Spatial and temporal analysis of African swine fever front-wave velocity in wild boar: implications for surveillance and control strategies.

The front-wave velocity of African swine fever (ASF) virus spread is depicted through a retrospective spatial and temporal analyses of wild boar outbreaks from Jan. 2014 to Jan. 2022 in Estonia, Latvia, Lithuania and Eastern Poland-regions responsible for more than 50% of all wild boar cases in the EU. The study uses empirical semivariograms in a universal kriging model to assess spatial autocorrelation in notification dates and identifies a discernable large-scale spatial trend. The critical parameter of ASF front-wave velocity was identified (Mean = 66.33 km/month, SD = 163.24) in the whole study area, and explored the variations across countries, wild boar habitat suitability, seasons, and the study period. Statistical differences in front-wave velocity values among countries and temporal clusters are explored, shedding light on potential factors influencing ASF transmission dynamics. The implications of these findings for surveillance and control strategies are discussed.

Exploring the Impact of Firefighter Trainee Fitness on Academy Graduation or Release.

ABSTRACT: Lockie, RG, Orr, RM, Montes, F, and Dawes, JJ. A research note exploring the impact of firefighter trainee fitness on academy graduation or release. J Strength Cond Res XX(X): 000-000, 2024-This study investigated the impact of fitness test performance on firefighter trainee ability to graduate an academy using ordinal logistic generalized linear models. Retrospective analysis was conducted on trainee data (N = 686) from one fire department who completed an occupational physical ability test (OPAT) that included the following: Illinois agility test (IAT); push-ups; pull-ups; leg tucks; maximal aerobic capacity (V̇o2max); backward overhead 4.54-kg medicine ball throw (BOMBT); 10-repetition maximum deadlift; and 91.44-m farmer's carry. Data were recorded in raw and scaled scores based on internal scoring (tests scored from 0 to 100; maximum total OPAT score of 800). Trainees were split into graduated (n = 576) or released (n = 110) groups. Data were analyzed through ordinal logistic generalized linear models (p < 0.05). Raw and scaled scores were investigated separately, with odds ratios (OR) and confidence intervals (CI) produced. Regarding raw scores, there was a difference in the odds of graduating relative to the IAT (OR = 1.357; CI = 1.047-1.760; p = 0.021), BOMBT (OR = 0.744; CI = 0.628-0.882; p < 0.001), and V̇o2max (OR = 0.907; CI = 0.862-0.954; p < 0.001). For scaled scores, there was a difference in the odds of graduating relative to the points attained for the BOMBT (OR = 0.985; CI = 0.972-0.999; p = 0.032), deadlift (OR = 0.982; CI = 0.968-0.995; p = 0.008), and total OPAT (OR = 0.994; CI = 0.988-1.000; p = 0.047). Change-of-direction speed (IAT), total-body power (BOMBT), aerobic fitness (V̇o2max), lower-body strength (deadlift), and overall fitness (total OPAT points) impacted the odds of trainee fire academy graduation. The IAT presented as the largest impacting variable where, for every unit increase in time (i.e., a slower IAT), there was 1.36 greater chance of a trainee being released from the academy.

Expanding Research on Firefighter Trainee Fitness, Reasons for Academy Release, and the Predictive Capabilities of Fitness Tests.

ABSTRACT: Lockie, RG, Orr, RM, Montes, F, and Dawes, JJ. Expanding research on firefighter trainee fitness, reasons for academy release, and the predictive capabilities of fitness tests. J Strength Cond Res 38(4): 724-733, 2024-Firefighter trainees need a level of fitness to be admitted to and complete a training academy. Fitness could indicate a trainee's likelihood of graduation, in addition to their reasons for release. This study determined fitness differences between firefighter trainees who graduated (GRAD) from academy or were released because of injury (RELI), performance test failures (RELP), or resignation (RELR), and whether fitness predicted graduation. Occupational physical ability test (OPAT) data for 686 trainees were analyzed, including: Illinois agility test; push-ups; pull-ups; leg tucks; maximal aerobic capacity (V̇O2max); backward overhead medicine ball throw; 10-repetition maximum deadlift; and farmer's carry. Raw and scaled (based on internal scoring) scores were recorded. Trainees were split into GRAD (n = 576), RELI (n = 33), RELP (n = 66), and RELR (n = 11) groups. A 1-way ANOVA with Bonferroni post hoc calculated between-group differences. Stepwise linear regression determined whether fitness predicted group inclusion. Receiver operating curves and area under the curve (AUC) derived test accuracy for predicting academy release. The GRAD group was superior (p ≤ 0.04) to the RELI group in all tests except push-ups, pull-ups, and farmer's carry; RELP group in all tests except the farmer's carry; and RELR group in V̇O2max, deadlift, and total OPAT score. Select fitness tests could predict inclusion in each group, although the explained variances were low (∼1-11%). Raw V̇O2max (AUC = 0.71) and total OPAT score (AUC = 0.74) had acceptable prediction accuracy. Fitness influenced academy graduation and reasons for release. Scaled scores could predict group inclusion in this department; V̇O2max and total OPAT score provided the most accurate predictors for release.

