Introduction:
Chagas disease (CD) is caused by Trypanosoma cruzi. When acquired, the disease develops in stages. For diagnosis, laboratory confirmation is required, and an extensive assessment of the ...patient’s health should be performed. Treatment consists of the administration of trypanocidal drugs, which may cause severe adverse effects. The objective of our systematic review was to analyze data contained in the CD published case reports to understand the challenges that patients and clinicians face worldwide.
Materials and methods:
We performed a systematic review following the PRISMA guidance. PubMed database was explored using the terms ‘American trypanosomiasis’ or ‘Chagas disease’. Results were limited to human case reports written in English or Spanish. A total of 258 reports (322 patients) were included in the analysis. Metadata was obtained from each article. Following this, it was analyzed to obtain descriptive measures.
Results:
From the sample, 56.2% were males and 43.8% were females. Most cases were from endemic countries (85.4%). The most common clinical manifestations were fever during the acute stage (70.0%), dyspnea during the chronic stage in its cardiac form (53.7%), and constipation during the chronic stage in its digestive form (73.7%). Most patients were diagnosed in the chronic stage (72.0%). Treatment was administered in 56.2% of cases. The mortality rate for the acute stage cases was 24.4%, while for the chronic stage this was 28.4%.
Discussion:
CD is a parasitic disease endemic to Latin America, with increasing importance due to human and vector migration. In this review, we report reasons for delays in diagnosis and treatment, and trends in medical practices. Community awareness must be increased to improve CD’s diagnoses; health professionals should be appropriately trained to detect and treat infected individuals. Furthermore, public health policies are needed to increase the availability of screening and diagnostic tools, trypanocidal drugs, and, eventually, vaccines.
Objetivo. Describir la legislación vigente respecto a historia clínica electrónica (HCE) y telesalud de los países latinoamericanos y analizar el tratamiento de la confidencialidad y el secreto ...profesional. Métodos. Entre marzo y septiembre de 2022, se realizó un relevamiento de la reglamentación vigente en los 21 países latinoamericanos en estudio, en dos niveles: i) la existencia de legislación respecto a la HCE y la telesalud, y ii) el tratamiento de la confidencialidad y el secreto profesional en la HCE y la telesalud. Se confeccionó una ficha de extracción de datos por país. Se recolectaron datos a partir de fuentes on-line oficiales. Se analizó cualitativamente la información y se sintetizó en forma de tablas cuando fue posible. Resultados. El uso de la HCE está reglamentado legalmente en 16 países. Para el caso de telesalud, son 19 países los que cuentan con legislación en referencia a esta herramienta. Todos los países analizados resguardan la confidencialidad y el secreto profesional a través de reglamentaciones. Sin embargo, en el contexto de telesalud se mencionan en 11 países, en tanto en el contexto de la HCE, solo en 9 países. Conclusiones. Desde el inicio del segundo milenio América Latina ha avanzado respecto a la legislación de herramientas digitales en la atención en salud como la HCE y la telesalud. Se observa a su vez un interés por las cuestiones éticas relacionadas con el uso de la HCE y la telesalud, en particular de la confidencialidad y secreto profesional, aunque dichos aspectos deben ser fortalecidos en la salud digital.
Summary
Body roundness index (BRI) is a new anthropometric index developed to predict both body fat and the percentage of visceral adipose tissue. Our aim was to investigate whether BRI is superior ...to traditional anthropometric indices in predicting metabolic syndrome (MetS). This systematic review and meta‐analysis was conducted using Pubmed, Scopus and Web of Sciences databases. The estimated pooled areas under curve (AUCs) for BRI predicting MetS was higher than body mass index (BMI), waist‐to‐hip ratio (WHR), body shape index (ABSI) and body adiposity index (BAI), similar to waist circumference (WC) and lower than waist‐to‐height ratio (WHtR). However, the difference between BRI and BMI, WC and WHtR predicting MetS was statistically non‐significant. Similar results were found with the summary receiver operating characteristic curve (AUC‐SROC). In addition, the non‐Chinese population had pooled AUCs greater than the Chinese population for all indices. Pooled ORs showed that BRI is associated with an increased MetS risk. In conclusion, BRI had good discriminatory power for MetS in adults of both sexes from diverse populations (AUC > 0.7; AUC‐SROC>0.7). However, WC and WHtR offer the best performance when screening for MetS, and non‐significant differences were found with BRI. In contrast, BRI was superior to BMI, WHR, ABSI and BAI in predicting MetS.
