Valuing mortality attributable to present and future temperature extremes in Argentina.

This study analyzes the weather-related health damage of present and future extreme temperatures in Argentina. Focusing on mortality, short-term impacts of temperature are obtained by regressing monthly mortality rates on inter-annual monthly weather variability. For this purpose, a countrywide panel dataset at the municipal level was constructed from the universe of deaths between 2010 and 2019, and daily meteorological records from the ERA5 weather dataset. Then, NASA Earth Exchange Global Daily Downscaled Projections (NEX-GDDP) are used to project future mortality by 2085 under two climate scenarios. Finally, present and future mortality-related economic damages are assessed using the Value of a Statistical Life. The results show that one additional day of extreme temperatures increase all-cause mortality rates relative to mild weather and that the impact of hotter-than-average temperatures is greater in magnitude than that of colder ones. Substantial heterogeneity exists between causes of death and age groups, with older people facing greater risks, while the results for gender are inconclusive. All days of extreme cold in a year generate damage equivalent to 0.64% of GDP, while heat damage is 0.11% of GDP. The total damage by extreme temperatures adds up to 0.75% of the 2019 GDP. When future temperatures are valued, the total damage increases by an additional 1.45% under scenario RCP8.5 because the lower mortality occurring on cold days only partially offsets the increase in the number of hot days. On the contrary, if temperature changes were to be mild (i.e., under scenario RCP4.5), overall mortality would be lower at the national level and the corresponding damages would decrease by 0.02%.

Physical Activity and Sitting Time Patterns and Sociodemographic Correlates Among 155,790 South American Adults.

BACKGROUND: To estimate the prevalence of different physical activity (PA) domains and sitting time (ST), and to analyze the association with sociodemographic indicators. METHODS: Data from the most recent nationally representative survey from each of the South American countries, comprising 155,790 adults (18-64 y), were used. Data on leisure-time, transport, and occupational PA (all 3 domains as nonzero), total PA (≥150 min/wk), and ST (≥8 h/d) were assessed by specific questionnaires in each survey. Gender, age group (18-34, 35-49, and 50-64 y), and education (quintiles) were used as sociodemographic factors. Random effect meta-analysis of the association between sociodemographic factors and PA and ST were conducted. RESULTS: The prevalence of PA guidelines compliance and elevated ST in South America was 70.3% and 14.1%, respectively. Women were less likely to achieve the recommended levels of total and domain-based PA. Participants in the highest quintile of education were more likely for elevated ST (2.80, 2.08-3.77), lower occupational PA (0.65, 0.44-0.95), but higher leisure-time PA (3.13, 2.31-4.27), in comparison with lowest quintile. Older adults were less likely to participate in total and leisure-time PA. CONCLUSION: Our findings highlight the urge to tackle the inequalities in PA practice in South America, especially gender and education inequalities, for leisure-time PA.

Perfusion of the proximal scaphoid pole: correlation between preoperative ge-MRI and intraoperative findings.

BACKGROUND: Gadolinium enhanced MRI (ge-MRI) is considered as gold standard for perfusion evaluation in case of scaphoid nonunion (SNU). However, its clinical value and specificity is still not clearly evaluated. This study compares preoperative ge-MRI-based perfusion assessment and intraoperative proximal pole (PP) perfusion after scaphoid reconstruction by vascularized bone grafts. In addition, the postoperative osseous consolidation (OC) was correlated to intraoperative perfusion findings. METHODS: Between 08/2010 and 01/2020, 60 of 271 patients with scaphoid nonunion received a vascularized radius bone graft for reconstruction. Medical reports were checked for intra-op perfusion findings. Consolidation rate was assessed at mean follow-up of 3 months by CT evaluation. In 50 cases (83.2%), complete medical and radiological history could be obtained. Preoperative ge-MRI was reevaluated by a blinded radiologist for advanced analysis of sensitivity and specificity. RESULTS: Preoperative ge-MRI (initial finding, IF) showed 23 avascular, 20 malperfused, and seven vital PP. Blinded radiological follow-up (second finding, SF) revealed 14 avascular, 28 malperfused, and 8 vital PP, with a concordance of 65.3% (n = 35). After correlation with the intra-op findings, a specificity of preoperative ge-MRI of 76.5% (IF) and 88.2 (SF), respectively, was revealed for exclusion of avitality. For detection of malperfusion, there was a sensitivity of 92.7% (IF) and 85.4% (SF), respectively. Complete OC was seen 12 weeks postoperatively in 37 (73.5%), partial OC in 9 (18.3%), and nonunion in 4 cases (8.2%) on CT-scans. Of the 41 malperfused/avascular PP, 31 (75.6%) progressed to complete and 6 (14.6%) to partial (at least 2 adjacent CT-layers of 2 mm) OC, with 4 nonunions. CONCLUSION: The sensitivity and specificity of ge-MRI for detection/ exclusion of malperfusion/avitality of the PP was lower than expected. Therewith, the intraoperative assessment of PP perfusion regains a high value in decision-making for the appropriate graft. We recommend preservation of the dorsal radial vascular plexus initially until the vascularity of the proximal pole has been estimated. Patient education for all contingencies and retraction options should be obtained.

