Anamnesis ambiental como parte de la consulta pediátrica: estudio piloto / Environmental history-taking as part of pediatric consultations: a pilot study

Introducción. La salud ambiental infantil es la rama de la pediatría que estudia la influencia del medioambiente en la salud y la enfermedad de los niños. Las exposiciones ambientales globales representan una seria amenaza para la salud, lo que justifica una mayor investigación y acción. Objetivo. Evaluar la salud ambiental de una muestra de niños que viven en áreas urbanas y rurales de la ciudad de Uruguaiana, Brasil. Población y métodos. Se incluyeron padres/tutores (n = 714) de niños atendidos en el Policlínico Infantil de la Ciudad de Uruguaiana de enero a octubre de 2021, que respondieron la anamnesis ambiental en pediatría (Sociedad Brasileña de Pediatría). Los datos obtenidos se analizaron según la residencia en zona urbana o rural, o el ingreso familiar. Resultados. Al comparar los habitantes de la zona urbana (n = 660) con los de la zona rural (n = 54), verificamos que entre los de la zona rural fue significativamente mayor la actividad con productos químicos (15 % vs. 32,7 %; p = 0,004), vivir cerca de plantación (7,5 % vs. 74,5 %; p <0,001) o con fuente de contaminación (4,8 % vs. 32,7 %; p <0,001), tener perro (62 % vs. 87,3 %; p <0,001), usar plaguicidas (0,6 % vs. 32,7 %; p <0,001) y exposición a contaminación química (2,6 % vs. 18,2 %; p <0,001). En el área urbana predominó la exposición al tránsito de vehículos cerca de la vivienda (85 % vs. 48,1 %; p <0,001), renta media inferior a 3 salarios mínimos (90 %) y baja escolaridad. Conclusión. Realizar la anamnesis ambiental es fundamental para la detección de amenazas ambientales presentes en los lugares donde los niños y adolescentes viven, aprenden, juegan y estudian.

Introduction. Children's environmental health studies the influence of the environment on health and disease in children. Global environmental exposures pose a serious threat to health, warranting further research and action. Objective. To assess the environmental health of a sample of children living in urban and rural areas in Uruguaiana, Brazil. Population and methods. We included parents/legal guardians (n = 714) of children seen at Policlinica Infantil de Uruguaiana between January and October 2021, who completed the environmental history- taking in pediatrics (Brazilian Society of Pediatrics). Collected data were analyzed based on place of residence (urban or rural) or household income. Results. The comparison between inhabitants of the urban area (n = 660) and the rural area (n = 54) established that, among those living in the rural area, activity with chemical substances (15% versus 32.7%; p = 0.004), living near a plantation (7.5% versus 74.5%; p < 0.001) or near a source of contamination (4.8% versus 32.7%; p < 0.001), having a dog (62% versus 87.3%; p < 0.001), using pesticides (0.6% versus 32.7%; p < 0.001), and exposure to chemical contamination (2.6% versus 18.2%; p < 0.001) were significantly higher. In the urban area, exposure to vehicle traffic near the house (85% versus 48.1%; p < 0.001), an average income below 3 minimum wages (90%), and a low level of education predominated. Conclusion. Environmental history-taking is critical for the detection of environmental threats present in the areas where children and adolescents live, learn, play, and study

Assessment of anthropometric and physical profile of selected school-age children in rural and urban setting in South-West Nigeria (NigeriaLINX pilot) / Avaliação do perfil antropométrico e físico de crianças em idade escolar selecionadas em ambientes rurais e urbanos no sudoeste da Nigéria (piloto NigeriaLINX)

Objective: the objective of this study was to examine the anthropometric and physical profile of selected school-age children in rural and urban setting. Methods: the descriptive cross-sectional design was adopted for the study while multistage sampling techniques, which included simple random and systematic sampling techniques, were used to draw samples from the target population. The sample constitute healthy children who voluntarily participated in the study after consent for participation was given by individual parent. Anthropometric measurements for the study included height, weight, sitting height and BMI while the physical fitness tests for the study included sit and reach, handgrip strength, speed bounce, standing broad jump, 10m x 5 shuttles run and multistage fitness test. Z score, STEN score and independent T-Test were used for data analysis. Results: a total of 222 healthy children with average age of 10 years (male=112, female=109) participated in the study. The results showed that the urban children were taller (Urban=141.3±9.2m; Rural=134±21.3m), heavier (Urban=37.6±10.4kg; Rural=28.2±6.2kg), had more leg power (Urban=105.7±25.5; Rural=49.4±41.0) and arm strength (Urban=15.7±4.1; Rural=13.4±5.2) than rural children. However, the rural children had higher sit and reach score (Rural=25.3±5.8; Urban=22.8±6.0) and completed more laps in multistage fitness test (Rural=35.5±25.5; Urban=12±5.7). The statistical analysis showed that all the variables were significantly different urban and rural children (P<0.05). Conclusion: the current study shows that the children in the urban and rural settings differed in the selected anthropometric and physical variables Therefore, the physical education program and infrastructural facilities for physical activity and sport participation for school age children should be designed based on the socioeconomic status, social amenities and level of development of the host community

Objetivo: examinar o perfil antropométrico e físico de crianças em idade escolar selecionadas em ambientes rurais e urbanos. Métodos: foi realizado um estudo transversal aplicando técnicas de amostragem em vários estágios, que incluíam processos de amostragem aleatória simples e sistemática, usadas para extrair amostras da população-alvo. A amostra constitui-se de crianças saudáveis que participaram voluntariamente do estudo, após consentimento para participação dado por um dos pais. As medições antropométricas incluíram altura, peso, altura sentada e IMC, enquanto os testes de aptidão física para o estudo incluíram sentar-se e alcançar, força de preensão manual, salto de velocidade, salto em largura, corrida de vaivém de 10 x 5 metros e teste de aptidão multiestágio. Foram usados para a análise escore z, escore STEN e teste t independentemente dos dados. Resultados: um total de 222 crianças saudáveis com idade média de 10 anos (masculino=112, feminino=109) participaram do estudo. Os resultados mostraram que as crianças urbanas eram mais altas (Urbano=141,3±9,2m; Rurais=134±21,3m), mais pesadas (Urbano=37,6±10,4kg; Rurais=28,2±6,2kg), tinham mais força nas pernas (Urbano=105,7±25,5; Rurais =49,4±41,0) e força de braço (Urbano=15,7±4,1; Rural=13,4±5,2) do que as crianças da zona rural. No entanto, as crianças da zona rural tiveram maior pontuação de sentar e alcançar (Rural=25,3±5,8; Urbana=22,8±6,0) e completaram mais voltas no teste de condicionamento físico multiestágio (Rural=35,5±25,5; Urbana=12±5,7). Todas as variáveis eram significativamente diferentes entre crianças urbanas e rurais (P<0,05). Conclusão: o presente estudo mostrou que as crianças das áreas urbana e rural diferiram nas variáveis antropométricas e físicas selecionadas. Portanto, o programa de educação física e as instalações de infraestrutura para atividades físicas e participação em esportes para crianças em idade escolar devem ser projetados com base no status socioeconômico, nas comodidades sociais e no nível de desenvolvimento da comunidade anfitriã

