Población y Salud en Mesoamérica 2022-01-26T13:51:35-06:00 Adrián Murillo González Open Journal Systems <p>Población y Salud en Mesoamérica&nbsp;is an&nbsp;academic&nbsp;electronic&nbsp;journal, published biannually by the Centro Centroamericano de Población&nbsp;and whose publisher is the University of Costa Rica. The main objective of this publication is the dissemination of research on population from demographic perspective, and public health. This journal is <a href="">registered and indexed</a> in important international indexes. E-mail: <a href=""></a></p> <p><strong>URL OAI-PMH:</strong> <a href="/index.php/psm/oai"></a></p> Health as a social representation: The phenomenon of health within the daily life of nicaraguan migrants in Costa Rica 2022-01-26T13:39:35-06:00 Wendel Mora-Rivera <p><strong>Introduction: </strong>Health is loaded with symbolisms and practical manifestations that differ according to social groups and sociocultural contexts. In order to make everyday life and needs visible, the Theoretical Paradigm of Social Representations provides the theoretical-methodological bases necessary to understand the common sense knowledge associated with health among the Nicaraguan migrant population in Costa Rica.<strong> Methodology: </strong>Qualitative study with ethnographic approach that aimed to identify the social representation of health, through the process of objectification, present among Nicaraguan migrants living in Costa Rica. Data collected through semi-structured interviews, participant observation, and field diaries. Processing according to Content Analysis. <strong>Results: </strong>The social representation of health found behaves analogously to a formula; where, the search for peaceful environments is added to the achievement of financial stability to result in two interdependent representations: 1) Health as physical-mental strength; and 2) Health as a future and abstract sensation of well-being, happiness and transcendence. The socio-political antecedents in Nicaragua, the migratory process, and the adaptation to Costa Rica play a preponderant role in shaping the representation on health. <strong>Conclusion: </strong>Social representations about health have direct practical implications on the ways of life and needs of migrant groups. Understanding their common sense knowledge allows to move towards more contextualized public policies. More integration of the thoughts, opinions and feelings of migrants in decision-making platforms is recommended.</p> 2021-10-19T11:39:43-06:00 ##submission.copyrightStatement## (Ine)quality in Healthcare: a perspective from the accreditation of clinical laboratories in Costa Rica 2022-01-26T13:40:40-06:00 Daniel Quesada-Yamasaki Raúl Zeledón-Mayorga <p><strong>Introduction:</strong> Given the relevance of quality-assured laboratory services for health system strengthening and improvement, this study had the objective of exploring the distribution of ISO 15189-accredited and non-accredited laboratories in Costa Rica, in order to identify possible gaps in the fulfillment of its commitment to provide ‘quality healthcare for all’. <strong>Methods:</strong> Our research was conducted with a descriptive scope and following a quantitative approach. Costa Rica’s Accreditation Body and College of Microbiologists databases were searched to collect data regarding clinical laboratory registration and ISO 15189 accreditation status. Laboratory availability indicators by geographical division were computed with this data. <strong>Results:</strong> Out of 480 clinical laboratories allowed to operate in Costa Rica as of January 2021, only 5 (about 1%) have been accredited in compliance with ISO 15189, all of which are private and located in the province of San José. Also, laboratory density (in terms of facilities per 100 km<sup>2</sup> and per 100&nbsp;000 population) is heterogeneous among provinces. Clinical laboratory services are more easily available in ‘central’ provinces of the country (e.g. San José and Heredia), where ratios for laboratory density are higher. On the contrary, coastal provinces such as Limón and Puntarenas exhibit low laboratory density ratios, reflecting geographical disparities in access to healthcare. <strong>Conclusions:</strong> Geographic disparities in the access to clinical laboratory services were observed. This should raise awareness among public health authorities and private healthcare providers regarding the country’s progress in attaining its ‘quality healthcare for all’ commitment.</p> 2021-10-19T11:56:36-06:00 ##submission.copyrightStatement## Impact in the integral health of the workers the area technology of the information who make home office during Covid -19 2022-01-26T13:40:40-06:00 Maria Elizabeth Pena Téllez Suzely Adas Saliba Moimaz Artênio José Isper Garbin Tânia Adas Saliba <p><strong>Introduction: </strong>With the social isolation imposed by the Covid 19 pandemic, teleworking in the home office modality has been an alternative used by some companies.<strong> Objective: </strong>To determine the impact of this remote work on the integral health of workers.<strong> Methodology:</strong> A cross-sectional study was carried out, through the "Google Forms" platform, a semi-structured questionnaire was elaborated that was sent to 150 information technology workers from a medium-sized municipality in the state of São Paulo, to obtain information on the variables: age, sex, working conditions, oral and systemic health, oral hygiene habits, musculoskeletal pain, physical exercises and emotional state.<strong> Results:</strong> Of the total of 116 responses received, 87.07% belonged to the male sex, 100% reported concern with their oral and general health, 56.03% reported changes in their eating habits, 44.83% increased food consumption and 77.58% reported feeling concerned and anxious. The prevalence of painful musculoskeletal symptomatology manifested in 100% of workers predominantly found in the cervical region (53.44%). In general, low frequency of physical activity and inadequate conditions for home work performance were corroborated. <strong>Conclusions:</strong> The change from the usual work routine to the home office modality (teleworking) significantly impacted the health of information technology workers. Given the possibility of maintaining this modality of remote work to reduce the exposure and spread of the virus, it is necessary to adopt strategies to preserve the integral health of these professionals.