Knowledge, Attitudes, and Practices Associated with the Selection of Sweetened Ultra-Processed Foods and Their Importance in Oral Health.

BACKGROUND: Reading nutritional labelling helps consumers select healthier food, thereby benefitting their oral health. The purpose of this study was to describe the knowledge, attitudes, and practices (KAPs) of parents and carers of children and preteens, associated with reading nutritional labelling, selecting sweetened ultra-processed foods, and their impact on oral health. MATERIALS AND METHODS: This was a descriptive cross-sectional study in which a validated questionnaire was administered to 298 parents and caregivers of children aged 1-12 years from different districts in Villavicencio, Colombia. Participants' scores, based on the number of correct answers, were used to classify their level of KAP as low, medium, or high. In addition, the frequency of responses, the KAP levels, and the median scores were analysed. Finally, associations were determined using the chi-square test. RESULTS: Most participants reached a medium level in terms of knowledge (41.6%) and attitudes (49.3%) and a low level in terms of practices (43.3%). An association was found between participants' level of KAPs and their socioeconomic and educational level (p < 0.05). CONCLUSIONS: The study findings reveal inadequate KAPs associated with nutritional labelling, adequate food selection, and the importance of oral health.

Factors Associated With Extrapulmonary Tuberculosis in Southeastern Mexico: A Case-Control Study.

INTRODUCTION: Extrapulmonary tuberculosis (EPTB) is a disease that can affect any organ or tissue. Due to its potential to cause more dangerous sequelae and the barriers to its timely diagnosis, greater clinical awareness of this disease is crucial. This study aimed to identify the factors associated with EPTB in the population of Oaxaca, Mexico. METHODS: This is an unpaired case-control study. The cases were patients with EPTB+ while the controls were patients with pulmonary tuberculosis (PTB+) registered in the Tuberculosis Epidemiological Surveillance System. Sociodemographic, clinical, and microbiological variables were recovered. Bivariate analyses were performed and logistic regression analyses were performed to calculate the odds ratio (OR). RESULTS: A total of 75 EPTB+ cases and 300 PTB+ controls were included. Of the total sample, 57.1% were men and 60.3% indigenous. The most frequent clinical presentations of EPTB+ were nodal (21.3%), miliary (21.3%), and breast (20.0%). According to logistic regression analysis, age <40 years (OR: 2.25 (95% CI: 1.13-4.49), female sex (OR: 1.92 (95% CI: 1.03-3.56)], urban residence (OR: 2.25 (95% CI: 1.11-4.55)), comorbidity with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (OR: 3.46 (95% CI: 1.31-9.10)), dyspnea (OR: 2.67 (1.22-5.82)), and adenopathy (OR: 3.38 (95% CI: 1.42-8.06)) were positively associated with EPTB+. CONCLUSION: These results can serve as a basis for screening EPTB+, thus improving the preventive and diagnostic capacity of local health services, taking as a starting point women under 40 years of age and patients with HIV/AIDS in urban areas, as well as the presence of adenopathy and dyspnea as clinical characteristics of the disease.

Validity and Reproducibility of an Electronic Food Frequency Questionnaire in Argentinian Adults.

This study aimed to validate a semiquantitative electronic food frequency questionnaire (eFFQ) in estimating the intake of a comprehensive list of nutrients and bioactive compounds among adults from six regions of Argentina using multiple 24 h dietary recall (24HR) as a reference. A total of 163 adults completed two administrations of the eFFQ and four 24HRs. The paired t-test/Wilcoxon signed-rank test, Spearman/Pearson correlations, cross-classification, weighted kappa statistics, and Bland-Altman plots were employed to determine relative validity. To determine reproducibility, intraclass correlations (ICC), cross-classification, and weighted kappa statistics were calculated. For relative validity, crude correlations ranged from 0.15 to 0.57; energy adjustment and de-attenuation slightly improved most of these correlations. In cross-classification analysis, agreements within one quintile adjacent to exact agreement (EA ± 1) ranged from 52.2% to ~74%; extreme misclassifications were < 7%. For reproducibility, the crude ICC ranged from 0.29 to 0.85, showing moderate to good correlations for most nutrients. Cross-classification analysis showed agreement levels for the EA ± 1 quintile of 70.6% to 87.7%. Weighted kappa values ranged from 0.21 to 0.62. The results show that this eFFQ is relatively valid in ranking adults according to their nutrient intake and has an acceptable reproducibility, yet it slightly overestimates the intake of most nutrients.

Knowledge, attitudes, and practices towards COVID-19 and associated factors in the mexican population

Introduction: The COVID-19 disease has been one of the most harmful pandemics for humanity; therefore, ensuring adherence to preventive and control measures is essential. This adherence largely depends on the population's knowledge, attitudes, and practices (KAP) towards COVID-19. Objective: To identify the level of knowledge, attitudes, and practices towards COVID-19 prevention and its associated factors in Oaxaca, Mexico. Materials and Methods: This cross-sectional and analytical study surveyed adults online regarding KAP. Descriptive statistics and Chi-square or Fisher's exact tests were used for categorical comparisons. Factors associated with higher KAP levels were analyzed by calculating odd ratios (ORs) through logistic regression. Results: A total of 176 people participated, of whom 82.42% were women, and 81.83% were <30 years old. Among the participants, 90.88% identified direct contact with infected individuals as the main mode of transmission, 73.86% correctly identified the incubation period, and 93.22% referred to handwashing as the main preventive measure. The KAP scores were 65.34%, 32.95%, and 40.91%, respectively, with no differences by sex or age. Discussion: Participants with higher COVID-19 knowledge and more positive attitudes towards the pandemic were associated with more frequent preventive practices [OR:1.89 (CI:1.17-3.73)] and [OR:3.21 (CI:1 .62-6.35)], respectively, compared to those with lower scores. Conclusions: The study population has a low level of KAP; greater knowledge about COVID-19 and more positive attitudes towards the pandemic increase preventive practices.