Physical fitness test performance in firefighter trainees: Differences between graduated and released trainees and predicting academy graduation.

BACKGROUND: Fitness tests have been previously used to predict academy graduation and highlight specific capacities to be targeted in applicants/trainees to optimise their potential for academy success. OBJECTIVE: To compare the fitness of graduated and released (did not complete academy requirements) firefighter trainees and explore using decision tree analysis to predict academy graduation via fitness tests. METHODS: Retrospective analysis was conducted on 686 trainees who completed an occupational physical ability test (OPAT): Illinois agility test; push-ups; pull-ups; leg tucks; estimated maximal aerobic capacity (VO2max); backwards overhead 4.54-kg medicine ball throw; 10-repetition maximum deadlift; and 91.44-m farmer's carry. Data were recorded in raw and scaled scores (tests scored from 0-100; maximum OPAT score was 800). Trainees were split into 'graduated' (GRAD; n = 576) or 'released' (REL; n = 110) groups. Mann-Whitney U-tests compared between-group OPAT scores. A decision tree analysis using Chi-square automatic interaction detection was conducted, with raw and scaled scores entered into the analysis. A separate analysis was conducted with only the raw scores. RESULTS: GRAD trainees outperformed REL trainees in all OPAT events (p < 0.001). OPAT total score was the best predictor of academy graduation (p < 0.001), followed by the deadlift score (p = 0.003). Estimated VO2max was the only significant raw score predictor (p < 0.001). CONCLUSIONS: GRAD trainees were fitter than the REL trainees. Fitness could predict trainees who graduated from the academy. Overall fitness (OPAT total score), muscular strength (deadlift) and aerobic capacity were important graduation predictors. Training staff could develop these fitness qualities in their trainees to potentially improve fire academy graduation rates.

Tuberculosis multirresistente en Colombia, 2013-2018: estudio de casos y controles / Drug-resistant tuberculosis in Colombia, 2013-2018: Case-control study

INTRODUCTION: Multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) is difficult to control, has high morbidity and mortality, and demands priority public health intervention. In Colombia, MDR/RR-TB has been becoming more widespread annually. Before the COVID-19 pandemic, over an 8-year period, the number of cases of multidrug-resistant tuberculosis in Colombia was close to a thousand cases. Timely identification of the different risk factors for MDR/RR-TB will contribute fundamentally to the systematic management. OBJECTIVE: To determine which risk factors were associated with the presentation of MDR in Colombia between 2013 and 2018. MATERIALS AND METHODS: A retrospective case-control study was carried out, for which the data from the routine surveillance of MDR/events in the country were used. RESULTS: The cases of multidrug-resistant tuberculosis were mainly in young people, Afrodescendants, and males. Of the clinical conditions, comorbidities such as malnutrition, diabetes, and HIV, presence of at least one factor, such as drug dependence, taking immunosuppressive medications, belonging to the black race, afro, and living in an area of high disease burden were risk factors. CONCLUSION: In addition to the diagnosis and timely provision of MDR-TB treatment, it is necessary that public health programs at the local level pay special attention to patients with the identified risk factors.

Introducción: La tuberculosis multirresistente-resistente a la rifampicina (TB-MDR/RR) es difícil de controlar, tiene una alta morbilidad y mortalidad y exige una intervención prioritaria en salud pública. En Colombia, la TB-MDR/RR se ha ido extendiendo cada año. Antes de la pandemia de COVID-19, en un periodo de 8 años, el número de casos de TB-MDR/RR en Colombia se acercaba a los mil. La identificación oportuna de los diferentes factores de riesgo de TB-MDR/RR contribuirá de manera fundamental al manejo sistemático de la enfermedad. Objetivo: Determinar los factores de riesgo que se asociaron a la presentación de la TBMDR/RR en Colombia entre 2013 y 2018. Materiales y métodos: Se realizó un estudio retrospectivo de casos y controles, para el cual se utilizaron los datos de la vigilancia rutinaria de eventos de TB MDR/RR en el país. Resultados: Los casos de TB MDR se presentaron principalmente en jóvenes, afrodescendientes y varones. De las condiciones clínicas, fueron factores de riesgo las comorbilidades como la desnutrición, la diabetes y el VIH, y la presencia de, al menos, un factor como la farmacodependencia, el consumo de medicamentos inmunosupresores, el ser de raza negra o afro y el vivir en una zona del país de alta carga de tuberculosis. Conclusiones: Además del diagnóstico y la provisión oportuna del tratamiento de la TB MDR, es necesario que los programas de salud pública a nivel local presten especial atención a los pacientes con los factores de riesgo identificados.

