Técnicas de comunicación para la prevención y el control de enfermedades = Communication techniques for disease prevention and control

Resumen: La comunicación puede influir notablemente en la salud de la población. En Atención Primaria de Salud (APS), la comunicación adquiere un carácter esencial debido a que es necesaria en la realización de la mayoría de los objetivos de dicho nivel de salud tales como en la prevención de la enfermedad y en la promoción de la salud. Los tipos de comunicación son el verbal y el no verbal, ocupando este último un papel más activo en el proceso de comunicación. Nuestro cuerpo, el tono, las pausas, las risas, etc. Son elementos no verbales de importancia en el proceso de comunicación interpersonal con el paciente. En cuanto a la comunicación de masas, el uso correcto de medios impresos y medios de comunicación de masas puede ayudar al profesional sanitario de APS ha desarrollar campañas sanitarias de salud dirigidas a la población en general. Las características que debe tener todo proceso de comunicación efectiva para garantizar la calidad en dicho proceso son definidas. Se presentan varias situaciones en APS donde el uso de la comunicación se hace necesario dándose una orientación y pautas a seguir. La comunicación para la salud es una herramienta clave en la labor del profesional de APS. El uso de una comunicación eficaz incrementaría los resultados sanitarios, sobre todo en la promoción de la salud y en la prevención de la enfermedad. Es necesaria una mayor formación por parte de los profesionales de Atención Primaria en técnicas de comunicación. Palabras clave: comunicación, campañas sanitarias, Atención Primaria de Salud Abstract: Communication could highly influence to the health of the population. In Primary Health Care (PHC), communication get an essential character due to that it is neccesary in developing most of these health level purposes, like disease prevention and health promotion. The types of communication are the verbal and non-verbal, being the last one more active in the process of communication. Our body, tone, pauses, laughs, etc. are important non-verbal elements in the process of interpersonal communication with the patient. Regarding to mass communication, the right use of print media and mass media may help the health professional in PHC to develope health campaigns addressed to the general population. The characteristics of every process of communication to ensure quality are defined. Some situations are showed in PHC where the use of communication becomes neccesary giving counselling and steps to follow. Health communication is a key tool in the PHC professional work. The use of effective communication would increase the health results, especially in health promotion and disease prevention. More training for health professionals in communication techniques is needed.Keywords: communication, health campaigns, primary healthcar

The Atacama Cosmology Telescope: Extragalactic Point Sources in the Southern Surveys at 150, 220 and 280 GHz observed between 2008-2010

We present a multi-frequency, multi-epoch catalog of extragalactic sources. The catalog is based on 150, 220 and 280 GHz observations carried out in 2008, 2009 and 2010 using the Millimeter Bolometric Array Camera on the Atacama Cosmology Telescope. We also present and release 280 GHz maps from 2008 and 2010. The catalog contains 695 sources, found in a sky area of ${\sim}600$ square degrees. It is obtained by cross-matching sources found in 11 sub-catalogs, one for each season and frequency band. Also include are co-added data from ${\sim}150$ and ${\sim}160$ square degrees using 2 and 3 years of overlapping observations. We divide the sources into two populations, synchrotron and dusty emitters, based on their spectral behavior in the 150-220 GHz frequency range. We find 374 synchrotron sources and 321 dusty source candidates. Cross-matching with catalogs from radio to X-ray results in 264 synchrotron sources (71%) and 89 dusty sources (28%) with counterparts, suggesting that 232 dusty candidates are not in existing catalogs. We study the variability and number counts of each population. In the case of synchrotron sources, we find year-to-year variability up to 60%, with a mean value around 35%. As expected, we find no evidence of dusty source variability. Our number counts generally agree with previous measurements and models, except for dusty sources at 280 GHz where some models overestimate our results. We also characterize the spectral energy distribution of a dusty star-forming galaxy, ACT-S J065207-551605, using our data and higher frequency observations.Comment: 24 pages, 16 figures, for associated data products see https://lambda.gsfc.nasa.gov/product/act/act_prod_table.htm

