Health decentralization policy and social answer. The Colombian region case

ABSTRACT: During the last twenty years, social participation in Latin America, especially in Colombia has been oriented by a policy of administrative and political decentralization, with consequences in the field of health where both the state and the communities have assumed new spaces and types of relation that impact social organization and justice. Through this framework the project analyses in the Colombian region of the antioqueño southwest, some of the effects health decentralization has had taking into consideration the historic characteristics of the participation process of the population, some central aspects of the legal context of the health and social security system reforms during the last two decades, the perceptions of local actors as regards the process of the implementation of decentralized health, and the actions undertaken by the local state agents and the people in comunitary participation processes for the improvement of life and health conditions.RESUMEN: Durante los últimos veinte años la participación social en América Latina, y particularmente en Colombia, ha estado orientada por la descentralización política y administrativa. Con la aplicación de esta estrategia en el campo de la salud, tanto el Estado como las comunidades han asumido nuevos espacios y formas de relación con impacto en lo social, lo organizativo y lo jurídico. Éste es el marco en el que se inscribe este trabajo, que analiza en la región colombiana del Suroeste antioqueño algunos efectos de la descentralización en salud, teniendo en cuenta las características históricas del proceso de participación de la población en el país; algunos aspectos centrales del contexto legal de las reformas del Sistema de Seguridad Social en Salud en las dos últimas décadas, las percepciones de los actores locales relacionadas con la implementación del proceso descentralizador en salud y las acciones desplegadas por los agentes locales del Estado y por los pobladores en procesos de participación comunitaria para el mejoramiento de las condiciones de vida y salud

Role of secondary plant metabolites on enteric methane mitigation in ruminants

The rumen microbiome plays a fundamental role in all ruminant species, it is involved in health, nutrient utilization, detoxification, and methane emissions. Methane is a greenhouse gas which is eructated in large volumes by ruminants grazing extensive grasslands in the tropical regions of the world. Enteric methane is the largest contributor to the emissions of greenhouse gases originating from animal agriculture. A large variety of plants containing secondary metabolites [essential oils (terpenoids), tannins, saponins, and flavonoids] have been evaluated as cattle feedstuffs and changes in volatile fatty acid proportions and methane synthesis in the rumen have been assessed. Alterations to the rumen microbiome may lead to changes in diversity, composition, and structure of the methanogen community. Legumes containing condensed tannins such as Leucaena leucocephala have shown a good methane mitigating effect when fed at levels of up to 30–35% of ration dry matter in cattle as a result of the effect of condensed tannins on rumen bacteria and methanogens. It has been shown that saponins disrupt themembrane of rumen protozoa, thus decreasing the numbers of both protozoa and methanogenic archaea. Trials carried out with cattle housed in respiration chambers have demonstrated the enteric methane mitigation effect in cattle and sheep of tropical legumes such as Enterolobium cyclocarpum and Samanea saman which contain saponins. Essential oils are volatile constituents of terpenoid or non-terpenoid origin which impair energy metabolism of archaea and have shown reductions of up to 26% in enteric methane emissions in ruminants. There is emerging evidence showing the potential of flavonoids as methane mitigating compounds, but more work is required in vivo to confirm preliminary findings. From the information hereby presented, it is clear that plant secondary metabolites can be a rational approach to modulate the rumen microbiome and modify its function, some species of rumen microbes improve protein and fiber degradation and reduce feed energy loss as methane in ruminants fed tropical plant species

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Frecuencia de anomalías dentales en pacientes de 6 a 12 años de edad con fisura labio palatina no sindrómica (FLPNS)

