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Objectives: The Brazilian Unified Health System (Sistema Único de Saúde-SUS) is the universal public healthcare system of Brazil that maintains a nationwide database of its patients. Our primary objective was to analyze regional and temporal trends, while our secondary goal was to establish correlations between states' health economy status and their prostate cancer (PCa) epidemiology. Methods: We analyzed Brazil's nationwide data on prostate cancer (PCa) incidence, mortality, and care gathered between 2013 and 2021 by the Information Technology Department of SUS (DATA-SUS), updated monthly using the International Classification of Diseases (ICD-10) code. Results: In the period, 273,933 new cases of PCa and 135,336 PCa deaths were reported in men aged 50 years or over in Brazil. The median annual PCa-specific incidence rate (PCSIR) ranged from 14.7 in the Southeast to 6.9 in the North region and the median annual PCa-specific mortality rate (PCSMR) ranged from 7.7 in the Northeast to 6.0 in the South region (per 10,000 men >50). The median annual mortality to incidence ratio (MIR) was highest in the North (0.88) and lowest in the Southeast region (0.44). There were significant regional differences in PCa treatment rates (per new cases); the Midwest region had the highest median annual surgery rate (0.63) while the North region had the highest median annual systemic therapy rate (0.75) and the lowest radiation therapy rate (0.06). Temporal analysis of the data showed significant change in annual rate trends after the year 2018 for PCSIR (coefficient [ß] = +3.66, p < 0.001), any treatment (ß = -0.06, p = 0.016), surgery ([SR] ß = +0.05, p = 0.017) radiation therapy ([RTR] ß = -0.06, p = 0.005) and systemic therapy ([STR] ß = -0.10, p = 0.002). After the 2020 pandemic, annual PCSIR decreased (ß = -2.15, p = 0.002) but annual PCSMR, MIR, and treatment rates remained stable. Correlation studies showed that the PCSIR was strongly negatively correlated with STR (p < 0.001) and positively correlated with RTR (p = 0.004). MIR was positively correlated with STR (p < 0.001) and negatively correlated with the number of robotic surgical systems per million population (p = 0.003). Conclusion: Our data shows that PCa care is dependent on the region and is likely influenced by access to treatment options. Furthermore, changes after the year 2018 underscore the influence of international guidelines on Brazilian clinicians' decision-making especially concerning population screening which in turn affected incidence and treatment rates. Limitation of our study includes limited patient-related information and data on private practices as well as an unknown impact of traveling patients.

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PURPOSE: To (1) describe secular trends in gross motor coordination (GMC) scores by sex and age; (2) investigate GMC trends adjusted for concomitant secular trends in height, weight, and overall physical fitness; and (3) examine trends in children's frequencies within different GMC categories. METHOD: The sample comprises 1562 Peruvian children (690 in 2009 and 872 in 2019), aged 6-11 years, from Junín (a high-altitude region). GMC was assessed with the KörperkoordinationsTest für Kinder. Physical fitness was assessed with handgrip strength, standing long jump, and shuttle-run test. Height and weight were measured with standardized protocols. Analysis of variance, covariance, and logistic regression were used. RESULTS: A negative secular trend in GMC (based on raw scores) for boys and girls aged 6-8 years was observed. However, a positive trend was observed at 11 years of age but only in boys. Finally, there were no significant changes in the likelihood of children having below-normal GMC from 2009 to 2019. CONCLUSIONS: Secular trends in GMC were negative in Peruvian children, especially at 6-8 years of age. Further, body size and physical fitness trends did not affect the negative secular trend. A high prevalence of children had below-normal GMC in both 2009 and 2019.

