Effect of a nutritional intervention based on an energy-reduced Mediterranean diet on environmental impact.

OBJECTIVE: To estimate the environmental impact of a dietary intervention based on an energy-reduced Mediterranean diet (MedDiet) after one year of follow-up. METHODS: Baseline and 1-year follow-up data were used for 5800 participants aged 55-75 years with metabolic syndrome in the PREDIMED-Plus study. Food intake was estimated through a validated semiquantitative food consumption frequency questionnaire, and adherence to the MedDiet was estimated through the Diet Score. Using the EAT-Lancet Commission tables we assessed the influence of dietary intake on environmental impact (through five indicators: greenhouse gas emissions (GHG), land use, energy used, acidification and potential eutrophication). Using multivariable linear regression models, the association between the intervention and changes in each of the environmental factors was assessed. Mediation analyses were carried out to estimate to what extent changes in each of 2 components of the intervention, namely adherence to the MedDiet and caloric reduction, were responsible for the observed reductions in environmental impact. RESULTS: We observed a significant reduction in the intervention group compared to the control group in acidification levels (-13.3 vs. -9.9 g SO2-eq), eutrophication (-5.4 vs. -4.0 g PO4-eq) and land use (-2.7 vs. -1.8 m2). Adherence to the MedDiet partially mediated the association between intervention and reduction of acidification by 15 %, eutrophication by 10 % and land use by 10 %. Caloric reduction partially mediated the association with the same factors by 55 %, 51 % and 38 % respectively. In addition, adherence to the MedDiet fully mediated the association between intervention and reduction in GHG emissions by 56 % and energy use by 53 %. CONCLUSIONS: A nutritional intervention based on consumption of an energy-reduced MedDiet for one year was associated with an improvement in different environmental quality parameters.

Genetic Variant HLA-DRB1*0403 and Therapeutic Response to Disease-Modifying Therapies in Multiple Sclerosis: A Case-Control Study.

Multiple sclerosis (MS) is a chronic and demyelinating disease with an autoimmune origin, which leads to neurodegeneration and progressive disability. Approximately 30 to 50% of patients do not respond optimally to disease-modifying therapies (DMTs), and therapeutic response may be influenced by genetic factors such as genetic variants. Therefore, our study aimed to investigate the association of the HLA-DRB1*0403 genetic variant and therapeutic response to DMTs in MS. We included 105 patients with MS diagnosis. No evidence of disease activity based on the absence of clinical relapse, disability progression or radiological activity (NEDA-3) was used to classify the therapeutic response. Patients were classified as follows: (a) controls: patients who achieved NEDA-3; (b) cases: patients who did not achieve NEDA-3. DNA was extracted from peripheral blood leukocytes. HLA-DRB1*0403 genetic variant was analyzed by quantitative polymerase chain reaction (qPCR) using TaqMan probes. NEDA-3 was achieved in 86.7% of MS patients treated with DMTs. Genotype frequencies were GG 50.5%, GA 34.3%, and AA 15.2%. No differences were observed in the genetic variant AA between patients who achieved NEDA-3 versus patients who did not achieve NEDA-3 (48.7% vs. 43.1%, p = 0.6). We concluded that in Mexican patients with MS, HLA-DRB1*0403 was not associated with the therapeutic response to DMTs.

Toward sustainability and resilience in Chilean cities: Lessons and recommendations for air, water, and soil issues.

Achieving sustainability and resilience depends on the conciliation of environmental, social, and economic issues integrated into a long-term perspective to ensure communities flourish. Many nations are transitioning toward both objectives, while at the same time addressing structural concerns that have not allowed them to look after the environment in the past. Chile is one of these nations dealing with such challenges within a particular administrative context, an increasing environmental awareness, and a set of unique and complex geophysical boundaries that impose a plethora of hazards for cities, ecosystems, and human health. This paper presents recent accomplishments and gaps, mostly from an environmental perspective, on issues related to air pollution, the urban water cycle, and soil contamination, in the path being followed by Chile toward urban sustainability and resilience. The focus is on the bonds between cities and their geophysical context, as well as the relationships between environmental issues, the built environment, and public health. The description and diagnosis are illustrated using two cities as case studies, Temuco and Copiapó, whose socioeconomic, geographical, and environmental attributes differ considerably. Particulate matter pollution produced by the residential sector, drinking water availability, wastewater treatment, stormwater management, and soil contamination from the mining industry are discussed for these cities. Overall, the case studies highlight how tackling these issues requires coordinated actions in multiple areas, including regulatory, information, and financial incentive measures. Finally, the policy analysis discusses frameworks and opportunities for Chilean cities, which may be of interest when conceiving transitional paths toward sustainability and resilience for other cities elsewhere.

