Socio-environmental assessment of a landfill using a mixed study design: A case study from México.

Municipal solid waste management is a challenge for local authorities since mismanagement leads to environmental damage and social discontent. The objective of this study was to assess in an integrated manner the socio-environmental situation of a municipal landfill from México, using a design of mixed methods, which considered a quantitative evaluation of physicochemical and microbiological variables measured in leachates, surface and groundwater samples, soil and air, and a qualitative evaluation by in-depth interviews with the near-by inhabitants about their perception of the impacts of the landfill. The results show that leachates polluted the soil and surface water in a radius of up to 500 m from the landfill, but did not reach the groundwater, while the mean concentrations of PM10, Mn, and Ni measured in air samples at the landfill of 146 µg m-3, 0.12 µg m-3, 0.10 µg m-3, respectively, in the dry season and of Mn and Ni of 0.13 µg m-3 and 0.11 µg m-3, respectively, in the rainy season, surpassed permissible limits. From the residents perspective the landfill pollutes soil, water and air and it contributes to vehicle traffic and noise, promotes harmful fauna and disturbs the esthetic view. Air measurements coincide with social perception and in general, the applied mixed study design helped to assess in an integrated manner the socio-environmental concerns and to give advice to improve the current management of the landfill.

Treatment of childhood acute lymphoblastic leukemia in central America: a lower-middle income countries experience.

BACKGROUND: Five Asociación de Hemato-Oncología de Centroamérica (AHOPCA) countries have used an adapted BFM-based protocol for childhood acute lymphoblastic leukemia (ALL). PROCEDURE: In the AHOPCA-ALL 2008 protocol, patients were stratified by age, white blood cell count, immunophenotype, central nervous system involvement, day 8 prednisone response, and morphologic bone marrow response to induction therapy. Patients at Standard Risk (SR) received a three-drug induction regimen, a reinduction phase, and maintenance with protracted intrathecal therapy. Those at Intermediate (IR) and High Risk (HR) received, in addition, daunorubicin during induction therapy, a consolidation phase and two or three reinduction phases respectively. RESULTS: From August 2008 through July 2012, 1,313 patients were enrolled: 353 in SR, 548 in IR, 412 in HR. During induction therapy, 3.0% of patients died, 2.7% abandoned treatment, 1.1% had resistant ALL, and 93.2% achieved morphological complete remission (CR). Deaths and abandonment in first CR occurred in 2.7% and in 7.0% of patients, respectively. The relapse rate at a median observation time of 2.1 years was 15.0%. At 3 years, the event-free survival (EFS) and overall survival (OS), with abandonment considered as an event, were 59.4% (SE 1.7) and 68.2% (SE 1.6). Three-year EFS was 68.5% (SE 3.0), 62.1% (SE 2.6), and 47.8% (SE 3.2) for SR, IR, and HR groups. Adolescents had a significantly higher relapse rate (P = 0.001). CONCLUSIONS: This experience shows that common international studies are feasible in lower-middle income countries. Toxic deaths, abandonment of treatment, and relapses remain major obstacles to the successful treatment. Alternative treatment strategies may be beneficial.

Radiosynovectomy in hemophilia: quantification of its effectiveness through the assessment of 10 articular parameters.

BACKGROUND: Radiosynovectomy (RS) can reduce the number of hemarthroses in chronic hemophilic synovitis. The purpose of this study was to quantitatively assess the effectiveness of RS in terms of the objective improvement of ten articular parameters. METHODS: One-hundred and fifty-six radiosynovectomies were performed in 104 joints of 78 hemophiliacs diagnosed with chronic synovitis. The mean patient age was 18 years. The RS was carried out with either yttrium-90 or rhenium-186 (1-3 injections with a 6-month interval between them). RESULTS: RS resulted in significant improvement in nine of the 10 variables studied, namely in the number of episodes of hemarthrosis, articular pain, range of motion (ROM) in flexion. ROM in extension, muscle strength (MS) in flexion, MS in extension, the degree of synovitis detected on clinical examination, the size of the synovium as measured by means of imaging techniques (in millimeters), the clinical scale developed by the World Federation of Haemophilia (WFH), and the radiologic scale of the WFH. The tenth parameter, the WFH radiologic score, showed no improvement. The other nine parameters studied improved independently for each one of the intra-articular injections of the radioisotope. CONCLUSIONS: Categorization of the variables with regard to the degree of improvement achieved showed that the number of episodes of hemarthrosis and the severity of pain were the variables associated with the greatest improvement, with a 70% decrease in the amount of bleeding and in the level of pain experienced by the patient. The reduction of articular bleeding after RS was 67.6% when RS-1 was used, 62.1% with RS-2 and 61.2% with RS-3. Synovial hypertrophy as assessed clinically and by imaging techniques also showed a reduction of 30% and 39%, respectively. The WFH clinical scale revealed an improvement of around 19%. MS also improved in flexion and extension (7.9% and 8.2% improvement, respectively). ROM showed a slight but non-significant improvement.

