Proportion of cancer cases and deaths attributable to potentially modifiable risk factors in Peru.

BACKGROUND: Limited evidence exists on the population attributable fraction (PAF) of cancer cases and deaths in Latin America. In Peru several studies have been published regarding the PAF of various risk factors and their associated diseases. The objective of this study was to estimate the fraction of cancer cases and deaths attributable to potentially modifiable risk factors in Peru in 2018, before the COVID-19 pandemic in the population of 15 years old and older. METHODS: An ecological study was conducted using the prevalence of exposure of the Peruvian population to modifiable risk factors for cancer, the relative risk associated with each factor, and the number of cancer cases and deaths in 2018 as inputs. We used the Parkin formula with a Montecarlo statistical simulation model to calculate the PAF and confidence intervals. The number of new cancer cases and deaths attributed to each risk factor was determined by multiplying the number of cases and deaths in each gender by the PAF of each risk factor. FINDINGS: In Peru, 38.5% of new cases (34.5% in men and 42% in women) and 43.4% of cancer-related deaths (43.4% in men and 43.4% in women) were attributable to modifiable risk factors. The number of cancers attributable was 25,308 (10,439 in men and 14,869 in women) and the number of deaths attributable to cancer was 14,839 (6,953 in men and 7,886 in women). The predominant modifiable risk factors contributing to the highest number of cases and deaths were HPV infection (4,563 cases, 2,409 deaths), current tobacco use (3,348 cases, 2,180 deaths), and helicobacter pylori infection (2,677 cases, 1,873 deaths). Among the risk factors, oncogenic infections constituted the group with the highest PAF (16.6% for cases, 19.2% for deaths) followed by other unhealthy lifestyle factors (14.2% for cases, 16.7% for deaths), tobacco (7.2% for cases, 7.2% for deaths) and ultraviolet radiation (0.5% for cases, 0.3% for deaths). CONCLUSIONS: Prior to the COVID-19 pandemic, 38.5% of cancer cases and 43.4% of cancer-related deaths in Peru were linked to modifiable risk factors in the population of 15 years old and older. Most preventable cancer cases and deaths were related to oncogenic infections, primarily caused by HPV and helicobacter pylori, followed by tobacco and obesity.

Shifts in maternal foraging strategies during pregnancy promote offspring health and survival in a marine top predator.

The success of maternal foraging strategies during the rearing period can greatly impact the physiology and survival of dependent offspring. Surprisingly though, little is known on the fitness consequences of foraging strategies during the foetal period. In this study, we characterized variation in maternal foraging strategy throughout pregnancy in a marine top predator (South American fur seal, Arctocephalus australis), and asked if these shifts predicted neonatal health and postnatal survival. We found that during early pregnancy all pregnant females belonged to a single, homogenized foraging niche without evident clusters. Intriguingly though, during late pregnancy, individual fur seal mothers diverged into two distinct foraging niches characterized by a benthic-nearshore and a pelagic-offshore strategy. Females that shifted towards the benthic-nearshore strategy gave birth to pups with greater body mass, higher plasmatic levels of glucose and lower levels of blood urea nitrogen. The pups born to these benthic females were eight times more likely to survive compared to females using the pelagic-offshore foraging strategy during late pregnancy. These survival effects were mediated primarily by the impact of foraging strategies on neonatal glucose independent of protein metabolic profile and body mass. Benthic-nearshore foraging strategies during late pregnancy potentially allow for the greater maternal transfer of glucose to the foetus, leading to higher chances of neonatal survival. These results call for a deeper understanding of the balance between resource acquisition and allocation provided by distinct foraging polymorphisms during critical life-history periods, and how this trade-off may be adaptive under certain environmental conditions.

Lower marine productivity increases agonistic interactions between sea lions and fur seals in Northern Pacific Patagonia.

Interspecific interactions are key drivers of individual and population-level fitness in a wide range of animals. However, in marine ecosystems, it is relatively unknown which biotic and abiotic factors impact behavioral interactions between competing species. We assessed the impact of weather, marine productivity, and population structure on the behavioral agonistic interactions between South American fur seals (SAFSs), Arctocephalus australis, and South American sea lions (SASLs), Otaria byronia, in a breeding colony of SAFS. We hypothesized that agonistic interactions between SAFSs and SASLs respond to biotic and abiotic factors such as SAFS population structure, marine productivity, and weather. We found that SASL and SAFS interactions almost always resulted in negative impacts on the social structure or reproductive success of the SAFS colony. SASL adult males initiated stampedes of SAFS and/or abducted and predated SAFS pups. Adult SAFS males abundance and severe weather events were negatively correlated with agonistic interactions between species. However, proxies for lower marine productivity such as higher sea surface temperature and lower catches of demerso-pelagic fish were the most important predictors of more frequent agonistic interactions between SAFS and SASL. Under the current scenario of decline in marine biomass due to global climate change and overfishing, agonistic interactions between competing marine predators could increase and exacerbate the negative impacts of environmental change in these species.

