High-Power Short-Duration Ablation of Paroxysmal and Persistent Atrial Fibrillation.

Catheter ablation has become a cornerstone in atrial fibrillation (AF) therapy, improving freedom from all-atrial arrhythmias, as well as outperforming antiarrhythmic drugs in alleviating AF-related symptoms, reducing hospitalizations, and enhancing quality of life. Nevertheless, the success rate of traditional radiofrequency ablation (RFA) methods remains less than ideal. To address these issues, refinement in RFA strategies has been developed to improve efficacy and laboratory efficiency during pulmonary vein isolation (PVI). High-power short-duration (HPSD) RFA has emerged as a safe strategy to reduce the time required to produce durable lesions. This article reviews critical aspects of HPSD ablation in the management of both paroxysmal and persistent AF, covering aspects such as effectiveness, safety, procedural intricacies, and the underlying biophysics.

Pulsed Field Ablation of Atrial Fibrillation: A Comprehensive Review.

Pulsed-field ablation (PFA) has emerged as a promising nonthermal ablation alternative for treating atrial fibrillation (AF). By delivering ultra-rapid high-energy electrical pulses, PFA induces irreversible electroporation, selectively targeting myocardial tissue while sparing adjacent structures from thermal or other damage. This article provides a comprehensive review of multiple pre-clinical studies, clinical studies, and clinical trials evaluating the safety, efficacy, and long-term outcomes of PFA in various settings and patient populations. Overall, the reviewed evidence highlights PFA's potential as a revolutionary ablation strategy for AF treatment. Offering comparable procedural efficacy to conventional ablation methods, PFA distinguishes itself with shorter procedure times and reduced risks of complications such as phrenic nerve palsy and potential esophageal injury. While further research is warranted to establish long-term efficacy, PFA's distinct advantages and evolving clinical evidence suggest a promising future for this novel nonthermal ablation approach. As PFA continues to advance, it has the potential to transform AF ablation procedures, providing a safer alternative for patients with atrial fibrillation.

When things get hot: Thermoregulation behavior in the lizard Sceloporus aeneus at different thermal conditions.

Rising environmental temperatures have become a global threat for ectotherms, with the increasing risk of overheating promoting population declines. Flexible thermoregulatory behavior might be a plausible mechanism to mitigate the effects of extreme temperatures. We experimentally evaluated thermoregulatory behavior in the bunchgrass lizard, Sceloporus aeneus, at three different environmental temperatures (25, 35 and 45 °C) both with and without a thermal refuge. We recorded themoregulatory behaviors (body posture and movement between hot and cold patches) and compared individual lizards across all experimental temperature and shelter combinations. Behavioral thermoregulation in S. aeneus was characterized by the expression of five body postures, whose frequencies varied based on environmental temperature and microthermal conditions. Behavioral responses allowed lizards to maintain a mean body temperature <40 °C, the critical thermal maximum for temperate species, even at extreme environmental temperatures (45 °C). Although S. aeneus express an array of behavioral postures that provide an effective mechanism to cope with elevating temperatures, the presence of a thermal refuge was important to better achieve this. Together, our study offers a novel method to evaluate microhabitat preference that encompasses both behavioral observations and time-space analysis based on the ambient thermal distribution, a consideration that can aid in the formulation of more accurate predictions on ectotherm vulnerability related to increasing global environmental temperatures.

Latin-American guidelines of recommendations at discharge from an acute coronary syndrome.

The diagnostic criteria, treatments at the time of admission, and drugs used in patients with acute coronary syndrome are well defined in countless guidelines. However, there is uncertainty about the measures to recommend during patient discharge planning. This document brings together the most recent evidence and the standardized and optimal treatment for patients at the time of discharge from hospitalization for an acute coronary syndrome, for comprehensive and safe care in the patient's transition between care from the acute event to the outpatient care, with the aim of optimizing the recovery of viable myocardium, guaranteeing the most appropriate secondary prevention, reducing the risk of a new coronary event and mortality, as well as the adequate reintegration of patients into daily life.

Los criterios diagnósticos, los tratamientos en el momento de la admisión y los fármacos utilizados en pacientes con síndrome coronario agudo están bien definidos en innumerables guías. Sin embargo, existe incertidumbre acerca de las medidas para recomendar durante la planificación del egreso de los pacientes. Este documento reúne las evidencias más recientes y el tratamiento estandarizado y óptimo para los pacientes al momento del egreso de una hospitalización por un síndrome coronario agudo, para un cuidado integral y seguro en la transición del paciente entre la atención del evento agudo y el cuidado ambulatorio, con el objetivo de optimizar la recuperación de miocardio viable, garantizar la prevención secundaria más adecuada, reducir el riesgo de un nuevo evento coronario y la mortalidad, así como la adecuada reinserción de los pacientes en la vida cotidiana.

