Modified Fitzpatrick Scale-Skin Color and Reactivity.

BACKGROUND: There is growing interest in the development of a skin classification system that captures the world's diverse population. The Fitzpatrick skin classification scale is used both clinically and in research settings to determine an individual's skin color. With the high global burden of skin sensitivity (atopic dermatitis, keloid formation, etc), there is a need for a skin classification system that takes into consideration an individual's reaction to environmental insults and injuries. Our proposal builds on the existing Fitzpatrick skin classification scale by asking two additional questions of patients: do patients have sensitive skin; do patients have a history of hypertrophic scarring or keloids. By separating patients into 2 categories (sensitive vs non-sensitive skin), we create a system that can help dermatologists decide on which treatments to offer patients based on their skin classification. Dermatologists can better predict patient outcomes for dermatologic or cosmetic procedures by knowing how they react to environmental insults/injury. Santiago S, Brown R, Shao K, et al. Modified fitzpatrick scale- skin color and reactivity. J Drugs Dermatol. 2023;22(7):641-646. doi:10.36849/JDD.6859.  .

The prediction of Metabolic Syndrome alterations is improved by combining waist circumference and handgrip strength measurements compared to either alone.

BACKGROUND: Adiposity is a major component of the metabolic syndrome (MetS), low muscle strength has also been identified as a risk factor for MetS and for cardiovascular disease. We describe the prevalence of MetS and evaluate the relationship between muscle strength, anthropometric measures of adiposity, and associations with the cluster of the components of MetS, in a middle-income country. METHODS: MetS was defined by the International Diabetes Federation criteria. To assess the association between anthropometric variables (waist circumference (WC), waist-to-hip ratio (W/H), body mass index (BMI)), strength (handgrip/kg bodyweight (HGS/BW)) and the cluster of MetS, we created a MetS score. For each alteration (high triglycerides, low HDLc, dysglycemia, or high blood pressure) one point was conferred. To evaluate the association an index of fat:muscle and MetS score, participants were divided into 9 groups based on combinations of sex-specific tertiles of WC and HGS/BW. RESULTS: The overall prevalence of MetS in the 5,026 participants (64% women; mean age 51.2 years) was 42%. Lower HGS/BW, and higher WC, BMI, and W/H were associated with a higher MetS score. Amongst the 9 HGS/BW:WC groups, participants in the lowest tertile of HGS/BW and the highest tertile of WC had a higher MetS score (OR = 4.69 in women and OR = 8.25 in men;p < 0.01) compared to those in the highest tertile of HGS/BW and in the lowest tertile of WC. CONCLUSION: WC was the principal risk factor for a high MetS score and an inverse association between HGS/BW and MetS score was found. Combining these anthropometric measures improved the prediction of metabolic alterations over either alone.

Racial/Ethnic Variations in Skin Barrier: Implications for Skin Care Recommendations in Skin of Color.

BACKGROUND: Genetic and environmental factors influence stratum corneum (SC) barrier properties and function. Researchers increasingly focus on biophysical studies that may help clinicians provide their patients with an informed choice on tailormade skincare. This literature review on skin barrier properties comparing different ethnic populations aims to offer insights into the information's clinical relevance. METHODS: A literature review followed by panel discussions and an online review process aimed to answer the questions: Are there racial/ethnic differences in the SC barrier structure and healthy skin barrier function? Is there a need for specific cleansers and moisturizers? RESULTS: Ethnic categories based on race and ethnicity are often not well defined and inconsistent across different studies. Studies comparing ethnic groups' physical and biochemical skin barrier properties have reported differences in transepidermal water loss (TEWL), skin lipid levels, pH, and mast cell granule size. However, these studies frequently had methodological flaws, mainly were small, and demonstrated conflicting results. The literature suggests racial/ethnic variations in ceramide content, SC structure, and filaggrin mutations. Furthermore, studies have shown a greater burden of pruritus and atopic dermatitis among Black populations. Data on barrier properties in Hispanic/LatinX and South Asian populations are lacking. CONCLUSION: Robust comparative studies are needed to understand these basic concepts to help tailor skincare and skin of color patients' education. J Drugs Dermatol. 2021;20(9):932-938. doi:10.36849/JDD.6312.

