Prevalencia de hipertensión arterial en alumnos de 4o básico a 1o medio en un colegio de Santiago (Chile)

 Objetivo: Determinar el comportamiento de la presión arterial en niños de 9 a 16 años y comprobar si existe asociación entre la presencia de HTA con diversos factores considera- dos como posibles riesgos por la literatura. Material y método: Estudio de tipo no experimental, exploratorio, descriptivo y trans- versal. La muestra estuvo constituida por 109 alumnos de ambos sexos. La variable “pre- sión arterial” se obtuvo mediante la técnica estandarizada de medición de presión arterial del Ministerio de Salud de Chile en dos ocasiones. Resultados: Se observaron alteraciones de la presión arterial en el 19,6 % del total con una cantidad de cuatro niños hipertensos, equivalente al 3,6 %. Discusión y conclusiones: No se encontró asociación entre los factores de riesgo estu- diados y la HTA; lo anterior podría atribuirse a que probablemente estos factores actúan a largo plazo. Los datos sobre colesterol fueron obtenidos mediante una ficha encuesta, no por medio de exámenes de laboratorio, ya que la muestra obtenida fue pequeña. La presencia y riesgo de HTA en niños revela una debilidad en la pesquisa de esta y sugiere la necesidad de implementar normas para la obligatoriedad de la medición de presión arte- rial en el control de niño sano.

Complement component C4 structural variation and quantitative traits contribute to sex-biased vulnerability in systemic sclerosis

Altres ajuts: Fondo Europeo de Desarrollo Regional (FEDER), "A way of making Europe".Copy number (CN) polymorphisms of complement C4 play distinct roles in many conditions, including immune-mediated diseases. We investigated the association of C4 CN with systemic sclerosis (SSc) risk. Imputed total C4, C4A, C4B, and HERV-K CN were analyzed in 26,633 individuals and validated in an independent cohort. Our results showed that higher C4 CN confers protection to SSc, and deviations from CN parity of C4A and C4B augmented risk. The protection contributed per copy of C4A and C4B differed by sex. Stronger protection was afforded by C4A in men and by C4B in women. C4 CN correlated well with its gene expression and serum protein levels, and less C4 was detected for both in SSc patients. Conditioned analysis suggests that C4 genetics strongly contributes to the SSc association within the major histocompatibility complex locus and highlights classical alleles and amino acid variants of HLA-DRB1 and HLA-DPB1 as C4-independent signals

Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning

Global urban environmental change drives adaptation in white clover

Urbanization transforms environments in ways that alter biological evolution. We examined whether urban environmental change drives parallel evolution by sampling 110,019 white clover plants from 6169 populations in 160 cities globally. Plants were assayed for a Mendelian antiherbivore defense that also affects tolerance to abiotic stressors. Urban-rural gradients were associated with the evolution of clines in defense in 47% of cities throughout the world. Variation in the strength of clines was explained by environmental changes in drought stress and vegetation cover that varied among cities. Sequencing 2074 genomes from 26 cities revealed that the evolution of urban-rural clines was best explained by adaptive evolution, but the degree of parallel adaptation varied among cities. Our results demonstrate that urbanization leads to adaptation at a global scale

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.

BACKGROUND: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk-outcome associations. METHODS: We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Stanaway JD, Afshin A, Gakidou E, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1923-1994.Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk outcome pairs, and new data on risk exposure levels and risk outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings In 2017,34.1 million (95% uncertainty interval [UI] 33.3-35.0) deaths and 121 billion (144-1.28) DALYs were attributable to GBD risk factors. Globally, 61.0% (59.6-62.4) of deaths and 48.3% (46.3-50.2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10.4 million (9.39-11.5) deaths and 218 million (198-237) DALYs, followed by smoking (7.10 million [6.83-7.37] deaths and 182 million [173-193] DALYs), high fasting plasma glucose (6.53 million [5.23-8.23] deaths and 171 million [144-201] DALYs), high body-mass index (BMI; 4.72 million [2.99-6.70] deaths and 148 million [98.6-202] DALYs), and short gestation for birthweight (1.43 million [1.36-1.51] deaths and 139 million [131-147] DALYs). In total, risk-attributable DALYs declined by 4.9% (3.3-6.5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23.5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18.6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd

Easing the development of healthcare architectures following RM-ODP principles and healthcare standards