Perchlorate and chlorate assessment in drinking water in northern Chilean cities.

Perchlorate and chlorate are endocrine disruptors considered emerging contaminants (ECs). Both oxyanions are commonly associated with anthropogenic contamination from fertilizers, pesticides, explosives, and disinfection byproducts. However, the soils of the Atacama Desert are the most extensive natural reservoirs of perchlorate in the world, compromising drinking water sources in northern Chile. Field campaigns were carried (2014-2018) to assess the presence of these ECs in the water supply networks of twelve Chilean cities. Additionally, the occurrence of perchlorate, chlorate and other anions typically observed in drinking water matrices of the Atacama Desert (i.e., nitrate, chloride, sulfate) was evaluated using a Spearman correlation analysis to determine predictors for perchlorate and chlorate. High concentrations of perchlorate (up to 114.48 µg L-1) and chlorate (up to 9650 µg L-1) were found in three northern cities. Spatial heterogeneities were observed in the physicochemical properties and anion concentrations of the water supply network. Spearman correlation analysis indicated that nitrate, chloride, and sulfate were not useful predictors for the presence of perchlorate and chlorate in drinking water in Chile. Hence, this study highlights the need to establish systematic monitoring, regulation, and treatment for these EC of drinking water sources in northern Chilean cities for public health protection.

Influence of the Osteogenomic Profile in Response to Alendronate Therapy in Postmenopausal Women with Osteoporosis: A Retrospective Cohort Study.

BACKGROUND: Postmenopausal osteoporosis is a multifactorial disease. Genetic factors play an essential role in contributing to bone mineral density (BMD) variability, which ranges from 60 to 85%. Alendronate is used as the first line of pharmacological treatment for osteoporosis; however, some patients do not respond adequately to therapy with alendronate. AIM: The aim of this work was to investigate the influence of combinations of potential risk alleles (genetic profiles) associated with response to anti-osteoporotic treatment in postmenopausal women with primary osteoporosis. METHODS: A total of 82 postmenopausal women with primary osteoporosis receiving alendronate (70 mg administered orally per week) for one year were observed. The bone mineral density (BMD; g/cm2) of the femoral neck and lumbar spine was measured. According to BMD change, patients were divided into two groups: responders and non-responders to alendronate therapy. Polymorphic variants in CYP19, ESR1, IL-6, PTHR1, TGFß, OPG and RANKL genes were determined and profiles were generated from the combination of risk alleles. RESULTS: A total of 56 subjects were responders to alendronate and 26 subjects were non-responders. Carriers of the G-C-G-C profile (constructed from rs700518, rs1800795, rs2073618 and rs3102735) were predisposed to response to alendronate treatment (p = 0.001). CONCLUSIONS: Our findings highlight the importance of the identified profiles for the pharmacogenetics of alendronate therapy in osteoporosis.

Challenges and opportunities for drinking water treatment residuals (DWTRs) in metal-rich areas: an integrated approach.

The physicochemistry and production rate of drinking water treatment residuals (DWTRs) depends on the raw water composition and the plant operational parameters. DWTRs usually contain Fe and/or Al oxyhydroxides, sand, clay, organic matter, and other compounds such as metal(oids), which are relevant in mining countries. This work proposes a simple approach to identify DWTRs reuse opportunities and threats, relevant for public policies in countries with diverse geochemical conditions. Raw water pollution indexes and compositions of DWTRs were estimated for Chile as a model case. About 23% of the raw drinking water sources had moderate or seriously contamination from high turbidity and metal(loid) pollution If the untapped reactivity of clean DWRTs was used to treat resources water in the same water company, the 73 and 64% of these companies would be able to treat water sources with As and Cu above the drinking water regulations, respectively. Integrating plant operational data and the hydrochemical characteristics of raw waters allows the prediction of DWTRs production, chemical composition, and reactivity, which is necessary to identify challenges and opportunities for DWTRs management.