</p> 2021-10-21T10:23:44-06:00 ##submission.copyrightStatement## Social Return on the investment of the elimination of the vertical transmission of Chagas, HIV / AIDS, HB and Syphilis: Case of a Municipality of the Province of Buenos Aires 2022-01-26T13:40:43-06:00 Malena Monteverde Constanza Silvestrini Ana Cristina Pereiro Tamara Wolovich Mariana Ceriotto Juan Manuel Castelli <p><strong>Introduction:</strong> we seek to quantify the returns on investment associated with an intervention in the public health system of a Municipality of the Province of Buenos Aires, Argentina. This intervention consists of strengthening the strategy for the Elimination of Mother-to-Child Transmission of HIV Infection, Syphilis, Congenital Chagas Disease and Perinatal Hepatitis B Infection, a strategy called ETMI-PLUS. <strong>Methodology:</strong> the study (quantitative) is based on the Social Return on Investment (RSI) methodology. Ad-hoc definitions are established for the measurement of returns based on the information available from various sources: primary information from the Ministry of Health of the MAB; rates of congenital transmission of each disease reported to the National Health Surveillance System; detailed budgets of the resources assigned to the project by Fundación Mundo Sano and costs of treatments and supplies from official nomenclators. <strong>Results:</strong> for each argentinean peso invested in strengthening the ETMI-PLUS in the MAB, a return of almost 4 pesos would have been obtained thanks to the improvements in the vertical elimination of the 4 diseases and the reduction of cardiac complications in pregnant women. <strong>Conclusions:</strong> these results suggest the existence of a return / investment relationship favorable to the intervention, analyzed under a conservative analysis since savings for the health system are exclusively included and other dimensions of returns associated with improvements in results are excluded.</p> 2021-10-21T10:58:10-06:00 ##submission.copyrightStatement## Trajectories of frailty and related factors of elderly people in Mexico 2022-01-26T13:42:13-06:00 Abigail Vanessa Rojas Huerta <p><strong>Introduction. </strong>Frailty is an indicator of health status in old age and a common clinical syndrome in older adults that carries an increased risk of poor health outcomes, including falls, incidents of disability, hospitalization, and mortality. This study aimed to identify the different trajectories of frailty and the factors related to frailty among Mexican older adults over time. <strong>Methods: </strong>Data are from a four-wave panel composed of older Mexican adults from 2001 to 2015 of the Mexican Health and Aging Study (MHAS). Frailty is the accumulation of deficits using a frailty index. A multilevel analysis, using hierarchical models, was applied to know the changes of frailty trajectories and what factors are related to it.<strong> Results. </strong>Being female, older, being widowhood, and having a lower level of education were risk factors for having a high frailty index and lower financial satisfaction doing activities at home have adverse effects. <strong>Conclusion. </strong>The findings of this work present information about the prevalence of frailty considering the proportion of deficits that individuals possess and their main associated components in older Mexican adults. It is necessary to improve socioeconomic health conditions in phases before old age to avoid developing frailty in the future.</p> 2021-11-04T15:07:12-06:00 ##submission.copyrightStatement## Excess mortality in Mexico 2020: a preliminary estimate at national and state level 2022-01-26T13:42:14-06:00 Jose Eliud Silva Urrutia Andrea Peralta Eric Peralta <p>As a direct or indirect consequence of the COVID-19 pandemic, joint other public health problems, Mexico is one of the most affected countries in terms of excess mortality, which is generalized and heterogeneous at the state level. That is why, the paper’s aim is to quantify it at national and subnational level both through the percentage of excess mortality (% EM) and using differences in life expectancies (EMex)&nbsp; by sex. For (EMex) , mortality tables are constructed with specific rates that are estimated through a non-parametric approach so-called controlled and segmented smoothing. The results show the greatest excesses in male population and for some states of the country. Likewise, regarding EMex, strong setbacks in life expectancy can be observed including the Mexico City.</p> 2021-11-30T14:29:57-06:00 ##submission.copyrightStatement## Precarious Work and Health Care among Working-Class Men in Buenos Aires, Argentina 2022-01-26T13:42:18-06:00 Betina Freidin Mercedes Krause Matías Salvador Ballesteros Agustín David Wilner <p><strong>Introduction:</strong> We analyze the relation between work and health drawing on the labor experiences of adult men who reside in a working-class neighborhood located in the periphery of Buenos Aires City. More specifically, we analyze how precarious jobs impact on their psychophysical health through work conditions that expose them to diverse risks and deprivations for quality of life and health care. <strong>Methodology:</strong> Data come from qualitative, in-depth, interviews that we conducted with adult men as part of a larger study on health care with residents of the neighborhood. <strong>Results: </strong>Precarious jobs affect health in various ways. Some of the interviewees have been exposed to physical and psychosocial risks due to the work conditions and environment in the workplace. The negative consequences that precarious jobs have for quality of life are also salient, by limiting their capability to plan ahead, organize everyday life and develop self-care practices. <strong>Conclusions:</strong> We highlight the importance of considering precarious work as a social determinant of health, since it is a multidimensional trait that helps to analyze its negative consequences on working-class men. We also point to the adverse consequences for health of precarious jobs throughout the life-course, in part, due to age-based chronic conditions but also due to the cumulative disadvantages produced by precarious and vulnerable work trajectories.