Effectiveness of health literacy interventions on anxious and depressive symptomatology in primary health care: A systematic review and meta-analysis.

Background: Affective disorders are a debilitating and very prevalent problem throughout the world. Often these are associated with the onset of comorbidities or a consequence of chronic diseases. Anxiety and depression are associated with poor social and personal relationships, compromised health. We aimed to synthesize evidence from studies measuring the impact of a health literacy (HL) intervention on the improvement of affective disorders. Methods: For this systematic review and meta-analysis, we searched PubMed/MEDLINE, Embase, Web of Science, Ibecs, Cuiden, Scielo, Science Direct and Dialnet for exclusively randomized controlled trial studies (RCTs) published between 1 Jan 2011, and 31 May 2022. The search terms employed were "health literacy," "health knowledge," "anxiety," "anxiety disorder," "depression," "depressive disorder," and "adult." The risk of bias assessment was performed using the Cochrane Collaboration Revised Risk of Bias tool (RoB2). We conducted random-effects meta-analyses and explored heterogeneity using meta-regression and a stratified survey. Results: Of 2,863 citations found through the initial screening, 350 records were screened by the title and abstract for their themes and relevance. Finally, nine studies complied with the inclusion criteria for the meta-analysis. 66.66% of studies (n = 6) were rated as having a low risk of bias and 33.33% (n = 3) were judged to raise some concerns. The health literacy interventions were associated with -1.378 reduction in depression and anxiety questionnaires scores [95% CI (-1.850, -0.906)]. Low mood disorder scores are associated with better mental health and wellbeing. Conclusion: Our findings demonstrate that an HL intervention in relation to the symptoms associated with affective disorders improves the emotional state of patients in PHC, with a moderately positive effect in reducing depression and anxiety.

Reflexiones acerca de las cambiantes narrativas sobre las vacunas contra la COVID-19

Nos propusimos discernir en qué medida las estrategias mediáticas adoptadas en torno a las vacunas contra la COVID-19, a lo largo de los primeros 15 meses desde el comienzo de su aplicación, pueden considerarse aportes legítimos y coherentes para comprender mejor su desempeño, y en qué grado las narrativas elaboradas pudieran responder a intereses económicos de las élites corporativas. Una vez recopilados los elementos más relevantes con que se configuran las narrativas predominantes desde el momento en que se concibieron las vacunas, se identificaron diversas anomalías que resultaron, en mayor o menor medida, invisibilizadas en el proceso de su aprobación y de los resultados de su aplicación. Las más significativas conciernen al manejo de las definiciones, los incumplimientos de compromisos y los conflictos de interés que comprometen la actuación de las empresas comercializadoras y los entes reguladores de las vacunas. Numerosos elementos relacionados con los intereses corporativos han gravitado en la elaboración del relato sobre las vacunas. Entre los que reclaman resignificación se hallan: su capacidad preventiva real de contagios, evoluciones graves y muertes, su eficacia ante nuevas variantes, la duración de la inmunidad que confieren, sus efectos adversos, el papel sinérgico de la inmunidad adquirida y los recursos empleados por las empresas para conseguir un predominio virtualmente monopólico en el mercado.

We set out to discern to what extent the media strategies adopted around the vaccines against covid-19 during the first 15 months since the beginning of their application can be considered as a legitimate and coherent contributions to a better understanding about their performance and to what extent the elaborated discourses could respond to the economic interests of the corporations' elites. Once the most relevant elements that have shaped the predominant narratives from the moment the vaccines were conceived were compiled, several anomalies were identified that were to a greater or lesser extent invisibilized in the process of their approval and the results of their application. The most significant of these concern the handling of definitions, non-compliance with commitments and conflicts of interest that compromise the actions of vaccine marketing companies and regulatory bodies. Many elements related to corporative interests have influenced the narrative concerning vaccines. Among those that require a resignification are: their real preventive capacity against contagions, serious diseases and deaths, their efficacy against new variants, the duration of the immunity they confer, their side effects, the synergic role of acquired immunity, and the resources used by the companies to achieve a virtually market monopolistic predominance.

Propomo-nos discernir em que medida as estratégias mediáticas adotadas em torno das vacinas covid-19, ao longo dos primeiros 15 meses desde o início da sua aplicação, podem dar contribuições legítimas e coerentes para melhor compreender o seu desempenho, e em que medida as narrativas poderiam responder aos interesses econômicos das elites corporativas. Uma vez compilados os elementos mais relevantes com os quais se configuram as narrativas predominantes desde o momento em que as vacinas foram concebidas, foram identificadas diversas anomalias que foram, em maior ou menor medida, invisibilizadas no processo de sua aprovação e nos resultados de sua aplicação . As mais significativas dizem respeito à gestão de definições, descumprimentos de compromissos e conflitos de interesse que comprometem a atuação das empresas comercializadoras e dos órgãos reguladores das vacinas. Inúmeros elementos relacionados a interesses corporativos gravitaram na elaboração da história sobre vacinas. Entre os que demandam ressignificação estão: sua real capacidade preventiva de contágios, evoluções graves e óbitos, sua eficácia contra novas variantes, a duração da imunidade que se consolidou, seus efeitos adversos, o papel sinérgico da imunidade adquirida e os recursos utilizados. empresas para alcançar o domínio do monopólio virtual no mercado.

