Developmental epigenomic effects of maternal financial problems.

Early-life adversity as neglect or low socioeconomic status is associated with negative physical/mental health outcomes and plays an important role in health trajectories through life. The early-life environment has been shown to be encoded as changes in epigenetic markers that are retained for many years.We investigated the effect of maternal major financial problems (MFP) and material deprivation (MD) on their children's epigenome in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Epigenetic aging, measured with epigenetic clocks, was weakly accelerated with increased MFP. In subsequent EWAS, MFP, and MD showed strong, independent programing effects on children's genomes. MFP in the period from birth to age seven was associated with genome-wide epigenetic modifications on children's genome visible at age 7 and partially remaining at age 15.These results support the hypothesis that physiological processes at least partially explain associations between early-life adversity and health problems later in life. Both maternal stressors (MFP/MD) had similar effects on biological pathways, providing preliminary evidence for the mechanisms underlying the effects of low socioeconomic status in early life and disease outcomes later in life. Understanding these associations is essential to explain disease susceptibility, overall life trajectories and the transition from health to disease.

Distributional effects of parental time investments on children's socioemotional skills and nutritional health.

Parental behavior is paramount to child health and skill formation, explaining a significant portion of differences in developmental outcomes. However, little is known regarding the distributional effects of parental time allocation at different levels of children's outcomes. I use a national administrative dataset of Chilean pre-school students to the estimate production functions for socioemotional development and body mass index z-scores at every decile of the distribution at baseline. Modest average effects conceal significant heterogeneity on the returns to parental time investments. Children in the bottom of the socioemotional development distribution could gain up to 0.4 standard deviations for a one standard deviation increase in time investments. A similar increase can lead to a reduction of 0.8 standard deviations in body mass index among severely obese students. Evidence reveals that children with high developmental scores are unlikely to benefit from additional parenting time.

Adherence to inhaled corticosteroids in patients with asthma prior to and during the COVID-19 pandemic.

The electronic prescription refill rate (EPRR) of 183 consecutive patients was determined over a 19-month retrospective study period, divided into 7 months PRE (Sep-19 to Mar-20) and 12 months POST pandemic (Apr-20 to Mar-21), in order to compare adherence to inhaled corticosteroids (ICS) in patients with asthma prior to and during the COVID-19 pandemic. Before the pandemic (PRE), an average of 0.58 inhalers/month were refill from the pharmacy; [SD 0.33], very similar to the 0.59 inhalers/month; [SD 0.34] retrieved during the 12 subsequent months since the pandemic (POST) (p = 0.768). EPRR showed no differences (p = 0.784). When EPRR was dichotomous or ordinal categorised no differences were found either (p = 0.851 and 0.928), even when McNemar's test was used (p = 0.949), with prevalences of nonadherence (EPRR < 80%) of 57 and 58% respectively. Our results do not support increased adherence to inhaler treatment in terms of EPRR, comparing before and since COVID-19 pandemic. Compliance with prescription remains suboptimal.

[Comparison of adherence as assessed by the Test of Adherence to Inhalers and Pharmacy Refill Records, in Asthma Patients. REFARMA study]. / Comparación de la adhesión terapéutica según el Test de Adherencia a Inhaladores y el registro de la retirada en farmacia de los fármacos prescritos en pacientes asmáticos. Estudio REFARMA.

Introduction: Clinical guidelines recommend the combined use of "self-completed questionnaires such as the Test of Adherence to Inhalers (TAI)" and the pharmacy refill rate (PRR) to determine adherence, but evidence based on comparative studies to support these recommendations is limited. Our objective was to determine adherence to inhalers in asthmatic patients, using the TAI and the PRR, as well as the correlation and concordance between both methods. Methods: Multicentre cross-sectional study including the first 196 consecutive adult asthmatic patients, of whom 183 were on maintenance treatment with Inhaled Corticosteroids (ICS). Nonadherence was defined as TAI < 50 or PRR < 80% in the previous 12 months. Results: A statistically significant positive correlation was observed between TAI and PRR scores (Spearman's rho coefficient = 0.185; p = 0.012). Prevalence of nonadherence based on TAI was 73.22%; 95%CI (66.54-79.91) and 57.92%; 95%CI (50.50-65.35) based on PRR was. In terms of agreement, a Cohen's kappa index = 0.174 and an overall % agreement of 61.7% were obtained. Twenty-two of the 49 patients who scored 50 on TAI (44.9%) refilled < 80% of inhalers. In contrast, 48 of the 134 patients who scored ≤ 49 on TAI (35.8%) refilled ≥ 80% at the pharmacy. Conclusions: Adherence remains suboptimal with prevalences of nonadherent patients > 50%. The concordance results supports, in line with guideline recommendations, that the use of both approaches (TAI and PRR) increases the ability to identify poor adherence compared to TAI or PRR alone.

