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Objetivo. Describir la estrategia implementada para la interrupción del brote de sarampión en el período 2019-2020 en el Área Metropolitana de Buenos Aires (Argentina) y la aplicación de los criterios estandarizados de cierre de brotes de la Organización Panamericana de la Salud (OPS) para documentar la interrupción de la circulación viral en el escenario adverso de la pandemia de COVID-19. Método. Se realizó un estudio observacional descriptivo y retrospectivo de las acciones realizadas ante el brote de sarampión ocurrido entre las semanas epidemiológicas 35 del 2019 y 12 del 2020. Se documentó la interrupción de la circulación viral mediante la aplicación de criterios epidemiológicos, de vacunación y de laboratorio. Los datos se obtuvieron del Sistema Nacional de Vigilancia, del Registro Federal de Vacunación y de los informes de brote. Resultados. La estrategia de control del brote en Argentina tuvo como ejes las acciones de vacunación intensificadas y el fortalecimiento de la vigilancia epidemiológica. La información obtenida permitió analizar el cumplimiento de los criterios de la OPS para verificar la interrupción de la circulación viral. Conclusiones. La interrupción del brote y su demostración representó un desafío en el escenario epidemiológico complejo que atravesaba el país. La aplicación de los criterios estandarizados de cierre de brotes permite planificar las actividades. Sin embargo, en situaciones extraordinarias es necesario realizar una ponderación con base en un sentido de priorización técnica e implementar estrategias innovadoras y adaptadas al contexto epidemiológico para cumplir con los criterios propuestos.

Abstract Introduction Access to and engagement with primary healthcare can be difficult for marginalized low-income populations residing in inner cities in high-income countries. We designed a study to examine retention in primary care among clients of a novel interdisciplinary primary care clinic in the Downtown Eastside of Vancouver, Canada who did not previously have access to care. Methods Beginning in June 2021, clients of the Hope to Health clinic were offered enrolment in a cohort study which involved a baseline and follow-up surveys every six months, and linking their data to information from the clinic’s electronic medical records. We used Chi-square or Fisher’s Exact test and Wilcoxon rank sum test to compare clients who were lost to follow-up (LTFU) or deceased, with clients who were retained in care at the end of follow-up, Cox proportional hazards modeling was used to examine independent associations with mortality or LTFU. Results Among 425 participants enrolled, the median age was 50 years (IQR 40–59), 286 (67.3%) participants were men and 128 (25.4%) were unstably housed at enrollment. Among 338 participants with at least six months of follow-up after enrolment, 262 participants (67.5%) were retained in care, 20 (5.2%) had moved, 57 (14.7%) were classified as LTFU, and 28 (7.2%) had died with a median of 19.9 months of follow-up time. The risk of death or LTFU was independently associated diagnosed with alcohol use disorder (AUD) (adjusted hazard ratio [AHR] = 2.23 vs. not; 1.38–3.60), frequency of medical doctor visits (AHR = 0.69 per visit per 3 months; 0.60–0.79) and social work visits (AHR = 0.73 per visit per 3 months; 0.59–0.90. Stimulant use disorder or asthma were not significantly associated with retention in care. Conclusion We found that a primary healthcare model of care was successful in retaining over two-thirds of clients in primary healthcare after more than 18 months of follow-up. Additional supports for those diagnosed with alcohol use disorder are needed to retain them in care.

Purpose: The globally increasing older population raises concerns about age-related conditions, including cognitive impairment and depressive symptoms. In Latin America, nearly one-third of the population is affected by either of these conditions. However, data investigating the association between cognitive impairment and depressive symptoms, particularly in Brazil, are limited to small-scale studies that have not carefully examined the critical effects of variables such as education level and socioeconomic status on this relationship. We aimed at exploring this association in a representative population-based cohort. Methods: We used the Brazilian Longitudinal Study of Aging (ELSI-BRAZIL) database to examine the relationship between depressive symptoms and cognitive impairment in Brazilian older adults, adjusted for potential confounders. Direct acyclic graphs and multivariable linear regression were used to build our model. Depressive symptoms were measured using a short version of the Center for Epidemiologic Studies Scale (CES D-8), and combined memory recall test as a surrogate of cognitive impairment. Results: The study included 8280 participants. Only education level was identified as a confounder for the relationship between memory loss and depressive symptoms. After adjusting for age, sex, and education level, there was strong evidence for a negative association between depressive symptoms and memory performance. For every 5-unit increase in the CES D-8 score, there was a reduction in memory capacity, translating to a loss of approximately one word in the combined words recall test (mean − 0.18, 95% CI -0.22; −0.15, P

Summary: Background: Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators to enhance surgical care. In Colombia, studies have been made using secondary data. However, strategies to reduce perioperative mortality have not been implemented. This study aims to describe the fourth indicator, perioperative mortality rate (POMR), with primary data in Colombia. Methods: A multicentre prospective cohort study was conducted across 54 centres (hospitals) in Colombia. Each centre selected a 7-day recruitment period between 05/2022 and 01/2023. Inclusion criteria involved patients over 18 years of age undergoing surgical procedures in operating rooms. Data quality was ensured through a verification guideline and statistical analysis using mixed-effects multilevel modelling with a case mix analysis of mortality by procedure-related, patient-related, and hospital-related conditions. Findings: 3807 patients were included with a median age of 48 (IQR 32–64), 80.3% were classified as ASA I or II, and 27% of the procedures had a low-surgical complexity. Leading procedures were Orthopedics (19.2%) and Gynaecology/Obstetrics (17.7%). According to the Clavien–Dindo scale, postoperative complications were distributed in major complications (11.7%, 10.68–12.76) and any complication (31.6%, 30.09–33.07). POMR stood at 1.9% (1.48–2.37), with elective and emergency surgery mortalities at 0.7% (0.40–1.23) and 3% (2.3–3.89) respectively. Interpretation: The POMR was higher than the ratio reported in previous national studies, even when patients had a low–risk profile and low-complexity procedures. The present research represents significant public health progress with valuable insights for national decision-makers to improve the quality of surgical care. Funding: This work was supported by Universidad del Rosario and Fundación Cardioinfantil-Instituto de Cardiología grant number CTO-057-2021, project-ID IV-FGV017.

BackgroundCardiac rehabilitation is fundamental among patients recovering from a coronary event, and mHealth technology may constitute a useful tool that provides guidelines based on scientific evidence in an entertaining, attractive, and user-friendly format. ObjectiveThis study aimed to compare the efficacy of an mHealth intervention involving the eMOTIVA app and that of usual care regarding compliance with cardiac rehabilitation guidelines in terms of lifestyle, cardiovascular risk factors, and satisfaction among patients with acute coronary syndrome. MethodsA randomized controlled clinical trial with a parallel group design was conducted. It included 300 patients (mHealth group, 150; control group, 150) who underwent percutaneous coronary intervention for acute coronary syndrome. Both groups underwent evaluations initially (during hospitalization) and after 3 and 6 months (face-to-face consultations). The eMOTIVA app incorporates a virtual classroom providing audio and video information about a healthy lifestyle, a section for self-recording cardiovascular risk factors, and a section for feedback messages and gamification. The primary outcome variables were (1) adherence to the Mediterranean diet and the frequency of consumption of food; (2) physical activity level, sedentary time, and exercise capacity; (3) smoking cessation and nicotine dependence; (4) level of knowledge about cardiovascular risk factors; and (5) app satisfaction and usability. ResultsThe study analyzed 287 patients (mHealth group, 145; control group, 142). Most participants were male (207/300, 69.0%), and the mean age was 62.53 (SD 8.65) years. Significant improvements were observed in the mHealth group compared with the control group at 6 months in terms of (1) adherence to the Mediterranean diet (mean 11.92, SD 1.70 vs 8.92, SD 2.66 points; P

