Consensus document on anemia and iron deficiency in heart failure: Consejo Interamericano de Falla Cardiaca e Hipertensión Pulmonar (CIFACAH) of the Interamerican Society of Cardiology (IASC).

Heart failure is a pathology that affects 1% of the population and is accompanied by iron deficiency as a comorbidity in 50% of cases. Anemia, meanwhile, is present between 22-37%. This is a consensus document that seeks to synthesize the information available on anemia and iron deficiency and its behavior in patients with HF, which is divided into pathophysiology, classification, clinical scenarios and algorithms (clinical pathways), treatment, and follow-up. This article integrates international recommendations based on evidence and presents a synthesis of management strategies.

La insuficiencia cardíaca (IC) es una patología que afecta al 1% de la población y se encuentra acompañada de deficiencia de hierro como comorbilidad en el 50% de los casos. La anemia, por su parte, está presente en el 22-37% de los casos de IC. Este es un documento de consenso que busca sintetizar la información disponible sobre la anemia y la deficiencia de hierro, y su comportamiento en pacientes con IC, que se divide en fisiopatología, clasificación, escenarios clínicos y algoritmos (rutas de manejo), tratamiento y seguimiento. Este artículo integra las recomendaciones internacionales basadas en la evidencia y se presenta una síntesis de las estrategias de manejo.

May Measurement Month 2019: an analysis of blood pressure screening results from Mexico.

May Measurement Month 2019 (MMM19) in Mexico was an opportunistic survey, aimed to improve blood pressure (BP) awareness at the individual and population levels. This survey followed the methodology of MMM19, previously published. The total number of participants screened was 39 700, 56.7% female, 36.6% were of mixed ethnicity, mean age [standard deviation (SD)] was 46.9 (17.4) years, and mean body mass index was 27.2 (SD: 4.4) kg/m2. Seven per cent of the participants reported having diabetes, 2.4% reported having a myocardial infarction in the past, 1.1% stroke, 2.0% were pregnant at the time of the survey, 3.7% of women had suffered from hypertension in a previous pregnancy, 11.4% declared that they were smokers, and 47.0% drank alcohol at least once a week. After multiple imputations, of all 39 700 participants, 10 140 (25.5%) had hypertension; of all participants with hypertension, 43.8% were aware of their diagnosis, 41.7% were on antihypertensive medication, and 27.8% had controlled BP (systolic BP <140 mmHg and diastolic BP <90 mmHg). Of those on antihypertensive medication, 27.8% had controlled BP. In Mexico, MMM is the largest hypertension survey ever done, it provides complementary data to the existing information on arterial hypertension in the country and helps to increase the visibility of hypertension: a priority health problem.

May Measurement Month 2018: an analysis of blood pressure screening results from Mexico.

In 2015, arterial hypertension was responsible for 18.1% of the total deaths in Mexico and its mortality rate has increased to 29.9% in the last 6 years. It is currently the main risk factor for preventable premature deaths of adults in the country. Good quality epidemiological information is the first step to improve health services. May Measurement Month 2018 (MMM18) in Mexico is an opportunistic survey, which follows the previously published methodology. MMM18 included screening 10 139 participants, 2187 (21.6%) of whom were classified as having hypertension. Of these, 42.0% were aware of the condition before measurement, and 38.0% were on medication, of which 66.5% were controlled. Hence, of all hypertensive patients, 25.3% were controlled (<140/90 mmHg). MMM18 in Mexico provides complementary data to the existing information on arterial hypertension in the country and helps to increase the visibility of hypertension: a priority health problem.

Marginalization and health service coverage among indigenous, rural, and urban populations: a public health problem in Mexico.

INTRODUCTION:   Marginalization is a significant issue in Mexico, involving a lack of access to health services with differential impacts on Indigenous, rural and urban populations. The objective of this study was to understand Mexico’s public health problem across three population areas, Indigenous, rural and urban, in relation to degree of marginalization and health service coverage. METHODS:   The sampling universe of the study consisted of 107 458 geographic locations in the country. The study was retrospective, comparative and confirmatory. The study applied analysis of variance, parametric and non-parametric, correlation and correspondence analyses. RESULTS:   Significant differences were identified between the Indigenous, rural and urban populations with respect to their level of marginalization and access to health services. The most affected area was Indigenous, followed by rural areas. The sector that was least affected was urban. CONCLUSIONS:   Although health coverage is highly concentrated in urban areas in Mexico, shortages are mostly concentrated in rural areas where Indigenous groups represent the extreme end of marginalization and access to medical coverage. Inadequate access to health services in the Indigenous and rural populations throws the gravity of the public health problem into relief.