Mortalidad excesiva porcentual por la COVID-19 en Cuba: un primer acercamiento / Percentage excessive mortality from COVID-19 in Cuba: a first approach

RESUMEN Fundamento: la mortalidad excesiva es considerada como un indicador especialmente útil para evaluar el impacto sanitario de la COVID-19; a nivel internacional, su empleo ha ido en aumento durante todo el 2021, pero en la literatura científica nacional su presencia es, hasta donde conocemos, nula. Objetivo: definir el indicador mortalidad excesiva y describir su empleo en el cálculo de la mortalidad excesiva para Cuba en el 2020, comparándola con la de otros países. Métodos: estudio ilustrativo del empleo e interpretación de un indicador de impacto de la COVID-19. Resultados: la mortalidad excesiva en Cuba en 2020 se compara, favorablemente, con la de otros países, en particular del área Latinoamericana. Conclusiones: la incidencia de la enfermedad, junto con las intervenciones no farmacéuticas implementadas por los gobiernos, entre otros factores, influyen en la mortalidad excesiva. En el caso de Cuba, es necesario calcularla para 2021, dado que en ese año se observaron las mayores tasas de incidencia, y de esa manera contribuir a la evaluación de la resiliencia global de nuestro Sistema de Salud en el enfrentamiento a la pandemia

ABSTRACT Background: Excessive Mortality is considered an especially useful indicator to assess the health impact of COVID-19 at the international level; its employment has been increasing throughout 2021, but in the national scientific literature its presence is, as far as we know, null. Objectives: to define and discuss the characteristics and computation requirements. To illustrate the use of the indicator through calculation of Excessive Mortality for Cuba, and compare results with other countries. Methods: Illustrative study of the use and interpretation of an indicator of COVID-19 impact. Results: Excessive Mortality in Cuba compares favorably with that of other countries, in particular in the Latin American region. Conclusions: The incidence of the disease, together with the Non-Pharmaceutical Interventions implemented by Governments, among other factors, influence Excessive Mortality. In the case of Cuba, it is necessary to calculate the Excessive Mortality for 2021, given that in that year the highest incidence rates were observed, and thus contribute to the evaluation of the global resilience of our Health System in the face of the pandemic.

Hematological Alterations in Patients Recovered from SARS-CoV-2 Infection in Havana, Cuba.

INTRODUCTION: COVID-19 sequelae, or the short-, medium-, and long-term manifestations of the disease are under continuous study. There are currently few reports on the evolution of hematological variables following a demonstrated absence of SARS-CoV-2 after infection. OBJECTIVE: Identify hematological alterations in Cuban adults recovered from SARS-CoV-2 infection, and their relation with disease severity. METHODS: We selected 348 persons recovered from COVID-19 residing in Havana, Cuba with an RT-PCR study negative for SARS-CoV-2 performed two weeks after hospital discharge; a structured survey was administered to obtain clinical-epidemiological data. Three groups were established according to COVID-19 clinical criteria: asymptomatic, mild/moderately symptomatic, and severely symptomatic, which, in turn, were divided according to hospital discharge date and blood sample collection date. We performed hemograms with differential leukocyte counts and compared results among groups. We then measured the associations between hematological variables, personal medical history, and relevant lifestyle habits (smoking). RESULTS: All hematological variables were within normal reference limits, although men from the group of severely ill patients had increased total leukocytes, neutrophils and lymphocytes, and decreased hemoglobin and eosinophils, which was also evident in those with a recovery time of 31-90 days. CONCLUSIONS: The relation between hematological variables and degree of clinical severity offers evidence as to persistence of systemic alterations (possibly inflammatory) associated with viral infection. Their identification and characterization can facilitate personalized patient followup and rehabilitation.

Assessment of changes in immune status linked to COVID-19 convalescent and its clinical severity in patients and uninfected exposed relatives.