Structural responses to the obesity epidemic in Latin America: what are the next steps for food and physical activity policies?

Obesity is among the most complex public health challenges, particularly in Latin America, where obesity rates have increased faster than in any other region. Many countries have proposed or enacted comprehensive policies to promote adequate diet and physical activity under a structural framework. We summarize articles discussing the scope and impact of recently implemented obesity-related interventions in the light of a structural response framework. Overall, we find that: (1) market-based food interventions, including taxes on junk food, nutrition labelling, and marketing restrictions, decrease the consumption of targeted foods, (2) programs directly providing healthy foods are effective in reducing obesity, and (3) the construction of public areas for recreation increases the average frequency of physical activity. Although obesity-related interventions in the region have somewhat improved health behaviours, obesity prevalence remains on an upward trend. We discuss some opportunities to continue tackling the obesity epidemic in LATAM under a structural framework.

Long-term mental health impact of COVID-19 on primary care health workers in northern Spain: Results from a two-phase longitudinal study.

Background: COVID-19 pandemic has affected the mental health of the general population, and in particular of health professionals. Primary care personnel are at greater risk due to being highly exposed to the disease and working regularly in direct contact with patients suffering COVID-19. However, there is not sufficient evidence on the long-term psychological impact these professionals may suffer. We aimed to explore the long-term psychological impact of COVID-19 on primary care professionals. Methods: We applied a two-phase design; a self-reported psychopathology screening (PHQ-9, GAD-7, ISI and IES-R) in phase-1, and a specialised psychiatric evaluation (MINI, HDRS and STAI) in phase-2 to confirm phase-1 results. Evaluations were carried at the beginning of the pandemic (May-June 2020) (n = 410) and one year later (n = 339). Chi-square, ANOVA and logistic regression tests were used for statistical analyses. Results: Primary care professionals presented high rates of depression, anxiety and psychological distress, measured by PHQ-9, GAD-7 and IES-R respectively, during the pandemic. Depressive symptoms' severity (PHQ-9: 7.5 vs 8.4, p = 0.013) increased after one year of COVID-19 pandemic. After one year nearly 40% of subjects presented depression. Being women, having suffered COVID-19 or a relative with COVID-19, and being a front-line professional were risk factors for presenting depression and anxiety. Conclusion: Primary Care professionals in Cantabria present a poor mental health during COVID-19 pandemic, which has even worsened at long-term, presenting a greater psychopathology severity one year after. Thus, it is critical implementing prevention and early-treatment programmes to help these essential professionals to cope with the pandemic.

Antecedentes: La pandemia de COVID-19 ha afectado la salud mental de la población general, y en particular de los sanitarios. El personal de atención primaria tiene mayor riesgo por estar más expuesto a la enfermedad y trabajar regularmente en contacto directo con pacientes que padecen COVID-19. Sin embargo, no existe suficiente evidencia sobre el impacto psicológico a largo plazo que pueden sufrir estos profesionales. Nuestro objetivo fue explorar el impacto psicológico a largo plazo de COVID-19 en los profesionales de atención primaria. Métodos: Se aplicó un diseño en dos fases; un cribado de psicopatología a través de cuestionarios autoaplicados (PHQ-9, GAD-7, ISI e IES-R) en la fase 1, y una evaluación psiquiátrica especializada (MINI, HDRS y STAI) en la fase 2 para confirmar los resultados de la fase 1. Las evaluaciones se realizaron al inicio de la pandemia (mayo-junio de 2020) (n = 410) y un año después (n = 339). Se utilizaron pruebas de X 2, ANOVA y regresión logística para los análisis estadísticos. Resultados: Los profesionales de atención primaria presentaron índices elevados de depresión, ansiedad y malestar psicológico, medidos por PHQ-9, GAD-7 e IES-R, respectivamente, durante la pandemia. La severidad de los síntomas depresivos (PHQ-9: 7,5 vs 8,4; p = 0,013) aumentó tras un año de pandemia COVID-19. Después de un año, casi 40% de los sujetos presentaron depresión. El sexo femenino, haber padecido COVID-19 o tener un familiar con COVID-19 y ser profesional de primera línea fueron factores de riesgo para presentar depresión y ansiedad. Conclusiones: Los profesionales de Atención Primaria en Cantabria presentaron una mala salud mental durante la pandemia de COVID-19, la cual además empeoró a largo plazo, presentando una mayor gravedad los síntomas un año después. Por lo tanto, es fundamental implementar programas de prevención y tratamiento temprano para ayudar a estos profesionales esenciales a hacer frente a la pandemia.

