APGW/AKH Precursor from Rotifer Brachionus plicatilis and the DNA Loss Model Explain Evolutionary Trends of the Neuropeptide LWamide, APGWamide, RPCH, AKH, ACP, CRZ, and GnRH Families.

In the year 2002, DNA loss model (DNA-LM) postulated that neuropeptide genes to emerged through codons loss via the repair of damaged DNA from ancestral gene namely Neuropeptide Precursor Predictive (NPP), which organization correspond two or more neuropeptides precursors evolutive related. The DNA-LM was elaborated according to amino acids homology among LWamide, APGWamide, red pigment-concentrating hormone (RPCH), adipokinetic hormones (AKHs) and in silico APGW/RPCH NPPAPGW/AKH NPP were proposed. With the above principle, it was proposed the evolution of corazonin (CRZ), gonadotropin-releasing hormone (GnRH), AKH, and AKH/CRZ (ACP), but any NPP never was considered. However, the evolutive relation via DNA-LM among these neuropeptides precursors not has been established yet. Therefore, the transcriptomes from crabs Callinectes toxotes and Callinectes arcuatus were used to characterized ACP and partial CRZ precursors, respectively. BLAST alignment with APGW/RPCH NPP and APGW/AKH NPP allow identified similar NPP in the rotifer Brachionus plicatilis and other invertebrates. Moreover, three bioinformatics algorithms and manual verification were used to purify 13,778 sequences, generating a database with 719 neuropeptide precursors. Phylogenetic trees with the DNA-LM parameters showed that some ACP, CRZ, AKH2 and two NPP share nodes with GnRH from vertebrates and some of this neuropeptide had nodes in invertebrates. Whereas the phylogenetic tree with standard parameters do not showed previous node pattern. Robinson-Foulds metric corroborates the differences among phylogenetic trees. Homology relationship showed four putative orthogroups; AKH4, CRZ, and protostomes GnRH had individual group. This is the first demonstration of NPP in species and would explain the evolution neuropeptide families by the DNA-LM.

Individual interventions to improve adherence to pharmaceutical treatment, diet and physical activity among adults with primary hypertension. A systematic review protocol.

INTRODUCTION: Hypertension is a chronic disease with 31% worldwide prevalence in adults. It has been associated with non-adherence to therapeutic regime with a negative impact on the prognosis of the disease and healthcare-associated costs. So, it is necessary to identify effective interventions to improve adherence among the afflicted population. The objective of this protocol is to describe the methods for a systematic review that will evaluate the effect of individual interventions so as to improve adherence to the prescribed pharmacological treatment, as well as to prescribed diet and physical activity in adults with primary hypertension. METHODS AND ANALYSIS: A systematic search of studies will be conducted in PubMed/MEDLINE, BVS, CINAHL, Embase, Cochrane and Scopus databases. Randomised and non-randomised clinical studies conducted in human beings, published from 1 January 2009 to 13 December 2019, are to be included, in any language. Adherence to pharmacological treatment, diet and physical activity, measured by direct and indirect methods, will be the primary outcome. Two independent reviewers will select relevant studies and will extract the data following the Cochrane's Handbook for Systematic Reviews of Approach and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. Methodological quality will be evaluated using the risk-of-bias (RoB) 2 and Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) tools. Risk of bias will also be evaluated, and if the criteria are met, a meta-analysis will be finally performed. ETHICS AND DISSEMINATION: Information to be analysed is of a grouped nature, and given that its sources are published studies, no ethics committee approval is required. Results will be published in scientific journals, and in conferences, seminars and symposiums. Copyrights will be addressed by giving due credit through bibliographic references. PROSPERO REGISTRATION NUMBER: CRD42020147655.

Asociación entre la razón Tg/HDL y la Enfermedad Renal Crónica en una cohorte colombiana / Association between Tg/HDL ratio and Chronic Kidney Disease in a colombian cohort

