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Traditional patient- and provider-level hypertension interventions have proven insufficient to halt hypertension as the leading cause of morbidity and mortality globally. Systems-level interventions are required to address factors challenging hypertension control across a social ecological framework, an under-studied topic particularly salient in low- and middle-income countries (LMICs) such as Peru. To inform such interventions, we sought to identify key health systems barriers to hypertension care in Puno, Peru. A participatory stakeholder workshop (October 2021) and 21 in-depth interviews (October 2021-March 2022) were conducted with 55 healthcare professionals (i.e., doctors, nurses, midwives, dentists, nutritionists), followed by a deductive qualitative analysis of transcripts and notes. Participating healthcare providers indicated that low prioritization and lack of national policies for hypertension care have resulted in limited funding and lack of societal-level prevention efforts. Additionally, limited cultural consideration, both in national guidelines as well as by some providers in Puno, results in inadequate care that may not align with local traditions. Providers highlighted that patient care is also hampered by inadequate distribution and occasional shortages of medications and equipment, as well as a lack of personnel and limited opportunities for training in hypertension. Multiple incompatible health information systems, complicated referral systems, and geographic barriers additionally hinder continuity of care and care seeking. Insights gained from health providers on the healthcare system in Puno provide essential contextual information to inform development of organizational-level strategies necessary to improve provider and patient behaviors to achieve better hypertension care outcomes.
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Ultrasound Core Laboratories (UCL) are used in multicenter trials to assess imaging biomarkers to define robust phenotypes, to reduce imaging variability and to allow blinded independent review with the purpose of optimizing endpoint measurement precision. The Household Air Pollution Intervention Network, a multicountry randomized controlled trial (Guatemala, Peru, India and Rwanda), evaluates the effects of reducing household air pollution on health outcomes. Field studies using portable ultrasound evaluate fetal, lung and vascular imaging endpoints. The objective of this report is to describe administrative methods and training of a centralized clinical research UCL. A comprehensive administrative protocol and training curriculum included standard operating procedures, didactics, practical scanning and written/practical assessments of general ultrasound principles and specific imaging protocols. After initial online training, 18 sonographers (three or four per country and five from the UCL) participated in a 2 wk on-site training program. Written and practical testing evaluated ultrasound topic knowledge and scanning skills, and surveys evaluated the overall course. The UCL developed comprehensive standard operating procedures for image acquisition with a portable ultrasound system, digital image upload to cloud-based storage, off-line analysis and quality control. Pre- and post-training tests showed significant improvements (fetal ultrasound: 71% ± 13% vs. 93% ± 7%, p < 0.0001; vascular lung ultrasound: 60% ± 8% vs. 84% ± 10%, p < 0.0001). Qualitative and quantitative feedback showed high satisfaction with training (mean, 4.9 ± 0.1; scale: 1â¯=â¯worst, 5â¯=â¯best). The UCL oversees all stages: training, standardization, performance monitoring, image quality control and consistency of measurements. Sonographers who failed to meet minimum allowable performance were identified for retraining. In conclusion, a UCL was established to ensure accurate and reproducible ultrasound measurements in clinical research. Standardized operating procedures and training are aimed at reducing variability and enhancing measurement precision from study sites, representing a model for use of portable digital ultrasound for multicenter field studies.
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Poluição do Ar em Ambientes Fechados/prevenção & controle , Vasos Sanguíneos/diagnóstico por imagem , Computadores de Mão , Feto/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Feminino , Guatemala , Humanos , Índia , Peru , Ruanda , Ultrassom/educação , Ultrassonografia/instrumentaçãoRESUMO
Rationale: Approximately 40% of people worldwide are exposed to household air pollution (HAP) from the burning of biomass fuels. Previous efforts to document health benefits of HAP mitigation have been stymied by an inability to lower emissions to target levels. Objectives: We sought to determine if a household air pollution intervention with liquefied petroleum gas (LPG) improved cardiopulmonary health outcomes in adult women living in a resource-poor setting in Peru. Methods: We conducted a randomized controlled field trial in 180 women aged 25-64 years living in rural Puno, Peru. Intervention women received an LPG stove, continuous fuel delivery for 1 year, education, and behavioral messaging, whereas control women were asked to continue their usual cooking practices. We assessed for stove use adherence using temperature loggers installed in both LPG and biomass stoves of intervention households. Measurements and Main Results: We measured blood pressure, peak expiratory flow (PEF), and respiratory symptoms using the St. George's Respiratory Questionnaire at baseline and at 3-4 visits after randomization. Intervention women used their LPG stove exclusively for 98% of days. We did not find differences in average postrandomization systolic blood pressure (intervention - control 0.7 mm Hg; 95% confidence interval, -2.1 to 3.4), diastolic blood pressure (0.3 mm Hg; -1.5 to 2.0), prebronchodilator peak expiratory flow/height2 (0.14 L/s/m2; -0.02 to 0.29), postbronchodilator peak expiratory flow/height2 (0.11 L/s/m2; -0.05 to 0.27), or St. George's Respiratory Questionnaire total score (-1.4; -3.9 to 1.2) over 1 year in intention-to-treat analysis. There were no reported harms related to the intervention. Conclusions: We did not find evidence of a difference in blood pressure, lung function, or respiratory symptoms during the year-long intervention with LPG. Clinical trial registered with www.clinicaltrials.gov (NCT02994680).