Children's internalizing behavior development is heterogeneously associated with the pace of epigenetic aging.

BACKGROUND: Internalizing behaviors are an indicator of children's psychological and emotional development, predicting future mental disorders. Recent studies have identified associations between DNA methylation (DNAm) and internalizing behaviors. This prospective study aimed at exploring the associations between pace of biological aging and the developmental trajectories of internalizing behaviors. METHODS: Participants were children from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort (N = 974). Measures of DNA methylation were collected at birth, age 7 and ages 15-17. The pace of aging was estimated using the DunedinPoAm algorithm (PoAm). Internalizing behaviors reported by caregivers between ages 4 and 16 using the Strengths and Difficulties Questionnaire. To explore heterogeneity in the association between PoAm and internalizing behaviors we use Poisson quantile regression in cross-section heterogeneity and longitudinal latent class analysis over the childhood and adolescence. RESULTS: Internalizing behavior trajectories were identified: low-risk, childhood limited, late onset and early onset (persistent). Accelerated aging at birth was negatively associated with internalizing behaviors in early childhood but positively correlated during adolescence. Higher PoAm at birth increased chance of low-risk profile, while decreasing likelihood of childhood limited trajectory. PoAm at age 15 was negatively associated with childhood limited profile and positively linked to late onset trajectories. Associations were larger at higher values of internalizing symptoms. CONCLUSIONS: The heterogeneity in the association between biological age acceleration and internalizing behaviors suggests a complex dynamic relationship, particularly in children with high or increased risk of adverse mental health outcomes.

The impact of COVID-19 lockdown stringency on loneliness in five European countries.

RATIONALE: The coronavirus pandemic has forced governments to implement a variety of different dynamic lockdown-stringency strategies in the last two years. Extensive lockdown periods could have potential unintended consequences on mental health, at least for at-risk groups. OBJECTIVE: We present novel evidence on the heterogeneous direct and indirect effects of lockdown-stringency measures on individuals' perception of social isolation (i.e. loneliness) using panel data from five European countries (Germany, France, Spain, Italy and Sweden), which tracks changes in both in-person and remote social interactions between May 2020 and March 2021. METHOD: We combine data from the COME-HERE panel survey (University of Luxembourg) and the Oxford COVID-19 Government Response Tracker (OxCGRT). We implement a dynamic mixture model in order to estimate the loneliness sub-population classes based on the severity of loneliness, as well as the evolution of social interactions. RESULTS: While loneliness is remarkably persistent over time, we find substantial heterogeneity across individuals, identifying four latent groups by loneliness severity. Group membership probability varies with age, gender, education and cohabitation status. Moreover, we note significant differences in the impact of social interactions on loneliness by degree of severity. Older people are less likely to feel lonely, but were more affected by lockdown measures, partly due to a reduction in face-to-face interactions. On the contrary, the younger, especially those living alone, report high levels of loneliness that are largely unaffected by changes in the pandemic after lockdown measures were initially implemented. CONCLUSIONS: Understanding the heterogeneity in loneliness is key for the identification of at-risk populations that can be severely affected by extended lockdown measures. As part of public-health crisis-response systems, it is critical to develop support measures for older individuals living alone, as well as promoting continuous remote communication for individuals more likely to experience high levels of loneliness.

The effectiveness of early colchicine administration in patients over 60 years old with high risk of developing severe pulmonary complications associated with coronavirus pneumonia SARS-CoV-2 (COVID-19): study protocol for an investigator-driven randomized controlled clinical trial in primary health care-COLCHICOVID study.

