Prácticas familiares en el cuidado de los menores de la zona rural de Sopetrán, Antioquia / Family practices in the care of children from the rural areas of Sopetrán, Antioquia / Práticas familiares no cuidado dos menores da zona rural de Sopetrán, Antioquia

Objetivo: determinar la aplicación de prácticas familiares clave de la estrategia de atención integral a las enfermedades prevalentes en la infancia, por parte de los padres de niños inscritos en hogares del Instituto Colombiano de Bienestar Familiar, en la zona rural del municipio de Sopetrán, Antioquia, en 2014. Metodología: estudio descriptivo, transversal. La fuente primaria fue el universo de padres o cuidadores. Resultados: participaron 79 padres o cuidadores de nueve Hogares comunitarios de ocho veredas del municipio. En promedio, las madres tenían 28 años y los padres 32. El 74.7% de las familias fue de estrato socioeconómico nivel uno; la frecuencia de familias de tipo nuclear fue del 48%. Las verduras, los vegetales, los lácteos, las calabazas y las zanahorias fueron los alimentos menos consumidos por los menores. El 54.4% de las familias obtiene el agua de nacimiento y el 21.5% no le realiza tratamiento antes de consumirla. El 5.1% deposita excretas a campo abierto. El 15.2% y el 35.4% desconocen los signos de peligro que ponen en riesgo la vida del menor por infección respiratoria y por enfermedad diarreica aguda, respectivamente. En el 89.9% de los casos las madres se encargan del cuidado de los menores, con poca o nula participación del padre. Conclusión: los padres desconocen las prácticas clave relacionadas con la identificación temprana de signos de alarma de enfermedades prevalentes en la infancia. Además, el derecho al agua potable y saneamiento básico no es una realidad para todas las familias participantes. Adicionalmente, muchas no hierven el agua para consumirla, lo que podría incrementar algunas enfermedades prevalentes.

Objective: To determine to what extent the parents of children participating in the Colombian Institute for Family Wellbeing community homes implemented key family practices as a part of integrated management of childhood illness in the rural areas of Sopetrán, Antioquia in 2014. Methodology: cross-sectional descriptive study. The main source was the universe of parents or caregivers. Results: Seventy-nine parents or caregivers participated from nine community wellbeing homes in eight rural communities. The average age of mothers and fathers was 28 and 32, respectively. Of all families, 74.7% belonged to the lowest socioeconomic strata, and 48% of families were nuclear families. Vegetables, dairy products, pumpkins, and carrots were the least consumed foods by children. Over half of families (54.4%) get water from springs, 21.5% do not treat the water before drinking it, and 5.1% still practice open defecation. In fact, 15.2% and 35.4% remain unaware of the warning signs of infant respiratory infection and acute diarrhea, respectively. In 89.9% of cases, mothers care for children with little or no help from fathers. Conclusion: Parents are unaware of the key practices related to the early identification of warning signs in diseases common to children. In addition, not all participating families have access to treated drinking water and basic sanitary conditions. Lastly, many families do not boil water prior to drinking it, which could increase the prevalence of certain diseases.

Objetivo: determinar a aplicação de práticas familiares chave da estratégia de atenção integral às doenças prevalentes na infância, por parte dos pais de crianças inscritas nos lares do Instituto Colombiano de Bienestar Familiar, na zona rural do município de Sopetrán, Antioquia, em 2014. Metodologia: estudo descritivo, transversal. A fonte primária foi o universo de pais ou cuidadores. Resultados: participaram 79 pais ou cuidadores de nove Lares comunitários de oito bairros rurais do município. Em média, as mães tinham 28 anos e os pais 32. 74.7% das famílias foi de estrato socioeconômico nível um; a frequência de famílias de tipo nuclear foi de 48%. As verduras, os vegetais, os lácteos, as abóbora e as cenouras foram os alimentos menos consumidos pelos menores. 54.4% das famílias obtém a água de nascimento e 21.5% não se realiza tratamento antes de consumir. 5.1% deposita resíduos a campo aberto. 15.2% e o 35.4% desconhecem os signos de perigo que colocam em risco a vida do menor por infecção respiratória e por doença diarreica aguda, respectivamente. Em 89.9% dos casos as mães se encarregam do cuidado dos menores, com pouca ou nula participação do pai. Conclusão: os padres desconhecem as práticas chave relacionadas com a identificação precoce de signos de alarme de doenças prevalentes na infância. Ademais, o direito à água potável e saneamento básico não é uma realidade para todas as famílias participantes. Adicionalmente, muitas não fervem a água para consumir, o que poderia aumentar algumas doenças prevalentes.