Drug-resistant tuberculosis in Colombia, 2013-2018: Case-control study

Abtract Introduction. Multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) is difficult to control, has high morbidity and mortality, and demands priority public health intervention. In Colombia, MDR/RR-TB has been becoming more widespread annually. Before the COVID-19 pandemic, over an 8-year period, the number of cases of multidrug-resistant tuberculosis in Colombia was close to a thousand cases. Timely identification of the different risk factors for MDR/RR-TB will contribute fundamentally to the systematic management. Objective. To determine which risk factors were associated with the presentation of MDR in Colombia between 2013 and 2018. Materials and methods. A retrospective case-control study was carried out, for which the data from the routine surveillance of MDR/events in the country were used. Results. The cases of multidrug-resistant tuberculosis were mainly in young people, Afrodescendants, and males. Of the clinical conditions, comorbidities such as malnutrition, diabetes, and HIV, presence of at least one factor, such as drug dependence, taking immunosuppressive medications, belonging to the black race, afro, and living in an area of high disease burden were risk factors. Conclusion. In addition to the diagnosis and timely provision of MDR-TB treatment, it is necessary that public health programs at the local level pay special attention to patients with the identified risk factors.

Introducción. La tuberculosis multirresistente-resistente a la rifampicina (TB-MDR/RR) es difícil de controlar, tiene una alta morbilidad y mortalidad y exige una intervención prioritaria en salud pública. En Colombia, la TB-MDR/RR se ha ido extendiendo cada año. Antes de la pandemia de COVID-19, en un periodo de 8 años, el número de casos de TB-MDR/RR en Colombia se acercaba a los mil. La identificación oportuna de los diferentes factores de riesgo de TB-MDR/RR contribuirá de manera fundamental al manejo sistemático de la enfermedad. Objetivo. Determinar los factores de riesgo que se asociaron a la presentación de la TB- MDR/RR en Colombia entre 2013 y 2018. Materiales y métodos. Se realizó un estudio retrospectivo de casos y controles, para el cual se utilizaron los datos de la vigilancia rutinaria de eventos de TB MDR/RR en el país. Resultados. Los casos de TB MDR se presentaron principalmente en jóvenes, afrodescendientes y varones. De las condiciones clínicas, fueron factores de riesgo las comorbilidades como la desnutrición, la diabetes y el VIH, y la presencia de, al menos, un factor como la farmacodependencia, el consumo de medicamentos inmunosupresores, el ser de raza negra o afro y el vivir en una zona del país de alta carga de tuberculosis. Conclusiones. Además del diagnóstico y la provisión oportuna del tratamiento de la TB MDR, es necesario que los programas de salud pública a nivel local presten especial atención a los pacientes con los factores de riesgo identificados.

Elucidating regulatory processes of intense physical activity by multi-omics analysis.

BACKGROUND: Physiological and biochemical processes across tissues of the body are regulated in response to the high demands of intense physical activity in several occupations, such as firefighting, law enforcement, military, and sports. A better understanding of such processes can ultimately help improve human performance and prevent illnesses in the work environment. METHODS: To study regulatory processes in intense physical activity simulating real-life conditions, we performed a multi-omics analysis of three biofluids (blood plasma, urine, and saliva) collected from 11 wildland firefighters before and after a 45 min, intense exercise regimen. Omics profiles post- versus pre-exercise were compared by Student's t-test followed by pathway analysis and comparison between the different omics modalities. RESULTS: Our multi-omics analysis identified and quantified 3835 proteins, 730 lipids and 182 metabolites combining the 3 different types of samples. The blood plasma analysis revealed signatures of tissue damage and acute repair response accompanied by enhanced carbon metabolism to meet energy demands. The urine analysis showed a strong, concomitant regulation of 6 out of 8 identified proteins from the renin-angiotensin system supporting increased excretion of catabolites, reabsorption of nutrients and maintenance of fluid balance. In saliva, we observed a decrease in 3 pro-inflammatory cytokines and an increase in 8 antimicrobial peptides. A systematic literature review identified 6 papers that support an altered susceptibility to respiratory infection. CONCLUSION: This study shows simultaneous regulatory signatures in biofluids indicative of homeostatic maintenance during intense physical activity with possible effects on increased infection susceptibility, suggesting that caution against respiratory diseases could benefit workers on highly physical demanding jobs.

Empirical and process-based models predict enhanced beech growth in European mountains under climate change scenarios: A multimodel approach.

Process-based models and empirical modelling techniques are frequently used to (i) explore the sensitivity of tree growth to environmental variables, and (ii) predict the future growth of trees and forest stands under climate change scenarios. However, modelling approaches substantially influence predictions of the sensitivity of trees to environmental factors. Here, we used tree-ring width (TRW) data from 1630 beech trees from a network of 70 plots established across European mountains to build empirical predictive growth models using various modelling approaches. In addition, we used 3-PG and Biome-BGCMuSo process-based models to compare growth predictions with derived empirical models. Results revealed similar prediction errors (RMSE) across models ranging between 3.71 and 7.54 cm2 of basal area increment (BAI). The models explained most of the variability in BAI ranging from 54 % to 87 %. Selected explanatory variables (despite being statistically highly significant) and the pattern of the growth sensitivity differed between models substantially. We identified only five factors with the same effect and the same sensitivity pattern in all empirical models: tree DBH, competition index, elevation, Gini index of DBH, and soil silt content. However, the sensitivity to most of the climate variables was low and inconsistent among the empirical models. Both empirical and process-based models suggest that beech in European mountains will, on average, likely experience better growth conditions under both 4.5 and 8.5 RCP scenarios. The process-based models indicated that beech may grow better across European mountains by 1.05 to 1.4 times in warmer conditions. The empirical models identified several drivers of tree growth that are not included in the current process-based models (e.g., different nutrients) but may have a substantial effect on final results, particularly if they are limiting factors. Hence, future development of process-based models may build upon our findings to increase their ability to correctly capture ecosystem dynamics.