Towards understanding the effects of oceanic plastic pollution on population growth for a South American fur seal (Arctocephalus australis australis) colony in Chile.

Entanglement of pinnipeds with plastic debris is an emerging conservation and animal welfare issue worldwide. However, the origins and long-term population level consequences of these entanglements are usually unknown. Plastic entanglement could produce a combination of wounds, asphyxiation, or inability to feed that results in the death of a certain percentage of individuals from the total population. In this research, we report on the consequent effect of plastic entanglement on population growth demographics in a South American fur seal (Arctocephalus australis australis) colony on Guafo Island, southern Chile. Using a stochastic matrix population model structured according to age and sex, and assuming an otherwise stable population, we explored population growth rates under five scenarios with differing rates of entanglement: A) a zero rate of plastic entanglement, B) entanglement rates (number of entangled individuals as a proportion of the total number of individuals) as observed in our study population (overall entanglement ratio of 1.2 × 10-3); and for the other scenarios, entanglement ratios as reported in the literature for other pinniped colonies around the world: C) 3.04 × 10-3, D) 4.42 × 10-2, and E) 8.39 × 10-2. Over the 30 years forecasting period and starting with a population size of ∼2950 individuals, the population growth rate was lower under all scenarios with rates of entanglement greater than zero (scenarios B-E). In comparison with scenario A, at the end of the 30-year period forecasted, we calculated a projected decrease in population size of between 20.34% (scenario B) and 91.38% (scenario E). These results suggest that even the lowest levels of entanglement in pinnipeds as reported in the literature might have significant effects over time on population-level dynamics. Our research offers potential insight when devising policy for the management and limitation of plastic pollution in the oceans, and indeed for the conservation and management policy of affected marine species. Furthermore, whilst there are some limitations to our methodology, it offers a straightforward and potentially useful approach for the standardized prediction of impacts at a population level of different rates of plastic pollution and entanglement and could be applied in distinct populations of the same species around the world.

Monitoring the occurrence of microplastic ingestion in Otariids along the Peruvian and Chilean coasts.

Repeated reports of microplastic pollution in the marine pinniped diet have emerged in the last years. However, only few studies address the drivers of microplastics presence and the potential implications for monitoring microplastic pollution in the ocean. This study monitored their in the scats (N = 205) of four pinniped species/subspecies at five different locations in the southern Pacific Ocean (Peru and Chile). Samples from all rookeries contained microplastics, and overall, 68% of the examined scats contained fragments/fibers, mostly blue colored. We confirmed that 81.5% of the fragments/fibers were anthropogenic in origin , but only 30% were polymers. Scats from Juan Fernández Archipelago presented higher microplastic concentrations than continental rookeries. Also, the common diet in each location may influence the levels found in the samples. This study presents a useful non-invasive technique to track plastic pollution in top predator diets as bioindicators for future surveillance/management plans applied to different location.

The influence of microplastics pollution on the feeding behavior of a prominent sandy beach amphipod, Orchestoidea tuberculata (Nicolet, 1849).

Pollution by microplastics has become a global threat affecting coastal habitats such as sandy beaches and their resident macrofauna. The goal of this study was to assess the influence of microplastics on the feeding behavior and growth rate of a widespread sandy beach amphipod, Orchestoidea tuberculata. These organisms were exposed to artificial food prepared with Poly(styrene-co-divinylbenzene) microspheres (8 µm particle size) at 3 different concentrations (0%, 5% and 10%). The amphipods consumed significantly more food when the concentration of microplastics was 0% and significantly less when the concentration was 10%, both in trials in which they had a choice (preference experiments) and those in which they did not have a food choice. In contrast to this, the amphipod's absorption efficiency and estimated growth rates were not significantly affected by the concentration of microplastics. Combined, these results indicate that high microplastics concentrations (e.g. 10%) cause a reduction in the amphipod's consumption rates and, indirectly, may affect the role of this species as a main consumer of stranded seaweeds in sandy beaches ecosystems.

The contrasting hidden consequences of parasitism: Effects of a hematophagous nematode (Uncinaria sp.) in the development of a marine mammal swimming behavior.

