Título del artículo:

Rationale and design of a cluster randomized trial of a multifaceted intervention in people with hypertension: The Heart Outcomes Prevention and Evaluation 4 (HOPE-4) Study

Background: Cardiovascular disease is the leading cause of death throughout the world, with the majority of deaths occurring in low- and middle-income countries. Despite clear evidence for the benefits of blood pressure reduction and availability of safe and low-cost medications, most individuals are either unaware of their condition or not adequately treated. Objective: The primary objective of this study is to evaluate whether a community-based, multifaceted intervention package primarily provided by nonphysician health workers can improve long-term cardiovascular risk in people with hypertension by addressing identified barriers at the patient, health care provider, and health system levels. Methods/design: HOPE-4 is a community-based, parallel-group, cluster randomized controlled trial involving 30 communities (1,376 participants) in Colombia and Malaysia. Participants ≥50 years old and with newly diagnosed or poorly controlled hypertension were included. Communities were randomized to usual care or to a multifaceted intervention package that entails (1) detection, treatment, and control of cardiovascular risk factors by nonphysician health workers in the community, who use tablet-based simplified management algorithms, decision support, and counseling programs; (2) free dispensation of combination antihypertensive and cholesterol-lowering medications, supervised by local physicians; and (3) support from a participant-nominated treatment supporter (either a friend or family member). The primary outcome is the change in Framingham Risk Score after 12 months between the intervention and control communities. Secondary outcomes including change in blood pressure, lipid levels, and Interheart Risk Score will be evaluated. Significance: If successful, the study could serve as a model to develop low-cost, effective, and scalable strategies to reduce cardiovascular risk in people with hypertension.

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American Heart Journal

Título del artículo:

Evidences in Neurological Surgery and a Cutting Edge Classification of the Trigeminocardiac Reflex: A Systematic Review

Background: The trigeminocardiac reflex (TCR) is characterized by bradycardia, decrease of mean arterial blood pressure, and sometimes, asystole during surgery. We critically reviewed TCR studies and devised a novel classification scheme for assessing the reflex. Methods: A comprehensive systematic literature review was performed using PubMed, MEDLINE, Web of Science, EMBASE, and Scielo databases. Eligible studies were extracted based on stringent inclusion and exclusion criteria. Statistical analyses were used to assess cardiovascular variables. TCR was classified according to morphophysiologic aspects involved with reflex elicitation. Results: A total of 575 patients were included in this study. TCR was found in 8.9% of patients. The reflex was more often triggered by interventions made within the anterior cranial fossa. The maxillary branch (type II in the new classification) was the most prevalent nerve branch found to trigger the TCR. Heart rate and mean arterial blood pressure were similarly altered (P = 0.06; F = 0.3912809), covaried with age (P = 0.012; F = 9.302), and inversely correlated to each other (r = −0.27). Conclusions: TCR is a critical cardiovascular phenomenon that must be quickly identified and efficiently classified and should trigger vigilance. Prompt therapeutic measures during neurosurgical procedures should be carefully addressed to avoid unwanted complications. Accurate categorization using the new classification scheme will help to improve understanding and guide the management of TCR in the perioperative period.

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World Neurosurgery

Título del artículo:

Strength-endurance training reduces the hamstrings strength decline following simulated football competition in female players

