Strengthening public health policies for childhood cancer: Peru's achievements through the WHO Global Initiative for Childhood Cancer.

Objective: To report the progress in Peru, since June 2019, in the implementation of the World Health Organization Global Initiative for Childhood Cancer using the CureAll framework, which can be replicated in low- and middle-income countries. Methods: A mixed method was used of participatory and documentary evaluation. The participatory evaluation included stakeholders from various government institutions, nonprofit organizations, and international partners. The documentary aspect consisted of a review of data on the regulatory environment, national projects, and interventions implemented. The Ministry of Health engaged more than 150 participants to form working committees, which have developed policy and regulatory documents to strengthen care services. Results: Achievements include a decrease in the national treatment abandonment rate from 18.6% to 8.5%, the approval of the Childhood Cancer Law, improvements in the management of patients with febrile neutropenia, and a reduction in rates of events of clinical deterioration and mortality of hospitalized patients. The Cure All implementation framework allows local teams to implement specific strategies and monitor early outcomes in pediatric oncology. Conclusions: The results obtained reflect the teamwork, the leadership of the authorities, the technical support of professionals, and the support of involved organizations. Further actions will be needed to guarantee sustainability, and monitoring tools are needed to assure success in the planned activities.

The role of the relational context and therapists' technical behaviors in brief motivational interviewing sessions for heavy alcohol consumption: Findings from a sample of Latinx adults.

INTRODUCTION: Motivational interviewing (MI) theory and process research highlights the role of therapist technical and relational behaviors in predicting client in-session statements for or against behavior change (i.e., change and sustain talk, respectively). These client statements, in turn, have been shown to predict intervention outcomes. The current study examines sequential associations between therapist behaviors and client change and sustain talk in a sample of Latinx individuals who engage in heavy alcohol consumption. DATA: Data are from a completed randomized clinical trial of a culturally adapted (CAMI) versus unadapted MI targeting alcohol use and consequences among Latinx individuals. METHOD: The study collected observational coding data with the Motivational Interviewing Skill Code (MISC 2.5, i.e., therapist behaviors and global ratings) and the Client Language Assessment - Proximal/Distal (CLA-PD, i.e., client language). Frequentist and Bayesian sequential analyses examined the relationship among nine different categories of therapist behaviors and three different categories of client language (i.e., change talk, sustain talk, neutral). We examined odds ratios and conditional probabilities for the direction, magnitude, and significance of the association between the use of MI technical behaviors and subsequent client statements about change. The study compared these same transitional associations between low/average (i.e., <4) and high (i.e., ≥4) MI Spirit sessions. RESULTS: The pattern of results was replicated across both analytic frameworks. Questions and reflections about change talk versus sustain talk versus neutral statements showed greater odds of predicting the intended client response (i.e., change talk, sustain talk, neutral, respectively) compared to other possible client responses. Conditional probabilities for these transitions were high, ranging from 0.55 to.88. The magnitude of certain technical transitions significantly differed between low/average and high MI Spirit sessions. CONCLUSIONS: Analyses supported the hypothesized associations between therapist use of technical MI behaviors and client change language within this Latinx sample. Analyses of MI Spirit as a moderator of these transitions showed partial support.

Quality of life, self-reported outcomes and impact of education among people with moderate and severe hemophilia A: An integrated perspective from a Latin American country.

Collecting and interpreting self-reported outcomes among people with hemophilia A supports the understanding of the burden of the disease and its treatment to improve holistic care. However, in Colombia, this information is limited. Therefore, this study aimed to describe the knowledge, perception and burden of hemophilia A from the patients' perspective. A cross-sectional study was conducted in the context of a hemophilia educational bootcamp held from November 29th to December 1st, 2019, in Medellin, Colombia. The bootcamp was organized by a hemophilia patient association responsible for contacting and inviting patients with hemophilia A (PwHA). Information on patients' health beliefs, treatment experiences, and health-related quality of life (HRQoL) was obtained through focus groups, individual interviews and the Patient Reported Outcomes, Burdens and Experiences (PROBE) questionnaire. A total of 25 moderate or severe PwHA were enrolled in this study and completed the PROBE questionnaire. Acute pain was the most frequently reported symptom, with 88% of the patients reporting the use of pain medication. Difficulty with activities of daily living was reported by 48%. Furthermore, 52% reported having more than 2 spontaneous bleeding events in the last year. Treatment was administered at home for 72% of patients, with regular prophylaxis as the most common treatment regimen. In terms of overall HRQoL, the median EQ-5D VAS score was 80 (IQR: 50-100). PwHA in Colombia still suffer from disease complications related to bleeding events, pain and disability that affect their HRQoL, which highlights the need to develop patient-centered initiatives to improve the wellness of this population.

Mindfulness Parenting and Childish Play: A Clinical Trial With Parents of Children With Autism Spectrum Disorders.

