Lipocalin-2 expression identifies an intestinal regulatory neutrophil population during acute graft-versus-host disease.

Acute graft-versus-host disease (aGVHD) is a life-threatening complication of allogeneic hematopoietic cell transplantation (allo-HCT), for which therapeutic options are limited. Strategies to promote intestinal tissue tolerance during aGVHD may improve patient outcomes. Using single-cell RNA sequencing, we identified a lipocalin-2 (LCN2)-expressing neutrophil population in mice with intestinal aGVHD. Transfer of LCN2-overexpressing neutrophils or treatment with recombinant LCN2 reduced aGVHD severity, whereas the lack of epithelial or hematopoietic LCN2 enhanced aGVHD severity and caused microbiome alterations. Mechanistically, LCN2 induced insulin-like growth factor 1 receptor (IGF-1R) signaling in macrophages through the LCN2 receptor SLC22A17, which increased interleukin-10 (IL-10) production and reduced major histocompatibility complex class II (MHCII) expression. Transfer of LCN2-pretreated macrophages reduced aGVHD severity but did not reduce graft-versus-leukemia effects. Furthermore, LCN2 expression correlated with IL-10 expression in intestinal biopsies in multiple cohorts of patients with aGVHD, and LCN2 induced IGF-1R signaling in human macrophages. Collectively, we identified a LCN2-expressing intestinal neutrophil population that reduced aGVHD severity by decreasing MHCII expression and increasing IL-10 production in macrophages. This work provides the foundation for administration of LCN2 as a therapeutic approach for aGVHD.

ROCK1/2 signaling contributes to corticosteroid-refractory acute graft-versus-host disease.

Patients with corticosteroid-refractory acute graft-versus-host disease (aGVHD) have a low one-year survival rate. Identification and validation of novel targetable kinases in patients who experience corticosteroid-refractory-aGVHD may help improve outcomes. Kinase-specific proteomics of leukocytes from patients with corticosteroid-refractory-GVHD identified rho kinase type 1 (ROCK1) as the most significantly upregulated kinase. ROCK1/2 inhibition improved survival and histological GVHD severity in mice and was synergistic with JAK1/2 inhibition, without compromising graft-versus-leukemia-effects. ROCK1/2-inhibition in macrophages or dendritic cells prior to transfer reduced GVHD severity. Mechanistically, ROCK1/2 inhibition or ROCK1 knockdown interfered with CD80, CD86, MHC-II expression and IL-6, IL-1ß, iNOS and TNF production in myeloid cells. This was accompanied by impaired T cell activation by dendritic cells and inhibition of cytoskeletal rearrangements, thereby reducing macrophage and DC migration. NF-κB signaling was reduced in myeloid cells following ROCK1/2 inhibition. In conclusion, ROCK1/2 inhibition interferes with immune activation at multiple levels and reduces acute GVHD while maintaining GVL-effects, including in corticosteroid-refractory settings.

Institutional care in four Latin American countries: the importance of fostering public information and evaluation strategies / Atención en centros de cuidados a largo plazo en cuatro países de América Latina: importancia de fomentar la información pública y las estrategias de evaluación / Cuidados institucionais em quatro países da América Latina: a importância de promover informações públicas e estratégias de avaliação

ABSTRACT More than 8 million older people in Latin America depend on long-term care (LTC), accounting for 12% of people aged ≥ 60 years and almost 27% of those aged ≥ 80. It is crucial to develop sustainable strategies for providing LTC in the area, including institutional care. This special report aims to characterize institutional LTC in four countries (Brazil, Chile, Costa Rica and Mexico), using available information systems, and to identify the strategies adopted to support institutional care in these countries. This narrative review used nationwide, open-access, public data sources to gather demographic estimates and information about institutional LTC coverage and the availability of open-access data for the proportion of people with LTC needs, the number of LTC facilities and the number of residents living in them. These countries have a larger share of older people than the average in Latin America but fewer LTC facilities than required by the demand. National surveys lack standardization in defining disability, LTC and dependency on care. Information about institutional care is mainly fragmented and does not regularly include LTC facilities, their residents and workers. Data are crucial to inform evidence-based decisions to favor prioritization and to support advances in promoting policies around institutional LTC in Latin America. Although information about institutional care in the region is fragmented and insufficient, this paper profiles the four selected countries. It highlights the need for a better structure for data-driven LTC information systems. The lack of information emphasizes the urgency of the need to focus on and encourage research into this topic.

RESUMEN En América Latina, más de 8 millones de personas mayores dependen de los cuidados a largo plazo (CLP), lo que representa el 12% de las personas de 60 años o más y casi el 27% de las de 80 años o más Resulta crucial elaborar estrategias sostenibles para la prestación de CLP en la región, incluida la atención en centros de CLP. Este artículo especial tiene como finalidad determinar las características de la atención prestada en centros de CLP en cuatro países (Brasil, Chile, Costa Rica y México), utilizando los sistemas de información disponibles, así como determinar cuáles son las estrategias adoptadas en estos países para brindar apoyo a la atención en centros de CLP. En esta revisión descriptiva se utilizaron fuentes de datos públicas, de libre acceso y de ámbito nacional para recopilar estimaciones demográficas e información sobre la cobertura de la atención en centros de CLP, así como sobre la disponibilidad de datos de libre acceso acerca de la proporción de personas con necesidades de CLP, el número de centros de CLP y su correspondiente número de residentes. Estos países tienen una proporción de personas mayores superior a la media de América Latina, pero menos centros de CLP de los necesarios para cubrir la demanda. En las encuestas nacionales no hay una definición estandarizada de la discapacidad, los cuidados a largo plazo y la dependencia. La mayor parte de la información sobre la atención en centros de CLP está fragmentada y no incluye datos periódicos sobre los centros de CLP existentes, sus residentes o sus trabajadores. Estos datos son cruciales para fundamentar decisiones basadas en la evidencia destinadas a propiciar la priorización y brindar apoyo a los avances en la promoción de políticas en materia de centros de CLP en América Latina. Aunque la información sobre la atención en centros de CLP en la región es fragmentaria e insuficiente, en este artículo se presenta el perfil de los cuatro países seleccionados. Se resalta la necesidad de mejorar la estructura de los sistemas de información sobre CLP basados en datos. Esta falta de información pone de relieve la necesidad urgente de centrarse en este tema y fomentar la investigación al respecto.