BackgroundIn Chagas disease (CD), a neglected tropical disease caused by the parasite Trypanosoma cruzi, the development of mental disorders such as anxiety, depression, and memory loss may be underpinned by social, psychological, and biological stressors. Here, we investigated biological factors underlying behavioral changes in a preclinical model of CD.Methodology/principal findingsIn T. cruzi-infected C57BL/6 mice, a kinetic study (5 to 150 days postinfection, dpi) using standardized methods revealed a sequential onset of behavioral changes: reduced innate compulsive behavior, followed by anxiety and depressive-like behavior, ending with progressive memory impairments. Hence, T. cruzi-infected mice were treated (120 to 150 dpi) with 10 mg/Kg/day of the selective serotonin reuptake inhibitor fluoxetine (Fx), an antidepressant that favors neuroplasticity. Fx therapy reversed the innate compulsive behavior loss, anxiety, and depressive-like behavior while preventing or reversing memory deficits. Biochemical, histological, and parasitological analyses of the brain tissue showed increased levels of the neurotransmitters GABA/glutamate and lipid peroxidation products and decreased expression of brain-derived neurotrophic factor in the absence of neuroinflammation at 150 dpi. Fx therapy ameliorated the neurochemical changes and reduced parasite load in the brain tissue. Next, using the human U-87 MG astroglioma cell line, we found no direct effect of Fx on parasite load. Crucially, serotonin/5-HT (Ser/5-HT) promoted parasite uptake, an effect increased by prior stimulation with IFNγ and TNF but abrogated by Fx. Also, Fx blocked the cytokine-driven Ser/5-HT-promoted increase of nitric oxide and glutamate levels in infected cells.Conclusion/significanceWe bring the first evidence of a sequential onset of behavioral changes in T. cruzi-infected mice. Fx therapy improves behavioral and biological changes and parasite control in the brain tissue. Moreover, in the central nervous system, cytokine-driven Ser/5-HT consumption may favor parasite persistence, disrupting neurotransmitter balance and promoting a neurotoxic environment likely contributing to behavioral and cognitive disorders.

Abstract Background Social support has previously been found to be associated with improved health outcomes of individuals managing chronic illnesses, including amongst people living with HIV (PLWH). For women and people who use injection drugs who continue to experience treatment disparities in comparison to other PLWH, social support may have potential in facilitating better treatment engagement and retention. In this analysis, we examined determinants of social support as measured by the Medical Outcomes Study – Social Support Survey (MOS-SSS) scale, and quantified the relationship between MOS-SSS and HIV treatment interruptions (TIs) among PLWH in British Columbia, Canada. Methods Between January 2016 and September 2018, we used purposive sampling to enroll PLWH, 19 years of age or older living in British Columbia into the STOP HIV/AIDS Program Evaluation study. Participants completed a baseline survey at enrolment which included the MOS-SSS scale, where higher MOS-SSS scores indicated greater social support. Multivariable linear regression modeled the association between key explanatory variables and MOS-SSS scores, whereas multivariable logistic regression modeled the association between MOS-SSS scores and experiencing TIs while controlling for confounders. Results Among 644 PLWH, we found that having a history of injection drug use more than 12 months ago but not within the last 12 months, self-identifying as Indigenous, and sexual activity in the last 12 months were positively associated with MOS-SSS, while being single, divorced, or dating (vs. married), experiences of lifetime violence, and diagnosis of a mental health disorder were inversely associated. In a separate multivariable model adjusted for gender, ethnicity, recent homelessness, sexual activity in the last 12 months, and recent injection drug use, we found that higher MOS-SSS scores, indicating more social support, were associated with a lower likelihood of HIV treatment interruptions (adjusted odds ratio: 0.90 per 10-unit increase, 95% confidence interval: 0.83, 0.99). Conclusions Social support may be an important protective factor in ensuring HIV treatment continuity among PLWH. Future research should examine effective means to build social support among communities that have potential to promote increased treatment engagement.

Foundation: Asthma is a chronic inflammatory disease with a high prevalence in South America, which requires proper diagnosis, optimal management and prevention measures supported by constantly updated scientific evidence.Objective: to carry out a comparative analysis between the Global Initiative for Asthma and the South American guidelines for the diagnosis, management and prevention of asthma in pediatric patients.Methods: descriptive observational study that compares the 2023 Global Initiative for Asthma guideline with national guidelines from the South American countries Colombia, Argentina, Chile, Uruguay, Venezuela and Peru, in the following parameters: diagnostic recommendations, management recommendations and prevention strategies.Results: differences were found in prevention and education recommendations in the guides analyzed, while the Global Initiative for Asthma and some South American guides mention prevention measures, other guides do not mention them or have limited information in this regard. In auxiliary tests, all guidelines mention performing spirometry to evaluate lung function, but there are differences with the inclusion of other tests, such as the allergy test or the measurement of exhaled nitric oxide.Conclusions: Greater standardization and updating of South American guidelines is required to guarantee adequate and consistent management of asthma in the region.

Foundation: self-assessment contributes to the self-regulation of learning by students, so it is convenient to monitor this activity. Objective: to analyze the students’ participation rate from the Miguel Enríquez, 10 de Octubre and Salvador Allende Medical Sciences Faculties, in their learning self-assessment from the subject Cells, Tissues and Integumentary System, during the 2023-2024 academic year.Methods: a descriptive, cross-sectional research with a mixed approach was developed. Theoretical methods were used: analysis-synthesis, inductive-deductive and logical history; empirical: documentary review and content analysis; as well as the statistical mathematician.Results: the data analysis obtained allowed us to classify the students’ participation rate in the self-assessment of their learning as very low in the Miguel Enríquez and 10 de Octubre Medical Sciences Faculties, and low in Salvador Allende. A significantly positive Spearman correlation index was determined between the students’ participation index and their schools of origin (p < 0.001), in six of the eight self-assessment activities considered, with a tendency to higher index values in the Salvador Allende faculty.Conclusions: the research carried out made it possible to determine the existence of limitations regarding the students’ participation in the self-assessment of their learning, in the subject Cells, Tissues and Integumentary System, whose degree is related to the origin faculties.

Objective. The DoTT (Decreasing Time to Therapy) project aimed to minimize the interval between fever onset and medical interventions for children with febrile neutropenia. The objective of this study was to determine the effect of implementing the DoTT project on the hospital time to antibiotic (TTA) and patient time to arrival (PTA) at the hospital in children with febrile neutropenia admitted to the emergency department. Methods. The DoTT project was implemented at a Peruvian hospital and followed the World Health Organization (WHO) multimodal improvement strategy model. Components included creating a healthcare delivery bundle and antibiotic selection pathways, training users of the bundle and pathways, monitoring patient outcomes and obtaining user feedback, encouraging use of the new system, and promoting the integration of DoTT into the institutional culture. Emergency room providers were trained in the care delivery for children with cancer and fever and taught to use the bundle and pathways. DoTT was promoted via pamphlets and posters, with a view to institutionalizing the concept and disseminating it to other hospital services. Results. Admission data for 129 eligible patients in our registry were analyzed. The TTA and PTA were compared before and after the DoTT intervention. The median TTA was 146 minutes (interquartile range [IQR] 97–265 minutes) before the intervention in 99 patients, and 69 minutes (IQR 50–120 minutes) afterwards in 30 patients (p < 0.01). The median PTA was reduced from 1 483 minutes at baseline to 660 minutes after the intervention (p < 0.01). Conclusions. Applying the WHO multimodal improvement strategy model to the care of children with febrile neutropenia arriving at the hospital had a positive impact on the PTA and TTA, thus potentially increasing the survival of these patients.

