Título del artículo:

Etiology of acute gastroenteritis among children less than 5 years of age in bucaramanga, colombia: A case-control study

Background Acute gastroenteritis (AGE) is a major cause of morbidity and mortality in children aged less than 5 years in low-and middle-income countries where limited access to potable water, poor sanitation, deficient hygiene, and food product contamination are prevalent. Research on the changing etiology of AGE and associated risk factors in Latin America, including Colombia, is essential to understand the epidemiology of these infections. The primary objectives of this study were to describe etiology of moderate to severe AGE in children less than 5 years of age from Bucaramanga, Colombia, a middle-income country in Latin Ameri-can, and to identify the presence of emerging E. coli pathotypes. Methodology/Principal findings This was a prospective, matched for age, case-control study to assess the etiology of moderate to severe AGE in children less than 5 years of age in Bucaramanga, Colombia, South America. We tested for 24 pathogens using locally available diagnostic testing, including stool culture, polymerase chain reaction, microscopy and enzyme-linked immunoassay. Adjusted attributable fractions were calculated to assess the association between AGE and each pathogen in this study population. The study included 861 participants, 431 cases and 430 controls. Enteric pathogens were detected in 71% of cases and in 54% of controls (p = <0.001). Co-infection was identified in 28% of cases and in 14% of controls (p = <0.001). The adjusted attributable fraction showed that Norovirus GII explained 14% (95% CI: 10–18%) of AGE, followed by rotavirus 9.3% (6.4–12%), adenovirus 3% (1–4%), astrovirus 2.9% (0.6–5%), enterotoxigenic Escherichia coli (ETEC) 2.4% (0.4–4%), Cryptosporidium sp. 2% (0.5–4%), Campylobacter sp. 2% (0.2–4%), and Salmonella sp.1.9% (0.3 to 3.5%). Except for Cryptosporidium, all parasite infections were not associated with AGE. Three emergent diarrheagenic E. coli pathotypes were identified in cases (0.7%), including an enteroaggre-gative/enterotoxigenic E.coli (EAEC/ETEC), an enteroaggregative/enteropathogenic E.coli (EAEC/EPEC), and an emergent enteroinvasive E. coli with a rare O96:H19. No deaths were reported among cases or controls. Conclusions/Significance Norovirus and rotavirus explained the major proportion of moderate to severe AGE in this study. Higher proportion of infection in cases, in the form of single infections or co-infections, showed association with AGE. Three novel E. coli pathotypes were identified among cases in this geographic region.

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PLoS Neglected Tropical Diseases

Título del artículo:

Follicular dynamics and hormonal in Creole cows of the race Blanco Orejinegro

The objective was to characterize the follicular dynamics and the measurement of estradiol during the estrous cycle of cows of the Blanco Orejinegro creole. They were selected 10 cows of the Blanco Orejinegro creole and subjected to estrus synchronization pro-tocol with the implementation of an intravaginal device more 2 mg Progesterone estradiol benzoate via I.M. Eight days later, the device of progesterone was removed and applied 150 µg of cloprostenol. 24 hours later, was administered 1 mg estradiol benzoate. After ovulation, ultrasounds were performed at intervals of 24 hours, throughout the estrous cycle. The length of the estrous cycle was 21 ±0,4 days, the dominant follicle diameter was 7,0± 0,2 mm and 6.7 ± 0,3 mm for the second largest follicle, diameter of the ovulatory follicle 14,3 ± 0,5, growth rate of the dominant follicle during the last 96 hours prior to ovulation was 1,05 ± 0,4 mm per day. In conclusion, the follicular dynamics and hormonal creole cows of the race Blanco Orejinegro (Bos taurus adapted) presented patterns similar to those observed in the races Bos taurus (not adapted) and Bos indicus.

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Taurus

Título del artículo:

Associations of outdoor fine particulate air pollution and cardiovascular disease in 157 436 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study

