The 2023 Latin America report of the Lancet Countdown on health and climate change: the imperative for health-centred climate-resilient development.

In 2023, a series of climatological and political events unfolded, partly driving forward the global climate and health agenda while simultaneously exposing important disparities and vulnerabilities to climate-related events. On the policy front, a significant step forward was marked by the inaugural Health Day at COP28, acknowledging the profound impacts of climate change on health. However, the first-ever Global Stocktake showed an important gap between the current progress and the targets outlined in the Paris Agreement, underscoring the urgent need for further and decisive action. From a Latin American perspective, some questions arise: How do we achieve the change that is needed? How to address the vulnerabilities to climate change in a region with long-standing social inequities? How do we promote intersectoral collaboration to face a complex problem such as climate change? The debate is still ongoing, and in many instances, it is just starting. The renamed regional centre Lancet Countdown Latin America (previously named Lancet Countdown South America) expanded its geographical scope adding Mexico and five Central American countries: Costa Rica, El Salvador, Guatemala, Honduras, and Panama, as a response to the need for stronger collaboration in a region with significant social disparities, including research capacities and funding. The centre is an independent and multidisciplinary collaboration that tracks the links between health and climate change in Latin America, following the global Lancet Countdown's methodologies and five domains. The Lancet Countdown Latin America work hinges on the commitment of 23 regional academic institutions, United Nations agencies, and 34 researchers who generously contribute their time and expertise. Building from the first report, the 2023 report of the Lancet Countdown Latin America, presents 34 indicators that track the relationship between health and climate change up to 2022, aiming at providing evidence to public decision-making with the purpose of improving the health and wellbeing of Latin American populations and reducing social inequities through climate actions focusing on health. This report shows that Latin American populations continue to observe a growing exposure to changing climatic conditions. A warming trend has been observed across all countries in Latin America, with severe direct impacts. In 2022, people were exposed to ambient temperatures, on average, 0.38 °C higher than in 1986-2005, with Paraguay experiencing the highest anomaly (+1.9 °C), followed by Argentina (+1.2 °C) and Uruguay (+0.9 °C) (indicator 1.1.1). In 2013-2022, infants were exposed to 248% more heatwave days and people over 65 years old were exposed to 271% more heatwave days than in 1986-2005 (indicator 1.1.2). Also, compared to 1991-2000, in 2013-2022, there were 256 and 189 additional annual hours per person, during which ambient heat posed at least moderate and high risk of heat stress during light outdoor physical activity in Latin America, respectively (indicator 1.1.3). Finally, the region had a 140% increase in heat-related mortality from 2000-2009 to 2013-2022 (indicator 1.1.4). Changes in ecosystems have led to an increased risk of wildfires, exposing individuals to very or extremely high fire danger for more extended periods (indicator 1.2.1). Additionally, the transmission potential for dengue by Aedes aegypti mosquitoes has risen by 54% from 1951-1960 to 2013-2022 (indicator 1.3), which aligns with the recent outbreaks and increasing dengue cases observed across Latin America in recent months. Based on the 2023 report of the Lancet Countdown Latin America, there are three key messages that Latin America needs to further explore and advance for a health-centred climate-resilient development. Latin American countries require intersectoral public policies that simultaneously increase climate resilience, reduce social inequities, improve population health, and reduce greenhouse gas (GHG) emissions. The findings show that adaptation policies in Latin America remain weak, with a pressing need for robust vulnerability and adaptation (V&A) assessments to address climate risks effectively. Unfortunately, such assessments are scarce. Up to 2021, Brazil is the only country that has completed and officially reported a V&A to the 2021 Global Survey conducted by the World Health Organization (WHO). Argentina, Guatemala, and Panama have also conducted them, but they have not been reported (indicator 2.1.1). Similarly, efforts in developing and implementing Health National Adaptation Plans (HNAPs) are varied and limited in scope. Brazil, Chile, and Uruguay are the only countries that have an HNAP (indicator 2.1.2). Moreover, self-reported city-level climate change risk assessments are very limited in the region (indicator 2.1.3). The collaboration between meteorological