BACKGROUND: There is no strong evidence that any drug is beneficial either for the treatment of SARS-CoV-2 disease or for post-exposure prophylaxis. Therefore, clinical research is crucial to generate results and evaluate strategies against COVID-19. Primary care (PC) centers, the first level of care in the health system, are in a favorable position to carry out clinical trials (CD), as they work with a large volume of patients with varied profiles (from acute to chronic pathologies). During the COVID-19 pandemic, the need for hospital admission and mortality is higher in people > 60 years. Therefore, this is a target population to try to reduce the serious complications and lethality of COVID pneumonia and to avoid overloading the hospital system. Given the pharmacological properties of colchicine (anti-inflammatory and anti-fibrotic, possible inhibition of viral replication, and inhibitory effect on coagulation activation), early treatment with colchicine may reduce the rate of death and serious pulmonary complications from COVID-19 in vulnerable patients. METHODS: The COLCHICOVID study is a randomized, multicenter, controlled, open-label parallel group (2:1 ratio), phase III clinical trial to investigate the efficacy of early administration of colchicine in reducing the development of severe pulmonary complications associated with COVID-19 infection in patients over 60 years of age with at-risk comorbidities. DISCUSSION: This is a pragmatic clinical trial, adapted to usual clinical practice. The demonstration that early administration of colchicine has clinical effectiveness in reducing the complications of SARS-CoV-2 infection in a population highly susceptible may mitigate the health crisis and prevent the collapse of the health system in the successive waves of the coronavirus pandemic. In addition, colchicine is a well-known medicine, simple to use in the primary care setting and with a low cost for the health system. TRIAL REGISTRATION: ClinicalTrials.gov NCT04416334 . Registered on 4 June 2020. Protocol version: v 3.0, dated 22 September 2020.

Situación de salud bucal de párvulos chilenos en un contexto comunitario / Oral health situation of Chilean children in a community context

INTRODUCCIÓN: Determinar la situación de salud bucal en párvulos ingresados a un programa promocional-preventivo en la comuna de Melipilla durante el año 2018. MATERIAL Y MÉTODOS: Estudio transversal realizado en 860 párvulos de entre dos a cinco años de edad matriculados en 17 establecimientos educacionales de la comuna, ubicados en zona urbana y rural. La experiencia de caries dental como variable dependiente y sexo, edad y zona geográfica del establecimiento educacional (urbano-rural) como variable independiente fueron medidas en un contexto comunitario (en aula). Estudio aprobado por Comité Científico de Ética de Universidad Finis Terrae y Servicio de Salud Metropolitano Occidente. RESULTADOS: El estudio abarcó al 88,5% de los párvulos matriculados, con promedio de edad de 3,76 ± 1,06 años. El 53,5% correspondieron a niñas. Un 34,1% (IC:95% 30,74:37,48) presentó caries dental, sin diferencias por sexo, zona geográfica, si por edad. A mayor edad, mayor daño por caries dental. Cada párvulo en promedio presentó un diente primario con caries (diente cariado:1,14 ± 2,28). El tercio de la población más afectada por caries dental presentó en promedio tres dientes primarios con daño. DISCUSIÓN: Los resultados muestran un elevado daño por caries dental cuyo inicio es temprano; esto pone de manifiesto la necesidad de avanzar en el desarrollo de políticas públicas de salud bucal destinadas a la primera infancia. (AU)

INTRODUCTION: To determine the oral health situation in the infants admitted to a pro-motional-preventive program in the municipality of Melipilla during the year 2018.MATERIAL AND METHODS: Cross-sectional study conducted with 860 infants between two to five years of age enrolled in 17 educational establishments in the community, located in urban and rural settings. The incidence of cavities as related to the variables of sex, age and geographical area of the educational establishment (urban-rural) as an independent variables were measured in a community context (in the classroom). Study approved by the Scientific Committee of Ethics of the Finis Terrae University and the Western Metropolitan Health Service.RESULTS: The study covered 88.5% of the enrolled children of 3.76 ± 1.06 years with an average age of 3,76 ± 1,06. 53.5% were girls. 34.1% (IC:95% 30,74:37,48) had cavities, without differences by sex or geographical area, but by age. The older you get, the more damage you get from tooth decay. Each toddler had on average one primary tooth with cavities (decayed tooth: 1.14 ± 2.28). One third of the population most affected by cavities presented on average three primary teeth with damage.DISCUSSION: The results show a high damage by cavities whose onset is early; This highlights the need to improve the development of public oral health policies aimed at early childhood. (AU)

Combined fiscal policies to promote healthier diets: Effects on purchases and consumer welfare.

