Spatial distribution of pesticides in surface water of the Estacas stream (Argentine Espinal region) associated with crop production.

The Espinal region (Entre Ríos, Argentina) has suffered land use changes caused by expansion of the agricultural frontier. This expansion has led to an increased use of pesticides. This study is aimed at better understanding the spatial distribution of pesticides in surface water of the Estacas stream, a representative basin of the Espinal region, associated with crop production. The location and proportion of area with soybean, maize, and wheat crops in each catchment area of the basin were estimated, and surface water samples were taken to perform a pesticide screening during a period of one year. Soybean represented approximately 71% of the total cultivated area of the basin, whereas maize and wheat accounted for 15% and 14%, respectively. The analysis of 125 analytes showed the presence of 19 pesticides. The pesticide load maps showed that atrazine was detected in an area of relatively low catchment compared to other pesticides as glyphosate, which is applied in all the agricultural fields of the basin. The load of metolachlor and S-metolachlor covered a large area of the basin. The highest recorded concentrations of these pesticides were 86 µg L-1 of atrazine, 24 µg L-1 of metolachlor, 19 µg L-1 of glyphosate, and 15 µg L-1 of S-metolachlor. The results allow better understanding the environmental distribution of pesticides associated with pest control in the crops of the basin studied, the doses and times of application, and the variation in the rainfall in the basin. This study provides relevant information about how aquatic ecosystems in agricultural basins receive the diffuse contribution of pesticides, representing potential sources of water pollution. Also, the results allow supporting the design of agricultural practices and politics to improve land-use planning for the development of sustainable basins.

The Association of Shared Care Networks With 30-Day Heart Failure Excessive Hospital Readmissions: Longitudinal Observational Study.

BACKGROUND: Higher-than-expected heart failure (HF) readmissions affect half of US hospitals every year. The Hospital Reduction Readmission Program has reduced risk-adjusted readmissions, but it has also produced unintended consequences. Shared care models have been advocated for HF care, but the association of shared care networks with HF readmissions has never been investigated. OBJECTIVE: This study aims to evaluate the association of shared care networks with 30-day HF excessive readmission rates using a longitudinal observational study. METHODS: We curated publicly available data on hospital discharges and HF excessive readmission ratios from hospitals in California between 2012 and 2017. Shared care areas were delineated as data-driven units of care coordination emerging from discharge networks. The localization index, the proportion of patients who reside in the same shared care area in which they are admitted, was calculated by year. Generalized estimating equations were used to evaluate the association between the localization index and the excessive readmission ratio of hospitals controlling for race/ethnicity and socioeconomic factors. RESULTS: A total of 300 hospitals in California in a 6-year period were included. The HF excessive readmission ratio was negatively associated with the adjusted localization index (ß=-.0474, 95% CI -0.082 to -0.013). The percentage of Black residents within the shared care areas was the only statistically significant covariate (ß=.4128, 95% CI 0.302 to 0.524). CONCLUSIONS: Higher-than-expected HF readmissions were associated with shared care networks. Control mechanisms such as the Hospital Reduction Readmission Program may need to characterize and reward shared care to guide hospitals toward a more organized HF care system.

Pesquisa activa de los alumnos de las Ciencias Médicas en prevención de la COVID-19 / Active research of students of Medical Sciences in prevention of COVID-19

RESUMEN Fundamento: la pesquisa activa en los alumnos de las Ciencias Médicas constituye unas de las fortalezas de la Educación Médica Superior en Cuba implementadas desde la Atención Primaria de Salud para la identificación de los factores de riesgo y lograr salud en la comunidad. Objetivo: caracterizar la pesquisa activa de los alumnos de las Ciencias Médicas en prevención del COVID-19 en un área de salud. Métodos: se realizó un estudio descriptivo trasversal en el área de salud del Policlínico Docente Francisco Peña Peña del municipio de Nuevitas en la provincia Camagüey desde abril a mayo de 2020. El universo se conformó por los 142 estudiantes de Medicina, Estomatología, Enfermería y Tecnologías de la Salud a participar en la pesquisa activa. Resultados: se determinó la carrera de Medicina como la más representativa en la participación de los alumnos en la pesquisa, se identificaron por los estudiantes 115 personas con sintomatología respiratoria, de ellos existió un discreto predominio del sexo femenino y predominó el grupo de edad de 41-60 años, el mayor porcentaje de la población mostró un nivel de muy satisfecho con la labor realizada por los galenos universitarios. Conclusiones: los estudiantes de la carrera de Medicina fueron los de mayor participación en las labores de pesquisa activa, el tema de vías de transmisión para el control del virus fue de los que más conocimiento tenían los galenos, identificaron síntomas respiratorios en las féminas, entre la cuarta y sexta década de vida, casi la totalidad de la población pesquisada manifestó un nivel muy satisfecho en relación al desempeño de los estudiantes durante las labores preventivas de pesquisa activa.

