Day 2 :
University Medicine Greifswald, Germany
Keynote: Reference values and therapeutic cut-offs - epidemiologists can help reduce confusion of clinicians
Time : 09:30-10:10
Henry Volzke is Professor for Clinical-Epidemiological Research with basic training as Certified Internist. He has been involved in research projects funded by the European Union, the German Research Foundation and numerous other public and private funding bodies and is member of several large national and international research consortia. His broad research interests cover common population-relevant diseases including thyroid and other endocrine disorders, cardiovascular, metabolic and gastrointestinal diseases. In PubMed, he is listed with more than 620 publications in international peer-reviewed journals. He is PI of the Studies of Health in Pomerania and the Northeast German part of the German National Cohort as well as Co-PI of the GANI_MED project and the Greifswald site of the German Centre for Cardiovascular Research. He coordinates the H2020 funded EUthyroid Consortium. He is past President of the German Society for Epidemiology (DGEpi) e.V and the German Representative in the Iodine Global Network
It is a common error in thinking of clinicians to hope that a reference value could help finding the right treatment decision. In general, reference values are nothing else than distribution markers of a clinical test among a healthy reference population, as analysed from cross-sectional studies. The value distribution is highly dependent on factors affecting the population and the selection of the reference population. The question that can be answered by analysing reference intervals is only the question on what is high or low or, more in general, what is usual in a given population. Values outside a reference range indicate that there is a high probability that the patient is not “healthy”, which may require further diagnostic work-up.
Reference values, however, are not sufficient to decide upon treatment initiation. Valid answers to the question on whether high or low values should be treated or not require 1) clinical information on symptoms, co-morbidities and other diagnostic findings and/or 2) longitudinal studies on outcomes related on a given baseline level.
Current epidemiology increasingly comprises large-scale population studies with comprehensive information from medical examinations. These studies offer optimal conditions for reference and cut-off value analyses by 1) results generalizable to the population under investigation, 2) validity in selecting reference populations by not only considering clinical diseases but also subclinical disorders to define health, and 3) high precision by large study populations. Comprehensive statistical methods such as quintile regression allows establishing individual reference values by considering physiological factors influencing test values including, for example, sex, age, body weight and height.
1. Chaker L, Korevaar TIM, Rizopoulos D, Collet TH, Völzke H, Hofman A, Rodondi N, Cappola AR, Peeters RP, Franco OH. Defining optimal health range for thyroid function based on the risk of cardiovascular disease. J Clin Endocrinol Metab 2017; in press
2. Chaker L, Baumgartner C, den Elzen WP, Collet TH, Ikram MA, Blum MR, Dehghan A, Drechsler C, Luben RN, Portegies ML, Iervasi G, Medici M, Stott DJ, Dullaart RP, Ford I, Bremner A, Newman AB, Wanner C, Sgarbi JA, Dörr M, Longstreth WT Jr, Psaty BM, Ferrucci L, Maciel RM, Westendorp RG, Jukema JW, Ceresini G, Imaizumi M, Hofman A, Bakker SJ, Franklyn JA, Khaw KT, Bauer DC, Walsh JP, Razvi S, Gussekloo J, Völzke H, Franco OH, Cappola AR, Rodondi N, Peeters RP; Thyroid Studies Collaboration. Thyroid function within the reference range and the risk of stroke: an individual participant data analysis. J Clin Endocrinol Metab 2016; 101:4270-82.
3. Ittermann T, Khattak RM, Nauck M, Cordova CM, Völzke H. Shift of the TSH reference range with improved iodine supply in Northeast Germany. Eur J Endocrinol 2015; 172(3):261-7.
4. Mensel B, Quadrat A, Schneider T, Kühn JP, Dörr M, Völzke H, Lieb W, Hegenscheid K, Lorbeer R. MRI-based determination of reference values of thoracic aortic wall thickness in a general population. Eur Radiol. 2014;24:2038-44.
5. Völzke H, Schmidt CO, Baumeister SE, Ittermann T, Fung G, Krafczyk-Korth J, Hoffmann W, Schwab M, Meyer zu Schwabedissen HE, Dörr M, Felix SB, Lieb W, Kroemer HK. Personalized cardiovascular medicine: concepts and methodological considerations. Nat Rev Cardiol. 2013 Jun;10(6):308-16.
The College of New Jersey, USA
Statement of the Problem: The way we connect to each other can affect our health status and other health related outcomes. Broadly, social capital refers to the characteristics that emerge from social connections among individuals in a given society that can be used for a common goal. Health related outcomes have been linked to lack in Social Capital such as high mortality rates, poor mental health, low well-being, poor oral health, poor maternal health weak adherence to health promotion policies, and obesity prevention.
Methodology & Theoretical Orientation: This cross-sectional study sought to test the association between social capital, health status, and use of health services, among Brazilian non-institutionalized elderly living in an industrialized area. Sample was composed by 2,052 respondents aged 60 or older, living in Sete Lagoas county in 2012 (Jan-Jul). Social Capital (SC) was measured by The World Bank Integrated Questionnaire (SC-IQ) dichotomized in “low Social Capital” and “high Social Capital”. Use of health services (11 variables), health status, community engagement, familiar functionality, and social demographics were assessed.
Findings: Out of total respondents, 68.6% belonged to the group of low social capital. Lack in social capital was associated to poor health status (69.5%), > medical treatment (70.7%). When controlled, Low SC increased chances to medical appointment within 6 months [OR=1.78; 95%IC=1.22-2.60], decreased chances to be assisted by Public Health Family Program [OR=0.77; 95%IC=0.59-0.99], of community engagement [OR=0.12; 95%IC=0.09-0.15], and good familiar functionality [OR=0.56; 95%IC=0.36-0.86].