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The relevance of atmospheric particulate matter (PM) to health and the environment is widely known. Long-term studies are necessary for understanding current and future trends in air quality management. This study aimed to assess the long-term PM concentration in the Magdalena department (Colombia). It focused on the following aspects: i) spatiotemporal patterns, ii) correlation with meteorology, iii) compliance with standards, iv) temporal trends over time, v) impact on health, and vi) impact of policy management. Fifteen stations from 2003 to 2021 were analyzed. Spearman-Rho and Mann-Kendall methods were used to correlate concentration with meteorology. The temporal and five-year moving trends were determined, and the trend magnitude was calculated using Teil-Sen. Acute respiratory infection odd ratios and risk of cancer associated with PM concentration were used to assess the impact on health. The study found that the maximum PM10 concentration was 194.5 µg/m3, and the minimum was 3 µg/m3. In all stations, a negative correlation was observed between PM10 and atmospheric water content, while the wind speed and temperature showed a positive correlation. The global trends indicated an increasing value, with five fluctuations in five-year moving trends, consistent with PM sources and socio-economic behavior. PM concentrations were found to comply with national standard; however, the results showed a potential impact on population health. The management regulation had a limited impact on increasing concentration. Considering that national regulations tend to converge towards WHO standards, the study area must create a management program to ensure compliance.

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BACKGROUND: The incidence of thyroid cancer in the United States has risen dramatically since the 1970s, driven by an increase in the diagnosis of small tumors. There is a paucity of published New Mexico (NM) specific data regarding thyroid cancer. We hypothesized that due to New Mexico's unique geographic and cultural makeup, the incidence of thyroid cancer and tumor size at diagnosis in this state would differ from that demonstrated on a national level. METHODS: The New Mexico Tumor Registry (NMTR) was queried to include all NM residents diagnosed with thyroid cancer between 1992 and 2019. For 2010 to 2019, age-adjusted incidence rates were calculated via direct method using the 2000 United States population as the adjustment standard. Differences in incidence rate and tumor size by race/ethnicity and residence (metropolitan vs non-metropolitan) were assessed with rate ratios between groups. For 1992 to 2019, temporal trends in age-adjusted incidence rates for major race/ethnic groups in NM [Non-Hispanic White (NHW), Hispanic, and American Indian (AI)] were assessed by joinpoint regression using National Cancer Institute software. RESULTS: Our study included 3,161 patients for the time period 2010 to 2019, including NHW (1518), Hispanic (1425), and AI (218) cases. The overall incidence rates for NM AIs were lower than those for Hispanics and NHWs because of a decreased incidence of very small tumors (<1.1 cm). The incidence rates for large tumors (>5.1 cm) was equivalent among groups. In the early 2000s, Hispanics also had lower rates of small tumors when compared to NHWs but this trend disappeared over time. CONCLUSION: AIs in New Mexico have been left out of the nationwide increase in incidental diagnosis of small thyroid tumors. This same pattern was noted for Hispanics in the early 2000s but changed over time to mirror incidence rates for NHWs. These data are illustrative of the health care disparities that exist among New Mexico's population and how these disparities have changed over time.

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Rabies, a globally distributed and highly lethal zoonotic neglected tropical disease, has a significant impact in South America. In Ecuador, animal rabies cases are primarily linked to livestock, and hematophagous bats play a crucial role in disease transmission. This study aims to identify temporal trends, spatial patterns, and risk factors for animal rabies in Ecuador between 2014 and 2019. Epidemiological survey reports from the official Animal Rabies Surveillance Program of the Phyto and Zoosanitary Regulation and Control Agency of Ecuador (AGROCALIDAD) were used. The Animal Rabies Surveillance Program from AGROCALIDAD consists of an official passive surveillance program that receives reports from farmers or individuals (both trained or untrained) who have observed animals with neurological clinical signs and lesions compatible with bat bites, or who have seen or captured bats on their farms or houses. Once this report is made, AGROCALIDAD personnel is sent for field inspection, having to confirm the suspicion of rabies based on farm conditions and compatibility of signs. AGROCALIDAD personnel collect samples from all suspicious animals, which are further processed and analyzed using the Direct Fluorescent Antibody (DFA) test for rabies confirmatory diagnosis. In this case, study data comprised 846 bovine farms (with intra-farm sample sizes ranging from 1 to 16 samples) located in different ecoregions of Ecuador; out of these, 397 (46.93%) farms tested positive for animal rabies, revealing six statistically significant spatial clusters. Among these clusters, three high-risk areas were identified in the southeast of Ecuador. Seasonality was confirmed by the Ljung-Box test for both the number of cases (p < 0.001) and the positivity rate (p < 0.001). The Pacific Coastal lowlands and Sierra regions showed a lower risk of positivity compared to Amazonia (OR = 0.529; 95% CI = 0.318 - 0.883; p = 0.015 and OR = 0.633; 95% CI = 0.410 - 0.977; p = 0.039, respectively). The breeding of non-bovine animal species demonstrated a lower risk of positivity to animal rabies when compared to bovine (OR = 0.145; 95% CI = 0.062 - 0.339; p < 0.001). Similarly, older animals exhibited a lower risk (OR = 0.974; 95% CI = 0.967 - 0.981; p < 0.001). Rainfall during the rainy season was also found to decrease the risk of positivity to animal rabies (OR = 0.996; 95% CI = 0.995 - 0.998; p < 0.001). This study underscores the significance of strengthening the national surveillance program for the prevention and control of animal rabies in Ecuador and other countries facing similar epidemiological, social, and geographical circumstances.