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Poluição do Ar em Ambientes Fechados/prevenção & controle , Biomassa , Culinária/métodos , Petróleo , Saúde da População Rural/estatística & dados numéricos , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , PeruRESUMO
BACKGROUND: Globally, nearly 3 billion people rely on solid fuels for cooking and heating, the vast majority residing in low- and middle-income countries (LMICs). The resulting household air pollution (HAP) is a leading environmental risk factor, accounting for an estimated 1.6 million premature deaths annually. Previous interventions of cleaner stoves have often failed to reduce exposure to levels that produce meaningful health improvements. There have been no multicountry field trials with liquefied petroleum gas (LPG) stoves, likely the cleanest scalable intervention. OBJECTIVE: This paper describes the design and methods of an ongoing randomized controlled trial (RCT) of LPG stove and fuel distribution in 3,200 households in 4 LMICs (India, Guatemala, Peru, and Rwanda). METHODS: We are enrolling 800 pregnant women at each of the 4 international research centers from households using biomass fuels. We are randomly assigning households to receive LPG stoves, an 18-month supply of free LPG, and behavioral reinforcements to the control arm. The mother is being followed along with her child until the child is 1 year old. Older adult women (40 to <80 years of age) living in the same households are also enrolled and followed during the same period. Primary health outcomes are low birth weight, severe pneumonia incidence, stunting in the child, and high blood pressure (BP) in the older adult woman. Secondary health outcomes are also being assessed. We are assessing stove and fuel use, conducting repeated personal and kitchen exposure assessments of fine particulate matter with aerodynamic diameter ≤2.5µm (PM2.5), carbon monoxide (CO), and black carbon (BC), and collecting dried blood spots (DBS) and urinary samples for biomarker analysis. Enrollment and data collection began in May 2018 and will continue through August 2021. The trial is registered with ClinicalTrials.gov (NCT02944682). CONCLUSIONS: This study will provide evidence to inform national and global policies on scaling up LPG stove use among vulnerable populations. https://doi.org/10.1289/EHP6407.
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Poluentes Atmosféricos/análise , Poluição do Ar em Ambientes Fechados/análise , Culinária/instrumentação , Gás Natural/efeitos adversos , Material Particulado/análise , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto , Idoso , Feminino , Guatemala , Humanos , Índia , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Peru , Gravidez , Ruanda , Adulto JovemRESUMO
El ayuno intermitente es una estrategia nutricional de creciente interés para el control del peso y mejora de la salud metabólica. El objetivo del presente estudio fue evaluar el efecto de un protocolo de ayuno intermitente sobre la composición corporal, perfil lipídico y los biomarcadores de riesgo cardiovascular en estudiantes universitarios. En este estudio experimental participaron 30 sujetos varones y fueron divididos aleatoriamente en dos grupos, 15 sujetos constituían el grupo experimental (GE) (edad: 20,83±0,98 años) y 15 el grupo control (GC) (edad: 23,71±5,55 años). El GE realizó un protocolo de ayuno 16/8, dieciséis horas de ayuno y ocho horas de ingesta calórica sin limitaciones, dos días consecutivos a la semana durante cinco semanas. Se evaluó la composición corporal, la ingesta calórica, el perfil lipídico y los biomarcadores del riesgo cardiovascular al inicio, mitad y final del protocolo. Se observaron descensos significativos en el GE en pliegues cutáneos, perímetro cintura, porcentaje de grasa, perfil lipídico y biomarcadores del riesgo cardiovascular en comparación con GC (p<0,05). Se encontraron incrementos significativos en la ingesta de colesterol y ácidos grasos poliinsaturados en el GE al final del estudio (p<0,05). Se observaron descensos en el colesterol total, triglicéridos, lipoproteínas de baja densidad y biomarcadores del riesgo cardiovascular a lo largo del protocolo en el GE (p<0,05). Un protocolo de ayuno intermitente 16/8, dos días consecutivos por semana, durante cinco semanas, parece efectivo para mejorar parámetros de composición corporal y perfil lipídico, así como para mejorar los biomarcadores relacionados con el riesgo cardiovascular(AU)
