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Environmental exposures and gene-exposure interactions are the major causes of some diseases. Early-life exposome studies are needed to elucidate the role of environmental exposures and their complex interactions with biological mechanisms involved in childhood health. This study aimed to determine the contribution of early-life exposome to DNA damage and the modifying effect of genetic polymorphisms involved in air pollutants metabolism, antioxidant defense, and DNA repair. We conducted a cohort study in 416 Colombian children under five years. Blood samples at baseline were collected to measure DNA damage by the Comet assay and to determine GSTT1, GSTM1, CYP1A1, H2AX, OGG1, and SOD2 genetic polymorphisms. The exposome was estimated using geographic information systems, remote sensing, LUR models, and questionnaires. The association exposome-DNA damage was estimated using the Elastic Net linear regression with log link. Our results suggest that exposure to PM2.5 one year before the blood draw (BBD) (0.83, 95 %CI: 0.76; 0.91), soft drinks consumption (0.94, 0.89; 0.98), and GSTM1 null genotype (0.05, 0.01; 0.36) diminished the DNA damage, whereas exposure to PM2.5 one-week BBD (1.18, 1.06; 1.32), NO2 lag-5 days BBD (1.27, 1.18; 1.36), in-house cockroaches (1.10, 1.00; 1.21) at the recruitment, crowding at home (1.34, 1.08; 1.67) at the recruitment, cereal consumption (1.11, 1.04; 1.19) and H2AX (AG/GG vs. AA) (1.44, 1.11; 1.88) increased the DNA damage. The interactions between H2AX (AG/GG vs. AA) genotypes with crowding and PM2.5 one week BBD, GSTM1 (null vs. present) with humidity at the first year of life, and OGG1 (SC/CC vs. SS) with walkability at the first year of life were significant. The early-life exposome contributes to elucidating the effect of environmental exposures on DNA damage in Colombian children under five years old. The exposome-DNA damage effect appears to be modulated by genetic variants in DNA repair and antioxidant defense enzymes.

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Exposome studies are advancing in high-income countries to understand how multiple environmental exposures impact health. However, there is a significant research gap in low- and middle-income and tropical countries. We aimed to describe the spatiotemporal variation of the external exposome, its correlation structure between and within exposure groups, and its dimensionality. A one-year follow-up cohort study of 506 children under 5 in two cities in Colombia was conducted to evaluate asthma, acute respiratory infections, and DNA damage. We examined 48 environmental exposures during pregnancy and 168 during childhood in eight exposure groups, including atmospheric pollutants, natural spaces, meteorology, built environment, traffic, indoor exposure, and socioeconomic capital. The exposome was estimated using geographic information systems, remote sensing, spatiotemporal modeling, and questionnaires. The median age of children at study entry was 3.7 years (interquartile range: 2.9-4.3). Air pollution and natural spaces exposure decreased from pregnancy to childhood, while socioeconomic capital increased. The highest median correlations within exposure groups were observed in meteorology (r = 0.85), traffic (r = 0.83), and atmospheric pollutants (r = 0.64). Important correlations between variables from different exposure groups were found, such as atmospheric pollutants and meteorology (r = 0.76), natural spaces (r = -0.34), and the built environment (r = 0.53). Twenty principal components explained 70%, and 57 explained 95% of the total variance in the childhood exposome. Our findings show that there is an important spatiotemporal variation in the exposome of children under 5. This is the first characterization of the external exposome in urban areas of Latin America and highlights its complexity, but also the need to better characterize and understand the exposome in order to optimize its analysis and applications in local interventions aimed at improving the health conditions and well-being of the child population and contributing to environmental health decision-making.