May Measurement Month 2017: an analysis of blood pressure screening results in Colombia-Americas.

Despite the availability of efficient methods to evaluate blood pressure (BP) and of safe and efficient medication to treat and control hypertension, the levels of awareness, treatment and control are very low globally, particularly in low- and middle-income countries. To highlight the importance of improving these rates, the International Society of Hypertension (ISH) endorsed by the World Hypertension League have implemented the May Measurement Month initiative. We present here the results obtained in Colombia. The Fundación Oftalmológica de Santander (FOSCAL) led the implementation of this strategy in Colombia and 11 departments participated. The data collection followed the guidelines of the ISH. The information collected was compiled for the report generation and the submission to the Technical Secretariat of the ISH. Data cleaning was performed locally by FOSCAL. Data were collated and analysed centrally. A total of 22 258 participants (58.8% female) were included in the analysis. Mean age was 40.9 ± 17.7 years. Age and sex-standardized BP excluding participants receiving BP medications was 118/74.3 mmHg, and in those on treatment 125/78 mmHg. High BP was present in 5036 (22.8%) individuals, 1637 of 18 644 (8.8%) who were not receiving anti-hypertensive medications were hypertensive, and 961 of 3359 (28.6%) receiving treatment were not controlled. These results highlight the need to develop innovative promotion strategies at individual and population levels to increase the awareness of the importance of BP, and the consequences of not having well-controlled hypertension. This initiative is an effective and easy to implement strategy that should be maintained in the coming years.

Skin Cancer in Hispanics in the United States

The Hispanic population has been the principal driver of U.S. demographic growth in the last two decades. In 2016, Hispanics accounted for 18% of the nation's population and were the second-largest racial or ethnic group behind whites making the people of Hispanic origin the nation's largest ethnic or racial minority. Non-melanoma skin cancer (NMSC) is the most common malignancy in the U.S. with over 3.5 million diagnosed in over 2 million people, incidence rising at about 2.6% per year. In Hispanics, Loh et al showed a retrospective 5-year one-institution study that revealed an incidence of 3% for NMSC, in a population that is younger and mainly females as compared to Caucasian and Asians. In the past two decades, melanomas incidence among Hispanics has risen by 20%. Hispanics are younger at diagnosis, present with thicker tumors (>1mm, 35% to 25%), regional involvement (12 to 8%), and distant metastasis (7 to 4%), having the worst survival rate as compared to whites. In general, even though increasing, the incidence of NMSC and MM is lower in Hispanics than Caucasians, however, the mortality is higher. The later stage at diagnosis and worse prognosis in Hispanics have been attributed to several factors: 1.) Less awareness of risks or symptoms leading to a lack of linguistically or culturally targeted screening efforts.20 2.) Decline in sun-safe behaviors because of increasing acculturation.21, 22 3.) Less access to health insurance-- more than 15% Hispanics in last census lack medical coverage causing delays in seeking treatment.23 Many of these factors may be associated with lower socioeconomic status (SES). For cancer control efforts to succeed, we must better understand the major causes of advanced presentation of melanoma in Hispanics (Hispanics and Latinos) who represent the most rapidly expanding demographic segment in the U.S. Increased awareness of skin cancer and ways to prevent it on the part of providers and patients has the potential to decrease incidence, increase early diagnosis, and improve outcomes among Hispanics. Primary care physicians and dermatologists can dispel the myth that melanoma only affects NHWs and educate Hispanic patients in a culturally appropriate manner on melanoma risk factors, how to recognize sunburn, how to identify abnormal lesions, and the need to check non-sun-exposed areas for ALMs that are comparatively more common among Hispanics than among NHWs. J Drugs Dermatol. 2019;18(3 Suppl):s117-120.

Simultaneous characterization of physical, chemical, and thermal properties of polymeric multilayers using infrared spectroscopic ellipsometry.

