Eco-Epidemiology of Chagas Disease in Chile

There are four vector species of Chagas disease in Chile: Triatoma infestans, responsible for the domestic cycle; Mepraia spinolai, the main wild vector; and M. gajardoi and M. parapatrica, two coastal wild species whose importance as vectors is not well known. They are species of dry environments of the central-north region of Chile, whose best predictors of distribution are warm average temperatures and low rainfall. They are found in rock quarries, nests of birds, and small mammals, and T. infestans has sylvatic foci associated with a Bromeliaceae species. While human blood represents 70% of the diet of T. infestans, in M. spinolai this value is 7%, which means that a large part of Chagas disease in Chile is due to T. infestans. However, all species have high percentages of T. cruzi infection. Chagas disease in Chile follows the distribution of T. infestans, and although the cycle of domestic transmission by this vector is interrupted, there is still a constant prevalence and mortality and ascending incidences. Models predict that although climate change will not vary greatly the north-south distribution of vectors, it could increase the reproductive number of the disease, increasing risk areas of Chagas disease

Relación entre parentalidad, depresión, ansiedad y estrés y el fenómeno de la ideación suicida durante la adolescencia

82 p.El presente estudio tiene como objetivo estimar los efectos de las variables parentales de control psicológico, apoyo, demanda, y depresión, ansiedad y estrés sobre la ideación suicida durante la adolescencia. La muestra comprende 243 adolescentes de diez a 17 años de edad (125 mujeres y 118 hombres) que residen en la Comuna de Curepto, Región del Maule, Chile. El estudio es de carácter cuantitativo, transversal y no experimental, buscando establecer la relación entre las variables dependientes ideación suicida en el peor momento de la vida y durante el último mes con las independientes control psicológico madre y padre, apoyo, demanda, ansiedad, estrés, depresión, sexo y edad. Para ésto se realizó un análisis correlacional y de regresión lineal múltiple para analizar las posibles influencias que pueden tener las variables independientes. Se obtuvieron dos principales resultados: 1) el control psicológico del padre y de la madre, y la depresión, ansiedad y estrés se relacionaron positivamente con la ideación suicida durante la adolescencia; 2) el apoyo actúa como factor protector ante la ideación suicida. Adicionalmente, se encontraron diferencias entre ideación suicida y sexo, ideación y adolescencia temprana (diez a catorce años) o media (quince a 17 años), e ideación y situación de pareja de los padres (separados o no), presentando mayor ideación el sexo femenino, los adolescentes que se encuentran en la adolescencia media y aquellos cuyos padres están separados. Palabras Clave Adolescencia, ideación suicida, parentalidad, depresión, ansiedad, estrés

Impact of type 2 diabetes on life expectancy and role of kidney disease among inpatients with heart failure in Switzerland: an ambispective cohort study.

BACKGROUND Type 2 diabetes (T2D) is expected to worsen the prognosis of inpatients with heart failure (HF) but the evidence from observational studies is inconsistent. We aimed to compare mortality outcomes and life expectancy among inpatients with HF with or without T2D and explored whether chronic kidney disease (CKD) influenced these associations. METHODS We collected hospital and civil registry records of consecutive inpatients from a tertiary hospital in Switzerland with a diagnosis of HF from the year 2015 to 2019. We evaluated the association of T2D with mortality risk using Cox regression and adjusted for confounders. RESULTS Our final cohort consisted of 10,532 patients with HF of whom 27% had T2D. The median age (interquartile range [IQR]) was 75 [68 to 82] and 78 [68 to 86] for the diabetes and non-diabetes groups, respectively. Over a median follow-up [IQR] of 4.5 years [3.3 to 5.6], 5,347 (51%) of patients died. T2D patients had higher risk of all-cause mortality (hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.14 to 1.29). Compared to control (i.e. no T2D nor CKD), average life expectancy (95% CI) among T2D patients, CKD, or both was shorter by 5.4 months (95% CI 1.1 to 9.7), 9.0 months (95% CI 8.4 to 9.6), or 14.8 months (95% CI 12.4 to 17.2), respectively. No difference by sex or ejection fraction category was observed. CONCLUSIONS T2D is associated with a significantly higher risk of all-cause mortality and shorter life expectancy compared to those without among middle-aged and elderly inpatients with HF; presence of CKD may further increase these risks

GLP-1 Receptor Agonists and Coronary Arteries: From Mechanisms to Events.