INTRODUCTION: The immune response during and after SARS-CoV-2 infection can be complex and heterogeneous, and it can be affected by the severity of the disease. It can also contribute to an unfavorable evolution and bring about short and long term effects. The aim of this study was to characterize the lymphocyte composition according to the severity of COVID-19, as well as its degree of relationship to the specific humoral response to SARS-CoV-2 in convalescents up to 106 days after the infection and in their exposed relatives. METHODS: An applied research was carried out with a cross-section analytical design, from March 11 to June 11, 2020 in Cuba. The sample consisted of 251 convalescents from COVID-19 over 18 years of age and 88 exposed controls who did not become ill. The B and T cell subpopulations, including memory T cells, as well as the relationship with the humoral immune response against SARS-CoV-2, were identified by flow cytometry and enzyme immunoassay. RESULTS: Convalescent patients, who evolved with severe forms, showed a decrease in frequency and a greater proportion of individuals with values ​​lower than the minimum normal range of B cells, CD3 + CD4 + cells and the CD4 + / CD8 + ratio, as well as a higher frequency and a greater proportion of individuals with values ​​above the normal maximum range of CD3 + CD8 + and NK cells. Convalescent patients with severe forms of COVID-19 that exhibited IgG / RBD titers ≥ 1/200 had a lower frequency of TEMRA CD8 + cells (p = 0.0128) and TEMRA CD4 + (p = 0.0068). IgG / RBD titers were positively correlated with the relative frequency of CD4 + CM T memory cells (r = 0.4352, p = 0.0018). CONCLUSIONS: The identified alterations of B and T lymphocytes suggest that convalescent patients with the severe disease could be vulnerable to infectious, autoimmune or autotinflammatory processes; therefore, these individuals need medical follow-up after recovering from the acute disease. Furthermore, the role of T cells CD4 + CM in the production of antibodies against SARS-CoV-2 is confirmed, and it is noted that the defect of memory T cells CD8 + TEMRA could contribute to the development of severe forms of COVID-19.

The role of tumor necrosis factor alpha - 308A > G polymorphism on the clinical states of SARS-CoV-2 infection.

Background: Tumor necrosis factor-alpha (TNFɑ) is a cytokine that manages the host defense mechanism, which may play a role in the pathogenesis of COVID-19 patients. Several single-nucleotide polymorphisms, described in the promoter region of the TNFα gene, have a significant role on its transcriptional activity. These include the - 308A > G polymorphism which increases the TNFα levels with the expression of the A allele. The aim of this study was to explore whether the TNFα.- 308A > G polymorphism affects the clinical state of COVID-19 patients. The study included a total of 1028 individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which were distributed in 3 groups: asymptomatic, mild symptomatic and severe symptomatic patients. The amplification-refractory mutation system was used to determine the genotype of the TNFα.- 308A > G polymorphism. Results: Results show a higher tendency of being asymptomatic in individuals carrying the GG genotype (336 of 411; OR 1.24, 95% CI 0.91-1.70). The development of a severe form of SARS-CoV-2 infection was not found in subjects with the A allele compared to those with the G allele (OR 0.96, 95% CI 0.51-1.79), except in the eastern region of the country where the risk increased (OR 4.41, 95% CI 1.14-17.05). However, the subjects carrying the A allele had a higher chance of developing symptoms (OR 1.24, 95% CI 0.91-1.70) compared to those with the G allele. Conclusion: The TNFα.- 308A allele has an influence on developing symptoms of COVID-19 in Cuban patients, and that it particularly increases the risk of presenting severe forms of the disease in the eastern region of the country.

A Year in the COVID-19 Epidemic: Cuba and Uruguay in the Latin American Context.

INTRODUCTION: One year after WHO declared COVID-19 a pandemic, we found it useful to carry out a diagnosis of the situation in Latin America. OBJECTIVE: Examine the prevailing epidemiological panorama in mid-March 2021 in 16 countries in Latin America and the performance, over time, in the two countries with the best responses to their respective epidemics. METHODS: Using morbidity and mortality data, we compared the relative performance of each country under review and identified the two countries with the most successful responses to the pandemic. We used five indicators to analyze the course of each country's performance during the pandemic throughout 2020: prevalence of active cases per million population; cumulative incidence rate in 7 days per 100,000 population; positivity rate over a 7-day period; percentage of recovered patients and crude mortality rate per 1,000,000 population. RESULTS: According to the performance indicators, Cuba was ranked highest, followed by Uruguay. Although figures remained within acceptable margins, both nations experienced notable setbacks in the first weeks of 2021, especially sharp in Uruguay. CONCLUSIONS: Any characterization of the situation is condemned to be short-lived due to the emergence of mutational variants; however, this analysis identified favorable sociodemographic characteristics in both nations, and in their health systems, which may offer possible explanations for the results we obtained.

La COVID-19 en Cuba. Apuntes para debates sobre métodos estadístico-matemáticos / COVID-19 in Cuba. Notes for debating statistical-mathematical methods

RESUMEN La epidemiología y los métodos estadístico-matemáticos asociados a ella son campos que adquieren relevancia a la luz del enfrentamiento a la epidemia por el SARS-CoV-2 en Cuba. Para optimizar los esfuerzos en futuras batallas, que al parecer se avecinan, es necesario analizar críticamente lo que se ha hecho en ese sentido. El objetivo de este trabajo es identificar las insuficiencias en el enfoque epidemiológico y de las técnicas estadístico-matemáticas asociadas, en el tratamiento estadístico del curso de la epidemia de COVID-19. Se realizó una revisión documental, fundamentalmente de revistas médicas cubanas, y en la base de datos Pubmed. Se seleccionaron artículos y reportes que trataron el tema de la COVID-19 desde una perspectiva epidemiológica y/o estadístico-matemática. El uso de técnicas estadístico-matemáticas sin un fundamento epidemiológico adecuado, puede generar falsas expectativas y dificultar la toma de decisiones adecuadas. Esto ocurre, en particular, con modelos que pretenden describir, analizar y predecir, el comportamiento de las curvas de casos activos. Los aspectos discutidos, de corte estadístico-epidemiológico, pueden contribuir modestamente a los necesarios debates, sin los cuales es imposible hacer un balance objetivo de la situación.

