Analysis on the trends of incidence and age change for global female breast cancer / 中华肿瘤杂志

Objective: To analyze the trends of incidence and age change for global female breast cancer in different regions of the world according to the database from Cancer Incidence in Five Continents Time Trends (CI5plus) published by the International Association of Cancer Registries (IACR). Methods: The recorded annual female breast cancer (ICD-10: C50) incidence data and corresponding population at-risk data (1998-2012) were extracted from CI5plus published by IACR. The annual change percentage and average annual change percentage (AAPC) were calculated to examine the trends of incidence. The age-standardized mean age at diagnosis and proportion of incidence cases by age were calculated to analyze the relationship between incidence and age. Results: For crude incidence, except in Northern America, all other regions showed an upward trend, with Asia showing the most obvious upward trend (AAPC: 4.1%, 95% CI: 3.9%, 4.3%). For age-standardized incidence, in Asia, Latin America and Europe, the rising trends had slowed down, in Oceania and Africa, the trends began to be stable, and in Northern America, the trend showed a downward trend (APPC: -0.6%; 95% CI: -1.0%, -0.1%). The mean age at diagnosis were increased from 1998 to 2012 in Asia, Latin America, Oceania and Europe, with an annual increase of 0.12 years, 0.09 years, 0.04 years and 0.03 years, respectively. But after age-standardized, only Europe still kept increasing year by year, with an annual increase of 0.02 years, while Northern America showed a decreasing trend, with an annual decrease of about 0.03 years. Conclusions: From 1998 to 2012, the trends of incidence and age change for global female breast cancer vary in different regions of the world, and the global population aging is widespread, which affects the trend of the actual age change. Prevention and control strategies should be targeted at different age groups in different regions.

Comparison on the clinical characteristics of patients with Takotsubo syndrome from China and from Europe/North America / 中华心血管病杂志

Objective: To summarize the clinical characteristics of patients with Takotsubo syndrome (TTS) from China and compare these features with patients from Europe/North America. Methods: We reviewed case reports published between 1990 and 2020 with the key words of "Takotsubo syndrome" "stress cardiomyopathy" "apical balloon syndrome" and "broken heart syndrome", in Wanfang, CNKI, Pubmed and Web of Science databases, and 1 294 articles were identified, including 128 articles reporting 163 cases in China and 1 166 articles reporting 1 256 cases in Europe/North America. The characteristics of demographics, triggers, symptoms, electrocardiogram, echocardiography, left ventriculogram,coronary angiography, treatment and prognosis were analyzed and compared between Chinese and European/North American cases. Results: A total of 1 294 articles (1 419 cases: 163 from China, 1 256 from Europe/North America) were included in the final analysis. The characteristics of Chinese cases included: (1) demographic:the age was (59.6±16.9) years, which was similar with that of European/North American ((59.7±17.4) years, P=0.90), and female accounting for 78.5% (128/163), which was lower than that of European/North American (85.4% (1 073/1 256), P=0.02). (2) Triggers:mental triggers accounted for 48.5% (79/163), physical triggers accounted for 43.6% (71/163), and no triggers accounted for 7.9% (13/163), respectively. Compared with Europe/North America, the ratio of patients with mental triggers was higher in China, while the ratio of patients with physical triggers and no triggers was lower (P<0.05). (3) Symptoms: chest pain (52.8% (86/163)), chest tightness (35.0% (57/163)), shortness of breath (33.1% (54/163)), dizziness (16.0% (26/163)), sweating (15.3% (25/163)), palpitations (12.3% (20/163)), syncope (9.2% (15/163)) abdominal pain/diarrhea (8.6% (14/163)), hypotension (7.4% (12/163)), and fatigue (1.2% (2/163)) were illustrated in sequence. Compared with patients in Europe/North America, the ratio of patients with chest tightness, dizziness, sweating, palpitations, abdominal pain/diarrhea was higher in Chinese patients, while the ratio of patients with hypotension was lower in Chinese patients (P<0.05). (4) Electrocardiogram: main manifestations were myocardial ischemia symptoms, such as ST-segment elevation (63.8% (104/163)), T wave inversion (46.0% (75/163)), ST-segment depression (8.6% (14/163)). Compared with European/North American, the ratio of patients with ST-segment elevation, T wave inversion, and atrioventricular block was higher in Chinese patients (P<0.05). (5) Echocardiography and imaging:apical dyskinesia (59.5% (97/163)) and apical/left ventricular bulbar dilation (36.2%(59/163)) dominated the echocardiography findings. Compared with European/North American, the ratio of patients with apical dyskinesia, apical/left ventricular bulbar dilation, and mitral regurgitation was higher in Chinese patients, while the ratio of patients with dyskinesia in other parts and left ventricular ejection fraction<50% was lower in Chinese patients (P<0.05). Left ventricular angiography showed 36.2% (59/163) of apical dyskinesia in Chinese patients, which was higher than that reported in European/North American patients, and 38.7% (63/163) of apical/left ventricular bulbar dilation was reported in Chinese patients, which was similar to that reported in European/North American patients. Coronary angiography showed percent of no stenosis or stenosis less than 50% was 87.1% (142/163), which was similar to that reported in European/North American patients (P>0.05). The typical type of TTS accounted for 96.3% (157/163), which was significantly higher than that reported in European/ American patients, while the ratio of basal type and midventricular type was lower (P<0.01). (6) Treatment and prognosis:the applied drugs in China were listed in order as following, β-blockers (41.1% (67/163)), antiplatelet agents (37.4%(61/163)), ACEI/ARB (36.2%(59/163)), anticoagulants (27.0%(44/163)), diuretics (19.6% (32/163)), etc. Compared with Europe/North America, the ratio of antiplatelet agents, anticoagulants, statins, diuretics, and nitrates use was higher in China (P<0.05), while the use of oxygen therapy and IABP was similar (P>0.05). The hospital mortality in China was 5.5% (9/163), during 1-year follow-up the recurrence rate was 3.7% (6/163) and the mortality was 0. The prognosis was similar with that in Europe/North America. Conclusions: Compared with TTS cases in Europe/North America, TTS cases in China also occur usually in middle-aged and elderly women, most of whom have mental/physical triggers and typical imaging manifestations, followed by a low hospital mortality rate and recurrence rate.