Thermo-Mechanical Treatment Effects on Stress Relaxation and Hydrogen Embrittlement of Cold-Drawn Eutectoid Steels

The effects of the temperature and stretching levels used in the stress-relieving treatment of cold-drawn eutectoid steel wires are evaluated with the aim of improving the stress relaxation behavior and the resistance to hydrogen embrittlement. Five industrial treatments are studied, combining three temperatures (330, 400, and 460 °C) and three stretching levels (38, 50 and 64% of the rupture load). The change of the residual stress produced by the treatments is taken into consideration to account for the results. Surface residual stresses allow us to explain the time to failure in standard hydrogen embrittlement test

The Atacama Cosmology Telescope: Mitigating the impact of extragalactic foregrounds for the DR6 CMB lensing analysis

We investigate the impact and mitigation of extragalactic foregrounds for the CMB lensing power spectrum analysis of Atacama Cosmology Telescope (ACT) data release 6 (DR6) data. Two independent microwave sky simulations are used to test a range of mitigation strategies. We demonstrate that finding and then subtracting point sources, finding and then subtracting models of clusters, and using a profile bias-hardened lensing estimator, together reduce the fractional biases to well below statistical uncertainties, with the inferred lensing amplitude, $A_{\mathrm{lens}}$, biased by less than $0.2\sigma$. We also show that another method where a model for the cosmic infrared background (CIB) contribution is deprojected and high frequency data from Planck is included has similar performance. Other frequency-cleaned options do not perform as well, incurring either a large noise cost, or resulting in biased recovery of the lensing spectrum. In addition to these simulation-based tests, we also present null tests performed on the ACT DR6 data which test for sensitivity of our lensing spectrum estimation to differences in foreground levels between the two ACT frequencies used, while nulling the CMB lensing signal. These tests pass whether the nulling is performed at the map or bandpower level. The CIB-deprojected measurement performed on the DR6 data is consistent with our baseline measurement, implying contamination from the CIB is unlikely to significantly bias the DR6 lensing spectrum. This collection of tests gives confidence that the ACT DR6 lensing measurements and cosmological constraints presented in companion papers to this work are robust to extragalactic foregrounds.Comment: Companion paper to Qu et al and Madhavacheril et a

Evolution after Anti-TNF Discontinuation in Patients with Inflammatory Bowel Disease: A Multicenter Long-Term Follow-Up Study

OBJECTIVES:The aims of this study were to assess the risk of relapse after discontinuation of anti-tumor necrosis factor (anti-TNF) drugs in patients with inflammatory bowel disease (IBD), to identify the factors associated with relapse, and to evaluate the overcome after retreatment with the same anti-TNF in those who relapsed.METHODS:This was a retrospective, observational, multicenter study. IBD patients who had been treated with anti-TNFs and in whom these drugs were discontinued after clinical remission was achieved were included.RESULTS:A total of 1, 055 patients were included. The incidence rate of relapse was 19% and 17% per patient-year in Crohn''s disease and ulcerative colitis patients, respectively. In both Crohn''s disease and ulcerative colitis patients in deep remission, the incidence rate of relapse was 19% per patient-year. The treatment with adalimumab vs. infliximab (hazard ratio (HR)=1.29; 95% confidence interval (CI)=1.01-1.66), elective discontinuation of anti-TNFs (HR=1.90; 95% CI=1.07-3.37) or discontinuation because of adverse events (HR=2.33; 95% CI=1.27-2.02) vs. a top-down strategy, colonic localization (HR=1.51; 95% CI=1.13-2.02) vs. ileal, and stricturing behavior (HR=1.5; 95% CI=1.09-2.05) vs. inflammatory were associated with a higher risk of relapse in Crohn''s disease patients, whereas treatment with immunomodulators after discontinuation (HR=0.67; 95% CI=0.51-0.87) and age (HR=0.98; 95% CI=0.97-0.99) were protective factors. None of the factors were predictive in ulcerative colitis patients. Retreatment of relapse with the same anti-TNF was effective (80% responded) and safe.CONCLUSIONS:The incidence rate of inflammatory bowel disease relapse after anti-TNF discontinuation is relevant. Some predictive factors of relapse after anti-TNF withdrawal have been identified. Retreatment with the same anti-TNF drug was effective and safe

