Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

C-ficocianinas: Modulación del sistema inmune y su posible aplicación como terapia contra el cáncer

Cancer is a complex, heterogeneous, and dynamic disease, characterized by uncontrolled mitosis. Historically, it has been treated with surgery, radiotherapy and chemotherapy, and in more recent years through immunotherapy. For this, different proteins have been investigated for the modulation of the immune response. A group of these are C-phycocyanins, biliproteins from bluish-green microalgae such as Spirulina platensis. The anti-inflammatory environment in healthy people is a prophylactic measure to reduce the risk of developing a certain type of cancer. Its intake has shown that behavior, by suppressing the release of pro-inflammatory substances. An immunomodulatory effect has also been appreciated by increasing or decreasing the expression of CD59, as well as by causing the macrophage proliferation and the release of inflammatory substances. The latter is an indication that there is insufficient information to corroborate its use as a prophylactic or therapeutic option against cancer. Therefore, the information about natural substances such as this one is transcendental, because although they are more attractive to treat this disease, there are no fully proven therapeutic effects.El cáncer es una enfermedad compleja, heterogénea y dinámica, caracterizada por una mitosis descontrolada. Históricamente, se ha tratado con cirugía, radioterapia y quimioterapia, y en años más recientes mediante la inmunoterapia. Para ello, se han investigado distintas proteínas para la modulación de la respuesta inmune. Un grupo de estas son las C-ficocianinas, biliproteinas proveniente de microalgas verde azuladas como Spirulina platensis. El ambiente antiinflamatorio en personas sanas es una medida profiláctica para disminuir el riesgo de desarrollar un determinado tipo de cáncer. Su ingesta ha mostrado ese comportamiento, al suprimir la liberación de sustancias proinflamatorias. También se ha apreciado un efecto inmunomodulador al aumentar o disminuir la expresión de CD59, así como al ocasionar la proliferación de macrófagos y la liberación de sustancias inflamatorias. Esto último es un indicativo de que no se cuenta con información suficiente para corroborar su uso como opción profiláctica o terapéutica contra el cáncer. Por ello, es trascendental la información sobre sustancias naturales como esta, porque aunque se ven más atractivas para tratar esta enfermedad, no existen efectos terapéuticos totalmente comprobados

C-ficocianinas: modulación del sistema inmune y su posible aplicación como terapia contra el cáncer

Cancer is a complex, heterogeneous, and dynamic disease, characterized by uncontrolled mitosis. Historically, it has been treated with surgery, radiotherapy and chemotherapy, and immunotherapy in more recent years. For this, different proteins have been investigated for the modulation of the immune response. A group of these are C-phycocyanins, biliproteins from bluish-green microalgae such as Spirulina platensis. The anti-inflammatory environment in healthy people is a prophylactic measure to reduce the risk of developing a specific cancer type. Its intake has shown that behavior, by suppressing the release of pro-inflammatory substances. An immunomodulatory effect has also been appreciated by increasing or decreasing the expression of CD59, and causing the macrophage proliferation and the release of inflammatory substances. The latter is an indication that there is insufficient information to corroborate its use as a prophylactic or therapeutic option against cancer. Therefore, the information about natural substances such as these ones are transcendental, because although they are more attractive to treat said disease, there are no fully proven therapeutic effects.El cáncer es una enfermedad compleja, heterogénea y dinámica, caracterizada por una mitosis descontrolada. Históricamente, se ha tratado con cirugía, radioterapia y quimioterapia, y en años más recientes mediante la inmunoterapia. Para ello, se han investigado distintas proteínas para la modulación de la respuesta inmune. Un grupo de estas son las C-ficocianinas, biliproteinas proveniente de microalgas verde azuladas como Spirulina platensis. El ambiente antiinflamatorio en personas sanas es una medida profiláctica para disminuir el riesgo de desarrollar un determinado tipo de cáncer. Su ingesta ha mostrado ese comportamiento, al suprimir la liberación de sustancias proinflamatorias. También se ha apreciado un efecto inmunomodulador al aumentar o disminuir la expresión de CD59, así como al ocasionar la proliferación de macrófagos y la liberación de sustancias inflamatorias. Esto último es un indicativo de que no se cuenta con información suficiente para corroborar su uso como opción profiláctica o terapéutica contra el cáncer. Por ello, es trascendental la información sobre sustancias naturales como estas, porque aunque se ven más atractivas para tratar dicha enfermedad, no existen efectos terapéuticos totalmente comprobados