Identification of novel genetic variants in the mutational hotspot region 14 kb upstream of the LCT gene in a Mexican population.

Several polymorphic loci linked to lactase persistence (LP) have been described, all located in a small mutational hotspot region far upstream (∼14 kb) of the lactase (LCT) gene. One is typically found in Europeans, LCT -13910C > T, several others are found in East Africans and Arabs, e.g. LCT -13907C > G and LCT -13915T > G. The possibility of similar loci, specific to populations in South and Central America, has not received much attention so far. To identify possible novel polymorphisms in the mutational hotspot region, we sampled 158 subjects from a rural area in South-Central Mexico. DNA was isolated from serum, and Sanger sequencing of a 501 bp region spanning the LCT -13910C > T hotspot was successfully performed in 150 samples. The frequency of the European-type LCT -13910 T-allele was q = 0.202, and 35% of the population was thus lactase-persistent (CT or TT). Sixteen novel genetic variants were found amongst 11 of the subjects, all were heterozygotes: seven of the subjects were also carriers of at least one LCT -13910 T-allele. Thus, the mutational hotspot region is also a hotspot in the rural Mexican population: 11/150 subjects carried a total of 16 previously unknown private mutations but no novel polymorphism was found. The relationship between such novel genetic variants in Mexicans and lactase persistence is worthy of more investigation.

An improved approach for assigning pumping rates to heterogeneous aquifer models.

A common assumption of ground water models formulated using a block-centered finite-difference method is that a well is located at the center of a cell regardless of its actual location. Due to this assumption, errors are introduced in the spatial distribution of simulated heads. This paper presents an alternative approach for assigning the pumping rates of wells that are located off cell centers. This approach consists of assigning the pumping rate not only to the cell in which the well is located but also to adjacent cells, taking into account the length of the well screen, the hydraulic conductivity, and the distance from the well to the center of its cell. The advantage of this alternative approach over the conventional one is illustrated with a test problem of a synthetic aquifer. Statistical measures of error indicate a much better model fit when pumping rates of wells are distributed over several cells.

Food security in Latin America.

Although the nutrition situation in most Latin American countries is improving and malnutrition is easing, worrisome factors are emerging. Huge rural-to-urban migrations have been accompanied by a worsening nutrition situation in rural populations, especially in Mexico, Colombia, and Brazil, a phenomenon not readily apparent from average food availability and malnutrition data. Average figures can also mask the severe nutrition problems that persist in four densely populated areas: the Caribbean Islands, Central America, the Andean region, and parts of Brazil. Although globalization is improving the nutritional status of many population groups in Latin America, it is also creating new pressures. Latin American countries dependent on agriculture are especially vulnerable.

Necesidades de investigación en carotenoides en América Latina / Investigation needs on carotenoids in Latin America

Muchos de los fitoquímicos bioactivos son muy importantes para mantener un buen estado de salud y de ellos los carotenoides han sido los más estudiados. Se conocen alrededor de 637 y se ha propuesto que posiblemente 70 de ellos puedan tener un papel en la salud humana. En cortes de cerebro humano se han encontrado 16 en relativamente alta cantidad. La mayoría de los estudios encuentran relación entre los carotenoides y varias enfermedades de tipo crónico no transmisibles, sobre todo con ciertos tipos de cáncer, enfermedades aterosclerósicas y enfermedades degenerativas del ojo. Esta relación esta mediada por los genes y la edad. Los carotenoides tienen interés científico y también económico para los países latinoamericanos, por lo que se propone hacer análisis en los productos tropicales, frutas y verduras más comunes, lo mismo que hacer estudios sobre su disponibilidad. Se sugiere un trabajo coordinado en el que se determinen los 7 carotenoides más relacionados con la salud en 40 ó 50 productos tropicales, lo mismo que comenzar a evaluar su disponibilidad metabólica. Se considera asimismo posible hacer estudios epidemiológicos basados en las poblaciones consumidoras de algunos alimentos ricos en carotenos para hacer análisis de riesgo comparativos. En algunos países de Latinoamérica, con el patrocinio de FAO e Infoods, y se han llevado a cabo algunas reuniones y cursos para iniciar este importante trabajo, lo mismo que para completar las tablas de composición de alimentos y hacer comparación entre países

Nutrición y desarrollo psicomotor durante el primer semestre de vida / Nutrition and psichomotor development during the first six months of life

