The Health Impacts of Severe Climate Shocks in Colombia

This paper studies the link between severe weather shocks in Colombia and municipality-level incidence of dengue and malaria. The unexpectedly high variability of the 2010 rainfalls relative to previous periods and their regional heterogeneity are exploited as an identification strategy. A differences-indifferences DD) strategy is thereby implemented where the period 2007-2009 is defined as the pre-treatment period and 2010-2011 as the post-treatment period. The treatment group is all municipalities that experienced higher intra-year rain variability in 2010 than in 2007-2009. The results from the different specifications confirm that the relationship between climate events and vector-borne diseases is intricate. The 2010 weather shocks are associated with not only an increase in the number of dengue cases, in the case of high variability (but not extreme) yearly rain, but also a decrease in its incidence, in particular in the presence of extreme rain events. Floods seem to have decreased the number of dengue cases

Glycaemic control and antidiabetic treatment trends in primary care centres in patients with type 2 diabetes mellitus during 2007-2013 in Catalonia: a population-based study.

OBJECTIVES: To assess trends in prescribing practices of antidiabetic agents and glycaemic control in patients with type 2 diabetes mellitus (T2DM). DESIGN: Cross-sectional analysis using yearly clinical data and antidiabetic treatments prescribed obtained from an electronic population database. SETTING: Primary healthcare centres, including the entire population attended by the Institut Català de la Salut in Catalonia, Spain, from 2007 to 2013. PARTICIPANTS: Patients aged 31-90 years with a diagnosis of T2DM. RESULTS: The number of registered patients with T2DM in the database was 257 072 in 2007, increasing up to 343 969 in 2013. The proportion of patients not pharmacologically treated decreased by 9.7% (95% CI -9.48% to -9.92%), while there was an increase in the percentage of patients on monotherapy (4.4% increase; 95% CI 4.16% to 4.64%), combination therapy (2.8% increase; 95% CI 2.58% to 3.02%), and insulin alone or in combination (increasing 2.5%; 95% CI 2.2% to 2.8%). The use of metformin and dipeptidyl peptidase-IV inhibitors increased gradually, while sulfonylureas, glitazones and α-glucosidase inhibitors decreased. The use of glinides remained stable, and the use of glucagon-like peptide-1 receptor agonists was still marginal. Regarding glycaemic control, there were no relevant differences across years: mean glycated haemoglobin (HbA1c) value was around 7.2%; the percentage of patients reaching an HbA1c≤7% target ranged between 52.2% and 55.6%; and those attaining their individualised target from 72.8% to 75.7%. CONCLUSIONS: Although the proportion of patients under pharmacological treatment increased substantially over time and there was an increase in the use of combination therapies, there have not been relevant changes in glycaemic control during the 2007-2013 period in Catalonia

POLÍNIAS COSTEIRAS DA ANTÁRTICA ATRAVÉS DE UMA REANÁLISE OCEÂNICA DE ALTA RESOLUÇÃO

As polínias costeiras são conhecidas como “fábricas” de gelo marinho com importância, desde aspectos climáticos até biológicos. Os processos que ocorrem nas polínias afetam a formação de águas de fundo, devido ao efeito brine. A alternativa mais usada para investigar as polínias é através do sensoriamento remoto, com o avanço tecnológico em assimilação de dados em modelos oceânicos, os produtos de reanálises oceânicas passam a ser uma alternativa. Assim, este estudo comparou a representação das áreas das polínias no produto da GLO-HR com as observações satelitais a partir da concentração de gelo adquirida pelo sensor AMSR-E. A média da área diária de onze polínias costeiras foi calculada no período de congelamento (2013 – 2016) e a representação foi condizente com as posições relatadas, pois a resolução mais refinada da GLO-HR retrata áreas com maior precisão, porém menores. A salinidade aumentou em quase todas as polínias, porém não houve correlação com a área. A correlação com os ventos demonstrou a direção determinante nas fases de abertura e fechamento das polínias. Concluindo, há mais fatores que auxiliam no fechamento do que na abertura das áreas, e compreender a variabilidade das polínias permite detalhamento nos modelos oceânicos, principalmente aos processos ocorridos na plataforma continental

Cibercrimen e informática forense : introducción y análisis en El Salvador

En este artículo se explica la situación de cibercrimen e informática forense, la importancia e interés dado por los gobiernos alrededor del mundo a este tema y un breve análisis enfocado en El Salvador a raíz de las medidas que abarcan leyes y políticas públicas referentes a ello. Finalmente se emite una crítica y conclusiones acerca del curso de la ciberseguridad en el país

Sobre a relação TS na porção central do atlântico sudoeste: uma contribuição para o estudo da variabilidade oceânica no entorno da Cadeia Vitória-Trindade