Hamstring strains are the most common injury in multiple sprint sports, with inadequate eccentric hamstring strength and fatigue identified as important risk factors. Resistance training interventions aimed at reducing injury risk typically focus on the development of maximum strength, while little is known about the impact of training on hamstring fatigue resistance. The present study compared the effects of strength endurance (SE) with a strength intervention (S) on the eccentric hamstring strength decline induced by a simulated soccer match. Twenty-one female soccer players were randomly assigned to a S group (n = 10) or a SE group (n = 11). Hamstrings and quadriceps isokinetic concentric and eccentric peak torque (PT) were assessed at 120°.s-1 and hamstrings-to-quadriceps ratio (HEcc:QCon) calculated, pre- and immediately post a 90-min simulated match (BEAST90). This was repeated following a 7-week intervention of either three to five sets of 6RM leg curl and stiff-leg deadlift with 3-min inter-set rest (S), or the same exercises performed using three sets of 12-20 RM with 45-90 s inter-set rest (SE). At baseline, the simulated match led to significant declines in hamstrings eccentric peak torque (EccPT) in both groups in both dominant (D) and non-dominant (ND) legs [SE: (D: -15.5, ND: -15.6%), P = 0.001 to 0.016; S: (D: -12.3%, ND: -15.5%), P = 0.001 to 0.018]. After the 7-week intervention, we observed a group*intervention*match interaction such that there was no significant decline in EccPT in the SE group following the simulated match (D: 5.3%, ND: 2.0%), but there remained significant declines in the S group (D: -14.2%, ND: -15.5%, P = 0.018-0.001). Similarly, in the SE group, there was a significant decrease in the HEcc:QCon in D before (-14.2%, P = 0.007), but not after the training intervention, whereas declines were observed in the S group both at baseline, and following the intervention (D: -13.9%, ND: -15.6%, P = 0.045). These results demonstrate that SE training can reduce the magnitude of the EccPT decline observed during soccer competition. As inadequate eccentric strength and fatigue are both risk factors for hamstring injury, SE training should be considered along with the development of peak eccentric strength, as a component of programs aimed at reducing injury risk in multiple-sprint sports.

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Frontiers in Physiology

Título del artículo:

Development of antibacterial and antifungal triazole chromium(III) and cobalt(II) complexes: Synthesis and biological activity evaluations

In this work, six complexes (2-7) of Cr(III) and Co(II) transition metals with triazole ligands were synthesized and characterized. In addition, a new ligand, 3,5-bis(1,2,4-triazol-1-ylmethyl)toluene (1), was synthesized and full characterized. The complexes were obtained as air-stable solids and characterized by melting point, electrical conductivity, thermogravimetric analysis, and Raman, infrared and ultraviolet/visible spectroscopy. The analyses and spectral data showed that complexes 3-7 had 1:1 (M:L) stoichiometries and octahedral geometries, while 2 had a 1:2 (M:L) ratio, which was supported by DFT calculations. The complexes and their respective ligands were evaluated against bacterial and fungal strains with clinical relevance. All the complexes showed higher antibacterial and antifungal activities than the free ligands. The complexes were more active against fungi than against bacteria. The activities of the chromium complexes against Candida tropicalis are of great interest, as they showed minimum inhibitory concentration 50 (MIC50) values between 7.8 and 15.6 μg mL-1. Complexes 5 and 6 showed little effect on Vero cells, indicating that they are not cytotoxic. These results can provide an important platform for the design of new compounds with antibacterial and antifungal activities.

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Molecules

Título del artículo:

Effects of lipid-lowering and antihypertensive treatments in addition to healthy lifestyles in primary prevention: An analysis of the HOPE-3 trial

Background-It is not clear whether the effects of lipid-lowering or antihypertensive medications are influenced by adherence to healthy lifestyle factors. We assessed the effects of both drug interventions in subgroups by the number of healthy lifestyle factors in participants in the HOPE-3 (Heart Outcomes Prevention Evaluation) trial. Methods and Results-In this primary prevention trial, 4 healthy lifestyle factors (nonsmoking status, physical activity, optimal body weight, and healthy diet) were recorded in 12 521 participants who were at intermediate risk of cardiovascular disease (CVD) and were randomized to rosuvastatin, candesartan/hydrochlorothiazide, their combination, or matched placebos. Median follow-up was 5.6 years. The outcome was a composite of CVD events. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression models. Participants with ≥2 healthy lifestyle factors had a lower rate of CVD compared with those with fewer factors (HR: 0.85; 95% CI, 0.73-1.00). Rosuvastatin reduced CVD events in participants with ≥2 healthy lifestyle factors (HR: 0.74; 95% CI, 0.62-0.90) and in participants with <2 factors (HR: 0.79; 95% CI, 0.61-1.01). Consistent results were observed with combination therapy (≥2 factors: HR: 0.74; 95% CI, 0.57-0.97; <2 factors: HR: 0.61; 95% CI, 0.43-0.88). Candesartan/ hydrochlorothiazide tends to reduce CVD only in participants with <2 healthy lifestyle factors (HR: 0.78; 95% CI, 0.61-1.00). Conclusions-Healthy lifestyles are associated with lower CVD. Rosuvastatin alone and combined with candesartan/ hydrochlorothiazide is beneficial regardless of healthy lifestyle status; however, the benefit of antihypertensive treatment appears to be limited to patients with less healthy lifestyles.

