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

Global variations in diabetes mellitus based on fasting glucose and haemogloblin A1c

Fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) are both used to diagnose diabetes, but may identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening had elevated FPG, HbA1c, or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardised proportion of diabetes that was previously undiagnosed, and detected in survey screening, ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the agestandardised proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global gap in diabetes diagnosis and surveillance.peer-reviewe

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

Vamos de excursión ...

No publicado.La Unidad Didáctica ha sido realizada por un grupo de profesores de Educación Física de León, pertenecientes al Primer Ciclo de Educación Primaria. El área de la Educación Física dentro de la presente Unidad Didáctica tiene por objetivo el desarrollo motriz del alumno a partir del trabajo global de los contenidos del área. Este trabajo está dirigido al Primer Ciclo de Educación Primaria, en una edad comprendida entre los seis y ocho años. Los alumnos es este momento tendrán por primera vez esta asignatura impartida por un especialista, mostrando un gran entusiasmo hacia la materia, lo cual será aprovechado por el profesor como elemento motivante para la consecución de los objetivos y fines propuestos. Se ha tomado como hilo conductor la expresión 'Vamos de excursión' ya que permite trabajar aspectos lúdicos, expresivos, comunicativos y de fantasía, motivados por la atracción que los alumnos sienten en esta etapa de su vida hacia los viajes y conocimiento de situaciones nuevas. Así mismo se ha escogido por el abanico de posibilidades que facilitaba este vínculo para poder tratar de forma globalizada los cinco bloques de contenidos. La metodología se ha basado fundamentalmente en actividades lúdicas y situaciones de juego en sus distintos tratamientos (sensoriales, motrices, expresivos, relajantes, etc.) Se facilita el trabajo en otro tipo de actividades como pueden ser las extraescolares : excursiones, visitas, salidas, etc. Así como también repercutirá beneficiosamente en la mejora de otras áreas. El trabajo ha sido realizado por especialistas en Educación Física, y como tal se han centrado en dicho campo de trabajo, pero recordando que tendría que integrarse dentro de una Unidad Didáctica elaborada por todo el equipo docente para darle un carácter globalizador. Los objetivos didácticos que se persiguen son los siguientes: utilizar las capacidades físicas básicas y destrezas motrices para mejorar las posibilidades de movimiento; desarrollar y afianzar las funciones de control, ajuste y dominio corporal; mejorar la percepción espacio-temporal; utilizar el cuerpo como elemento de expresión y comunicación; desarrollar hábitos de higiene y salud corporal; participar en las actividades respetando a los compañeros y materiales y cooperar con los demás. La unidad didáctica se estructura en cinco bloques: El cuerpo 'Imagen y percepción'; El cuerpo 'Habilidades y destrezas'; El cuerpo 'Expresión y comunicación'; Salud corporal y Juegos. La evaluación se basará en la observación sistemática, planificada, concreta y delimitada en el desarrollo de las sesiones para conseguir informaciones que serán registradas en los instrumentos pertinentes. Se evaluará de forma contínua, partiendo de una evaluación inicial. Durante el proceso de enseñanza-aprendizaje se realizará una evaluación formativa para obtener información relativa a este proceso y para informar al alumno sobre su aprendizaje. Por último se desarrollará una evaluación sumativa de la Unidad Didáctica que tendrá por objeto obtener informaciones relativas al grado de consecución de los objetivos. Es importante también que el maestro valore su práctica docente, para lo cual planificará y sistematizará el registro de su intervención.El material utilizado es variado: cassette, cintas de cassette, pañuelos y cintas, saquitos de arena, pelotas, aros, espalderas, cartulinas, rotuladores, tijeras y cuerdas. Las sesiones se realizan en el patio, el gimnasio y el parque de tráfico, donde colaborará el monitor del parque y se utilizarán doce bicicletas..CEP de LeónCastilla y LeónES

Juegos y deportes alternativos

Se presenta un Proyecto educativo dentro del área de Educación Física dirigido a alumnos de Educación Primaria, consistente en una serie de juegos y deportes distintos a los más conocidos. Los autores ofrecen un material alternativo para ser utilizado en los centros educativos, que por lo general no disponen de un mínimo material y de unas instalaciones adecuadas. Estos juegos y deportes aportan experiencias no habituales en el niño, que enriquecen su autoconocimiento, pudiendo influir a través de él en los distintos contenidos del Currículum : Esquema Corporal, Educación Rítmica, Coordinación, etc. Los alumnos pueden elaborarlos ellos mismos, ya que son de fácil diseño y adquisición, y se pueden adaptar a sus características físicas, con lo cual se disminuye el riesgo de accidentes. La metodología se basa en tres puntos: investigación y conocimiento por parte del profesor de todas las posibilidades que ofrece este material, pudiendo seleccionar los objetivos y contenidos que le interesen alcanzar; presentación del material, su técnica de elaboración, dificultades, motivación y construcción; aplicación práctica tomando las propuestas que haga el profesor y las que vayan surgiendo por parte de los alumnos. La evaluación se realizaría desde cinco enfoques: autoevaluación por parte de los alumnos, evaluación del proceso seguido con el fin de analizar , detectar y corregir todos los aspectos implicados en el proceso; una evaluación del trabajo de los alumnos y una evaluación de éstos del trabajo del profesor. Los materiales a utilizar serían cartón, sacos, periódicos, cajas de zapatos, etc..CEP de LeónCastilla y LeónES

Las instalaciones deportivas

No publicadoEl grupo de Especialistas de Educación Física surgió a raíz del Curso de especialización de E.F. convocado por el M.E.C. en 1989, y por el interés de sus componentes hacia la E.F. y el deporte en el ámbito escolar. Integrado por ocho profesores de esta disciplina en el Colegio Público González de Lama (León), Colegio Público de Villaverde de Arcayos (León) y del Colegio Público de Cistierna (León). Se ha realizado un trabajo de investigación sobre aspectos un tanto desconocidos y que tienen una importante incidencia en el ámbito de esta disciplina, como son las instalaciones deportivas. Los objetivos fueron los siguientes: analizar la problemática existente en torno a los espacios escolares en lo que a Educación Física se refiere; investigar sobre los diferentes tipos de instalaciones, sus ventajas e inconvenientes, y hacia dónde apuntan las nuevas técnicas de vanguardia en este tipo de construcciones; realizar un estudio del estado de las instalaciones deportivas en la provincia de León. El desarrollo de la experiencia se ha basado en tres puntos: debates y puestas en común sobre lo referente a las instalaciones deportivas; realización de gráficos ilustrativos; investigación de las necesidades existentes y en función de ellas elaborar una propuesta. La metodología se ha basado en la participación en seminarios y ponencias relativas al tema, trabajos de investigación en pequeños grupos y por zonas, puestas en común para obtención de conclusiones, elaboración de un informe y memoria final. Se han analizado los distintos aspectos de un sistema deportivo y las implicaciones que éste tiene en las instalaciones deportivas. Esto da pie al estudio de las instalaciones propiamente dichas: tipos, pavimentación, iluminación, vestuarios, etc. También se han estudiado las zonas de juegos para niños en cuanto a su acondicionamiento, equipamiento, y organización del espacio. como conclusión, el grupo estima que el modelo ideal sería el cercano al existente en algunos países centroeuropeos y al ofertado por algunos clubs privados, el modelo de grandes centros integrados polivalentes en torno a la escuela, abiertos a toda la comunidad, gestionados por Instituciones o Consejos Locales..Ministerio de Educación y CulturaCastilla y LeónES

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective