Comparing long-term educational effects of two early childhood health interventions.

We compare the educational effects of two medical protocols that mitigate long-term consequences of prematurity or low birth weight. The two protocols are Traditional Care (TC), which uses incubators, and Kangaroo Mother Care (KMC) which replaces incubators for 24-hour skin-to-skin contact between newborns and caregivers. We concentrate on educational outcomes addressing contradictory results in previous contributions. We use a randomized controlled trial implemented in 1993 that randomly assigned children to either TC or KMC. OLS results suggest that KMC children spent more time in preschool, had fewer temporary school absences, and showed lower math test scores. Both groups observed similar effects on high-school graduation and language test scores. We correct for attrition, small sample, and multiple outcomes. Effects on preschool attendance and school absenteeism are robust, particularly for more vulnerable infants (birth weight ≤ 1,800 g). The other effects lose statistical significance due to multiple outcome testing or attrition corrections.

Kangaroo mother care had a protective effect on the volume of brain structures in young adults born preterm.

AIM: The protective effects of Kangaroo mother care (KMC) on the neurodevelopment of preterm infants are well established, but we do not know whether the benefits persist beyond infancy. Our aim was to determine whether providing KMC in infancy affected brain volumes in young adulthood. METHOD: Standardised cognitive, memory and motor skills tests were used to determine the brain volumes of 20-year-old adults who had formed part of a randomised controlled trial of KMC versus incubator care. Multivariate analysis of brain volumes was conducted according to KMC exposure. RESULTS: The study comprised 178 adults born preterm: 97 had received KMC and 81 were incubator care controls. Bivariate analysis showed larger volumes of total grey matter, basal nuclei and cerebellum in those who had received KMC, and the white matter was better organised. This means that the volumes of the main brain structures associated with intelligence, attention, memory and coordination were larger in the KMC group. Multivariate lineal regression analysis demonstrated the direct relationship between brain volumes and duration of KMC, after controlling for potential confounders. CONCLUSION: Our findings suggest that the neuroprotective effects of KMC for preterm infants persisted beyond childhood and improved their lifetime functionality and quality of life.

Networks Disrupted in Linguistic Variants of Frontotemporal Dementia.

The non-fluent/agrammatic variant of primary progressive aphasia (nfvPPA) and semantic variant (svPPA) of frontotemporal dementia (FTD) are neurodegenerative diseases. Previous works have shown alterations of fractional anisotropy (FA) and mean diffusivity (MD) from diffusion tensor images (DTIs). This manuscript is aimed at using DTI images to build a global tractography and to identify atrophy patterns of white matter in each variant. Twenty patients with svPPA, 20 patients with nfvPPA, 26 patients with behavioral variant of FTD (bvFTD) and, 33 controls were included. An analysis based on the connectivity of structural networks showed changes in FA and MD in svPPA and nfvPPA with respect to bvFTD. Much damage in the internal networks of the left temporal lobe was found in svPPA patients; in contrast, patients with nfvPPA showed atrophy in networks from the basal ganglia to motor and premotor areas. Those findings support the dual stream model of speech and language.

Twenty-year Follow-up of Kangaroo Mother Care Versus Traditional Care.

BACKGROUND AND OBJECTIVES: Kangaroo mother care (KMC) is a multifaceted intervention for preterm and low birth weight infants and their parents. Short- and mid-term benefits of KMC on survival, neurodevelopment, breastfeeding, and the quality of mother-infant bonding were documented in a randomized controlled trial (RCT) conducted in Colombia from 1993 to 1996. The aim of the present study was to evaluate the persistence of these results in young adulthood. METHODS: From 2012 to 2014, a total of 494 (69%) of the 716 participants of the original RCT known to be alive were identified; 441 (62% of the participants in the original RCT) were re-enrolled, and results for the 264 participants weighing ≤1800 g at birth were analyzed. The KMC and control groups were compared for health status and neurologic, cognitive, and social functioning with the use of neuroimaging, neurophysiological, and behavioral tests. RESULTS: The effects of KMC at 1 year on IQ and home environment were still present 20 years later in the most fragile individuals, and KMC parents were more protective and nurturing, reflected by reduced school absenteeism and reduced hyperactivity, aggressiveness, externalization, and socio-deviant conduct of young adults. Neuroimaging showed larger volume of the left caudate nucleus in the KMC group. CONCLUSIONS: This study indicates that KMC had significant, long-lasting social and behavioral protective effects 20 years after the intervention. Coverage with this efficient and scientifically based health care intervention should be extended to the 18 million infants born each year who are candidates for the method.

Asociación entre enfermedad periodontal y disfunción endotelial valorada por vasodilatación mediada por flujo en la arteria braquial: Estudio piloto / Association between periodontal disease and endothelial dysfunction assessed by flow-mediated dilation in the brachial artery: Pilot study

Objetivo: evaluar la disfunción endotelial a través de la vasodilatación mediada por flujo (VMF) en la arteria braquial en pacientes fumadores con periodontitis crónica avanzada y compararla con pacientes fumadores sin enfermedad periodontal, para determinar si hay diferencias en cuando a disfunción endotelial entre quienes presentan o no periodontitis crónica avanzada. Métodos: se incluyeron 30 pacientes con hábito de tabaquismo, 15 con periodontitis crónica avanzada y 15 sin periodontitis. Se realizó historia clínica completa, exámenes de laboratorio y prueba de vasodilatación mediada por flujo de la arteria braquial. Resultados: el estudio mostró que había diferencias significativas en los diámetros finales, resultantes de vasodilatación mediada por flujo (p=0,0328), con menores valores finales para quienes tenían enfermedad periodontal. Las diferencias en las respuestas porcentuales y en el número de personas con disfunción determinada dicotómicamente, no alcanzaron significación estadística. Conclusión: se observó que el grupo de pacientes con periodontitis crónica avanzada tuvo diámetros resultantes luego de la prueba que fueron significativamente menores que los del grupo de controles. Aunque al evaluar las diferencias en porcentajes no se alcanzó significación estadística, el estudio mostró una respuesta claramente menor en vasodilatación en el grupo con enfermedad periodontal.

Objective: To evaluate endothelial dysfunction through flow-mediated vasodilation (FMD) in the brachial artery in smokers with advanced chronic periodontitis and compare it with smokers without periodontal disease, to determine whether there are differences in endothelial dysfunction among those with or without advanced chronic periodontitis. Methods: We included 30 patients with smoking habit, 15 with advanced chronic periodontitis and 15 without periodontal disease. We performed a complete medical history, laboratory tests and flow-mediated vasodilation test of the brachial artery. Results: The study showed that there were significant differences in the final diameters, resulting from flow-mediated dilation (p = 0.0328), with lower final values for those with periodontal disease. The differences in the percentage responses and the number of people with specific dysfunction determined dichotomously did not reach statistical significance. Conclusion: We observed that the group of patients with advanced chronic periodontitis had after the test resulting diameters that were significantly lower than those in the control group. Although when evaluating differences in percentages no statistical significance was found, the study showed a clearly lower response in vasodilation in the group with periodontal disease.

Determination of the cutoff point for waist circumference that establishes the presence of abdominal obesity in Latin American men and women.

AIMS: The recent definitions of the metabolic syndrome (MS) recognize the need for ethnic and region-specific waist circumference (WC) cut-offs that identify people with abdominal obesity. We tested WC as a diagnostic tool to identify people with visceral adiposity in Hispanics from the Latin America region. METHODS: We used the area of visceral adipose tissue (VAT) ≥ 100 cm² at the level between the 4th and 5th lumbar vertebrae in abdominal CT scans as a marker of visceral adiposity and established the optimal WC threshold for men and women by means of receiver operating characteristic (ROC) curves. RESULTS: 179 men and 278 women from Mexico, El Salvador, Venezuela, Colombia and Paraguay were included. The ROC curves were highly discriminative of excess VAT for men and women (area under the curve 0.9 and 0.8 respectively) and the WC threshold was identified at 94 cm for men and between 90 and 92 cm for women. CONCLUSION: In men the WC cutoff was equal to that proposed for europids and suggested for US adults who may have strong genetic contribution to insulin resistance such as Hispanics. In women the threshold was significantly higher than previously proposed for South and Central Americans.

Dyslipidemia in seven Latin American cities: CARMELA study.

OBJECTIVE: The objective of this study was to describe the prevalence of dyslipidemia in the CARMELA study population. METHODS: CARMELA was a cross-sectional study of cardiovascular risk conducted between September 2003 and August 2005 in adults (aged 25 to 64 years) living in Barquisimeto (n=1,824), Bogotá (n=1,511), Buenos Aires (n=1,412), Lima (n=1,628), Mexico City (n=1,677), Quito (n=1,620), and Santiago (n=1,605). Dyslipidemia was defined as the presence of one or more of the following conditions: triglycerides>/=200 mg/dL, or total cholesterol (TC)>/=240 mg/dL, or HDL cholesterol<40 mg/dL, or LDL cholesterol=not optimal, or currently taking antilipemic agents. RESULTS: Prevalence rates of dyslipidemia in men and women were: 75.5% (CI: 71.9-79.1) and 48.7% (CI: 45.4-51.9) in Barquisimeto; 70% (CI: 66.2-73.8) and 47.7% (CI: 43.9-51.5) in Bogotá; 50.4% (CI: 46.8-54.0) and 24.1% (CI: 21.0-27.2) in Buenos Aires; 73.1% (CI: 69.3-76.8) and 62.8% (CI: 59.2-66.5) in Lima; 62.5% (CI: 58.5-66.5) and 37.5% (CI: 33.5-41.6) in Mexico City; 52.2% (CI: 47.9-56.5) and 38.1% (CI: 34.5-41.7) in Quito; and, 50.8% (CI: 47.1-54.4) and 32.8% (CI: 29.3-36.3) in Santiago. CONCLUSIONS: Dyslipidemia was disturbingly prevalent and varied across cities. The most frequent dyslipidemia was low HDL-C followed by high triglycerides. The high TC/HDL-C ratios and non-HDL-C levels suggest a high risk of cardiovascular disease.

Efecto del grado de estenosis y de la viscosidad sanguínea en el nivel de activación plaquetaria en la arteria carótida: desarrollo de un modelo computacional / Effect of the grade of stenosis and blood viscosity in the level of platelet activation in the carotid artery: development of a computerized model

La enfermedad arteriosclerótica de la arteria carótida es la primera causa de eventos cerebrovasculares (ECV) en el mundo occidental y su estudio se ha convertido en un gran reto en el campo de la investigación, debido a las complejas propiedades biomecánicas y los distintos factores que influyen en la dinámica del flujo, como las altas tasas de corte, zonas de estancamiento de flujo y de recirculación, nivel de activación plaquetaria y el tiempo de exposición a esfuerzo cortante entre otros (1-5). Los últimos desarrollos en simulación hacen posible realizar estudios de dinámica de fluidos computacional (CFD) en flujos pulsátiles, con paredes elásticas y entornos cercanos a la realidad. Resultados obtenidos a partir simulaciones CFD de cada paciente permiten una temprana detección, diagnóstico, tratamiento de la enfermedad y clarifican la relación entre la estenosis, los síntomas y por último el riesgo de un ECV. Es conocido que el fenómeno de agregación plaquetaria depende, entre otros, del esfuerzo cortante al que están sometidas las pla¬quetas dentro del fluido y de su duración. Para esto se han asociado ciertos indicadores de activación, como el Nivel de Activación (NA) plaquetaria, esfuerzo cortante máximo a través de la trayectoria de una partícula y la dependencia de la activación a diferentes tasas de corte (1,4,6-8). Se estudió el fenómeno global hemodinámico y de activación plaquetaria en arterias carótidas simplificadas...