A ciência entre a infodemia e outras narrativas da pós-verdade: desafios em tempos de pandemia / The science between the infodemic and other post-truth narratives: challenges during the pandemic

Resumo Propõe-se neste ensaio uma reflexão acerca do fenômeno social que envolve comunicação e construção de fatos e de narrativas em torno da ciência e da pandemia. O texto está dividido em quatro momentos. Parte-se de um rápido panorama sobre a desinformação em saúde em um contexto de integração digital global; na sequên cia argumenta-se sobre como este fenômeno é característico da era pós-factual em que vivemos, situando-se criticamente a negação da ciência no contexto pandêmico. Por fim, são trazidas proposições no campo jurídico e institucional comentando avanços recentes nos Estados Unidos e na Europa. Pretende-se contribuir para uma reflexão inicial que possa reposicionar o papel da ciência na governança em saúde.

Abstract This essay proposes a reflection on the social phenomenon that involves communication and construction of facts and narratives around science and the pandemic. We divide the text into four parts. It begins with a rapid overview on the disinformation over health in the context of the global digital integration: in the sequence, we argue about how this phenomenon is characteristic of the post-factual era in which we live, and then critically situate the denial of science in the pandemic context. Finally, the text discusses some propositions on the legal and institutional field commenting on recent advances in the United States and Europe. Our intention is to contribute to an initial reflection that can reposition science in health governance.

Estimación del número de fallecimientos evitables por COVID-19 en relación con las medidas restrictivas adoptadas en Europa / Estimation of the number of preventable COVID-19 deaths in relation to the restrictive measures adopted in Europe

Resumen Introducción: En diciembre de 2019 surgió un nuevo coronavirus en Wuhan, China, que se ha convertido en un problema de salud global. Objetivo: Estimar cuántos fallecimientos diarios atribuibles a COVID-19 por cada 100 000 habitantes se podrían haber evitado si se hubiese llevado a cabo cada una de las cinco medidas restrictivas al momento del diagnóstico del primer caso, así como estimar un modelo de regresión lineal múltiple predictivo del número de fallecimientos por cada 100 000 habitantes. Métodos: Se realizó un modelo de regresión lineal simple entre los días transcurridos desde el primer caso diagnosticado de COVID-19, la implantación de cada una de las cinco medidas llevadas a cabo por los 39 países europeos estudiados, el número de camas hospitalarias por 1000 habitantes (variables independientes) y el número de fallecimientos por COVID-19 por 100 000 habitantes. Resultados: Por cada día transcurrido desde el primer caso notificado de COVID-19 hasta la adopción de las medidas restrictivas, fallecieron entre 0.611 (p = 0.004) y 1.863 (p = 0.000) pacientes por cada 100 000 habitantes, dependiendo de la medida implementada. Conclusiones: Las medidas restrictivas y el distanciamiento social, así como la celeridad de su instauración, son necesarios para lograr el descenso del número de contagios de COVID-19 y su mortalidad.

Abstract Introduction: In December 2019, a new coronavirus emerged in Wuhan, China, which has become a global health problem. Objectives: To estimate how many daily COVID-19 deaths per 100,000 population could have been avoided if each one of five restrictive measures had been implemented at the time the first case was diagnosed, and to estimate a multiple linear regression model predictive of the number of deaths per 100,000 population. Methods: A simple linear regression was performed between the days elapsed since the first COVID-19 diagnosed case, implementation of each one of the five restrictive measures carried out by the 39 European studied countries, the number of hospital beds per 1,000 population (independent variables) and the number of COVID-19 deaths per 100,000 population. Results: For each day elapsed from the first COVID-19 reported case to the adoption of restrictive measures, between 0.611 (p = 0.004) and 1.863 (p = 0.000) patients died per 100,000 population, depending on the implemented measure. Conclusions: Restrictive measures and social distancing, as well as promptness of their implementation, are necessary for achieving a decrease in COVID-19 infections and mortality.

Tuberculosis and COVID-19, the new cursed duet: what differs between Brazil and Europe? / Tuberculose e COVID-19, o novo dueto maldito: quais as diferenças entre Brasil e Europa?

ABSTRACT On April 1st, 2020, COVID-19 surpassed tuberculosis regarding the number of deaths per day worldwide. The combination of tuberculosis and COVID-19 has great potential for morbidity and mortality. In addition, the COVID-19 pandemic has had a significant impact on the diagnosis and treatment of tuberculosis. In this review article, we address concurrent tuberculosis and COVID-19, with particular regard to the differences between Brazil and Europe. In addition, we discuss priorities in clinical care, public health, and research.