La fisura labio palatina no sindrómica (FLPNS) representa una de las malformaciones craneofaciales congénitas más comunes y ha sido asociada a una alta frecuencia de anomalías dentales. Objetivo: Identificar la frecuencia y tipo de anomalías dentales en un grupo de pacientes de 5 a 12 años de edad que presentan FLPNS. Métodos: Se analizaron radiografías panorámicas de 200 niños de 5 a 12 años de edad, 100 con FLPNS (72 hombres y 28 mujeres) y 100 sin FLPNS (43 hombres y 57 mujeres) que conformaron el grupo control. Las comparaciones se realizaron utilizando las pruebas estadísticas Chi cuadrado y OR. Resultados: 98% de los pacientes con FLPNS y 11% del grupo control, presentaron al menos una anomalía dental. En los sujetos con FLPNS, la anomalía más frecuente fue la microdoncia de incisivos laterales superiores (56%), seguido por agenesia (54%). Se encontraron diferencias estadísticamente significativas y asociación de riesgo entre presencia de FLPNS y frecuencia de microdoncia (p: 0.000 OR: no evaluado), agenesia (p: 0.000, OR: 57,5), rotación (p: 0.000 OR: 13.5) y dientes supernumerarios (p: 0.000 OR: 10,7) en el grupo caso, con un IC del 95%. Igualmente se encontraron estas diferencias en las anomalías anteriormente mencionadas relacionadas con el lado afectado por la fisura (pmenor que0.05). Conclusión: Se demostró un mayor número de anomalías dentales en el grupo con FLPNS, comparadas con el grupo control y estas anomalías fueron más frecuentes en la hemiarcada afectada por la fisura, sugiriendo una asociación entre la presencia de FLPNS y de anomalías dentales en la población evaluada.Non-syndromic cleft lip palate (NSCLP) represents one of the most common congenital craniofacial malformations, that has been associated with a high frequency of dental anomalies. Objective: To compare the frequency of dental anomalies in patients affected by Unilateral non-syndromic cleft lip palate (UNSCLP) and Bilateral non-syndromic cleft lip palate (BNSCLP) and to determine whether statistical differences are associated to cleft sides in UNSCLP. Methods: Panoramic X-rays were analyzed from 200 children from 5 to 12 years old, 100 with NSCLP (72 men and 28 women) and 100 without NSCLP (43 men and 57 women) who formed the control group. Chi square and OR were performed for statistical comparisons. Results: 98% of the patients with NSCLP and 11% of the control group had at least one dental anomaly. In subjects with NSCLP, the most frequent anomaly was the microdontia of maxillary lateral incisors (56%), followed by agenesis (54%). There was a statistically significant difference and it was also found association in the frecuency of microdontia (p: 0.000, OR: not evaluated), agenesis (p: 0.000, OR: 57,5), rotation (p: 0.000 OR: 13.5) and supernumerary teeth (p: 0.000 OR: 10,7) in the case group. Statistical significant difference was showed in dental anomalies previously mentioned by the affected side (p menor que 0.005). Conclusions: The frequency of dental anomalies reported in NSCLP patients is greater than in control group with a higher incidence in the affected side, suggesting that NSCLP constitutes a risk factor for the presence of dental anomalies in the evaluated population

Política de descentralización en salud y respuesta social: el caso de una región colombiana

During the last twenty years, social participation in Latin America, especially in Colombia has been oriented by a policy of administrative and political decentralization, with consequences in the field of health where both the state and the communities have assumed new spaces and types of relation that impact social organization and justice. Through this framework the project analyses in the Colombian region of the antioqueño southwest, some of the effects health decentralization has had taking into consideration the historic characteristics of the participation process of the population, some central aspects of the legal context of the health and social security system reforms during the last two decades, the perceptions of local actors as regards the process of the implementation of decentralized health, and the actions undertaken by the local state agents and the people in comunitary participation processes for the improvement of life and health conditions.Durante los últimos veinte años la participación social en América Latina, y particularmente en Colombia, ha estado orientada por la descentralización política y administrativa. Con la aplicación de esta estrategia en el campo de la salud, tanto el Estado como las comunidades han asumido nuevos espacios y formas de relación con impacto en lo social, lo organizativo y lo jurídico. Éste es el marco en el que se inscribe este trabajo, que analiza en la región colombiana del Suroeste antioqueño algunos efectos de la descentralización en salud, teniendo en cuenta las características históricas del proceso de participación de la población en el país; algunos aspectos centrales del contexto legal de las reformas del Sistema de Seguridad Social en Salud en las dos últimas décadas, las percepciones de los actores locales relacionadas con la implementación del proceso descentralizador en salud y las acciones desplegadas por los agentes locales del Estado y por los pobladores en procesos de participación comunitaria para el mejoramiento de las condiciones de vida y salud

