Population-level detection of early loss of kidney function: 7-year follow-up of a young adult cohort at risk of Mesoamerican nephropathy

BACKGROUND: Mesoamerican nephropathy is a leading contributor to premature mortality in Central America. Efforts to identify the cause are hampered by difficulties in distinguishing associations with potential initiating factors from common exposures thought to exacerbate the progression of all forms of established chronic kidney disease (CKD). We explored evidence of disease onset or departure from the healthy estimated glomerular filtration rate distribution [departure from ∼eGFR(healthy)] in an at-risk population. METHODS: Two community-based cohorts (adults aged 18-30 years, n = 351 and 420) from 11 rural communities in Northwest Nicaragua were followed up over 7 and 3 years respectively. We examined associations with both (i) incident CKD and (ii) the time point of departure from ∼eGFR(healthy), using a hidden Markov model. RESULTS: CKD occurred in men only (male incidence rate: 0.7%/year). Fifty-three (out of 1878 visits, 2.7%) and 8 (out of 1067 visits, 0.8%) episodes of probable departure from ∼eGFR(healthy) occurred in men and women, respectively. Cumulative time in sugarcane work and symptoms of excess occupational sun exposure were associated with incident CKD. The same exposures were associated with probability of departure from ∼eGFR(healthy) in time-updated analyses along with measured and self-reported weight loss, nausea, vomiting and cramps, as well as non-steroidal anti-inflammatory drug use. CONCLUSIONS: CKD burden in this population is high and risk factors for established disease are occupational. Additionally, a syndrome suggesting an alternative exposure is associated with evidence of disease onset supporting a possible separate unknown initiating factor for which further investigation is needed. Interventions to reduce the impact of occupational risks should be pursued meanwhile

Decline in Kidney Function among Apparently Healthy Young Adults at Risk of Mesoamerican Nephropathy.

Background Epidemic levels of CKD of undetermined cause, termed Mesoamerican nephropathy in Central America, have been found in low- and middle-income countries. We investigated the natural history of, and factors associated with, loss of kidney function in a population at high risk for this disease.Methods We conducted a 2-year prospective, longitudinal study with follow-up every 6 months in nine rural communities in northwestern Nicaragua and included all men (n=263) and a random sample of women (n=87) ages 18-30 years old without self-reported CKD, diabetes, or hypertension. We used growth mixture modeling to identify subgroups of eGFR trajectory and weighted multinomial logistic regression to examine associations with proposed risk factors.Results Among men, we identified three subpopulations of eGFR trajectory (mean baseline eGFR; mean eGFR change over follow-up): 81% remained stable (116 ml/min per 1.73 m2; -0.6 ml/min per 1.73 m2 per year), 9.5% experienced rapid decline despite normal baseline function (112 ml/min per 1.73 m2; -18.2 ml/min per 1.73 m2 per year), and 9.5% had baseline dysfunction (58 ml/min per 1.73 m2; -3.8 ml/min per 1.73 m2 per year). Among women: 96.6% remained stable (121 ml/min per 1.73 m2; -0.6 ml/min per 1.73 m2 per year), and 3.4% experienced rapid decline (132 ml/min per 1.73 m2; -14.6 ml/min per 1.73 m2 per year; n=3 women). Among men, outdoor and agricultural work and lack of shade availability during work breaks, reported at baseline, were associated with rapid decline.Conclusions Although Mesoamerican nephropathy is associated with agricultural work, other factors may also contribute to this disease

Statut et fonctions du narrateur dans la chanson de geste

Ce travail a pour but d'esquisser une approche à un problème narratif, sans entrer dans la grande question qui a soulevé tant de controverses entre les savants depuis longtemps : les discussions à propos de l'auteur et du chanteur. En laissant donc de côté si celui qui écrit est ou non celui qui chante, nous nous situons dans une perspective interne, celle de connaître comment fonctionne le narrateur d'une chanson de geste, quel est le rôle qu'il joue dans la structure de l'oeuvre et quelles ..

