Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990-2015

Importance: Elevated systolic blood (SBP) pressure is a leading global health risk. Quantifying the levels of SBP is important to guide prevention policies and interventions. Objective: To estimate the association between SBP of at least 110 to 115 mm Hg and SBP of 140 mm Hg or higher and the burden of different causes of death and disability by age and sex for 195 countries and territories, 1990-2015. Design: A comparative risk assessment of health loss related to SBP. Estimated distribution of SBP was based on 844 studies from 154 countries (published 1980-2015) of 8.69 million participants. Spatiotemporal Gaussian process regression was used to generate estimates of mean SBP and adjusted variance for each age, sex, country, and year. Diseases with sufficient evidence for a causal relationship with high SBP (eg, ischemic heart disease, ischemic stroke, and hemorrhagic stroke) were included in the primary analysis. Main Outcomes and Measures Mean SBP level, cause-specific deaths, and health burden related to SBP (≥110-115 mm Hg and also ≥140 mm Hg) by age, sex, country, and year. Results: Between 1990-2015, the rate of SBP of at least 110 to 115 mm Hg increased from 73 119 (95% uncertainty interval [UI], 67 949-78 241) to 81 373 (95% UI, 76 814-85 770) per 100 000, and SBP of 140 mm Hg or higher increased from 17 307 (95% UI, 17 117-17 492) to 20 526 (95% UI, 20 283-20 746) per 100 000. The estimated annual death rate per 100 000 associated with SBP of at least 110 to 115 mm Hg increased from 135.6 (95% UI, 122.4-148.1) to 145.2 (95% UI 130.3-159.9) and the rate for SBP of 140 mm Hg or higher increased from 97.9 (95% UI, 87.5-108.1) to 106.3 (95% UI, 94.6-118.1). Loss of disability-adjusted life-years (DALYs) associated with SBP of at least 110 to 115 mm Hg increased from 148 million (95% UI, 134-162 million) to 211 million (95% UI, 193-231 million), and for SBP of 140 mm Hg or higher, the loss increased from 95.9 million (95% UI, 87.0-104.9 million) to 143.0 million (95% UI, 130.2-157.0 million). The largest numbers of SBP-related deaths were caused by ischemic heart disease (4.9 million [95% UI, 4.0-5.7 million]; 54.5%), hemorrhagic stroke (2.0 million [95% UI, 1.6-2.3 million]; 58.3%), and ischemic stroke (1.5 million [95% UI, 1.2-1.8 million]; 50.0%). In 2015, China, India, Russia, Indonesia, and the United States accounted for more than half of the global DALYs related to SBP of at least 110 to 115 mm Hg. Conclusions and Relevance: In international surveys, although there is uncertainty in some estimates, the rate of elevated SBP (≥110-115 and ≥140 mm Hg) increased substantially between 1990 and 2015, and DALYs and deaths associated with elevated SBP also increased. Projections based on this sample suggest that in 2015, an estimated 3.5 billion adults had SBP of at least 110 to 115 mm Hg and 874 million adults had SBP of 140 mm Hg or higher

Modelos de financiación de vivienda. casos: México, Chile y Colombia.

Esta investigación compara los sistemas de financiación de vivienda en Chile, Colombia y México. Usando metodologías similares en la amortización se observa que las variables principales en los créditos son el interés, el monto y plazo. El índice de precio al consumidor –IPC–, varía en cada país, porque realizan el cálculo de forma diferente y este afecta la unidad de cuenta empleada para la amortización de los créditos de vivienda

Urban Policies and Health In Developing Countries: The Case of Maputo (Mozambique) and Cochabamba (Bolivia)

