Doença de Lyme: anticorpos anti Borrelia burgdorferi nos trabalhadores rurais da Argentina

Lyme Disease is a tick-borne (specially by Ixodes ticks) immune-mediated inflammatory disorder caused by a newly recognize spirochete, Borrelia burgdorferi. Indirect fluorescent antibody (IF) staining methods and enzyme-linked immunosorbent assay are frequently relied upon to confirm Lyme borreliosis infections. Although serologic testing for antibodies has limitations, it is still the only practical means of confirming B. burgdorferi infections. Because we have no previous report of Lyme disease in human inhabitants in Argentina, a study was designed as a seroepidemiologic investigation of the immune response to B. burgdorferi in farm workers of Argentina with arthritis symptoms. Three out of 28 sera were positive (#1,5 and 9). Serum # 1 was positive for Immunoglobulin G at dilution 1:320, serum # 5 and # 9 both to dilution 1:160; while for Immunoglobulin M all (#1, 5 and 9) were positive at low dilution (1:40) using IF. The results showed that antibodies against B. burgdorferi are present in an Argentinian population. Thus caution should be exercised in the clinical interpretation of arthritis until the presence of B. burgdorferi be confirmed by culture in specific media.A doença de Lyme, é uma desordem inflamatória, intermediada pelo sistema imunogênico, transmitida por carrapatos (especialmente do Gênero Ixodes) e causada por uma espiroqueta recentemente descoberta, a Borrelia burgdorferi. A técnica de Imunofluorescência Indireta (IF) é com freqüência usada para confirmar o diagnóstico da infecção por este microrganismo. Embora os métodos práticos tenham limitações, é no entanto o único método prático para seu diagnóstico. Devido a não existência de registros prévios dessa doença na Argentina, foi realizada pesquisa seroepidemiológica para determinar a presença de imunoglobulinas nos trabalhadores rurais da Argentina, com sintomas de artrite. Sobre um total de 28 soros analisados, 3 resultaram positivos (o soro número 1 com um título de 1:320 para IgG, embora os soros números 5 e 9 ambos foram reativos a diluição 1:160). Esses mesmos soros foram analisados para a IgM sendo todos eles levemente reativos (1:40), usando IF. Os resultados mostram que anticorpos anti Borrelia burgdorferi se encontram presentes na população da Argentina. Deve-se ter, portanto, precaução na interpretação clínica das artrites até que a presença de Borrelia burgdorferi seja confirmada pelo cultivo nos meios específicos

Modelling innovative interventions for optimising healthy lifestyle promotion in primary health care: "Prescribe Vida Saludable" phase I research protocol

<p>Abstract</p> <p>Background</p> <p>The adoption of a healthy lifestyle, including physical activity, a balanced diet, a moderate alcohol consumption and abstinence from smoking, are associated with large decreases in the incidence and mortality rates for the most common chronic diseases. That is why primary health care (PHC) services are trying, so far with less success than desirable, to promote healthy lifestyles among patients. The objective of this study is to design and model, under a participative collaboration framework between clinicians and researchers, interventions that are feasible and sustainable for the promotion of healthy lifestyles in PHC.</p> <p>Methods and design</p> <p>Phase I formative research and a quasi-experimental evaluation of the modelling and planning process will be undertaken in eight primary care centres (PCCs) of the Basque Health Service – OSAKIDETZA, of which four centres will be assigned for convenience to the Intervention Group (the others being Controls). Twelve structured study, discussion and consensus sessions supported by reviews of the literature and relevant documents, will be undertaken throughout 12 months. The first four sessions, including a descriptive strategic needs assessment, will lead to the prioritisation of a health promotion aim in each centre. In the remaining eight sessions, collaborative design of intervention strategies, on the basis of a planning process and pilot trials, will be carried out. The impact of the formative process on the practice of healthy lifestyle promotion, attitude towards health promotion and other factors associated with the optimisation of preventive clinical practice will be assessed, through pre- and post-programme evaluations and comparisons of the indicators measured in professionals from the centres assigned to the Intervention or Control Groups.</p> <p>Discussion</p> <p>There are four necessary factors for the outcome to be successful and result in important changes: (1) the commitment of professional and community partners who are involved; (2) their competence for change; (3) the active cooperation and participation of the interdisciplinary partners involved throughout the process of change; and (4) the availability of resources necessary to facilitate the change.</p

