Residential surrounding greenness and the incidence of childhood asthma: Findings from a population-based cohort in Ontario, Canada.

Several epidemiological studies have investigated the possible role that living in areas with greater amounts of greenspace has on the incidence of childhood asthma. These findings have been inconsistent, and few studies explored the relevance of timing of exposure. We investigated the role of residential surrounding greenness on the risk of incident asthma using a population-based retrospective cohort study. We included 982,131 singleton births in Ontario, Canada between 2006 and 2013. Two measures of greenness, the Normalized Difference Vegetation Index (NDVI) and the Green View Index (GVI), were assigned to the residential histories of these infants from pregnancy through to 12 years of age. Longitudinally-based diagnoses of asthma were determined by using provincial administrative health data. The extended Cox hazards model was used to characterize associations between greenness measures and asthma (up to age 12 years) while adjusting for several risk factors. In a fully adjusted model, that included a term for traffic-related air pollution (NO2), we found no association between an interquartile range increase (0.08) of the NDVI during childhood and asthma incidence (HR = 0.99; 95 % CI = 0.99-1.01). In contrast, we found that an 0.08 increase in NDVI during childhood reduced the risk of asthma in children 7-12 years of age by 14 % (HR = 0.86, 95 % CI:0.79-0.95). Seasonal differences in the association between greenness and asthma were noted. Our findings suggest that residential proximity to greenness reduces the risk of asthma in children aged 7-12.

Intra-urban variability of long-term exposure to PM2.5 and NO2 in five cities in Colombia.

Rapidly urbanizing cities in Latin America experience high levels of air pollution which are known risk factors for population health. However, the estimates of long-term exposure to air pollution are scarce in the region. We developed intraurban land use regression (LUR) models to map long-term exposure to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) in the five largest cities in Colombia. We conducted air pollution measurement campaigns using gravimetric PM2.5 and passive NO2 sensors for 2 weeks during both the dry and rainy seasons in 2021 in the cities of Barranquilla, Bucaramanga, Bogotá, Cali, and Medellín, and combined these data with geospatial and meteorological variables. Annual models were developed using multivariable spatial regression models. The city annual PM2.5 mean concentrations measured ranged between 12.32 and 15.99 µg/m3 while NO2 concentrations ranged between 24.92 and 49.15 µg/m3. The PM2.5 annual models explained 82% of the variance (R2) in Medellín, 77% in Bucaramanga, 73% in Barranquilla, 70% in Cali, and 44% in Bogotá. The NO2 models explained 65% of the variance in Bucaramanga, 57% in Medellín, 44% in Cali, 40% in Bogotá, and 30% in Barranquilla. Most of the predictor variables included in the models were a combination of specific land use characteristics and roadway variables. Cross-validation suggests that PM2.5 outperformed NO2 models. The developed models can be used as exposure estimate in epidemiological studies, as input in hybrid models to improve personal exposure assessment, and for policy evaluation.

Exposure to perfluoroalkyl and polyfluoroalkyl substances and pediatric obesity: a systematic review and meta-analysis.

INTRODUCTION: Perfluoroalkyl and polyfluoroalkyl substances (PFAS) are potentially obesogenic for children. We undertook a systematic review to synthesize this literature and explore sources of heterogeneity in previously published epidemiological studies. METHODS: Studies that collected individual-level PFAS and anthropometric data from children up to 12 years of age were identified by searching six databases. We excluded studies that only evaluated obesity measures at the time of birth. A full-text review and quality assessment of the studies was performed using the Office of Health Assessment and Translation (OHAT) criteria. Forest plots were created to summarize measures of association and assess heterogeneity across studies by chemical type and exposure timing. Funnel plots were used to assess small-study effects. RESULTS: We identified 24 studies, of which 19 used a cohort design. There were 13 studies included in the meta-analysis examining various chemicals and outcomes. Overall prenatal exposures to four different types of PFAS were not statistically associated with changes in body mass index (BMI) or waist circumference. In contrast, for three chemicals, postnatal exposures were inversely related to changes in BMI (i.e., per log10 increase in PFOS: BMI z-score of -0.16 (95% CI: -0.22, -0.10)). There was no substantial heterogeneity in the reported measures of association within prenatal and postnatal subgroups. We observed modest small-study effects, but correction for these effects using the Trim and Fill method did not change our summary estimate(s). CONCLUSION: Our review found no evidence of a positive association between prenatal PFAS exposure and pediatric obesity, whereas an inverse association was found for postnatal exposure. These findings should be interpreted cautiously due to the small number of studies. Future research that can inform on the effects of exposure mixtures, the timing of the exposure, outcome measures, and the shape of the exposure-response curve is needed.

