Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Colombian consensus recommendations for diagnosis, management and treatment of the infection by SARS-COV-2/ COVID-19 in health care facilities - Recommendations from expert´s group based and informed on evidence

La Asociación Colombiana de Infectología (ACIN) y el Instituto de Evaluación de Nuevas Tecnologías de la Salud (IETS) conformó un grupo de trabajo para desarrollar recomendaciones informadas y basadas en evidencia, por consenso de expertos para la atención, diagnóstico y manejo de casos de Covid 19. Estas guías son dirigidas al personal de salud y buscar dar recomendaciones en los ámbitos de la atención en salud de los casos de Covid-19, en el contexto nacional de Colombia

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

O método do projeto em geotecnia rodoviária caso: balastro ferroviário Belencito - Paz del Río

The article is a research product at Santo Tomás University. The project method in Road Geotechnics was applied in railways, since it is a process that is beginning to be used in several universities around the world. In this regard, interviews and observations were made to establish the changes in the competences. Learning environments were used, such as laboratory tests, field work, visits to quarries, sampling and simulation with test sections and the main advances are described. Although the iron material is used for steelmaking, the option of using it in a seat layer and as a granular subbase was established. On the other hand, iron ore was extracted, irrigated on the road and two test sections of 25 meters each were obtained to be analyzed in the field for six months and prices were studied. The laboratory tests were: Los Angeles Machine Wear, Sand Equivalent, Elongation and Flattening Index, Percentage of fractured faces and Atterberg Limits. The main results are framed in the increase and construction of disciplinary and human competences and in the option to use the gravel material as a seat layer and the distance to which it is possible and profitable to put it. The kindliness of the project method to structure skills in engineers is taken as a relevant conclusion.El artículo es producto de investigación, en la Universidad Santo Tomás. Se aplicó el método de proyectos en Geotecnia vial, en ferrocarriles, dado que es un proceso que se comienza a utilizar en varias universidades del mundo. Al respecto, se hicieron entrevistas y observaciones para establecer los cambios en las competencias. Se utilizaron ambientes de aprendizaje como ensayos de laboratorio, trabajo de campo, visitas a canteras, toma de muestras y simulación con tramos de prueba y se describen los principales avances. Aunque el material de hierro se usa para la fabricación de acero, se estableció la opción de utilizarlo en capa de asiento y como sub-base granular. De otro lado, el mineral de hierro se extrajo, se regó sobre la vía y se obtuvieron dos tramos de prueba de 25 metros cada uno, para analizarlos en campo, durante seis meses y se estudiaron los precios. Los ensayos de laboratorio, fueron: Desgaste en la máquina de los Ángeles, equivalente de arena, índice de alargamiento y aplanamiento, porcentaje de caras fracturadas y límites de Atterberg. Los principales resultados se enmarcan en el incremento y construcción de competencias disciplinares y humanas y en la opción para utilizar el material de grava como capa de asiento y la distancia hasta la que es posible y rentable ponerlo. Se tiene como conclusión relevante la bondad del método de proyectos para estructurar habilidades en los ingenieros.Cet article est un produit de recherche, à L’Université Santo Tomás. Il a été appliqué la méthode de projets en géotechnique routière, aux chemins de fer, vu que c’est un processus qui commence à être utilisée dans plusieurs universités dans le monde. À cet égard, des entretiens et des observations ont été réalisés afin d’établir les changements dans les compétences. Ils ont été utilisés des environnements d’apprentissage, tels que des tests de laboratoire, des travaux sur le terrain, des visites de carrières, des échantillonnages et des simulations avec des sections de test afin de décrire les principales avancées. De plus, même si le matériel de fer est utilisé pour la fabrication de l’acier, on a établit l’option de l’utiliser en couche de siège et en sous-couche granulaire. D’autre part, du minerai de fer a été extrait et irrigué sur la voie. On a obtenu comme résultat deux tronçons d’essai de 25 mètres chacune pour être analysées sur le terrain pendant six mois. De plus, les coûts ont été étudiés. Les tests de laboratoire ont été: Usure dans la machine de Los Angeles, équivalent de sable, Indice d’allongement et d’aplatissement, pourcentage de faces fracturées et de limites d’Atterberg. Les principaux résultats sont encadrés par l’augmentation et la construction de compétences disciplinaires et humaines et par la possibilité d’utiliser le gravier comme couche de siège et la distance à laquelle il est possible et rentable de le placer. On a pour conclusion pertinente la qualité de la méthode du projet pour structurer les compétences des ingénieurs.O artigo é um produto de pesquisa, na Universidade Santo Tomás. O método do projeto foi aplicado em rodovias geotécnicas, em ferrovias, já que é um processo que está começando a ser usado em várias universidades ao redor do mundo. A este respeito, entrevistas e observações foram feitas para estabelecer as mudanças nas competências. Ambientes de aprendizagem foram utilizados, como testes de laboratório, trabalho de campo, visitas a pedreiras, amostragem e simulação com seções de teste e os principais avanços são descritos. Embora o material de ferro seja usado para a produção de aço, a opção de usá-lo em uma camada de assento e como uma sub-base granular foi estabelecida. Por outro lado, o minério de ferro foi extraído, irrigado na estrada e duas seções de teste de 25 metros cada foram obtidas, para serem analisadas no campo, durante seis meses e os preços foram estudados. Os testes laboratoriais foram: Los Angeles Machine Wear, Equivalente a Areia, Índice de Alongamento e Achatamento, Porcentagem de faces fraturadas e Limites de Atterberg. Os principais resultados são enquadrados no aumento e construção de competências disciplinares e humanas e na opção de usar o material de cascalho como a camada de assento e a distância a que é possível e rentável colocá-lo. A bondade do método de projeto para estruturar habilidades em engenheiros é considerada uma conclusão relevante

