Sensors Network as an Added Value for the Characterization of Spatial and Temporal Air Quality Patterns at the Urban Scale.

Within the scope of the Aveiro STEAM City project, an air quality monitoring network was installed in the city of Aveiro (Portugal), to evaluate the potential of sensors to characterize spatial and temporal patterns of air quality in the city. The network consists of nine sensors stations with air quality sensors (PM10, PM2.5, NO2, O3 and CO) and two meteorological stations, distributed within selected locations in the city of Aveiro. The analysis of the data was done for a one-year measurement period, from June 2020 to May 2021, using temporal profiles, statistical comparisons with reference stations and Air Quality Indexes (AQI). The analysis of sensors data indicated that air quality variability exists for all pollutants and stations. The majority of the study area is characterized by good air quality, but specific areas-associated with hotspot traffic zones-exhibit medium, poor and bad air quality more frequently. The daily patterns registered are significantly different between the affected and non-affected road traffic sites, mainly for PM and NO2 pollutants. The weekly profile, significative deltas are found between week and weekend: NO2 is reduced on the weekends at traffic sites, but PM10 is higher in specific areas during winter weekends, which is explained by residential combustion sources.

Variantes de la normalidad del crecimiento infantil versus fallo de medro

Introducción: El fallo de medro es la incapacidad de un niño menor de 3 años de conseguir un desarrollo y crecimiento óptimo. A menudo es confundido con las variantes normales del crecimiento y desarrollo infantil. Objetivo: Examinar las variantes normales del crecimiento infantil y diferenciarlas del verdadero fallo de medro. Métodos: Se localizaron y seleccionaron estudios relevantes en las bases electrónicas Medline, Biblioteca Virtual de Salud, Google Académico, SciELO y en libros digitales. Para la búsqueda se emplearon los vocablos: fallo de medro, variantes de la normalidad del crecimiento y desarrollo infantil. Se hallaron 89 artículos publicados entre 2005-2020 sobre temáticas afines, se escogieron 41 que conformaron la muestra. Análisis y síntesis de la información: Se actualizaron diferentes aspectos del fallo de medro: definición, clasificación, criterios diagnósticos, factores de riesgo, causas potenciales, evaluación diagnóstica y conducta. Se examinaron las características clínicas de las variantes de la normalidad del crecimiento y desarrollo infantil que permiten diferenciarlas del fallo de medro. Conclusiones: El retardo constitucional del crecimiento y desarrollo, la talla baja familiar, la talla baja idiopática, la prematuridad, el crecimiento intrauterino retardado, la delgadez y el catch-down, constituyen variantes normales del crecimiento infantil que se diagnostican erróneamente como fallo de medro y genera medicalización injustificada, gastos innecesarios en análisis complementarios y angustia familiar. Diferenciar estas entidades del fallo de medro permitiría enfocar las acciones de salud hacia objetivos más concretos y ofrecer a cada niño un tratamiento individualizado de acuerdo a su condición real de salud.

Introduction: Failure to thrive is the inability of a child under 3 years of age to achieve optimal development and growth. It is often confused with the normal variants of child growth and development. Objective: To examine the normal variants of infant growth and differentiate them from true failure to thrive. Methods: Relevant studies were located and selected in the electronic databases Medline, Virtual Health Library, Google Scholar, SciELO and in digital books. For the search, the words used were: failure to thrive, variants of the normality of growth and child development. 89 articles published between 2005-2020 on related topics were found; 41 were chosen and made up the sample. Analysis and synthesis of information: Different aspects of failure to thrive were updated: definition, classification, diagnostic criteria, risk factors, potential causes, diagnostic evaluation and behavior. The clinical characteristics of the variants of the normality of child growth and development that allow them to be differentiated from the failure of growth were examined. Conclusions: Constitutional growth and development retardation, family short stature, idiopathic short stature, prematurity, delayed intrauterine growth, thinness and catch-down were normal variants of infant growth that are erroneously diagnosed as failure to thrive and generate unjustified medicalization, unnecessary expenses in complementary tests and family anguish. Differentiating these entities from the failure to thrive would allow health actions to focus on more specific objectives and offer each child an individualized treatment according to their real health condition.

Worldwide Evaluation of CAMS-EGG4 CO2 Data Re-Analysis at the Surface Level.