Neighborhood greenness and participation in specific types of recreational physical activities in the Sister Study.

BACKGROUND: Urban green spaces have been consistently shown to have important human health benefits across a range of outcomes. These benefits are thought to be achieved, in part, because urban greenness provides opportunities for participation in recreational activity. However, the findings from studies that have assessed links between exposure to greenness and physical activity have been mixed. To date, few studies have examined association between greenness and specific types of recreational physical activities. OBJECTIVE: We evaluated associations between measures of greenness and specific types of recreational physical activities. Moreover, we explored the extent to which these associations were modified by socioeconomic conditions, and regionally. METHODS: We analyzed cross-sectional data from 49,649 women in the Sister Study and assigned three residentially-based measures of greenness based on national land cover data at buffer distances of 250 m and 500 m. Data on participation in up to ten specific recreational physical activities, including time spent in each activity were collected. Logistic regression was used to estimate odds ratios (OR) and their 95% confidence intervals (CI) controlling for confounders. RESULTS: Compared to those in the lowest tertile of greenness, participants in the upper tertile of greenness within a 500 m buffer, were more likely to garden (OR = 1.46, 95% CI = 1.25,1.69), participate in sports (OR = 1.28, 95% CI = 1.19,1.38), run (OR = 1.15, 95% CI = 1.04,1.27), walk (OR = 1.11, 95% CI = 1.06,1.16), and engage in conditioning exercises (OR = 1.10, 95% CI = 1.05,1.16) at least once a week for at least one month over the past year. These associations were modified by household income and US region. DISCUSSION: Our findings suggest a beneficial effect of greenness on physical activity and provide additional information to inform planning of green environments that contribute to better health and wellbeing.

Contrary Perceptions of Environmental Health and the Governance of the Bucaramanga Metropolitan Area, Colombia.

The participation of civil society is essential for environmental health policies to be accepted. The objective of this study was to know the perceptions of government officials, members of civil society, and academics about environmental health problems and its governance in the Bucaramanga Metropolitan Area, Colombia. In the region, there is a strong citizens movement that defends the moorland ecosystem (páramo) as a source of drinking water for large-scale mining projects. A multi-method study was conducted, including the review of newspaper and scientific articles, a citizens survey, and interviews and focus groups with identified key stakeholders. The findings indicate that government officials prioritize their actions on issues related to air and water pollution and environmental education. In contrast, citizens prioritize water availability from the moorland ecosystem. There are some advances in the management of environmental health, mainly related to greater citizen awareness. Contrary perceptions among government officials, academics, and civil society prevent adequate prioritization of environmental health problems. Participation of civil society is absent in activities related to environmental governance. An ongoing citizens science experience engaging high school students and the academy can be the first meeting point with government officials in the pathway to improve the environmental governance in the territory. The participation of civil society in the environmental health governance must be enforced to broaden the issues of interest and prioritize the activities in short- and long-term policy planning.

Altitude and COVID-19 in Colombia: An updated analysis accounting for potential confounders.

We assessed the relationship between the altitude of municipalities and the incidence, mortality, and fatality from COVID-19 and excess of mortality in Colombia between 2020 and 2022. We conducted an ecologic study including all 1122 municipalities in Colombia and used categories of altitude as main independent variable. We fit multivariable regression models for incidence, mortality, fatality rates, and excess of mortality controlling for several variables at municipality level. There was a higher incidence rate, similar mortality rate and lower case-fatality rate for COVID-19 during 2020-2022 in municipalities in the upper category of altitude (>=2500 masl) compared to the lower category (<1000 masl). The excess of mortality was lower but not statistically different in municipalities in the upper category of altitude, and significantly lower in the intermediate altitude category compared to the lowlands. Our findings provide evidence that municipalities with high altitude had similar mortality rate, and lower case-fatality rate and excess of mortality for COVID-19 compared to lowlands in Colombia.