ABSTRACT Epidemiology and the statistical-mathematical methods associated with it are fields that acquire relevance in light of the confrontation with the SARS-CoV-2 epidemic in Cuba. To optimize efforts in future battles, it is necessary to critically analyze what has been done in this regard. The objective of this work is to identify the shortcomings in the epidemiological approach and associated statistical-mathematical techniques, in the statistical treatment of the course of the COVID-19 epidemic. A documentary review was carried out, mainly of Cuban medical journals, and in the Pubmed database. Articles and reports were selected that dealt with the subject of COVID-19 from an epidemiological and/or statistical-mathematical perspective. The use of statistical-mathematical techniques without an adequate epidemiological basis can generate false expectations and make it difficult to make adequate decisions. This occurs, in particular, with models that aim to describe, analyze and predict the behavior of the curves of active cases. The issues discussed, of a statistical-epidemiological nature, can contribute modestly to the necessary debates, without which it is impossible to make an objective assessment of the situation.

Características clínico-epidemiológicas de pacientes cubanos residentes en La Habana afectados por la COVID-19 / Clinical-epidemiological characteristics of patients affected by COVID-19 residing in Havana

Introducción: La Habana fue el territorio más complejo a nivel nacional en el enfrentamiento al primer brote de la COVID-19. Su condición de capital, la densidad poblacional, la escasa delimitación geográfica entre sus municipios, el elevado flujo intermunicipal e interprovincial de personas, sumado a que es la provincia que mayor número de viajeros recibe procedentes del extranjero, confirieron a este territorio particularidades en el enfrentamiento a la pandemia. Objetivo: Determinar las principales características clínico-epidemiológicas de pacientes cubanos residentes en La Habana afectados por la COVID-19. Métodos: Se realizó un estudio observacional, analítico, de corte transversal. La muestra quedó formada por 431 pacientes, mayores de un año, de alta epidemiológica de la infección por SARS-CoV-2. Para la recolección de información se aplicó un cuestionario a través de una entrevista. Resultados: La edad promedio de la muestra fue de 45 años. Más de la mitad de los casos evolucionaron de modo sintomático (no grave o grave). La fiebre fue la manifestación clínica más frecuente. Los individuos incluidos en la muestra, con grupo sanguíneo O, o con antecedentes de asma, mostraron menos riesgo de presentar formas sintomáticas de la enfermedad. Conclusiones: Los resultados sugieren que la edad constituye el principal factor de riesgo para desarrollar formas sintomáticas (no graves o graves) de la COVID-19. De modo contrario, el grupo sanguíneo O y el antecedente de asma son factores de protección para estas formas de evolución clínica(AU)

Introduction: Havana city was the most complex territory at the national level facingthe first outbreak of COVID-19. Its condition of capital, the population density, the limited geographical delimitation between its municipalities, the high inter-municipal and inter-provincial flow of people, added to the fact that it is the province that receives the largest number of travelers from abroad, conferred particularities on this territory. Objective: To determine the main clinical-epidemiological characteristics of patients affected by COVID-19 living in Havana. Methods: An observational, analytical, cross-sectional study was carried out. The sample contained 431 patients, older than one year, with epidemiological discharge from the SARS-CoV-2 infection. To collect information, a questionnaire was applied through an interview. Results: The average age of the sample was 45 years. More than half of the cases evolved in a symptomatic way (not serious or serious). Fever was the most frequent clinical manifestation. The individuals included in the sample, with blood group O or with a background of asthma, showed less risk of presenting symptomatic forms of the disease. Conclusions: The results suggest that age is the main risk factor for developing symptomatic forms (not severe or severe) of COVID-19. On the contrary, blood group O and a history of asthma are protective factors for these forms of clinical evolution(AU)

Un año de epidemia de COVID-19: Cuba y Uruguay en el contexto latinoamericano

RESUMEN Introducción: Transcurrido un año desde que la OMS declaró la diseminación del SARS-COV-2 como una pandemia, consideramos útil realizar un diagnóstico de la situación prevaleciente en la región latinoamericana. Objetivos: Examinar el panorama epidemiológico prevaleciente a mediados del mes de marzo de 2021 en 16 países de la región y el desempeño en el tiempo en los dos países con mejores resultados. Métodos: Con los datos de morbilidad y mortalidad, se realizó una comparación del desempeño relativo de los países considerados y se identificaron las dos naciones con mejores resultados. Para analizar cuantitativamente el derrotero seguido por el proceso epidémico en dichas naciones a lo largo de 2020, se usaron 5 indicadores: tasa de prevalencia de casos activos por millón de habitantes, tasa de incidencia acumulada en 7 días por 100 mil habitantes, tasa de positividad en 7 días, porcentaje de enfermos recuperados y tasa cruda de mortalidad por millón de habitantes. Resultados: Se constató la posición cimera de Cuba en primer lugar, seguido de Uruguay según los indicadores de desempeño considerados. Aunque las cifras se mantienen dentro de márgenes aceptables, se puso de manifiesto el retroceso que ambas naciones han experimentado en las primeras semanas de 2021, especialmente acusado en Uruguay. Conclusiones: Cualquier caracterización de la situación está condenada a ser efímera por la naturaleza mutante de la epidemia; no obstante, el análisis permite identificar que los favorables rasgos sociodemográficos de ambas naciones, así como los de sus sistemas de salud aportan posibles explicaciones para los resultados obtenidos.