Functional diversity of bacterioplankton assemblages in western Antarctic seawaters during late spring

Functional diversity and aminopeptidase activity (AMA) in bacterial assemblages were determined in western Antarctic waters during late spring 2002. Functional diversity was assayed by the patterns of sole carbon source utilization in Biolog-ECO Microplates(TM) and AMA with the fluorogenic substrate leucine 7-amido-4-methylcoumarin. N-acetyl-D-glucosamine and D-cellobiose were the most used carbohydrates. This suggested that used dissolved organic carbon (DOC) was mostly of either zoo-or phytoplankton origin. Principal component analysis of the sole carbon source utilization profiles separated the samples according to salinity and temperature. This separation corresponded roughly with the 3 areas of study: Bransfield Strait (BR), Gerlache Strait (GE) and Belling-shausen Sea (BE). AMA was higher in the upper 40 m, probably associated with the higher organic matter load. Phytoplankton biomass was the factor that accounted for the highest variance in AMA, but did not have a clear influence on functional diversity of bacterioplankton. Our findings indicate that differences in functional diversity of bacterioplankton populations in western Antarctic waters are not directly related to phytoplanktonic abundance. This suggests that bacteria could utilize other carbon sources than DOC freshly released by phytoplankton

Lyme Disease: antibodies against Borrelia burgdorferi in farm workers in Argentina

Lyme Disease is a tick-borne (specially by Ixodes ticks) immune-mediated inflammatory disorder caused by a newly recognize spirochete, Borrelia burgdorferi. Indirect fluorescent antibody (IF) staining methods and enzyme-linked immunosorbent assay are frequently relied upon to confirm Lyme borreliosis infections. Although serologic testing for antibodies has limitations, it is still the only practical means of confirming B. burgdorferi infections. Because we have no previous report of Lyme disease in human inhabitants in Argentina, a study was designed as a seroepidemiologic investigation of the immune response to B. burgdorferi in farm workers of Argentina with arthritis symptoms. Three out of 28 sera were positive (#1,5 and 9). Serum # 1 was positive for Immunoglobulin G at dilution 1:320, serum # 5 and # 9 both to dilution 1:160; while for Immunoglobulin M all (#1, 5 and 9) were positive at low dilution (1:40) using IF. The results showed that antibodies against B. burgdorferi are present in an Argentinian population. Thus caution should be exercised in the clinical interpretation of arthritis until the presence of B. burgdorferi be confirmed by culture in specific media

Conceptos. Medicina mínimamente disruptiva

Resumen: En este artículo se presentan algunos conceptos acerca del sobrediagnóstico y sus consecuencias: sobretratamiento y medicalización de la sociedad. Se recuerda el origen del término a partir del cribado y diagnóstico del cáncer y se revisan las estrategias para «sobrediagnosticar», como la modificación de los umbrales diagnósticos de las enfermedades y la conversión de procesos vitales normales, así como los factores de riesgo, en enfermedad. Se exponen algunas estrategias para afrontar el sobrediagnóstico «desde la consulta», como son el manejo de la incertidumbre y la toma compartida de decisiones a través de la correcta interpretación de los estimadores de resultado de diagnóstico y de tratamiento. Finalmente, se presenta la medicina mínimamente disruptiva como la mejor estrategia para afrontar la carga de enfermedad a la que conduce el sobretratamiento en los pacientes con multimorbilidad. Abstract: This paper presents some concepts about overdiagnosis and its consequences: overtreatment and the medicalization of the society. It recalls the origin of the term, that comes from the screening and diagnosis of cancer, and it reviews the strategies to overdiagnose. Furthermore, it analyses the conversion of illnesses diagnostic thresholds as well as the transformation of normal and vital processes and risk factors in illnesses. It shows some strategies to confront overdiagnosis at the time of medical consultation, including the management of uncertainty and the shared decision making through the right interpretation of the diagnosis results and treatment estimators. Finally, it shows the minimally disruptive medicine as the best strategy to face the disease burden induced by the overtreatment in patients suffering from multimorbidity. Palabras clave: Sobrediagnóstico, Atención centrada en el paciente, Multimorbilidad, Medicina basada en la evidencia, Keywords: Medical overuse, Patient centered care, Multimorbidity, Evidence based medicin