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This study comprehensively analyzed cases of scorpion envenomation in Brazil, exploring the temporal trends and geographic patterns of such incidents between January 1, 2012, and December 31, 2022. Simultaneously, we assessed the correlation between scorpion envenomation and social determinants of health and social vulnerability. We conducted a population-based ecological study, gathering information on the number of scorpion envenomation cases in Brazil, as well as socioeconomic data and social vulnerability indicators across the 5,570 Brazilian municipalities. The season-trend model, based on the classical additive decomposition method, informed estimations of scorpion envenomation variations over time. The spatial correlation of scorpion envenomation with socioeconomic and vulnerability indicators was assessed using the Bivariate Moran's I. A total of 1,343,224 cases of scorpion envenomation were recorded in Brazil from Jan 2012 to Dec 2022. A single increasing time trend was observed for the entire country for this period (APC 8.94, P < 0.001). The seasonal analysis was significant for Brazil as a whole and all regions (p < 0.001), with peaks evident between October and November. The spatial distribution of cases was heterogeneous, with spatial clusters concentrated in the high-risk Southeast and Northeast regions. There was a high incidence of scorpion envenomation in municipalities facing social vulnerability, and, paradoxically, in those with better sanitation and waste collection. Our study revealed a heterogeneous geographical distribution of scorpion accidents in Brazil. Municipalities with higher social vulnerability exhibited a high incidence of scorpion envenomation.

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OBJECTIVE: This study aimed to assess global trends in mean birthweights at term, as reported in peer-reviewed literature. DATA SOURCES: We electronically searched PubMed, Embase, and Web of Science up to September 2023, using combinations of the search terms: "birth weight"; "birth-weight"; "birthweight"; "trend". There were no restrictions based on language or geographic area. STUDY ELIGIBILITY CRITERIA: We included all ecological and observational studies reporting mean birthweight at term as a continuous numerical variable over time. METHODS: We assessed the quality of included studies using the Dufault and Klar checklist modified by Betran et al. Univariate and multivariate linear models were used to examine the effects of time (years) and geographical origins. Subgroup analyses focused on national data sources and on data collected from 1950 onward. RESULTS: Among 6447 reviewed articles, 29 met our criteria, reporting mean birthweight data from over 183 million infants worldwide. Most studies were hospital-based (48.3%), 44.8% used national data, and a minority used municipality, community, or regional data (6.9%). Geographically, North America (31.0%) had the highest representation, followed by Asia and Europe (27.6% each), and South America and Oceania (6.9% each). Our univariate linear regression model (Model 1) revealed a significant increase in mean birthweight at term over time (4.74 g/y; 95% confidence interval, 3.95-5.53; P<.001). Model 2, incorporating continental dummy variables into the first model, confirmed this trend (3.85 g/y; 95% confidence interval, 2.96-4.74; P<.001). Model 3, focusing on available national data, did not find a significant relationship. Model 4 narrowed its focus on records from 1950 onward, reporting a robust annual increase of 7.26 g/y (95% confidence interval, 6.19-8.33; P<.001). Model 5, adjusting for the number of participants included in each study, reported a conclusive mean term birthweight increase of 1.46 g/y (95% confidence interval, 0.74-2.18; P<.001). CONCLUSION: This systematic review of 29 studies shows an increase in term birthweights over time, particularly when considering data since 1950. Limitations include study quality variations, data source diversity, and data sparsity, underscoring the need for future research to use precise gestational age distinctions and predetermined time frames to gain a deeper understanding of this trend and its implications for maternal and child health.