Parasites are an important part of ecosystems, playing a critical role in their equilibrium. However, the consequences of parasitism beyond the direct effects associated with disease and mortality are not completely understood. This gap in knowledge is in part due to the difficulties to isolate the effect of single parasite species on physiological and behavioral traits in natural systems.The South American fur seal (Arctocephalus australis)-hookworm (Uncinaria sp.) interaction offers an ideal system to overcome these difficulties and study the behavioral and physiological effects of parasites in their hosts.Hookworms cause stunted growth and anemia in pinniped pups, which could affect early life active behaviors such as swimming. The aim of this study was to determine the effects of hookworms (Uncinaria sp.) on the development of swimming capabilities in A. australis through physiological and ethological analyses.Higher parasite burden was associated with reduced growth rates and lower blood hemoglobin concentrations, whereas scaled body mass and blood hemoglobin levels had an important positive effect on the water activity of the pups. However, antihookworm treatment did not affect the level of water activity of the pups, and pups with high hookworm burden increased their time budget in water. This was probably related to lower maternal attendance in heavily parasitized pups, leaving these pups more time to perform water activities. Therefore, pups with heavy hookworm burden, despite having decreased growth rates and blood hemoglobin concentrations, compensated for their handicap in physiological traits related to swimming by spending more time in the water.This work offers new insights to understand the contrasting effects of parasites on aquatic organisms, and the compensatory mechanisms employed by infected animals to avoid the worst consequences of parasitism.

Parasitism Elicits a Stress Response That Allocates Resources for Immune Function in South American Fur Seals (Arctocephalus australis).

Parasites can cause chronic stress in some animal species, and this type of stress response has been associated with adverse consequences for the host. In order to know whether parasitism elicited a stress response associated with decreased host fitness, hookworm (Uncinaria sp.) infection was studied in a colony of South American fur seals (Arctocephalus australis) in which hookworms infect nearly all pups born in a reproductive season. A parasite-free group was generated by treating a subset of pups with an antiparasitic drug before they developed patent hookworm infection. Stress and metabolic hormones, energy balance, and humoral and cellular immune parameters were measured in this group and hookworm-infected pups. Hookworms elicited a marked increase in plasma cortisol levels in fur seal pups. These hookworm-infected pups were able to maintain constant glucose levels, despite losing body mass over the course of infection potentially because of increased protein catabolism. Infected pups were able to mount an effective immune response against the parasite and eliminated hookworms from the intestine, recovering partial body mass lost as a result of hookworm infection at the end of the study period. As shown in previous studies, adequate glucose levels are critical for proper T lymphocyte reactivity, and it is possible that, through activation of a stress response, energy can be readily available for immune response against the parasite contributing to early recovery from infection. Although there are potential fitness costs to mounting a sustained stress response, these could also be adaptive and promote survival during critical life-history stages.

Immune-mediated hookworm clearance and survival of a marine mammal decrease with warmer ocean temperatures.

Increases in ocean temperature are associated with changes in the distribution of fish stocks, and the foraging regimes and maternal attendance patterns of marine mammals. However, it is not well understood how these changes affect offspring health and survival. The maternal attendance patterns and immunity of South American fur seals were assessed in a rookery where hookworm disease is the main cause of pup mortality. Pups receiving higher levels of maternal attendance had a positive energy balance and a more reactive immune system. These pups were able to expel hookworms through a specific immune mediated mechanism and survived the infection. Maternal attendance was higher in years with low sea surface temperature, therefore, the mean hookworm burden and mortality increased with sea surface temperature over a 10-year period. We provide a mechanistic explanation regarding how changes in ocean temperature and maternal care affect infectious diseases dynamics in a marine mammal.

The life history strategy of a fur seal hookworm in relation to pathogenicity and host health status.

The strategies that parasites use to exploit their hosts can lead to adverse effects on human and animal populations. Here, we describe the life cycle, epidemiology, and consequences of hookworm (Uncinaria sp.) disease in South American fur seals (Arctocephalus australis), and propose that hookworm adaptation to fur seal life history traits has led to maximizing transmission at high levels of parasite-induced anemia and mortality. Fur seal pups acquire hookworms during their first days of life through their mothers' colostrum and most adult hookworms are expelled from the pups' intestine 30-65 days later. This gives hookworms little time to feed and reproduce. However, despite reaching high within-host densities, female hookworms do not decrease egg output, therefore pups with high hookworm burden contribute disproportionately to parasite egg shedding. These heavily infected pups also suffer severe anemia and high levels of hookworm-induced mortality. Alternative strategies to maximize total egg shedding and/or transmission, such as increased environmental survival of larval stages or avoidance of clearance, have not been developed by this hookworm. We propose that fur seal hookworms exploit a live fast-die young life history strategy, which translates to the highest levels of host anemia and mortality recorded among hookworms.