Change-of-Direction Speed in Firefighter Trainees: Fitness Relationships and Implications for Occupational Performance.

Change-of-direction (COD) speed and ability could assist a firefighter moving about the fire ground more efficiently. There has been limited investigations of COD speed in firefighter trainees, and what measures of fitness could contribute to faster performance in a test such as the Illinois agility test (IAT), which measures longer COD speed. This study analyzed archival data from 292 trainees (262 males, 30 females). The trainees completed the following fitness tests at their training academy: IAT, push-ups, pull-ups, leg tucks, 20-m multistage fitness test to measure estimated maximal aerobic capacity (VO2max), backwards overhead 4.54-kg medicine ball throw (BOMBT), 10-repetition maximum (10RM) deadlift, and a 91.44-m farmer's carry with 2 x 18-kg kettlebells. Independent samples t-tests compared male and female trainees to determine the need to control for trainee sex in the analyses. Partial correlations, controlling for trainee sex, analyzed relationships between the IAT and fitness tests. Stepwise regression analyses controlling for trainee sex determined if any fitness test predicted the IAT. On average, male trainees outperformed females in all fitness tests (p ≤ 0.002). The IAT significantly related to all fitness tests (r = ±0.138-0.439, p ≤ 0.019), and was predicted by trainee sex, estimated VO2max, the 10RM deadlift, BOMBT, and the farmer's carry (R = 0.631; R2 = 0.398; adjusted R2 = 0.388). The results indicate the trainees who are generally fit may perform well in a range of different fitness tests, including the IAT. Nonetheless, improving muscular strength (measured by the 10RM deadlift), total-body power (BOMBT), and metabolic capacity (estimated VO2max, farmer's carry) could enhance COD speed in firefighter trainees.

Impact of Physical Fitness on Reasons for Academy Release in Firefighter Trainees.

ABSTRACT: Lockie, RG, Orr, RM, Montes, F, Ruvalcaba, TJ, and Dawes, JJ. Impact of physical fitness on reasons for academy release in firefighter trainees. J Strength Cond Res 37(7): 1515-1522, 2023-Firefighter trainees require a certain level of fitness to be admitted to and to complete a fire training academy. There is no research detailing whether there are fitness differences between trainees who graduate (GRAD) or those released due to either injury (RELI) or skills test performance failures (RELP). Archival data from 305 trainees (274 males and 31 females) were analyzed. Trainees completed the following fitness tests at the start of academy: Illinois agility test, metronome push-ups, pull-ups, leg tucks, multistage fitness test, backward overhead medicine ball throw (BOMBT) with a 4.54-kg ball, 10 repetition maximum deadlift, and a farmer's carry with 18-kg kettlebells over a 91.44-m course. Trainees were split into GRAD (245 males and 16 females), RELI (9 males and 1 female), and RELP (20 males and 14 females) groups. Kolmogorov-Smirnov data indicated most data were not normally distributed. Accordingly, Kruskal-Wallis H-tests, with Bonferroni post hoc, calculated between-group fitness test differences. Effect sizes were also derived. Except for the leg tuck and farmer's carry, the RELP group performed significantly poorer in all fitness tests compared with the GRAD group ( p ≤ 0.032). The largest effects were seen for the BOMBT ( d = 1.02), Illinois agility test, and 10 repetition maximum deadlift (both d = 0.78). There were no significant fitness test differences for the GRAD and RELI groups. Trainees with poorer fitness were more likely to be released from academy due to skills test failures. Multiple fitness components, but particularly muscular strength and power, should be developed in trainees to aid their ability to perform academy firefighting tasks.

Exploring Predictive Ability of Fitness Test Data Relative to Fire Academy Graduation in Trainees: Practical Applications for Physical Training.