In this study, multilayered films of polyethylenimine/poly (sodium-p-styrene sulfonate) (PEI)/(PSS) and type I collagen/heparin sodium (COL)/(HEP) were fabricated using the layer-by-layer technique, and fully characterized using Infrared Variable Angle Spectroscopic Ellipsometry (IRVASE) to simultaneously analyze the chemistry, thickness, and roughness of the multilayers with respect to changes in pH of the washing solution, and changes in temperature. Film topography and Young's modulus were obtained by atomic force microscopy (AFM) and nanoindentation. Our results show that with IRVASE it is possible to analyze the thickness of the multilayers prepared using a washing solution of pH 5, obtaining values of 71.7 nm and 40.3 nm for three bilayers of PEI/PSS and COL/HEP, respectively. Film roughness varies between multilayer systems, obtaining values of 37.76 nm for three bilayers of PEI/PSS and 33.58 nm for three bilayers of COL/HEP. Increasing the pH of the washing solution for PEI/PSS yielded thinner films that were less susceptible to thermal induced changes in film chemistry in the range of 25 - 150 °C. PEI/PSS films decreased in thickness with increasing temperature up to 75 °C, whereas above 75 °C film thickness increased. Through IRVASE, a transition temperature for the PEI/PSS multilayers was observed at 75 °C. Temperatures above 37 °C drastically alter the chemistry and the thickness of the COL/HEP multilayers indicating a possible degradation of the polymers. We obtained, through nanoindentation, a Young's modulus of 15000 kPa and 9000 kPa for 12 bilayers of PEI/PSS and COL/HEP, respectively. These results demonstrate that, using IRVASE, we can simultaneously evaluate the physical, chemical, and thermal properties of synthetic and natural multilayered polymeric films.

Natural Cosmeceutical Ingredients for Hyperpigmentation.

As Dermatologists caring for patients with hyperpigmentation problems, we are always looking for more alternative therapies. Hydroquinone (HQ) is still the standard of care. However, traditional depigmenting agents such as HQ and corticosteroids, although highly effective, can raise safety concerns including exogenous ochronosis, atrophy, carcinogenesis and local and systemic untoward effects with long term use. Therefore, we need to investigate non-prescription natural alternatives. This manuscript presents many of the natural ingredients found in cosmeceuticals for the treatment of hyperpigmentation and their mechanisms of action. It will also describe the melanocyte activation pathways and how each of these ingredients interferes with it.

Successful use of 1064 Nm Nd:YAG in conjunction with 2790 Nm YSGG ablative laser for traumatic scarring.

Patients with traumatic scarring often seek both aesthetic and functional improvement and can be a challenge to treat; however, advances in laser and light technologies have helped to treat many of these patients with rather minimally invasive approaches. A nineteen year old girl with Fitzpatrick skin type III skin presented for the evaluation of extensive traumatic scarring involving her right cheek, right chin, and right oral commissure that she sustained after a motor vehicle accident. We report the successful use of the 1064 nm Nd:YAG laser in conjunction with the ablative 2790 nm YSGG laser for the treatment of traumatic scarring in this patient. Our patient noted a notable improvement in the appearance of her traumatic scarring in addition to decrease in contracture of the right oral commissure. The treatment regimen described provides an effective option for clinicians to utilize when treating traumatic scarring and skin textural changes.

The use of the 300 microsecond 1064 nm Nd:YAG laser in the treatment of keloids.