Single frequency thermal wave radar: A next-generation dynamic thermography for quantitative non-destructive imaging over wide modulation frequency ranges.

Single-Frequency Thermal Wave Radar Imaging (SF-TWRI) was introduced and used to obtain quantitative thickness images of coatings on an aluminum block and on polyetherketone, and to image blind subsurface holes in a steel block. In SF-TWR, the starting and ending frequencies of a linear frequency modulation sweep are chosen to coincide. Using the highest available camera frame rate, SF-TWRI leads to a higher number of sampled points along the modulation waveform than conventional lock-in thermography imaging because it is not limited by conventional undersampling at high frequencies due to camera frame-rate limitations. This property leads to large reduction in measurement time, better quality of images, and higher signal-noise-ratio across wide frequency ranges. For quantitative thin-coating imaging applications, a two-layer photothermal model with lumped parameters was used to reconstruct the layer thickness from multi-frequency SF-TWR images. SF-TWRI represents a next-generation thermography method with superior features for imaging important classes of thin layers, materials, and components that require high-frequency thermal-wave probing well above today's available infrared camera technology frame rates.

Kelp and dolphin gulls cause perineal wounds in South American fur seal pups (Arctocephalus australis) at Guafo Island, Chilean Patagonia.

During five reproductive seasons, we documented the presence, extent and origin of perineal wounds in South American fur seal pups (Arctocephalus australis) on Guafo Island, Northern Chilean Patagonia. The seasonal prevalence of perineal wounds ranged from 5 to 9%, and new cases were more common at the end of the breeding season (February), when pups were on average two months old and were actively expelling hookworms (Uncinaria sp). Histologically, wounds corresponded to marked ulcerative lymphoplasmacytic and histiocytic dermatitis with granulation tissue and mixed bacterial colonies. In 2015 and 2017, kelp gulls (Larus dominicanus) and dolphin gulls (Leucophaeus scoresbii) were observed picking and wounding the perineal area of marked pups. This behaviour occurred more frequently after the pups' defecation, when sea gulls engaged in consumption of pups' faeces. The affected pups usually had moderate to marked hookworm infections along with bloody diarrhoea and anaemia. Pups with severe wounds (23% of affected animals) had swollen perineal areas and signs of secondary systemic bacterial infection. We propose that seagulls on Guafo Island have learned to consume remains of blood and parasites in the faeces of pups affected by hookworm infection, causing perineal wounds during this process. We conclude that this perineal wounding is an unintentional, occasional negative effect of an otherwise commensal gull-fur seal relationship.

Is the feeding type related with the content of microplastics in intertidal fish gut?

Microplastics pollution is a growing global concern that affects all aquatic ecosystems. Microplastics in the environment can be in the form of fibers and/or particles, being the former the most abundant in the marine environment, representing up to 95% of total plastics. The aim of this work was to compare the content of microplastics among intertidal fish with different feeding type. Our results show that omnivorous fish presented a higher amount of microplastic fibers than registered in herbivores and carnivores. Moreover, lower condition factors (K) were found in omnivorous specimens with higher microplastic content. We hypothesized that the type of feeding resulted in different microplastic ingestion, with species with wider range of food sources as omnivores with higher rates. Futures studies carried out to evaluate the biological impacts of microplastics on marine organisms, and microplastics cycling on the marine environment should consider the type of feeding of the studied species.

Hematology, Serum Chemistry, and Early Hematologic Changes in Free-Ranging South American Fur Seals ( Arctocephalus australis ) at Guafo Island, Chilean Patagonia.

The establishment of clinical pathology baseline data is critical to evaluate temporal and spatial changes in marine mammal groups. Despite increased availability of studies on hematology and biochemistry of marine mammals, reference ranges are lacking for many populations, especially among fur seal species. During the austral summers of 2014 and 2015, we evaluated basic hematologic and biochemical parameters in clinically healthy, physically restrained South American fur seal ( Arctocephalus australis ) lactating females and 2-mo-old pups. We also assessed the temporal variation of hematology parameters on the pups during their first 2 mo of life. Reference ranges of lactating females were similar to those previously reported in other fur seal species. In the case of pups, reference ranges are similar to values previously reported in sea lion species. As expected, most biochemical and hematologic values differ significantly between adult females and pups. As in other otariids, South American fur seals pups are born with higher values of total red blood cells, hemoglobin, and packed cell volume, and lower numbers of total leukocytes, neutrophils, lymphocytes, and eosinophils. To the best of our knowledge, data on hematology reference values for South American fur seals has not been previously reported and is useful for continued health monitoring of this species, as well as for comparisons with other otariid groups.

