Tecnologías de la información y la comunicación como herramienta educativa en pacientes con enfermedades crónicas no transmisibles en una IPS de la ciudad de Manizales

ABSTRACT Introduction: chronic noncommunicable  diseases cause high morbidity and mortality worldwide so it requires innovative strategies that impact on self-care, adoption of healthy lifestyles and the diseases treatment. Nowadays, the information and communication technologies compose a resource in order to improve the effectiveness and efficiency of the patient’s programs with chronic diseases, overcome structural limitations and the availability of human resources in the health system. Objective: to evaluate the impact of theinformation and communication technologies to promote healthy lifestyles and adherence to medication, to know the perception of users about the usefulness of the intervention and also their effect on clinical variables. Methods: longitudinal study, in which 90 patients outpatient health institution in Manizales were included to receive text messages, was made. There were chosen over-age-18 men and women, with arterial hypertension diagnosis or diabetes mellitus who owned a cell phone or were with a near carer assistant who would accept receiving text massages in its own mobile. The massages were about their healthy lifestyle, and these were sent between august and december during 29 weeks. 68 subject completed the follow up. At the end of the intervention, acceptance, usefulness and effects on laboratory and clinical parameters were evaluated. Results: it was found that 100% of the patients who confirmed receiving the messages perceived an improvement in self care; showing changes in diet (95.16%) and the amelioration of medication adherence (59%). Besides, the service utility was qualified as excellent. Conclusions: the patient’s perceptions about the use of the information and communication technologies was positive and it could generates changes in areas such as alimentary habits and medication adherence, in promoting healthy lifestyles and management of chronic noncommunicable diseases. However, it requires controlled studies using a standardized long-term monitoring to determine the actual impact on clinical variables and cost-effective. In addition, it should identify the type of population would get greater benefit. MÉD.UIS. 2016;29(2):59-70.Keywords: Diabetes Mellitus. Hypertension. Primary prevention. Text Messaging. Cell Phones. Education. Technology.Introducción: las enfermedades crónicas no transmisibles causan gran morbilidad y mortalidad a nivel mundial por lo que se requiere de estrategias innovadoras que impacten en el autocuidado, adopción de estilos de vida saludables y manejo de ellas. En la actualidad, las Tecnologías de la información y la comunicación constituyen un recurso para mejorar la efectividad y la eicacia de programas dirigidos a pacientes con enfermedades crónicas, superar las limitaciones estructurales y la disponibilidad de recursos humanos existentes en los sistemas de salud. Objetivo: evaluar el impacto de las Tecnologías de la información y la comunicación como herramienta educativa para promover estilos de vida saludables y adherencia a la medicación, conocer la percepción de los usuarios frente a la intervención y observar el efecto sobre variables clínicas. Materiales y Métodos: estudio longitudinal, donde se incluyeron 90 pacientes de la consulta externa de una institución prestadora de salud de Manizales para recibir mensajes de texto. Fueron seleccionados hombres y mujeres mayores de 18 años con diagnóstico de hipertensión arterial o diabetes mellitus con teléfono celular propio o de un cuidador cercano que aceptaran recibir los mensajes de texto en su teléfono móvil. Los mensajes contenían información sobre estilos de vida saludable y fueron enviados entre agosto y diciembre de 2014 durante 29 semanas. 68 sujetos completaron el seguimiento. Al inal de la intervención, se evaluó la aceptación, utilidad y efectos sobre parámetros de laboratorio y clínicos. Resultados: el 100% de los pacientes que conirmaron la recepción de los mensajes percibieron una mejoría en su autocuidado; evidenciándose cambios en la dieta (95,16%) y mejoría en la adherencia a la medicación (59%), además de caliicarse la utilidad del servicio como excelente por el 61,5% de los sujetos. Sin embargo no se encontraron cambios estadísticamente signiicativos en variables clínicas y de laboratorio. Conclusiones: la percepción de los pacientes frente al uso de las Tecnologías de la información y la comunicación es positiva y genera cambios en aspectos como la alimentación y la adherencia a la medicación, por lo que constituye una herramienta en la promoción de estilos de vida saludables y manejo de enfermedades crónicas no transmisibles. Se requiere de estudios controlados estandarizados mediante un seguimiento a largo plazo para determinar el impacto real sobre variables clínicas y su costo-beneicio. Además se deberá individualizar el tipo de población que obtendría mayor beneicio. MÉD. UIS. 2016;29(2):59-70.Palabras clave: Diabetes Mellitus. Hipertensión. Prevención primaria. Mensaje de texto. Teléfonos celulares. Educación. Tecnología.