Probiotics, as Adjuvant Therapy and Preventive Measure on Progression, and Complications of Head and Neck Cancer.

BACKGROUND: Preclinical and clinical evidence implies that destructive therapies in local and malignant tissue are frequently used on patients with head and neck cancer. Consequently, the microbiome of the treated and adjacent regions is affected. Disruption of the normal microbiome plays an important role not only in the disease progression but also in its emergence, therefore new therapies involving probiotics, prebiotics, and synbiotics have been developed to control or regulate this microbial disruption. OBJECTIVE: This review aims to describe the current and potential uses of probiotics at different stages of development of head and neck squamous cell carcinoma, as an adjuvant therapy to prevent common complications such as radiation-induced oral mucositis (RIOM) and its role in other areas. METHODS: Currently, there is no widely effective strategy to treat or prevent this kind of cancer. Surgery, radiation therapy, and chemotherapy are the three main treatments for head and neck cancer. Some therapies can also cause long-term health problems, or complications which might change the way you eat, talk, hear and breathe. RESULTS: The main uses for which probiotics have been studied are: Prevention and reduction of severity of RIOM, change in dental plaque to reduce dysbiosis, and reduction of complications in post-operated patients. Potential uses of probiotics include the reduction of disease initiation and progression by reducing local inflammation caused by bacteria and other organisms. CONCLUSION: The incidence and severity of RIOM may be lessened by probiotics. To establish its uses in additional clinical settings, though, more studies are necessary.

Oral cancer and dentists: knowledge, attitudes and practices in a South Colombian context.

An estimated 36.38% of oral cancer cases in Colombia are lethal. Most cases are diagnosed in late stages, so early detection and control of risk factors would be the most effective tools for prevention. The aim of this study was to use a questionnaire to evaluate knowledge and practices regarding oral cancer among a group of dentists in southern Colombia. A sample of 93 dentists was asked to respond to a confidential survey which was based on prior studies. It was found that one quarter of the respondents knew that squamous cell carcinoma is the most frequent form of oral cancer and that leukoplakia and erythroplakia are the two lesions most probably associated to oral cancer. Most respondents believe they advise their patients adequately about suspicious lesions. Three quarters believe they are prepared to explain the risks of smoking. Over half evaluate their patients' personal history of tumors and less than one quarter evaluate the history of cancer in patients' families. In general, an oral examination is performed for cancer diagnosis and almost all the respondents consider it important to keep up to date. A statistically significant correlation was found between dentists 'belief that they are adequately prepared to perform a physical examination and having attended a "formal course within the past 12 months". This study revealed that dentists' level of knowledge and application of preventive measures are an important part of the public health strategy for reducing the morbidity and mortality for oral cancer.

Seasonal effect on Salmonella, Shiga toxin-producing E. coli O157:H7 and non-O157 in the beef industry in Colombia, South America.

This research investigated the variations in the occurrence of Salmonella, STEC O157:H7 and non-O157 in the beef production chain in Colombia affected by seasons, hypothesizing that pathogen prevalence will be highest in the rainy season owing to soil moisture promoting bacteria multiplication and transfer between animals. To test this hypothesis, samples were obtained from five abattoirs, which represent 50% of the beef production in this country. A total of 1017 samples were collected, from which 606 were bovine feces, 206 were hide swabs, and 205 corresponded to carcass post-intervention. From the 1017 samples, 49.9% (n = 507) were collected during dry season, while 50.1% (n = 510) during rainy season. All samples (n = 1017) underwent screening for E. coli O157:H7 and Salmonella, while only a proportion of fecal samples (n = 339) were screened for the big six STEC serogroups and their virulence markers. The effect of season, age of animal and sex of animal were correlated with the prevalence results. A total of 84.7% of fecal samples carried virulence genes associated to STEC (stx or eae), suggesting that testing and control should be increased for the big-six STEC compared to E. coli O157:H7. Pathogen prevalence in feces was found to be 8.3%, 5.0%, and 51.0% for Salmonella, E. coli O157:H7 and STEC non-O157, respectively. Hides had a prevalence of 15.0% and 6.8% of Salmonella and E. coli O157:H7, respectively. Carcasses post-intervention were found to have 4.4% and 2.5% prevalence of Salmonella and E. coli O157:H7, respectively. A seasonal effect was found for fecal samples. E. coli O157 and non-O157 STEC shedding were significantly higher (P ≤ 0.05) during rainy season compared to dry season. In contrast, hides and carcasses were more likely to present lower incidence of pathogens during rainy months compared to dry season; however, it was significant only for Salmonella on carcasses with estimated odds of detection almost six times higher in the dry season relative to the rainy season (OR = 5.90, 95% CI 1.18-29.57).