Quality of life group of cameroonian patients aged over 65 years in an urban setting: A cross-sectional study

Background. The quality of life of the elderly can be compromised by several chronic diseases. This has a considerable impact on their physical and mental capacities.This study aimed to evaluate the quality of life of the elderly at the Yaoundé Central Hospital. Methods.We carried out a cross-sectional study of elderly patients who consulted at the Yaounde Central Hospital forfive months. Sociodemographic characteristics were taken, and we also took data concerning their chronic conditions and depressive symptoms. The presence of any cognitive impairment was evaluated using the Mini-mental state Examination (MMSE). Their functional capacity was assessed with the six-minute walk test. Quality of life was evaluated using the older people's quality of life questionnaire (OPQOL). The multivariate analysis was done on the logistic regression model, and the p values < 0.05 were considered statistically significant. Results.66 participants were included (35 women) with a median age of 70 (IQR: 67 -75) years. About 87.8% had at least one chronic condition, and 47% had two or more. The most prevalent chronic condition was hypertension (71.2%), followed by abdominal obesity (40.9%) and heart failure (24.2%). Mild depressive symptoms were present in 1.5% of our study population. Fourteen participants (21.2%) had a poor quality of life. The factors associated with a poor quality of life was a distance covered in the 6 MWT less than 350m (OR: 3.7, p < 0.05). Conclusion.There is a high prevalence of poor quality of life among elderly patients consulting at the Yaoundé Central Hospital. A distance covered in the 6MWT less than 350m is associated with poor quality of life.

Introduction. La qualité de vie des personnes âgées peut être compromise par la survenue de plusieurs pathologies chroniques. Cela a un impact considérable sur leurs capacités physiques mais aussi sur leurs capacités mentales. Le but de cette étude était d'évaluer la qualité de vie des personnes âgées suivies à l'Hôpital Central de Yaoundé. Méthodologie. Nous avons réalisé une étude transversale analytique sur des patients âgés ayant consulté à l'hôpital central de Yaoundé pendant une période de cinq mois. Les caractéristiques sociodémographiques ont été prises, ainsi que leurs différentes comorbidités. La présence d'un déficit cognitif a été évaluée à l'aide du Mini Mental State Examination(MMSE). Leur capacité fonctionnelle a été évaluée à l'aide du test de marche de six minutes. La qualité de vie a été évaluée à l'aide du score OPQOL.. L'analyse multivariée a été effectuée sur le modèle de régression logistique et les valeurs de p < 0,05 ont été considérées comme statistiquement significatives. Résultats. 66 participants ont été inclus (35 femmes) avec un âge médian de 70 (IQR : 67 -75) ans. Parmi eux, environ 87,8 % avaient au moins une maladie chronique et 47 % en avaient deux ou plus. L'affection chronique la plus répandue était l'hypertension artérielle (71,2 %), suivie de l'insuffisance cardiaque (24,2 %) et de l'arthrose (12,1 %). Des symptômes dépressifs légers étaient présents chez 1,5 % de la population de notre étude. 14 participants (21,2 %) avaient une mauvaise qualité de vie. Les facteurs associés à unemauvaise qualité de vie étaient une distance parcourue dans le 6MWT inférieure à 350m (OR : 3,7, p < 0,05). Conclusion. Il existe une forte prévalence de la mauvaise qualité de vie chez ce groupe de patients âgés camerounais dont le facteur associé retrouvéest une distance parcourue durant le 6MWT inférieure à 350m.Ceci confirme le bénéfice de l'activité physique sur le plan physique et mental, indispensable pour une meilleure qualité de vie.

Effect of Age and Sex on Stroke Mortality of Young and Middle-aged Adults in China, 2002-2019, and Predictions to 2030 / 生物医学与环境科学（英文）

OBJECTIVE@#This study aimed to examine the trends in stroke mortality among young and middle-aged adults in China.@*METHODS@#Data were obtained from the China national vital registration system. Significant changes in mortality were assessed by Joinpoint regression. Age-period-cohort analysis was used to explain the reasons for the changes. Future mortality and counts were predicted by the Bayesian age-period-cohort model.@*RESULTS@#Between 2002 and 2019, a total of 6,253,951 stroke mortality in young and middle-aged adults were recorded. The age-adjusted mortality rates (AAMRs) of women showed a downward trend. The annual percent changes (APC) were -3.5% (-5.2%, -1.7%) for urban women and -2.8% (-3.7%, -1.9%) for rural women. By contrast, the AAMRs per 100,000 for rural men aged 25-44 years continued to rise from 9.40 to 15.46. The AAMRS for urban men aged 25-44 years and urban and rural men aged 45-64 years did not change significantly. Between 2020 and 2030, the projected stroke deaths are 1,423,584 in men and 401,712 in women.@*CONCLUSION@#Significant sex and age disparities in the trends of stroke mortality among young and middle-aged adults were identified in China. Targeted health policy measures are needed to address the burden of stroke in the young generation, especially for rural men, with a focus on the prevention and management of high risk factors.

