Factors associated with Chagas screening among immigrants from an endemic country in Madrid, Spain

INTRODUCTION: Approximately 120,000 people live with Chagas disease in Europe, 43% of whom are living in Spain. Early diagnosis and treatment are critical to improve outcomes for those living with Chagas, and also for the prevention of ongoing transmission. The decision to be tested for Chagas is affected by a range of factors. Studies have highlighted the need to consider the wider social determinants of healthcare seeking behaviour related to Chagas. In Madrid, 44% of Bolivians undergo Chagas screening, which is a higher rate than other European regions, but studies concerning the factors which determine testing have not been performed. This study aimed to assess, for a first time, the factors associated with screening for Chagas among Bolivians living in Madrid trying to help in developing strategies and health recommendations. METHODS: This was a cross-sectional survey about knowledge of Chagas and practices of Bolivians living in Madrid, Spain. A structured questionnaire was administered to 376 participants regarding Chagas health-seeking behaviour. Determinants were assessed by multiple logistic regressions adjusted by sex. RESULTS: After adjusting for others variables and sex, the factors shown to be associated with Chagas screening were to have between 35 and 54 years of age; coming from a department with high prevalence of Chagas (OR 2.17 95% CI 0.99-4.76); received information about Chagas in Spain (OR 2.44 95% CI 1.32-4.51); and received any advice to do the test, especially if the advice came from a professional. CONCLUSIONS: Health authorities should coordinate and promote strategies addressed to diagnose and treat Chagas taking into account all factors associated with screening. Our study suggests that professional advice appears to be the cornerstone to encourage Bolivians to undergo Chagas screening in Madrid. It is time to change the burden of the decision of being screened from the patient to the doctor. Being diagnosed for Chagas needs to become an institutional strategy.This study was funding by the Insituto de Salud Carlos III (www.isciii.es)PI15CIII/00047 to TBH. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Diagnostic pathways of Chagas disease in Spain: a qualitative study

Background: Due to the mobility of the population in recent years and the spread of Chagas disease (CD) to non-endemic regions, early diagnosis and treatment of CD has become increasingly relevant in non-endemic countries. In order for screening to be effective, health system accessibility must be taken into consideration. This study uses Tanahashi's Health Service Coverage model to gain a deeper understanding of the main diagnostic pathways for Chagas disease in a non-endemic country and the barriers and bottlenecks present in each pathway. Methods: This study used a qualitative design with a phenomenological approach. Twenty-one interviews, two focus group sessions, and two triangular group sessions were conducted between 2015 and 2018 with 37 Bolivian men and women diagnosed with CD in Madrid, Spain. A topic guide was designed to ensure that the interviewers obtained the data concerning knowledge of CD (transmission, symptoms, and treatment), attitudes towards CD, and health behaviour (practices in relation to CD). All interviews, focus groups and triangular groups were recorded and transcribed. A thematic, inductive analysis based on Grounded Theory was performed by two researchers. Results: Three main pathways to CD diagnosis were identified: 1) pregnancy or blood/organ donation, with no bottlenecks in effective coverage; 2) an individual actively seeking CD testing, with bottlenecks relating to administrative, physical, and time-related accessibility, and effectiveness based on the healthcare professional's knowledge of CD; 3) an individual not actively seeking CD testing, who expresses psychological discomfort or embarrassment about visiting a physician, with a low perception of risk, afraid of stigma, and testing positive, and with little confidence in physicians' knowledge of CD. Conclusions: Existing bottlenecks in the three main diagnostic pathways for CD are less prevalent during pregnancy and blood donation, but are more prevalent in individuals who do not voluntarily seek serological testing for CD. Future screening protocols will need to take these bottlenecks into consideration to achieve effective coverage.This study was funded by the Carlos III Institute of Health (www.isciii.es) PI15CIII/00047. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors received no specific funding for this work.S

Mapping health behaviour related to Chagas diagnosis in a non-endemic country: Application of Andersen's Behavioural Model

Background: Chagas disease has become a challenge for non-endemic countries since population mobility has increased in recent years and it has spread to these regions. In order to prevent vertical transmission and improve the prognosis of the disease, it is important to make an early diagnosis. And to develop strategies that improve access to diagnosis, it is important to know the factors that most influence the decision of the population to know their serological status. For this reason, this study uses Andersen's Behavioural Model and its proposed strategies to explore the health behaviours of Bolivian population. Methods: Twenty-three interviews, two focus groups, and two triangular groups were performed with Bolivian men and women, involving a total of 39 participants. In addition, four interviews were conducted with key informants in contact with Bolivian population to delve into possible strategies to improve the Chagas diagnosis. Results: The most relevant facts for the decision to being diagnosed pointed out by participants were having relatives who were sick or deceased from Chagas disease or, for men, having their pregnant wife with a positive result. After living in Spain more than ten years, population at risk no longer feels identified with their former rural origin and the vector. Moreover, their knowledge and awareness about diagnosis and treatment still remains low, especially in younger people. Limitations on access to healthcare professionals and services were also mentioned, and proposed strategies focused on eliminating these barriers and educating the population in preventive behaviours. Conclusions: Based on Andersen's Behavioural Model, the results obtained regarding the factors that most influence the decision to carry out Chagas diagnosis provide information that could help to develop strategies to improve access to health services and modify health behaviours related to Chagas screening.This study was funded by the Instituto de Salud Carlos III (www.isciii.es) PI15CIII/00047 to TBH. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors received no specific funding for this work.S

