Inequalities in adiposity trends between 1979 and 1999 in Guatemalan children.

BACKGROUND: Guatemala suffered from civil war and high levels of inequality and childhood stunting in the second half of the 20th century, but little is known about inequalities in secular trends in adiposity. OBJECTIVES: To investigate differences in childhood body mass index (BMI) and skinfold thickness trajectories from 1979 to 1999 between three groups of children: High socioeconomic position (SEP) Ladino, Low SEP Ladino, and Low SEP Indigenous Maya. METHODS: The sample comprised 19 346 children aged 7-17 years with 54 638 observations. The outcomes were height, BMI, triceps skinfold thickness (TST), and subscapular skinfold thickness (SST) Z-scores according to the Centers for Disease Control and Prevention (CDC) references. Sex-specific multilevel models were used to estimate and compare mean trajectories from 1979 to 1999 between the three groups. RESULTS: Mean Z-scores were always highest for High SEP Ladino children and lowest for Low SEP Maya children. Despite their very short stature, the Low SEP groups had SST trajectories that were above the 50th centile. The BMI trajectories were relatively flat and within one major centile band of the CDC median, with differences between the three groups that were small (0.2-0.3 Z-scores) and did not attenuate over time. Conversely, the TST Z-score trajectories demonstrated larger positive secular trends (e.g., from -1.25 in 1979 to -0.06 in 1999 for Low SEP Maya boys), with differences between the three groups that were large (0.5-1.2 Z-scores) and did attenuate over time (in boys). Secular trends and between-group difference in the SST Z-score trajectories were less pronounced, but again we found stronger evidence in boys that the estimated inequalities attenuated over time. CONCLUSIONS: Secular trends and inequalities in skinfolds differ from those for BMI in Guatemalan children. Differences between groups in skinfolds attenuated over time, at least in boys, but whether this is good news is questionable given the very short stature yet relatively large subscapular skinfolds of the Low SEP groups.

Differences and secular trends in childhood IQ trajectories in Guatemala City.

This study documents differences in childhood IQ trajectories of Guatemala City children, aged 6-15 years and born 1961-1993, according to school attended, height-for-age Z-scores (HAZ) and over time (Flynn effect). IQ data come from the Universidad del Valle de Guatemala Longitudinal Study of Child and Adolescent Development. IQ was measured using standardised tests from the Otis-Lennon Mental Ability Test-series. A multilevel model was developed to describe 60,986 IQ observations (level 1), in 22,724 children (level 2), in five schools representing students of different socioeconomic status (SES) (level 3). Average IQ trajectories differed by school. The difference in average IQ at age 11 years between the students of high and low SES schools was 28.7 points. A one-unit increase in HAZ was associated with a 1.42 (0.72, 2.11) unit higher IQ if HAZ was <0, this association was stronger in public compared to private schools. Conversely, one unit increase in HAZ was only associated with a 0.3 (0.001, 0.5) unit higher IQ if HAZ was ≥0. With each birth year increase, IQ at age 11 years increased by 0.14 (95% CI 0.12, 0.16) units, although this Flynn effect attenuated slightly across adolescence. We found no evidence of secular change in the inequality in IQ trajectories (according to school or HAZ). Shorter children from disadvantaged schools in Guatemala City have lower IQ than their taller and wealthier peers, possibly reflecting the damaging effects of poor early life environments both for linear growth and cognitive development.

Four decades of socio-economic inequality and secular change in the physical growth of Guatemalans.

OBJECTIVE: To investigate changes in socio-economic inequalities in growth in height, weight, BMI and grip strength in children born during 1955-1993 in Guatemala, a period of marked socio-economic-political change. DESIGN: We modelled longitudinal data on height, weight, BMI and hand grip strength using Super-Imposition by Translation and Rotation (SITAR). Internal Z-scores summarising growth size, timing and intensity (peak growth velocity, e.g. cm/year) were created to investigate inequalities by socio-economic position (SEP; measured by school attended). Interactions of SEP with date of birth were investigated to capture secular changes in inequalities. SETTING: Urban and peri-urban schools in the region of Guatemala City, Guatemala. PARTICIPANTS: Participants were 40 484 children and adolescents aged 3-19 years of Ladino and Maya ancestry (nobservations 157 067). RESULTS: The difference in height (SITAR size) between lowest and highest SEP decreased from -2·0 (95 % CI -2·2, -1·9) sd to -1·4 (95 % CI -1·5, -1·3) sd in males, and from -2·0 (95 % CI -2·1, -1·9) sd to -1·2 (95 % CI -1·3, -1·2) sd in females over the study period. Inequalities also reduced for weight, BMI and grip strength, due to greater secular increases in lowest-SEP groups. The puberty period was earlier and shorter in higher-SEP individuals (earlier SITAR timing and higher SITAR intensity). All SEP groups showed increases in BMI intensity over time. CONCLUSIONS: Inequality narrowed between the 1960s and 1990s. The lowest-SEP groups were still >1 sd shorter than the highest. Risks remain for reduced human capital and poorer population health for urban Guatemalans.