The MOVAR (Monitoring the variability of heat transport between Rio de Janeiro-RJ and Trindade Island-ES) project was created in order to study the oceanic circulation south of the Vitória-Trindade seamount chain. The periodic sampling in the area is possible by using ships of opportunity to launch expendable bathythermographs (XBT). In order to investigate the oceanic volume flows using the geostrophic method based on the measured data, which is the temperature only, we have chosen to use a methodology based on the regional correlation between temperature and salinity (TS). Within this context, polynomials of order 1 to 10 were obtained and tested, in order to enable the estimation of salinity as a function of temperature. Hence, to reach this purpose, TS data from the WOD-05 (World Ocean Data Base 2005) as well as ARGO profiles available in the region were used. After a sequence of tests, the polynomials of first to fourth order were discarded, while the remaining polynomials were used to estimate the transport along three sections. The results obtained with the polynomials were very similar to each other leading to the choice of the simpler equation, P5, to represent the TS relation for the region. Estimates of transport were satisfactory and indicated that the polynomial can be used for this purpose.O projeto MOVAR (Monitoramento da Variabilidade do Transporte de Calor entre o Rio de Janeiro-RJ e a Ilha da Trindade-ES) foi criado com intuito de estudar a circulação na região oceânica ao sul da Cadeia Submarina de Vitória-Trindade. A amostragem periódica na área é possível graças ao uso de navios de oportunidade para lançar batitermógrafos descartáveis (XBT). Para investigar os fluxos oceânicos de volume usando o método geostrófico com base nos dados mensurados, temperatura apenas, optou-se por utilizar uma metodologia baseada na correlação regional entre temperatura e salinidade (TS). Dentro deste contexto, foram obtidos e testados polinômios de ordem 1 a 10 que possibilitassem estimar a salinidade em função da temperatura. Para tal foram utilizados dados TS do WOD-05 (World Ocean Data Base 2005) e dos perfiladores ARGO disponíveis na região. Após uma seqüência de testes, os polinômios de primeira a quarta ordem foram descartados, sendo os demais utilizados para estimar o transporte ao longo de três seções. Os resultados obtidos com os polinômios foram muito semelhantes entre si, levando à escolha da equação mais simples, P5, para representar a relação TS da região. As estimativas de transporte foram satisfatórias e indicaram que o polinômio pode ser utilizado para este fim

Evaluation of clinical and antidiabetic treatment characteristics of different sub-groups of patients with type 2 diabetes : Data from a Mediterranean population database

Altres ajuts: Institut Universitari d'Investigació en Atenció Primària Jordi GolAltres ajuts: MSD Spain 4R16/062-1Aims: To describe the characteristics and antidiabetic treatment among type 2 diabetes patients according to the clinical conditions prioritized in the Spanish 2020 RedGDPS (Primary Care Diabetes Study Groups Network) therapeutic algorithm: obesity, older than 75 years, chronic kidney disease, cardiovascular disease, and heart failure. Methods: Retrospective, cross-sectional study. Clinical characteristics, the use of antidiabetic drugs and the KDIGO renal risk categories at 31.12.2016 were retrieved from the SIDIAP (Information System for Research in Primary Care) database (Catalonia, Spain). Results: From a total of 373,185 type 2 diabetes patients, 37% were older than 75 years, 45% obese, 33% had chronic kidney disease, 23.2% cardiovascular disease and 6.9% heart failure. Insulin was more frequently prescribed in chronic kidney disease, cardiovascular disease and heart failure whereas Sodium-Glucose cotransporter 2 inhibitors and Glucagon Like Peptide 1 receptor agonists were scarcely prescribed (2.6% and 1.4%, respectively). Among patients with severe renal failure, contraindicated drugs like metformin (16%) and sulfonylureas (6.1%) were still in use. The 2012 KDIGO renal risk categories distribution was: Low: 60.9%, Moderate: 21.6%, High: 9.8% and Very high: 7.7%. Conclusions: Almost 80% of our T2DM patients meet one of the five clinical conditions that should be considered for treatment individualization. Importantly, a relevant number of patients with severe renal failure were found to use contraindicated drugs

Central de resultats: Revisió de 20 anys d’atenció a la diabetis a Catalunya

Atenció al pacient; Diabetis; CatalunyaAtención al paciente; Diabetes; CataluñaPatient Care; Diabetes; CataloniaCatalunya es troba entre els països de la Unió Europea amb una menor hospitalització per complicacions de la diabetis. Destaca especialment la baixa hospitalització per amputacions. L’any 1993 es va iniciar a Catalunya el primer programa de “Millora Contínua de la Qualitat assistencial (MCQ)” a partir dels indicadors i de les avaluacions periòdiques realitzades pel “Grup d’estudi de la diabetis a l’atenció primària” (GEDAPS). Des de la primera avaluació feta al 1993 s’ha anat observant una progressiva millora en la major part dels indicadors, no només dels de procés assistencial sinó també dels de resultat. Els bons resultats es deuen al lideratge dels professionals de l’atenció primària, l’establiment de les rutes assistencials, la coordinació dels diferents nivells i serveis assistencials, i la implicació dels pacients en el coneixement i control de la malaltia i de l’Administració.Cataluña se encuentra entre los países de la Unión Europea con una menor hospitalización por complicaciones de la diabetes. Destaca especialmente la baja hospitalización por amputaciones. En 1993 se inició en Cataluña el primer programa de "Mejora Continua de la Calidad asistencial (MCQ)" a partir de los indicadores y de las evaluaciones periódicas realizadas por el "Grupo de estudio de la diabetes en la atención primaria" (GEDAPS). Desde la primera evaluación realizada en 1993 ha ido observando una progresiva mejora en la mayor parte de los indicadores, no sólo los de proceso asistencial sino también de los de resultado. Los buenos resultados se deben al liderazgo de los profesionales de la atención primaria, el establecimiento de las rutas asistenciales, la coordinación de los diferentes niveles y servicios asistenciales, y la implicación de los pacientes en el conocimiento y control de la enfermedad y de la Administración