Resumen Introducción: La Enfermedad Renal Crónica (ERC) supone un fuerte impacto en la salud pública mundial. Esto es debido al elevado riesgo de enfermedad cardiovascular que presentan quienes la padecen. La razón triglicéridos/ lipoproteína de alta densidad se ha asociado con el desarrollo y progresión de la enfermedad renal. Objetivo: Estimar la asociación entre la razón triglicéridos/lipoproteína de alta densidad y la incidencia de enfermedad renal en una cohorte colombiana. Metodología: Estudio de cohorte prospectiva del seguimiento de INEFAC 2007-2017, con 1626 participantes. Para determinar la exposición principal se tomó como punto de corte >3,75 en la razón. Los casos se definieron con una tasa de filtración glomerular estimada <60ml/min/1,73m2 o con diagnóstico médico previo. Se ajustaron modelos de regresión lineal y log-binomial para los cambios en la tasa estimada y la incidencia de enfermedad renal crónica. Como covariables: edad, sexo, raza, alcohol, cigarrillo, circunferencia de cintura y actividad física. Resultados: La incidencia de enfermedad renal fue de 0,4% (IC 95% 0,1-0,8), el promedio de la tasa estimada de 94,3 ml/min/1,73m2. La asociación entre la razón triglicéridos/lipoproteína de alta densidad y la enfermedad renal crónica no fue estadísticamente significativa en el modelo crudo (RR= 2,3; IC 95%: 0,5-9,4) ni en el ajustado por confusores (RR= 1,1; IC 95%: 0,2-5,6). Conclusión: A partir del modelo múltiple no fue posible determinar la asociación, probablemente porque ésta no existe en la población estudiada o porque se requiere una alta muestra debido al bajo número de eventos encontrados.

Abstract Introduction: Chronic Kidney Disease (CKD) has a strong impact on global public health. This is due to the high risk of cardiovascular disease in those who suffer from it. The triglycerides / high density lipoprotein ratio has been associated with the development and progression of kidney disease. Objective: To estimate the association between the ratio triglycerides / high density lipoprotein and the incidence of kidney disease in a Colombian cohort. Methodology: Prospective cohort study of the follow-up of INEFAC 2007-2017, with 1626 participants. The main exposure was determined as a cut-off point> 3.75 in the ratio. The cases were defined as having an estimated glomerular filtration rate <60ml / min / 1.73m2 or previous medical diagnosis. Linear regression and log-binomial models were adjusted for changes in the estimated rate and incidence of chronic kidney disease. As covariates: age, sex, race, alcohol, cigarette, waist circumference, and physical activity. Results: The incidence of kidney disease was 0.4% (95% CI: 0.1-0.8), the average of the estimated rate was 94.3ml / min / 1.73m2. The association between the ratio triglycerides / high density lipoprotein and chronic kidney disease was not statistically significant in the unadjusted model (RR = 2.3, 95% CI: 0.5-9.4) nor in the adjusted by confounders (RR = 1.1, 95% CI: 0.2-5.6). Conclusion: It was not possible to determine the explored association, probably because it does not exist in the studied population or because a higher sample size is required, due to the low number of events.

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)

Evaluación de percepción de competencias de trabajadores respecto del Modelo Integral de Atención en Salud / Perception of competencies of health workers related to the integrated health care model

Resumen Introducción: Santander es pionero en atención primaria y lidera la implementación del nuevo Modelo Integral de Atención en Salud (MIAS) en Colombia. Este proceso requiere fortalecer las competencias del recurso humano encargado de atender los usuarios del sistema de salud. Objetivo: Identificar la percepción de los trabajadores de salud del primer nivel, y sus supervisores, respecto a sus competencias para desempeñarse dentro del MIAS. Metodología: Estudio transversal. Se construyó y validó un cuestionario de competencias en el saber Ser, Conocer y Hacer, basado en lineamientos del MIAS e instrumentos de competencias de profesionales de medicina y enfermería; se aplicó en línea a profesionales de siete profesiones de salud y auxiliares de enfermería. Se realizó un análisis por grupo de trabajadores y se compararon las percepciones de éstos y sus supervisores. Resultados: Participaron 359 trabajadores y 102 supervisores. En el Ser hubo menores puntajes dados por los supervisores en competencias de liderazgo profesional, trabajo en equipo y autonomía profesional. En el Conocer observamos menor percepción en competencia sobre Rutas Integrales de Atención en Salud (RIAS), priorización de grupos de riesgo, niveles y redes de prestadores, planes de beneficios, actores del sistema, y actividades a realizar en los entornos definidos por el MIAS. En el Hacer las competencias con menores puntajes fueron actividades de investigación en salud pública y ejecución de programas intersectoriales. Conclusiones: Múltiples competencias se deben fortalecer en los trabajadores de salud del primer nivel de atención, para implementar el MIAS.