Effects of aluminum on the expansion and microstructure of alkali-activated MSWI fly ash-based pastes.

Alkaline activation is of great potential in the solidification of municipal solid waste incineration (MSWI) fly ash, but the metallic aluminum in the ash inhibits its application. This work studies the effects of residual metallic aluminum on the expansion and microstructure of alkali-activated MSWI fly ash-based pastes. Based on the results obtained, an optimized preparation process is suggested. Characterizations of the pastes include expansion ratio, morphology (SEM), mechanical strength and microstructure (XRD and FTIR). It is confirmed that MSWI fly ash could be solidified through alkaline activation when using a small amount of coal fly ash to adjust the reactive silica and aluminum ratios. In the optimized preparation, sodium hydroxide was added separately, so that expansion in the pastes was significantly mitigated, the formation of geopolymer gel was improved and the compressive strength of the pastes increased.

Risk factors for mortality following emergency colectomy for fulminant Clostridium difficile infection.

PURPOSE: This study evaluated risk factors for mortality after emergency colectomy for fulminant Clostridium difficile infection. METHODS: Retrospective study of 130 cases of Clostridium difficile infection that required a colectomy between 1994 and 2007 in four hospitals of Quebec, Canada. Primary outcome was 30-day mortality. RESULTS: Twenty-five cases underwent colectomy in 1994 to 2002, 41 in 2003, 40 in 2004, and 24 in 2005 to 2007. Common indications were septic shock (41 percent) and nonresponse to medical treatment (39 percent). Overall, 30-day mortality was 37 percent. Mortality increased with age but was not influenced by comorbidities burden. Mortality correlated with preoperative lactate (< or =2.1 mmol/L: 26 percent; 2.2-4.9 mmol/L: 52 percent; > or =5.0 mmol/L: 75 percent, P < 0.001), leukocytosis (<20.0 x 10(9)/L: 32 percent; 20.0-49.9 x 10(9)/L: 33 percent; > or =50.0 x 10(9)/L: 73 percent, P = 0.008), albumin (> or =25 g/L: 19 percent; 15-24 g/L: 38 percent; <15 g/L: 52 percent, P = 0.04) and renal failure. In multivariate analysis, risk factors for mortality were age (per year, adjusted odds ratio: 1.03, 95 percent confidence interval: 1.00-1.06), preoperative lactate greater than or equal to 5.0 mmol/L (adjusted odds ratio: 10.32, 95 percent confidence interval: 2.59-41.1), leukocytosis greater than or equal to 50.0 x10(9)/L (adjusted odds ratio: 3.68, 95 percent confidence interval: 0.92-14.8) and albumin less than 15 g/L (adjusted odds ratio, 6.57, 95 percent confidence interval: 1.31-33.1). CONCLUSIONS: Incidence of Clostridium difficile infection-related emergency colectomies increased 20-fold during the epidemic. Postoperative mortality can be predicted by simple laboratory parameters. Three-fourths of patients with leukocytosis greater or equal to 50.0 x10(9)/L or lactate greater or equal to 5.0 mmol/L died. When possible, emergency colectomy should be performed earlier.

CTCF-KDM4A complex correlates with histone modifications that negatively regulate CHD5 gene expression in cancer cell lines.

Histone demethylase KDM4A is involved in H3K9me3 and H3K36me3 demethylation, which are epigenetic modifications associated with gene silencing and RNA Polymerase II elongation, respectively. KDM4A is abnormally expressed in cancer, affecting the expression of multiple targets, such as the CHD5 gene. This enzyme localizes at the first intron of CHD5, and the dissociation of KDM4A increases gene expression. In vitro assays showed that KDM4A-mediated demethylation is enhanced in the presence of CTCF, suggesting that CTCF could increase its enzymatic activity in vivo, however the specific mechanism by which CTCF and KDM4A might be involved in the CHD5 gene repression is poorly understood. Here, we show that CTCF and KDM4A form a protein complex, which is recruited into the first intron of CHD5. This is related to a decrease in H3K36me3/2 histone marks and is associated with its transcriptional downregulation. Depletion of CTCF or KDM4A by siRNA, triggered the reactivation of CHD5 expression, suggesting that both proteins are involved in the negative regulation of this gene. Furthermore, the knockout of KDM4A restored the CHD5 expression and H3K36me3 and H3K36me2 histone marks. Such mechanism acts independently of CHD5 promoter DNA methylation. Our findings support a novel mechanism of epigenetic repression at the gene body that does not involve promoter silencing.