This study systematically examines the global uncertainties and biases in the carbon dioxide (CO2) mixing ratio provided by the Copernicus Atmosphere Monitoring Service (CAMS). The global greenhouse gas re-analysis (EGG4) data product from the European Centre for Medium-Range Weather Forecasts (ECMWF) was evaluated against ground-based in situ measurements from more than 160 of stations across the world. The evaluation shows that CO2 re-analysis can capture the general features in the tracer distributions, including the CO2 seasonal cycle and its strength at different latitudes, as well as the global CO2 trend. The emissions and natural fluxes of CO2 at the surface are evaluated on a wide range of scales, from diurnal to interannual. The results highlight re-analysis compliance, reproducing biogenic fluxes as well the observed CO2 patterns in remote environments. CAMS consistently reproduces observations at marine and remote regions with low CO2 fluxes and smooth variability. However, the model's weaknesses were observed in continental areas, regions with complex sources, transport circulations and large CO2 fluxes. A strong variation in the accuracy and bias are displayed among those stations with different flux profiles, with the largest uncertainties in the continental regions with high CO2 anthropogenic fluxes. Displaying biased estimation and root-mean-square error (RMSE) ranging from values below one ppmv up to 70 ppmv, the results reveal a poor response from re-analysis to high CO2 mixing ratio, showing larger uncertainty of the product in the boundaries where the CAMS system misses solving sharp flux variability. The mismatch at regions with high fluxes of anthropogenic emission indicate large uncertainties in inventories and constrained physical parameterizations in the CO2 at boundary conditions. The current study provides a broad uncertainty assessment for the CAMS CO2 product worldwide, suggesting deficiencies and methods that can be used in the future to overcome failures and uncertainties in regional CO2 mixing ratio and flux estimates.

How can the built environment affect the impact of autonomous vehicles' operational behaviour on air quality?

Autonomous vehicles (AVs) are pointed out as the technology that will reshape the concept of mobility, with significant implications for the economy, the environment, and society. This fact will bring new challenge to cities urban planning. Research to anticipate the AVs impacts, maximizing their benefits and reduce trade-offs are currently crucial. This work investigates the potential challenges and benefits of gradually replace internal combustion engine human driven vehicles with different penetration rates of AVs - 10%, 30%, 50%, 70%, 90%, and 100% - in urban roads of different characteristics, either in terms of traffic singularities or volumes, and its related implications on air quality. For that purpose, two urban areas with distinct features, Porto and Aveiro, were selected as case studies, and a modelling setup composed of a traffic model, an emission model, and a local air quality model was applied. The results revealed that the AVs benefits are directly linked with the urban design and the road characteristics. In the Aveiro case study, the AVs promoted positive changes with average reductions in daily NOx emissions (compared with the baseline scenario, without AVs) ranging between -2.1% (for C10%) and -7.7% (for C100%). In line with the emissions impacts, positive effects were found on air quality, with average reductions of NO2 concentrations up to -4% (for C100%). In Porto urban area, slight differences in NOx emissions were obtained (<2%), which implied no changes in the air quality levels. The distinct impact of AVs in the study areas is mostly explained by the traffic light coordination system and directional split distributions in the main roads. These results provide valuable insights to support decision-makers in the definition of strategies that allow the integration of these new emerging technologies in the road infrastructure, considering the features of the urban design, traffic profile and road characteristics.

Caracterización clínico epidemiológica de la leishmaniosis visceral infantil / Clinical epidemiological characterization of children visceral leishmaniasis

Introducción: La leishmaniosis visceral es la más grave de las formas clínicas de la leishmaniosis, afecta principalmente a los niños y es potencialmente fatal. Objetivo: Exponer la caracterización clínico-epidemiológica de la leishmaniosis visceral en población pediátrica y su respuesta terapéutica. Métodos: Se realizó un estudio retrospectivo, longitudinal y descriptivo en el Hospital Italiano, Ciudad de Djibouti en el período septiembre 2016-agosto 2017. El universo lo conformaron 166 menores de 15 años que ingresaron con diagnóstico de fiebre prolongada sin foco de localización, la muestra fue de 22 niños con diagnóstico confirmado de leishmaniosis visceral. La información se obtuvo de las historias clínicas. Se operacionalizaron 20 variables: sociodemográficas, clínicas, analíticas, terapéuticas y evolutivas. Se utilizó el procesador Epidat 3.1. Los resultados se expresaron en valores absolutos y porcentajes. Resultados: Se diagnosticó leishmaniosis visceral en 13,2 por ciento de niños hospitalizados por fiebre prolongada, 90,9 por ciento de procedencia rural y 59,1 por ciento desnutridos. El 77,3 por ciento de los casos recibió antimoniales, 90,9 por ciento tuvo estadía hospitalaria mayor de 21 días y el 36,4 por ciento se complicó con neumonía. Conclusiones: La leishmaniosis visceral es una entidad relativamente frecuente en niños admitidos por fiebre prolongada en el Hospital Italiano, predominan los varones desnutridos, mayores de cinco años de edad, procedentes de zonas rurales. La fiebre y la esplenomegalia son manifestaciones clínicas constantes, la anemia y la leucopenia los principales hallazgos de laboratorio. La aplicación de antimoniales es el tratamiento electivo, con larga estadía hospitalaria y la neumonía es la complicación más frecuente(AU)