ABSTRACT Background: active research in students of Medical Sciences constitutes one of the strengths of Medical Higher Education in Cuba implemented from Primary Health Care to identify risk factors and achieve health in the community. Objective: to characterize the active research of students of Medical Sciences in COVID-19 prevention in a health area. Methods: a cross-sectional descriptive study was carried out in the health area of ​​the Francisco Peña Peña Teaching Polyclinic of Nuevitas in the period from April to May 2020. The universe was formed by the 142 students of medicine, dentistry, nursing and technological careers to participate in active research. Results: the most representative medical degree in the participation of Medical Sciences students in the research was determined, 115 people with respiratory symptoms were identified by the students, of them there was a discrete predominance of the female sex and the group of the age of 41-60 years, the highest percentage of the population showed a level of very satisfied with the work carried out by students of the University of Medical Science. Conclusions: the medical career was the one with the highest participation in active research tasks, the issue of transmission routes for virus control was one of which the doctors knew the most, respiratory symptoms were identified in females, among the fourth and the sixth decade of life, almost the entire population surveyed showed a very satisfied level in relation to the performance of the students during the preventive work of active research.

Geographic access to COVID-19 healthcare in Brazil using a balanced float catchment area approach.

The rapid spread of COVID-19 across the world has raised concerns about the responsiveness of cities and healthcare systems during pandemics. Recent studies try to model how the number of COVID-19 infections will likely grow and impact the demand for hospitalization services at national and regional levels. However, less attention has been paid to the geographic access to COVID-19 healthcare services and to hospitals' response capacity at the local level, particularly in urban areas in the Global South. This paper shows how transport accessibility analysis can provide actionable information to help improve healthcare coverage and responsiveness. It analyzes accessibility to COVID-19 healthcare at high spatial resolution in the 20 largest cities of Brazil. Using network-distance metrics, we estimate the vulnerable population living in areas with poor access to healthcare facilities that could either screen or hospitalize COVID-19 patients. We then use a new balanced floating catchment area (BFCA) indicator to estimate spatial, income, and racial inequalities in access to hospitals with intensive care unit (ICU) beds and mechanical ventilators while taking into account congestion effects. Based on this analysis, we identify substantial social and spatial inequalities in access to health services during the pandemic. The availability of ICU equipment varies considerably between cities, and it is substantially lower among black and poor communities. The study maps territorial inequalities in healthcare access and reflects on different policy lessons that can be learned for other countries based on the Brazilian case.

Cross-border spatial accessibility of health care in the North-East Department of Haiti.

BACKGROUND: The geographical accessibility of health services is an important issue especially in developing countries and even more for those sharing a border as for Haiti and the Dominican Republic. During the last 2 decades, numerous studies have explored the potential spatial access to health services within a whole country or metropolitan area. However, the impacts of the border on the access to health resources between two countries have been less explored. The aim of this paper is to measure the impact of the border on the accessibility to health services for Haitian people living close to the Haitian-Dominican border. METHODS: To do this, the widely employed enhanced two-step floating catchment area (E2SFCA) method is applied. Four scenarios simulate different levels of openness of the border. Statistical analysis are conducted to assess the differences and variation in the E2SFCA results. A linear regression model is also used to predict the accessibility to health care services according to the mentioned scenarios. RESULTS: The results show that the health professional-to-population accessibility ratio is higher for the Haitian side when the border is open than when it is closed, suggesting an important border impact on Haitians' access to health care resources. On the other hand, when the border is closed, the potential accessibility for health services is higher for the Dominicans. CONCLUSION: The openness of the border has a great impact on the spatial accessibility to health care for the population living next to the border and those living nearby a road network in good conditions. Those findings therefore point to the need for effective and efficient trans-border cooperation between health authorities and health facilities. Future research is necessary to explore the determinants of cross-border health care and offers an insight on the spatial revealed access which could lead to a better understanding of the patients' behavior.