T-Cell Immune Responses Against Env from CRF12_BF and Subtype B HIV-1 Show High Clade-Specificity that Can Be Overridden by Multiclade Immunizations

BACKGROUND: The extreme genetic diversity of the human immunodeficiency virus type 1 (HIV-1) poses a daunting challenge to the generation of an effective AIDS vaccine. In Argentina, the epidemic is characterized by the high prevalence of infections caused by subtype B and BF variants. The aim of this study was to characterize in mice the immunogenic and antigenic properties of the Env protein from CRF12_BF in comparison with clade B, employing prime-boost schemes with the combination of recombinant DNA and vaccinia virus (VV) vectors. METHODOLOGY/PRINCIPAL FINDINGS: As determined by ELISPOT from splenocytes of animals immunized with either EnvBF or EnvB antigens, the majority of the cellular responses to Env were found to be clade-specific. A detailed peptide mapping of the responses reveal that when there is cross-reactivity, there are no amino acid changes in the peptide sequence or were minimal and located at the peptide ends. In those cases, analysis of T cell polifunctionality and affinity indicated no differences with respect to the cellular responses found against the original homologous sequence. Significantly, application of a mixed immunization combining both clades (B and BF) induced a broader cellular response, in which the majority of the peptides targeted after the single clade vaccinations generated a positive response. In this group we could also find significant cellular and humoral responses against the whole gp120 protein from subtype B. CONCLUSIONS/SIGNIFICANCE: This work has characterized for the first time the immunogenic peptides of certain EnvBF regions, involved in T cell responses. It provides evidence that to improve immune responses to HIV there is a need to combine Env antigens from different clades, highlighting the convenience of the inclusion of BF antigens in future vaccines for geographic regions where these HIV variants circulate

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Impacts of attacks to female health care workers in three territories of Colombia

Abstract Background This study explores the impacts of attacks perpetrated in the context of armed conflict, to female health workers in three Colombian territories. Methods We conducted a document review of the reports and databases of the Colombian Truth Commission, 17 in-depth semi-structured interviews with experts on the national and regional armed conflict and the medical mission, and 26 female health workers who were victims of attacks. Results Experts and female health workers reported attacks to health activities, facilities, equipment, and personnel, including attacks to traditional doctors belonging to indigenous communities. The most frequent attacks were threats and retention of health personnel; theft of supplies and medicines; damage and use of infrastructure and means of transport for purposes other than health care; and hinderance of health service provision. The attacks occurred in a framework of structural violence that intersects with poverty, racism, and gender bias. The impacts of these attacks include gender-based violence, significant disruption of the lives of health workers, and physical, emotional, psychological, social, and economic effects on the victims and their families. The government response to protect victims and populations has been absent or insufficient. Conclusions Attacks to health care were reported in all the studied territories obstructing adequate health care. Impacts of these attacks affect negatively the professional and personal life of the workers and are aggravated by structural violence and absent or little institutional response