Incidence and survival of neuroendocrine neoplasms in China with comparison to the United States / 中华医学杂志(英文版)

BACKGROUND@#Neuroendocrine neoplasms (NENs) are rare tumors characterized by variable biology and delayed diagnosis. However, the nationwide epidemiology of NENs has never been reported in China. We aimed to estimate the incidence and survival statistics of NENs in China, in comparison to those in the United States during the same period.@*METHODS@#Based on the data from 246 population-based cancer registries covering 272.5 million people of China, we calculated age-specific incidence on NENs in 2017 and multiplied by corresponding national population to estimate the nationwide incidence in China. The data of 22 population-based cancer registries were used to estimate the trends of NENs incidence from 2000 to 2017 through the Joinpoint regression model. We used the cohort approach to analyze the 5-year age-standardized relative survival by sex, age group, and urban-rural area between 2008 and 2013, based on data from 176 high-quality cancer registries. We used data from the Surveillance, Epidemiology, and End Results (SEER) 18 program to estimate the comparable incidence and survival of NENs in the United States.@*RESULTS@#The overall age-standardized rate (ASR) of NENs incidence was lower in China (1.14 per 100,000) than in the United States (6.26 per 100,000). The most common primary sites were lungs, pancreas, stomach, and rectum in China. The ASRs of NENs incidence increased by 9.8% and 3.6% per year in China and the United States, respectively. The overall 5-year relative survival in China (36.2%) was lower than in the United States (63.9%). The 5-year relative survival was higher for female patients than male patients, and was higher in urban areas than in rural areas.@*CONCLUSIONS@#The disparities in burden of NENs persist across sex, area, age group, and site in China and the United States. These findings may provide a scientific basis on prevention and control of NENs in the two countries.

Association between different growth patterns and metabolic syndrome in children and adolescents aged 7 to 17 years / 北京大学学报(医学版)

OBJECTIVE@#To analyze the association between different growth patterns and metabolic syndrome in children and adolescents aged 7 to 17 years, and to provide suggestions for the prevention and control of metabolic syndrome in Chinese children and adolescents.@*METHODS@#Data were collected from the research project "Development and Application of Technology and Related Standards for Prevention and Control of Major Diseases among Students" of public health industry in 2012. This project is a cross-sectional study design. A total of 65 347 students from 93 primary and secondary schools in 7 provinces including Guangdong were selected by stratified cluster random sampling method. Given the budget, 25% of the students were randomly selected to collect blood samples. In this study, 10 176 primary and middle school students aged 7 to 17 years with complete physical measurements and blood biochemical indicators were selected as research objects. Chi-square test was used to compare the distribution differences of growth patterns under different demographic characteristics. Birth weight, waist circumference and blood biochemical indexes were expressed in the form of mean ± standard deviation, and the differences among different groups were compared by variance analysis. Binary Logistic regression model was used to analyze the relationship between different growth patterns and metabolic syndrome in children and adolescents aged 7 to 17 years.@*RESULTS@#The prevalence of metabolic syndrome in children and adolescents was 6.56%, 7.18% in boys and 5.97% in girls. The risk of metabolic syndrome was higher in the catch-down growth group than in the normal growth group (OR=1.417, 95%CI: 1.19-1.69), and lower in the catch-up growth group(OR=0.66, 95%CI: 0.53-0.82). After adjusting for gender, age and so on, the risk of developing metabolic syndrome in the catch-down growth group was higher than that in the normal growth group (OR=1.25, 95%CI: 1.02-1.52), but there was no significant difference between the catch-up growth group and the normal growth group (OR=0.79, 95%CI: 0.62-1.01). Stratified analysis showed that the association between different growth patterns and metabolic syndrome was statistically significant in the 7-12 years group, urban population, and Han Chinese student population.@*CONCLUSION@#There is a correlation between different growth patterns and metabolic syndrome in children and adolescents. The risk of developing metabolic syndrome in children and adolescents with catch-down growth is higher than that in the normal growth group, which suggests that attention should be paid to the growth and development of children and adolescents, timely correction of delayed growth and prevention of adverse health outcomes.

A study on knowledge, attitude, and vaccination behavior of herpes zoster vaccine among urban residents in selected areas of China / 中华流行病学杂志

Objective: To understand the knowledge, attitude, and current status of vaccination of herpes zoster vaccination among urban residents aged 25 years and above in China. Methods: In August to October 2022, a convenience sampling method was used to survey residents aged 25 years and above at 36 community centers in 9 cities across China. Questionnaires were used to collect basic information, knowledge, and attitude toward herpes zoster and its vaccination, as well as vaccination status and reasons for non-vaccination among residents. Results: A total of 2 864 urban residents were included in the study. The total score of residents' cognition of herpes zoster and its vaccine was 3.01±2.08, and the total score of their attitude was 18.25±2.76. Factors such as being male (β=-0.45, P<0.001), older than 40-59 years (β=-0.34, P=0.023) or ≥60 years (β=-0.68, P<0.001), married (β=-0.69, P=0.002) were negatively associated with knowledge score. The educational level of high school or secondary school (β=0.44, P=0.036), college (β=0.65, P=0.006), bachelor's degree and above (β=1.20, P<0.001), annual net household income ≥120 000 Yuan in 2021 (β=0.42, P=0.020), having urban employee medical insurance (β=0.62, P=0.030), having public or commercial medical insurance (β=0.65, P=0.033), and having a history of chickenpox (β=0.29, P=0.025) were positively associated with knowledge scores. Being male (β=-0.38, P=0.008) and not remembering a history of chickenpox (β=-0.49, P=0.012) were negatively associated with attitude scores. Annual net household income in 2021 was between 40 000-80 000 Yuan (β=0.44, P=0.032) or between 80 000-120 000 Yuan (β=0.62, P=0.002) or ≥120 000 Yuan (β=0.93, P<0.001), and a history of herpes zoster (β=0.59, P=0.004) were positively associated with attitude scores. Of the 2 864 residents surveyed, only 29 (1.01%) had received the herpes zoster vaccine, with a vaccination rate of 1.70% for those aged 50 years and above, with the main reason for non-vaccination being lack of knowledge about the herpes zoster vaccine, followed by the high price. 42.67% of the population said they would consider getting the herpes zoster vaccine in the future. Conclusion: Low knowledge of herpes zoster and its vaccine, positive attitudes towards the preventive effects of herpes zoster and its vaccine, and extremely low vaccination rates among the urban population in China call for multiple measures to strengthen health education and vaccination recommendations for residents, especially for the elderly, low-education and low-income populations.