Geological context and human exposures to element mixtures in mining and agricultural settings in Colombia.

Anthropogenic and natural sources contribute to chemical mixtures in air, water, and soil, posing potential risks to the environment and human health. To understand the interplay between element profiles in the human body, geographical location, and associated economic activities, we carried out an observational analytic cross-sectional study. The study recruited 199 participants from three municipalities, two of which had gold-mining as their primary economic activity, while the other was dedicated to agricultural and other local activities not related to mining. The concentrations of a total of 30 elements in human hair samples and 21 elements in environmental soil samples were measured using various spectrometry techniques. Unsupervised clustering analysis using Self-Organizing Maps was applied to human hair samples to analyze element concentrations. Distinct clusters of individuals were identified based on their hair element profiles, which were mapped to geographical location and economic activities. While higher levels of heavy metals (Ag, As, Hg, and Pb) were observed in individuals engaged in mining activities in certain clusters, individuals in agricultural areas show higher concentrations of elements found in pesticides (Ba and Sr). However, the elemental composition of hair is influenced not only by the anthropogenic activities but also by the inherent geological context where people live. Our findings highlight the significance of accounting for environmental factors when evaluating human health risks, as the intricate mixture of elements can yield valuable insights for targeted health interventions.

Daily changes in ambient air pollution concentrations and temperature and suicide mortality in Canada: Findings from a national time-stratified case-crossover study.

INTRODUCTION: Worldwide, approximately 1900 people die by suicide daily. Daily elevations in air pollution and temperature have previously been linked to a higher risk of death from suicide. To date, there have been relatively few studies of air pollution and suicide, particularly at a national level. National analyses play an important role in shaping health policy to mitigate against adverse health outcomes. METHODS: We used a time-stratified case-crossover study design to investigate the influence of short-term (i.e., day to day) interquartile range (IQR) increases in air pollutants (nitrogen dioxide [NO2], ozone [O3], and fine particulate matter [PM2.5]) and temperature on suicide mortality in Canada between 2002 and 2015. For air pollution models, odds ratios (ORs) derived from conditional logistic regression models were adjusted for average daily temperature, and holidays. For temperature models, ORs were adjusted for holidays. Stratified analyses were undertaken by suicide type (non-violent and violent), sex, age, and season. RESULTS: Analyses are based on 50,800 suicide deaths. Overall, temperature effects were stronger than those for air pollution. A same day IQR increase in temperature (9.6 °C) was associated with a 10.1% increase (95% confidence interval (CI): 9.0%-11.2%) of death from suicide. For 3-day average increase of O3 (IQR = 14.1 ppb), PM2.5 (IQR = 5.6 µg/m3) and NO2 (IQR = 9.7 ppb) the corresponding risks were 4.7% (95% CI: 3.9, 5.6), 3.4% (95% CI: 3.0, 3.8), and 2.0% (95% CI: 1.1, 2.8), respectively. All pollutants showed stronger associations with suicide during the warmer season (April-September). Stratified analyses revealed stronger associations for both temperature and air pollution in women. CONCLUSIONS: Daily increases in air pollution and temperature were found to increase the risk of death from suicide. Females, particularly during warmer season, were most vulnerable to these exposures. Policy decisions related to air pollution and climate change should consider effects on mental health.

Chemical Element Mixtures and Kidney Function in Mining and Non-Mining Settings in Northern Colombia.