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Rapidly urbanizing cities in Latin America experience high levels of air pollution which are known risk factors for population health. However, the estimates of long-term exposure to air pollution are scarce in the region. We developed intraurban land use regression (LUR) models to map long-term exposure to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) in the five largest cities in Colombia. We conducted air pollution measurement campaigns using gravimetric PM2.5 and passive NO2 sensors for 2 weeks during both the dry and rainy seasons in 2021 in the cities of Barranquilla, Bucaramanga, Bogotá, Cali, and Medellín, and combined these data with geospatial and meteorological variables. Annual models were developed using multivariable spatial regression models. The city annual PM2.5 mean concentrations measured ranged between 12.32 and 15.99 µg/m3 while NO2 concentrations ranged between 24.92 and 49.15 µg/m3. The PM2.5 annual models explained 82% of the variance (R2) in Medellín, 77% in Bucaramanga, 73% in Barranquilla, 70% in Cali, and 44% in Bogotá. The NO2 models explained 65% of the variance in Bucaramanga, 57% in Medellín, 44% in Cali, 40% in Bogotá, and 30% in Barranquilla. Most of the predictor variables included in the models were a combination of specific land use characteristics and roadway variables. Cross-validation suggests that PM2.5 outperformed NO2 models. The developed models can be used as exposure estimate in epidemiological studies, as input in hybrid models to improve personal exposure assessment, and for policy evaluation.

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This topic review aims to present a global vision of multilevel analysis models' applicability to health research, explaining its theoretical, methodological, and statistical foundations. We describe the basic steps to build these models and examples of their application according to the data hierarchical structure. It ir worth noticing that before using these models, researchers must have a rationale for needing them, and a statistical evaluation accounting for the variance percentage explained by the observations grouping effect. The requirements to conduct this type of analysis depends on special conditions such as the type of variables, the number of units per level, or the type of hierarchical structure. We conclude that multilevel analysis models are a useful tool to integrate information, considering the complexity of the relationships and interactions involved in most health conditions, including the loss of independence between observation units.

Este trabajo tiene como objetivo presentar una mirada global de la aplicabilidad de los modelos de análisis multinivel en el ámbito de la investigación sanitaria. Ofrece información sobre los fundamentos teóricos, metodológicos y estadísticos y, además, menciona los pasos básicos para la construcción de estos modelos, y da ejemplos de su uso, según la estructura jerárquica de los datos. Cabe resaltar que, antes de utilizar estos modelos, se requiere contar con un soporte teórico sobre la necesidad de uso y una valoración estadística que dé cuenta del porcentaje de varianza explicada por el efecto de agrupación de las observaciones. Los requisitos para llevar a cabo este tipo de análisis dependen de condiciones especiales como el tipo de variables, la cantidad de unidades por nivel o el tipo de estructura jerárquica. Se concluye que los modelos de análisis multinivel son una herramienta útil para lograr la integración de información, dadas la complejidad de las relaciones y las interacciones que determinan la mayoría de las condiciones de salud, incluida la pérdida de independencia entre las unidades de observación.

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Introducción: Colombia es uno de los países con mayor número de casos de COVID-19 en América Latina y el Caribe. Los gobiernos no pueden trabajar solos en una crisis de gran intensidad, por lo que las alianzas y la colaboración Gobierno-academia toman un valor preponderante. Objetivo: Sistematizar la experiencia del trabajo colaborativo que se realizó entre actores académicos de la región y las autoridades de salud del departamento de Santander, Colombia, en el marco de la emergencia sanitaria por COVID-19 durante 2020-2021. Metodología: A partir de la sistematización de experiencias y desde el enfoque crítico social se realizó un abordaje cualitativo con ocho actores clave del sector académico y de la autoridad en salud que participaron activamente en la alianza. Se hizo una revisión documental y se realizaron entrevistas semiestructuradas. Resultados: Una vez declarada la emergencia sanitaria, de manera rápida se conformaron dos grupos de trabajo colaborativo, uno entre academia y actores gubernamentales del municipio de Bucaramanga y otro entre academia y actores gubernamentales departamentales; ambos grupos se conformaron de manera voluntaria, pero se diferenciaron en su forma de organización. El trabajo colaborativo y voluntario brindó apoyo a las autoridades en salud, principalmente en la fase de preparación para afrontar la pandemia, traducción y difusión del conocimiento, vigilancia epidemiológica y actividades de fortalecimiento de la capacidad de respuesta. Conclusiones: El apoyo brindado por el equipo colaborativo fue muy proliferativo en actividades e intervenciones, no obstante, se presentaron dificultades y una de ellas fue que un número importante de sus recomendaciones no fueron atendidas por las autoridades sanitarias. Las dificultades presentadas no son diferentes a las ya reportadas en otras emergencias de salud pública, por lo que se requiere continuar fortaleciendo las relaciones Gobierno-academia para que se pueda trazar de manera proactiva una agenda que contribuya a superar las limitaciones que se reportan en este trabajo.