BackgroundCoronary heart disease is one of the leading causes of mortality worldwide. Secondary prevention is essential, as it reduces the risk of further coronary events. Mobile health (mHealth) technology could become a useful tool to improve lifestyles. ObjectiveThis study aimed to evaluate the effect of an mHealth intervention on people with coronary heart disease who received percutaneous coronary intervention. Improvements in lifestyle regarding diet, physical activity, and smoking; level of knowledge of a healthy lifestyle and the control of cardiovascular risk factors (CVRFs); and therapeutic adherence and quality of life were analyzed. MethodsThis was a randomized controlled trial with a parallel group design assigned 1:1 to either an intervention involving a smartphone app (mHealth group) or to standard health care (control group). The app was used for setting aims, the self-monitoring of lifestyle and CVRFs using measurements and records, educating people with access to information on their screens about healthy lifestyles and adhering to treatment, and giving motivation through feedback about achievements and aspects to improve. Both groups were assessed after 9 months. The primary outcome variables were adherence to the Mediterranean diet, frequency of food consumed, patient-reported physical activity, smoking, knowledge of healthy lifestyles and the control of CVRFs, adherence to treatment, quality of life, well-being, and satisfaction. ResultsThe study analyzed 128 patients, 67 in the mHealth group and 61 in the control group; most were male (92/128, 71.9%), with a mean age of 59.49 (SD 8.97) years. Significant improvements were observed in the mHealth group compared with the control group regarding adherence to the Mediterranean diet (mean 11.83, SD 1.74 points vs mean 10.14, SD 2.02 points; P

Introduction Dementia is a progressive and debilitating disease, and people living with HIV (PLWH) often develop dementia much earlier than those not living with HIV. We estimated the incidence and prevalence of dementia and identified its key risk factors in a cohort of PLWH in British Columbia, Canada.Methods This retrospective cohort study used data from the Seek and Treat for Optimal Prevention of HIV/AIDS study. Eligible individuals were diagnosed with HIV, ≥40 years of age, naïve to antiretroviral therapy (ART), had no dementia at the index date and were followed for ≥1 year during 2002–2016. Our main outcome was incident dementia. We examined the effect of sociodemographic and clinical covariates on the incidence of dementia using a cause-specific hazard (CSH) model, with all-cause mortality as a competing risk event.Results Among 5121 eligible PLWH, 108 (2%) developed dementia. The crude 15-year prevalence of dementia was 2.1%, and the age–sex standardised incidence rate of dementia was 4.3 (95% CI: 4.2 to 4.4) per 1000 person-years. Among the adjusted covariates, CD4 cell count

Los inhibidores de la enzima convertidora de angiotensina son utilizados por más de 40 millones de personas en todo el mundo para el tratamiento de enfermedades cardiovasculares. Son considerados seguros, aunque pueden producir angioedema severo en el 0,1 a 0, 5 % de los pacientes. Se presenta el caso de un paciente del sexo masculino, de 67 años de edad, con diagnóstico de diabetes mellitus e hipertensión arterial, tratado con metformina, hidroclorotiazida y enalapril desde hacía aproximadamente cuatro años, que ingresó en cuerpo de guardia con edema severo del tercio anterior de la lengua, sin compromiso respiratorio. Se indicó hidrocortisona y difenhidramina y evolucionó satisfactoriamente, por lo que fue dado de alta y se prescribió prednisona y difenhidramina por vía oral; se suspendió el enlapril y a las 48 horas se reevaluó y estaba asintomático. El mecanismo por el que estos medicamentos producen angioedema no está claro, pero probablemente sería por la acumulación tisular de bradiquinina y puede presentarse en cualquier momento del tratamiento. La correcta anamnesis, el diagnóstico precoz y el tratamiento inmediato con hidrocortisona por vía endovenosa son aspectos a considerar ante casos similares. El análisis del evento mediante la farmacovigilancia, permitió clasificarlo como severo, probablemente relacionado con el consumo de enalapril. Esto genera alertas para informar al personal de salud y tomar decisiones relacionadas con los medicamentos, que permitan la actuación inmediata con la finalidad de reducir la morbimortalidad.

Hamman's syndrome is characterized by the presence of free air in the interstitial space of the mediastinum, associated with subcutaneous emphysema. The case of a 19-years-old male patient, referred to the General Surgery Service of the Leopoldito Martínez General Teaching Hospital, presenting with moderate intensity dyspnea, accompanied by a sudden increase in volume of the neck and anterior region of the thorax, after a coughing fit during an acute attack of bronchial asthma is presented. The physical examination identified subcutaneous emphysema in the neck, thorax, anterior wall of the abdomen and upper limbs. A positive Hamman sign was observed. Chest X-ray and simple computed tomography were indicated, showing subcutaneous emphysema and pneumomediastinum. It was concluded as a Hamman syndrome. The treatment was conservative and the evolution was satisfactory. Hamman's syndrome is a rare and self-limiting entity that generally occurs in young, apparently healthy male patients. The diagnosis is defined by imaging studies and conservative treatment is recommended. This case is presented with the aim of exposing the presentation, diagnosis and treatment of this syndrome.

BackgroundThe challenge of chronicity has led developed countries to design strategies to respond to the new needs of complex chronic patients (CCP). There is evidence supporting better beneficial effects and more efficient care for CCP when home-base care programs are provided by Primary Health Care professionals. The main objective of the present study was to assess the effectiveness of a nursing intervention program of home visits for CCP analyzing the use of health services in terms of hospital admissions, emergency care unit visits, and mortality rate.MethodsA quasi-experimental study was designed to retrospectively evaluate the effectiveness of a 3-year proactive, individualized nursing intervention in improving health outcomes measured by health service utilization (hospitalization, emergency care, and nursing home visits) in these patients. Of the 344 complex chronic patients participating in the study, 93 were assigned to the intervention group (IG) and 251 to the control group (CG).ResultsAlong the period of study, the number of home visits in the IG almost tripled in relation to the CG (14.29 ± 4.49 vs. 4.17 ± 2.68, p

Summary: Background: Pseudomonas aeruginosa healthcare-associated infections are one of the top antimicrobial resistance threats world-wide. In order to analyze the current trends, we performed a Spanish nation-wide high-resolution analysis of the susceptibility profiles, the genomic epidemiology and the resistome of P. aeruginosa over a five-year time lapse. Methods: A total of 3.180 nonduplicated P. aeruginosa clinical isolates from two Spanish nation-wide surveys performed in October 2017 and 2022 were analyzed. MICs of 13 antipseudomonals were determined by ISO-EUCAST. Multidrug resistance (MDR)/extensively drug resistance (XDR)/difficult to treat resistance (DTR)/pandrug resistance (PDR) profiles were defined following established criteria. All XDR/DTR isolates were subjected to whole genome sequencing (WGS). Findings: A decrease in resistance to all tested antibiotics, including older and newer antimicrobials, was observed in 2022 vs 2017. Likewise, a major reduction of XDR (15.2% vs 5.9%) and DTR (4.2 vs 2.1%) profiles was evidenced, and even more patent among ICU isolates [XDR (26.0% vs 6.0%) and DTR (8.9% vs 2.6%)] (p

Introducción: La Leishmaniasis es una enfermedad infecciosa parasitaria zoonótica que afecta la piel, las mucosas y las vísceras. Es endémica en 98 países y hay más de 350 millones de personas en riesgo de transmisión. En Colombia, los campamentos de las antiguas Fuerzas Armadas Revolucionarias de Colombia, se ubicaban en zonas selváticas donde la enfermedad está presente. El objetivo del presente trabajo está dirigido a describir las prácticas y saberes de los excombatientes de las FARC-EP sobre la Leishmaniasis cutánea y su manejo en escenarios de combate al convivir con esta enfermedad. Métodos: El estudio es cualitativo/exploratorio, donde se abordaron los conocimientos sobre la enfermedad y su forma de transmisión, como también aquellas prácticas relacionadas con el uso de medicamentos para su tratamiento. Resultados: En el análisis de las entrevistas se encontró que los excombatientes conocen el ciclo de la enfermedad desde sus vivencias y por transmisión oral, como también de prácticas curativas propias adaptadas al contexto del conflicto armado, esta experiencia los llevó a desarrollar estrategias de gestión del conocimiento basado en la evidencia. Discusión: Las entrevistas dan cuenta del conocimiento empírico y clínico de los excombatientes sobre el ciclo de la enfermedad; no existe un registro documental, ni manuales de procedimientos realizados en la selva por las FARC-EP sobre tratamiento de enfermedades; los miembros de las FARC-EP a desarrollar estrategias de gestión del conocimiento basados en la evidencia; el contexto de conflicto afectó de manera importante el tiempo y los recursos técnicos para manejar la Leishmaniasis, esto posibilitó las respuestas alternativas a la enfermedad documentadas en este trabajo.