Attitudes and beliefs towards low back pain (LBP) among physiotherapists in Spain

Abstract Background The aim of this study is to investigate the attitudes and beliefs of Spanish physiotherapists towards the diagnosis and management of low back pain (LBP). A descriptive, cross-sectional study was conducted according to STROBE guidelines from December 18, 2021, to May 2022. An online survey was developed based on Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT), a reliable and validated self-administered instrument developed to assess the strength of two possible treatment orientations of physiotherapists towards the diagnosis and management of LBP. Respondents were selected through a non-probabilistic convenience sampling technique, and the selection criteria were (1) active physiotherapists with no restrictions on gender and length of service, (2) physical therapists who have worked in both public and private environments, and (3) physiotherapists who have been officially registered with no restriction on the place of practice in Spain. Survey data was obtained and analyzed using the SPSS Statistic 28 (IBM®) statistical software. Results Three hundred eighty-one questionnaires were finally included (F;n=151, M;n=230). In relation to the diagnosis, the respondents indicated that the tissue damage was sufficient to explain widespread and lasting pain, but rather that it was due to psychological factors. In addition, for those surveyed, the diagnosis should not focus exclusively on imaging tests but on clinical symptoms and signs. However, the weak relationship between objective damage and perceived pain intensity, as well as the weak relationship between posture and the development or worsening of LBP, did not seem to be clear to physiotherapists. From the point of view of treatment, we can indicate that professionals are committed to maintaining adequate and individualized physical activity as a first-line treatment in pain management. Conclusions Most physiotherapists in Spain have up-to-date knowledge of the biopsychosocial model of pain care. However, regarding attitudes and beliefs towards LBP, there are still contents and behaviors based on spine protective paradigms that are not conducive to active pain management

Minería y salud ambiental : un análisis desde la producción de carbón, ferroníquel y oro en Colombia.

Este libro Minería y salud ambiental. Un análisis desde la producción de carbón, ferroníquel y oro en Colombia es el resultado de un proceso académico que intenta dar cuenta de estos puntos en los que convergen la minería de oro, carbón y ferroníquel con la afectación a la salud y la salud pública en Colombia. El lector podrá encontrar en el mismo, desde la visión de la salud de los ecosistemas, una descripción detallada de los procesos de explotación minera de oro, carbón, y níquel, pasando por el marco legal vigente en que se enmarca esta actividad, para finalizar con una perspectiva epidemiológica para aplicar estudios, y de esta manera generar la evidencia para evaluar el impacto de la minería sobre la salud pública

Minería y salud ambiental : un análisis desde la producción de carbón, ferroníquel y oro en Colombia.

Este libro Minería y salud ambiental. Un análisis desde la producción de carbón, ferroníquel y oro en Colombia es el resultado de un proceso académico que intenta dar cuenta de estos puntos en los que convergen la minería de oro, carbón y ferroníquel con la afectación a la salud y la salud pública en Colombia. El lector podrá encontrar en el mismo, desde la visión de la salud de los ecosistemas, una descripción detallada de los procesos de explotación minera de oro, carbón, y níquel, pasando por el marco legal vigente en que se enmarca esta actividad, para finalizar con una perspectiva epidemiológica para aplicar estudios, y de esta manera generar la evidencia para evaluar el impacto de la minería sobre la salud pública

Valuación de inmuebles.

El INSTITUTO POLITÉCNICO NACIONAL es una institución educativa laica, gratuita del Estado, rectora de la educación tecnológica pública en México, líder en la generación, aplicación, difusión y transferencia del conocimiento científico y tecnológico, creada para contribuir al desarrollo económico, social y político de la nación. Para lograrlo, el Instituto y su comunidad forman integralmente profesionales en los niveles medio superior, superior y posgrado, realiza investigación y extiende a la sociedad sus resultados, con calidad, responsabilidad, ética, tolerancia y compromiso social. La Escuela Superior de Ingeniería y Arquitectura Unidad Zacatenco, es una de las once escuelas superiores en el área de Ingeniería y Ciencias Físico-Matemáticas, del INSTITUTO POLITÉCNICO NACIONAL

II Congreso internacional en educación física, recreación, deporte y actividad física. “Innovación y tendencias” - Memorias

El II Congreso Internacional de Educación Física, Recreación, Deporte y Actividad Física: “Innovación y Tendencias“ y el II Encuentro de Egresados del Departamento de Cultura Física de la Universidad de Córdoba se realizó en la ciudad de Montería, capital del Departamento de Córdoba, Colombia, como iniciativa del Grupo de Investigación en Ciencias de la Actividad Fisica y la Salud –GICAFS- del Departamento de Cultura Física, perteneciente a la Facultad de Educación y Ciencias Humanas de la Universidad de Córdoba, como muestra hacia la comunidad académica y la sociedad en general de la responsabilidad ética, social y profesional, para aportar a la construcción de tejido social, atendiendo a las recomendaciones del plan decenal del deporte, la Educación Física, la Recreación y la Actividad Física 2009-2019 (COLDEPORTES, 2009).Edición 201