Cancer statistics in China, 2016 / 中华肿瘤杂志

Objective: Data for 2016 from cancer registries were used to estimate cancer incidence and mortality in China in 2016. Methods: According to the quality control process of the National Central Cancer Registry, the data from 683 cancer registries submitted by each province were evaluated, and the data of 487 cancer registries were qualified and included in the final analysis. Age-specific incidence and mortality rates were calculated by area (urban/rural), sex, age and cancer site, combined with national population data to estimate cancer incidence and mortality in China in 2016. Chinese population census in 2000 and Segi's population were used for age-standardized incidence and mortality rates. Results: Total population covered by 487 cancer registries was 381 565 422 (192 628 370 in urban and 188 937 052 in rural areas). The percentages of morphologically verified (MV%) and death certificate-only cases (DCO%) accounted for 68.31% and 1.40%, respectively, and the mortality to incidence ratio was 0.61. It was estimated about 4 064 000 new cases occurred in China in 2016, with the crude incidence rate being 293.91/100 000 (the rates of males and females were 315.52/100 000 and 271.23/100 000), age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population (ASIRW) were 190.76/100 000 and 186.46/100 000, with the cumulative incidence rate (0-74 years old) being 21.42%. The crude incidence and ASIRC were 314.74/100 000 and 196.38/100 000 in urban areas, whereas in rural areas, they were 265.90/100 000 and 182.21/100 000, respectively. It was estimated about 2 413 500 cancer deaths occurred in China in 2016, the crude mortality rate was 174.55/100 000 (216.16/100 000 in males and 130.88/100 000 in females), the age-standardized mortality rates by Chinese standard population (ASMRC) and by world standard population (ASMRW) were 106.00/100 000 and 105.19/100 000, and the cumulative mortality rate (0-74 years old) was 11.85%. The crude mortality and ASMRC were 180.31/100 000 and 104.44/100 000 in urban areas, whereas in rural areas, they were 166.81/100 000 and 108.01/100 000, respectively. The most common cancer cases include lung, colorectal, stomach, liver and female breast cancers. The top five cancers accounted for about 57.27% of all cancer cases. The most common cancer deaths included lung, liver, stomach, colorectal and esophageal cancers. The top five cancers accounted for about 69.25% of all cancer deaths. Conclusions: The burden of cancer shows a continuous increasing trend in China. Regional and gender differences in cancer burden are obvious. The cancer patterns still show the coexistence of cancer patterns in developed countries and developing countries. The situation of cancer prevention and control is still serious in China.

Reporte nacional de Costa Rica sobre los avances en la implementación de la Nueva Agenda Urbana 2016 - 2021

El Ministerio de Vivienda y Asentamientos Humanos (MIVAH), de Costa Rica, presenta el primer reporte nacional voluntario de implementación de la Nueva Agenda Urbana (NAU) 2016 ­ 2021, que ha sido elaborado sobre la base de los lineamientos que, para tal efecto, fueron propuestos por ONU-Hábitat. El MIVAH enfatiza que, teniendo en consideración las múltiples variables y factores que intervienen en el desarrollo urbano sostenible, así como las corresponsabilidades establecidas en la Conferencia Hábitat III, en la que se adoptó la NAU, en la elaboración del informe, necesariamente se han involucrado entidades y actores adicionales a los que conforman el Sector de Ordenamiento Territorial y Asentamientos Humanos de nuestro país. Para asumir esta tarea, se ha conformado un equipo nacional constituido por enlaces institucionales, quienes aportaron información oficial y pertinente, sobre los indicadores que contiene la guía. En el caso de Costa Rica, el MIVAH reconoce que no es posible completar todas las variables propuestas por ONU-Hábitat. A continuación, se presenta el primer reporte voluntario, que fue construido con el aporte de múltiples instituciones nacionales, gobiernos locales, academia y sociedad civil, convocadas para conformar la comisión responsable de la elaboración del informe, que fue coordinada por este Ministerio. El MIVAH reconoce y agradece la colaboración de las entidades nacionales y las organizaciones de la sociedad civil, que contribuyeron con el informe, así como el constante apoyo técnico brindado por la Oficina Regional de América Latina y el Caribe de ONU-Hábitat.

A cidade importa: urbanização, análise regional e segregação urbana em tempos de pandemia de Covid-19 / La ciudad importa: urbanización, análisis regional y segregación urbana en tiempos de pandemia de COVID-19 / The city matters: urbanization, regional analysis and urban segregation in times of the COVID-19 pandemic

No início de 2020, assentamentos urbanos em todo o mundo experimentaram a rápida expansão da síndrome respiratória aguda grave (SARS-CoV-2). As cidades foram os focos de contaminação nos países que apresentaram notificações significativas de Covid-19. Neste estudo, investigamos primeiramente a disseminação do novo coronavírus entre cidades espraiadas e compactas, examinando aspectos como densidade urbana, localização de pessoas e empregos e padrões de deslocamento. Nessa análise, a literatura anterior e os dados recentes de três grandes cidades distintas (Nova York, Los Angeles e São Paulo) apoiam a discussão. Com base na revisão da literatura, demonstra-se que a morfologia urbana, a infraestrutura e os projetos de mobilidade e atividades econômicas são aspectos relevantes do desenvolvimento urbano que podem afetar as interações entre os cidadãos e a disseminação da Covid-19. Além disso, observa-se que a escala regional e a análise da rede urbana também são importantes nos estudos que investigam o crescimento da Covid-19. Por fim, a revisão da literatura mostra que a vulnerabilidade socioespacial urbana é relevante em tempos de pandemia, diante das associações entre a disseminação da Covid-19 e aspectos socioespaciais nas cidades, como pobreza e desigualdade.

A principios de 2020, los asentamientos urbanos de todo el mundo experimentaron la rápida expansión del síndrome respiratorio agudo severo (SARS-CoV-2). Las ciudades fueron los puntos críticos de contaminación por el virus dentro de los países que presentaron notificaciones significativas de COVID-19. En este estudio, primero investigamos la diseminación de COVID-19 en grandes ciudades compactas y extensas, y examinamos aspectos como la densidad urbana, la ubicación de personas y trabajos, y los patrones de desplazamiento. En este análisis, la literatura previa y los datos recientes de tres distintas grandes ciudades (Nueva York, Los Ángeles y San Pablo) apoyan nuestra discusión. Aquí, confirmamos que la morfología urbana, la infraestructura, los proyectos de movilidad y las actividades económicas son aspectos relevantes del desarrollo urbano que pueden afectar las interacciones entre los ciudadanos y la difusión de la COVID-19. Además, demostramos que la escala regional y el análisis de redes urbanas también son importantes en los estudios que investigan el crecimiento de COVID-19. Finalmente, investigamos la vulnerabilidad socioespacial urbana en tiempos de pandemia, destacando las asociaciones entre la diseminación de la COVID-19 y aspectos socio-dentro de las ciudades, como la pobreza y la desigualdad.

