Diseño metodológico para desarrollar un procedimiento de gestión de comunicación interna en el Ministerio de Salud Pública de Cuba / Methodological Design to Develop an Internal Communication Management Procedure in The Ministry of Public Health of Cuba

Introducción: La gestión de la comunicación interna en las organizaciones de salud representa una herramienta sistémica y organizativa que impacta en el nivel de satisfacción y compromiso de los trabajadores con la organización y se extiende hasta beneficiar a los pacientes como usuarios de los servicios. Su implementación constituye una política de la Administración Central del Estado Cubano que la dirección del Ministerio de Salud Pública prioriza, al considerarla imprescindible para el logro de los objetivos de trabajo. Esto condujo a diseñar un procedimiento que permitiera gestionar la comunicación interna en la institución. Objetivo: Exponer los métodos, las técnicas y los procedimientos empleados para diseñar un procedimiento para la gestión de la comunicación interna en el Ministerio de Salud Pública de Cuba. Resultados: Se plantea una investigación de desarrollo tecnológico, de tipo mixta, aplicada en dos fases y desarrolladas con técnicas cuantitativas y cualitativas. Conclusiones: El empleo de técnicas cuantitativas y cualitativas permitió identificar los elementos que componen un procedimiento para gestionar la comunicación interna en el Ministerio de Salud Pública. El procesamiento de los datos obtenidos desde el nivel individual hasta el colectivo facilitó la integración de conocimientos para organizar el diseño del procedimiento por etapas. La metodología empleada permitió obtener un procedimiento actualizado y válido por expertos y el público interno(AU)

Introduction: The management of internal communication in health organizations represents a systemic and organizational tool that impacts the level of satisfaction and commitment of workers with the organization and it extends to benefit patients as users of services. Its implementation constitutes a policy of the Central Administration of the Cuban State that the management of the Ministry of Public Health prioritizes, considering it essential for the achievement of work objectives. This led to designing a procedure that would allow managing internal communication in the institution. Objective: To present the methods, techniques and procedures used to design a procedure for the management of internal communication in the Ministry of Public Health of Cuba. Results: A mixed type technological development research is proposed, applied in two phases and developed with quantitative and qualitative techniques. Conclusions: The use of quantitative and qualitative techniques allowed to identify the elements that make up a procedure to manage internal communication in the Ministry of Public Health. The processing of the data gained from the individual to the collective level facilitated the integration of knowledge to organize the design of the procedure in stages. The methodology used allowed to obtain an updated and valid procedure by experts and the internal public(AU)

The association of socio-economic and psychological factors with limitations in day-to-day activity over 7 years in newly diagnosed osteoarthritis patients.

Previous research has established links between chronic pain and impaired cognitive ability, as well as between chronic pain and anxiety, in osteoarthritis. Furthermore, there is evidence linking risk of osteoarthritis to lower educational attainment. However, the inter-play of these factors with key social factors (e.g., social deprivation) at the early stages of osteoarthritis are not understood. Here, we used data from waves 4, 5, 6 and 7 of the Survey of Health, Ageing and Retirement in Europe (SHARE) (n = 971) and selected a subsample of respondents who initially did not report a diagnosis of osteoarthritis until wave 6. We used path models to test how social deprivation, education and anxiety, before diagnosis (waves 4 and 5), affect the relationship between cognitive ability, pain and limitations in activities of daily living following diagnosis (waves 6 and 7). We show that high social deprivation before diagnosis predicts greater limitations in activities of daily living after diagnosis, with this effect partly mediated by impaired cognitive ability. We also find that higher educational attainment before diagnosis may protect against limitations in activities of daily living after diagnosis via better cognitive ability and lower anxiety. Therefore, improving cognitive ability and managing anxiety may mitigate the associations of social deprivation and low educational attainment with limitations in activities of daily living.

Fidelity assessment of nurse-led non-pharmacological package of care for knee pain in the package development phase of a feasibility randomised controlled trial based in secondary care: a mixed methods study.

