Clustering Patterns of 24-Hour Physical Activity in Children 6-36 Months Old

PURPOSE

To determine 24-hour physical activity (PA) clusters in children 6-36 months of age, factors associated with the clusters, and their agreement across time.

METHOD

A longitudinal study followed 150 infants from South Carolina up to 36 months of age. Measures included 24-hour PA and demographic data. Functional clustering was used to obtain the clusters. The association between cluster membership and infant/parent characteristics was examined by Kruskal-Wallis and chi-squared tests. Concordance was measured with the kappa coefficient and percent agreement.

RESULTS

At each follow-up, 3 clusters were optimal, identified as late activity (cluster 1), high activity (cluster 2), and medium activity (cluster 3). The defining feature of the late activity cluster was that their physical activity (PA) activity was shifted to later in the day versus children in clusters 2 and 3. At 6 months, the clusters were associated with race (<0.001), crawling (0.043), other children in the household (0.043), and mother's education (0.004); at 12 months with race (0.029), childcare (<0.001), and education (<0.001); and at 36 months with other children in the household (0.019). Clusters showed moderate agreement (kappa = .41 [.25 to .57], agreement = 61% [49% to 72%]) between 6 and 12 months and, at 36 months, showed no agreement with either 6 or 12 months.

CONCLUSION

Twenty-four-hour PA can be clustered into medium, high, and late PA. Further research is needed into the consequences of late sleeping in children at this age. Clusters are associated with household and childcare factors, and cluster membership is dynamic across time.

Brief counseling for smoking cessation and alcohol use reduction concomitant with hospital procedures: a randomized clinical trial

OBJECTIVE

To evaluate the effect of brief counseling on patient readiness for behavioral change and cessation/reduction of tobacco and alcohol use.

METHODS

This clinical trial randomized patients in blocks, stratified by risk factor. Adult smokers or at-risk drinkers undergoing surgical or diagnostic procedures were recruited. Outcome assessments and analyses were blinded. Brief counseling was compared with educational materials for the outcomes progress in stage of change and smoking/alcohol cessation/reduction.

RESULTS

Overall, 222 participants were randomly assigned to the intervention group and 218 to the control group. Among them, 28 and 18 patients were lost to follow-up, respectively. Progress in change stage was 94.1% at 1 month in both groups (RR = 1.00; 95%CI 0.95-1.05) and 94.8 vs. 90.5% at 3 months (RR = 1.05; 95%CI 0.99-1.11) in the intervention and control groups, respectively. Smoking cessation and alcohol reduction rates at 3 months were 57.2 vs. 41% (RR = 1.40; 95%CI 1.14-1.71) in the intervention and control groups, respectively. Only brief counseling led to significant differences in smoking cessation (51.4 vs. 35.1%; RR = 1.46; 95%CI 1.12-1.92).

CONCLUSIONS

Brief counseling and educational materials improved patient motivation for behavioral change, but brief counseling had a greater effect on smoking cessation.

Factores asociados a la intención de disminuir el consumo de alcohol en personas con consumo riesgoso en un hospital universitario de Bogotá, Colombia

Introducción. Las intervenciones para reducir el consumo riesgoso de alcohol son una prioridad en todos los escenarios clínicos, incluido el hospitalario. Objetivos. Describir las características sociodemográficas, familiares y clínicas en personas con consumo riesgoso de alcohol atendidas en un hospital universitario y evaluar la asociación entre estos factores y la intención de disminuir el consumo, medida según la etapa de cambio comportamental y denominada en este estudio como “intención de cambio”. Materiales y métodos. Estudio descriptivo transversal realizado en 176 pacientes entre 19 y 64 años con consumo riesgoso de alcohol (según puntaje AUDIT) atendidos o valorados entre abril de 2018 y marzo de 2020 en un hospital de cuarto nivel de Bogotá D.C., Colombia. Se realizó un análisis bivariado (Chi-cuadrado) y uno multivariado (regresión logística ordinal) para evaluar las asociaciones entre las variables independientes (características sociodemográficas, familiares, clínicas y relacionadas con el consumo de alcohol) y la intención de cambio. Se calcularon Odds Ratio ajustados (ORa) y se consideró un nivel de significancia de p<0.05 Resultados. La prevalencia de consumo riesgoso de alcohol fue de 4.88% (IC95%: 4.17-5.58) (176/3609). La mayoría de participantes eran hombres (82.95%) con más de 30 años (71.02%) y estaban en la etapa “preparación” de cambio comportamental (63.63%). En el análisis multivariado, ser mayor de 30 años se asoció con mayor intención de cambio (31-45 años: OR=3.68, IC95%:1.56-9.06; 46-64 años: OR=2.63; IC95%: 1.20–5.86) y, por el contrario, ser de un estrato socioeconómico alto se asoció con una menor intención (OR=0.06; IC95%: 0.01-0.50). Conclusiones. Se observó una mayor intención de disminuir el consumo de alcohol en los participantes mayores de 30 años, aquellos con mayor percepción de los beneficios de dicha disminución, aquellos con mayor percepción de autoeficacia, y en los pacientes con intentos previos de disminución; en contraposición, el estrato socioeconómico alto se asoció con menor intención de cambio.

