ABSTRACT
The ECHO model was developed to expand access to medical care for populations with HCV infection in underserved areas. We aimed to compare HCV treatment outcomes in community-based clinics with the Austral University Hospital (AUH) and to assess improvement in physician knowledge and skills. In October 2015, we established an HCV ECHO clinic at the AUH in Buenos Aires. To evaluate the impact of this programme, we conducted a prospective cohort study comparing treatment for HCV infection at the AUH with healthcare providers from different Argentinean provinces. A survey evaluating skills and competence in HCV care was administered, and results were compared. The primary endpoint was sustained virologic response (SVR) and under direct-acting antivirals. Since the implementation of ECHO clinics, a total of 25 physicians participated in at least one session (median 10.0; IQR 3.0-18.0). SVR rates (n = 437 patients) were 94.2% (95% CI 90.4-96.8) in patients treated at AUH clinic (n = 227/242) and 96.4% (95% CI 92.7-98.5) in those treated at ECHO sites (n = 188/195), with a nonsignificant difference between sites, 2.2% SVR difference (95% CI -0.24-0.06; P = 0.4). We also found a significant improvement in all the evaluated skills and abilities. Replicating the ECHO model helped to improve participants' skills in the management of HCV achieving similar SVR rates. ECHO model was demonstrated to be an effective intervention able to multiply and expand HCV treatment, a critical barrier to access to care that needs to be solved if we are committed with WHO goals to eliminate HCV by 2030.
Subject(s)
Clinical Competence , Hepatitis C/epidemiology , Patient Care , Practice Patterns, Physicians' , Telemedicine , Adult , Aged , Antiviral Agents/therapeutic use , Argentina/epidemiology , Drug Therapy, Combination , Female , Geography , Hepatitis C/diagnosis , Hepatitis C/therapy , Hepatitis C/virology , Humans , Male , Middle Aged , Models, Theoretical , Sustained Virologic Response , Telemedicine/methodsABSTRACT
OBJECTIVE: Frequency of cognitive impairment among people over 65 years old in community pharmacy. Study of asssociated factors, referral of cases to the specialist and inclusion in a program of health education. MATERIAL AND METHODS: Cross-sectional study of prevalence, frequency, conducted in four pharmacies (two urban and two rural pharmacies) in the Autonomous Community of Valencia. PARTICIPANTS: people over 65 years old who come to the pharmacy and who agree to participate in the study after signing an informed consent. It is used as the initial screening test, the Short Portable Mental State Questionnaire of Pfeiffer. Pfeiffer positive cases undergo a second test (Mini-Mental State Examination, NORMACODEM version). A questionnaire designed specifically for the study has been used to collect information. It includes questions to gain demographic data, questions on lifestyle and chronic diseases. We used analysis logistic regression multilevel. RESULTS: 245 patients have participated (76% of respondents). 12.65% were detected to have cognitive impairment. In the Logistic regression analysis multivariate there is a relation between cognitive impairment and some variables: age, lack of reading habit, unusual reading habit, sleeping less than 6 or more than 8 hours a day. Only 12.9% wanted to be referred for clinical evaluation and 42% were included in a cognitive training program. CONCLUSIONS: There are asssociation between lifestyle habits that are modifiable and cognitive impairment.
Subject(s)
Cognition Disorders/epidemiology , Life Style , Aged , Aged, 80 and over , Cognition Disorders/diagnosis , Cognition Disorders/rehabilitation , Cross-Sectional Studies , Disease Susceptibility , Female , Habits , Health Promotion , Humans , Interview, Psychological , Leisure Activities , Male , Pharmacies , Prevalence , Psychological Tests , Reading , Risk Factors , Sleep Wake Disorders/epidemiology , Surveys and QuestionnairesABSTRACT
The biosorption of three reactive azo dyes (red, black and orange II) found in textile effluents by inactive mycelium of Cunninghamella elegans has been investigated. It was found that after 120 hours of contact the adsorption led to 70%, 85%, 93% and 88% removal of reactive orange II, reactive black, reactive red and a mixture of them, respectively. The mycelium surface was found to be selective towards the azo dyes in the following order: reactive red > reactive black > orange II. Dye removal from a mixture solution resulted in 48.4 mg/g retention by mycelium and indicated a competition amongst the dyes for the cellular surface. A Freundlich adsorption isotherm model exhibited a better fit, thus suggesting the presence of heterogeneous binding sites. Electrondense deposits observed on the mycelium ultrastructure suggest that the dyes are mainly retained under the cellular surface of the inactive biomass of C. elegans.
Subject(s)
Azo Compounds/isolation & purification , Biodegradation, Environmental , Coloring Agents/isolation & purification , Cunninghamella/chemistry , Mycelium/chemistry , Adsorption , Algorithms , Azo Compounds/chemistry , Coloring Agents/chemistry , Cunninghamella/ultrastructure , Kinetics , Microbial Viability , Microscopy, Electron, Transmission , Models, Chemical , Mycelium/ultrastructure , Spectrophotometry, Ultraviolet , Textile IndustryABSTRACT
Esta obra constituye una guía en la confección de la Historia Clínica a fin de establecer la utilidad de los métodos complementarios solicitados en la exploración del paciente, para llegar así al diagnóstico y encauzar la propuesta terapéutica...