This study investigated the predictive abilities of fitness tests relative to academy graduation in firefighter trainees. Archival fitness test data from 305 trainees were analyzed, including: Illinois agility test (IAT); push-ups; pull-ups; leg tucks; multistage fitness test; 4.54-kg backwards overhead medicine ball throw (BOMBT); 10-repetition maximum deadlift; and a 91.44-m farmers carry with 18-kg kettlebells. Within the department, trainees were allocated points for each test. Trainees were split into graduated (245 males, 16 females) or released (29 males, 15 females) groups. Independent samples t-tests and effect sizes calculated between-group fitness test differences (raw and scaled points). To provide a binary definition for the sensitivity/specificity analysis, trainees were defined as those scoring 60+ points for a test, and those scoring 0 points. For each test, the binary result (graduated/released) was plotted against the trainee's test performance (60+ Points/0 Points). Receiver operating curves were plotted for each fitness test, and the area under the curve (AUC) determined accuracy. Trainees who graduated performed more push-ups, pull-ups, and leg tucks than released trainees, and scored more points in all tests (p≤0.005; d=0.34-1.41). Pull-ups, BOMBT, leg tuck, and the farmer's carry had high sensitivity (>80% true positive rate); the IAT had high specificity (83.3% for the true negative rate). Metronome push-ups, BOMBT points, and total points had fair accuracy for predicting academy graduation (AUC=0.709-0.754). While the data demonstrated that trainees who graduated tended to have better total-body muscular strength, endurance, and power, fitness tests may not be appropriate as a sole predictor for academy graduation.

Measurement of stigma and associated characteristics in people with tuberculosis in Medellín, Colombia: a cross-sectional study.

BACKGROUND: Stigma towards tuberculosis (TB) delays diagnosis and compromises adherence to treatment. We measured the degree of stigma and identified the sociodemographic and clinical characteristics that were associated with a higher degree of stigma in patients with pulmonary and extrapulmonary TB in Colombia. METHODS: We conducted a cross-sectional study with 232 participants included in the TB control program in 2017. Sociodemographic and clinical variables were measured. The stigma component was measured through a validated scale and a multiple linear regression was used. RESULTS: The study analysed 232 patients, of which 52.2% were men, 53.5% were between 27 and 59 y of age and 66.8% had a basic-medium education level. Two characteristics were significantly related to a higher stigma score: the basic-medium education level and homeless status. Homeless status increased the stigma score by 0.27. In contrast, the adjusted stigma score decreased by 0.07 if the patient's health status was perceived as 'healthy'. CONCLUSION: Stigma is maximized in homeless patients and patients with a low education level. It is minimized in patients who perceive their state of health as 'healthy'.

Impact of successive spring frosts on leaf phenology and radial growth in three deciduous tree species with contrasting climate requirements in central Spain.

Rear-edge tree populations forming the equatorward limit of distribution of temperate species are assumed to be more adapted to climate variability than central (core) populations. However, climate is expected to become more variable and the frequency of climate extremes is forecasted to increase. Climatic extreme events such as heat waves, dry spells and spring frosts could become more frequent, and negatively impact and jeopardize rear-edge stands. To evaluate these ideas, we analyzed the growth response of trees to successive spring frosts in a mixed forest, where two temperate deciduous species, Fagus sylvatica L. (European beech) and Quercus petraea (Matt.) Liebl. (sessile oak), both at their southernmost edge, coexist with the Mediterranean Quercus pyrenaica Willd. (Pyrenean oak). Growth reductions in spring-frost years ranked across species as F. sylvatica > Q. petraea > Q. pyrenaica. Leaf flushing occurred earlier in F. sylvatica and later in Q. pyrenaica, suggesting that leaf phenology was a strong determinant of spring frost damage and stem growth reduction. The frost impact depended on prior climate conditions, since warmer days prior to frost occurrence predisposed to frost damage. Autumn Normalized Difference Vegetation Index data showed delayed leaf senescence in spring-frost years and subsequent years as compared with pre-frost years. In the studied forest, the negative impact of spring frosts on Q. petraea and especially on F. sylvatica growth, was considerably higher than the impacts due to drought. The succession of four spring frosts in the last two decades determined a trend of decreasing resistance of radial growth to frosts in F. sylvatica. The increased frequency of spring frosts might prevent the expansion and persistence of F. sylvatica in this rear-edge Mediterranean population.

Adverse treatment outcomes in multidrug resistant tuberculosis go beyond the microbe-drug interaction: Results of a multiple correspondence analysis. / Los resultados adversos en el tratamiento de la tuberculosis resistente a múltiples fármacos sobrepasan la relación fármaco-microorganismo: resultados de un análisis de correspondencia múltiple

INTRODUCTION: Multidrug-resistant tuberculosis treatment is effective in 50% of patients due to several factors including antibiotic susceptibility of the microorganism, adverse treatment reactions, social factors, and associated comorbidities. OBJECTIVES: In this study, we describe the demographics, clinical characteristics, and factors associated with treatment outcomes in multidrug-resistant tuberculosis (MDR-TB) patients in Medellín, Colombia. MATERIALS AND METHODS: We conducted a retrospective analysis using data from patients diagnosed with MDR-TB attending Hospital La María in Medellín, Colombia, for treatment between 2010 and 2015. Patients were categorized as having successful (cured) or poor (failure, lost to follow-up, and death) treatment outcomes. Associations between demographic, clinical factors, laboratory results, treatment outcomes, and follow-up information were evaluated by univariate, multivariate, and multiple correspondence analyses. RESULTS: Of the 128 patients with MDR-TB, 77 (60%) had successful outcomes. Of those with poor outcomes, 26 were lost to follow-up, 15 died, and 10 were treatment failures. Irregular treatment, the presence of comorbidities, and positive cultures after more than two months of treatment were associated with poor outcomes compared to successful ones (p<0.05 for all). The multiple correspondence analyses grouped patients who were lost to follow-up, had HIV, and drug addiction, as well as patients with treatment failure, irregular treatment, and chronic obstructive pulmonary disease. CONCLUSION: The recognition of factors affecting treatment is essential and was associated with treatment outcomes in this series of patients. Early identification of these factors should increase the rates of treatment success and contribute to MDR-TB control.

