Social and Behavioral Barriers to Effective Care During the Transition to End-Stage Kidney Care.

Individuals living with CKD are disproportionately burdened by a multitude of adverse clinical and person-centered outcomes. When patients transition from advanced kidney disease to kidney failure, the psychosocial effects as well as social determinants of health challenges are magnified, making this a particularly difficult time for patients beginning kidney replacement therapy. The key social determinants of health challenges often include food and housing insecurity, poverty, unreliable transportation, low level education and/or health literacy, lack of language interpreters and culturally concordant educational materials, lack of health care insurance coverage, and mistrust of the health care system. Psychosocial and physical stressors, such as depression, anxiety, sexual dysfunction, sleep difficulty, fatigue, and pain, are often part of the illness burden among individuals living with CKD and can interact synergistically with the social challenges making the transition to kidney replacement therapy particularly challenging. To better support patients during this time, it is critical that social and structural determinants of health as well as mental health be assessed and if needs are identified, that services be provided.

Adaptación al cambio climático basada en servicios ecosistémicos. Acciones desde el sector de la salud en Matanzas

Introducción: El impacto del cambio climático en Cuba requiere acciones de adaptación. Para el sector de la salud, conocer e integrar los servicios ecosistémicos contribuye a la efectividad de la adaptación y seguridad a la salud humana. Objetivo: Abordar la contribución de los servicios ecosistémicos a la adaptación al cambio climático y la salud. Métodos: En la investigación se implementó un enfoque cuantitativo estructurado en dos etapas: diagnóstico del conocimiento de los recursos humanos del sector de la salud sobre los impactos del cambio climático en los municipios Ciénaga de Zapata y Martí, y la incorporación de criterios sobre la contribución de los servicios ecosistémicos a la adaptación al cambio climático y la salud. Se aplicaron métodos epidemiológicos mediante revisión documental, observación y trabajo en equipo. La clasificación de servicios ecosistémicos se realizó según la clasificación internacional establecida. Resultados: Se analiza la relación entre servicios ecosistémicos de las áreas, los impactos por las actividades socioeconómicas y los beneficios que ofrecen los mismos a la adaptación al cambio climático y la salud. Se identificó que los trabajadores del sector de la salud no perciben la variabilidad climática como riesgo y consideran sus conocimientos insuficientes. Conclusiones: Los servicios ecosistémicos contribuyen a la adaptación al cambio climático, ya que aportan recursos y son procesos que soportan actividades socioeconómicas. Las acciones de creación de capacidades se deben intencionar y reenfocar a las evidencias de basar la adaptación en mantener el flujo de estos servicios.

Introduction: The impact of climate change in Cuba requires adaptation actions. For the health sector, knowing and integrating ecosystem services contributes to the effectiveness of adaptation and security to human health. Objective: To address the contribution of ecosystem services to climate change adaptation and health. Methods: A quantitative approach structured in two stages was implemented in the research: diagnosis of the knowledge of human resources in the health sector on the impacts of climate change in the municipalities of Ciénaga de Zapata and Martí, and the incorporation of criteria on the contribution of ecosystem services to adaptation to climate change and health. Epidemiological methods were applied through documentary review, observation, and teamwork. The classification of ecosystem services was carried out according to the established international classification. Results: The relationship between ecosystem services of the areas, the impacts of socioeconomic activities and the benefits they offer to adaptation to climate change and health is analyzed. It was identified that health sector workers do not perceive climate variability as a risk and consider their knowledge insufficient. Conclusions: Ecosystem services contribute to adaptation to climate change, since they provide resources and are processes that support socioeconomic activities. Capacity-building actions must be intentional and refocused on evidence of basing adaptation on maintaining the flow of these services.

Rotation of Cotton (Gossypium hirsutum) Cultivars and Fallow on Yield and Rotylenchulus reniformis.

A three-year rotation of cotton (Gossypium hirsutum) cultivars either resistant (R) or susceptible (S) to Rotylenchulus reniformis and fallow (F) was examined for effect on cotton yield and nematode density. In year 1, 2, and 3, the resistant cultivar (DP 2143NR B3XF) yielded 78, 77, and 113% higher than the susceptible cultivar (DP 2044 B3XF). Fallow in year 1 followed by S in year 2 (F1S2) improved yield in year 2 by 24% compared with S1S2, but not as much as R1S2 (41% yield increase over S1S2). One year of fallow followed by R (F1R2) had lower yield in year 2 (11% reduction) than R1R2. The highest yield after three years of these rotations occurred with R1R2R3, followed by R1S2R3 (17% less yield) and F1F2S3 (35% less yield). Rotylenchulus reniformis density in soil averaged 57, 65, and 70% lower (year 1, 2, 3, respectively) in R1R2R3 compared with S1S2S3. In years 1 and 2, LOG10 transformed nematode density (LREN) was lower in F1, and F1F2, than for all other combinations. In year 3, the lowest LREN were associated with R1R2R3, F1S2F3, and F1F2S3. The highest LREN were associated with F1R2S3, F1S2S3, S1S2S3, R1R2S3, and R1S2S3. The combination of higher yield and lower nematode density will be a strong incentive for producers to use the R. reniformis resistant cultivars continuously.

