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Bridging the gap between the micro and the macro scale in modelling food security to inform context-specific regionalised policies remains a major scientific challenge. A better understanding of the relations between global and local drivers impacting local food self-sufficiency (LFSS) is essential. We applied to the whole Mediterranean environmental area (Southern and Northern) a modelling framework for structural estimates (PLS-PM) using qualitative and quantitative methods to combine local-level information from field surveys and participatory workshops with global-level data. Our findings show that farmland expansion and intensification spatially disconnected from urban consumption areas do not appear to foster LFSS. On the other hand, public policies appear key to enhancing LFSS in the Mediterranean area if appropriate to the particular regional context. We outline how this multi-level modelling methodology can contribute to a place-based approach by informing context-specific regionalised policies aimed at food security.
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Agricultura , Política Pública , Fazendas , Alimentos , Abastecimento de AlimentosRESUMO
Potato cyst nematodes (PCNs; Globodera spp.) cause significant losses in worldwide cultivated potato (Solanum tuberosum) crops. In Colombia, PCN was first reported in 1970 (Baeza 1972), although this report lacked a comprehensive species description and diagnosis. After that, G. pallida has been the only PCN species reported affecting potatoes in the main producing regions of Colombia (Evans et al. 1975; Nieto et al. 1983; Vallejo et al. 2021). However, in the survey conducted by Vallejo et al. (2021), a single sample from Chocontá, Cundinamarca in the central region of the country (N 5,22396046668291, W -73,6571338400244) showed molecular characters similar to G. rostochiensis. As correct identification is essential for effective pest management, the location was re-sampled in September 2022. From the soil samples collected, PCN cysts and second-stage juveniles (J2s) were retrieved from soil using Fenwick and centrifugation methods, respectively. Morphometric characters of cysts (n = 53) were consistent with G. rostochiensis, with a length without neck (L) ranging from 451 to 614 µm (XÌ = 546.9 ± 20.3 µm), width (W) from 424 to 658 µm (XÌ = 546.9 ± 25.5 µm) and L/W ratio was 1.00 ± 0.02. Distance from anus to vulva varied from 41 to 109 µm (XÌ =75.67 ± 13.8 µm), Granek's ratio from 2.3 to 5.5 µm (XÌ = 3.89 ± 0.7 µm), and the number of cuticular ridges between the vulva and the anus were 14 to 20 (XÌ = 16.19 ± 1.7). The second-stage juvenile (n = 90) length ranged from 394 to 547 µm (XÌ = 495.62 ± 31.0 µm), the stylet length varied from 18 to 24 µm (XÌ = 21.21 ± 0.9 µm) with rounded knobs. The length of the hyaline tail ranged from 20 - 31 µm (XÌ = 24.09 ± 1.92) and the true tail from 31- 56 µm (XÌ = 48.30 ± 5.71 µm). Molecular analyses confirmed morphological identification. DNA was extracted from cysts and J2s. PCR was performed for the 28S rDNA D2-D3 segment using primers D2A and D3B (Subbotin et al. 2006), and for the mitochondrial COI gene region using primers JB3 and JB5 (Derycke et al. 2005). BLAST analyses of target 28S rDNA D2-D3 sequences (OP293373-OP293380) showed 100% identity of the 658 bp to other sequences on Genbank, including isolates from Turkey, United Kingdom, and Iran (MK311329.1, MG994942.1, KU297659.1, and KU297658.1). Similarly, the target COI region sequences (OP297993-OP298001) were 100% identical to the 407 bp of G. rostochiensis POT01 isolate from Germany, and 99.75% identical to voucher NRM67 from Indonesia, and isolate CD2200 from USA (MF773722.1, MT240262.1, and MN095979.1). Phylogenetic analysis of both gene regions strongly supported G. rostochiensis, with the Colombian sequences clustering with MH399815.1, and KU297654.1 isolates for the COI and 28S regions, respectively (Fig. 1S). In addition, a pathogenicity test was conducted in the greenhouse. For this, ten cysts were inoculated to potato plants of Criolla variety grown in 5 pots of 15 cm diameter with sterile soil and sand (1:1). Noninoculated plants served as controls (three replicates each). After three months, 54 ± 23 cysts/100 g of soil were isolated from inoculated plants (Fig. 2S), resulting in a reproduction factor (R=Pf/Pi) of 4.54 ± 0.86, while no yellow females or cysts were observed on the control plants. To our knowledge, this is the first report of G. rostochiensis in Colombia. This is an important pest that causes serious yield losses of potatoes and is a quarantine nematode in many countries (EPPO 2017). Further studies are necessary to prevent the spread of this PCN species in the main producing potato regions of Colombia.