Taxes on unhealthy foods and sweetened beverages, as well as subsidies to healthy foods, have become increasingly popular strategies to curb obesity and related non-communicable diseases. The existing evidence on the welfare effects of such fiscal policies is mixed and almost uniquely focused on tax schemes. Using the 2016-2017 Chilean Household Budget Survey, we estimate a censored Exact Affine Stone Index (EASI) incomplete demand system and simulate changes in purchases, tax incidence, and consumer welfare of three different policy scenarios: (1) a 5 percentage point additional tax on sweetened beverages (currently taxed at 18%) and a new 18% tax on sweets and snacks, (2) a healthy subsidy by zero-rating fruits and vegetables from the current 19% value-added tax, and (3) a combined (tax plus subsidy) policy. Under full pass-through of these policies, the combined scheme captures the incentives to switch purchases from both single-policy alternatives, resulting in a net welfare gain and subsidy transfer for the average Chilean household. In terms of welfare, low-income households strictly benefit from a combined policy, while high-income households experience a small consumer welfare loss, resulting in re-distributional effects.

Prevalencia y morfología del segundo conducto en la raíz mesiovestibular de primeros molares superiores en base a cuatro técnicas ex vivo / Prevalence and morphology of second mesiobuccal canal in maxillary first molars based on four ex vivo techniques

Los objetivos principales del tratamiento de endodoncia no quirúrgico son la prevención y/o tratamiento de periodontitis apical junto con la resolución de signos y síntomas de las lesiones pulpares irreversibles. Debido a la compleja morfología del sistema de conductos radicular, la persistencia de un conducto no tratado puede mantener la contaminación y sintomatología pulpar y periapical. La prevalencia para MV2 reportado a nivel mundial para el primer molar superior varía ampliamente según las técnicas in vivo o ex vivo empleadas en cada estudio, es por esto que el presente trabajo tiene por objetivo evaluar la prevalencia de MV2 en primeros molares superiores en base a cuatro técnicas diagnósticas aplicadas ex vivo. Se realizó un estudio transversal observacional en 101 primeros molares superiores extraídos bajo consentimiento informado para determinar la prevalencia del conducto MV2 y su morfología en base a las técnicas de radiografía ortoradial, tomografía Cone Beam, apertura coronaria con microscopio quirúrgico (16x) y cortes radiculares axiales de aplicación ex vivo. La prevalencia encontrada para MV2 por cada técnica fue de 81,1 % para cortes radiculares y tomografía Cone Beam, 59,4 % para la apertura coronal con microscopio (16x) y 32,6 % con radiografía ortoradial. En el 3,96 % de la muestra se encontró un tercer conducto mesiovestibular en base a la técnica de corte radicular. La morfología interna del sistema de conductos radiculares fue de 36 % clase II, 19 % clase I y 16 % clase IV de Vertucci. Los resultados del presente estudio están en concordancia con lo reportado en la literatura y confirman la mayor prevalencia reportada en estudios ex vivo para esta situación. La presencia de MV2 en el primer molar superior es una condición frecuente que el endodoncista debe considerar, empleando técnicas imagenológicas y tecnologías de magnificación para asegurar el éxito terapéutico en estos dientes.