and health sectors remains insufficient, with only Argentina, Brazil, Colombia, and Guatemala self-reporting some level of integration (indicator 2.2.1), hindering comprehensive responses to climate-related health risks in the region. Additionally, despite the urgent need for action, there has been minimal progress in increasing urban greenspaces across the region since 2015, with only Colombia, Nicaragua, and Venezuela showing slight improvements (indicator 2.2.2). Compounding these challenges is the decrease in funding for climate change adaptation projects in Latin America, as evidenced by the 16% drop in funds allocated by the Green Climate Fund (GCF) in 2022 compared to 2021. Alarmingly, none of the funds approved in 2022 were directed toward climate change and health projects, highlighting a critical gap in addressing health-related climate risks (indicator 2.2.3). From a vulnerability perspective, the Mosquito Risk Index (MoRI) indicates an overall decrease in severe mosquito-borne disease risk in the region due to improvements in water, sanitation, and hygiene (WASH) (indicator 2.3.1). Brazil and Paraguay were the only countries that showed an increase in this indicator. It is worth noting that significant temporal variation within and between countries still persists, suggesting inadequate preparedness for climate-related changes. Overall, population health is not solely determined by the health sector, nor are climate policies a sole responsibility of the environmental sector. More and stronger intersectoral collaboration is needed to pave development pathways that consider solid adaptation to climate change, greater reductions of GHG emissions, and that increase social equity and population health. These policies involve sectors such as finance, transport, energy, housing, health, and agriculture, requiring institutional structures and policy instruments that allow long-term intersectoral collaboration. Latin American countries need to accelerate an energy transition that prioritises people's health and wellbeing, reduces energy poverty and air pollution, and maximises health and economic gains. In Latin America, there is a notable disparity in energy transition, with electricity generation from coal increasing by an average of 2.6% from 1991-2000 to 2011-2020, posing a challenge to efforts aimed at phasing out coal (indicator 3.1.1). However, this percentage increase is conservative as it may not include all the fossil fuels for thermoelectric electricity generation, especially during climate-related events and when hydropower is affected (Panel 4). Yet, renewable energy sources have been growing, increasing by an average of 5.7% during the same period. Access to clean fuels for cooking remains a concern, with 46.3% of the rural population in Central America and 23.3% in South America lacking access to clean fuels in 2022 (indicator 3.1.2). It is crucial to highlight the concerning overreliance on fossil fuels, particularly liquefied petroleum gas (LPG), as a primary cooking fuel. A significant majority of Latin American populations, approximately 74.6%, rely on LPG for cooking. Transitioning to cleaner heating and cooking alternatives could also have a health benefit by reducing household air pollution-related mortality. Fossil fuels continue to dominate road transport energy in Latin America, accounting for 96%, although some South American countries are increasing the use of biofuels (indicator 3.1.3). Premature mortality attributable to fossil-fuel-derived PM2.5 has shown varied trends across countries, increasing by 3.9% from 2005 to 2020 across Latin America, which corresponds to 123.5 premature deaths per million people (indicator 3.2.1). The Latin American countries with the highest premature mortality rate attributable to PM2.5 in 2020 were Chile, Peru, Brazil, Colombia, Mexico, and Paraguay. Of the total premature deaths attributable to PM2.5 in 2020, 19.1% was from transport, 12.3% from households, 11.6% from industry, and 11% from agriculture. From emission and capture of GHG perspective, commodity-driven deforestation and expansion of agricultural land remain major contributors to tree cover loss in the region, accounting for around 80% of the total loss (indicator 3.3). Additionally, animal-based food production in Latin America contributes 85% to agricultural CO2 equivalent emissions, with Argentina, Brazil, Panama, Paraguay, and Uruguay ranking highest in per capita emissions (indicator 3.4.1). From a health perspective, in 2020, approximately 870,000 deaths were associated with imbalanced diets, of which 155,000 (18%) were linked to high intake of red and processed meat and dairy products (indicator 3.4.2). Energy transition in Latin America is still in its infancy, and as a result, millions of people are currently exposed to dangerous levels of air pollution and energy poverty (i.e., lack of access to essential energy sources or services). As shown in this report, the levels of air pollution, outdoors