Exploring cosmic origins with CORE: Gravitational lensing of the CMB

Lensing of the CMB is now a well-developed probe of large-scale clustering over a broad range of redshifts. By exploiting the non-Gaussian imprints of lensing in the polarization of the CMB, the CORE mission can produce a clean map of the lensing deflections over nearly the full-sky. The number of high-S/N modes in this map will exceed current CMB lensing maps by a factor of 40, and the measurement will be sample-variance limited on all scales where linear theory is valid. Here, we summarise this mission product and discuss the science that it will enable. For example, the summed mass of neutrinos will be determined to an accuracy of 17 meV combining CORE lensing and CMB two-point information with contemporaneous BAO measurements, three times smaller than the minimum total mass allowed by neutrino oscillations. In the search for B-mode polarization from primordial gravitational waves with CORE, lens-induced B-modes will dominate over instrument noise, limiting constraints on the gravitational wave power spectrum amplitude. With lensing reconstructed by CORE, one can "delens" the observed polarization internally, reducing the lensing B-mode power by 60%. This improves to 70% by combining lensing and CIB measurements from CORE, reducing the error on the gravitational wave amplitude by 2.5 compared to no delensing (in the null hypothesis). Lensing measurements from CORE will allow calibration of the halo masses of the 40000 galaxy clusters that it will find, with constraints dominated by the clean polarization-based estimators. CORE can accurately remove Galactic emission from CMB maps with its 19 frequency channels. We present initial findings that show that residual Galactic foreground contamination will not be a significant source of bias for lensing power spectrum measurements with CORE. [abridged

The Atacama Cosmology Telescope: Millimeter observations of a population of asteroids or: ACTeroids

We present fluxes and light curves for a population of asteroids at millimeter wavelengths, detected by the Atacama Cosmology Telescope (ACT) over 18,000 deg2 of the sky using data from 2017 to 2021. We utilize high cadence maps, which can be used in searching for moving objects such as asteroids and trans-Neptunian Objects, as well as for studying transients. We detect 170 asteroids with a signal-to-noise of at least 5 in at least one of the ACT observing bands, which are centered near 90, 150, and 220 GHz. For each asteroid, we compare the ACT measured flux to predicted fluxes from the near-Earth asteroid thermal model fit to WISE data. We confirm previous results that detected a deficit of flux at millimeter wavelengths. Moreover, we report a spectral characteristic to this deficit, such that the flux is relatively lower at 150 and 220 GHz than at 90 GHz. Additionally, we find that the deficit in flux is greater for S-type asteroids than for C-type

Incidence, clinical characteristics and management of inflammatory bowel disease in Spain: large-scale epidemiological study

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD—Crohn’s disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)—during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100, 000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31–56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

The Atacama Cosmology Telescope: A Measurement of the DR6 CMB Lensing Power Spectrum and its Implications for Structure Growth