Intermittent fasting is a nutritional strategy of high interest in weight control and improvement of metabolic health. The objective of this study was to evaluate the effect of an intermittent fasting protocol on body composition, lipid profile and biomarkers of cardiovascular risk in university students. In this experimental study thirty male subjects participated and were randomly divided into two groups; fifteen subjects constituted the experimental group (GE) (age: 20.83 ± 0.98 years) and fifteen the control group (GC) (age: 23.71 ± 5.55 years). The GE performed a fasting protocol 16/8, sixteen hours of fasting and eight hours of caloric intake without limitations, two consecutive days per week for five weeks. Body composition, calorie intake, lipid profile and biomarkers of cardiovascular risk were evaluated at the beginning, middle and at the end of the protocol. Significant decreases were found in GE in skinfolds, waist perimeter, % fat, lipid profile and biomarkers of cardiovascular risk as compared to GC (p <0.05). There were significant increases in the intake of cholesterol and polyunsaturated fatty acids in the GE at the end of the study (p <0.05). There were decreases in total cholesterol, triglycerides, low-density lipoproteins, and biomarkers of cardiovascular risk throughout the study in GE (p<0.05). An intermittent fasting protocol 16/8, two consecutive days per week, for five weeks, seems effective to improve parameters of body composition and lipid profile, as well as to improving biomarkers related to cardiovascular risk(AU)
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Humanos , Masculino , Adulto , Jejum/efeitos adversos , Comportamento Alimentar , Lipídeos/análise , Composição Corporal , Estado Nutricional , Composição de AlimentosRESUMO
BACKGROUND: Biomass fuel smoke is a leading risk factor for the burden of disease worldwide. International campaigns are promoting the widespread adoption of liquefied petroleum gas (LPG) in resource-limited settings. However, it is unclear if the introduction and use of LPG stoves, in settings where biomass fuels are used daily, reduces pollution concentration exposure, improves health outcomes, or how cultural and social barriers influence the exclusive adoption of LPG stoves. METHODS: We will conduct a randomized controlled, field intervention trial of LPG stoves and fuel distribution in rural Puno, Peru, in which we will enroll 180 female participants aged 25-64 years and follow them for 2 years. After enrollment, we will collect information on sociodemographic characteristics, household characteristics, and cooking practices. During the first year of the study, LPG stoves and fuel tanks will be delivered to the homes of 90 intervention participants. During the second year, participants in the intervention arm will keep their LPG stoves, but the gas supply will stop. Control participants will receive LPG stoves and vouchers to obtain free fuel from distributors at the beginning of the second year, but gas will not be delivered. Starting at baseline, we will collect longitudinal measurements of respiratory symptoms, pulmonary function, blood pressure, endothelial function, carotid artery intima-media thickness, 24-h dietary recalls, exhaled carbon monoxide, quality-of-life indicators, and stove-use behaviors. Environmental exposure assessments will occur six times over the 2-year follow-up period, consisting of 48-h personal exposure and kitchen concentration measurements of fine particulate matter and carbon monoxide, and 48-h kitchen concentrations of nitrogen dioxide for a subset of 100 participants. DISCUSSION: Findings from this study will allow us to better understand behavioral patterns, environmental exposures, and cardiovascular and pulmonary outcomes resulting from the adoption of LPG stoves. If this trial indicates that LPG stoves are a feasible and effective way to reduce household air pollution and improve health, it will provide important information to support widespread adoption of LPG fuel as a strategy to reduce the global burden of disease. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02994680 , Cardiopulmonary Outcomes and Household Air Pollution (CHAP) Trial. Registered on 28 November 2016.