Detección rápida de antígenos de Streptococcus pyogenes en pacientes de 0 a 14 años asistidos en dos servicios de urgencia pediátrica (14/2/2018-13/4/2018) / Rapid detection of Streptococcus pyogenes' antigens in patients of 0 to 14 years of age, assisted in two pediatric emergency wards (2/14/2018-4/13/2018) / Detecção rápida de antígenos de Streptococcus pyogenes em pacientes de 0 a 14 anos de idade assistidos por emergência pediátrica (14/2/2018-13/4/2018)

Introducción: las infecciones estreptocócicas pueden presentarse con fiebre, inflamación faringoamigdalina con o sin exudados, petequias en el paladar, adenitis cervical, exantema escarlatiniforme y / o dolor abdominal. Resulta útil en área de urgencia disponer de pruebas de detección rápida de antígenos de S. pyogenes (DRASP) de alta especificidad y sensibilidad algo menor. Objetivos: conocer la utilidad de un test de DRASP en 2 servicios de Urgencia Pediátrica, describiendo las características clínicas y epidemiológicas de los pacientes estudiados durante el período de la investigación y su correlación con el cultivo de exudado faríngeo mediante el cálculo de sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN). Material y métodos: estudio prospectivo, observacional, transversal en dos servicios de emergencia pediátrica. Se incluyeron niños a los que se les realizó DRASP y exudado faríngeo (EF) entre el 14 de febrero y el 13 de abril de 2018. Se registró: sexo, edad, motivo de consulta, diagnóstico, tratamiento, destino, resultado del test y de cultivo faríngeo. Se calcularon S, E, VPP y VPN. Resultados: n=241 niños. Rango 8 meses - 14 años, media 6 años. Consultaron por fiebre 103 niños (42,7%); por odinofagia 48, por erupción 11 y 47 por otros síntomas. Al 95% de los niños se le otorgó el alta. DRASP negativos 87,6% (N: 211) y positivos 12,9% (N: 31). EF negativos 80,1% (n: 193) y positivos para SßHGA en 13,7% (n: 33). La sensibilidad de la prueba fue del 52% y su especificidad del 93%. El VPP 55% y el negativo 92%. El diagnóstico más frecuente fue faringitis viral 132 (54,7%). Conclusiones: el test se aplicó fundamentalmente a escolares febriles, algunos con odinofagia. Contribuye a diferenciar en forma rápida la etiología y habilita a no usar antibióticos en caso de resultado negativo. Estos resultados avalan el uso de DRASP en la urgencia pediátrica.

Introduction: streptococcal infections can show fever, pharyngotonsillar inflammation with or without swabs, palatal petechiae, cervical adenitis, scarlatiniform rash and/or abdominal pain. Rapid detection tests for S. pyogenes antigens (DRASP) with high specificity and somewhat lower sensitivity are a useful at the Emergency Ward. Objectives: know the usefulness of a DRASP test in 2 Pediatric Emergency, describe the clinical and epidemiological characteristics of the patients studied during the research period and its correlation with the culture of pharyngeal exudates by calculating sensitivity (S) , specificity (S), positive predictive value (PPV), and negative predictive value (NPV). Material and Methods: prospective, observational, cross-sectional study carried out in two pediatric emergency wards. We included children who underwent DRASP and pharyngeal swab (PS) between February 14 and April 13, 2018. The following data were recorded: sex, age, reason for consultation, diagnosis, treatment, destination, test results and throat cultures. S, S, PPV and NPV were calculated. Results: n=241 children. Range 8 months - 14 years, average 6 years. 103 children (42.7%) consulted due to fever; 48 due to sore throat, 11 due to rash and 47 due to other symptoms. 95% of children were discharged. DRASP negative 87.6% (N: 211) and positive 12.9% (N: 31). Negative EP 80.1% (n: 193) and positive for SßHGA in 13.7% (n: 33). The test sensitivity was 52% and specificity 93%. The PPV 55% and the negative 92%. The most frequent diagnosis was viral pharyngitis 132 (54.7%). Conclusions: the test was applied mainly to febrile schoolchildren, some with odynophagia. A quick etiology differentiation is helpful, since it prevents antibiotics from being used in the event of a negative result. These results support the use of DRASP in pediatric emergency wards.