Contemporary and dynamic effects of socio-economic factors on physical (in)activity: Does intensity matter?

Objective: This paper identifies varying contemporary and dynamic effects of socio-economic factors on individuals' decisions to allocate their time to physical activities when the intensity of these activities comes into play. Methods: Based on repeated cross-sectional data sourced from the Argentinean National Risk Factor Surveys of 2005, 2009, and 2013, we developed 18 fictitious cohorts to set up a pseudo panel. To address endogeneity problems, four econometric specifications were estimated: OLS, Heckman two-stage model, fixed- and random-effects models. Results: We find that changes in the opportunity cost of time are highly significant and provide shifts in individuals' decisions regarding the allocation of their time to physical activity consumption. When considering the intensity at which physical activities are consumed, increased income impacts less, suggesting that individuals faced with a wage increase reduce the time of consumption but increase its intensity. An interesting finding is that employed people consume more physical activity than inactive individuals. This indicates that the substitution effect produced by an increase in the wage rate is less than the income effect. Additionally, the increase in the coefficient of employed persons is greater when the intensity factor is considered, indicating that for employed individuals a trade-off between time and intensity is generated. We also found that higher levels of education increase the probability of participating in physical activities, but decrease the time spent in such activities. Furthermore, there are heterogeneous impacts on physical activity consumption between males and females, which can be observed in the strong effect of household production for women with at least one child. Finally, such impacts remain in a variety of estimated specifications. Conclusions: These results may be useful in order to suggest some tools for the design of interventions that are aimed at increasing participation in physical activities.

Time trends and inequalities of physical activity domains and sitting time in South America.

Background: We aimed to investigate time trends and inequalities of different physical activity (PA) domains and sitting time (ST) in adults from South American countries. Methods: We included cross-sectional data of nationally representative surveys on adults (n = 597 843) from nine South American countries (Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Peru, Uruguay, and Venezuela), with data collection time frames ranging from 2005 to 2020. Data on different PA domains (leisure-time, transport, and occupational) and ST were assessed through questionnaires. Trends according to education level (quintiles), gender (m/w), and age group (18-34 years, 35-49 years, 50-64 years) were estimated for the harmonized indicators of nonzero PA in the different domains, ≥150 min/week of total PA and ≥8 hours/d of ST. Results: Chile (2009/2010 = 78.9% vs 2016/2017 = 70.5%), and Peru (2009/2010 = 78.6% vs 2011 = 69.6%) reduced total PA, while Brazil (2013 = 57.3% vs 2019 = 67.0%) and Uruguay (2006 = 69.4% vs 2013 = 79.4%) increased, and Argentina and Venezuela maintained. There was an increasing trend for ST in Argentina, Peru, and Uruguay. Leisure-time PA increased in most countries (6/8 countries). Transport PA was relatively stable, while occupational PA presented mixed findings. Education inequalities increased over time for total and leisure-time PA, while age and gender inequalities were relatively constant. Conclusions: Future South American countries' efforts may be warranted to promote PA and reduce ST in adults, while addressing inequalities when implementing actions.

Temporal and Spatial Trends From Counterfactual Scenarios of Physical Activity on Mortality, Years of Life Lost, and Life Expectancy Due to Noncommunicable Diseases in Argentina.

BACKGROUND: This study estimates the spatial distribution and trends in preventable deaths, years of life lost (YLL), and life expectancy (LE), associated with noncommunicable diseases under alternative distributions of physical activity in Argentina. METHODS: Potential impact fractions were used to calculate the preventable deaths and YLL attributable to various scenarios of physical activity. Cause-eliminated life tables were used to estimate LE gains, and Monte Carlo simulations were performed for uncertainty analysis. RESULTS: From 2005 to 2018, physical activity could have prevented up to 7544 to 8220 potential deaths (≈4.27% of major noncommunicable diseases and ≈2.66% of all causes) and about 221 to 219 YLL per 100,000 inhabitants; between 0.67 and 0.71 years of LE could have been gained. If the World Health Organization recommendations (at least 600 metabolic equivalent tasks minutes per week) had been achieved, between 2813 and 3111 potential deaths could have been prevented, about 80 fewer years of life (per 100,000 inhabitants) would have been lost, and 0.23 years of LE could have been gained. A 15% reduction in insufficient physical activity has shown a small impact on outcomes. CONCLUSION: Public health initiatives aimed at increasing population-wide physical activity could reduce noncommunicable disease deaths in Argentina.