RESUMO Na América Latina, mais de 8 milhões de pessoas idosas dependem de cuidados de longa duração (CLD), o que representa 12% das pessoas com mais de 60 anos e quase 27% das pessoas com mais de 80 anos. É fundamental criar estratégias sustentáveis para oferecer CLD na região, inclusive cuidados institucionais. O objetivo deste relatório especial é caracterizar CLD institucionais em quatro países (Brasil, Chile, Costa Rica e México), usando os sistemas de informação disponíveis, e identificar as estratégias adotadas para apoiar os cuidados institucionais nesses países. Esta revisão narrativa usou dados públicos de acesso aberto de âmbito nacional para coletar estimativas demográficas e informações sobre a cobertura de CLD institucionais e a disponibilidade de dados de acesso aberto sobre a porcentagem de pessoas com necessidades de CLD, o número de instituições de CLD e o número de residentes nessas instituições. Esses países têm uma parcela maior de pessoas idosas do que a média da América Latina, mas menos instituições de CLD do que a demanda exige. Falta padronização na definição de incapacidade, CLD e dependência de cuidados nas pesquisas nacionais. Em sua maior parte, as informações sobre cuidados institucionais são fragmentadas e não incluem instituições de CLD, seus residentes e trabalhadores de maneira regular. É essencial usar dados para guiar decisões baseadas em evidências a fim de favorecer a priorização e apoiar avanços que promovam políticas para CLD institucionais na América Latina. Embora as informações sobre cuidados institucionais na região sejam fragmentadas e insuficientes, este documento traça o perfil dos quatro países selecionados, destacando a necessidade de uma estrutura melhor para sistemas de informações de CLD orientados por dados. A falta de informações ressalta a urgência de aumentar o foco no tópico e encorajar pesquisas sobre o assunto.

Equity throughout the life course and the evolving role of the Pan American Health Organization / Equidad a lo largo del curso de vida y la evolución del papel de la Organización Panamericana de la Salud / Equidade ao longo da vida e a evolução do papel da Organização Pan-Americana da Saúde

ABSTRACT The objective of this article is to summarize the evolution of the regional commitments of the Pan American Health Organization (PAHO) on health promotion and strategies to improve the health and well-being of women, children, adolescents, and older persons. PAHO regional strategies approved by Member States in the last 20 years are used as the main source of information. The article presents the challenges of making health promotion a public health strategy widely applied in the Region of the Americas and the efforts to renew Member States' collective actions. The article also describes current PAHO efforts to include the positive aspects of health (i.e., well-being, optimal development, and functional ability) and the life course approach as opportunities to advance equity. The article reflects on immunization as a public good and the urgency to address the current challenges as a core element of the regional efforts to transform health systems after more than two years of the COVID-19 pandemic.

RESUMEN El objetivo de este artículo es resumir la evolución de los compromisos regionales de la Organización Panamericana de la Salud (OPS) en materia de promoción de la salud y estrategias para mejorar la salud y el bienestar de mujeres, niños y niñas, adolescentes y personas mayores. Se han empleado como principal fuente de información las estrategias regionales de la OPS aprobadas por los Estados Miembros en los últimos 20 años. En el artículo se presentan los desafíos de convertir la promoción de la salud en una estrategia de salud pública de amplia ejecución en la Región de las Américas y los esfuerzos para renovar las medidas colectivas de los Estados Miembros. Asimismo, se describe la labor actual de la OPS para incluir los aspectos positivos de la salud (como el bienestar, el desarrollo óptimo y la capacidad funcional) y el enfoque del curso de vida como oportunidades para fomentar la equidad. Finalmente, se reflexiona sobre la inmunización como bien público y la urgencia de abordar los desafíos actuales como elemento central de los esfuerzos regionales para transformar los sistemas de salud tras más de dos años de pandemia de COVID-19.

RESUMO O objetivo deste artigo é resumir a evolução dos compromissos regionais da Organização Pan-Americana da Saúde (OPAS) relativos à promoção da saúde e estratégias para melhorar a saúde e o bem-estar de mulheres, crianças, adolescentes e pessoas idosas. As estratégias regionais da OPAS aprovadas pelos Estados Membros nos últimos 20 anos são a principal fonte de informação. O artigo apresenta os desafios enfrentados para fazer da promoção da saúde uma estratégia de saúde pública amplamente aplicada na Região das Américas e os esforços para renovar as ações coletivas dos Estados Membros. O artigo também descreve os atuais esforços da OPAS para incluir os aspectos positivos da saúde (isto é, bem-estar, desenvolvimento ideal e habilidade funcional) e a abordagem de curso da vida como oportunidades para promover a equidade. O artigo faz reflexões sobre a imunização como um bem público e a urgência de abordar os desafios atuais como um elemento central dos esforços regionais para transformar os sistemas de saúde após mais de dois anos da pandemia de COVID-19.

Vice-versa: The iron trade in the western Roman Empire between Gaul and the Mediterranean.