Percepción de las vías del parto de mujeres en edad reproductiva: una revisión de la literatura / Perception regarding the delivery routes of women in reproductive age: a literature review

OBJETIVO: Explorar la percepción de mujeres en edad reproductiva con respecto a las vías del parto reportada en la evidencia disponible. MÉTODO: Se llevó a cabo una revisión sistematizada de artículos en las bases de datos PubMed, SciELO, SCOPUS, Web of Science, LILACS, Cochrane Library y Biblioteca Virtual de Salud. La búsqueda se realizó entre agosto y noviembre del año 2020. Los términos MeSH usados fueron "Perception", "Delivery Obstetric", "Cesarean Section" y "Woman", junto con los términos DECS "Percepción", "Parto Obstétrico", "Cesárea" y "Mujeres". Además, se utilizaron los términos libres "Perceptions", "Vaginal Delivery", "Obstetric Deliveries", "Abdominal Deliveries", "Caesarean Section" y "Womens Groups". En la totalidad de las bases de datos utilizadas se aplicaron como límites de búsqueda "Last 5 Years" y "Free Full Text". RESULTADOS: Respecto a la percepción de las vías de parto, se constató la preferencia de la vía vaginal sobre la cesárea. Además, se evidenciaron factores que influyen en el proceso, tales como miedo, experiencia previa, influencia de terceros, religión, cultura, nivel socioeconómico y zona demográfica. CONCLUSIONES: La evidencia revisada sugiere que las mujeres prefieren la vía del parto vaginal sobre la cesárea, siendo el miedo el factor más influyente al momento de su elección, seguido por los factores asociados a experiencias previas, el nivel socioeconómico y las creencias.

OBJECTIVE: To explore the perception of women of reproductive age regarding delivery routes reported in the available evidence. METHOD: A systematized review of articles in PubMed, SciELO, SCOPUS, Web of Science, LILACS, Cochrane Library, Biblioteca Virtual de Salud databases, was carried out. The search was conducted between August and November 2020. MeSH descriptors "Perception", "Delivery Obstetric", "Cesarean Section" and "Woman", along with DECS descriptors "Percepciones", "Parto Obstétrico", "Cesárea" and "Mujeres", were used. Also, free terms "Perceptions", "Vaginal Delivery", "Obstetric Deliveries", "Abdominal Deliveries", "Caesarean Section" and "Womens Groups". In the totality of databases limits of search "Last 5 years" and "Free Full Text", were used. RESULTS: Regarding the perception of the delivery routes, the preference of the vaginal route over caesarean section was verified. In addition, factors that influence the process such as fear, previous experience, influence of third parties, religion, culture, socioeconomic level and demographic area were evidenced. CONCLUSIONS: The reviewed evidence suggests that women prefer the vaginal delivery route over caesarean section with fear being the most influential factor at the time of their choice, and secondly, the factors associated with previous experiences, socioeconomic level and beliefs.

Over-the-counter access to levonorgestrel emergency contraception in South Texas: Does Over-the-counter mean ready to buy?

OBJECTIVE: To determine the percentage of pharmacies in Hidalgo County, Texas, with unrestricted over-the-counter access to levonorgestrel emergency contraceptive pills (ECPs). Unrestricted over-the-counter access means product is available directly to consumer on store shelf, in-stock the day of data collection, and with no security barriers present (such as locked cabinet or individual locked product container), and to compare this access to that of other reproductive health items. STUDY DESIGN: We conducted in-person secret shopper surveys from October 2018 to March 2019, recording in-stock over-the-counter availability of levonorgestrel ECPs, security barriers, and price. We collected the same information for condom multipacks, ovulation prediction test kits, and pregnancy tests. RESULTS: Out of the 76 pharmacies surveyed, 31 (40.8%) sold levonorgestrel ECPs over-the-counter, 23 (30.3%) had product in-stock over-the-counter and two (2.6%) had unrestricted over-the-counter access. Other reproductive health items such as condom multipacks, ovulation prediction test kits and pregnancy tests had unrestricted over-the-counter access in at least 33 (43.4%, p < 0.01) pharmacies. Of the chain pharmacies, 30 (73.2%) sold levonorgestrel ECPs over-the-counter with and without security barriers, while only one (2.9%) of the 35 independent pharmacies sold levonorgestrel ECPs over-the-counter with security barriers (p < 0.001). CONCLUSIONS: While previous research has noted high prevalence of levonorgestrel ECP availability in pharmacies, potential purchasers of over-the-counter levonorgestrel ECPs encounter access barriers not associated with other reproductive health products. These additional access barriers to levonorgestrel ECPs may increase consumer discomfort, decrease privacy, and delay access. IMPLICATIONS: Advocacy efforts may be needed to promote unrestricted access to over-the-counter emergency contraceptives on par with other reproductive health items.

Chlorpyrifos induces cell proliferation in MCF-7 and MDA-MB-231 cells, through cholinergic and Wnt/ß-catenin signaling disruption, AChE-R upregulation and oxidative stress generation after single and repeated treatment.