OBJECTIVES: To evaluate fidelity of delivery of a nurse-led non-pharmacological complex intervention for knee pain. SETTING: Secondary care. Single-centre study. STUDY DESIGN: Mixed methods study. PARTICIPANTS: Eighteen adults with chronic knee pain. INCLUSION CRITERIA: Age >40 years, knee pain present for longer than 3 months, knee pain for most days of the previous month, at least moderate pain in two of the five domains of Western Ontario and McMaster Universities Osteoarthritis Index pain scale. INTERVENTIONS: Nurse-led non-pharmacological intervention comprising assessment, education, exercise, use of hot/cold treatments, footwear modification, walking aids and weight-loss advice (if required). OUTCOMES: Primary: fidelity of delivery of intervention, secondary: nurses' experience of delivering intervention. METHODS: Each intervention session with every participant was video recorded and formed part of fidelity assessment. Fidelity checklists were completed by the research nurse after each session and by an independent researcher, after viewing the video-recordings blinded to nurse ratings. Fidelity scores (%), percentage agreement and 95% Confidence Intervals (CI) were calculated. Two semi-structured interviews were conducted with the research nurse. RESULTS: Fourteen participants completed all visits. 62 treatment sessions took place. Nurse self-report and assessor video rating scores for all 62 treatment sessions were included in fidelity assessment. Overall fidelity was higher on nurse self-report (97.7%) than on objective video-rating (84.2%). Percentage agreement between nurse self-report and video-rating was 73.3% (95% CI 71.3 to 75.3). Fidelity was lowest for advice on footwear and walking aids. The nurse reported difficulty advising on thermal treatments, footwear and walking aids, and did not feel confident negotiating achievable and realistic goals with participants. CONCLUSIONS: A trained research nurse can deliver most components of a non-pharmacological intervention for knee pain to a high degree of fidelity. Future research should assess intervention fidelity in a routine clinical setting, and examine its clinical and cost-effectiveness. TRIAL REGISTRATION NUMBER: NCT03670706.

Longitudinal assessment of symptoms and risk of SARS-CoV-2 infection in healthcare workers across 5 hospitals to understand ethnic differences in infection risk.

BACKGROUND: : Healthcare workers (HCWs) have increased rates of SARS-CoV-2 infection compared with the general population. We aimed to understand ethnic differences in SARS-CoV-2 seropositivity among hospital healthcare workers depending on their hospital role, socioeconomic status, Covid-19 symptoms and basic demographics. METHODS: A prospective longitudinal observational cohort study. 1364 HCWs at five UK hospitals were studied with up to 16 weeks of symptom questionnaires and antibody testing (to both nucleocapsid and spike protein) during the first UK wave in five NHS hospitals between March 20 and July 10 2020. The main outcome measures were SARS-CoV-2 infection (seropositivity at any time-point) and symptoms. Registration number: NCT04318314. FINDINGS: 272 of 1364 HCWs (mean age 40.7 years, 72% female, 74% White, ≥6 samples per participant) seroconverted, reporting predominantly mild or no symptoms. Seropositivity was lower in Intensive Therapy Unit (ITU) workers (OR=0.44 95%CI 0.24, 0.77; p=0.0035). Seropositivity was higher in Black (compared to White) participants, independent of age, sex, role and index of multiple deprivation (OR=2.61 95%CI 1.47-4.62 p=0.0009). No association was seen between White HCWs and other minority ethnic groups. INTERPRETATION: In the UK first wave, Black ethnicity (but not other ethnicities) more than doubled HCWs likelihood of seropositivity, independent of age, sex, measured socio-economic factors and hospital role.

Metabolic costs of altered growth trajectories across life transitions in amphibians.