Enfermedades no transmisibles: efecto de las grandes transiciones y los determinantes sociales / Noncommunicable diseases: effect of major transitions and social determinants

Las enfermedades no transmisibles (ENT) se definen como enfermedades de etiología no infecciosa caracterizadas por su larga latencia, larga duración, períodos de remisión y recurrencia, expresión clínica diversa y por sus consecuencias discapacitantes a largo plazo. La emergencia de las ENT se relaciona con cambios económicos y sociales ocurridos a nivel mundial, en los cuales, a medida que se incrementa la esperanza de vida en los países, se producen modificaciones en los estilos de vida de su población (Transición demográfica) lo que a su vez ha con llevado a un cambio en los patrones de enfermedad y mortalidad en el que las enfermedades no transmisibles desplazan a las enfermedades infecciosas (Transición epidemiológica). Las repercusiones socioeconómicas y sobre el desarrollo que tienen las ENT, al igual que sus efectos sobre los sistemas de salud, por las desigualdades en la carga de enfermedad y prevalencia, son atribuibles en gran medida a determinantes sociales como la pobreza, educación, género, urbanización, etnia/raza. La presente revisión muestra la gran influencia que el contexto social, económico, cultural, medioambiental y político tienen sobre las ENT y sus factores de riesgo. Para responder a los determinantes sociales de las ENT se deben adoptar medidas mundiales y nacionales que promuevan la salud y la equidad como el aseguramiento universal en salud.

Noncommunicable diseases (NCDs) are defined as diseases of noninfectious etiology characterized by its long latency, long duration, periods of remission and recurrence, diverse clinical manifestations and its debilitating long-term consequences. The emergence of NCDs is related to economic and social changes in the world, for which, as life expectancy in countries increases, changes occur in the lifestyles of its population (demographic transition) at which in turn has led to a change in the patterns of disease and mortality, where non-communicable diseases displace infectious diseases (epidemiological transition). The socioeconomic and developmental implications with NCDs, as well as their effects on health systems, by inequalities in the burden of disease prevalence are attributable largely to social determinants such as poverty, education, gender, urbanization, ethnicity / race. This review shows the great influence that the social, economic, cultural, environmental and political context have on NCDs and their risk factors. To address the social determinants of NCDs must be taken global and national actions to promote health and equity and universal health insurance.

Cost-effectiveness analysis of breast cancer control interventions in Peru.

OBJECTIVES: In Peru, a country with constrained health resources, breast cancer control is characterized by late stage treatment and poor survival. To support breast cancer control in Peru, this study aims to determine the cost-effectiveness of different breast cancer control interventions relevant for the Peruvian context. METHODS: We performed a cost-effectiveness analysis (CEA) according to WHO-CHOICE guidelines, from a healthcare perspective. Different screening, early detection, palliative, and treatment interventions were evaluated using mathematical modeling. Effectiveness estimates were based on observational studies, modeling, and on information from Instituto Nacional de Enfermedades Neoplásicas (INEN). Resource utilizations and unit costs were based on estimates from INEN and observational studies. Cost-effectiveness estimates are in 2012 United States dollars (US$) per disability adjusted life year (DALY) averted. RESULTS: The current breast cancer program in Peru ($8,426 per DALY averted) could be improved through implementing triennial or biennial screening strategies. These strategies seem the most cost-effective in Peru, particularly when mobile mammography is applied (from $4,125 per DALY averted), or when both CBE screening and mammography screening are combined (from $4,239 per DALY averted). Triennially, these interventions costs between $63 million and $72 million per year. Late stage treatment, trastuzumab therapy and annual screening strategies are the least cost-effective. CONCLUSIONS: Our analysis suggests that breast cancer control in Peru should be oriented towards early detection through combining fixed and mobile mammography screening (age 45-69) triennially. However, a phased introduction of triennial CBE screening (age 40-69) with upfront FNA in non-urban settings, and both CBE (age 40-49) and fixed mammography screening (age 50-69) in urban settings, seems a more feasible option and is also cost-effective. The implementation of this intervention is only meaningful if awareness raising, diagnostic, referral, treatment and basic palliative services are simultaneously improved, and if financial and organizational barriers to these services are reduced.