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Journal of the American Heart Association

Título del artículo:

Functional physical condition and risk of falls in older adults

Introduction: Approximately 30% of subjects older than 60 years may experience a fall during their life, an event that in most cases demands hospital care and can lead to death. Falls are considered the second cause of death for accidental injuries in the elderly population and the decrease in physical condition in this age is usually one of its triggering factors. Thus, shows that the health condition in this population should be evaluated according to the degree of the functional capacity, since its alteration might generate consequences on the family, the community and the health system. Objective: To determine the physical and risk of falls in older adults belonging to the Sports and Recreation Institute of Barrancabermeja (INDERBA). Methods: analytical cross-sectional study, carried out on 40 subjects to whom the Tinetti scale was applied to identify risk of falling and the Senior Fitness Test battery that determines functional physical fitness. Results: All the components of the physical fitness, except flexibility, were above the average according to the age range of the population. In addition, it was observed that the risk of falling is inversely proportional to weight, to BMI, to muscular resistance and directly proportional to agility p <0.05. Conclusions: The population group evaluated shows low risk of falling, however, it is suggested to control body weight, promote strength training and muscle power, which can lead to a decrease in the incidence of falling.

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Revista Cubana de Investigaciones Biomedicas

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Biological characterization of the CD66c marker and its clinical importance in acute lymphoid leukemia

Leukemias are a heterogeneous group of blood diseases with a diverse etiology, pathogenesis, natural history and prognosis in which a clonal proliferation may be triggered. Acute lymphoid leukemia (ALL) is one of the most common types of cancer in children, it is characterized by the infiltration of neoplastic cells from the haematopoietic system to the bone marrow, blood and other tissues. Until 30 years ago, it was considered fatal; nowadays, the five-year survival rate exceeds 70 %, which implies that most patients may heal. Nevertheless, in developing countries the situation might be different for pediatric population; it is estimated that cancer survival rate ranges between 10 and 20 % less than those children living in developed countries. One of the immunophenotype markers that has been relevant in the last few years in the diagnosis of B-ALL and the follow-up of the minimal residual disease is CD66c. This is a member of the glycoprotein family from the carcinoembryonic antigen with a cellular adhesion function that has been widely used as a tumor marker as discovered by Sven Berg in the late 1970\'s. This antigen has been identified as a superficial protein expressed on the granulocytes and it is also involved in several biological functions, including cellular adhesion, migration, signal transduction and regulation of gene expression. This antigen is frequently presented in several types of cancer and its overexpression is often associated with a poor response to treatment and a decrease of survival rates for patients. Several studies have evidenced that this marker is relatedwith the presence of several chromosomal abnormalities, such as: BCR-ABL, CRLF2, and hyperdiploidy, which may help in the disease prognosis.

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Revista Cubana de Hematologia, Inmunologia y Hemoterapia

Título del artículo:

Prevalence and characterization of autoimmune diseases in patients older than 13 years in a hospital of Colombia

BACKGROUND: Autoimmune diseases affect around 3-5% of human beings, especially women. Due to its low prevalence, local clinical data on the behavior of this disease are unknown. OBJECTIVE: To find the prevalence of autoimmune diseases in the University Hospital of Santander, as well as to carry out the clinical and sociodemographic characterization of the diseases. MATERIAL AND METHOD: An observational, descriptive and retrospective cross-sectional study on the prevalence of autoimmune diseases was done at the University Hospital of Santander between 2012 and 2016 in patients over 13 years of age who entered to the institution. RESULTS: A total of 1463 autoimmune diseases were found, with a prevalence of 378 cases per 100,000 patients over 13 years of age treated at the University Hospital of Santander and the population with autoimmune disease was 0.4%. The most prevalent diseases were rheumatoid arthritis, psoriasis, Graves\' disease, immune thrombocytopenic purpura and systemic lupus erythematosus and the most affected organs were the skin, thyroid gland, hematology system, pancreas and nervous system. CONCLUSIONS: The data suggest that the prevalence in our environment is similar to that of studies in other populations; however, these prevalences are multifactorial and may vary among different populations.

