Effect of Two Meal Replacement strategies on Cardiovascular Risk Parameters in Advanced Age Patients with Obesity and Osteoarthritis

Producción CientíficaBackground and aims: Meal replacement diets consist of replacing one or more meals with an artificial nutritional supplement. The objective of this study was to compare the effect of one against two meal replacement strategies on body composition and cardiovascular risk parameters in patients with obesity. Methods: A randomized clinical trial was designed with a modified hypocaloric diet with an artificial nutritional preparation replacing one or two meals for three months in patients with obesity and osteoarthritis pending orthopedic surgery. An anthropometric evaluation and a measurement of the body composition were done with bioelectrical impedance measurement at the beginning and at three months. Results: A total of 112 patients were recruited. Fifty-two patients (46.4%) were randomized to one replacement and 60 patients (53.6%) to two meal replacements. Eighty-one patients (72.3%) were women, and the average age was 61 (11.03) years. The percentage of weight loss at three months was 8.27 (4.79)% (one meal replacement: 7.98 (5.97)%; two meal replacements: 8.50 (3.48)%; p = 0.56). A decrease in fat mass measured by the fat mass index (FMI) was detected (one meal replacement: −2.15 (1.45) kg/m2 vs. two meal replacements: −2.78 (2.55) kg/m2; p > 0.05), and a relative increase in fat-free mass was observed (one meal replacement: +3.57 (4.61)% vs. two meal replacements: +2.14 (4.45)%; p > 0.05). A decrease in HOMA-IR, systolic blood pressure (SBP), and total cholesterol was observed in both groups without differences between them. Conclusions: The substitution strategies of one or two meal replacements were effective in weight loss and fat mass decrease without differences between the two groups. An improvement in lipid parameters, glycemic control, and systolic blood pressure was observed without differences between strategies

Significados de alteridad en las prácticas de la estrategia cero a siempre desarrollo infantil en medio familiar de Popayán, adscritos a la Fundación Gimnasio Moderno del Cauca.

Maestría en Educación desde la Diversidad, Facultad de Ciencias Sociales y Humanas.El presente artículo de investigación, muestra los significados de alteridad en la estrategia de cero a siempre, a partir de una propuesta metodológica cualitativa, en el diseño y aplicación de entrevistas semiestructuradas y cartas de libre asociación a docentes de la Fundación Gimnasio Moderno del Cauca. Los hallazgos evidenciaron una concepción de infancia por parte de los docentes en contravía de la alteridad. En este sentido, la consideración de los niños comprende intenciones en su visibilización como sujetos y en la promoción de ambientes para su cuidado y protección; sin embargo, sobreviene en un enfoque de derechos supeditado al cumplimiento de parámetros del marco normativo nacional, bajo una perspectiva de cuidado y desde una estructura pedagógica tradicional unilateral que aborda, además, la realidad educativa desde la colectividad, dejando de lado la individualidad. El estudio permitió concluir que es necesario abordar el valor del “reconocimiento del otro” desde la resignificación de los escenarios pedagógicos actuales, pensando en los niños y las niñas como sujetos de alteridad y no solo como sujetos de derecho

Detection of antibodies against Ehrlichia spp in owners of domestic dogs with ehrlichiosis

Se determinó la seropositividad contra Ehrlichia chaffeensis en propietarios de perros con antecedentes de ehrlichiosis mediante la prueba de inmunofluorescencia indirecta (IFI) y su asociación con el género, edad, exposición a garrapatas y nivel de contacto con los perros. El estudio se realizó entre enero de 2009 y diciembre de 2009, donde se evaluaron 95 personas de Lima Metropolitana (Perú), sin distinción de género, edad o condición socioeconómica y cuyos perros tenían historia de ehrlichiosis menor de un año. El 31.6% (30/95) presentaron anticuerpos contra E. chaffeensis. El 38.7% (24/62) de los individuos menores a 40 años y el 18.2% (6/33) de los individuos mayores a 40 años resultó ser seropositivo a E. chaffeensis (p<0.05). El 29.4% de varones y el 32.7% de mujeres resultaron seropositivos a E. chaffeensis (p<0.05). Además, el 40.0 y 8.0% de las personas expuestas y no expuestas a artrópodos presentaron seropositividad a este patógeno.The seroreaction of Ehrlichia chaffeensis through the indirect immunofluorescence test (IFI) was determined in owners of dogs with a history of ehrlichiosis. In addition, the association with gender, age, exposure to ticks and level of contact with dogs was evaluated. The study was conducted between January and December 2009, where 95 people from Lima Metropolitan Region (Peru) were evaluated, regardless of gender, age or socioeconomic status, and whose dogs had a history of ehrlichiosis of less than one year. The results showed that 31.6% (30/95) of dog owners presented antibodies against E. chaffeensis. Besides, 38.7% (24/62) of the individuals younger than 40 years and 18.2% (6/33) of individuals older than 40 years were seropositive to E. chaffeensis (p<0.05), 29.4% of males and 32.7% of females were seropositive to E. chaffeensis (p<0.05), and 40.0 and 8.0% of those exposed and not exposed to arthropods presented seropositivity to this pathogen