BACKGROUND: Problems of behaviour, communication, and social interaction associated with Autism Spectrum Disorders can overwhelm parents. Disturbances in parents' psychological well-being (anxiety, depression) affect adherence to treatment, making it less effective. There is a need to investigate how to increase psychological wellbeing in parents of children with autism. METHOD: An 8-week brief training programme using the Mindfulness Parenting (MP) intervention was applied to fourteen parents (6 couples and two mothers). Participants were assigned to one of two groups, both groups received the same treatment but at two different time points. Measures of anxiety (SCAARED), parental stress (PSI-4), autism severity level (AIM) and mindfulness awareness (FFMQ), were assessed. RESULTS: Analysis indicates that MP training increased mindfulness awareness, increasing non-judgment and reactivity, and consequently, reduced anxiety (parental, general, social), improving parent-child interaction. This improvement did not influence parents' perception of the severity of the disorder. CONCLUSIONS: The small number of participants precludes generalisation of the results. More clinical trials are needed to demonstrate the usefulness of including these programmes in early intervention services, as well as profiles of parents who may potentially benefit from it.

An Improbable Thromboembolic Manifestation of COVID-19: A Case Report.

The coronavirus disease 2019 (COVID-19) disease is a multisystem disease and recent studies have shown an increase in reported thromboembolic complications as deep venous thrombosis, pulmonary embolism (PE), stroke, and less frequently mesenteric artery thrombosis. We present a case of a 75-year-old woman, COVID-19 positive with five days of evolution, who was admitted to the emergency room due to diffuse abdominal pain with several days of progression, along with diarrhea and biliary vomit. Abdominal computed tomography presented images of subtraction of the lumen of the upper mesenteric artery. With the reported clinical case the authors intend to clarify the importance of differential diagnosis in patients with a typical severe acute respiratory syndrome coronavirus 2 (SARS CoV2) infection presentation. The gastrointestinal symptoms of SARS CoV2 infection can mask a more severe condition, so a high index suspicion for abdominal thromboembolic events is required once this complication may threaten patient's life.

Can Reclaimed Water Be Used for Sustainable Food Production in Aquaponics?

Aquaculture is a technology used for the production of animal protein but produces a great amount of waste that decreases productivity and adversely affects the environment. Sedimentation and filtration have been used for the treatment of the suspended fraction of these wastes although dissolved substances like nutrients can be an asset. Therefore, the management of aquaculture waste remains a challenge. Aquaponics is a technology that can eliminate dissolved N and P from aquaculture systems as they serve as nutrients for plants, which are absorbed through the roots and are incorporated into their tissues. Several reports and studies exist on the benefits of aquaponic systems for the combined production of plants and aquatic organisms and its advantages in terms of economics and environmental protection. The great majority of the studies use the wastewater from the aquatic production tanks as a source of nutrients for plants production. However, domestic or municipal wastewater is a resource that has been used extensively in other production systems such as conventional agriculture and aquaculture, yet its potential as a source of water for aquaponics has not been established. The current analysis hypothesizes that reclaimed water can be used for aquaponics. Despite the extensive use of reclaimed water in agriculture and aquaculture and the low risk to human health when properly managed, there are no academic studies that have tackled this issue. In order to overcome the generalized mistrust of the public in consuming crops irrigated with reclaimed water or fish growing in reclaimed water, it is recommended that only ornamental fish and plants would be cultivated by this method. There is an urgent need for studies to verify the safety and advantages of such cultivation technique. Finally, it is necessary to establish guidelines for the responsible use of reclaimed water in aquaponics.

Mindfulness-Based Stress Reduction (MBSR) and Self Compassion (SC) Training for Parents of Children with Autism Spectrum Disorders: A Pilot Trial in Community Services in Spain.

This study aims to develop a clinical trial to test the efficacy of a mindfulness-based stress reduction (MBSR) and self-compassion (SC) program on self-reported values of anxiety, depression, and stress in parents of children with autism spectrum disorder (ASD) in primary school, in order to assess their integration into the framework of community intervention programs in Spain. METHODS: A brief 8-week training program using mindfulness-based intervention (MBSR) and self-compassion (SC) has been applied to twelve Valencian ASD parents, ten of whom completed the program. Participants were assigned to two groups; both groups received the same treatment but at two different measurement moments. Depression, anxiety, stress, satisfaction with life and mindful attention awareness measurements were performed, in all participants, in three testing stages. RESULTS: Analysis of variance results suggested that MBSR and SC training reduces stress and anxiety and increases mindful attention awareness. No significant changes were found in life satisfaction measurements. CONCLUSIONS: The small number of participants prevents us from generalizing the results found. More MBSR and SC clinical trials are needed in parents of ASD with results on anxiety, depression and stress in order to demonstrate the relevance of the inclusion of these programs in community-based early intervention services.

Semantic Memory and Lexical Availability in Parkinson's Disease: A Statistical Learning Study.