Concepciones de salud mental en el campo de la salud pública / Conceptions about mental health in the field of public health

Aun cuando existe un reconocimiento de la importancia de la salud mental en el campo de la salud pública y de la amplia utilización de este concepto en los ámbitos profesionales, académicos y políticos, no obstante enfrenta importantes dificultades epistemológicas y prácticas para precisar qué se entiende por lo “mental”, cómo se relacionan “la salud” y “lo mental” y, en consecuencia, cómo se investiga e interviene en el ámbito de la salud mental, puesto que, en la práctica, la orientación de las acciones y de las investigaciones no obedecen a definiciones “universales”, sino a concepciones construidas a partir de los diferentes enfoques de salud-enfermedad. En el presente trabajo se discuten las concepciones de salud mental que se configuran a partir de los enfoques biomédico, comportamental y socioeconómico, así como de las nociones de “lo mental” en las cuales se soportan dichas concepciones y sus implicaciones para la intervención en el campo de la salud pública.

In the field of public health, mental health has had a great deal of relevance. This concept has been used extensively in the professional, academic, and political fields. Despite that, the different definitions of mental health face significant epistemological and practical problems. These difficulties are encountered by those who try to specify the meaning of "mental", the relationship between "health" and "mental", and, consequently, how research and intervention actions are to be carried out in the field of mental health. In practice, the orientation of actions and research involving mental health is not based on “universal” definitions in the field of public health. It is rather based on conceptions constructed from different approaches to the health-disease issue. This paper discusses the conceptions of mental health that have been configured from the biomedical, behavioral, and socio-economic approaches, the notions of "mind" underlying these conceptions, and their implications for intervention in the field of public health.

Bacteriologic monitoring of multidrug-resistant tuberculosis patients in five DOTS-Plus pilot projects.

BACKGROUND: Multidrug-resistant tuberculosis programs in DOTS-Plus pilot sites in five countries. OBJECTIVES: To calculate sputum conversion time and its relationship to treatment outcome, document the frequency of culture reversions and examine concordance of smear and culture to assess the potential consequences of monitoring by smear microscopy alone. DESIGN: Retrospective cohort analysis of 1926 patients receiving individualized, second-line therapy. RESULTS: Among 1385 sputum culture-positive cases at baseline, 1146 (83%) experienced at least one culture conversion during treatment. Conversion, however, was not sustained in all patients: 201 (15%) experienced initial culture conversion and at least one subsequent culture reversion to positive; 1064 (77%) achieved sustained culture conversion. Median time to culture conversion was 3 months. Among 206 patients whose nal conversion occurred 7-18 months after the initiation of therapy, 71% were cured or had completed treatment. CONCLUSIONS: Prolonged treatment for patients with delayed conversion may be beneficial, as 71% of late converters still achieved cure or completed treatment. This has implications for programs with de ned end points for treatment failure. The interval between rst and nal conversion among patients whose initial con- version is not sustained raises concern with respect to the ongoing debate regarding duration of treatment and the definition of cure.

La metáfora de no-lugar / The noplace metaaphor

El propósito del escrito consiste en explorar la metáfora levinasiana del no-lugar, precisar sus sentidos y evaluar críticamente su pertinencia en el ámbito de las reflexiones contemporáneas. Para ello, contextualizaremos la propuesta levinasiana en torno al no-lugar, especialmente bajo los conceptos de sensibilidad, proximidad e infinito; reconstruiremos algunas de las críticas de Levinas a lo que denominamos: "filosofías del regreso a casa"; y, finalmente, sugeriremos algunos aspectos en los cuales las tesis del filósofo judío podrían hacerse pertinentes. Este último propósito lo acompañaremos con una investigación social adelantada al respecto.

The purpose of this writing is to explore the Levinasian no-place metaphor, in order to clarify its meanings as well as to critically evaluate its pertinence under the light of contemporary reflections. In order to do this, we will contextualize the Levinasian proposal around the no-place, especially under the concepts of sensitivity, proximity, and infinite; we will reconstruct some Levinas's critiques which we will call "philosophies of the coming back home", and finally we will suggest some aspects in which the Jew philosopher theses might be pertinent. This last purpose will be accompanied by a social research carried out about this issue.

Adverse events in the treatment of multidrug-resistant tuberculosis: results from the DOTS-Plus initiative.

