Problemas de la investigación y las oportunidades para su desarrollo desde la Revista Médica de Risaralda

La crisis de la investigación en el país y el actual manejo de la Revista Medica de Risaralda resaltan las oportunidades del desarrollo de la investigación en pro de los impactos en salud publica

Relevance of Qualitative Research Approach in Evaluating Mental Health Interventions among Victims of Violence

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Nocebo Effect in Randomized Clinical Trials of Antidepressants in Children and Adolescents: Systematic Review and Meta-Analysis

Objective:: To compare the incidence of adverse events between active and placebo arms of randomized clinical trials in depressive children and adolescents (C&A) with antidepressant treatments, in order to look for similarities in both groups that allow to establish a possible nocebo effect. Methods:: Systematic search strategy (January 1974–March 2013) in electronic databases, conference abstracts, and reference list of systematic reviews and included studies to identify parallel randomized placebo-controlled trials of antidepressants in C&A (<19 years) with major depressive disorder, and one or more interventions of any orally administered antidepressant. The pooled adverse events were calculated based on a fixed-effect model and statistical analysis involved the risk ratio (RR) of adverse events, with 95% confidence intervals (95% CI). Results:: Sixteen studies were included in the review, of which seven studies with a sample of 1911 patients had data to include in the meta-analysis. There was similar risk for the incidence of adverse events between non-active and active group (global RR 1.04, 95% CI: 0.97–1.11). Conclusion:: Depressive C&A allocated to placebo or active group had similar risk to develop adverse events. These similarities in both groups are attributed to the nocebo effect. It is of note that defining “nocebo” effects is challenging in clinical populations because adverse effects may be attributed to the intervention or may be manifestation of the disease itself. The inclusion of a no-treatment arm may be warranted. Nocebo effects are likely when adverse events of placebo mimic the adverse events of active treatment, as was the case here

Effectiveness of Hydrotherapy on Neuropathic Pain and Pain Catastrophization in Patients With Spinal Cord Injury: Protocol for a Pilot Trial Study.

BACKGROUND Neuropathic pain (NP) is one of the most frequent spinal cord injury (SCI) complications. Pain, quality of life, and functionality are associated and can lead to pain catastrophization. Pharmacological management of patients with NP secondary to SCI is widely known and there is increasing evidence in the area. Nevertheless, nonpharmacological management is not fully elucidated since its efficacy is inconclusive. OBJECTIVE We hypothesize that (1) hydrotherapy is effective in reducing NP secondary to SCI. Additionally, our secondary hypotheses are that (2) hydrotherapy decreases the catastrophization of NP, and that (3) hydrotherapy improves life quality and minimizes the degree of disability, when compared to physical therapy. METHODS A sample of approximately 20 participants will be randomly assigned to either the intervention (hydrotherapy) or control group (standard physical therapy). Both interventions will be administered twice a week over a 9-week period (18 sessions in total). Primary outcomes are changes in neuropathic pain perception and pain catastrophization. Secondary outcomes are changes in disability and quality of life scores. They will be assessed at baseline and follow-up at 4 weeks after discharge. Validated Spanish language scales that will be used are the following: Numerical Pain Rating Scale, Pain Catastrophization, Health-related Quality of life, and the World Health Organization's Disability Assessment Schedule 2.0. Generalized mixed linear models will be used for comparing baseline and postintervention means of each group and their differences, together with 95% CIs and P values. A P value of less than .05 will be considered significant. RESULTS Recruitment began in April 2019, and we recruited the last participants by December 2019, with 10 individuals assigned to hydrotherapy and 8 to physical therapy (control). Results from this study will be disseminated via scientific publication, in ClinicalTrials.gov, and in national and international conferences in the latter half of 2022. CONCLUSIONS This trial will explore the effects of hydrotherapy on neuropathic pain, together with functionality and quality of life, in patients with SCI. Furthermore, this study aims to evaluate these therapeutic modalities, including perception variables, and mental processes, which may affect the clinical condition and rehabilitation outcomes in these patients. Hydrotherapy is likely to be a safe, efficient, and cost-effective alternative to the current standard of care for NP secondary to SCI, with comparable results between the two. TRIAL REGISTRATION ClinicalTrials.gov NCT04164810; https://clinicaltrials.gov/ct2/show/NCT04164810. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/37255

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Evaluación de una intervención cognitivo-conductual basada en la comunidad para la disminución de síntomas en salud mental en población afrocolombiana víctima de la violencia en Buenaventura y Quibdó, Colombia.