and indoors, are a significant problem in the wholeregion, with marked disparities between urban and rural areas. In 2022, Peru, Chile, Mexico, Guatemala, Colombia, El Salvador, Brazil, Uruguay, Honduras, Panama, and Nicaragua were in the top 100 most polluted countries globally. Transitioning to cleaner sources of energy, phasing out fossil fuels, and promoting better energy efficiency in the industrial and housing sectors are not only climate mitigation measures but also huge health and economic opportunities for more prosperous and healthy societies. Latin American countries need to increase climate finance through permanent fiscal commitments and multilateral development banks to pave climate-resilient development pathways. Climate change poses significant economic costs, with investments in mitigation and adaptation measures progressing slowly. In 2022, economic losses due to weather-related extreme events in Latin America were US$15.6 billion -an amount mainly driven by floods and landslides in Brazil-representing 0.28% of Latin America's Gross Domestic Product (GDP) (indicator 4.1.1). In contrast to high-income countries, most of these losses lack insurance coverage, imposing a substantial financial strain on affected families and governments. Heat-related mortality among individuals aged 65 and older in Latin America reached alarming levels, with losses exceeding the equivalent of the average income of 451,000 people annually (indicator 4.1.2). Moreover, the total potential income loss due to heat-related labour capacity reduction amounted to 1.34% of regional GDP, disproportionately affecting the agriculture and construction sectors (indicator 4.1.3). Additionally, the economic toll of premature mortality from air pollution was substantial, equivalent to a significant portion of regional GDP (0.61%) (indicator 4.1.4). On a positive note, clean energy investments in the region increased in 2022, surpassing fossil fuel investments. However, in 2020, all countries reviewed continued to offer net-negative carbon prices, revealing fossil fuel subsidies totalling US$23 billion. Venezuela had the highest net subsidies relative to current health expenditure (123%), followed by Argentina (10.5%), Bolivia (10.3%), Ecuador (8.3%), and Chile (5.6%) (indicator 4.2.1). Fossil fuel-based energy is today more expensive than renewable energy. Fossil fuel burning drives climate change and damages the environment on which people depend, and air pollution derived from the burning of fossil fuels causes seven million premature deaths each year worldwide, along with a substantial burden of disease. Transitioning to sustainable, zero-emission energy sources, fostering healthier food systems, and expediting adaptation efforts promise not only environmental benefits but also significant economic gains. However, to implement mitigation and adaptation policies that also improve social wellbeing and prosperity, stronger and solid financial systems are needed. Climate finance in Latin American countries is scarce and strongly depends on political cycles, which threatens adequate responses to the current and future challenges. Progress on the climate agenda is lagging behind the urgent pace required. While engagement with the intersection of health and climate change is increasing, government involvement remains inadequate. Newspaper coverage of health and climate change has been on the rise, peaking in 2022, yet the proportion of climate change articles discussing health has declined over time (indicator 5.1). Although there has been significant growth in the number of scientific papers focusing on Latin America, it still represents less than 4% of global publications on the subject (indicator 5.3). And, while health was mentioned by most Latin American countries at the UN General Debate in 2022, only a few addressed the intersection of health and climate change, indicating a lack of awareness at the governmental level (indicator 5.4). The 2023 Lancet Countdown Latin America report underscores the cascading and compounding health impacts of anthropogenic climate change, marked by increased exposure to heatwaves, wildfires, and vector-borne diseases. Specifically, for Latin America, the report emphasises three critical messages: the urgent action to implement intersectoral public policies that enhance climate resilience across the region; the pressing need to prioritise an energy transition that focuses on health co-benefits and wellbeing, and lastly, that need for increasing climate finance by committing to sustained fiscal efforts and engaging with multilateral development banks. By understanding the problems, addressing the gaps, and taking decisive action, Latin America can navigate the challenges of climate change, fostering a more sustainable and resilient future for its population. Spanish and Portuguese translated versions of this Summary can be found in Appendix B and C, respectively. The full translated report in Spanish is available in Appendix D.