ABSTRACT Introduction: One year after the WHO declared the spread of SARS-COV-2 as a pandemic, we consider it useful to approach a diagnosis of the prevailing situation in the Latin American region. Objectives: To examine the prevailing epidemiological scenario in mid-March 2021 in 16 countries of the region, as well as performance over time in the two countries with best outcomes. Methods: Using morbidity and mortality data, we made a comparison of the relative performance of the countries considered and the two nations with the best results were identified. To quantitatively analyze the course followed by the epidemic process in these nations from the outbreak of COVID-19 until the moment of the analysis, 5 indicators were used: prevalence rate of active cases per million inhabitants, cumulative incidence rate in 7 days per 100.000 inhabitants, positivity rate in 7 days, percentage of recovered patients and crude mortality rate per million inhabitants. Results: The top position of Cuba was shown, followed by Uruguay, according to the performance indicators considered. Although the figures remain within acceptable margins, the setback that both nations have experienced in the first weeks of 2021 was revealed, especially marked in Uruguay. Conclusions: Any characterization of the situation is condemned to be transitory due to the mutant nature of the epidemic. However, the examination of twelve complete months allowed to identify that the favorable socio-demographic characteristics of both nations, as well as those of their health systems, provide possible explanations for the results obtained.

Dr. Francisco Rojas Ochoa: actor, testigo y gloria de la salud pública cubana / Dr. Francisco Rojas Ochoa: actor, witness and glory of Cuban public health

El Dr. Francisco Rojas Ochoa fue un intelectual pleno, poseedor de una sensibilidad artística realmente formidable. Sus aportes más notables trascendieron el marco de la ciencia. Desde muy temprano, comprendió la importancia de cuidar la calidad del dato primario como pilar de las estadísticas de salud; defendió infatigablemente los principios de la Salud Pública Cubana, se sumó al combate decidido contra la pseudociencia, cultivó la demografía, las técnicas de dirección administrativa y, sobre todo, la ética médica. Desplegó una valiosa contribución a la Historia de la Medicina y la Salud Pública. No tuvo formación estadística, pero sí un poderoso sentido común que le permitía apropiarse de los resultados de esta disciplina, para cuya interpretación práctica demostraba gran destreza. Durante toda su vida publicó decenas de artículos científicos y numerosos libros. La etapa más fructífera la desarrolló en el marco de diversas instituciones académicas, entre ellas, nuestra actual Escuela Nacional de Salud Pública. Su última publicación, considerada entre las más destacadas, fue Actor y Testigo, constituye un verdadero testamento intelectual(AU)

Dr. Francisco Rojas Ochoa distinguished himself by a full intellectual conviction and a really formidable artistic sensitivity. His most outstanding contributions went beyond the framework of science. Very early in his life, he realized the importance of caring for the quality of primary data as a pillar of health statistics; he tirelessly defended the principles of the Cuban Public Health, joined the decided combat against pseudoscience, developed demography and management techniques and, above all, he safeguarded the principles of medical ethics. He made a significant contribution to the History of Medicine and Public Health. Dr. Rojas Ochoa did not have statistical formation, but he actually had a powerful common sense that allowed him to benefit from its results, demonstrating great skill for their interpretation. During all his life, he published lots of scientific articles and many books. His most fruitful period was specially developed within the framework of several academic institutions, among them, our National School of Public Health. His last publication, which is considered one of the most outstanding, is "Actor y Testigo", a genuine intellectual testament that reveals both privileged spaces as reflected in its title(AU)

The chronic kidney disease epidemic in El Salvador: the influence of agrochemicals / La epidemia de enfermedad renal crónica en El Salvador: la influencia de los agroquímicos