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Medicina Interna de Mexico

Título del artículo:

The Athletic Shoulder (ASH) test: Reliability of a novel upper body isometric strength test in elite rugby players

Objectives Lower limb isometric tests are used to assess strength and strength asymmetries and monitor reductions in muscle force that may contribute to loss of performance and increase injury risk. Isometric tests in the upper body may be appropriate to monitor neuromuscular performance of the shoulder joint in sports involving contact and overhead actions. The aim of this study was to determine the reliability of a novel upper body isometric strength test. Methods Eighteen elite rugby players (age 22.4±4.6 years; body mass 95.5±13.4 kg) were tested on consecutive days. Maximal isometric contractions using both limbs against a force platform were assessed at three angles of abduction (180°, â I\'; 135°, â Y\' and 90°, â T\'), in a prone lying position. To evaluate interday reliability, intraclass coefficients (ICC) were calculated for mean net peak force (NPF) and highest NPF achieved in any trial (peak NPF). Intratrial variability was assessed using coefficient of variation (CV), and the standard error of measurement (SEM) was used to calculate minimal detectable change (MDC). Results Interday reliability for NPF was excellent in all test positions (ICC 0.94-0.98). The test demonstrated high absolute reliability values (SEM 4.8-10.8) and interday measurement error was below 10% in all test positions (CV 5.0-9.9%) except for the non-dominant arm I-position (CV 11.3%). Minimum detectable change was between 13.2 and 25.9 N. Conclusion The Athletic Shoulder test demonstrated excellent reliability for each test position supporting its use as a reliable tool to quantify the ability to produce and transfer force across the shoulder girdle.

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BMJ Open Sport and Exercise Medicine

Título del artículo:

Central Obesity is the Key Component in the Association of Metabolic Syndrome With Left Ventricular Global Longitudinal Strain Impairment

Introduction and objectives: Subclinical systolic dysfunction is one of the proposed mechanisms for increased cardiovascular risk associated with metabolic syndrome (MS). This study investigated the association between MS and impaired left ventricular global longitudinal strain (GLS) and the role of each MS criteria in this association. Methods: We analyzed a random sample of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) after excluding participants with prevalent heart disease. Results: Among the 1055 participants fulfilling the inclusion criteria (53% women; 52 ± 9 years), 444 (42%) had MS. Those with MS had worse GLS (–18.0% ± 2.5%) than those without (–19.0% ± 2.4%; P <.0001). In multiple linear regression models, MS was associated with worse GLS after adjustment for various risk factors (GLS difference = 0.86%; P <.0001), even after inclusion of body mass index. Adjusted PR for impaired GLS as assessed by 3 cutoffs (1, 1.5, and 2 standard deviations) were higher among participants with than without MS: GLS –16.1% (PR, 1.76; 95%CI, 1.30-2.39); GLS –14.8% (PR, 2.35; 95%CI, 1.45-3.81); and GLS –13.5% (PR, 2.07; 95%CI, 0.97-4.41). After inclusion of body mass index in the models, these associations were attenuated, suggesting that they may, at least in part, be mediated by obesity. In quantile regression analyses, elevated waist circumference was the only MS component found to be independently associated with GLS across the whole range of values. Conclusions: Metabolic syndrome is independently associated with impaired GLS. Among the MS criteria, central obesity best depicted the link between metabolic derangement and cardiac function. Full English text available from: www.revespcardiol.org/en

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Revista Espanola de Cardiologia

Título del artículo:

Strengthening of the Occupational Health and Safety Management System in the Psychosocial Scope from the Perspective of the Logical Framework

This proposal is aimed at Strengthening the Occupational Health and Safety Management System in the Psychosocial Scope according to Resolution 2646 of 2008, emphasizing the evaluation of psychosocial factors, intra-labor, nonwork and stress in IPS officials. This proposal was designed from the Logical Framework Methodology (MML) due to the need to identify, prepare, evaluate, monitor and control psychosocial risks at work.