BACKGROUND: Keloids can be quite resistant to conventional methods of treatment. A wide range of treatment modalities exists, often with suboptimal results, recurrences, and adverse events occurring. Laser therapy with the carbon dioxide, erbium:YAG, Q switched frequency doubled neodymium-doped yttrium aluminium garnet (Nd:YAG), and 585/595 nm pulsed dye lasers have all be purported as potential treatment modalities however with limited efficacy and data especially in the skin of color population is limited. We report the successful use of the 300 microsecond 1064 nm Nd:YAG laser in treating keloids in patients with skin types ranging from Fitzpatrick I through VI with special attention in treating skin of color patients. OBJECTIVE: We examined the use of the 300 microsecond 1064 nanometer (nm) Nd:YAG laser for the treatment keloids in patients with skin types ranging from Fitzpatrick I through VI. METHODS & MATERIALS: A retrospective analysis of treatment efficacy was conducted on 44 patients with keloids. Three separate treatment groups were compared. The groups consisted of: a "control group" in which the whole keloid was only treated with intralesional corticosteroid (triamcinolone 10 mg/cc) (16 patients); a "laser only" group in which the patient's keloid was only treated with the 1064 nm Nd:YAG laser at a fluency of 13 to 18 Joules / centimeter2 (J/cm2), a fixed pulse duration of 300 microseconds, 5 mm spot size, and a total of 2000 pulses (14 patients); and a "combination group" that received both the aforementioned laser therapy and adjuvant intralesional triamcinolone (14 patients). RESULTS: Patients in the "combination group" treated with the 300 microsecond 1064 nm Nd:YAG laser therapy plus intralesional corticosteroid and the "laser only" group both were observed to have durable clinical reduction in the thickness and erythema of the keloids. These results were shown to be superior to the "control group" whom were only treated with intralesional corticosteroids. Only mild and transient post treatment erythema was noted as an adverse effect. STATISTICAL ANALYSIS: Data analysis was performed using IBM SPSS Statistics 19.0.0 (Armonk, NY). In order to assess the statistical significance of differences in keloid improvement among the three treatment groups, The Kruskal-Wallis test (non-parametric ANOVA test) was applied. The level of statistical significance was set at P< 0.05. A statistically significant difference in keloid improvement was appreciated between treatment groups (P<0.0001). LIMITATIONS: A small sample size and the retrospective nature of the analysis are limitations to the study.
CONCLUSION: The 300 microsecond 1064 nm Nd:YAG laser proved effective in improving the clinical appearance of keloids. We recommended this laser protocol in conjunction with intralesional corticosteroids as a treatment option for patients with keloids, especially in the skin of color population. The 1064 nm Nd:YAG laser did not show post inflammatory hyperpigmentation nor hypopigmenatation, which are concerns for skin types IV to VI, and therefore is a suitable option for such patients.

[Correlation between Predictive Index of Difficult Intubation and Cormack]. / Correlación entre el Índice predictivo de intubación difícil y el Cormack.

Background: More than 600 people die each year in developed countries from complications at the time of orotracheal intubation. Studies have shown that all predictors used so far have low ability to predict difficult airway. When analyzing this ability, both clinical suspicion, indirect laryngoscopy and even the different individual examinations showed predictive values higher than 80%. Objective: To evaluate the concordance between the Predictive Index of Difficult Intubation (PIDI) and the Cormack regarding the diagnosis of difficult intubation in patients undergoing open and laparoscopic cholecystectomy under balanced general anesthesia. Material and methods: Observational, prospective, cross-sectional, analytical concordance study, carried out in patients aged 18 to 60 who underwent open and laparoscopic cholecystectomy. The sample was probabilistic, the statistical analysis applied univariate and bivariate, specifically the Kappa index. Results: A total of 96 patients were analyzed; 77 were female with a mean age of 40.4 years. Said sample presented a PIDI of easy intubation in 75%, discreet difficulty in 21.9% and frank difficulty in 3.1%. After conventional direct laryngoscopy, 75% presented Cormack I, 16.7% presented Cormack II, 8.3% presented Cormack III. The bivariate analysis with the Kappa index statistic showed a value of 0.242. Conclusions: It is accepted the alternative hypothesis demonstrating that there is a correlation between the PIDI and the Cormack concerning the diagnosis of difficult intubation in patients undergoing open and laparoscopic cholecystectomy under balanced general anesthesia.

Introducción: más de 600 personas mueren al año en los países desarrollados por complicaciones con la intubación orotraqueal. Estudios han demostrado que todos los predictores utilizados hasta el momento tienen baja capacidad para predecir la vía aérea difícil. Al analizar esta capacidad, tanto la sospecha clínica como la laringoscopía indirecta y los diferentes exámenes individuales mostraron valores predictivos superiores al 80%. Objetivo: evaluar la concordancia entre el Índice predictivo de intubación difícil (IPID) y el Cormack respecto al diagnóstico de intubación difícil en pacientes intervenidos de colecistectomía abierta y laparoscópica bajo anestesia general balanceada. Material y métodos: estudio observacional, prospectivo, transversal, analítico de concordancia, realizado en pacientes de 18 a 60 años intervenidos de colecistectomía abierta y laparoscópica. La muestra fue de tipo probabilístico, el análisis estadístico aplicado univariado y bivariado, específicamente el Índice de Kappa. Resultados: se analizaron 96 pacientes; 77 fueron del sexo femenino, con una media de 40.4 años de edad. Se presentó un IPID de intubación fácil en 75%, dificultad discreta en 21.9% y dificultad franca en 3.1%. Posterior a la laringoscopía directa convencional, 75% presentó Cormack I, 16.7% Cormack II y 8.3% Cormack III. El análisis bivariado con el Índice de Kappa evidenció un valor de 0.242. Conclusiones: se acepta la hipótesis alterna que demuestra que sí hay correlación entre el IPID y el Cormack respecto al diagnóstico de intubación difícil en pacientes intervenidos de colecistectomía abierta y laparoscópica bajo anestesia general balanceada.