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Substituição de Aminoácidos , Transplante de Células-Tronco Hematopoéticas , Leucemia de Mastócitos/genética , Leucemia Mielomonocítica Crônica/genética , Mutação de Sentido Incorreto , Proteínas de Neoplasias/genética , Segunda Neoplasia Primária/genética , Mutação Puntual , Proteínas Proto-Oncogênicas c-kit/genética , Aloenxertos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Combinada , Progressão da Doença , Estudos de Associação Genética , Humanos , Cadeias kappa de Imunoglobulina/sangue , Leucemia de Mastócitos/tratamento farmacológico , Leucemia de Mastócitos/patologia , Leucemia de Mastócitos/terapia , Leucemia Mielomonocítica Crônica/tratamento farmacológico , Leucemia Mielomonocítica Crônica/patologia , Leucemia Mielomonocítica Crônica/terapia , Masculino , Pessoa de Meia-Idade , Gamopatia Monoclonal de Significância Indeterminada/sangue , Gamopatia Monoclonal de Significância Indeterminada/genética , Segunda Neoplasia Primária/tratamento farmacológico , Segunda Neoplasia Primária/patologia , Segunda Neoplasia Primária/terapia , Paraproteínas/análise , Indução de RemissãoRESUMO
Anthropogenic and natural sources contribute to chemical mixtures in air, water, and soil, posing potential risks to the environment and human health. To understand the interplay between element profiles in the human body, geographical location, and associated economic activities, we carried out an observational analytic cross-sectional study. The study recruited 199 participants from three municipalities, two of which had gold-mining as their primary economic activity, while the other was dedicated to agricultural and other local activities not related to mining. The concentrations of a total of 30 elements in human hair samples and 21 elements in environmental soil samples were measured using various spectrometry techniques. Unsupervised clustering analysis using Self-Organizing Maps was applied to human hair samples to analyze element concentrations. Distinct clusters of individuals were identified based on their hair element profiles, which were mapped to geographical location and economic activities. While higher levels of heavy metals (Ag, As, Hg, and Pb) were observed in individuals engaged in mining activities in certain clusters, individuals in agricultural areas show higher concentrations of elements found in pesticides (Ba and Sr). However, the elemental composition of hair is influenced not only by the anthropogenic activities but also by the inherent geological context where people live. Our findings highlight the significance of accounting for environmental factors when evaluating human health risks, as the intricate mixture of elements can yield valuable insights for targeted health interventions.
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OBJECTIVES: Despite the demonstrated efficacy of physiotherapy in palliative care programmes, there are scarce data of its real-life impact on patients' and caregivers' wellness and stress. Our aim was to assess effectiveness of a 30-day physiotherapy programme in psychological wellness and health-related quality of life (HRQoL) of patients with advanced chronic diseases or cancer and in their caregivers' stress. METHODS: Quasiexperimental before-after study applying personalised kinesitherapy, exercise with curative effects, respiratory physiotherapy, therapeutic massages and ergotherapy. Psychological wellness, HRQoL and caregiver's strain outcomes were measured. RESULTS: 207 patients (60% men, with a mean age of 73.6±12 years) were included; 129 (62.3%) with advanced cancer, and the remaining 78 with advanced chronic diseases. Psychological wellness (Emotional Stress Detection Tool decreased from 12.4±3 to 11±3; p<0.0001), caregiver's strain (Caregiver Strain Index decreased from 8.5±3.2 to 7.9±3.5; p<0.0001) and HRQoL (WHO-BREF physical health domain increased from 8.3±2.6 to 9.4±2.9; p<0.0001) showed a significant improvement after the physiotherapy programme. Global satisfaction with the physiotherapy intervention was also high (Client Satisfaction Questionnaire-8 of 28.3±3.3 points). CONCLUSIONS: A personalised physiotherapy programme incorporated to integral palliative care improved psychological wellness, HRQoL and caregivers' strain of patients with advanced chronic diseases and cancer.