In early 2020, urban settlements worldwide have experienced the rapid expansion of severe acute respiratory syndrome (SARS-CoV-2). Cities were the hotspots of virus contamination within countries presenting significant COVID-19 notifications. In this study, we first investigate the COVID-19 dissemination between compact and sprawling big cities, examining aspects such as urban density, location of people and jobs and commuting patterns. Previous literature and recent data from three distinct big cities (New York, Los Angeles and Sao Paulo) support our discussion. Our literature review demonstrates that urban morphology, infrastructure, mobility projects and economic activities are relevant aspects of urban development that might affect interactions among citizens and COVID-19 dissemination. In addition, we show that regional scale and urban network analysis are also relevant in studies investigating COVID-19 growth. Finally, our literature review shows that urban socio-spatial vulnerability is also relevant in times of pandemic, highlighting the associations between COVID-19 dissemination and socio aspects within cities, such as poverty and inequality.

Cutaneous leishmaniasis - Awareness, knowledge and practices among general population in rural and urban areas in Malakand region, Pakistan / Leishmaniose cutânea - conscientização, conhecimentos e práticas entre a população em geral nas áreas rurais e urbanas da região de Malakand, Paquistão

Malakand region is an endemic area for cutaneous leishmaniasis (CL). However, there are limited number of studies of this disease in Pakistan. Therefore, a study was conducted to understand the level of awareness attitude and practice among the residents of Makaland towards CL and the disease vectors. This study adopted a cross-sectional approach with a total of 400 respondents (n=93 rural and n= 307 urban). Overall, the population in Malakand region (61.2%) were well-informed in the role of sand fly in transmitting diseases, but most lack knowledge on the vector's behavior and almost a quarter (24.5%) were unable to provide knowledge on proper control measures. Alarmingly, the practice and attitudes of the general population was not satisfactory as close to half (49.8%) of the population did adopt any control method. This study calls for increase in awareness through health education campaign to reduce the risk of cutaneous leishmaniasis outbreaks in the future.

A região de Malakand é uma área endêmica para leishmaniose cutânea (CL). No entanto, há um número limitado de estudos sobre esta doença no Paquistão. Portanto, foi realizado um estudo para entender o nível de atitude e prática de conscientização entre os residentes de Makaland em relação aos CL e os vetores da doença. Este estudo adotou uma abordagem transversal com um total de 400 entrevistados (n = 93 rural e n = 307 urbano). No geral, a população da região de Malakand (61,2%) estava bem informada sobre o papel da mosca na transmissão de doenças, mas a maioria não possui conhecimento sobre o comportamento do vetor e quase um quarto (24,5%) foi incapaz de fornecer conhecimento sobre medidas de controle adequadas . De maneira alarmante, a prática e as atitudes da população em geral não foram satisfatórias, pois cerca da metade (49,8%) da população adotou algum método de controle. Este estudo apela ao aumento da conscientização por meio de campanhas de educação em saúde para reduzir o risco de surtos de leishmaniose cutânea no futuro.

Analysis on incidence trend of liver cancer in China, 2005-2016 / 中华流行病学杂志

Objective: To understand the incidence trend of liver cancer in China from 2005 to 2016, and explore the correlation between the incidence trend of liver cancer and the incidence trend of hepatitis B. Methods: The incidence data of liver cancer in China from 2005 to 2016 were collected from the Annual Report of Cancer Registry in China. The incidence data of hepatitis B were collected from China Public Health Science Data Center. World standardized incidence rate (WSR) was calculated according to the World Segi's population. Joinpoint regression model was used to analyze the trend of WSR of liver cancer [measured by average annual percentage change (AAPC)]. The age-period-cohort model was fitted to analyze the age, period and cohort effects in people aged 20- years and above. Pearson correlation coefficient was used to explore the correlation between the incidence of liver cancer and the incidence of hepatitis B. Results: The crude incidence of liver cancer in China showed a trend of first increase before 2009 and then relatively stable. The world standardized morbidity rate of liver cancer in China decreased from 19.11 per 100 000 in 2005 to 17.74 per 100 000 in 2016 (AAPC=-0.5%, 95%CI: -1.3%-0.3%, P=0.240). The incidence of liver cancer in male decreased significantly (AAPC=-1.0%, 95%CI: -1.5%--0.5%, P=0.001). The incidence of liver cancer in women increased from 2005 to 2010 [annual percentage change (APC)=1.7%, 95%CI: -0.1%-3.4%, P=0.059] but showed a significant decrease trend from 2010 to 2016 (APC=-1.6%, 95%CI: -2.3%--1.0%, P=0.001). From 2005 to 2016, the incidence of liver cancer showed a decreasing trend in urban areas (AAPC=-0.3%, 95%CI: -0.8%-0.3%, P=0.316) and rural areas (AAPC=-3.9%, 95%CI: -4.4%--3.3%, P<0.001). Risk for liver cancer increased with age, while the period effect showed a trend of first increase then decrease and cohort effect showed a decrease trend. The morbidity rates of both hepatitis B and liver cancer showed decrease trends from 2009 to 2016, and there was a significant correlation (r=0.71, 95%CI: 0.01-0.94, P=0.048). Conclusions: From 2005 to 2016, the morbidity rate of liver cancer in China showed a decrease trend, and there were significant gender and urban-rural area specific differences. Age effect had a great impact on the risk for liver cancer. With the progress of population aging in China, liver cancer is still a public health problem, to which close attention needs to be paid.

Analysis of changes in mortality of children and adolescents aged 5 to 19 years in China from 2004 to 2018 and policy effects / 中华预防医学杂志

Objective: To analyze the trend of child and adolescent mortality rate in China from 2004 to 2018 and explore the possible policy effects. Methods: This study used the mortality data of child and adolescent aged 5 to 19 years from 2004 to 2018 based on the National Disease Surveillance System. Age-standardized mortality rate was calculated by using the population from the sixth national census. Joinpoint regression was used to analyze the trend of child and adolescent mortality with different features from 2004 to 2018. Results: From 2004 to 2018, the overall mortality rate of children and adolescents in China dropped from 40.02 per 100 000 to 22.00 per 100 000, and the average annual percentage change (AAPC) was -4.28 (95%CI:-5.35,-3.20,P<0.001). The mortality rate dropped rapidly from 2004 to 2006, and the annual percentage change (APC) was -9.20 (95%CI:-15.63,-2.28,P=0.017). The decline rate slowed down between 2006 and 2013, and the APC was -1.56 (95%CI:-2.78,-0.33,P=0.020). The downward trend accelerated from 2013 to 2018, and the APC was -5.99 (95%CI:-7.52,-4.43,P<0.001). The trend of child mortality rate in rural area, females, eastern provinces of China, children aged 10 to 14 years, children aged 15 to 19 years, and injury mortality rate were basically consistent with the overall trend. The child mortality rate in urban area, central provinces of China and the mortality rate of infectious diseases, maternal and infant, and nutritional deficiencies diseases showed a uniform downward trend from 2004 to 2018, with AAPC values about -3.59 (95%CI:-4.38,-2.78,P<0.001), -2.89 (95%CI:-3.24,-2.54,P<0.001) and -6.66 (95%CI:-7.64,-5.68,P<0.001), respectively. Conclusion: The mortality rate of children and adolescents aged 5 to 19 years in China continues to decline from 2004 to 2018, and the decline rate becomes faster after 2011.