Introducción: La enfermedad de COVID-19 ha sido una de las pandemias más perjudiciales para la humanidad, por lo cual, garantizar la adherencia a medidas preventivas y de control es fundamental. Esta adherencia depende en gran medida de los conocimientos, actitudes y prácticas (CAP) de la población frente al COVID-19. Objetivo: Identificar el nivel de conocimientos, actitudes y prácticas hacia la prevención de COVID-19 y sus factores asociados en Oaxaca, México. Materiales y Métodos: Estudio transversal y analítico, en mayores de edad a través de una encuesta en línea sobre CAP. Se aplicó estadística descriptiva, y chi cuadrada o exacta de Fisher para comparaciones categóricas. Se analizaron los factores asociados a un mayor nivel de CAP calculando OR´s a través de regresión logística. Resultados: En total 176 personas participaron, de los cuales 82,42% fueron mujeres y 81,83% fueron <30 años. El 90,88% identificó como principal medio de transmisión el contacto directo con personas enfermas, 73,86% identificó correctamente el periodo de incubación y el 93,22% refirió el lavado de manos como principal medida preventiva. Las puntuaciones CAP fueron 65,34%, 32,95% y 40,91% respectivamente, sin diferencias por sexo y edad. Discusión: Los participantes con mayor conocimiento sobre COVID-19 y actitudes más positivas hacia la pandemia se asociaron con tener prácticas preventivas más frecuentes, [OR:1,89 (IC:1,17-3,73)] y [OR:3,21(IC:1,62-6,35)] respectivamente, en comparación con aquellos con menor puntuación. Conclusiones: La población de estudio tiene un bajo nivel de CAP. Un mayor conocimiento sobre COVID-19 y actitudes más positivas hacia la pandemia aumentan las prácticas preventivas.

Introdução: A doença COVID-19 tem sido uma das pandemias mais prejudiciais para a humanidade, portanto, garantir a adesão às medidas preventivas e de controle é fundamental. Esta adesão depende em grande parte dos conhecimentos, atitudes e práticas (CAP) da população relativamente à COVID-19. Objetivo: Identificar o nível de conhecimento, atitudes e práticas em relação à prevenção da COVID-19 e seus fatores associados em Oaxaca, México. Materiais e Métodos: Estudo transversal e analítico, em adultos através de inquérito online sobre CAP. Estatísticas descritivas e qui-quadrado ou estatística exata de Fisher foram aplicadas para comparações categóricas. Os fatores associados ao maior nível de CAP foram analisados por meio do cálculo de OR por meio de regressão logística. Resultados: Participaram no total 176 pessoas, das quais 82,42% eram mulheres e 81,83% tinham <30 anos. 90,88% identificaram o contacto direto com pessoas doentes como principal meio de transmissão, 73,86% identificaram corretamente o período de incubação e 93,22% referiram a lavagem das mãos como principal medida preventiva. Os escores do CAP foram de 65,34%, 32,95% e 40,91% respectivamente, sem diferenças por sexo e idade. Discussão: Participantes com maior conhecimento sobre a Covid-19 e atitudes mais positivas frente à pandemia foram associados a práticas preventivas mais frequentes, [1,89 (IC:1,17-3,73)] e [3,21(IC:1,62-6,35)] respectivamente, comparados para aqueles com pontuação mais baixa. Conclusões: A população estudada apresenta baixo nível de CAP. Maior conhecimento sobre a COVID-19 e atitudes mais positivas frente à pandemia aumentam as práticas preventivas.

Peso al nacer en el noroeste argentino. Comparación con una referencia nacional y un estándar internacional / Birth weight in the Northwest region of Argentina. Comparison with a national reference and an international standard

Introducción. El tamaño al nacer se encuentra sujeto a influencias genéticas y ambientales; la altura geográfica es muy influyente. El peso al nacer (PN) es el indicador más utilizado para evaluarlo; existen diferentes estándares y referencias. Debido a la variabilidad de la distribución del PN en relación con la altura en la provincia de Jujuy (Argentina), este trabajo analiza la distribución percentilar del PN para tierras altas (TA) y tierras bajas (TB) jujeñas según edad gestacional (EG) y sexo, y su comparación con una referencia nacional y el estándar internacional INTERGROWTH-21st (IG-21). Población y métodos. Se analizaron los registros de 78 524 nacidos vivos en Jujuy en el período 20092014. Utilizando el método LMS, se estimaron los percentiles 3, 10, 50, 90 y 97 de PN/EG por sexo, para TA (≥2000 msnm), TB (<2000 msnm) y el total provincial, y se compararon gráficamente con la referencia poblacional argentina de Urquía y el estándar IG-21. La significación estadística se determinó mediante la prueba de Wilcoxon. Resultados. El PN en Jujuy presentó distribución heterogénea, con diferencias estadísticamente significativas (p <0,05) entre TB y TA. Al comparar con la referencia nacional y el estándar IG-21, se observaron diferencias por altitud, principalmente en los percentiles 90 y 97 para ambas regiones, y en los percentiles 3 y 10 en TA comparados con el estándar. Conclusiones. Se observó variabilidad de la distribución del PN asociada a la altura geográfica, por lo que, para evaluar el crecimiento intrauterino, resulta fundamental incluir la EG y el contexto donde transcurre la gestación.