Cáncer Oral: Conocimiento, Actitudes y Prácticas de los Odontologos de la Provincia de Salta, Argentina, 2018

RESUMEN: Según Global Cancer Observatory de la IARC, el cáncer oral en Argentina tiene una tasa de mortalidad de 1,1 por 100.00 habitantes para 2020. La mayoría de los casos se diagnostican en etapas tardías aun cuando la detección temprana y el control de los factores de riesgo son las herramientas más eficaces para reducir la alta letalidad de esta enfermedad. Se desconoce el nivel de conocimientos, actitudes y prácticas de los odontólogos acerca de la prevención del cáncer oral en Argentina. Evaluar a través de un cuestionario, los conocimientos, actitudes y prácticas sobre el cáncer oral en la provincia de Salta, Argentina. En una muestra a conveniencia de 76 odontólogos que ejercían su profesión y que asistían a un evento de la colegiatura odontológica provincial, se aplicó una encuesta confidencial sobre conocimientos, actitudes y prácticas sobre la prevención del cáncer oral. Se analizó la encuesta a partir de estadística descriptiva e inferen cial. Los odontólogos tienen conocimiento sobre los factores de riesgo del cáncer oral, tales como consumo de tabaco (88,2 %), presencia de lesiones potencialmente malignas (84,2 %), consumo de alcohol, pero también sobre tipos de lesiones premalignas (88,2 %) y principal localización del cáncer oral (84,2 %). Las actitudes dependen de "tener una especialidad en el campo odontológico" y de "haber tomado un curso formal en los últimos 12 meses" (c2 = 13,512, GL= 4, p=0,009). Las prácticas dependen de "haber tomado un curso formal en los últimos 12 meses", de la "creencia de que el profesional está adecuadamente preparado para realizar un examen para cáncer oral", y el "tipo de práctica profesional" (c2 = 14,078, GL=7, p=0,034). Este estudio reveló que es necesario fortalecer los conocimiento, actitudes y prácticas de los odontólogos de la Provincia de Salta en Argentina frente a la prevención del cáncer oral, esto con el propósito de diseñar estrategias de salud pública realmente efectivas, que además no solo deben ser ejecutadas por la autoridad sanitaria, sino que deben ser examinadas por las escuelas de Odontología.

ABSTRACT: According to Global Cancer Observatory of the IARC, oral cancer in Argentina has a mortality rate of 1.1 per 100,000 inhabitants for 2020. Most cases diagnosed in late stages even when early detection and control of risk factors are the most effective tools to reduce the high lethality of this disease. The level of knowledge, attitudes and practices of dentists regarding oral cancer prevention in Argentina is unknown. To evaluate, through a questionnaire, the knowledge, attitudes and practices about oral cancer in the province of Salta, Argentina. In a convenience sample of 76 dentists who practiced their profession and who attended an event of the provincial dental association, a confidential survey applied on knowledge, attitudes and practices on the prevention of oral cancer. The survey analyzed based on descriptive and inferential statistics. Dentists are aware of risk factors for oral cancer, such as tobacco use (88.2 %), presence of potentially malignant lesions (84.2 %), alcohol consumption, but also about types of premalignant lesions. (88.2 %) and main location of oral cancer (84.2 %). Attitudes depend on "having a specialty in the dental field" and "having taken a formal course in the last 12 months" (c2 = 13.512, DF= 4, p=0.009). Practices depend on "having taken a formal course in the last 12 months", on the "belief that the professional is adequately prepared to perform an examination for oral cancer", and the "type of professional practice" (c2 = 14.078, DF=7, p=0.034). This study revealed that it is necessary to strengthen the knowledge, attitudes and practices of dentists in the Province of Salta in Argentina regarding the prevention of oral cancer, this with the purpose of designing really effective public health strategies, which also not only must be executed by the health authority but must be examined by dental schools.

Preparation and characterization of 45S5 bioactive glass-based scaffolds loaded with PHBV microspheres with daidzein release function.

Poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) microsphere loaded 45S5 bioactive glass (BG) based scaffolds with drug releasing capability have been developed. PHBV microspheres with a mean particle size 4 ± 2 µm loaded with daidzein were obtained by oil-in-water single emulsion solvent evaporation method and applied to the surface of BG scaffolds by dip coating technique. The morphology, in vitro bioactivity in simulated body fluid (SBF), mechanical properties and drug release kinetics of microsphere loaded scaffolds were studied. The microspheres were shown to be homogeneously dispersed on the scaffold surfaces. It was confirmed that hydroxyapatite crystals homogeneously grew not only on the surface of the scaffold but also on the surface of the microspheres within 3 days of immersion in SBF. The daidzein release from the microsphere loaded scaffolds lasted almost 1 month and was determined to be diffusion controlled. The microsphere loaded BG scaffolds with daidzein releasing capability obtained in this study are a candidate for bone tissue engineering. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 1765-1774, 2017.