Background: Most studies of long-term exposure to outdoor fine particulate matter (PM2·5) and cardiovascular disease are from high-income countries with relatively low PM2·5 concentrations. It is unclear whether risks are similar in low-income and middle-income countries (LMICs) and how outdoor PM2·5 contributes to the global burden of cardiovascular disease. In our analysis of the Prospective Urban and Rural Epidemiology (PURE) study, we aimed to investigate the association between long-term exposure to PM2·5 concentrations and cardiovascular disease in a large cohort of adults from 21 high-income, middle-income, and low-income countries. Methods: In this multinational, prospective cohort study, we studied 157 436 adults aged 35–70 years who were enrolled in the PURE study in countries with ambient PM2·5 estimates, for whom follow-up data were available. Cox proportional hazard frailty models were used to estimate the associations between long-term mean community outdoor PM2·5 concentrations and cardiovascular disease events (fatal and non-fatal), cardiovascular disease mortality, and other non-accidental mortality. Findings: Between Jan 1, 2003, and July 14, 2018, 157 436 adults from 747 communities in 21 high-income, middle-income, and low-income countries were enrolled and followed up, of whom 140 020 participants resided in LMICs. During a median follow-up period of 9·3 years (IQR 7·8–10·8; corresponding to 1·4 million person-years), we documented 9996 non-accidental deaths, of which 3219 were attributed to cardiovascular disease. 9152 (5·8%) of 157 436 participants had cardiovascular disease events (fatal and non-fatal incident cardiovascular disease), including 4083 myocardial infarctions and 4139 strokes. Mean 3-year PM2·5 at cohort baseline was 47·5 μg/m3 (range 6–140). In models adjusted for individual, household, and geographical factors, a 10 μg/m3 increase in PM2·5 was associated with increased risk for cardiovascular disease events (hazard ratio 1·05 [95% CI 1·03–1·07]), myocardial infarction (1·03 [1·00–1·05]), stroke (1·07 [1·04–1·10]), and cardiovascular disease mortality (1·03 [1·00–1·05]). Results were similar for LMICs and communities with high PM2·5 concentrations (>35 μg/m3). The population attributable fraction for PM2·5 in the PURE cohort was 13·9% (95% CI 8·8–18·6) for cardiovascular disease events, 8·4% (0·0–15·4) for myocardial infarction, 19·6% (13·0–25·8) for stroke, and 8·3% (0·0–15·2) for cardiovascular disease mortality. We identified no consistent associations between PM2·5 and risk for non-cardiovascular disease deaths. Interpretation: Long-term outdoor PM2·5 concentrations were associated with increased risks of cardiovascular disease in adults aged 35–70 years. Air pollution is an important global risk factor for cardiovascular disease and a need exists to reduce air pollution concentrations, especially in LMICs, where air pollution levels are highest. Funding: Full funding sources are listed at the end of the paper (see Acknowledgments).

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The Lancet Planetary Health

Título del artículo:

May measurement month 2017: Latin America

OBJECTIVES: To raise awareness of blood pressure, measured by number of countries involved, number of people screened, and number of people who have untreated or inadequately treated hypertension. METHODS: An opportunistic cross-sectional survey of volunteers aged at least 18 years was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard May measurement month protocol. Eighteen countries in Latin America and the Caribbean participated in the campaign, providing us with a wide sample for characterization. RESULTS: During May measurement month 2017 in Latin America and the Caribbean, 105 246 individuals were screened. Participants who had cardiovascular disease, 2245 (2.3%) had a prior myocardial infarction, and 1711 (1.6%) a previous stroke, additionally 6760 (6.4%) individuals were diabetic, 7014 (6.7%) current smokers and 9262 (8.8%) reported alcohol intake once or more per week. Mean SBP was 122.7 mmHg and DBP was 75.6 mmHg. After imputation, 42 328 participants (40,4%) were found to be hypertensive. CONCLUSION: The high numbers of participants detected with hypertension and the relatively large proportion of participants on antihypertensive treatment but with uncontrolled hypertension reinforces the importance of this annual event in our continent, to raise awareness of the prevention of cardiovascular events.

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Journal of hypertension

Título del artículo:

Identification of potential natural neuroprotective molecules for Parkinson\'s disease by using chemoinformatics and molecular docking

Parkinson\'s disease is a progressive nervous system disorder characterized by motor, cognitive, sensory, psychiatric, and autonomic disturbances. While there is currently no cure for Parkinson\'s Disease, medication can offer relief from its symptoms for many years. Although these medications are considered safe, they can present acute or chronic side effects and can become less effective over time. Thus, new medications are highly needed. In this regard, α-synuclein is a protein of great interest to Parkinson\'s researchers because it is a major constituent of Lewy bodies, which are protein clumps being the pathological hallmark of Parkinson\'s disease. However, current medications are not focused on the inhibition of α-synuclein oligomerization, and therefore, therapeutics preventing the formation of these bodies through the inhibition of α-synuclein oligomerization may play a role in the fight against this and other synucleinopathies. In this study, we used chemoinformatics tools and molecular docking simulations to analyze molecules that have been experimentally tested and bound to α-synuclein, causing neuroprotective or neurotoxic activity, and whose results have been used to select potential natural neuroprotective molecules. We identified 6 potential natural neuroprotective molecules that are similar in their chemical structure to neuroprotective molecules and have a high number of hydrogen bonds with α-synuclein. We expect that these molecules may lead to the design or discovery of new effective treatments for Parkinson\'s disease.