Starting from the second century BC, with the fast expansion of the Roman Empire, iron production and consumption developed exponentially in north-western Europe. This rapid growth naturally led to an increase in trade, that still remains to be studied encompassing a broad scope, so as to not neglect long-distance exchanges. This is today possible by taking advantage of the progress made in the past 40 years in archaeology and archaeometallurgy. Cargoes of iron bars recovered from a group of 23 wrecks located off the coast of Saintes-Maries-de-la-Mer (Bouches-du-Rhône, France), opposite an old branch of the Rhône River, constitute a rich opportunity to examine this trade, by comparing the slag inclusions trapped in iron bars to primary slag from the six main ironmaking areas in Gaul. Based on a trace element analysis of these inclusions and this slag, we suggest that ships travelled down the Rhône carrying iron produced in Wallonia (Belgium), while others sailed up the Rhône transporting iron produced in Montagne Noire (Aude, France).

Masculinidades y salud de los hombres en la Región de las Américas / Masculinities and men's health in the Region of the Americas / Masculinidades e saúde dos homens na Região das Américas

RESUMEN Objetivo. Describir los resultados en salud de los hombres a partir del análisis sobre la interrelación de estos con las masculinidades, que permitirá la identificación de acciones para mejorar los resultados de salud de hombres, mujeres y niños. Métodos. Actualización y expansión de los hallazgos del informe Masculinidades y Salud en las Américas publicado por la Organización Panamericana de la Salud en el 2019, el cual se realizó a partir de una búsqueda intencionada y actualizada de datos secundarios sobre la salud masculina y otras investigaciones que abordan la temática. Resultados. La salud de los hombres y de las mujeres es distinta, no solo por los factores biológicos, sino también por la construcción y las desigualdades de género, y la intersección de los determinantes sociales. Existen importantes diferencias en los patrones de mortalidad y morbilidad por sexo a lo largo del curso de vida, incluida la sobremortalidad de los hombres por causas prevenibles como las muertes violentas, los accidentes viales y el consumo de alcohol y otras drogas (cocaína, cannabis y anfetaminas, entre otras). Varias de las causas de la mortalidad y la morbilidad se encuentran vinculadas con la expresión del modelo hegemónico de masculinidad y esto representa un riesgo para la salud integral de los hombres y para las personas cercanas. Conclusiones. Proponemos que se deben políticas coordinadas e intersectoriales con perspectiva de género relacional e interseccional que incluyan a los hombres para generar acciones de salud en todas las políticas para la diversidad de hombres con consecuencias positivas también para niños, adolescentes y mujeres.

ABSTRACT Objective. Describe health outcomes for men based on analysis of their interrelationship with masculinities, which will make it possible to identify actions to improve health outcomes of men, women, and children. Methods. Update and expansion of the findings stated in the report on Masculinities and Health in the Region of the Americas, published by the Pan American Health Organization in 2019, which was based on a targeted, up-to-date search for secondary data on men's health and other research addressing the topic. Results. Men's and women's health is different, not only because of biological factors, but also because of gender constructs and inequalities, and the intersection of social determinants. Considerable differences are seen in mortality and morbidity patterns by sex over the life course, including men's over-mortality from preventable causes such as violent deaths, road accidents, and use of alcohol and other drugs (cocaine, cannabis, and amphetamines, among others). Several causes of mortality and morbidity are linked to expressions of the hegemonic model of masculinity, which endangers the overall health of men and people close to them. Conclusions. We propose the adoption of coordinated and intersectoral policies with a relational and intersectional gender perspective that includes men, in order to generate health actions in all policies aimed at men in all their diversity, with positive consequences as well for children, adolescents, and women.

RESUMO Objetivo. Descrever os desfechos da saúde dos homens a partir da análise de sua inter-relação com as masculinidades, que permitirá identificar ações para melhorar os desfechos de saúde de homens, mulheres e crianças. Métodos. Atualização e ampliação dos achados do relatório Masculinidades e Saúde nas Américas, publicado pela Organização Pan-Americana da Saúde em 2019, que foi realizado a partir de uma busca intencional e atualizada de dados secundários sobre a saúde do homem e outras pesquisas que abordam o tema. Resultados. A saúde dos homens e das mulheres é distinta não apenas por fatores biológicos, mas também pela construção e pelas desigualdades de gênero, e pela intersecção dos determinantes sociais. Existem diferenças importantes nos padrões de morbimortalidade por sexo ao longo do curso de vida, incluindo a sobremortalidade dos homens por causas evitáveis como mortes violentas, acidentes de trânsito, e consumo de álcool e outras drogas (cocaína, cannabis e anfetaminas, entre outros). Várias causas de mortalidade e morbidade estão vinculadas à expressão do modelo hegemônico de masculinidade, que representa um risco à saúde integral dos homens e das pessoas próximas a eles. Conclusões. Propomos o desenvolvimento de políticas coordenadas e intersetoriais, com perspectiva de gênero relacional e interseccional que inclua homens, a fim de gerar ações de saúde em todas as políticas para a diversidade dos homens, com consequências positivas também para crianças, adolescentes e mulheres.

Retomando los sonidos: Prevención de la hipoacusia y rehabilitación auditiva en las personas mayores / Bringing back sounds: prevention of hearing loss and auditory rehabilitation in the elderly / Recuperando os sons: prevenção da perda auditiva e reabilitação auditiva em pessoas idosas

RESUMEN La hipoacusia representa una de las principales causas de discapacidad a nivel mundial y su prevalencia aumenta a medida que se envejece. Representa un tipo de discapacidad que, en la mayoría de los casos, puede ser potencialmente prevenible y tratable, por lo que su prevención, identificación temprana y rehabilitación integral deberían ser algunos de los puntos de acción a nivel local ya que se ha relacionado con numerosos desenlaces adversos en salud, incluyendo los dominios físico, mental, social y económico de las personas mayores. El objetivo de este artículo es resaltar la importancia de la prevención de la hipoacusia y promover su rehabilitación a lo largo del curso de vida, especialmente en personas mayores, y describir estrategias que se han planteado desde la Organización Mundial de la Salud y la Organización Panamericana de la Salud.