Burden of disease in Nariño, Colombia, 2010.

OBJECTIVE: This study sought to measure burden of disease and identifies health priorities from the Disability Adjusted Life Years (DALYs) indicator. METHODS: This is the first study on burden of disease for a department in Colombia by using a standardized methodology. By using the. DALYs indicator, burden of disease was identified in the department of Nariño according to the guidelines established by the World Health Organization. RESULTS: The DALYs in the Department of Nariño highlight the emergence of communicable, maternal, perinatal, and nutritional diseases during the first years of life; of accidents and lesions among youth, and non-communicable diseases in older individuals. Also, accidents and lesions are highlighted in men and non-communicable diseases in women. CONCLUSIONS: This study is part of the knowledge management process in the Departmental Health Plan for Nariño - Colombia 2012-2015 and contributes to the system of indicators of the 2012 ten-year public health plan. This research evidences that communicable diseases generate the biggest part of the burden of disease in the Department of Nariño, that DALYs due to non-communicable diseases are on the rise, and that accidents and lesions, especially due to violence are an important cause of DALYs in this region, which is higher than that of the country.

OBJETIVO: Medir la carga de enfermedad e identificar las prioridades de salud a partir del indicador Años de Vida Saludables Perdidos (AVISA). MÉTODOS: Mediante el uso del indicador AVISA, identificar la carga de enfermedad en el departamento de Nariño según la Guía de la Organización Mundial de la Salud. RESULTADOS: Este es el primer estudio de carga de enfermedad de un departamento en Colombia que utiliza una metodología estandarizada. Los AVISA en el Departamento de Nariño destacan la emergencia de las enfermedades transmisibles, maternales, perinatales y nutricionales en los primeros años de vida; de los accidentes y lesiones entre los jóvenes y las enfermedades no trasmisibles en individuos mayores; así como los accidentes y lesiones destacan en los hombres y las enfermedades no transmisibles en las mujeres. CONCLUSIONES: Este estudio es parte del proceso de gestión de conocimiento del Plan de Salud Departamental de Nariño -Colombia 2012-2015 y contribuye al sistema de indicadores del plan decenal de salud pública 2012. Esta investigación evidencia que las enfermedades trasmisibles generan la mayor parte de la carga de enfermedad del Departamento de Nariño, que los AVISA por enfermedades no transmisibles están en ascenso, y que los accidentes y lesiones, especialmente por causa de la violencia son una causa importante de AVISA en esta región, siendo superior a la del país.

Respiratory syncytial virus infection as a cause of hospitalization in population under 1 year in Colombia.

OBJECTIVE: to determine the frequency, complications and seasonality at which respiratory syncytial virus (RSV) infection of the lower respiratory tract causes hospitalization in infants of age 1 year or less in 6 cities of Colombia. METHODS: one-year prospective multicentric observational study that included 717 patients presenting to the emergency department with respiratory symptoms in 6 cities of Colombia. Hospitalized children were tested for RSV with an immunofluorescence rapid test in nasopharyngeal secretions. Descriptive and statistical analyses of the population were conducted. RESULTS: the study population included 717 patients with a mean age of 3.6 months (SD 3.25), 4:3 male: female ratio and a positive RSV LRTI prevalence of 30.0% (216 infants/City, range 26.0 - 49.0%). Risk factors for RSV LRTI were found in 8.2% of the population, of which 28.8% were RSV positive. RSV positive and negative groups were compared using a two-tailed t test with 95.0%CI, p < 0.05. No statistically significant differences were found. All cities presented specific year trimesters in the occurrence of RSV LRTI. CONCLUSIONS: the RSV caused 1 in 3 LRTI hospitalizations in the population, with an incidence of 30.0%. This confirms a continuous circulation of RSV in Colombia varying by geographic location.