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Neoplasias , Medicina Paliativa , Masculino , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Cuidadores/psicologia , Qualidade de Vida/psicologia , Doença Crônica , Neoplasias/psicologia , Modalidades de FisioterapiaAssuntos
Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Neoplasias Vasculares/diagnóstico por imagem , Feminino , Humanos , Linfoma Difuso de Grandes Células B/genética , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Cariotipagem Espectral/métodos , Neoplasias Vasculares/genéticaRESUMO
Mercury (Hg) vapor can produce kidney injury, where the proximal tubule region of the nephron is the main target of the Hg-induced oxidative stress. Hg is eliminated from the body as a glutathione conjugate. Thus, single nucleotide polymorphisms (SNPs) in glutathione-related genes might modulate the negative impact of this metal on the kidneys. Glutathione-related SNPs were tested for association with levels of Hg and renal function biomarkers between occupationally exposed (n = 160) and non-exposed subjects (n = 121). SNPs were genotyped by TaqMan assays in genomic DNA samples. Total mercury concentration was measured in blood, urine and hair samples. Regression analyses were performed to estimate the effects of SNPs on quantitative traits. Alleles GCLM rs41303970-T and GSTP1 rs4147581-C were significantly overrepresented in the exposed compared with the non-exposed group (P < 0.01). We found significant associations for GCLM rs41303970-T with higher urinary clearance rate of Hg (ß = 0.062, P = 0.047), whereas GCLC rs1555903-C was associated with lower levels of estimated glomerular filtration rate in the non-exposed group (eGFR, ß = - 3.22, P = 0.008) and beta-2-microglobulin in the exposed group (ß-2MCG, ß = - 19.32, P = 0.02). A SNP-SNP interaction analysis showed significant epistasis between GSTA1 rs3957356-C and GSS rs3761144-G with higher urinary levels of Hg in the exposed (ß = 0.13, P = 0.04) but not in the non-exposed group. Our results suggest that SNPs in glutathione-related genes could modulate the pathogenesis of Hg nephrotoxicity in our study population by modulating glutathione concentrations in individuals occupationally exposed to this heavy metal.
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Glutationa/metabolismo , Ouro , Rim/efeitos dos fármacos , Mercúrio/metabolismo , Mineração , Exposição Ocupacional , Polimorfismo de Nucleotídeo Único , Adolescente , Adulto , Biomarcadores/sangue , Biomarcadores/metabolismo , Colômbia , Feminino , Humanos , Rim/metabolismo , Masculino , Mercúrio/sangue , Mercúrio/toxicidade , Pessoa de Meia-Idade , Adulto JovemRESUMO
Potato cyst nematodes (PCN) from the genus Globodera spp. cause major losses in the potato (Solanum tuberosum) industry worldwide. Despite their importance, at present little is known about the status of this plant pathogen in cultivated potatoes in Colombia. In this study, a total of 589 samples collected from 75 geographic localities in nine potato producing regions of Colombia (Cundinamarca, Boyacá, Antioquia, Nariño, Santander, Norte de Santander, Tolima, Caldas and Cauca) were assayed for the presence of potato cyst nematodes. Fifty-seven percent of samples tested positive for PCN. Based on phylogenetic analysis of the internal transcribed spacer region (ITS1-5.8S-ITS2) of the rRNA gene and D2-D3 expansion segments of the 28S rRNA gene, all populations but one were identified as Globodera pallida. Sequences of G. pallida from Colombia formed a monophyletic group closely related to Peruvian populations, with the lowest average number of nucleotide substitutions per site (Dxy = 0.002) and net nucleotide substitutions per site (Da = 0.001), when compared to G. pallida populations from Europe, South and North America. A single sample formed a well-supported subclade along with G. rostochiensis and G. tabacum from Japan, USA and Argentina. To our knowledge this is the first comprehensive survey of Globodera populations from Colombia that includes genetic data. Our findings on species diversity and phylogenetic relationships of Globodera populations from Colombia may help elucidate the status and distribution of Globodera species, and lead to the development of accurate management strategies for the potato cyst nematodes.