Introduction: Visceral leishmaniasis is the most severe clinical form of leishmaniasis that mainly affects children and is potentially fatal. Objective: To explain the clinical-epidemiological characterization of visceral leishmaniasis in the pediatric population and its therapeutic response. Methods: It was conducted a retrospective, longitudinal and descriptive study in the Italian Hospital, Djibouti City in the period from September 2016 to August 2017. The sample group was formed by 166 children under 15 years old that were admitted with a diagnosis of prolonged fever without localization focus and the sample was of 22 children with confirmed diagnosis of visceral leishmaniasis. The information was obtained from the clinical records. Twenty variables were operationalized: sociodemographic, clinical, analytical, therapeutic and evolutive ones. Epidat 3.1 proccessor was used. The results were expressed in absolute values and percentages. Results: Visceral leishmaniasis was diagnosed in 13.2 percent children that were admitted in hospital due to prolonged fever, 90.9 percent of them were from rural areas and 59.1 percent were undernourished. 77,3 percent of the cases had antimonial treatment, 90.9 percent had hospital stay for more than 21 days and the 36.4 percent had complications due to pneumonia. Conclusions: Visceral leishmaniasis is a relatively frequent entity in children admitted in the Italian Hospital due to prolonged fever with a predominance of undernourished males, older that five years and from rural areas. Fever and splenomegaly are constant clinical manifestations, and anemia and leucopenia are the main laboratory findings. The use of antimonials is the election treatment with long hospital stay, and pneumonia is the most frequent complication(AU)

Climate-Change Adaptation Framework for Multiple Urban Areas in Northern Portugal.

Climate change is increasingly exerting pressure with intensified impacts in the short-, medium-, and long-term. Cities are highly vulnerable to the impacts of climate change, and it is recognized that they play a significant role in the European Strategy on adaptation to climate change. This study intends to develop a climate adaptation framework to identify effective measures that will be evaluated using a multi-urban area located in the north of Portugal, as a case study. The climate adaptation framework was developed following the Urban Adaptation Support Tool (AST), adapted to the Portuguese reality. The Weather Research and Forecasting (WRF) model was used to provide future projections with a high level of spatial resolution over the study area, increasing the accuracy of the identification of future climatic vulnerabilities. The results show a tendency for an increase of extreme weather events associated with the increase of both temperature and annual accumulated precipitation variables. A set of both urban and rural measures to promote a sustainable development path to climate adaptability and increase cities resilience to climate change are presented and discussed.

Autonomous vehicles opportunities for cities air quality.

The impacts of autonomous vehicles (AV) on safety, energy and atmospheric emissions have been recognised to be important issues, but an air quality impact assessment is missing. In this study, by using a numerical modelling approach, the impact of AV on the air quality of a medium-sized Portuguese urban area was evaluated. For that, the air pollutants nitrogen oxides (NOx) and carbon dioxide (CO2) were considered and three scenarios were developed: i) a baseline scenario; ii) an autonomous scenario, assuming an AV market penetration rate of 30%; and iii) an electric autonomous scenario, taking into account that those 30% of AV are pure battery electric cars. A modelling system composed by a road traffic model, a road transport emission model and a Computational Fluid Dynamics air quality model was used. The autonomous scenario promoted an increase of both NOx (+1.8%) and CO2 (+0.7%) emissions, while the electric autonomous scenario resulted in emission reductions of about 30% for both air pollutants. In terms of air quality, distinct patterns were found: i) the autonomous scenario promoted both increases and decreases of NOx concentrations; and ii) the electric autonomous scenario promoted a widespread reduction of NOx concentrations (with an average value of -4%). Overall the results showed that AV have the potential to improve urban air quality, but, further research is needed to enrich the findings of this work.

Impact of harbour activities on local air quality: A review.

Several harbour activities cause negative environmental impacts in the harbours' surrounding areas, namely the degradation of air quality. This paper intends to comprehensively review the status of the air quality measured in harbour areas. The published studies show a limited number of available air quality monitoring data in harbours areas, mostly located in Europe (71%). Measured concentrations of the main air pollutants were compiled and intercompared, for different countries worldwide allowing a large spatial representativeness. The higher NO2 and PM10 concentrations were found in Europe - ranging between 12 and 107 µg/m3 and 2-50 µg/m3, respectively, while the higher concentrations of PM2.5 were found in Asia (25-70 µg/m3). In addition, the lower levels of SO2 monitored in recent years suggest that current mitigation strategies adopted across Europe were very efficient in promoting the reduction of SO2 concentrations. Part of the reviewed studies also estimated the contributions from ship emissions to PM concentration through the application of source apportionment methods, with an average of 5-15%. In some specific harbour areas in Asia, ships can contribute up to 7-26% to the local fine particulate matter concentrations. This review confirms that emissions from the maritime transport sector should be considered as a significant source of particulate matter in harbour areas, since this pollutant concentrations are frequently exceeding the established standard legal limit values. Therefore, the results from this review boost the implementation of mitigation measures, aiming to reduce, in particular, particulate matter emissions.

