Perfil lipídico na adolescência: efeito de exposições pré-natais e neonatais

This study assessed the effects of intrauterine growth restriction (IUGR) and prenatal variables related to fetal growth on blood lipids in adolescence. All hospital births taking place in 1982 in Pelotas were identified and this population has been followed-up since then. All male subjects were identified in 2000 when enrolling in the national army; 79% (n = 2250) were traced and 2089 blood samples were made available. The following outcome variables were studied: Total cholesterol and fractions (VLDL, LDL, and HDL), non-HDL cholesterol, LDL/HDL ratio and serum triglycerides. The explanatory variables were IUGR, maternal pre-pregnancy body mass index (BMI) and maternal smoking during pregnancy. After adjusting for confounding variables, total and LDL cholesterol levels were slightly and significantly higher among adolescents whose mothers were in the 3rd and 4th quartile of pre-pregnancy BMI. However, these associations disappeared after adjusting for adolescent’s diet, schooling and BMI. A similar relation was observed for non-HDL cholesterol. Other associations were not significant (p>0.05). A higher maternal pre-pregnancy BMI seems to have an influence on the lipid profile of their offspring. Yet, this association is mediated by current BMI.Sem bolsaEste estudo avaliou os efeitos do retardo de crescimento intra-uterino (RCIU) e de variáveis pré-natais relacionadas ao crescimento fetal sobre o perfil lipídico em adolescentes. Em 1982, todos os nascimentos hospitalares ocorridos em Pelotas foram identificados e esta população tem sido acompanhada inúmeras vezes. Em 2000, os participantes masculinos da coorte foram identificados no alistamento militar; 79% (n=2250) foram entrevistados e 2089 doaram amostra de sangue. No presente estudo, as variáveis dependentes foram o colesterol total e suas frações (VLDL, LDL, HDL), colesterol não-HDL, razão LDL/HDL e triglicerídeos. As exposições estudadas foram o RCIU, o índice de massa corporal (IMC) materno pré-gestacional e o tabagismo materno na gravidez. Após ajuste para fatores de confusão, o colesterol total e LDL foram maiores entre os adolescentes cujo IMC materno pré-gestacional estava no terceiro e quarto quartil. No entanto, estas associações desapareceram após controle para dieta, escolaridade e IMC do adolescente. Associação similar foi observada para o colesterol não-HDL. O RCIU e o tabagismo materno na gravidez não foram associados com o perfil lipídico aos 18 anos de idade. Um IMC materno pré-gestacional elevado parece influenciar o perfil lipídico dos filhos, mas essa associação é mediada pelo IMC atual do adolescente

Efecto de las condiciones individuales, del hogar y del área de residencia en la autopercepción de su salud en adultos colombianos: un estudio multinivel