Introduction. Size at birth is subject to genetic and environmental influences; altitude is highly influential. Birth weight (BW) is the most widely used indicator to assess size at birth; different standards and references are available. Due to the variability in BW distribution in relation to altitude in the province of Jujuy (Argentina), the purpose of this study is to analyze the percentile distribution of BW in the highlands (HL) and the lowlands (LL) of Jujuy based on gestational age (GA) and sex and compare it with a national reference and the INTERGROWTH-21 st (IG-21) international standard. Population and methods. The records of 78 524 live births in Jujuy in the 2009­2014 period were analyzed. Using the LMS method, the 3 rd, 10 th, 50 th, 90 th, and 97 th percentiles of BW/GA by sex were estimated for the HL (≥ 2000 MASL), the LL (< 2000 MASL), and the total for Jujuy, and compared with the Argentine population reference by Urquía and the IG-21 standard using growth charts. The statistical significance was established using the Wilcoxon test. Results. BW in Jujuy showed a heterogeneous distribution, with statistically significant differences (p < 0.05) between the LL and the HL. When compared with the national reference and the IG-21 standard, differences in terms of altitude were observed, mainly in the 90 th and 97 th percentiles for both regions and the 3 rd and 10 th percentiles in the HL compared with the international standard. Conclusions. BW distribution varied in association with altitude; therefore, to assess intrauterine growth, it is critical to include GA and the environment in which the pregnancy takes place.

Enhancing knowledge, attitudes, and practices related to dental caries in mothers and caregivers of children through a neuroeducational strategy.

BACKGROUND: Knowledge, attitudes, and practices related to oral health among parents play a crucial role in shaping oral hygiene and preventing early childhood caries. This study was intended to determine the effect of a neuroeducational strategy in improving knowledge, attitudes, and practices related to early childhood caries among mothers or caregivers of children. METHODS: A quasi-experimental study was conducted, implementing an educational strategy involving 33 mothers or female caregivers of children who met specific selection criteria. The strategy consisted of three key elements derived from neuroeducation: (1) experiment, (2) surprise and play, and (3) learn. Based on the participants' attendance at the sessions, they were categorized into two groups: those who underwent in-person intervention (G1) and those who received a combined in-person and virtual intervention (G2). The impact of the strategy was evaluated by comparing the participants' knowledge and attitudes, as well as their children's plaque index, before and after the intervention (immediate and 6-month impact). RESULTS: The participants exhibited a favorable and statistically significant effect on the median number of correct answers related to knowledge (G1 immediate effect (IE): p = 0.03, 6-month effect (ME): p = 0.002; G2 IE p = 0.002, ME: p = 0.001), and in the children's plaque index (G1 IE: p = 0.003, ME: p = 0.003; G2 IE: p = 0.033, ME: p = 0.003). Furthermore, there was an increase in the number of participants with a high level of knowledge (G1 IE: 41.5%; ME: 75%; G2 IE: 45.5%, ME: 42.9%), and of children with a good level of oral hygiene (G1 IE: 50%; ME: 73.0%; G2 IE: 27.3%, ME: 84.6%). Finally, qualitative interviews revealed a lasting clarity in concepts and sustained knowledge and attitudes at the six-month mark. However, a slightly diminished understanding of the relationship between bacteria, sugar, and caries was observed in G2 group, and some loss of association in the G1 group, at six months. CONCLUSION: The implementation of this strategy resulted in significant and lasting impacts on knowledge, attitudes, and practices, especially in the G1 group. Nevertheless, there is a need for further reinforcement of the association between bacteria, sugar, and caries.

Birth weight in the Northwest region of Argentina. Comparison with a national reference and an international standard. / Peso al nacer en el noroeste argentino. Comparación conuna referencia nacional y un estándar internacional.

Introduction. Size at birth is subject to genetic and environmental influences; altitude is highly influential. Birth weight (BW) is the most widely used indicator to assess size at birth; different standards and references are available. Due to the variability in BW distribution in relation to altitude in the province of Jujuy (Argentina), the purpose of this study is to analyze the percentile distribution of BW in the highlands (HL) and the lowlands (LL) of Jujuy based on gestational age (GA) and sex and compare it with a national reference and the INTERGROWTH-21st (IG-21) international standard. Population and methods. The records of 78 524 live births in Jujuy in the 2009-2014 period were analyzed. Using the LMS method, the 3rd, 10th, 50th, 90th, and 97th percentiles of BW/GA by sex were estimated for the HL (≥ 2000 MASL), the LL (< 2000 MASL), and the total for Jujuy, and compared with the Argentine population reference by Urquía and the IG-21 standard using growth charts. The statistical significance was established using the Wilcoxon test. Results. BW in Jujuy showed a heterogeneous distribution, with statistically significant differences (p < 0.05) between the LL and the HL. When compared with the national reference and the IG-21 standard, differences in terms of altitude were observed, mainly in the 90th and 97th percentiles for both regions and the 3rd and 10th percentiles in the HL compared with the international standard. Conclusions. BW distribution varied in association with altitude; therefore, to assess intrauterine growth, it is critical to include GA and the environment in which the pregnancy takes place.