Conclusion & Significance: Individual Social Capital affected health status and the pattern that elderly used health service in this population.Recent Publications
1. Carolina M Borges, Silvia Spivakovsky. Adjusted protocol for dental extractions in oncology patients taking anti-resorptive drugs may reduce occurrence of medication-related osteonecrosis of the jaw. Evidence-Based Dentistry 2016, 17:14–15.
2. Ana Cristina V Campos, Carolina M Borges, Andréa Maria D Vargas, Viviane Elisangela Gomes, Simone D Lucas and Efigênia F Ferreira. Measuring social capital through multivariate analyses for the IQ-SC. BMC Research Notes 2015, 8:11.
3. Chalub LL, Borges CM, Ferreira RC, Haddad JP, Ferreira EF, Vargas AM. Association between social determinants of health and functional dentition in 35-year-old to 44-year-old Brazilian adults: a population-based analytical study. Community Dental of Oral Epidemiology 2014, Dec; 42(6):503-16.
4. Borges CM, Campos ACV, Vargas AM, Ferreira EF. Tooth loss profile among adults according to social capital, socioeconomic and demographic characteristics. Ciência & Saúde Coletiva 2014, 19(6):1849-1858.
5. CAMPOS, ANA CRISTINA VIANA; Borges CM; LELES, CLÁUDIO RODRIGUES; LUCAS, SIMONE DUTRA; FERREIRA, EFIGÊNIA F. Social capital and quality of life in adolescent apprentices in Brazil: An exploratory study. Health (Irvine), v. 05, p. 973-980, 2013.
Flores, R. A |National University of Santiago del Estero| Argentina
Keynote: Control and follow up for 7 years and 9 months of patients with arterial hypertension in the Community of the National University of Santiago del Estero, Argentina. Flores, R. A
Time : 10:50-11:30
Roberto Antonio Flores has been Graduated from the National University of Tucuman, Argentina as Medical Doctor, with the specialties including Internal Medicine, Social and Community Medicine. He did diploma in Cardiology from the National University of Tucuman and Medical Clinic National Academy of Medicine Argentina. Later on he obtained his post-graduation from National University of Cuyo with subjects Pharmacology & Biology and then started working at The Nurses School, Faculty of Humanities, Social Sciences and Health, National University of Santiago del Estero, Argentina where he has continued his research. Presently he has been working at the at the Regional Hospital Dr. Ramon Carrillo, Santiago del Estero City.
Introduction: The intention of this work was to obtain complementary information regarding patients suffering from Hypertension, and to observe as the presence of some risk factors for cardiovascular disease, impacts on the tension figures of said hypertensive patients of the Community of the National University Of Santiago del Estero.
Objectives: General: To control and follow up the hypertensive population and investigate the presence of some risk factors for cardiovascular disease.
1. Describe the hypertensive population of the University Community of the National University of Santiago del Estero.
2. Demonstrate how the presence of some risk factors for cardiovascular diseases, such as obesity, sedentary lifestyle, smoking, impact on the tension figures in the hypertensive population of the University Community of the National University of Santiago del Estero.
Development: This is a quantitative, descriptive and cross-sectional study, which began in December 2008, recording blood pressure figures and controlling for risk factors and their modifications in the Primary Care Unit of health. The variables studied were age, sex, obesity, sedentary lifestyle, smoking habits. At the beginning of the study, patients were advised to perform walks of at least 30 minutes daily, to continue with a hyposclic and hypolipid diet.
Outcome: Total visits were 6314.1 times per month during the 7 years and 9 months of the study. There were 6314 controls of blood pressure, and weight, and questioned about smoking and physical activity. Tension figures averaged at the start of the study were 150/90 mm Hg, at the end was 135/80 mm Hg in 40% of hypertensive patients, during the first 5 years, at the end of the study 134/78 mm Hg In 40% of patients.
Depending on the age: 20 - 29: 06, 30-39: 22, 40-49: 07, 50-59: 11, 60-69: 18, 70-79: 01, 80-89: 01, with a total of 66 hypertensive patients, these figures were at the beginning of the study. Sixty patients were terminated, two men and two women retired, two men died.
According to sex: Men: 41, 62.12% of the total population. Women: 25, 37.87% of the total population.
Number of obese: 57, which represents 86.36% of the total sample at the beginning of the study. At the end of 26, they reduced their weight, thanks to the programmed physical activity and the hyposódic and hypolipid diet.
Number of sedentarians: 66, representing 100% of the total sample, at the beginning of the study, at the end of 26 performed scheduled physical activities.
Number of smokers: 18, representing 27.27% of the total sample, at the beginning of the study. They completed 17, 1 died, the 2 who proposed to reduce the amount of cigarettes daily achieved their goal, smoking only 10 of 20 cigarettes a day, and 12 of 40 cigarettes a day.
It was recorded that 01 patient suffers from Cardiometabolic Syndrome. There are 04 patients suffering from type 2 diabetes. One patient suffers from hyperthyroidism. One patient had acute myocardial infarction with posterior stenting and pacemaker placement, 01 suffering from osteoporosis and osteoporosis. Only 40% of hypertensive patients usually follow the treatment.
Conclusions: It was demonstrated that when hypertensive patients perform physical activities and lose weight, it is possible to reduce tension figures.
Smoking is a toxic habit that denotes a great psychic dependence for those who suffer from it, which is why patients were advised of psychological consultations and controls that would help overcome this addiction.