IntroductionPrevious studies measuring intervals on the oral cancer care pathway have been heterogenous, showing mixed results with regard to patient outcomes. The aims of this research were (1) to calculate pooled meta-analytic estimates for the duration of the patient, diagnostic and treatment intervals in oral cancer, considering the income level of the country, and (2) to review the evidence on the relationship of these three intervals with tumor stage at diagnosis and survival.Materials and methodsWe conducted a systematic review with meta-analysis following PRISMA 2020 guidelines (pre-registered protocol CRD42020200752). Following the Aarhus statement, studies were eligible if they reported data on the length of the patient (first symptom to first presentation to a healthcare professional), diagnostic (first presentation to diagnosis), or treatment (diagnosis to start of treatment) intervals in adult patients diagnosed with primary oral cancer. The risk of bias was assessed with the Aarhus checklist.ResultsTwenty-eight studies reporting on 30,845 patients met the inclusion criteria. The pooled median duration of the patient interval was 47 days (95% CI = 31–73), k = 18, of the diagnosis interval 35 days (95% CI = 21–38), k = 11, and of the treatment interval 30 days (95% CI = 23–53), k = 19. In lower-income countries, the patient and treatment intervals were significantly longer, and longer patient intervals were related to later stage at diagnosis. In studies with a lower risk of bias from high-income countries, longer treatment intervals were associated with lower survival rates.ConclusionInterval duration on the oral cancer care pathway is influenced by the socio-economic context and may have implications for patient outcomes.

BackgroundEstimating and analyzing trends and patterns of health loss are essential to promote efficient resource allocation and improve Peru’s healthcare system performance.MethodsUsing estimates from the Global Burden of Disease (GBD), Injuries, and Risk Factors Study (2019), we assessed mortality and disability in Peru from 1990 to 2019. We report demographic and epidemiologic trends in terms of population, life expectancy at birth (LE), mortality, incidence, prevalence, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by the major diseases and risk factors in Peru. Finally, we compared Peru with 16 countries in the Latin American (LA) region.ResultsThe Peruvian population reached 33.9 million inhabitants (49.9% women) in 2019. From 1990 to 2019, LE at birth increased from 69.2 (95% uncertainty interval 67.8–70.3) to 80.3 (77.2–83.2) years. This increase was driven by the decline in under-5 mortality (−80.7%) and mortality from infectious diseases in older age groups (+60 years old). The number of DALYs in 1990 was 9.2 million (8.5–10.1) and reached 7.5 million (6.1–9.0) in 2019. The proportion of DALYs due to non-communicable diseases (NCDs) increased from 38.2% in 1990 to 67.9% in 2019. The all-ages and age-standardized DALYs rates and YLLs rates decreased, but YLDs rates remained constant. In 2019, the leading causes of DALYs were neonatal disorders, lower respiratory infections (LRIs), ischemic heart disease, road injuries, and low back pain. The leading risk factors associated with DALYs in 2019 were undernutrition, high body mass index, high fasting plasma glucose, and air pollution. Before the COVID-19 pandemic, Peru experienced one of the highest LRIs-DALYs rates in the LA region.ConclusionIn the last three decades, Peru experienced significant improvements in LE and child survival and an increase in the burden of NCDs and associated disability. The Peruvian healthcare system must be redesigned to respond to this epidemiological transition. The new design should aim to reduce premature deaths and maintain healthy longevity, focusing on effective coverage and treatment of NCDs and reducing and managing the related disability.

Abstract Introduction In 2010, the Canadian province of British Columbia (BC) initiated the Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) program to improve HIV testing, linkage to care, and treatment uptake, thereby operationalizing the HIV Treatment as Prevention (TasP) framework at the population-level. In this analysis, we evaluated self-reported HIV care experiences and therapeutic outcomes among people diagnosed with HIV prior to and after implementation of this provincial program. Methods A cross-sectional analysis was performed on the baseline data of a cohort of people living with HIV (PLWH) (19 years and older) in the province of BC sampled from July 2016 to September 2018. All participants consented to linking their survey data to the provincial HIV treatment registry. Individuals diagnosed with HIV from January 1 2000—December 31 2009 were classified as pre-intervention and those diagnosed January 1 2010—December 31 2018 as post-intervention cohorts. Bivariate analyses were run using Chi-square and Wilcoxon Rank Sum tests. Cox proportional hazards regression model demonstrates time to antiretroviral therapy (ART) initiation (from HIV baseline) and virological suppression (2 consecutive plasma viral load measurements

Introducción: la anemia aplásica (AA) es una enfermedad poco frecuente, caracterizada por presentar una insuficiencia en la médula ósea y una pancitopenia, sin rastro de procesos mieloproliferativos o fibróticos. Objetivo: conocer los diversos tratamientos farmacológicos usados en la terapia inmunosupresora (IST) en la AA; adicionalmente, se profundizará en la respuesta de los pacientes frente a la IST y los mecanismos de acción de los fármacos utilizados. Metodología: se realizó una búsqueda sistemática en las bases de datos de literatura médica como PUBMED, British Medical Journal, New England Journal, entre otros. Se incluyeron artículos tanto en inglés como en español. Conclusiones: el manejo de la anemia aplásica continúa representando un reto para la medicina moderna; no obstante, se ha desarrollado un gran número de nuevas opciones terapéuticas para tratar a los pacientes.

Aim: It is not well known how comorbidities may change the prognosis of atrial fibrillation (AF) patients. This study was aimed to analyze the impact of cardiovascular disease on this population. Materials & methods: EMIR was a multicenter, prospective study, including 1433 AF patients taking rivaroxaban for ≥6 months. Data were analyzed according to the presence of vascular disease. Results: Coronary artery disease was detected in 16.4%, peripheral artery disease/aortic plaque in 6.7%, vascular disease in 28.3%. Patients with coronary artery disease had higher rates (per 100 patient-years) of major adverse cardiovascular events (2.98 vs 0.71; p < 0.001) and cardiovascular death (1.79 vs 0.41; p = 0.004). Those with vascular disease had higher rates of thromboembolic events (1.47 vs 0.44; p = 0.007), major adverse cardiovascular events (2.03 vs 0.70; p = 0.004), and cardiovascular death (1.24 vs 0.39; p = 0.025). Patients with peripheral artery disease/aortic plaque had similar rates. Conclusion: AF patients with vascular disease have a higher risk of non-embolic outcomes.