Objetivo. Estudiar el desarrollo psicomotor de niños pequeños de una comunidad rural pobre y mal alimentada y relacionarlo con la alimentación y nutrición tanto de su madre como de ellos mismos. Material y métodos. Se estudiaron 82 unidades madre-niño, desde antes del quinto mes de embarazo hasta los seis meses de edad del niño, en antropometría y dieta; en el niño se aplicaron pruebas de Brazelton al nacer, de bayley a los tres y seis meses de edad y de interacción con su madre. Resultados. Varias de las pruebas psicomotoras del niño se correlacionaron positivamente con el peso de la madre y sus pliegues cutáneos, lo mismo que con su propio peso y talla previos. También con el consumo materno de productos animales y frutas durante el embarazo y negativamente con el consumo de tortillas y frijoles. Las correlaciones de varias de las pruebas del niño a los seis meses fueron positivas con su consumo complementario, de energía total y de varios alimentos, sobre todo de huevo, leche y frutas alrededor de los tres meses de edad. Conclusiones. Es importante que dentro del estrato social rural pobre estudiado, pequeñas variaciones de consumo de alimentos y nutrición de la unidad materno-infantil den lugar a cambios en las diversas pruebas de desarrollo psicomotor del niño pequeño, lo que sugiere la necesidad de impulsar más los programas de nutrición aplicados

Comparative research in social epidemiology: measurement issues

The aim of comparative research in soical epidemiology is to determine how risk factors for disease may vary within and between sociocultural and ethnic groups and in relation to outcomes. This aim assumes that measurement equivalence within and between social groups can be established, an assumption usually left untested. A model is presented here for deriving cross-culturally valid measures that are also intraculturally sensitive. Measurements so derived can then be used to compare cross-cultural and intracultural effects in a single analytic model. This approach is illustrated by pooling data on social stressors, social supports, and blood pressure from three studies. (AU)

Algunos datos sobre la situación nutricional en México / Some data on the nutrition situation in Mexico

This article presents the over-all results of 26 nutritional surveys, consisting mainly of dietetic, clinical, epidemiological, and economic data. Ten of the surveys were conducted in small agricultural communities; then in more organized communities with certain health and general services as well as some tradesmen and artisans; and six surveys were made in urban areas where the population was made up predominantly of wage earners and employees. The diet in the rural areas was found to be very deficient, consisting mainly of corn, which contributes over one half the total calories and a large part of the proteins. Depending on the area and socio-economic level, it is supplemented with varying amounts of beans, sugar, some fats, a little meat, bread and alimentary pastes, rice occasionally, and vegetables and fruits. Milk, eggs, and other dairy foods are rarely consumed. The diet is deficient in calories, proteins, riboflavin, ascorbic acid, and vitamin A. In some areas it is also deficient in calcium and niacin. Moreover, the proteins are of low quality, and tryptophane is the limiting amino acid. The diet gives rise to various deficiency disorders among the population, children being the most severely affected. These show marked growth and maturation disorders and frequently present various signs and symptoms of several deficiencies. About 2 per cent of the rural population is decidedly undernourished. A study of the correlation between the consumption of good-quality proteins and pre-school mortality showed that one important manifestation of

Algunos datos sobre la situación nutricional en México / Some data on the nutrition situation in Mexico

This article presents the over-all results of 26 nutritional surveys, consisting mainly of dietetic, clinical, epidemiological, and economic data. Ten of the surveys were conducted in small agricultural communities; then in more organized communities with certain health and general services as well as some tradesmen and artisans; and six surveys were made in urban areas where the population was made up predominantly of wage earners and employees. The diet in the rural areas was found to be very deficient, consisting mainly of corn, which contributes over one half the total calories and a large part of the proteins. Depending on the area and socio-economic level, it is supplemented with varying amounts of beans, sugar, some fats, a little meat, bread and alimentary pastes, rice occasionally, and vegetables and fruits. Milk, eggs, and other dairy foods are rarely consumed. The diet is deficient in calories, proteins, riboflavin, ascorbic acid, and vitamin A. In some areas it is also deficient in calcium and niacin. Moreover, the proteins are of low quality, and tryptophane is the limiting amino acid. The diet gives rise to various deficiency disorders among the population, children being the most severely affected. These show marked growth and maturation disorders and frequently present various signs and symptoms of several deficiencies. About 2 per cent of the rural population is decidedly undernourished. A study of the correlation between the consumption of good-quality proteins and pre-school mortality showed that one important manifestation of