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Background: Natural water sources are considered as the major environmental exposure of fluoride, resulting in increased prevalence of enamel fluorosis. This type of natural exposure should be permanently monitored to avoid the interactions with other non-natural fluoride sources. We evaluated the prevalence of enamel fluorosis in Colombian schoolchildren and its relationship with fluoride-containing water ingestion exposure dose and urinary fluoride excretion. Material and Methods: We included 923 schoolchildren aged 7-12 years residing in eight municipalities in Colombia. Sampling of consumption water was performed in major aquifers used for daily supply. Samples were collected in 98 polyethylene containers and refrigerated until analysis. Water and urine fluoride concentrations were measured using the fluoride selective electrode method. Enamel fluorosis was evaluated using Thylstrup and Ferjerskov Index (TFI). Demographic and anthropometric characteristics were assessed. Besides, other exposures to non-natural fluoride were also evaluated. Logistic regression was applied for multiple analyses. Results: The median fluoride concentration in water and urine samples was 10.5 mg/L and 0.63 mg/L respectively, with the highest value found in Algarrobo-Magdalena, and the lowest value found in Manzanares-Caldas. The overall prevalence of enamel fluorosis was 86.1%, being more frequent the mild codes with TFI-1 to TFI-2. The highest prevalence was found in Margarita-Bolívar and Manzanares-Caldas, and the most severe codes (TFI-5 to TFI-9) were detected in Manzanares-Caldas. The multiple analysis revealed water ingestion exposure dose, urinary excretion, involuntary intake of toothpaste, amount of table salt consumption and sex as significant factors (p< 0.001). Conclusions: The fluoride ingestion exposure dose and its subsequent urinary excretion could be used as estimators of past fluoride exposure, explaining the current prevalence of enamel fluorosis in Colombian schoolchildren. Key words:Fluoride, groundwater ingestion, enamel fluorosis, prevalence, severity.

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Ranaviruses have been associated with amphibian, fish and reptile mortality events worldwide and with amphibian population declines in parts of Europe. Xenopus laevis is a widespread invasive amphibian species in Chile. Recently, Frog virus 3 (FV3), the type species of the Ranavirus genus, was detected in two wild populations of this frog near Santiago in Chile, however, the extent of ranavirus infection in this country remains unknown. To obtain more information about the origin of ranavirus in Chile, its distribution, species affected, and the role of invasive amphibians and freshwater fish in the epidemiology of ranavirus, a surveillance study comprising wild and farmed amphibians and wild fish over a large latitudinal gradient (2,500 km) was carried out in 2015-2017. In total, 1,752 amphibians and 496 fish were tested using a ranavirus-specific qPCR assay, and positive samples were analyzed for virus characterization through whole genome sequencing of viral DNA obtained from infected tissue. Ranavirus was detected at low viral loads in nine of 1,011 X. laevis from four populations in central Chile. No other amphibian or fish species tested were positive for ranavirus, suggesting ranavirus is not threatening native Chilean species yet. Phylogenetic analysis of partial ranavirus sequences showed 100% similarity with FV3. Our results show a restricted range of ranavirus infection in central Chile, coinciding with X. laevis presence, and suggest that FV3 may have entered the country through infected X. laevis, which appears to act as a competent reservoir host, and may contribute to the spread the virus locally as it invades new areas, and globally through the pet trade.

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In this paper we present the design of an open-source and low-cost buoy prototype for remote monitoring of water quality variables in fish farming. The designed battery-powered system periodically measures temperature, pH and dissolved oxygen, transmitting the information locally through a low-power wide-area network protocol to a gateway connected to a cloud service for data storage and visualization. We provide a novel buoy design that can be easily constructed with off-the-shelf materials, delivering a stable anchored float for the IoT device and the probes immersed in the water pond. The prototype was tested at an operating fish farm, showing promising results for a low-cost remote monitoring tool that enables automatic data acquisition and storage in fish farming scenarios. All the elements of this design, including hardware and software designs, are freely available under permissive licenses as an open-source project.