Changing trend of incidence and mortality of stomach cancer during 2010-2016 in Henan Province, China / 中华肿瘤杂志

Objective: To estimate stomach cancer incidence and mortality in Henan, 2016 and analyze the trend of stomach cancer incidence and mortality from 2010 to 2016. Methods: Stomach cancer related data in 2016 was extracted from Henan cancer registration and follow-up system. All data were qualified in validity, reliability and completeness according to the Guideline on Cancer Registration in China and International Agency for Research on Cancer (IARC/IACR). The incidence and mortality of stomach cancer were estimated by areas, gender and age based on the quality data and the registered population data of Henan province in 2016. The epidemic trend of stomach cancer was also been evaluated based on the age-standardized incidence and mortality by Chinese population (ASR China) from 2010 to 2016. Results: In 2016, the estimated incident cases of stomach cancer were 44 311. The incidence was 41.07/100 000, ASR China was 30.17/100 000, ASR by world population (ASR world) was 30.36/100 000, and the cumulative incidence rate was 3.84%. The incidences of male and female were 55.65/100 000 and 25.35/100 000, respectively. Meanwhile, 32 927 people died of stomach cancer in Henan. The mortality was 30.52/100 000, ASR China was 21.45/100 000, ASR world was 21.54/100 000, and the cumulative mortality was 2.53%. From 2010 to 2016, both the ASR China for incidence and mortality of stomach cancer in Henan showed a steady downward trend. In rural, the ASR China for incidence and mortality decreased rapidly, while the stable trend was observed in urban. Nevertheless, the incidence and mortality of stomach cancer in rural were still higher than those in urban. Conclusions: The incidence and mortality of stomach cancer in Henan province showed steadily declining trend from 2010 to 2016, and the geographical distribution difference between rural and urban areas was gradually narrowing. However, the disease burden was still high in 2016.

Changing trend of incidence and mortality of esophageal cancer during 2010-2016 in Henan Province, China / 中华肿瘤杂志

Objective: To estimate the incidence and mortality of esophageal cancer in 2016 and their changing trend during 2010-2016 according to the cancer registration data in Henan province. Methods: The data quality including completeness, validity, and reliability of local registries which submitted the cancer registration data of 2016 were assessed according to the criteria of Guideline on Cancer Registration in China and IARC/IACR. Esophageal cancer cases (ICD10: C15) were extracted from the database, and the incidence and mortality stratified by gender, age, and areas (urban/rural) were calculated, the incidence and mortality of provincial cancer were estimated combined with provincial population data. China's 2000 census population and Segi's population were used to calculate the age-standardized rate. Joinpoint model was used to estimate the changing trend of age standardized incidence and mortality along with the calendar year. Results: Approximately 40.10 thousand new esophageal cancer cases were diagnosed in Henan in 2016, accounting for 13.46% of all new cancer cases, and it ranked the third among cancer of all sites. The crude incidence of esophageal cancer was 37.21/100 000 with an age-standardized incidence rate by China standard population (ASIRC) of 26.74/100 000 and an age-standardized incidence rate by world standard population (ASIRW) of 27.12/100 000. The incidence of esophageal cancer in males was higher than that in females, with the ASIRC of 34.53/100 000 and 19.19/100 000, respectively. It was higher in rural areas than that in urban areas, with the ASIRC of 28.13/100 000 and 20.90/100 000, respectively. About 29.30 thousand deaths of esophageal cancer in Henan in 2016, accounting for 15.61% of all cancer deaths in Henan, which ranked the third among cancer of all sites. The crude mortality rate was 27.14/100 000 with an age-standardized mortality rate by China standard population (ASMRC) of 18.74/100 000 and an age-standardized mortality rate by world standard population (ASMRW) of 18.78/100 000. The mortality in males was higher than that in females, with the ASMRC of 24.78/100 000 and 13.12/100 000, respectively. It was also higher in rural areas than that in urban areas, with the ASMRC of 19.48/100 000 and 15.73/100 000, respectively. The ASIRC and ASMRC were declining with annual percent change (APC) of 3.12% (APC=-3.12%; 95%CI: -5.30%, -0.90%; P=0.015) and 2.47% (APC=-2.47%; 95%CI: -4.70%, -0.20%; P=0.039) during 2010-2016. However, the significant declining trend was only observed in rural areas in Henan, and the changing trend was same between males and females. Conclusions: The incidence and mortality of esophageal cancer are declining since 2010, however, the disease burden remains large in Henan. Therefore, comprehensive prevention and control efforts should be strengthened according to its epidemic characteristics and risk factors.

A comparative analysis of the distribution of the high-risk population of upper gastrointestinal cancer and endoscopic screening compliance in two urban areas and two rural areas in China / 中华肿瘤杂志

Objective: To analyze and compare the distribution of the high-risk population of upper gastrointestinal (UGI) cancer and the factors influencing the compliance rate of endoscopic screening in urban China and rural China. Methods: From 2015 to 2017, an epidemiological survey was conducted on residents aged 40-69 in two rural areas (Luoshan county of Henan province, Sheyang county of Jiangsu province) and two urban areas (Changsha city of Hunan province, Harbin city of Heilongjiang province). As a result, high-risk individuals were recommended for endoscopic screening. Chi-square χ(2) test was used to compare the high-risk rate of UGI cancer between urban and rural residents. In addition, the multivariate logistic regression model was used to analyze the factors influencing the compliance rate of endoscopic screening. Results: A total of 48, 310 residents aged 40-69 were enrolled in this study, including 22 870 (47.34%) residents from rural areas and 25 440 (52.66%) residents from urban areas. A total of 23 532 individuals were assessed with a high risk of UGI cancer, with an overall risk rate of 48.71%. A higher proportion of participants with high risk was observed in rural China (56.17%, 12 845/22 870) than in urban China (42.01%, 10 687/25 440). A total of 10 971 high-risk individuals with UGI cancer participated in endoscopic screening, with an overall compliance rate of 46.62% (10 971/23 532), 45.15% (5 799/12 845) in rural China, and 48.40% (5 172/10 687) in urban China. In rural population, the compliance rate of endoscopic screening was higher in those of females, aged 50-69 years, primary school education or above, high income, a family history of UGI cancer, history of gastric and duodenal ulcer, history of reflux esophagitis, and history of superficial gastritis, but lower in smokers (P<0.05). Among the urban population, the compliance rate of endoscopic screening was higher in those aged 40-49 years, uneducated, low income, family history of UGI cancer, history of reflux esophagitis, history of superficial gastritis, but lower in smokers (P<0.05). Conclusions: The proportion of participants with high risk of UGI cancer in rural areas is higher than that of urban areas. The compliance rates of endoscopic screening in urban and rural areas are low, and influencing factors of endoscopic screening exhibit some differences in rural China and urban China.