Patrones antropométricos y consumo máximo de oxígeno (VO2) entre niños escolares chilenos Aymaras y no Aymaras de 10 a 12 años, que viven en altura (3.500 msnm) y en la planicie (500 msnm) / Anthropometric patterns and oxygen consumption (VO2) of school-children Aymara and non-Aymara of 10-12 years, living in high altitude (3500m) and the plain (500 m), from Chile

El objetivo del estudio fue comparar peso, talla, índice de masa corporal (IMC) y consumo de oxígeno (VO2 max) en una muestra de 73 alumnos de 10 a 12 años del poblado de Putre a 3500 metros de altitud (n=31) y del pueblito de San Miguel de Azapa, que lo hacen a 500 metros de altitud (n=42). Los sujetos fueron evaluados según, procedencia, sexo y etnia aymará y No aymará. Los resultados muestran una disminución significativa de los patrones antropométricos de niños y niñas de Putre en comparación con los de San Miguel de Azapa. Los aymará de Putre damas y varones presentan un IMC bajo lo normal (<20). Los varones aymará de San Miguel de Azapa presentan un peso significativamente mayor que los varones no aymará, sin embargo todos los alumnos de San Miguel expresan un IMC de normales. La distancia recorrida en metros (Test de 6 minutos de carrera continua) y el consumo máximo de oxígeno expresado en litros por minuto (VO2), no presentan diferencias significativas según sexo, etnia y localidad de origen de los niños y niñas en estudio. Se concluye que el ambiente multiestresante de la altura (hipoxia hipobárica, bajas temperaturas y el nivel socioeconómico), tendría un gran impacto en el crecimiento infantil y el consumo máximo de oxígeno, lo que posiblemente reflejarían mecanismos adaptativos de los niños y niñas de Putre.

The objective of this study was to evaluate weight, height, body mass index (BMI) and oxygen consumption (VO2 max) in a sample of 73 students of 10 to 12 years from Putre to 3500 meters of altitude (n = 31) and San Miguel de Azapa, 500 meters of altitude (n = 42). Subjects were grouped according origin, gender, and aymara and non-aymara ethnic. The results show a significant decrease in anthropometric patterns in children of Putre compared with students from San Miguel de Azapa. Girls and boys Aymara of Putre have a BMI below normal (<20). Boys Aymara from San Miguel de Azapa have a significantly greater weight than boys non-aymara, however all students from San Miguel express a normal BMI. The distance traveled in meters (Test of 6 minutes of continuous running) and maximal oxygen consumption in liters per minute (VO2), not show significant differences by gender, ethnicity and geographic origin. We conclude that multistressful environment of the high altitude (hypobaric hypoxia, low temperatures and socioeconomic status), would have a major impact on child growth, and maximum oxygen consumption, possibly reflecting adaptive mechanisms of boys and girls from Putre.

[Are the tools recommended by ASPEN and ESPEN comparable for assessing the nutritional status?]. / Son las herramientas recomendadas por la ASPEN y la ESPEN equiparables en la valoración del estado nutricional?