The exposure to chemical mixtures is a problem of concern in developing countries and it is well known that the kidney is the major target organ for toxic elements. This cross-sectional study aimed to estimate the individual and composite mixture effect of a large number of chemical elements on kidney function in gold-mining and surrounding non-mining populations in northeast Colombia. We measured concentrations of 36 chemical elements in hair as indicators of chronic exposure from 199 adult participants. We estimated the effect of exposure to mixtures of chemical elements on estimated glomerular filtration rate (eGFR) using weighted quantile sum regression (WQS). The WQS index of the mixture was associated with reduced eGFR (Coefficient -2.42; 95%CI: -4.69, -0.16) being Be, Cd, Pb, As, and Mn, the principal contributors of the toxic mixture. Mining activities and Hg concentration were not associated with decreased kidney function. Our results suggest that complex mixtures of chemical elements, mainly heavy metals, act as nephrotoxic in these populations and therefore the analysis of chemical element mixtures is a better approach to identify environmental and occupational chemical risks for kidney damage.

Intraurban Geographic and Socioeconomic Inequalities of Mortality in Four Cities in Colombia.

Mortality inequalities have been described across Latin American countries, but less is known about inequalities within cities, where most populations live. We aimed to identify geographic and socioeconomic inequalities in mortality within the urban areas of four main cities in Colombia. We analyzed mortality due to non-violent causes of diseases in adults between 2015 and 2019 using census sectors as unit of analysis in Barranquilla, Bogotá, Cali, and Medellín. We calculated smoothed Bayesian mortality rates as main health outcomes and used concentration indexes (CInd) for assessing inequalities using the multidimensional poverty index (MPI) as the socioeconomic measure. Moran eigenvector spatial filters were calculated to capture the spatial patterns of mortality and then used in multivariable models of the association between mortality rates and quintiles of MPI. Social inequalities were evident but not consistent across cities. The most disadvantaged groups showed the highest mortality rates in Cali. Geographic inequalities in mortality rates, regardless of the adults and poverty distribution, were identified in each city, suggesting that other social, environmental, or individual conditions are impacting the spatial distribution of mortality rates within the four cities.

Avoidable mortality due to long-term exposure to PM2.5 in Colombia 2014-2019.

OBJECTIVE: To compare estimates of spatiotemporal variations of surface PM2.5 concentrations in Colombia from 2014 to 2019 derived from two global air quality models, as well as to quantify the avoidable deaths attributable to the long-term exposure to concentrations above the current and projected Colombian standard for PM2.5 annual mean at municipality level. METHODS: We retrieved PM2.5 concentrations at the surface level from the ACAG and CAMSRA global air quality models for all 1,122 municipalities, and compare 28 of them with available concentrations from monitor stations. Annual mortality data 2014-2019 by municipality of residence and pooled effect measures for total, natural and specific causes of mortality were used to calculate the number of annual avoidable deaths and years of potential life lost (YPLL) related to the excess of PM2.5 concentration over the current mean annual national standard of 25 µg/m3 and projected standard of 15 µg/m3. RESULTS: Compared to surface data from 28 municipalities with monitoring stations in 2019, ACAG and CAMSRA models under or overestimated annual mean PM2.5 concentrations. Estimations from ACAG model had a mean bias 1,7 µg/m3 compared to a mean bias of 4,7 µg/m3 from CAMSRA model. Using ACAG model, estimations of total nationally attributable deaths to PM2.5 exposure over 25 and 15 µg/m3 were 142 and 34,341, respectively. Cardiopulmonary diseases accounted for most of the attributable deaths due to PM2.5 excess of exposure (38%). Estimates of YPLL due to all-cause mortality for exceeding the national standard of 25 µg/m3 were 2,381 years. CONCLUSION: Comparison of two global air quality models for estimating surface PM2.5 concentrations during 2014-2019 at municipality scale in Colombia showed important differences. Avoidable deaths estimations represent the total number of deaths that could be avoided if the current and projected national standard for PM2.5 annual mean have been met, and show the health-benefit of the implementation of more restrictive air quality standards.

Short-term changes in meteorological conditions and suicide: A systematic review and meta-analysis.