ABSTRACT Introduction: Santander is pioneer in primary health care and is leading the implementation of the new comprehensive health care model (CHCM) in Colombia. This process requires to strength the competences of the health system's workers. Objective: To identify the primary health care workers' perception, and their supervisor's perception, regarding their competences for working in the framework of the new CHCM. Methods: We conducted a cross-sectional online survey in health professionals and technicians, and their supervisors, working in primary health care centers. We built and validated a questionnaire for the assessment of the three competences dimensions (attitude, knowledge, skills) based on the CHCM conceptual documents and questionnaires of competences for physicians and nurses. We stratified results by health profession and then, the worker and supervisors' perceptions were compared. Results: Participants were 359 health workers and 102 supervisors. In the attitude dimension, scores of leadership, teamwork, and professional autonomy were lower in supervisors than workers. In the knowledge dimension, the items with lower perception were those related to the new healthcare delivery's routes, risk prioritization's mechanisms, health services' network, plans of benefits and health system's structure. In the skills dimension, the competences with lower scores were the ones related to public health research and interdisciplinary work. Conclusions: We identify specific competencies that should be strengthened in primary healthcare workers, in order to achieve the expected performance in the new healthcare model in Colombia.

[Assessment of curricular contents and perception of competencies of health students related to the integrated health care model in Colombia]. / 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.

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.

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.

Prevalence and correlates of breast and cervical cancer screening among a Midwest community sample of low-acculturated Latinas.

BACKGROUND: Low adherence to cervical and breast cancer (CBC) screening recommendations contributes to high CBC mortality among Latinas. PURPOSE: To estimate the prevalence of, and factors associated with, last 12-month Pap smear and mammogram receipt among a Midwest community sample of low-acculturated Latinas. METHODS: We conducted a cross-sectional study with 278 Latina immigrants in Dane County, Wisconsin. Participants completed a self-administered questionnaire. We estimated multivariate logistic regression models to identify factors associated with CBC screening receipt. RESULTS: Rates of last 12-month Pap smear and mammogram receipt were 56.8% and 39.4%, respectively. Age, knowledge of screening recommendations, and having a regular health care provider were independently associated with both Pap smear and mammogram receipt. Having ever used Planned Parenthood and fear of cancer were uniquely correlated with Pap smear and mammogram receipt, respectively. CONCLUSIONS: Modifiable individual, structural, and cultural factors contribute to suboptimal rates of CBC screening among low-acculturated Latino immigrants.

A 'polypill' aimed at preventing cardiovascular disease could prove highly cost-effective for use in Latin America.

We evaluated the cost-effectiveness of administering a daily "polypill" consisting of three antihypertensive drugs, a statin, and aspirin to prevent cardiovascular disease among high-risk patients in Latin America. We found that the lifetime risk of cardiovascular disease could be reduced by 15 percent in women and by 21 percent in men if the polypill were used by people with a risk of cardiovascular disease equal to or greater than 15 percent over ten years. Attaining this goal would require treating 26 percent of the population at a cost of $34-$36 per quality-adjusted life-year. Offering the polypill to women at high risk and to men age fifty-five or older would be the best approach and would yield acceptable incremental cost-effectiveness ratios. The polypill would be very cost-effective even in the country with the lowest gross national income in our study. However, policy makers must weigh the value of intervention with the polypill against other interventions, as well as their country's willingness and ability to pay for the intervention.

Symptoms of depression and anxiety and adherence to antihypertensive medication.

BACKGROUND: Nonadherence to drug treatment is a major contributor to antihypertensive treatment failure. Mood disorders could impair the patient's desire and ability to follow physician's recommendations. We evaluated the role of symptoms of depression and anxiety on adherence to antihypertensive drug treatment. METHODS: We conducted a longitudinal cohort study in 20-70 years old patients starting antihypertensive drug treatment, without other chronic conditions, and not taking mood-modifying drugs. Severity of symptoms of depression and anxiety were evaluated at enrollment and 3, 6, 9, and 12 months of follow-up, using the Beck depression inventory-II (BDI-II) and the psychological general well-being index (PGWB), respectively. Treatment adherence was measured by pill count. Nonadherence was defined as taking <80% of the prescribed number of pills. Poisson regression was used to model the association of the exposures with adherence. RESULTS: We enrolled 178 patients (58% male; mean age: 50 years; 508 follow-up visits). The risk of nonadherence was 52.6% in 12 months (95% confidence interval (CI): 46.1, 59.1). After adjusting for other risk factors, individuals with at least mild depression (BDI-II ≥14) and those with at least mild anxiety (PGWB anxiety score <22) were 2.48 (95% CI: 1.47, 4.18) and 1.59 (95% CI: 0.99, 2.56) times more likely to become nonadherent in the following 3 months, respectively. CONCLUSIONS: Patients with at least mild anxiety and depression symptoms are at increased risk of becoming nonadherent to antihypertensive medication. Screening for depression and anxiety symptoms could be used to identify high-risk patients. Further evidence is needed to elucidate whether interventions targeting these conditions improve adherence.