</p> 2021-12-03T09:49:41-06:00 ##submission.copyrightStatement## Epidemiological analysis of Aids cases in Southeastern Brazil from 2010 to 2019 2022-01-26T13:42:19-06:00 Isabela Martins Rodrigues Bárbara Martins Faria Leticia Verri Marquez Uriel da Silva Pires Vinícius Ferreira Rende William Nicoleti Turazza da Silva Stefan Vilges de Oliveira <p><strong>Introduction:</strong> The HIV and Aids epidemic represents one of the biggest public health problems today. In Brazil, it is estimated that only 83 % of people living with HIV know their diagnosis and only 46 % have an undetectable viral load. This highlights the need for studies aimed at understanding HIV and Aids in Brazil, to improve public policies. Thus, this study aims to conduct a survey of data on the epidemiological profile of Aids patients in Southeast Brazil. <strong>Methods:</strong> It is a descriptive, quantitative epidemiological study. The data was extracted from SINAN. The analysis was restricted to the period from January 2010 to June 2019. <strong>Results:</strong> In the analyzed period, 2017 had the highest prevalence of the disease (11,97 %). In addition, there was an increase in the number of cases between 2010 and 2014 and a drop over the last few years. Rio de Janeiro was the state with the highest number of new cases (21,90 %) in the Southeast Region. <strong>Results: </strong>The groups with the highest incidence of cases were: man (71,1 %), young and adults (79,37 %), white (46,67 %), high school graduates (19,71 %) and heterosexuals (46,94 %). However, a relative increase in incidence was observed among homosexual men and among browns. Also, sexual transmission was the most prevalent (78,09 %). <strong>Conclusion:</strong> The study concluded that more research on the topic is needed, to monitor the epidemiology of Aids and to guide efficient government measures.</p> 2021-12-03T10:23:30-06:00 ##submission.copyrightStatement## Capacity of the foods included in the Basic Tax Basket of Costa Rica to satisfy the nutritional requirements of the quintile with less incomes 2022-01-26T13:44:08-06:00 Katalina Peraza Garita <p>On a national level, several regulations have been developed with the aim of protecting the economically most vulnerable sectors of the population. One of these regulations is the Costa Rica’s Basic Tax Basket Regulations (CBT by the Spanish acronym for Canasta Básica Tributaria), which establishes a decrease in the tax burden on food consumed by the most vulnerable population of the 2013 National Household Income and Expense Survey (ENIGH by the Spanish acronym for Encuesta Nacional de Ingresos y Gastos de los Hogares). The objective of this research is to compare the nutritional value of the foods included in the CBT and the nutritional requirements of the first quintile members of the 2013 ENIGH. The research is quantitative and co-relational in type. The sample is the first income quantile of the ENIGH of 2013 and is composed of healthy adults with ages between 19 and 60. The analysis was made during the first four months of 2020, using an instrument formulated in Excel, in which meal plans are formulated only with the foods that are part of the CBT, to calculate the content of energy, macronutrients, saturated fatty acids, fiber, calcium, zinc, magnesium, vitamin E and vitamin D. The results determined that 46% of CBT foods are classified as source or good source of some of the studied nutrients. As well as 6 of the 11 studied nutrients are satisfactorily adapted to the requirements of the population. The results allow to conclude that with the foods included in the CBT, an adequately balanced meal plan can be formulated, because excess or deficiency of nutrients found in the meal plan are not considered harmful to the health.</p> 2021-12-06T09:22:48-06:00 ##submission.copyrightStatement## Effectiveness of «Universal Newborn Hearing Screening program» of Caja Costarricense del Seguro Social, in detecting deafness in children, from 2016 to 2018 2022-01-26T13:43:57-06:00 Leiner Rodríguez González Ana Laura Zeledón Díaz Óscar Centeno Mora <p><strong>Introduction:</strong> Hearing screening is a detection method, its objective is to provide an early intervention that allows reducing the negative consequences of an eventual hearing impairment, in the integral development of the infant. Costa Rica has implemented a universal neonatal hearing screening program in the public health system, where the hearing of every child born in the country is examined before the first month of life. Although multiple benefits have been perceived, it is important to demonstrate with scientific evidence if it accomplishes its objectives. <strong>Methodology:</strong> the effectiveness of the Universal Newborn Hearing Screening Program in Costa Rica was analyzed, based on the information recorded from 37,656 children evaluated since 2016 to 2018, through empirical contrast using both descriptive techniques: frequency distribution of variables, as well as the use of inferential tests: chi square and analysis of variance (ANOVA). <strong>Results:</strong> 71 % of the sample was between 0 and 3 days old at the moment of being examined. Its performance over time and extension to different health centers has been satisfactory, likewise, the number of infants evaluated has been up to 98 % of the population. <strong>Conclusions:</strong> the TANU program is effective in most of the aspects analyzed, the identification of risk factors and the early detection of hearing disorders are outstanding, however, improvements are proposed in relation to the handling of information.</p> <p><span style="font-weight: 400;">&nbsp;</span></p> 2021-12-10T12:16:31-06:00 ##submission.copyrightStatement## Prenatal care and social determinants: ecological study in Argentina 2022-01-26T13:43:59-06:00 Natalia Tumas Ana Carolina Godoy Virginia Peresini María Eugenia Peisino Gisela Boldrini Gaetano Vaggione Gabriel Esteban Acevedo <p>Introduction: the prenatal care is a key aspect in public health, with great impact in maternal and perinatal health, as well as in other stages of the life cycle. The features of the prenatal care could be variable between and within countries, and be related to social determinants. The aim of this study was to identify socio-sanitary scenarios of prenatal care, and to analyze associations between social determinants and selected synthetic indicators of prenatal care in Argentina (2010-2018). Methodology: A multi-group ecological study (n=24 jurisdictions) was developed. The data were obtained from secondary sources: the latest available data of the Perinatal Informatics’ System (2018) and national census (2010). A hierarchical and agglomerative cluster analysis was carried out (Ward's method). The spatial distribution of the scenarios was illustrated by a map. ANOVA test was applied to assess the differences between the identified scenarios. To estimate associations between social indicators and indicators of prenatal care, linear regression models were applied. Results: five socio-sanitary scenarios of prenatal care were identified, which reveal heterogeneities in the distribution of prenatal and social care indicators. In addition, the percentage of households living in poverty presented a direct association, and the human development index and life expectancy at birth an inverse association with insufficient prenatal care. Conclusions: different socio-sanitary scenarios exist in Argentina, and some social characteristics of the contexts in which people live might underlie its configuration.