Saúde mental em estudantes de odontologia de uma universidade pública de Medellín (Colômbia) e seus fatores relacionados

Objective: To analyze the prevalence of signs and symptoms related to stress, depression/anxiety and poor mental health and its association with sociodemographic factors in undergraduate students of the Faculty of Dentistry of the University of Antioquia.   Methods: A cross-sectional study was conducted by means of a survey in 205 students (104 women). Variables: sociodemographic, general health, mental health (GHQ-12), depression/anxiety (Zung test), self-perceived stress. Analyses were carried out by sex, by means of a description of variables and crude and adjusted Odds ratio with 95% confidence intervals (aOR- 95%CI) was calculated, by logistic regression, in order to estimate association between variables.   Results: Prevalence of indicators for men and women were the following (in order): poor mental health 43% and 52%, depression/anxiety 42% and 50% and self-perceived stress 34% and 41% (higher percentages in women). Significant statistically associations were found for men reporting depression/anxiety and stress and low social support (OR 20.94; 95%CI 2.13- 205.81 and OR 5.04; 95%CI 1.01- 25.02 respectively). Also, men and women proceeding from extended-assembled families were more likely to report depression/anxiety (OR: 8.82; 95%CI 1.29- 60.17 and OR: 14.94; 95%CI 1.56- 143.15 respectively).  Women reporting low social support were more likely to report poor mental health, depression/anxiety and stress (OR: 20.72; 95%CI 2.19- 195.73; OR: 15.61; 95%CI 1.68- 144.62 y OR: 30.61; 95%CI 3,08- 304,35 respectively).  Conclusions: Higher prevalence of signs and symptoms that suggest poor mental health, and differences according to sex and sociodemographic characteristics were found. Objetivo: Analizar la prevalencia de signos y síntomas sugerentes de estrés, depresión/ansiedad y mala salud mental y sus factores sociodemográficos relacionados en estudiantes de pregrado de la Facultad de Odontología de la Universidad de Antioquia.  Métodos: Estudio transversal mediante encuesta a 205 estudiantes (104 mujeres).  Variables: sociodemográficas, salud general, salud mental (GHQ-12), depresión/ansiedad (test de Zung), estrés autopercibido. Análisis por sexo, descripción de variables y cálculo de Odds Ratio crudas/ajustadas con sus intervalos de confianza al 95% (ORa- IC95%), para observar asociaciones entre las variables (regresión logística).  Resultados: La prevalencia de indicadores para hombres y mujeres fue en su orden: mala salud mental 43% y 52%, depresión y ansiedad 42% y 50% y estrés autopercibido 34% y 41% (porcentajes más altos en mujeres). La asociación fue estadísticamente significativa en los hombres que reportaron depresión/ansiedad y estrés y apoyo social bajo (OR 20,94; IC95% 2,13- 205,81 y OR 5,04; IC95% 1,01- 25,02 respectivamente). También se reportó mayor riesgo en los hombres que refieren depresión/ansiedad y con familias extensas-ensambladas (OR: 8,82; IC95% 1,29- 60,17).  En las mujeres, se reportó mayor riesgo en aquellas que refieren depresión/ansiedad y procedentes de familias extensas-ensambladas (OR: 14,94; IC95% 1,56- 143,15) y en las que reportan mala salud mental, depresión/ansiedad y estrés y con bajo apoyo social (OR: 20,72; IC95% 2,19- 195,73; OR: 15,61; IC95% 1,68- 144,62 y OR: 30,61; IC95% 3,08- 304,35 respectivamente).  Conclusiones: Se encontraron altas prevalencias de signos y síntomas sugerentes de mala salud mental, encontrándose diferencias según sexo y factores sociodemográficos. Objetivo: Analisar a prevalência de sinais e sintomas sugestivos de estresse, depressão / ansiedade e problemas de saúde mental e fatores sociodemográficos relacionados em estudantes de graduação da Faculdade de Odontologia da Universidade de Antioquia. Métodos: Estudo transversal através de uma pesquisa com 205 estudantes (104 mulheres). Variáveis: sociodemográficas, saúde geral, saúde mental (GHQ-12), depressão / ansiedade (teste de Zung), autopercepção de estresse. Análise por sexo, descrição das variáveis e cálculo da Odds Ratio bruto / ajustado com seus intervalos de confiança de 95% (ORa-IC95%), para observar associações entre as variáveis (regressão logística). Resultados: A prevalência de indicadores para homens e mulheres foi ordenada: problemas de saúde mental 43% e 52%, depressão e ansiedade 42% e 50% e estresse percebido por si mesmo 34% e 41% (porcentagens mais altas nas mulheres). A associação foi estatisticamente significante nos homens que relataram depressão / ansiedade e estresse ebaixo apoio social (OR 20,94; IC 95% 2,13-205,81 e OR 5,04; IC 5,04; IC 95% 1,01-25,02, respectivamente ) Um risco maior também foi relatado em homens que relataram depressão / ansiedade e com famílias reunidas (OR: 8,82; IC95% 1,29-60,17) .Nas mulheres, um risco maior foi relatado naqueles que relataram depressão / ansiedade e de famílias extensas (OR: 14,94; IC95% 1,56-143,15) e naqueles que relatam problemas de saúde mental, depressão / ansiedade e estresse e com baixo apoio social (OR: 20, 72; IC95% 2,19 - 195,73; OR: 15,61;IC95% 1,68-144,62 e OR: 30,61; IC95% 3,08 - 304,35, respectivamente). Conclusões: Foram encontradas altas prevalências de sinais e sintomas sugestivos de problemas de saúde mental, encontrando diferenças de acordo com o sexo e fatores sociodemográficos