Precisão do aparelho Omron HEM-705 CP na medida de pressão arterial em grandes estudos epidemiológicos / Accuracy of the Omron HEM-705 CP for blood pressure measurement in large epidemiologic studies / Precisión del aparato Omron HEM-705 CP en la medida de presión arterial en grandes estudios epidemiológicos

FUNDAMENTO: A medida precisa da pressão arterial (PA) é de grande importância na pesquisa da hipertensão. No contexto de estudos clínicos e epidemiológicos, dispositivos oscilométricos frequentemente oferecem importantes vantagens para superar algumas das limitações do método auscultatório. Embora sua acurácia tenha sido avaliada em estudos múltiplos no ambiente clínico, há pouca evidência de seu desempenho em grandes estudos epidemiológicos. OBJETIVO: Avaliamos a precisão do Omron HEM-705-CP, um dispositivo automático para medida de PA, quando comparado com o método padrão auscultatório com esfigmomanômetro de mercúrio em um grande estudo de coorte. MÉTODOS: Três medidas auscultatórias foram obtidas, seguidas por duas mensurações com o dispositivo Omron em 1.084 indivíduos. O viés foi estimado como a média de duas medidas pelo dispositivo Omron menos a média das duas últimas medidas auscultatórias, com seus correspondentes limites de concordância (LC) de 95 por cento. RESULTADOS: O dispositivo Omron superestimou a pressão arterial sistólica (PAS) por 1,8 mmHg (LC:-10,1, 13,7) e subestimou a pressão arterial diastólica (PAD) por 1,6 mmHg (LC:-12,3, 9,2). O viés foi significantemente maior em homens. O viés na PAS aumentou com a idade e diminuiu com o nível da PA, enquanto o viés na PAD diminuiu com a idade e aumentou com o nível da PA. A sensibilidade e a especificidade do dispositivo Omron para detectar hipertensão foram 88,2 por cento e 98,6 por cento, respectivamente. O uso das medidas do dispositivo Omron resultou em viés mínimo na estimativa dos efeitos de vários fatores. CONCLUSÃO: Nossos resultados demonstraram que o dispositivo Omron HEM-705-CP pode ser utilizado para medir a PA em grandes estudos epidemiológicos sem comprometer a validade do estudo ou sua precisão.

BACKGROUND: Accurate measurement of blood pressure is of utmost importance in hypertension research. In the context of epidemiologic and clinical studies, oscillometric devices offer important advantages to overcome some of the limitations of the auscultatory method. Even though their accuracy has been evaluated in multiple studies in the clinical setting, there is little evidence of their performance in large epidemiologic studies. OBJECTIVE: We evaluated the accuracy of the Omron HEM-705-CP, an automatic device for blood pressure (BP) measurement, as compared to the standard auscultatory method with a mercury sphygmomanometer in a large cohort study. METHODS: We made three auscultatory measurements, followed by two measurements with the Omron device in 1,084 subjects. Bias was estimated as the average of the two Omron minus the average of the last two auscultatory measurements, with its corresponding 95 percent limits of agreement (LA). RESULTS: The Omron overestimated systolic blood pressure (SBP) by 1.8 mmHg (LA:-10.1, 13.7) and underestimated diastolic blood pressure (DBP) by 1.6 mmHg (LA:-12.3, 9.2). Bias was significantly larger in men. Bias in SBP increased with age and decreased with BP level, while bias in DBP decreased with age and increased with BP level. The sensitivity and specificity of the Omron to detect hypertension were 88.2 percent and 98.6 percent, respectively. Minimum bias in the estimates of the effects of several factors resulted from the use of Omron measurements. CONCLUSION: Our results showed that the Omron HEM-705-CP could be used for measuring BP in large epidemiology studies without compromising study validity or precision.