Climate change is causing increases in temperature and in the frequency of extreme weather events. Under this scenario, organisms should maintain or develop strategies to cope with environmental fluctuations, such as the capacity to modify growth trajectories. However, altering growth can have negative consequences for organisms' fitness. Here, we investigated the metabolic alterations induced by compensatory growth during the larval development of the common frog (Rana temporaria), quantifying changes in oxidative stress, corticosterone levels and telomere length. We induced compensatory growth responses by exposing frog embryos to cold conditions (i.e. a 'false spring' scenario), which cause a delay in hatching. Once hatched, we reared larvae at two different photoperiods (24:0, representing the natural photoperiod of larvae, and 18:6) to test also for the interactive effects of light on growth responses. Larvae experiencing delayed hatching showed fast compensatory responses and reached larger size at metamorphosis. Larvae shortened their developmental period in response to delayed hatching. Non-permanent light conditions resulted in relaxed growth compared with larvae reared under permanent light conditions, which grew at their natural photoperiod and closer to their maximal rates. Growth responses altered the redox status and corticosterone levels of larvae. These physiological changes were developmental stage-dependent and mainly affected by photoperiod conditions. At catch-up, larvae reared at 18:6 light:dark cycles showed higher antioxidant activities and glucocorticoid secretion. On the contrary, larvae reared at 24:0 developed at higher rates without altering their oxidative status, likely an adaptation to grow under very restricting seasonal conditions at early life. At metamorphosis, compensatory responses induced higher cellular antioxidant activities probably caused by enhanced metabolism. Telomere length remained unaltered by experimental treatments but apparently tended to elongate across larval ontogeny, which would be a first evidence of telomere lengthening across metamorphosis. Under the forecasted increase in extreme climatic events, adjusting growth and developmental rates to the dynamics of environmental fluctuations may be essential for survival, but it can carry metabolic costs and affect later performance. Understanding the implications of such costs will be essential to properly estimate the impact of climate change on wild animals.

Gut microbiota and osteoarthritis management: An expert consensus of the European society for clinical and economic aspects of osteoporosis, osteoarthritis and musculoskeletal diseases (ESCEO).

The prevalence of osteoarthritis (OA) increases not only because of longer life expectancy but also because of the modern lifestyle, in particular physical inactivity and diets low in fiber and rich in sugar and saturated fats, which promote chronic low-grade inflammation and obesity. Adverse alterations of the gut microbiota (GMB) composition, called microbial dysbiosis, may favor metabolic syndrome and inflammaging, two important components of OA onset and evolution. Considering the burden of OA and the need to define preventive and therapeutic interventions targeting the modifiable components of OA, an expert working group was convened by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) to review the potential contribution of GMB to OA. Such a contribution is supported by observational or dietary intervention studies in animal models of OA and in humans. In addition, several well-recognized risk factors of OA interact with GMB. Lastly, GMB is a critical determinant of drug metabolism and bioavailability and may influence the response to OA medications. Further research targeting GMB or its metabolites is needed to move the field of OA from symptomatic management to individualized interventions targeting its pathogenesis.

Evolving child and adolescent mental health and development programs in Chile.

This analysis reviews the situation of child and adolescent mental health in Chile, organizational determinants, and the initiatives and interventions implemented to enhance child development despite the country's inequities. Progressive development of national mental health plans is covered, from the country's first plan in 2000, to growing the number of mental health professionals and the training they receive, such as MhGAP, to the implementation of "Chile Crece Contigo," whose preliminary evaluations are starting to show some effectiveness. However, the World Health Organization reports that progress in complying with the United Nations Convention of Children's Rights is insufficient. A set off legislative initiatives on behalf of children and adolescents have been passed, while others are being discussed in Parliament. There is much to be done in the nation as a whole and within its health system to ensure improved child and adolescent mental health and wellbeing. More research into child and adolescent mental health should be undertaken. Adequate funding and policymaking are also crucial to giving priority to child and adolescent mental health in Chile.

En este análisis se examina la situación de la salud mental de niños y adolescentes en Chile, los determinantes institucionales y las iniciativas e intervenciones ejecutadas para mejorar el desarrollo infantil a pesar de las inequidades del país. Se ha abarcado el desarrollo progresivo de los planes nacionales de salud mental, desde el primer plan nacional en el año 2000, pasando por el aumento del número de profesionales de salud mental y la capacitación que reciben, como el programa MhGAP, hasta la ejecución de "Chile Crece Contigo", cuyas evaluaciones preliminares están comenzando a mostrar cierta eficacia. Sin embargo, la Organización Mundial de la Salud informa que el progreso en el cumplimiento de la Convención de las Naciones Unidas sobre los Derechos del Niño es insuficiente. Se ha aprobado un conjunto de iniciativas legislativas a favor de los niños y adolescentes, mientras que otras están tratándose en el parlamento. Es mucho lo que hay por hacer en el país en general y en su sistema de salud para garantizar el mejoramiento de la salud mental y el bienestar de niños y adolescentes. Es necesario aumentar la investigación sobre la salud mental de niños y adolescentes. La disponibilidad de fondos suficientes y la formulación de políticas son también cruciales para dar prioridad a la salud mental de niños y adolescentes en Chile.

