Cross-sector co-creation of a community-based physical activity program for breast cancer survivors in Colombia.

Benefits of physical activity (PA) in breast cancer survivors (BCS) are well established. However, programs to promote PA among BCS tailored to real-world contexts within low- to middle-income countries are limited. Cross-sector co-creation can be key to effective and scalable programs for BCS in these countries. This study aimed to evaluate the networking process to engage multisector stakeholders in the co-creation of a PA program for Colombian BCS called My Body. We employed a mixed-methods design including semistructured interviews, workshops and a social network analysis of centrality measures to assess stakeholders' engagement, resources and skills enabling the collaborative work, challenges, outcomes and lessons learned. The descriptive analysis and the centrality measures of the network revealed that 19 cross-sector stakeholders engaged in the My Body collaborative network. Through ongoing communication and cooperation, My Body built relationships between the academic lead institutions (local and international), and local and national public, private and academic institutions working in public health, sports and recreation, social sciences and engineering fields. The outcomes included the co-creation of the community-based PA program for BCS, its implementation through cross-sector synergies, increased relationships and communications among stakeholders, and successful dissemination of evidence and project results to the collaboration partners and other relevant stakeholders and community members. The mixed-methods assessment enabled understanding of ways to advance cross-sector co-creation of health promotion programs. The findings can help to enable continued development of sustainable cross-sector co-creation processes aimed at advancing PA promotion.

Collaborative work among stakeholders and researchers from different governmental sectors and disciplinary fields can be key to design and implement effective and scalable programs to promote physical activity (PA) among breast cancer survivors (BCS). This might be particularly critical in low- to middle-income countries where the implementation of evidence-based health-promoting programs tailored to real-world contexts are limited. This study aimed to evaluate the networking process to engage multisector stakeholders in the co-creation of a PA program for Colombian BCS. We employed qualitative methods and social network analyses to assess stakeholders' engagement, resources and skills enabling the collaborative work, challenges, outcomes and lessons learned. The co-creation of the program improved synergies between research, policy and practice. Communication through several channels including e-mail and workshops was the key resource to advance the collaborative work. Stakeholders underscored that cross-sector networking allowed allocating resources and achieving shared goals. Sustainable cross-sector collaborative processes are key for health promotion.

La afiliación al sistema de salud de personas migrantes venezolanas en Colombia / The Affiliation to the Health System among Venezuelan Migrants in Colombia

Resumen: Introducción:El acceso de las personas migrantes venezolanas al sistema de salud es fundamental para su supervivencia y bienestar futuro. El objetivo de esta investigación es analizar los niveles de afiliación a dicho sistema de las personas venezolanas en las áreas urbanas de Colombia por periodos de arribo, así como los factores sociodemográficos y laborales asociados. Metodología: Se realiza análisis cuantitativo de tipo estadístico descriptivo e inferencial, a partir de la Gran Encuesta Integrada de Hogares 2018, la cual aporta datos representativos para Colombia y sus 13 ciudades más importantes. Se utilizan los módulos de migración, de variables sociodemográficas del hogar y de ocupación relativos a la población de 14 a 65 años. Resultados:Únicamente 24,5 % de dichos migrantes están inscritos al sistema de salud en contraste a 93 % de las personas colombianas. Los niveles de afiliación se redujeron de 82 % entre las personas venezolanos que arribaron en 2013 o antes a 10 % entre los que llegaron en 2017-2018. Las personas venezolanas afiliadas al sistema de salud son una población selecta en términos sociodemográficos; más joven, más educada, con mayor participación laboral y mayores ingresos que la población nativa en Colombia. La baja inserción de las personas migrantes venezolanas en empleos con contrato escrito restringe dicha afiliación. Conclusiones: Las personas venezolanas en Colombia tienen muy limitada la inscripción al sistema de salud. A pesar de que este es un derecho protegido por los marcos jurídicos internacional y nacional, estas personas enfrentan barreras económicas, políticas y sociales para ejercer ese derecho en Colombia.