Perfil de Salud Ocupacional de América Central

Este perfil de salud ocupacional (Perfil SOA) fue desarrollado por un grupo de investigadores del Programa Salud, Trabajo y Ambiente en América Central (SALTRA). Los datos analizados parten de la información publicada en los perfiles nacionales de salud ocupacional, elaborados por los miembros SALTRA de siete universidades públicas de Centroamérica. Así, el perfil SO, consta de un resumen de la mejor información disponible en materia de salud y seguridad en el trabajo de los países de la región centroamericana, exceptuando Belice. Se reconoce que el acceso a datos sobre salud ocupacional es escaso y que las estadísticas sobre lesiones y enfermedades están subregistradas, pero también existe un limitado acceso a registros, los cuales son recogidos periódicamente por algunas entidades vinculadas con esta temática. Sumado a esto, las investigaciones desarrolladas en la región concluyen que los factores de riesgo a los que se ven expuestos los trabajadores, son múltiples.Saltra Unión Europe

Shift within age-groups of mumps incidence, hospitalizations and severe complications in a highly vaccinated population. Spain, 1998-2014

The mumps vaccine (Jeryl-Lynn-strain) was introduced in Spain in 1981, and a vaccination policy which included a second dose was added in 1995. From 1992-1999, a Rubini-strain based vaccine was administered in many regions but later withdrawn due to lack of effectiveness. Despite high levels of vaccination coverage, epidemics have continued to appear. We characterized the three epidemic waves of mumps between 1998 and 2014, identifying major changes in susceptible populations using Poisson regression. For the period 1998-2003 (P1), the most affected group was from 1 to 4years old (y) [Incidence Rate (IR)=71.7 cases/100,000 population]; in the periods 2004-2009 (P2) and 2010-2014 (P3) IR ratio (IRR) increased among 15-24y (P2=1.46; P3=2.68) and 25-34y (P2=2.17; P3=4.05). Hospitalization rate (HR), complication rate (CR) and neurological complication rate (NR) among hospitalized subjects decreased across the epidemics, except for 25-34y which increased: HR ratio (HRR) (P2=2.18; P3=2.16), CRR (P3=2.48), NRR (P3=2.41). In Spain mumps incidence increased, while an overall decrease of hospitalizations and severe complications occurred across the epidemics. Cohorts born during periods of low vaccination coverage and those vaccinated with Rubini-strain were the most affected populations, leading to a shift in mumps cases from children to adolescents and young adults; this also reveals the waning immunity provided by the mumps vaccine. Despite not preventing all mumps cases, the vaccine appears to prevent serious forms of the disease.This study was funded in part by Fondo de Investigación Sanitaria, Instituto de Salud Carlos III (PI12/02006) and by Acción Estratégica de Salud, Instituto de Salud Carlos III (PI15CIII/00023)

Prevalence of obesity, tobacco use, and alcohol consumption by socioeconomic status among six communities in Nicaragua Prevalencia de la obesidad, el tabaquismo y el consumo de alcohol según la condición socioeconómica en seis comunidades de Nicaragua