Introdução: as infecções estreptocócicas manifestam-se com febre, inflamação faringotonsilar com ou sem exsudado, petéquias palatinas, adenite cervical, erupção cutânea escarlatiniforme e/ou dor abdominal. Nos serviços de emergência é útil realizar testes de detecção rápida para antígenos de S. pyogenes (DRASP) com alta especificidade e sensibilidade um pouco mais baixa Objetivos: conhecer a utilidade do teste DRASP em 2 Emergências Pediátricas, descrever as características clínicas e epidemiológicas dos pacientes estudados durante o período da pesquisa e sua correlação com a cultura de exsudatos faríngeos por meio do cálculo de sensibilidade (S) , especificidade (S), positivo valor preditivo (VPP) e valor preditivo negativo (VPN). Material e métodos: estudo prospectivo, observacional, transversal, realizado em duas unidades de emergência pediátrica. Foram incluídas crianças que realizaram DRASP e swab faríngeo (PS) entre 14 de fevereiro e 13 de abril de 2018. Foram registrados os seguintes dados: sexo, idade, motivo da consulta, diagnóstico, tratamento, destino, resultados de exames e culturas de garganta. S, S, VPP e VPN foram calculados. Resultados: n=241 crianças. Faixa 8 meses - 14 anos, média 6 anos. 103 crianças (42,7%) consultadas por febre; 48 por dor de garganta, 11 por erupção cutânea e 47 por outros sintomas. 95% das crianças receberam alta. DRASP negativo 87,6% (N: 211) e positivo 12,9% (N: 31). EP negativo 80,1% (n: 193) e positivo para SßHGA em 13,7% (n: 33). A sensibilidade do teste foi de 52% e a especificidade de 93%. O PPV 55% e o negativo 92%. O diagnóstico mais frequente foi faringite viral 132 (54,7%). Conclusões: o teste foi aplicado principalmente em escolares febris, alguns com odinofagia. A rápida diferenciação etiológica é útil, pois evita o uso de antibióticos em caso de resultado negativo. Esses resultados apoiam o uso do DRASP em enfermarias de emergência pediátrica.

Opciones de Producción Más Limpia en la Universidad de Ciencias Médicas de Matanzas

Introducción: la sostenibilidad ambiental es una de las metas del milenio establecidas por la Asamblea General de las Naciones Unidas. La minimización de residuos, la producción más limpia, la ecoeficiencia y la prevención de la contaminación contribuyen a su cumplimiento. En el sector de la salud, la Producción Más Limpia se enfoca en la prevención de la contaminación, y en la eliminación de desechos peligrosos, infecciosos y químicos y de emisiones o vertimientos dentro de la institución; se fundamenta en buenas prácticas durante la prestación de servicios, en la sustitución de insumos con características peligrosas, en cambios en los procedimientos y en mejoramiento tecnológico. Objetivo: proponer opciones de Producción Más Limpia en la Universidad de Ciencias Médicas de Matanzas. Materiales y métodos: se desarrolló una investigación de tipo cualitativa, descriptiva y documental. La búsqueda se realizó en la base de datos SciELO y en Google Académico, en el período 2016-2020. Resultados: se identificaron cinco opciones de Producción Más Limpia con resultados satisfactorios que contribuyen a la sostenibilidad ambiental de la Universidad. Conclusiones: la introducción de nuevas tecnologías, la sustitución de sustancias contaminantes, el desarrollo energético y la separación correcta de los residuos, son opciones de Producción Más Limpia que favorecen el desarrollo sostenible.

Introduction: environmental sustainability is one of the millennium goals set by the United Nations General Assembly. Waste minimization, cleaner production, eco-efficiency and pollution prevention contribute to its compliance. In the health sector, Cleaner Production focuses on the prevention of pollution, the disposal of hazardous, infectious and chemical wastes and emissions or discharges within the institution; it is based on good practices during the provision of services, on the replacement of inputs with hazardous characteristics, on changes in procedures and on technological improvement. Objective: to propose Cleaner Production options at Matanzas University of Medical Sciences. Materials and methods: a qualitative, descriptive and documentary research was developed. The search was carried out in the SciELO database and in Google Scholar, in the period 2016-2020. Results: five Cleaner Production options were identified with satisfactory results that contribute to the environmental sustainability of the University. Conclusions: the introduction of new technologies, the replacement of pollutants, energy development and the correct separation of waste are Cleaner Production options that favor sustainable development.

