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Urbanization transforms environments in ways that alter biological evolution. We examined whether urban environmental change drives parallel evolution by sampling 110,019 white clover plants from 6169 populations in 160 cities globally. Plants were assayed for a Mendelian antiherbivore defense that also affects tolerance to abiotic stressors. Urban-rural gradients were associated with the evolution of clines in defense in 47% of cities throughout the world. Variation in the strength of clines was explained by environmental changes in drought stress and vegetation cover that varied among cities. Sequencing 2074 genomes from 26 cities revealed that the evolution of urban-rural clines was best explained by adaptive evolution, but the degree of parallel adaptation varied among cities. Our results demonstrate that urbanization leads to adaptation at a global scale.

Historically, there has been a debate on the effects of recessions on population health, and especially on mortality and its distribution across different social groups. This paper contributes to this discussion by means of a critical review of the research on the impact of economic recessions on mortality inequalities in the period 1980-2020. We analyzed 19 studies according to their mortality outcomes, socioeconomic indicators, design, analysis, and main findings. Twelve studies focused on European countries or urban areas, two on Asian countries, two on Russia, one on Asia and Europe, one on the USA, and one in Somalia. Five articles included cross-country comparisons (four between European countries or cities and one between Asian and European countries). The Great Recession of 2008 was the most researched economic crisis, followed by country-specific crises in the 90s, the fall of the Soviet Union, and some crises during the 80s. Most studies (n = 15) showed an overall or partial increase in mortality inequalities after an economic recession. However, two papers found a decrease in mortality inequalities due to the worsening of the health of the upper and middle classes, one article found a decrease in inequalities due to a general improvement in population health, and a study found a "slow-down" effect of pre-existent mortality inequalities., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Introduction: Children under five years of age living in poor areas and with low availability of healthy food have a higher risk of undernutrition-related mortality. However, this relationship has not been well established among older adults., Objective: To analyse socioeconomic inequality trends related to undernutrition mortality in children under five years of age and adults over 60 in Colombian municipalities during 2003-2009 and 2010-2016., Materials and Methods: We conducted an ecological study of trends between 2003 and 2016. The study population consisted of children under five years of age and adults over 60 residing in the Colombian municipalities during the study period. We estimated smoothed and standardized mortality rates by fitting a hierarchical Bayesian model and explored their relationship with five socioeconomic area-level variables., Results: In most of the municipalities, undernutrition-related mortality was three times higher in older adults compared to children. Moreover, the difference in the risk of undernutrition-related mortality between municipalities showed a marked reduction. Finally, the poor and less developed municipalities had higher rates of undernutrition-related mortality in children; conversely, wealthier territories had higher rates in older adults., Conclusions: Although in most of the municipalities the mortality rates due to undernutrition in children under five and older adults have decreased, their socioeconomic conditions influence in different ways the risk of mortality for these two populations so there is the need to develop age-specific strategies to close social gaps considering the structural conditions of the areas.

Objective: To describe eating behaviors in a group of overweight pregnant women., Material and Methods: Qualitative study from the focused ethnography perspective that included pregnant women over the age of 18 years, with overweight or obesity or excess weight gain during pregnancy, who attended the pre-natal care program at two public healthcare institutions belonging to the government-subsidized regime under the General Social Security System in two municipalities of the Department of Antioquia (Colombia). Thirteen individual semi-structured and three group interviews were carried out. Analysis was based on triangulation and open and axial coding., Results: Overall, 22 pregnant women participated in the study. Five determinants of eating behavior in this population were found: low socioeconomic level that limits access to a variety of foods, social support network, health condition during previous pregnancies or during the current gestation, generic dietary and nutritional recommendations provided by healthcare staff and, finally, knowledge of the participants regarding diet and the implications of maternal overweight for the health of the mother and the child., Conclusion: It is imperative to provide dietary and nutritional education and care based on the particular characteristics that influence the adoption of changes in eating behaviors among overweight pregnant women; prenatal care professionals must be trained to promote standardized criteria and care that is tailored to the social reality of the pregnant woman., (Copyright (c) 2021 Revista Colombiana de Obstetricia y Ginecología)