RESUMO Em 1º de abril de 2020, a COVID-19 ultrapassou a tuberculose em número de óbitos por dia no mundo. A associação da tuberculose com a COVID-19 apresenta grande potencial de morbidade e mortalidade. Além disso, a pandemia de COVID-19 tem tido um impacto significativo no diagnóstico e tratamento da tuberculose. Neste artigo de revisão, abordamos tuberculose e COVID-19 concomitantes, com particular atenção às diferenças entre Brasil e Europa. Além disso, discutimos as prioridades em atendimento clínico, saúde pública e pesquisa.

Defunciones por COVID-19: distribución por edad y universalidad de la cobertura médica en 22 países / COVID-19 deaths: Distribution by age and universal medical coverage in 22 countries / Mortes por COVID-19: distribuição por idade e universalidade da cobertura médica em 22 países

RESUMEN Objetivo. Relacionar la distribución etaria estandarizada de las defunciones por COVID-19 en 22 países americanos y europeos, con diferentes indicadores de las características de las poblaciones y de los sistemas de salud. Métodos. Las distribuciones de las defunciones por COVID-19 por grupo etario en 22 países americanos y europeos fueron estandarizadas sobre la pirámide de edades de la población mundial. Se calcularon las correlaciones entre la proporción estandarizada de personas de menos de 60 años dentro de las personas fallecidas y cada uno de los seis indicadores. Resultados. Se evidenció la existencia de diferencias importantes de distribución por grupo etario entre los países después de haber estandarizado sobre la pirámide de edades a nivel mundial, siendo la proporción de personas de menos de 60 años superior en América Latina y Estado Unidos que en Canadá o Europa occidental. La proporción estandarizada de personas de menos de 60 años dentro de las personas fallecidas por COVID-19 está fuertemente correlacionada con la universalidad de una cobertura médica de calidad (r=-0,92, p<0,01). Esta relación se mantuvo significativa después de haber ajustado sobre los otros indicadores analizados. Conclusión. Se propone que las debilidades de la cobertura médica de la población podrían haber creado una mayor letalidad en las poblaciones de menos de 60 años en América Latina y en los Estados Unidos.

ABSTRACT Objective. Relate standardized age distribution of COVID-19 deaths in 22 countries in the Americas and Europe to different indicators of population characteristics and health systems. Methods. Distributions of COVID-19 deaths by age group in 22 countries of the Americas and Europe were standardized based on the age pyramid of the world's population. Correlations were calculated between the standardized proportion of people aged <60 years among the deceased and each of six indicators. Results. Standardization based on the world age pyramid revealed considerable differences in age distribution among countries; the proportion of people aged <60 years was higher in Latin America and the United States than in Canada or Western Europe. The standardized proportion of people aged <60 years among persons who died of COVID-19 is strongly correlated to the existence of universal quality medical coverage (r=-0.92, p<0.01). This relationship remained significant after being adjusted for the other indicators. Conclusion. We propose that weaknesses in medical coverage of the population may have created higher case-fatality in populations aged <60 years in Latin America and the United States.

RESUMO Objetivo. Correlacionar a distribuição etária padronizada de mortes por COVID-19 em 22 países das Américas e da Europa com diversos indicadores das características das populações e dos sistemas de saúde. Métodos. As distribuições das mortes por COVID-19 por faixa etária em 22 países das Américas e da Europa foram padronizadas pela pirâmide etária da população mundial. Foram calculadas correlações entre a proporção padronizada de pessoas com menos de 60 anos entre as pessoas que morreram e cada um dos seis indicadores. Resultados. Foram evidenciadas diferenças importantes de distribuição etária entre os países estudados após a padronização pela pirâmide etária da população mundial, sendo maior a proporção de mortes de pessoas com menos de 60 anos na América Latina e nos Estados Unidos que no Canadá ou na Europa ocidental. A proporção padronizada de pessoas com menos de 60 anos entre as pessoas que morreram por COVID-19 está fortemente correlacionada com a universalidade de cobertura médica de qualidade (r=-0,92, p<0,01). Esta correlação se manteve significativa após o ajuste para outros indicadores analisados. Conclusão. O nosso estudo sugere que falhas na cobertura médica da população podem ter provocado maior letalidade nas pessoas com menos de 60 anos na América Latina e nos Estados Unidos.

Segunda onda de COVID-19 na Europa 2 / Second wave of COVID-19 in Europe 2

O número de novos casos na Europa vem aumentando desde agosto, porém, em outubro, houve uma elevação considerável. Houve maior número de hospitalizações e a taxa de ocupação de leitos de UTI por COVID-19 está aumentando rapidamente, principalmente, devido à sua demanda pela população de 65 anos ou mais. Ao descrever a análise situacional por região, a OMS aponta que na Europa houve aumento de 22% dos novos casos e de 43% de novas mortes nos últimos sete dias comparados à semana anterior.

The number of new cases in Europe has been increasing since August, however, in October, there were a considerable elevation. There was a greater number of hospitalizations and the rate of occupation of ICU beds by COVID-19 is increasing rapidly, mainly due to its demand by the population aged 65 and over. To the describe the situational analysis by region, the WHO points out that in Europe there was an increase of 22% of new cases and 43% of new deaths in the last seven days compared to the previous week.