</p> 2021-12-10T15:56:52-06:00 ##submission.copyrightStatement## A public policy proposal: organ donation culture program in Morelia, Michoacán, México 2022-01-26T13:44:02-06:00 América Ivonne Zamora Torres Yesica Díaz Barajas <h2 style="text-align: justify; margin: 12.0pt 0cm 12.0pt 0cm;"><span style="font-size: 11.0pt; font-family: 'Arial',sans-serif; font-weight: normal;" lang="ES-MX">Although in our times organ transplantation is already a routine medical procedure that represents in most of cases the only alternative for waiting list patients continue living, the problem in the city of Morelia, Michoacán, is similar to that which occurs around the world, the lack of organ donation culture, do not let people in favor of it, put into practice their preferences, showing a high percentage of family rejections when consent for donation is requested. The objective of this work was the design of a public policy using the rational approach, with the Logical Framework Matrix methodology, resulting in a proposal for a <a name="_Hlk74740155"></a>post mortem organ donation culture program in Morelia, Michoacán, in order to reduce these refusals and improve the level of organ donations and transplants.</span></h2> 2021-12-13T09:10:12-06:00 ##submission.copyrightStatement## Bioavailability of phosphorus in food and its effect in chronic kidney disease 2022-01-26T13:44:05-06:00 Eduardo Martínez Hernández Rodolfo A. De La Luz Maya María De Los Á. Ramírez Robledo Gabriela K. Núñez-Murillo Claudia Nelly Orozco González <p><strong>Introduction</strong><strong>:</strong> to know the importance of the investigations that relate the bioavailability of phosphorus in different groups of foods of animal, vegetable and industrialized origin and its effect on the progression in patients with Chronic Kidney Disease (CKD).<strong> Methodology</strong><strong>:</strong> the review is based on a literary search that was carried out on web pages such as: PUBMED, Redalyc, SciELO, SCIHUB and Google Academic. Each of the studies was selected discarding those that were not quantitative, original, complete, with clear methodology, carried out in mammals, and that in their results specified the bioavailability of phosphorus in percentages. All the studies were read, placing main emphasis and interest on the percentage of phosphorus bioavailability when consuming different food groups. Three matrices were made according to the origin of the food and the bioavailability of phosphorus that is absorbed in the body; grouping them into foods of animal, vegetable and industrialized origin and additives. <strong>Results</strong><strong>:</strong> it was found that industrialized foods and additives show a phosphorus bioavailability of 90-100%, those of animal origin 40-80%, those of plant origin 30%. <strong>Conclusions:</strong> The additives used in industrialized foods promote hyperphosphatemia and thus accelerate the progression of chronic kidney disease, unlike foods of animal and vegetable origin that are less harmful to health. This guides the training of the health sector, expanding its knowledge in the nutritional treatment of the patient.</p> 2021-12-13T11:30:01-06:00 ##submission.copyrightStatement## Editorial: Instituto de Investigaciones en Salud 45 years caring for Costa Rica 2022-01-26T13:46:19-06:00 Carolina Santamaría-Ulloa <p>The Instituto de Investigaciones en Salud (INISA), of the University of Costa Rica, is a multidisciplinary unit that for 45 years has been conducting research in four major fields: human genetics, cancer, aging and the interaction between nutrition and infection processes.</p> 2022-01-01T00:00:00-06:00 ##submission.copyrightStatement## Presentation 2022-01-26T13:46:25-06:00 Melina Montero López <p>The Instituto de Investigaciones en Salud of the University of Costa Rica has contributed to the promotion of human health through scientific research, teaching and social action since 1974, when the creation of an institute for research on human health was proposed by recommendation of the National Council for Scientific and Technological Research (CONICIT).</p> 2022-01-01T00:00:00-06:00 ##submission.copyrightStatement## The impact of the antibiotic resistance on the sustainable development 2022-01-26T13:46:27-06:00 Kenia Barrantes Jiménez Luz Chacón Jiménez María Arias Andrés <p>Antibiotic resistance (AR) is an increasingly complex public health problem, considered one of the greatest threats globally. The development of AR in bacterial pathogens is an expected consequence of evolutionary adaptation due to antimicrobials contamination in the environment. However, multiple factors are associated with the emergence and dissemination of AR, including excessive and poorly regulated use of antibiotics in human and animal medicine, agriculture, livestock, and industry, among other fields. The role of the environment as a reservoir for the generation and dissemination of AR genes and AR bacteria has recently been indicated. The approach to contain and control this problem involves multiple disciplines such as human and animal medicine, the environment, the industry, and the economy. This article describes the AR problem, the factors associated with its origin, and the multidisciplinary approach proposed for its management at a global level. Also, it will be described how AR affects sustainable development according to the UN 2030 Agenda, in compliance with some of the sustainable development goals.</p> 2021-11-10T15:40:44-06:00 ##submission.copyrightStatement## Circulation of diarrheagenic Escherichia coli associated virulence genes in Costa Rican Great Metropolitan Area wastewaters 2022-01-26T13:46:29-06:00 Luz María Chacón Jiménez Karolina Hall Loría Pablo César Rivera Navarro Liliana Reyes Lizano Rosario Achí Araya Kenia Barrantes Jiménez <p><strong>Introduction:</strong>&nbsp;Diarrheic disease is one of the most important disease’s causes in children under five years. One of the most recognized etiological agents is&nbsp;<em>Escherichia coli. </em>This bacterium has the capacity of causing infections by multiple mechanisms associated with the acquisition of different virulence genes.