Parkinson's disease (PD) is a neurodegenerative disorder that causes a progressive impairment in motor and cognitive functions. Although semantic fluency deficits have been described in PD, more specific semantic memory (SM) and lexical availability (LA) domains have not been previously addressed. Here, we aimed to characterize the cognitive performance of PD patients in a set of SM and LA measures and determine the smallest set of neuropsychological (lexical, semantic, or executive) variables that most accurately classify groups. Thirty early-stage non-demented PD patients (age 35-75, 10 females) and thirty healthy controls (age 36-76, 12 females) were assessed via general cognitive, SM [three subtests of the CaGi battery including living (i.e., elephant) and non-living things (i.e., fork)], and LA (eliciting words from 10 semantic categories related to everyday life) measures. Results showed that PD patients performed lower than controls in two SM global scores (picture naming and naming in response to an oral description). This impairment was particularly pronounced in the non-living things subscale. Also, the number of words in the LA measure was inferior in PD patients than controls, in both larger and smaller semantic fields, showing a more inadequate recall strategy. Notably, the classification algorithms indicated that the SM task had high classification accuracy. In particular, the denomination of non-living things had a classification accuracy of ∼80%. These results suggest that frontostriatal deterioration in PD leads to search strategy deficits in SF and the potential disruption in semantic categorization. These findings are consistent with the embodied view of cognition.

Acute respiratory distress syndrome (ARDS) caused by the novel coronavirus disease (COVID-19): a practical comprehensive literature review.

INTRODUCTION: The exponential growth of SARS-CoV-2 virus transmission during the first months of 2020 has placed substantial pressure on most health systems around the world. The complications derived from the novel coronavirus disease (COVID-19) vary due to comorbidities, sex and age, with more than 50% of the patients requiring some level of intensive care developing acute respiratory distress syndrome (ARDS). The authors carried out an extensive and comprehensive literature review on SARS-CoV-2 infection, the clinical, pathological, and radiological presentation as well as the current treatment strategies. AREAS COVERED: Various complications caused by SARS-CoV-2 infection have been identified, the most lethal being the acute respiratory distress syndrome, caused most likely by the presence of severe immune cell response and the concomitant alveolus inflammation. The new treatment strategies are updated, and the analysis of the physiopathology is included in this review. EXPERT OPINION: ARDS is one of the most frequent complications in patients with COVID-19. Information regarding the etiology and physiopathology are still unfolding and for the prevention and amelioration, good clinical management, adequate ventilatory support and the use of systemic corticoids seem to be the most efficient way to reduce mortality and to reduce hospital lengths.

Early Intervention with Parents of Children with Autism Spectrum Disorders: A Review of Programs.

The aim of this article was to analyze the evidence regarding the effectiveness of intervention programs for children with autism based on the participation of their parents. To obtain the data, a systematic search was carried out in four databases (PsycARTICLES (ProQuest), ERIC (ProQuest), PubMed (ProQuest), and Scopus). The retrieved documents were refined under the inclusion/exclusion criteria, and a total of 51 empirical studies were selected. These studies were first classified according to the function of the intervention objective and, later, by the methodology applied (19 studies were based on comprehensive interventions, 11 focused on the nuclear symptoms of autism spectrum disorder (ASD), 12 focused on the promotion of positive parenting, and nine interactions focused on child play). Once all of the documents had been analyzed, the evidence indicated scientific efficacy in most studies, mainly in those based on child development and the application of behavioral analysis principles. Moreover, the positive influence of parent participation in such programs was demonstrated.

Adipokines in a group of Mexican patients with nonalcoholic steatohepatitis.

INTRODUCTION: Leptin has been implicated in the pathogenesis of nonalcoholic steatohepatitis. It has also been suggested that adiponectin plays an important role in the transition from fatty liver disease to nonalcoholic steatohepatitis. OBJECTIVE: To evaluate whether leptin and adiponectin levels are related to the degree of necroinflammatory activity and fibrosis in patients with nonalcoholic steatohepatitis. METHODS: Leptin and adiponectin levels were determined in 52 patients with nonalcoholic steatohepatitis and in 49 controls by enzyme-linked immunosorbent analysis. RESULTS: Median (interquartile range) leptin levels were higher in patients with nonalcoholic steatohepatitis than in the controls (5.75 (12.3) ng mL-1 and 2.80 (2.40) ng mL-1, respectively; P = 0.0035). Adiponectin levels were lower in patients with nonalcoholic steatohepatitis than in the controls (6.55 (5.05) mg mL-1 and 9.30 (6.70) mg mL-1, respectively; P = 0.0218). Leptin levels were lower in overweight patients than in obese patients (2.25 (6.73) and 8.0 (16.0) ng mL-1, respectively; P = 0.0025). The amount of necroinflammatory activity observed in liver biopsies correlated positively with the amount of fibrosis (P < 0.0001). Increased lactate dehydrogenase correlated with increased fibrosis in patients with nonalcoholic steatohepatitis (P = 0.0012). Necroinflammatory activity correlated with adiponectin, g-glutamyltranspeptidase, the quantitative insulin-sensitivity check index, and ferritin (P < 0.05). Risk factors for nonalcoholic steatohepatitis in the logistic regression analysis were leptin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and g-glutamyltranspeptidase (P < 0.0001). Only lactate dehydrogenase (P = 0.0012) was significantly associated with advanced fibrosis on logistic regression analysis. CONCLUSIONS: Lactate dehydrogenase was associated with fibrosis and advanced fibrosis. Leptin was associated with nonalcoholic steatohepatitis but not with fibrosis or necroinflammatory activity. Adiponectin was related to necroinflammatory activity. Risk factors for nonalcoholic steatohepatitis were leptin and liver enzymes (aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and gama-glutamyltranspeptidase).

