La medicina social y las experiencias de atención primaria de salud (APS) en Latinoamérica: historia con igual raíz

Los orígenes de la APS y de la Política de SALUD PARA TODOS se remontan al siglo XVIII y al movimiento de Medicina Social de 1848. Del siglo XX se destacan las experiencias pioneras de los años 30-50s. Entre ellas, Chile, Saskachewa (Canadá), EUA, Suráfrica, con Henry Sigerist, Sidney Kark, Salvador Allende, Gustavo Molina, trabajos pioneros de la medicina y la epidemiologia social vinculados a los del antropólogo Benjamin Paul. Así como personajes menos reconocidos en APS especialmente el italiano Franco Basaglia transformador de la atención psiquiátrica y sanitaria con los principios de libertad terapéutica. A éstas están articuladas numerosas y desconocidas experiencias en América Latina y Colombia con Héctor Abad Gómez, Santiago Rengifo y César Uribe Piedrahita por el proceso de “Renovación de APS” de la OPS. En Latinoamérica, las luchas por la salud estaban articuladas a la luchas por una sociedad justa, con personajes como Ernesto Guevara desde la medicina, Paulo Freire en pedagogía, teología y filosofía de la liberación, y el sociólogo colombiano Camilo Torres, que aportaron metodologías cualitativas en la investigación en salud, los que junto aportes de integración como el Desarrollo a Escala Humana, consideran a los servicios sanitarios como elementos principales en la vida de las personas, y aportan a la construcción transdisciplinar e intersectorial de la salud para nuestro hoy.The origins of the APS and the Policy HEALTH FOR ALL go back to the eighteenth century and the movement of Social Medicine on 1848. Twentieth century highlights the pioneering experiences of the years 30-50s. Among them, Chile, Saskatchewan (Canada), USA, South Africa, with Henry Sigerist, Sidney Kark, Salvador Allende, Gustavo Molina, pioneering work of social medicine and epidemiology related to the anthropologist Benjamin Paul. As well as less recognized characters, especially the Italian Franco Basaglia, APS who transformed psychiatric care and health with the principles of therapeutic freedom. To these are articulated numerous and unknown experiences in Latin America and Colombia with Héctor Abad Gómez, Santiago Rengifo and César Uribe Piedrahita by the process of PHC renewal» of the OPS. In Latin America, the struggles for health were articulated to the struggles for a just society, with people like Ernesto Guevara in medicine, Paulo Freire in pedagogy, theology and philosophy of liberation, and the sociologist Camilo Torres, who provided qualitative methodologies on health research, which altogether with views on integration such as Human Scale Development, consider health services as key elements in people’s lives, and contribute in building cross-disciplinary and intersectorial health for our today.Les origines des APS et de la Politique de Santé Pour Tous remontent au 18ème siècle et s’inspire du mouvement de Médecine Sociale de 1848. Au cours du 20ème siècle, deux expériences pionnières furent mises en œuvre entre les années trente et les années cinquante. Parmi celles-ci retenons le Chili, Saskachewa (Canada), les Etats-Unis, l’Afrique du Sud, avec Henry Sigerist, Sidney Kark, Salvador Allende, Gustavo Molina, auteurs de travaux pionniers de la médecine et de l’épidémiologie sociale associés aux travaux de l’anthropologue Benjamin Paul. Des personnalités beaucoup moins reconnues des APS sont ici mentionnées, comme l’italien Franco Basaglia qui a transformé les soins psychiatriques et sanitaires en se basant sur les principes de liberté thérapeutique. A celles-ci s’articulent de nombreuses expériences méconnues en Amérique latine et en Colombie avec Héctor Abad Gomez, Santiago Rengifo et César Uribe Piedrahita qui entreprirent la « Rénovation des APS » de la OPS. En Amérique latine, les mobilisations pour la santé allaient de pair avec le combat pour une société plus juste, comptant sur des personnalités telles que Ernesto Guevara dans le domaine de la médecine, de Paulo Freire pour la pédagogie, la théologie et la philosophie de la libération, et du sociologue colombien Camilo Torres, qui contribuèrent à l’élaboration de méthodologies qualitatives pour des enquêtes de santé, favorisant ainsi l’intégration du Développement à Echelle Humaine qui considère les soins sanitaires comme des éléments fondamentaux dans la vie des individus, et contribuant à la construction transdisciplinaire et intersectorielle de la santé jusqu’à nos jours.As origens da APS e da Política de Saúde PARA TODOS voltar ao século XVIII e do movimento de Medicina Social, 1848. século XX destaca as experiências pioneiras dos anos 30-50s. Incluindo o Chile, Saskatchewan (Canadá), EUA, África do Sul, com Henry Sigerist, Kark Sidney, Salvador Allende, Gustavo Molina, um trabalho pioneiro da medicina social e epidemiologia relacionada com o antropólogo Paul Benjamin. E menos reconhecidas personagens, especialmente o italiano Franco Basaglia transformador APS cuidados psiquiátricos e de saúde com os princípios da terapia de liberdade. Estes são articuladas inúmeras experiências e desconhecidos na América Latina e Colômbia, com Héctor Abad Gómez, Rengifo Santiago e César Piedrahita Uribe pelo processo de renovação da APS “da OPS. Na América Latina, a luta pela saúde foram articuladas com a luta por uma sociedade justa, com pessoas como Ernesto Guevara de medicina, Paulo Freire, em Pedagogia e Teologia e filosofia da libertação, incluindo o sociólogo Camilo Torres, que forneceram as metodologias qualitativas investigação em saúde com a participação de integração, Escala de Desenvolvimento Humano de considerar elementos-chave dos serviços de saúde na vida das pessoas e contribuindo na construção de inter-disciplinar e de saúde para o nosso hoje