&nbsp;<strong>Methodology:&nbsp;</strong>water samples were collected from the affluents and effluents of five wastewater treatment plants located in the Costa Rican Great Metropolitan Area, during three sequential days, in March, May, October, and December from 2013. The aim was to quantify&nbsp;<em>E. coli's&nbsp;</em>concentration by multiple tubes fermentation method and to evaluate the presence of&nbsp;<em>aatA, bfpA, eaeA, ipaH, lt, st, stx1,&nbsp;</em>and&nbsp;<em>stx2&nbsp;</em>virulence genes, related with diarrheagenic&nbsp;<em>E. coli</em>, by PCR end-point method.&nbsp;<strong>Results:&nbsp;</strong>The study revealed that the levels of&nbsp;<em>E. coli&nbsp;</em>into the affluents are similar to those reported in other world regions. The effluent's concentration presented higher than 4 Log10 NMP/100 mL level of <em>E. coli</em>. A year-round circulation of virulence genes was demonstrated, and it was associated with enterotoxigenic, Shiga-toxin producers/ enterohemorrhagic, enteroaggregative, and enteropathogenic pathotypes. Genes related to enteroinvasive variety did not were detected. Not all wastewater treatment plants removed <em>E. coli</em> efficiently<em>.&nbsp;</em><strong>Conclusions:&nbsp;</strong>Diarrheagenic&nbsp;<em>E. coli&nbsp;</em>circulation is common in our county with the possibility of dissemination to the environment by effluent's wastewater discharge in surface water bodies.&nbsp;</p> 2021-11-12T10:02:30-06:00 ##submission.copyrightStatement## Ultra-processed and highly palatable foods on the development of obesity 2022-01-26T13:46:30-06:00 Rebeca Vindas-Smith Dayana Vargas-Sanabria Juan C. Brenes <p>Introduction: Obesity is a multifactorial trait provoked by the interaction of biological, environmental, psychosocial, and socioeconomic factors. Proposal: The goal of the present review is to discuss the role of ultra-processed and highly palatable foods (UPHP) in the development of the obesity epidemic through an exploratory-descriptive review and to present some suggestions for controlling its consumption. Arguments for discussion: UPHP are energy dense foods with high contents of fat and sugar. UPHP are formulated with many industrial additives used for enhancing flavor, shelf life, and the stability of their components. UPHP used to contain diverse chemicals known as endocrine disruptors (EDC), which are transferred from packaging to foods, with bisphenol A and phthalates as the most common EDC. The EDC disrupt different hormonal signaling pathways affecting the metabolism of the adipose tissue and other endocrine systems. The overconsumption of UPHP induces neuroplastic changes in the brain reward system that increases their consumption, leading to body fat accumulation. In addition, the overconsumption of UPHP alters the composition of the intestinal microbiome (dysbiosis), which is associated with the development of obesity. Conclusions: The overconsumption of UPHP increases the risk of obesity and its related chronic, non-communicable diseases, especially when consumption initiates during early life. To counteract this problem, we proposed the following actions: changing the structure of the market-food basket, incorporating regulations to reduce the UPHP supply in and around educational centers, creating new taxes upon UPHP, and strengthening the research regarding obesity, and the effects of UPHP and EDC.</p> 2021-11-19T14:00:44-06:00 ##submission.copyrightStatement## Beginning of Biological Dosimetry in Costa Rica and its importance in the care of populations overexposed to ionizing radiation 2022-01-26T13:48:44-06:00 Luisa Valle Bourrouet Fernando Ortiz Morales Omar García Lima Jorge Ernesto González Mesa Andrés Chaves Campos Marvin Rodríguez González Melissa Abarca Ramírez <p><strong>Introduction: </strong>The cytogenetics laboratory of the Health Research Institute (INISA) of the University of Costa Rica established a Biological Dosimetry Service in January 2020 using cytogenetic biomarkers of exposure to ionizing radiation. It is the first of its kind in the Central American region. <strong>Objective: </strong>establish a biological dosimetry service for Costa Rica, developing a dose-effect calibration curve for gamma rays. <strong>Methodology:</strong> to carry out the calibration curve, peripheral blood samples from two volunteers, one female and the other male, were irradiated in vitro with gamma rays, at 11 dose points in the range of 0 to 5 Gy. Blood was cultured according to international protocols for 48 hours and induced aberrations were recorded. The Dose Estimate V5.2 and R version 4.03 programs were used to calculate the coefficients of the calibration curve that correlates the frequency of dicentric chromosomes with the dose. <strong>Results: </strong>the coefficients of the curve are α: 0.02737 ± 0.00658, ß: 0.05938 ± 0.00450 and C: 0.00129 ± 0.00084. These coefficients have values similar to those reported internationally. The curve was validated by calculating two unknown doses, in the first unknown case the delivered dose was 1.5 Gy and the estimated dose was 1.47 Gy and in the second case the delivered dose was 4 Gy and the estimated dose was 3.616 Gy. for both cases there are no statistically significant differences between the delivered and estimated doses.<strong> Conclusions: </strong>the Biological Dosimetry Service of the INISA can estimate absorbed dose in persons suspected of overexposure to gamma rays in occupationally exposed personnel or persons involved in a radiological accident.</p> 2022-01-01T00:00:00-06:00 ##submission.copyrightStatement## Preclinical model of obesity based on ultra-processed and highly palatable foods 2022-01-26T13:48:31-06:00 Dayana Quesada Mónica I. Hernández-Solano Juan C. Brenes Rebeca Vindas-Smith <p><strong>Introduction:</strong> The alarming increase in obesity both worldwide and in Costa Rica is mainly due to changes in the composition of the usual diet of the population. The goal of our research was to implement a feeding protocol formulated from ultra-processed and highly palatable foods (UPHP) consumed by the Costa Rican population and to evaluate the effects of the UPHP diet on eating behavior and biometric and biochemical parameters. <strong>Methods:</strong> Adult male Wistar rats were assigned to two groups. One group was given standard rodent chow (DC group) while the other group received UPHP foods (UPHP group) for eight weeks. <strong>Results:</strong> Throughout this period, animals exposed to the UPHP diet exhibited higher food and energy intake characterized by high consumption of fat and lower consumption of protein and fiber. Animals in the UPHP group also showed a significant increase in obesity parameters (e.g., body weight and bodyweight gain, Lee's index, and central adiposity). Furthermore, the UPHP group had descriptively higher levels of blood glucose and triglycerides and significantly lower levels of total cholesterol. <strong>Conclusions:</strong> Our results indicate that a feeding protocol based on the most frequent food choices of the Costa Rican population is capable of inducing hyperphagia and obesity. This model constitutes a promising tool to delve into the study of the neurobiological and metabolic factors related to obesity induced by overconsumption of UPHP foods.