Estimate of intestinal parasites prevalence in infants of two Colombian communities

Objetivo: Determinar la presencia de enteroparásitos en niños de edad preescolar y escolar en dos comunidades de Risaralda (Colombia). Metodología: Se trata de un estudio de estimación de prevalencia –corte transversal– usando una muestra de 258 niños, seleccionados de forma no aleatoria a través de una actividad de demanda inducida. De cada niño se obtuvieron muestras de heces que fueron procesadas mediante la técnica de Ritchie. El método de Graham se aplicó en menores que refiriesen prurito anal. Además, por parte de los padres de familia, se diligenció una encuesta para indagar acerca de las condiciones clínicas en relación con el parasitismo intestinal. Resultados: La prevalencia general de enteroparásitos fue del 37,2%. Los casos de monoinfección e infección mixta se presentaron en el 28,7% y 2,3%, respectivamente. Los enteroparásitos patógenos encontrados según su frecuencia fueron: Blastocystis hominis 16,7%, complejo Entamoeba histolytica/dispar 8,9%, Giardia lamblia 7%, Enterobius vermiculares 0,8%. Además, se hallaron otros enteroparásitos no patógenos. La infección fue más frecuente en hombres. Conclusión: Se identificó una prevalencia general y específica por cada microorganismo de aproximadamente la mitad a la encontrada en otros estudios de similares características. Los niños evaluados presentan factores de alto riesgo para dicha infección y, por tanto, para las consecuencias desfavorables que de estos se derivan.Objective: To determine the presence of intestinal parasites in preschool and school age children in two communities of Risaralda Department (Colombia). Methodology: Crosssectional study of prevalence estimation using a sample of 258 children selected in a nonrandom sorting through an induced demand activity. Fecal samples were taken from each child and were processed using Ritchie’s technique. The Graham method was applied to infants who presented anal itching. In addition, the parents filled out a survey to determine the clinical conditions related to intestinal parasitism. Results: The general prevalence of enteric parasites was 37.2%. Infections by a single or mixed infection were present in 28.7% and 2.3%of the population respectively. The pathogenic enteric parasites found were: Blastocystis hominis 16.7%, Entamoeba histolytica/dispar 8.9%, Giardia lamblia 7%, and Enterobius vermiculares 0.8%. Likewise, other non-pathogen enteric parasites were found and the infection was more frequent in males. Conclusion: General and specific prevalence for each organism approximately half of that found in other similar studies of simple characteristics was identified. The children evaluated present high risk factors for intestinal parasite infection and, therefore, to suffer the unfavorable consequences derived it

Cognitive vulnerability in mental disorders

ABSTRACT: Introduction: Modes of cognitive vulnerability were evaluated in outpatients of psychological services centers with diagnoses of mental disorders. Objective: To establish components of cognitive vulnerability in different mental disorders. Method: The participants were 490 users of psychological services centers from twelve universities in Colombia. To identify the presence or absence of mental disorders, they completed the MINI International Neuropsychiatric Interview.The Young Schemes Questionnaire, the Core Beliefs Questionnaire for Personality Disorders, the Inventory of Automatic Thoughts, and the Coping Strategies Questionnaire were also applied. To establish distinctive characteristics among actual major depression, generalized anxiety disorder, panic disorder, social anxiety, and non-alcoholic substance abuse, a logistic regression analysis was conducted. Results: The results showed cognitive distinctive vulnerability profiles, according to the disorder. Conclusion: The hypothesis of cognitive specificity for the different mental disorders is confirmed.RESUMEN: Introducción: Se evaluaron los modos de vulnerabilidad cognitiva en usuarios de consulta externa en psicología, diagnosticados con trastornos mentales. Objetivo: Establecer componentes de vulnerabilidad cognitiva en diferentes trastornos mentales. Método: Participaron 490 usuarios de servicios psicológicos de doce universidades de Colombia. Se aplicó la Entrevista Neuropsiquiátrica Internacional para identificar la presencia o no de trastornos mentales; igualmente, se aplicaron el Cuestionario de Esquemas de Young, el Cuestionario de Creencias Centrales de Trastornos de la Personalidad, el Inventario de Pensamientos Automáticos y el Cuestionario de Estrategias de Afrontamiento. Se realizaron análisis de regresión logística para establecer características distintivas en los trastornos de depresión mayor actual, ansiedad generalizada, angustia, ansiedad social y abuso de sustancias no alcohólicas. Resultados: Se reportaron perfiles cognitivos de vulnerabilidad diferenciados de acuerdo con el trastorno. Conclusión: Se confirma la hipótesis de especificidad cognitiva para los diferentes trastornos mentales