Dengue is the most prevalent arthropod-borne viral disease in humans, primarily transmitted by the Aedes aegypti mosquito. We conducted a descriptive analysis of dengue cases from 2009 to 2017 in Medellín, Colombia, using data available from the Secretariat of Health. We analyzed the burden of outbreak years on the healthcare system, risk of cases exhibiting severe illness, potential disease surveillance problems, gender and age as risk factors, and spatiotemporal patterns of disease occurrence. Our data consisted of 50,083 cases, separated based on whether they were diagnostic test negative, diagnostic test positive (primarily IgM ELISA), clinically confirmed, epidemiologically linked, or probable. We used dengue incidence to analyze epidemiological trends between our study years, related to human movement patterns, between gender and age-groups, and spatiotemporally. We used risk to analyze the severity of dengue cases between the study years. We identified human movement could contributed to dengue spread, and male individuals (incidence rate: 0.86; 95% CI: 0.76-0.96) and individuals younger than 15 years (incidence rate: 1.24; 95% CI: 1.13-1.34) have higher incidence of dengue and located critical parts of the city where dengue incidence was high. Analysis was limited by participant diagnostic information, data concerning circulating strains, and a lack of phylogenetic information. Understanding the characteristics of dengue is a fundamental part of improving the health outcomes of at-risk populations. This analysis will be useful to support studies and initiatives to counteract dengue and provide context to the surveillance data collected by the health authorities in Medellín.

Background: Delay in tuberculosis (TB) diagnosis is one of the first obstacles for controlling the disease. Delays generate greater deterioration of the health of the patients and increase the possibilities of transmission and infection at home and in the community. The aim of the study was to identify profiles and individual variables associated with patient delays and health care system delays in patients with pulmonary tuberculosis (PTB) in Medellín, Colombia, a city that notifies 1400 new cases per year., Methods: A retrospective cohort study in adults with PTB was conducted from May to September of 2017. Sociodemographic, health care-seeking behaviour, and clinical variables were measured. The outcomes were patient delay and health care system delay. The data were obtained from records of the local TB program, and a questionnaire was applied by the health care team that performs routine field visits. Simple correspondence analysis was used to identify groups (profiles), and their characteristics. Cox's proportional hazards model was carried out to identify the variables associated with the delays., Results: The study included 183 patients. The total delay median was 101 days (IQR: 64-163). Patient delay was of 35 days (IQR: 14-84), the profile with greater delay belonged to consumers of psychoactive substances. The health care system delay was of 27 days (IQR: 7-89), the attributes of the profile with greater delay were being a female, having more than two consultations before the diagnosis, and having prescribed antibiotics. Basic-medium educational level [HR a  = 0.69; 95% CI (0.49-0.97)] and having a TB home contact [HR a  = 0.68; 95% CI (0.48-0.96)] were associated with greater patient delay. Having negative acid-fast bacilli (AFB) smear [HR a  = 0.64; 95% CI (0.45-0.92)] and more than two consultations before the diagnosis [HR a  = 0.33; 95% CI (0.22-0.49)] was associated with greater health care system delay., Conclusions: Data from epidemiological surveillance allowed locating risk groups with delays in TB diagnosis which requires the prioritisation of the local TB control program to promote early detection and prevention of adverse outcomes.