FUNDAMENTO: La medida precisa de la presión arterial (PA) es de gran importancia en la investigación de la hipertensión. En el contexto de estudios clínicos y epidemiológicos, dispositivos oscilométricos frecuentemente ofrecen importantes ventajas para superar algunas de las limitaciones del método auscultatorio. Aunque su precisión haya sido evaluada en estudios múltiples en el ambiente clínico, hay poca evidencia de su desempeño en grandes estudios epidemiológicos. OBJETIVO: Evaluamos la precisión del Omron HEM-705-CP, un dispositivo automático para medida de PA, cuando fue comparado con el método estándar auscultatorio con esfigmomanómetro de mercurio, en un gran estudio de cohorte. MÉTODOS: Tres medidas auscultatorias fueron obtenidas, seguidas por dos mediciones con el dispositivo Omron en 1.084 individuos. El sesgo fue estimado como la media de dos medidas por el dispositivo Omron menos la media de las dos últimas medidas auscultatorias, con sus correspondientes límites de concordancia (LC) de 95 por ciento. RESULTADOS: El dispositivo Omron superestimó la presión arterial sistólica (PAS) por 1,8 mmHg (LC:-10,1, 13,7) y subestimó la presión arterial diastólica (PAD) por 1,6 mmHg (LC:-12,3, 9,2). El sesgo fue significantemente mayor en hombres. El sesgo en la PAS aumentó con la edad y disminuyó con el nivel de la PA, mientras que el sesgo en la PAD disminuyó con la edad y aumentó con el nivel de la PA. La sensibilidad y la especificidad del dispositivo Omron para detectar hipertensión fueron 88,2 por ciento y 98,6 por ciento, respectivamente. El uso de las medidas del dispositivo Omron resultó en sesgo mínimo en los estimados de los efectos de varios factores. CONCLUSIÓN: Nuestros resultados demostraron que el dispositivo Omron HEM-705-CP puede ser utilizado para medir la PA en grandes estudios epidemiológicos sin comprometer la validez del estudio o su precisión. (Arq Bras Cardiol 2011;96(5):393-398).

Accuracy of the Omron HEM-705 CP for blood pressure measurement in large epidemiologic studies.

BACKGROUND: Accurate measurement of blood pressure is of utmost importance in hypertension research. In the context of epidemiologic and clinical studies, oscillometric devices offer important advantages to overcome some of the limitations of the auscultatory method. Even though their accuracy has been evaluated in multiple studies in the clinical setting, there is little evidence of their performance in large epidemiologic studies. OBJECTIVE: We evaluated the accuracy of the Omron HEM-705-CP, an automatic device for blood pressure (BP) measurement, as compared to the standard auscultatory method with a mercury sphygmomanometer in a large cohort study. METHODS: We made three auscultatory measurements, followed by two measurements with the Omron device in 1,084 subjects. Bias was estimated as the average of the two Omron minus the average of the last two auscultatory measurements, with its corresponding 95% limits of agreement (LA). RESULTS: The Omron overestimated systolic blood pressure (SBP) by 1.8 mmHg (LA:-10.1, 13.7) and underestimated diastolic blood pressure (DBP) by 1.6 mmHg (LA:-12.3, 9.2). Bias was significantly larger in men. Bias in SBP increased with age and decreased with BP level, while bias in DBP decreased with age and increased with BP level. The sensitivity and specificity of the Omron to detect hypertension were 88.2% and 98.6%, respectively. Minimum bias in the estimates of the effects of several factors resulted from the use of Omron measurements. CONCLUSION: Our results showed that the Omron HEM-705-CP could be used for measuring BP in large epidemiology studies without compromising study validity or precision.

Analysis of human mini-exome sequencing data from Genetic Analysis Workshop 17 using a Bayesian hierarchical mixture model.

Next-generation sequencing technologies are rapidly changing the field of genetic epidemiology and enabling exploration of the full allele frequency spectrum underlying complex diseases. Although sequencing technologies have shifted our focus toward rare genetic variants, statistical methods traditionally used in genetic association studies are inadequate for estimating effects of low minor allele frequency variants. Four our study we use the Genetic Analysis Workshop 17 data from 697 unrelated individuals (genotypes for 24,487 autosomal variants from 3,205 genes). We apply a Bayesian hierarchical mixture model to identify genes associated with a simulated binary phenotype using a transformed genotype design matrix weighted by allele frequencies. A Metropolis Hasting algorithm is used to jointly sample each indicator variable and additive genetic effect pair from its conditional posterior distribution, and remaining parameters are sampled by Gibbs sampling. This method identified 58 genes with a posterior probability greater than 0.8 for being associated with the phenotype. One of these 58 genes, PIK3C2B was correctly identified as being associated with affected status based on the simulation process. This project demonstrates the utility of Bayesian hierarchical mixture models using a transformed genotype matrix to detect genes containing rare and common variants associated with a binary phenotype.