BACKGROUND: Suicide is a leading cause of death, particularly for young adults. Suicidal behaviours are influenced by a wide-range of personal, social, and cultural factors. Emerging evidence suggests that daily changes in meteorological conditions, including temperature, increases the risk of suicide. METHODS: We conducted a systematic review and meta-analysis of studies that examined associations between either daily, or weekly, variations for eight meteorological variables and suicide outcomes (attempts, or deaths). Meta-analytic methods were applied to derive summary measures of association using random effect models. We assessed the heterogeneity in these associations by region and biological sex. RESULTS: We identified 29 studies of suicide. Of these, 26 reported associations between temperature, while fewer studies reported on rain (n = 4), solar radiation (n = 4), humidity (n = 3), sunshine (n = 3), atmospheric pressure (n = 2), wind (n = 2) and cloud cover (n = 2). The overall relative risk for suicide deaths/attempts per 1 °C increase in ambient temperature was 1.016 (95% CI: 1.013-1.019). Subgroup analysis of temperature found stronger associations with suicide when using the maximum rather than the mean daily temperature, among men, and for completed suicides relative to attempts. Regionally, the strongest associations were found in the East Asia and Pacific region. While associations were found for solar radiation and cloud coverage and suicide, we did not undertake a meta-analysis for these exposures as it was not possible to standardize measures of association across studies. Statistically significant associations were not observed for other identified meteorological variables. CONCLUSIONS: Our findings suggest that daily increases in temperature increase the risk of suicide, particularly, among men and in the East Asia and Pacific region.

Multi-antibiotic resistant bacteria in landfill bioaerosols: Environmental conditions and biological risk assessment.

Landfills, as well as other waste management facilities are well-known bioaerosols sources. These places may foment antibiotic-resistance in bacterial bioaerosol (A.R.B.) due to inadequate pharmaceutical waste disposal. This issue may foster the necessity of using last-generation antibiotics with extra costs in the health care system, and deaths. The aim of this study was to reveal the multi-antibiotic resistant bacterial bioaerosol emitted by a sanitary landfill and the surrounding area. We evaluated the influence of environmental conditions in the occurrence of A.R.B. and biological risk assessment. Antibiotic resistance found in the bacteria aerosols was compared with the AWaRE consumption classification. We used the BIOGAVAL method to assess the workers' occupational exposure to antibiotic-resistant bacterial bioaerosols in the landfill. This study confirmed the multi-antibiotic resistant in bacterial bioaerosol in a landfill and in the surrounding area. Obtained mean concentrations of bacterial bioaerosols, as well as antibiotic-resistant in bacterial bioaerosol (A.R.B.), were high, especially for fine particles that may be a threat for human health. Results suggest the possible risk of antibiotic-resistance interchange between pathogenic and non-pathogenic species in the landfill facilities, thus promoting antibiotic multi-resistance genes spreading into the environment.

Air pollution, sociodemographic and health conditions effects on COVID-19 mortality in Colombia: An ecological study.

OBJECTIVE: The present study aimed to determine the association between chronic exposure to fine particulate matter (PM2.5), sociodemographic aspects, and health conditions with COVID-19 mortality in Colombia. METHODS: We performed an ecological study using data at the municipality level. We used COVID-19 data obtained from government public reports up to and including July 17th, 2020. We defined PM2.5 long-term exposure as the 2014-2018 average of the estimated concentrations at municipalities obtained from the Copernicus Atmospheric Monitoring Service Reanalysis (CAMSRA) model. We fitted a logit-negative binomial hurdle model for the mortality rate adjusting for sociodemographic and health conditions. RESULTS: Estimated mortality rate ratios (MRR) for long-term average PM2.5 were not statistically significant in either of the two components of the hurdle model (i.e., the likelihood of reporting at least one death or the count of fatal cases). We found that having 10% or more of the population over 65 years of age (MRR = 3.91 95%CI 2.24-6.81), the poverty index (MRR = 1.03 95%CI 1.01-1.05), and the prevalence of hypertension over 6% (MRR = 1.32 95%CI1.03-1.68) are the main factors associated with death rate at the municipality level. Having higher hospital beds capacity is inversely correlated to mortality. CONCLUSIONS: There was no evidence of an association between long-term exposure to PM2.5 and COVID-19 mortality rate at the municipality level in Colombia. Demographics, health system capacity, and social conditions did have evidence of an ecological effect on COVID-19 mortality. The use of model-based estimations of long-term PM2.5 exposure includes an undetermined level of uncertainty in the results, and therefore they should be interpreted as preliminary evidence.