ABSTRACT Hearing loss is one of the leading causes of disability worldwide and its prevalence increases with age, though in most cases, this disability is potentially preventable and treatable. Thus, its prevention, early identification, and comprehensive rehabilitation should be points of action at the local level, since hearing loss has been linked to numerous adverse health outcomes affecting the physical, mental, social, and economic conditions of older people. The objective of this article is to highlight the importance of hearing loss prevention, promote rehabilitation throughout the life course, especially in older people, and describe strategies put forth by the World Health Organization and Pan American Health Organization.

RESUMO A perda auditiva representa uma das principais causas de incapacidade em todo o mundo e sua prevalência aumenta com a idade. Representa um tipo de deficiência que, na maioria dos casos, é potencialmente prevenível e tratável e, por essa razão, sua prevenção, identificação precoce e reabilitação integral devem ser alguns dos pontos de ação no âmbito local, considerando que está relacionada a inúmeros desfechos adversos de saúde, incluindo os domínios físico, mental, social e econômico das pessoas idosas. O objetivo deste artigo é ressaltar a importância da prevenção da perda auditiva e de sua reabilitação ao longo da vida, especialmente nas pessoas idosas, e descrever estratégias propostas pela Organização Mundial da Saúde e pela Organização Pan-Americana da Saúde.

Four reasons for adopting a life course approach to health in the COVID-19 era and beyond / Cuatro razones para adoptar el enfoque del curso de vida en el ámbito de la salud en la era de la COVID-19 y los años posteriores / Quatro motivos para adotar uma abordagem de curso de vida à saúde na era da COVID-19 e mais além

ABSTRACT The life course approach effectively responds to pressing health needs and fills critical gaps to improve health outcomes in the era of COVID-19 and beyond. This article outlines four main reasons to adopt and implement the life course approach in public health at national and local levels: (i) the approach effectively responds to new health trends and evidence, (ii) it fills longstanding gaps in care, (iii) it best addresses health inequities, and (iv) it can help achieve more with less.

RESUMEN El enfoque del curso de vida da respuestas eficaces a las urgentes necesidades de salud y salva brechas críticas para mejorar los resultados de salud en la era de la COVID-19 y los años posteriores. En este artículo se describen las cuatro razones principales para adoptar y poner en práctica el enfoque del curso de vida en la salud pública a nivel local y nacional: este enfoque (i) da respuestas eficaces a las tendencias y la evidencia nuevas en el ámbito de la salud, (ii) salva brechas de larga data en la atención, (iii) aborda de la mejor manera posible las inequidades de salud, y (iv) puede contribuir a lograr más con menos recursos.

RESUMO A abordagem de curso de vida responde de forma efetiva a necessidades urgentes de saúde e preenche lacunas críticas para melhorar os resultados de saúde na era da COVID-19 e mais além. Este artigo descreve quatro motivos principais para adotar e implementar a abordagem de curso de vida na saúde pública em nível nacional e local: (i) a abordagem responde de forma efetiva a novas evidências e tendências em saúde, (ii) preenche lacunas antigas nos cuidados de saúde, (iii) lida melhor com iniquidades em saúde e (iv) pode ajudar a conquistar mais com menos recursos.

Formation of Iron Sulfides on Carbon Steel in a Specific Cement Grout Designed for Radioactive Waste Repository and Associated Corrosion Mechanisms.

Carbon steel coupons were buried in a specific low-pH cement grout designed for radioactive waste disposal and left 6 months in anoxic conditions at 80 °C. The corrosion product layers were analyzed by µ-Raman spectroscopy, XRD, and SEM. They proved to be mainly composed of iron sulfides, with magnetite as a minor phase, mixed with components of the grout. Average corrosion rates were estimated by weight loss measurements between 3 and 6 µm yr-1. Corrosion profiles revealed local degradations with a depth up to 10 µm. It is assumed that the heterogeneity of the corrosion product layer, mainly composed of conductive compounds (FeS, Fe3S4, and Fe3O4), promotes the persistence of corrosion cells that may lead to locally aggravated degradations of the metal. New cement grouts, characterized by a slightly higher pH and a lower sulfide concentration, should then be designed for the considered application.

Effects of intra-set rest on morphological variables, maximal strength and jump performance in university students / Efectos del descanso intra-serie sobre variables morfológicas, fuerza máxima y saltabilidad en estudiantes universitarios

SUMMARY: The appropriate dosage of resistance training could promote physical and physiological adaptations and decrease injuries. The aim of the study was to analyze the effects of the different intra-set rest after eight weeks of resistance training on morphological variables, maximal strength, and jump performance in physically active university students. Twenty-five students (15 men and 10 women) were randomized by sex and distributed in Control Group (CG) (n=8) with rest only at the end of the series; Experimental Group 1 (EG1) (n=9) with an intra-set rest of 30 s, and Experimental Group 2 (EG2) (n=8) with four intra-set rest of 10 s. Morphological variables [body weight, bipedal height, body mass index (BMI), fat mass and muscle mass], maximum upper body strength (bench press and military press), lower body strength [parallel squat (45°) and deadlift], as well as countermovement jump (CMJ) were measured. All three groups obtained a significant increase (p0.05); thereby, there is an equivalent increase in muscle mass, maximal strength, jump performance, and a fat mass reduction.

