Aging in Indigenous Communities: Perspective from Two Ancestral Communities in the Colombian Andean-Amazon Region.

The phenomenon of world aging is not foreign to indigenous communities. In the last few years, research about these communities around the world has increased, but aging in indigenous towns still has not been studied widely. The purpose of this research is to interpret the meaning of old age in two indigenous communities from the Colombian Andean-Amazon region (the Inga and Kamëntsa) to reinforce the relevance of the local sociocultural context within the configuration of the meaning of old age and to emphasize the importance of considering particular regional characteristics for the design of policies and interventions aiming to recognize and integrate indigenous populations. This is a qualitative study with an interactionism-symbolism approach. In total, six indigenous people older than 60 years from two ancestral communities from the Colombian Andean-Amazon region participated in the in-depth interviews. Data analysis was carried out in three moments: discovery, coding, and relativization of the information. The results show that old age means wisdom, "I am wise," which is supported in the cosmology and the trajectory of life, reinforces the identity and autonomy, and allows them to be agents in the dynamics of their communities from the "I do," in other words, their roles as builders of the family-society and as guards of ancestral knowledge. The loss of this knowledge and the elements that it is composed of uproot them and put them at risk of disappearing as individuals and as a collective. In conclusion, the meaning of old age in these communities is not centered on a determinate age; you are not old, you are wise, and as such, they play a central role in their communities. Moreover, wisdom is built in parallel with their cosmology and assigns them the task of safekeeping ancestral knowledge. In order to do this, they use oral tradition as a tool, words that are born in their territories, travel in a nonlinear timeline, and get strengthened by the community while also protecting it and building it. Knowing what aging means for Indigenous communities can facilitate to the development of policies and initiatives and to provide culturally appropriate and effective programs.

FAM111A regulates replication origin activation and cell fitness.

FAM111A is a replisome-associated protein and dominant mutations within its trypsin-like peptidase domain are linked to severe human developmental syndrome, the Kenny-Caffey syndrome. However, FAM111A functions remain unclear. Here, we show that FAM111A facilitates efficient activation of DNA replication origins. Upon hydroxyurea treatment, FAM111A-depleted cells exhibit reduced single-stranded DNA formation and a better survival rate. Unrestrained expression of FAM111A WT and patient mutants causes accumulation of DNA damage and cell death, only when the peptidase domain remains intact. Unrestrained expression of FAM111A WT also causes increased single-stranded DNA formation that relies on S phase entry, FAM111A peptidase activity but not its binding to proliferating cell nuclear antigen. Altogether, these data unveil how FAM111A promotes DNA replication under normal conditions and becomes harmful in a disease context.

Proteomic profiling reveals distinct phases to the restoration of chromatin following DNA replication.

Chromatin organization must be maintained during cell proliferation to preserve cellular identity and genome integrity. However, DNA replication results in transient displacement of DNA-bound proteins, and it is unclear how they regain access to newly replicated DNA. Using quantitative proteomics coupled to Nascent Chromatin Capture or isolation of Proteins on Nascent DNA, we provide time-resolved binding kinetics for thousands of proteins behind replisomes within euchromatin and heterochromatin in human cells. This shows that most proteins regain access within minutes to newly replicated DNA. In contrast, 25% of the identified proteins do not, and this delay cannot be inferred from their known function or nuclear abundance. Instead, chromatin organization and G1 phase entry affect their reassociation. Finally, DNA replication not only disrupts but also promotes recruitment of transcription factors and chromatin remodelers, providing a significant advance in understanding how DNA replication could contribute to programmed changes of cell memory.

Community-based entomological surveillance in three Chagas disease-endemic regions in sub-Andean Bolivia.

BACKGROUND: Chagas disease is endemic throughout most of Bolivia, with prevalence rates of 25% observed in some geographic areas located mainly in the sub-Andean region. METHODS: Community-based entomological surveillance was carried out in the sub-Andean departments of Cochabamba (municipalities of Cochabamba, Punata and Sacaba), Tarija (municipality of Tarija) and Chuquisaca (municipality of Sucre). The surveillance parameters evaluated were: (i) the proportion of cards with the presence of triatomines; (ii) the distribution of positive cards by area; and (iii) the proportion of cards with the presence of infected triatomines. RESULTS: Of the cards returned, in 852 (3.1%) there was a mention of the presence of triatomines. The species Triatoma infestans, Triatoma sordida and Triatoma guasayana were identified in 812 (95.3%), 39 (4.6%) and 1 (0.1%), respectively. The median monthly positivity rate of the cards during 2011-2018 was higher in Punata (9.1%; IQR=3.2-15.4%). The median monthly rate was highest in 2012 (2.7%; IQR=0-5.6%). Fifty positive cards (5.8%) presented insects that were positive for trypanosomatids, mainly in Cochabamba and Punata. CONCLUSIONS: The report of triatomines foci by inhabitants represents an effective surveillance system coordinated by a network of specialized and multidisciplinary health centers. These strategies, which should be included in the health policies of endemic countries, enable extending and deepening the dialogue among technicians, communities and their local authorities.