Economic impacts associated with the health effects of climate change in South America: a scoping review.

This scoping review assesses the current evidence on the health impacts of climate change and associated economic costs in South America. In total, 3281 studies were identified using a systematic search strategy, but only 23 articles met the inclusion criteria and were analysed. The results from these articles indicate that the health effects of climate change will likely be costly for South America; however, evidence is limited to a handful of countries or regional analyses that ignore heterogeneity across and within countries. Most of the analysed studies looking at extreme weather events related to climate change focus on the effects and costs of droughts and fire events. A broader understanding of the topic could be achieved by estimating other extreme weather events' health effects and costs, using appropriate research methods to identify causal impacts, and including a more comprehensive and representative regional population sample. Beyond identifying effects, it is important to investigate demand responses for healthcare services, associated costs, availability and expansion of infrastructure, and cost-effectiveness of policies aimed at coping with and adapting to the health dimension of climate change.

The Lancet Countdown South America: increasing health opportunities by identifying the gaps in health and climate change research.

South America is experiencing the effects of climate change, including extreme weather events and changes in temperature and precipitation patterns. These effects interact with existing social vulnerabilities, exacerbating their impact on the health and wellbeing of populations. This viewpoint highlights four main messages from the series, which presented key gaps from five different perspectives of health and climate. First, there is an overall need for local analyses of priority topics to inform public policy, which include national and sub-national evidence to adequately strengthen responses and preparedness for climate change hazards and address relevant social vulnerabilities in South American countries. Second, research in health and climate is done in silos and the intersection is not clear in terms of responsibility and leadership; therefore, transdisciplinary research and action are key. Third, climate research, policies, and action need to be reflected in effective funding schemes, which until now are very limited. For adaptation and mitigation policies to be effective, they need a robust and long-term funding scheme. Finally, climate action is a big opportunity for healthier and more prosperous societies in South America, taking the advantage of strategic climate policies to face the challenges of climate change and tackle existing social inequities.

Semiparametric generalized estimating equations for repeated measurements in cross-over designs.

A model for cross-over designs with repeated measures within each period was developed. It was obtained using an extension of generalized estimating equations that includes a parametric component to model treatment effects and a non-parametric component to model time and carry-over effects; the estimation approach for the non-parametric component is based on splines. A simulation study was carried out to explore the model properties. Thus, when there is a carry-over effect or a functional temporal effect, the proposed model presents better results than the standard models. Among the theoretical properties, the solution is found to be analogous to weighted least squares. Therefore, model diagnostics can be made by adapting the results from a multiple regression. The proposed methodology was implemented in the data sets of the cross-over experiments that motivated the approach of this work: systolic blood pressure and insulin in rabbits.

Assessing tradeoffs in the design of climate change adaptation strategies for water utilities in Chile.

Climate change is a challenge to drinking water providers worldwide and to regulatory frameworks that consider long-term investment decisions. Coping with an unstable climate warrants adjustments in regulations and new investments. The investment required to maintain a selected service level needs to balance the potential for high regret stranded assets with the political and socioeconomic consequences of not meeting water demands. In recent years, the City of Santiago in Chile has seen drought events associated with climate change, which could worsen in the future. Chile's drinking water regulatory framework does not account for uncertainty in infrastructure design to cope with the potential impacts of such events. This work presents an adaptation option design process that considers multiple plausible climate change-impacted future scenarios, accommodating both structural and nonstructural measures. In our Santiago case study adaptation measures include extensions to the existing Chilean water market and traditional structural alternatives (e.g., storage infrastructure); all are represented in a simulation model of the water utility. We evaluate and optimize packages of efficient adaptation measures for various climate scenarios. This allows comparing different portfolios of combined institutional and infrastructure interventions via a range of stakeholder measures and comparing their tradeoffs under different plausible climate-impacted hydrological scenarios. Results showed that water supply performance without climate change adaptation is worse under climate scenarios with lower water availability, which are likely to be associated with higher GHG emission scenarios such as RCP 8.5. The optimized portfolios implement various combinations of adaptation strategies to reduce the impacts of this poor performance. Considering the uncertainty on future climate scenarios, the use of nonstructural adaptation measures such as option contracts exhibits the advantage of providing water in critical periods while avoiding large investments such as building reservoirs or the purchase of permanent water rights, which could end up underused if favorable climate scenarios manifest.

Ten principles to integrate the water-energy-land nexus with climate services for co-producing local and regional integrated assessments.

The water-energy-land nexus requires long-sighted approaches that help avoid maladaptive pathways to ensure its promise to deliver insights and tools that improve policy-making. Climate services can form the foundation to avoid myopia in nexus studies by providing information about how climate change will alter the balance of nexus resources and the nature of their interactions. Nexus studies can help climate services by providing information about the implications of climate-informed decisions for other economic sectors across nexus resources. First-of-its-kind guidance is provided to combine nexus studies and climate services. The guidance consists of ten principles and a visual guide, which are discussed together with questions to compare diverse case studies and with examples to support the application of the principles.