RESUMEN: La dosificación adecuada de ejercicios de resistencia muscular permite favorecer adaptaciones físicas y fisiológicas, y reducir lesiones. El objetivo de este estudio fue analizar los efectos de distintos tiempos de descanso intra-serie luego de ocho semanas de ejercicios de resistencia muscular sobre variables morfológicas, fuerza máxima y saltabilidad en estudiantes universitarios físicamente activos. Veinticinco estudiantes (15 hombres y 10 mujeres) fueron aleatorizados por sexo y distribuidos en: grupo control (GC) (n=8) con descanso sólo al final de la serie; grupo experimental 1 (GE1) (n=9) con un descanso intra-serie de 30 s y grupo experimental 2 (GE2) (n=8) con cuatro descansos intra-serie de 10 s. Se midieron variables morfológicas [peso corporal, estatura bípeda, índice de masa corporal (IMC), masa adiposa y masa muscular], fuerza máxima del tren superior (press de banco plano y press militar) e inferior [sentadilla paralela (45°) y peso muerto] y saltabilidad con el salto contramovimiento (CMJ). Se obtuvo un aumento significativo (p<0,01) del peso corporal e IMC y, una reducción significativa (p<0,01) de la masa adiposa en los tres grupos. La masa muscular aumentó significativamente (p<0,01) en el GC y GE1. La fuerza máxima del tren superior e inferior aumentaron significativamente (p<0,05) en los tres grupos y para todos los ejercicios, mientras que el CMJ aumentó significativamente en el GC y GE1. No existen diferencias significativas entre distintos tiempos de descanso intra-serie cuando se utiliza el mismo volumen, intensidad y descanso total durante las series de ejercicios, logrando un aumento equivalente en masa muscular, fuerza máxima, saltabilidad y reducción de la masa adiposa.

Trends in premature avertable mortality from non-communicable diseases for 195 countries and territories, 1990-2017: a population-based study.

BACKGROUND: The reduction by a third of premature non-communicable disease (NCD) mortality by 2030 is the ambitious target of Sustainable Development Goal (SDG) 3.4. However, the indicator is narrowly defined, including only four major NCDs (cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases) and only for people aged 30-70 years. This study focuses on premature avertable mortality from NCDs-premature deaths caused by NCDs that could be prevented through effective public policies and health interventions or amenable to high-quality health care-to assess trends at global, regional, and national levels using estimates from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2017. METHODS: We reviewed existing lists of NCD causes of death that are either preventable through public health policies and interventions or amenable to health care to create a list of avertable NCD causes of death, which was mapped to the GBD cause list. We estimated age-standardised years of life lost (YLL) per 100 000 population due to premature avertable mortality from NCDs, avertable NCD cause clusters, and non-avertable NCD causes by sex, location, and year and reported their 95% uncertainty intervals (UIs). We examined trends in age-standardised YLL due to avertable and non-avertable NCDs, assessed the progress of premature avertable mortality from NCDs in achieving SDG 3.4, and explored specific avertable NCD cause clusters that could make a substantial contribution to overall trends in premature mortality. FINDINGS: Globally, premature avertable mortality from NCDs for both sexes combined declined -1·3% (95% UI -1·4 to -1·2) per year, from 12 855 years (11 809 to 14 051) in 1990 to 9008 years (8329 to 9756) in 2017. However, the absolute number of avertable NCD deaths increased 49·3% (95% UI 47·3 to 52·2) from 23·1 million (22·0-24·1) deaths in 1990 to 34·5 million (33·4 to 35·6) in 2017. Premature avertable mortality from NCDs reduced in every WHO region and in most countries and territories between 1990 and 2017. Despite these reductions, only the Western Pacific and European regions and 25 countries (most of which are high-income countries) are on track to achieve SDG target 3.4. Since 2017, there has been a global slowdown in the reduction of premature avertable mortality from NCDs. In 2017, high premature avertable mortality from NCDs was clustered in low-income and middle-income countries, mainly in the South-East Asia region, Eastern Mediterranean region, and African region. Most countries with large annual reductions in such mortality between 1990 and 2017 had achieved low levels of premature avertable mortality from NCDs by 2017. Some countries, the most populous examples being Afghanistan, the Central African Republic, Uzbekistan, Haiti, Mongolia, Turkmenistan, Pakistan, Ukraine, Laos, and Egypt, reported both an upward trend and high levels of premature avertable mortality from NCDs. Cardiovascular diseases, cancers, and chronic respiratory diseases have been the main drivers of the global and regional reduction in premature avertable mortality from NCDs, whereas premature mortality from substance use disorders, chronic kidney disease and acute glomerulonephritis, and diabetes have been increasing. INTERPRETATION: Worldwide, there has been a substantial reduction in premature avertable mortality from NCDs, but progress has been uneven across populations. Countries vary substantially in current levels and trends and, hence, the extent to which they are on track to achieve SDG 3.4. By accounting for premature avertable mortality while avoiding arbitrary age cutoffs, premature avertable mortality from NCDs is a robust, comprehensive, and actionable indicator for quantifying and monitoring global and national progress towards NCD prevention and control. FUNDING: None.

Aging and the cancer burden in Latin America and the Caribbean: Time to act.

