Estimating mortality and disability in Peru before the COVID-19 pandemic: a systematic analysis from the Global Burden of the Disease Study 2019.

Background: Estimating and analyzing trends and patterns of health loss are essential to promote efficient resource allocation and improve Peru's healthcare system performance. Methods: Using estimates from the Global Burden of Disease (GBD), Injuries, and Risk Factors Study (2019), we assessed mortality and disability in Peru from 1990 to 2019. We report demographic and epidemiologic trends in terms of population, life expectancy at birth (LE), mortality, incidence, prevalence, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by the major diseases and risk factors in Peru. Finally, we compared Peru with 16 countries in the Latin American (LA) region. Results: The Peruvian population reached 33.9 million inhabitants (49.9% women) in 2019. From 1990 to 2019, LE at birth increased from 69.2 (95% uncertainty interval 67.8-70.3) to 80.3 (77.2-83.2) years. This increase was driven by the decline in under-5 mortality (-80.7%) and mortality from infectious diseases in older age groups (+60 years old). The number of DALYs in 1990 was 9.2 million (8.5-10.1) and reached 7.5 million (6.1-9.0) in 2019. The proportion of DALYs due to non-communicable diseases (NCDs) increased from 38.2% in 1990 to 67.9% in 2019. The all-ages and age-standardized DALYs rates and YLLs rates decreased, but YLDs rates remained constant. In 2019, the leading causes of DALYs were neonatal disorders, lower respiratory infections (LRIs), ischemic heart disease, road injuries, and low back pain. The leading risk factors associated with DALYs in 2019 were undernutrition, high body mass index, high fasting plasma glucose, and air pollution. Before the COVID-19 pandemic, Peru experienced one of the highest LRIs-DALYs rates in the LA region. Conclusion: In the last three decades, Peru experienced significant improvements in LE and child survival and an increase in the burden of NCDs and associated disability. The Peruvian healthcare system must be redesigned to respond to this epidemiological transition. The new design should aim to reduce premature deaths and maintain healthy longevity, focusing on effective coverage and treatment of NCDs and reducing and managing the related disability.

Unintentional injuries in Mexico, 1990-2017: findings from the Global Burden of Disease Study 2017.

BACKGROUND: To date, the burden of injury in Mexico has not been comprehensively assessed using recent advances in population health research, including those in the Global Burden of Disease Study 2017 (GBD 2017). METHODS: We used GBD 2017 for burden of unintentional injury estimates, including transport injuries, for Mexico and each state in Mexico from 1990 to 2017. We examined subnational variation, age patterns, sex differences and time trends for all injury burden metrics. RESULTS: Unintentional injury deaths in Mexico decreased from 45 363 deaths (44 662 to 46 038) in 1990 to 42 702 (41 439 to 43 745) in 2017, while age-standardised mortality rates decreased from 65.2 (64.4 to 66.1) in 1990 to 35.1 (34.1 to 36.0) per 100 000 in 2017. In terms of non-fatal outcomes, there were 3 120 211 (2 879 993 to 3 377 945) new injury cases in 1990, which increased to 5 234 214 (4 812 615 to 5 701 669) new cases of injury in 2017. We estimated 2 761 957 (2 676 267 to 2 859 777) disability-adjusted life years (DALYs) due to injuries in Mexico in 1990 compared with 2 376 952 (2 224 588 to 2 551 004) DALYs in 2017. We found subnational variation in health loss across Mexico's states, including concentrated burden in Tabasco, Chihuahua and Zacatecas. CONCLUSIONS: In Mexico, from 1990 to 2017, mortality due to unintentional injuries has decreased, while non-fatal incident cases have increased. However, unintentional injuries continue to cause considerable mortality and morbidity, with patterns that vary by state, age, sex and year. Future research should focus on targeted interventions to decrease injury burden in high-risk populations.

Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017.

BACKGROUND: The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates. METHODS: Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate. RESULTS: For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced. CONCLUSIONS: The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.

Microwave-assisted polystyrene sulfonate-catalyzed synthesis of novel pyrroles.

BACKGROUND: Pyrroles are widely distributed in nature and important biologically active molecules. The reaction of amines with 2,5-dimethoxytetrahydrofuran is a promising pathway for the synthesis of pharmacologically active pyrroles under microwave irradiation. RESULTS: Microwave-induced polystyrenesulfonate-catalyzed synthesis of pyrroles from amines and 2,5-diemthoxytetrahydrofuran has been accomplished with excellent yield. This method produces pyrroles with polyaromatic amines. CONCLUSION: The present procedure for the synthesis of N-aromatic substituted pyrroles will find useful application in the area of pharmacologically active molecules.

[Dietary patterns and access to food among displaced families in the municipality of Girón, Santander, Colombia]. / Patrón alimentario y acceso a los alimentos en familias desplazadas en el municipio de Girón, Santander, Colombia.

OBJECTIVES: Describe the dietary patterns and extent of access to food among families displaced by armed conflict in a locality of the Santander department of Colombia. METHODS: A descriptive study of the food consumption of 101 families living in forced displacement in the urban and suburban areas of the municipality of Girón, Santander department, Colombia. During the second half of 2003, the person in charge of the family's food preparation completed a sociodemographic survey with questions on the monthly food expenditure, where the food was bought and with what frequency, and a log of food consumption during the preceding 24 hours. The dietary pattern was established according to the frequency of food consumption and preparation through a linear regression model that used the expenditure as a dependent variable. RESULTS: Of all the families, 34.7% reported not having access to food shopping and 13.9% received food donations. The average expenditure on food was 0.52 of the standard minimum wage. The only variable associated with expenditure was the number of family members working and contributing to the family budget (P = 0.037); for each working member, expenditure rose by increments of 0.07 of the minimum wage (95% confidence interval: 0.004- 0.149). No association was found between the length of time of the displacement and the food expenditure. The overall quality of the diet was deficient given that the recommended allowances of fruits, vegetables, and dairy products were not being met. CONCLUSIONS: Food insecurity encompassed 95.0% of the study families, even though they had been living as refugees for three years. The diet quality was substandard. The principal causes were low household income and a lack of knowledge regarding how to choose nutritionally superior foods. In addition to food donations, relief programs caring for displaced families should provide practical and educational training on nutrition, and thus, successful alternatives.