Objective: Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) lower plasma glucose through effects on insulin and glucagon secretion and by decelerating gastric emptying. GLP-1 RAs have many beneficial effects beyond glycemic control, including a protective role on the cardiovascular system. However, underlying mechanisms linking GLP-1 RAs with coronary artery disease are complex and not fully elucidated. In this mini-review, we discuss these mechanisms and subsequent clinical events. Data Sources: We searched PubMed and Google Scholar for evidence on GLP-1 RAs and coronary events. We did not apply restrictions on article type. We reviewed publications for clinical relevance. Synopsis of Content: In the first part, we review the current evidence concerning the role of GLP-1 RAs on potential mechanisms underlying the development of coronary events. Specifically, we discuss the role of GLP-1 RAs on atherosclerosis and vasospasms of epicardial coronary arteries, as well as structural/functional changes of coronary microvasculature. In the second part, we summarize the clinical evidence on the impact of GLP-1 RAs in the prevention of acute and chronic coronary syndromes and coronary revascularization. We conclude by discussing existing gaps in the literature and proposing directions for future research

Denominación de Origen del Producto Mezcal y Desarrollo Local Sustentable en Michoacán: Prácticas de Producción más Limpia

EL presente artículo tiene como objetivo identificar la problemática de la región productiva del producto mezcal en el estado de Michoacán y sus prácticas sustentables, que aporten elementos al desarrollo local sustentable (DLS) a pesar de contar con el reconocimiento Denominación de Origen (DO). La unidad de análisis es la Sociedad de Producción Rural, destiladora, que reúne a 29 Vinatas de la región. Como metodología: Se revisó la información pública y de artículos especializados, se aplicó la herramienta Producción Más Limpia (P+L) y un análisis FODA mediante entrevistas a productores y presidente de la organización, en la localidad de Etúcuaro. Se encontró que las unidades productoras de mezcal llamadas Vinatas en la Región de Producción Mezcalera de Michoacán están siendo impulsadas a incrementar sus niveles de producción que les permita tener mayor participación en el mercado regional, nacional e internacional, pero la incipiente visión sobre la importancia de la dimensión ambiental y la organización de la producción impide el logro de tales objetivos. Algunas de las conclusiones sugieren que las unidades productoras de mezcal deben adoptar prácticas sustentables que permitan (a los productores de mezcal) no solo potenciar su endeble DO, mejorar su producción y organización laboral, sino también convertirse en actores del DLS

On the continuous processing of health data in edge-fog-cloud computing by using micro/nanoservice composition

The edge, the fog, the cloud, and even the end-user's devices play a key role in the management of the health sensitive content/data lifecycle. However, the creation and management of solutions including multiple applications executed by multiple users in multiple environments (edge, the fog, and the cloud) to process multiple health repositories that, at the same time, fulfilling non-functional requirements (NFRs) represents a complex challenge for health care organizations. This paper presents the design, development, and implementation of an architectural model to create, on-demand, edge-fog-cloud processing structures to continuously handle big health data and, at the same time, to execute services for fulfilling NFRs. In this model, constructive and modular $blocks$ , implemented as microservices and nanoservices, are recursively interconnected to create edge-fog-cloud processing structures as ¿This work was supported in part by the Council for Science and Technology of Mexico (CONACYT) through the Basic Scientific Research under Grant 2016-01-285276, and in part by the Project CABAHLA-CM: Convergencia Big data-Hpc: de los sensores a las Aplicaciones from Madrid Regional Government under Grant S2018/TCS-4423

A 7-Step Guideline for Qualitative Synthesis and Meta-Analysis of Observational Studies in Health Sciences