OBJECTIVE: To describe the cancer burden in adults aged 65 years and older in Latin America and the Caribbean to serve as rational for improving cancer control planning among region's older population. MATERIALS AND METHODS: Using the up-to-date GLOBOCAN estimates for 2018, we describe the cancer burden including key patterns for the major cancer sites among adults aged 65 years and older in Latin America and the Caribbean. We also predict the future burden in 2040 by applying population projections, assuming no changes in incidence rates over time. RESULTS: In 2018, an estimated 679,000 new cancer cases occurred among older adults in LAC, representing almost half (48%) of the total incidence burden (43% in Central America, 49% in South America, and 52% in the Caribbean). Prostate, colorectum, and lung were the most common cancers among older males in South America and the Caribbean, with non-melanoma skin cancer ranking third in Central America. Among older females, the most common sites were breast, colorectum, and non-melanoma skin cancer, except in the Caribbean, where lung cancer ranked third. Overall, the number of new cancer cases among older adults in the region is expected to double by 2040, reaching 1.6 million new cases. CONCLUSION: Our findings highlight the need for an urgent adaptation of healthcare systems across LAC by improving training in geriatrics for the oncology workforce, and by including older adults in clinical guidelines, insurance schemes, and cancer prevention policies.

Percepción de los estudiantes de kinesiología sobre la incorporación de la metodología b-learning y uso de dispositivos móviles en el curso de análisis del movimiento / Kinesiology students' perception of the incorporation of the b-learning methodology and the use of mobile devices in the course of movement analysis

Introducción: el aumento del número de estudiantes en carreras de la salud hace necesario incluir nuevas metodologías de enseñanza-aprendizaje. La literatura avala el uso de las tecnologías de la información y comunicación (TICs) y el b-learning como recursos para abordar esta problemática. El propósito fue evaluar la percepción de los estudiantes universitarios de la carrera de kinesiología sobre la incorporación de TICs y b-learning en el curso Análisis del Movimiento. Material y Método: se aplicó un cuestionario a 94 estudiantes. Se determinó evidencia de validez de constructo a través de análisis confirmatorio de factores y confiabilidad mediante Alpha de Cronbach. Se estimó la mediana (Q1-Q3) de cada dimensión, determinando posibles diferencias mediante la prueba de Kruskal-Wallis. Resultados: se definió una encuesta con 5 dimensiones y 27 ítems. Los enunciados cargaron en las 5 dimensiones. El coeficiente de Alpha de Cronbach fue de α=0,83. Los resultados según la Mediana (Q1-Q3) por dimensión fueron: Percepción General de la Metodología 4,83 (4,67-5), Percepción de los materiales utilizados 4,75 (4,5-5), Percepción del Autoaprendizaje 4,09 (3,82-4,27), Interacción con los docentes y compañeros 4,75 (4,25-5), Evaluación 5 (4,67-5) y la nota global fue de 6 (6-7). Discusión: el cuestionario posee adecuada evidencia de validez y confiabilidad, hubo diferencias estadísticamente significativas entre dimensiones, especialmente en Percepción del Autoaprendizaje. Los estudiantes valoran positivamente la organización en los procesos de innovación en metodologías de enseñanza y evaluación, el uso de sistemas digitales como facilitadores de su aprendizaje y la oportunidad de aprendizaje autónomo.(AU)

Introduction: physiotherapy has systematically increased its students, being necessary to include new teaching and learning methodologies. The literature supports the use of information and communication technologies (ICT) and b-learning as resources to address this problem. The aim was to evaluate the perception of Physiotherapy students about the incorporation of ICTs and b-learning in the course of Movement Analysis. Methods: experts designed an instrument that applied to 94 students. The construct validity determined through a factor confirmatory analysis and reliability by Cronbach's Alpha. The median (Q1-Q3) of each dimension was estimated, determining the existence of possible differences through the Kruskal-Wallis test. Results: a survey with five categories and 27 items was defined and loaded in the five dimensions. The coefficient of Cronbach's alpha was α = 0.83. The results according to the Median (Q1-Q3) for the measure were: General Perception of the Methodology 4.83 (4.67-5), Perception of the materials used 4.75 (4.5-5), Perception of Self-Learning 4.09 (3.82-4.27), Interaction with teachers and classmates 4.75 (4.25-5), Evaluation 5 (4.67-5) and overall score was 6 (6-7). Discussion: the questionnaire has validity and reliability, statistical differences between measures were found, especially in the Perception of Self-Learning. The students valued positively the organization in the processes of innovation in teaching and evaluation methodologies, the use of digital systems as facilitators of their learning and the opportunity for autonomous learning.(AU)

Paralithocins, Antimicrobial Peptides with Unusual Disulfide Connectivity from the Red King Crab, Paralithodes camtschaticus.

As part of an ongoing exploration of marine invertebrates as a source of new antimicrobial peptides, hemocyte extracts from the red king crab, Paralithodes camtschaticus, were studied. Three cationic cysteine (Cys)-rich peptides, named paralithocins 1-3, were isolated by bioassay-guided purification, and their amino acid sequences determined by Edman degradation and expressed sequences tag analysis. Disulfide bond mapping was performed by high-resolution tandem mass spectrometry. The peptides (38-51 amino acids in length) share a unique Cys motif composed of eight Cys, forming four disulfide bridges with a bond connectivity of (Cys relative position) Cys1-Cys8, Cys2-Cys6, Cys3-Cys5, and Cys4-Cys7, a disulfide arrangement that has not been previously reported among antimicrobial peptides. Thus, paralithocins 1-3 may be assigned to a previously unknown family of antimicrobial peptides within the group of Cys-rich antimicrobial peptides. Although none of the isolated peptides displayed antimicrobial activity against the target strains Escherichia coli, Pseudomonas aeruginosa, or Staphylococcus aureus, they inhibited the growth of several marine bacterial strains with minimal inhibitory concentrations in the 12.5-100 µM range. These findings corroborate the hypothesis that marine organisms are a valuable source for discovering bioactive peptides with new structural motifs.