Mi Gente, Nuestra Salud: Protocol for a People's Movement for Health Ownership.

BACKGROUND: Community-based participatory research (CBPR) is an increasingly recognized approach to address health inequities. Although in CBPR all processes occur within the community context, its diagrammatic model places the intervention/research outside of the community rather than conceptualizing it as an event in a complex web of system components. OBJECTIVES: We sought to 1) introduce a systems-oriented community ownership conceptual framework that integrates a systems perspective with CBPR and 2) to describe an application of this framework in the form of the Mi Gente, Nuestra Salud initiative, a research-based, action-oriented collaboration between Cal Poly investigators and community partners in Santa Maria and Guadalupe, California. METHODS: We conducted a stocktake of community assets and partnerships in Santa Maria and Guadalupe, among California's poorest and most medically underserved cities; created marketing materials; launched the initiative in December 2020; and collected survey and interview data on community health concerns. An advisory board guides direction of the work. Activities are intended to affect partnerships (who is involved in actions and decisions) and processes (what actions will be taken), as well as resources (e.g., building human and social capital by changing narratives of local, historically rooted power dynamics and offering peer learning opportunities on advocacy and health care interactions). Implementation challenges within this framework are also discussed. CONCLUSIONS: By de-centering specific interventions and conceptualizing them as single events in a complex web, our system-oriented community ownership model brings the focus back to the system itself, and to system-based processes and solutions, while still guided by CBPR principles.

Multinational prediction of household and personal exposure to fine particulate matter (PM2.5) in the PURE cohort study.

INTRODUCTION: Use of polluting cooking fuels generates household air pollution (HAP) containing health-damaging levels of fine particulate matter (PM2.5). Many global epidemiological studies rely on categorical HAP exposure indicators, which are poor surrogates of measured PM2.5 levels. To quantitatively characterize HAP levels on a large scale, a multinational measurement campaign was leveraged to develop household and personal PM2.5 exposure models. METHODS: The Prospective Urban and Rural Epidemiology (PURE)-AIR study included 48-hour monitoring of PM2.5 kitchen concentrations (n = 2,365) and male and/or female PM2.5 exposure monitoring (n = 910) in a subset of households in Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania and Zimbabwe. PURE-AIR measurements were combined with survey data on cooking environment characteristics in hierarchical Bayesian log-linear regression models. Model performance was evaluated using leave-one-out cross validation. Predictive models were applied to survey data from the larger PURE cohort (22,480 households; 33,554 individuals) to quantitatively estimate PM2.5 exposures. RESULTS: The final models explained half (R2 = 54%) of the variation in kitchen PM2.5 measurements (root mean square error (RMSE) (log scale):2.22) and personal measurements (R2 = 48%; RMSE (log scale):2.08). Primary cooking fuel type, heating fuel type, country and season were highly predictive of PM2.5 kitchen concentrations. Average national PM2.5 kitchen concentrations varied nearly 3-fold among households primarily cooking with gas (20 µg/m3 (Chile); 55 µg/m3 (China)) and 12-fold among households primarily cooking with wood (36 µg/m3 (Chile)); 427 µg/m3 (Pakistan)). Average PM2.5 kitchen concentration, heating fuel type, season and secondhand smoke exposure were significant predictors of personal exposures. Modeled average PM2.5 female exposures were lower than male exposures in upper-middle/high-income countries (India, China, Colombia, Chile). CONCLUSION: Using survey data to estimate PM2.5 exposures on a multinational scale can cost-effectively scale up quantitative HAP measurements for disease burden assessments. The modeled PM2.5 exposures can be used in future epidemiological studies and inform policies targeting HAP reduction.

Melasma in Latin Americans.