Introduction: Self-rated health is strongly associated with morbidity and mortality. It is largely influenced by individual factors but also by individuals’ social surroundings and environment.Objective: To investigate individual, household, and locality factors associated with self-rated ealth in Colombian adults.Materials and methods: We conducted a cross-sectional multilevel study using data from national databases on 19 urban localities and 37,352 individuals nested within 15,788 households using a population-based survey. Given the natural hierarchical structure of the data, the estimates of self-rated health related to individual, household, and locality characteristics were obtained by fitting a three-level logistic regression.Results: The adjusted multilevel logistic models showed that at individual level, higher odds of poor self-rated health were found among older adults, persons from low socio-economic status, those living without a partner, with no regular physical activity, and reporting morbidities. At the household level, poor self-rated health was associated with households of low socioeconomic status located near noise sources and factories and in polluted and insecure areas. At the locality level, only poverty was associated with poor self-rated health after adjusting for individual and household variables.Conclusions: These results highlight the need for a more integrated framework when designing and implementing strategies and programs that aim to improve health conditions in urban populations in Latin America.Introducción. La autopercepción de la salud se asocia con la morbilidad y la mortalidad debido principalmente al efecto de las condiciones individuales y las características sociales y del ambiente en el que viven las personas.Objetivo. Investigar los factores individuales, del hogar y de la localidad asociados con la autopercepción de la salud en adultos colombianos.Materiales y métodos. Se llevó a cabo un estudio transversal. La información sobre las 19 localidades urbanas consideradas se obtuvo de bases de datos nacionales, en tanto que los datos sobre los 37.352 individuos anidados en 15.788 hogares provinieron de una encuesta de base poblacional. Dada la estructura jerárquica de los datos, las estimaciones del efecto de las variables individuales, del hogar y de la localidad sobre la autopercepción de la salud se hicieron utilizando un modelo de regresión logística de tres niveles.Resultados. Los modelos multinivel ajustados evidenciaron que a nivel individual había una mayor probabilidad de tener una peor percepción de la salud entre adultosmayores, personas de bajo nivel socioeconómico, sin compañero, físicamente inactivos y con enfermedades. A nivel de hogar, la peor percepción de la salud se asoció con la pertenencia a familias de bajo nivel socioeconómico, residentes cerca de fábricas, áreas contaminadas, inseguras y de alto ruido. Por último, a nivel de localidad y después del ajuste por variables individuales y del hogar, la residencia en localidades pobres aumentó la probabilidad de tener una peor percepción de la propia salud.Conclusiones. Los resultados evidencian la necesidad de considerar un marco conceptual más amplio en el momento de diseñar e implementar estrategias y programas que apunten al mejoramiento de las condiciones de salud de las poblaciones urbanas en Latinoamérica

Socioeconomic inequalities in skilled birth attendance and child stunting in selected low and middle income countries: Wealth quintiles or deciles?

BACKGROUND: Wealth quintiles derived from household asset indices are routinely used for measuring socioeconomic inequalities in the health of women and children in low and middle-income countries. We explore whether the use of wealth deciles rather than quintiles may be advantageous. METHODS: We selected 46 countries with available national surveys carried out between 2003 and 2013 and with a sample size of at least 3000 children. The outcomes were prevalence of under-five stunting and delivery by a skilled birth attendant (SBA). Differences and ratios between extreme groups for deciles (D1 and D10) and quintiles (Q1 and Q5) were calculated, as well as two summary measures: the slope index of inequality (SII) and concentration index (CIX). RESULTS: In virtually all countries, stunting prevalence was highest among the poor, and there were larger differences between D1 and D10 than between Q1 and Q5. SBA coverage showed pro-rich patterns in all countries; in four countries the gap was greater than 80 pct points. With one exception, differences between extreme deciles were larger than between quintiles. Similar patterns emerged when using ratios instead of differences. The two summary measures provide very similar results for quintiles and deciles. Patterns of top or bottom inequality varied with national coverage levels. CONCLUSION: Researchers and policymakers should consider breakdowns by wealth deciles, when sample sizes allow. Use of deciles may contribute to advocacy efforts, monitoring inequalities over time, and targeting health interventions. Summary indices of inequalities were unaffected by the use of quintiles or deciles in their calculation

Association between preterm-birth phenotypes and differential morbidity, growth, and neurodevelopment at age 2 years: Results from the INTERBIO-21st newborn study