Pre-operative factors associated with increased mortality in elderly patients with a hip fracture: A cohort study in a developing country.

BACKGROUND: Hip fractures are a public health problem worldwide, and several factors are involved with post-operative mortality. The aim of this study was to identify the pre-operative factors associated with increased mortality in elderly patients with hip fractures in a developing country during the first post-operative year. METHODS: An ambidirectional cohort study was conducted with patients ≥ 65 years of age who underwent hip surgery due to a hip fracture caused by a fall from a standing position. Socio-demographic data, time to surgery, and comorbidities measured by the Charlson Comorbidity Index (CCI) were recorded. One-year mortality from all causes was the primary outcome, and 30-day and 6-month mortality were the secondary outcomes. Log-rank test was used to evaluate survival, and Cox's proportional hazard regression was used to detect the factors associated with increased mortality. RESULTS: 478 patients who underwent hip surgery were included in this study. The mean age was 80.2 ±â€¯9.9, and 297 (62%) were females. There were 150 (31.4%) deaths at the end of the first follow-up year, and the mean of surgical delay was 8.8 days ±â€¯6.4. Patients who underwent surgery during the first 4 days (Log-rank test < 0.001) after hip fracture occurred and patients with a CCI ≤ 2 (Log-rank test < 0.001) showed better survival (90%), comparing to mortality (52%) of patients with a CCI ≥ 3 and surgical delay > 4 days. The age ≥ 80 years (Hazard ratio 2.55 (HR), 95% confidence interval (CI) 1.70 to 3.84, p < 0.001), CCI ≥ 3 (HR 1.61, 95% CI 1.14-2.26, p 0.006), surgical delay > 4 days (HR 2.41, 95% CI 1.38-4.21, p 0.006), and haemoglobin < 10 g/dl (HR 1.51, 95% CI 1.06-2.15, p 0.02) were associated with increased 1-year mortality. In addition, 30-day mortality was associated with age ≥ 80 years (HR 4.15, 95% CI 1.98-8.70, p < 0.001), CCI ≥ 3 (HR 1.80, 95% CI 1.08-2.99, p 0.023), pre-surgical time >48 h (HR 3.0, 95% CI 1.58-5.92, p 0.001), and surgical delay > 4 days (HR 3.0, 95% CI 1.33-6.81, p 0.008); and 6-month mortality was associated with surgical delay > 4 days (HR 2.72, 95% CI 1.42-5.23, p 0.003), and haemoglobin < 10 g/dl (HR 1.56, 95% CI 1.04-2.33, p < 0.028). CONCLUSIONS: Surgical delay greater than 4 days and Charlson Comorbidity Index ≥ 3 were found as factors associated with increased mortality, along with anaemia < 10 g/dl and age ≥ 80 years. A similar mortality rate was found in this study compared to the rates reported by the literature, despite a surgical delay of 8.8 days.

Impacto de la COVID-19 en la práctica clínica de la fonoaudiologia en Colombia

Introducción: Son pocos los estudios que describen cómo la pandemia por COVID-19 ha afectado las prácticas clínicas de los profesionales en fonoaudiología, y es aún más escaso el conocimiento de este impacto en países latinoamericanos, como Colombia. Objetivo: Describir el impacto de la pandemia por COVID-19 sobre el ejercicio de la fonoaudiología clínica, así como las adaptaciones implementadas para garantizar la atención de salud en Colombia. Materiales y métodos: Estudio de corte transversal en el que se aplicó un cuestionario online entre enero y febrero de 2021 a fonoaudiólogos clínicos con experiencia en el área. El cuestionario indagó sobre variables sociodemográficas y categorías como el ejercicio profesional clínico y el impacto del COVID-19 en la práctica clínica fonoaudiológica. Los resultados se analizaron descriptivamente y se aplicó Chi2 de independencia para encontrar posibles asociaciones. Resultados: El 9 % de los profesionales perdió su trabajo debido a la pandemia, y del total restante, el 14 % optó por la telesalud. Existen restricciones de intervención, principalmente en la atención deglutoria y de habla, así como adaptaciones que buscan proteger la salud del paciente y el profesional. Se evidencia que el entrenamiento en atención con pacientes con COVID-19 promueve el uso de elementos de protección personal (p < 0,01), la construcción de protocolos de atención institucional (p < 0,01) y la estabilidad de tiempos de intervención durante las sesiones (p < 0,04). Conclusiones: la pandemia por COVID-19 impactó la práctica clínica fonoaudiológica y modificó el actuar de los profesionales no sólo por la adopción de medidas de bioseguridad sino por la transición a la teleconsulta para garantizar la atención en salud.