Cambio climático, inseguridad alimentaria y obesidad infantil / Climate change, food insecurity and obesity

Introducción. El cambio climático es un fenómeno ya en desarrollo y afecta de forma directa e indirecta en la salud humana. Uno de sus efectos es la alta prevalencia de la obesidad infantil. Objetivo. Analizar la repercusión del cambio climático y la inseguridad alimentaria en la obesidad infantil. Métodos. Se realizó una revisión documental. Se localizaron y seleccionaron estudios relevantes en las bases electrónicas Medline, Biblioteca Virtual de Salud, Google Académico, SciELO y en libros digitales. Para la búsqueda se emplearon los vocablos: clima, cambio climático, inseguridad alimentaria y obesidad infantil. Se encontraron 119 artículos publicados en los últimos 15 años sobre temáticas afines. De ellos se escogieron 50 que abordaban el tema de la relación que existe entre el cambio climático, la inseguridad alimentaria y la obesidad infantil. Conclusiones. El cambio climático es irreversible y la agricultura es una de las áreas más vulnerable, lo que compromete la producción de alimentos saludables y lleva a determinados sectores poblacionales a un estado de inseguridad alimentaria. La población, entre ellos los niños, para satisfacer sus necesidades recurren a la comida chatarra, esta tiene un alto contenido energético y en interacción compleja con otros factores contribuye a la prevalencia de la obesidad en edad pediátrica. Es un reto para los gobiernos lograr una alimentación segura, sostenible y con enfoque ecológico para revertir el estado de inseguridad alimentaria en que viven determinados sectores a nivel global y, así, impactar de forma positiva en la actual pandemia de sobrepeso y obesidad infantil(AU)

Introduction: The climate change is a developing phenomenon and it affects directly or indirectly human health. One of its effects is the high prevalence of child obesity. Objective: To analyze the climate change repercussion and food insecurity over child obesity. Methods: A documentary review was performed. Relevant researches were localized and selected from electronics databases as Medline, Health Virtual Library, Google Scholar, SciELO and digitals books. For the search there were used some terms like: climate, climate change, food insecurity and child obesity, locating 119 published articles on the topic in the last 15 years. Fifty articles on the relationship between climate change, food insecurity and child obesity were selected. Conclusions: Climate change is irreversible and agriculture is a very vulnerable area, which jeopardizes the production of healthy food and moves specific population sectors to a food insecurity state. The population, including children, whom resorts to fast food, with high energetic content, to supply nourishment needs, and as a result of complex interaction with others factors, increases pediatric obesity's prevalence. It is a challenge for governments to achieve a safe, sustainable, with ecologic approach diet to revert the food insecurity state in which some sectors live globally, and in that way to impact positively in the current child obesity and overweight's epidemic(AU)

Instrumento pronóstico de neumonía comunitaria complicada en niños / Prognostic instrument for complicated community pneumonia in children

Introducción: La neumonía comunitaria complicada es una entidad con gran impacto sobre la morbimortalidad pediátrica. Objetivo: Desarrollar un instrumento que permita pronosticar a los niños con alto riesgo de desarrollar neumonía comunitaria complicada. Métodos: Se realizó un estudio cuali-cuantitativo en el Hospital General Comandante Pinares de San Cristóbal, en el período 2013-2016 en dos etapas: una etapa diagnóstica inicial, en la que se efectuó un estudio de cohorte prospectivo observacional que permitió estimar la incidencia de neumonía complicada, describir sus características relevantes e identificar factores de riesgo. En una segunda etapa, se elaboró y validó un instrumento pronóstico de esta entidad. Resultados: La incidencia de neumonía complicada fue del 39,5 por ciento, identificándose seis factores de riesgo: hacinamiento [OR 1,9], fumador pasivo [OR 1,76], no lactancia materna exclusiva hasta el sexto mes [OR 1,85], anemia [OR 4,5], morbilidad infecciosa recurrente [OR 1,69] y uso reciente de antimicrobianos [OR 2,38]. Al aplicar el instrumento pronóstico se obtuvo una sensibilidad del 85,47 y una especificidad del 92,74. Conclusiones: La neumonía complicada es una entidad de presentación frecuente, identificándose seis factores de riesgo. El instrumento desarrollado pronostica la posibilidad de desarrollar neumonía complicada en niños con sensibilidad aceptable y alta especificidad(AU)