Estudio comparativo de la incidencia de diabetes mellitus en dos áreas de salud / Comparative study of the incidence of diabetes mellitus in two health areas

Fundamento: La diabetes mellitus aumenta exponencialmente su prevalencia a nivel mundial y es causa de una elevada morbilidad por sus complicaciones. Objetivo: Conocer la incidencia de diabetes mellitus bajo los conceptos actuales internacionales en dos áreas de salud. Método: Se realizó un estudio transversal, cuantitativo y de campo donde se aplicaron los criterios de la Organización Mundial de la Salud para el pesquizaje de diabetes mellitus en dos grupos básicos de trabajo de los policlínicos comunitarios «Ignacio Agramonte¼ y «Rodolfo Ramírez Esquivel¼ desde el 1 de enero de 2003 hasta el 1 de enero del 2005. El universo estuvo constituido por toda la población del Grupo de Trabajo 2 del policlínico «Ignacio Agramonte¼ y del Grupo 1 del policlínico «Rodolfo Ramírez Esquivel¼ que cumplieran con los criterios de la Organización Mundial de la Salud para el pesquizaje de diabetes mellitus. La fuente de información se obtuvo del estado de la situación de salud. Se utilizó la glucemia plasmática en ayunas (GPA como piedra angular del diagnóstico). Se determinó estadística descriptiva, distribución de por ciento y tasa de incidencia. Resultados: Se reportó un incremento en la tasa de incidencia de 465.5 por cien mil personas a 1687 por cien mil personas, aumentando el porcentaje de incidencia de 0.5 % a 1.7 % el cual fue 3.4 veces superior al existente en el Policlínico «Ignacio Agramonte¼. En el policlínico «Rodolfo Ramírez Esquivel¼ hubo una variación de 244 a 2400 por cien mil personas y en el por ciento de incidencia de 0.3 a 2.4 Conclusiones: Por vez primera se determinaron las personas con glucemia en ayunas anómala con un total de 12 y 14 personas para el Policlínico «Ignacio Agramonte¼ y en el «Rodolfo Ramírez Esquivel¼, respectivamente.

Background: Diabetes mellitus exponentially increases its prevalence all over the world and it is cause of a high morbidity by its complications. Objective: To know the incidence of diabetes mellitus under the international current concepts in two health areas. Method: A quantitative, cross-sectional study was carried out where the World Health Organization criteria for diabetes mellitus inquest was applied in two basic work groups of the community Polyclinics «Ignacio Agramonte¼ and «Rodolfo Ramírez Esquivel¼ from January 1st, 2003 to January 1st, 2005. The universe was constituted by all the population of the work group 2 at «Ignacio Agramonte¼ Polyclinic and of the Group 1 at «Rodolfo Ramírez Esquivel¼ Polyclinic that comply with the World Health Organization criteria for diabetes mellitus inquest. The information source was obtained from the health situation state. The fasting blood sugar was utilized (GPA as cornerstone of the diagnosis). Descriptive statistics, percent distribution and incidence rate was determined. Results: An increment in the incidence rate of 465.5 for a hundred thousand people to 1687 for a hundred thousand people was reported, increasing the incidence percentage from 0.5% to 1.7% which was 3.4 times over the existing at «Ignacio Agramonte¼ Polyclinic. At «Rodolfo Ramírez Esquivel¼ Polyclinic there was a variation from 244 to 2400 for a hundred thousand people and in the incidence percent from 0.3 to 2.4 Conclusions: For the first time people with anomalous fasting blood sugar were determined with a total of 12 and 14 people for the «Ignacio Agramonte¼ Polyclinic and in the «Rodolfo Ramírez Esquivel¼, respectively.