Segunda onda de COVID-19 na Europa / Second wave of COVID-19 in Europe

A Organização Mundial de Saúde publicou, em seu site oficial, uma advertência aos governantes e responsáveis de saúde de toda a União Europeia e Reino Unido quanto ao aumento no número de notificação de pessoas infectadas pelo coronavírus (SARS-CoV-2), a preocupação é a ocorrência de uma segunda onda de COVID-19 na Europa, que apresenta tendência crescente de casos em vários países (ex.: Espanha e Itália) após o período de férias de verão (Figuras 01 e 02) (WHO, 2020).

The World Health Organization published, on its official website, a warning to governments and health officials across the European Union and the United Kingdom regarding the increase in the number of notifications of people infected by the coronavirus (SARS-CoV-2), the concern it is the occurrence of a second wave of COVID-19 in Europe, which shows an increasing trend of cases in several countries (eg Spain and Italy) after the summer vacation period (Figures 01 and 02) (WHO, 2020).

Remedios curativos y propaganda médica contra la influenza de 1918 en México: ideas y conocimientos / Therapeutic remedies and medical propaganda on influenza in Mexico in 1918: ideas and knowledge sets

Resumen El artículo explora el pensamiento médico en torno al impacto de la pandemia de influenza de 1918 en México. Se analizan las ideas científicas sobre la etiología de la gripe, las cuales se reflejaron en el tipo de remedios y recetas médicas que se publicaron en la prensa y en boletines de salud. Para adentrarse en este tema profundizamos en el contexto histórico internacional dominado por la guerra. En México, años de conflictos armados a consecuencia de la Revolución agravaron las condiciones de vida de la población: hambre, tifo, viruela y otros padecimientos infecciosos se presentaron antes y durante el brote de la pandemia. El trabajo se apoya en documentación de archivo, boletines de salud, prensa de la época y bibliografía actualizada.

Abstract This article explores medical thought on the impact of the influenza pandemic of 1918 in Mexico. It analyzes scientific ideas on the etiology of the flu, as reflected in the types of remedies and medical prescriptions published in the press and in health bulletins. It then goes deeper into the topic by examining the international historic context, dominated by the war. In Mexico, years of armed conflict unleashed by the Revolution exacerbated living conditions among the population: starvation, typhus, smallpox and other infectious diseases were present before and during the outbreak of the pandemic. This study is based on archival documentation, health bulletins, press sources from the period, and modern bibliography.

Inequalities in depressive symptoms between natives and immigrants in Europe: the mediating role of social exclusion / Desigualdades em sintomas depressivos entre a população local e os imigrantes na Europa: o papel mediador da exclusão social / Inequidades en los síntomas depresivos entre nativos e inmigrantes en Europa: el papel de mediación de la exclusión social

The aim of this study was to analyze inequalities in depressive symptoms between natives and immigrant groups according to their length of residence in Europe, and to test the mediating role of social exclusion in explaining these differences. The study is based on cross-sectional data from the 7th round of the 2014 European Social Survey (sample of 1,792 immigrants and 22,557 native-born Europeans). Dependent variables: self-reported depressive symptoms. Independent variables: immigrant background and social exclusion factors that were classified into four groups. Socially excluded individuals were those less advantaged in each factor. All analyses were stratified by the length of residence. The independent and overall associations between Social Exclusion and health outcomes were examined using binary logistic regression models (OR; IC95%). Immigrants had a higher prevalence of self-reported depressive symptoms than natives; those residing in Europe for 1-10 years and > 20 years had the highest prevalence. Multidimensional social exclusion factors analyzed together completely explained these differences for immigrants residing in Europe for 1-10 years and partially for immigrants residing for > 20 years. The economic factors also explained these differences completely for 1-10 years and partially for immigrants residing for > 20 years. Policies should offer migrants the possibility to settle in good social and economic condition, promote efforts to eliminate social exclusion and prevent the associated health inequalities.

O estudo teve como objetivos, analisar as desigualdades na prevalência de sintomas depressivos entre a população local e os imigrantes na Europa de acordo com o tempo de residência naquele continente, e testar o papel mediador da exclusão social na explicação dessas diferenças. O estudo teve como base os dados transversais da sétima rodada do Inquérito Social Europeu de 2014 (uma amostra de 1.792 imigrantes e 22.557 nascidos na Europa). As variáveis dependentes eram os sintomas depressivos autorrelatados. As variáveis independentes eram a história de imigração e fatores de exclusão social, classificados em quatro grupos. Os indivíduos socialmente excluídos mostraram desvantagem em relação a cada fator. As análises foram estratificadas pelo tempo de residência na Europa. As associações independentes e globais entre a exclusão social e os desfechos de saúde foram examinadas com o uso de modelos de regressão logística binária (OR; IC95%). Os imigrantes tiveram maior prevalência de sintomas depressivos, comparados aos indivíduos nascidos na Europa; as maiores prevalências de sintomas depressivos foram observadas nos imigrantes com 1-10 anos de tempo de residência e com mais de 20 anos de residência na Europa. Os fatores de exclusão social multidimensionais, quando analisados conjuntamente, explicavam inteiramente essas diferenças nos imigrantes que haviam residido na Europa entre 1-10 anos, e parcialmente nos imigrantes que residiam há mais de 20 anos. Fatores econômicos também explicavam essas diferenças completamente para os imigrantes com 1-10 anos na Europa e parcialmente para aqueles com mais de 20 anos. As políticas públicas devem oferecer aos imigrantes a possibilidade de viverem com boas condições sociais e econômicas, com esforços para eliminar a exclusão social e prevenir as desigualdades sociais.