Abstract: Introduction: Venezuelan migrants' access to the health system is fundamental to their survival and future well-being. This article aims to analyze the level of affiliation to the health care system of these migrants in the urban areas in Colombia by arrival periods and the associated sociodemographic and labor factors. Methodology: To this end, quantitative analysis is done based on descriptive and inferential statistical analyses of the 2018 Gran Encuesta Integrada de Hogares, which is a representative survey for Colombia and its 13 more important urban areas. We use the modules on migration, sociodemographic variables of the household and occupation relative to the population aged 14 to 65. Results: Only 24,5% of Venezuelan migrants are affiliated with any health care provider in contrast to 93% of Colombians. The levels of affiliation diminished from 82% among Venezuelans who arrived in 2013 or before to 10% among Venezuelans who arrived in 2017-2018. Venezuelans registered in the health system are a select population in sociodemographic terms; younger, more educated, with more labor participation and higher income than the native population in Colombia. The low insertion of Venezuelan immigrants in jobs with a written contract restricts this enrollment. Conclusions:The Venezuelans in Colombia have a very limited affiliation with the health system. Even though this is a right protected by international and national legal frameworks, Venezuelans encounter economic, political, and social barriers to exercise it in Colombia.

MyD88 controls airway epithelial Muc5ac expression during TLR activation conditions from agricultural organic dust exposure.

Inflammation from airborne microbes can overwhelm compensatory mucociliary clearance mechanisms, leading to mucous cell metaplasia. Toll-like receptor (TLR) activation via myeloid differentiation factor 88 (MyD88) signaling is central to pathogen responses. We have previously shown that agricultural organic dust extract (ODE), with abundant microbial component diversity, activates TLR-induced airway inflammation. With the use of an established model, C57BL/6J wild-type (WT) and global MyD88 knockout (KO) mice were treated with intranasal inhalation of ODE or saline, daily for 1 wk. ODE primarily increased mucin (Muc)5ac levels relative to Muc5b. Compared with ODE-challenged WT mice, ODE-challenged, MyD88-deficient mice demonstrated significantly increased Muc5ac immunostaining, protein levels by immunoblot, and expression by quantitative PCR. The enhanced Muc5ac levels in MyD88-deficient mice were not explained by differences in the differentiation program of airway secretory cells in naïve mice. Increased Muc5ac levels in MyD88-deficient mice were also not explained by augmented inflammation, IL-17A, or neutrophil elastase levels. Furthermore, the enhanced airway mucins in the MyD88-deficient mice were not due to defective secretion, as the mucin secretory capacity of MyD88-KO mice remained intact. Finally, ODE-induced Muc5ac levels were enhanced in MyD88-deficient airway epithelial cells in vitro. In conclusion, MyD88 deficiency enhances airway mucous cell metaplasia under environments with high TLR activation.

Incidence of intraoperative seizures during motor evoked potential monitoring in a large cohort of patients undergoing different surgical procedures.

OBJECTIVE The purpose of this study was to investigate the incidence of seizures during the intraoperative monitoring of motor evoked potentials (MEPs) elicited by electrical brain stimulation in a wide spectrum of surgeries such as those of the orthopedic spine, spinal cord, and peripheral nerves, interventional radiology procedures, and craniotomies for supra- and infratentorial tumors and vascular lesions. METHODS The authors retrospectively analyzed data from 4179 consecutive patients who underwent surgery or an interventional radiology procedure with MEP monitoring. RESULTS Of 4179 patients, only 32 (0.8%) had 1 or more intraoperative seizures. The incidence of seizures in cranial procedures, including craniotomies and interventional neuroradiology, was 1.8%. In craniotomies in which transcranial electrical stimulation (TES) was applied to elicit MEPs, the incidence of seizures was 0.7% (6/850). When direct cortical stimulation was additionally applied, the incidence of seizures increased to 5.4% (23/422). Patients undergoing craniotomies for the excision of extraaxial brain tumors, particularly meningiomas (15 patients), exhibited the highest risk of developing an intraoperative seizure (16 patients). The incidence of seizures in orthopedic spine surgeries was 0.2% (3/1664). None of the patients who underwent surgery for conditions of the spinal cord, neck, or peripheral nerves or who underwent cranial or noncranial interventional radiology procedures had intraoperative seizures elicited by TES during MEP monitoring. CONCLUSIONS In this largest such study to date, the authors report the incidence of intraoperative seizures in patients who underwent MEP monitoring during a wide spectrum of surgeries such as those of the orthopedic spine, spinal cord, and peripheral nerves, interventional radiology procedures, and craniotomies for supra- and infratentorial tumors and vascular lesions. The low incidence of seizures induced by electrical brain stimulation, particularly short-train TES, demonstrates that MEP monitoring is a safe technique that should not be avoided due to the risk of inducing seizures.