Is integration of healthy lifestyle promotion into primary care feasible? Discussion and consensus sessions between clinicians and researchers

Abstract Background The adoption of a healthy lifestyle, including physical activity, a healthy diet, moderate alcohol consumption and abstinence from smoking, is associated with a major decrease in the incidence of chronic diseases and mortality. Primary health-care (PHC) services therefore attempt, with rather limited success, to promote such lifestyles in their patients. The objective of the present study is to ascertain the perceptions of clinicians and researchers within the Basque Health System of the factors that hinder or facilitate the integration of healthy lifestyle promotion in routine PHC setting. Methods Formative research based on five consensus meetings held by an expert panel of 12 PHC professionals with clinical and research experience in health promotion, supplied with selected bibliographic material. These meetings were recorded, summarized and the provisional findings were returned to participants in order to improve their validity. Results The Health Belief Model, the Theory of Planned Action, the Social Learning Theory, "stages of change" models and integrative models were considered the most useful by the expert panel. Effective intervention strategies, such as the "5 A's" strategy (assess, advise, agree, assist and arrange) are also available. However, none of these can be directly implemented or continuously maintained under current PHC conditions. These strategies should therefore be redesigned by adjusting the intervention objectives and contents to the operation of primary care centres and, in turn, altering the organisation of the centres where they are to be implemented. Conclusion It is recommended to address optimisation of health promotion in PHC from a research perspective in which PHC professionals, researchers and managers of these services cooperate in designing and evaluating innovative programs. Future strategies should adopt a socio-ecological approach in which the health system plays an essential role but which nevertheless complements other individual, cultural and social factors that condition health. These initiatives require an adequate theoretical and methodological framework for designing and evaluating complex interventions.</p

Sleep quality in individuals with post-COVID-19 condition: Relation with emotional, cognitive and functional variables

The study aimed to assess sleep quality in PCC patients and its predictors by analysing its relationship with emotional, cognitive and functional variables, as well as possible differences based on COVID-19 severity. We included 368 individuals with PCC and 123 healthy controls (HCs) from the NAUTILUS Project (NCT05307549 and NCT05307575). We assessed sleep quality (Pittsburgh Sleep Quality Index, PSQI), anxiety (Generalized Anxiety Disorder, GAD-7), depression (Patient Health Questionnaire, PHQ-9), global cognition (Montreal Cognitive Assessment, MoCA), everyday memory failures (Memory Failures of Everyday Questionnaire, MFE-30), fatigue (Chadler Fatigue Questionnaire, CFQ), quality of life (European Quality of Life-5 Dimensions, EQ-5D), and physical activity levels (International Physical Activity Questionnaire, IPAQ). 203 were nonhospitalized, 83 were hospitalized and 82 were admitted to the intensive care unit (ICU). We found statistically significant differences in the PSQI total score between the PCC and HC groups (p < 0.0001), but there were no differences among the PCC groups. In the multiple linear regressions, the PHQ-9 score was a predictor of poor sleep quality for mild PCC patients (p = 0.003); GAD-7 (p = 0.032) and EQ-5D (p = 0.011) scores were predictors of poor sleep quality in the hospitalized PCC group; and GAD-7 (p = 0.045) and IPAQ (p = 0.005) scores were predictors of poor sleep quality in the group of ICU-PCC. These results indicate that worse sleep quality is related to higher levels of depression and anxiety, worse quality of life and less physical activity. Therapeutic strategies should focus on these factors to have a positive impact on the quality of sleep