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Poluição do Ar em Ambientes Fechados/efeitos adversos , Culinária/instrumentação , Cardiopatias/etiologia , Utensílios Domésticos , Exposição por Inalação/efeitos adversos , Pneumopatias/etiologia , Petróleo/efeitos adversos , Adulto , Poluição do Ar em Ambientes Fechados/prevenção & controle , Sistema Cardiovascular/fisiopatologia , Monitoramento Ambiental/métodos , Desenho de Equipamento , Feminino , Gases , Cardiopatias/diagnóstico , Cardiopatias/fisiopatologia , Cardiopatias/prevenção & controle , Habitação , Humanos , Exposição por Inalação/prevenção & controle , Pulmão/fisiopatologia , Pneumopatias/diagnóstico , Pneumopatias/fisiopatologia , Pneumopatias/prevenção & controle , Pessoa de Meia-Idade , Peru , Projetos de Pesquisa , Fatores de Risco , Saúde da População Rural , Fatores de TempoRESUMO
Miele, Catherine H., Alan R. Schwartz, Robert H. Gilman, Luu Pham, Robert A. Wise, Victor G. Davila-Roman, Jonathan C. Jun, Vsevolod Y. Polotsky, J. Jaime Miranda, Fabiola Leon-Velarde, and William Checkley. Increased cardiometabolic risk and worsening hypoxemia at high altitude. High Alt Med Biol. 17:93-100, 2016.-Metabolic syndrome, insulin resistance, diabetes, and dyslipidemia are associated with an increased risk of cardiovascular disease. While excessive erythrocytosis is associated with cardiovascular complications, it is unclear how worsening hypoxemia of any degree affects cardiometabolic risk factors in high-altitude populations. We studied the relationship between daytime resting oxyhemoglobin saturation and cardiometabolic risk factors in adult participants living in Puno, Peru (3825 m above sea level). We used multivariable logistic regression models to study the relationship between having a lower oxyhemoglobin saturation and markers of cardiometabolic risk. Nine hundred and fifty-four participants (mean age 55 years, 52% male) had information available on pulse oximetry and markers of cardiometabolic risk. Average oxyhemoglobin saturation was 90% (interquartile range 88%-92%) and 43 (4.5%) had excessive erythrocytosis. Older age, decreased height-adjusted lung function, and higher body mass index (BMI) were associated with having an oxyhemoglobin saturation ≤85%. When adjusting for age, sex, socioeconomic status, having excessive erythrocytosis, and site, we found that each 5% decrease in oxyhemoglobin saturation was associated with a higher adjusted odds of metabolic syndrome (OR = 1.35, 95% CI: 1.07-1.72, p < 0.04), insulin resistance as defined by homeostasis model assessment-insulin resistance (HOMA-IR) >2 mass units (OR = 1.29, 95% CI: 1.00-1.67, p < 0.05), hemoglobin A1c ≥6.5% (OR = 1.66, 95% CI: 1.09-2.51, p < 0.04), and high sensitivity C-reactive protein (hs-CRP) ≥3 mg/L (OR = 1.46, 95% CI: 1.09-1.96, p < 0.01). In high-altitude populations in Puno, Peru, a higher BMI and lower pulmonary function were associated with lower resting daytime oxyhemoglobin saturation. Lower resting oxyhemoglobin saturation, in turn, was associated with higher odds of having multiple unfavorable cardiometabolic factors. Worsening hypoxia of any degree in high-altitude dwellers may be an independent risk factor for cardiovascular disease.