Urban planning and related policies can contribute to improvement in health. Recent epidemiological and quantitative Health Impact Assessment (HIA) studies in Europe and North America suggest that a change from passive (car) to active transportation (cycling, walking) and public transport in daily life could improve health. HIA studies are still largely lacking in low and middle-income countries. We conducted a scoping study to evaluate the availability of data to conduct quantitative HIA in two cities from two low-income countries. We collected information through interviews with different local agents, from the National Institute of Statistics and by conducting field work to identify the built environment and mobility characteristics in the respective cities. Conducting a quantitative HIA in Maputo (Mozambique) is currently not possible, mainly because there is no appropriate data on mortality, road traffic accidents and physical activity of the general population. However, in Cochabamba (Bolivia) it might be possible when the mobility plan will be available (currently under development), in which data on traffic flows, mobility surveys and transport modal shares will become available. The current paper describes two examples of the opportunities and difficulties to conduct quantitative HIA in low- and middle-income countries, highlighting the limited availability of data (quantitatively and qualitatively) on transport and urban planning and health outcomes

Urban and Transport Planning Related Exposures and Mortality: A Health Impact Assessment for Cities

BACKGROUND: By 2050, almost 70% of people globally are projected to live in urban areas. As the environments we inhabit affect our health, urban and transport designs that promote healthy living are needed. OBJECTIVE: We estimated the number of premature deaths preventable under compliance with international exposure recommendations for physical activity (PA), air pollution, noise, heat, and access to green spaces. METHODS: We developed and applied the Urban and TranspOrt Planning Health Impact Assessment (UTOPHIA) tool to Barcelona. Exposure estimates and mortality data were available for 1357361 residents. We compared recommended with current exposure levels. We quantified the associations between exposures and mortality and calculated population attributable fractions to estimate the number of premature deaths preventable. We also modeled life-expectancy and economic impacts. RESULTS: We estimated that annually almost 20% of mortality could be prevented if international recommendations for performance of PA, exposure to air pollution, noise, heat, and access to green space were complied with. Estimations showed that the biggest share in preventable deaths was attributable to increases in PA, followed by exposure reductions in air pollution, traffic noise and heat. Access to green spaces had smaller effects on mortality. Compliance was estimated to increase the average life expectancy by 360 (95% CI: 219, 493) days and result in economic savings of 9.3 (95% CI: 4.9; 13.2) billion euro per year. CONCLUSIONS: PA factors and environmental exposures can be modified by changes in urban and transport planning. We emphasize the need for (1) the reduction of motorized traffic through the promotion of active and public transport and (2) the provision of green infrastructure, which are both suggested to provide PA opportunities and mitigation of air pollution, noise, and heat

Active Mobility – the New Health Trend in Smart Cities, or even More?

Active mobility (AM), including walking and cycling as single trips or in combination with public transport, has recently been promoted by health professionals – with WHO leading the way – to tackle health problems caused by physical inactivity. In fact only 1/3 of the European population is estimated to meet the minimum recommended levels of physical activity by the WHO of 30 minutes of moderate-intensity activity 5 times per week. Being aware that we spend between 70 to 80 min per day travelling and that 50% of all car trips (in Europe) are shorter than 5 km, active mobility has an enormous potential to get people more active. However, how is this knowledge of proven positive health effects of AM been taken into account – either by urban and transport planning authorities or by health administration? Is this „new health trend“ visible in strategies, cooperation or – what’s even more important – in implemented measures in smart cities? “Physical activity through sustainable transport approaches” (PASTA1)” is a European project addressing and analyzing the promising link between transport and health. It pursues an interdisciplinary approach involving scientists and leading experts from a range of disciplines, including (among others) transport and urban planning, public health, environmental sciences, climate change and energy, and transport economics. The overall aim of the project is to generate knowledge about the effects of AM in consideration of health effects. This paper reveals backgrounds and relationships between transport and health work in seven European case study cities (Antwerp, Barcelona, London, Örebro, Rome, Vienna and Zurich) based on workshops and stakeholder interviews conducted in PASTA. Considering cities‘ framework conditions (strategies and policies, infrastructure and other measures promoting AM etc.) and comparing stakeholders‘ perspectives bring out that cities have to struggle with similar barriers and challenges. Otherwise they take promising approaches and efforts towards sustainable and healthy urban development; increasing synergies between the health and transport sector seems to be one of the missing links between transport and health. Good practices and new ideas for transport planners and health experts are provided aiding to create livable conditions through well-planned infrastructure, a safe environment and attractive public space, awareness-raising activities and various broader policies – including the health policy. After all AM should not just be an ephemeral health trend, but common (health) practice