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BACKGROUND: Blindness and vision loss (BVL) is a major global health issue affecting older adults, but its burden in transition countries has received limited attention. Therefore, we aimed to assess the trends in the burden of BVL among older adults between 1990 and 2019 across Brazil, Russia, India, China, and South Africa (BRICS), and predict the burden by 2040. METHODS: Data on BVL and its related causes were obtained from the Global Burden of Disease 2019 study. We investigated the temporal trends by calculating the average annual percentage change using joinpoint regression analysis. Subsequently, we performed Bayesian age-period-cohort modeling to estimate the burden of BVL and its related causes by 2040. RESULTS: Most BRICS countries experienced a significant decline (p < 0.05) in age-standardized prevalence rates, and the decreasing trends tend to continue. However, by 2040, the number of BVL cases is expected to increase by approximately 50% across BRICS, with an estimated approximately 192, 170, 25, 17, and 7 million cases in China, India, Russia, Brazil, and South Africa, respectively. The related ranks of BVL causes are also estimated to change in the future, particularly in India. CONCLUSIONS: The different burdens and trends of BVL across BRICS reflected the different stages of population health transition. Effective eye disease prevention requires appropriate public health interventions. Developing effective health policies and services for older adults is urgently needed in BRICS countries.

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Understanding temporal and spatial trends in pregnancy and birth outcomes within an urban area is important for the monitoring of health indicators of a population. We conducted a retrospective cohort study of all births in the public hospital of Temuco, a medium-sized city in Southern Chile between 2009 and 2016 (n = 17,237). Information on adverse pregnancy and birth outcomes, as well as spatial and maternal characteristics (insurance type, employment, smoking, age, and overweight/obesity), was collected from medical charts. Home addresses were geocoded and assigned to neighborhood. We tested whether births and prevalence of adverse pregnancy outcomes changed over time, whether birth events were spatially clustered (Moran's I statistic), and whether neighborhood deprivation was correlated to outcomes (Spearman's rho). We observed decreases in eclampsia, hypertensive disorders of pregnancy, and small for gestational age, while gestational diabetes, preterm birth, and low birth weight increased over the study period (all p < 0.01 for trend), with little changes after adjusting for maternal characteristics. We observed neighborhood clusters for birth rate, preterm birth, and low birth weight. Neighborhood deprivation was negatively correlated with low birth weight and preterm birth, but not correlated with eclampsia, preeclampsia, hypertensive disorders of pregnancy, small for gestational age, gestational diabetes, nor stillbirth. Several encouraging downward trends and some increases in adverse pregnancy and birth outcomes, which, overall, were not explained by changes in maternal characteristics were observed. Identified clusters of higher adverse birth outcomes may be used to evaluate preventive health coverage in this setting.

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Background: In Brazil, 5870 new cases of malignant central nervous system tumors (MCNST) were estimated for men and 5220 for women for each year of the 2020-2022 triennium. The objective of this study was to analyze incidence rate trends and compare demographic characteristics of new MCNST cases according to tumor topographies in Brazil from 2000 to 2015. Methods: This study comprises an analytical cross-sectional assessment of secondary databases extracted from the Brazilian National Cancer Institute (INCA) website. Data comprised new neoplasm cases of meninges (C70), brain (C71), spinal cord, cranial nerves, and other central nervous system parts (C72) retrieved from 23 population-based cancer registries. A descriptive analysis was performed. Crude and age-adjusted incidence rates were calculated. Linear trends were calculated using a linear least squares regression for adjusted incidence rates versus time. Results: A total of 24 986 new MCNST cases were recorded. The main topography was the brain (91.5%). Except for meninges tumors, where 62.4% of the cases were observed in women, MCNST cases were more frequent among men concerning the other evaluated topographies. All 3 topographies occurred predominantly in adult patients aged from 40- to 64-year-old. Between 2000 and 2015, incidence rates ranged from 5.12 to 4.95 (a 1.4% increase of per year; 95% CI -4.0 to 6.8; P = .584) in men and from 4.35 to 3.61 (a 3.1% increase per year; 95% CI -1.7 to 8.0; P = .189). Conclusions: The most frequent topography was the brain. Incidence rates of MCNST remained relatively stable over time in both sexes.