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Altitude , Doenças Cardiovasculares/etiologia , Progressão da Doença , Hipóxia/complicações , Síndrome Metabólica/etiologia , Adulto , Biomarcadores/sangue , Índice de Massa Corporal , Proteína C-Reativa/análise , Feminino , Humanos , Hipóxia/sangue , Hipóxia/fisiopatologia , Resistência à Insulina , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Oximetria , Oxiemoglobinas/análise , Peru , Policitemia/sangue , Policitemia/complicações , Descanso/fisiologia , Fatores de RiscoRESUMO
Painschab, Matthew S., Gary E. Malpartida, Victor G. Davila-Roman, Robert H. Gilman, Todd M. Kolb, Fabiola Leon-Velarde, J. Jaime Miranda, and William Checkley. Association between serum concentrations of hypoxia inducible factor responsive proteins and excessive erythrocytosis in high altitude Peru. High Alt Med Biol 16:26-33, 2015.-Long-term residence at high altitude is associated with the development of chronic mountain sickness (CMS), which is characterized by excessive erythrocytosis (EE). EE occurs under chronic hypoxia, and a strongly selected mutation in hypoxia-inducible factor 2α (HIF2A) has been found in native Tibetans that correlates with having a normal hemoglobin at high altitude. We sought to evaluate differences in plasma levels of four HIF-responsive proteins in 20 participants with EE (hemoglobin >21 g/dL in men and >19 in women) and in 20 healthy, age- and sex-matched participants without EE living at high altitude in Puno, Peru. We performed ELISA to measure plasma levels of the four HIF-responsive proteins: vascular endothelial growth factor (VEGF), soluble VEGF receptor 1 (sVEGF-R1), endothelin-1, and erythropoietin. As a secondary aim, we evaluated the association between HIF-responsive proteins and echocardiography-estimated pulmonary artery systolic pressure (PASP) in a subset of 26 participants. sVEGF-R1 was higher in participants with vs. without EE (mean 107 pg/mL vs. 90 pg/mL; p=0.007). Although plasma concentrations of endothelin-1, VEGF, and erythropoietin were higher in participants with vs. without EE, they did not achieve statistical significance (all p>0.25). Both sVEGF-R1 (p=0.04) and erythropoietin (p=0.04) were positively associated with PASP after adjustment for age, sex, and BMI. HIF-responsive proteins may play a pathophysiological role in altitude-related, chronic diseases but our results did not show consistent changes in all measured HIF-responsive proteins. Larger studies are needed to evaluate for additional genetic and environmental risk factors.
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Doença da Altitude/sangue , Fatores de Transcrição Hélice-Alça-Hélice Básicos/sangue , Hipóxia/sangue , Policitemia/sangue , Adulto , Idoso , Altitude , Biomarcadores/sangue , Pressão Sanguínea , Estudos de Casos e Controles , Endotelina-1/sangue , Eritropoetina/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Artéria Pulmonar/fisiologia , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/sangue , Fatores de Crescimento do Endotélio Vascular/sangueRESUMO
Household air pollution from biomass fuel use affects 3 billion people worldwide; however, few studies have examined the relationship between biomass fuel use and blood pressure. We sought to determine if daily biomass fuel use was associated with elevated blood pressure in high altitude Peru and if this relationship was affected by lung function. We analyzed baseline information from a population-based cohort study of adults aged ≥ 35 years in Puno, Peru. Daily biomass fuel use was self-reported. We used multivariable regression models to examine the relationship between daily exposure to biomass fuel smoke and blood pressure outcomes. Interactions with sex and quartiles of forced vital capacity were conducted to evaluate for effect modification. Data from 1004 individuals (mean age, 55.3 years; 51.7% women) were included. We found an association between biomass fuel use with both prehypertension (adjusted relative risk ratio, 5.0; 95% confidence interval, 2.6-9.9) and hypertension (adjusted relative risk ratio, 3.5; 95% confidence interval, 1.7-7.0). Biomass fuel users had a higher systolic blood pressure (7.0 mm Hg; 95% confidence interval, 4.4-9.6) and a higher diastolic blood pressure (5.9 mm Hg; 95% confidence interval, 4.2-7.6) when compared with nonusers. We did not find interaction effects between daily biomass fuel use and sex or percent predicted forced vital capacity for either systolic blood pressure or diastolic blood pressure. Biomass fuel use was associated with a higher likelihood of having hypertension and higher blood pressure in Peru. Reducing exposure to household air pollution from biomass fuel use represents an opportunity for cardiovascular prevention.
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Poluição do Ar em Ambientes Fechados/efeitos adversos , Altitude , Biomassa , Doença Ambiental/complicações , Hipertensão/epidemiologia , População Rural , Fumaça/efeitos adversos , Adulto , Idoso , Pressão Sanguínea , Doença Ambiental/epidemiologia , Feminino , Seguimentos , Humanos , Hipertensão/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Peru/epidemiologiaRESUMO
BACKGROUND: Chronic exposure to biomass fuel smoke has been implicated in the development of pulmonary hypertension and right ventricular pressure/volume overload through activation of inflammation, increase in vascular resistance, and endothelial dysfunction. We sought to compare N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and echocardiography-derived pulmonary artery systolic pressure (PASP) levels in a high-altitude population-based study in Peru with and without chronic exposure to biomass fuel smoke. METHODS: NT-pro-BNP levels were measured in 519 adults (275 with and 244 without chronic exposure to biomass fuel smoke). Participants answered sociodemographics and clinical history questionnaires, underwent a clinical examination and blood testing for cardiopulmonary biomarkers. PASP was measured in a subgroup of 153 (31%) subjects. RESULTS: The study group consisted of 280 men (54%) and 239 women (46%). Average age was 56 years and average body mass index was 27 kg/m(2). In multivariable analysis, there was no association between chronic exposure to biomass fuel smoke and NT-pro-BNP (P = .31) or PASP (P = .31). In the subgroup in which both NT-pro-BNP levels and PASP were measured, there was strong evidence of an association between these two variables (ρ = 0.24, 95% CI 0.09-0.39; P = .003). We found that age, high sensitivity C-reactive protein, being male, and systolic blood pressure were positively associated with NT-pro-BNP levels whereas body mass index, low-density/high-density lipoprotein ratio, and Homeostasis Model of Assessment-Insulin Resistance were negatively associated (all P ≤ .02). CONCLUSIONS: In this population-based study in a high-altitude setting, neither NT-pro-BNP levels nor echocardiography-derived PASP were associated with chronic exposure to biomass fuel smoke.