Introduction: Few studies have described how the COVID-19 pandemic has affected the clinical practices of speech and language therapists, and the knowledge of this impact in Latin American countries, such as Colombia, is even scarcer. The aim of the present study was to describe the impact of the COVID-19 pandemic on the clinical practice of speech and language therapy, as well as the adaptations implemented to guarantee health care in Colombia. Materials and methods: Cross-sectional study, in which an online questionnaire was applied between January and February 2021 to speech and language therapists with experience in the clinical area. The instrument inquired about sociodemographic variables and categories such as clinical professional practice and the impact of COVID-19 on clinical speech and language therapy practice. The results were analyzed descriptively and chi-square for independence was applied to find associations. Results: Nine percent of the professionals lost their jobs due to the pandemic, and of the remaining total, 14% opted for telehealth. There are intervention restrictions, in swallowing and speech care, as well as adaptations that seek to protect the health of the patient and the professional. It is evidenced that training in care with patients with COVID-19 promotes the use of personal protection elements (p<0.01), the construction of institutional care protocols (p<0.01) and the stability of intervention times during the sessions (p<0.04). Conclusions: The COVID-19 pandemic impacted clinical Speech and Language Therapy practice and changed the actions of professionals, not only by adopting biosecurity measures, but also by the transition to telehealth to guarantee health care.

Strengthening public health policies for childhood cancer: Peru's achievements through the WHO Global Initiative for Childhood Cancer / Fortalecimiento de las políticas de salud pública contra el cáncer infantil: logros de Perú en el marco de la Iniciativa Mundial de la OMS contra el Cáncer Infantil / Fortalecimento das políticas públicas de saúde para o câncer infantil: As conquistas do Peru por meio da Iniciativa Global da OMS para o Câncer Infantil

ABSTRACT Objective. To report the progress in Peru, since June 2019, in the implementation of the World Health Organization Global Initiative for Childhood Cancer using the CureAll framework, which can be replicated in low- and middle-income countries. Methods. A mixed method was used of participatory and documentary evaluation. The participatory evaluation included stakeholders from various government institutions, nonprofit organizations, and international partners. The documentary aspect consisted of a review of data on the regulatory environment, national projects, and interventions implemented. The Ministry of Health engaged more than 150 participants to form working committees, which have developed policy and regulatory documents to strengthen care services. Results. Achievements include a decrease in the national treatment abandonment rate from 18.6% to 8.5%, the approval of the Childhood Cancer Law, improvements in the management of patients with febrile neutropenia, and a reduction in rates of events of clinical deterioration and mortality of hospitalized patients. The Cure All implementation framework allows local teams to implement specific strategies and monitor early outcomes in pediatric oncology. Conclusions. The results obtained reflect the teamwork, the leadership of the authorities, the technical support of professionals, and the support of involved organizations. Further actions will be needed to guarantee sustainability, and monitoring tools are needed to assure success in the planned activities.

RESUMEN Objetivo. Informar sobre los avances de Perú en el periodo transcurrido a partir de junio del 2019, en relación con la puesta en práctica de la Iniciativa Global de la Organización Mundial de la Salud contra el Cáncer Infantil utilizando el marco CureAll, que es posible replicar en los países de ingresos bajos y medianos. Métodos. Se utilizó un método mixto de evaluación participativa y documental. En la evaluación participativa intervinieron las partes interesadas de diversas instituciones gubernamentales, organizaciones sin fines de lucro y asociados internacionales. El aspecto documental consistió en un examen de los datos sobre el entorno regulatorio, los proyectos nacionales y las intervenciones llevadas a cabo. El Ministerio de Salud involucró a más de 150 participantes que formaron los comités de trabajo que han elaborado documentos normativos y regulatorios a fin de reforzar los servicios de asistencia. Resultados. Entre los logros cabe citar la disminución del 18,6% al 8,5% de la tasa nacional de abandono del tratamiento, la aprobación de la Ley de Cáncer Infantil, las mejoras en el tratamiento de los pacientes con neutropenia febril y la reducción de las tasas de episodios de deterioro clínico y de mortalidad en los pacientes hospitalizados. El marco de aplicación de CureAll permite que los equipos locales pongan en práctica estrategias específicas y realicen un seguimiento de los resultados iniciales en el ámbito de la oncología pediátrica. Conclusiones. Los resultados obtenidos reflejan el trabajo en equipo, el liderazgo de las autoridades, el respaldo técnico de los profesionales y el apoyo de las organizaciones implicadas. En el futuro, será necesario adoptar nuevas medidas para asegurar su viabilidad, y será preciso contar con herramientas de seguimiento para garantizar el éxito de las actividades planificadas.