Valuation of observable attributes in differentiated beef products in Chile using the hedonic price method.

Beef imports in Chile have increase annually by close to 10% in the past 10 years, threatening the national industry. Understanding the importance of different attributes may help guide a strategy for the local beef industry. Thus, the goal of the study was to identify which attributes observable at the point of sale influence the beef buying process. The sample was a set of 406 price observations, search attributes (intrinsic and extrinsic cues), and credence attributes of differentiated beef. The study was conducted in 15 counties in the Metropolitana region in Chile, and the results indicated that among differentiated beef, the highest valued attributes were low fat and natural. In addition, Angus and Wagyu beef, breeds associated by consumers with increased tenderness and flavor, were highly valued. Finally, processed beef products (portioned, marinated, or seasoned) were more valued than unprocessed products. An important and unexpected result is that highlighting Chile as the country of origin is a negatively valued attribute.

Estudio comparativo de la producción de biomasa en fermentación superficial y en estado líquido de macromicetos con diferentes fuentes nutrimentales / Comparative study of the production of biomass in surface fermentation and in the liquid state of macromycetes with different nutrient sources

RESUMEN Los macromicetos han adquirido gran interés por su importancia alimenticia, terapéutica y económica, razón por la cual es necesario enfocar esfuerzos en la búsqueda de optimizar su producción de biomasa. El presente trabajo buscó determinar y comparar el efecto de la fermentación líquida (FEL) y superficial (FeSup) (medio solido) sobre la producción de biomasa de Flammulina velutipes, Hypsizigus tessulatus y Grifola frondosa empleando seis fuentes de nutrientes de bajo costo: harina de soja, trigo integral, maíz blanco, maíz amarillo precocido, salvado de trigo y semillas de linaza molida. Los resultados de la FeSup permitieron determinar que la especie de mayor crecimiento radial, indistintamente de la fuente de nutrientes, es F. velutipes seguida de H. tessulatus y por ultimo G. frondosa. Adicionalmente, la mayor producción de biomasa con FeSup se observa para F. velutipes y H. tessulatus (6,4480 g/L y 5,7320 g/L, respectivamente) Por el contrario, para la FEL, G. frondosa (11,4620 g/L) es la especie de mayor producción. La comparación en la producción de biomasa empleando FEL y FeSup, evidenció que los resultados son dependientes de la técnica de cultivo y que la FeSup no puede ser empleada para la selección preliminar de hongos macromicetos, enfocada en la producción de biomasa por FEL.

ABSTRACT Macromycetes have acquired great interest because of their nutritional, therapeutic and economic importance, which is why it is necessary to focus efforts in the search to optimize their biomass production. The present work sought to determine and compare the effect of liquid fermentation (FEL) and surface fermentation (FeSup) (solid medium) on the biomass production of Flammulina velutipes, Hypsizigus tessulatus and Grifola frondosa using six sources of low cost nutrients: soybeans, whole wheat, white corn, precooked yellow corn, wheat bran and ground flax seed. The results of the FeSup allowed to determine that the species with the highest radial growth, indistinctly from the nutrient source, is F. velutipes followed by H. tessulatus and finally G. frondosa. Additionally, the highest biomass production with FeSup is observed for F. velutipes and H. tessulatus (6.4480 g/L and 5.7320 g/L, respectively) On the contrary, for the FEL, G. frondosa (11.4620 g/L) is the species with the highest production. The comparison in the production of biomass using FEL and FeSup, showed that the results are dependent on the culture technique and that the FeSup cannot be used for the preliminary selection of fungi macromycetes, focused on the production of biomass by FEL.

Risk factors for new bovine brucellosis infections in Colombian herds.