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Altitude , Biomassa , Exposição Ambiental/estatística & dados numéricos , Hipertensão Pulmonar/epidemiologia , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Artéria Pulmonar/diagnóstico por imagem , Fumaça , Disfunção Ventricular Direita/epidemiologia , Pressão Ventricular , Adulto , Fatores Etários , Idoso , Pressão Arterial , Pressão Sanguínea , Proteína C-Reativa/metabolismo , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Estudos de Coortes , Ecocardiografia , Feminino , Hemoglobinas/metabolismo , Humanos , Hipertensão Pulmonar/sangue , Hipertensão Pulmonar/diagnóstico por imagem , Resistência à Insulina , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Peru/epidemiologia , Fatores Sexuais , Disfunção Ventricular Direita/sangue , Disfunção Ventricular Direita/diagnóstico por imagemRESUMO
BACKGROUND: Excessive erythrocytosis (EE) is a prevalent condition in populations living at high altitudes (> 2,500 m above sea level). Few large population-based studies have explored the association between EE and multiple subject-specific traits including oxygen saturation, iron status indicators, and pulmonary function. METHODS: We enrolled a sex-stratified and age-stratified sample of 1,065 high-altitude residents aged ≥ 35 years from Puno, Peru (3,825 m above sea level) and conducted a standardized questionnaire and physical examination that included spirometry, pulse oximetry, and a blood sample for multiple clinical markers. Our primary objectives were to estimate the prevalence of EE, characterize the clinical profile and iron status indicators of subjects with EE, and describe subject-specific traits associated with EE. RESULTS: Overall prevalence of EE was 4.5% (95% CI, 3.3%-6.0%). Oxygen saturation was significantly lower among EE than non-EE group subjects (85.3% vs 90.1%, P < .001) but no difference was found in iron status indicators between both groups (P > .09 for all values). In multivariable logistic regression, we found that age ≥ 65 years (OR = 2.45, 95% CI, 1.16-5.09), male sex (3.86, 1.78-9.08), having metabolic syndrome (2.66, 1.27-5.75) or being overweight (5.20, 1.95-16.77), pulse oximetry < 85% (14.90, 6.43-34.90), and % predicted FVC < 80% (13.62, 4.40-41.80) were strongly associated with EE. Attributable fractions for EE were greatest for being overweight (26.7%), followed by male sex (21.5%), pulse oximetry < 85% (16.4%), having metabolic syndrome (14.4%), and % predicted FVC < 80% (9.3%). CONCLUSIONS: We found a lower prevalence of EE than in previous reports in the Peruvian Andes. Although the presence of hypoxemia and decreased vital capacity were strongly associated with excessive erythrocytosis, being overweight or having metabolic syndrome were associated with an important fraction of cases in our study population.