The main objectives of non-surgical endodontic treatment are the prevention and / or treatment of apical periodontitis, as well as resolving signs and symptoms of irreversible pulpal lesions. Considering the complex morphology of the root canal system, the a canal left untreated, can generate contamination, pulp and periapical symptoms. The prevalence for MV2 reported worldwide for the upper first molar, varies depending on the ex vivo or ex vivo techniques used in each study. Consequently, the present work aims to assess the prevalence of MV2 in first upper molars based on four ex vivo diagnostic techniques applied. An observational crosssectional study was performed in 101 upper first molars extracted under informed consent to determine the prevalence of the MV2 duct and its morphology based on orthoradial radiography, Cone Beam tomography, coronary opening with a surgical microscope (16x), and axial root cuts applied ex vivo. The prevalence found for MV2 by each technique was 81.1 % for root cuts and Cone Beam tomography, 59.4 % for coronal opening with a microscope (16x) and 32.6 % with orthoradial radiography. In 3.96 % of the sample, a third mesiovestibular canal was found based on the root cutting technique. The internal morphology of the root canal system was 36 % Vertucci´s class II, 19 % class I and 16 % class IV. The results of the present study coincide with that reported in the literature, and confirm the higher prevalence reported in ex vivo studies for this situation. The presence of MV2 in the upper first molar is a frequent condition that the endodontist must consider, using imaging techniques and magnification technology to ensure therapeutic success in these teeth.

El arte de respirar: inspirando juntos / The Art of Breathing: Getting Inspiration

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Sputum Microbiome Dynamics in Chronic Obstructive Pulmonary Disease Patients during an Exacerbation Event and Post-Stabilization.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) affects up to 65 million people worldwide, and COPD exacerbation causes tissue damage and subsequent loss of lung function. It is a multifactorial event in which respiratory infections are involved, but little is known about its dynamics. OBJECTIVES: The objective of our study was to determine the microbiome composition during an exacerbation event and post-stabilization. METHODS: We conducted an observational analytical study of a cohort of 55 COPD patients in which 2 sputum samples (the first taken during an exacerbation event and the second during clinical post-stabilization) were submitted to 16s RNA ribosomal analysis by Illumina Miseq Next Generation Sequencing (NGS). The presence of respiratory viruses was also determined. RESULTS: Our study found a stable microbiome composition in the post-stabilization sputum samples of COPD patients, and 4 additional microbiomes in samples taken during the exacerbation, 3 of which showed a marked dysbiosis by Haemophilus, Pseudomonas, and Serratia. The fourth exacerbation microbiome had a very similar composition to post-stabilization samples, but some pathogens such as Moraxella and respiratory viruses were also found. CONCLUSIONS: Our study reveals the main protagonists involved in lung microbiome dynamics during an exacerbation event and post-stabilization in COPD patients by NGS analysis.

Impact of a homeopathic medication on upper respiratory tract infections in COPD patients: Results of an observational, prospective study (EPOXILO).

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a progressive lung disorder in which airflow is obstructed. Viral or bacterial upper respiratory tract infections (URTIs) may lead to exacerbations. Homeopathic medication administration to COPD patients during the influenza-exposure period may help to reduce the frequency of common URTIs. METHODS: This prospective, observational, multicenter study was carried out in Cantabria, Spain. Patients with COPD were divided into two groups: group 1 received conventional treatment + homeopathic medication (diluted and dynamized extract of duck liver and heart; Boiron) (OG); group 2 received conventional treatment only (CG). The primary endpoint was the number of URTIs between the 4-5 months follow up (mean 4.72 ± 0.96) from basal to last visit. Secondary endpoints included the duration of URTIs, number and duration of COPD exacerbations, use of COPD drugs, changes in quality of life (QoL), compliance, and adverse events (AEs). RESULTS: 219 patients were analyzed (OG = 109, CG = 110). There was a significant reduction in mean number of URTIs during the follow-up period in OG compared to CG (0.514 ±â€¯0.722 vs. 1.037 ±â€¯1.519, respectively; p = 0.014). Logistic regression analysis showed a 3.3-times higher probability of suffering ≥2 URTI episodes in CG (p = 0.003, n = 72). OG patients having ≥1 URTI also had a significant reduction in mean URTI duration per episode (3.57 ±â€¯2.44 days OG vs. 5.22 ±â€¯4.17 days CG; p = 0.012). There was no significant difference in mean number of exacerbations, mean duration of exacerbations, or QoL between OG and CG. There was a greater decrease in proportion of patients using corticosteroids for exacerbations between baseline and visit 2 in OG compared to CG (22.1% vs. 7.5% fewer respectively, p = 0.005). Exacerbator phenotype patients had a significant decrease in number of URTIs (0.54 ±â€¯0.72 vs. 1.31 ±â€¯1.81; p = 0.011), and fewer COPD exacerbations (0.9 ±â€¯1.3 vs. 1.5 ±â€¯1.7; p = 0.037) in OG vs. CG, respectively. CONCLUSIONS: Homeopathic medication use during the influenza-exposure period may have a beneficial impact at reducing URTIs' number and duration in COPD patients and at reducing the number of COPD exacerbations in patients with the exacerbator phenotype. Further studies are needed to confirm the effects observed in this study.