</p> 2021-11-22T00:00:00-06:00 ##submission.copyrightStatement## Molecular-genetic studies of inherited myotonic conditions in Costa Rica 2022-01-26T13:48:33-06:00 Melissa Vásquez Cerdas Rebeca Vindas-Smith Patricia Cuenca Berger Gerardo del Valle Carazo Fernando Morales Montero <p><strong>Introduction</strong>: Hereditary myotonias are a clinically and genetically heterogeneous group of skeletal muscle diseases characterized by myotonia (delayed muscle relaxation). Clinically, they are classified as dystrophic and non-dystrophic myotonias, which are caused by mutations in the DNA. Aim: Describe the most relevant findings on some hereditary myotonias in Costa Rica. <strong>Methodology:</strong> Genetic-molecular studies of these diseases were carried out in individuals affected with a myotonic condition and their relatives at genetic risk. <strong>Results:</strong> The mutation for myotonic dystrophy type 1 (DM1) was found in 246 individuals. We have seen an improvement in the correlations between the size of the mutation and the age of onset of symptoms, in addition we have demonstrated the modifying role of some genetic factors in DM1.&nbsp; Of 18 patients who were negative for the mutation causing DM1, in eight families, a mutation was identified in genes, that provide the instructions for producing proteins called ion channels. Analyzes at the functional level helped to show that these mutations cause structural changes that modify the properties of these channels, causing a loss or gain of channel function. <strong>Conclusions:</strong> Our studies have allowed a correct clinical classification for many patients with these pathologies, in addition to explore the genetic and molecular basis of the clinical variability of these diseases, by searching for DM1 modifying factors and functional studies of new mutations that cause hereditary channelopathies, which is key to provide genetic counseling to patients and families and treating the disease in the most appropriate way.</p> 2021-11-22T00:00:00-06:00 ##submission.copyrightStatement## Joint responsibility in health as the basis for an inter-institutional action plan: Addressing overweight and obesity in a Costa Rican population 2022-01-26T13:48:36-06:00 Melina Montero-López Krysia Badilla-Alpízar Deigo Salazar Sandoval Carolina Santamaría-Ulloa <p>The objective of this study is to describe the process of creating an inter-institutional action plan to address overweight and obesity in the population of mothers from the urban counties of Alajuelita and Escazu in Costa Rica. This research has a qualitative approach, is a descriptive transversal study, and uses a research-action methodology, which takes as participants the institutional actors of both counties, during a six-month time frame. The main results is the creation of an action plan for in each of the two counties. Process, product and result indicators are also proposed for each of the 4 work areas that were part of the action plan, It is concluded that joint responsibility in health is of vital importance for the creation of actions that seek to improve the health of the population, especially in communities in which there is significant political will from institutional actor, but there are few resources.</p> 2021-12-01T00:00:00-06:00 ##submission.copyrightStatement## Major depression disorder in Costa Rica: epidemiological and neurobiological aspects 2022-01-26T13:48:42-06:00 Andrey Sequeira Cordero Marilyn Blanco-Vargas Juan Carlos Brenes <p><strong>Introduction:</strong> Major depression is one of the most common mental illnesses and one of the principal causes of disability worldwide, with an increasing prevalence in recent decades. The aim of this essay is to present epidemiological data, as well as to briefly review the psychobiological mechanisms of depression related to the exposure to chronic stress. Finally, we will also discuss some strategies for the prevention and/or treatment of the disease. <strong>Proposal:</strong> Alternative treatments complementing medication and psychotherapy could be much more effective in preventing and mitigating the effects of chronic stress and the risk of depression than these treatments alone. <strong>Arguments for discussion:</strong> Chronic stress can precipitate a depressive episode due to hyperactivity of the amygdala and hypothalamic-pituitary-adrenal (HPA) axis, failure of the HPA negative feedback, monoamine depletion, decreased levels of neurotrophins, increased glutamatergic excitotoxicity, reduced hippocampal neurogenesis, prefrontal cortex dysfunction, and excessive inflammatory response. <strong>Conclusions: </strong>The chronic accumulation of uncontrollable psychosocial stressors plus a sedentary lifestyle, a poor diet, and limited time or places for recreational activities underlie the high depresogenic potential of our current lifestyles. In contrast, activities that include exercise, meaningful social interactions, recreational activities, exposure to natural environments, a balanced diet, and healthy routines would represent a highly effective strategy for managing depression and improving overall health.