Multiple cardiovascular risk factors in adolescents from a middle-income country: Prevalence and associated factors

Venous thromboembolism (VTE) is a recognized complication of hospital stay in young patients in many developed countries, but such an information is largely unavailable from a low middle-income country (LMIC). This study aimed at identifying the frequency, risk factors, treatment options and outcome of deep venous thrombosis/pulmonary embolism (DVT/PE) in pediatric population in a tertiary care center from a LMIC. International classification of disease, ninth revision (ICD-9) was used to identify VTE in patients aged 0-18 years during January 2011 to September 2019. In-house computerized system was used to collect data for demographics, clinical and laboratory details. SPSS version 19 was used to analyzed data. The study was approved by Institutional ethical review committee (3872-Pat-ERC-15). During the study period, 134617 pediatric patients were hospitalized, DVT/PE was observed in 77 unique patients (47 males and 30 females) with a median (IQR) age of 14 (5-16) years equivalent to 5.9 VTE events /10,000 hospital admissions. Malignancy, community acquired infections and autoimmune diseases were the predominant risk factors (75%) in adolescent age-group while surgery for congenital heart anomalies was the primary reason (71%) in infants. Overall, lower extremity thrombosis was the most frequent (51%) followed by pulmonary embolism (25%). and upper extremity thrombosis (24%). Enoxaparin and unfractionated heparin were mainly used to treat VTE and all-cause mortality was 13% in the cohort studied. We observed substantial VTE events in pediatric patients during their hospital stay in a tertiary care center of a low-middle income country.

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The impact of a private sector living wage intervention on consumption and cardiovascular disease risk factors in a middle income country

BMC Public Health ◽

10.1186/s12889-018-5052-2 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 3

Author(s):

David H. Rehkopf ◽

Katharine Burmaster ◽

John C. Landefeld ◽

Sarah Adler-Milstein ◽

Emily P. Flynn ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Private Sector ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Middle Income Country ◽

Income Country ◽

Living Wage ◽

Middle Income ◽

The Impact

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Development and Evaluation of a Mobile Decision Support System for Hypertension Management in the Primary Care Setting in Brazil: Mixed-Methods Field Study on Usability, Feasibility, and Utility (Preprint)

10.2196/preprints.9869 ◽

2018 ◽

Author(s):

Daniel Vitório Silveira ◽

Milena Soriano Marcolino ◽

Elaine Leandro Machado ◽

Camila Gonçalves Ferreira ◽

Maria Beatriz Moreira Alkmim ◽

...

Keyword(s):

Primary Care ◽

Decision Support ◽

Cardiovascular Risk ◽

Care Setting ◽

Primary Care Setting ◽

Middle Income Country ◽

Income Country ◽

Daily Routine ◽

Evidence Based ◽

Middle Income

BACKGROUND Despite being an important cardiovascular risk factor, hypertension has low control levels worldwide. Computerized clinical decision support systems (CDSSs) might be effective in reducing blood pressure with a potential impact in reducing cardiovascular risk. OBJECTIVE The goal of the research was to evaluate the feasibility, usability, and utility of a CDSS, TeleHAS (tele–hipertensão arterial sistêmica, or arterial hypertension system), in the care of patients with hypertension in the context of a primary care setting in a middle-income country. METHODS The TeleHAS app consists of a platform integrating clinical and laboratory data on a particular patient, from which it performs cardiovascular risk calculation and provides evidence-based recommendations derived from Brazilian and international guidelines for the management of hypertension and cardiovascular risk. Ten family physicians from different primary care units in the city of Montes Claros, Brazil, were randomly selected to use the CDSS for the care of hypertensive patients for 6 months. After 3 and 6 months, the feasibility, usability, and utility of the CDSS in the routine care of the health team was evaluated through a standardized questionnaire and semistructured interviews. RESULTS Throughout the study, clinicians registered 535 patients with hypertension, at an average of 1.24 consultations per patient. Women accounted for 80% (8/10) of participant doctors, median age was 31.5 years (interquartile range 27 to 59 years). As for feasibility, 100% of medical users claimed it was possible to use the app in the primary care setting, and for 80% (8/10) of them it was easy to incorporate its use into the daily routine and home visits. Nevertheless, 70% (7/10) of physicians claimed that the time taken to fill out the CDSS causes significant delays in service. Clinicians evaluated TeleHAS as good (8/10, 80% of users), with easy completion and friendly interface (10/10, 100%) and the potential to improve patients’ treatment (10/10, 100%). A total of 90% (9/10) of physicians had access to new knowledge about cardiovascular risk and hypertension through the app recommendations and found it useful to promote prevention and optimize treatment. CONCLUSIONS In this study, a CDSS developed to assist the management of patients with hypertension was feasible in the context of a primary health care setting in a middle-income country, with good user satisfaction and the potential to improve adherence to evidence-based practices.

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Factores de riesgo cardiovascular y evolución de pacientes con COVID-19 atendidos en un Hospital Nacional de Referencia de Lima, P

Revista Peruana de Investigación en Salud ◽

10.35839/repis.5.3.1071 ◽

2021 ◽

Vol 5 (3) ◽

pp. 195-200

Author(s):

Germán V. Valenzuela-Rodríguez ◽

Alfonso J. Rodriguez-Morales ◽

Roxana Mamani-Quiroz ◽

Ricardo Ayala-García ◽

Katherine Pérez ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Multivariate Analysis ◽

Cardiovascular Risk ◽

Arterial Hypertension ◽

Cardiovascular Risk Factors ◽

Associated Factors ◽

Myocardial Injury ◽

Bivariate Analysis ◽

Clinical Records

Introduction: Coronavirus disease 2019 (COVID-19) fatal outcomes have been associated with multiple cardiovascular risk factors. In new epidemic areas, such as Latin America, there is a lack of studies about this. Objectives: To evaluate demographic data, signs and symptoms during emergency arrival, prevalence of cardiovascular risk factors, laboratory and ECG findings and their influence in mortality, in a retrospective cohort of patients in a national reference hospital of Lima, Peru. Methods: Review the clinical records of the patients attended at Hospital Rebagliati Hospital during March 6th and April 30th, 2020, using rRT-PCR was used for the detection of the RNA of SARS-CoV-2 following the protocol Charité, Berlin, Germany, from nasopharyngeal swabs at the National Institute of Health. Bivariate analysis and multivariate analysis using logistic regression was done. Values of p < 0.05 were considered significant for all analyses. Results: One hundred six hospitalized patients were evaluated. The mean age of patients was 61.58 years (SD 16.81). Cardiovascular risk factors among them were hypertension (46.2%), diabetes (28.3%), and obesity (28.3%), among others. Fifty-six patients died (52.8%). Mortality associated factors at the multivariate analysis were arterial hypertension (OR=1.343, 95% 1.089-1.667), myocardial injury (OR=1.303, 95% 1.031-1.642), and mechanical ventilation (OR 1.262, 95% 1.034-1.665), as associated factors. Conclusion: Cardiovascular risk factors and cardiovascular signs or symptoms are common during emergency arrival in patients with COVID-19. Arterial hypertension, myocardial injury and mechanical ventilation were associated with mortality in multivariate analysis, as observed in other regions of the world.

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