Adverse events associated with second-line drugs have been mentioned as obstacles in the management of multidrug-resistant tuberculosis (MDR-TB). Data on adverse events were collected from five DOTS-Plus sites in Estonia, Latvia, Peru (Lima), the Philippines (Manila) and the Russian Federation (Tomsk Oblast). The results show that among 818 patients enrolled on MDR-TB treatment only 2% of patients stopped treatment, but 30% required removal of the suspected drug(s) from the regimen due to adverse events. The study shows that adverse events are manageable in the treatment of MDR-TB in resource-limited settings provided that standard management strategies are applied.

El diálogo como encuentro: aproximaciones a la relación médico paciente / Dialog as an encounter: reviews on doctor patient relation

A partir de dos estudios sobre la relación de pacientes y ‘médicos’ (léase personal de salud); uno de tipo conceptual y fenomenológico elaborado desde las vivencias de uno de los autores y el otro de tipo etnográfico realizado a partir de entrevistas con pacientes del servicio de Agudos del Hospital Universitario de Caldas, se inicia un diálogo que busca comprender desde los protagonistas, la enfermedad en cuanto situación vital y el diálogo que surge en el ámbito clínico. Normalmente el médico quiere saber quésiente el paciente, cuáles son los síntomas y cómo se comporta la enfermedad con una finalidad diagnóstica y terapéutica; pero, poco se interesa en saber cómo se siente el paciente, cómo percibe su enfermedad y que pasa cuando se enfrenta al dolor y al miedo. Esta comunicación fragmentada genera una distancia emocional y humana que limita los alcances de la acción terapéutica. El acto profesional de cuidar la salud se ha ido deteriorando en la medida que la comunicación con el paciente se ha ido restringiendo a encuentros cadavez más técnicos, distantes y fríos que esquivan el diálogo y privilegian la información. Esto plantea un reto al personal de salud y particularmente a las escuelas y facultades de ciencias de la salud; hoy más que nunca, en medio de una nación que sucumbe en el conflicto y la intolerancia, resurge la necesidad de reconocer la enfermedad, más allá del mero hecho biológico, como hecho social y cultural; de volver a valorar el diálogo como estrategia que nos permite un encuentro entre personas para dar sentido a la existenciay hacernos humanos en el acto de enfermar y de sanar.

Tuberculosis in children: reassessing the need for improved diagnosis in global control strategies.

Pediatric pulmonary tuberculosis (PPTB) remains a major cause of morbidity and mortality worldwide, particularly in less developed countries. Current techniques are inadequate for diagnosing PPTB. This is an impediment not only for the diagnosis and treatment of PPTB cases, but also for epidemiological investigations assessing PPTB burden and disease transmission. Causes of misdiagnosis of PPTB include non-specific signs/symptoms, low bacillary load, recovery methods (sputum or gastric aspirate) for obtaining a clinical sample with low bacillary yield, and the inherent low sensitivities of the diagnostic tests themselves. New diagnostic and recovery methods have recently been evaluated which may provide a means of overcoming some of these obstacles. Unfortunately, progress in developing and implementing improved diagnostic tests for PPTB has been partially impeded by the very low priority of PPTB in global TB control programs based on cost-effective strategies. Regardless of the cost-effectiveness of diagnosing and treating PPTB, our moral obligation to provide access to health care demands that we evaluate and deal with this neglected group of patients. Furthermore, recent evidence indicates that PPTB may actually be responsible for more disease transmission than previously thought. In this review, we present compelling evidence that research agendas and TB control programs should be reassessed and possibly revised to deal with the global disease caused by PPTB.

The impact of media-based health education on tuberculosis diagnosis in Cali, Colombia.

Tuberculosis (TB) is one of the most worrying infectious diseases facing less developed countries. Diagnosis and treatment of those who are transmitting Mycobacterium tuberculosis is considered a very effective control strategy. Within this strategy the priority is to achieve high cure rates before attempting to increase case finding. However, there is a dearth of research on how to increase case finding and diagnostic coverage in those settings where high cure rates are being achieved. This paper presents an evaluation of the impact on case finding of a mass media health education campaign for TB control in Cali, Colombia. The campaign aimed at increasing case finding and reducing levels of prejudice against people with TB. The impact assessment shows that the campaign produced an increase of 64% in the number of direct smears processed by the laboratories and an increase of 52% in the number of new cases of positive pulmonary TB, with respect to the previous period. Unfortunately, the effects of the campaign were short-lived. These findings have at least two important implications. First, passive case finding is likely to be an insufficient strategy to reach the operational targets of diagnostic coverage. Secondly, providing basic information about the earliest symptoms of TB and the procedures for diagnosis can increase diagnostic coverage, and thus strengthen the effect on infection risk of control programmes with high cure rates. Further research is required to identify other strategies that could, first, increase diagnostic coverage and, secondly, make the intervention effects sustainable.