Objectives: To provide a step-by-step, easy-to-understand, practical guide for systematic review and meta-analysis of observational studies. Methods: A multidisciplinary team of researchers with extensive experience in observational studies and systematic review and meta-analysis was established. Previous guidelines in evidence synthesis were considered. Results: There is inherent variability in observational study design, population, and analysis, making evidence synthesis challenging. We provided a framework and discussed basic meta-analysis concepts to assist reviewers in making informed decisions. We also explained several statistical tools for dealing with heterogeneity, probing for bias, and interpreting findings. Finally, we briefly discussed issues and caveats for translating results into clinical and public health recommendations. Our guideline complements "A 24-step guide on how to design, conduct, and successfully publish a systematic review and meta-analysis in medical research" and addresses peculiarities for observational studies previously unexplored. Conclusion: We provided 7 steps to synthesize evidence from observational studies. We encourage medical and public health practitioners who answer important questions to systematically integrate evidence from observational studies and contribute evidence-based decision-making in health sciences

Mental health of migrants with pre-migration exposure to armed conflict: a systematic review and meta-analysis.

BACKGROUND Exposure to armed conflict has been associated with negative mental health consequences. We aimed to estimate the prevalence of generalised anxiety disorder, major depressive disorder, and post-traumatic stress disorder among migrants exposed to armed conflict. METHODS In this systematic review and meta-analysis, we searched online databases (Cochrane Library, Embase, LILACS, PsycInfo [via Ovid], PubMed, and Web of Science Core Collection) for relevant observational studies published between Jan 1, 1994, and June 28, 2021. We included studies that used standardised psychiatric interviews to assess generalised anxiety disorder, major depressive disorder, or post-traumatic stress disorder among migrants (refugees or internally displaced persons; aged ≥18 years) with pre-migration exposure to armed conflict. We excluded studies in which exposure to armed conflict could not be ascertained, studies that included a clinical population or people with chronic diseases that can trigger the onset of mental disease, and studies published before 1994. We used a random effects model to estimate each mental health disorder's pooled prevalence and random effects meta-regression to assess sources of heterogeneity. Two independent reviewers assessed the risk of bias for each study using the Joanna Briggs Institute Checklist for Prevalence Studies. The protocol was registered with PROSPERO, CRD42020209251. FINDINGS Of the 13 935 studies identified, 34 met our inclusion criteria; these studies accounted for 15 549 migrants. We estimated a prevalence of current post-traumatic stress disorder of 31% (95% CI 23-40); prevalence of current major depressive disorder of 25% (17-34); and prevalence of generalised anxiety disorder of 14% (5-35). Younger age was associated with a higher prevalence of current post-traumatic stress disorder (odds ratio 0·95 [95% CI 0·90-0·99]), lifetime post-traumatic stress disorder (0·88 [0·83-0·92]), and current generalised anxiety disorder (0·87 [0·78-0·97]). A longer time since displacement was associated with a lower lifetime prevalence of post-traumatic stress disorder (0·88 [0·81-0·95]) and major depressive disorder (0·81 [0·77-0·86]). Migrating to a middle-income (8·09 [3·06-21·40]) or low-income (39·29 [11·96-129·70]) country was associated with increased prevalence of generalised anxiety disorder. INTERPRETATION Migrants who are exposed to armed conflict are at high risk of mental health disorders. The mental health-care needs of migrants should be assessed soon after resettlement, and adequate care should be provided, with particular attention paid to young adults. FUNDING Marie Skłodowska-Curie Actions (Horizon 2020-COFUND), MinCiencias (Colombia), and Swiss National Science Foundation

Emergent complex neural dynamics

A large repertoire of spatiotemporal activity patterns in the brain is the basis for adaptive behaviour. Understanding the mechanism by which the brain's hundred billion neurons and hundred trillion synapses manage to produce such a range of cortical configurations in a flexible manner remains a fundamental problem in neuroscience. One plausible solution is the involvement of universal mechanisms of emergent complex phenomena evident in dynamical systems poised near a critical point of a second-order phase transition. We review recent theoretical and empirical results supporting the notion that the brain is naturally poised near criticality, as well as its implications for better understanding of the brain