RESUMO Objetivo. Relatar o progresso, desde junho de 2019, da implementação da Iniciativa Global da Organização Mundial da Saúde para o Câncer Infantil no Peru, no âmbito do marco CureAll, que pode ser replicado em países de baixa e média renda. Método. Foi utilizado um método misto de avaliação participativa e documental. A avaliação participativa incluiu interessados diretos de diferentes instituições governamentais, organizações sem fins lucrativos e parceiros internacionais. O aspecto documental consistiu em uma revisão de dados sobre o ambiente regulatório, projetos nacionais e intervenções implementadas. O Ministério da Saúde do Peru contou com mais de 150 participantes para a formação de comitês de trabalho, que elaboraram políticas e documentos normativos para fortalecer os serviços de atenção primária à saúde. Resultados. Entre os resultados alcançados estão a redução da taxa nacional de abandono do tratamento, de 18,6% para 8,5%, a aprovação da Lei do Câncer Infantil, melhorias no manejo de pacientes com neutropenia febril e redução nas taxas de deterioração clínica e mortalidade de pacientes hospitalizados. A implementação do CureAll permite que as equipes locais adotem estratégias específicas e monitorem os resultados iniciais em oncologia pediátrica. Conclusões. Os resultados obtidos refletem o trabalho em equipe, a liderança das autoridades, o suporte técnico dos profissionais e o apoio das organizações envolvidas. Serão necessárias mais ações para garantir a sustentabilidade, além de ferramentas de monitoramento para assegurar o sucesso das atividades planejadas.

Factores asociados con amputación de miembros inferiores de pacientes con pie diabético en una cohorte / Factors associated with lower limb amputation of patients with diabetic foot in a cohort

Introducción: El desarrollo de ulceraciones en el Pie Diabético (PD) puede derivar en amputación de miembros inferiores e incluso impactar la morbi mortalidad de los pacientes diabéticos. Por lo anterior, este estudio pretende evaluar las características de los pacientes con PD hospitalizados y manejados en un hospital regional. Materiales y métodos: 121 pacientes son incluidos en el estudio de cohorte retrospectiva entre amputados y no amputados, tomados de la base de datos del hospital entre enero de 2013 y enero de 2018. Los datos demográficos, así como factores relacionados fueron analizados con regresión logística bi y multivariada en relación con la amputación de miembro inferior como variable de desenlace, calculando razón de probabilidades (OR) con intervalos de confianza del 95%. Dicha información fue analizada con el programa estadístico STATA. Resultados: 81 pacientes requirieron amputación de miembros inferiores. En la regresión logística bivariada hay 3 factores relacionados con amputación [nivel de Wagner (p < 0.05 CI 95%), la presencia de leucocitosis (p <0.05 CI 95%) y el compromiso vascular en Doppler arterial (p < 0.05 CI 95%)], sin embargo, la regresión multivariada sólo relaciona el compromiso vascular del Doppler arterial como estadísticamente significativo con amputación de miembros inferiores (p < 0.05 CI 95%). Conclusión: Se muestran 3 factores estadísticamente significativos con la amputación de miembros inferiores en PD (Wagner, leucocitosis y compromiso vascular), reflejando la importancia de un diagnóstico temprano y un manejo adecuado como parte clave en el manejo de esta patología.

Introduction: The development of ulcerations in the Diabetic Foot (DP) can lead to lower limb amputation and even impact the morbidity and mortality of diabetic patients. Therefore, this study aims to evaluate the characteristics of patients with PD hospitalized and managed in a regional hospital. Materials and methods: 121 patients are included in the retrospective cohort study between amputees and non-amputees, taken from the hospital database between January 2013 and January 2018. Demographic data, as well as related factors, were analyzed with logistic regression. bi and multivariate in relation to lower limb amputation as an outcome variable, calculating odds ratio (OR) with 95% confidence intervals. This information was analyzed with the STATA statistical program. Results: 81 patients required lower limb amputation. In the bivariate logistic regression there are 3 factors related to amputation [Wagner level (p < 0.05 95% CI), the presence of leukocytosis (p < 0.05 95% CI) and vascular compromise on arterial Doppler (p < 0.05 95% CI). )], however, multivariate regression only relates vascular compromise on arterial Doppler as statistically significant to lower limb amputation (p < 0.05 95% CI). Conclusion: 3 statistically significant factors are shown with lower limb amputation in PD (Wagner, leukocytosis and vascular compromise), reflecting the importance of early diagnosis and adequate management as a key part in the management of this pathology.

Panorama de la investigación en fonoaudiología: tendencias en Colombia / Overview of research in speech therapy: trends in Colombia