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Produtos Agrícolas/parasitologia , Filogenia , Solanum tuberosum/parasitologia , Tylenchoidea/fisiologia , Animais , Colômbia , Doenças das PlantasRESUMO
The role of decentralized assessment of measurable residual disease (MRD) for risk stratification in acute myeloid leukemia (AML) remains largely unknown, and so it does which methodological aspects are critical to empower the evaluation of MRD with prognostic significance, particularly if using multiparameter flow cytometry (MFC). We analyzed 1076 AML patients in first remission after induction chemotherapy, in whom MRD was evaluated by MFC in local laboratories of 60 Hospitals participating in the PETHEMA registry. We also conducted a survey on technical aspects of MRD testing to determine the impact of methodological heterogeneity in the prognostic value of MFC. Our results confirmed the recommended cutoff of 0.1% to discriminate patients with significantly different cumulative-incidence of relapse (-CIR- HR:0.71, P < 0.001) and overall survival (HR: 0.73, P = 0.001), but uncovered the limited prognostic value of MFC based MRD in multivariate and recursive partitioning models including other clinical, genetic and treatment related factors. Virtually all aspects related with methodological, interpretation, and reporting of MFC based MRD testing impacted in its ability to discriminate patients with different CIR. Thus, this study demonstrated that "real-world" assessment of MRD using MFC is prognostic in patients at first remission, and urges greater standardization for improved risk-stratification toward clinical decisions in AML.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Citometria de Fluxo/métodos , Transplante de Células-Tronco Hematopoéticas/mortalidade , Quimioterapia de Indução/mortalidade , Leucemia Mieloide Aguda/patologia , Recidiva Local de Neoplasia/patologia , Neoplasia Residual/patologia , Idoso , Terapia Combinada , Progressão da Doença , Feminino , Seguimentos , Humanos , Leucemia Mieloide Aguda/terapia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/terapia , Neoplasia Residual/terapia , Prognóstico , Sistema de Registros , Taxa de Sobrevida , Transplante HomólogoRESUMO
The genes required for tetralin biodegradation by Sphingomonas macrogolitabida strain TFA are clustered in two divergent and closely linked operons. ThnR, a LysR-type regulator, activates transcription from each operon in response to tetralin. The regulatory thnR gene is co-transcribed with the catabolic genes thnC, thnA3 and thnA4, resulting in positive autoregulation. ThnR binds with different affinity to two primary binding sites, designated B and C, in the intervening region between the two operons and makes additional contact with secondary sites that extend towards the promoters. In addition, ThnR may interact with itself when bound to each site via the formation of a DNA loop, as evidenced by the distortion of the DNA between the primary binding sites and the elimination of the higher-order complexes following the introduction of a half-turn of the DNA helix between the primary binding sites. Transcription from each promoter is not fully independent since mutations in each binding site affected transcription from both promoters. Based on these results, we propose a model of transcription activation that involves the formation of a complex structure by interactions between ThnR molecules bound to distant binding sites and favours transcription from one promoter to the detriment of the other.