Patrón alimentario y acceso a los alimentos en familias desplazadas en el municipio de Girón, Santander, Colombia / Dietary patterns and access to food among displaced families in the municipality of Girón, Santander, Colombia

OBJETIVO: Describir el patrón alimentario y la capacidad de acceso a los alimentos de las familias desplazadas por el conflicto armado en una localidad del departamento de Santander, Colombia. MÉTODOS: Estudio dietético descriptivo en 101 familias que vivían en condiciones de desplazamiento forzado en la zona urbana y suburbana del municipio de Girón, departamento de Santander, Colombia. Durante el segundo semestre de 2003, el responsable de preparar los alimentos contestó una encuesta sociodemográfica con preguntas sobre el gasto mensual en alimentos, el lugar y la frecuencia de compra, y un recordatorio del consumo de alimentos en las 24 horas previas. El patrón alimentario se estableció según la frecuencia del consumo de alimentos y preparaciones mediante modelos de regresión lineal con el gasto como variable dependiente. RESULTADOS: De las familias, 34,7 por ciento manifestaron no tener acceso a la compra de alimentos y 13,9 por ciento los recibía como obsequios. El gasto promedio en alimentos fue de 0,52 salarios mínimos vigentes (SMV). La única variable asociada con el gasto fue el número de miembros de la familia que trabajaban y aportaban al presupuesto familiar (P = 0,037); por cada miembro que trabajaba, el gasto aumentó en 0,07 unidades de SMV (intervalo de confianza de 95 por ciento: 0,004 a 0,149). No se encontró asociación entre el tiempo de desplazamiento y el gasto en alimentos. La calidad de la dieta fue deficiente, ya que no se cumplió la norma recomendada de consumo de frutas, verduras y productos lácteos. CONCLUSIONES: La inseguridad alimentaria abarcó a 95,0 por ciento de las familias estudiadas aún después de tres años de vivir en condiciones de desplazamiento. La calidad de la dieta era insatisfactoria. Las causas principales de esta situación eran los bajos ingresos familiares y el desconocimiento de alternativas nutricionales más ventajosas. Además de la ayuda alimentaria, los programas de atención a las familias...

OBJECTIVES: Describe the dietary patterns and extent of access to food among families displaced by armed conflict in a locality of the Santander department of Colombia. METHODS: A descriptive study of the food consumption of 101 families living in forced displacement in the urban and suburban areas of the municipality of Girón, Santander department, Colombia. During the second half of 2003, the person in charge of the family's food preparation completed a sociodemographic survey with questions on the monthly food expenditure, where the food was bought and with what frequency, and a log of food consumption during the preceding 24 hours. The dietary pattern was established according to the frequency of food consumption and preparation through a linear regression model that used the expenditure as a dependent variable. RESULTS: Of all the families, 34.7 percent reported not having access to food shopping and 13.9 percent received food donations. The average expenditure on food was 0.52 of the standard minimum wage. The only variable associated with expenditure was the number of family members working and contributing to the family budget (P = 0.037); for each working member, expenditure rose by increments of 0.07 of the minimum wage (95 percent confidence interval: 0.004- 0.149). No association was found between the length of time of the displacement and the food expenditure. The overall quality of the diet was deficient given that the recommended allowances of fruits, vegetables, and dairy products were not being met. CONCLUSIONS: Food insecurity encompassed 95.0 percent of the study families, even though they had been living as refugees for three years. The diet quality was substandard. The principal causes were low household income and a lack of knowledge regarding how to choose nutritionally superior foods. In addition to food donations, relief programs caring for displaced families should provide practical and educational training on...

[Cesarean-associated complications: the importance of a scarcely justified use]. / Complicaciones asociadas a la cesárea: la importancia de un uso módicamente justificado.

Undoubtedly, cesarean section is one of the most important surgical procedures for solving obstetrical problems. However, the steady increase in its use might be reflecting a non-medically justified utilization. This work reviews the main complications associated to cesarean section and their effect on the health of mothers and their children. An additional objective is to highlight the importance of establishing clinical protocols aimed at identifying those cases in which a cesarean section should be practiced. The implementation of these guidelines might help to reduce the effect that factors such as preferences of medical personnel or women's demand exert upon the increase of cesarean section use.

Complicaciones asociadas a la cesárea: la importancia de un uso médicamente justificado / Cesarean-associated complications: the importance of a scarcely justified use

Undoubtedly, cesarean section is one of the most important surgical procedures for solving obstetrical problems. However, the steady increase in its use might be reflecting a non-medically justified utilization. This work reviews the main complications associated to cesarean section and their effect on the health of mothers and their children. An additional objective is to highlight the importance of establishing clinical protocols aimed at identifying those cases in which a cesarean section should be practiced. The implementation of these guidelines might help to reduce the effect that factors such as preferences of medical personnel or women's demand exert upon the increase of cesarean section use.