Estudio de caso sobre el programa por el derecho a la educación de calidad en los municipios de Florida, Pradera y Zarzal

115 páginasDocument and evaluate the results of the case study research on the "For the right to quality education" program, implemented by the Caicedo Gonzalez Riopaila Castilla Foundation, in the municipalities of Florida, Pradera and Zarzal (Valle del Cauca). The program was carried out in the area of influence of the company Riopaila Castilla S.A. The process was developed between private enterprise, municipal administration, civil society and the educational community. The transformations related to participation in the formulation of solutions to educational problems were established, all based on establishing relationships in spaces of dialogue, where the educational aspect was included in the public agenda, which allowed the strengthening of social capital, the capacity for analysis And management of social actors, with whom common objectives were worked, with the purpose of closing social gaps of illiteracy, school dropout, educational quality mainly. For the educational community and municipal government, the leadership of the Foundation motivated the communities to participate in the construction of public educational policy. The sources of information used were interviews, direct observations and unpublished and specialized documents. The case study was conducted between February and November 2015.Documentar y valorar los resultados de la investigación de estudio de caso sobre el programa "Por el derecho a la educación de calidad", implementado por la Fundación Caicedo González Riopaila Castilla, en los municipios de Florida, Pradera y Zarzal (Valle del Cauca). El programa se Ilevó a cabo en el área de influencia de la empresa Riopaila Castilla S.A. El proceso fue desarrollado entre la empresa privada, la administración municipal, la sociedad civil y la comunidad educativa. Lográndose transformaciones relacionadas con la participación en la formulación de soluciones a problemáticas educativas, todo ello a partir de establecer relaciones en espacios de interlocución, donde el aspecto educativo se incluyó en la agenda pública, lo que permitió fortalecer el capital social, la capacidad de análisis y gestión de los actores sociales, con quienes se trabajaron objetivos comunes, con el propósito de cerrar brechas sociales de analfabetismo, deserción escolar, calidad educativa principalmente. Para la comunidad educativa y Gobierno municipal, el liderazgo de la Fundación motivó a las comunidades a participar en la construcción de la política pública educativa. Las Fuentes de información utilizadas fueron entrevistas, observaciones directas y documentos inéditos y especializados. El estudio de caso se realizó entre febrero y noviembre de 2015.Magíster en Responsabilidad Social y SostenibilidadMaestrí

Predictors of Missed Hepatitis C Intake Appointments and Failure to Establish Hepatitis C Care Among Patients Living With HIV.

BackgroundWe estimated and characterized the proportion of patients living with HIV (PLWH) who missed hepatitis C (HCV) intake appointments and subsequently failed to establish HCV care.MethodsLogistic regression analyses were used to identify factors associated with missed HCV intake appointments and failure to establish HCV care among PLWH referred for HCV treatment between January 2014 and December 2017. In addition to demographics, variables included HIV treatment characteristics, type of insurance, liver health status, active alcohol or illicit drug use, unstable housing, and history of a mental health disorder (MHD).ResultsDuring the study period, 349 new HCV clinic appointments were scheduled for 202 unduplicated patients. Approximately half were nonwhite, and 80% had an undetectable HIV viral load. Drug use (31.7%), heavy alcohol use (32.8%), and MHD (37.8%) were prevalent. Over the 4-year period, 21.9% of PLWH referred for HCV treatment missed their HCV intake appointment. The proportion increased each year, from 17.2% in 2014 to 25.4% in 2017 (P = .021). Sixty-six of the 202 newly referred HCV patients (32.7%) missed their first HCV appointment, and 28 of these (42.4%) failed to establish HCV care. Having a history of MHD, CD4 <200, ongoing drug use, and being nonwhite were independent predictors of missing an intake HCV appointment. The strongest predictor of failure to establish HCV care was having a detectable HIV viral load.ConclusionsThe proportion of PLWH with missed HCV appointments increased over time. HCV elimination among PLWH may require integrated treatment of MHD and substance use