Ecological Modelling

During the past decades, the development and use of ecological models to predict the presence or absence of macroinvertebrates as water quality indicators for decision support in river management has gained a lot of interest. However, these models rarely integrate hydromorphological, physicochemical, and biological components in the submodels. We developed a generic framework for decision support in water management that can be applied to any river basin based on an integrated modelling approach. This approach integrates a mechanistic hydraulic and physicochemical water quality model with aquatic ecological models. Two types of ecological models were developed, habitat suitability models to predict the occurrence of macroinvertebrates and ecological assessment models to predict a biotic index score. Our main purpose was to assess the effectiveness of different wastewater treatment/disposal strategies considering receiving water's ecological aspects and to determine water quality requirements. This paper presents the testing and validation of this integrated framework on a case study of a mountain river (River Cuenca) in the Andes of Ecuador. Three wastewater management scenarios were tested. The different scenarios indicated that the foreseen investments in sanitation infrastructure will lead to modest improvements of the ecological water quality. This improvement (i.e. increase of the biotic index) was only identified in 6 of the 21 monitoring stations considered in the River Cuenca and its tributaries. Therefore, it is necessary to control the impact of the industrial wastewaters discharges and the diffuse pollution at the upper catchment of the tributaries to achieve a good ecological status. With these results, we proved that integrated models, like the one presented here, have an added value for decision support in water management by coupling ecological water quality to a set of hydraulic and chemical water quality measures based on a water quality model. In order to improve these models, it is necessary to change the river monitoring strategy towards collection of data which include simultaneous measurements of physicochemical, hydromorphological and biological data.Cuencavolumen 25

Tecnologías de la información y la comunicación como herramienta educativa en pacientes con enfermedades crónicas no transmisibles en una IPS de la ciudad de Manizales

Introducción: las enfermedades crónicas no transmisibles causan gran morbilidad y mortalidad a nivel mundial por lo que se requiere de estrategias innovadoras que impacten en el autocuidado, adopción de estilos de vida saludables y manejo de ellas. En la actualidad, las Tecnologías de la información y la comunicación constituyen un recurso para mejorar la efectividad y la eicacia de programas dirigidos a pacientes con enfermedades crónicas, superar las limitaciones estructurales y la disponibilidad de recursos humanos existentes en los sistemas de salud. Objetivo: evaluar el impacto de las Tecnologías de la información y la comunicación como herramienta educativa para promover estilos de vida saludables y adherencia a la medicación, conocer la percepción de los usuarios frente a la intervención y observar el efecto sobre variables clínicas. Materiales y Métodos: estudio longitudinal, donde se incluyeron 90 pacientes de la consulta externa de una institución prestadora de salud de Manizales para recibir mensajes de texto. Fueron seleccionados hombres y mujeres mayores de 18 años con diagnóstico de hipertensión arterial o diabetes mellitus con teléfono celular propio o de un cuidador cercano que aceptaran recibir los mensajes de texto en su teléfono móvil. Los mensajes contenían información sobre estilos de vida saludable y fueron enviados entre agosto y diciembre de 2014 durante 29 semanas. 68 sujetos completaron el seguimiento. Al inal de la intervención, se evaluó la aceptación, utilidad y efectos sobre parámetros de laboratorio y clínicos. Resultados: el 100% de los pacientes que conirmaron la recepción de los mensajes percibieron una mejoría en su autocuidado; evidenciándose cambios en la dieta (95,16%) y mejoría en la adherencia a la medicación (59%), además de caliicarse la utilidad del servicio como excelente por el 61,5% de los sujetos. Sin embargo no se encontraron cambios estadísticamente signiicativos en variables clínicas y de laboratorio. Conclusiones: la percepción de los pacientes frente al uso de las Tecnologías de la información y la comunicación es positiva y genera cambios en aspectos como la alimentación y la adherencia a la medicación, por lo que constituye una herramienta en la promoción de estilos de vida saludables y manejo de enfermedades crónicas no transmisibles. Se requiere de estudios controlados estandarizados mediante un seguimiento a largo plazo para determinar el impacto real sobre variables clínicas y su costo-beneicio. Además se deberá individualizar el tipo de población que obtendría mayor beneicio

Additional file 1 of Impacts of attacks to female health care workers in three territories of Colombia

Supplementary Material 1