Introduction: Colombia is one of the countries with the highest number of COVID-19 cases in Latin America and the Caribbean. In a health crisis of high intensity, governments cannot work alone, so alliances and collaboration between Government and academia take on a preponderant value. Objective: Systematize the experience of the collaborative work carried out between academic actors in the region and the health authorities from the Department of Santander, Colombia in the framework of the health emergency due to COVID-19 during 2020-2021. Methods: Based on the systematization of experiences and from the critical social approach, a qualitative approach was carried out with eight key actors from the academic sector and the health authority that actively participated in the alliance. Documentary review and semi-structured interviews were conducted. Results: Once the health emergency was declared, two collaborative working groups were quickly formed, one between academia and government actors of the municipality of Bucaramanga and another between academia and departmental government actors; both groups were formed voluntarily but differed in their form of organization. The collaborative and voluntary work provided support to health authorities mainly in the preparation phase to face the pandemic, knowledge translation and dissemination, epidemiological surveillance, and response capacity-building activities. Conclusions: The support provided by the collaborative team was very proliferative in activities and interventions; however, difficulties occurred and one of them was that a significant number of their recommendations were not addressed by the health authorities. The difficulties presented are not different from those already reported in other public health emergencies, so it is necessary to continue strengthening the relations between Government-Academia, so that they can proactively draw up an agenda that contributes to overcoming the limitations that are reported in this work.

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Los barrenadores del tallo del género de Diatraea spp. (Lepidoptera:Crambidae) han sido reconocidos por ser la plaga de mayor impacto en el cultivo de caña de azúcar, en el que causan importantes pérdidas económicas. Para su control, una cepa colombiana de Beauveria bassiana (Bals.) Vuill (aislamiento Bv062) que demostró alta virulencia frente a larvas de D. saccharalis (Fabricius), fue utilizada para el desarrollo de un bioinsecticida formulado como un concentrado emulsionable (CE). Con el fin de integrar este bioinsecticida en un esquema de manejo integrado de plagas, es necesario evaluar su compatibilidad con los agroquímicos utilizados comúnmente en el cultivo de caña de azúcar. Para tal fin se evaluó el efecto in vitro de 11 agroquímicos (fungicidas, insecticidas y herbicidas) sobre la germinación y actividad insecticida de conidios formulados. Inicialmente el CE y los agroquímicos fueron ajustados al doble de la concentración recomendada y mezclados en proporción 1:1, se incubaron durante dos horas, y se determinó el porcentaje de germinación. Los conidios expuestos a los agroquímicos fueron también purificados y utilizados para un bioen-sayo frente a larvas de segundo instar de D. saccharalis. El CE resultó ser compatible con los herbicidas e insecticidas evaluados, manteniendo una germinación y eficacia superior al 80%. Por el contrario, el CE fue incompatible con todos los fungicidas evaua-dos. Estos resultados permiten sugerir recomendaciones de aplicación del bioplaguicida a base de B. bassiana Bv062, junto con insecticidas y herbicidas empleados en el cultivo de caña, pero se recomienda no aplicarlo de manera simultánea con fungicidas como el benomil y del grupo de triazoles. Se recomienda validar estos resultados en condiciones de campo.

Sugarcane stem borers of the genus Diatraea spp. (Lepidoptera:Crambidae) have been recognized as the pest of the greatest impact on sugarcane crops causing significant economic losses. For its control, a colombian strain of Beauveria bassiana (Bals.) Vuill (code Bv062) that showed a high virulence against D. saccharalis (Fabricius) larvae was used for a biopesticide development, formulated as emulsifiable concentrate (EC). In order to include the EC into an integrated pest management (IPM) scheme, it is necessary to evaluate its compatibility with the agrochemicals commonly used in sugarcane crops. For this purpose, the in vitro effect of 11 agrochemicals (fungicides, insecticides and herbicides) on the germination and insecticidal activity of Bv062 formulated conidia was evaluated. Initially, the EC and agrochemicals were adjusted to double the recommended concentration and mixed in a 1:1 ratio. The mixes were incubated for two hours, and the germination percentage was calculated. The conidia exposed to the agrochemicals were also purified and used for a bioassay against second instar larvae of D. saccharalis. The EC was compatible with the herbicides and insecticides, maintaining germination and efficacy higher than 80%. In contrast, EC was incompatible with all the fungicides evaluated. These results allow us to suggest recommendations for the application of the biopesticide based on B. bassiana Bv062 with insecticides and herbicides used in sugarcane crops, but it is not recommended to apply it simultaneously with fungicides such as benomyl and the triazole group. It is recommended to validate these results under field conditions.