Importance: The etiologic complexities of preterm birth remain inadequately understood, which may impede the development of better preventative and treatment measures.Objective: To examine the association between specific preterm-birth phenotypes and clinical, growth, and neurodevelopmental differences among preterm newborns compared with term newborns up to age 2 years.Design, setting, and participants: The INTERBIO-21st study included a cohort of preterm and term newborn singletons enrolled between March 2012 and June 2018 from maternity hospitals in 6 countries worldwide who were followed up from birth to age 2 years. All pregnancies were dated by ultrasonography. Data were analyzed from November 2019 to October 2020.Exposures/interventions: Preterm-birth phenotypes.Main outcomes and measures: Infant size, health, nutrition, and World Health Organization motor development milestones assessed at ages 1 and 2 years; neurodevelopment evaluated at age 2 years using the INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) tool.Results: A total of 6529 infants (3312 boys [50.7%]) were included in the analysis. Of those, 1381 were preterm births (mean [SD] gestational age at birth, 34.4 [0.1] weeks; 5148 were term births (mean [SD] gestational age at birth, 39.4 [0] weeks). Among 1381 preterm newborns, 8 phenotypes were identified: no main maternal, fetal, or placental condition detected (485 infants [35.1%]); infections (289 infants [20.9%]); preeclampsia (162 infants [11.7%]); fetal distress (131 infants [9.5%]); intrauterine growth restriction (110 infants [8.0%]); severe maternal disease (85 infants [6.2%]); bleeding (71 infants [5.1%]); and congenital anomaly (48 infants [3.5%]). For all phenotypes, a previous preterm birth was a risk factor for recurrence. Each phenotype displayed differences in neonatal morbidity and infant outcomes. For example, infants with the no main condition detected phenotype had low neonatal morbidity but increased morbidity and hospitalization incidence at age 1 year (odds ratio [OR], 2.2; 95% CI, 1.8-2.7). Compared with term newborns, the highest risk of scoring lower than the 10th centile of INTER-NDA normative values was observed in the fine motor development domain among newborns with the fetal distress (OR, 10.6; 95% CI, 5.1-22.2) phenotype.Conclusions and relevance: Results of this study suggest that phenotypic classification may provide a better understanding of the etiologic factors and mechanisms associated with preterm birth than continuing to consider it an exclusively time-based entity

Antimicrobial stewardship programs in seven Latin American countries: facing the challenges

Antecedentes: Diversos estudios han demostrado que más del 50% de los antibióticos utilizados en los hospitales son innecesarios o inadecuados y que la resistencia a los antimicrobianos puede suponer cada año hasta 20.000 millones de dólares de sobrecostes médicos. Por otro lado, los programas de administración de antimicrobianos (PEA) reducen significativamente el uso inadecuado de antimicrobianos, la aparición de resistencias a los antimicrobianos, las infecciones asociadas a la atención sanitaria y los costes en el ámbito hospitalario. Objetivo: Evaluar el desarrollo de ASP y el ahorro de antibióticos en 7 hospitales latinoamericanos utilizando indicadores cuantitativos estandarizados en todas las instituciones de salud participantes. Métodos: Se realizó un estudio de intervención, donde se realizaron evaluaciones pre y post utilizando una herramienta de puntuación estandarizada adaptada de los estándares de acreditación de la Joint Commission International y, del Instituto Colombiano de Normas Técnicas y Certificación. Se evaluó ASP de 7 hospitales latinoamericanos entre 2019 y 2020. Se realizó una evaluación pre-intervención en cada hospital para cuantificar el grado de desarrollo de la ASP (ASP Development score). Con base en estos resultados, se implementó una capacitación in situ adaptada en cada hospital, seguida de una evaluación posterior a la intervención para cuantificar la mejora de los indicadores de desarrollo de ASP. Además, se estimó el ahorro monetario en antimicrobianos derivado de la intervención del PEA. Resultados: En la evaluación previa a la intervención, la puntuación media de desarrollo del PEA en las 7 instituciones fue del 65,8% (40-94,3%). Los puntos con la puntuación más baja fueron los relacionados con el seguimiento y la comunicación de los progresos y el éxito del PEA. Para la evaluación posterior a la intervención, 2 instituciones no pudieron participar debido a la presión impuesta por la pandemia COVID-19. Para los 5/7 hospitales restantes, la puntuación media del desarrollo del PEA fue del 82,3%, con un aumento del 12,0% en comparación con la medición previa a la intervención de las mismas instituciones (puntuación media previa a la intervención 70,3% (48,2%-94,3%) Los puntos con un aumento significativo fueron los indicadores clave de rendimiento, la educación de los AMS y la formación de los prescriptores. Tres de los siete (3/7) hospitales informaron de ahorros monetarios en antibióticos asociados a la intervención ASP. Conclusiones: El uso de la herramienta descrita demostró ser útil para evaluar áreas específicas del desarrollo del PEA que eran deficientes y adaptar las intervenciones para los hospitales participantes, en consecuencia, ayudó a mejorar el desarrollo del PEA en las instituciones que se sometieron al análisis previo y posterior a la intervención. Además, las estrategias mostraron ahorros monetarios en los costes antimicrobianos cuando se midieron. © 2023, Los autores.Background: Studies have shown that more than 50% of the antibiotics used in hospitals are unnecessary or inappropriate and, that antimicrobial resistance may cost up to 20 billion USD in excess medical costs each year. On the other hand, Antimicrobial Stewardship Programs (ASP) significantly reduce inappropriate antimicrobial use, emergence of antimicrobial resistance, healthcare associated infections, and costs in hospital settings. Objective: To evaluate the development of ASP and antibiotic savings in 7 Latin American hospitals using standardized quantitative indicators in all the participating health care institutions. Methods: An interventional study was conducted, where pre- and post- evaluations were performed using a standardized score tool adapted from the Joint Commission International accreditation standards and, the Colombian Institute of Technical Standards and Certification. We evaluated ASP from 7 Latin American hospitals between 2019 and 2020. A pre-intervention evaluation was done in each hospital to quantify the degree of development of the ASP (ASP Development score). Based on these results, tailored on-site training was implemented in each hospital, followed by a post-intervention evaluation to quantify improvement of ASP-development indicators. In addition, monetary savings in antimicrobials derived from the ASP intervention were estimated. Results: In the pre-intervention evaluation, the average ASP development score for the 7 institutions was 65.8% (40-94.3%). The items with the lowest development score were those related to monitoring and communicating the ASP progress and success. For the post-intervention evaluation, 2 institutions couldn’t participate due to the pressure imposed by the COVID-19 pandemic. For the remaining 5/7 hospitals, the average ASP development score was 82.3% with an increase of 12.0% when compared to the pre-intervention measurement of the same institutions (average pre-intervention score 70.3% (48.2%-94.3%) The items with a significant increase were key performance indicators, AMS education and training of the prescribers. Three of the seven (3/7) hospitals reported antibiotic monetary savings associated to the ASP intervention. Conclusions: The use of the tool described shown to be useful to evaluate specific areas of ASP-development that were lacking and tailor interventions for the participating hospitals, consequently, it helped improve ASP-development in the institutions that underwent pre- intervention and post-intervention analysis. In addition, the strategies showed monetary savings on antimicrobial costs when measured. © 2023, The Author(s)