Asociación entre características antropométricas y funcionalidad motriz en sujetos chilenos con distintos niveles de actividad física / Association between anthropometric characteristics and the motor function in Chileans subjects with different levels of physical activity

Existe escasa información respecto a la relación entre los parámetros antropométricos y la funcionalidad motriz en sujetos activos e inactivos. En ese sentido, la presente investigación pretende determinar la relación entre las características antropométricas y la puntuación de funcionalidad motriz en sujetos chilenos con distintos niveles de actividad física. La muestra incluyó 63 sujetos (20 mujeres), distribuidos en tres grupos: grupo físicamente activo (GFA, n=21), grupo deportista (GD, n=21) y grupo físicamente inactivo (GFI, n=21). Las variables estudiadas correspondieron a la composición corporal, perímetro de cintura (PC), índice de masa corporal (IMC), índice cintura-cadera (ICC) y funcionalidad motriz a través del Functional Movement Screen (FMS). Se aplicó Anova una vía, el test de Pearson y un modelo de regresión lineal múltiple, considerando un p <0,05. Los resultados indican correlaciones moderadas e inversas entre la puntuación FMS y la sumatoria de pliegues cutáneos, Zadiposidad, masa adiposa (kg) e IMC en el GFI (-0,52 ≤ r ≤ -0,62), y con la sumatoria de pliegues cutáneos, masa adiposa (kg y %) en el GFA(-0,54 ≤ r ≤ -0,60). Los cambios en la puntuación del FMS se explican principalmente por la suma de pliegues cutáneos, la Zadiposidad, la masa grasa (kg), el porcentaje de masa grasa y el PC. En conclusión, las características antropométricas y la funcionalidad motriz se encuentran asociadas en sujetos chilenos físicamente activos (GFA) e inactivos, mostrando una relación inversa entre el puntaje del FMS con los parámetros de la composición corporal relacionados con la adiposidad(AU)

There is little information about the relationship between anthropometric indexes and motor function in active and inactive subjects. In that sense, this research aims todetermine the relationship between anthropometric characteristics and motor function score in Chilean subjects with different levels of physical activity. The sample included 63 subjects (20 women), allocated into three groups:physically active group (GFA, n=21), athlete group (GD, n=21) and physically inactive group (GFI, n=21).The variables studied were body composition, waist circumference (WC), body mass index (BMI), waist-to-hip ratio (WHR), and motor functionality using the Functional Movement Screen (FMS). A One-way ANOVA, Pearson’s correlation test, and a multiple linear regression model were applied, considering P <0.05.The results showed a moderate inverse correlation (-0.52 ≤ r ≤ -0.62)between FMS score and sum of skin folds, Z-score fat, fat mass (Kg), BMI in the GFI. Similarly, in the GFA the FMS showed a moderate inverse correlation (-0.54 ≤ r ≤ -0.60) with the sum of skin folds, fat mass (Kg& %). Changes in the FMS score were mainly explained by the sum of skin fold, Z-score fat, fat mass (kg), percentage of fat mass and WC. In conclusion, anthropometric characteristics are associated with motor function in physically active (GFA) and inactive Chilean subjects, showing an inverse relationship between the FMS score and adiposity parameters of body composition(AU)

Association between anthropometric characteristics and the motor function in Chileans subjects with different levels of physical activity.

There is little information about the relationship bet- ween anthropometric indexes and motor function in active and inactive subjects. In that sense, this research aims todetermine the relationship between anthropometric characteristics and motor function score in Chilean subjects with different levels of physical activity. The sample included 63 subjects (20 women), allocated into three groups:physically active group (GFA, n=21), athlete group (GD, n=21) and physically inactive group (GFI, n=21).The variables studied were body composition, waist circumference (WC), body mass index (BMI), waist-to-hip ratio (WHR), and motor functionality using the Functional Movement Screen (FMS). A One-way ANOVA, Pearson's correlation test, and a multiple linear regression model were applied, considering P <0.05.The results showed a moderate inverse correlation (-0.52:≤ r :≤ -0.62)between FMS score and sum of skin folds, Z-score fat, fat mass (Kg), BMI in the GFI. Similarly, in the GFA the FMS showed a moderate inverse correlation (-0.54 ≤ r ≤ -0.60) with the sum of skin folds, fat mass .(Kg& %). Changes in the FMS score were mainly explained by the sum of skin fold, Z-score fat, fat mass (kg), percentage of fat mass and WC. In conclusion, anthropometric characteristics are associated with motor function in physically active (GFA) and inactive Chilean subjects, showing an inverse relationship between the FMS score and adiposity parameters of body composition.

A comparative assessment of avoidable blindness and visual impairment in seven Latin American countries: prevalence, coverage, and inequality.

OBJECTIVE: To conduct a comparative analysis of social inequalities in eye health and eye health care and generate baseline evidence for seven Latin American countries as a benchmarking exercise for monitoring progress toward three goals of the regional Plan of Action for the Prevention of Blindness and Visual Impairment: increasing eye health service coverage, minimizing barriers, and reducing eye health-related disease burden. METHODS: Results from cross-sectional eye health surveys conducted in six Latin American countries (Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay) from 2011 to 2013 and recently published national surveys in Paraguay were analyzed. The magnitude of absolute and relative inequalities between countries in five dimensions of eye health across the population gradient defined by three equity stratifiers (educational attainment, literacy, and wealth) were explored using standard exploratory data analysis techniques. RESULTS: Overall prevalence of blindness in people 50 years old and older varied from 0.7% (95% CI: 0.4-1.0) in Argentina to 3.0% (95% CI: 2.3-3.6) in Panama. Overall prevalence of visual impairment (severe plus moderate) varied from 8.0% (95% CI: 6.5-11.0) in Uruguay to 14.3% (95% CI: 13.9-14.7) in El Salvador. The main reported cause of blindness was unoperated cataract and most cases of visual impairment were caused by uncorrected refractive error. Three countries had cataract surgical coverage of more than 90% for blind persons, and two-thirds of cataract-operated patients had good visual acuity. CONCLUSIONS: Blindness and moderate visual impairment prevalence were concentrated among the most socially disadvantaged, and cataract surgical coverage and cataract surgery optimal outcome were concentrated among the wealthiest. There is a need for policy action to increase services coverage and quality to achieve universality.