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Altitude , Etnicidade , Ferro/sangue , Policitemia/etnologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oximetria , Peru/epidemiologia , Policitemia/sangue , Prevalência , Valores de ReferênciaRESUMO
BACKGROUND: Biomass fuels are used for cooking in the majority of rural households worldwide. While their use is associated with an increased risk of lung diseases and all-cause mortality, the effects on cardiovascular disease (CVD) are not well characterised. Exposure to biomass fuel smoke has been associated with lung-mediated inflammation and oxidative stress, which may increase the risk of atherosclerosis as evaluated by carotid intima-media thickness (CIMT), carotid atherosclerotic plaque prevalence and blood pressure. METHODS: A cross-sectional study was performed in 266 adults aged ≥35 years in Puno, Peru (3825 m above sea level). We stratified participants by their long-term history of exposure to clean fuel (n=112) or biomass fuel (n=154) and measured 24 h indoor particulate matter (PM2.5) in a random subset (n=84). Participants completed questionnaires and underwent a clinical assessment, laboratory analyses and carotid artery ultrasound. The main outcome measures were CIMT, carotid plaque and blood pressure. RESULTS: The groups were similar in age and gender. The biomass fuel group had greater unadjusted mean CIMT (0.66 vs 0.60 mm; p<0.001), carotid plaque prevalence (26% vs 14%; p=0.03), systolic blood pressure (118 vs 111 mm Hg; p<0.001) and median household PM2.5 (280 vs 14 µg/m(3); p<0.001). In multivariable regression, the biomass fuel group had greater mean CIMT (mean difference=0.03 mm, 95% CI 0.01 to 0.06; p=0.02), a higher prevalence of carotid plaques (OR=2.6, 95% CI 1.1 to 6.0; p=0.03) and higher systolic blood pressure (mean difference=9.2 mm Hg, 95% CI 5.4 to 13.0; p<0.001). CONCLUSIONS: Chronic exposure to biomass fuel was associated with increased CIMT, increased prevalence of atherosclerotic plaques and higher blood pressure. These findings identify biomass fuel use as a risk factor for CVD, which may have important global health implications.
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Doenças Cardiovasculares/induzido quimicamente , Espessura Intima-Media Carotídea , Culinária , Óleos/efeitos adversos , Placa Aterosclerótica/induzido quimicamente , Adulto , Idoso , Doenças Cardiovasculares/diagnóstico por imagem , Estudos Transversais , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Placa Aterosclerótica/epidemiologia , Placa Aterosclerótica/ultraestrutura , Prevalência , Fatores de Tempo , População UrbanaRESUMO
En octubre de 2002 se llevó a cabo un estudio descriptivo de corte con el propósito de investigar sobre el conocimiento y la aplicación del Derecho Internacional Humanitario (DIH) y la Misión Médica (MM), en los servicios de urgencias localizados en municipios del oriente del departamento de Antioquia, región que sufre desde hace varios años las consecuencias del conflicto armado colombiano y que refleja la problemática general del país. El estudio se hizo encuestando a los directores de esos servicios de urgencias para averiguar qué formación habían tenido sobre DIH y MM y qué pautas había en las instituciones que representaban para la aplicación de estas normas. Los directores encuestados manifestaron tener muy poca información acerca del DIH y la MM. Durante su formación académica de pregrado y posgrado no recibieron educación formal al respecto. Estuvieron de acuerdo en la importancia del tema, la necesidad de capacitarse y la posibilidad de aplicarlo. Por otra parte, en las instituciones de salud que cuentan con servicios de urgencias en el oriente antioqueño se carece de protocolos o manuales sobre el DIH y la MM así como de actividades de formación continua que permitan al personal sanitario actuar a la luz de estas normas; además, el conocimiento previo de estos aspectos no es requisito para laborar en las instituciones de salud que cuentan con servicios de urgencias en la región.
In october ctober 2002 a descriptive study was made to find out the grade of knowledge in the Emergency Services of the East region of Antioquia of the International Human Right, (IHR) and the Medical Mission (MM). This region has been suffering since many years the consequences of the war that show what has been happening in the entire country. A questionnaire was filled by the directors of the hospitals in this region about both items. They agree on the importance of the items but said they have little knowledge about them and they have received few instructions regarding those items. In their hospitals there are neither guides nor education programs for the personnel in this regard. To be posted in a hospital, a person needs not show proficiency in IHR or MM