El objetivo de este estudio fue analizar las inequidades en los síntomas depresivos entre nativos y grupos de inmigrantes, según su período de residencia en Europa, con el fin de probar el papel de mediación de la exclusión social explicando estas diferencias. Este estudio está basado en datos transversales procedentes de la séptima ronda de la Encuesta Social Europea de 2014 (muestra de 1.792 inmigrantes y 22.557 europeos nativos). Las variables dependientes son los síntomas depresivos autoinformados. Las variables independientes son: origen inmigrante y factores de exclusión social que fueron clasificados en cuatros grupos. Entre las personas socialmente excluidas estaban quienes se encontraban con menos puntuación en cada factor. Todos los análisis fueron estratificados por la duración de su residencia. Las asociaciones independientes y generales entre la exclusión social y los resultados de salud fueron examinados usando modelos de regresión logística binaria (OR; IC95%). Los inmigrantes tenían una prevalencia más alta de síntomas depresivos autoinformados que los nativos; quienes residían en Europa entre 1-10 años y > 20 años contaban con la prevalencia más alta. Los factores de exclusión social multidimensionales analizados conjuntamente explicaron completamente estas diferencias en el caso de los inmigrantes que residían en Europa de 1-10 años y parcialmente para los inmigrantes residiendo durante ≥ 20 años. Los factores económicos también explicaron estas diferencias completamente en el caso de los 1-10 años y, parcialmente, en el caso de los inmigrantes residiendo > 20 años. Las estrategias políticas deberían ofrecer a los inmigrantes la posibilidad de establecerse en buenas condiciones sociales y económicas, así como promover esfuerzos para erradicar la exclusión social y prevenir las inequidades de salud asociadas.

Tracking the onset date of the community spread of SARS-CoV-2 in western countries

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapidly spread around the world during 2020, but the precise time in which the virus began to spread locally is difficult to trace for most countries. Here, we estimate the probable onset date of the community spread of SARS-CoV-2 for heavily affected countries from Western Europe and the Americas on the basis of the cumulative number of deaths reported during the early stage of the epidemic. Our results support that SARS-CoV-2 probably started to spread locally in all western countries analysed between mid-January and mid-February 2020, thus long before community transmission was officially recognised and control measures were implemented.

Prevalencia de los trastornos del espectro autista en niños en Estados Unidos, Europa y España: coincidencias y discrepancias / Prevalence of autism spectrum disorders in USA, Europe and Spain: coincidences and discrepancies

Los trastornos del espectro autista (TEA) engloban a un grupo heterogéneo de trastornos del neurodesarrollo que tienen en común la presencia de problemas para la interacción/comunicación social y la tendencia a mostrar intereses restringidos o conductas repetitivas. Diversos estudios epidemiológicos realizados en diferentes países en los últimos años han mostrado de forma consistente dos características: el incremento progresivo en la prevalencia de los TEA a nivel mundial y la existencia de una gran variabilidad geográfica entre territorios y dentro de un mismo territorio. En el presente artículo analizamos los datos de prevalencia más recientemente publicados en EE.UU. y en diversos países de Europa (incluyendo España), que muestran tasas de prevalencia muy variables, con un rango que abarca desde 1/59 niños con trastornos del espectro autista en EE. UU., hasta 1/806 en Portugal. En un segundo tiempo describimos brevemente algunas de las principales hipótesis que intentan explicar esta variabilidad.

Autism spectrum disorders are a heterogeneous group of disorders that share the presence of two core symptoms: problems in social interaction / communication and the tendency to present restricted interests and repetitive behavior. Over the last years, several epidemiologic studies have been published by different authors in diverse countries, having all of them shown two common characteristics: a global increase in the prevalence rates of autism spectrum disorders, and the existence of a great geographical variability no only between geographical areas, but also within the same geographical areas. At the present manuscript, we analyze some of the most recent prevalence data published in USA and some European countries (including Spain). All of them show different prevalence rates, ranging from 1/59 children with autism spectrum disorders in the USA to 1/806 in Portugal. In a second part, we briefly describe some of the current scientific hypotheses that try to explain this variability.

Axial Spondyloarthritis after bariatric surgery: a 7-year retrospective analysis

Abstract Background: In recent decades, obesity has become a public health problem in many countries. The objective of this study was to evaluate the main joint and extra-articular manifestations related to spondyloarthritis (SpA) after bariatric surgery (BS) in a retrospective cohort. Methods: Demographic, clinical, laboratory and imaging data from nine patients whose SpA symptoms started after a BS have been described. Modified New York (mNY) criteria for ankylosing spondylitis (AS) and the Assessment of Spondyloarthritis International Society (ASAS) criteria for axial (ax-SpA) and peripheral (p-SpA) spondyloarthritis were applied. Results: The mean weight reduction after BS was 49.3 ±21.9 kg. The BS techniques were Roux-en-Y gastric bypass (n =8; 88.9%) and biliopancreatic diversion with duodenal switch (n = 1; 11.1%). Four (44.4%) patients had no axial or peripheral pain complaints before BS, while the other four (44.4%) had sporadic non-inflammatory back pain that had been attributed to obesity. One patient (11.1%) had persistent chronic back pain. In all nine cases, patients reported back pain onset or pattern (intensity or night pain) change after BS (mean time 14.7 ± 18 months). In addition, 8 of them (88.9%) were human leukocyte antigen (HLA)-B27 positive. All nine patients could be classified according to ASAS criteria as ax-SpA and five (55.6%) patients were classified as AS, according to the mNY criteria. Conclusion: Our data highlight a temporal link between SpA onset symptoms and the BS, suggesting a possible causal plausibility between the two events.