Introducción. El tamaño al nacer se encuentra sujeto a influencias genéticas y ambientales; la altura geográfica es muy influyente. El peso al nacer (PN) es el indicador más utilizado para evaluarlo; existen diferentes estándares y referencias. Debido a la variabilidad de la distribución del PN en relación con la altura en la provincia de Jujuy (Argentina), este trabajo analiza la distribución percentilar del PN para tierras altas (TA) y tierras bajas (TB) jujeñas según edad gestacional (EG) y sexo, y su comparación con una referencia nacional y el estándar internacional INTERGROWTH-21st (IG-21). Población y métodos. Se analizaron los registros de 78 524 nacidos vivos en Jujuy en el período 2009-2014. Utilizando el método LMS, se estimaron los percentiles 3, 10, 50, 90 y 97 de PN/EG por sexo, para TA (≥2000 msnm), TB (<2000 msnm) y el total provincial, y se compararon gráficamente con la referencia poblacional argentina de Urquía y el estándar IG-21. La significación estadística se determinó mediante la prueba de Wilcoxon. Resultados. El PN en Jujuy presentó distribución heterogénea, con diferencias estadísticamente significativas (p <0,05) entre TB y TA. Al comparar con la referencia nacional y el estándar IG-21, se observaron diferencias por altitud, principalmente en los percentiles 90 y 97 para ambas regiones, y en los percentiles 3 y 10 en TA comparados con el estándar. Conclusiones. Se observó variabilidad de la distribución del PN asociada a la altura geográfica, por lo que, para evaluar el crecimiento intrauterino, resulta fundamental incluir la EG y el contexto donde transcurre la gestación.

Dietary patterns associated with physical activity and sedentary behavior in university students in Mexico

Dietary patterns (DPs) are conditioned by a large number of factors, including physical activity and sedentary lifestyle, however, there is limited information on their interaction. This study aimed to identify DPs and their associations with physical activity and sedentary behavior among university students from Mexico. We conducted a cross-sectional, observational and analytical study. The participants were university students from Southwest Mexico. A total of 419 participants who did not suffer from any disease that affects oral nutrition or that prevented them from performing physical activity were included. DPs were generated from a principal component analysis and associations were analyzed using a logistic regression model. Three DPs were identified: "western", "prudent" and "traditional". The traditional pattern was significantly associated with high physical activity (OR: 2.78; 95% CI: 1.34-5.75) and was a protective factor against sedentary lifestyle (OR: 0.35; 95% CI: 0.13-0.93). The results show that a high physical activity and a lower sedentary lifestyle were associated with a healthier dietary pattern in the study population. It is important to implement interventions towards nutrition, physical activity and sedentary behavior for the population being studied.

Los patrones dietéticos están condicionados por una gran cantidad de factores, entre ellos la actividad física y el sedentarismo, sin embargo, existe poca información sobre su interacción. Este estudio tuvo como objetivo identificar patrones dietéticos y sus asociaciones con la actividad física y el comportamiento sedentario entre estudiantes universitarios del suroeste de México. Se trata de un estudio transversal, observacional y analítico. Los participantes fueron estudiantes universitarios del suroeste de México. Se incluyeron un total de 419 participantes que no padecían alguna enfermedad que condicionara su nutrición oral, ni condición que les impidiera realizar actividad física. Se realizó un análisis de componentes principales para determinar los patrones dietéticos, mientras que se utilizó un modelo de regresión logística para verificar las asociaciones. Se identificaron tres patrones dietéticos: "occidental", "prudente" y "tradicional". El patrón tradicional se asoció significativamente con actividad física elevada (OR: 2,78; IC 95%: 1,34-5,75) y fue un factor protector contra el sedentarismo (OR: 0,35; IC 95%: 0,13-0,93). Los resultados muestran que una alta actividad física y un menor sedentarismo se asociaron con un patrón dietético más saludable en la población de estudio. Es importante implementar intervenciones hacia la nutrición, la actividad física y el sedentarismo para la población en estudio.

Spatio-Temporal Distribution of Colorectal Cancer Incidence in Córdoba, Argentina.

OBJECTIVE: To study the trend of colorectal cancer (CRC) incidence, considering its spatiotemporal distribution and its association with the level of urbanisation in Córdoba, Argentina (2004-2014). METHODS: An ecological and longitudinal study was conducted in the province of Córdoba (the second most populated of the country) using annual data for the period 2004-2014. Age-standardised incidence rates (ASIR) (standard national and world population) by sex were calculated for Córdoba and its 26 departments for CRC using the provincial tumour registry database. Joinpoint regression models were adjusted to provincial ASIRs. Departments ASIRs were mapped in quintiles. The departments were grouped into three strata according to urbanisation: High (n1=6, >107,000 people); Intermediate (n2=13, 33,000-107,000 people); and Low (n3=7, <33,000 people). The spatio-temporal correlation analysis of the departments' rates was fulfilled using the multilevel modelling strategy. RESULTS: ASIRs of CRC in Córdoba province were 30.9 ±1.5 and 24.3 ±1.5 cases/100,000 for men and women, respectively. During 2004-2014, ASIRs tended to decrease (annual per cent change: -0.6; CI95% -1.8, 0.6). Maps reflected different geospatial patterns by sex. CRC incidence in males was higher than in females in all strata (high urbanisation, incidence rate ratios (IRR): 1.66; intermediate, IRR: 1.59; and low, IRR: 1.40). There was a significant downward temporary variation in the most populous departments (3% per year). CONCLUSIONS: CRC presents a non-random spatial pattern across the territory with a decreasing temporal variation in the most populous departments. Differential incidence and temporospatial tendency burden in Córdoba involve sex and urbanisation. Men continue to be the population at the greatest risk; this pattern is more noticeable in most urban settings.