BACKGROUND: Bovine brucellosis is a zoonotic disease that causes substantial economic losses and has a strong impact on public health. The main objective of this paper is to determine the risk factors for new infections of Brucella abortus on Colombian cattle farms previously certified as being free of brucellosis. A case-control study was conducted by comparing 98 cases (farms certified as brucellosis-free for three or more years but became infected) with 93 controls (farms that remained brucellosis-free during at least the previous three years). The farms were matched by herd size and geographical location (municipality). Information was obtained via a questionnaire completed by veterinary officers through a personal interview with the herd owners. RESULTS: Two-thirds of the herds (67%) were dairy herds, 16% were beef herds, and 17% were dual-purpose (beef and milk) herds. After exploratory univariate analysis, all explanatory variables with a p-value of ≤0.20 were included in a logistic regression model using the forward stepwise method to select the model with the best goodness of fit. The significant risk factors were the replacement of animals from farms not certified as brucellosis-free compared to replacement from certified brucellosis-free farms (OR = 4.84, p-value < 0.001) and beef cattle farms compared to dairy cattle farms (OR = 3.61, p-value = 0.017). When herds with and without artificial insemination were compared, it was observed that farms that used natural breeding with bulls from non-certified herds had a higher risk than farms using artificial insemination (OR = 2.45, p-value = 0.037), but when the bulls came from brucellosis-free farms, farms with natural breeding were less affected (OR = 0.30, p-value = 0.004) than farms using artificial insemination, whether with frozen semen from certified brucellosis-free herds or fresh semen from uncontrolled herds. The latter is commonly sold to neighbouring farms. CONCLUSIONS: The government should make efforts to inform farmers about the risks involved in the introduction of semen and replacement heifers from farms that are not certified as brucellosis-free and to establish measures to control these practices.

Public opinion towards castration without anaesthesia and lack of access to pasture in beef cattle production.

Recent publications have shown that citizens in developing nations are gaining interest in farm animal welfare. The aims of this study were to assess the opinion of Chilean citizens about surgical castration without anaesthesia and lack of access to pasture in beef cattle production, to investigate how involvement in livestock production influences opinions, and to evaluate if different types of information would affect their opinion towards these management practices. The study was carried out in the Metropolitan Region of Santiago, Chile, and consisted of two surveys with 400 participants in each study. The first one used an online, self-administered questionnaire and the second one used a face to face questionnaire. The second questionnaire had four information treatments assigned randomly to survey participants (no information; negative information; negative and positive information; positive information). Most participants were aware that the two management practices are common in beef production systems and were opposed to them. Involvement in animal production was associated with greater acceptance of both management practices and participants that had visited a beef production farm before the study were more likely to support castration without anaesthesia in Survey 1. Belonging to any socioeconomic group and providing negative or positive information had no impact on participants' opinion. The results show a disconnection between the views of participants recruited for this study and beef production systems that do not provide pain control for male cattle surgical castration or provide little or no access to pasture.

Evolution of bovine brucellosis in Colombia over a 7-year period (2006-2012).

Bovine brucellosis is endemic in Colombia, and is a mandatory notifiable disease, subjected to a control program based on four surveillance procedures: passive surveillance, test-and-remove, certification of disease-free farms, and animal movements. The objective of this study is to estimate the evolution of bovine brucellosis in Colombia over a 7-year period (2006-2012) using data from the official control program. A total of 58 epidemiologic variables were analyzed for each year at the department level. Univariate descriptive analysis and principal components analysis (PCA) were performed to ascertain the behavior of the variables. These programs covered 3% of the census in 2006, increasing to 15% in 2012. The percentage of positive farms averaged 22% in 2006 and 23% in 2012. The highest proportion of positive farms was in the Orinoquía region (24.6 to 49.6%); the lowest was in the Amazon region, (17.9 to 32.7%). The percentage of positive animals presented certain differences between years but without any clear trend (4.7% in 2006 and 4.6% in 2012), indicating that the brucellosis control program had a low impact in Colombia in these years. The results for each surveillance procedure were 6.8% for passive surveillance, 5.9% for test-and-remove, and 4.4% both in disease-free farms and in animal movement tests. The results obtained by PCA led to finding three different clusters: geographic areas with low bovine production and low bovine brucellosis surveillance, areas with medium bovine production and medium surveillance for bovine brucellosis, and areas with a predominant bovine production, applying sanitary measures to control bovine brucellosis.