Characterizing the hydrogeochemistry of two low-temperature thermal systems in Central Mexico

Two low-temperature geothermal systems located at the Trans-Mexican Volcanic Belt with presence of fluoride and arsenic were studied with the aim to determine hydrogeochemical indicators of the toxic elements' presence, and to propose adequate geothermometers. The hydrogeological and geochemical study was carried out in Ixtapan de la Sal and Tonatico (IxS-T) and Santa Cruz de Juventino Rosas (JR), both located at the limits of the Trans-Mexican Volcanic Belt (TMVB). In these regions, low-temperature geothermal activity is present (T = 32–47 °C), and various fault and fracture systems have been identified. Several faults are active, enabling the upward flow of deep geothermal water. The geothermal waters of IxS-T manifest in the form of springs and have high Na+ and Cl− concentrations, whereas those of JR are captured in wells and mainly present high Na+ and HCO3 – concentrations. The hydrochemistry of water samples was analyzed to determine the dominant hydrogeochemical processes in both regions. These data were also useful for understanding the natural origin of the high levels of arsenic and fluoride reported in the water, which are likely due to mineral dissolution processes. The concentrations of these elements surpassed the permissible limits according to Mexican law (Astot = 0.025 mg/L; F− = 1.5 mg/L) and represent a toxicity risk for the local populations. The groundwater at JR supplies all needs of the local population, while the water at IxS-T is mainly used for recreational and health spa purposes. Increasing trends of As and F− in the sedimentary aquifer of IxS-T are related with the increase in TDS, Cl−, HCO3 – and SiO2, while silicate alteration releasing Na and HCO3 – are related with As and F− presence in the volcanic aquifer of JR. Reservoir temperature was adequately estimated with K2 /Mg and Na-K-Ca (Mg corrected) geothermometers at IxS-T, and with chalcedony and quartz geothermometers at JRUAEM 3716/201

Monitoring and modeling of household air quality related to use of different Cookfuels in Paraguay.

In Paraguay, 49% of the population depends on biomass (wood and charcoal) for cooking. Residential biomass burning is a major source of fine particulate matter (PM2.5 ) and carbon monoxide (CO) in and around the household environment. In July 2016, cross-sectional household air pollution sampling was conducted in 80 households in rural Paraguay. Time-integrated samples (24 hours) of PM2.5 and continuous CO concentrations were measured in kitchens that used wood, charcoal, liquefied petroleum gas (LPG), or electricity to cook. Qualitative and quantitative household-level variables were captured using questionnaires. The average PM2.5 concentration (μg/m3 ) was higher in kitchens that burned wood (741.7 ± 546.4) and charcoal (107.0 ± 68.6) than in kitchens where LPG (52.3 ± 18.9) or electricity (52.0 ± 14.8) was used. Likewise, the average CO concentration (ppm) was higher in kitchens that used wood (19.4 ± 12.6) and charcoal (7.6 ± 6.5) than in those that used LPG (0.5 ± 0.6) or electricity (0.4 ± 0.6). Multivariable linear regression was conducted to generate predictive models for indoor PM2.5 and CO concentrations (predicted R2  = 0.837 and 0.822, respectively). This study provides baseline indoor air quality data for Paraguay and presents a multivariate statistical approach that could be used in future research and intervention programs

Small-Extracellular-Vesicle-Derived miRNA Profile Identifies miR-483-3p and miR-326 as Regulators in the Pathogenesis of Antiphospholipid Syndrome (APS)

Antiphospholipid syndrome; Pathogenesis; Small extracellular vesicleSíndrome antifosfolípid; Patogènesi; Petita vesícula extracel·lularSíndrome antifosfolípido; Patogénesis; Pequeña vesícula extracelularPrimary antiphospholipid syndrome (PAPS) is a systemic autoimmune disease associated with recurrent thrombosis and/or obstetric morbidity with persistent antiphospholipid antibodies (aPL). Although these antibodies drive endothelial injury and thrombophilia, the underlying molecular mechanism is still unclear. Small extracellular vesicles (sEVs) contain miRNAs, key players in intercellular communication. To date, the effects of miRNA-derived sEVs in PAPS are not well understood. We characterised the quantity, cellular origin and miRNA profile of sEVs isolated from thrombotic APS patients (PAPS, n = 50), aPL-carrier patients (aPL, n = 30) and healthy donors (HD, n = 30). We found higher circulating sEVs mainly of activated platelet origin in PAPS and aPL patients compared to HD, that were highly engulfed by HUVECs and monocyte. Through miRNA-sequencing analysis, we identified miR-483-3p to be differentially upregulated in sEVs from patients with PAPS and aPL, and miR-326 to be downregulated only in PAPS sEVs. In vitro studies showed that miR-483-3p overexpression in endothelial cells induced an upregulation of the PI3K-AKT pathway that led to endothelial proliferation/dysfunction. MiR-326 downregulation induced NOTCH pathway activation in monocytes with the upregulation of NFKB1, tissue factor and cytokine production. These results provide evidence that miRNA-derived sEVs contribute to APS pathogenesis by producing endothelial cell proliferation, monocyte activation and adhesion/procoagulant factors