Distribución espacial y tendencia secular (1991-2014) de nacidos pequeños para la edad gestacional en Jujuy / Spatial distribution and secular trend (1991­2014) of small for gestational age infants born in Jujuy

Introducción. El feto que no alcanza el potencial de crecimiento esperado en el útero se considera pequeño para la edad gestacional (PEG). Esta restricción depende de factores genéticos y/o ambientales; la altura geográfica es uno muy relevante. Este trabajo analiza la distribución espacial de las prevalencias de PEG y su tendencia secular en Jujuy (1991-2014). Materiales y métodos. Se analizaron los registros de 308 469 nacidos vivos de Jujuy (Dirección de Estadísticas e Información de Salud). Se estimaron prevalencias de PEG (peso/edad gestacional

Introduction. A fetus that does not reach the expected growth potential in utero is considered small for gestational age (SGA). Such restriction depends on genetic and/or environmental factors, being altitude a very relevant factor. This study analyzes the spatial distribution of the prevalence of SGA and its secular trend in Jujuy (1991­2014). Materials and methods. The records of 308 469 live births in Jujuy (Health Statistics and Information Department) were analyzed. The prevalence of SGA (weight/gestational age < P10 and < P3) was estimated for sex according to the INTERGROWTH-21 st standard in the ecoregions of Jujuy (Valle and Ramal ­less than 2000 MASL­, Puna, and Quebrada) across 3 periods (1991­2000, 2001­2009, 2010­2014) and proportions were compared. The secular trend was assessed using the Joinpoint regression analysis. Results. The overall prevalence of SGA was 2.3% (< P3) and 7% (< P10). Significantly higher values were observed in Puna and Quebrada in both SGA categories and across all periods. Only in Valle, significant differences were observed between sexes across all periods. The prevalence of SGA showed a significant downward secular trend at a provincial and regional level, and this was greater in Quebrada (5.2% < P3 and 3.5% < P10). Conclusions. A consistent and significant decrease in the prevalence of SGA has been observed since the 1990s in Jujuy, where altitude is itself a determining factor of size at birth, since the Puna and Quebrada regions showed the highest prevalence of SGA during the entire period.

An empirically derived "prudent" dietary pattern is associated with lower obesity occurrence: Modeling and mapping from a national nutrition survey.

The characterization of dietary patterns linked to obesity is important to address evidence-based interventions against the obesity epidemic. We hypothesized that both dietary behaviors and environmental characteristics affect the spatial distribution of obesity. This study aimed to analyze the role of dietary patterns in the occurrence of obesity in Colombia, taking into account the hierarchical (geographical) structure of the data. A cross-sectional study based on the Colombian National Nutrition Survey (2015) was carried out. A subsample of 8750 adults who reported dietary intake data (by the 24-hour diet recall method) was extracted. Dietary patterns were identified by principal component factor analysis. Their association with obesity occurrence was assessed by using multilevel Poisson regression models (8750 subjects nested in 33 geographic units). Thematic maps were constructed. The obesity prevalence was 18.0% (95% CI, 16.7-19.4). Four dietary patterns were identified for the study group. An inverse (negative) association was found in people with high adherence (vs. low adherence) to the "prudent pattern" (dairy products, fruits, vegetables) (prevalence ratio, 0.87; 95% CI, 0.78-0.96; P = .01). People with high adherence to the "soft drinks and snacking pattern" (sugary drinks, meat products, snacks) tended to show a direct (positive) association with obesity occurrence (prevalence ratio, 1.12; 95% CI, 0.99-1.27; P = .06). Maps showed higher adherence levels to the prudent pattern in departments with higher socioeconomic conditions and lower obesity prevalence. To conclude, a prudent dietary pattern emerges as a key factor in obesity occurrence in Colombia. Obesity spatial distribution may be conditioned by contextual factors that represent social inequalities in health.

Spatial distribution and secular trend (1991-2014) of small for gestational age infants born in Jujuy. / Distribución espacial y tendencia secular (1991-2014) de nacidos pequeños para la edad gestacional en Jujuy.

Introduction. A fetus that does not reach the expected growth potential in utero is considered small for gestational age (SGA). Such restriction depends on genetic and/or environmental factors, being altitude a very relevant factor. This study analyzes the spatial distribution of the prevalence of SGA and its secular trend in Jujuy (1991-2014). Materials and methods. The records of 308 469 live births in Jujuy (Health Statistics and Information Department) were analyzed. The prevalence of SGA (weight/gestational age < P10 and < P3) was estimated for sex according to the INTERGROWTH-21st standard in the ecoregions of Jujuy (Valle and Ramal -less than 2000 MASL-, Puna, and Quebrada) across 3 periods (1991-2000, 2001-2009, 2010-2014) and proportions were compared. The secular trend was assessed using the Joinpoint regression analysis. Results. The overall prevalence of SGA was 2.3% (< P3) and 7% (< P10). Significantly higher values were observed in Puna and Quebrada in both SGA categories and across all periods. Only in Valle, significant differences were observed between sexes across all periods. The prevalence of SGA showed a significant downward secular trend at a provincial and regional level, and this was greater in Quebrada (5.2% < P3 and 3.5% < P10). Conclusions. A consistent and significant decrease in the prevalence of SGA has been observed since the 1990s in Jujuy, where altitude is itself a determining factor of size at birth, since the Puna and Quebrada regions showed the highest prevalence of SGA during the entire period.