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Journal of Molecular Graphics and Modelling

Título del artículo:

Association of dairy consumption with metabolic syndrome, hypertension and diabetes in 147 812 individuals from 21 countries

Objective Our aims were to assess the association of dairy intake with prevalence of metabolic syndrome (MetS) (cross-sectionally) and with incident hypertension and incident diabetes (prospectively) in a large multinational cohort study. Methods The Prospective Urban Rural Epidemiology (PURE) study is a prospective epidemiological study of individuals aged 35 and 70 years from 21 countries on five continents, with a median follow-up of 9.1 years. In the cross-sectional analyses, we assessed the association of dairy intake with prevalent MetS and its components among individuals with information on the five MetS components (n=112 922). For the prospective analyses, we examined the association of dairy with incident hypertension (in 57 547 individuals free of hypertension) and diabetes (in 131 481 individuals free of diabetes). Results In cross-sectional analysis, higher intake of total dairy (at least two servings/day compared with zero intake; OR 0.76, 95% CI 0.71 to 0.80, p-trend<0.0001) was associated with a lower prevalence of MetS after multivariable adjustment. Higher intakes of whole fat dairy consumed alone (OR 0.72, 95% CI 0.66 to 0.78, p-trend<0.0001), or consumed jointly with low fat dairy (OR 0.89, 95% CI 0.80 to 0.98, p-trend=0.0005), were associated with a lower MetS prevalence. Low fat dairy consumed alone was not associated with MetS (OR 1.03, 95% CI 0.77 to 1.38, p-trend=0.13). In prospective analysis, 13 640 people with incident hypertension and 5351 people with incident diabetes were recorded. Higher intake of total dairy (at least two servings/day vs zero serving/day) was associated with a lower incidence of hypertension (HR 0.89, 95% CI 0.82 to 0.97, p-trend=0.02) and diabetes (HR 0.88, 95% CI 0.76 to 1.02, p-trend=0.01). Directionally similar associations were found for whole fat dairy versus each outcome. Conclusions Higher intake of whole fat (but not low fat) dairy was associated with a lower prevalence of MetS and most of its component factors, and with a lower incidence of hypertension and diabetes. Our findings should be evaluated in large randomized trials of the effects of whole fat dairy on the risks of MetS, hypertension, and diabetes.

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BMJ Open Diabetes Research and Care

Título del artículo:

Residual biomass-based hydrogen production: Potential and possible uses in Ecuador

The residual biomass sources available in Ecuador are evaluated as prime matter for hydrogen (H2) production when considering that it sourced in agriculture, animal husbandry and forestry-related activities. The analysis is performed out of the official cropping information available per provinces. H2 production methods to be assayed consider thermochemical, biochemical and electrochemical paths. The total H2 production potential is 1,600,000 ton H2/year and its use as energy vector would contribute with 38% of the national energy demand in 2017. In addition, its potential application as input in fat hydrogenation and nitrogenated products, in a country-wide scale, would be completely fulfilled. This finding demonstrates that residual biomass-based H2 could become a suitable source of this vector for energy and chemical uses in Ecuador, since it proposes novel approaches for diversifying the secondary energy sources, petrochemical and chemical industry inputs with the purpose of promoting the incorporation of the country to the Hydrogen Economy.

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International Journal of Hydrogen Energy

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Mechanisms of hamstring strain injury: Interactions between fatigue, muscle activation and function

Isolated injury to the long head of biceps femoris is the most common type of acute hamstring strain injury (HSI). However, the precise hamstring injury mechanism (i.e., sprint-type) is still not well understood, and research is inconclusive as to which phase in the running cycle HSI risk is the greatest. Since detailed information relating to hamstring muscle function during sprint running cannot be obtained in vivo in humans, the findings of studies investigating HSI mechanisms are based on modeling that requires assumptions to be made based on extrapolations from anatomical and biomechanical investigations. As it is extremely difficult to account for all aspects of muscle-tendon tissues that influence function during high-intensity running actions, much of this complexity is not included in these models. Furthermore, the majority of analyses do not consider the influence of prior activity or muscular fatigue on kinematics, kinetics and muscle activation during sprinting. Yet, it has been shown that fatigue can lead to alterations in neuromuscular coordination patterns that could potentially increase injury risk. The present critical review will evaluate the current evidence on hamstring injury mechanism(s) during high-intensity running and discuss the interactions between fatigue and hamstring muscle activation and function.

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Sports

Título del artículo:

Effect of el niño southern oscillation cycle on the potential distribution of cutaneous leishmaniasis vector species in colombia