Remodelación caddiovascular en el paciente hipertenso en un área de salud / Cardiovascular remodeling in the hypertensive patient in a health area

Se realizó un estudio transversal para conocer las modificaciones del remodelado cardiovascular de 70 pacientes hipertensos del Policlínico Ignacio Agramonte Loynaz de Camagüey en el trienio 2002-2004. Se estudiaron variables como los grupos de edades, el sexo, el estado nutricional, el tiempo de evolución y estadio de la hipertensión arterial, patrón geométrico en la primera y segunda mediciones después del tratamiento con inhibidores de la enzima convertidora de la angiotensina u otros antihipertensivos. Más del 95 % tenía más de 46 años, el 61.4 % eran mujeres, el 57.1 % tenían sobrepeso u obesidad, el 58.6 % más de diez años de evolución de la hipertensión arterial, el 72.8 % fueron clasificados en estadio II y el 45.7 % presentó hipertrofia concéntrica. Se obtuvo una regresión a la normalidad en el 58.5 % de los pacientes. La remodelación cardiovascular fue más frecuente en las mujeres al aumentar la edad, el peso corporal, el tiempo de evolución y el estadio de la hipertensión arterial. En la segunda medición más de la mitad de los pacientes revirtieron su patrón geométrico, el resto persistió con remodelado concéntrico exclusivamente. El tratamiento con inhibidores de la enzima convertidora de la angiotensina no mostró resultados superiores.

A cross-sectional study to identify the modifications of the cardiovascular remodeled of 70 hypertensive patients at "Ignacio Agramonte Loynaz" Hospital of Camagüey in the period of three years 2002-2004. Variables such as age groups, sex, nutritional state, evolution time and arterial hypertension stage, geometric pattern on the first and second measurements after treatment with inhibitors of angiotensin-converting enzyme or other antihypertensives were studied. More than the 95% had more than 46 years, the 61.4% were women, the 57.1% were overweight or obese, the 58.6% had more than ten years of hypertension evolution, the 72.8% were classified in stage II and the 45.7% presented concentric hypertrophy. A regression to normality in the 58.5% of the patients was obtained. The cardiovascular remodelling was more frequent in women with increasing the age, body weight, evolution time and arterial hypertension stage. In the second measurement more than the half of the patients reverted their geometric pattern; the remainder persisted exclusively with concentric remodeled. The treatment with inhibitors of the angiotensin-converting enzyme showed no superior results.

A sexualidad enllos adolescentes: algunas consideraciones / Sexuality in adolescents: some considerations

Se realizó un estudio descriptivo para conocer el nivel cognoscitivo de los adolescentes sobre sexualidad en el policlínico "Joaquín de Agüero y Agüero" desde diciembre de 2004 a diciembre de 2005. El universo estuvo constituido por 98 adolescentes entre 12 y 19 años de los consultorios del médico de la familia 40 y 46 pertenecientes a este policlínico, de ellos fueron escogidos al azar 42 y se les aplicó una encuesta con las siguientes variables: edad de comienzo de las relaciones sexuales, vías de conocimientos de orientación sexual y de transmisión de ITS. Los datos obtenidos fueron procesados de forma automatizada, se empleó estadística descriptiva. La edad predominante en ambos sexos fue de 13-15 años (64.2 %), el 42.8 % realizó las primeras relaciones sexuales entre los 13 y14 años, fundamentalmente los varones (59 %). La mayoría de los adolescentes tuvo relaciones sexuales y reconoció la vía de transmisión de las infecciones de transmisión sexual.

A descriptive study was carried out in order to describe the cognitive level of the adolescents on sexuality at "Joaquín de Agüero y Agüero" polyclinic from December 2004 to December 2005. The universe was constituted by 98 adolescents between 12 and 19 years from the doctor's offices 40 and 46, belonging to this polyclinic, of them they were chosen at random 42 and applied them itself a survey with the following variables: age of beginning of the sexual intercourses, knowledge ways of sexual orientation, and ITS transmission. The obtained data were processed of automated form, descriptive statistics was employed. The found results were: the predominant age in both sexes was about 13-15 years (64.2%), the 42.8% carried out the first sexual intercourses among the 13 and 14 years, males (59%) fundamentally. The majority of the adolescents had sexual intercourses and they recognized the way of transmission of the sexual infections.