Introducción: El cierre de instituciones educativas a nivel mundial debido a la pandemia global de COVID-19 dio como resultado una educación a distancia que ha modificado la apreciación y la actitud de los estudiantes universitarios ante ciertos aspectos educativos. Se desconoce si este cambio afecta la actitud hacia la investigación. Objetivo: Analizar la actitud hacia la investigación de los estudiantes de enfermería en un contexto educativo a distancia. Metodología: Estudio descriptivo transversal correlacional, en 376 estudiantes inscritos de todos los años de enfermería de una universidad mexicana, excluyendo estudiantes de otras escuelas, en estancia académica o bajas. Se midieron variables sociodemográficas y el cuestionario actitud hacia la investigación en universitarios, con previa aprobación de un comité de ética y autorización por consentimiento informado. Resultados: Los estudiantes tuvieron una actitud hacia la investigación de mala a regular, 69-71% manifestó que los principales obstáculos para no investigar fueron falta de tiempo y conocimientos, consideraron que hacer investigación fue estresante y tedioso, 96-98% pensaban que saber citar, redactar y organizarse eran las principales habilidades a tomar en cuenta para investigar, con sentido ético y flexibilidad de pensamiento. Los estudiantes mostraron un decremento en la actitud conforme avanzaban de año en la universidad con p

Multimorbidity is associated with lower quality of life, greater disability and higher use of health services and is one of the main challenges facing governments in Europe. There is a need to identify and characterize patterns of chronic conditions and analyse their association with social determinants not only from an individual point of view but also from a collective point of view. This paper aims to respond to this knowledge gap by detecting patterns of chronic conditions and their social determinants in 19 European countries from a multilevel perspective. We used data from the ESS round 7. The final sample consisted of 18,933 individuals over 18 years of age, and patterns of multimorbidity from 14 chronic conditions were detected through Multilevel Latent Class Analysis, which also allows detecting similarities between countries. Gender, Age, Housing Location, Income Level and Educational Level were used as individual covariates to determine possible associations with social inequalities. The goodness-of-fit indices derived in a model with six multimorbidity patterns and five countries clusters. The six patterns were “Back, Digestive and Headaches”, “Allergies and Respiratory”, “Complex Multimorbidity”, “Cancer and Cardiovascular”, “Musculoskeletal” and “Cardiovascular”; the five clusters could be associated with some geographical areas or welfare states. Patterns showed significant differences in the covariates of interest, with differences in education and income being of particular interest. Some significant differences were found among patterns and the country groupings. Our findings show that chronic diseases tend to appear in a combined and interactive way, and socioeconomic differences in the occurrence of patterns are not only of the individual but also of group importance, emphasising how the welfare states in each country can influence in the health of their inhabitants.

During the course of the 2015-2017 outbreak of Zika virus (ZIKV) in the Americas, the emerging virus was recognized as a congenital infection that could damage the developing brain. As the Latin American ZIKV outbreak advanced, the scientific and public health community questioned if this newly recognized neurotropic flavivirus could affect the developing brain of infants and young children infected after birth. We report here the study design, methods and the challenges and lessons learned from the rapid operationalization of a prospective natural history cohort study aimed at evaluating the potential neurological and neurodevelopmental effects of postnatal ZIKV infection in infants and young children, which had become epidemic in Central America. This study enrolled a cohort of 500 mothers and their infants, along with nearly 400 children 1.5-3.5 years of age who were born during the initial phase of the ZIKV epidemic in a rural area of Guatemala. Our solutions and lessons learned while tackling real-life challenges may serve as a guide to other researchers carrying out studies of emerging infectious diseases of public health priority in resource-constrained settings.

Resulta un gran desafío encontrar una vía que le otorgue un valor real a las publicaciones científicas desde su impacto y calidad. Esta realidad exige el uso de indicadores bibliométricos y más reciente, algunos alternativos para la evaluación, tanto de los autores como de sus publicaciones. En este sentido se realiza un estudio de ambos sistemas de indicadores y sus metodologías, desde el análisis de debilidades y potencialidades para su integración en un único índice, de modo que permita una evaluación más integral y justa de su impacto en la comunidad científica. Se indagó además sobre la importancia, necesidad y nivel de información que se posee sobre este tema en profesores cubanos de varias universidades, durante el período 2018-2019. El objetivo del presente trabajo es argumentar algunas ideas para el acercamiento gradual del Sistema de Evaluación y Acreditación de la Educación Superior de la República de Cuba (SEAES) a estos indicadores, teniendo en cuenta el nivel de atención que reciben por bases de datos reconocidas globalmente. Los resultados son parte del proyecto de investigación El impacto social de la formación continua como parte de los procesos de mejora de la calidad en la Universidad de Camagüey.

Summary: Background: Cancer is a leading cause of disease and death in Latin America and the Caribbean (LAC). Contemporary data on the cancer burden aims to inform effective cancer policies; this article provides an update and benchmarking of national cancer incidence and mortality estimates for the year 2020, alongside recent mortality trends in the region. Methods: The number of new cancer cases and deaths were extracted from the GLOBOCAN 2020 database developed by the International Agency for Research on Cancer (IARC), and mortality data over time from IARC's cancer mortality database, New cancer cases, deaths and corresponding age-standardized rates per 100,000 person-years are presented. Random fluctuations in mortality trends by country, sex and cancer site were smoothed using LOWESS regression. Findings: An estimated total of 1.5 million new cancer cases and 700,000 deaths occur annually in LAC, with corresponding incidence and mortality rates of 186.5 and 86.6 per 100,000. The most common cancers in 2020 were prostate (15%), breast (14%), colorectal (9%), lung (7%) and stomach (5%). Lung cancer remained the leading cause of cancer death (12%), though rates varied substantially between countries. The mortality trends of infectious-related cancers tended to decline in most countries, while rates of cancer types linked to westernization were mainly increasing. Assuming rates remain unchanged, the cancer burden in LAC will increase by 67% reaching 2.4 million new cases annually by 2040. Interpretation: The cancer patterns reflect important underlying sociodemographic changes occurring over the last decades. With an increasing burden anticipated over the next decades in this region, there is a need to plan oncological service provision accordingly. Funding: No external funds received.

INTRODUCCIÓN: La tuberculosis (TB) genera una gran carga de enfermedad a nivel global. Su elevada presencia en grandes ciudades se explica porque ellas son escenarios de urbanización acelerada, fuertes inequidades sociales y concentración de circunstancias de vulnerabilidad. El objetivo fue analizar la situación epidemiológica de la TB en un área programática (AP) de la Ciudad de Buenos Aires entre 2017 y 2019. MÉTODOS: Se realizó un estudio descriptivo de corte transversal. La población de estudio fueron los casos notificados de TB en residentes en el AP del Hospital Fernández (HF). La fuente de datos principal fue el Sistema Nacional de Vigilancia de Salud. RESULTADOS: Se registraron 375 casos. En 2017 se presentó la tasa de notificación de TB más alta del AP (29,2). Los casos se concentraron en el barrio de Retiro y alcanzaron su mayor tasa en 2018 (134,5). Los barrios populares presentaron 12 veces la tasa del AP (305,1). De todos los casos, 213 fueron de género masculino (56,8%), con 29 años como mediana de edad. Mayormente fueron notificados por la red de efectores del AP del HF. Respecto a la evolución, en 169 casos fue satisfactoria (45,1%), y 138 no registraron datos de evolución (36,8%). DISCUSIÓN: El análisis epidemiológico desagregado reveló la gran complejidad del territorio respecto a este padecimiento de salud. Las redes de abordaje interdisciplinarias e intersectoriales resultan claves para garantizar la accesibilidad al cuidado y tratamiento en esta población.