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Regiões Promotoras Genéticas , Sphingomonas/fisiologia , Tetra-Hidronaftalenos/metabolismo , Fatores de Transcrição/metabolismo , Sequência de Bases , Pegada de DNA , DNA Bacteriano/metabolismo , DNA Intergênico , Regulação Bacteriana da Expressão Gênica , Modelos Biológicos , Dados de Sequência Molecular , Óperon , Ligação Proteica , Multimerização Proteica , Sphingomonas/genética , Transcrição GênicaRESUMO
In artisanal and small-scale gold mining, occupational exposure to mercury (Hg) vapor is related to harmful effects on several organs, including the kidneys. We previously reported significantly increased levels of Hg in blood and urine despite normal kidney function in individuals from Colombia occupationally exposed to Hg compared with those nonexposed. We evaluated the contribution of 4 genetic variants in key genes encoding the transporters solute carrier (SLC; rs4149170 and rs4149182) and ATP-binding cassette(ABC; rs1202169 and rs1885301) in the pathogenesis of nephrotoxicity due to Hg exposure in these groups. Regression analysis was performed to determine the association between the blood- and urine-Hg concentration with SLC and ABC polymorphisms in 281 Colombian individuals (160 exposed and 121 nonexposed to Hg). We found an enrichment of ABCB1 rs1202169-T allele in the exposed group (p = .011; OR= 2.05; 95% CI = 1.18-3.58) compared with the nonexposure group. We also found that carriers of SLC22A8 rs4149182-G and ABCB1 rs1202169-T alleles had a higher urinary clearance rate of Hg than noncarriers (ß = 0.13, p = .04), whereas carriers of SLC22A6 rs4149170-A and ABCB1 rs1202169-C alleles showed abnormal levels of estimated glomerular filtration rate (ß = -84.96, p = .040) and beta-2-microglobulin (ß = 743.38, p < .001). Our results suggest that ABCB1 rs1202169 and its interaction with SLC22A8 rs4149182 and SLC22A6 rs4149170 could mitigate Hg nephrotoxicity by controlling the renal proximal tubule cell accumulation of inorganic Hg. This will be useful to estimate the risk of kidney toxicity associated to Hg and the genetic selection to aid adaptation to Hg-rich environments.
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Mercúrio , Mineração , Transportadores de Ânions Orgânicos Sódio-Independentes/genética , Polimorfismo Genético , Subfamília B de Transportador de Cassetes de Ligação de ATP/genética , Adolescente , Adulto , Colômbia , Monitoramento Ambiental , Feminino , Ouro , Humanos , Masculino , Mercúrio/toxicidade , Pessoa de Meia-Idade , Proteína 1 Transportadora de Ânions Orgânicos/genética , Adulto JovemRESUMO
Active edible films based on corn starch containing glycerol as a plasticizer and an olive extract obtained from Spanish olive fruit (Olea europaea) by-products (olive extract; OE) at different concentrations (0, 0.05, 0.1 and 0.2 wt%) were prepared by using the casting technique and further solvent-evaporation. OE showed high total phenolic and flavonoids contents and antioxidant activity, which was evaluated by using three different methods: free radical scavenging assay by (1, 1-Dipheny l-2-picrylhydrazyl) DPPH, 2, 2-Azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) ABTS radical inhibition and ferric reducing antioxidant power (FRAP). The incorporation of OE into the corn starch/glycerol matrix underlined the antioxidant potential and antimicrobial effect against E. coli and S. aureus of these novel active films, being noticeable for films added with 0.2 wt% OE. The developed active films showed a clear thermo-oxidative stability improvement with OE incorporation, in particular at 0.2 wt% loading with an increase of around 50 °C in the initial degradation temperature (Tini) and oxidation onset temperature (OOT). The functional properties of control films were also improved with OE addition resulting in a decrease in Young's modulus, elongation at break, shore D hardness and water vapor permeability. The present work suggested the potential of the developed corn starch-based edible films as low-price and sustainable food packaging systems to prevent the oxidative deterioration of packaged foodstuff while reducing also the generation of olive by-products.