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The neurotoxic alkaloid ß-N-methyl-amino-l-alanine (BMAA) and related isomers, including N-(2-aminoethyl glycine) (AEG), ß-amino-N-methyl alanine (BAMA), and 2,4-diaminobutyric acid (DAB), have been reported previously in cyanobacterial samples. However, there are conflicting reports regarding their occurrence in surface waters. In this study, we evaluated the impact of amending lake water samples with trichloroacetic acid (0.1 M TCA) on the detection of BMAA isomers, compared with pre-existing protocols. A sensitive instrumental method was enlisted for the survey, with limits of detection in the range of 5−10 ng L−1. Higher detection rates and significantly greater levels (paired Wilcoxon's signed-rank tests, p < 0.001) of BMAA isomers were observed in TCA-amended samples (method B) compared to samples without TCA (method A). The overall range of B/A ratios was 0.67−8.25 for AEG (up to +725%) and 0.69−15.5 for DAB (up to +1450%), with absolute concentration increases in TCA-amended samples of up to +15,000 ng L−1 for AEG and +650 ng L−1 for DAB. We also documented the trends in the occurrence of BMAA isomers for a large breadth of field-collected lakes from Brazil, Canada, France, Mexico, and the United Kingdom. Data gathered during this overarching campaign (overall, n = 390 within 45 lake sampling sites) indicated frequent detections of AEG and DAB isomers, with detection rates of 30% and 43% and maximum levels of 19,000 ng L−1 and 1100 ng L−1, respectively. In contrast, BAMA was found in less than 8% of the water samples, and BMAA was not found in any sample. These results support the analyses of free-living cyanobacteria, wherein BMAA was often reported at concentrations of 2−4 orders of magnitude lower than AEG and DAB. Seasonal measurements conducted at two bloom-impacted lakes indicated limited correlations of BMAA isomers with total microcystins or chlorophyll-a, which deserves further investigation.

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Multiple myeloma (MM) survival has improved due to recent developments in MM treatment. As a result, other co-morbid conditions may be of increasing importance to MM patients' long-term survival. This study examines trends in common causes of death among patients with MM in Puerto Rico, and in the US Surveillance, Epidemiology, and End Results (SEER) population. We analyzed the primary cause of death among incident MM cases recorded in the Puerto Rico Central Cancer Registry (n = 3,018) and the US SEER Program (n = 67,733) between 1987 and 2013. We calculated the cumulative incidence of death due to the eight most common causes and analyzed temporal trends in mortality rates using joinpoint regression. Analyses of SEER were also stratified by Hispanic ethnicity. MM accounted for approximately 72% of all reported deaths among persons diagnosed with MM in Puerto Rico and in SEER. In both populations, the proportion of patients who died from MM decreased with increasing time since diagnosis. Age-standardized temporal trends showed a decreased MM-specific mortality rate among US SEER (annual percent change [APC] = -5.0) and Puerto Rican (APC = -1.8) patients during the study period, and particularly after 2003 in non-Hispanic SEER patients. Temporal decline in non-MM causes of death was also observed among US SEER (APC = -2.1) and Puerto Rican (APC = -0.1) populations. MM-specific mortality decreased, yet remained the predominant cause of death for individuals diagnosed with MM over a 26-year period. The most pronounced decreases in MM-specific death occurred after 2003, which suggests a possible influence of more recently developed MM therapies.

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Because of a rich cultural history and excellent preservation of archaeological materials the south coast of the Central Andes is a region where many anthropological questions can be explored, using the latest methods and techniques. Over the last 20 years, multidisciplinary paleopathological studies have revealed interesting and unanticipated perspectives regarding the lives and cultures of the peoples who inhabited this region in pre-Hispanic times. This paper presents a panorama of these recent investigations, beginning with a review of the data sources - the collections of human remains - available for study, their numbers, preservation, accessibility, strengths and weaknesses. Then follows a revision of recent investigations, presenting new knowledge about temporal trends in human health in the region, including mortality curves, stature achieved in adulthood, porotic hyperososis, cribra orbitalia, linear enamel hypoplasias, dental caries, biochemical analysis, trauma, and violence. This review shows how the knowledge of the history of this region has increased but also the many new questions that have emerged. Hopefully this paper will encourage more investigation, as the collections of human remains from this region are abundant, well documented and well preserved.