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Este trabajo tiene como objetivo presentar una mirada global de la aplicabilidad de los modelos de análisis multinivel en el ámbito de la investigación sanitaria. Ofrece información sobre los fundamentos teóricos, metodológicos y estadísticos y, además, menciona los pasos básicos para la construcción de estos modelos, y da ejemplos de su uso, según la estructura jerárquica de los datos. Cabe resaltar que, antes de utilizar estos modelos, se requiere contar con un soporte teórico sobre la necesidad de uso y una valoración estadística que dé cuenta del porcentaje de varianza explicada por el efecto de agrupación de las observaciones. Los requisitos para llevar a cabo este tipo de análisis dependen de condiciones especiales como el tipo de variables, la cantidad de unidades por nivel o el tipo de estructura jerárquica. Se concluye que los modelos de análisis multinivel son una herramienta útil para lograr la integración de información, dadas la complejidad de las relaciones y las interacciones que determinan la mayoría de las condiciones de salud, incluida la pérdida de independencia entre las unidades de observación.

This topic review aims to present a global vision of multilevel analysis models' applicability to health research, explaining its theoretical, methodological, and statistical foundations. We describe the basic steps to build these models and examples of their application according to the data hierarchical structure. It ir worth noticing that before using these models, researchers must have a rationale for needing them, and a statistical evaluation accounting for the variance percentage explained by the observations grouping effect. The requirements to conduct this type of analysis depends on special conditions such as the type of variables, the number of units per level, or the type of hierarchical structure. We conclude that multilevel analysis models are a useful tool to integrate information, considering the complexity of the relationships and interactions involved in most health conditions, including the loss of independence between observation units.

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The participation of civil society is essential for environmental health policies to be accepted. The objective of this study was to know the perceptions of government officials, members of civil society, and academics about environmental health problems and its governance in the Bucaramanga Metropolitan Area, Colombia. In the region, there is a strong citizens movement that defends the moorland ecosystem (páramo) as a source of drinking water for large-scale mining projects. A multi-method study was conducted, including the review of newspaper and scientific articles, a citizens survey, and interviews and focus groups with identified key stakeholders. The findings indicate that government officials prioritize their actions on issues related to air and water pollution and environmental education. In contrast, citizens prioritize water availability from the moorland ecosystem. There are some advances in the management of environmental health, mainly related to greater citizen awareness. Contrary perceptions among government officials, academics, and civil society prevent adequate prioritization of environmental health problems. Participation of civil society is absent in activities related to environmental governance. An ongoing citizens science experience engaging high school students and the academy can be the first meeting point with government officials in the pathway to improve the environmental governance in the territory. The participation of civil society in the environmental health governance must be enforced to broaden the issues of interest and prioritize the activities in short- and long-term policy planning.

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We assessed the relationship between the altitude of municipalities and the incidence, mortality, and fatality from COVID-19 and excess of mortality in Colombia between 2020 and 2022. We conducted an ecologic study including all 1122 municipalities in Colombia and used categories of altitude as main independent variable. We fit multivariable regression models for incidence, mortality, fatality rates, and excess of mortality controlling for several variables at municipality level. There was a higher incidence rate, similar mortality rate and lower case-fatality rate for COVID-19 during 2020-2022 in municipalities in the upper category of altitude (>=2500 masl) compared to the lower category (<1000 masl). The excess of mortality was lower but not statistically different in municipalities in the upper category of altitude, and significantly lower in the intermediate altitude category compared to the lowlands. Our findings provide evidence that municipalities with high altitude had similar mortality rate, and lower case-fatality rate and excess of mortality for COVID-19 compared to lowlands in Colombia.

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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.