Melasma is an acquired skin condition characterized by irregular brown or hyperpigmented patches typically located on the forehead, cheeks, nose, chin and upper lip. The pathogenesis of melasma is not completely understood, but is thought to be influenced by genetics, UV exposure, thyroid dysfunction and hormonal influences from either pregnancy or hormonal therapeutic medications. Peoples of Latin descent comprise a vast array of skin colors and skin phototypes. Similarly, disorders of pigmentation, particularly melasma, occur more frequently in people of Latin descent when compared to the general population. Melasma can be particularly distressing to patients and has been shown to impact a patient's quality of life in several studies. These factors can raise significant quality of life issues and therefore treatment is not only significant for improving patient clinical outcomes, but is crucial in improving important psychological and emotional aspects of patients' overall well being. This article provides a stepwise approach to the treatment of melasma based on current literature recommendations.

Self-Reported Prevalence of Chronic Non-Communicable Diseases in Relation to Socioeconomic and Educational Factors in Colombia: A Community-Based Study in 11 Departments.

Background: Chronic non-communicable diseases are prevalent conditions in developing countries, such as Colombia. Several socioeconomic and educational factors have been associated with these pathologies. However, there is little country-specific information regarding the self-reported prevalence of chronic diseases and their association with the aforementioned factors in Colombia. Objectives: To evaluate the current situation of chronic non-transmissible diseases in Colombia by self-report and to analyze its potential relationship with sociodemographic, economic and educational factors. Methods: This is a cross-sectional baseline sub-analysis from the prospective, standardized collaborative PURE study in Colombia. Participants were recruited between 2005 to 2009, in 11 departments of the country, and included 7,485 subjects of 35 to 70 years old. Questionnaires of self-reported chronic non-communicable diseases, and demographic, socioeconomic and educational variables were applied. Results: Hypertension was the most prevalent chronic condition reported with a prevalence of 22.2% (21.2%-23.1%, 95% CI), followed by diabetes with a prevalence of 5.7% (5.1%-6.2%, 95% CI), asthma 2.7% (2.2%-3.0%, 95% CI), coronary heart disease 2.4% (2.0%-2.7%, 95% CI), stroke and heart failure 1.5% (1.2%-1.8%, 95% CI) each, chronic obstructive pulmonary disease 1.2% (0.6%-1.5%, 95% CI), and cancer 1.2% (1.0%-1.5%, 95% CI). Among the study sample, 23.3% (22.4%-24.3%, 95% CI) reported having one chronic NCDs, and 6.4% (5.9%-7.0%, 95% CI) reported having multiple chronic NCDs. The prevalence of multiple NCDs increased significantly with age, was more common in those from households with higher income, whereas it was significantly lower in persons with high education.The central and central-east regions of the country are those with the higher prevalence of self-reported NCDs. Conclusion: The results of the current study indicate the presence of socioeconomic and educational inequalities in the distribution of chronic NCDs in the Colombian population.

Household and personal air pollution exposure measurements from 120 communities in eight countries: results from the PURE-AIR study.