Prevalence of pre-diabetes and undiagnosed diabetes in the Mollerussa prospective observational cohort study in a semi-rural area of Catalonia

Objectives: To assess the prevalence of undiagnosed diabetes and pre-diabetes in the healthy population in the Mollerussa cohort. As a secondary objective, to identify the variables associated with these conditions and to describe the changes in glycaemic status after 1 year of follow-up in subjects with pre-diabetes. Design: Prospective observational cohort study. Setting: General population from a semi-rural area. Participants: The study included 583 participants without a diagnosis of diabetes recruited between March 2011 and July 2014. Results: The prevalence of undiagnosed diabetes was 20, 3.4% (95% CI 2.6 to 4.2) and that of pre-diabetes was 229, 39.3% (37.3 to 41.3). Among those with pre-diabetes, 18.3% had isolated impaired fasting plasma glucose (FPG) (FPG: 100 to <126 mg/dL), 58.1% had isolated impaired glycated haemoglobin (HbA1c) (HbA1c 5.7 to <6.5) and 23.6% fulfilled both criteria. Follow-up data were available for 166 subjects; 41.6%(37.8 to 45.4) returned to normoglycaemia, 57.6% (57.8 to 61.4) persisted in pre-diabetes and 0.6% (0 to 1.2) progressed to diabetes. Individuals with pre-diabetes had worse cardiometabolic risk profiles and sociodemographic features than normoglycaemic subjects. In the logistic regression model, variables significantly associated with pre-diabetes were older age (OR; 95% CI) (1.033; 1.011 to 1.056), higher physical activity (0.546; 0.360 to 0.827), body mass index (1.121; 1.029 to 1.222) and a family history of diabetes (1.543; 1.025 to 2.323). The variables significantly associated with glycaemic normalisation were older age (0.948; 0.916 to 0.982) and body mass index (0.779; 0.651 to 0.931). Conclusions: Among adults in our region, the estimated prevalence of undiagnosed diabetes was 3.4% and that of pre-diabetes was 39.3%. After a 1-year follow-up, a small proportion of subjects (0.6%) with pre-diabetes progressed to diabetes, while a high proportion (41.6%) returned to normoglycaemia. Individuals with pre-diabetes who returned to normoglycaemia were younger and had a lower body mass inde

Trends in the Degree of Control and Treatment of Cardiovascular Risk Factors in People With Type 2 Diabetes in a Primary Care Setting in Catalonia During 2007-2018

Objective: To assess the trends in cardiovascular risk factor control and drug therapy from 2007 to 2018 in subjects with type 2 diabetes mellitus (T2DM). Materials and Methods: Cross-sectional analysis using yearly clinical data and treatment obtained from the SIDIAP database. Patients aged ≥18 years with a diagnosis of T2DM seen in primary care in Catalonia, Spain. Results: The number of T2DM patients increased from 299,855 in 2007 to 394,266 in 2018. We also found an increasing prevalence of cardiovascular disease, heart failure, and chronic kidney disease (from 18.4 to 24.4%, from 4.5 to 7.3%, and from 20.2 to 31.3%, respectively). The achievement of glycemic targets (HbA1c<7%) scarcely changed (54.9% to 55.9%). Major improvements were seen in blood pressure (≤140/90 mmHg: from 55% to 71.8%), and in lipid control (low-density lipoprotein cholesterol <100 mg/dl: 33.4% to 48.4%), especially in people with established cardiovascular disease (48.8 to 69.7%). Simultaneous achievement of all three targets improved from 12.5% to 20.1% in the overall population and from 24.5% to 32.2% in those with cardiovascular disease but plateaued after 2013. There was an increase in the percentage of patients treated with any antidiabetic drug (70.1% to 81.0%), especially metformin (47.7% to 67.7%), and DPP4i (0 to 22.6%). The use of SGLT-2 and GLP-1ra increased over the years, but remained very low in 2018 (5.5% and 2.1% of subjects, respectively). There were also relevant increases in the use of statins (38.0% to 49.2%), renin-angiotensin system (RAS) drugs (52.5% to 57.2%), and beta-blockers (14.3% to 22.7%). Conclusions: During the 2007-2018 period, relevant improvements in blood pressure and lipid control occurred, especially in people with cardiovascular disease. Despite the increase in the use of antidiabetic and cardiovascular drugs, the proportion of patients in which the three objectives were simultaneously achieved is still insufficient and plateaued after 2013. The use of antidiabetic drugs with demonstrated cardio renal benefits (SGLT-2 and GLP-1ra) increased over the years, but their use remained quite low