Feasibility of eliciting the H reflex in the masseter muscle in patients under general anesthesia.

OBJECTIVE: To explore the feasibility of eliciting the brainstem H reflex in the masseter muscle in patients under general anesthesia. METHODS: We electrically stimulated the masseteric nerve, a branch of the trigeminal nerve, and recorded ipsilateral masseteric and temporalis muscle responses. We tested eight patients who presented with trigeminal neuralgia; one patient had a temporal bone tumor and one patient had a brainstem arteriovenous malformation. All responses were elicited when patients were under general anesthesia and before the initiation of surgery. RESULTS: The H reflex in the masseter muscle was reliably elicited in 70% of the patients. The reflexes met the usual criteria for the H reflex because they were elicited below the threshold of the direct M response, and their amplitudes decreased when the M response increased with stronger stimuli. The mean onset latencies of the masseter H reflex and the M response were 5.4±1.3ms and 2.6±0.6ms, respectively. CONCLUSIONS: In the present study, we provide evidence of the feasibility of eliciting the H reflex in the masseter muscles of patients under general anesthesia. SIGNIFICANCE: The H reflex of the masseter muscle may represent a new method available for intraoperative monitoring. Specifically, this method may be important for the monitoring of brainstem functional integrity, particularly in the midbrain and mid-pons, in addition to the trigeminal nerve path.

Grupo psicoeducativo en cuidados paliativos para el paciente cardiópata y su familia / Psychoeducational group in palliative care for cardiac patient and his family

El presente artículo tiene la finalidad de compartir la experiencia que ha tenido la Unidad de Cuidados Integrales Avanzados (UCIA) con la conformación de grupos a los que se les brinda atención psicoeducativa, como parte de los cuidados paliativos ofrecidos por el Instituto Nacional de Cardiología Ignacio Chávez. En la atención directa con los pacientes en situación de terminalidad y su familia se identificaron situaciones que afectan directamente su calidad de vida, razón por la cual se diseñó un programa para realizar intervención psicoeducativa con enfoque biopsicosocial a través de un equipo de salud transdisciplinar con el objetivo principal de ampliar el repertorio de afrontamiento del paciente y del cuidador principal a través de la orientación respecto a la enfermedad, síntomas y cuidados paliativos específicos que puede realizar en el hogar. Dicho programa cuenta con las políticas, normas y lineamientos de operación que considera el contexto actual de los pacientes en situación de terminalidad y de su familia. Se destacan aspectos importantes observados posterior a la psicoeducación tales como: identificación de conductas adaptativas, ampliación del repertorio de afrontamiento, disminución de las consultas en los servicios de urgencias y del número de hospitalizaciones.

This article aims to share the experience of the Comprehensive Care Unit (CCU) with the formation of groups that are given psychoeducational care, as part of the palliative care offered by the National Institute of Cardiology Ignacio Chavez. In direct care with terminally ill patients and their families, situations that directly affect their quality of life were identified, that is why a program was designed to carry out a psychoeducational intervention with a bio-psycho-social approach through a team of transdisciplinary health, with the main objective of expanding the repertoire for coping with the patient and the main caregiver through orientation regarding the illness, symptoms and specific palliative care that can be done at home. This program has the policies, rules and guidelines of operation that considers the current context of terminally ill patients and their family. Important aspects observed after psychoeducation are highlighted such as identification of adaptive behaviors, expansion of coping repertoire, reduction of visits to the emergency services and number of hospitalizations.

Mortalidad evitable en los estados colindantes de la frontera México-Estados Unidos, 1999-2001 y 2009-2011 / Avoidable mortality in the states adjacent to the Mexico-United States border; 1999-2001 and 2009-2011

El objetivo de este artículo es medir el efecto de la mortalidad evitable en los cambios de la esperanza de vida en los estados colindantes de ambos lados de la frontera México-Estados Unidos entre 1999-2001 y 2009-2011. Los datos utilizados fueron los registros de mortalidad y los censos de población, provenientes de fuentes oficiales de cada país. Se estimaron tasas estandarizadas de mortalidad y se calcularon los años de esperanza de vida perdidos. Tanto en 1999-2001 como en 2009-2011 los estados pertenecientes a la frontera sur de Estados Unidos tuvieron tasas de mortalidad evitable más bajas que las observadas en los estados del norte de México. En la región fronteriza las muertes evitables representaron en promedio una ganancia de 0.19 años de vida para Estados Unidos y una pérdida de 0.47 años de vida para México. Los estados de la frontera México-Estados Unidos presentan rasgos comunes en sus perfiles de salud que hacen necesario abordar algunos problemas de forma global y otros considerando las particularidades de cada uno de ellos, con el fin de reducir las brechas y aumentar la equidad social, mediante estrategias que involucren acciones nacionales independientes y otras de coordinación transfronteriza.