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Espacios

Título del artículo:

Management by values: A strategy for the improvement of the organizational climate

Presented Below are the results of the research on the Management by Values as a strategy for improving the organizational climate in organizations located in the city of Valledupar, whose general objective was to establish a program of Management by Values as a strategy for improving the organizational climate for enterprise which identified the current status of the organizational climate that presents the company; it was determined the values that will be part of the program of Management by Values and design strategies for the implementation of a program of management by values. For the above developed a diagnosis of the current situation of the organizational climate; laying down the strengths, weaknesses, threats and opportunities for the design and implementation of the program of Management by Values. According to the above, there is a need to train and create compensation strategies, different to the economic, within companies, and they become a motivator and power-ups of good organizational climate; the implementation of the program management by values, allows you to generate a better attitude on the part of all the personnel of the companies, from the administrative, commercial operators and, toward the work and the relationship between them. In addition, the organizations has generated a culture of leadership and team work much more dynamic and spontaneous, allowing the empowerment and ownership for the organization.

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Espacios

Título del artículo:

Development, Testing, and Implementation of a Training Curriculum for Nonphysician Health Workers to Reduce Cardiovascular Disease

Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. The need to address CVD is greatest in low- and middle-income countries where there is a shortage of trained health workers in CVD detection, prevention, and control. Objectives: Based on the growing evidence that many elements of chronic disease management can be shifted to nonphysician health care workers (NPHW), the HOPE-4 (Heart Outcomes Prevention and Evaluation Program) aimed to develop, test, and implement a training curriculum on CVD prevention and control in Colombia, Malaysia, and low-resource settings in Canada. Methods: Curriculum development followed an iterative and phased approach where evidence-based guidelines, revised blood pressure treatment algorithms, and culturally relevant risk factor counseling were incorporated. Through a pilot-training process with high school students in Canada, the curriculum was further refined. Implementation of the curriculum in Colombia, Malaysia, and Canada occurred through partner organizations as the HOPE-4 team coordinated the program from Hamilton, Ontario, Canada. In addition to content on the burden of disease, cardiovascular system pathophysiology, and CVD risk factors, the curriculum also included evaluations such as module tests, in-class exercises, and observed structured clinical examinations, which were administered by the local partner organizations. These evaluations served as indicators of adequate uptake of curriculum content as well as readiness to work as an NPHW in the field. Results: Overall, 51 NPHW successfully completed the training curriculum with an average score of 93.19% on module tests and 84.76% on the observed structured clinical examinations. Since implementation, the curriculum has also been adapted to the World Health Organization\'s HEARTS Technical Package, which was launched in 2016 to improve management of CVD in primary health care. Conclusions: The robust curriculum development, testing, and implementation process described affirm that NPHW in diverse settings can be trained in implementing measures for CVD prevention and control.

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Global Heart

Título del artículo:

Application of the association for children\'s palliative care (ACT) criteria at a pediatric reference institution in the Colombian Caribbean

Objective To assess the existence of a population susceptible to pediatric palliative care using the classification of the Association for Children\'s Palliative Care (ACT). Materials and Methods Descriptive, retrospective study. The data included in clinical records of the pediatric population aged 0-18 years and attended at the Hospital Infantil Napoleón Franco Pareja in the city of Cartagena, Colombia, were reviewed. Results 2 718 patients were included and classified according to ACT groups in group I with 462 patients; group II with 61 patients; group III with 29 patients; and group IV with 1 195, representing 4.5% of the total population attended by the institution Conclusions The study found a population susceptible to pediatric palliative care, which requires establishing measures to complement and provide comprehensive care.

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Revista de Salud Publica

Título del artículo:

Identification of Cry1 genes in Bacillus thuringiensis isolates and their toxic effect against Milax gagates , plague in lettuce ( Lactuca sativa )

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Revista Chapingo, Serie Horticultura

Título del artículo:

Point prevalence of gastrointestinal parasites in double purpose cattle of Rio de Oro and Aguachica municipalities, Cesar state, Colombia

Gastrointestinal parasites are one of the most important health problems in cattle worldwide, as they cause economic losses in the herds. Twenty - seven double purpose herds were visited to determine the prevalence of gastrointestinal parasites in cattle at the Rio de Oro and Aguachica municipalities. Overall, 862 fecal samples were collected in three age groups: < 12 months, 12–24 months and > 24 months. Stool samples were taken directly from the rectum and refrigerated until processing. For parasite determination, fecal samples were processed using coprological techniques. The parasitic genera were identified by egg or infective larval morphology. The global prevalence of gastrointestinal parasites was 83.2%, being the highest values for Eimeria sp. (77.9%), Strongyloides sp. (10.8%) and Haemonchus sp. (8.5%). Regarding the prevalence by municipalities, there was no statistical association (P > 0.05) indicating that the prevalence was similar in the two municipalities. Regarding the results for Eimeria sp., different degrees of positivity were observed, reflecting that there was statistical association (P < 0.05) with respect to the age group, suggesting that adult animals may act as infection source for calves. Likewise, there was statistical association (P < 0.05) between the prevalence for Strongyloides sp., Haemonchus sp. and Trichostrongylus sp. with respect to the age group. It is concluded that there is a high prevalence of gastrointestinal parasites in dual-purpose cattle in the municipalities under study, and that it could be controlled by improving the hygienic conditions of the herds, and informing the farmer about parasite control programs.