Introducción. El feto que no alcanza el potencial de crecimiento esperado en el útero se considera pequeño para la edad gestacional (PEG). Esta restricción depende de factores genéticos y/o ambientales; la altura geográfica es uno muy relevante. Este trabajo analiza la distribución espacial de las prevalencias de PEG y su tendencia secular en Jujuy (1991-2014). Materiales y métodos. Se analizaron los registros de 308 469 nacidos vivos de Jujuy (Dirección de Estadísticas e Información de Salud). Se estimaron prevalencias de PEG (peso/edad gestacional

Streptococcus mutans and Streptococcus dentisani in dental biofilm of children with different caries status: a pilot study / Streptococcus dentisani e Streptococcus mutans no biofilme dental de crianças com diferentes estados de cárie: um estudo piloto

Objective:Streptococcus mutans is one of the etiological agents associated with caries due to its ability to metabolize carbohydrates and resist acidic environments. On the other hand, Streptococcus dentisani, shows characteristics associated with caries control due to its ability to inhibit growth of cariogenic bacteria. The aim of this work was to quantify the levels of Streptococcus mutans and Streptococcus dentisani from dental biofilm of children related to their caries situation. Material and Methods: After identification of morphologic characteristics of reference strains was performed, clinical isolates of biofilm compatible with these strains were selected and the Polymerase Chain Reaction technique was performed using species-specific primers. Biofilm samples from 25 children with caries and 21 without caries were collected to quantify the levels of S. mutans and S. dentisani. Results: There were statistically significant differences in the levels of S. mutans in the caries group and the levels increased as the severity of the carious lesion increased. By contrast, higher levels of S. dentisaniwere found in the caries-free group, although no statistically significant differences were found. In addition, the levels of S. dentisani decreased as the severity of the carious lesion increased. Conclusion: The increase in the frequency of S. dentisani in the caries-free group suggests the possibility of requiring minimum levels of this species in the dental biofilm to show an actual protective effect. It must also be considered that this effect might be related to intrinsic factors in children and the intraspecies genetic variability found in every individual. (AU)

Objetivo : Streptococcus mutans é um dos agentes etiológicos associados à cárie devido à sua habilidade de metabolizar carboidratos e resistir a ambientes ácidos. Já o Streptococcus dentisani , apresenta características associadas ao controle da cárie devido à sua capacidade de inibir o crescimento de bactérias cariogênicas. O objetivo deste trabalho foi quantificar os níveis de Streptococcus mutans e Streptococcus dentisani no biofilme dental de crianças em relação à situação de cárie destas. Material e Métodos: Após a identificação das características morfológicas das cepas de referência, foram selecionados do biofilme isolados clínicos compatíveis com essas cepas e realizada a técnica de Reação em Cadeia da Polimerase utilizando primers espécie-específicos. Amostras de biofilme de 25 crianças com cárie e 21 sem cárie foram coletadas para quantificar os níveis de S. mutans e S. dentisani. Resultados: Houve diferenças estatisticamente significativas nos níveis de S. mutans no grupo com cárie e os níveis aumentaram à medida que a gravidade da lesão cariosa aumentou. Por outro lado, foram encontrados níveis mais elevados de S. dentisani no grupo sem cáries, embora não tenham sido encontradas diferenças estatisticamente significativas. Além disso, os níveis de S. dentisani diminuíram à medida que a gravidade da lesão cariosa aumentava. Conclusão: O aumento da frequência de S. dentisani no grupo livre de cárie sugere a possibilidade de exigir níveis mínimos desta espécie no biofilme dental para mostrar um efeito protetor real. Deve-se considerar também que esse efeito pode estar relacionado a fatores intrínsecos nas crianças e à variabilidade genética intraespécie encontrada em cada indivíduo. (AU)

Does high sugar intake really alter the oral microbiota?: A systematic review.

OBJECTIVES: Diet is one of the main factors influencing the diversity and interactions of the oral microbiota. The purpose of this study is to determine the impact of sugar intake on the microbial diversity and bacteria that predominate under these conditions. MATERIAL AND METHODS: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guide, using the PubMed, Scopus, and Science Direct databases and combinations of the words "microbiota," "microbiology," "bacteria," "sugars," "dysbiosis," "caries," "microbiome," "oral microbial," and "oral microbiota profile pattern." The selection criteria included year, language, type of publication, comparison of microbiota during low and high sugar intake, and bacterial identification by molecular sequencing of the 16S subunit of ribosomal RNA. RESULTS: Out of a total of 374 papers that came up after the initial search, 8 met the criteria for this review. The papers included research on populations comprising children, young adults, and adults, with most of the studies reporting selection criteria for the participants and using validated instruments to determine sugar intake. Apart from one study, all others reported for high sugar intake conditions a significant decrease in microbial diversity of the oral microbiome and the predominance of several bacterial genera or species, including Streptococcus, Scardovia, Veillonella, Rothia, Actinomyces, and Lactobacillus. CONCLUSIONS: Sugar-rich diets have a significantly unfavorable effect on the diversity and balance of oral microbiota; however, further studies are required to determine the exact role of sugar in microbial interactions.

The impact of the COVID-19 pandemic on mortality: life expectancy reduction and geographical disparities in Argentina.