Surgical procedures as a major risk factor for chronic hepatitis C virus infection in Italy: Evidence from a case-control study

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optimizing patient referral and center capacity in the management of chronic hepatitis c lessons from the italian experience

Abstract Aims In 2017 the Italian Drug Agency (Agenzia Italiana del Farmaco, AIFA) revised the criteria for access to therapy for patients with chronic hepatitis C as part of a three-year plan to eradicate HCV. We conducted a Delphi study to determine strategies to identify and treat patients with HCV and to develop through a shared pathway, a model to manage patient referral and optimize prescription center capacity with the overall aim of increasing access to therapy. Methods The process took place in two phases – Phase I (January 2017), before the criteria for treatment of HCV were revised and Phase II (May 2017) when AIFA developed a framework for the eradication of HCV infection in Italy. Two questionnaires were devised with Q1 administered in Phase I and Q2 in Phase II. Results Q1 was sent to 823 hepatitis specialists working in 235 Italian HCV centers authorized to prescribe direct-acting antiviral drugs (DAAs). Overall, 167 centers (71%) participated with a good geographical representativeness (North 69%, Centre 74%; South and islands 70%). 548 prescribers (68.8%) provided responses to Q1 and 443 (80%) specialists who responded to Q1 completed Q2. Over 70% considered that to meet the new therapy targets local/regional networks need to be consolidated and reinforced with GPs providing the 'missing link' in current regional networks. Adherence to therapy was considered important by 75% of clinicians with reduction in follow-up intervals/length considered important by 65% – to free up staff/resources to manage increasing numbers of new patients. About 80% of respondents stated that medical personnel were principally involved in follow-up with follow-up having a significant impact on center capacity. Conclusion Enhancing patient referral, the need for an increased role of GPs, increasing center capacity in particular medical personnel in outpatient centers and greater liaison between Hub centers and healthcare professionals currently managing high-risk groups as yet untreated, were factors that need to be streamlined in order to meet treatment targets for eradication of HCV

Cardioprotective effects of sodium glucose cotransporter 2 inhibition in angiotensin II-dependent hypertension are mediated by the local reduction of sympathetic activity and inflammation

The cardioprotective effects of sodium glucose cotrasponter 2 (SGLT2) inhibitors seem to be independent from the effects on glycemic control, through little-known mechanisms. In this study, we investigate whether the cardioprotective effects of empagliflozin, a SGLT2 inhibitor, may be associated with myocardial sympathetic activity and inflammatory cell infiltration in an experimental model of angiotensin II-dependent hypertension. Angiotensin II (Ang II), Ang II plus Empagliflozin, physiological saline, or physiological saline plus empagliflozin were administered to Sprague Dawley rats for two weeks. Blood pressure was measured by plethysmographic method. Myocardial hypertrophy and fibrosis were analysed by histomorphometry, and inflammatory cell infiltration and tyrosine hydroxylase expression, implemented as a marker of sympathetic activity, were evaluated by immunohistochemistry. Ang II increased blood pressure, myocardial hypertrophy, fibrosis, inflammatory infiltrates and tyrosine hydroxylase expression, as compared to the control group. Empagliflozin administration prevented the development of myocardial hypertrophy, fibrosis, inflammatory infiltrates and tyrosine hydroxylase overexpression in Ang II-treated rats, without affecting blood glucose and the Ang II-dependent increase in blood pressure. These data demonstrate that the cardioprotective effects of SGLT2 inhibition in Ang II-dependent hypertension may result from the myocardial reduction of sympathetic activity and inflammation and are independent of the modulation of blood pressure and blood glucose levels

Consensus document on controversial issues in the diagnosis and treatment of bloodstream infections and endocarditis.