Local anomalies in rainfall and temperature induced by El Niño and La Niña episodes could change the structure of the vector community. We aimed to estimate the effect of the El Niño–La Niña cycle in the potential distribution of cutaneous leishmaniasis (CL) vector species in Colombia and to compare the richness of the vectors with the occurrence of CL in the state of Norte de Santander. The potential distributions of four species were modeled using a MaxEnt algorithm for the following episodes: La Niña 2010–2011, Neutral 2012–2015 and El Niño 2015–2016. The relationship between the potential richness of the vectors and the occurrence of CL in Norte de Santander was evaluated with a log-binomial regression model. During the El Niño 2015–2016 episode, Lutzomyia ovallesi and Lutzomyia panamen-sis increased their distribution into environmentally suitable areas, and three vector species (Lutzomyia gomezi, Lutzomyia ovallesi and Lutzomyia panamensis) showed increases in the range of their altitudinal distribution. During the La Niña 2010–2011 episode, a reduction was observed in the area suitable for occupation by Lutzomyia gomezi and Lutzomyia spini-crassa. During the El Niño 2015–2016 episode, the occurrence of at least one CL case was related to a higher percentage of rural localities showing a richness of vectors = 4. The anomalies in rainfall and temperature induced by the episodes produced changes in the potential distribution of CL vectors in Colombia. In Norte de Santander, during Neutral 2012–2015 and El Niño 2015–2016 episodes, a higher probability of at least one CL case was related to a higher percentage of areas with a greater richness of vectors. The results help clarify the effect of the El Niño–La Niña cycle in the dynamics of CL in Colombia and emphasize the need to monitor climate variability to improve the prediction of new cases.

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PLoS Neglected Tropical Diseases

Título del artículo:

Enzymatic transesterification ofwaste frying oil from local restaurants in east colombia using a combined lipase system

The search for innovation and biotechnological strategies in the biodiesel production chain have become a topic of interest for scientific community owing the importance of renewable energy sources. This work aimed to implement an enzymatic transesterification process to obtain biodiesel from waste frying oil (WFO). The transesterification was performed by varying reaction times (8 h, 12 h and 16 h), enzyme concentrations of lipase XX 25 split (14%, 16% and 18%), pH of reaction media (6, 7 and 8) and reaction temperature (35, 38 and 40 °C) with a fixed alcohol-oil molar ratio of 3:1. The optimum operating conditions were selected to quantify the amount of fatty acid methyl esters (FAMEs) generated. The highest biodiesel production was reached with an enzyme concentration of 14%, reaction time of 8 h, pH of 7 and temperature of 38 °C. It was estimated a FAMEs production of 42.86% for the selected experiment; however, best physicochemical characteristics of biodiesel were achieved with an enzyme concentration of 16% and reaction time of 8 h. Results suggested that enzymatic transesterification process was favorable because the amount of methyl esters obtained was similar to the content of fatty acids in the WFO.

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Applied Sciences (Switzerland)

Título del artículo:

Role of uric acid in the pathogenesis of heart disease and pulmonary hypertension. How are we in Pediatrics?

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Revista Colombiana de Cardiologia

Título del artículo:

Improving surgical quality in Colombia through indicators

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The Lancet Global Health

Título del artículo:

Antifungal effect of zinc oxide nanoparticles (ZnO-NPs) on Colletotrichum sp., causal agent of anthracnose in coffee crops

Coffee cultivation around the world is affected by phytopathogenic fungi, among them Colletotrichum sp., the causative agent of anthracnose. In the present work, therefore, an in vitro study was carried out on the antifungal effect of zinc oxide nanoparticles (ZnO-NPs) obtained by a chemical route on Colletotrichum sp. To this end, the area of growth of the fungus exposed to the action of concentrations of 9 mmolL−1 (730 ppm), 12 mmolL−1 (980 ppm), and 15 mmolL−1 (1200 ppm) of ZnO-NPs was monitored and their behavior was compared with the effect of the fungicide, ciproconazole (positive control) as well as with a sample of the fungus that grew normally (negative control). The ZnO-NPs showed an appreciable percent inhibition of fungal growth, ~96% for the concentration of 15 mmolL−1 at 6 days, causing loss in the continuity of some hyphae and the formation of groups of hyphal structures. Additionally, the ZnO-NPs favored the formation of structures of compact appearance (similar to vacuoles) within the hypha, as well as decreasing the cytoplasmic space.

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Biocatalysis and Agricultural Biotechnology

Título del artículo:

The relationship between hamstring muscle length and low back pain: A systematic review

Background and aim: Eighty percent of the population has experienced low back pain (LBP). Worldwide, LBP causes huge social and economic impact; among the deficiencies related to the presence of LBP is shortening of the hamstring muscles (HM), which, due to their insertion in the ischial tuberosity, can generate posterior pelvic tilt and flattening lumbar lordosis, overloading the lumbopelvic region, favouring the onset of LBP. A possible biomechanical link has been described between HM shortening and LBP, with inconclusive literature. The aim of this article is: to analyse the literature systematically and establish whether there is a relationship between HM shortening and presence of LBP. Materials and methods: Following the recommendations of the PRISMA statement, a search was carried out for articles in different databases, between August and September 2018, applying the inclusion criteria. After screening and secondary search, the methodological quality of selected articles was evaluated, through STROBE Declaration (Strengthening the Reporting of Observational Studies in Epidemiology). Results: A database search returned 102 articles, 12 of them, met methodological quality to be included in the review, 33.3% with very good quality and 66.7% with good quality. The tests used to evaluate HM length in the included studies were straight leg raise and active knee extension. Eight articles analysed found differences in HM length in people with LBP and the control group and four did not find differences. Conclusion: There is not enough scientific support to establish whether HM shortening is a cause or a consequence of LBP. That is why studies with more methodological rigour are required.