Effects of Fusarium Wilt on Cotton Cultivars with and without Meloidogyne Incognita Resistance in Fields.

Cotton (Gossypium hirsutum) cultivar trials were conducted in four fields (6 trials total) with Meloidogyne incognita (Mi)/Fusarium oxysporum f. sp. vasinfectum (Fov) from 2019 to 2021. Cotton cultivars were divided into groups based on company/Mi resistance: S = susceptible to Mi; R-FM, R-DP, and R-PHY = resistance to Mi in FiberMax®, Deltapine®, and Phytogen® cultivars, respectively; ST 4946GLB2 (moderate resistance to Mi and observed field tolerance to Fov); and ST 5600B2XF (resistance to Mi). The S and R-FM groups had the highest transformed Mi densities LOG10(Mi + 1) (LMi = 3.22 and 3.01, respectively), while R-DP and R-PHY had the lowest LMi (2.21 and 1.85, respectively). Plant mortality (%) was higher for R-DP (28.1%) than for all other groups except ST 5600B2XF (24.8%). Mi-susceptible cultivars averaged 23.3% mortality. Relative yield (0-1 scale) was higher for ST 4946GLB2 (0.706) and R-PHY (0.635) than for R-DP (0.530), ST 5600B2XF (0.578), and S (0.491). All groups except R-DP averaged higher relative yield than the susceptible cultivars. ST 4946GLB2 had the lowest mortality (16.5%) and highest relative yield, while R-DP cultivars had the highest mortality and no difference in relative yield from the Mi-susceptible cultivars. The group of R-DP cultivars had excellent Mi resistance but were susceptible to Fov. No cultivars were identified with high resistance to Fov.

Transplant Onconephrology: An Update.

Transplant onconephrology is a growing specialty focused on the health care of kidney transplant recipients with cancer. Given the complexities associated with the care of transplant patients, along with the advent of novel cancer therapies such as immune checkpoint inhibitors and chimeric antigen-receptor T cells, there is a dire need for the subspecialty of transplant onconephrology. The management of cancer in the setting of kidney transplantation is best accomplished by a multidisciplinary team, including transplant nephrologists, oncologists, and patients. This review addresses the current state and future opportunities for transplant onconephrology, including the roles of the multidisciplinary team, and related scientific and clinical knowledge.

The relationship between commercial cotton cultivars with varying Meloidogyne incognita resistance genes and yield.

Small plot cotton cultivar trials (12 trials) were conducted from 2016 to 2019 in fields infested with Meloidogyne incognita. Entries in these trials included commercial cultivars with partial and high resistance to M. incognita, as well as cultivars with no known resistance. Different resistant groups were created based on different cotton seed companies and their descriptions of the M. incognita resistant cultivars. Groups were none (susceptible); partial resistance found in Stoneville or Fibermax cultivars (PR-FM/ST); partial resistance found in PhytoGen cultivars (PR-PHY); resistance (unknown gene(s)) in Deltapine cultivars (NR-DP); and highly resistant cultivars homozygous for RK1 and RK2 resistant genes in PhytoGen cultivars (HR-PHY). The highest lint yields using a mixed model analysis were found in the PR-FM/ST (1,396 kg lint/ha), HR-PHY (1,327 kg lint/ha), and PR-PHY (1,314 kg lint/ha) groups. Yield for NR-DP (1,234 kg lint/ha) was not different (p > 0.05) than yield for susceptible cultivars (1,243 kg lint/ha). If the older resistant cultivars from Deltapine and PhytoGen (those with only Roundup Ready® herbicide technology) were removed from the analysis, then HR-PHY yields increased by 133 kg of lint/ha to 1,460 kg lint/ha and NR-DP yields remained approximately unchanged (1,227 kg lint/ha). Newer HR-PHY had much improved yield over the first HR-PHY cultivars. Newer HR-PHY averaged 17% higher yield than the susceptible group. LOG10 (M. incognita eggs/500 cm3 soil + 1) were highest for the susceptible cultivars (3.2), followed by PR-FM/ST (2.6), NR-DP (2.4), PR-PHY (2.1), and lowest with HR-PHY (1.4). The newer HR-PHY cultivars (those with ENLIST® herbicide technology) combine excellent yields (17% higher than susceptible cultivars) with high (96%) suppression of M. incognita.Small plot cotton cultivar trials (12 trials) were conducted from 2016 to 2019 in fields infested with Meloidogyne incognita. Entries in these trials included commercial cultivars with partial and high resistance to M. incognita, as well as cultivars with no known resistance. Different resistant groups were created based on different cotton seed companies and their descriptions of the M. incognita resistant cultivars. Groups were none (susceptible); partial resistance found in Stoneville or Fibermax cultivars (PR-FM/ST); partial resistance found in PhytoGen cultivars (PR-PHY); resistance (unknown gene(s)) in Deltapine cultivars (NR-DP); and highly resistant cultivars homozygous for RK1 and RK2 resistant genes in PhytoGen cultivars (HR-PHY). The highest lint yields using a mixed model analysis were found in the PR-FM/ST (1,396 kg lint/ha), HR-PHY (1,327 kg lint/ha), and PR-PHY (1,314 kg lint/ha) groups. Yield for NR-DP (1,234 kg lint/ha) was not different (p > 0.05) than yield for susceptible cultivars (1,243 kg lint/ha). If the older resistant cultivars from Deltapine and PhytoGen (those with only Roundup Ready® herbicide technology) were removed from the analysis, then HR-PHY yields increased by 133 kg of lint/ha to 1,460 kg lint/ha and NR-DP yields remained approximately unchanged (1,227 kg lint/ha). Newer HR-PHY had much improved yield over the first HR-PHY cultivars. Newer HR-PHY averaged 17% higher yield than the susceptible group. LOG10 (M. incognita eggs/500 cm3 soil + 1) were highest for the susceptible cultivars (3.2), followed by PR-FM/ST (2.6), NR-DP (2.4), PR-PHY (2.1), and lowest with HR-PHY (1.4). The newer HR-PHY cultivars (those with ENLIST® herbicide technology) combine excellent yields (17% higher than susceptible cultivars) with high (96%) suppression of M. incognita.