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Veterinary Parasitology: Regional Studies and Reports

Título del artículo:

Effect of the kangaroo mother program on posture and breastfeeding

Introduction: Postural alterations are static and dynamic modifications of the body, leading to erroneous motor patterns and incorrect attitudes. During breastfeeding the adoption of different postures is necessary, implying keeping them for long periods of time; it is there where the accompaniment, training and advice is essential to the mother and support group aimed at the achievement of a successful, satisfactory breastfeeding process for the mother and the child. Objective: To identify the effect of Kangaroo Mother Program (KMP) on musculoskeletal disorders and the permanence of breastfeeding in mothers of premature infants. Method: One hundred mothers of premature children were selected, 50 of them were in a hospital institution that has implemented the kangaroo mother program and the rest in another institution without this program. Data were analysed in SPSS 15.0 version 2, a Shapiro Wilk normality test was performed to establish whether the kangaroo mother program affects the appearance of pain through 2 x 2 tables. In all tests, the level of significance was established when the value was p ≤ 0.05. Results: Women who participate in the Kangaroo Mother program have 3.1 times less risk of developing musculoskeletal pain than women who do not participate.

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Revista Cubana de Obstetricia y Ginecologia

Título del artículo:

Reevaluating nutrition as a risk factor for cardio-metabolic diseases

Introduction: The consumption of saturated fats is considered a risk factor for cardiovascular diseases. Objective: Review published papers on the role of macro-nutrient intake in cardiovascular risk. Results: Recent reports from the PURE study and several previous meta-analyses, show that the consumption of total saturated and unsaturated fat is not associated with risk of acute myocardial infarction or mortality due to cardiovascular disease. High carbohydrate intake was associated with the highest risk of total and cardiovascular mortality, while total fat consumption or of its different types was associated with a lower risk of mortality. A high consumption of fruits, vegetables and legumes was associated with lower risk of total mortality and non-cardiovascular mortality. The consumption of 100 g of legumes, two or three times a week, ameliorated deficiencies of the nutrients contained in these foods and was associated with a reduction in the risk of developing chronic non-communicable diseases. Conclusion: A healthy diet should be balanced and varied, be composed of a proportion of complex carbohydrates rich in fibber between 50-55% of the daily energy consumed, of saturated and unsaturated fat (25-30%), animal and vegetable protein (including legumes) between 15-25%, vitamins, minerals and water. These nutrients are abundantly present in fruits, vegetables, cereals, legumes, milk and its derivatives, eggs and meats, so public policies should promote the availability and access to these nutrients within primary prevention programs to reduce the growing prevalence of cardio-metabolic diseases.

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Colombia Medica

Título del artículo:

Perceptive analysis of the quality in health services´ delivery with a Six-Sigma approach

Introduction: Ensuring access to quality health services is one of the necessary conditions for reducing poverty and inequality in a country. Objective: To analyze the perception of quality in the provision of health services in a public care hospital. Methods: A cross-sectional study of patients treated from March to April 2016 in the emergency and outpatients clinics of Lázaro Alfonso Hernández Lara Hospital, in Colombia. The sample included 220 patients that were randomly selected. Six sigma methodology which is useful for organizing the continuous improvement of health services was applied. Data from the target population were obtained through the SERVQUAL survey, which measures the perception of quality. Results: Regarding the perceived quality of care, the security dimension appeared confused with empathy, and as a differentiating factor, the comfort dimension emerged, separated from tangible elements. The overall rating of perception confirmed that about 50% of patients had low perceptions on the quality’s dimensions assessed. Conclusions: Patients show low quality’s perception regarding the health services they receive. This makes possible to recommend hospital directives to review the processes related to the quality of the services provided, and to propose improvement policies in the emergency and outpatient areas, according to the needs and conditions of the users.