Saúde mental e ambientes restauradores urbanos em tempos de covid-19 / Mental health and urban restorative environments during the COVID-19 / Santé mentale et environnements urbains réparateurs pendant le Covid-19 / Salud mental y ambientes urbanos restaurativos en tiempos de Covid-19

Resumo A pandemia de covid-19 impactou significativamente o estilo de vida das pessoas em todo o mundo. Esta pesquisa visa discutir a influência dos ambientes restauradores urbanos na saúde mental em tempos de pandemia. Trata-se de uma pesquisa básica de abordagem qualitativa, feita por meio de pesquisa bibliográfica. Os dados que orientaram o estudo contribuíram para a fase descritiva dos fenômenos e sua relação com a necessidade de aprimorar tendências biofílicas. A pesquisa apontou fortes correlações entre meio ambiente natural, saúde mental e qualidade de vida da população urbana. A pandemia também nos faz refletir sobre o modo de vida nas cidades e a forma como tratamos as questões ambientais. Diante deste cenário, notabiliza-se a importância do espaço natural na contribuição para a saúde mental da população urbana, minimizando o aparecimento das doenças mentais e dos prejuízos causados na qualidade de vida, acentuados pelo covid-19.

Abstract The COVID-19 Pandemic significantly affected people's lifestyles around the world. This qualitative study discusses the influence of urban restorative environments on mental health in times of pandemic. Data was collected by means of bibliographic research, to describe the phenomena related to the need to improve biophilic tendencies. Results showed strong correlations between the natural environment, mental health and quality of life of the urban population. The pandemic also questions how we live in cities and the way we treat environmental issues. Given this scenario, the natural environmental contributes greatly to the mental health of the urban population, minimizing the onset of mental illnesses and the damage to quality of life, accentuated by COVID-19.

Résumé La pandémie Covid-19 a affecté de manière significative le mode de vie des gens. Cette étude qualitative traite de l'influence des environnements urbains réparateurs sur la santé mentale en période de pandémie. Les données ont étés collectées par le biais d'une recherche bibliographique, afin de décrire les phénomènes liés à la nécessité d'améliorer les tendances biophiliques. Les résultats ont montré de fortes corrélations entre l'environnement naturel, la santé mentale et la qualité de vie de la population urbaine. La pandémie remet également en question la façon dont nous vivons dans les villes et la manière dont nous traitons les questions environnementales. Dans ce scénario, l'environnement naturel contribue grandement à la santé mentale de la population urbaine, en minimisant l'apparition de maladies mentales et l'atteinte à la qualité de vie, accentués par le Covid-19.

Resumen La pandemia del Covid-19 ha tenido un impacto significativo en el estilo de vida de las personas en todo el mundo. Esta investigación busca discutir la relación de los ambientes restaurativos urbanos en la salud mental en tiempos de pandemia. Se trata de una investigación básica con enfoque cualitativo a través de una investigación bibliográfica. Los datos del estudio contribuyeron a la fase descriptiva de los fenómenos y su relación con la necesidad de mejorar las tendencias biofílicas. La investigación mostró fuertes correlaciones en cuanto a la importancia del ambiente natural, la salud mental y la calidad de vida de la población urbana. La pandemia también nos hace reflexionar sobre la forma de vida en las ciudades y la forma en que tratamos los temas ambientales. Ante este escenario, se destaca el espacio natural como importante para contribuir a la salud mental de la población urbana, minimizando la aparición de enfermedades mentales y los daños ocasionados a la calidad de vida agravados por el Covid-19.

Condiciones socioambientales y prevalencia de enfermedades de la piel en un asentamiento urbano precario de Asunción (Paraguay) / Socio-Environmental Conditions and Prevalence of Skin Diseases in a Precarious Urban Settlement in Asunción (Paraguay) / Condições socioambientais e prevalência de dermatoses em um assentamento urbano precário em Assunção (Paraguai)

Introducción: se buscó analizar la prevalencia de enfermedades dermatológicas de la población de un asentamiento urbano precario próximo al vertedero municipal de Asunción (Paraguay), atendiendo a la exposición de las condiciones socioambientales. Materiales y métodos: estudio descriptivo y transversal con una muestra no probabilística intencional que incluyó a 77 personas de entre 5 meses y 76 años. Resultados: en el momento del examen físico, el 96.2 % de las personas presentó, al menos, una lesión cutánea, y el 79.2 %, una o más enfermedades infecciosas de piel; sin embargo, el 77.9 % no había recu-rrido a consulta médica. Las más sobresalientes fueron las micosis (35.1 %), las bacterianas (35.1 %) y las ectoparasitosis (27.3 %). Se identificó que la prevalencia de enfermedades bacterianas de piel apunta a una posible mayor exposición a condiciones adversas como: un clima subtropical de altas temperaturas y húmedo, una alta relación de convivientes en el hogar por dormitorio, problemas de provisión de agua y suelos de arena en los hogares, así como un sistema de evacuación de excretas deficiente, la presencia de animales con escasa vigilancia sanitaria, la proximidad a arroyos y cauces al aire libre depositarios de materia cloacal y el impacto recurrente de raudales los días de intensa lluvia. Conclusión: los resul-tados sugieren que la alta prevalencia de enfermedades cutáneas infecciosas podría relacionarse con una mayor exposición a condiciones socioambientales locales adversas, que son factores relevantes por tener en cuenta para mejorar la atención a la salud de las enfermedades dermatológicas de la población urbana que habita en un asentamiento urbano precario