American visceral leishmaniasis (VL) is a vector-borne disease caused by Leishmania infantum (syn. chagasi ) and transmitted by Lutzomyia longipalpis and Lutzomyia evansi phlebotomine sand flies. Dogs not only are the main host reservoirs of the parasite but also suffer the disease; therefore, canine VL (CVL) has assumed an important role in public health. In Colombia, human and CVL are restricted to two transmission foci: one in the north region (Caribbean coast) and other in the central south region (middle Magdalena River Valley). We present a CVL case involving a 2-year-old male dog with a history of lack of appetite, general weakness, and progressive loss of weight. A diagnosis of CVL was obtained using the direct parasitological examination in spleen and bone marrow samples stained with Giemsa and RT-qPCR. The infecting Leishmania species was identified as L. infantum by PCR-restriction fragment length polymorphism amplifying the Hsp70 gene from bone marrow and spleen samples and confirming by sequencing. The patient responded favorably to treatment with intramuscular meglumine antimoniate at a dose of 100 mg/kg daily for 8 weeks and oral allopurinol at a dose of 10 mg/kg every 12 hours until new indication. This is the first report of urban CVL in the city of Cali, Colombia, highlighting the need for surveillance and control programs in the municipalities of the department of Valle del Cauca, a region where VL has not been informed before. The findings also indicate the need to reinforce the surveillance programs in other rural and urban regions of the country where favorable eco-epidemiological conditions exist.

Type 2 diabetes mellitus prevalence has increased worldwide, especially in low- and middle-income countries. This study aimed to evaluate in the Colombian context whether the geographic variations of mortality due to type 2 diabetes mellitus are random or statistically significant and to measure the effect of the socioeconomic conditions of municipalities on these variations. An ecological study of trends for regions and subregions was undertaken considering two periods (2003-2009 and 2010-2016). The study population consisted of adults of 20 to 79 years old residing in each of Colombia's municipalities during the period 2003-2016. Smoothed and standardized mortality rates were obtained by fitting a hierarchical Bayesian model, which considers the spatial structure of the data. Four socioeconomic variables related to municipal deprivation and development were included into the model to obtain their relative risk (RR) and 95% credible intervals. Mortality due to type 2 diabetes mellitus decrease between 2003 and 2016 in Colombia, both nationally and regionally. In addition, there was a clear positive association between mortality due to diabetes mellitus and the level of municipal development; the wealthiest and most developed municipalities had higher mortality risks.

Chikungunya virus (CHIKV) emerged in Colombia in 2014 into a population presumed fully susceptible. This resulted in a quick and intense spread across Colombia, resulting in an epidemic that affected an estimated 450,000 people. The reported Colombian cases accounted for over 49% of all the cases reported to the PAHO. Eco-environmental factors are known to be associated with the spread of arboviruses such as CHIKV, and likely contribute to the differences in transmission profiles that were observed across several municipalities. To determine the association of eco-environmental factors and CHIKV, the basic reproduction number (R0) in 85 municipalities, which accounted for 65.6% of reported CHIKV cases in Colombia, was estimated. Estimates of R0 ranged from 1 to 9, where over 76% of municipalities had R0 values between 1 and 2. When we looked at the distribution of R0, the cumulative proportions were 20% with R0>2, 14% with R0>3, and 9% with R0>4. Next, we determined that there were different patterns of correlation between environmental and/or ecological variables and R0 when we considered different R0 lower-thresholds. Broadly, we found that temperature-related variables are significantly and positively correlated to R0 regardless of the lower threshold, while other variables like duration of outbreak and size of the urban area are inversely related to R0. Specifically, we conclude that high values of temperature-related variables where R0 > 1 will result in a fast growth of cases in a shorter time period (with faster cessation of outbreak transmission) but will result overall in a fewer total cases compared to outbreak areas (R0 > 1, but classified as lower). Thus, in the absence of vector control, a less explosive outbreak may be more advantageous for the virus in terms of transmission., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Dengue, mainly transmitted by Aedes aegypti, is a very important viral disease in terms of public health. Colombia is an endemoepidemic country for dengue and, in cities like Medellín, there are neighborhoods with high and low incidence. The disease dynamics in the neighborhoods might be determined by differences in the knowledge, practices and entomological aspects of the vector among the communities. Objective: To identify the knowledge and practices of residents of neighborhoods with high and low incidence of dengue, and to explore the entomological aspects related to the presence of the vector. Materials and methods: We conducted a cross-sectional study comparing two neighborhoods with high incidence and two with low incidence during the triennium of 2013-2015. A random sample of 100 houses per neighborhood was selected in order to evaluate the knowledge, practices and entomological aspects related to dengue. In addition, descriptive, bivariate and multivariate analyses (logistic regression) were performed. Results: In neighborhoods with high incidence, participants had not attended school or had only a primary school level of education (OR=1.69; 95% CI: 1.09-2.63). Additionally, they did not have health coverage or belonged to the subsidized regime (OR=2.16; 95% CI: 1.41-3.32). In contrast, they had a greater knowledge of the vector (OR=1.53; 95% CI: 1.00-2.35). In terms of practices, there was a greater chance of finding houses where water was stored (OR=1.69; 95% CI: 1.11-2.57) and regarding the entomological aspects, more houses with adult mosquitoes were found (OR=2.13 95% CI: 1.29-3.50). Conclusions: We found important differences among the neighborhoods regarding knowledge, practices, and the presence of adult stages of the vector, which helps to explain the epidemiology of dengue in these sites.