El objetivo de este artículo es analizar el panorama investigativo disciplinar desde la producción académica nacional, para identificar poblaciones, áreas, enfoques de investigación, de esta manera reconocer necesidades y retos para la investigación formativa de la fonoaudiología en Colombia. Se analizó información proveniente de proyectos de investigación de pregrado y posgrado de 13 programas de formación en Fonoaudiología del país, entre 2010 y 2019, reportados por las instituciones de educación superior. Se recolectó información de informes y documentos de investigación (N=638). En primer lugar, se observa un incremento en la producción investigativa entre 2010 (4,9%) y 2019 (18,3%). El 85% de la investigación se identificó en pregrado y el 15% en postgrado. El enfoque predominante fue cualitativo (55,3%), el que, junto con el alcance descriptivo (77,8%) que representan la mayoría de productos de investigación. El escenario relacionado con el ámbito de salud clínico asistencial lidera la investigación (52,9%). Las áreas predominantes en este escenario investigativo son Lenguaje (29,1%) y Audición (27,4%) en poblaciones de adultos (56,7%) e infantil (28,52%). Se concluye que la producción investigativa desde la academia, específicamente desde los programas de formación de fonoaudiólogos en Colombia, evidencian la necesidad de fomentar la investigación de tipo experimental y analítica, con poblaciones de neonatos y lactantes, en áreas relacionadas con la función oralfaríngea y en escenarios inéditos. Además, es necesario incluir el uso de tecnologías y nuevos enfoques de intervención para aportar al abordaje basado en la evidencia. Futuras investigaciones deben permitir comparar la investigación antes y después de la pandemia, dada la virtualización y la inclusión de la fonoaudiología en escenarios como las unidades de cuidado crítico y cuidado paliativo.

The objective of this article is to analyze the disciplinary research landscape from the national academic production, to identify populations, areas, research approaches, in this way identify needs and challenges for formative research of speech therapy in Colombia. Information from undergraduate and graduate research projects of 13 training programs in Speech Therapy in the country, between 2010 and 2019, reported by higher education institutions, was analyzed. Information was collected from reports and research papers (N=638). First, there was an increase in research production between 2010 (4.9%) and 2019 (18.3%). 85% of the researchwas identified in undergraduate and 15% in postgraduate. The predominant approach was qualitative (55.3%), which, together with the descriptive scope (77.8%) that represent the majority of research products. The scenario related to the field of clinical health care leads the research (52.9%). The predominant areas in this research scenario are Language (29.1%) and Hearing (27.4%)in adult (56.7%) and child (28.52%) populations. It is concluded that the research production from the academy, specifically from the trainingprograms of speech therapists in Colombia, evidences the need to promote experimental and analytical research, with populations of neonates and infants, in areas related to oral function and in unprecedented scenarios. Besides, it is necessary to include the use oftechnologies and new intervention approaches to contribute to the evidence-based approach. Future research should allow comparison of research before and after the pandemic, given the virtualization and the inclusion of speech therapy in settings such as critical careand palliative care units.

[Foodborne disease outbreaks studied by molecular techniques]. / Brotes de enfermedades transmitidas por los alimentos estudiados mediante técnicas moleculares.

OBJECTIVE: To apply a multiplex real-time polymerase chain reaction (PCR) technique to detect Salmonella spp., Listeria monocytogenes, and Yersinia enterocolitica as a diagnostic support tool for the surveillance of foodborne disease outbreaks. MATERIALS AND METHODS: Molecular methodology was applied on clinical samples taken from individuals who were associated with foodborne disease outbreaks in two departments of Colombia. The results were compared with the data obtained by conventional culture methodology. In addition, the clonal relation of the isolations was evaluated using the Pulsed Field Gel Electrophoresis (PFGE) technique. RESULTS: 123 cases of foodborne disease were determined, of which 45 biological samples were confirmed by laboratory and 88 by epidemiological link. The molecular methodology detected 35/45 positive samples versus 17/45 positive samples detected by conventional methodology. PFGE demonstrated a clonal relation during each outbreak. CONCLUSION: The results of the study demonstrate the applicability of the molecular technique as a useful diagnostic support tool to characterize foodborne disease outbreaks, allowing a timely and reliable response.

OBJETIVO: Aplicar una técnica de reacción en cadena de la polimerasa (PCR) múltiple en tiempo real para la detección de Salmonella spp., Listeria monocytogenes y Yersinia enterocolitica, como herramienta de apoyo diagnóstico en la vigilancia de brotes de enfermedad transmitida por alimentos. MATERIALES Y MÉTODOS: Se aplicó la metodología molecular en muestras clínicas provenientes de individuos que estaban asociados a brotes de enfermedad transmitida por alimentos de dos departamentos de Colombia. Los resultados se compararon con los datos arrojados por la metodología convencional de cultivo. Adicionalmente a los aislamientos obtenidos se les evaluó relación clonal mediante la técnica de electroforesis de campo pulsado (PFGE). RESULTADOS: Se determinó un total de 123 casos de enfermedad transmitida por alimentos de los cuales 45 muestras biológicas fueron confirmadas por laboratorio y 88 mediante nexo epidemiológico. La metodología molecular detectó 35/45 muestras positivas frente a 17/45 muestras positivas detectadas mediante la metodología convencional. La PFGE demostró relación clonal en cada brote. CONCLUSIÓN: Los resultados del estudio demuestran la aplicabilidad de la técnica molecular como herramienta útil de apoyo diagnóstico en la caracterización de brotes de enfermedad transmitida por alimentos, permitiendo una respuesta oportuna y confiable.