Gradient, UC3M

En este artículo se presenta un resumen de las líneas de investigación que se realizan en el Laboratorio Gradient perteneciente al Grupo GAST (Grupo de Aplicaciones y Servicios Telemáticos) del Departamento de Ingeniería Telemática de la Universidad Carlos III de Madrid. La temática principal de investigación es la aplicación de tecnologías para la mejora de la enseñanza y el aprendizaje. El resumen se centra en tres líneas: Personalización del aprendizaje, uso de dispositivos móviles con fines educativos y aplicaciones de Realidad Virtual y Realidad Aumentada en educación.En este artículo se presenta un resumen de las líneas de investigación que se realizan en el Laboratorio Gradient perteneciente al Grupo GAST (Grupo de Aplicaciones y Servicios Telemáticos) del Departamento de Ingeniería Telemática de la Universidad Carlos III de Madrid. La temática principal de investigación es la aplicación de tecnologías para la mejora de la enseñanza y el aprendizaje. El resumen se centra en tres líneas: Personalización del aprendizaje, uso de dispositivos móviles con fines educativos y aplicaciones de Realidad Virtual y Realidad Aumentada en educación.Publicad

The health risks and benefits of cycling in urban environments compared with car use: health impact assessment study

Objective To estimate the risks and benefits to health of travel by bicycle, using a bicycle sharing scheme, compared with travel by car in an urban environment

Penalized Distributed Lag Interaction Model: Air Pollution, Birth Weight and Neighborhood Vulnerability

Maternal exposure to air pollution during pregnancy has a substantial public health impact. Epidemiological evidence supports an association between maternal exposure to air pollution and low birth weight. A popular method to estimate this association while identifying windows of susceptibility is a distributed lag model (DLM), which regresses an outcome onto exposure history observed at multiple time points. However, the standard DLM framework does not allow for modification of the association between repeated measures of exposure and the outcome. We propose a distributed lag interaction model that allows modification of the exposure-time-response associations across individuals by including an interaction between a continuous modifying variable and the exposure history. Our model framework is an extension of a standard DLM that uses a cross-basis, or bi-dimensional function space, to simultaneously describe both the modification of the exposure-response relationship and the temporal structure of the exposure data. Through simulations, we showed that our model with penalization out-performs a standard DLM when the true exposure-time-response associations vary by a continuous variable. Using a Colorado, USA birth cohort, we estimated the association between birth weight and ambient fine particulate matter air pollution modified by an area-level metric of health and social adversities from Colorado EnviroScreen.Comment: 41 pages, 4 figures, 2 table

Toxoplasma gondii Infection and Threatened Abortion in Women from Northern Peru

Introduction. Toxoplasma gondii infection can cause important complications during pregnancy. Threatened abortion may be a late indicator for infection in settings with high prevalence of toxoplasmosis. We aimed to determine the association between T. gondii infection and threatened abortion in women from northern Peru. Methods. We conducted a secondary analysis of a cross-sectional study in pregnant women from a hospital and a rural community in Lambayeque, Peru. Exposure variable was serological diagnosis of toxoplasmosis, defined as the demonstration of either IgM or IgG antibodies against T. gondii. Outcome variable was threatened abortion, defined as the diagnosis of bloody vaginal discharge or bleeding during the first half of pregnancy. Prevalence ratios were estimated in simple and multiple regression analyses. Results. Of 218 pregnant women, 35.8% presented positive serology for T. gondii and 14.7% had threatened abortion in their current pregnancy. Pregnant women with positive T. gondii infection had 2.45-fold higher frequency of threatened abortion (PR: 2.45, 95% CI: 1.15-5.21). In addition, the frequency of threatened abortion decreased by 9% for each additional year of age (PR: 0.91, 95% CI: 0.86-0.97). A previous history of threatened abortion also showed a higher frequency of threatened abortion (PR: 5.22, 95% CI: 2.45-11.12). Conclusions. T. gondii infection is associated with threatened abortion. An early age of pregnancy and a previous history of abortion are also associated with this condition