Subject(s)
Humans , Diagnosis , Medical RecordsABSTRACT
Esta obra constituye una guía en la confección de la Historia Clínica a fin de establecer la utilidad de los métodos complementarios solicitados en la exploración del paciente, para llegar así al diagnóstico y encauzar la propuesta terapéutica...(AU)
Subject(s)
Humans , Medical Records , DiagnosisABSTRACT
Para acompanhar as mudanças em curso no sistema de saúde, a Superintendência de Vigilância de Goiás vem realizando um conjunto de ações que objetivam atender as exigências de uma sociedade cada vez mais bem informada e participativa. Nesse sentido, a Superintendência de Vigilância Sanitária trabalha para aperfeiçoar seus recursos, investindo prioritariamente na reformulação do conceito de gestão em saúde. Nessa perspectiva, é dada especial atenção à qualificação dos seus profissionais, à coordenação dos sistemas municipais de vigilância sanitária, ao monitoramento da qualidade dos produtos e serviços, e a divulgação e execução de programas e projetos
Subject(s)
Health Policy , Health Surveillance , Health SystemsSubject(s)
Humans , Ascites , Patient Care Management , Ascites , Disease Management , Practice Guidelines as TopicABSTRACT
Resumo: Objetivando determinar as condiçöes ideais para a sobrevivência e efetividade do Bradyrhizobium sp em substratos alternativos com diferentes potenciais matriciais, foi conduzido u experimento utilizando-se como veículo de inoculaçäo os substratos: diatomia, vinhaça, seca, vermiculita e composto urbano em relaçäo à turfa. A inoculaçäo foi procedida com a estirpe UMKL-58, selecionada em trabalhos anteriores. Os substratos foram submetidos aos m de -0,33, -1,0 e -3,00 bar e incubados por 240dias. Para a qualificaçäo dos veiculos foram feitos testes de sobrevivência da estirpe nos materiais utilizando-se os métodos de diluiçäo em placas e de infecçäo em plantas coma leguminosa cunhä (Clitoria ternatea L.) nos intervalos de 0, 12, 30, 60, 90, 120, 150, 180 e 240dias após a inoculaçäo, como também, avaliaçäo da eficiência da fixaçäo biológica do N2 em funçäo do veículo de inoculaçäo. Os resultados demonstram que o Bradyrhizobium sobreviveu melhor na diatomita submetida a m -3,0 bar e nos demais potenciais foi comparável a turfa. Para todos os veículos, observou-se que altos valores de m reduzirama taxa de sobrevivência da bactéria como também afetaram a qualidade do inóculo diminuindo a efetividade da estirpe (au)
Subject(s)
Soil , Substrates for Biological Treatment , Bradyrhizobium/growth & development , Nitrogen Fixation , In Vitro TechniquesABSTRACT
La hepatitis NoA NoB de presentación esporádica, no atribuible a infección parenteral, está muy extendida en la India y en diversos países del sudoeste asiático, se identifica cada vez con mayor frecuencia en Africa y puede aparecer en forma esporádica en América Latina. Presentamos la experiencia recogida en nuestro medio entre Enero de 1987 y Septiembre de 1990, con 21 casos de hepatitis aguda, en donde no se encontraron marcadores de infección para VHA, VHB, VHC, toxoplasmosis, mononucleosis infecciosa, ni presentaban clínica de Herpes. Analizamos los parámetros biológicos y clínicos que cursaron con la patología, pudiendo observarse una elevación considerable de las transaminasas, así como de la colestasis. De los pacientes diagnosticados de ser portadores de hepatitis aguda NoA NoB probablemente de transmisión enteral (NANBE), se encontraban 10 varones y 11 mujeres. La edad promedio fue 24.7 años. La enfermedad fue autolimitada en todos los casos y en el seguimiento por más de un año, después del episodio agudo, no observamos signos de reactivación ni de sospechas de peso a la cronicidad
Subject(s)
Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Hepatitis C/diagnosis , Hepatitis C/epidemiology , Hepatitis C/etiologyABSTRACT
Hemos estudiado un grupo de 276 trabajadores sanitarios, de distintos niveles (médicos, enfermeras bioquímicos, administrativos, estudiantes y maestranza), a quienes les efectuamos, por ELISA, marcadores de infección por los vírus de la hepatitis (A y B), interrogamos sobre el antecedente clínico de enfermedad hepática aguda; finalmente se realizó un análisis de la incidencia de ambos agentes, donde resulta que: el VHB determinó anticuerpos en el 90,21% y la penetración del VHB (medida en la presencia del anti-HBc) fue del 19,20%. Sin embargo, existieron diferencias en cuanto al tipo de hospital estudiado
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Hepatitis A/diagnosis , Hepatitis B Antibodies/analysis , Hepatitis B/diagnosis , Personnel, Hospital , Enzyme-Linked Immunosorbent Assay , Hepatitis A/immunology , Hepatitis B/immunology , Risk FactorsABSTRACT
Hemos estudiado un grupo de 276 trabajadores sanitarios, de distintos niveles (médicos, enfermeras bioquímicos, administrativos, estudiantes y maestranza), a quienes les efectuamos, por ELISA, marcadores de infección por los vírus de la hepatitis (A y B), interrogamos sobre el antecedente clínico de enfermedad hepática aguda; finalmente se realizó un análisis de la incidencia de ambos agentes, donde resulta que: el VHB determinó anticuerpos en el 90,21% y la penetración del VHB (medida en la presencia del anti-HBc) fue del 19,20%. Sin embargo, existieron diferencias en cuanto al tipo de hospital estudiado (AU)