Life course associations of height, weight, fatness, grip strength, and all-cause mortality for high socioeconomic status Guatemalans.

OBJECTIVES: The objective of this study was to investigate the association between physical growth in preadult life with five outcomes at ages 64 to 76: weight, body mass index (BMI), estimated body fat percentage, hand grip strength, and mortality. METHODS: Super-imposition by translation and rotation (SITAR) growth curves of 40 484 Guatemalan individuals aged 3 to 19 years were modeled for the parameters of size, timing and intensity (peak growth velocity, eg, cm/year) of height, weight, BMI, and grip strength. Associations between the SITAR parameters and old age outcomes were tested using linear and binary logistic regression for a follow-up sample of high socioeconomic status (SES) Guatemalans, of whom 50 were aged 64 to 76 years at re-measurement and 45 died prior to the year 2017. RESULTS: SITAR models explained 69% to 98% of the variance in each outcome, with height the most precise. Individuals in the follow-up sample who had a higher BMI before the age of 20 years had higher estimated body fat (B = 1.4 CI -0.02-2.8) and BMI (B = 1.2, CI 0.2-2.2) at the ages of 64 to 76 years. Those who grew slower in height but faster in weight and BMI before the age of 20 years had higher BMI and body fat later in life. CONCLUSIONS: These findings highlight the importance of a life course perspective on health and mortality risk. Childhood exposures leading to variation in preadult growth may be key to better understanding health and mortality risks in old age.

Instability in longitudinal childhood IQ scores of Guatemalan high SES individuals born between 1941-1953.

Childhood IQ has been used to predict later life outcomes across disciplines in epidemiology, education, and psychology. Most often only a single childhood IQ test is available or is used for these purposes in the belief that IQ is stable across the life course. The primary aim of this study was to examine the longitudinal stability of individuals' IQ test scores derived from school-age tests. The secondary aim was to investigate the association of the pre-adult scores with later life intelligence scores. The longitudinal pre-adult IQ scores of 42 high socioeconomic status Guatemalans born 1941-1953 were analysed and showed low stability of longitudinal test scores. Fluctuations of >1SD were found for 59.5% of the sample. The same participants, aged 64-76 years, were re-assessed and average pre-adult IQ explained 12% of variance in the older age intelligence score. The reasons behind the longitudinal instability in test scores reported in this study remains unknown but the results suggest single point measurements of intelligence before adulthood should be regarded with some caution.

Development of a Dating Violence Assessment Tool for Late Adolescence Across Three Countries: The Violence in Adolescents' Dating Relationships Inventory (VADRI).

Accurate assessment of dating violence (DV) is crucial for evaluation and intervention planning. However, extant self-report measurement tools of DV do not adequately consider age-, generation-, and culture-specific issues, which are essential for its accurate conceptualization. To address these gaps, we developed the Violence in Adolescents' Dating Relationships Inventory (VADRI) and evaluated its psychometric properties. The VADRI was developed based on a qualitative approach for item development through adolescents' individual interviews, focus groups, and experts' judgments, followed by a quantitative approach for tool assessment. Two aspects of DV were addressed: victimization and perpetration. After the necessary cultural and linguistic adaptation of items, the instrument was administered to 466 adolescents from three Spanish-speaking countries: Guatemala, Mexico, and Spain. The items were best represented by a one-factor solution in each country, which suggests that DV is a unidimensional construct combining victimization and perpetration. Analyses of item-level factor weights and differential item functioning were conducted aimed at obtaining information about items that best represented the construct, resulting in a 26-item final version that was cross-culturally equivalent. Convergent validity was supported by positive correlations with the Conflict in Adolescent Dating Relationships Inventory, and reliability analyses yielded favorable results (with all Cronbach's α values above .90). We conclude that the VADRI is a valid and reliable instrument for the assessment of DV in various cultural contexts.