Introduction: In Colombia there are three Anopheles species implicated in malaria transmission as primary vectors; however, the local role of some Anopheles species must still be defined., Objective: To determine the abundance, composition and natural infection rates for Anopheles mosquitoes with Plasmodium spp. in two malaria-endemic regions of Colombia., Materials and Methods: Anopheles mosquitoes were collected using the human-landing catches and while resting in livestock corrals in nine localities of two malaria-endemic regions of Colombia. Mosquitoes were morphologically identified and confirmed by PCR-RFLP-ITS2. Identified mosquitoes were processed and tested for Plasmodium parasite infection by ELISA and ssrRNA-based nested PCR., Results: We collected 1,963 Anopheles mosquitoes corresponding to nine species. The most abundant species were Anopheles nuneztovari (53.5%) and A. darlingi (34.5%), followed by A. triannulatus s.l. (6%), and other species (≈5.9%). Three species were naturally infected with Plasmodium spp.: A. darlingi, A. nuneztovari and A. triannulatus s.l., Conclusions: Natural infection of A. darlingi and A. nuneztovari indicate that these malaria vectors continue to be effective carriers of Plasmodium in the localities under study in Valle del Cauca and Chocó. Additionally, the infected A. triannulatus s.l. collected in livestock corrals in the locality of the department of Córdoba suggests the need for further studies to define the epidemiological importance of this species given its abundance and opportunistic anthropophilic behavior.

Introduction: Aedes (Stegomyia) aegypti is the main vector of dengue. Chemical insecticides have been used to control the mosquito and it has developed resistance. It is necessary to evaluate alternative strategies that are efficient, economical and easy to apply, such as ovitraps with Bacillus thuringiesis israeliensis ., Objective: To evaluate the impact of ovitraps loaded with B. t. israeliensis on traditional indexes, as strategies for surveillance and control of A. aegypti ., Materials and Methods: We selected eight neighborhoods from the municipalities of Apartadó and Carepa. Two neighborhoods in each municipality were chosen for intervention and two for control. The intervention consisted in the installation of ovitraps with B. t. israeliensis in every house. The traps were visited each month between September, 2009, and March, 2010. Traditional indexes were obtained and compared among the neighborhoods. Ovitrap positivity index and egg density index were calculated and we generated density maps., Results: Five hundred and nineteen ovitraps were placed monthly; 3,114 samples were obtained, from which 76.4% were positive. We collected 501,425 eggs. In Apartadó, statistically significant differences were observed in the house, container and Breteau indexes. The ovitrap positivity index showed high risk of A. aegypti infestation and traditional indexes showed medium and low risk levels., Conclusions: Ovitraps had an impact on traditional indexes and proved to be useful strategies for surveillance and control of A. aegypti in Urabá, Antioquia.