ON THE ASSIMILATION OF GNSS PWV MEASUREMENTS IN HEAVY TO TORRENTIAL RAIN EVENTS IN DAVAO CITY, PHILIPPINES

A standalone Global Navigation Satellite System (GNSS) receiver was utilized in this study to get a measure of the atmospheric water vapor in Davao City, Philippines. It aims to monitor the variability of GNSS precipitable water vapor (PWV) especially during heavy to torrential rain. The results of the study showed a positive correlation between GNSS-PWV and precipitation especially in these severe (heavy to torrential) rain events which implies that the assimilation of atmospheric water vapor measurements can improve forecasts of such events

Activity Pattern of School/University Tenants and their Family Members in Metro Manila – Philippines

Existing studies that focus on personal exposure to or the deposition dose of particulate pollution in developing regions are limited. Hence, in this study, as a first step, we present results on how people spend their daily time in Metro Manila, Philippines. This information is critical to assessing personal exposure to and the deposition dose of particulate pollutants. We found that people spend less time at home on workdays than weekends (52% versus 70%), the fraction of time spent at work/school increases with age until retirement, adult males spend less time at home than females (18% versus 28%), and people spend most of their time indoors (84%). The biggest difference from previous studies is the discovery that people in Metro Manila spend 11% of their daily time on average in transit traffic, which is up to 2.2 times more than in Europe, America, Korea, or China. Longer times in transit traffic subject the population of Metro Manila to a higher risk of increased exposure to toxic pollutants and adverse health symptoms. The main results of this research will be used in an upcoming study on the personal deposition dose of soot

Aerosol Particle and Black Carbon Emission Factors of Vehicular Fleet in Manila, Philippines

Poor air quality has been identified as one of the main risks to human health, especially in developing regions, where the information on physical chemical properties of air pollutants is lacking. To bridge this gap, we conducted an intensive measurement campaign in Manila, Philippines to determine the emission factors (EFs) of particle number (PN) and equivalent black carbon (BC). The focus was on public utility jeepneys (PUJ), equipped with old technology diesel engines, widely used for public transportation. The EFs were determined by aerosol physical measurements, fleet information, and modeled dilution using the Operational Street Pollution Model (OSPM). The results show that average vehicle EFs of PN and BC in Manila is up to two orders of magnitude higher than European emission standards. Furthermore, a PUJ emits up to seven times more than a light-duty vehicles (LDVs) and contribute to more than 60% of BC emission in Manila. Unfortunately, traffic restrictions for heavy-duty vehicles do not apply to PUJs. The results presented in this work provide a framework to help support targeted traffic interventions to improve urban air quality not only in Manila, but also in other countries with a similar fleet composed of old-technology vehicles

Respiratory tract deposition of inhaled roadside ultrafine refractory particles in a polluted megacity of South-East Asia

Recent studies demonstrate that Black Carbon (BC) pollution in economically developing megacities remain higher than the values, which the World Health Organization considers to be safe. Despite the scientific evidence of the degrees of BC exposure, there is still a lack of understanding on how the severe levels of BC pollution affect human health in these regions. We consider information on the respiratory tract deposition dose (DD) of BC to be essential in understanding the link between personal exposure to air pollutants and corresponding health effects. In this work, we combine data on fine and ultrafine refractory particle number concentrations (BC proxy), and activity patterns to derive the respiratory tract deposited amounts of BC particles for the population of the highly polluted metropolitan area of Manila, Philippines. We calculated the total DD of refractory particles based on three metrics: refractory particle number, surface area, and mass concentrations. The calculated DD of total refractory particle number in Metro Manila was found to be 1.6 to 17 times higher than average values reported from Europe and the U.S. In the case of Manila, ultrafine particles smaller than 100 nm accounted for more than 90% of the total deposited refractory particle dose in terms of particle number. This work is a first attempt to quantitatively evaluate the DD of refractory particles and raise awareness in assessing pollution-related health effects in developing megacities. We demonstrate that the majority of the population may be highly affected by BC pollution, which is known to have negative health outcomes if no actions are taken to mitigate its emission. For the governments of such metropolitan areas, we suggest to revise currently existing environmental legislation, raise public awareness, and to establish supplementary monitoring of black carbon in parallel to already existing PM 10 and PM 2.5 measures. © 201