The scope of this article is to measure the effect of avoidable mortality in changes in life expectancy in the states adjacent to both sides of the US-Mexico border between 1999-2001 and 2009-2011. The data used were the records of mortality and population censuses from official sources in each country. Standardized mortality rates were estimated and the expected years of life lost were calculated. Both in 1999-2001 and in 2009-2011 the states belonging to the southern border of the United States had lower rates of avoidable mortality rates than those observed in the northern states of Mexico. In the border region avoidable deaths have seen an averageincrease of 0.19 years of life for America and a loss of 0.47 years of life for Mexico. The states of the US-Mexico border have common features in their health profiles that make it necessary to address some problemson a global basis and consider the particularities of each, in order to reduce gaps and enhance social equity through strategies involving independent national actions and othersby cross-border coordination.

Intervención grupal en víctimas de represión política con trastorno de estrés postraumático crónico a través de técnicas de arteterapia / Group intervention in victims of political repression with chronic posttraumatic stress disorder through art therapy techniques

Este artículo pretende dar a conocer una experiencia grupal mediante técnicas de Arteterapia en pacientes con diagnóstico de Estrés Postraumático Crónico, usuarios del Programa PRAIS Coquimbo, víctimas de represión política. Para ello mostraremos la importancia del arte en el desempeño de intervenciones en salud mental, especialmente en trastornos complejos en los que la verbalización y canalización de emociones es poco factible. Se describirá el proceso a través del cual se logra no sólo un trabajo individual que fortalece destrezas artísticas, sino también cómo el acompañamiento mutuo y empatía permiten la resignificación del trauma, en un ambiente de horizontalidad y respeto por las vivencias de los otros. Finalmente, se detallarán los resultados del trabajo realizado, en que los participantes manifiestan su satisfacción frente al entorno.

This article seeks to highlight a group experience through techniques of art therapy in patients with a diagnosis of chronic Post-traumatic Stress, in the PRAIS Program users in Coquimbo, victims of political repression. We will show the importance of art in the performance of mental health interventions, especially in complex disorders in which the verbalization and channeling of emotions becomes unfeasible. We describe the process by which it is achieved not only an individual work which strengthens artistic skills, but also how the mutual support and empathy enable the redefinition of trauma, in an atmosphere of horizontality and respect for the experiences of others. Finally we detail the results of work performed, in which participants expressed their satisfaction with the environment.

Sensibilidad al benzonidazol de cepas de Trypanosoma cruzi sugiere la circulación de cepas naturalmente resistentes en Colombia / Trypanosoma cruzi strains resistant to benznidazole occurring in Colombia

Introducción. La enfermedad de Chagas, causada por Trypanosoma cruzi, es uno de los problemas más graves de salud pública en el continente americano. El benzonidazol es uno de los dos medicamentos utilizados para tratar la enfermedad de Chagas. Sin embargo, la variación de la sensibilidad del parásito a este medicamento es una de las principales causas del fracaso del tratamiento. Objetivo. Evaluar la sensibilidad in vitro al benzonidazol de cepas colombianas de T. cruzi de diferentes orígenes y procedencia geográfica. Materiales y métodos. Treinta y tres cepas colombianas de T. cruzi aisladas de humanos, vectores y mamíferos, se analizaron in vitro mediante el micrométodo enzimático de MTT para determinar la concentración inhibitoria 50 (CI50) al benzonidazol. Se estudió la correlación entre la sensibilidad in vitro al medicamento y diferentes parámetros biológicos y eco-epidemiológicos. Resultados. El análisis de sensibilidad al medicamento indicó que el 36 % de las cepas eran sensibles, el 48 %, parcialmente resistentes y, el 16 %, resistentes al benzonidazol. Los análisis de correlación entre las CI50 con algunos parámetros biológicos y eco-epidemiológicos, mostraron diferencias en cuanto a la sensibilidad según el origen biológico y el área geográfica de procedencia de la cepa. Conclusiones. Existe una gran variabilidad en cuanto a la sensibilidad al benzonidazol de las cepas circulantes de T. cruzi en Colombia, lo cual sugiere la presencia de cepas naturalmente resistentes en el país.