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Fisioterapia

Título del artículo:

Self-reported prevalence of chronic non-communicable diseases in relation to socioeconomic and educational factors in colombia: A community-based study in 11 departments

Background: Chronic non-communicable diseases are prevalent conditions in developing countries, such as Colombia. Several socioeconomic and educational factors have been associated with these pathologies. However, there is little country-specific information regarding the self-reported prevalence of chronic diseases and their association with the aforementioned factors in Colombia. Objectives: To evaluate the current situation of chronic non-transmissible diseases in Colombia by self-report and to analyze its potential relationship with sociodemographic, economic and educational factors. Methods: This is a cross-sectional baseline sub-analysis from the prospective, standardized collaborative PURE study in Colombia. Participants were recruited between 2005 to 2009, in 11 departments of the country, and included 7,485 subjects of 35 to 70 years old. Questionnaires of self-reported chronic non-communicable diseases, and demographic, socioeconomic and educational variables were applied. Results: Hypertension was the most prevalent chronic condition reported with a prevalence of 22.2% (21.2%-23.1%, 95% CI), followed by diabetes with a prevalence of 5.7% (5.1%-6.2%, 95% CI), asthma 2.7% (2.2%-3.0%, 95% CI), coronary heart disease 2.4% (2.0%-2.7%, 95% CI), stroke and heart failure 1.5% (1.2%-1.8%, 95% CI) each, chronic obstructive pulmonary disease 1.2% (0.6%-1.5%, 95% CI), and cancer 1.2% (1.0%-1.5%, 95% CI). Among the study sample, 23.3% (22.4%-24.3%, 95% CI) reported having one chronic NCDs, and 6.4% (5.9%-7.0%, 95% CI) reported having multiple chronic NCDs. The prevalence of multiple NCDs increased significantly with age, was more common in those from households with higher income, whereas it was significantly lower in persons with high education. The central and central-east regions of the country are those with the higher prevalence of self-reported NCDs. Conclusion: The results of the current study indicate the presence of socioeconomic and educational inequalities in the distribution of chronic NCDs in the Colombian population.

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Global Heart

Título del artículo:

Association of egg intake with blood lipids, cardiovascular disease, and mortality in 177,000 people in 50 countries

Eggs are a rich source of essential nutrients, but they are also a source of dietary cholesterol. Therefore, some guidelines recommend limiting egg consumption. However, there is contradictory evidence on the impact of eggs on diseases, largely based on studies conducted in high-income countries. Objectives: Our aim was to assess the association of egg consumption with blood lipids, cardiovascular disease (CVD), and mortality in large global studies involving populations from low-, middle-, and high-income countries. Methods: We studied 146,011 individuals from 21 countries in the Prospective Urban Rural Epidemiology (PURE) study. Egg consumption was recorded using country-specific validated FFQs. We also studied 31,544 patients with vascular disease in 2 multinational prospective studies: ONTARGET (Ongoing Telmisartan Alone and in Combination with Ramipril Global End Point Trial) and TRANSCEND (Telmisartan Randomized Assessment Study in ACEI Intolerant Subjects with Cardiovascular Disease). We calculated HRs using multivariable Cox frailty models with random intercepts to account for clustering by study center separately within each study. Results: In the PURE study, we recorded 14,700 composite events (8932 deaths and 8477 CVD events). In the PURE study, after excluding those with history of CVD, higher intake of egg (≥7 egg/wk compared with <1 egg/wk intake) was not significantly associated with blood lipids, composite outcome (HR: 0.96; 95% CI: 0.89, 1.04; P-trend = 0.74), total mortality (HR: 1.04; 95% CI: 0.94, 1.15; P-trend = 0.38), or major CVD (HR: 0.92; 95% CI: 0.83, 1.01; P-trend = 0.20). Similar results were observed in ONTARGET/TRANSCEND studies for composite outcome (HR 0.97; 95% CI: 0.76, 1.25; P-trend = 0.09), total mortality (HR: 0.88; 95% CI: 0.62, 1.24; P-trend = 0.55), and major CVD (HR: 0.97; 95% CI: 0.73, 1.29; P-trend = 0.12). Conclusions: In 3 large international prospective studies including ∼177,000 individuals, 12,701 deaths, and 13,658 CVD events from 50 countries in 6 continents, we did not find significant associations between egg intake and blood lipids, mortality, or major CVD events. The ONTARGET and TRANSCEND trials were registered at clinicaltrials.gov as NCT00153101. The PURE trial was registered at clinicaltrials.gov as NCT03225586.