Introduction: An epidemic of chronic kidney disease (CKD) of devastating consequences has been taking place in El Salvador over the last few decades. In a significant portion of affected subjects, no other common cause of chronic kidney disease is present, such as diabetes and hypertension. This illness is usually called Chronic Kidney Disease from Non-Traditional Causes (CKDnT). Previous studies have shown a high prevalence of exposure to agrochemicals in affected populations, particularly in rural areas. In addition to sustained exposure to agrochemicals, the other leading hypothesis to explain this epidemic is prolonged exposure to high temperatures and dehydration in a context of exhausting agricultural work. Objectives: To assess the possible causal effect of exposure to agrochemicals in the emergence of the CKD epidemic in the adult population of El Salvador. Methods: We conducted a case-control analysis based on the 2015 survey of Chronic Diseases in Adults in El Salvador, a national probabilistic sample that covered 4,817 adults ;20 years old. Those suffering from CKD were considered cases; the rest were managed as controls. Self-reported agrochemical exposures, other risk factors and health conditions were recorded. For binary exposures, the odds ratio (OR) of CKD and CKDnT was estimated. For variables measuring length of exposure, the average valu 8203; 8203;for cases and for controls were compared. In all cases, the corresponding 95 percent confidence intervals were calculated. Multivariate logistic regression was used to examine the association between exposure to agrochemicals and CKD while controlling for potential confounding variables. Results: Regardless of how past exposure to agrochemicals was characterized (e.g., contact with paraquat or aerial fumigation) the OR of both CKD and CKDnT was always greater than 1.0 (range, 1.36 to 3.75). Similarly, the average number of years of exposure was consistently higher for cases than for controls for all continuous variables examined (greater than 2 years in most cases). Conclusions: The results of this study are consistent with previous epidemiologic and toxicological evidence and support the hypothesis that exposure to agrochemicals may be causally implicated in the ongoing CKD epidemics in El Salvador(AU)

Introducción: Durante las últimas décadas, una epidemia de enfermedad renal crónica (ERC) de consecuencias devastadoras ha tenido lugar en El Salvador. Una parte importante de los sujetos afectados, no padece de una causa frecuente para padecer enfermedad renal crónica, tal como como diabetes e hipertensión. En tal caso, suele distinguirse la dolencia mediante el nombre de Enfermedad Renal Crónica de Causas no Tradicionales (ERCnT). Estudios previos muestran una alta prevalencia de exposición a agroquímicos en las poblaciones afectadas, particularmente en las zonas rurales. Además de la exposición sostenida a agroquímicos, la otra hipótesis principal para explicar esta epidemia es la exposición prolongada a altas temperaturas y deshidratación, en un contexto de trabajo agrícola agotador. Objetivos: Evaluar el posible efecto causal de la exposición a agroquímicos en la irrupción de la epidemia de ERC en la población adulta de El Salvador. Métodos: Se realizó un estudio de casos y controles, a partir de la Encuesta de Enfermedades Crónicas no Transmisibles en Adultos en El Salvador, basada en una muestra probabilística nacional que abarcó 4,817 adultos de 20 o más años de edad, concluida en 2015. Fueron considerados casos todos aquellos que padecían ERC; el resto dos restantes participantes se manejaron como controles. Se registraron las exposiciones a agroquímicos, así como a otros factores de riesgo y condiciones de salud según testimonio de los participantes. Para las exposiciones binarias, se estimó la razón de odds (OR) con respecto a padecer ERC y ERCnT. Para las variables que medían la duración de la exposición, se compararon los valores medios para casos y controles. En todos los casos, se calcularon los respectivos intervalos de confianza al 95 por ciento. Se utilizó la regresión logística multivariada para examinar la asociación entre la exposición a agroquímicos y la ERC, controlando las posibles variables confusoras. Resultados: Independientemente de cómo fuera caracterizada la exposición pasada a agroquímicos (por ejemplo, contacto con paraquat o fumigación aérea), el OR de ERC y ERCnT siempre fue mayor que 1.0 (rango, 1.36 a 3.75). Del mismo modo, la media de años de exposición fue consistentemente más alta para los casos que para los controles, para todas las variables continuas examinadas (más de 2 años en la mayoría de los casos). Conclusiones: Los resultados de este estudio son consistentes con la evidencia epidemiológica y toxicológica previa y respaldan la hipótesis de que la exposición a agroquímicos puede estar causalmente implicada en la epidemia de ERC que se registra en El Salvador(AU)

Chronic interstitial nephritis of nontraditional causes in Salvadoran agricultural communities.

In El Salvador, a form of chronic kidney disease (CKD) of nontraditional causes (CKDnt) affecting farmers is being reported. Its behavior has been epidemic and is responsible for tens of thousands of deaths. This article summarizes the results obtained from a series of studies conducted to identify the epidemiology and clinical behavior of this disease, proposing a case definition and an etiopathogenic hypothesis. Methods included a survey of CKD in agricultural communities studying 2,388 people ≥ 18 years and 1,755 < 18, a descriptive clinical study followed by histopathological assessment conducted in 46 possible cases of CKDnt ≥ 18 years, and a national survey to study the prevalence of CKD and associated risk factors in 4,817 participants ≥ 20 years followed by a nested case-control study. In the agricultural communities, the prevalence of CKD in adults was 18% (men: 23.9%, women: 13.9%), 26.8% in agricultural workers (non-agricultural 13.8%), CKDnt accounted for 51.9% of cases. CKD in the population < 18 years was 3.9% (mean estimated glomerular filtration rate > 160 mL/1.73m2). The national CKD prevalence was 12.6% (urban: 11.3%; rural: 14.4%; males: 17.8%, females 8.5%), and CKDnt was only 3.8%; with associations between CKD and exposure to agrochemicals. The clinical study revealed the presence of markers of kidney damage (A3 albuminuria: 80.4%; ß2-microglobulin: 78.2%), urine electrolyte anomalies (100% hypermagnesuria, 45.7% hypernatriuria, 43.5% osmotic polyuria), abnormal osteotendinous reflexes (45.7%), sensorineural hearing loss (56.5%), and damage of the tibial arteries by Doppler imaging (66.7%). Biopsies revealed a chronic tubulointerstitial nephropathy. The etiopathogenesis of CKDnt is possibly multifactorial, including environmental contamination by agrochemicals, heat stress, and dehydration.