Epidemia por COVID-19 en Colombia: del "pico" de la emergencia a la sostenibilidad de la respuesta / COVID-19 epidemic in Colombia: from the "peak" of the emergency to the sustainability of the response

Resumen El pasado 6 de marzo de 2020 se identificó el primer caso de infección por SARS-Cov-2 en Colombia. Luego de seis meses de desarrollo de la epidemia, la mayoría de las ciudades del país han experimentado un periodo agudo de ascenso de casos y fallecimientos, así como las consecuencias devastadoras sobre sus economías. En el ambiente nacional y regional se percibe un agotamiento gubernamental y ciudadano por la afectación de la epidemia en términos de la cantidad de infectados y fallecidos y por el tiempo transcurrido con las medidas de aislamiento preventivo obligatorio que se prolongaron desde el 25 de marzo hasta el 1 de septiembre en todo el territorio nacional. Sin embargo, estamos todavía lejos de estar cerca del final de la epidemia y en esta nueva etapa se requiere pasar del centralismo de la respuesta inicial a la sostenibilidad de la respuesta regional.

Abstract On March 6, 2020, the first case of SARS-Cov-2 infection was identified in Colombia. After six months of development of the epidemic in Colombia, most cities in the country have experienced an acute period of rise in cases and deaths as well as the devastating consequences on their economies. In the national and regional environment, government and citizen exhaustion is perceived due to the impact of the epidemic in terms of the number of infected and deceased and the time elapsed with the mandatory preventive isolation measures that lasted from March 25 to September 1 throughout the national territory. However, we are still far from being close to the end of the epidemic and in this new stage it is necessary to move from the centrality of the initial response to the sustainability of the regional response.

Estilos de crianza, autoeficacia parental y problemas conductuales infantiles en tres municipios de Santander / Parental style, parental self-efficacy and children behavioral problems in three municipalities of Santander

Resumen Introducción: La familia, a partir de la crianza, juega un papel fundamental en el desarrollo de habilidades sociales y de autocuidado de las personas. Objetivo: Describir los estilos de crianza, la autoeficacia parental y la percepción de problemas de la conducta infantil por parte de padres y cuidadores de niños, además, explorar diferencias por sexo y zona de residencia en tres municipios de Santander. Materiales y método: Estudio cuantitativo, observacional, descriptivo de corte transversal. Se incluyeron padres y cuidadores adultos de niños menores de 12 años residentes en los municipios de Girón, Lebrija y Matanza. Se aplicaron el cuestionario de capacidades y dificultades, la escala de estilo parental y la lista de verificación de las tareas parentales. Se realizaron comparaciones por sexo, municipio y zona (urbana/rural). Resultados: Participaron 1.425 adultos cuidadores de niños menores de 12 años. La mayoría de los participantes fueron mujeres (80%) y su rol era madre (70%). Se identificó una prevalencia alta de estilos de crianza disfuncionales caracterizados por la sobrerreactividad (36%), la laxitud (23%) y la hostilidad (22%). En la zona rural se encontró una mayor proporción de falta de autoeficacia contextual (p<0,001). Conclusiones: Se evidencia la presencia de estilos de crianza disfuncionales y alteraciones comportamentales de los niños que sugieren la necesidad de intervenciones poblacionales intersectoriales a padres y cuidadores. Se propone posicionar la crianza como un proceso de interés en salud pública.

Abstract Introduction: The family, through child rearing, has a key role in the development of children's social skills and self-care. Objective: To describe parental styles, parental self-efficacy and perception of children behavior's problems among parents and caregivers, and explore differences by sex and place of residence in three municipalities of Santander. Material and Method: Quantitative, observational, descriptive cross-sectional study. Participants were parents and caregivers of children under 12 years old, living in the municipalities of Girón, Lebrija, and Matanza. The Strengths and Difficulties Questionnaire, the Parenting Scale and the Parenting Tasks Checklist were used. Comparisons were made by sex, municipality, and zone (urban/rural). Results: Participants were 1425 parents and caregivers of children under 12 years old. Most participants were female (80%) and mothers (70%). High prevalence of dysfunctional parental styles was identified with predominance of over reactivity (36%), laxness (23%) and hostility (22%). Higher percentage of difficulties with parent's contextual self-efficacy was identified in the rural area (p<0,001). Conclusions: This study found dysfunctional parental styles and perception of children's behavioral problems that suggest the need for population-based interventions focused on parental skills for parents and caregivers. Child rearing is proposed as a process of interest in public health.