Introduction: Community complicated pneumonia is an entity with great impact on morbidity and mortality in children. Objective: To develop an instrument that allows prognosticating children at high risk of developing community complicated pneumonia. Methods: A qualitative-quantitative study was carried out at Comandante Pinares General Hospital, San Cristobal municipality, in the period from 2013 to 2016 in two stages: an initial diagnostic stage, in which it was performed a prospective observational cohort study that allowed to estimate the incidence of complicated pneumonia, to describe its relevant characteristics and identify risk factors. In a second stage, it was developed and validated a prognosis instrument for this entity. Results: The incidence of complicated pneumonia was 39.5 por ciento identifying six risk factors: overcrowding (OR 1.9), passive smoking (OR 1.76), not exclusive breastfeeding until the sixth month (OR 1.85), anemia (OR 4.5), recurrent infectious morbidity (OR 1.69), and recent use of antimicrobials (OR 2.38). When the prognosis instrument was applied, it was obtained a sensitivity of 85.47 and a specificity of 92.74. Conclusions: Complicated pneumonia is an entity of frequent presentation. Six risk factors were identified. The instrument predicts the possibility of developing complicated pneumonia in children with acceptable sensitivity and high specificity(AU)

Assessment of source contribution to air quality in an urban area close to a harbor: Case-study in Porto, Portugal.

Several harbors, like the Port of Leixões (Porto, Portugal), are located near urban and industrial areas, places where residential urban areas, highways and the refinery industry coexist. The need for assessing the contribution of the port to the air quality in its vicinity around the port is the motivation for the present study. This contribution was investigated using a numerical modelling approach based on the web-based research screening tool C-PORT. The impact of the meteorological conditions (namely atmospheric stability and wind direction) was first evaluated, and the most critical conditions for pollutants dispersion were identified. The dominant wind direction, from WSW, was responsible for the transport of pollutants over the surrounding urban area, which was potentiated by the diurnal sea breeze circulation. Multiple scenario runs were then performed to quantify the contribution of each emission sector/activity (namely maritime emissions; port activities; road traffic and refinery) to the ambient air quality. The multiple scenario runs indicated that land-based emission sources at the Port (including trucks, railways, cargo handling equipment and bulk material stored) were the major contributors (approximately 80%) for the levels of surface PM10 concentrations over the study area. Whereas, the main drivers of NOX concentrations were docked ships, responsible for 55-73% of the total NOX concentrations.

El fallo de medro desde una perspectiva ambulatoria integradora / The failure to thrive from an integrative perspective outpatient

RESUMEN Introducción: el fallo de medro es identificado cuando un niño presenta un crecimiento significativamente menor que sus semejantes, y está asociado frecuentemente con pobre desarrollo mental y psicoemocional. Objetivo: analizar y sintetizar, a través de la producción científica, las características del fallo de medro de un modo integrador, que facilite su abordaje desde la atención ambulatoria. Métodos: se realizó una revisión integrativa, conducida de acuerdo con las siguientes etapas: identificación del tema y elaboración de la pregunta de investigación, establecimiento de los criterios de inclusión y exclusión, definición de las informaciones que serían extraídas de los estudios seleccionados, selección de banco y bases de datos para consulta, evaluación de los estudios incluidos en la revisión, interpretación de los resultados y presentación de la síntesis del conocimiento. Conclusiones: el fallo de medro tiene una etiología multifactorial, siendo su prevalencia variable. Se han identificado factores de riesgo biológicos, socioculturales y ambientales. Existe discrepancia entre los autores sobre los elementos diagnósticos para su identificación, constituyendo los criterios estáticos y dinámicos los de mayor aceptación. La clave del éxito radica en la prevención(AU)

ABSTRACT Introduction: Failure to thrive is identified when a child has a significantly lower growth than its peers and is often associated with poor mental and psycho-emotional development. Objective: Analyze and synthesize, through scientific production, the characteristics of failure to thrive in an integrated way that facilitates its approach from outpatient care. Methods: an integrative review, conducted in accordance with the following steps are performed: identification of the subject and development of the research question, establishing the criteria for inclusion and exclusion definition of the information that would be extracted from the selected studies, selection of bank and databases for consultation, evaluation studies included in the review, interpretation of results and presentation of the synthesis of knowledge. Conclusions: The failure to thrive has a multifactorial etiology, with its variable prevalence. Factors have been identified biological, sociocultural and environmental risk. There is a discrepancy between the authors on diagnostic elements for identification, constituting the static and dynamic criteria the most widely accepted. The key to success lies in prevention(AU)

Assessment of health benefits related to air quality improvement strategies in urban areas: An Impact Pathway Approach.

Air pollution is, increasingly, a concern to our society given the threats to human health and the environment. Concerted actions to improve air quality have been taken at different levels, such as through the development of Air Quality Plans (AQPs). However, air quality impacts associated with the implementation of abatement measures included in AQPs are often neglected. In order to identify the major gaps and strengths in current knowledge, a literature review has been performed on existing methodologies to estimate air pollution-related health impacts and subsequent external costs. Based on this review, the Impact Pathway Approach was adopted and applied within the context of the MAPLIA research project to assess the health impacts and benefits (or avoided external costs) derived from improvements in air quality. Seven emission abatement scenarios, based on individual and combined abatement measures, were tested for the major activity sectors (traffic, residential and industrial combustion and production processes) of a Portuguese urban area (Grande Porto) with severe particular matter (PM10) air pollution problems. Results revealed a strong positive correlation between population density and health benefits obtained from the assessed reduction scenarios. As a consequence, potential health benefits from reduction scenarios are largest in densely populated areas with high anthropic activity and, thus, where air pollution problems are most alarming. Implementation of all measures resulted in a reduction in PM10 emissions by almost 8%, improving air quality by about 1% and contributing to a benefit of 8.8 million €/year for the entire study domain. The introduction of PM10 reduction technologies in industrial units was the most beneficial abatement measure. This study intends to contribute to policy support for decision-making on air quality management.