Introducción. El tratamiento de la tuberculosis multirresistente tiene una efectividad del 50 %, afectado por múltiples factores como la sensibilidad del microorganismo, las reacciones secundarias, los factores sociales y las comorbilidades existentes. Objetivos. Describir la demografía, las características clínicas y los factores pronósticos asociados con los resultados del tratamiento en pacientes multirresistentes (TB-MDR) de Medellín, Colombia. Métodos. Se hizo un análisis retrospectivo de los datos de los pacientes con TB-MDR atendidos en el Hospital La María de Medellín, Colombia, que fueron tratados entre el 2010 y el 2015. Los pacientes se categorizaron con tratamiento exitoso (curados) o con tratamiento fallido (falla en el tratamiento, pérdida durante el seguimiento y muerte). Se determinó la asociación entre las características demográficas y clínicas, los resultados de los exámenes de laboratorio, los desenlaces del tratamiento y la información del seguimiento, utilizando análisis univariado, multivariado y de correspondencia múltiple. Resultados. De 128 pacientes con TB-MDR, 77 (60 %) tuvieron un tratamiento exitoso. De los que tuvieron un tratamiento fallido, 26 pacientes se perdieron en el seguimiento, 15 murieron y 10 tuvieron falla en el tratamiento. El tratamiento irregular, las comorbilidades y los cultivos positivos más allá de 2 meses de tratamiento se asociaron significativamente con los tratamientos fallidos (p<0,05). El análisis de correspondencia múltiple agrupó los pacientes con pérdida en el seguimiento, con HIV y tratamientos irregulares, y los pacientes con tratamientos irregulares y enfermedad pulmonar obstructiva crónica con falla en el tratamiento y muerte. Conclusión. El reconocimiento temprano de los factores que afectan el desenlace del tratamiento de los pacientes con TB-MDR es esencial; la identificación de dichos factores debería incrementar el éxito del tratamiento y contribuir al adecuado control de la TB-MDR.

Adverse treatment outcomes in multidrug resistant tuberculosis go beyond the microbe-drug interaction: Results of a multiple correspondence analysis / Los resultados adversos en el tratamiento de la tuberculosis resistente a múltiples fármacos sobrepasan la relación fármaco-microorganismo: resultados de un análisis de correspondencia múltiple

Abstract . Introduction: Multidrug-resistant tuberculosis treatment is effective in 50% of patients due to several factors including antibiotic susceptibility of the microorganism, adverse treatment reactions, social factors, and associated comorbidities. Objectives: In this study, we describe the demographics, clinical characteristics, and factors associated with treatment outcomes in multidrug-resistant tuberculosis (MDR-TB) patients in Medellín, Colombia. Materials and methods: We conducted a retrospective analysis using data from patients diagnosed with MDR-TB attending Hospital La María in Medellín, Colombia, for treatment between 2010 and 2015. Patients were categorized as having successful (cured) or poor (failure, lost to follow-up, and death) treatment outcomes. Associations between demographic, clinical factors, laboratory results, treatment outcomes, and follow-up information were evaluated by univariate, multivariate, and multiple correspondence analyses. Results: Of the 128 patients with MDR-TB, 77 (60%) had successful outcomes. Of those with poor outcomes, 26 were lost to follow-up, 15 died, and 10 were treatment failures. Irregular treatment, the presence of comorbidities, and positive cultures after more than two months of treatment were associated with poor outcomes compared to successful ones (p<0.05 for all). The multiple correspondence analyses grouped patients who were lost to follow-up, had HIV, and drug addiction, as well as patients with treatment failure, irregular treatment, and chronic obstructive pulmonary disease. Conclusion: The recognition of factors affecting treatment is essential and was associated with treatment outcomes in this series of patients. Early identification of these factors should increase the rates of treatment success and contribute to MDR-TB control.

