colombiana contra la apatridia expedida a raíz de la migración ocasionada por la emergencia humanitaria en Venezuela durante los últimos años. La migración venezolana se puede dividir en tres oleadas, la primera en el año de 2005, la segunda en el año de 2010 y la última desde el año de 2017 hasta la actualidad. Para la realización del presente artículo, se utilizó el método cualitativo de carácter sociojurídico con un enfoque descriptivo. Finalmente, se concluye que, a pesar del esfuerzo de las entidades colombianas por regular la apatridia de los menores hijos de padres venezolanos, dicha legislación presenta vacíos normativos por la falta de comunicación de los diferentes órganos del Estado. Dichos vacíos crean contradicciones, generan inseguridad jurídica en el ordenamiento nacional y, ulteriormente, violentan de manera directa los derechos fundamentales de los menores hijos de migrantes venezolanos nacidos en Colombia.
Este artigo analisa a legislação colombiana contra a apatridia emitida como resultado da migração causada pela emergência humanitária na Venezuela nos últimos anos. A migração venezuelana pode ser dividida em três ondas, a primeira em 2005, a segunda em 2010 e a última de 2017 até o presente. Para este artigo, usamos um método sociojurídico qualitativo com uma abordagem descritiva. Por fim, conclui-se que, apesar dos esforços das entidades colombianas para regulamentar a apatridia de menores nascidos de pais venezuelanos, essa legislação apresenta lacunas regulatórias devido à falta de comunicação entre os diferentes órgãos do Estado. Essas lacunas criam contradições, geram insegurança jurídica no sistema jurídico nacional e, consequentemente, violam diretamente os direitos fundamentais das crianças nascidas na Colômbia de migrantes venezuelanos.
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PURPOSE: Classifying tibial plateau fractures is paramount in determining treatment regimens and systemizing decision making. The original AO classification described by Müller in 1996 and the Schatzker classification of 1970 are the most cited classifications for tibial plateau fractures, demonstrating substantial to almost perfect agreement. The main problem with these classifications schemes is that they lack the detail required to convey the variety of fracture patterns encountered. In 2018, the AO foundation published a new classification system for proximal tibia fractures, highlighting a more complete and detailed number of categories and subcategories. We sought to independently determine inter and intraobserver agreement of the AO classification system, compared to the previous systems described by Müller and Schatzker. METHODS: One hundred seven consecutive tibial plateau fractures were screened, and a representative data set of 69 was created. Six independent evaluators (three knee surgeons, three senior orthopedic residents) classified the fractures using the original AO, the Schatzker and the new AO classifications. After six weeks, the 69 cases were randomized and reclassified by all evaluators. The Kappa coefficient (k) was calculated for inter- and intraobserver correlation and is expressed with 95% confidence intervals. RESULTS: interobserver agreement was moderate for all three classifications. k = 0.464 (0.383-0.560) for the original AO; k = 0.404 (0.337-0.489) for Schatzker; and k = 0.457 (0.371-0.545) for the base categories of the new AO classification. The inclusion of subcategories and letter modifiers to the new classification worsened agreement to k = 0.358 (0.302-0.423) and k = 0.174 (0.134-0.222), respectively. There were no significant differences between knee surgeons and residents for the new classification. Intra-observer correlation was also moderate for each of the scores: k = 0.630 (0.578-0.682) for the original AO; k = 0.623 (0.569-0.674) for Schatzker; and k = 0.621 (0.566-0.678) for the new AO base categories; without differences between knee surgeons or residents. CONCLUSIONS: This study demonstrated an adequate inter and intra-observer agreement for the new AO tibial plateau fractures classification system for its base categories, but not at the subcategory or letter modifier levels.