Escala predictora de fallo de medro en lactantes / Predictive scale of failure to thrive in breastfed babies

INTRODUCCIÓN: el fallo de medro es identificado en niños con crecimiento significativamente menor que sus semejantes. OBJETIVOS: identificar la incidencia y características del fallo de medro en la población estudiada, y desarrollar una escala predictora de esta entidad en lactantes. MÉTODOS: se efectuó un estudio de cohorte prospectivo, en el Policlínico "Manuel González Díaz", del municipio Bahía Honda, en el período 2009-2013, en 3 etapas: en la primera, se efectuó la captación de los niños que formaron parte del estudio, se identificó la incidencia, y se obtuvo la descripción de las características relevantes de la entidad en 1 490 lactantes nacidos durante la etapa investigada; la segunda, posibilitó el diagnóstico de los factores de riesgo; y en la tercera, se elaboró y validó una escala predictora. RESULTADOS: la incidencia del fallo de medro fue del 19,4 %. Al aplicar la escala a la muestra A se obtuvo una sensibilidad del 72,1 % y una especificidad del 90,2 %; en la muestra B, la sensibilidad fue 76,34 y la especificidad 92,75. CONCLUSIONES: el fallo de medro es una entidad frecuente, con mayor incidencia en el segundo y tercer trimestre, en su mayoría es de causa orgánica, y resulta la afectación del peso, la variante antropométrica más frecuente. Se identificaron 13 factores de riesgo asociados a esta entidad. Se obtuvo una escala que permite predecir el riesgo de desarrollar fallo de medro en lactantes, con una sensibilidad aceptable y elevada especificidad.

INTRODUCTION: the failure to thrive is identified in children whose growth is significantly lower than their fellows. OBJECTIVES: to identify the incidence and the characteristics of the failure to thrive in the studied population and to develop a predictive scale of this illness in nursing babies. METHODS: a prospective cohort study was conducted in "Manuel Gonzalez Diaz" polyclinics in Bahia Honda municipality in three phases in the 2009 to 2013 period. In the first phase, the screening of children who participated in the study and of the incidence of disease together with the description of the relevant characteristics in 1 490 breastfed babies born in the studied phase; in the second one, the diagnosis of risk factors was possible and in the third phase, a predictive scale was designed and validated. RESULTS: the incidence of the failure to thrive was 19.4 %. When applying the scale to the sample A, the sensitivity was 72.1 % and the specificity reached 90.2 % whereas in the sample B, the sensitivity was 76.34 and the specificity 92.75 %. CONCLUSIONS: the failure to thrive is a common entity, with higher incidence in the second and third trimesters; it is mostly of organic cause and the most frequent anthropometric variant is the impaired weight. Thirteen risk factors associated to this illness were detected. The final scale allows predicting the risk of developing failure to thrive in breastfed babies with acceptable sensitivity and high specificity.

Algunos factores familiares asociados a fallo de medro en lactantes / Some Family Factors Associated To Growth Failure in Infants

Introducción: el fallo de medro es un problema comúnmente identificado en consultas ambulatorias, asociado con frecuencia a problemas médicos y psicosociales. Objetivo: identificar algunos factores familiares de riesgo de fallo de medro en lactantes. Métodos: estudio observacional de cohortes, prospectivo, en el Policlínico "Manuel González Díaz", del municipio Bahía Honda, provincia Artemisa, en el período de enero de 2009 a mayo de 2011. El universo estuvo constituido por 815 lactantes que cumplieron los criterios de inclusión del estudio. Se realizó un muestreo aleatorio estratificado, dividiéndose a la población en dos estratos, en dependencia de la presencia o no de fallo de medro, conformándose un grupo de casos constituido por 158 lactantes con fallo de medro y un grupo de control formado por 316 lactantes sin fallo de medro. El trabajo se desarrolló en dos etapas. En la primera, se efectuó la captación de los niños que formaron parte del estudio y se identificó la incidencia de la entidad en lactantes nacidos durante la etapa investigada. La segunda, posibilitó el diagnóstico de los factores de riesgo. Resultados: la incidencia de fallo de medro en lactantes fue del 19,4 por ciento. Ser hijo de madre no acompañada [OR 1,9; IC 95 por ciento (1,24-2,91)] y vivir en el seno de una familia disfuncional [OR 4,5; IC 95 por ciento (2,94-6,95)] constituyeron factores asociados a dicha entidad. Conclusiones: el fallo de medro es un problema identificado frecuentemente por médicos de familia. Ser hijo de madre no acompañada y vivir en el seno de una familia disfuncional constituyeron factores de riesgo asociados a esta condición(AU)