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The improvement of the postharvest quality of tomato fruits was evaluated using an edible coating functionalized with an Flourensia cernua extract evaluating the antifungal, structural, barrier, and optical properties. The formulation and evaluation of an edible coating and its application on tomato was evaluated using a response surface methodology to determine the ideal concentrations of candelilla wax, whey protein, and glycerol. Edible films showed good barrier properties, with water vapor permeability varying from 0.435-0.404 g mm/m2 day kPa. The addition o F. cernua extract showed significant improvement in the transparency of films. The edible coating applied to tomato reduced weight and firmness loss. The sensory evaluation proved that the product obtained is acceptable for consumers. The edible coating added with F. cernua extract was the most effective in inhibiting the growth of pathogenic fungi and the visual appearance at the end of storage confirmed the beneficial effect of the edible coating.
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AIM: To analyze the levels of chronic fatigue in Spanish women with endometriosis and its relationship with their psychosocial status and quality of life (QoL). METHODS: A total of 230 Spanish women with a clinical diagnosis of endometriosis were recruited. Chronic fatigue (Piper Fatigue Scale) and pelvic pain (Numeric Rating Scale) were evaluated. An on-line battery of validated scales was used to assess psychosocial status [Hospital Anxiety and Depression Scale, Scale for Mood Assessment, Pain Catastrophizing Scale, Pittsburgh Sleep Quality Index, Gastrointestinal Quality of Life Index, Female Sexual Function Index and Medical Outcomes Study-Social Support Survey] and QoL [Endometriosis-Health Profile questionnaire-30]. Associations between fatigue and both psychosocial and QoL outcomes were explored through multivariate regression models. RESULTS: One-third and one-half of women showed moderate and severe fatigue, respectively. Fatigue was associated with higher anxiety and depression, poorer sleep quality, poorer sexual functioning, worse gastrointestinal health, higher catastrophizing thoughts, higher anger/hostility scores and lower QoL (p-values < 0.050). Moreover, fatigue and catastrophizing thoughts showed a mediating effect on the association between pelvic pain and QoL. CONCLUSION: This work reveals the important role of fatigue in the association between pain, psychosocial status, and QoL of Spanish women with endometriosis.
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Endometriose/epidemiologia , Síndrome de Fadiga Crônica , Ansiedade/epidemiologia , Catastrofização , Depressão/epidemiologia , Feminino , Humanos , Dor Pélvica/epidemiologia , Qualidade de Vida , Espanha/epidemiologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Little information has become available after psychiatric reforms regarding outcomes of persons with schizophrenia and related disorders cared for in community-based mental health facilities. AIMS: The aim of this study was to determine the consequences of psychiatric services in the users of mental health services in Malaga. METHOD: We describe the cohort and methods involved in the Schizophrenia Case Register (RESMA) in Malaga, Spain. All cases (n = 1,022) were users of public mental health services provided in the catchment area over one year. The majority were male (65%), single (68%), living with their original family (50%), with primary education (41%) and living on disability benefits (52%). RESULTS: Concerning use of services, the majority had out-patient contacts (89%). RESULT: s show a substantial overlap in the use of different services during the study period. CONCLUSION: The Malaga Schizophrenia Case Register provides sociodemographic, clinical and service use information for a large sample of patients with schizophrenia or related disorders. Results obtained from the cohort studied will be instrumental for the follow-up and evaluation of the mental health care reform.