Proximity to two main sources of industrial outdoor air pollution and emergency department visits for childhood asthma in Edmonton, Canada.

OBJECTIVE: Children are recognized to be more susceptible than healthy adults to the effects of air pollution; however, relatively few Canadian studies of children have focused on industrial emissions. We conducted a spatial cross-sectional study to explore associations between emergency department (ED) visits for childhood asthma and residential proximity to two industrial sources of air pollution (coal-fired power plant and petrochemical industry) in Edmonton, Canada. METHODS: Using administrative health care data for Alberta between 2004 and 2010, we conducted a spatial analysis of disease clusters of count data around these two industrial sources. The distance from children's place of residence to these industrial sources was determined by using the six-character postal code from the children's ED visit. Clusters of cases were identified at the census dissemination area. Negative binomial multivariable spatial regression was used to estimate the risks of clusters in relation to the distance to these industrial sources. RESULTS: The relative risk of ED visits for asthma, calculated using a spatial scan test for events, was 10.4 (p value <0.01) within the power plant area when compared with the outside area. In addition, there was an inverse association of the distance to the power plant (coefficient = -0.01 per km) with asthma visits when multivariable models were used. No asthma clusters were identified around the petrochemical industrial area. CONCLUSION: Our analyses revealed that there was a cluster of ED visits for asthma among children who lived near the coal-fired power plant just outside Edmonton.

Evaluación de contenidos curriculares y percepción de competencias de estudiantes del área de la salud respecto del Modelo Integral de Atención en Salud en Colombia / Assessment of curricular contents and perception of competencies of health students related to the integrated health care model in Colombia

RESUMEN Objetivo Identificar la percepción de los estudiantes de último nivel de los programas de formación profesional y técnica en salud respecto a sus competencias para desempeñarse en el MIAS, y evaluar la presencia de dichas competencias dentro de los contenidos curriculares de los programas de salud en Santander. Métodos Se realizó un estudio descriptivo transversal en 451 estudiantes y una revisión documental de currículos de 26 programas. Se construyó y validó el contenido de un cuestionario en línea de percepción de competencias en los ámbitos del saber ser, saber conocer y saber hacer. Resultados En la revisión documental se encontró deficiencias en la inclusión de competencias tales como las de ejercer liderazgo (80 %) y realizar un enfoque diferencial en la atención (84 %). En la encuesta de percepción, el 36 % de los estudiantes manifestaron tener un conocimiento regular o deficiente sobre Rutas Integrales de Atención en Salud, planes de beneficios y actores del sistema de salud. Adicionalmente, el 7,5 % afirmaron ser poco competentes para realizar actividades de coordinación intersectorial, vigilancia epidemiológica o investigación en salud pública. Conclusiones Los resultados evidencian la necesidad de incluir en los currículos de programas de salud algunos aspectos fundamentales para la adecuada implementación del MIAS.(AU)

ABSTRACT Objective To identify the perception of the last level students of the professional and technical health training programs regarding their competences to perform in the MIAS, and to evaluate the presence of said competences within the curricular contents of the health programs in Santander. Methods A transversal descriptive study was carried out in 451 students and a documentary review of curricula was performed for 26 programs. The content of an online questionnaire on the perception of competences in the areas of knowledge, attitudes and abilities was constructed and validated. Results In the documentary review, deficiencies were found in the inclusion of competencies such as leadership (80 %) and differential approach in care (84 %). In the perception survey, 36 % of the students stated that they had regular or deficient knowledge about Integral Routes of Health Care, benefit plans and actors of the health system. Additionally, 7.5 % stated they were not competent to carry out intersectoral coordination activities, epidemiological surveillance or public health research. Conclusion: The results show the need to include in the curricula of health programs some fundamental aspects for the proper implementation of MIAS.(AU)