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Most of the planet's diversity is concentrated in the tropics, which includes many regions undergoing rapid climate change. Yet, while climate-induced biodiversity changes are widely documented elsewhere, few studies have addressed this issue for lowland tropical ecosystems. Here we investigate whether the floristic and functional composition of intact lowland Amazonian forests have been changing by evaluating records from 106 long-term inventory plots spanning 30 years. We analyse three traits that have been hypothesized to respond to different environmental drivers (increase in moisture stress and atmospheric CO2 concentrations): maximum tree size, biogeographic water-deficit affiliation and wood density. Tree communities have become increasingly dominated by large-statured taxa, but to date there has been no detectable change in mean wood density or water deficit affiliation at the community level, despite most forest plots having experienced an intensification of the dry season. However, among newly recruited trees, dry-affiliated genera have become more abundant, while the mortality of wet-affiliated genera has increased in those plots where the dry season has intensified most. Thus, a slow shift to a more dry-affiliated Amazonia is underway, with changes in compositional dynamics (recruits and mortality) consistent with climate-change drivers, but yet to significantly impact whole-community composition. The Amazon observational record suggests that the increase in atmospheric CO2 is driving a shift within tree communities to large-statured species and that climate changes to date will impact forest composition, but long generation times of tropical trees mean that biodiversity change is lagging behind climate change.

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OBJECTIVE: To assess composite health outcomes in pediatric and young adult kidney transplant recipients following kidney transplantation. STUDY DESIGN: We conducted a cross-sectional study of all recipients at our center who had a 1-, 3-, 5-, and/or 10-year transplant anniversary visit between October 2008 and February 2015. The kidney transplant recipients were assessed at each time point according to an outcome measure consisting of 15 pass/fail criteria in 5 domains: allograft health, rejection and immunology, infection, cardiovascular health, and growth. RESULTS: We analyzed 148 patients at 231 transplantation anniversary visit time points; 52 of 82 (63%) patients assessed at 1 year had an ideal outcome, meeting at least 13 of the 15 criteria. This decreased to 37% at year 3, 40% at year 5, and 26% at year 10 (P < .01). The most common failures across all time points occurred in the domains of growth (43%-52% passing) and cardiovascular health (33%-51% passing). Allograft health declined significantly, decreasing from 74% at year 1 to 33% at year 10 (P < .01). The percentage of patients with graft failure increased from 2.4% at 1 year to 39.5% at 10 years (P < .01), and patient deaths increased from 0 to 11% (P < .01) in the same time frame. CONCLUSIONS: Ideal outcomes for pediatric kidney transplant recipients decrease over time with growth, cardiovascular health, and allograft health as the primary failure modes. Understanding the composite health of young recipients will allow primary care providers and nephrologists alike to evaluate the overall health of kidney transplant recipients and focus clinical care on the most common sequelae.

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BACKGROUND: Developed countries continue to show a decrease in cardiovascular disease (CVD) mortality. Little is known about CVD mortality trends in low and middle-income countries. The aim of our study is to describe myocardial infarction (MI) mortality trends and evaluate if differences between ethnic groups and geographic regions are present among the Ecuadorians with acute MI. METHODS: We conducted a cross sectional analysis mortality national registry and included deaths related to MI between 2012 and 2016 that had complete demographic data. To describe the general population, we used the 2010 census and applied estimates as population projections. We calculated age and sex standardized MI mortality rates per 100,000. We compared trends in MI mortality rate for every ethnic group and geographic region and used linear regression to estimate predictors of the changing mortality rates. RESULTS: We included 18,277 MI deaths between the years 2012 and 2016. The mean age of death was 73.6±19.5, 59% were male and 33% were illiterate. From 2012 to 2016, the standardized MI mortality rate increased from 51 to 157 deaths per 100,000. The most significant predictors of the increasing mortality rate were living in the coast (ß=0.10), belonging to a mixed race (ß=-0.033) and the year of death (ß=0.013). CONCLUSIONS: Our study found a worrisome increase in MI mortality between 2012-2016 in Ecuador, a middle-income country in South America. This rapid increase seems to be driven by geographic and racial differences. A thorough evaluation of the causes of this increase has to be undertaken by the Ecuadorian health authorities.