Evaluación de la susceptibilidad de especies de Candida al fluconazol por el método de difusión de disco.

Infections caused by yeasts belonging to the genus Candida have increased dramatically in the last decades, especially in hospital settings. Concomittantly, antimycotic resistance has emerged, as well as the appearance of non-Candida albicans isolates. To standardize in vitro antifungal susceptibility tests, the agar diffusion test was developed using disks impregnated with the antimycotic compound. Electronic recording of the inhibition zone (BIOMIC), furnishes objective values for the minimal inhibitory concentration (MIC). The fluconazole susceptibility patterns were determined for Candida species isolated from 2.139 patients seen in outpatient clinics or in health-care centers in Colombia, Ecuador and Venezuela. Candida albicans was the species most frequently isolated (62%), followed at a distance by Candida parapsilosis (11%), Candida tropicalis (8.5%), Candida glabata (3.5%) and Candida krusei (2.2%). MIC determinations showed that 88.1% of these isolates were susceptible to fluconazole, 5.1% were susceptible-dose-dependant and 6.8% resistant. An important proportion (92.1%) of the C. albicans isolates proved susceptible while resistance predominated in the remaining species. These results indicate that the BIOMIC method is rapid and simple, constituting a suitable tool for the epidemiologic surveillance of resistance in Candida species.Las infecciones causadas por levaduras del género Candida han aumentado en forma dramática en las últimas décadas, especialmente a nivel hospitalario. Paralelamente con este aumento, se ha notado la aparición de resistencia a los antimicóticos, así como la selección de especies diferentes a Candida albicans, todo lo cual ha hecho necesaria la estandarización de pruebas de susceptibilidad in vitro. Entre las varias pruebas disponibles está la de difusión en agar con discos impregnados de antifúngicos, cuya lectura se hace electrónicamente (BIOMIC), lo que proporciona indicaciones objetivas de la concentración inhibitoria mínima (CIM). Se realizó el estudio para determinar la sensibilidad in vitro al fluconazol de 2.139 aislamientos de especies de Candida provenientes de pacientes atendidos en consulta externa o en salas de hospitalización de centros asistenciales en Colombia, Ecuador y Venezuela (región CELA). Candida albicans fue el microorganismo más frecuentemente aislado (62%), seguido a distancia por Candida parapsilosis (11%), Candida tropicalis (8,5 %), Candida glabrata (3,5%) y Candida krusei (2,2%). La CIM demostró que el 88,1% de estos aislamientos eran susceptibles al fluconazol, 5,1% eran susceptibles-dosisdependiente y 6,8% resistentes. El 92,1% de la especie C. albicans fue susceptible mientras que la resistencia al fluconazol fue más notoria en las restantes especies. El BIOMIC es un método rápido y sencillo para la vigilancia epidemiológica de resistencia en levaduras del género Candida recuperadas de pacientes atendidos en centros hospitalarios