BACKGROUND: Approximately 2·8 billion people are exposed to household air pollution from cooking with polluting fuels. Few monitoring studies have systematically measured health-damaging air pollutant (ie, fine particulate matter [PM2·5] and black carbon) concentrations from a wide range of cooking fuels across diverse populations. This multinational study aimed to assess the magnitude of kitchen concentrations and personal exposures to PM2·5 and black carbon in rural communities with a wide range of cooking environments. METHODS: As part of the Prospective Urban and Rural Epidemiological (PURE) cohort, the PURE-AIR study was done in 120 rural communities in eight countries (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Data were collected from 2541 households and from 998 individuals (442 men and 556 women). Gravimetric (or filter-based) 48 h kitchen and personal PM2·5 measurements were collected. Light absorbance (10-5m-1) of the PM2·5 filters, a proxy for black carbon concentrations, was calculated via an image-based reflectance method. Surveys of household characteristics and cooking patterns were collected before and after the 48 h monitoring period. FINDINGS: Monitoring of household air pollution for the PURE-AIR study was done from June, 2017, to September, 2019. A mean PM2·5 kitchen concentration gradient emerged across primary cooking fuels: gas (45 µg/m3 [95% CI 43-48]), electricity (53 µg/m3 [47-60]), coal (68 µg/m3 [61-77]), charcoal (92 µg/m3 [58-146]), agricultural or crop waste (106 µg/m3 [91-125]), wood (109 µg/m3 [102-118]), animal dung (224 µg/m3 [197-254]), and shrubs or grass (276 µg/m3 [223-342]). Among households cooking primarily with wood, average PM2·5 concentrations varied ten-fold (range: 40-380 µg/m3). Fuel stacking was prevalent (981 [39%] of 2541 households); using wood as a primary cooking fuel with clean secondary cooking fuels (eg, gas) was associated with 50% lower PM2·5 and black carbon concentrations than using only wood as a primary cooking fuel. Similar average PM2·5 personal exposures between women (67 µg/m3 [95% CI 62-72]) and men (62 [58-67]) were observed. Nearly equivalent average personal exposure to kitchen exposure ratios were observed for PM2·5 (0·79 [95% 0·71-0·88] for men and 0·82 [0·74-0·91] for women) and black carbon (0·64 [0·45-0·92] for men and 0·68 [0·46-1·02] for women). INTERPRETATION: Using clean primary fuels substantially lowers kitchen PM2·5 concentrations. Importantly, average kitchen and personal PM2·5 measurements for all primary fuel types exceeded WHO's Interim Target-1 (35 µg/m3 annual average), highlighting the need for comprehensive pollution mitigation strategies. FUNDING: Canadian Institutes for Health Research, National Institutes of Health.

The spectrum of the dyslipidemia in Colombia: The PURE study.

BACKGROUND: Dyslipidemia is a major risk factor for cardiovascular diseases (CVD). Worldwide, a third of ischemic heart disease is due to abnormal cholesterol levels and it is the most common cause of cardiovascular deaths in Colombia. In Colombia, no representative, large-scale study has assessed the prevalence of dyslipidemia. The aim of the present analysis was to identify the magnitude of the problem in Colombia, a middle-income-country with large regional, geographic, and socio-economical differences. MATERIAL AND METHODS: The sample comprised 6628 individuals aged 35 to 70 years (mean age 50.7 years, 64.1% women) residing in the four Colombian regions. RESULTS: The overall prevalence of dyslipidemia was 87.7% and was substantially higher among participants older than 50 years, male, rural residents, and those with a lower level of education (66.8%), and with a lower income (66.4%). High non HDL-c was the most common abnormality (75.3%). The values of total cholesterol and non-HDL-cholesterol were higher in areas with the lowest health needs index than in the areas with intermediate and highest health need index, the isolated HDL-c value was much lower. CONCLUSION: Colombia has a high prevalence of abnormalities of the lipid profile. The causes of the high rates of dyslipidemia were not well define in this study, but were more common in rural and poorer regions and among those with lower socio-economical status. Strategies to tackle the adverse lipid profile to reduce CVD are needed in Colombia, particularly in rural areas and among the areas with the higher health need index.

[Comparison of traditional cardiovascular risk factors frequency among women of different education levels]. / Comparación de frecuencia de factores de riesgo cardiovascular tradicionales en mujeres con distinto nivel educativo.

INTRODUCTION: Ischemic heart disease is the first cause of death in the world in both genders between 30 and 40 years of age. It has been proposed that socioeconomic status could affect the prevalence of cardiovascular risk factors (CVRF), as well as cardiovascular disease incidence and mortality. The purpose of this work was to compare the frequency of CVRF in two groups of women with different educational level. RESULTS: A higher frequency of visceral obesity was identified in the women with lower educational level and hypo-HDL-C in the group of women with higher educational level. Correlation between age and modifiable CVRF was different between the studied groups. A larger proportion of women with higher educational level than those with lower educational level drank alcoholic beverages and smoked cigarettes. DISCUSSION: Frequency of identified modifiable CVRF was similar to that found in other Hispanic-American populations. The inverse relationship between CVRF and educational level, a commonly used measure of socioeconomic status, and prevalence of CVRF informed in English and American studies was not observed in this investigation; probably because social and cultural conditions could affect the educational level in a different manner. Health education programs must take into account the cultural processes of each country, city, or community, regardless of the socioeconomic status, based on social and cultural backgrounds of each group.