Factores relacionados con el control de la hipertensión arterial en Cienfuegos / Factors related to the control of hypertension in Cienfuegos

Introducción: El control de la presión arterial es un desafío global y uno de los principales problemas de salud pública en la actualidad. Objetivos: Describir los factores relacionados con la evolución, detección y control de la hipertensión arterial en Cienfuegos en el periodo de 2001 a 2011, en un contexto de acceso universal a los servicios de salud. Métodos: Estudio poblacional desarrollado en el año 2011, con una muestra representativa probabilística de 1276 adultos entre 25-74 años, residentes en la ciudad de Cienfuegos, Cuba. Resultados: De los hipertensos, el 32,8 por ciento desconocía su condición, el 90 por ciento de los que conocían su condición llevaban tratamiento y el 29,8 por ciento estaban controlados. El riesgo de no control fue significativamente superior en las personas con más de 65 años, en las de raza negra o mestiza y en las que tenían más de un año sin ir a su médico o controlarse la presión arterial. Con relación al 2001, el porcentaje de hipertensos que desconocían su condición se incrementó en 11,3 por ciento; se redujo el número de tratados en un 3,4 por ciento y el nivel de control en un 10 por ciento. Conclusiones: Existe un grupo de factores como la edad, la raza, y la falta de seguimiento de las personas en los servicios de salud para la detección y control de la HTA que afectan su comportamiento. Los resultados, aunque superan los reportados por otros países de la región, sugieren brechas en la detección, el seguimiento de los casos y la gestión del sistema en el 2011, si se compara con la década precedente(AU)

Introduction: The control of blood pressure is a global challenge and one of the main public health problems nowadays. Objectives: To describe the factors related to the evolution, detection and control of hypertension in Cienfuegos from 2001 to 2011 in a scenario of universal access to health services. Methods: Population study developed during 2011, with a representative, probabilistic sample of 1276 adults in the ages from 25 to 74 years old whom lived in the city of Cienfuegos, Cuba. Results: From the hypertensive patients, 32,8 percent were unaware of their condition, 90 percent of those who knew their condition had treatment, and 29,8 percent were controlled. Uncontrolled hypertension's risk was significantly higher in people with age ≥ 65 years, the ones of black race or mixed race, in the ones not attending to the doctor's consultation or not controlling the blood pressure for more than one year. In relation to 2001, the percentage of hypertensive patients who did not know their condition increased by 11,3 percent; the number of treated patients was reduced by 3,4 percent and the level of control by 10 percent. Conclusions: There are a group of factors as age, race, and the lack of follow up to these patients in the health care services in order to detect and control hypertension that affect its behavior. The results, although better than those observed in other countries in the region, show a gap in terms of detection and control of hypertension, the follow up of the patients and management of the system in the year 2011 in comparison with the previous decade(AU)

The Chronic Kidney Disease Epidemic in El Salvador: A Cross-Sectional Study.

INTRODUCTION Chronic kidney disease has reached epidemic levels in several Central American countries since the early years of this century. In El Salvador, it is the second cause of death in men, the fifth in persons over 18 years old and the third cause of hospital deaths in the adult population. Its features, especially those of a subtype unassociated with traditional risk factors such as diabetes and high blood pressure, are only partially understood. OBJECTIVE Estimate the magnitude of chronic kidney disease in the adult population of El Salvador, considering both prevalence of the disease in its diverse forms as well as presence of potential risk factors nationally and in major subpopulations. METHODS A descriptive, cross-sectional analysis was conducted on data obtained from the Survey of Chronic Non-communicable Diseases in Adults in El Salvador, completed in 2015. The original data (interviews and measurements) were collected between October 2014 and March 2015 from 4817 adults employing a two-stage probabilistic cluster sample, with stratification of primary sampling units. Our analysis, using 20 of the 118 primary variables included in the original survey, focused on point estimation of prevalence rates and means, related to both traditional biological risk factors and nontraditional ones, such as insufficient hydration, strenuous working conditions and exposure to toxic agents. A separate analysis was performed to estimate prevalence of chronic kidney disease from nontraditional causes. Corresponding confidence intervals were calculated with proper weighting. RESULTS The general prevalence of chronic kidney disease in El Salvador was 12.8% (men 18.0%; women 8.7%). Of the chronically ill kidney patients, 13.1% were between 20 and 40 years of age. Among biological risk factors, the most frequent was high blood pressure (37.0%). Among nontraditional risk factors, high levels of sugary drink consumption (81.0%), insufficient hydration (65.9%) and high levels of exposure to agrochemicals in the work environment (12.6%) were also observed. Prevalence of chronic kidney disease from nontraditional causes was 3.9% (men 6.1%; women 2.2%). CONCLUSIONS Chronic kidney disease has reached epidemic proportions in El Salvador. The data confirm a health tragedy that, although especially striking older men, also takes a severe toll on young men and women. The results confirm findings of previous research in several Salvadoran agricultural communities. The relatively high level of population exposure to agrochemicals is important and alarming, especially in rural areas, meriting health-impact studies that include and go beyond possible impact on chronic kidney disease. KEYWORDS Kidney, renal insufficiency, chronic, risk factors, epidemics, El Salvador.