Propuesta para intervenir la Diabetes Mellitus tipo 2

La diabetes es una de las enfermedades que más afecta la salud de los seres humanos y en este siglo XXI es considerada un desafío para la salud mundial. Según datos y cifras presentadas por la OMS, la diabetes es una importante causa de ceguera, insuficiencia renal, infarto de miocardio, accidente cerebrovascular y amputación de los miembros inferiores. Según estimaciones de la OMS, 422 millones de adultos en todo el mundo tenían diabetes en 2014, frente a los 108 millones de 1980. En Colombia la prevalencia de diabetes mellitus 2 oscila entre el 4 y el 8%, en función del rango de edad de la población estudiada. El mestizaje, el envejecimiento y los factores asociados a la urbanización son los principales determinantes de la epidemia de diabetes que se observa en la región. El Valle del Cauca es uno de los departamentos de Colombia donde hay mayor presencia de diabetes. Según registros preliminares del Dane, en el 2014, 890 personas murieron por causa de la diabetes. La directora del Instituto Nacional de Salud, INS, Martha Lucía Ospina, indica que el sobrepeso, la obesidad, la falta de hábitos saludables y el sedentarismo son algunos de los factores que hacen que la enfermedad sea más recurrente . Según explico Carlos Hernán Mejía, nefrólogo y asesor de la Secretaría de Salud Municipal, el Valle del Cauca es uno de los departamentos con mayor índice de sedentarismo, siendo este uno de los principales factores de riesgo. Por ello, se ve necesario renovar la atención a las políticas y las acciones e intervenciones eficaces en salud, basadas en el diagnostico comunitario para mitigar los factores de riesgo que conllevan las ECNT, ampliar el alcance de estas intervenciones, obtener resultados de impacto que contribuyan en la disminución de las complicaciones que generan este tipo de enfermedades crónicas.Diabetes is one of the diseases that most affects the health of human beings and in this 21st century it is a challenge for global health. According to the data and figures included by the WHO, diabetes is a major cause of blindness, kidney failure, myocardial infarction, stroke and lower limb amputation. According to WHO reports, 422 million adults worldwide had diabetes in 2014, up from 108 million in 1980. In Colombia, the prevalence of diabetes mellitus 2 ranges between 4 and 8%, depending on the age range of the study population. Miscegenation, aging and the factors associated with urbanization are the main determinants of the diabetes epidemic observed in the region. Valle del Cauca is one of the departments of Colombia with the highest presence of diabetes. According to preliminary Dane records, in 2014, 890 people died from diabetes. The director of the National Institute of Health, INS, Martha Lucía Ospina, indicates that overweight, obesity, lack of healthy habits and sedentary lifestyle are some of the factors that make the disease more recurrent. According to Carlos Hernán Mejía, nephrologist and advisor to the Municipal Health Secretariat, Valle del Cauca is one of the departments with the highest rate of sedentary lifestyle, this being one of the main risk factors. Therefore, it is necessary to renew attention to policies and actions and the problems affected in health, based on the community diagnosis to mitigate the risk factors associated with CNCDs, expand the scope of these interventions, obtain impact results that contribute to the reduction of complications that occur in this type of chronic disease

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial

Background: Liraglutide 3·0 mg was shown to reduce bodyweight and improve glucose metabolism after the 56-week period of this trial, one of four trials in the SCALE programme. In the 3-year assessment of the SCALE Obesity and Prediabetes trial we aimed to evaluate the proportion of individuals with prediabetes who were diagnosed with type 2 diabetes. Methods: In this randomised, double-blind, placebo-controlled trial, adults with prediabetes and a body-mass index of at least 30 kg/m2, or at least 27 kg/m2 with comorbidities, were randomised 2:1, using a telephone or web-based system, to once-daily subcutaneous liraglutide 3·0 mg or matched placebo, as an adjunct to a reduced-calorie diet and increased physical activity. Time to diabetes onset by 160 weeks was the primary outcome, evaluated in all randomised treated individuals with at least one post-baseline assessment. The trial was conducted at 191 clinical research sites in 27 countries and is registered with ClinicalTrials.gov, number NCT01272219. Findings: The study ran between June 1, 2011, and March 2, 2015. We randomly assigned 2254 patients to receive liraglutide (n=1505) or placebo (n=749). 1128 (50%) participants completed the study up to week 160, after withdrawal of 714 (47%) participants in the liraglutide group and 412 (55%) participants in the placebo group. By week 160, 26 (2%) of 1472 individuals in the liraglutide group versus 46 (6%) of 738 in the placebo group were diagnosed with diabetes while on treatment. The mean time from randomisation to diagnosis was 99 (SD 47) weeks for the 26 individuals in the liraglutide group versus 87 (47) weeks for the 46 individuals in the placebo group. Taking the different diagnosis frequencies between the treatment groups into account, the time to onset of diabetes over 160 weeks among all randomised individuals was 2·7 times longer with liraglutide than with placebo (95% CI 1·9 to 3·9, p<0·0001), corresponding with a hazard ratio of 0·21 (95% CI 0·13–0·34). Liraglutide induced greater weight loss than placebo at week 160 (–6·1 [SD 7·3] vs −1·9% [6·3]; estimated treatment difference −4·3%, 95% CI −4·9 to −3·7, p<0·0001). Serious adverse events were reported by 227 (15%) of 1501 randomised treated individuals in the liraglutide group versus 96 (13%) of 747 individuals in the placebo group. Interpretation: In this trial, we provide results for 3 years of treatment, with the limitation that withdrawn individuals were not followed up after discontinuation. Liraglutide 3·0 mg might provide health benefits in terms of reduced risk of diabetes in individuals with obesity and prediabetes. Funding: Novo Nordisk, Denmark