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Revista Cubana de Salud Publica

Título del artículo:

Epidemiological aspects of Cystoisospora suis in swine herds located at the Central region of Venezuela

It was carried out an investigation during 2016 with the aim to study epidemiological aspects of Cystoisospora suis infections. Sixty-seven (67) intensive swine herds with a history of neonatal diarrhea were included. Overall, 572 litters and 1,712 fecal samples in mature pigs were examined. A written epidemiological survey was applied on all farms. Fecal samples were cultured in 2.5% potassium dichromate and analyzed with a copro-parasitological technique. C. suis was found in 55/67 herds (82.1 %) and 210 litters (36.7 %) with highest prevalence in the first 2 wk of age (P>0.05). Regarding mature pigs, a significant correlation was found (rho= 0.35; P>0.05) between infection in piglets and sows, suggesting that mothers sows could act as infection sources. Statistical associations were determined among parity number and frequency values in litters and sows (P>0.05), indicating that as parity increase, prevalence decrease. Probably these findings are associated with unknown immunologic mechanisms. Infection in litters less than 3 d of age, presupposes the existence of some alternative infection route. It is concluded that C. suis is broadly distributed at the central region of Venezuela and it could be controlled by improving the sanitary conditions of the herds; however, immunologic mechanisms might be involved in the protozoa transmission cycle which remain yet to be determined.

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Revista Mexicana De Ciencias Pecuarias

Título del artículo:

The simultaneous assessment of glycosylated hemoglobin, fasting plasma glucose and oral glucose tolerance test does not improve the detection of type 2 diabetes mellitus in Colombian adults

Introduction Guidelines recommend early detection of type 2 diabetes mellitus (DM2). The objective of the present study was to evaluate the capacity to identify DM2 in subjects that were screened for DM2 simultaneously with all three of the tests recommended—fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c) and a 2-hour post 75-g oral glucose tolerance test (OGTT). Methods and results The present analysis of an anonymous database of 1113 adults from a reference clinical laboratory in Bucaramanga, Colombia, was an observational, descriptive, cross-sectional secondary source study. 259 individuals met at least one of the criteria for DM2: FPG 126mg/dL (7.0mmol/L), HbA1c 6.5% (48mmol/mol) and OGTT 200mg/dL (11.1mmol/ L). 30 subjects (2.7%) were diabetic according to FPG, 56 subjects (5.0%) by HbA1c and 250 subjects (22.5%) by OGTT. In total 259 subjects (23.3% [IC 95%: 20.7%– 25.8%] were diabetic either by FPG, OGTT or HbA1c. Discussion The largest number of patients were identified as diabetic with the OGTT. The combination of two or three tests did not increase the detection of new cases of DM2. Our findings suggest that routinely requesting FPG, OGTT and HbA1c at the same time may be inappropriate in at risk individuals, as this approach does not significantly improve the diagnostic capacity compared to using FPG+OGTT and substantially increases the financial burden on the health system, insurers or individual.

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PLoS ONE

Título del artículo:

Fixed-dose combination therapy to improve hypertension treatment and control in Latin America

Hypertension is a major risk factor for cardiovascular disease. Its prevalence is increasing worldwide, and is more common in low and middle-income countries. The effectiveness of hypertension treatment is determined by health cost, awareness, and patients’ compliance with the treatment. People worldwide with an adequate control of hypertension correspond to a very small percentage in low and medium income countries as the Latin America ones. Between the causes to explain these are the low availability, affordability and adherence to treatment with multiple pills. It has been proposed that fixed dose combination therapy could improve the availability, affordability, adherence and control of hypertension. This article aims to review the evidence, showing that fixed dose combination can improve adherence, decrease health cost and improve control of hypertension. Improvement in hypertension control with fixed dose combination could make an important contribution to efforts to fight against the global cardiovascular morbidity and mortality.