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American Journal of Clinical Nutrition

Título del artículo:

First report of furuncular myiasis in a domestic dog caused by Dermatobia hominis (Linnaeus, 1781) in Colombia

This paper reports a case of furuncular myiasis caused by Dermatobia hominis in a domestic dog from Colombia. A male domestic dog, German shepherd breed, of approximately 2 years old was brought for medical consultation. The reason was the presence of one furuncular lesion and discomfort in the patient. Clinical examination revealed a wound over the sacral area similar to an inflammatory papule, with a central punctum exuding a serosanguinous discharge. In the medical examination was applied pressure around the wound, that allowed evidencing a larva inside the tissue. The applied treatment was surgical removal of the larva in the dog. Treatment was complemented with Cephalexin (20 mg / kg, twice a day orally for 7 days), Meloxicam (0.2 mg / kg, once a day orally for 3 days) and cleaning with chlorhexidine, three times a day until removal of points 7 days later. The larva was sent to Parasitology laboratory of the UDES for morphology identification. The larva was identified as Dermatobia hominis.

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Veterinary Parasitology: Regional Studies and Reports

Título del artículo:

Perceived facilitators and barriers to physical activity in adolescents in Piedecuesta (Santander), in 2016: Qualitative analysis

Objective: Describe the perception of adolescents aged between 12 and 16 years, in Piedecuesta (Santander), in 2016, about the facilitators and barriers that influence physical activity. Methodology:. Qualitative analysis from a phenomenological approach, with the participation of 20 adolescents who talked about the practice, benefits, environments, influence and company in connection with physical activity, to identify barriers and facilitators, through semi-structured interviews and a focus group. Results: Physical activity was limited to physical education classes in most cases. The main companion in extracurricular physical activity was the parent of the same sex. Physical activity represented an opportunity for enjoyment, improvement of physical and mental health, as well as body composition, and to have a break in their daily routine. Lack of time due to academic commitments was the main reason for not doing physical activity. Public places were not always available and they were often not considered to be safe. Space and facilities at school were inadequate, and their use was restricted. Conclusions: The school is an important point of convergence for doing physical activity, suggesting the need to strengthen the curriculum in this respect; this environment is a potential facilitator to increasing the level of physical activity in adolescents. It can also be seen as a barrier, given that the practice interferes with academic activities. Improvements in safety and aesthetic appeal in the surrounding community are seen as a facilitator to promoting physical activity.

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Revista Facultad Nacional de Salud Publica

Título del artículo:

Variations in common diseases, hospital admissions, and deaths in middle-aged adults in 21 countries from five continents (PURE): a prospective cohort study

Background: To our knowledge, no previous study has prospectively documented the incidence of common diseases and related mortality in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) with standardised approaches. Such information is key to developing global and context-specific health strategies. In our analysis of the Prospective Urban Rural Epidemiology (PURE) study, we aimed to evaluate differences in the incidence of common diseases, related hospital admissions, and related mortality in a large contemporary cohort of adults from 21 HICs, MICs, and LICs across five continents by use of standardised approaches. Methods: The PURE study is a prospective, population-based cohort study of individuals aged 35–70 years who have been enrolled from 21 countries across five continents. The key outcomes were the incidence of fatal and non-fatal cardiovascular diseases, cancers, injuries, respiratory diseases, and hospital admissions, and we calculated the age-standardised and sex-standardised incidence of these events per 1000 person-years. Findings: This analysis assesses the incidence of events in 162 534 participants who were enrolled in the first two phases of the PURE core study, between Jan 6, 2005, and Dec 4, 2016, and who were assessed for a median of 9·5 years (IQR 8·5–10·9). During follow-up, 11 307 (7·0%) participants died, 9329 (5·7%) participants had cardiovascular disease, 5151 (3·2%) participants had a cancer, 4386 (2·7%) participants had injuries requiring hospital admission, 2911 (1·8%) participants had pneumonia, and 1830 (1·1%) participants had chronic obstructive pulmonary disease (COPD). Cardiovascular disease occurred more often in LICs (7·1 cases per 1000 person-years) and in MICs (6·8 cases per 1000 person-years) than in HICs (4·3 cases per 1000 person-years). However, incident cancers, injuries, COPD, and pneumonia were most common in HICs and least common in LICs. Overall mortality rates in LICs (13·3 deaths per 1000 person-years) were double those in MICs (6·9 deaths per 1000 person-years) and four times higher than in HICs (3·4 deaths per 1000 person-years). This pattern of the highest mortality in LICs and the lowest in HICs was observed for all causes of death except cancer, where mortality was similar across country income levels. Cardiovascular disease was the most common cause of deaths overall (40%) but accounted for only 23% of deaths in HICs (vs 41% in MICs and 43% in LICs), despite more cardiovascular disease risk factors (as judged by INTERHEART risk scores) in HICs and the fewest such risk factors in LICs. The ratio of deaths from cardiovascular disease to those from cancer was 0·4 in HICs, 1·3 in MICs, and 3·0 in LICs, and four upper-MICs (Argentina, Chile, Turkey, and Poland) showed ratios similar to the HICs. Rates of first hospital admission and cardiovascular disease medication use were lowest in LICs and highest in HICs. Interpretation: Among adults aged 35–70 years, cardiovascular disease is the major cause of mortality globally. However, in HICs and some upper-MICs, deaths from cancer are now more common than those from cardiovascular disease, indicating a transition in the predominant causes of deaths in middle-age. As cardiovascular disease decreases in many countries, mortality from cancer will probably become the leading cause of death. The high mortality in poorer countries is not related to risk factors, but it might be related to poorer access to health care. Funding: Full funding sources are listed at the end of the paper (see Acknowledgments).