INTRODUCTION: [corrected] There is no "gold standard" for identification of malnutrition. The ASPEN board of directors (2002) suggest the subjective global assessment (SGA) and ESPEN (2002) recommend the nutritional risk screening-2002 (NRS-2002) to detect the prevalence of malnutrition. AIMS: This cross-sectional study aims (1) to assess the prevalence of malnutrition on admission and (2) to know association between two tools used to evaluate nutritional risk. MATERIAL AND METHODS: 135 patients (42.2% women and 58.8% men, 62.1 +/- 14.4 years) are studied at admission. Different parameters are assessed to evaluate nutritional state. Patient's energy requirements (Harris Benedict x Long's factor) and energy intake, calculated as 24 h-recall, are compared. The prevalence of malnutrition is assessed with two screening tools: SGA and NRS-2002. RESULTS: 42.2% of the patients had lost more than 5% body weight and 39.3% had an intake lower than required at admission. The prevalence of malnutrition is 40.7 and 45.1/100 patients admitted at hospital, if SGA or NRS-2002 are used, respectivility. There is strong agreement between results of two nutritional assessment methods (p = 0.000). Serum albumin and protein concentrations and linfocytes count are less in the malnourished patients. CONCLUSIONS: The prevalence of malnutrition is elevated. In clinical practice, both methods could be used to identify patients at nutritional risk, but the NRS-2002 is a less subjective method.

Prospective comparison of intraoperative angiography with duplex scanning in evaluating lower-extremity bypass grafts in a community hospital.

The gold standard for intraoperative evaluation of lower-extremity bypass grafts has been angiography. Limitations of this technique include inability to measure flow dynamics, violation of graft integrity, cost, and length of assessment time. The goal of this study was to evaluate duplex scanning as an alternative modality for intraoperative graft assessment. Our study group comprised of 19 consecutive patients undergoing infrainguinal bypass procedures at our institution between March 1999 and March 2000. Intraoperative angiography was compared with duplex scanning by evaluating parameters of assessment time, graft flow velocities, serum creatinine levels, and 30-day graft patency rates. Mean study times were the following: cut-film angiography, 22 +/- 1.8 minutes; real-time fluoroscopy, 17 +/- 2.5 minutes; and duplex imaging, 10.4 +/- 1.1 minutes. As noted duplex imaging times as compared with radiographic modalities were significantly shorter (P < 0.05). There was a substantial cost difference between angiography ($650) and duplex scanning ($350). A 100 per cent correlation of study findings was noted between angiography and duplex scanning. No significant change in pre- versus postoperative creatinine levels was found. We conclude that duplex scanning is an effective modality and provides reliable intraoperative vascular graft assessment data in a community hospital setting. Advantages include a shorter study time, lower cost, flow dynamic data acquisition, and avoidance of mechanical graft trauma.

[Prevalences of diabetes, glucose intolerance, hyperlipemia and risk factors as a function of socioeconomic level]. / Prevalencias de diabetes, intolerancia a la glucosa, hiperlipemia y factores de riesgo en función de nivel socioeconómico.

We studied the prevalence of non-insulin dependent diabetes (NIDDM) and hyperlipemia in older than 15 years old population in the city of San Luis Potosi and in a rural area 50 km north of this city. They are located in the state of San Luis Potosi in the central plateau of Mexico. A total of 1136 subjects were surveyed (645 males, 491 females). Weight and height were measured and the body mass index (BMI) calculated in all subjects. After a fasting capillary sample was obtained, 75 g of glucose were given and a second sample was taken 120 minutes later. The WHO recommendations for diagnosis of DM were used. The overall prevalence of DM was 10.0%: the lowest rate was for individuals in the rural area (0.9%) which contrasts with the 11% seen in the urban population (p 0.0001). In the urban subjects, the highest rates were observed in the very low income group (27.7%) whereas the low income group had a rate of 6.2%; the prevalence was 7.0, 7.7 and 18.2% in the medium, high medium and high socioeconomic groups. The prevalence was influenced by age, BMI, sex (males = 6.8% females = 14.3%) and socioeconomic status; hypercholesterolemia (> 200 mg/dL) was found in 16%. In conclusion, we have documented high rates of NIDDM in a mexican urban population with very high levels in the very poor which contrasts with the rural population.

Analisis evolutivo del sistema de salud chileno. / Evolutional analysis of the Chilean health system

La aplicacion del actual modelo socioeconomico ha producido un conjunto de cambios estructurales en los diferentes ambitos y ha generado importantes variaciones tanto en el area economica como en el area social. En el sector Salud, esta reorientacion exigira una considerable participacion privada que permita modificar la proporcionalidad actual y un cambio de mentalidad de la poblacion. El autor analiza los principios basicos de los modelos vigentes y examina un itinerario de los cambios producidos hasta febrero de 1981, para terminar con un analisis de la nueva institucionalidad del sector y su proyeccion de desarrollo