[Health insurance for infants and infant vaccination related to forced-displacement in Colombia]. / Seguro de Salud y Cobertura de Vacunación en Población Infantil con y sin Experiencia de Desplazamiento Forzado en Colombia.

OBJECTIVE: Determining vaccination coverage amongst children (<5 years old) having multiple socio-economic risk factors and their relationship to insurance status. METHODS: This was a cross-sectional study of 514 families from urban settlements receiving people displaced by the armed conflict in 4 municipalities in the Santander department ( Colombia ). The households were selected by probabilistic sampling, using proportional modelling by municipality. Immunisation data was collected from vaccination cards; interviews provided socio-demographic data. The dependent variable consisted of having the complete vaccination scheme by age according to the official Ministry of Social Protection's programme. The probability of being vaccinated was modelled by a logistical regression, adjusted for sociodemographic variables. RESULTS: 369 children were studied, of whom 48,8 % belonged to families displaced by the armed conflict. 46,1 % of the people being interviewed presented their vaccination cards. Contrary to what had been expected, only 21,2 % of those having a vaccination card were insured and 22,9 % of them had a complete vaccination scheme for their age. The probability of having a complete vaccination scheme for those individuals who were covered by the subsidised health system was 2,4 times higher when compared to those who were not insured (p=0.042). CONCLUSIONS: Low vaccination coverage indicated barriers for people living in conditions of poverty and displacement obtaining health services and low insurance coverage suggested faults in health insurance policies addressing similar populations.

Seguro de Salud y Cobertura de Vacunación en Población Infantil con y sin Experiencia de Desplazamiento Forzado en Colombia / Health insurance for infants and infant vaccination related to forced-displacement in Colombia

Objetivo: Determinar la cobertura de vacunación y su relación con el status de afiliación al seguro en niños y niñas menores de cinco años de edad, en condiciones de alta vulnerabilidad social. Material y métodos: Estudio transversal en 514 familias residentes en asentamientos urbanos, receptores de población desplazada por conflicto armado, de 4 municipios del departamento de Santander, Colombia. A través de un muestreo probabilístico con afijación proporcional por municipio se seleccionaron los hogares y se aplicó una encuesta. Los datos de inmunización fueron obtenidos del carné de vacunación. La variable dependiente fue estar vacunado con esquema completo para la edad según los biológicos estipulados por el programa oficial del Ministerio de Protección Social. Mediante regresión logística se modeló la probabilidad de estar vacunado ajustando por las variables sociodemográficas. Resultados: Se estudiaron 369 niños y niñas, de los cuales 48,8 por ciento pertenecía a familias desplazadas por conflicto armado; 46,1 por ciento de los entrevistados presentaron carné de vacunación. Entre los que tenían carné, contrario a lo esperado, sólo 21,2 por ciento estaba asegurado y 22,9 por ciento estaba vacunado con esquema completo para la edad. La probabilidad de estar vacunado para la edad, dado que se está afiliado al sistema de salud mediante el régimen subsidiado, es 2,4 veces más, comparada con los no asegurados (p=0.042). Conclusión Las bajas coberturas de vacunación indican la existencia de barreras de acceso a los servicios y las bajas coberturas de afiliación al seguro sugieren fallas en las políticas de afiliación al seguro para poblaciones que viven en contextos de pobreza y desplazamiento.