New regimens of benznidazole monotherapy and in combination with fosravuconazole for treatment of Chagas disease (BENDITA): a phase 2, double-blind, randomised trial.

BACKGROUND: Current treatment for Chagas disease with the only available drugs, benznidazole or nifurtimox, has substantial limitations, including long treatment duration and safety and tolerability concerns. We aimed to evaluate the efficacy and safety of new benznidazole monotherapy regimens and combinations with fosravuconazole, in the treatment of Chagas disease. METHODS: We did a double-blind, double-dummy, phase 2, multicentre, randomised trial in three outpatient units in Bolivia. Adults aged 18-50 years with chronic indeterminate Chagas disease, confirmed by serological testing and positive qualitative PCR results, were randomly assigned (1:1:1:1:1:1:1) to one of seven treatment groups using a balanced block randomisation scheme with an interactive response system. Participants were assigned to benznidazole 300 mg daily for 8 weeks, 4 weeks, or 2 weeks, benznidazole 150 mg daily for 4 weeks, benznidazole 150 mg daily for 4 weeks plus fosravuconazole, benznidazole 300 mg once per week for 8 weeks plus fosravuconazole, or placebo, with a 12-month follow-up period. The primary endpoints were sustained parasitological clearance at 6 months, defined as persistent negative qualitative PCR results from end of treatment, and incidence and severity of treatment-emergent adverse events, serious adverse events, and adverse events leading to treatment discontinuation. Primary efficacy analysis was based on the intention-to-treat and per-protocol populations and secondary efficacy analyses on the per-protocol population. Safety analyses were based on the as-treated population. Recruitment is now closed. This trial is registered with ClinicalTrials.gov, NCT03378661. FINDINGS: Between Nov 30, 2016, and July 27, 2017, we screened 518 patients, and 210 were enrolled and randomised. 30 patients (14%) were assigned to each treatment group. All 210 randomised patients were included in the intention-to-treat population, and 190 (90%) were included in the per-protocol population. In the intention-to-treat analysis, only one (3%) of 30 patients in the placebo group had sustained parasitological clearance at 6 months of follow-up. Sustained parasitological clearance at 6 months was observed in 25 (89%) of 28 patients receiving benznidazole 300 mg daily for 8 weeks (rate difference vs placebo 86% [95% CI 73-99]), 25 (89%) of 28 receiving benznidazole 300 mg daily for 4 weeks (86% [73-99]), 24 (83%) of 29 receiving benznidazole 300 mg daily for 2 weeks (79% [64-95]), 25 (83%) of 30 receiving benznidazole 150 mg daily for 4 weeks (80% [65-95]), 23 (85%) of 28 receiving benznidazole 150 mg daily for 4 weeks plus fosravuconazole (82% [67-97]), and 24 (83%) of 29 receiving benznidazole 300 mg weekly for 8 weeks plus fosravuconazole (79% [64-95]; p<0·0001 for all group comparisons with placebo). Six patients (3%) had ten serious adverse events (leukopenia [n=3], neutropenia [n=2], pyrexia, maculopapular rash, acute cholecystitis, biliary polyp, and breast cancer), eight had 12 severe adverse events (defined as interfering substantially with the patient's usual functions; elevated alanine aminotransferase [n=4], elevated gamma-glutamyltransferase [n=2], elevated aspartate aminotransferase [n=1], neutropenia [n=3], leukopenia [n=1], and breast cancer [n=1]), and 15 (7%) had adverse events that led to treatment discontinuation (most of these were in the groups who received benznidazole 300 mg daily for 8 weeks, benznidazole 300 mg once per week for 8 weeks plus fosravuconazole, and benznidazole 150 mg daily for 4 weeks plus fosravuconazole). No adverse events leading to treatment discontinuation were observed in patients treated with benznidazole 300 mg daily for 2 weeks or placebo. There were no treatment-related deaths. INTERPRETATION: Benznidazole induced effective antiparasitic response, regardless of treatment duration, dose, or combination with fosravuconazole, and was well tolerated in adult patients with chronic Chagas disease. Shorter or reduced regimens of benznidazole could substantially improve treatment tolerability and accessibility, but further studies are needed to confirm these results. FUNDING: Drugs for Neglected Diseases initiative (DNDi). TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.

New chemotherapy regimens and biomarkers for Chagas disease: the rationale and design of the TESEO study, an open-label, randomised, prospective, phase-2 clinical trial in the Plurinational State of Bolivia.