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We examined the hypothesis that in an emerging economy such as Chile the abundances of Anthropogenic Marine Debris (AMD) on beaches are increasing over time. The citizen science program Científicos de la Basura ("Litter Scientists") conducted three national surveys (2008, 2012 and 2016) to determine AMD composition, abundance, spatial patterns and temporal trends. AMD was found on all beaches along the entire Chilean coast. Highest percentages of AMD in all surveys were plastics and cigarette butts, which can be attributed to local sources (i.e. beach users). The Antofagasta region in northern Chile had the highest abundance of AMD compared with all other zones. Higher abundances of AMD were found at the upper stations from almost all zones. No significant tendency of increasing or decreasing AMD densities was observed during the 8years covered by our study, which suggests that economic development alone cannot explain temporal trends in AMD densities.

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BACKGROUND: Chile has the highest mortality rate for gallbladder cancer in the Andean region. The areas most affected by this cancer are found in southern Chile. OBJECTIVE: To describe the mortality rate trends for gallbladder cancer in the Araucanía region between 2004 and 2014. METHODS: Ecological observational descriptive study. The cases were identified by the codes ICD-10: C-23. The population at risk was obtained from the projections of the National Institute of Statistics of Chile. The mortality rate was modeled using the Poisson regression method, including age, time, and interaction between the two variables. The annual percentage change (APC) was used as a summary measure. RESULTS: In 2014, the Araucanía region had a standardized mortality rate of 10.36 per 100,000 inhabitants, while in the country it was 6.13 per 100,000. At the country level, the temporal evolution of mortality due to gallbladder cancer presented an annual percentage change of 9.1% (incidence rate ratio = 0.91 p-value <0.05), while in Araucanía the decrease was 7 % (incidence rate ratio = 0.93 p-value= 0.16), which is not statistically significant. The mortality rate was 2.68 times higher in women than in Araucanía men (p-value <0.05), a result similar to that of the country. At the national level, the trend according to age group shows a decrease for all groups, being the one of greater magnitude in those people from 45 to 54 years with an annual percent change of -5.36%, these results are not observed in the Araucanía. CONCLUSIONS: Mortality from gallbladder cancer shows a decreasing trend in the period studied for the whole country; however, this is not so for the Araucanía region, which maintains a higher mortality rate than that of the country.

INTRODUCCIÓN: Chile presenta la mayor tasa de mortalidad por cáncer de vesícula de la región andina. Las zonas más afectadas por este cáncer se encuentran al sur del país. OBJETIVO: Describir la tendencia de la tasa de mortalidad por cáncer de vesícula en Región de la Araucanía, entre los años 2004 y 2014. MÉTODOS: Estudio descriptivo observacional de tipo ecológico. Se utilizaron las defunciones por cáncer de vesícula ocurridas entre los años 2004 y 2014 en la Región de la Araucanía y en Chile. Los casos se identificaron utilizando el código CIE-10: C-23. La población en riesgo se obtuvo de las proyecciones del Instituto Nacional de Estadística de Chile. La tasa de mortalidad se modelizó a través del método de regresión de Poisson, utilizando como variables explicativas el tiempo, la edad y la interacción entre estas. Se empleó el porcentaje de cambio anual como medida de resumen. RESULTADOS: En el año 2014 la Región de la Araucanía presentó una tasa de mortalidad por cáncer de vesícula estandarizada de 10,36 por 100 000 habitantes, mientras que en el país fue de 6,13 por 100 000. En Chile, la evolución temporal de la mortalidad por cáncer de vesícula presenta una disminución con un porcentaje de cambio anual de 9,1% (razón de tasas de incidencia: 0,91; p <0,05), mientras que en la Araucanía la disminución fue de un 7% (razón de tasas de incidencia 0,93 p =0,16), no siendo estadísticamente significativo. La tasa de mortalidad fue 2,68 veces mayor en mujeres que en hombres de la Araucanía (p <0,05), resultado similar al del país. A nivel nacional, la evolución según grupo etario muestra un descenso para todos los grupos. La disminución de mayor magnitud se produce en aquellas personas de 45 a 54 años, con un porcentaje de cambio anual de -5,36%. Estos resultados no se observan en la Araucanía. CONCLUSIONES: La mortalidad por cáncer de vesícula tiene una tendencia decreciente en el período estudiado para el país. Sin embargo, no arroja resultados significativos para la Región de la Araucanía, manteniéndose la tasa de mortalidad superior a la nacional.