Alternative HPV vaccination schedules in Latin America / Los esquemas alternativos de vacunación contra VPH en América Latina

Abstract: In 2008, the first HPV vaccination program in Latin America started in Panama, targeting girls aged 10-11 years with a 3-dose vaccine schedule, an initiative that was to be followed by other Latin American countries after local feasibility and population acceptability evaluations were completed. A 3-dose vaccine regimen over six months was originally chosen for HPV vaccines, copying the Hepatitis B vaccine schedule (0, 1-2, 6 months). Alternative vaccine schedules have been proposed afterwards based on: i) noninferior immunogenicity or immune response levels compared to those at which clinical efficacy has been proven (i.e., those observed in a 3-dose HPV vaccine schedule in women aged 15-26), and, ii) proven efficacy in clinical trials and/or effectiveness among women who were provided less than three doses due to a lack of adherence to a 3-dose vaccine schedule. In 2014, based on the available evidence and the potential increase in coverage by expansion of vaccination target groups, particularly in low and middle income countries (LMIC), the World Health Organization recommended a 2-dose schedule with at least a 6-month interval between doses for females up to 15 years of age and a 3-dose schedule for older women. More recently, it has been suggested that 1-dose HPV vaccination schemes may provide enough protection against HPV infection and may speed up the introduction of HPV vaccination in LMIC, where most needed.

Resumen: En 2008, se inició en Panamá el primer programa de vacunación contra el virus del papiloma humano (VPH), dirigido a niñas de 10 a 11 años, utilizando un esquema de tres dosis en seis meses, iniciativa que fue adoptada por otros países de la región tras evaluar la aceptabilidad en la población y la viabilidad de llevar a cabo el programa. Inicialmente, el esquema de tres dosis para las vacunas contra el VPH se basó en el utilizado en la vacunación contra la hepatitis B (0, 1-2, 6 meses). Posteriormente, se han propuesto esquemas de vacunación alternativos, utilizando evidencia sobre: i) la inmunogenicidad o niveles de respuesta inmune no inferiores a aquéllos con los cuales la eficacia clínica de la vacuna fue probada (es decir, aquéllos observados con tres dosis en mujeres de 15 a 26 años); y ii) la eficacia demostrada en ensayos clínicos y efectividad demostrada en mujeres a quienes se vacunó con menos de tres dosis debido a falta de adherencia al esquema completo de tres dosis. En 2014, la Organización Mundial de la Salud recomendó un esquema de dos dosis con al menos seis meses de intervalo entre dosis para mujeres de hasta 15 años de edad y uno de tres dosis para mujeres mayores. La recomendación se basó en la evidencia disponible hasta entonces y a un posible aumento en cobertura mediante la ampliación de los grupos etarios a vacunarse, particularmente en países de ingresos bajos y medios (PIBMs). Más recientemente, se ha sugerido un esquema de vacunación contra el VPH de una sola dosis, el cual podría proporcionar suficiente protección contra la infección por VPH y así acelerar la introducción de la vacunación contra el VPH en PIBMs donde más se necesita.

A cien años de la gripe "española / One hundred years after the "Spanish" flu

La pandemia de gripe "española", de la que se cumplen 100 años, es considerada la más devastadora de la historia. Se estima que afectó a un tercio de la población mundial, y más del 2.5% de los enfermos murieron. Esta pandemia se presentó en dos oleadas principales, en 1918 y 1919, y la morbimortalidad por edades tuvo una curva en W. En general, la muerte no ocurría como consecuencia directa de la gripe, sino por bronconeumonías bacterianas, para las que se carecía de tratamiento. Hubo, además, una mayor mortalidad en enfermos con tuberculosis preexistente con respecto al resto de los afectados de influenza. En Argentina la epidemia también se presentó en dos oleadas principales, con amplias variaciones en la mortalidad por regiones. El tratamiento disponible incluía dieta, antisepsia de garganta, valerianato de quinina, salicilato, codeína para la tos y aceite alcanforado. También se aplicaban primitivas vacunas y sueros anti-neumococos. Con la disponibilidad de la secuencia de ARN completa del genoma del virus de la influenza 1918 ha sido posible ensamblar, mediante genética inversa, partículas virales semejantes a las de la pandemia mortal. El virus reconstituido demostró ser extraordinariamente virulento para ratones. En la actualidad, la vacunación contra la gripe estacional reduce el riesgo de otra pandemia, pero por el momento no puede eliminarlo. El desarrollo de vacunas "universales" contra la gripe, que confieran inmunidad confiable y duradera, podrá evitar en el futuro su propagación mundial.