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Archivos de Cardiologia de Mexico

Título del artículo:

Prognostic validation of a non-laboratory and a laboratory based cardiovascular disease risk score in multiple regions of the world

Objective To evaluate the performance of the non-laboratory INTERHEART risk score (NL-IHRS) to predict incident cardiovascular disease (CVD) across seven major geographic regions of the world. The secondary objective was to evaluate the performance of the fasting cholesterol-based IHRS (FC-IHRS). Methods Using measures of discrimination and calibration, we tested the performance of the NL-IHRS (n=100 475) and FC-IHRS (n=107 863) for predicting incident CVD in a community-based, prospective study across seven geographic regions: South Asia, China, Southeast Asia, Middle East, Europe/North America, South America and Africa. CVD was defined as the composite of cardiovascular death, myocardial infarction, stroke, heart failure or coronary revascularisation. Results Mean age of the study population was 50.53 (SD 9.79) years and mean follow-up was 4.89 (SD 2.24) years. The NL-IHRS had moderate to good discrimination for incident CVD across geographic regions (concordance statistic (C-statistic) ranging from 0.64 to 0.74), although recalibration was necessary in all regions, which improved its performance in the overall cohort (increase in C-statistic from 0.69 to 0.72, p<0.001). Regional recalibration was also necessary for the FC-IHRS, which also improved its overall discrimination (increase in C-statistic from 0.71 to 0.74, p<0.001). In 85 078 participants with complete data for both scores, discrimination was only modestly better with the FC-IHRS compared with the NL-IHRS (0.74 vs 0.73, p<0.001). Conclusions External validations of the NL-IHRS and FC-IHRS suggest that regionally recalibrated versions of both can be useful for estimating CVD risk across a diverse range of community-based populations. CVD prediction using a non-laboratory score can provide similar accuracy to laboratory-based methods.

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Heart

Título del artículo:

Ovine and caprine fasciolosis incidence in the north of Cesar and south of the Guajira

Fascioliasis is an important disease caused by the parasite Fasciola hepatica, which usually attacks production animals, especially domestic ruminants and occasionally humans, which is why it is of great importance in public health. Commonly described in temperate and humid regions, the indiscriminate transport of animals has allowed this trematode to settle and complete the biological cycle in regions of the dry tropics, such as north of Cesar and south of La Guajira of Colombia. Objective: to identify the incidence of fasciolosis in sheep and goats. Methods: 1039 sheep and goats without discrimination of sex or age of ten municipalities of the two departments randomly were selected. Samples of fecal material were collected by rectal palpation (approximately 100 gr for parasitological diagnosis) using the Dennis technique from samples collected in August 2015 to May 2016. The recovered eggs were analyzed morphologically through light microscopy (increases of 10 x and 40 x). Results: for the total of the analyzed population of 1039 animals of the two species, 150 were positive (14.43%), a total of 27 in goats (18%): 26 females and 1 male; 123 in sheep (82%), 111 females and 12 males. Conclusions: this study demonstrates the importance of fasciolosis in ovine-caprine livestock of north Cesar and south of La Guajira to will take control measures in sanitary inspection processes due to their impact on public health.

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Revista Electronica de Veterinaria

Título del artículo:

Spatiotemporal dynamics of human leptospirosis and its relationship with rainfall anomalies in Colombia

Background: In Colombia, human leptospirosis (HL) is a disease that has had a mandatory notification rule since 2007. Humans usually acquire the infection through water contaminated with animal urine that comes into direct contact with cutaneous lesions, eyes or mucous membranes. Objectives: To analyze the spatiotemporal variability in the occurrence of HL cases in Colombia between 2007 and 2016, and its relation with the El Niño Southern Oscillation (ENSO) cycle and the consequent anomalies in rainfall in spatiotemporal clusters. Methods: An ecological study of the HL cases, aggregated by municipality, and reported between 2007 and 2016, is presented. Findings: During the period of study, 9928 cases of HL were reported, and 58.9% of the municipalities reported at least one case of leptospirosis. Six spatiotemporal clusters were identified-five were in the Andean region and one was in the Caribbean region. The assessment of the ENSO cycle and rainfall anomalies suggests the importance of La Niña episodes, and excess rainfall periods in the occurrence of cases of HL. Conclusions: Our results demonstrate the importance of the ENSO cycle, rainfall periods and periods with excess rainfall in the occurrence of cases and outbreaks of HL in Colombia, and suggest the importance of the topography of valleys and flood zones as zones in which the risk of infection is elevated.

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Transactions of the Royal Society of Tropical Medicine and Hygiene