Desigualdades en mortalidad relacionadas con características socioeconómicas en el departamento del Huila, Colombia 2009-2013 / Inequalities in mortality related to socioeconomic characteristics in the department of Huila, Colombia 2009-2013 / Desigualdades na mortalidade relacionadas a características socioeconômicas no departamento de Huila, Colômbia 2009-2013

Resumen Objetivo: determinar las desigualdades en la mortalidad por causas específicas relacionadas con características socioeconómicas, en municipios del Huila 2009-2013. Métodos: estudio ecológico que comparó las mortalidades por Infección Respiratoria Aguda, cáncer de estómago, enfermedades hipertensivas y cerebrovasculares, accidentes de tránsito, homicidio, diabetes y mortalidad en niñez, con base en su situación socioeconómica, según las variables socioeconómicas Cobertura en Educación Media, NBI, Ruralidad, Suficiencia Económica, Valor Agregado Municipal y el Índice de Calidad del Agua en los 37 municipios del Huila. Se calcularon tasas ajustadas por edad con el método directo y medición de desigualdades confrontando las variables descritas, usando medidas basadas en rango, regresión y desproporcionalidad, usando el software Epidat 4.0. Resultados: en la mortalidad por cáncer gástrico, por enfermedades hipertensivas y en la mortalidad en niñez se identificó constante desigualdad frente a las variables socioeconómicas evaluadas, en contra de los municipios menos favorecidos. En la mortalidad por infecciones respiratorias agudas y homicidios, se observaron mayores tasas en los municipios con mejores condiciones socioeconómicas. Conclusiones: existe gran variabilidad entre las condiciones socioeconómicas de los municipios y entre las mortalidades por los eventos evaluados, observando aceptable correlación entre las diferentes medidas de desigualdades utilizadas.

Abstract Objective: to determine the inequalities in mortality due to specific causes related to socioeconomic characteristics in the municipalities of the Huila department, Colombia between 2009 and 2013. Methodology: an ecological study comparing mortality rates due to acute respiratory infection, stomach cancer, hypertensive and cerebrovascular disease, traffic accidents, homicide, diabetes and childhood mortality based on socioeconomic status according to the following socioeconomic variables: secondary education coverage, unsatisfied basic needs, rurality, economic sufficiency, municipality's added value and water quality index. The study included the 37 municipalities of the Huila department. Age-adjusted rates were calculated using the direct method and the inequalities were measured by comparing against the described variables using rank, regression and disproportionality based measures. The Epidat 4.0 software was used for this purpose. Results: child mortality and mortality due to gastric cancer and hypertensive disease showed constant inequality regarding the assessed socioeconomic variables in the less favored municipalities. As for mortality due to acute respiratory infections and homicides, higher rates were observed in municipalities with better socioeconomic conditions. Conclusions: there is great variability in the socioeconomic conditions of the municipalities and the mortality rates due to the assessed events. The authors observed an acceptable correlation between the different measures of inequality used in the study.

Resumo Objetivo: Determinar as desigualdades na mortalidade por causas específicas relacionadas a características socioeconômicas nos municípios de Huila entre os anos de 2009 e 2013. Metodologia: Estudo ecológico que comparou as mortalidades por infecção respiratória aguda, câncer de estômago, doenças hipertensivas e acidentes vasculares cerebrais, acidentes de trânsito, homicídio, diabetes e mortalidade na infância com base na situação socioeconômica segundo as variáveis socioeconômicas cobertura do ensino médio, NBI, Ruralidade, Suficiência Econômica; Valor Agregado Municipal e o Índice de Qualidade da Água nos 37 municípios de Huila. Foram calculadas as taxas ajustadas por idade com o método direto e a medição de desigualdades, confrontando-as com as variáveis descritas, a partir da utilização de medidas baseadas no intervalo, em regressão e em desproporcionalidade, utilizando-se o software Epidat 4.0. Resultados: Na mortalidade por câncer gástrico, por doenças hipertensivas e na mortalidade na infância foram identificadas constantes desigualdades em relação às variáveis socioeconômicas avaliadas contrárias aos municípios menos favorecidos. Para a mortalidade por infecções respiratórias agudas e homicídios, foram observadas maiores taxas nos municípios com melhores condições socioeconômicas. Conclusões: Existe uma grande variedade entre as condições socioeconômicas dos municípios e entre as mortalidades para os eventos avaliados, observando-se uma correlação aceitável entre as diferentes medidas de desigualdade utilizadas.