Garantía Explícita en Salud Oral en adulto de 60 años: impacto en la percepción de la calidad de vida / Explicit Oral Health Guarantee for Adults 60 Years of Age: impact on their perception of quality of life

OBJETIVO: Evaluar la Garantía Explícita en Salud Oral en el Adulto de 60 años (GES-60 años) desde la percepción de la calidad de vida. MÉTODO: Se realizó una evaluación antes y después de la prestación del programa GES-60, sin grupo control. Se utilizó el cuestionario Geriatric Oral Health Assessment Index (GOHAI) para cuantificar los cambios en la percepción de la calidad de vida como un indicador de resultado del programa. Se aplicó el test no paramétrico de Wilcoxon para datos emparejados en STATA 12.0. RESULTADOS: Participaron 103 adultos en el estudio y 85,5% fueron mujeres. Al término del programa GES-60 se presentaron mejoras significativas en la valoración global de la percepción de la calidad de vida relacionada con salud oral, como también en cada una de las dimensiones, particularmente en términos de la limitación psicológica. CONCLUSIÓN: Existe una significativa contribución del programa en el mejoramiento de la percepción de la calidad de vida de la población intervenida.

OBJECTIVE: To evaluate the Explicit Guarantee in Oral Health for Adults 60 years of Age (GES-60) on the basis of their perception of quality of life. METHOD: Evaluations were conducted before and after users participated in the GES-60 program, without a control group. The Geriatric Oral Health Assessment Index (GOHAI) was used to quantify changes in the perception of quality of life as an indicator of the program's results. The nonparametric Wilcoxon test was used to analyze matched data in STATA 12.0. RESULTS: A total of 103 adults participated in the study, and 85.5% were women. At the end of the GES-60 program, there were significant improvements in the overall assessment of the participants' perception of quality of life related to oral health, in each of the dimensions, particularly in terms of psychological limitations. CONCLUSION: The program significantly improves the target population's perception of quality of life.

Chile's 2014 sugar-sweetened beverage tax and changes in prices and purchases of sugar-sweetened beverages: An observational study in an urban environment.

BACKGROUND: On October 1, 2014, the Chilean government modified its previous sugar-sweetened beverage (SSB) tax, increasing the tax rate from 13% to 18% on industrialized beverages with high levels of sugar (H-SSBs) (greater than 6.25 grams [g] sugar/100 milliliters [mL]) and decreasing the tax rate from 13% to 10% on industrialized beverages with low or no sugar (L-SSBs) (less than 6.25 g sugar/100 mL). This study examines changes in beverage prices and household beverage purchases following the implementation of the tax reform. METHODS AND FINDINGS: We used longitudinal data collected between January 1, 2013, and December 31, 2015, from 2,000 households. We defined the pretax period as January 1, 2013, to September 30, 2014, and the posttax period as October 1, 2014, to December 31, 2015. We conducted a pre-post analysis for changes in prices and purchases, with the latter examined by volume and calories. We compared posttax changes in prices and purchases to a counterfactual, defined as what would have been expected in the posttax period based on pretax trends. All results are stated as comparisons to this counterfactual. We linked beverages at the bar code level to nutrition facts panel data collected by a team of Chilean nutritionists who categorized them by taxation level and beverage subcategory, which included carbonated and noncarbonated H-SSBs and concentrated, ready-to-drink L-SSBs and untaxed beverages. We reconstituted concentrated beverages and analyzed all beverages using as-consumed volumes and calories. Posttax monthly prices of H-SSBs increased, but these changes were small. Prices of carbonated H-SSBs increased by 2.0% (95% confidence interval [CI] 1.0%-3.0%), while those of noncarbonated H-SSBs increased by 3.9% (95% CI 1.6%-6.2%). Prices of L-SSB concentrates decreased after the tax by 6.7% (95% CI -8.2%--4.6%), and prices of ready-to-drink L-SSBs increased by 1.5% (95% CI 0.3%-2.7%). Households decreased monthly per capita purchases of H-SSBs by 3.4% by volume (95% CI -5.9%--0.9%) and 4.0% by calories (95% CI -6.3%--1.9%), and this change was greater among high socioeconomic status (SES) households. The volume of household purchases of L-SSBs increased 10.7% (95% CI 7.5%-13.9%), while that of untaxed beverage purchases decreased by 3.1% (95% CI -5.1%--1.1%). The main limitation of this study was that there was no control group, so we were unable to assess the causal impact of the tax. CONCLUSIONS: The modifications of Chile's SSB tax were small, and observed changes in prices and purchases of beverages after the tax were also small. Our results are consistent with previous evidence indicating that small increases in SSB taxes are unlikely to promote large enough changes in SSB purchases to reduce obesity and noncommunicable diseases (NCDs).