OBJECTIVE: To assess the impact of the COVID-19 pandemic on mortality in Argentina, considering temporal trends in life expectancy at birth and premature mortality rate during 2010-2020. METHODS: Based on demographic projections, this ecological time-series study compares a "normal" versus a "COVID-19" mortality scenario for 2020 over a set of 11 Argentine provinces. Annual life expectancy at birth and age-standardized rates of premature mortality were estimated from 2010 to 2020. Joinpoint regression and multilevel models were used. RESULTS: A potential reduction in life expectancy at birth (a gap between scenarios >1 year) was observed. A significant (negative) point of inflection in temporal trends was identified for the country and most of the provinces, under the COVID-19 mortality scenario. However, our findings reveal disparities between provinces in the estimated life expectancy reduction toward 2020 (values range from -0.63 to -1.85 year in females and up to -2.55 years in males). While men showed more accentuated declines in life expectancy at birth in 2020 (a national gap between scenarios of -1.47 year in men vs. -1.35 year in women), women experienced more unfavorable temporal trends of premature mortality. In the absence of COVID-19, an improvement in both indicators was estimated toward 2020 in both sexes, while a return to levels reported in the past was observed under the COVID-19 scenario. CONCLUSION: The COVID-19 pandemic might seriously affect the trends of mortality and exacerbate health disadvantages in Argentina. A temporal and contextual perspective of health inequities merits special attention in the COVID-19 research.

Higher dietary glycemic index, intake of high-glycemic index foods, and insulin load are associated with the risk of breast cancer, with differences according to body mass index in women from Córdoba, Argentina.

Dietary patterns based on rich-carbohydrate foods were associated with breast cancer (BC) in Córdoba (Argentina). Nevertheless, the effect of dietary indicators of postprandial blood glucose or insulinemia on this cancer has not been studied. Thus, we hypothesize that higher dietary glycemic and insulinemic indices increase the risk of BC occurrence, with differential effects according to the presence/absence of overweight. A case-control study was conducted for BC (346/596 cases/controls) in Córdoba, Argentina, from 2008 to 2016. Multiple logistic regression models were used to assess the effect of glycemic index (GI), glycemic load, insulin index, and insulin load (IL) and the intake of high-GI foods (HGIF) on BC occurrence, adjusted by specific confounders and stratified by body mass index (BMI, <25 or ≥25 kg/m2). The odds ratio (OR) for BC occurrence comparing the highest versus the lowest tertile of dietary GI was 1.77 (95% confidence interval [CI], 1.19-2.64). Additionally, a positive association between the weekly intake of HGIF and the dietary IL was found (OR, 1.71; 95% CI, 1.14-2.55 and OR, 1.50; 95% CI, 1.03-2.19, respectively). In normal-weight women, dietary GI and IL were associated with cancer occurrence, whereas in overweight women, only weekly intake of HGIF was associated. Our findings suggest that the BC risk related to hyperglycemic and hyperinsulinemic diet changed according to BMI. Furthermore, frequent exposure to HGIF has a relevant role in BC occurrence and its promoting effect is even higher in the presence of overweight.

Factors associated with tuberculosis-diabetes mellitus type 2 binomial in rural population of Oaxaca, Mexico.

INTRODUCTION: Type 2 diabetes mellitus (T2DM) is a growing condition that hinders the treatment and control of tuberculosis (TB). Several factors promote this comorbidity showing variations according to characteristics of the population affected. The objective was to identify the factors associated with the comorbidity of TB-T2DM in a rural population of Oaxaca, Mexico. METHODOLOGY: This was an unpaired case-control study. Descriptive statistics was performed for clinical and sociodemographic variables. Logistic regression was used to calculate odds ratio (OR) to identify associated factors with TB-T2DM binomial. RESULTS: 126 controls (TB+ T2DM-) and 69 cases (TB+ T2DM+) were included. 43% were considered as indigenous population. Significant differences were found according to the groups. Treatment failure was higher in individuals with binomial (p = 0.015), as well as a higher bacillary load (two crosses) and presence of pulmonary TB (p ≤ 0.001). Association analysis showed that the risk factors of binomial were: female sex (OR = 2.47; 95% CI 1.24-4.92), age ≥ 45 years (OR = 2.90; 95% CI 1.42-5.92), body mass index ≥ 25 kg/m2 (OR = 2.69; 95% CI 1.25-5.77) and presenting > 6 symptoms (OR = 2.71; 95% CI 1.19-6.14). CONCLUSIONS: This is the first report of this comorbidity in a rural Mexican population. The results highlight the growing problem of TB-T2DM, and the need to address the issue from an integral and gender perspective. Furthermore, mandatory screening is necessary in patients with T2DM to improve early diagnosis of TB and T2DM. This would promote better management of both conditions.

Impact of a virtual learning environment on the conscious prescription of antibiotics among Colombian dentists.

Appropriate antibiotic prescription contributes to reducing bacterial resistance; therefore, it is critical to provide training regarding this challenge. The objective of this study was to develop a virtual learning environment for antibiotic prescription and to determine its impact on dentists' awareness, attitudes, and intention to practice. First, the learning content on multimedia resources was developed and distributed into three challenges that participants had to overcome. Then, a quasi-experimental study was performed in which the virtual learning environment was implemented on dentists from seven Colombian cities. The median of correct answers and the levels of awareness, attitudes, and intention to practice were compared before, immediately after, and 6-months post-intervention. Wilcoxon signed-rank and McNemar's tests were used to determine the differences. A total of 206 participants who finished the virtual learning environment activities exhibited a favorable and statistically significant impact on the median of correct answers of awareness (p < 0.001), attitudes (p < 0.001), and intention to practice (p = 0.042). A significant increase occurred in the number of participants with a high level of awareness (p < 0.001) and a non-significant increase in participants with high levels of attitudes (p = 0.230) and intention to practice (p = 0.286). At 6 months, the positive effect on the median of correct answers on awareness and intention to practice persisted (p < 0.001); however, this was not evident for attitudes (p = 0.105). Moreover, there was a significant decrease in the number of participants who showed low levels of awareness (p = 0.019) and a slight increase in those with high levels of the same component (p = 0.161). The use of a virtual learning environment designed for dentists contributed to a rapid improvement in awareness and intention to practice antibiotic prescription; however, their attitudes and information retention need reinforcement.