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Ortopedia , Fraturas da Tíbia , Fraturas do Planalto Tibial , Humanos , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Fraturas da Tíbia/diagnóstico por imagemRESUMO
BACKGROUND: Patients with hypotension usually receive intravenous fluids, but only 50% will respond to fluid administration. We aimed to assess the intra and interobserver agreement to evaluate fluid tolerance through diverse ultrasonographic methods. METHODS: We prospectively included critically ill patients on mechanical ventilation. One trained intensivist and two intensive care residents obtained the left ventricular outflow tract velocity-time integral (VTI) variability, inferior vena cava (IVC) distensibility index, internal jugular vein (IJV) distensibility index, and each component of the venous excess ultrasound (VExUS) system. We obtained the intraclass correlation coefficient (ICC) and Gwet's first-order agreement coefficient (AC1), as appropriate. RESULTS: We included 32 patients. In-training observers were unable to assess the VTI-variability in two patients. The interobserver agreement was moderate to evaluate the IJV-distensibility index (AC1 0.54, CI 95% 0.29-0.80), fair to evaluate VTI-variability (AC1 0.39, CI 95% 0.12-0.66), and absent to evaluate the IVC-distensibility index (AC1 0.19, CI 95% - 0.07 to 0.44). To classify patients according to their VExUS grade, the intraobserver agreement was good, and the interobserver agreement was moderate (AC1 0.52, CI 95% 0.34-0.69). CONCLUSIONS: Point-of-care ultrasound is frequently used to support decision-making in fluid management. However, we observed that the VTI variability and IVC-distensibility index might require further training of the ultrasound operators to be clinically useful. Our findings suggest that the IJV-distensibility index and the VExUS system have acceptable reproducibility among in-training observers.
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Cuidados Críticos , Sistemas Automatizados de Assistência Junto ao Leito , Humanos , Reprodutibilidade dos Testes , Ultrassonografia/métodos , Veia Cava Inferior/diagnóstico por imagemRESUMO
PURPOSE: This study evaluated the agreement and reproducibility of ACA measurements obtained using the built-in software of the CASIA2 (Version 3G.1) and the measurements derived from expert clinicians. METHODS: Healthy volunteers underwent ophthalmological evaluation and AS-OCT examination. ACA measurements derived from automated and manual SS location were obtained using the CASIA2 automated software and clinician identification, respectively. The intraobserver, interobserver reproducibility, CASIA2-human grader reproducibility and CASIA2 repeatability were assessed using intraclass correlation coefficients (ICCs). RESULTS: The study examined 58 eyes of 30 participants. The CASIA2 software showed excellent repeatability for all ACA parameters (ICC > 0.84). Intraobserver, interobserver, and CASIA2-human grader reproducibility were also excellent (ICC > 0.87). Interobserver agreement was high, except for nasal TISA500, differing between observers 1 and 2 (p < 0.05). The agreement between CASIA2 measurements and human graders was high, except for nasal TISA500, where observer 1 values were smaller (p < 0.05). CONCLUSION: The CASIA2 built-in software reliably measures ACA parameters in healthy individuals, demonstrating high consistency. Although a small difference was observed in nasal TISA500 measurements, interobserver and CASIA2-human grader reproducibility remained excellent. Automated SS detection has the potential to facilitate evaluation and monitoring of primary angle closure disease.
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The North American Free Trade Agreement (NAFTA) was introduced in 1994 between Canada, Mexico, and the United States to encourage trilateral trade. In 2008, an unrestricted reciprocal sugar trade agreement, was implemented between Mexico and the United States as part of NAFTA, which led to a significant decrease in the United States' sugar price. However, critics argue that free trade agreements that reduce trade barriers on products such as sugar threaten public health. This study uses the synthetic control method to investigate the causal impact of the unrestricted sugar trade agreement on sugar consumption and diabetes prevalence in the United States. First, we show that sugar consumption in the United States increased by an average of 16% annually after the agreement was signed, corresponding to 5240g per capita. Second, we show that the crude prevalence of diabetes increased by an average of 1% annually in the United States after the agreement was signed, with an increase of 1% and 2% for men and women, respectively. This unintended consequence of NAFTA has had an estimated economic cost of $324.37 million annually.