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Monitoring variables such as dissolved oxygen, pH, and pond temperature is a key aspect of high-quality fish farming. Machine learning (ML) techniques have been proposed to model the dynamics of such variables to improve the fish farmer's decision-making. Most of the research on ML in aquaculture has focused on scenarios where devices for real-time data acquisition, storage, and remote monitoring are available, making it easy to develop accurate ML techniques. However, fish farmers do not necessarily have access to such devices. Many of them prefer to use equipment to manually measure these variables limiting the amount of available data to process. In this work, we study the use of random forests, multivariate linear regression, and artificial neural networks in scenarios with limited amount of measurements to analyze data from water-quality variables that are commonly measured in fish farming. We propose a methodology to build models in two scenarios: i) estimation of unobserved variables based on the observed ones, and ii) forecasting when a low amount of data is available for training. We show that random forests can be used to forecast dissolved oxygen, pond temperature, pH, ammonia, and ammonium when the water pond variables are measured only twice per day. Moreover, we showed that these prediction models can be implemented on a mobile-based information system and run in an average smartphone that fish farmers can afford.

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Las úlceras pueden aparecer sobre protuberancias óseas, como las falanges proximales o los codos, pero es más probable que sean secundarias a la piel tensa y al trauma y no respondan a la terapia vasodilatadora. Todas las úlceras son muy dolorosas. El propósito de este trabajo es presentar aspectos relacionados con la atención de las úlceras digitales en la esclerodermia, según la experiencia de diferentes autores. En reumatología, se recomienda, en todo paciente con dolor reumático crónico, calcular la intensidad del dolor, tanto para la elección primera del tratamiento analgésico como para la medición de la respuesta. Y, para ello, se han propuesto varios métodos de cuantificación. El manejo de las úlceras digitales en la esclerodermia incluye la intervención no farmacológica, farmacológica y quirúrgica. El uso de nitratos, infusiones de acetilcisteína, el gel de vitamina E, entre otros métodos mejoran el tiempo de curación en pacientes con esclerodermia. La falta de terapias aprobadas por la Administración de Alimentos y Medicamentos de los Estados Unidos para las ulceraciones digitales garantiza un enfoque y una atención renovados para encontrar opciones de tratamiento significativas. Los médicos deberán emplear un enfoque terapéutico multifacético para optimizar el tratamiento de úlceras digitales existente y evitar la formación de nuevas lesiones para proporcionar a los pacientes la mejor calidad de vida(AU)

Ulcers can occur on bony bumps, such as the proximal phalanges or elbows, but are more likely to be secondary to tight skin and trauma and not responsive to vasodilator therapy. All ulcers are characteristically very painful. To present aspects related to the management of digital ulcers in scleroderma based on the experience of different authors. The management of digital ulcers in scleroderma includes non-pharmacological, pharmacological and surgical intervention. The use of nitrates, infusions of acetylcysteine, Vitamin E Gel, among other methods, improve the healing time in patients with scleroderma. The lack of US Food and Drug Administration approved therapies for digital ulcerations ensures a renewed focus and attention on finding meaningful treatment options. Clinicians should employ a multi-faceted therapeutic approach to optimize existing digital ulcers treatment and avoid new lesion formation to provide patients with the best quality of life(AU)

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This paper analyzes the main advances in health coverage and health services demand in Colombia using the 1997 and 2003 living standards surveys. The study showed an increase in health coverage associated with expansion of the subsidized care system, although a large proportion of the population is still not entitled to health care. The type of entitlement also directly affects the demand for services. There was an increase in preventive medical consultations in 2003 and a decrease in the use medical care for acute illness, due mainly to lack of money. Access to medicines increased from 1997 to 2003, as reflected by a decrease in out-of-pocket expenditure on medicines.