Deep data science to prevent and treat growth faltering in Maya children.

The Maya people are descended from the indigenous inhabitants of southern Mexico, Guatemala and adjacent regions of Central America. In Guatemala, 50% of infants and children are stunted (very low height-for-age), and some rural Maya regions have >70% children stunted. A large, longitudinal, intergenerational database was created to (1) provide deep data to prevent and treat somatic growth faltering and impaired neurocognitive development, (2) detect key dependencies and predictive relations between highly complex, time-varying, and interacting biological and cultural variables and (3) identify targeted multifactorial intervention strategies for field testing and validation. Contributions to this database included data from the Universidad del Valle de Guatemala Longitudinal Study of Child and Adolescent Development, child growth and intergenerational studies among the Maya in Mexico and studies about Maya migrants in the United States.

An accelerated buoyancy adhesion assay combined with 3-D morphometric analysis for assessing osteoblast adhesion on microgrooved substrata.

An accelerated negative buoyancy method has been developed to assess cell adhesion strength. This method has been used in conjunction with 3-D morphometric analysis to understand the effects of surface topology on cell response. Aligned micro-grooved surface topographies (with a range of groove depths) were produced on stainless steel 316L substrates by laser ablation. An investigation was carried out on the effect of the micro-grooved surface topography on cell adhesion strength, cell and nucleus volumes, cell phenotypic expression and attachment patterns. Increased hydrophobicity and anisotropic wettability was observed on surfaces with deeper grooves. A reduction was noted in cell volume, projected areas and adhesion sites for deeper grooves, linked to lower cell proliferation and differentiation rates and also to reduced adhesion strength. The results suggest that the centrifugation assay combined with three-dimensional cell morphometric analysis has considerable potential for obtaining improved understanding of the cell/substrate interface.

Clinical outcomes and genetic expression profile in human liver graft dysfunction during ischemia/reperfusion injury.

INTRODUCTION: This study aims to compare the molecular gene expression during ischemia reperfusion injury. Several surgical times were considered: in the beginning of the harvesting (T0), at the end of the cold ischemia period (T1), and after reperfusion (T2) and compared with graft dysfunction after liver transplant (OLT). METHODS: We studied 54 patients undergoing OLT. Clinical, laboratory data, and histologic data (Suzuki classification) as well as the Survival Outcomes Following Liver Transplantation (SOFT) score were used and compared with the molecular gene expression of the following genes: Interleukin (IL)-1b, IL-6, tumor necrosis factor-α, perforin, E-selectin (SELE), Fas-ligand, granzyme B, heme oxygenase-1, and nitric oxide synthetase. RESULTS: Fifteen patients presented with graft dysfunction according to SOFT criteria. No relevant data were obtained by comparing the variables graft dysfunction and histologic variables. We observed a statistically significant relation between SELE at T0 (P = .013) and IL-1ß at T0 (P = .028) and early graft dysfunction. CONCLUSIONS: We conclude that several genetically determined proinflammatory expressions may play a critical role in the development of graft dysfunction after OLT.

Genetic expression profile of human liver grafts in ischemia-reperfusion injury: comparison of familial amyloidotic polyneuropathy and deceased-donor liver grafts.

This study aimed to compare the histologic and molecular gene expression at several surgical times (beginning of harvesting, T0; end of cold ischemia period, T1; and after reperfusion, T2) to characterize the ischemia-reperfusion injury (IRI) in deceased-donor liver grafts harvested from patients with familial amyloidotic polyneuropathy (FAP). For this purpose, 54 patients undergoing liver transplantation were studied and divided into 3 groups: deceased donor to cirrhotic recipient (group 1; n = 27), deceased donor to FAP recipient (group 2; n = 15), and FAP donor to cirrhotic recipient (group 3; n = 12). The main comparison was performed between a histologic score (Suzuki score, adding steatosis and neutrophil infiltration), and molecular gene expression of the following genes: interleukin (IL) 1ß, IL-6, E-selectin, Fas-ligand, granzyme B, heme oxygenase 1 (HO1), and nitric oxide synthetase (iNOS2A). We observed less neutrophil infiltration levels in group 3 in sample T0 (P = .0082), which was associated with gene expression of HO1 in the biopsies at T2 (P = .022). In group 3, the molecular expression of genes related to attenuated proinflammatory reaction during IRI, iNOS2A at T0 and HO1 at T2, was detected. We conclude that FAP liver grafts express differently the genes associated with an attenuated proinflammatory reaction, presenting less neutrophil infiltration at harvesting. These findings add more knowledge about the better short-term outcomes in patients receiving this type of liver graft.