Resumen . Introducción. El tratamiento de la tuberculosis multirresistente tiene una efectividad del 50 %, afectado por múltiples factores como la sensibilidad del microorganismo, las reacciones secundarias, los factores sociales y las comorbilidades existentes. Objetivos. Describir la demografía, las características clínicas y los factores pronósticos asociados con los resultados del tratamiento en pacientes multirresistentes (TB-MDR) de Medellín, Colombia. Métodos. Se hizo un análisis retrospectivo de los datos de los pacientes con TB-MDR atendidos en el Hospital La María de Medellín, Colombia, que fueron tratados entre el 2010 y el 2015. Los pacientes se categorizaron con tratamiento exitoso (curados) o con tratamiento fallido (falla en el tratamiento, pérdida durante el seguimiento y muerte). Se determinó la asociación entre las características demográficas y clínicas, los resultados de los exámenes de laboratorio, los desenlaces del tratamiento y la información del seguimiento, utilizando análisis univariado, multivariado y de correspondencia múltiple. Resultados. De 128 pacientes con TB-MDR, 77 (60 %) tuvieron un tratamiento exitoso. De los que tuvieron un tratamiento fallido, 26 pacientes se perdieron en el seguimiento, 15 murieron y 10 tuvieron falla en el tratamiento. El tratamiento irregular, las comorbilidades y los cultivos positivos más allá de 2 meses de tratamiento se asociaron significativamente con los tratamientos fallidos (p<0,05). El análisis de correspondencia múltiple agrupó los pacientes con pérdida en el seguimiento, con HIV y tratamientos irregulares, y los pacientes con tratamientos irregulares y enfermedad pulmonar obstructiva crónica con falla en el tratamiento y muerte. Conclusión. El reconocimiento temprano de los factores que afectan el desenlace del tratamiento de los pacientes con TB-MDR es esencial; la identificación de dichos factores debería incrementar el éxito del tratamiento y contribuir al adecuado control de la TB-MDR.

Delays in diagnosing pulmonary tuberculosis within a context of medium incidence, Medellín, Colombia, 2017: an operational research.

BACKGROUND: Delay in tuberculosis (TB) diagnosis is one of the first obstacles for controlling the disease. Delays generate greater deterioration of the health of the patients and increase the possibilities of transmission and infection at home and in the community. The aim of the study was to identify profiles and individual variables associated with patient delays and health care system delays in patients with pulmonary tuberculosis (PTB) in Medellín, Colombia, a city that notifies 1400 new cases per year. METHODS: A retrospective cohort study in adults with PTB was conducted from May to September of 2017. Sociodemographic, health care-seeking behaviour, and clinical variables were measured. The outcomes were patient delay and health care system delay. The data were obtained from records of the local TB program, and a questionnaire was applied by the health care team that performs routine field visits. Simple correspondence analysis was used to identify groups (profiles), and their characteristics. Cox's proportional hazards model was carried out to identify the variables associated with the delays. RESULTS: The study included 183 patients. The total delay median was 101 days (IQR: 64-163). Patient delay was of 35 days (IQR: 14-84), the profile with greater delay belonged to consumers of psychoactive substances. The health care system delay was of 27 days (IQR: 7-89), the attributes of the profile with greater delay were being a female, having more than two consultations before the diagnosis, and having prescribed antibiotics. Basic-medium educational level [HRa = 0.69; 95% CI (0.49-0.97)] and having a TB home contact [HRa = 0.68; 95% CI (0.48-0.96)] were associated with greater patient delay. Having negative acid-fast bacilli (AFB) smear [HRa = 0.64; 95% CI (0.45-0.92)] and more than two consultations before the diagnosis [HRa = 0.33; 95% CI (0.22-0.49)] was associated with greater health care system delay. CONCLUSIONS: Data from epidemiological surveillance allowed locating risk groups with delays in TB diagnosis which requires the prioritisation of the local TB control program to promote early detection and prevention of adverse outcomes.

Assessing the relationship between multimorbidity and depression in older men and women: the International Mobility in Aging Study (IMIAS).

Objectives: Our study aims to assess whether multimorbidity is an independent risk factor for the development of depression in older adults living in Canada, Brazil, Colombia, and Albania and examines differences in incidence of depression regarding social and psychosocial characteristics.Methods: The longitudinal International Mobility Aging Study (IMIAS) collected information from adults between 65-74 years old. Depression was defined by a 16 or higher score assessed by the Centre for Epidemiological Studies Depression (CES-D) Scale. Multimorbidity was defined as having two or more chronic conditions, which were self-reported by participants using a list of eight physical chronic conditions. Poisson regression was performed to estimate the relative risk of depression in older adults with multimorbidity compared to those living with 0-1 chronic conditions, adjusting for sex, age, education, number of doctor visits, degree of assistance needed, social support, and smoking status. The analysis was stratified by study region (Canada; Latin America; Albania).Results: Crude and adjusted models showed no statistically significant associations between multimorbidity and the incidence of depression in any of the study regions, confirmed by sensitivity analyses. However, the incidence of depression varied across study region, confirmed by the intra-class correlation coefficient which indicated that 13% of variations in depression incidence were due to geographic differences.Conclusion: Multimorbidity does not appear to increase the risk of developing depression in older adults between 65-74. Higher rates of depression in Latin America and Albania (compared to Canada) may be attributed to lifecourse exposures to social and economic adversity in these regions.

Is tuberculosis elimination a feasible goal in Colombia by 2050?