RM-ODP has been widely accepted and used in the field of system and software model engineering and of enterprise computing within different environments. One of these specific domains is healthcare, in which the international standard Health Information Services Architecture (HISA) is applied under the directives of RM-ODP. HISA presents a flexible architecture identifying common use cases, actors, information, and services and easing its extension with specific services, systems and information. The HISA standard follows system specification through the RM-ODP viewpoints but it does not consider other features of the reference model, such as the Enterprise language or the UML4ODP specification. In this paper, we introduce the rationale and specification of the three technology-independent viewpoints of an HISA-based architecture conforming to RM-ODP and UML4ODP. Moreover, we evaluate how easy it is to extend this architecture to introduce specific services and elements. As proof of concept we explore security and privacy issues (i.e., requirements, actors, information objects, etc.) and enrich the architecture with suitable objects and services, mainly from access control standardization efforts. In addition, a detailed discussion about the divergences between RM-ODP and HISA is presented. The main contribution of our work is to develop (guided by RM-ODP, HISA, and other standards) a methodology and tools allowing healthcare service developers and designers to build solutions conforming to standards and leveraging the benefits of distribution and interoperability. These tools consist of the specification of three technology-independent viewpoints according to the guidelines of HISA, RM-ODP and UML4ODP for the healthcare domain, and they will be freely available. In parallel, these viewpoints are extended with access control issues, and the adequacy of the HISA extension mechanism is evaluated

Privilege Management Infrastructure for Virtual Organizations in Healthcare Grids

This paper is focused on the management of virtual organizations (VO) inside healthcare environments where grid technology is used as middleware for a healthcare services-oriented architecture (HSOA). Some of the main tasks considered for the provision of an efficient VOmanagement aremanagement of users, assignation of roles to users, assignation of privileges to roles, and definition of resources access policies. These tasks are extremely close to privilege management infrastructures (PMI), so we face VOmanagement services as part of the PMI supporting access control to healthcare resources inside the HSOA. In order to achieve a completely open and interoperable PMI, we review and apply standards of security and architectural design. Moreover, semantic technologies are introduced in decision points for access control allowing the management of a high degree of descriptors by means of ontologies and infer the decision making through rules and reasoners

The first public bodies for the management of economic policy in tourism in Spain (1904-1931)

Traditionally, studies that address the evolution of tourism activities and the policies that regulate them, as well as their economic effects, have been linked to the analysis of political, and not economic, periods related to tourism, that is, the Monarchy of Alfonso XIII, the Republic, Francoism and Democracy. The purpose of this work is to analyze the tourism sector during the period from 1904 to 1931, based on the study of three major stages that show its progress or stagnations, especially taking into account two aspects: the legal articulation of the sector and the people who carried it out, as well as the economic aspects that have stood out in those stages. The reasons that have led us to apply this methodology are mainly based on the fact that Spain, despite having considerable own or "inherited" resources for tourism activities, given its cultural, environmental or coastal heritage, has suffered of a continued political drive to generate this activity, being the effort and personal tenacity of some public officials or political figures such as the Marquis de la Vega-Inclán, among others, those who develop the sector from the regulatory point of view, and also economic, to make it more attractive internationally. In addition, it is important to analyze the conformation of the tourist sector from a descriptive analysis, which takes into account a historical-economic vision, rather than a historical-political one, thus showing its trajectory throughout the indicated study period. In this way, it can be said that this period of analysis stands out for a greater awareness on the part of the Governments about the importance of tourism in Spain, differentiating the following stages: The National Commission in charge of promoting artistic and recreational excursions for the foreign public (1904-1911). The Regia Comisaría de Turismo (1911-1928). The National Tourist Board (1928-1931).Tradicionalmente, los estudios que abordan la evolución de las actividades turísticas y las políticas que las regulan, así como sus efectos económicos, han estado ligados al análisis de los períodos políticos, y no económicos, relacionados con el turismo, es decir, la Monarquía de Alfonso XIII, la República, el Franquismo y la Democracia. El propósito de este trabajo es analizar el sector del turismo durante el periodo que va desde 1904 hasta 1931, a partir del estudio de tres grandes etapas que muestren sus avances o estancamientos, teniendo en cuenta especialmente dos aspectos: la articulación legal del sector y las personas que la llevaron a cabo, así como los aspectos económicos que hayan destacado en esas etapas. Las razones que nos han llevado a la aplicación de esta metodología se basan principalmente en que España, a pesar de contar con unos considerables recursos propios o “heredados” para la realización de actividades turísticas, dado su patrimonio cultural, medioambiental o litoral, ha adolecido de un empuje político continuado para generar esa actividad, siendo el esfuerzo y el tesón personal de algunos funcionarios públicos o personajes políticos como el Marqués de la Vega-Inclán, entre otros, los que desarrollan el sector desde el punto de vista normativo, y también económico, para hacerlo más atractivo internacionalmente. Además, es importante analizar la conformación del sector turístico desde un análisis descriptivo, que tenga en cuenta una visión histórico-económica, más que histórico-política,  mostrando así su trayectoria a lo largo del periodo de estudio señalado. De esta forma, se puede decir que este periodo de análisis destaca por una mayor concienciación por parte de los Gobiernos sobre la importancia del turismo en España, diferenciándose las siguientes etapas: La Comisión Nacional encargada de fomentar las excursiones artísticas y de recreo del público extranjero (1904-1911). La Comisaría Regia de Turismo (1911-1928). El Patronato Nacional de Turismo (1928-1931)