</p> 2021-12-06T00:00:00-06:00 ##submission.copyrightStatement## Energy expenditure and time spent on physical activity in Costa Rican schoolchildren with overweight or obesity by means of the Actiheart accelerometer 2022-01-26T13:51:23-06:00 Juan Diego Zamora Salas Adriana Laclé Murray <p><strong>Objective:</strong> To determine the energy expenditure and time spent on physical activities in Costa Rican overweight or obese schoolchildren in free-living conditions. <strong>Methodology:</strong> Participants were 31 boys and 13 girls aged 6 to 9 years old (7.6 ± 1.03 years) with overweight or obesity; nutritional status was established by BMI. The variables of the study were: anthropometric, body fat percentage (%BF), total energy expenditure product of physical activity performed during the day (EEPA daily total), plus the energy expenditure by physical activity (EEPA), and time spent on physical activity (TPA), both variables in sedentary condition, light, moderate and vigorous intensity estimated by the Actiheart accelerometer. <strong>Results:</strong> Size and %BF were significantly higher in girls (126.8 ± 5.9 cm, 34.0 ± 6.4% BF) than in boys (123.0 ± 5.4 cm, 25.2 ± 6.9% BF). Boys recorded a daily total EEPA of 824 ± 228.1 &nbsp;kcal / day, moderate + vigorous EEPA &nbsp;285.6 ± 131.7 kcal / day and a moderate + vigorous TPA 147.0 ± 66.6 min; significantly higher (P &lt;0.05) than girls 395 ± 144.4 kcal / day, 139.6 ± 90.1 kcal / day and 75.6 ± 43.2 min respectively . <strong>Conclusions: </strong>&nbsp;Schoolchildren perform over 60 min/day moderate to vigorous intensity PA recommended, however; the EEPA moderate to vigorous intensity does not meet the minimum recommendation of 300 kcal / day for weight reduction. This could be one of the causes for overweight schoolchildren.</p> 2021-12-06T00:00:00-06:00 ##submission.copyrightStatement## Identification of chromosomal aberrations in a Costa Rican children population with idiopathicintellectual disability 2022-01-26T13:51:25-06:00 Melissa Abarca Ramírez Fernando Morales Montero Rebeca Vindas Smith Fernando Ortiz Morales Isabel Castro Volio <p>The prevalence of intellectual disability (ID) in the global population is 3%. One of the most frequent cause of ID are chromosome aberrations, which are easily detected by a karyotype. However, many of these maygoundetected during a conventional cytogenetic analysis because of their length.These small alterations can be localized in the subtelomeres and it has been observed that when localized there, they are an important cause of ID in patients without a causality diagnostic. In this observational study, we use the MLPA technique for the purpose of identifying the frequency of submicroscopicsubtelomere chromosomal aberrations in a population of people with ID of unknown origin. 70 samples were successfully analyzed with MLPA and we found one case with a microduplication in the 17p subtelomere for a frequency of 1,4%. Also,the karyotype was performed in 33cases, and we foundone case with a chromosome aberration that can be detect by microscope for a frequency of 3%. The subtelomeric chromosome aberration frequency was lower than expected as we compare our results with similar studies. Finally, with this work we conclude that the karyotype and the MLPA technique complement each other for approaching people with ID of unknown origin.</p> 2021-12-06T00:00:00-06:00 ##submission.copyrightStatement## Substance dependence in Costa Rica: epidemiological and neurobiological aspects of a misunderstood disease 2022-01-26T13:51:27-06:00 Andrey Sequeira Cordero Marilyn Blanco-Vargas Juan Carlos Brenes Sáenz <p><strong>Introduction:</strong> It has been estimated that 80% to 90% of the population worldwide has ever consumed psychoactive substances (PAS), but only 15% will develop addiction. The goal of the current essay is to describe concisely the epidemiological background, the clinical foundations, and neurobiological mechanisms of addiction. Finally, it will briefly examine some environmental strategies aimed to prevent and/or treat addiction. Addiction is not a simple vice consequence of laziness or lack of character, but a neuropsychiatric disorder that must be recognized as such. <strong>Proposal:</strong> To attain this ultimate goal, the etiological factors and the neurobiological mechanisms of addiction must be revealed and disseminated. <strong>Arguments for discussion: </strong>All PAS directly or indirectly activate the mesolimbic dopaminergic system, which –after repeated intake– sensitizes and desensitizes the motivational and the hedonic system, respectively. This phenomenon causes PAS to be consumed more frequently and at higher doses despite their effects being progressively less rewarding. Consequently, the physical and emotional distress derived from the withdrawal syndrome exacerbates the compulsive PAS intake, while the completely loss of control results from impairments in the executive functions and the prefrontal cortex. <strong>Conclusions:</strong> Addiction is a brain disease induced by the chronic consumption of PAS combined with neurobiological and psychosocial risk factors. Exposure social contact, physical exercise, and sensory-cognitive stimulation may constitute a highly effective strategy for preventing and treating addiction and improving mental health as well.</p> 2021-12-07T00:00:00-06:00 ##submission.copyrightStatement## Micronucleus assay as biomarker of DNA damage in population exposed to ionizing radiation 2022-01-26T13:51:29-06:00 Fabio Andrés Chaves-Campos Luisa Valle Bourrouet Wendy Malespín-Bendaña Vanessa Ramírez-Mayorga <p><strong>Introduction: </strong>Ionizing radiation (IR) is capable of causing DNA damage. For the evaluation of this phenomenon it is possible to use chromosomal aberrations as biomarkers. The “Cytokinesis-Block Micronucleus assay” (CBMN) is a cytogenetic technique that allows to demonstrate the effect of genotoxic agents. <strong>Proposition: </strong>in the present review, we will describe the molecular mechanisms involved in micronucleus radioinduction, the micronucleus technique and criteria for analysis, its applications within biological research and its extension in clinical research, with emphasis on its application as a biomarker of radioinduced genetic damage. <strong>Arguments for discussion:</strong> the CBMN is considered a reliable, simple and fast technique and there is evidence of its applicability in the evaluation of biological effects in occupationally exposed personnel and in isolated or large-scale radiological accidents. <strong>Conclusions:</strong> the CBMN a valuable tool in estimating radiological risk in populations exposed to low doses of IR, allowing to guide decision-making regarding prevention or mitigation of exposure to IR in populations involved. Similarly, the CBMN can be used in research in the field of radiobiology, as a means to describe the effects of ionizing radiation on DNA.