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This paper analyzes the main advances in health coverage and health services demand in Colombia using the 1997 and 2003 living standards surveys. The study showed an increase in health coverage associated with expansion of the subsidized care system, although a large proportion of the population is still not entitled to health care. The type of entitlement also directly affects the demand for services. There was an increase in preventive medical consultations in 2003 and a decrease in the use medical care for acute illness, due mainly to lack of money. Access to medicines increased from 1997 to 2003, as reflected by a decrease in out-of-pocket expenditure on medicines.

En este documento se esbozan los principales avances en cuanto a aseguramiento en salud y demanda de servicios médicos en Colombia, a partir de las Encuestas de Calidad de Vida de 1997 y 2003. Se encuentra un aumento en el aseguramiento en salud de la población, con un mayor incremento del régimen subsidiado; aún así, persiste una gran proporción que no cuenta con aseguramiento. También se encuentra que el tipo de afiliación afecta directamente la demanda de servicios. Se evidencia un aumento en la consulta por prevención para 2003 y una disminución en las consultas médicas cuando el individuo se siente enfermo, esta disminución se debe principalmente a la falta de dinero. El acceso a los medicamentos aumenta entre 1997 y 2003, lo que se refleja en la disminución del gasto privado en medicamentos.

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Reducing the impact of insurance market failures with regulations such as community-rated premiums, standardized benefit packages and open enrolment, yield limited effect because they create room for selection bias. The Colombian social health insurance system started a market approach in 1993 expecting to improve performance of preexisting monopolistic insurance funds by exposing them to competition by new entrants. This paper tests the hypothesis that market failures would lead to biased selection favoring new entrants. Two household surveys are analyzed using Self-Reported Health Status and the presence of chronic conditions as prospective indicators of individual risk. Biased selection is found to take place, leading to adverse selection among incumbents, and favorable selection among new entrants. This pattern is absent in 1997 but is evident in 2003. Given that the two incumbents analyzed are public organizations, the fiscal implications of the findings in terms of government bailouts, are analyzed.

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Con el objetivo de determinar la magnitud de la prevalencia de infecciones nosocomiales (IN) en el sistema de hospitales cubanos, se realizó un estudio multicéntrico en 28 hospitales seleccionados aleatoriamente de un total de 119 hospitales de más de 50 camas, en el periodo comprendido del 5 de mayo al 11 del mismo mes del año 1997. La prevalencia general fue de 8,2%. De los 6152 pacientes evaluados, a 418 se le diagnosticó un total de 504 infecciones nosocomiales. Las tasas más altas de infección nosocomial fueron encontradas en las unidades de cuidados intensivos (24,6%), las unidades quirúrgicas (10,3%), unidades de quemados y unidades de Cirugía Cardiovascular. La herida quirúrgica fue la localización de la infección más prevalente (23%), seguida del tracto respiratorio bajo y alto, la piel y el tracto urinario. Los patógenos más frecuentemente aislados fueron E. coli, Staphylococcus spp., Enterobacter spp., Proteus y Pseudomonas. Nuestros resultados son comparables con estudios internacionales a excepción de las infecciones del tracto urinario. Se propone la realización de estudios en busca de factores de riesgo en los servicios más prevalentes, los grupos de pacientes más afectados, las operaciones de mayor riesgo y la frecuencia relativa de cada localización; así como de estudios cualitativos que pudieran ofrecer datos sobre el conocimiento, las actitudes y el comportamiento del personal hospitalario frente a las IN

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El objetivo final es brindar elementos técnicos y financieros a la Secretaria Distrital de Salud para universalizar la cobertura del aseguramiento en salud para la población de 1-4 anos, eliminando toda barrera económica tipo copago o cuota moderadora y unificando el POS sin importar la pertenencia al régimen contributivo, subsidiado o vinculado. Metodología: El estudio tuvo un componente retrospectivo con base en datos secundarios, un componente de corte en el tiempo con base en datos primarios recolectados mediante una encuesta de hogares y una proyección de demanda esperada de servicios de salud y de sus costos.

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