Update on hepatitis C virus resistance to direct-acting antiviral agents

Review[Abstract] Resistance to direct-acting antiviral (DAA) agents against hepatitis C virus (HCV) infection is driven by the selection of mutations at different positions in the NS3 protease, NS5B polymerase and NS5A proteins. With the exception of NS5B nucleos(t)ide inhibitors, most DAAs possess a low genetic barrier to resistance, with significant cross-resistance between compounds belonging to the same family. However, a specific mutation profile is associated with each agent or drug class and varies depending on the genotype/subtype (e.g., genotype 1b showed higher rates of sustained virological response (SVR) and a higher genetic barrier for resistance than genotype 1a). Moreover, some resistance mutations exist as natural polymorphisms in certain genotypes/subtypes at frequencies that require baseline drug resistance testing before recommending certain antivirals. For example, the polymorphism Q80K is frequently found among genotype 1a (19–48%) and is associated with resistance to simeprevir. Similarly, L31M and Y93H, key resistance mutations to NS5A inhibitors, are frequently found (6–12%) among NS5A genotype 1 sequences. In particular, the presence of these polymorphisms may be of relevance in poorly interferon-responsive patients (i.e., null responders and non-CC IL28B) under DAA-based therapies in combination with pegylated interferon-α plus ribavirin. The relevance of pre-existing resistance mutations for responses to interferon-free DAA therapies is unclear for most regimens and requires further study.Instituto de Salud Carlos III; CP08/00214Instituto de Salud Carlos III; PI10/0216

Revisión crítica : efectos de la goma de mascar en la reducción del íleo paralítico para los pacientes posoperados

El trabajo académico titulado: Efectos de la goma de mascar en la reducción del íleo paralitico para los pacientes posoperados, tuvo como objetivo evaluar la eficacia de la goma de mascar en la reducción del íleo paralítico para pacientes posoperados. El tipo de investigación es una Investigación secundaria, a través de enfermería basada en la evidencia. La búsqueda de información se ha realizado en diferentes bases de datos: Pubmed, Cochrane, Scielo, Biblioteca Virtual en Salud, Scient direct y Google Académico. Los artículos seleccionados se sometieron a una lectura crítica, utilizando la lista de chequeo de Gálvez Toro para identificar su validez, utilidad y aplicabilidad aparentes; de los cuales se eligieron dos artículos, correspondientes a Estados Unidos y China. Los artículos son de tipo de investigación cuantitativa, incluyendo estudios experimentales y ensayos clínicos aleatorizados. Estos estudios fueron evaluados según metodología: Ensayo clínico, por la lista de chequeo Quorum. En la selección definitiva se eligió un artículo logrando responder a la pregunta clínica, siendo la respuesta: La goma de mascar sí garantiza la reducción del íleo posoperatorio. Posee un nivel de evidencia 1 +, con grado de recomendación “MODERADO

Association Between Chronic Hepatitis C Virus Infection and Myocardial Infarction Among People Living With HIV in the United States.

Hepatitis C virus (HCV) infection is common among people living with human immunodeficiency virus (PLWH). Extrahepatic manifestations of HCV, including myocardial infarction (MI), are a topic of active research. MI is classified into types, predominantly atheroembolic type 1 MI (T1MI) and supply-demand mismatch type 2 MI (T2MI). We examined the association between HCV and MI among patients in the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems, a US multicenter clinical cohort of PLWH. MIs were centrally adjudicated and categorized by type using the Third Universal Definition of Myocardial Infarction. We estimated the association between chronic HCV (RNA+) and time to MI while adjusting for demographic characteristics, cardiovascular risk factors, clinical characteristics, and history of injecting drug use. Among 23,407 PLWH aged ≥18 years, there were 336 T1MIs and 330 T2MIs during a median of 4.7 years of follow-up between 1998 and 2016. HCV was associated with a 46% greater risk of T2MI (adjusted hazard ratio (aHR) = 1.46, 95% confidence interval (CI): 1.09, 1.97) but not T1MI (aHR = 0.87, 95% CI: 0.58, 1.29). In an exploratory cause-specific analysis of T2MI, HCV was associated with a 2-fold greater risk of T2MI attributed to sepsis (aHR = 2.01, 95% CI: 1.25, 3.24). Extrahepatic manifestations of HCV in this high-risk population are an important area for continued research

The role of coinfections in HIV epidemic trajectory and positive prevention: a systematic review and meta-analysis.

