Monitoring ecological change during rapid socio-economic and political transitions: Colombian ecosystems in the post-conflict era

After more than 50-years of armed conflict, Colombia is now transitioning to a more stable social and political climate due to a series of peace agreements between the government and different armed groups. Consequences of these socio-economic and political changes on ecosystems are largely uncertain, but there is growing concern about derived increases in environmental degradation. Here, we review the capacity of Colombia to monitor the state of its ecosystems and their rate of change over time. We found several important programs currently set in place by different institutions as well as by independent groups of scientists that address different aspects of environmental monitoring. However, most of the current initiatives could be improved in terms of data coverage, quality and access, and could be better articulated among each other. We propose a set of activities that would increase the capacity of Colombia to monitor its ecosystems, provide useful information to policy makers, and facilitate scientific research. These include: 1) the establishment of a national center for ecological synthesis that focuses on analyzing existing information; 2) the establishment of an ecological observatory system that collects new information, integrates remote sensing products, and produces near real-time products on key ecological variables; and 3) the creation of new platforms for dialog and action within existing scientific and policy groups

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining https://researchonline.ljmu.ac.uk/images/research_banner_face_lab_290.jpgunderweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity

Outcome and cost-effectiveness of cardiopulmonary resuscitation after in-hospital cardiac arrest in octogenarians.

Octogenarians are the fastest growing segment of the population and little is known about the results of cardiopulmonary resuscitation (CPR) after in-hospital cardiac arrest in this population.We sought to investigate the clinical benefit and cost-effectiveness of CPR after in-hospital cardiac arrest in octogenarians.Years of life saved.Effectiveness data were obtained from a review of 91,372 hospital discharges from January 1st, 1993 until June 30th, 1996. Cardiac arrest was reported in 956 patients. The study group consisted of 474 patients &gt; or = 80 years old. CPR costs included equipment and training, physician and nursing time and medications. Post-CPR expenses included in-hospital true cost, repeat hospitalizations, physician office visits, nursing home, rehabilitation, and chronic care hospital costs. Life expectancy of the patients who were still alive at the end of the study was estimated from census data. A utility of 0.8 was used to calculate quality-adjusted-life years saved (QALYS). We used a societal perspective for analysis.The study population was 86 +/- 4.8 years old (range 80-103), and 42% were male. Fifty-four patients (11%) were discharged alive, 35 to a chronic care facility and 19 to their home. Assuming that a cardiac arrest without CPR has 100% mortality, 12 octogenarians required treatment with CPR in order to save one life to hospital discharge. Similarly, 29 octogenarian patients with cardiac arrest have to be treated with CPR to net one long-term survivor (mean survival 21 months, with a range from 9 to 48 months). The cost-effectiveness ratio, after estimating the life expectancy of octogenarian survivors, was USD 50,412 per year of life saved, and USD 63,015 per QALYS. However, a utility of 0.5 yielded a cost of USD 100,825 per QALYS.In comparison with other life-saving strategies, CPR in octogenarians is effective. The favorable cost-effectiveness ratio is highly dependent on the patients' preference for quality rather than quantity of life, as expressed by the utility assumptions

Monitoring ecological change during rapid socio-economic and political transitions: Colombian ecosystems in the post-conflict era

After more than 50-years of armed conflict, Colombia is now transitioning to a more stable social and political climate due to a series of peace agreements between the government and different armed groups. Consequences of these socio-economic and political changes on ecosystems are largely uncertain, but there is growing concern about derived increases in environmental degradation. Here, we review the capacity of Colombia to monitor the state of its ecosystems and their rate of change over time. We found several important programs currently set in place by different institutions as well as by independent groups of scientists that address different aspects of environmental monitoring. However, most of the current initiatives could be improved in terms of data coverage, quality and access, and could be better articulated among each other. We propose a set of activities that would increase the capacity of Colombia to monitor its ecosystems, provide useful information to policy makers, and facilitate scientific research. These include: 1) the establishment of a national center for ecological synthesis that focuses on analyzing existing information; 2) the establishment of an ecological observatory system that collects new information, integrates remote sensing products, and produces near real-time products on key ecological variables; and 3) the creation of new platforms for dialog and action within existing scientific and policy groups. © 2017 The Author

Monitoring ecological change during rapid socio-economic and political transitions: Colombian ecosystems in the post-conflict era

After more than 50-years of armed conflict, Colombia is now transitioning to a more stable social and political climate due to a series of peace agreements between the government and different armed groups. Consequences of these socio-economic and political changes on ecosystems are largely uncertain, but there is growing concern about derived increases in environmental degradation. Here, we review the capacity of Colombia to monitor the state of its ecosystems and their rate of change over time. We found several important programs currently set in place by different institutions as well as by independent groups of scientists that address different aspects of environmental monitoring. However, most of the current initiatives could be improved in terms of data coverage, quality and access, and could be better articulated among each other. We propose a set of activities that would increase the capacity of Colombia to monitor its ecosystems, provide useful information to policy makers, and facilitate scientific research. These include: 1) the establishment of a national center for ecological synthesis that focuses on analyzing existing information; 2) the establishment of an ecological observatory system that collects new information, integrates remote sensing products, and produces near real-time products on key ecological variables; and 3) the creation of new platforms for dialog and action within existing scientific and policy groups. © 2017 The Author