Epidemic of Chronic Kidney Disease of Nontraditional Etiology in El Salvador: Integrated Health Sector Action and South-South Cooperation.

In El Salvador, chronic kidney disease had reached epidemic propor-tions towards the end of this century's first decade. In 2011-2012, the Ministry of Health reported it was the leading cause of hospital deaths in men, the fifth in women, and the third overall in adult hospital fa-talities. Farming was the most common occupation among men in dialysis (50.7%). By 2017, chronic kidney disease admissions had overwhelmed hospital capacity.In 2009, El Salvador's Ministry of Health, Cuba's Ministry of Public Health and PAHO launched a cooperative effort to comprehensively tackle the epidemic. The joint investigations revealed a total prevalence of chronic kidney disease in the adult population of farming communities higher than that reported internationally (18% vs.11%-14.8%), higher in men than in women (23.9% vs 13.9%) and higher in men who were farmers/farmworkers than in men who were not (31.3% vs. 14.8%). The disease was also detected in children. An association was found between chronic kidney disease and exposure to agrochemicals (OR 1.4-2.5). In 51.9% of all chronic kidney disease cases, traditional causes (diabetes, hyperten-sion, glomerulopathies, obstructive nephropathies and cystic diseases) were ruled out and the existence of a particular form of chronic kidney disease of nontraditional etiology was confirmed (whose initial cases were reported as early as 2002). In the patients studied, functional altera-tions and histopathologic diagnosis confirmed a chronic tubulointerstitial nephritis; most presented with neurosensory hearing loss, altered tendon refiexes and tibial artery damage. The main results of this cooperation were the epidemiologic, physio-pathologic, clinical and histopathologic characterization of chronic kid-ney disease of nontraditional etiology. This characterization facilitated case definition for the epidemic and led to the hypothesis of systemic toxicity from agrochemicals (e.g., paraquat, glyphosate), which par-ticularly affect the kidneys and to which farmers/farmworkers (who may also become dehydrated in the fields) are most exposed. The research thus also laid the foundations for design of comprehensive intersectoral government actions to reduce cases and put an end to the epidemic. KEYWORDS Chronic kidney disease; chronic renal failure; tubuloint-erstitial nephritis; epidemiology; histopathology; international coopera-tion; agrochemicals; environmental pollutants, noxae, and pesticides; occupational health; PAHO; El Salvador; Cuba.

Osos polares que se convierten en personas y congresos depredadores / Polar bears that turn into people and predatory congresses

A lo largo de los últimos cinco años, la Revista Cubana de Información en Ciencias de la Salud (RCICS) publicó algunos artículos1,2 destinados a tratar de conseguir elevadas cotas de integridad científica en aquella información que luego se disemina en revistas o redes (ya sea por vías formales como informales). En ese contexto, se precavía acerca de editoriales que mercan inescrupulosamente con la ingenuidad de los autores,3 así como sobre revistas presuntamente científicas que en su momento recibieron una calificación que llegó para quedarse: las llamadas "predatory journals(AU)

Over the last five years, the Cuban Journal of Information in Health Sciences (RCICS) published some articles1,2 aimed at trying to achieve high levels of scientific integrity in that information that is then disseminated in magazines or networks (and either formal or informal). In this context, he cautioned against publishers who market unscrupulously with the ingenuity of the authors, 3 as well as about allegedly scientific journals that at the time received a qualification that came to stay: the so-called predatory journals(AU)

Osos polares que se convierten en personas y congresos depredadores / Polar bears that turn into people and predatory congresses

A lo largo de los últimos cinco años, la Revista Cubana de Información en Ciencias de la Salud (RCICS) publicó algunos artículos1,2 destinados a tratar de conseguir elevadas cotas de integridad científica en aquella información que luego se disemina en revistas o redes (ya sea por vías formales como informales). En ese contexto, se precavía acerca de editoriales que mercan inescrupulosamente con la ingenuidad de los autores,3 así como sobre revistas presuntamente científicas que en su momento recibieron una calificación que llegó para quedarse: las llamadas "predatory journals(AU)

Over the last five years, the Cuban Journal of Information in Health Sciences (RCICS) published some articles1,2 aimed at trying to achieve high levels of scientific integrity in that information that is then disseminated in magazines or networks (and either formal or informal). In this context, he cautioned against publishers who market unscrupulously with the ingenuity of the authors, 3 as well as about allegedly scientific journals that at the time received a qualification that came to stay: the so-called predatory journals(AU)