ARG CAP-NET: 20 años de cooperación para la gestión integrada del agua

La Red Argentina de Capacitación y Fortalecimiento en Gestión Integrada de los Recursos Hídricos (Arg Cap-Net) se crea en 2002 con el objetivo de propiciar el desarrollo de capacidades para promover la Gestión Integrada de los Recursos Hídricos (GIRH) en nuestro país. Esta red en la actualidad está formada por 23 instituciones que incluyen universidades (UNL, UBA, UNLP, UNER, UNRC, UNICEN, UNS, UTN, UNSA, UM, UFasta, UNS, UNNE, UC, UNT), organismos de gestión (INTA, Depto. de Irrigación de Mendoza, COIRCO, DPA-Rio Negro, INA) y organismos no gubernamentales (AIDIS, IARH). Es una red federal que cubre la gran mayoría del territorio del país y en el cual todas las instituciones integrantes trabajan de manera colaborativa en diferentes proyectos y actividades a asociadas a la formación de recursos humanos en la temática de la gestión integrada de los recursos hídricos. Las acciones desarrolladas por Arg- Cap-Net a lo largo de los años incluyeron el dictado de una maestría (Maestría en Gestión de los Recursos Hídricos), la articulación con otros posgrados del país, el dictado de cursos, capacitaciones, talleres, seminarios, así como el desarrollo de proyectos vinculados a la GIRH (https://www.argcapnet.org.ar/). El trabajo conjunto y la formación de lazos interpersonales e interinstitucionales ha permitido la concreción de numerosos objetivos y el fortalecimiento de las capacidades en gran parte del territorio del país, así como la difusión de esta temática a toda la sociedad. En este trabajo se presentan los principales hitos de la trayectoria de la red y los desafíos y perspectivas a futuro que conlleva el trabajo cooperativo.Facultad de Ingenierí

Consenso para las prácticas de alimentación complementaria en lactantes sanos

ResumenLa nutrición adecuada durante los primeros dos años de vida es fundamental para el desarrollo pleno del potencial de cada ser humano; actualmente se reconoce que este periodo es una ventana crítica para la promoción de un crecimiento y desarrollo óptimos y un buen estado de salud. Por tanto, cumplir con una alimentación adecuada en esta etapa de la vida tiene impacto sobre la salud, estado de nutrición, crecimiento y desarrollo de los niños; no sólo en el corto plazo, sino en el mediano y largo plazo. El presente trabajo ofrece recomendaciones de alimentación complementaria (AC) que se presentan en forma de preguntas o enunciados que consideran temas importantes para quienes atienden niños durante esta etapa de la vida; por ejemplo: inicio de la alimentación complementaria a los 4 o 6 meses de edad; exposición a alimentos potencialmente alergénicos; introducción de bebidas azucaradas; uso de edulcorantes artificiales y productos light; secuencia de introducción de alimentos; modificaciones de consistencia de alimentos de acuerdo a la maduración neurológica; número de días para probar aceptación y tolerancia a los alimentos nuevos; cantidades por cada tiempo de comida; prácticas inadecuadas de alimentación complementaria; mitos y realidades de la alimentación complementaria; hitos del desarrollo; práctica del “Baby Led Weaning” y práctica de vegetarianismo.AbstractA proper nutrition during the first two years of life is critical to reach the full potential of every human being; now, this period is recognized as a critical window for promoting optimal growth, development, and good health. Therefore, adequate feeding at this stage of life has an impact on health, nutritional status, growth and development of children; not only in the short term, but in the medium and long term. This paper provides recommendations on complementary feeding (CF) presented as questions or statements that are important for those who take care for children during this stage of life. For example: When to start complementary feedings: 4 or 6 months of age?; Exposure to potentially allergenic foods; Introduction of sweetened beverages; Use of artificial sweeteners and light products; Food introduction sequence; Food consistency changes according to neurological maturation; Number of days to test acceptance and tolerance to new foods; Amounts for each meal; Inadequate complementary feeding practices; Myths and realities of complementary feeding; Developmental milestones; Practice of “Baby Led Weaning” and practice of vegetarianism

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved