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4.
Sci Rep ; 10(1): 3917, 2020 03 03.
Artículo en Inglés | MEDLINE | ID: mdl-32127596

RESUMEN

Nitrogenous fertilizers have nearly doubled global grain yields, but have also increased losses of reactive N to the environment. Current public investments to improve soil health seek to balance productivity and environmental considerations. However, data integrating soil biological health and crop N response to date is insufficient to reliably drive conservation policy and inform management. Here we used multilevel structural equation modeling and N fertilizer rate trials to show that biologically healthier soils produce greater corn yields per unit of fertilizer. We found the effect of soil biological health on corn yield was 18% the magnitude of N fertilization, Moreover, we found this effect was consistent for edaphic and climatic conditions representative of 52% of the rainfed acreage in the Corn Belt (as determined using technological extrapolation domains). While N fertilization also plays a role in building or maintaining soil biological health, soil biological health metrics offer limited a priori information on a site's responsiveness to N fertilizer applications. Thus, increases in soil biological health can increase corn yields for a given unit of N fertilizer, but cannot completely replace mineral N fertilization in these systems. Our results illustrate the potential for gains in productivity through investment in soil biological health, independent of increases in mineral N fertilizer use.


Asunto(s)
Fertilizantes/análisis , Nitrógeno/farmacología , Suelo/química , Zea mays/efectos de los fármacos , Zea mays/crecimiento & desarrollo
6.
PLoS One ; 14(5): e0216612, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31071142

RESUMEN

BACKGROUND: There is recognition that effective interventions are available to prevent neonatal and maternal deaths but providing reliable and valid coverage estimates remains a challenge. Household surveys rely on recall of self-reported events that may span up to 5 years, raising concerns of recall bias. OBJECTIVE: This study assessed the reliability of maternal recall of pregnancy, delivery, and postpartum events over a six-month period and identified relevant individual characteristics associated with inconsistent reporting. METHODOLOGY: A longitudinal household survey was conducted with 321 pregnant women in 44 enumeration areas in Southern Nationals, Nationalities and People's Region in Ethiopia. Women who were six or more months pregnant were enrolled and interviewed at seven days, six weeks, and six months post-partum using an identical set of questions regarding maternal and neonatal health and receipt of select neonatal care interventions. We compared responses given at 7 days to those reported at 6 weeks and 6 months and conducted sensitivity, specificity, area under receiving operative curve, and Kappa analyses of selected indicators. RESULTS: We find that reporting complications is higher at the first interview after birth than at either the six-week or six-month interview. The specificity of the majority of complications is high, however sensitivity is generally much lower. The sensitivity of reporting any complication during pregnancy, delivery, or post-partum ranged from 54.5% to 67.6% at the 6-week interview and from 39.2% to 63.2% at the 6-month interview. Though sensitivity of receipt of neonatal interventions was high, specificity and kappa demonstrate low consistency. CONCLUSION: As with childbirth, it may be that during the first seven days women note symptoms with higher scrutiny, but if these do not later develop into serious health issues, they may be forgotten over time. Maternal complications and care are likely to be under-reported by women if interviewed for distant events.


Asunto(s)
Cesárea/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Centros de Salud Materno-Infantil/estadística & datos numéricos , Recuerdo Mental/fisiología , Aceptación de la Atención de Salud , Hemorragia Posparto/psicología , Complicaciones del Embarazo/psicología , Adolescente , Adulto , Etiopía/epidemiología , Femenino , Humanos , Recién Nacido , Estudios Longitudinales , Persona de Mediana Edad , Hemorragia Posparto/epidemiología , Hemorragia Posparto/terapia , Embarazo , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/terapia , Adulto Joven
8.
Bull World Health Organ ; 96(9): 654-659, 2018 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-30262947

RESUMEN

Transforming our world: the 2030 agenda for sustainable development promotes the improvement of health equity, which entails ongoing monitoring of health inequalities. The World Health Organization has developed a multistep approach to health inequality monitoring consisting of: (i) determining the scope of monitoring; (ii) obtaining data; (iii) analysing data; (iv) reporting results; and (v) implementing changes. Technical considerations at each step have implications for the results and conclusions of monitoring and subsequent remedial actions. This paper presents some technical considerations for developing or strengthening health inequality monitoring, with the aim of encouraging more robust, systematic and transparent practices. We discuss key aspects of measuring health inequalities that are relevant to steps (i) and (iii). We highlight considerations related to the selection, measurement and categorization of dimensions of health inequality, as well as disaggregation of health data and calculation of summary measures of inequality. Inequality monitoring is linked to health and non-health aspects of the 2030 agenda for sustainable development, and strong health inequality monitoring practices can help to inform equity-oriented policy directives.


Asunto(s)
Conservación de los Recursos Naturales , Equidad en Salud , Disparidades en el Estado de Salud , Objetivos , Humanos , Factores Socioeconómicos
10.
Epidemiol Serv Saude ; 26(1): 215-222, 2017.
Artículo en Portugués | MEDLINE | ID: mdl-28226024

RESUMEN

Measurements of health indicators are rarely available for every population and period of interest, and available data may not be comparable. The Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) define best reporting practices for studies that calculate health estimates for multiple populations (in time or space) using multiple information sources. Health estimates that fall within the scope of GATHER include all quantitative population-level estimates (including global, regional, national, or subnational estimates) of health indicators, including indicators of health status, incidence and prevalence of diseases, injuries, and disability and functioning; and indicators of health determinants, including health behaviours and health exposures. GATHER comprises a checklist of 18 items that are essential for best reporting practice. A more detailed explanation and elaboration document, describing the interpretation and rationale of each reporting item along with examples of good reporting, is available on the GATHER website (http://gather-statement.org).


Asunto(s)
Recolección de Datos/normas , Salud Global , Guías como Asunto , Indicadores de Salud , Lista de Verificación , Conductas Relacionadas con la Salud , Humanos
12.
Lancet ; 388(10062): e19-e23, 2016 12 10.
Artículo en Inglés | MEDLINE | ID: mdl-27371184

RESUMEN

Measurements of health indicators are rarely available for every population and period of interest, and available data may not be comparable. The Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) define best reporting practices for studies that calculate health estimates for multiple populations (in time or space) using multiple information sources. Health estimates that fall within the scope of GATHER include all quantitative population-level estimates (including global, regional, national, or subnational estimates) of health indicators, including indicators of health status, incidence and prevalence of diseases, injuries, and disability and functioning; and indicators of health determinants, including health behaviours and health exposures. GATHER comprises a checklist of 18 items that are essential for best reporting practice. A more detailed explanation and elaboration document, describing the interpretation and rationale of each reporting item along with examples of good reporting, is available on the GATHER website.


Asunto(s)
Lista de Verificación , Salud Global , Guías como Asunto/normas , Indicadores de Salud , Recolección de Datos , Métodos Epidemiológicos , Investigación sobre Servicios de Salud , Humanos
13.
J Glob Health ; 6(1): 010506, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-27418960

RESUMEN

BACKGROUND: An urgent priority in maternal, newborn and child health is to accelerate the scale-up of cost-effective essential interventions, especially during labor, the immediate postnatal period and for the treatment of serious infectious diseases and acute malnutrition. Tracking intervention coverage is a key activity to support scale-up and in this paper we examine priorities in coverage measurement, distinguishing between essential interventions that can be measured now and those that require methodological development. METHODS: We conceptualized a typology of indicators related to intervention coverage that distinguishes access to care from receipt of an intervention by the population in need. We then built on documented evidence on coverage measurement to determine the status of indicators for essential interventions and to identify areas for development. RESULTS: Contact indicators from pregnancy to childhood were identified as current indicators for immediate use, but indicators reflecting the quality of care provided during these contacts need development. At each contact point, some essential interventions can be measured now, but the need for development of indicators predominates around interventions at the time of birth and interventions to treat infections. Addressing this need requires improvements in routine facility based data capture, methods for linking provider and community-based data, and improved guidance for effective coverage measurement that reflects the provision of high-quality care. CONCLUSION: Coverage indicators for some essential interventions can be measured accurately through household surveys and be used to track progress in maternal, newborn and child health. Other essential interventions currently rely on contact indicators as proxies for coverage but urgent attention is needed to identify new measurement approaches that directly and reliably measure their effective coverage.


Asunto(s)
Salud del Niño/normas , Conservación de los Recursos Naturales/economía , Parto Obstétrico/normas , Servicios de Salud Materna/normas , Indicadores de Calidad de la Atención de Salud/tendencias , Niño , Análisis Costo-Beneficio/métodos , Parto Obstétrico/economía , Femenino , Salud Global/normas , Objetivos , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Servicios de Salud Materna/economía , Madres , Embarazo
16.
Child Obes ; 11(6): 683-90, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26561722

RESUMEN

BACKGROUND: Factors at birth and infancy may increase risk of being overweight in childhood. The aim of this study was to examine the relationship of birth size and infant growth (2-24 months) with BMI at age 5 years in a multiethnic population. METHODS: This was a retrospective study (using electronic medical records of a health maintenance organization in Hawaii) of singleton children born in 2004-2005, with linked maternal and birth information, infant weights (n = 597) and lengths (n = 473) in the first 2 years, and BMI measures at age 5 years (n = 894). Multiple regression models were used to estimate the association of BMI at age 5 years with birth size and infant growth. RESULTS: Birth weight was positively associated with BMI at age 5 years, adjusting for gestational age, sex, race/ethnicity, and maternal prepregnancy weight, age, education, and smoking. A greater change in infant weight was associated with a higher BMI at age 5 years, though the effect of birth weight on BMI was neither mediated nor modified by infant growth rate. Birth weight, change in infant weight, and BMI at age 5 years varied by race/ethnicity. Change in infant BMI in the first 2 years was higher in other Pacific Islanders and whites (Δ = 0.966; confidence interval [CI] = 0.249-1.684; p = 0.02) than in Asian, other, and part Native Hawaiian race/ethnic groups. CONCLUSIONS: Early biological measures of birth weight and infant weight gain varied by race/ethnicity and positively predicted BMI at age 5 years.


Asunto(s)
Peso al Nacer , Estatura , Índice de Masa Corporal , Grupos Étnicos , Crecimiento y Desarrollo , Asia/etnología , Preescolar , Grupo de Ascendencia Continental Europea , Femenino , Edad Gestacional , Hawaii/epidemiología , Humanos , Estudios Longitudinales , Masculino , Grupo de Ascendencia Oceánica , Sobrepeso/epidemiología , Estudios Retrospectivos
17.
BMC Pregnancy Childbirth ; 15 Suppl 2: S8, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26391444

RESUMEN

BACKGROUND: The Every Newborn Action Plan (ENAP), launched in 2014, aims to end preventable newborn deaths and stillbirths, with national targets of ≤12 neonatal deaths per 1000 live births and ≤12 stillbirths per 1000 total births by 2030. This requires ambitious improvement of the data on care at birth and of small and sick newborns, particularly to track coverage, quality and equity. METHODS: In a multistage process, a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work. Consultations were held throughout. RESULTS: ENAP published 10 core indicators plus 10 additional indicators. Three core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well defined, with future efforts needed to focus on improving data quantity and quality. Three core indicators on coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content and quality of the interventions. Four core (antenatal corticosteroids, neonatal resuscitation, treatment of serious neonatal infections, kangaroo mother care) and one additional coverage indicator for newborns at risk or with complications (chlorhexidine cord cleansing) lack indicator definitions or data, especially for denominators (population in need). To address these gaps, feasible coverage indicator definitions are presented for validity testing. Measurable process indicators to help monitor health service readiness are also presented. A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care. CONCLUSIONS: The ENAP Measurement Improvement Roadmap (2015-2020) outlines tools to be developed (e.g., improved birth and death registration, audit, and minimum perinatal dataset) and actions to test, validate and institutionalise proposed coverage indicators. The roadmap presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys. Real measurement change requires intentional transfer of leadership to countries with the greatest disease burden and will be achieved by working with centres of excellence and existing networks.


Asunto(s)
Mortalidad Perinatal , Mejoramiento de la Calidad , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Corticoesteroides/provisión & distribución , Corticoesteroides/uso terapéutico , Antiinfecciosos Locales/uso terapéutico , Lactancia Materna/estadística & datos numéricos , Clorhexidina/uso terapéutico , Parto Obstétrico/normas , Parto Obstétrico/estadística & datos numéricos , Femenino , Humanos , Cuidado del Lactante/normas , Recién Nacido , Infecciones/terapia , Método Madre-Canguro/normas , Método Madre-Canguro/estadística & datos numéricos , Muerte Perinatal/prevención & control , Atención Posnatal/normas , Embarazo , Nacimiento Prematuro/terapia , Resucitación/normas , Resucitación/estadística & datos numéricos , Estadística como Asunto , Mortinato , Terminología como Asunto , Cordón Umbilical/microbiología
18.
BMC Infect Dis ; 15: 16, 2015 Jan 16.
Artículo en Inglés | MEDLINE | ID: mdl-25592774

RESUMEN

BACKGROUND: Pneumonia and diarrhea are leading causes of death for children under five (U5). It is challenging to estimate the total number of deaths and cause-specific mortality fractions. Two major efforts, one led by the Institute for Health Metrics and Evaluation (IHME) and the other led by the World Health Organization (WHO)/Child Health Epidemiology Reference Group (CHERG) created estimates for the burden of disease due to these two syndromes, yet their estimates differed greatly for 2010. METHODS: This paper discusses three main drivers of the differences: data sources, data processing, and covariates used for modelling. The paper discusses differences in the model assumptions for etiology-specific estimates and presents recommendations for improving future models. RESULTS: IHME's Global Burden of Disease (GBD) 2010 study estimated 6.8 million U5 deaths compared to 7.6 million U5 deaths from CHERG. The proportional differences between the pneumonia and diarrhea burden estimates from the two groups are much larger; GBD 2010 estimated 0.847 million and CHERG estimated 1.396 million due to pneumonia. Compared to CHERG, GBD 2010 used broader inclusion criteria for verbal autopsy and vital registration data. GBD 2010 and CHERG used different data processing procedures and therefore attributed the causes of neonatal death differently. The major difference in pneumonia etiologies modeling approach was the inclusion of observational study data; GBD 2010 included observational studies. CHERG relied on vaccine efficacy studies. DISCUSSION: Greater transparency in modeling methods and more timely access to data sources are needed. In October 2013, the Bill & Melinda Gates Foundation (BMGF) hosted an expert meeting to examine possible approaches for better estimation. The group recommended examining the impact of data by systematically excluding sources in their models. GBD 2.0 will use a counterfactual approach for estimating mortality from pathogens due to specific etiologies to overcome bias of the methods used in GBD 2010 going forward.


Asunto(s)
Diarrea Infantil/mortalidad , Modelos Estadísticos , Neumonía/mortalidad , Niño , Servicios de Salud del Niño , Preescolar , Diarrea Infantil/etiología , Diarrea Infantil/prevención & control , Femenino , Salud Global , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Masculino , Tamizaje Masivo/métodos , Neumonía/etiología , Neumonía/prevención & control , Análisis de Regresión
19.
Am J Hypertens ; 28(4): 508-17, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25249372

RESUMEN

BACKGROUND: The mechanistic target of rapamycin (mTOR) pathway is pivotal for cell growth. Regulatory associated protein of mTOR complex I (Raptor) is a unique component of this pro-growth complex. The present study tested whether variation across the raptor gene (RPTOR) is associated with overweight and hypertension. METHODS: We tested 61 common (allele frequency ≥ 0.1) tagging single nucleotide polymorphisms (SNPs) that captured most of the genetic variation across RPTOR in 374 subjects of normal lifespan and 439 subjects with a lifespan exceeding 95 years for association with overweight/obesity, essential hypertension, and isolated systolic hypertension. Subjects were drawn from the Honolulu Heart Program, a homogeneous population of American men of Japanese ancestry, well characterized for phenotypes relevant to conditions of aging. Hypertension status was ascertained when subjects were 45-68 years old. Statistical evaluation involved contingency table analysis, logistic regression, and the powerful method of recursive partitioning. RESULTS: After analysis of RPTOR genotypes by each statistical approach, we found no significant association between genetic variation in RPTOR and either essential hypertension or isolated systolic hypertension. Models generated by recursive partitioning analysis showed that RPTOR SNPs significantly enhanced the ability of the model to accurately assign individuals to either the overweight/obese or the non-overweight/obese groups (P = 0.008 by 1-tailed Z test). CONCLUSION: Common genetic variation in RPTOR is associated with overweight/obesity but does not discernibly contribute to either essential hypertension or isolated systolic hypertension in the population studied.


Asunto(s)
Proteínas Adaptadoras Transductoras de Señales/genética , Grupo de Ascendencia Continental Asiática/genética , Hipertensión/genética , Sobrepeso/genética , Polimorfismo de Nucleótido Simple , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Frecuencia de los Genes , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Hawaii/epidemiología , Humanos , Hipertensión/diagnóstico , Hipertensión/etnología , Japón/etnología , Masculino , Persona de Mediana Edad , Sobrepeso/diagnóstico , Sobrepeso/etnología , Fenotipo , Proteína Reguladora Asociada a mTOR , Factores de Riesgo
20.
J Gerontol A Biol Sci Med Sci ; 70(2): 133-42, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24589862

RESUMEN

The mechanistic target of rapamycin (mTOR) pathway is crucial for life span determination in model organisms. The aim of the present study was to test tagging single-nucleotide polymorphisms that captured most of the genetic variation across key TOR complex 1 (TORC1) and TOR complex 2 (TORC2) genes MTOR, RPTOR, and RICTOR and the important downstream effector gene RPS6KA1 for association with human longevity (defined as attainment of at least 95 years of age) as well as health span phenotypes. Subjects comprised a homogeneous population of American men of Japanese ancestry, well characterized for aging phenotypes and who have been followed for 48 years. The study used a nested case-control design involving 440 subjects aged 95 years and older and 374 controls. It found no association of 6 tagging single-nucleotide polymorphisms for MTOR, 61 for RPTOR, 7 for RICTOR, or 5 for RPS6KA1 with longevity. Of 40 aging-related phenotypes, no significant association with genotype was seen. Thus common genetic variation (minor allele frequency ≥10%) in MTOR, RPTOR, RICTOR, and RPS6KA1 is not associated with extreme old age or aging phenotypes in this population. Further research is needed to assess the potential genetic contribution of other mTOR pathway genes to human longevity, gene expression, upstream and downstream targets, and clinically relevant aging phenotypes.


Asunto(s)
Proteínas Adaptadoras Transductoras de Señales/genética , Americanos Asiáticos/genética , Proteínas Portadoras/genética , Longevidad/genética , Polimorfismo de Nucleótido Simple , Proteínas Quinasas S6 Ribosómicas 90-kDa/genética , Serina-Treonina Quinasas TOR/genética , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Frecuencia de los Genes , Genotipo , Hawaii , Humanos , Japón/etnología , Estudios Longitudinales , Masculino , Proteína Asociada al mTOR Insensible a la Rapamicina , Proteína Reguladora Asociada a mTOR
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