High throughput generated micro-aggregates of chondrocytes stimulate cartilage formation in vitro and in vivo.

Cell-based cartilage repair strategies such as matrix-induced autologous chondrocyte implantation (MACI) could be improved by enhancing cell performance. We hypothesised that micro-aggregates of chondrocytes generated in high-throughput prior to implantation in a defect could stimulate cartilaginous matrix deposition and remodelling. To address this issue, we designed a micro-mould to enable controlled high-throughput formation of micro-aggregates. Morphology, stability, gene expression profiles and chondrogenic potential of micro-aggregates of human and bovine chondrocytes were evaluated and compared to single-cells cultured in micro-wells and in 3D after encapsulation in Dextran-Tyramine (Dex-TA) hydrogels in vitro and in vivo. We successfully formed micro-aggregates of human and bovine chondrocytes with highly controlled size, stability and viability within 24 hours. Micro-aggregates of 100 cells presented a superior balance in Collagen type I and Collagen type II gene expression over single cells and micro-aggregates of 50 and 200 cells. Matrix metalloproteinases 1, 9 and 13 mRNA levels were decreased in micro-aggregates compared to single-cells. Histological and biochemical analysis demonstrated enhanced matrix deposition in constructs seeded with micro-aggregates cultured in vitro and in vivo, compared to single-cell seeded constructs. Whole genome microarray analysis and single gene expression profiles using human chondrocytes confirmed increased expression of cartilage-related genes when chondrocytes were cultured in micro-aggregates. In conclusion, we succeeded in controlled high-throughput formation of micro-aggregates of chondrocytes. Compared to single cell-seeded constructs, seeding of constructs with micro-aggregates greatly improved neo-cartilage formation. Therefore, micro-aggregation prior to chondrocyte implantation in current MACI procedures, may effectively accelerate hyaline cartilage formation.

Evidence for epistatic gene interactions between growth factor genes in stroke outcome.

BACKGROUND AND PURPOSE: Growth factors are thought to modulate neurological function in stroke recovery through effects in angiogenesis, neurogenesis, and neuroprotection. METHODS: We tested the association of variants in the brain-derived neurotrophic factor (BDNF), fibroblast growth factor 2 (FGF2) and vascular endothelial growth factor A (VEGFA) genes, and epistatic interactions between them, with functional outcome in a sample of 546 stroke patients. RESULTS: While none of the tested genes was independently associated with stroke outcome, two significant gene-gene interaction models were identified. One model combined one BDNF and three FGF2 markers, with a global odds ratio (OR) (95% confidence interval [CI]) of 4.15 [2.86-6.04]. The second model included one FGF2 and two VEGFA markers with a global OR [95% CI] = 2.54 [1.76-3.67]. CONCLUSIONS: The results provide evidence for gene interactions in stroke outcome, highlighting the complexity of the recovery mechanisms after a stroke event.

The effects of impulsiveness and alcohol abuse on traffic code violations

This paper examines the contribution of the facets assessed by the I7 Impulsiveness Questionnaire (viz., impulsiveness, venturesomeness and empathy), and of alcohol abuse, to the prediction of traffic rule violations controlling for the effect of variables such as age and annual mileage. To this end, a study was conducted on a sample of 535 drivers aged 20-73 years and the results were examined separately by gender. Based on them, impulsiveness and venturesomeness account for a substantial proportion of traffic violations reported by males and females, even if the effects of other variables such as age or annual mileage are considered. By contrast, empathy is relevant only for male drivers. The results also reveal a strong relationship between alcohol abuse and Highway Code violations, which significantly increases the predictive ability of personality variables in both males and females. These results support the need to consider the drivers’ personality in the design of interventions for driving offenders, whereas programs which are focused only on road safety education may be insufficient. Results also evidence the need to highlight the role in the intervention of alcohol abuse and its relationship with driving behaviours (AU)