Introduction: This study analyzes the prevalence of dermatological diseases in the population of a precarious urban settlement near the municipal landfill of Asunción (Paraguay), in relation to expo-sure to socio-environmental conditions. Materials and methods: descriptive, cross-sectional study with a non-probabilistic purposive sample that included 77 people aged between 5 months and 76 years. Results: at the time of physical examination, 96.2% of the people presented at least one skin lesion and 79.2% one or more infectious skin diseases, but 77.9% had not consulted a doctor. The most prominent were mycoses (35.1%), bacterial (35.1%) and ectoparasitoses (27.3%). It was identified that the preva-lence of bacterial skin diseases points to possible increased exposure to adverse conditions such as: a subtropical climate with high temperatures and humidity, a high ratio of people living in the household per bedroom, water supply problems and sandy soils in homes, as well as a deficient excreta disposal system, the presence of animals with poor sanitary surveillance, proximity to streams and open-air waterways that deposit sewage and the recurrent impact of floods on days of heavy rainfall. Conclusion:the results suggest that the high prevalence of infectious skin diseases could be related to increased exposure to adverse local socio-environmental conditions, which are relevant factors to be taken into to improve the health care of skin diseases in the urban population living in a slum settlement

Introdução: este estudo analisa a prevalência de doenças dermatológicas na população de um assen-tamento urbano precário próximo ao aterro sanitário municipal de Asunción (Paraguai) em relação à exposição às condições socioambientais. Materiais e métodos: estudo descritivo, transversal, com uma amostra não-probabilística de propósito que incluiu 77 pessoas com idade entre 5 meses e 76 anos. Resultados: no momento do exame físico, 96,2% das pessoas tinham pelo menos uma lesão de pele e 79,2% tinham uma ou mais doenças infecciosas de pele, mas 77,9% não tinham consultado um médico. As mais importantes foram micoses (35,1%), bacterianas (35,1%) e ectoparasitoses (27,3%). A preva-lência de doenças bacterianas da pele foi identificada como apontando para um possível aumento da exposição a condições adversas tais como: um clima subtropical com altas temperaturas e umidade, uma alta proporção de pessoas vivendo na casa por quarto, problemas de abastecimento de água e solos arenosos nas habitações, bem como um sistema de eliminação de excrementos deficiente, a presença de animais com vigilância sanitária deficiente, proximidade a riachos e cursos de água abertos que depositam águas residuais, e o impacto recorrente de enchentes em dias de chuvas fortes. Conclusão:Os resultados sugerem que a alta prevalência de doenças infecciosas de pele pode estar relacionada ao aumento da exposição a condições sócio-ambientais locais adversas, que são fatores relevantes a serem considerados para melhorar os cuidados com doenças de pele na população urbana que vive em uma favela

Deterioro cognitivo en poblaciones urbanas y rurales de la mediana altura geográfica en Bolivia: prevalencia y factores asociados / Cognitive impairment in urban and rural populations of the middle altitude in Bolivia: prevalence and associated factors

RESUMEN INTRODUCCIÓN: El deterioro cognitivo es una patología importante entre los ancianos, pero pocos estudios evalúan a poblaciones en una altura geográfica importante. OBJETIVOS: Caracterizar y encontrar los factores asociados al deterioro cognitivo en poblaciones urbanas y rurales de la mediana altura geográfica. METODOLOGÍA: Estudio transversal analítico, se evaluó el deterioro cognitivo con el Test de Pfeiffer (Alpha de Cronbach: 0,69), sus resultados se combinaron versus tres variables socioeducativas y cuatro comorbilidades; se obtuvo estadísticos analíticos. RESULTADOS: De los 400 adultos mayores, el 26,5% (106) no tuvo deterioro cognitivo, el 47,5% (190) tuvo un deterioro leve, el 25,5% (102) moderado y el 0,5% (2) severo; el 60% fueron mujeres, la mediana de edades fue de 66 años (rango intercuartílico: 63-69 años), el 67% vivían en la zona rural. En el análisis multivariado se encontró que, hubo más deterioro cognitivo moderado/severo a mayor edad (RPa: 1,05; IC95%: 1,02-1,08; p<0,001), entre los que tenían diabetes (RPa: 1,23; IC95%: 1,17-1,29; p<0,001), hipertensión arterial (RPa: 1,47; IC95%: 1,33-1,61; p<0,001), enfermedad renal crónica (RPa: 2,21; IC95%: 2,01-2,43; p<0,001) e insuficiencia cardiaca (RPa: 2,25; IC95%: 1,92-2,64; p<0,001); en cambio, los que tenían grado universitario tuvieron menos deterioro cognitivo (RPa: 0,89; IC95%: 0,22-0,65; p<0,001); ajustados por el sexo y el lugar de residencia. CONCLUSIONES: Se encontró importantes asociaciones del deterioro cognitivo en una población adulta mayor que residía entre los 2500-3900 msnm, estos resultados son importantes por no ser una población muy estudiada.

INTRODUCTION: Cognitive impairment is an important pathology among the Aged, but few studies evaluate populations at an important geographical height. OBJECTIVES: To characterize and find the factors associated with cognitive deterioration in urban and rural populations of medium geographic height. METHODOLOGY: Analytical cross-sectional study, cognitive impairment was evaluated with the Pfeiffer Test (Cronbach's Alpha: 0.69), its results were combined versus three socio-educational variables and four comorbidities; analytical statistics were obtained. RESULTS: Of the 400 older adults, 26.5% (106) had no cognitive impairment, 47.5% (190) had mild impairment, 25.5% (102) moderate and 0.5% (2) severe; 60% were women, the median age was 66 years (interquartile range: 63-69 years), 67% lived in rural areas. In the multivariate analysis it was found that there was more moderate / severe cognitive impairment at older age (RPa: 1.05; 95% CI: 1.02-1.08; p <0.001), among those with diabetes (RPa: 1, 23; 95% CI: 1.17-1.29; p <0.001), arterial hypertension (RPa: 1.47; 95% CI: 1.33-1.61; p <0.001), chronic kidney disease (RPa: 2.21, 95% CI 2.01-2.43, p <0.001) and heart failure (RPa: 2.25, 95% CI 1.92-2.64, p <0.001); On the other hand, those with a university degree had less cognitive deterioration (RPa: 0.89, 95% CI: 0.22-0.65, p <0.001); adjusted for sex and place of residence. CONCLUSION: Important associations of cognitive deterioration were found in an older adult population residing between 2500-3900 msnm, these results are important as they are not a highly studied population; therefore, these data should be taken for diagnosis and treatment.