OBJECTIVES: Recurrent or persistent coinfections may increase HIV viral load and, consequently, risk of HIV transmission, thus increasing HIV incidence. We evaluated the association between malaria, herpes simplex virus type 2 (HSV-2) and tuberculosis (TB) coinfections and their treatment on HIV viral load. DESIGN: Systematic review and meta-analysis of the association of malaria, HSV-2 and TB coinfections and their treatment with HIV viral load. METHODS: PubMed and Embase databases were searched to 10 February 2010 for studies in adults that reported HIV plasma and/or genital viral load by coinfection status or treatment. Meta-analyses were conducted using random-effects models. RESULTS: Forty-five eligible articles were identified (six malaria, 20 HSV-2 and 19 TB). There was strong evidence of increased HIV viral load with acute malaria [0.67 log(10) copies/ml, 95% confidence interval (CI) 0.15-1.19] and decreased viral load following treatment (-0.37 log(10) copies/ml, 95% CI -0.70 to -0.04). Similarly, HSV-2 infection was associated with increased HIV viral load (0.18 log(10) copies/ml, 95% CI 0.01-0.34), which decreased with HSV suppressive therapy (-0.28 log(10) copies/ml, 95% CI -0.36 to -0.19). Active TB was associated with increased HIV viral load (0.40 log(10) copies/ml, 95% CI 0.13-0.67), but there was no association between TB treatment and viral load reduction (log(10) copies/ml -0.02, 95% CI -0.19 to 0.15). CONCLUSION: Coinfections may increase HIV viral load in populations where they are prevalent, thereby facilitating HIV transmission. These effects may be reversed with treatment. However, to limit HIV trajectory and optimize positive prevention for HIV-infected individuals pre-antiretroviral therapy, we must better understand the mechanisms responsible for augmented viral load and the magnitude of viral load reduction required, and retune treatment regimens accordingly

Pre-vaccination prevalence of anogenital and oral human papillomavirus in young HIV-infected men who have sex with men.

The aims of this study were to: 1) determine prevalence of anogenital and oral HPV, 2) determine concordance between HPV at anal, perianal, scrotal/penile, and oral sites; and 3) describe factors associated with anogenital HPV types targeted by the 9-valent vaccine. Data were collected from 2012 to 2015 among men who have sex with men 18-26 years of age enrolled in a vaccine trial (N = 145). Penile/scrotal, perianal, anal, and oral samples were tested for 61 HPV types. Logistic regression was used to identify factors associated with types in the 9-valent vaccine. Participants' mean age was 23.0 years, 55.2% were African-American, and 26.2% were Hispanic; 93% had anal, 40% penile, and 6% oral HPV. Among those with anogenital infection, 18% had HPV16. Concordance was low between anogenital and oral sites. Factors independently associated with a 9-valent vaccine-type HPV were: race (African-American vs. White, OR=2.67, 95% CI=1.11-6.42), current smoking (yes vs. no, OR=2.37, 95% CI=1.03-5.48), and number of recent receptive anal sex partners (2+ vs. 0, OR=3.47, 95% CI=1.16-10.4). Most MSM were not infected with HPV16 or HPV18, suggesting that they may still benefit from HPV vaccination, but anogenital HPV was very common, highlighting the importance of vaccinating men before sexual initiation. CLINICAL TRIAL NUMBER: NCT01209325