Introduction: the failure to thrive is a common problem identified in ambulatory medicine, frequently associate with medical and psychosocial disorder. Objectives: to identify some risk families factors of failure to thrive in breastfed babies. Methods: a prospective cohort study was conducted in "Manuel Gonzalez Diaz" polyclinics in Bahia Honda municipality in two phases in the 2009 to 2011 period. In the first phase, the screening of children who participated in the study and of the incidence of disease together with the description of the relevant characteristics in 815 breastfed babies born in the studied phase; in the second one, the diagnosis of risk family factors was possible. Results: the incidence of the failure to thrive in breastfed babies was 19.4 percent. To be child of unmarried woman [OR 1,9 IC 95 percent (1,24-2,91)] and to live under dysfunctional family [OR 4,5 IC 95 percent (2,94-6,95)] were factors associates to failure to thrive. Conclusions: the failure to thrive is a common entity, identify for family doctors. To be child of unmarried woman and to live under dysfunctional family were factors associates to failure to thrive in breastfed babies(AU)

Instrumento predictor de obesidad en adolescentes en el Policlínico Universitario "Manuel González Díaz", 2013-2014 / Prediction instrument for obesity in adolescents at the Policlínico Universitario "Manuel González Díaz", 2013-2014

Introducción: La obesidad constituye una de las principales enfermedades no declarables que afectan fundamentalmente a niños y adolescentes. Métodos: Con el objetivo de desarrollar un instrumento predictor para identificar adolescentes con alto riesgo de desarrollar obesidad, se efectuó un estudio prospectivo de cohortes en el Policlínico "Manuel González Díaz", Municipio Bahía Honda, durante el periodo 2013-2014. Se llevó a cabo en tres etapas: en la primera, se efectuó la captación de 1,800 adolescentes entre 10 y 19 años que formaron parte del estudio, se identificó la prevalencia y se describieron las características más relevantes de la obesidad (IMC > percentil 97 según edad y sexo); la segunda etapa posibilitó el diagnóstico de los factores que incrementaban la probabilidad de ocurrencia de obesidad; en la tercera, se elaboró y validó un instrumento predictor de obesidad a partir de los resultados de las etapas iniciales. Resultados: Al aplicar el instrumento en la muestra A, para su elaboración y validación interna, se obtuvo una sensibilidad del 77.78% y una especificidad del 86.11%. El ABC ROC fue de 0.86. Para la muestra B, la sensibilidad fue del 79.63% y la especificidad del 92.13% para la validación externa. El VPP fue de 83.5% y el VPN de 90.05%. Conclusiones: El instrumento permite predecir el riesgo de desarrollo de obesidad en adolescentes con una sensibilidad aceptable y alta especificidad. Su aplicación rutinaria sería interesante en consultas de puericultura.

Background: Obesity is one of the principal non declarable diseases affecting children and adolescents. Methods: With the objective of developing a predictive instrument to identify high-risk adolescents with obesity, a cohort prospective study was carried out at the Policlinic "Manuel González Díaz", Bahía Honda City from 2013-2014. It was developed in three stages. In the first stage, 1800 adolescents from 10-19 years of age were included. The prevalence was identified and the most relevant characteristics of obesity were described (defined as body mass index >97th percentile according to age and sex). In the second stage we identified the possibility of the diagnosis of factors that increase the probability of obesity. The third stage elaborated and validated an obesity predictor instrument from the results of the initial stages. Results: To apply the instrument to sample A for internal elaboration and validation, sensitivity was 77.78% and specificity was 86.11%. Area under the curve (AUC) receiver operating characteristic (ROC) was 0.86, whereas for sample B the sensitivity was 79.63% and specificity was 92.13%. Positive predictive value (PPV) was 83.5% and negative predictive value (NPV) was 90.05%. Conclusions: The instrument allows predicting the risk for developing obesity in adolescents with acceptable sensitivity and high specificity. Its routine application will be interesting in pediatric health consultations.

[Prediction instrument for obesity in adolescents at the Policlínico Universitario "Manuel González Díaz", 2013-2014]. / Instrumento predictor de obesidad en adolescentes en el Policlínico Universitario "Manuel González Díaz", 2013-2014.