We present new measurements of cosmic microwave background (CMB) lensing over $9400$ sq. deg. of the sky. These lensing measurements are derived from the Atacama Cosmology Telescope (ACT) Data Release 6 (DR6) CMB dataset, which consists of five seasons of ACT CMB temperature and polarization observations. We determine the amplitude of the CMB lensing power spectrum at $2.3\%$ precision ($43\sigma$ significance) using a novel pipeline that minimizes sensitivity to foregrounds and to noise properties. To ensure our results are robust, we analyze an extensive set of null tests, consistency tests, and systematic error estimates and employ a blinded analysis framework. The baseline spectrum is well fit by a lensing amplitude of $A_{\mathrm{lens}}=1.013\pm0.023$ relative to the Planck 2018 CMB power spectra best-fit $\Lambda$CDM model and $A_{\mathrm{lens}}=1.005\pm0.023$ relative to the $\text{ACT DR4} + \text{WMAP}$ best-fit model. From our lensing power spectrum measurement, we derive constraints on the parameter combination $S^{\mathrm{CMBL}}_8 \equiv \sigma_8 \left({\Omega_m}/{0.3}\right)^{0.25}$ of $S^{\mathrm{CMBL}}_8= 0.818\pm0.022$ from ACT DR6 CMB lensing alone and $S^{\mathrm{CMBL}}_8= 0.813\pm0.018$ when combining ACT DR6 and Planck NPIPE CMB lensing power spectra. These results are in excellent agreement with $\Lambda$CDM model constraints from Planck or $\text{ACT DR4} + \text{WMAP}$ CMB power spectrum measurements. Our lensing measurements from redshifts $z\sim0.5$--$5$ are thus fully consistent with $\Lambda$CDM structure growth predictions based on CMB anisotropies probing primarily $z\sim1100$. We find no evidence for a suppression of the amplitude of cosmic structure at low redshiftsComment: 45+21 pages, 50 figures. Prepared for submission to ApJ. Also see companion papers Madhavacheril et al and MacCrann et a

The Atacama Cosmology Telescope: DR6 Gravitational Lensing Map and Cosmological Parameters

We present cosmological constraints from a gravitational lensing mass map covering 9400 sq. deg. reconstructed from CMB measurements made by the Atacama Cosmology Telescope (ACT) from 2017 to 2021. In combination with BAO measurements (from SDSS and 6dF), we obtain the amplitude of matter fluctuations $\sigma_8 = 0.819 \pm 0.015$ at 1.8% precision, $S_8\equiv\sigma_8({\Omega_{\rm m}}/0.3)^{0.5}=0.840\pm0.028$ and the Hubble constant $H_0= (68.3 \pm 1.1)\, \text{km}\,\text{s}^{-1}\,\text{Mpc}^{-1}$ at 1.6% precision. A joint constraint with CMB lensing measured by the Planck satellite yields even more precise values: $\sigma_8 = 0.812 \pm 0.013$, $S_8\equiv\sigma_8({\Omega_{\rm m}}/0.3)^{0.5}=0.831\pm0.023$ and $H_0= (68.1 \pm 1.0)\, \text{km}\,\text{s}^{-1}\,\text{Mpc}^{-1}$. These measurements agree well with $\Lambda$CDM-model extrapolations from the CMB anisotropies measured by Planck. To compare these constraints to those from the KiDS, DES, and HSC galaxy surveys, we revisit those data sets with a uniform set of assumptions, and find $S_8$ from all three surveys are lower than that from ACT+Planck lensing by varying levels ranging from 1.7-2.1$\sigma$. These results motivate further measurements and comparison, not just between the CMB anisotropies and galaxy lensing, but also between CMB lensing probing $z\sim 0.5-5$ on mostly-linear scales and galaxy lensing at $z\sim 0.5$ on smaller scales. We combine our CMB lensing measurements with CMB anisotropies to constrain extensions of $\Lambda$CDM, limiting the sum of the neutrino masses to $\sum m_{\nu} < 0.12$ eV (95% c.l.), for example. Our results provide independent confirmation that the universe is spatially flat, conforms with general relativity, and is described remarkably well by the $\Lambda$CDM model, while paving a promising path for neutrino physics with gravitational lensing from upcoming ground-based CMB surveys.Comment: 30 pages, 16 figures, prepared for submission to ApJ. Cosmological likelihood data is here: https://lambda.gsfc.nasa.gov/product/act/actadv_prod_table.html ; likelihood software is here: https://github.com/ACTCollaboration/act_dr6_lenslike . Also see companion papers Qu et al and MacCrann et al. Mass maps will be released when papers are publishe