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Rabies is a zoonotic disease of great impact to public health. According to the World Health Organization, the country of Chile is currently declared free from human rabies transmitted by dogs. An epidemiological characterization and description was conducted using rabies data from 2003 to 2013 held by the National Program for Prevention and Control of Rabies from the Ministry of Health, consisting of bats samples reported as suspect and samples taken by active surveillance (bats brain tissue). Spatial autocorrelation analysis was performed using Local Indicators of Spatial Association (LISA) statistics, particularly Moran's I index, for the detection of spatial clusters. Temporal descriptive analysis was also carried out. Nine hundred and twenty-seven positive cases were reported, presenting an average of 84 cases per year, mainly originated from passive surveillance (98.5%), whilst only 1.5% of cases were reported by active surveillance. Global positivity for the study period was 7.02% and 0.1% in passive and active surveillance respectively. Most of the cases were reported in the central zone of Chile (88.1%), followed by south zone (9.1%) and north zone (2.8%). At a regional level, Metropolitana (40.6%), Valparaíso (19.1%) and Maule (11.8%) regions reported the majority of the cases. Tadarida brasiliensis (92%) presented the majority of the cases reported, with viral variant 4 (82%) being most commonly diagnosed. Only two cases were detected in companion animals. The central zone presented a positive spatial autocorrelation (Moran's I index=0.1537, 95% CI=0.1141-0.1933; p-value=0.02); north and south zones returned non-significant results (Moran's I index=0.0517 and -0.0117, 95% CI=-0.0358-0.1392 and -0.0780-0.0546, and p-values=0.21 and 0.34 respectively). The number of rabies cases decreased between May and August (late fall and winter) and tended to increase during the hot season (December to March), confirmed with the evidence from Autocorrelation analysis and the Ljun-Box test (X2=234.85 and p-value<0.0001). Knowledge of animal rabies epidemiologic behaviour becomes relevant when designing prevention and control measures and surveillance programs. This is especially important considering the high impact to Public Health of this disease and that wildlife rabies in bats remains endemic in Chile.

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Understanding the impacts of global warming and human-disturbances on lakes is required for implementing management strategies aimed at mitigating the decline of the quality and availability of water for humans. We assessed temporal trends in water parameters, and the contribution of land use to the eutrophication of the largest lakes of central-southern Chile. The mean values of water parameters varied seasonally, with lakes Chapo and Caburgua exhibiting lower pH, temperature, and N/P ratio values. Over the assessed period (19 years), we found a temporal reduction in water conductivity and temperature of the lakes. The concentration of NO3(-)-N, PO4(3-)-P and dissolved oxygen increased in all the lakes, but pH increased in eight out of the ten lakes. The negative temporal trend in temperature was more pronounced as the depth level increased. Lakes whose basins had a higher percentage of forest plantation and urban areas had larger values of Chlorophyll a and pH, as well as, smaller values of dissolved oxygen. Lakes whose basins included larger percentages of native forest had smaller nutrient (NO3(-)-N, PO4(3-)-P) concentrations. Our findings suggest that decreased rainfall in central-southern Chile due to climate change may cause a decrease of particulate material that is carried by tributaries into the lakes. The observed temporal decrease in temperature, especially at the deeper levels, may be explained by the rapid melting of glaciers. Although the studied lakes are classified as oligotrophic, deforestation and expansion of urban areas around the lakes have led to increased nutrient input, thus accelerating their eutrophication.