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Sistema de Registros , Esquizofrenia/diagnóstico , Adulto , Área Programática de Saúde , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Demografia , Feminino , Humanos , Masculino , Prevalência , Esquizofrenia/epidemiologia , Esquizofrenia/terapia , Psicologia do Esquizofrênico , Espanha/epidemiologiaRESUMO
The dataset presented in this paper is based on data gathered from several countries within the West Mediterranean area at the highest detailed scale regarding official statistics, with the aim of investigating land and food systems dynamics in the Mediterranean. Characterizing land and food systems dynamics is critical to reveal insights regarding interactions between current dynamics of agricultural practices, species diversity and local food systems. These interactions were analyzed, at multiple spatial scales, on a large part of the Mediterranean basin within the DIVERCROP Project (https://divercropblog.wordpress.com/). An harmonized dataset with the desired characteristics was not readily available from official sources and, therefore, it was necessary to build an ad hoc database that could: (1) cover the Mediterranean areas of seven countries, namely Algeria (DZ), France (FR), Italy (IT), Malta (MT), Portugal (PT), Spain (ES) and Tunisia (TN); (2) contain data referred to the most disaggregated level of administrative units for which data is available in each country; (3) contain data referred to at least two time points, including the latest available data, in each country; (4) contain data on number of farm holdings, on the physical areas covered by the main annual and permanent crops and on livestock (number of heads); (5) contain a primary key that allows joining the census and surveys database to a geographical dataset of administrative units covering the entire area; (6) have an associated complete geographical dataset of administrative units, to allow spatial data analyses.
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This study investigates the role of neighborhoods in adolescent violence in poor neighborhoods in San Juan, Puerto Rico. The study is part of a larger longitudinal project examining risk and resilience in adolescents' ages 12 to 15 years old and their caregivers. Using a cross-sectional design, a self-completion questionnaire, and an interviewer questionnaire, the authors assessed violent behaviors among participants across demographics, characteristics, and neighborhood social disorganization using the concepts of physical disorders and social disorder. Adolescent violence was positively associated with social disorder. The finding that adults in these neighborhoods walk around with visible firearms and engage in fighting, may have led adolescents to perceive that violence is an accepted behavior. Furthermore, socially disorganized neighborhoods might be less likely to organize on their own behalf because the occurrence of negative experience limits the amount of social support and resources that are available in the neighborhood.
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Comportamento do Adolescente , Delinquência Juvenil/estatística & dados numéricos , Relações Pais-Filho , Características de Residência/estatística & dados numéricos , Meio Social , População Urbana/estatística & dados numéricos , Adolescente , Comportamento do Adolescente/psicologia , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Porto Rico/epidemiologia , Assunção de Riscos , Fatores SocioeconômicosRESUMO
OBJECTIVE: To describe the 1-year outcomes of recurring infrapopliteal disease after endovascular revascularization with the Lutonix drug-coated balloons (LDCB) in diabetic patients with critical limb ischemia (CLI), and to benchmark our findings with previously published objective performance goals (OPG) addressing safety and efficacy of new catheter-based therapies for CLI. METHODS: The present study was a retrospective, single-center, and single-arm trial of symptomatic diabetic patients with CLI, who underwent LDCB-angioplasty for recurring infrapopliteal disease. Acute procedural and technical success were recorded. TcPO2 metrics variations at baseline and follow up were analyzed. Freedom from clinically driven target lesion revascularization (CD-TLR) was calculated using Kaplan-Meier analysis, and outcomes compared with previously published OPG for infrapopliteal interventions. RESULTS: 21 patients (15 men; mean age 66,6±11,2 years) were followed-up for 356.5±159.2 days and 90.47% had 12-months follow up data available for analysis. TcPO2 increased (14.3±11.6mmHg to 53.8±11.7mmHg; p<0.05). Limb salvage rate was 100%, and 90.4% of patients achieved the combined endpoint of reduction in ulcer size/depth or complete healing. LDCB had superior efficacy (MALE+post-operative death, amputation free survival, freedom from re-intervention, limb salvage and survival rates), while attaining superior or equivalent safety (Major Adverse Limb Events, major adverse cardiovascular events and Amputation) endpoints for the overall, modified clinical and anatomical high-risk groups. CONCLUSIONS: Lutonix DCB is safe and effective for recurring infrapopliteal disease. It outperforms the OPG for CLI patients with clinical and anatomical high-risk features.