Objective: Determining vaccination coverage amongst children (<5 years old) having multiple socio-economic risk factors and their relationship to insurance status. Methods: This was a cross-sectional study of 514 families from urban settlements receiving people displaced by the armed conflict in 4 municipalities in the Santander department ( Colombia ). The households were selected by probabilistic sampling, using proportional modelling by municipality. Immunisation data was collected from vaccination cards; interviews provided socio-demographic data. The dependent variable consisted of having the complete vaccination scheme by age according to the official Ministry of Social Protection's programme. The probability of being vaccinated was modelled by a logistical regression, adjusted for sociodemographic variables. Results 369 children were studied, of whom 48,8 percent belonged to families displaced by the armed conflict. 46,1 percent of the people being interviewed presented their vaccination cards. Contrary to what had been expected, only 21,2 percent of those having a vaccination card were insured and 22,9 percent of them had a complete vaccination scheme for their age. The probability of having a complete vaccination scheme for those individuals who were covered by the subsidised health system was 2,4 times higher when compared to those who were not insured (p=0.042). Conclusions: Low vaccination coverage indicated barriers for people living in conditions of poverty and displacement obtaining health services and low insurance coverage suggested faults in health insurance policies addressing similar populations.

[Displaced and local children's alimentary patterns and nutritional state in Piedecuesta, Colombia]. / Patrón Alimentario y Estado Nutricional en Niños Desplazados en Piedecuesta, Colombia.

OBJECTIVES: This study was aimed at establishing displaced and local children's alimentary patterns amongst the school-age population from the Guatiguará area (Piedecuesta) and correlating their nutritional state with chosen socioeconomic and nutritional factors. METHODS: This descriptive transversal study of 89 displaced and local school-aged children (6 to 12 years of age) from the Guatiguará area (population=258) was carried out in 2004. Data was collected from socio-demographic and nutritional surveys as well as a food intake questionnaire (SICI). Twenty-four hour dietary recall, standardised kitchen item games and photographic models of the size of food portions were also used. The children's height and weight were measured. SICI, Excel, Epi Info 6.04d and Stata 8.0 software were used for processing the data. RESULTS: Nutritional state (weight per age - W/A) was as follows: 25,8 % deficit and 14,6 % risk of deficit. Low vegetable, fruit and protein consumption was found. The lowest percentages regarding consumption of needed items pertained to calcium, vitamin B6, iron, zinc and niacin. The relationship between receiving a monthly family income of less than Col $150 000 and nutritional deficit was (OR=2.76 CI(95 %) 0,92-8,44, p=0,040). Nutritional deficit protection factors consisted of having an employed mother (OR=0.29 CI(95 %) 0,09-0,84, p=0,012) and families having 2 or 3 employed members covering household expenses (OR=0.17 CI(95 %) 0,03-0,69 p=0,0052). CONCLUSION: Selected socioeconomic factors influenced the studied population's alimentary pattern and nutritional state.

Patrón Alimentario y Estado Nutricional en Niños Desplazados en Piedecuesta, Colombia / Displaced and local children's alimentary patterns and nutritional state in Piedecuesta, Colombia

Objetivos: Determinar el patrón alimentario en la población de niños en edad escolar del sector Guatiguará (Piedecuesta), evaluar su estado nutricional y la asociación con los factores socioeconómicos y alimentarios. Metodología: Estudio descriptivo de corte transversal en 89 niños desplazados y no desplazados en edad escolar (6 a 12 años) del sector Guatiguará (población: 258), realizado en 2004. Se aplicó una Encuesta Sociodemográfica y Nutricional y un Formato de Consumo de Alimentos (SICI); Se utilizó el método recordatorio de 24 horas, juegos de menaje y gráficas representativas del tamaño de porción de alimentos. Se tomó el peso y la talla de los niños. Procesamiento en programas SICI, Excel, Epi Info 6.04d y Stata 8.0. Resultados: Estado Nutricional (P/E): Déficit 25,8 por ciento y Riesgo de Déficit 14,6 por ciento; déficit T/E 25,7 por ciento y déficit P/T 4,3 por ciento. Se observa un bajo consumo de verduras, frutas y alimentos proteicos. Los porcentajes más bajos de adecuación del consumo correspondieron a calcio, vitamina B6, hierro, cinc y niacina. Se encontró Asociación entre recibir ingresos familiares mensuales menores de $150 000 y déficit nutricional (OR=2,76 IC(95 por ciento) 0,92-8,44, p=0,040). Factores protectores para déficit nutricional: ser madre empleada (OR=0,29, IC(95 por ciento) 0,09-0,84, p=0,012) y familias con 2 o 3 miembros trabajadores y aportantes a los gastos del hogar (OR=0,17 IC(95 por ciento) 0,03-0,69 p=0,005). Conclusión: En la población de estudio, el factor socioeconómico es determinante del patrón alimentario y del estado nutricional.