The "Spanish" flu pandemic, which occurred a century ago, is considered the most devastating in human history. An estimated one third of world population fell ill with flu and more than 2.5% of them died. The course of the epidemic had two main waves (1918 and 1919) and showed an unusual W-shaped morbidity/mortality distribution. Death was not a direct outcome of flu itself but rather a consequence of secondary bacterial bronchopneumonia, for which antibiotics had not yet been discovered. Pre-existing pulmonary tuberculosis was also accountable for increased flu death rates during the pandemic. As it happened in Europe, in Argentina the epidemic had two main waves, with ample variation in mortality by region. Available treatment at the time included diet, throat antiseptic rinses, low doses of quinine valerianate, salicylates, codeine as a cough suppressant, and camphor oil. Primitive anti-pneumococcal vaccines and immune sera were also applied. Upon the disclosure of the whole RNA sequence of the 1918 influenza virus genome, by means of reverse genetics it was possible to assemble viral particles resembling those of the deadly pandemic. The reconstituted virus proved to be extraordinarily virulent for mice. Current seasonal flu vaccines help to reduce, but not to abolish, the risk of another pandemic. The ongoing development of "universal" vaccines against influenza conferring reliable and long-lasting immunity may prevent its global spread in the future.

Acromegaly: a rare disease?

Acromegaly is generally considered a benign and uncommon disease. However, some recent data bring support to the idea that it is more frequent than previously thought. Besides, acromegaly can significantly shorten the length of life due to its cardiovascular and metabolic complications. Since its clinical signs are insidiously progressive for many years, there is a considerable delay in its detection. Usually, many different specialists have been consulted before reaching diagnosis of acromegaly. Those specialists include cardiologists, pulmonologists, dentists, rheumatologists, and diabetes specialists. Possible means to achieve earlier detection are based on increasing awareness of doctors and the public in general. In this paper, the author analyzes the factors related to delayed diagnosis and the potential ways to ameliorate awareness of the disease with particular attention to screening procedures.

Existe la idea generalizada de que la acromegalia es una enfermedad benigna e infrecuente. Sin embargo, el paciente acromegálico ve comprometida su vida a causa de complicaciones cardiovasculares y metabólicas. Por otra parte, trabajos recientes muestran que su frecuencia parece mucho mayor que lo supuesto previamente. Dado que los signos y síntomas de la enfermedad se instalan lenta e insidiosamente, existe una demora considerable en su diagnóstico. Habitualmente, los pacientes han consultado diversos especialistas antes de que el trastorno sea detectado. Los mismos incluyen cardiólogos, neumonólogos, odontólogos, reumatólogos y diabetólogos. Un camino posible para lograr una detección temprana es el incremento del grado de concientización de los médicos y de la comunidad. En este artículo se analizan los factores vinculados al retraso diagnóstico y los medios posibles para mejorar el conocimiento y detección precoz de la enfermedad.

Obesidade adulta nas nações: uma análise via modelos de regressão beta / Obesidad adulta en naciones: un análisis mediante modelos de regresión beta / Adult obesity in different countries: an analysis via beta regression models

Resumo: A obesidade é considerada um grave problema de saúde pública, por se tratar de uma doença epidêmica de grande repercussão no cenário mundial e que está relacionada ao desenvolvimento de outras doenças crônicas, como, por exemplo, hipertensão, diabetes e doenças cardiovasculares. Diante disso, o presente trabalho tem como objetivo estudar a distribuição da obesidade em adultos de diferentes nações, por meio do modelo de regressão beta. Trata-se de um estudo ecológico descritivo com abordagem quantitativa e inferencial com foco na análise de regressão beta. A aplicação desse método considerou um conjunto de dados reais, obtidos a partir de fontes de informação pública, referente à obesidade adulta nas nações no ano de 2014. Após a análise descritiva dos dados, verificou-se que 50% das nações apresentam uma prevalência de adultos obesos maiores que 0,20 (20%). Adicionalmente, ao analisar a distribuição de sua prevalência por nação, constatou-se que os menores valores de obesidade adulta estão concentrados nos países pertencentes aos continentes da Ásia e África. Por outro lado, os maiores valores encontram-se distribuídos entre os países nos continentes da América e Europa. Ainda, a partir da análise gráfica do boxplot, foram observadas evidências de uma possível diferença nas proporções de adultos obesos entre os continentes da América e Europa com os da África e Ásia. Após ajustar o modelo de regressão beta com dispersão variável, foi possível identificar, ao nível de 5% de significância, que as variáveis consumo médio de álcool em litros por pessoa, porcentagem de atividade física insuficiente, porcentagem da população que vive em áreas urbanas e expectativa de vida apresentam efeito.

Resumen: La obesidad está considerada un grave problema de salud pública, al tratarse de una enfermedad epidémica de gran repercusión en el escenario mundial, que está relacionada con el desarrollo de otras enfermedades crónicas, como, por ejemplo, hipertensión, diabetes y enfermedades cardiovasculares. Ante esto, el presente trabajo tiene como objetivo estudiar la distribución de la obesidad en adultos de diferentes naciones, mediante un modelo de regresión beta. Se trata de un estudio ecológico descriptivo con un abordaje cuantitativo e inferencial, centrándose en el análisis de regresión beta. La aplicación de este método consideró un conjunto de datos reales, obtenidos a partir de fuentes de información pública, referente a la obesidad adulta en las naciones durante el año 2014. Tras el análisis descriptivo de los datos, se verificó que el 50% de las naciones presentan una prevalencia de adultos obesos mayor de un 0,20 (20%). Asimismo, al analizar la distribución de su prevalencia por nación, se constató que los menores valores de obesidad adulta están concentrados en los países pertenecientes a los continentes de Asia y África. Por otro lado, los mayores valores se encuentran distribuidos entre los países en los continentes de América y Europa. Sin embargo, a partir del análisis gráfico del diagrama de caja, se observaron evidencias de una posible diferencia en las proporciones de adultos obesos entre los continentes de América y Europa, respecto a los de África y Asia. Tras ajustar el modelo de regresión beta con dispersión variable, fue posible identificar, con un nivel de un 5% de significancia, que variables como: el consumo medio de alcohol en litros por persona, el porcentaje de actividad física insuficiente, el porcentaje de la población que vive en áreas urbanas y su expectativa de vida presentan efectos en este sentido.