Implementación de un programa de prevención de la tuberculosis en el departamento de Nariño, Colombia 2002-2012 / Implementation of a tuberculosis prevention programme in the department of Nariño, Colombia 2002-2012 / Implementação de um programa de prevenção da tuberculose no departamento de Nariño, Colômbia 2002-2012

Introducción. El objeto de este manuscrito es reflexionar sobre la experiencia de la implementación del programa de prevención de la tuberculosis en el departamento de Nariño en la última década, bajo la estrategia DOTS-TAES (Direct Observerd Treatment Short Course) y tratamiento acortado estrictamente supervisado de la OMS. Metodología. Se realizó una reflexión a partir de documentos y experiencias institucionales, y una revisión narrativa. Resultados. La experiencia en el departamento de Nariño ha permitido reducir significativamente la incidencia de tuberculosis, dado el apoyo internacional y el énfasis en la prevención, mediante esquemas de atención primaria en salud. La intervención más relevante de este programa ha sido contar con un grupo exclusivo de atención a la tuberculosis y el seguimiento a los casos en cada municipio Conclusión. El programa es novedoso porque difiere de otros, orientados al diagnóstico y tratamiento oportunista; es decir, cuando el paciente consulta enfermo.

Introduction. The purpose of this manuscript is to reflect on the experience of the implementation of the tuberculosis prevention program in the department of Nariño in the last decade, under the strategy DOTS-TAES (Direct Observerd Treatment Short Course) and strictly supervised WHO shortened treatment. Methodology. A reflection was made from documents and experiences and a narrative review. Results. The experience in the department of Nariño has significantly reduced the incidence of tuberculosis, given the international support and emphasis on prevention, through primary health care schemes. The most relevant intervention of this program has been to have an exclusive group of tuberculosis care and case monitoring in each municipality Conclusion. The program is novel because it differs from others, oriented to diagnosis and opportunistic treatment; that is, when the patient consults sick.

Introdução. O objeto deste manuscrito é refletir sobre a experiência da implementação do programa de prevenção da tuberculose no departamento de Nariño na última década, sob a estratégia DOTS-TAES (Direct Observerd Treatment Short Course) e tratamento abreviado rigorosamente supervisionado pela OMS. Metodologia. Realizou-se uma reflexão a partir de documentos e experiências institucionais, e uma revisão narrativa. Resultados. A experiência no departamento de Nariño permitiu reduzir significativamente a incidência de tuberculose, dado o apoio internacional e a ênfase na prevenção, mediante esquemas de atenção primária em saúde. A intervenção mais relevante deste programa foi contar com um grupo exclusivo de atenção à tuberculose e o acompanhamento dos casos em cada município Conclusão. O programa é novo porque difere de outros, orientados ao diagnóstico e tratamento oportunista; ou seja, quando o paciente consulta doente.

Implementación de un programa de prevención de la tuberculosis en el departamento de nariño, colombia 2002-2012

Introducción. El objeto de este manuscrito es reflexionar sobre la experiencia de la implementación del programa de prevención de la tuberculosis en el departamento de Nariño en la última década, bajo la estrategia DOTS-TAES (Direct Observerd Treatment Short Course) y tratamiento acortado estrictamente supervisado de la OMS. Metodología. Se realizó una reflexión a partir de documentos y experiencias institucionales, y una revisión narrativa. Resultados. La experiencia en el departamento de Nariño ha permitido reducir significativamente la incidencia de tuberculosis, dado el apoyo internacional y el énfasis en la prevención, mediante esquemas de atención primaria en salud. La intervención más relevante de este programa ha sido contar con un grupo exclusivo de atención a la tuberculosis y el seguimiento a los casos en cada municipio. Conclusión. El programa es novedoso porque difiere de otros, orientados al diagnóstico y tratamiento oportunista; es decir, cuando el paciente consulta enfermo.

Introduction. The purpose of this manuscript was to conduct a reflection on the experience of the implementation of the TB program in the Department of Nariño in the last decade under the DOTS DOTS (Direct Observerd Treatment Short Course) strategy and observed treatment short of WHO. Methodology. It has been made a reflection from documents and institutional experiences, and a narrative review. Results. Experience in the Department of Nariño has significantly reduced the incidence of tuberculosis in the Department of Nariño given international support and emphasis on prevention through schemes primary health care. The most important intervention of this program has been to have an exclusive group of TB care and follow up cases in each municipality. Conclusion. The program is new because it differs from other diagnostic oriented opportunist treatment, i.e. when the patient consults patient.

Introdução. O objetivo deste artigo foi realizar uma reflexão sobre a experiência da implementação do programa de TB no Departamento de Nariño, na última década sob o DOTS DOTS (Directly Observed Treatment Short Course) estratégia e observado o tratamento a curto da OMS. Metodologia. Foi feita uma reflexão a partir de documentos e experiências institucionais e uma revisão narrativa. Resultados. Experiência no Departamento de Nariño reduziu significativamente a incidência de tuberculose no Departamento de Nariño dado apoio internacional e ênfase na prevenção através de sistemas de cuidados de saúde primários. A intervenção mais importante deste programa tem sido a de ter um grupo exclusivo de cuidados de TB e acompanhamento dos casos em cada município. Conclusão. O programa é novo, porque ele difere de outras formas de tratamento oportunista orientada de diagnóstico, isto é, quando o paciente consulta paciente.