Economic analysis of Steel consumption in Mexico

Se determinó el efecto del cambio en los principales factores que explican el consumo de acero en México así como el impacto de precios internacionales de este producto en el precio de venta, a través de un modelo de ecuaciones simultáneas 1980-2016.In 2016, the apparent world consumption of steel was more than 1,630 million tons. World exports of steel were concentrated by China and Japan with 22.8%, Mexico imported 21% of those made by North America; what impacted on the internal dynamics of its steel consumption. To determine the effect of the change in the main factors that explain the consumption of Mexican steel; As well as quantifying the level of impact of the international price of this commodity on the steel wholesale price in Mexico, a model of simultaneous equations was estimated with annual information from 1980 to 2016; integrated by 3 regression equations. The results indicate that in the short term the steel consumption in Mexico responds inelastically (- 0.2354%) before changes of 1% in the own price. The changes in the price of the factors that most affect consumption are the urbanization process, the national income per capita and the price of housing with price-cross elasticities of 0.5518, 0.4720 and 0.3596. The effect of the international price of steel and the cost of transportation in Mexico, affect the wholesale price at a level of 0.0513 and 1.0521%, for each unit percentage change in the first ones

Analytical strategy to investigate 3,4-methylenedioxypyrovalerone (MDPV) metabolites in consumers’ urine by high-resolution mass spectrometry

The potential of high-resolution mass spectrometry (HRMS) for the investigation of human in vivo metabolism of 3,4-methylenedioxypyrovalerone (MDPV) using urine collected from a consumer (this is, in non-controlled experiments) has been investigated. As a control sample was not available, the common approach based on the comparison of a control/blank sample and samples collected after drug intake could not be used. Alternatively, an investigation based on common fragmentation pathways was applied, assuming that most metabolites share some fragments with the parent drug. An extension of this approach was also applied based on the fragmentation pathway of those metabolites identified in urine samples in the first step. The use of MSE experiments (sequential acquisition of mass spectra at low and high collision energy) has been crucial to this aim as it allowed promoting fragmentation in the collision cell without any previous precursor ion selection. MDPV belongs to the group of new psychoactive substances (NPS), being known as the “cannibal drug”. This substance is being abused more and more and is associated with dangerous side effects. The human metabolites (both phase I and phase II) were detected and tentatively identified by accurate mass full-spectrum measurements using ultra-high performance liquid chromatography coupled to hybrid quadrupole time-of-flight mass spectrometry (UHPLC-QTOF MS). Following this strategy, up to 10 phase I metabolites, together with some glucuronides and sulphates, were detected and tentative structures were proposed. Several compounds identified in this work have not been previously reported in the literature.MINECO (CTQ2012-36189) i Generalitat Valenciana (research group of excellence PROMETEOII/2014/023; ISIC Envi-Food 2014/016). Spanish Health National System is acknowledged for O. J. Pozo contract (MS10/00576)

Consumo de agua subterránea en Guanajuato, México

El problema de sobreexplotación de acuíferos en México se agudiza debido a la baja eficiencia en el uso del recurso y a la contaminación de las fuentes de abastecimiento. La situación del estado de Guanajuato es grave y requiere alternativas de solución que pueden darse mediante recomendaciones de política que contribuyan a hacer más eficiente y racional el uso del vital líquido. En este trabajo se determinaron los factores que afectan el consumo de agua en los sectores urbano, pecuario, agrícola de riego e industrial del estado, para lo cual se estimó un modelo de ecuaciones simultáneas compuesto de cuatro ecuaciones de demanda y cuatro identidades para el período 1980-2004. El análisis de los resultados muestra que la cantidad consumida de agua responde de manera inelástica a cambios en el precio, con elasticidades de -0.0150 para el sector urbano, -0.0038 para el pecuario, -0.052 para la agricultura de riego (se utilizó la cuota de mantenimiento de la infraestructura del Distrito de Riego más el efecto del costo de la energía eléctrica para uso agrícola, ya que el agua es gratuita) y -0.126 para el sector industrial. Estas elasticidades indican que el consumo de agua en los sectores urbano y pecuario es más insensible a cambios en el precio, que en el industrial y agrícola de riego. Por tanto, las políticas de administración del consumo deberán considerar aumentos en estos sectores, pues se puede reducir en 1 % la cantidad consumida de la industria y la agricultura de riego aumentando el precio del agua en 7.93 y 19.2 %