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The Lancet

Título del artículo:

Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study

Background: Global estimates of the effect of common modifiable risk factors on cardiovascular disease and mortality are largely based on data from separate studies, using different methodologies. The Prospective Urban Rural Epidemiology (PURE) study overcomes these limitations by using similar methods to prospectively measure the effect of modifiable risk factors on cardiovascular disease and mortality across 21 countries (spanning five continents) grouped by different economic levels. Methods: In this multinational, prospective cohort study, we examined associations for 14 potentially modifiable risk factors with mortality and cardiovascular disease in 155 722 participants without a prior history of cardiovascular disease from 21 high-income, middle-income, or low-income countries (HICs, MICs, or LICs). The primary outcomes for this paper were composites of cardiovascular disease events (defined as cardiovascular death, myocardial infarction, stroke, and heart failure) and mortality. We describe the prevalence, hazard ratios (HRs), and population-attributable fractions (PAFs) for cardiovascular disease and mortality associated with a cluster of behavioural factors (ie, tobacco use, alcohol, diet, physical activity, and sodium intake), metabolic factors (ie, lipids, blood pressure, diabetes, obesity), socioeconomic and psychosocial factors (ie, education, symptoms of depression), grip strength, and household and ambient pollution. Associations between risk factors and the outcomes were established using multivariable Cox frailty models and using PAFs for the entire cohort, and also by countries grouped by income level. Associations are presented as HRs and PAFs with 95% CIs. Findings: Between Jan 6, 2005, and Dec 4, 2016, 155 722 participants were enrolled and followed up for measurement of risk factors. 17 249 (11·1%) participants were from HICs, 102 680 (65·9%) were from MICs, and 35 793 (23·0%) from LICs. Approximately 70% of cardiovascular disease cases and deaths in the overall study population were attributed to modifiable risk factors. Metabolic factors were the predominant risk factors for cardiovascular disease (41·2% of the PAF), with hypertension being the largest (22·3% of the PAF). As a cluster, behavioural risk factors contributed most to deaths (26·3% of the PAF), although the single largest risk factor was a low education level (12·5% of the PAF). Ambient air pollution was associated with 13·9% of the PAF for cardiovascular disease, although different statistical methods were used for this analysis. In MICs and LICs, household air pollution, poor diet, low education, and low grip strength had stronger effects on cardiovascular disease or mortality than in HICs. Interpretation: Most cardiovascular disease cases and deaths can be attributed to a small number of common, modifiable risk factors. While some factors have extensive global effects (eg, hypertension and education), others (eg, household air pollution and poor diet) vary by a country\'s economic level. Health policies should focus on risk factors that have the greatest effects on averting cardiovascular disease and death globally, with additional emphasis on risk factors of greatest importance in specific groups of countries. Funding: Full funding sources are listed at the end of the paper (see Acknowledgments).

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The Lancet

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Experience and perception of risk associated with knowledge, attitudes and practices regarding dengue in Riohacha, Colombia

Recognition of the determinants of knowledge, attitudes and practices (KAP), which could be conditioned by the experiences and perceptions of the population at risk, is essential for the control of dengue. The scope of this article is to estimate the relationship between the risk perception and dengue diagnosis experiences with KAPs on dengue in an endemic Colombian population. A cross-sectional study with multi-stage random sampling was conducted. Adjusted prevalence ratios (aPR) were estimated using regression models as measures of association. Of the 206 families interviewed, 7% know dengue is caused by a virus and less than 40% recognize other symptoms besides fever. As control strategies, 31% eliminate hatchery sites and 58% use fumigation, though 73% perceive the risk of dengue. The association was identified between the perception of the risk of dengue and knowledge about the vector (aPR = 3.32 CI95% 1.06–10.36), and the experience of diagnosis of dengue with the attitude towards dengue control (aPR = 1.61 CI95% 1.09–2.37). Risk perception and experience with dengue could become determinants of KAPs in relation to this disease.