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Cooperação Internacional , Saúde Pública , Masculino , Estados Unidos , Feminino , Humanos , México , Açúcares , Açúcares da Dieta , ComércioRESUMO
BACKGROUND: As the gold standard test to quantify insulin resistance (IR) involves intravenous insulin loading and repeated blood glucose monitoring, many indexes have been developed for IR assessment for convenience. OBJECTIVE: The objective of this study was to evaluate the agreement of the Single-Point Insulin Sensitivity Estimator (SPISE) by comparing it with the homeostasis model assessment of insulin resistance (HOMA-IR) in identifying IR. METHOD: Data came from the ongoing LIMACHE BIRTH COHORT. 1,948 individuals (aged 22-28 years) were studied. We performed an agreement plot called a Bangdiwala's Observer Agreement to evaluate patterns in departures from agreement in ordinal categorical variables. RESULTS: According to the Bangdiwala-Weighted statistics, we found that the agreement between both indexes was 0.14; this value would be considered a slight agreement. Thus, we found bias in the marginal distributions, and we noticed that the SPISE has a bias toward the central quintiles of the index. CONCLUSIONS: The identification of IR in young adult individuals by the SPISE index has slight agreement with HOMA-IR. Therefore, caution would be taken when considering SPISE index among young Chilean adults.
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Resistência à Insulina , Humanos , Adulto Jovem , Chile , Automonitorização da Glicemia , Glicemia , InsulinaRESUMO
Background: In 131I therapies internal dosimetry is crucial for determining the mean absorbed dose to organs at risk, particularly the bone marrow, which has a dose constraint of 2 Gy. Traditionally, multicompartmental models have been used for bone marrow dosimetry, necessitating whole-body absorbed-dose assessments. However, noninvasive techniques, such as γ-camera scans or ceiling-mounted Geiger-Müller (GM) counters, can estimate the aforementioned. This study was aimed to evaluate the agreement between whole-body mean absorbed dose using γ-camera scans and ceiling-mounted GM in patients with thyroid carcinoma undergoing 131I therapy. Methods: This study included 31 patients with thyroid cancer who were treated with 131I. The whole-body time-integrated activity (TIA) and mean absorbed dose were estimated using the elimination curves obtained with γ-camera scans and ceiling-mounted GM. In addition, statistical analysis was performed on the data to determine the Coefficient Correlation Coefficient and the Bland-Altman limits of agreement for both parameters, as well as for the elimination curves' effective half-life. Results: The study revealed correlations of 0.562 and 0.586 between whole-body TIA and mean absorbed dose, respectively. The Bland-Altman limits of agreement were found to be below -3.75% and within 12.75% of the bone marrow dose constraint of 2 Gy. The nonparametric evaluation revealed that whole-body TIA and mean absorbed dose medians from GM were lower than those from γ-camera scans (p < 0.001). Effective half-life estimation mean was significantly lower in the GM than in the γ-camera of 13 and 23 h. Conclusions: Although GM calculates the whole-body absorbed dose with margins of error within clinical acceptance, underestimation of the effective half-life makes it an unacceptable substitute method for γ-cameras in clinical practice. Further research should be conducted to evaluate single-point GM measurement substitutions in time-activity curves.
Assuntos
Radiometria , Neoplasias da Glândula Tireoide , Humanos , Radiometria/métodos , Radioisótopos do Iodo/uso terapêutico , Cintilografia , Câmaras gama , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/diagnóstico por imagemRESUMO
BACKGROUND: The laboratory tests most used by blood banks to diagnose anemia are the hemoglobin (Hb) and microhematocrit (Hct) tests, measured from capillary samples. OBJECTIVE: To analyze the two capillary screening methods for pre-donation anemia by comparing their agreement in diagnosing anemia. METHOD: A cross-sectional study in a population of 15,521 blood donation candidates for whom information was available on Hb and Hct, performed from capillary blood samples. Hb was determined using the HemoCue® test and Hct by the centrifugation method. The Kappa coefficient was calculated to assess the agreement between the methods. Pearson's correlation tests and gender-adjusted linear regression were used to assess the change in the response variable (Hb) as a function of the explanatory variable (Hct). RESULTS: The majority of the study population were men (70.4%), aged between 18 and 44 years (72.1%), who declared themselves white or mixed skin color (85.6%), and had undergone at least 11 years of complete education (72.4%). The Kappa coefficient found was 92.7 and 99.2 for women and men, respectively. Pearson's correlation showed a correlation coefficient of 0.98 and the linear regression graph showed an adequate relationship between the tests with R2 = 0.97. CONCLUSIONS: Comparing the Hb and Hct capillary tests, it was found that Hct can be safely used to screen for anemia in pre-blood donation.