</p> 2021-12-07T00:00:00-06:00 ##submission.copyrightStatement## Exploratory multigroup structural equation modeling approach to analyzing H. pylori infection, serological pepsinogen levels, and life style factors in an elderly population in Costa Rica. 2022-01-26T13:51:31-06:00 Gabriel Molina-Castro Stefany Matarrita-Muñoz Silvia Elena Molina-Castro Ericka Méndez-Chacón Clas Une Vanessa Ramírez-Mayorga <p>The aim of this work is to describe and analyze the association of PGI/PGII ratio (indicator of gastric atrophy) with H. pylori-CagA and life style factors such as caloric intake, obesity, and harmful habits amongst H. pylori-positive elderly people infected in Costa Rica using an exploratory multigroup structural equations model (SEM). Using a sample of 1748 H. pylori-positive elderly people from CRELES first wave study, a SEM was employed analyze if the relationships between PGI/PGII ratio with levels of H. pylori-CagA, caloric intake, obesity, and harmful habits, differs by sex, age and risk areas subgroups. The proposed SEMs exhibited a good fit in males (RMSEA = 0.039), females (RMSEA = 0.000), low-risk area (RMSEA = 0.038), middle-risk area (RMSEA = 0.042), individuals under 80 years (RMSEA = 0.038) and individuals aged 80 and over (RMSEA = 0.042), while an acceptable fit was observed for the high-risk area (RMSEA = 0.061). Fitted SEMs showed that CagA predicted PG-ratio as expected, with effects increasing with the risk area, but similar between sex and age groups. All indicators measuring obesity (BMI, arms, and waist) showed significant standardized coefficients, with similar effects between sex, age and risk area groups. No other significant effects or differences between groups were identified. We propose a good-fitted SEM model for the possible relationships between CagA and PG ratio and the geographical risk area level for elderly people. No differences were observed on measured parameters between male and female population, or between under 80 years and older individuals.</p> 2021-12-07T00:00:00-06:00 ##submission.copyrightStatement## Inequalities in the early detection of cervical cancer: a reality in the Costa Rica 2022-01-26T13:51:33-06:00 Carolina Santamaría-Ulloa Melina Montero-López Hazel Quesada-Leitón Ileana Quirós-Rojas <p><strong>Introduction: </strong>Cervical cancer is one of the most common cancer types that affects the health of women worldwide. <strong>Objective: </strong>To determine if there are differences in the use of Pap smears at the regional level in Costa Rica, in order to visualize the inequalities related to the early detection of cervical-uterine cancer. <strong>Methodology</strong>. This study was conducted based on information from the 2014 National Household Survey. This survey is representative at the national level. R-Studio was used to estimate two multinomial regression models. The first one was used to explain the time that has elapsed since the last time women had a Pap smear. The second one was used to explain the reasons why women had never had a Pap smear. Data on the incidence of cervical cancer, from the National Tumor Registry of the Ministry of Health, were used in order to estimate the in-situ/invasive ratio. <strong>Results</strong>: Women who participate less regularly in screening are those residing in the Chorotega, Central Pacific and Huetar Caribbean regions. Compared to women in the Central region, women in these three regions are 80% (OR=1.80; p&lt;0.01), 52% (OR=1.52; p=0.031) and 58% (OR=1.58; p&lt;0.01) respectively more likely to have had a Pap screening 5 or more years ago, as compared to 1 to 2 years ago. <strong>Discussion</strong>: According to the results of this research, the Chorotega Region presents the most disadvantageous conditions in terms of the use of PAP, which represents a higher risk for women to develop lesions and cervical cancer. <strong>Conclusions</strong>: In order to reduce gaps and improve conditions of access to prevention, it is necessary to coordinate institutional efforts, both governmental and non-governmental, as well as the participation and protagonism of women.</p> 2021-12-07T14:23:47-06:00 ##submission.copyrightStatement## Helicobacter pylori infection and serum pepsinogen concentrations in an elderly population representative of Costa Rica 2022-01-26T13:51:35-06:00 Clas Une Wendy Malespín Bendaña Vanessa Ramírez-Mayorga Luis Rosero Bixby Rafaela Sierra Ramos <p><strong>INTRODUCTION:</strong> Costa Rica has among the highest mortality rates from gastric cancer in the world, largely due to late detection. It is therefore important that economically and logistically sustainable screening is implemented in order to detect risk of developing cancer. We have previously shown that low pepsinogen (PG) values and infection with <em>Helicobacter pylori</em>-CagA+ are associated with risk of gastric atrophy and cancer in Costa Rican populations. &nbsp;<strong>OBJECTIVES:</strong> To determine how markers for gastric cancer risk are distributed in an elderly population representative of Costa Rica in order to design a screening strategy. <strong>METHODS:</strong> The population studied consists of 2,652 participants in a nationally representative survey of ageing. Information concerning epidemiologic, demographic, nutritional and life style factors is available. Serum PG concentrations as well as <em>H. pylori </em>and CagA status were determined by serology. Possible associations were determined by regression analyses. <strong>RESULTS:</strong> Antibodies to <em>H. pylori</em> were present in 72% of the population and of those, 58% were CagA positive. Infection with <em>H. pylori</em> was associated with higher PGI concentrations (p=0.000) and infection with <em>H. pylori</em>-CagA<sup>+</sup> with lower PGI concentrations (p=0.025). Both showed association with lower PGI/PGII (p=0.006 and p=0.000). Higher age was associated with lower prevalence of <em>H. pylori</em> infection (OR=0.98; p=0.000) and CagA<sup>+</sup> (OR=0.98; p=0.000) but not with PG values. Regions with high risk of gastric cancer showed lower PGI (p=0.004) and PGI/PGII values (p=0.021) as well as higher prevalence of <em>H. pylori</em> infection (OR=1.39; p=0.013) but not CagA<sup>+</sup>. Using cut-off values of PGI&lt;100 µg/L and PGI/PGII&lt;2.0, 2.5 and 3.0, 7-15% of the population would be considered at risk. <strong>CONCLUSIONS:</strong><em> H. pylori </em>alone is not a useful marker for risk of gastric cancer. Screening using serum pepsinogen concentrations and infection with <em>H. pylori</em>-CagA<sup>+</sup> is feasible in the general elderly population of Costa Rica but appropriate cut-off values have to be determined based on more clinical data and follow up capacity.</p> 2022-01-01T00:00:00-06:00 ##submission.copyrightStatement##