Primary distal renal tubular acidosis: novel findings in patients studied by next-generation sequencing.

Primary distal renal tubular acidosis (DRTA) is a rare disease caused by loss-of-function mutations in at least three genes (ATP6V0A4, ATP6V1B1, and SLC4A1) involved in urinary distal acidification. The next-generation sequencing (NGS) technique facilitates the search for mutations in DRTA patients and helps to characterize the genetic and clinical spectrum of the disease. Ten DRTA patients were studied. They had normal serum anion gap (AG), metabolic acidosis with simultaneous positive urinary AG, and inability to maximally acidify the urine. The exons of the three genes were sequenced in two pools by ultrasequencing. Putative mutations were confirmed by corresponding Sanger sequencing of each exon. We found 13 mutations in nine patients. ATP6V0A4: Intron16+2insA; p.R807Q; p.Q276fs; p.P395fs; Intron7-2T>C. ATP6V1B1: p.I386fs; p.R394Q. SLC4A1: p.V245M; p.R589C; p.R589H; p.G609A. One case was a compound heterozygous with a known mutation in ATP6V1B1 (p.G609R) and a pathogenic variation at SLC4A1 (p.E508K). One patient was negative for mutations. This study evidences that NGS is labor and cost effective for the analysis of DRTA genes. Our results show for the first time SLC4A1 gene mutations in Spanish patients and disclose that compound heterozygosity at two different genes can be responsible for DRTA

Papel de los metabolitos secundarios de las plantas en la mitigación del metano entérico en los rumiantes

International audienceIn the context of semantic segmentation of urban scenes, the calibrated multi-views and the flatness assumption are commonly used to estimate a warped image based on the homography estimation. In order to classify planar and non-planar areas, we propose an evaluation protocol that compares several Image Quality Assessments (IQA) between a reference zone and its warped zone. We show that cosine angle distance-based measures are more efficient than euclidean distance-based for the planar/non-planar classification and that the Universal Quality Image (UQI) measure outperforms the other evaluated measures