Chlorpyrifos (CPF) biocide, is associated with breast cancer. The processes underlying this association have not been elucidated to date. CPF increases MCF-7 and MDA-MB-231 cell proliferation after acute and long-term treatment, partially through KIAA1363 overexpression and aryl-hydrocarbon receptor activation but also through estrogen receptor-alpha activation after 24 h exposure in MCF-7 cells, suggesting other mechanisms may be involved. CPF induces reactive oxygen species (ROS) generation, acetylcholine accumulation, and overexpression of acetylcholinesterase-R/S (AChE-R/S) variants, while it also alters the Wnt/ß-catenin pathway, both in vitro and in vivo, in processes different from cancer. These latter mechanisms are also linked to cell proliferation and could mediate this effect induced by CPF. Our results show that CPF (0.01-100 µM), following one-day and fourteen-days treatment, respectively, induced ROS generation and lipid peroxidation, and acetylcholine accumulation due to AChE inhibition, Wnt/ß-catenin up- or downregulation depending on the CPF treatment concentration, and AChE-R and AChE-S overexpression, with the latter being mediated through GSK-3ß activity alteration. Finally, CPF promoted cell division through ACh and ROS accumulation, AChE-R overexpression, and Wnt/ß-catenin signaling disruption. Our results provide novel information on the effect of CPF on human breast cancer cell lines that may help to explain its involvement in breast cancer.

Genotypic Analyses of the Sclerostin rs851056 and Dickkopf rs1569198 Polymorphisms in Mexican-Mestizo Postmenopausal Osteoporosis: A Case-Control Study.

Background: The Wnt/ß catenin pathway promotes bone mineralization stimulating proliferation, differentiation, and survival of osteoblasts; it also inhibits osteoclast differentiation and osteocyte activity. Sclerostin (SOST) and Dickkopf 1 (DKK1) are Wnt/ß catenin pathway inhibitors. Genetic variability in the expression of SOST and DKK1 might be involved in the development of postmenopausal osteoporosis (OP). Aim: To determine whether the SOST rs851056 and DKK1 rs1569198 polymorphisms are associated with OP in Mexican-Mestizo postmenopausal women. Materials and Methods: Two hundred and eighty Mexican-Mestizo postmenopausal women were assessed for their bone mineral density by dual-energy X-ray absorptiometry (DXA). Patients were classified as OP or non-OP. Genomic DNA was extracted from peripheral blood leukocytes. Genetic polymorphisms were analyzed by quantitative polymerase chain reaction using TaqMan probes. Results: The frequency of OP was 40% among the study population. Osteoporotic patients were older (p < 0.001), had a higher frequency of smoking (p = 0.01), and lower body mass index (p < 0.001) compared with the non-osteoporotic patients. The genotypic frequencies of the rs851056 locus of the SOST gene were GG 19%, GC 45%, and CC 35%, whereas the genotypic frequencies of the rs1569198 locus of the DKK1 gene were GG 15%, GA 40%, and AA 44%. In relation to rs851056 locus of the SOST gene, no differences were observed between the OP and non-OP cohorts in the frequencies of the GC polymorphism (48.7% vs. 43.1%). Similarly, analyses of the DKK1 rs1569198 does not demonstrate differences in the GA genotypic frequencies between the OP and non-OP cohorts (42.5% vs. 38.9%). Conclusion: Polymorphisms SOST rs851056 and DKK1 rs1569198 polymorphisms are not associated with OP in Mexican-Mestizo postmenopausal women.

An integrated study of health, environmental and socioeconomic indicators in a mining-impacted community exposed to metal enrichment.

The occurrence of toxic metals and metalloids associated with mine tailings is a serious public health concern for communities living in mining areas. This work explores the relationship between metal occurrence (e.g., spatial distribution in street dusts), human health indicators (e.g., metals in urine samples, lifestyle and self-reported diseases) and socioeconomic status (SES) using Chañaral city (in northern Chile) as study site, where a copper mine tailing was disposed in the periurban area. This study model may shed light on the development of environmental and health surveillance plans on arid cities where legacy mining is a sustainability challenge. High concentrations of metals were found in street dust, with arsenic and copper concentrations of 24 ± 13 and 607 ± 911 mg/kg, respectively. The arsenic concentration in street dust correlated with distance to the mine tailing (r = - 0.32, p-value = 0.009), suggesting that arsenic is dispersed from this source toward the city. Despite these high environmental concentrations, urinary levels of metals were low, while 90% of the population had concentrations of inorganic arsenic and its metabolites in urine below 33.2 µg/L, copper was detected in few urine samples (< 6%). Our results detected statistically significant differences in environmental exposures across SES, but, surprisingly, there was no significant correlation between urinary levels of metals and SES. Despite this, future assessment and control strategies in follow-up research or surveillance programs should consider environmental and urinary concentrations and SES as indicators of environmental exposure to metals in mining communities.