Orientation of Phalerisida maculata Kulzer (Coleoptera, Tenebrionidae) in sandy beaches of the Chilean coast. Orientation of Phalerisida maculata in sandy beaches.

The orientation stimuli of adult individuals of the beetle Phalerisida maculata Kulzer (Coleoptera, Tenebrionidae) over the beach surface, were studied at two sandy beaches of the chilean coast approximately 1300 km apart, Apolillado (ca. 29 degrees S) and Playa Universitaria de Mehuín (ca. 39 degrees S). Phalerisida maculata did not orient by astronomic cues such as the sun and moon, nor by the terrestrial magnetic field. Both populations showed positive scototaxis, and oriented downward on slopes with dry sediments, and upwards on slopes with wet sediments.

Encompassing treatment with prevention: the path for a lasting control of tuberculosis.

Tuberculosis is an important cause of death, mainly in the less developed countries. Thus far the strategy for its control had relied on the diagnosis of sick individuals and provision of chemotherapy. However, this strategy is problematic for several reasons: poor education about the disease and the low income of people with tuberculosis are important barriers for them to have access to early diagnosis and to keep adherence to treatment; provision of 'preventive therapy' to the enormous pool of people infected with tuberculosis is not feasible in less developed countries; and finally, long-term political commitment with the strategy is unlikely. Several facts indicate that tuberculosis patterns in different populations are shaped by biological, behavioral and socio-economic factors. This paper argues that a lasting control of tuberculosis requires a strategy based on a broader model of causality, which takes account of all these three causal factors.

Tuberculosis and stigma: predictors of prejudice against people with tuberculosis.

Tuberculosis is a main cause of mortality and morbidity in developing countries. Although diagnostic and curative means are well known, they are not always available and affordable. Also, the disease has a worldwide stigma, which adds to the suffering. A survey exploring the correlates of prejudice, as an attitudinal component of this stigma, was carried out in Cali, Colombia. Results show that scientifically unfounded beliefs about the transmission of the disease are the main significant predictor of the instrumental function of this attitude. Health education and, arguably, more successful control programmes could help to reduce the social isolation suffered by people with tuberculosis.

Tuberculosis control in less developed countries: can culture explain the whole picture?

Healthcare practices, adherence to treatment, and organizational behaviour of healthcare workers are the main issues concerning tuberculosis (TB) control influenced by culture. A review of research findings published in the English language literature concerning these issues, and the way in which they are affected by cultural and structural factors is presented and discussed. These findings suggest that structural rather than cultural factors may be the main explanation for the questionable behaviour of healthcare workers and patients suffering from TB in less developed countries.

Pulmonary tuberculosis and health-seeking behaviour: how to get a delayed diagnosis in Cali, Colombia.

Tuberculosis is a heavy burden in the developing countries. Early diagnosis and adherence to treatment are difficult to achieve by patients. Our qualitative research looked at the paths followed and the barriers experienced by patients at the health care services of Cali, Colombia, while seeking help for pulmonary tuberculosis symptoms. Results show that the cultural-based explanation patients give to the symptoms, the stigma attached to the disease, and the poor quality of health care services (communication skills, organizational structure, attitudes, and knowledge of the tuberculosis control strategy of health care workers) are strong barriers to early diagnosis.

Paracoccidioidomycosis and AIDS: report of the first two Colombian cases.

The records of the first two Colombian patients with AIDS and paracoccidioidomycosis are presented. Both patients were males and had no known risk factors for HIV although in the past they had worked in the field where they could have been infected with the fungus. They exhibited the juvenile type of disease with multiple organ system involvement and symptoms of short duration. They were deeply immunodepressed as indicated by less than 100 CD4 T lymphocytes per mL; however, serologic tests revealed circulating anti-Paracoccidioides brasiliensis antibodies and in one patient the first diagnostic clue came from such tests. In one case, the mycosis preceded the AIDS diagnosis while in the other, both pathologies were discovered simultaneously. Antimycotic therapy with itraconazole was administered for over 10 months, with an initial dose of 200 mg/day followed by 100 mg/day; marked improvement of the mycotic signs and symptoms was soon noticed an there have been no signs of relapse. The patients improvement was also due to the combined retroviral treatment that was instituted. In spite of the rarity of the AIDS-paracoccidioidomycosis association, physicians practicing in endemic areas should consider the presence of the mycosis in immunosuppressed patients, since a prompt diagnosis and institution of combined antimycotic-anti-retroviral treatments would result in patient improvement and survival. It appears possible that the longer survival time of today's AIDS patients would give the quiescent fungus the opportunity to revive, multiply and cause overt disease.