OBJECTIVE: To describe the prevalence of noncommunicable disease (NCD) risk factors (overweight/obesity, tobacco smoking, and alcohol consumption) and identify correlations between these and sociodemographic characteristics in western and central Nicaragua. METHODS: This was a cross-sectional study of 1 355 participants from six communities in Nicaragua conducted in September 2007-July 2009. Demographic and NCD risk-related health behavior information was collected from each individual, and their body mass index (BMI), blood pressure, diabetes status, and renal function were assessed. Data were analyzed using descriptive statistics, bivariate analyses, and (non-stratified and stratified) logistic regression models. RESULTS: Of the 1 355 study participants, 22.0% were obese and 55.1% were overweight/obese. Female sex, higher income, and increasing age were significantly associated with obesity. Among men, lifelong urban living correlated with obesity (Odds Ratio [OR] = 4.39, 1.18-16.31). Of the total participants, 31.3% reported ever smoking tobacco and 47.7% reported ever drinking alcohol. Both tobacco smoking and alcohol consumption were strikingly more common among men (OR = 13.0, 8.8-19.3 and 15.6, 10.7-22.6, respectively) and lifelong urban residents (OR = 2.42, 1.31-4.47 and 4.10, 2.33-7.21, respectively). CONCLUSIONS: There was a high prevalence of obesity/overweight across all income levels. Women were much more likely to be obese, but men had higher rates of tobacco and alcohol use. The rising prevalence of NCD risk factors among even the poorest subjects suggests that an epidemiologic transition in underway in western and central Nicaragua whereby NCD prevalence is shifting to all segments of society. Raising awareness that health clinics can be used for chronic conditions needs to be priority.<br>OBJETIVO: Describir la prevalencia de los factores de riesgo (sobrepeso/obesidad, tabaquismo y consumo de alcohol) de las enfermedades no transmisibles (ENT), y determinar las correlaciones entre estos y las características sociodemográficas en las zonas occidental y central de Nicaragua. MÉTODOS: De septiembre del 2007 a julio del 2009, se llevó a cabo este estudio transversal en 1 355 participantes de seis comunidades de Nicaragua. Para cada persona, se recopiló información demográfica y sobre la conducta en materia de salud relacionada con el riesgo de ENT, y se evaluaron el índice de masa corporal (IMC), la presión arterial, la presencia o no de diabetes y la función renal. Se analizaron los datos mediante estadísticas descriptivas, análisis de dos variables, y modelos de regresión logística (análisis no estratificado y estratificado). RESULTADOS: De los 1 355 participantes en el estudio, 22,0% eran obesos y 55,1% presentaban sobrepeso u obesidad. El sexo femenino, los ingresos más altos y la edad más avanzada se asociaron significativamente con la obesidad. En los varones, la residencia de por vida en un entorno urbano se correlacionó con la obesidad (razón de posibilidades [OR] = 4,39, 1,18-16,31). Del total de participantes, 31,3% habían fumado tabaco y 47,7% habían consumido alcohol alguna vez. Tanto el tabaquismo como el consumo de alcohol fueron considerablemente más frecuentes en los varones (OR = 13,0, 8,8-19,3 y 15,6, 10,7-22,6, respectivamente) y en los que residían de por vida en un entorno urbano (OR = 2,42, 1,31-4,47 y 4,10, 2,33-7,21, respectivamente). CONCLUSIONES: Se observó una alta prevalencia de obesidad/sobrepeso en todos los niveles de ingresos. Las mujeres tenían muchas más probabilidades de ser obesas, pero los varones mostraban mayores tasas de tabaquismo y consumo del alcohol. La creciente prevalencia de los factores de riesgo de las ENT, incluso en las personas más pobres, sugiere que se está produciendo una transición epidemiológica en las zonas occidental y central de Nicaragua mediante la cual la prevalencia de las ENT se está desplazando a todos los segmentos de la sociedad. La concientización de que los dispensarios pueden utilizarse para atender a las afecciones crónicas debe ser prioritaria

Mortality in Patients with Pituitary Disease

Pituitary disease is associated with increased mortality predominantly due to vascular disease. Control of cortisol secretion and GH hypersecretion (and cardiovascular risk factor reduction) is key in the reduction of mortality in patients with Cushing's disease and acromegaly, retrospectively. For patients with acromegaly, the role of IGF-I is less clear-cut. Confounding pituitary hormone deficiencies such as gonadotropins and particularly ACTH deficiency (with higher doses of hydrocortisone replacement) may have a detrimental effect on outcome in patients with pituitary disease. Pituitary radiotherapy is a further factor that has been associated with increased mortality (particularly cerebrovascular). Although standardized mortality ratios in pituitary disease are falling due to improved treatment, mortality for many conditions are still elevated above that of the general population, and therefore further measures are needed. Craniopharyngioma patients have a particularly increased risk of mortality as a result of the tumor itself and treatment to control tumor growth; this is a key area for future research in order to optimize the outcome for these patients