Patient preferences and treatment safety for uncomplicated vulvovaginal candidiasis in primary health care

<p>Abstract</p> <p>Background</p> <p>Vaginitis is a common complaint in primary care. In uncomplicated candidal vaginitis, there are no differences in effectiveness between oral or vaginal treatment. Some studies describe that the preferred treatment is the oral one, but a Cochrane's review points out inconsistencies associated with the report of the preferred way that limit the use of such data. Risk factors associated with recurrent vulvovaginal candidiasis still remain controversial.</p> <p>Methods/Design</p> <p>This work describes a protocol of a multicentric prospective observational study with one year follow up, to describe the women's reasons and preferences to choose the way of administration (oral vs topical) in the treatment of not complicated candidal vaginitis. The number of women required is 765, they are chosen by consecutive sampling. All of whom are aged 16 and over with vaginal discharge and/or vaginal pruritus, diagnosed with not complicated vulvovaginitis in Primary Care in Madrid.</p> <p>The main outcome variable is the preferences of the patients in treatment choice; secondary outcome variables are time to symptoms relief and adverse reactions and the frequency of recurrent vulvovaginitis and the risk factors. In the statistical analysis, for the main objective will be descriptive for each of the variables, bivariant analysis and multivariate analysis (logistic regression).. The dependent variable being the type of treatment chosen (oral or topical) and the independent, the variables that after bivariant analysis, have been associated to the treatment preference.</p> <p>Discussion</p> <p>Clinical decisions, recommendations, and practice guidelines must not only attend to the best available evidence, but also to the values and preferences of the informed patient.</p

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Innovación del Diseño para el Desarrollo Social

Una labor de síntesis alrededor de la gran temática de este libro que surge a partir de una serie de reflexiones y propuestas encaminadas desde la innovación del diseño para el desarrollo social, refleja una invitación al lector para enunciar a partir de su lectura nuevas discusiones sobre el quehacer del diseño con una perspectiva de innovación para este tipo de desarrollo, es pues este texto una invitación a enunciar nuevos retos y diálogos partiendo de reconocer al desarrollo social como uno de los pilares fundamentales desde la Organización de las Naciones Unidas (ONU) como parte fundamental para garantizar el mejoramiento de la vida de las personas. Desde la disciplina del diseño y retomado como eje para su discusión se pretendería establecer una serie de reflexiones y acciones que permitan atender situaciones para grupos minoritarios y vulnerables, así como apoyar esfuerzos encaminados a mejorar la calidad de vida de los integrantes de grupos y sociedades establecidas y recuperar el patrimonio cultural como parte fundamental de las identidades culturales y por tanto de la historia de la humanidad.A lo largo de la historia, el diseño, en cualquiera de sus manifestaciones, ha estado presente en todos los ámbitos. Se ha convertido en una disciplina que evoluciona al ritmo de las sociedades, que se pone al servicio de las necesidades de mercado pero también de las que requieren un abordaje distinto, observadas desde una mirada que concierne a lo social, entendido éste como lo que se reproduce o se instaura en el colectivo, en el grupo, en las comunidades, en las sociedades como parte significativa de sus cotidianeidades. El Diseño desde esta perspectiva acompaña al ser humano produciendo una significación de los objetos como parte fundamental de sus vidas, que transforma una realidad deseada en una realidad concreta, de aquí la importancia de crear una conciencia social para la praxis laboral de esta disciplina. En este sentido el campo profesional, académico y de investigación del diseño debe ocuparse de crear, difundir y divulgar el quehacer de la misma, manifestando un equilibrio entre conciencia, racionalidad y la realidad. Desde el contexto planteado, la Universidad Autónoma del Estado de México, a través de su Facultad de Arquitectura y Diseño presenta en esta obra una serie de reflexiones en torno al papel que desempeña el diseño humanístico, científico y tecnológico desde un enfoque de vanguardia e innovación para el desarrollo social, como resultado de la experiencia vertida en el Coloquio Internacional de Diseño que organiza éste año este espacio académico, en donde cada una de las aportaciones refleja la experiencia de cada uno de sus participantes; con base en ello, el presente libro integrado por una compilación de trabajos ofrece descripciones, análisis y propuestas que contribuyen a la solución de problemas procurando un desarrollo social

Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand.

Background: Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods: Children aged <18 years initiating combination ART (≥2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of ≥1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results: Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions: One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch

Gasificación de cascarilla de arroz en reactor de lecho fluidizado a escala piloto

IP 1210-06-1246