Protected areas are of paramount relevance to conserving wildlife and ecosystem contributions to people. Yet, their conservation success is increasingly threatened by human activities including ...habitat loss, climate change, pollution, and species overexploitation. Thus, understanding the underlying and proximate drivers of anthropogenic threats is urgently needed to improve protected areas' effectiveness, especially in the biodiversity-rich tropics. We addressed this issue by analyzing expert-provided data on long-term biodiversity change (last three decades) over 14 biosphere reserves from the Mesoamerican Biodiversity Hotspot. Using multivariate analyses and structural equation modeling, we tested the influence of major socioeconomic drivers (demographic, economic, and political factors), spatial indicators of human activities (agriculture expansion and road extension), and forest landscape modifications (forest loss and isolation) as drivers of biodiversity change. We uncovered a significant proliferation of disturbance-tolerant guilds and the loss or decline of disturbance-sensitive guilds within reserves causing a "winner and loser" species replacement over time. Guild change was directly related to forest spatial changes promoted by the expansion of agriculture and roads within reserves. High human population density and low nonfarming occupation were identified as the main underlying drivers of biodiversity change. Our findings suggest that to mitigate anthropogenic threats to biodiversity within biosphere reserves, fostering human population well-being via sustainable, nonfarming livelihood opportunities around reserves is imperative.
There is a paucity of data on the relationship between backpack use and foot posture in children. The aim of this study was to assess the effects of a backpack on foot posture in children with ...neutral foot posture during three years of follow-up.
A prospective longitudinal observational study was conducted in a sample of 627 children with neutral foot. For each participant included in the study, age, sex, weight, height, body mass index, type of schoolbag (backpack or non-backpack), foot shape, metatarsal formula and type of shoes were recorded. Foot posture was described by the mean of the foot posture index (FPI) and reassessed after three years in a follow-up study.
The average age of the children was 8.32 ± 1.32 years. A total of 458 used a backpack when going to school. Over the three-year follow-up period, 50 children who had neutral foot developed supinated foot (
= 18) or pronated foot (
= 32). Univariate and multivariate analysis showed that the children using a backpack were at a higher risk of developing pronated foot (adjusted Odds Ratio (aOR) = 2.05, 95% IC: 1.08-3.89,
= 0.028). Backpack use was not associated with the change from neutral foot to supinated foot.
We found a positive association between using a backpack and the risk of developing pronated but not supinated foot. Clinical trials should be conducted to analyze the effect of backpack use on the foot among schoolchildren.
The anthropogenic modification of natural landscapes, and the consequent changes in the environmental conditions and resources availability at multiple spatial scales can affect complex species ...interactions involving key-stone species such as bat-parasite interactions. In this study, we aimed to identify the drivers potentially influencing host-bat fly interactions at different spatial scales (at the host, vegetation stand and landscape level), in a tropical anthropogenic landscape. For this purpose, we mist-netted phyllostomid and moormopid bats and collected the bat flies (streblids) parasitizing them in 10 sites representing secondary and old growth forest. In general, the variation in fly communities largely mirrored the variation in bat communities as a result of the high level of specialization characterizing host-bat fly interaction networks. Nevertheless, we observed that: (1) bats roosting dynamics can shape bat-streblid interactions, modulating parasite prevalence and the intensity of infestation; (2) a degraded matrix could favor crowding and consequently the exchange of ectoparasites among bat species, lessening the level of specialization of the interaction networks and promoting novel interactions; and (3) bat-fly interaction can also be shaped by the dilution effect, as a decrease in bat diversity could be associated with a potential increase in the dissemination and prevalence of streblids.