ESTRATEGIAS DE ADAPTACIÓN Y MEDIOS DE VIDA DE LAS FAMILIAS INTEGRANTES DE LA FUNDACIÓN CONSEJO VEREDAL -FCV-, MUNICIPIO DE CALARCÁ, QUINDÍO / ADAPTATION STRATEGIES AND LIVELIHOOD OF FAMILIES MAKING UP THE VILLAGE FOUNDATION COUNCIL -VFC- MUNICIPALITY OF CALARCÁ, QUINDÍO

Este artículo presenta la estructura de estrategias de vida de la organización campesina Fundación Consejo Veredal ubicada en la vereda Travesías, municipio de Calarcá, en ella se llevó a cabo un estudio con nueve familias beneficiarias del proceso de reforma agraria Ley 160 de 1994 que tuvo como objetivo la identificación de las estrategias de vida de los hogares y las restricciones que impiden el éxito de estas estrategias. El estudio se realizó mediante la caracterización de los sistemas de producción y la identificación de los medios de vida que despliegan las familias para su supervivencia. Se utilizó la metodología de Enfoque de Medios de Vida del DFID -Department for International Development- a través de la cual se valoraron los capitales: Humano, Social, Natural, Físico y Financiero por medio de la medición de 17 indicadores pertenecientes a cinco capitales. Los resultados del estudio permitieron la identificación de los medios de vida utilizados por esta comunidad para adaptarse a las nuevas dinámicas generadas por los efectos de la globalización en el sector rural en economías campesinas y particularmente por la crisis cafetera. Se logró la identificación de estrategias que implementan las familias con el fin de generar ingresos y mejores condiciones de vida, así como las interacciones que se establecen entre estas y fenómenos sociales como: la pobreza, el origen y distribución de los ingresos, las políticas para la diversificación, diversificación vs. agricultura, organización social, educación y acceso a mercados. Los resultados del estudio muestran que los capitales de mayor valoración fueron el Humano con una media de 4,16 y el Físico con una media de 4,04. Los capitales con menor valoración fueron el Social con una media de 3,09 y el Financiero con una media de 3,29. El Capital Natural se ubica en un rango medio con 3,56.

This article presents the structure of living strategies of the rural organization "Village Foundation Council" located in the Travesías village, municipality of Calarcá, where a study with nine families beneficiary of the process of the agrarian reformation Law 160 of 1994 took place which had as objective the identification of living strategies of the homes and the restrictions which inhibit the success of these strategies. The study was carried out through the characterization of the production systems and the identification of livelihood families display for their survival. The DFID -Department for International Development- Livehood Focus methodology was used to value the human, social, natural, physical and financial capitals by means of the measurement of 17 indicators belonging to five capitals. The results of the study allowed the identification of the ways of livelihood used by this community to adapt to the new dynamics generated by the effects of globalization in the rural sector in peasant economy and particularly because of the coffee growers crisis. It was possible to achieve the identification of strategies that the families implement in order to generate income and better living conditions as well as the interactions that exist between these and social phenomena such as poverty, origin and distribution of incomes, policies for diversification, diversification vs. agriculture, social organization, education and access to markets. The results of the study, shows that the capitals with higher evaluation were the social with a 4.16 average and Physical with a 4.04. average The capitals with lower evaluation were the Social with a 3.09 average and the financial with a 3.29 average. The natural capital is located in a middle range with 3.56.

¿Por qué la salud pública es justa? / ¿Why public health is fair?

El presente documento es una reflexión que pretende favorecer la discusión ético-política de la justicia en la modernidad, para lo cual se revisan las implicaciones de las políticas públicas y la organización de los sistemas de servicios de salud, especialmente cuando la discusión actual de la equidad en salud implica valorar las desigualdades desde una idea de justicia. Se eligieron aquellos artículos que abordaran la justicia en la salud pública desde una mirada netamente ético-política. La búsqueda de información se obtuvo en varias bases de datos tales como: Medline, Proquest, Science Direct, Ovid, así como también en páginas web de revistas y organizaciones nacionales.

This document is a reflection that seeks to promote the ethical-political discussion of justice in modernity. The implications of the public policies and the organization of health care systems are reviewed, especially when the current discussion of equity in health involves assessing inequalities from a sense of justice. Articles that addressed justice in public health from a purely ethical-political view were chosen. The search for information was obtained in several databases such as Medline, Proquest, Science Direct, Ovid, as well as on websites of national magazines and organizations.