BACKGROUND: Obesity is one of the principal non declarable diseases affecting children and adolescents. METHODS: With the objective of developing a predictive instrument to identify high-risk adolescents with obesity, a cohort prospective study was carried out at the Policlinic "Manuel González Díaz", Bahía Honda City from 2013-2014. It was developed in three stages. In the first stage, 1800 adolescents from 10-19 years of age were included. The prevalence was identified and the most relevant characteristics of obesity were described (defined as body mass index >97th percentile according to age and sex). In the second stage we identified the possibility of the diagnosis of factors that increase the probability of obesity. The third stage elaborated and validated an obesity predictor instrument from the results of the initial stages. RESULTS: To apply the instrument to sample A for internal elaboration and validation, sensitivity was 77.78% and specificity was 86.11%. Area under the curve (AUC) receiver operating characteristic (ROC) was 0.86, whereas for sample B the sensitivity was 79.63% and specificity was 92.13%. Positive predictive value (PPV) was 83.5% and negative predictive value (NPV) was 90.05%. CONCLUSIONS: The instrument allows predicting the risk for developing obesity in adolescents with acceptable sensitivity and high specificity. Its routine application will be interesting in pediatric health consultations.

Algunos factores familiares asociados a fallo de medro en lactantes / Some Family Factors Associated To Growth Failure in Infants

Introducción: el fallo de medro es un problema comúnmente identificado en consultas ambulatorias, asociado con frecuencia a problemas médicos y psicosociales. Objetivo: identificar algunos factores familiares de riesgo de fallo de medro en lactantes. Métodos: estudio observacional de cohortes, prospectivo, en el Policlínico Manuel González Díaz, del municipio Bahía Honda, provincia Artemisa, en el período de enero de 2009 a mayo de 2011. El universo estuvo constituido por 815 lactantes que cumplieron los criterios de inclusión del estudio. Se realizó un muestreo aleatorio estratificado, dividiéndose a la población en dos estratos, en dependencia de la presencia o no de fallo de medro, conformándose un grupo de casos constituido por 158 lactantes con fallo de medro y un grupo de control formado por 316 lactantes sin fallo de medro. El trabajo se desarrolló en dos etapas. En la primera, se efectuó la captación de los niños que formaron parte del estudio y se identificó la incidencia de la entidad en lactantes nacidos durante la etapa investigada. La segunda, posibilitó el diagnóstico de los factores de riesgo. Resultados: la incidencia de fallo de medro en lactantes fue del 19,4 por ciento. Ser hijo de madre no acompañada [OR 1,9; IC 95 por ciento (1,24-2,91)] y vivir en el seno de una familia disfuncional [OR 4,5; IC 95 por ciento (2,94-6,95)] constituyeron factores asociados a dicha entidad. Conclusiones: el fallo de medro es un problema identificado frecuentemente por médicos de familia. Ser hijo de madre no acompañada y vivir en el seno de una familia disfuncional constituyeron factores de riesgo asociados a esta condición(AU)

Introduction: the failure to thrive is a common problem identified in ambulatory medicine, frequently associate with medical and psychosocial disorder. Objectives: to identify some risk families factors of failure to thrive in breastfed babies. Methods: a prospective cohort study was conducted in Manuel Gonzalez Diaz polyclinics in Bahia Honda municipality in two phases in the 2009 to 2011 period. In the first phase, the screening of children who participated in the study and of the incidence of disease together with the description of the relevant characteristics in 815 breastfed babies born in the studied phase; in the second one, the diagnosis of risk family factors was possible. Results: the incidence of the failure to thrive in breastfed babies was 19.4 percent. To be child of unmarried woman [OR 1,9 IC 95 percent (1,24-2,91)] and to live under dysfunctional family [OR 4,5 IC 95 percent (2,94-6,95)] were factors associates to failure to thrive. Conclusions: the failure to thrive is a common entity, identify for family doctors. To be child of unmarried woman and to live under dysfunctional family were factors associates to failure to thrive in breastfed babies(AU)

Integrating health on air quality assessment--review report on health risks of two major European outdoor air pollutants: PM and NO2.

Quantifying the impact of air pollution on the public's health has become an increasingly critical component in policy discussion. Recent data indicate that more than 70% of the world population lives in cities. Several studies reported that current levels of air pollutants in urban areas are associated with adverse health risks, namely, cardiovascular diseases and lung cancer. IARC recently classified outdoor air pollution and related particulate matter (PM) as carcinogenic to humans. Despite the air quality improvements observed over the last few years, there is still continued widespread exceedance within Europe, particularly regarding PM and nitrogen oxides (NOx). The European Air Quality Directive 2008/50/EC requires Member States to design appropriate air quality plans for zones where air quality does not comply with established limit values. However, in most cases, air quality is only quantified using a combination of monitored and modeled data and no health impact assessment is carried out. An integrated approach combining the effects of several emission abatement measures on air quality, impacts on human health, and associated implementation costs enables an effective cost-benefit analysis and an added value to the decision-making process. Hence, this review describes the basic steps and tools for integrating health into air quality assessment (health indicators, exposure-response functions). In addition, consideration is given to two major outdoor pollutants: PM and NO2. A summary of the health metrics used to assess the health impact of PM and NO2 and recent epidemiologic data are also described.