Abstract One‐in‐four ophthalmology trials are single‐armed, which poses challenges to their interpretation. We demonstrate how real‐world cohorts used as external/synthetic control arms can contextualize such trials. We herein emulated a target trial on the intention‐to‐treat efficacy of off‐label bevacizumab (q6w) pro re nata relative to fixed‐interval aflibercept (q8w) for improving week 54 visual acuity of eyes affected by neovascular age‐related macular degeneration. The bevacizumab arm (n = 65) was taken from the ABC randomized controlled trial. A total of 4,471 aflibercept‐treated eyes aligning with the ABC trial eligibility were identified from electronic health records and synthetic control arms were created by emulating randomization conditional on age, sex, and baseline visual read via exact matching and propensity score methods. We undertook an inferiority analysis on mean difference at 54 weeks; outcomes regression on achieving a change in visual acuity of greater than or equal to 15, greater than or equal to 10, and less than or equal to −15 Early Treatment Diabetic Retinopathy (ETDRS) letters at week 54; and a time‐to‐event analysis on achieving a change in visual acuity of greater than or equal to 15, greater than or equal to 10, and less than or equal to −15 ETDRS letters by week 54. The findings suggest off‐label bevacizumab to be neither inferior nor superior to licensed aflibercept. Our study highlights how real‐world cohorts representing the counterfactual intervention could aid the interpretation of single‐armed trials when analyzed in accord to the target trial framework. Study Highlights WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC? One‐in‐four randomized controlled trials in ophthalmology are single‐armed, which poses challenges for interpreting their efficacy relative to standard of care. Recent conceptual advances in the methods of causal inference and in the emulation of target trials suggests that the standard‐of‐care arms representing the counterfactual intervention can be approximated with observational data. WHAT QUESTION DID THIS STUDY ADDRESS? How real‐world cohorts representing the counterfactual intervention can aid the interpretation of single‐armed ophthalmological trials. WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE? Our study highlights how real‐world cohorts representing the counterfactual intervention could aid the interpretation of single‐armed ophthalmological trials when undertaken in accord with the target trial framework. HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE? External counterfactual arms could reduce the time and cost to reach potential regulatory approval.

Abstract Introduction Universal provision of effective antiretroviral medication has been essential to reduce mortality, increase longevity, and reduce onward transmission of HIV. This study aims to illuminate persistent threats to the health and longevity of under-served PLWH in British Columbia (BC), Canada. Methods Between 2007 and 2010, 1000 PLWH across BC were enrolled in the Longitudinal Investigation into Supportive and Ancillary health services (LISA) study and completed a cross-sectional survey on their HIV-care experiences and healthcare engagement. The sample generally reflects an under-served population of PLWH. A linkage to the provincial Vital Statistics registry is used in this analysis in order to examine overall mortality and cause-specific mortality trends; probability of death was modeled using logistic regression for participants with ongoing clinical monitoring (n = 910). Results By June 2017, 208 (20.8%) participants had died. The majority of deaths 57 (27.4%) were attributed to drug-related complications or overdoses, 39 (18.8%) were attributed to HIV-related complications, and 36 (17.3%) to non-AIDS-defining malignancies. We observed elevated odds of death among PLWH who smoked tobacco (aOR: 2.11, 95% CI: 1.38, 3.23), were older (aOR: 1.06 per one-year increase, 95% CI: 1.04, 1.08), indicated heavy alcohol consumption (aOR: 1.57, 95% CI: 1.11, 2.22), and reported unstable housing (aOR: 1.96, 95% CI: 1.37, 2.80); while higher CD4 cell count was protective (aOR: 0.87 per 100-unit increase, 95% CI: 0.79, 0.94) as was male gender), though non-significant (aOR: 0.73, 95% CI: 0.49, 1.07). Conclusions Overdose is - the leading cause of mortality among a cohort of under-served PLWH in BC, Canada. Public health efforts to end the HIV epidemic and support the health and well-being of PLWH are being thwarted by persistent health inequities and the enormous and persistent risks facing people who use drugs. Integrated low-barrier primary care is essential for supporting under-served PLWH, and safe drug supply is needed to support PLWH who use drugs.

Abstract Background Informal family caregivers constitute an important and increasingly demanding role in the cancer healthcare system. This is especially true for caregivers of patients with primary malignant brain tumors based on the rapid progression of disease, including physical and cognitive debilitation. Informal social network resources such as friends and family can provide social support to caregivers, which lowers caregiver burden and improves overall quality of life. However, barriers to obtaining needed social support exist for caregivers. To address this need, our team developed and is assessing a multi-component caregiver support intervention that uses a blend of technology and personal contact to improve caregiver social support. Methods We are currently conducting a prospective, longitudinal 2-group randomized controlled trial which compares caregivers who receive the intervention to a wait-list control group. Only caregivers directly receive the intervention, but the patient-caregiver dyads are enrolled so we can assess outcomes in both. The 8-week intervention consists of two components: (1) The electronic Social Network Assessment Program, a web-based tool to visualize existing social support resources and provide a tailored list of additional resources; and (2) Caregiver Navigation, including weekly phone sessions with a Caregiver Navigator to address caregiver social support needs. Outcomes are assessed by questionnaires completed by the caregiver (baseline, 4-week, 8-week) and the cancer patient (baseline, and 8-week). At 8 weeks, caregivers in the wait-list condition may opt into the intervention. Our primary outcome is caregiver well-being; we also explore patient well-being and caregiver and patient health care utilization. Discussion This protocol describes a study testing a novel social support intervention that pairs a web-based social network visualization tool and resource list (eSNAP) with personalized caregiver navigation. This intervention is responsive to a family-centered model of care and calls for clinical and research priorities focused on informal caregiving research. Trial registration clinicaltrials.gov , Registration number: NCT04268979 ; Date of registration: February 10, 2020, retrospectively registered.

Fundamento: Los cierres temporales de instituciones de educación superior a causa de la COVID-19, han significado un proceso de rápida asimilación de nuevos contenidos, que antes apoyaban la modalidad presencial, pero que ahora son el único medio de enseñanza.Objetivo: describir la experiencia de adquisición de habilidades por docentes universitarios en los contextos educativos impuestos por la COVID-19.Métodos: estudio descriptivo, realizado en el periodo febrero-julio de 2020, con la participación de 16 docentes de la Universidad Metropolitana de Ecuador, específicamente de dos carreras de ciencias de la Salud. La técnica fundamental fue la encuesta. Se analizaron variables relacionadas con las habilidades adquiridas, directa e indirectamente.Resultados: en cuanto al dominio de los entornos virtuales de aprendizaje predominó el manejo “adecuado”, y en ningún caso se consideró “inadecuado”. Sobre la percepción del proceso de adquisición de habilidades, el tiempo de estudio fue calificado de “poco adecuado” por el 69 % de los docentes; y el 61 % manifestó como “adecuado”, el interés por el contenido recibido. El 93 % de los participantes manifestó que, en alguna medida, las habilidades adquiridas habían servido como motivación para su acción docente, tanto presente como futura.Conclusión: Aunque los resultados denotan que el conocimiento sobre los entornos virtuales de aprendizaje no es óptimo entre los docentes del claustro, estos ya cuentan con habilidades cognitivas y tecnológicas, las cuales podrán incrementarse con el tiempo.

Background: in therapeutic decision-making, the importance of knowledge of the drug receptor theory content is recognized; however, there is a lack of proposals from interdisciplinarity, which is useful as reference for teachers to improve the teaching of this process.Objective: to design a methodological proposal with an interdisciplinary approach for the teaching-learning of the content theory of the pharmacological receptor in the Medicine career.Methods: study carried out at the Cienfuegos University of Medical Sciences, during the 2018-2019 school year. From a universe of 250 fourth-year medical students, 75 students were selected through a simple random probability sampling, to whom a survey was applied. 19 professionals were surveyed corresponding to all the teachers involved in the process for teaching the subjects Pharmacology I, Molecular Biology and Nervous, Endocrine and Reproductive Systems. Five key informants selected by intentional non-probability sampling were interviewed. In addition, a documentary analysis was carried out that included the study plans and programs of the Medicine career in Cuba to identify the interrelationship between the disciplines.Results: based on the weaknesses detected, a proposal was elaborated that will facilitate the linking of the subjects, which will allow greater importance and relevance of the knowledge and pharmacological skills in medical training from an interdisciplinary perspective.Conclusions: the experts considered that the proposal will contribute favorably to the preparation of teachers in response to the current medical training model.