Caracterización de pacientes con aislamiento de Klebsiella productora de carbapenemasa en un hospital pediátrico de tercer nivel de Bogotá, Colombia / Characterisation of patients with carbapenemase- producing Klebsiella isolates in a third-level paediatric hospital in Bogota, Colombia

Objetivo: Describir las características clínicas de pacientes pediátricos con aislamiento de Klebsiella productora de carbapenemasa. Materiales y métodos: Entre 2012 y 2015 se realizó un estudio descriptivo que incluyó a pacientes de 0-18 años (media 4,8 años), todos con aislamientos de Klebsiella productora de carbapenemasa. Resultados: Se documentó infección en 21 pacientes; el 81% tenía antecedente de hospitalización en los 6 meses previos y el 67% de antibioticoterapia. Los sitios de aislamiento fueron sangre (48%), orina (33%), líquido pleural (9%), líquido peritoneal y tráquea (5%). El 95% de los pacientes tenía comorbilidad asociada; el 81% de los aislamientos correspondió a infecciones nosocomiales. Los servicios de hospitalización fueron UCIP 43%, Pediatría General 29%, Oncología, Unidad Neonatal y Urgencias 9,5% cada uno. El 81% de los aislamientos presentó corresistencia a otros antimicrobianos. El tratamiento definitivo se realizó con monoterapia en un 19%, terapia doble en un 28,5% y terapia triple en un 23,8%. La mortalidad fue del 24%.

Objective: To describe the clinical characteristics of paediatric patients with carbapenemase-producing Klebsiella isolates. Material and methods: Between 2012 and 2015, we conducted a descriptive study that included patients aged 0-18 years (mean 4.8 years), all with Klebsiella carbapenemase-producing isolates. Results: The infection was documented in 21 patients, 81% of the patients had a history of hospitalisation in the last 6 months and 67% had undergone antibiotic therapy. The isolation sites were blood (48%), urine (33%), pleural fluid (9%), peritoneal liquid and trachea (5). Ninety-five percent of the patients had associated comorbidity; 81% of the isolates corresponded to nosocomial infections. The hospital departments were the paediatric intensive care unit (43%), general paediatrics (29%), oncology, neonatal unit and emergency department (9.5% each). Eighty-one percent of the isolates had co-resistance to other antimicrobials. Definitive treatment was performed with monotherapy in 19% of the cases, double therapy in 28.5% and triple therapy in 23.8%. The mortality rate was 24%.

Active and legacy mining in an arid urban environment: challenges and perspectives for Copiapó, Northern Chile.

Urban expansion in areas of active and legacy mining imposes a sustainability challenge, especially in arid environments where cities compete for resources with agriculture and industry. The city of Copiapó, with 150,000 inhabitants in the Atacama Desert, reflects this challenge. More than 30 abandoned tailings from legacy mining are scattered throughout its urban and peri-urban area, which include an active copper smelter. Despite the public concern generated by the mining-related pollution, no geochemical information is currently available for Copiapó, particularly for metal concentration in environmental solid phases. A geochemical screening of soils (n = 42), street dusts (n = 71) and tailings (n = 68) was conducted in November 2014 and April 2015. Organic matter, pH and elemental composition measurements were taken. Notably, copper in soils (60-2120 mg/kg) and street dusts (110-10,200 mg/kg) consistently exceeded international guidelines for residential and industrial use, while a lower proportion of samples exceeded international guidelines for arsenic, zinc and lead. Metal enrichment occurred in residential, industrial and agricultural areas near tailings and the copper smelter. This first screening of metal contamination sets the basis for future risk assessments toward defining knowledge-based policies and urban planning. Challenges include developing: (1) adequate intervention guideline values; (2) appropriate geochemical background levels for key metals; (3) urban planning that considers contaminated areas; (4) cost-effective control strategies for abandoned tailings in water-scarce areas; and (5) scenarios and technologies for tailings reprocessing. Assessing urban geochemical risks is a critical endeavor for areas where extreme events triggered by climate change are likely, as the mud flooding that impacted Copiapó in late March 2015.