Summary Background The treatment of severe bloodstream infections (sepsis, endocarditis, and infections of vascular prostheses) caused by Gram-positive microorganisms is made even more difficult by the emergence of resistant strains. The introduction of new antibiotics with activity against these strains has created new opportunities, but many controversial issues remain. Controversial issues The aim of this GISIG (Gruppo Italiano di Studio sulle Infezioni Gravi) working group – a panel of multidisciplinary experts – was to define recommendations for some controversial issues using an evidence-based and analytical approach. The controversial issues concerned the duration of therapy and role of aminoglycosides and teicoplanin in the treatment of Gram-positive bacterial endocarditis, the optimal use of the new antibiotics in the treatment of bloodstream infections caused by resistant Gram-positive strains, and the use of microbiological techniques (i.e., bactericidal serum testing and synergy testing) and of pharmacokinetic data (e.g., monitoring of plasma levels of antibiotics) in the treatment of difficult-to-treat Gram-positive bloodstream infections. Methods A systematic literature search of randomized controlled trials and/or non-randomized studies was performed mainly using the MEDLINE database. A matrix was created to extract evidence from original studies using the CONSORT method to evaluate randomized clinical trials and the Newcastle–Ottawa Quality Assessment Scale for non-randomized studies. The GRADE method for grading the quality of evidence and strength of recommendation was applied

Physiological responses of 'Italia' grapevines infected with Esca pathogens

Physiological features were examined of a 20-year-old Vitis vinifera 'Italia' table grape vineyard cropped in Apulia, Italy. Healthy vines with no foliar symptoms and any indications of wood or berry alterations, vines with natural wood infections by Phaeoacremonium minimum (syn. P. aleophilum) and Phaeomoniella chlamydospora showing brown wood streaking symptoms, and vines naturally infected with P. minimum, P. chlamydospora and Fomitiporia mediterranea with brown wood streaking and white rot symptoms, were surveyed. Bleeding xylem sap, collected at bud-break from healthy vines showed the greatest total ascorbic acid level, while vines with brown wood streaking and white rot had the greatest viscosity coefficient, glutathione concentration, and plant growth regulator activities. Compared to healthy vines, leaves of wood affected vines, sampled during the unfolded leaf, fruit setting, cluster closing and bunch ripening vine growth stages, had reduced fresh and dry weights, total chlorophyll concentrations, and increased leaf surface area. Low ascorbic acid and reduced glutathione concentrations, weak redox state, and moderate levels of dehydroascorbic acid and oxidized glutathione were also detected in these vines. Analyses also detected reduced activities of dehydroascorbate reductase, ascorbate free radical reductase and glutathione reductase in diseased vines. The cell membrane damage, associated with lipid peroxidation, was coupled with high hydrogen peroxide concentrations. These changes could contribute to the cell death of leaves and foliar symptom development. The ascorbate-glutathione cycle supports grapevine susceptibility to Esca complex-associated fungi

Estrategias para la eliminación de malaria: Una perspectiva afro-colombiana

Objective To describe strategies for malaria elimination based on the perception of Afro-Colombian residents in Guapí, in the context of the Integrated Management Strategy for the Promotion, Prevention and Control of Vector-Borne Diseases in Colombia (EGI-ETV). Materials and Methods Qualitative study based on focus group discourse analysis. Eight participants from the urban area of Guapi were divided into two groups. The first group included three female nursing assistants, and was called “women with more experience”; they were workers in the current health system and former Malaria Eradication Service officers. The second group was made up of female nursing assistants, and was called “women with limited experience”; they were workers in the current health system and were not directly trained in the malaria program. An inductive and interpretative analysis was performed. Results Eight subcategories emerged, framed in the EGI-EVT, making emphasis on promotion and prevention aimed at reducing malaria, especially in rural areas. This problem must be addressed comprehensively, including other health issues and social determinants that affect them, such as: basic sanitation, access to health services, lack of education, use of popular treatments, and lack of infrastructure, among others. Conclusion Participants consider that malaria in Guapi can be reduced but not eliminated. This problem needs to be addressed from an institutional and community perspective, taking into account cultural differences, based on strategies that include community empowerment and administrative and institutional strengthening of the program. © 2019, Universidad Nacional de Colombia. All rights reserved