Estado de salud de la población matancera año 2001 / Matanzas State of the population's Health. Year 2001

El sistema de salud de nuestro país ha sufrido durante esta última década los efectos restrictivos en la disponibilidad de recursos debido sobre todo al recrudecimiento del bloqueo impuesto por el imperialismo, al derrumbe del campo socialista, la agudización y profundización de la crisis general que sufre el capitalismo expresado a nivel internacional por el fenómeno de la globalización, el cual no sólo abarca la esfera económica sino también la política y social. Es por este motivo que presentamos el presente trabajo tratando de abarcar de manera sintética todos los aspectos esenciales que conforman la situación de salud actual de nuestro territorio, haciendo énfasis en los aspectos a nuestro juicio más importantes. Evaluando los principales indicadores demográficos, de mortalidad, morbilidad, recursos y servicios.Se presentan los resultados del trabajo dividido en indicadores demográficos de mortalidad, morbilidad y finalmente de recursos y servicios, se emplean medidas de resumen para datos cualitativos, cifras absolutas, porcientos y tasas brutas y ajustadas, se concluye que existe una reducción considerable de la natalidad con una tendencia marcada al envejecimiento de la población, el índice de masculinidad de la provincia es de 102 hombres por cada 100 mujeres, se determinó una razón de dependencia elevada (48.2 por ciento). Sólo se incrementan las Enfermedades Diarreicas Agudas en relación con el año anterior (EDA) y el riesgo de morir en la provincia aumenta, aunque al hacer el ajuste por grupos de edad este disminuye. De manera general se reducen las camas y se mejoran los indicadores de aprovechamiento del recurso cama. La mortalidad infantil y sus componentes disminuyen con relación al año anterior...

Transicion epidemiologica / Epidemiological transition

Analizaremos la situación de salud en Las Américas utilizando la noción de transición epidemiológica como concepto conductor del análisis, resumiendo los orígenes y significado de este concepto y presentando una panorámica general de las condiciones de salud en la región, así como la implicación del análisis empírico para la formulación futura de la teoría de la transición epidemiológica. La comprensión de los fenómenos que acompañan a la transición epidemiológica son de vital importancia para que los países puedan planear sus políticas de salud teniendo en cuenta que éstas responden a las características de la formación económico social y al modelo económico seguido por la mayoría de los países de América Latina, donde el neoliberalismo es la tendencia que predomina inducida por el gobierno de los Estados Unidos de América. La mayoría de los países del área experimentan en la actualidad una profunda transición donde la disminución de las enfermedades infecciosas y parasitarias ha sido sustancial. Cualquiera que sea el resultado, es claro que cuanto mayor sea la complejidad epidemiológica mayor será la necesidad de que éstas se reflejen en un sistema concordante de atención de salud. La transición epidemiológica en la región presenta ya características propias que ameritan el desarrollo de modalidades de suministro de servicios más adaptados a las realidades particulares de la región...