Sugary drinks taxation, projected consumption and fiscal revenues in Colombia: Evidence from a QUAIDS model.

The global shift towards diets high in sugar-sweetened beverages (SSBs) is linked to higher prevalence of obesity, diabetes and most other non-communicable diseases. In Colombia, one out of every two people was overweight or obese by 2010. This study estimates price-elasticities from a Quadratic Almost Ideal Demand System model, using the 2006-2007 Colombian Income and Expenditure survey. The food groups that were jointly considered were: unsweetened unflavored milks; coffee and tea; sugar sweetened beverages (SSBs); sweets and candies (including sugar); dairy products; meats and animal-based products; grains based staples; fruits and vegetables; and condiments and snacks. We take into account the high proportion of households not purchasing specific food and beverage groups (censored data) and endogeneity on both prices (as unit values) and total expenditure. Unhealthy beverages are price-elastic (-1.61 for SSBs) meaning that the change in consumption is proportionally larger with respect to a change in price. Also, there is a high complementarity among SSBs and major food groups (grains, meats and fruits and vegetables). In Colombia, the design of a meaningful tax to influence healthier diets is a next critical step. This study also shows that a tax of 20% on SSBs should prove to be effective, and can yield revenues of about 1% of the Colombian government's total annual fiscal revenue, which can potentially be directed towards public health promotion and investments.

Designing a food tax to impact food-related non-communicable diseases: the case of Chile.

The global shift towards diets high in sugar-sweetened beverages (SSBs) and energy dense ultra-processed foods is linked to higher prevalence of obesity, diabetes and most other noncommunicable diseases (NCDs), causing significant health costs. Chile has the highest SSB consumption in the world, very high junk food intake and very rapid increases in these poor components of the diet plus obesity prevalence. This study's purpose is to compare the effect of different tax schemes for SSBs and ultra-processed foods on nutrient availability, utilizing price-elasticities, which are estimated from a Quadratic Almost Ideal Demand System model, using the 2011-2012 Income and Expenditure survey. We take into account the high proportion of households not purchasing various food and beverage groups (censored nature of data). The food groups considered were: sweets and desserts; salty snacks and chips; meat products and fats; fruits, vegetables and seafood; cereals and cereal products; SSB ready-to-drink; SSB from concentrate; plain water, coffee and tea; and milk, which together represent 90% of food expenditures. The simulated taxes were: (1) 40% price tax on SSBs(22% above the current tax level); (2) a 5 cents per gram of sugar tax on products with added sugar; and (3) 30% price tax on all foods(27% above current tax levels) and beverages (12% above the current tax level) exceeding thresholds on sodium, saturated fat, and added sugar and for which marketing is restricted (based on a Chilean law, effective June 16 2016). Unhealthy foods are price-elastic (-1.99 for salty snacks and chips, -1.06 for SSBs ready-to-drink, and -1.27 for SSBs from concentrate), meaning that the change in consumption is proportionally larger with respect to a change in price. Results are robust to different model specification, and consistent among different socioeconomic sub-populations. Overall, the tax on marketing controlled foods and beverages is associated with the largest reduction in household purchases of sodium, added sugar, saturated fat and calorie purchases. Chile is unique in currently having instituted a small current SSB tax as well as marketing controls and front-of-package labeling of unhealthy foods and beverages. The design of a larger, more comprehensive tax to enhance the overall effect of these policies on healthier diets is a next critical step. This study shows that a large tax on the same foods and beverages already delineated as unhealthy by the marketing controls and front-of-pack labeling should prove to be more effective for promoting a healthier diet.