Background: the use of antibiotics is frequently excessive and inappropriate, which can produce adverse effects.Objective: to characterize the use of antibiotics in the Cienfuegos municipality urban population.Methods: an exploratory, retrospective study was carried out in which 164 people over 18 years of age were surveyed and this survey was applied with the following variables to study: sociodemographic characteristics; If you used antibiotics in the last six months, who prescribed or suggested it, drug used, disease against which you took it, when did you stop taking them, if you had self-medication habits and knowledge about the negative consequences of such actions.Results: The 148 people (90, 2%) declared having used antibiotics in the last six months, the drug that they most reported consuming was amoxacillin (29, 7%); Tonsillitis (31.7%) was the main condition that motivated the use of antibiotics and the moment the patient stopped taking it was when he was advised by his doctor (66.2%). The highest percentage of use was by medical prescription (75.7%); the 23.7% self-medicated and the people who did it the most were female (71.4%) and with a level between pre-university (34.3%) and university (51.4%).Conclusions: the high consumption of antibiotics, their use in viral infections, self-medication and unfulfillment with the indicated treatment are irrational practices, which contribute to increase the negative effects of antibiotics, for which it is necessary to expand the informative campaigns, aimed at the modification of these behaviors in the population and in the health staff in charge of prescribing these drugs.

Background: Due to many antineoplastic drugs’ toxicity and narrow therapeutic window, medication errors are a health concern in pediatric oncology patients. This study aimed to identify and classify medication errors in a pediatric inpatient chemotherapy facility and evaluate the outcomes of these medication errors. Methods: We conducted an observational retrospective study over 5 months in a chemotherapy facility for pediatric patients. The evaluation consisted of the review of the available medical records. The medication errors detected were manually recorded in a medical logbook. The International Classification for Patient Safety was adjusted to our clinical setting for the analysis, the terminology, and the classification system. A descriptive analysis was performed. Results: A total of 286 medical records were reviewed; one type of medication error was noted in at least 97.6%, and 962 errors were identified totally, with an overall rate of 3.36 errors per visit. Most errors occurred in the documentation stage (643; 66.8%), followed by the administration stage (227; 23.6%). Of all medication errors, 37.2% had the potential to cause injury, but only five reached the patient (0.5%), and only two (0.2%) resulted in a severe harmful incident. Conclusions: Medication errors were common, especially at the documentation stage. Better documentation strategies need to be implemented to reduce the rate of near misses and prevent potential adverse events.

Summary: Background: Multidisciplinary care (MDC) remains a cornerstone for breast cancer management as it is associated with improved quality of care and patient outcomes. However, the adoption of MDC practice is heterogeneous and has been poorly explored in Latin America. The objective was to describe barriers and possible facilitators for providing MDC to breast cancer patients in five Latin American countries. Methods: A panel of experts with an active clinical practice in Bolivia, Colombia, Ecuador, Mexico, and Uruguay was convened to identify barriers and facilitators to MDC. This study is a qualitative synthesis of a structured discussion regarding the state of MDC in the setting of breast cancer. Findings: Experts recognized that most oncology practices in Latin America do not apply a multidisciplinary approach for breast cancer patients. Predominant barriers for MDC are fragmentation of health services, being understaffed, inadequate infrastructure, and geographic disparities. Access to MDC varies widely in the region, with significant heterogeneity documented within countries. MDC practice was described as being more common in the private sector in Ecuador and Uruguay, while it is more widely implemented in public institutions of Colombia and Bolivia. Interpretation: Establishing quality MDC remains a challenge for oncology practices in Latin America. Addressing regional issues and identifying specific local needs is warranted to encourage the adoption of an effective multidisciplinary approach and, consequently, improve clinical outcomes. Active involvement of all stakeholders is required to build locally solutions and should involve institutions, health professionals, and patients. Funding: Research was funded by Productos Roche S.A.

Objective. To evaluate the reactogenicity of the SPUTNIK V vaccine in post-vaccinated 6th year Medicine students who carry out their care practices in the Autonomous Teaching Service of the Central Hospital of Maracay-Venezuela. Period February 2021- February 2022. Materials and methods. Prospective, evaluative, cross-sectional study. Medicine students were recruited, between 21 and 35 years of age who carried out their internships in the Autonomous Teaching Service of the Central Hospital of Maracay. The most important study variables were: The Sputnik V vaccine and the adverse reactions, evaluated using the anamnesis in an epidemiological consultation after the first 24 hours following the administration of the first dose, and 21 days later, 24 hours after the second dose of the vaccine in the same group. A medical file, validated by three experts, was used. Descriptive statistics, frequency tables and graphs were applied. Results. The predominant age group is between 21-25 years of age, 45 (81.82%) female, 37 (67.27%), 46 (83.67%) from the state of Aragua. The vaccination interval between doses was 3 weeks. The most frequent adverse reactions in the I dose: fever (83.64), malaise (58.18), headache (47.27) and myalgia (43.64%) that decreased significantly in the II dose. (16%) did not show reaction in I and (60%) in I. Conclusion. The post-vaccinated population is young. When receiving the first dose of the vaccine, more adverse reactions appeared than in the second. This is due to activation of the immune system (humoral response against COVID-19).

Entre las especies de mosquitos (Diptera: Culicidae) sinantrópicos que existen en la región de las Américas, tres desempeñan un papel protagónico en la transmisión de enfermedades de importancia médica en países de bajos y medios ingresos (LMIC): Aedes aegypti, Aedes albopictus y Culex quinquefasciatus. Con el objetivo de caracterizar la infestación domiciliar de estos mosquitos, se realizó un estudio entomológico en el municipio de Jutiapa (Guatemala) y Jarabacoa (República Dominicana), ambos incluidos dentro de la clasificación de LMIC. En cada municipio se muestrearon 100 viviendas seleccionadas aleatoriamente; en cada criadero se capturó la mayor cantidad posible de larvas y/o pupas con la ayuda de pipetas Pasteur, bandejas plásticas y botes herméticos. El porcentaje de depósitos con agua infestados por alguna de las especies de culícidos estudiada fue similar en ambos municipios (Jutiapa = 27.9 %, Jarabacoa = 20.0 %); entre estos predominaron los ubicados en el peri-domicilio (Jutiapa = 76.3 %, Jarabacoa = 93.7 %) en depósitos permanentes y útiles (Jutiapa = 79.6 %, Jarabacoa = 56.9 %). De forma general, Ae. aegypti fue la especie que más depósitos colonizó (Jutiapa = 92, Jarabacoa = 84), en cohabitación o no con otras especies. Los resultados refuerzan la necesidad de desarrollar estrategias de comunicación y participación comunitaria contextualizadas a las características de cada territorio y especie, así como direccionar los esfuerzos hacia el control doméstico, teniendo en cuenta sus contribuciones a la efectividad y sostenibilidad del manejo integrado de culícidos en estos y otros municipios con características similares.