An RNAi in silico approach to find an optimal shRNA cocktail against HIV-1

<p>Abstract</p> <p>Background</p> <p>HIV-1 can be inhibited by RNA interference <it>in vitro </it>through the expression of short hairpin RNAs (shRNAs) that target conserved genome sequences. <it>In silico </it>shRNA design for HIV has lacked a detailed study of virus variability constituting a possible breaking point in a clinical setting. We designed shRNAs against HIV-1 considering the variability observed in naïve and drug-resistant isolates available at public databases.</p> <p>Methods</p> <p>A Bioperl-based algorithm was developed to automatically scan multiple sequence alignments of HIV, while evaluating the possibility of identifying dominant and subdominant viral variants that could be used as efficient silencing molecules. Student t-test and Bonferroni Dunn correction test were used to assess statistical significance of our findings.</p> <p>Results</p> <p>Our <it>in silico </it>approach identified the most common viral variants within highly conserved genome regions, with a calculated free energy of ≥ -6.6 kcal/mol. This is crucial for strand loading to RISC complex and for a predicted silencing efficiency score, which could be used in combination for achieving over 90% silencing. Resistant and naïve isolate variability revealed that the most frequent shRNA per region targets a maximum of 85% of viral sequences. Adding more divergent sequences maintained this percentage. Specific sequence features that have been found to be related with higher silencing efficiency were hardly accomplished in conserved regions, even when lower entropy values correlated with better scores. We identified a conserved region among most HIV-1 genomes, which meets as many sequence features for efficient silencing.</p> <p>Conclusions</p> <p>HIV-1 variability is an obstacle to achieving absolute silencing using shRNAs designed against a consensus sequence, mainly because there are many functional viral variants. Our shRNA cocktail could be truly effective at silencing dominant and subdominant naïve viral variants. Additionally, resistant isolates might be targeted under specific antiretroviral selective pressure, but in both cases these should be tested exhaustively prior to clinical use.</p

La Comisión de la Verdad en Colombia: conocimiento, percepción, eficacia y emociones asociadas

La Comisión de la Verdad en Colombia se estableció a partir del modelo de justicia transicional. Su función es servir como medida de reconocimiento de los hechos violentos durante el conflicto armado, que han dejado más de nueve millones de víctimas. En este marco, se realizó un estudio descriptivo correlacional (N=1166) con una muestra de 22 departamentos del país para evaluar el conocimiento, la aprobación y la efectividad percibida de los primeros años de la Comisión a partir de aspectos psicosociales: victimización, emociones colectivas, reconciliación, memoria colectiva. El 58% eran víctimas directas. Los resultados indican altos niveles de aprobación y de disposición a participar en las actividades de la Comisión, así como cierto escepticismo sobre su utilidad y una baja confianza en las disculpas oficiales de los grupos en conflicto. También se encuentra un alto índice de emociones positivas relacionadas con la comisión y una baja confianza en las instituciones gubernamentales. Lo encontrado en este estudio, coincide con experiencias previas de comisiones de la verdad en Latinoamérica, y abre el debate sobre las especificidades del contexto colombiano en la búsqueda de paz y las implicaciones del trabajo de la comisión en el proceso de reparación