Adaptación transcultural al Español y Validación de la Escala de Lysholm para evaluar la funcionalidad de la rodilla / Cross-cultural adaptation to Spanish and Validation of Lysholm knee Score

Introducción La escala de Lysholm fue desarrollada en 1982 y modificada en 1985 con el fin de evaluar la funcionalidad de los pacientes con lesiones ligamentarias; desde entonces ha sido ampliamente utilizada para evaluar subjetivamente a los pacientes en relación con su capacidad funcional. El propósito de este estudio fue realizar su traducción y adaptación transcultural al español colombiano y desarrollar la validación psicométrica a través de la evaluación de la consistencia interna y fiabilidad test-retest. Materiales y métodos Previa identificación de la escala original de interés, se realizó traducción (inglés-español), adaptación cultural y re-traducción (español-inglés) por expertos lingüistas nativos, quienes valoraron la similitud del contenido de ambos productos (original y retraducido). Asimismo, dicha última versión fue valorada por 40 pacientes con enfermedad de rodilla (lesión meniscal, ruptura de ligamento cruzado anterior, condromalacia y gonartrosis), quienes confirmaron comprender el texto. Posteriormente fue evaluada la consistencia interna mediante la prueba de alfa de Cronbach para todos los ítems, y el coeficiente correlación intraclase­puntaje total del sub-constructo a través de una muestra aleatoria (n=93), la cual validó la estructura factorial de la escala. Resultados El alfa de Cronbach fue de 0,737 y el coeficiente de correlación interclase fue de 0,844, asociado a una concordancia inter-observador alta (Gamma=0,752). El gráfico de Bland-Altman no demostró diferencias sistemáticas entre las mediciones Discusión La presente versión al español (colombiano) de la escala Lysholm es una herramienta válida para medir la funcionalidad en pacientes con lesiones meniscales del ligamento cruzado anterior, condromalacia patelofemoral y gonartrosis en países de habla hispana (preferentemente en Colombia).

Background The Lysholm scale was developed in 1982 and modified in 1985 in order to assess the functionality of patients with knee ligament injuries; since then it has been widely used to subjectively evaluate patients in relation to their functional capacity. The purpose of the study was to carry out its translation and cross-cultural adaptation to Colombian Spanish and to develop psychometric validation through the evaluation of internal consistency and test-retest reliability. Methods After identifying the original scale of interest, translation (English-Spanish), cultural adaptation and re-translation (Spanish-English) were carried out by native linguist experts, who assessed the similarity of the content of both products (original and retranslated). Likewise, this latest version was evaluated by 40 patients with knee disease (meniscal injury, anterior cruciate ligament rupture, chondromalacia and gonarthrosis), who confirmed that they understood the text. Subsequently, the internal consistency was evaluated using Cronbach's alpha test for all items, and the intraclass correlation coefficient ­ ??total score of the sub-construct through a random sample (n=93), which validated the factorial structure of the scale. Results Cronbach's alpha was 0.737 and the interclass correlation coefficient was 0.844, associated with a high inter-observer agreement (Gamma=0.752). The Bland-Altman plot did not show systematic differences between the measurements Discussion This Spanish (Colombian) version of the Lysholm scale is a valid tool to measure functionality in patients with meniscal lesions of the anterior cruciate ligament, patellofemoral chondromalacia and gonarthrosis in Spanish-speaking countries (preferably in Colombia).

La "moda del burnout' en el sector salud: una revisión sistemática de la literatura / The «fashion of burnout"in the health sector: a systematic review of the literature

Resumen El propósito de este revisión sistemática fue describir la situación actual del síndrome de burnout en Colombia en estudiantes y trabajadores de las ciencias de la salud. Se realizó una búsqueda en las bases de datos Medline, Scopus, Science Direct, Lilacs y repositorios de revistas como Scielo, Pubmed, Redylacs, BIRE-ME. Se llevó a cabo un filtro inicial mediante títulos y resúmenes de acuerdo con los criterios de inclusión y exclusión. Posteriormente, se evaluó la calidad metodológica y con los estudios incluidos se estimó la prevalencia global. Finalmente se seleccionaron tres estudios. La población total fue de 5874 estudiantes y profesionales de las ciencias de la salud, 96,1 % (n=5647) y 3,86 % (n=227), respectivamente. Esta revisión deja en evidencia que en Colombia, aunque se han realizado varios estudios relacionados con el síndrome de Burnout, aún se requieren más investigaciones con mayor rigurosidad metodológica que profundicen en las intervenciones una vez sea diagnosticado.

Abstract The aim of the present systematic review was to describe the current situation of the Burnout Syndrome in Colombia in students and workers of the health sciences. A search was made in the databases: Medline, Scopus, Science Direct, Lilacs and magazine repositories: Scielo, Pubmed, Redylacs, BIREME. An initial filter was carried out through titles and abstracts according to the inclusion and exclusion criteria. Subsequently, the methodological quality was evaluated and with the included studies, the overall prevalence was estimated. Finally, three studies were selected, the total population was of 5874 students and professionals of the health sciences, 96.1% (n = 5647) and 3.86% (n = 227) respectively. This review shows that in Colombia, although several studies related to Burnout Syndrome have been carried out, there is still more research with greater methodological rigor that delves into complications once the syndrome is diagnosed.