Modelo multinivel de tasa global de ganancia de peso en el programa madre canguro en Bogotá / Multilevel model for global weight gain rate in the kangaroo-mother program in Bogotá

Objetivos Formular un modelo multinivel para el análisis longitudinal de la tasa global de ganancia de peso en el Programa Madre Canguro. Metodología Se realiza un modelo multinivel, considerando en el primer nivel la variable tiempo y algunas variables del infante y de la madre; para el segundo nivel se consideran las mediciones asociadas a la tasa global de ganancia de peso. Resultados Al 5 % de significancia el intercepto y el parámetro asociado a la variable días transcurridos desde el nacimiento al cuadrado tienen efecto significativo sobre la tasa global de ganancia de peso. La pendiente para la variable días transcurridos desde el nacimiento resulta ser significativa al nivel del 6 %. Además, bajo este modelo se encuentra que el género y el retraso de crecimiento intrauterino del infante no tienen efecto significativo, así como la talla y el perímetro en los diferentes controles del infante. El peso en los diferentes controles del infante resulta ser significativo al 5 %, pero hay diferencias entre las dos clasificaciones gestacionales del infante (1: 26 a 40 semanas; 2: mayor de 40 semanas) y entre las clasificaciones del peso del infante de las categorías dos con uno, y tres con uno (1: 2500 gm. o más; 2: entre 1500 y 2499 gm.; 3: menor de 1500 gm.). Conclusión Por cada cita adicional menor es la tasa de ganancia de peso en promedio que va a tener el infante; sin embargo, el infante sigue ganando peso pero no en la misma razón de ganancia de las primeras citas.(AU)

Objectives To formulate a multilevel model for the longitudinal study of global weight gain rate in the Kangaroo-Mother Care Program. Methodology A multilevel model is used, taking time and some infant and mother variables in the first level. Measures associated with the global weight gain rate are considered for the second level. Results At 5 % significance, the intercept and the parameter associated to the time (days after birth) squared variable have a significant effect on the global rate of weight gain. The slope for the time variable is significant at the 6 % level. Also, under this model, we find that the gender delay in intrauterine growth of the infant, height and perimeter do not have a significant effect on the infant's global rate of weight gain. The weight in the various controls performed is significant at the 5 % level. There are differences between the two infant's gestational classifications (1: 26 to 40 weeks; 2: greater than 40 weeks), and between the infant's weight classifications of the categories two with one, and three with one (1: 2500 gm or more; 2: between 1500 and 2499 gm; 3: less than 1500 gm). Conclusion For each additional appointment, the average weight gain rate of the infant decreases. However, the infant keeps gaining weight, but not at the same rate as in the initial appointments.(AU)

Spatial generalised linear mixed models based on distances.

Risk models derived from environmental data have been widely shown to be effective in delineating geographical areas of risk because they are intuitively easy to understand. We present a new method based on distances, which allows the modelling of continuous and non-continuous random variables through distance-based spatial generalised linear mixed models. The parameters are estimated using Markov chain Monte Carlo maximum likelihood, which is a feasible and a useful technique. The proposed method depends on a detrending step built from continuous or categorical explanatory variables, or a mixture among them, by using an appropriate Euclidean distance. The method is illustrated through the analysis of the variation in the prevalence of Loa loa among a sample of village residents in Cameroon, where the explanatory variables included elevation, together with maximum normalised-difference vegetation index and the standard deviation of normalised-difference vegetation index calculated from repeated satellite scans over time.

[Multilevel model for global weight gain rate in the kangaroo-mother program in Bogotá]. / Modelo multinivel de tasa global de ganancia de peso en el programa madre canguro en Bogotá.

Objectives To formulate a multilevel model for the longitudinal study of global weight gain rate in the Kangaroo-Mother Care Program. Methodology A multilevel model is used, taking time and some infant and mother variables in the first level. Measures associated with the global weight gain rate are considered for the second level. Results At 5 % significance, the intercept and the parameter associated to the time (days after birth) squared variable have a significant effect on the global rate of weight gain. The slope for the time variable is significant at the 6 % level. Also, under this model, we find that the gender delay in intrauterine growth of the infant, height and perimeter do not have a significant effect on the infant's global rate of weight gain. The weight in the various controls performed is significant at the 5 % level. There are differences between the two infant's gestational classifications (1: 26 to 40 weeks; 2: greater than 40 weeks), and between the infant's weight classifications of the categories two with one, and three with one (1: 2500 gm or more; 2: between 1500 and 2499 gm; 3: less than 1500 gm). Conclusion For each additional appointment, the average weight gain rate of the infant decreases. However, the infant keeps gaining weight, but not at the same rate as in the initial appointments.