A comparative assessment of avoidable blindness and visual impairment in seven Latin American countries: prevalence, coverage, and inequality / Una evaluación comparativa de la ceguera y la deficiencia visual evitables en siete países latinoamericanos: prevalencia, cobertura y desigualdades

Objective. To conduct a comparative analysis of social inequalities in eye health and eye health care and generate baseline evidence for seven Latin American countries as a benchmarking exercise for monitoring progress toward three goals of the regional Plan of Action for the Prevention of Blindness and Visual Impairment: increasing eye health service coverage, minimizing barriers, and reducing eye health-related disease burden. Methods. Results from cross-sectional eye health surveys conducted in six Latin American countries (Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay) from 2011 to 2013 and recently published national surveys in Paraguay were analyzed. The magnitude of absolute and relative inequalities between countries in five dimensions of eye health across the population gradient defined by three equity stratifiers (educational attainment, literacy, and wealth) were explored using standard exploratory data analysis techniques. Results. Overall prevalence of blindness in people 50 years old and older varied from 0.7% (95% CI: 0.4-1.0) in Argentina to 3.0% (95% CI: 2.3-3.6) in Panama. Overall prevalence of visual impairment (severe plus moderate) varied from 8.0% (95% CI: 6.5-11.0) in Uruguay to 14.3% (95% CI: 13.9-14.7) in El Salvador. The main reported cause of blindness was unoperated cataract and most cases of visual impairment were caused by uncorrected refractive error. Three countries had cataract surgical coverage of more than 90% for blind persons, and two-thirds of cataract-operated patients had good visual acuity. Conclusions. Blindness and moderate visual impairment prevalence were concentrated among the most socially disadvantaged, and cataract surgical coverage and cataract surgery optimal outcome were concentrated among the wealthiest. There is a need for policy action to increase services coverage and quality to achieve universality.

Objetivo. Realizar un análisis comparativo de las desigualdades sociales en materia de salud ocular y atención oftálmica, y generar datos probatorios de referencia de siete países latinoamericanos como un ejercicio de evaluación comparativa para vigilar el progreso hacia tres metas del Plan de Acción para la Prevención de la Ceguera y la Deficiencia Visual Evitables: el aumento de la cobertura de los servicios de salud ocular, la reducción al mínimo de las barreras y la disminución de la carga de morbilidad relacionada con la salud ocular. Métodos. Se analizaron los resultados de las encuestas transversales de salud ocular realizadas en seis países latinoamericanos (Argentina, El Salvador, Honduras, Panamá, Perú y Uruguay) desde el 2011 al 2013, y las encuestas nacionales del Paraguay recientemente publicadas. Mediante el empleo de técnicas ordinarias de análisis exploratorio de datos, se investigó la magnitud de las desigualdades absolutas y relativas entre países en cinco dimensiones de la salud ocular a través del gradiente poblacional definido por tres variables de estratificación de equidad (logro educativo, alfabetización y riqueza). Resultados. La prevalencia general de la ceguera en personas de 50 años de edad o mayores varió de 0,7% (intervalo de confianza (IC) de 95%: 0,4-1,0) en Argentina a 3,0% (IC95%: 2,3-3,6) en Panamá. La prevalencia general de la deficiencia visual (grave y moderada) varió de 8,0% (IC95%: 6,5-11,0) en Uruguay a 14,3% (IC95%: 13,9-14,7) en El Salvador. La principal causa notificada de ceguera fue la catarata no operada, mientras que la mayor parte de los casos de deficiencia visual fueron causados por un error de refracción no corregido. Tres países tenían una cobertura quirúrgica de la catarata de más de 90% para las personas ciegas, mientras que dos terceras partes de los pacientes operados de cataratas mostraban una buena agudeza visual. Conclusiones. Las prevalencias de la ceguera y la deficiencia visual moderada se concentraban en las personas más desfavorecidas socialmente, mientras que la cobertura quirúrgica de la catarata así como los resultados óptimos de esta intervención se concentraban en los más adinerados. Son necesarias acciones políticas para aumentar la cobertura y la calidad de los servicios con objeto de alcanzar la universalidad.

[Information needs and internet use in patients with breast cancer in Spain]. / Necesidades de información y uso de Internet en pacientes con cáncer de mama en España.

OBJECTIVE: To analyze information needs and search strategies among women with breast cancer in Spain. An additional aim was to explore how the internet, as a source of health information, influences the autonomy and active management of this disease among patients. The research was conducted in 2010 and 2011. METHOD: This study forms part of a broader qualitative study that focuses on describing patients' experiences of breast cancer and the trajectory of the disease, with the aim of creating a platform of integrated information resources for patients, relatives and healthcare professionals (PyDEsalud: http://www.pydesalud.com). We carried out 41 in-depth, semi-structured interviews with breast cancer patients in different stage of the disease, who were aged between 32 and 69 years. The interviewees' were selected by intentional sampling, which included 15 Spanish regions. The field work was carried out from June to August, 2010. The interviews were recorded on videotape or audio. Based on patients' narratives of their disease, a thematic-inductive analysis was performed of the information gathered. RESULTS: The findings show the importance of the internet as a source of health information. Moreover, the internet is a resource that is able to promote the empowerment process among patients and, consequently, to aid improvement in disease management. CONCLUSIONS: Users need access to web sites with high quality health information, adapted to their needs and objectives.