Colombia has an underreporting of 30% of the total cases, according to World Health Organization (WHO) estimations. In 2016, successful tuberculosis (TB) treatment rate was 70%, and the mortality rate ranged between 3.5% and 10%. In 2015, Colombia adopted and adapted the End TB strategy and set a target of 50% reduction in incidence and mortality by 2035 compared with 2015. The aims of this study were: To evaluate whether Colombia will be able to achieve the goals of TB incidence and mortality by 2050, using the current strategies; and whether the implementation of new screening, diagnosis and TB treatment strategies will allow to achieve those WHO targets. An ecological study was conducted using TB case-notification, successful treatment and mortality rates from the last 8 years (2009-17). System dynamics analysis was performed using simulated scenarios: (1) continuation with the same trends following the trajectory of the last 8 years (Status quo) and (2) modification of the targets between 2017 through 2050, assuming the implementation of multimodal strategies to increase the screening, to improve the early diagnosis and to improve the treatment adherence. Following the current strategies, it is projected that Colombia will not achieve the End TB strategy targets. Achieving the goal of TB incidence of 10/100 000 by 2050 will only be possible by implementing combined strategies for increasing screening of people with respiratory symptoms, improving access to rapid diagnostic tests and improving treatment adherence. Therefore, it is necessary to design and implement simultaneous strategies according to the population needs and resources, in order to stride towards the End TB targets.

Homelessness and HIV: A Combination Predictive of Poor Tuberculosis Treatment Outcomes and in Need of Innovative Strategies to Improve Treatment Completion.

Antioquia Department is the state with the highest burden of tuberculosis (TB) in Colombia. Our aim was to determine the risk factors associated with unsuccessful TB treatment in HIV-seropositive and homeless persons, compared with non-HIV-infected and non-homeless persons with TB. We conducted a retrospective cohort study using observational, routinely collected health data from all drug-susceptible TB cases in homeless and/or HIV-seropositive individuals in Antioquia from 2014 to 2016. Unsuccessful TB treatment was defined as individuals having been lost to follow-up, having died, or treatment failure occurrence during the study period. Successful treatment was defined as cure of TB or treatment completion according to the WHO definitions. We identified 544 homeless persons with TB (432 HIV- and 112 HIV+), 835 HIV+ persons with TB and non-homeless, and 5,086 HIV-/non-homeless people with TB. Unsuccessful treatment rates were 19.3% in HIV-/non-homeless persons, 37.4% in non-homeless HIV+ patients, 61.5% in homeless HIV- patients, and 70.3% in homeless HIV+ patients; all rates fall below End TB strategy targets. More than 50% of homeless patients were lost to follow-up. Risk factors associated with unsuccessful treatment were HIV seropositivity, homelessness, male gender, age ≥ 25 years, noncontributory-type health insurance, TB diagnosis made during hospitalization, and previous treatment for TB. These results highlight the challenge of treating TB in the homeless population. These findings should put an onus on TB programs, governments, clinicians, and others involved in the collaborative care of TB patients to pursue innovative strategies to improve treatment success in this population.

The effect of vapour pressure deficit on stomatal conductance, sap pH and leaf-specific hydraulic conductance in Eucalyptus globulus clones grown under two watering regimes.

BACKGROUND AND AIMS: Stomatal conductance has long been considered of key interest in the study of plant adaptation to water stress. The expected increase in extreme meteorological events under a climate change scenario may compromise survival in Eucalyptus globulus plantations established in south-western Spain. We investigated to what extent changes in stomatal conductance in response to high vapour pressure deficits and water shortage are mediated by hydraulic and chemical signals in greenhouse-grown E. globulus clones. METHODS: Rooted cuttings were grown in pots and submitted to two watering regimes. Stomatal conductance, shoot water potential, sap pH and hydraulic conductance were measured consecutively in each plant over 4 weeks under vapour pressure deficits ranging 0·42 to 2·25 kPa. Evapotranspiration, growth in leaf area and shoot biomass were also determined. KEY RESULTS: There was a significant effect of both clone and watering regime in stomatal conductance and leaf-specific hydraulic conductance, but not in sap pH. Sap pH decreased as water potential and stomatal conductance decreased under increasing vapour pressure deficit. There was no significant relationship between stomatal conductance and leaf-specific hydraulic conductance. Stomata closure precluded shoot water potential from falling below -1·8 MPa. The percentage loss of hydraulic conductance ranged from 40 to 85 %. The highest and lowest leaf-specific hydraulic conductances were measured in clones from the same half-sib families. Water shortage reduced growth and evapotranspiration, decreases in evapotranspiration ranging from 14 to 32 % in the five clones tested. CONCLUSIONS: Changes in sap pH seemed to be a response to changes in atmospheric conditions rather than soil water in the species. Stomata closed after a considerable amount of hydraulic conductance was lost, although intraspecific differences in leaf-specific hydraulic conductance suggest the possibility of selection for improved productivity under water-limiting conditions combined with high temperatures in the early stages of growth.