IntroductionCardio‐ankle vascular index (CAVI) is a new marker of arterial stiffness (AS) that can assess vascular wall stiffness in the aorta, femoral artery and tibial artery. CAVI is less affected ...by blood pressure at the time of measurement than the gold standard method (carotid-femoral pulse wave velocity (PWV)). Our group has developed a device called VOPITB (Velocidad Onda de Pulso Índice Tobillo Brazo) that uses the oscillometric method and easily and accurately measures the PWV in the arms and legs separately, allowing new AS indices to be studied. This article describes the research protocol to determine CAVI using VOPITB and to validate the device against a reference device (VaSera VS-1500) and assess its clinical utility.Methods and analysesA cross-sectional, descriptive and observational study will be conducted. In all, 120 subjects (a minimum of 40% of subjects from any one gender) will be evaluated. CAVI will be determined from the measurement by VOPITB and VaSera VS-1500. For each subject, the average of the three readings taken with each device will be calculated. The Bland-Altman plot will be used to determine whether any bias exists in the data—that is, a tendency of the size of the difference to vary with the mean. The participants will be divided roughly equally between the following age bands: <30, 30–60 and >60 years.Ethics and disseminationThe study has been approved by the ethics committee of the Hospital San Pedro de Alcántara, Cáceres, Spain. The participants will be required to sign an informed consent form before inclusion in the study, in accordance with the Declaration of Helsinki and WHO standards for observational studies. The dissemination plan of the research study results will be through presentations in relevant national and international conferences and scientific publications in peer-reviewed journals.Trial registration numberNCT04303546.
Background: The simultaneous effect of physical activity (PA) and smoking on pulmonary function in young people remains unclear. Propose: The aim of this study was to determine the influence of ...smoking and PA on pulmonary function in young university students in Cáceres, Spain. Methods: A sample of 120 young nursing students was studied (60 smokers and 60 nonsmokers). All subjects underwent spirometry with a COPD-6 portable device, and their level of PA was quantified using the International Physical Activity Questionnaire. The influence of PA and smoking on pulmonary function was determined by comparing hypotheses. Results: Significant differences were observed between smokers and nonsmokers in terms of percent forced expiratory volume in 1 second, percent forced expiratory volume in 6 seconds, lung age, and the difference between lung age and chronological age (LA-CA) in those who practiced mild PA. In the subjects who performed moderate and vigorous PA, these differences were not noted. In the intragroup analysis, significant differences were observed in smokers in terms of percent forced expiratory volume in 1 second, percent forced expiratory volume in 6 seconds, lung age, and LA-CA; however, in the control group, differences were only observed in terms of lung age and LA-CA. These findings were confirmed in the multivariate analysis. Conclusions/Implications for Practice: Our findings confirmed a deterioration in pulmonary function in smokers who did not perform moderate or vigorous PA. The level of PA performed was positively related to pulmonary function in smokers, whereas in nonsmokers, improvements were only significant in LA-CA.
Introducción: El incremento acelerado de la prevalencia de sobrepeso y obesidad infantil constituye uno de los mayores problemas de salud pública en la actualidad, al estar probada su asociación con ...diversas enfermedades crónicas responsables de las principales causas de morbimortalidad. Las causas de dicho problema son multifactoriales, pero las principales son la falta de actividad física y el aumento del sedentarismo, sumadas a una dieta poco saludable. Dado el interés sociosanitario y económico de este problema, el objetivo de nuestro trabajo fue conocer las horas que dedican los niños al ocio sedentario y a actividades deportivas extraescolares y su relación con el sobrepeso y la obesidad.
Material y Métodos: Estudio descriptivo transversal en escolares con edades comprendidas entre los 6 y 10 años de edad (n=83). La antropometría incluyó el peso y talla, calculando el índice de masa corporal (kg/m2). Se consideró normopeso < percentil 85, sobrepeso ≥ percentil 85 y obesidad ≥ percentil 95. El nivel de actividad física fue valorado mediante el test corto de actividad física Krece Plus.
Resultados: Se han encontrado diferencias significativas entre el estado nutricional y el número de horas dedicadas al ocio sedentario. Un 41% de las niñas no practican actividades deportivas extraescolares. El 87,5% de los escolares obesos presenta un nivel de actividad física malo.
Conclusiones: La obesidad infantil se asocia a un nivel de actividad física malo. Los escolares obesos son los que dedican más horas a ver televisión o jugar a videojuegos y menos horas a actividades deportivas.
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