Introduction. Chagas disease caused by Trypanosoma cruzi is one of the most serious public health problems in the Americas. Benznidazole is one of two drugs used to treat Chagas´ disease. However, the variation in susceptibility of the parasite to this drug is one of the main causes of treatment failure. Objective. The in vitro susceptibility to benznidazole was assessed in Colombian strains of T. cruzi from several sources and geographical regions. Materials and methods. Thirty-three Colombian T. cruzi strains were isolated from humans, vectors and mammals. These were analyzed in vitro by the MTT enzymatic micromethod to determine the IC50 to benznidazole. Additionally, the in vitro susceptibility was correlated with several biological and ecoepidemiological parameters. Results. Thirty-six percent of the strains were considered to be sensitive, 48% partially resistant, and 16% were resistant. Correlations between the IC50 and several biological and eco-epidemiological parameters indicated that differences in susceptibility depended on the biological source and geographical origin of the strain. Conclusions. A high degree of variability exists in the susceptibility to benznidazole of T. cruzi strains in Colombia. The distribution data indicate the presence and circulation of naturally resistant strains.

Distribución geográfica y ecoepidemiología de la fauna detriatominos (reduviidae: triatominae) en la Isla Margaritadel departamento de Bolívar, Colombia / Distribution and ecoepidemiology of the triatomine fauna (hemiptera: reduviidae) in Margarita Island, Bolívar, Colombia

Introducción. Los reportes sobre la diversidad de triatominos y algunos aspectos ecoepidemiológicos en la Isla Margarita se han limitado sólo a dos de los cinco municipios que la conforman. El conocimiento de las especies, su hábitat y la infección, es fundamental para establecer el riesgo en áreas endémicas para la enfermedad de Chagas.Objetivo. Describir la fauna de triatominos, la distribución y la infección por Trypanosoma cruzi en la Isla Margarita, con el fin de aportar conocimientos que permitan establecer y estratificar el riesgo de transmisión de la zona. Materiales y métodos. Se realizó la captura de triatominos en las viviendas y el extradomicilio. En las viviendas se hizo búsqueda activa en el intradomicilio y el peridomicilio, mientras en el extradomicilio, se hizo en palmas y nidos de aves. La infección por T. cruzi se determinó por PCR a partir de las heces.Resultados. Se capturaron 1.154 insectos de cinco especies en los municipios de la isla, Triatoma maculata y Rhodnius pallescens mostraron altos índices de infección en el intra domicilio y en el peridomicilio en Mompós y Talaigua Nuevo. En las palmas, R. pallescens fue hallado infectado en todos los municipios y Eratyrus cuspidatus sólo en San Fernando y Margarita. Conclusión. La presencia de triatominos infectados en las viviendas y en las palmas en los cinco municipios de la isla, llama la atención sobre el potencial riesgo que representan estos insectos en la zona.

Introduction. Information concerning to triatomine diversity and some eco-epidemiologic aspects on Margarita Island has been recorded only from two of the five counties on the island. Knowledge about species habitat and their natural infection is essential to establish the risk for Chagas disease in endemic areas. Objective. The distribution of triatomine insect fauna and its infection with Trypanosoma cruzi was described in order to establish and to stratify the risk of Chagas disease transmission. Material and methods. Each of the 5 counties on Margarita Island were surveyed for triatomid insects inside and outside each dwelling. In the extradomicilary area, searches were conducted in the palms and bird nests located within forests and in pastures near domiciles. Infection with T. cruzi was determined amplifying by PCR the DNA extracted from triatomine feces. Results. Five species of Reduviidae were recovered among the 1,154 triatomines captured in the 5 counties. Triatoma maculata and Rhodnius pallescens showed high infection rates within dwellings and as well as in the peridomestic areas in Mompós and Talaigua Nuevo. On the palm trees, only R. pallescens and Eratyrus cuspidatus were found infected, and only in San Fernando and Margarita. In Cicuco, only R. pallescens was infected. Presence of Triatoma dimidiata was also ascertained.Conclusion. Infected triatomines were present in houses and on palm trees in all counties on the island. These observations indicate a potential risk of Chagas across the entire island; furthermore the presence of T. dimidiata, a very efficient Chagas vector, emphasizes the need to establish its epidemiological status on the island.