High-risk human papillomavirus infection among women living with HIV in Latin America and the Caribbean: A systematic review and meta-analysis

We carried out a systematic review to summarize available data regarding prevalence of high-risk human papillomavirus (HR-HPV) among women living with HIV (WLHIV) in Latin America and the Caribbean (LAC). A literature search in PubMed and LILACS was conducted and supplemented with cross-referencing and grey literature. The primary outcome was prevalence of HR-HPV by age as a major determinant of HPV infection. Pooled prevalence and weighted averages were obtained. A random effects meta-analysis conducted for HPV- and HIV-associated factors. In total, 6157 women from 19 cross-sectional studies were included. Weighted prevalence of HR-HPV in WLHIV was 51.0% (95% CI 42.8-59.1, I2 = 97.4%) with a bimodal trend by age. No association between antiretroviral therapy and HR-HPV prevalence was observed, but low CD4 cell count was associated (PR 1.64, 95% CI 1.07-2.52). Although not significant, a higher HR-HPV prevalence was observed with Hybrid Capture 2 versus PCR. The high prevalence of HR-HPV among WLHIV in LAC underlines the need for improved cervical cancer prevention and early detection in this vulnerable population. Moreover, the high prevalence across age groups, and particularly in young women, deserves careful consideration for defining target populations of HPV-based screening and HPV immunization programs.

Accuracy of combined molecular and morphology-based triage for HPV-positive women in routine cervical cancer screening services from Colombia

WHO cervical cancer elimination goals comprise 70% of highly-sensitive screening coverage and 90% treatment of precancerous lesions. Triage for HPV-positive women may challenge sensitivity of screening algorithms and women's follow-up, particularly in low- and middle-income countries (LMIC) where screening quality and protocol adherence are frequently deficient. We aimed to determine the accuracy of triage for HPV positive women in routine screening services from Colombia by a prospective cross-sectional study. Consecutively, HPV DNA-positive women underwent six triage strategies (conventional cytology, two methods of visual inspection, HPV16/18/45-genotyping, telomerase, and HPV mRNA). Positive triage results underwent regular colposcopy/biopsy in public hospitals. Adjusted sensitivity, specificity, and predictive values for CIN2+/CIN3+ were estimated for stand-alone and combined tests. We explored the impact of triage strategies on referral rates and the complete screening algorithm (screening plus triage). Overall 16,242 women underwent HPV screening and 1789 (11.0%) were HPV-positive. In total, 20.1% of women were lost to follow-up. mRNA showed the highest positivity rate (0.64 among HPV-positive and 0.05 among the total screened cohort), the highest sensitivity (0.94 95%CI 0.75-0.96), and the lowest specificity (0.36 95%CI 0.29-0.43). Parallel testing with HPV-mRNA revealed the highest increase in sensitivity for all triage strategies. Accuracy of cytology and visual inspection differ between screening units but parallel testing with HPV16/18/45 genotyping significantly increased their sensitivity (over 0.80). Morphology-based triage for HPV-positive women remains a suitable alternative for routine practice in LMIC if combined with HPV16/18/45-genotyping; however, point-of-care triage would be preferable to reduce losses to follow-up. HPV-mRNA triage deserves cost-benefit analyses.

Cardiovascular Risk Prediction Models in People Living with HIV in Colombia

BACKGROUND

People living with HIV are at increased risk of cardiovascular disease. Cardiovascular risk (CVR) prediction scores are powerful tools for individualized assessment that inform decision-making about follow-up frequency, hypolipemiant treatment intensification, and choice antiretroviral therapy.

OBJECTIVES

The objectives of the study were to evaluate the performance of multiple cardiovascular assessment scores in predicting major adverse cardiovascular events (MACE) at 5 and 10 years. Framingham (2004, 2008, and Colombia-adjusted), SCORE, PROCAM, ASCVD, and D:A:D scores were included in the analysis.