The impact of the COVID-19 pandemic on mortality: life expectancy reduction and geographical disparities in Argentina / O impacto da pandemia de COVID-19 na mortalidade: redução da expectativa de vida e disparidades geográficas na Argentina

ABSTRACT: Objective: To assess the impact of the COVID-19 pandemic on mortality in Argentina, considering temporal trends in life expectancy at birth and premature mortality rate during 2010-2020. Methods: Based on demographic projections, this ecological time-series study compares a "normal" versus a "COVID-19" mortality scenario for 2020 over a set of 11 Argentine provinces. Annual life expectancy at birth and age-standardized rates of premature mortality were estimated from 2010 to 2020. Joinpoint regression and multilevel models were used. Results: A potential reduction in life expectancy at birth (a gap between scenarios >1 year) was observed. A significant (negative) point of inflection in temporal trends was identified for the country and most of the provinces, under the COVID-19 mortality scenario. However, our findings reveal disparities between provinces in the estimated life expectancy reduction toward 2020 (values range from -0.63 to -1.85 year in females and up to -2.55 years in males). While men showed more accentuated declines in life expectancy at birth in 2020 (a national gap between scenarios of -1.47 year in men vs. -1.35 year in women), women experienced more unfavorable temporal trends of premature mortality. In the absence of COVID-19, an improvement in both indicators was estimated toward 2020 in both sexes, while a return to levels reported in the past was observed under the COVID-19 scenario. Conclusion: The COVID-19 pandemic might seriously affect the trends of mortality and exacerbate health disadvantages in Argentina. A temporal and contextual perspective of health inequities merits special attention in the COVID-19 research.

RESUMO: Objetivo: Avaliar o impacto da pandemia de COVID-19 sobre a mortalidade na Argentina, considerando as tendências temporais da expectativa de vida ao nascer e a taxa de mortalidade prematura 2010-2020. Métodos: Com base em projeções demográficas, este estudo ecológico de séries temporais compara um cenário de mortalidade "normal" versus "COVID-19" para 2020 em 11 províncias argentinas. Foram calculadas a expectativa de vida ao nascer anual e taxas de mortalidade prematura padronizadas por idade (2010-2020). Utilizaram-se modelos de regressão joinpoint e multiníveis. Resultados: Observou-se redução da expectativa de vida ao nascer (lacuna entre cenários >1 ano). Foi identificado um ponto de inflexão significativo (negativo) nas tendências temporais para o país e a maioria das províncias no cenário COVID-19. Nossos resultados revelam disparidades entre as províncias na redução da expectativa de vida 2020 (valores de -0,63 a -1,85 ano nas mulheres e até -2,55 nos homens). Enquanto os homens mostraram declínios mais acentuados na expectativa de vida ao nascer em 2020 (lacuna nacional entre os cenários de -1,47 vs. -1,35 ano nas mulheres), as mulheres experimentaram tendências temporais mais desfavoráveis de mortalidade prematura. Na ausência do COVID-19, estimou-se melhoria de ambos os indicadores até 2020 em ambos os sexos, enquanto se observou retorno aos níveis reportados no passado no cenário COVID-19. Conclusão: A pandemia de COVID-19 pode afetar seriamente as tendências de mortalidade e agravar as desvantagens para a saúde na Argentina. Uma perspectiva temporal e contextual das iniquidades em saúde merece atenção especial na pesquisa em COVID-19.

Sociodemographic disparities and contextual factors in obesity: updated evidence from a National Survey of Risk Factors for Chronic Diseases.

OBJECTIVE: To assess the association of sociodemographic and environmental factors with the obesity occurrence in Argentina from a sex- and age-comparative perspective and a multilevel approach. DESIGN: Cross-sectional study based on secondary data from the National Survey of Chronic Diseases Risk Factors (CDRF) 2018, Argentina. Two-level logistic regression models stratified by sex and age were used. SETTING: The nationwide probabilistic sample of the CDRF survey and twenty-four geographical units. PARTICIPANTS: 16 410 adult people, living in Argentine towns of at least 5000 people, nested into 24 geographical units. Sex and age groups were defined as young (aged 18-44 years), middle-aged (45-64 years) and older (65 years and older) men and women. RESULTS: Single men (all age groups) and divorced/widowed men (aged 45 years or older) had a lower obesity risk compared to married ones. In the middle-aged group, men with higher education showed a lower risk than men with incomplete primary education. In young women, a marked social gradient by educational level was observed. A low-income level coupled with highly urbanised contexts represents an unfavourable scenario for young and middle-aged women. Having a multi-person household was a risk factor for obesity (OR = 1·26, P = 0·038) in middle-aged women. Contextual factors linked to the availability of socially constructed recreational resources and green spaces were associated with obesity among young adults. CONCLUSIONS: Socio-environmental determinants of obesity seem to operate differently according to sex and age in Argentina. This entails the need to address the obesity epidemic considering gender inequalities and the socio-environmental context at each stage of life.