Abstract: Obesity is considered a serious public health problem, as an epidemic disease with major global repercussions that is associated with the development of other chronic conditions such as hypertension, diabetes, and cardiovascular diseases. The current study examines the distribution of adult obesity in different countries using a beta regression model. This is a descriptive ecological study with a quantitative and inferential approach and a focus on beta regression analysis. Application of this method used a set of real data from public sources on adult obesity in 78 countries in 2014. Descriptive data analysis showed that 50% of the countries showed adult obesity prevalence greater than 20%. In addition, analysis of the distribution of prevalence by country showed lower adult obesity levels in countries of Asia and Africa. Meanwhile, higher values were found in countries of the Americas and Europe. Boxplot analysis also evidenced a possible difference in the proportion of obese adults between the Americas and Europe on one side and Africa and Asia on the other. Adjustment of the beta regression model with varying dispersion and 5% significance identified mean annual per capita alcohol intake, percentage of insufficient physical activity, percentage of the population living in urban areas, and life expectancy as variables associated with adult obesity.

Nuevas consideraciones sobre la salud de las personas con trastornos del desarrollo intelectual / New considerations on the health of the persons with intellectual developmental disorders

Resumen: La literatura reciente indica que las personas con trastornos del desarrollo intelectual (TDI) presentan diferencias respecto de la población general en cuanto a la prevalencia de determinadas enfermedades y a la atención sanitaria que reciben. El conocimiento actual con base en la evidencia es aún muy escaso en países no anglosajones. Los proyectos europeos POMONA-I y POMONA-II tenían el objetivo de recoger información sobre el estado de salud de las personas con TDI en Europa. Actualmente, el proyecto POMONA-ESP en España pretende recoger dicha información en una muestra amplia y representativa de personas con TDI. También se están llevando a cabo otros estudios sobre la necesidad de contar con servicios especializados y sobre la formación que reciben los profesionales sanitarios sobre TDI. En este artículo se revisan las últimas evidencias sobre la salud de las personas con TDI y se exponen las principales actividades de investigación y asistencia sanitaria sobre este tema.

Abstract: Recent literature indicates that people with Disorders of Intellectual Development (DID) experience health disparities in the pathologies that they present, and a worst access to health care. However, current evidence-based knowledge is still sparse outside the Anglo-Saxon countries. The POMONA-I and POMONA-II European projects aimed to collect information on the health status of people with DID in Europe. The POMONA-ESP project in Spain is meant to collect health information in a wide and representative sample of persons with DID. Also, there are studies that claim for the need of specialized services for people with DID at the public health system. There are also studies about the current state of the education and training about DID for students within the health sector. In this paper we review the latest evidences about the health of the persons with DID and we present the main research activities and care initiatives about this issue.

Atuais diretrizes do rastreamento do câncer colorretal: revisão de literatura / Current guidelines for screening colorectal cancer: a review of the literature

O câncer colorretal (CCR) é atualmente considerado uma neoplasia com alta taxa de incidência e de mortalidade na população, sendo o terceiro tipo de câncer mais prevalente no mundo e a segunda causa de mortes por câncer. Devido à importância de amenizar estas taxas, foram avaliados diversos métodos existentes nos Estados Unidos, na Europa e no Brasil para o rastreio do câncer colorretal, sendo notável a variedade de opções de exames disponíveis, além dos fatores de risco mundialmente difundidos. Foi observado que a mudança do estilo de vida é de difícil adesão, tornando assim imprescindível a adoção de um método de rastreio eficaz para detecção precoce e remoção de lesões pré-malignas e de neoplasias em estágio inicial, visando reduzir a incidência e a mortalidade do CCR e os gastos despendidos com o tratamento no caso de uma neoplasia avançada. No entanto, ainda não há um consenso acerca de um método de rastreio altamente qualificado e utilizado mundialmente de maneira unânime (AU)

Colorectal cancer (CRC) is currently considered a neoplasm with a high rate of incidence and mortality in the population, being the third most prevalent type of cancer in the world and the second cause of cancer deaths. Due to the importance of mitigating these rates, several methods for the screening of colorectal cancer used in the United States, Europe and Brazil were assessed, being noteworthy the variety of options for tests available, in addition to the risk factors broadcast worldwide. It has been observed that lifestyle changes are difficult to implement, thus making it imperative to adopt an effective screening method for the early detection and removal of premalignant lesions and early stage neoplasms in order to reduce the incidence and mortality of CRC and the costs incurred with treatment in case of advanced neoplasia. However, there is as yet no consensus on a highly qualified screening method used universally worldwide (AU)