Uma análise foi realizada para examinar a situação da saúde mental de crianças e adolescentes no Chile, determinantes organizacionais e iniciativas e intervenções implementadas para melhorar o desenvolvimento infantil diante das iniquidades no país. É descrita a evolução dos planos nacionais de saúde mental, a partir do primeiro plano elaborado em 2000, o crescimento do número de profissionais de saúde mental e a capacitação recebida, como parte do programa mundial de ação para reduzir as lacunas em saúde mental da OMS (MhGAP), e a implementação do programa Chile Crece Contigo cujas avaliações preliminares indicam certo grau de efetividade. Porém, segundo informou a Organização Mundial da Saúde (OMS), houve pouco progresso no cumprimento da Convenção das Nações Unidas sobre os Direitos da Criança. Um conjunto de iniciativas legislativas em prol das crianças e adolescentes foi aprovado e outras propostas estão em debate no congresso. Há ainda muito a ser feito no país como um todo e dentro do sistema de saúde para garantir melhor saúde mental e bem-estar para crianças e adolescentes. Devem ser realizadas outras pesquisas sobre saúde mental da criança e do adolescente. É indispensável dispor de financiamento e políticas adequados que priorizem a saúde mental da criança e do adolescente no Chile.

Evolving child and adolescent mental health and development programs in Chile

[ABSTRACT]. This analysis reviews the situation of child and adolescent mental health in Chile, organizational determinants, and the initiatives and interventions implemented to enhance child development despite the country’s inequities. Progressive development of national mental health plans is covered, from the country’s first plan in 2000, to growing the number of mental health professionals and the training they receive, such as MhGAP, to the implementation of “Chile Crece Contigo,” whose preliminary evaluations are starting to show some effectiveness. However, the World Health Organization reports that progress in complying with the United Nations Convention of Children´s Rights is insufficient. A set off legislative initiatives on behalf of children and adolescents have been passed, while others are being discussed in Parliament. There is much to be done in the nation as a whole and within its health system to ensure improved child and adolescent mental health and wellbeing. More research into child and adolescent mental health should be undertaken. Adequate funding and policymaking are also crucial to giving priority to child and adolescent mental health in Chile.

[RESUMEN]. En este análisis se examina la situación de la salud mental de niños y adolescentes en Chile, los determinantes institucionales y las iniciativas e intervenciones ejecutadas para mejorar el desarrollo infantil a pesar de las inequidades del país. Se ha abarcado el desarrollo progresivo de los planes nacionales de salud mental, desde el primer plan nacional en el año 2000, pasando por el aumento del número de profesionales de salud mental y la capacitación que reciben, como el programa MhGAP, hasta la ejecución de “Chile Crece Contigo”, cuyas evaluaciones preliminares están comenzando a mostrar cierta eficacia. Sin embargo, la Organización Mundial de la Salud informa que el progreso en el cumplimiento de la Convención de las Naciones Unidas sobre los Derechos del Niño es insuficiente. Se ha aprobado un conjunto de iniciativas legislativas a favor de los niños y adolescentes, mientras que otras están tratándose en el parlamento. Es mucho lo que hay por hacer en el país en general y en su sistema de salud para garantizar el mejoramiento de la salud mental y el bienestar de niños y adolescentes. Es necesario aumentar la investigación sobre la salud mental de niños y adolescentes. La disponibilidad de fondos suficientes y la formulación de políticas son también cruciales para dar prioridad a la salud mental de niños y adolescentes en Chile.

[RESUMO]. Uma análise foi realizada para examinar a situação da saúde mental de crianças e adolescentes no Chile, determinantes organizacionais e iniciativas e intervenções implementadas para melhorar o desenvolvimento infantil diante das iniquidades no país. É descrita a evolução dos planos nacionais de saúde mental, a partir do primeiro plano elaborado em 2000, o crescimento do número de profissionais de saúde mental e a capacitação recebida, como parte do programa mundial de ação para reduzir as lacunas em saúde mental da OMS (MhGAP), e a implementação do programa Chile Crece Contigo cujas avaliações preliminares indicam certo grau de efetividade. Porém, segundo informou a Organização Mundial da Saúde (OMS), houve pouco progresso no cumprimento da Convenção das Nações Unidas sobre os Direitos da Criança. Um conjunto de iniciativas legislativas em prol das crianças e adolescentes foi aprovado e outras propostas estão em debate no congresso. Há ainda muito a ser feito no país como um todo e dentro do sistema de saúde para garantir melhor saúde mental e bem-estar para crianças e adolescentes. Devem ser realizadas outras pesquisas sobre saúde mental da criança e do adolescente. É indispensável dispor de financiamento e políticas adequados que priorizem a saúde mental da criança e do adolescente no Chile.