Maestría en EpidemiologiaAntecedentes: La exposición a la violencia genera efectos negativos en la salud mental de las víctimas. El conflicto armado en Colombia ha generado muerte y desplazamiento en todo el país y en a costa pacifica, el desplazamiento hacia Buenaventura en el Valle del Cauca y Quibdó en el Chocó. El presente estudio se realizó en el marco del Programa Comunitario de Tratamiento para Víctimas de Violencia en el Pacífico Colombiano ACOPLE, Asociación con Organizaciones por lo Emocional) y el Estudio Marco "Evaluación de dos intervenciones en salud mental basadas en la comunidad para población afrocolornbiana víctima de la violencia en Buenaventura y Quibdó", La siguiente propuesta de tesis abarca uno de los objetivos del Estudio Marco. Objetivo: Determinar la efectividad de una intervención cognitivo-conductual por componentes y basada en la comunidad, para disminuir síntomas en salud mental en personas afro-colombianas víctimas de la violencia en Buenaventura y Quibdó. Metodología: Ensayo de prevención controlado aleatonzado en donde se analizaron los datos de los participantes de la intervención cognitivo-conductual basada en componentes (CBI) y del grupo control. Se calculó tamaño de muestra esperándose 35 participantes por grupo en cada ciudad. Se realizó imputación múltiple para predecir los valores perdidos y realizar análisis de intención a tratar (ITT) con todos los participantes. El resultado primario fue el cambio en las subescalas de depresión, ansiedad y estrés postraumático, y el secundario, el cambio en las escalas total de síntomas de salud mental y funcionalidad. Se realizó análisis de ITI, de sensibilidad y por protocolo, por medio de modelos mixtos para evaluar el efecto de la intervención en el cambio de las escalas y subescalas identificando diferencias en la Iinea de base e interacciones. Se realizaron análisis de subgrupos para género y estado civil. CONTINUACIÓN: Resultados: Se incluyeron en Buenaventura 88 participantes en el grupo control (73,9% completaron seguimiento) y 92 en CBI (77,200 completaron seguimiento y 52,2% el tratamiento), y en Quibdó, 83 para cada grupo (control: 81,9% completo seguimiento; CBI: 67,5% completo seguimiento y 61,4% el tratamiento). Las escalas y subescalas en Buenaventura presentaron una reducción significativa entre -0,40 (IC95% -0,62 a -0,18) y -0,62 (-0,87 a -0,38) (p<O,O 1). En Quibdó, se presentaron mejorías no significativas en todas las escalas y subescalas entre -0,08 (-0,33 a 0,18) y -0,22 (-D,42 a -D,009). En el análisis de subgrupos se encontraron resultados significativos de mayor dimensión en los grupos de mujeres y con pareja estable. Se encontraron diferencias en el número de sesiones entre las ciudades siendo menor en Quibdó comparadas con Buenaventura (p 0,006) y finalmente, en Quibdó el efecto de los trabajadores comunitarios no fue significativo. Conclusión: Se presenta el primer ensayo controlado y aleatorizado de una intervención en salud mental para víctimas de violencia en Colombia, con resultados positivos para la población de Buenaventura y con efectos positivos no SIgnificativos en Quibdó. La intervención es efectiva principalmente para los subgrupos de mujeres y con pareja estable y en las subescalas de ansiedad, depresión y estrés posrraumático. Se recomienda la selección de personal con mayor experiencia en trabajo comunitario e incrementar la supervisión en Quibdó y entrenamiento de los trabajadores comunitarios lo que pennitiria obtener un mayor efecto. Se requieren más estudios que indaguen sobre los efectos en salud mental de la violencia en la población Colombiana, así como sobre la baja adherencia o reclutamiento de hombres en estudios de salud mental y la evaluación de potenciales intervenciones con miras al proceso postconflicto del país

Teleophthalmology to Prevent Diabetic Retinopathy: Implementation, Outcomes, and Associated Factors with Lack of Follow-Up in Western Pennsylvania

This dissertation explores the implementation and outcomes of a teleophthalmology program designed to prevent diabetic retinopathy in Western Pennsylvania, focusing on why some patients do not follow up after screening. By examining asynchronous telemedicine implementations at the University of Pittsburgh and UPMC, the work highlights the significant barriers to routine diabetic retinopathy screenings and subsequent follow-up care. The findings underscore the impact of socioeconomic, clinical, and systemic factors on patient engagement and adherence to follow-up recommendations. Through a detailed analysis of program data and patient characteristics, the research identifies key factors that contribute to patients being lost to follow-up, offering insights into improving patient outcomes in teleophthalmology and diabetic care

Las lesiones no son accidentes: hacia una cultura de la prevención

Injuries are the result of an acute exposure to exhort of energy or a consequence of a deficiency in a vital element that exceeds physiological thresholds resulting threatens life. They are classified as intentional or unintentional. Injuries are considered a global health issue because they cause more than 5 million deaths per year worldwide and they are an important contributor to the burden of disease, especially affecting people of low socioeconomic status in low- and middle-income countries. A common misconception exists where injuries are thought to be the same as accidents; however, accidents are largely used as chance events, without taken in consideration that all these are preventable. This review discusses injuries and accidents in the context of road traffic and emphasizes injuries as preventable events. An understanding of the essence of injuries enables the standardization of terminology in public use and facilitates the development of a culture of prevention among all of us. Las lesiones son el resultado de la exposición aguda a energía o consecuencia de la insuficiencia de un elemento vital que sobrepasan los umbrales fisiológicos e impiden la vida. Se clasifican en intencionales o no intencionales. Son consideradas un problema de salud pública a nivel mundial debido a que causan más de 5 millones de muertes por año en el mundo y por la carga de enfermedad que generan, afectando principalmente a población de bajos recursos en países de bajos y medianos ingresos. Un error común existe cuando las lesiones son consideradas como accidentes, sin embargo los accidentes están dados por el azar mientras que las lesiones son prevenibles. Esta es una revisión en torno a las lesiones y los accidentes para la comprensión de las lesiones en el tránsito como eventos prevenibles en pro de la estandarización de la terminología en salud pública y en seguridad vial para una cultura de prevención

Problemas de la investigación y las oportunidades para su desarrollo desde la Revista Médica de Risaralda

La crisis de la investigación en el país y el actual manejo de la Revista Medica de Risaralda resaltan las oportunidades del desarrollo de la investigación en pro de los impactos en salud publica.http://revistas.utp.edu.co/index.php/revistamedic