Cáncer epitelial de ovario: experiencia de 10 años en SOLCA Quito / Epithelial cancer of ovary: experience of 10 years in Exempt SOLCA Quito

Realiza un estudio retrospectivo en el período de ene. 1985 a dic. 1994, de 71 casos de tumores malignos de ovario manejados en SOLCA-Núcleo de Quito, de los cuales 53 (74.6xciento) fueron tumores de estirpe epitelial. El grupo etáreo más afectado fue el de 40 a 70 años (62.26xciento). La sintomatología predominante fue masa tumoral más ascitis (37.73xciento). El tumor más frecuente fue el cistoadenocarcinoma seroso papilar con 37 casos. En cuanto a la evolución con seguimiento de 3 a 12 años, 10 pacientes están vivas (18.8xciento) 9 de ellas (37.73xciento) sin actividad tumoral, el 50xciento pertenecen al estadío clínico IA. Hay 20 pacientes perdidas con actividad tumoral. (37.73xciento), 7 perdidas sin actividad tumoral (13.7xciento), y 16 fallecidas (30.19xciento).

[Essential aspects of the reorganization of medical education at the University of Chile School of Medicine]. / Reorganización en la educación médica. Aspectos esenciales de la reestructuración de la Facultad de Medicina de la Universidad de Chile.

The Medical School of the University of Chile is enforcing deep transformations in its curricular setting, to cope with the physician model of the next century. It is following the universal trends that look for new objectives, methodologies, scenarios and resources in medical teaching. These goals should be accomplished very soon, allowing the School to be in the lead of curricular transformations. These changes have overflowed the limits of curricular renovation and a process of institutional reorganisation is aiming to increase its efficacy and yield. The bases of this reorganisation are the search for excellency, the renovation of academic staff with the incorporation of better trained professionals, the integration of basic and clinical disciplines in coherent programmatic proposals and the configuration of structures to organise and articulate medical knowledge. Optimisation of education has also extra-institutional implications with the establishment of accreditation systems for professionals and educational institutions. These systems are mandatory world wide and guarantee the capability of educational institutions and their products. The School of Medicine is committed in this achievement along with the Association of Medical Schools and The Superior Education Council.

Detección precoz del cáncer de cuello uterino mediante colposcopia Informe de 559 casos

Con el propósito de efectuar diagnóstico precoz y tratamiento del cáncer de cuello uterino en el Departamento de Caldas, Colombia, S.A. se creó un grupo interdisciplinario o institucional descentralizado, que desde junio de 1989 se desplaza periódicamente y en forma continua a los Hospitales Regionales del Departamento de Caldas, para hacer actividades de prevención, educación a la población de riesgo, adolescentes y detección del cáncer del cuello uterino. El ginecólogo practica colposcopia a todas las mujeres con citología anormal compatible con NIC o infección por VHP. Entre junio de 1989 y junio de 1992, se realizaron 559 colposcopias de primera vez; se diagnosticaron 152 casos de NIC y 21 casos de cáncer avanzado. La edad promedio para Ca microinvasivo e invasivo es de 47.5 años; de 33.9 años para lesiones preinvasoras. El 79.5 por ciento de mujeres tuvo relaciones sexuales antes de los 20 años y en la colposcopia se encontraron lesiones en el 60 por ciento de los casos, siendo el punteado y la zona acetoblanca los cambios más frecuentes. En 41 colposcopias se observaron vasos atípicos o lesiones clínicamente invasoras. De 404 biopsias tomadas se detectaron 21 carcinomas de tipo escamocelular, 4 microinvasoras y 17 invasoras. El 88 por ciento de las lesiones fueron intraepiteliales. La sensibilidad de la colposcopia frente a la biopsia fue de 94 por ciento y la especificidad del 46 por ciento. El 97 por ciento de los pacientes con PAP compatible con NIC-CA, presentaron algún tipo de lesión colposcopica. El promedio de edad de los pacientes con NIC fue de 13.8 años menor que los pacientes con carcinoma invasor. EL 100 por ciento de la población estudiada es de clase económica baja y 42 por ciento de zona rural. Se efectuaron tratamientos en el Hospital Regional consistentes en Crioterapia conización, histerectomía simple o ampliada; según el caso o radioterapia a nivel central. El programa ha posibilitado detectar un gran número de lesiones pre-invasoras, cuyo tratamiento oportuno ha permitido mejorar las condiciones de salud de la población y racionalizar los recursos, demostrándose los beneficios de una atención regionalizada con colposcopia. Además ha permitido determinar características colpo-histológicas y epidemiológicas