Assessment of osteoarthritis candidate genes in a meta-analysis of nine genome-wide association studies.

OBJECTIVE: To assess candidate genes for association with osteoarthritis (OA) and identify promising genetic factors and, secondarily, to assess the candidate gene approach in OA. METHODS: A total of 199 candidate genes for association with OA were identified using Human Genome Epidemiology (HuGE) Navigator. All of their single-nucleotide polymorphisms (SNPs) with an allele frequency of >5% were assessed by fixed-effects meta-analysis of 9 genome-wide association studies (GWAS) that included 5,636 patients with knee OA and 16,972 control subjects and 4,349 patients with hip OA and 17,836 control subjects of European ancestry. An additional 5,921 individuals were genotyped for significantly associated SNPs in the meta-analysis. After correction for the number of independent tests, P values less than 1.58 × 10(-5) were considered significant. RESULTS: SNPs at only 2 of the 199 candidate genes (COL11A1 and VEGF) were associated with OA in the meta-analysis. Two SNPs in COL11A1 showed association with hip OA in the combined analysis: rs4907986 (P = 1.29 × 10(-5) , odds ratio [OR] 1.12, 95% confidence interval [95% CI] 1.06-1.17) and rs1241164 (P = 1.47 × 10(-5) , OR 0.82, 95% CI 0.74-0.89). The sex-stratified analysis also showed association of COL11A1 SNP rs4908291 in women (P = 1.29 × 10(-5) , OR 0.87, 95% CI 0.82-0.92); this SNP showed linkage disequilibrium with rs4907986. A single SNP of VEGF, rs833058, showed association with hip OA in men (P = 1.35 × 10(-5) , OR 0.85, 95% CI 0.79-0.91). After additional samples were genotyped, association at one of the COL11A1 signals was reinforced, whereas association at VEGF was slightly weakened. CONCLUSION: Two candidate genes, COL11A1 and VEGF, were significantly associated with OA in this focused meta-analysis. The remaining candidate genes were not associated.

Alcance social de las inmunizaciones en el niño en Cuba / Social reach of immunizations in children in Cuba

Se realizó una revisión bibliográfica acerca del alcance social que han tenido en el transcurso de los años las inmunizaciones en el niño en Cuba como forma de prevenir las enfermedades, se hace énfasis en las primeras etapas de la vida. El documento principal fue el programa específico de la Salud Pública donde recae el peso de esta noble tarea, que es el llamado Programa Nacional de Inmunización, cuya efectividad radica no solo en su estricto cumplimiento desde el nacimiento de una criatura sino desde antes, cuando se hace cumplir en cada mujer embarazada.

A review was carried out on the social reach they have had, in the course of the years, the immunizations in children in Cuba as a way of preventing diseases doing emphasis in the first stage of live. With the support of the specific program of Public Health where it falls the weight of this noble task, that is call National Immunization Program, the effectiveness lie in its strict fulfillment from the birth of a child and also before, when we make it fulfill in each pregnant woman.

Potencialidades de los recursos geográficos para la investigación en salud / Potentiality of geographic resources for health research

El mapa es el lenguaje de la geografía. Es un medio que como recurso de análisis convierte los datos espaciales en información espacial. Al mapa le sigue el análisis, que utiliza las categorías de espacio, territorio y lugar. En un sistema de información geográfico los mapas o bases gráficas adquieren un valor agregado mayor ya que a estos se les asocian otros datos, que pueden ser alfanuméricos, en forma de tablas, imágenes, videos y textos. El propósito de esta comunicación es proponer la fundamentación y acciones concretas que el desarrollo de los sistemas de información geográficos logrados por GEOCUBA ofrecen al Sistema de Salud