En este trabajo se analiza la contribución de las facetas evaluadas en el Cuestionario de Impulsividad I7 (impulsividad, afán de aventuras y empatía) y el abuso de alcohol en la predicción de las violaciones de las normas de tráfico, después de controlar variables como la edad o el número de kilómetros conducidos en el último año. para ello se ha realizado un estudio con una muestra de 535 conductores con edades comprendidas entre los 20 y los 73 años y se han analizado de forma separado los datos para hombres y mujeres. Los resultados mostraron que la impulsividad y el afán de aventuras contribuyen a explicar una parte significativa de las infracciones de tráfico informadas por hombres y mujeres aún después de controlar los efectos de otras variables com la edad o la cantidad de kilómetros conducidos al año. Sin embargo, la empatía sólo se mostró relevante en el caso de los varones. Los resultados también pusieron de manifiesto una alta relación del abuso del alcohol con la violación de las normas de tráfico, contribuyendo a incrementar de forma significativa la capacidad predictiva de las variables de personalidad tanto en hombres como en mujeres. Estos resultados apoyan la necesidad de considerar las características de personalidad de los conductores a la hora de diseñar las intervenciones dirigidas a infractores, mostrándose insuficientes los programas que se centran exclusivamente en la educación vial. Los resultados también evidencian la importancia que se le debe conceder al abuso de alcohol y su relación con el uso del vehículo en este ámbito de intervención (AU)

Values and antisocial behavior among Spanish adolescents.

A number of studies have indicated that delinquent adolescents have characteristic value systems. However, most of these studies have adopted a "known-groups" design--that is, they have compared institutionalized delinquents and non-institutionalized adolescents, assuming those adolescents to be non-delinquent. Designs of this type do not distinguish effectively between the statistical effects of delinquency and of institutionalization. In this study, the authors investigated relationships between values and self-reported antisocial behavior in three adolescent groups: 435 school-attending boys, 529 school-attending girls, and 95 delinquent boys in juvenile rehabilitation centers or prisons. The results indicate that antisocial behavior is associated with hedonistic values and a lack of interest in conventional values and social values. These relationships cannot be explained by the institutionalization effects.

[Mechanisms favoring and triggering atrial fibrillation]. / Mécanismes favorisant et déclenchant la fibrillation auriculaire.

Many experimental and clinical studies have demonstrated that it is possible to trigger atrial fibrillation (AF) by vagal stimulation which reduces and disperses the atrial refractory periods and decreases the threshold of fibrillation. In order to induce fibrillation, it is necessary to deliver a stimulation near to the refractory period. It has also been shown that, in these conditions, there is a delay in atrial conduction. A temporal relationship between the preceding diastole and the coupling interval increases atrial vulnerability and plays an equally important role. The decrease in the effective atrial refractory period, especially when the values are widely dispersed, and the delay in conduction predisposing to atrial reentry, may be considered to be the two most important electrophysiological mechanisms of AF. However, in order to maintain AF, the atrium must be dilated, especially when there is a concurrent cardiac disease. The presence of a shorter "wave length" of activation allowing multiple reentry circuits is an essential condition for sustaining AF. All conductions of induction and maintenance of AF may be observed without participation of S.N.A.. When no cause of AF (atrial pathology, etc.) is apparent, a short atrial refractory period with dispersion of its values and slowing of atrial conduction in presence of an extrastimulus are the probable inducing factors.

An open assessment of three different treatment regimens of itraconazole for the management of vaginal candidosis.

An assessment was carried out in 59 women with proven vaginal candidosis to compare the efficacy and tolerance of itraconazole used in three different treatment regimens. Patients were allocated at random to receive a single oral dose of 200 mg itraconazole for 1, 2 or 3 days. They were reassessed 1 week and 4 weeks after treatment for remission of clinical signs and symptoms and repeat mycological investigations. All three regimens yielded successful clinical results, global evaluation at 4 weeks showing complete remission in 100% (5/5), 81.5% (25/27) and 92.3% (24/26) of patients, respectively. One patient (on 2-day treatment) required alternative treatment before the 4-week assessment. Minor gastric side-effects were reported by a few patients on the 2-day and 3-day treatment regimens; these resolved spontaneously.