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Direito Humanitário Internacional , EmergênciasAssuntos
Infecções por HIV/prevenção & controle , Controle de Doenças Transmissíveis/organização & administração , Feminino , Infecções por HIV/transmissão , Política de Saúde , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , México , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Diagnóstico Pré-NatalRESUMO
Éste es un estudio prospectivo realizado en un centro médico privado de Maracaibo, Venezuela, entre enero de 1999 y enero de 2001, en el que se usó cefprozil en 860 niños con infecciones agudas de vías respiratorias en dosis de 15 a 30 mg/k peso, en suspensión oral, cada 12 horas. El intervalo de edad de los participantes, de ambos sexos, fue de seis meses a 12 años. Se estudiaron las variables de edad, sexo, fecha de inicio de la sintomatología, diagnóstico, fecha de inicio y terminación del tratamiento, reacciones adversas y evolución clínica. Los pacientes fueron evaluados a las 48 horas y al quinto día de tratamiento. Las patologías más comunes fueron: otitis media (34,8 por ciento), rinosinusitis (46,5 por ciento), bronquitis y neumonía (11,6 por ciento), además de patologías mixtas (6,9 por ciento). Los cultivos de secreciones fueron positivos para Streptococcus pneumonide, H. influenzae y Moraxella catarrhalis. En 98 por ciento de casos se demostró la eficacia de cefprozil, con mejoría clínica a las 72 horas y curación entre el quinto y séptimo día. Se concluye que Cefprozil puede ser usado en casos de infecciones respiratorias agudas, sobre todo en sinusitis y otitis media, con buena tolerancia por vía oral, mejoría a las 72 horas y curación entre los 5 y 7 días
Assuntos
Humanos , Masculino , Feminino , Pneumologia , Infecções Respiratórias , Pediatria , VenezuelaRESUMO
Mediante un estudio prospectivo se evaluó la eficacia de dicloxacilina para el tratamiento de infecciones de piel y tejidos blandos en 120 niños de 6 a 12 años de edad. Las dosis fueron de 12.5 mg/kg para niños con peso <40 kg, y 125 mg/día en quienes pesaban >40 kg, cada seis horas. Las lesiones más frecuentes fueron impétigo (30.80 por ciento), hidradenitis (25 por ciento) y abscesos (25.8 por ciento). Staphylococcus aureus fue el agente etiológico que se aisló con mayor frecuencia (59,8 por ciento). Dicloxacilina produjo mejoría clínica a las 72 horas y curación a los seis días de tratamiento en 95 por ciento (115) de los casos. Por tanto, este antibiótico es eficaz para el tratamiento de infecciones de piel y tejidos blandos en niños, además, se relaciona con buen perfil de seguridad
Assuntos
Humanos , Masculino , Feminino , Dicloxacilina , Pele , Infecções dos Tecidos Moles , Pediatria , VenezuelaAssuntos
Humanos , Masculino , Adulto , Tireotoxicose , Debilidade Muscular , Carboidratos/efeitos adversosRESUMO
Se realizó un estudio prospectivo y aleatorio, comparando la efectividad de la amoxicilina y el ceftibuten en el tratamiento de la sinusitis maxilar recurrente en pacientes pediátricos. El diagnóstico se basó en sintomatología sugestiva como: fiebre, rinorea, tos y el goteo postnasal mucopurulento, acompañados de una radiografía convencional en proyección de Waters, con hallazgo anormales como opacidad de uno o ambos antros maxilares, o engrosamiento de 4 ó más milímetros de la mucosa del antro maxilar. Se incluyeron 40 pacientes con edades comprendidas entre uno y doce años, que se asignaron en forma aleatoria en 2 grupos de 20 pacientes cada uno. El grupo I recibió amoxicilina a dosis de 40 mgr x Kg x día en tres tomas diarias y el grupo II recibió ceftibutén 9 mgr x Kg x día en dosis única diaria. En ambos casos la duración del tratamiento fue de 10 días. En el grupo I se obtuvo curación o mejoría en 15 días
Assuntos
Criança , Humanos , Masculino , Feminino , Amoxicilina/uso terapêutico , Sinusite Maxilar/terapiaRESUMO
El estudio evalúa la efectividad de la azitromicina en el tratamiento de la sinusitis maxilar recurrente en el paciente pediátrico. El diagnóstico se fundamentó en la sintomatología sugestiva de la enfermedad como fiebre, tos, rinorrea purulenta y goteo postnasal acompañados de una radiografía convencional en proyección de Waters con hallazgos anormales como opacidad de uno ó ambos antros maxilares ó engrosamiento de 4 ó más milímetros de la mucosa antral. Se aislaron en el cultivo predominante S.pneumoniae, H.influenzae y M.catarrhalis. Se incluyeron 20 pacientes entre 1 y ocho años, que recibieron azitromicina los días lunes, martes y miércoles de 3 semanas consecutivas a razón de 10 mg/kg/día en dosis única diaria. Se obtuvo curación en 15 niños (75 por ciento) y mejoría (15 por ciento). El porcentaje de recurrencia a las 4 semanas fue de 11 por ciento (2 pacientes). Estos resultados sugieren que la azitromicina parece ser una alternativa efectiva en el tratamiento de niños con esta enfermedad