Objectives This study was aimed at establishing displaced and local children's alimentary patterns amongst the school-age population from the Guatiguará area (Piedecuesta) and correlating their nutritional state with chosen socioeconomic and nutritional factors. Methods This descriptive transversal study of 89 displaced and local school-aged children (6 to 12 years of age) from the Guatiguará area (population=258) was carried out in 2004. Data was collected from socio-demographic and nutritional surveys as well as a food intake questionnaire (SICI). Twenty-four hour dietary recall, standardised kitchen item games and photographic models of the size of food portions were also used. The children's height and weight were measured. SICI, Excel, Epi Info 6.04d and Stata 8.0 software were used for processing the data. Results Nutritional state (weight per age - W/A) was as follows: 25,8 percent deficit and 14,6 percent risk of deficit. Low vegetable, fruit and protein consumption was found. The lowest percentages regarding consumption of needed items pertained to calcium, vitamin B6, iron, zinc and niacin. The relationship between receiving a monthly family income of less than Col $150 000 and nutritional deficit was (OR=2.76 CI(95 percent) 0,92-8,44, p=0,040). Nutritional deficit protection factors consisted of having an employed mother (OR=0.29 CI(95 percent) 0,09-0,84, p=0,012) and families having 2 or 3 employed members covering household expenses (OR=0.17 CI(95 percent) 0,03-0,69 p=0,0052). Conclusion Selected socioeconomic factors influenced the studied population's alimentary pattern and nutritional state.

Asistencia a citología del cuello uterino y sus determinantes en una población rural colombiana, 1998-1999 / Use and determinants of pap smear in a rural Colombian municipality 1998-1999

Objetivos: Establecer la prevalencia de uso de la citología del cuello uterino e identificar los factores que determinan la asistencia a este examen. Métodos Estudio de corte transversal en voluntarias de un programa de prevención de cáncer de cuello uterino realizado en Mogotes, Colombia. Se calcularon razones de prevalencia (RP). La variable dependiente fue el antecedente de asistencia a citología. Se recolectaron características sociodemográficas, clínicas, familiares y de hábitos. Resultados La prevalencia de asistencia previa a citología fue 67,3 por ciento. A mayor edad de la mujer aumentaba la probabilidad de tener una citología anterior. El uso de métodos de planificación familiar que requerían control (RP: 1,4; IC95 por ciento: 1,2-1,7) y la residencia rural (RP: 0,9; IC95 por ciento: 0,8-1,0) también fueron factores que determinaron su utilización. Conclusiones Estos datos confirman que vivir en zonas rurales está asociado con una menor oportunidad de la mujer para acceder al examen citológico.

Objectives: Determining the prevalence of Pap smear use and identifying the factors associated with Pap test performance. Methods A cross-sectional study was carried out on volunteer women recruited from a local programme for detecting cervical cancer in Mogotes, Colombia. Prevalence ratios (PR) were calculated. Papanicolau smear use was the outcome being measured. Information about demographic characteristics, clinical factors, history of cancer in the family, lifestyle factors and using birth control methods was collected. Results Pap smear use prevalence was 67,3 percent. Age group, using birth control methods (PR:1,4; 95 percentCI:1,2-1,7) and living in rural settings (PR:0,9; 95 percentCI:0,8-1,0) were the factors associated with Pap test performance. Conclusions This data suggests that living in rural settings is associated with decreased opportunities for performing Pap tests.

[Use and determinants of Pap smear in a rural Colombian municipality 1998-1999]. / Asistencia a citología del cuello uterino y sus determinantes en una población rural Colombiana, 1998-1999.

OBJECTIVES: Determining the prevalence of Pap smear use and identifying the factors associated with Pap test performance. METHODS: A cross-sectional study was carried out on volunteer women recruited from a local programme for detecting cervical cancer in Mogotes, Colombia. Prevalence ratios (PR) were calculated. Papanicolau smear use was the outcome being measured. Information about demographic characteristics, clinical factors, history of cancer in the family, lifestyle factors and using birth control methods was collected. RESULTS: Pap smear use prevalence was 67.3%. Age group, using birth control methods (PR: 1.4; 95% CI: 1.2-1.7) and living in rural settings (PR: 0.9; 95% CI: 0.8-1.0) were the factors associated with Pap test performance. CONCLUSIONS: This data suggests that living in rural settings is associated with decreased opportunities for performing Pap tests.