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Ciencia e Saude Coletiva

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Temporal lagged relationship between a vegetation index and cutaneous leishmaniasis cases in Colombia: an analysis implementing a distributed lag nonlinear model

Cutaneous leishmaniasis is a neglected tropical disease with a strong environmental component. The aim of this research was to implement a distributed lag nonlinear model to explore the temporal lagged relationship between a vegetation index and cutaneous leishmaniasis cases. In this ecological study, a time series of weekly cases of cutaneous leishmaniasis reported between 2007 and 2016 in the five municipalities in Colombia with the most cases of the disease and a vegetation index was analyzed. During the study period, a total of 16,321 cases were reported in these five municipalities. Two municipalities showed a lagged nonlinear positive association between the risk of occurrence of new cases and the magnitude of the vegetation index; two municipalities showed a negative association; and in the remaining municipality, the risk was associated with the vegetation index but its confidence interval was not significant. Our results show different patterns and magnitudes of the lagged relationship between the vegetation index and cutaneous leishmaniasis cases and suggest the possibility of using the lag pattern of the vegetation index in the development of an early warning system where a lagged positive relationship is identified.

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Parasitology Research

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Thermodynamic assessment of the integrated gasification-power plant operating in the sawmill industry: An energy and exergy analysis

Biomass thermochemical conversion into heat and electricity is a promising technological alternative for the management of the biomass residues from the sawmill process. In this study, an energetic and exergetic analysis for syngas production from biomass gasification has been performed, including its potential use for heat and power generation. A stoichiometric model of biomass gasification with air as gasifying agent was accomplished to evaluate the syngas production and the potential energy recovery from pinewood chips residues. From the thermodynamic analysis of the biomass residues gasification process and syngas production, it was observed that a cold-gas and hot-gas efficiencies close to 74.5% and 84.6% could be achieved by considering an ER ratio of 0.34, respectively; while energy losses represented 15.3% of the total energy input to the gasifier. Furthermore, an exergy balance of the integrated gasification-power plant (IGPP) was considered. Biomass gasification and power generation processes showed a higher contribution to the total destroyed exergy; reaching values of 42.4% and 45.5% of the total destroyed exergy, respectively. According to energy balance, the IGPP and heat recovery from exhaust gases could supply 52.6% of electricity and 38.9% of thermal energy requirements for the sawmill process.

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Renewable Energy

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The household economic burden of non-communicable diseases in 18 countries

Background Non-communicable diseases (NCDs) are the leading cause of death globally. In 2014, the United Nations committed to reducing premature mortality from NCDs, including by reducing the burden of healthcare costs. Since 2014, the Prospective Urban and Rural Epidemiology (PURE) Study has been collecting health expenditure data from households with NCDs in 18 countries. Methods Using data from the PURE Study, we estimated risk of catastrophic health spending and impoverishment among households with at least one person with NCDs (cardiovascular disease, diabetes, kidney disease, cancer and respiratory diseases; n=17 435), with hypertension only (a leading risk factor for NCDs; n=11 831) or with neither (n=22 654) by country income group: high-income countries (Canada and Sweden), upper middle income countries (UMICs: Brazil, Chile, Malaysia, Poland, South Africa and Turkey), lower middle income countries (LMICs: the Philippines, Colombia, India, Iran and the Occupied Palestinian Territory) and low-income countries (LICs: Bangladesh, Pakistan, Zimbabwe and Tanzania) and China. Results The prevalence of catastrophic spending and impoverishment is highest among households with NCDs in LMICs and China. After adjusting for covariates that might drive health expenditure, the absolute risk of catastrophic spending is higher in households with NCDs compared with no NCDs in LMICs (risk difference=1.71%; 95% CI 0.75 to 2.67), UMICs (0.82%; 95% CI 0.37 to 1.27) and China (7.52%; 95% CI 5.88 to 9.16). A similar pattern is observed in UMICs and China for impoverishment. A high proportion of those with NCDs in LICs, especially women (38.7% compared with 12.6% in men), reported not taking medication due to costs. Conclusions Our findings show that financial protection from healthcare costs for people with NCDs is inadequate, particularly in LMICs and China. While the burden of NCD care may appear greatest in LMICs and China, the burden in LICs may be masked by care foregone due to costs. The high proportion of women reporting foregone care due to cost may in part explain gender inequality in treatment of NCDs.

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BMJ Global Health

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Measles in pediatrics: The resurgence of a vaccine-preventable disease

Measles is a disease caused by an RNA virus of the Morbillivirus genus, which is part of the Paramyxoviridae family. Measles is highly contagious, but can be preventable by vaccination. In recent years, an increasing number of cases reported in both developed and developing countries, mainly as a consequence of population changes and inadequate vaccination policies and strategies, as well as the rise of anti-vaccine groups. Clinical manifestations are based on four typical stages of the disease. Mortality rates are estimated to be as high as 25%, primarily in children with comorbidities such as malnutrition or vitamin A deficiency. This article reviews and updates the epidemiological, clinical, and measles vaccination aspects, particularly in some Latin American countries. We highlight the need for compliance with immunization policies and strategies, in order to prevent the spread of outbreaks.

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Revista Mexicana de Pediatria