La narrativa de las situaciones de enfermería resalta las vivencias y significados de la persona objeto de cuidado con un proceso de enfermedad y da cuenta de la relación de cuidado enfermero-paciente como aspecto clave para la recuperación de la salud física, mental y espiritual, teniendo como base el proceso de atención de enfermería. Se presenta la situación de enfermería de una persona mayor de 74 años de edad, posquirúrgica de laparotomía exploratoria más resección de masa en colon sigmoide, que derivó en una colostomía. Se resaltan situaciones relacionadas con la ansiedad y preocupación de parte de una de sus hijas por el estado de salud de su madre. Con base en la narrativa se analizaron los patrones de conocimiento personal, empírico, ético y estético, la visión del mundo de enfermería integrativa-interactiva, así como la aplicación de la teoría de rango medio de las transiciones; los supuestos de las propiedades de la transición de Afaf Meleis.

INTRODUCCIÓN: El desarrollo de las Tablas de Composición de Alimentos tiene varios desafíos, por lo que es necesario formar equipos interdisciplinarios que trabajen de manera articulada. El objetivo fue desarrollar una Tabla Nacional de Composición de Alimentos actualizada y metodológicamente adecuada para responder a las necesidades de programas alimentarios y la formulación de nuevos alimentos saludables. MÉTODOS: Se realizó una búsqueda electrónica de la literatura publicada sobre composición de alimentos desde 2010 con el software Covidence. También se efectuó una búsqueda manual de publicaciones nacionales no indexadas. La inclusión de los datos se evaluó en términos de criterios analíticos. RESULTADOS: A partir de la búsqueda se identificaron 1647 referencias potencialmente elegibles, de las cuales 103 artículos e informes cumplieron los criterios de inclusión. Estos estudios proporcionaron información principalmente sobre valor energético, macronutrientes, ácidos grasos y, en menor proporción, sobre vitaminas y minerales para diversos alimentos individuales y de múltiples ingredientes. Se inició la inclusión de esta información en la Base Nacional de Datos de Alimentos mediante un software desarrollado a tal efecto, y se continúa trabajando en la compilación y generación de datos analíticos. DISCUSIÓN: Estos resultados contribuirán a la actualización continua y sistemática de la base de datos de composición de alimentos, que es de suma importancia para la salud pública

Objetivo: Comparar la felicidad durante la COVID-19 según sexo, rangos de edad, país de residencia y tipo de aislamiento por medio de los instrumentos felicidad subjetiva de Lyubomirsky y Lepper (1999) y Escala de Satisfacción con la Vida de Diener, Emmons, Larsen y Griffin (1985). Metodología: enfoque cuantitativo, tipo de investigación comparativa, diseño no experimental. Se recolectaron 335 respuestas por medio de una encuesta vía web con Formularios de Google, previo consentimiento de los participantes, aplicada entre junio y agosto de 2020. Resultados: 67,8% femenino y 32,2% masculino, edad 27,5 ± 11,89 años, la satisfacción con la vida, según Diener et al. (1985), señalan que en promedio valores entre 4-5 en la escala, la felicidad subjetiva de Lyubomirsky y Lepper (1999), muestran resultados promedios rondando entre 5,13 a 5,31. Se determinó que el sexo es la única variable influyente sobre la felicidad subjetiva (p=0,001) y la satisfacción con la vida (p=0,012), el sexo femenino en ambos instrumentos presentó una mayor felicidad. Conclusiones: la satisfacción con la vida y la felicidad subjetiva, mostraron una felicidad media, no existió relación en los tipos de aislamiento señalados, ni en los rangos de edad, ni en el lugar de residencia de las personas de la muestra con relación a los niveles de felicidad descritos. Sin embargo, la variable sexo si arrojó relación estadísticamente significativa para representar que las mujeres tienden a ser más felices que los hombres. Objective: Compare happiness during COVID-19 according to sex, age ranges, country of residence and type of isolation using the subjective happiness instruments of Lyubomirsky and Lepper (1999) and the Scale of Satisfaction with Life of Diener, Emmons, Larsen and Griffin (1985). Methodology: quantitative approach, type of comparative research, non-experimental design. 335 responses were collected through a web survey with Google Forms, with the consent of the participants, applied between June and August 2020. Results: 67.8% female and 32.2% male, age 27.5 ± 11,89 years, satisfaction with life, according to Diener et al. (1985), indicate that on average values between 4-5 on the scale, the subjective happiness of Lyubomirsky and Lepper (1999), show average results ranging from 5.13 to 5.31. It was determined that sex is the only influential variable on subjective happiness (p = 0.001) and life satisfaction (p = 0.012), the female sex in both instruments presented greater happiness. Conclusions: satisfaction with life and subjective happiness, showed average happiness, there was no relationship in the types of isolation indicated, nor in the age ranges, nor in the place of residence of the people in the sample in relation to the levels of happiness described. However, the sex variable showed a statistically significant relationship to represent that women tend to be happier than men.

Dada la incertidumbre que acompaña a la pandemia por SARS-CoV-2 y ante la necesidad de dar respuesta a múltiples problemas de salud crónicos y agudos que afectan a la población general, incluidos aquellos que precisan de una intervención quirúrgica, se presentan las recomendaciones implementadas en clínicas y hospitales de Colombia como guía para lograr una reapertura de los servicios de cirugía electiva de forma segura, escalonada y monitoreada acorde a la dinámica que impone la pandemia, la regulación nacional e internacional y la velocidad en la producción de evidencia científica relacionada con la COVID-19.

Abstract Background Chlamydia screening in high schools offers a way to reach adolescents outside of a traditional clinic setting. Using transmission dynamic modeling, we examined the potential impact of high-school-based chlamydia screening programs on the burden of infection within intervention schools and surrounding communities, under varying epidemiological and programmatic conditions. Methods A chlamydia transmission model was calibrated to epidemiological data from three different settings. Philadelphia and Chicago are two high-burden cities with existing school-based screening programs. Rural Iowa does not have an existing program but represents a low-burden setting. We modeled the effects of the two existing programs to analyze the potential influence of program coverage and student participation. All three settings were used to examine a broader set of hypothetical programs with varying coverage levels and time trends in participation. Results In the modeled Philadelphia program, prevalence among the intervention schools’ sexually active 15–18 years old population was 4.34% (95% credible interval 3.75–4.71%)after 12 program years compared to 5.03% (4.39–5.43%) in absence of the program. In the modeled Chicago program, prevalence was estimated as 5.97% (2.60–7.88%) after 4 program years compared to 7.00% (3.08–9.29%) without the program. In the broader hypothetical scenarios including both high-burden and low-burden settings, impact of school-based screening programs was greater in absolute terms in the higher-prevalence settings, and benefits in the community were approximately proportional to population coverage of intervention schools. Most benefits were garnered if the student participation did not decline over time. Conclusions Sustained high student participation in school-based screening programs and broad coverage of schools within a target community are likely needed to maximize program benefits in terms of reduced burden of chlamydia in the adolescent population.

En Chile se ha producido un desarrollo económico que no ha resuelto profundas desigualdades. Hoy en día, se intenta resolver una intensa crisis política y social que irrumpe de modo explosivo en octubre de 2019 motivada por un alza del transporte público. Una década después de que se iniciara la implementación de la última reforma al sistema de salud, este sigue siendo un ámbito prioritario en la preocupación de la población y parte de las actuales demandas ciudadanas. Desde el movimiento social, se proponen nuevas reformas que requerirán de consensos para ser viables desde un punto de vista técnico y político. Los cambios necesarios en el ámbito de la salud son impostergables. Entre otras medidas, es preciso implementar transformaciones en el sector prestador, tanto público como privado, en la lógica de un modelo estructurado en redes integradas y basado en la estrategia de la atención primaria de salud. Esto permitirá la consecuente alineación de los recursos humanos y financieros con el acceso y cobertura de salud universal y, de esta manera, resolver de manera efectiva y eficiente las necesidades de salud de las personas y sus comunidades.