METHODS

Data were obtained from a medical registry of adults living with HIV attended by a teaching hospital in Colombia. All patients with complete information necessary for risk score calculations and determination of MACE at 5 and 10 years were included in the study. Receiver operating characteristic curves (ROC) were generated using calculations with all the aforementioned models for every individual. Differences between curves were compared with De- Long's test.

RESULTS

A total of 808 patients were included in the analysis. Mean age was 35 years, and 12% were female. The majority of subjects had low and very low CVR. Eight MACE occurred during follow-up. Area under ROC curves were: Framingham (0.90), Framingham ATP3 (0.92), Framingham calibrated for Colombia (0.90), SCORE (0.92), PROCAM (0.92), ASCVD (0.89), and D:A:D (0.92), with no statistically significant differences.

CONCLUSIONS

The evaluated scores had an acceptable performance for HIV-infected patients in the studied cohort, especially for those in low and very low risk categories.

Características sociodemográficas, familiares y clínicas asociadas con la intención de cesación del tabaquismo en fumadores atendidos en un hospital de cuarto nivel

Introducción. Las intervenciones dirigidas a la cesación del tabaquismo son una prioridad en los escenarios de atención médica, incluido el hospitalario. Objetivo. Describir las características sociodemográficas, familiares y clínicas de fumadores atendidos en un hospital de cuarto nivel y establecer las variables asociadas con la intención de cesación del tabaquismo con el fin de optimizar el manejo del tabaquismo en el entorno hospitalario. Materiales y métodos. Estudio transversal realizado en 321 fumadores activos atendidos entre abril de 2018 y noviembre de 2019 en Bogotá D.C., Colombia. Se calculó la prevalencia de tabaquismo y se obtuvo información sociodemográfica, familiar y clínica, la cual fue analizada mediante estadística descriptiva. Se establecieron asociaciones entre dichas variables y la intención de cesación mediante un análisis bivariado (prueba χ²) y uno multivariado (modelo de regresión logística ordinal con sus correspondientes intervalos de confianza al 95%). Resultados. La prevalencia de tabaquismo activo fue de 8.89% (IC95%: 7.97-9.82), (N=3609; n=321 fumadores activos). La mayoría fueron hombres (66.67%), de estrato socioeconómico bajo o medio (96.89%), con nivel educativo básico (52.34%) y el 42.06% estaban entre los 46 y 64 años. La mayoría de los fumadores activos tenían un grado leve de tabaquismo y un bajo nivel de dependencia a la nicotina (78.82% y 81.62%, respectivamente); además, el 78.82% reportó intentos previos de cesación. El tipo de familia predominante fue la nuclear (58.57%) y 40.19% de los fumadores experimentaban algún grado de disfuncionalidad familiar. Los fumadores con mayor percepción de beneficios derivados de dejar de fumar y con alta autoeficacia tienen una mayor probabilidad de realizar un intento de cesación de tabaquismo (OR=9.44; IC95%:1.27–85.03 y OR=3.73; IC95%: 1.55–8.78, respectivamente). Conclusiones. La identificación y caracterización de fumadores en el entorno hospitalario brinda claves para personalizar las intervenciones de cesación del tabaquismo.

Complete study for erectile dysfunction (CompED) improving diagnosis and treatment decision-making

Erectile dysfunction is a condition associated with increasing age. Patient evaluation and management should follow a comprehensive, stepwise approach. The aim of this article was to report our experience with the complete study for erectile dysfunction, including intracavernous injection rigidity test, biothesiometry and colour duplex Doppler ultrasound. Data were collected and analysed prospectively. The primary end point was to determine whether treatment decision-making was eased by the CompED test. Secondary end points were to establish which clinical variables prior to the study could impact the results of the CompED test, to finally improve patient selection for the study. 187 patients were recruited, 31.2% of the patients had an axial rigidity below 50%, 28.5% had a peak systolic velocity <25 cm/s, 13.2% had an end-diastolic velocity >5cm/s and 27.5% had an abnormal biothesiometry. The factors that best predicted an abnormal result in any of the tests were age >70 years, IIEF domain A < 14 points, and previous radical prostatectomy or radiotherapy. The CompED test stands as a new alternative for the evaluation of patients with erectile dysfunction, being less time consuming, aiding in a more accurate determination of the aetiology and guiding treatment decision-making.