INTRODUCTION: Chagas disease (CD) affects ~7 million people worldwide. Benznidazole (BZN) and nifurtimox (NFX) are the only approved drugs for CD chemotherapy. Although both drugs are highly effective in acute and paediatric infections, their efficacy in adults with chronic CD (CCD) is lower and variable. Moreover, the high incidence of adverse events (AEs) with both drugs has hampered their widespread use. Trials in CCD adults showed that quantitative PCR (qPCR) assays remain negative for 12 months after standard-of-care (SoC) BZN treatment in ~80% patients. BZN pharmacokinetic data and the nonsynchronous nature of the proliferative mammal-dwelling parasite stage suggested that a lower BZN/NFX dosing frequency, combined with standard or extended treatment duration, might have the same or better efficacy than either drug SoC, with fewer AEs. METHODS AND ANALYSIS: New ThErapies and Biomarkers for ChagaS infEctiOn (TESEO) is an open-label, randomised, prospective, phase-2 clinical trial, with six treatment arms (75 patients/arm, 450 patients). Primary objectives are to compare the safety and efficacy of two new proposed chemotherapy regimens of BZN and NFX in adults with CCD with the current SoC for BZN and NFX, evaluated by qPCR and biomarkers for 36 months posttreatment and correlated with CD conventional serology. Recruitment of patients was initiated on 18 December 2019 and on 20 May 2021, 450 patients (study goal) were randomised among the six treatment arms. The treatment phase was finalised on 18 August 2021. Secondary objectives include evaluation of population pharmacokinetics of both drugs in all treatment arms, the incidence of AEs, and parasite genotyping. ETHICS AND DISSEMINATION: The TESEO study was approved by the National Institutes of Health (NIH), U.S. Food and Drug Administration (FDA), federal regulatory agency of the Plurinational State of Bolivia and the Ethics Committees of the participating institutions. The results will be disseminated via publications in peer-reviewed journals, conferences and reports to the NIH, FDA and participating institutions. TRIAL REGISTRATION NUMBER: NCT03981523.

Carious Lesion Severity Induces Higher Antioxidant System Activity and Consequently Reduces Oxidative Damage in Children's Saliva.

Oxidative stress biomarkers can be found at detectable concentrations in saliva. These salivary biomarkers reflect specific oxidation pathways associated with caries and periodontitis. Our study evaluated the influence of dental caries severity (assessed using the ICCMS™ criteria) on the levels of oxidative stress biomarkers in saliva from children. Unstimulated saliva samples were collected from patients (from one to three years old) in a day care center in Birigui, SP, Brazil, two hours after fasting. Children were divided into four groups (n = 30/group), according to caries severity: caries free (group A), early carious lesions (group B), moderate carious lesions (group C), and advanced carious lesions (group D). The following salivary biomarkers were determined: total proteins (TP), measured by the Lowry method; oxidative damage, measured by the TBARS method; total antioxidant capacity (TAC); superoxide dismutase (SOD) enzymatic antioxidant activity; and uric acid (UA) non-enzymatic antioxidant activity. Data were analyzed by ANOVA, followed by the Student-Newman-Keuls test, Pearson and Spearman correlation coefficients, and multivariable linear regression (p < 0.05). TP, TAC, SOD enzymatic antioxidant activity, and UA non-enzymatic antioxidant activity increased with caries severity, consequently reducing salivary oxidative damage. It was concluded that higher caries severity increases salivary antioxidant system activity, with consequent reduction in salivary oxidative damage.

Evaluation of Dental Caries Behavior in Childhood: Health Promotion and Control / Avaliação do Comportamento da Cárie Dentária na Infância: Controle e Promoção de Saúde

Dental caries is still the most common pathology in childhood, caused mainly by lack of adequate prevention. The aim of this project was to evaluate the dental caries profile in children and the importance of multidisciplinary practice in dental caries. Material and methods: 1st stage- meetings were held with the teachers of the child education network and conferences addressed to parents and those responsible for the children. 2nd stage- Assessment and examination of oral health with education process and motivation for dental hygiene. Results: A total of 3390 children were analyzed, of which 859 had carious teeth, that is, 25.34% of the children had caries disease. There is a large presence of caries in the PRE II level, whose highest prevalence of caries is 41.73%, and the lowest recorded in Kindergarten I with 3.11%. This is mainly due to age, directly related to the period in which the basic oral health care program began in day care centers, as older children already had high caries rates when the preventive program was institutionalized to control the occurrences of caries and health promotion. Conclusion: The prevalence of caries in preschool children is still high, but the multidisciplinary approach has shown to be effective and able to reach the levels recommended by ONU 2030 appointment book for dental caries control. (AU)

A cárie dentária é a enfermidade mais comum na infância, causada essencialmente pela falta de prevenção adequada. O objetivo deste estudo foi avaliar o perfil da cárie dentária em crianças e a importância da ação multidisciplinar no controle da mesma. Na primeira fase, foram realizadas reuniões com os professores da rede de educação infantil e conferências dirigidas aos pais e responsáveis das crianças. Na 2ª fase: avaliação e exame de saúde bucal com orientação e motivação para higiene bucal. Foram analisadas 3390 crianças, das quais 859 apresentaram cárie dentária (25,34%). Obervou-se grande presença de cárie no nível PRE II, cuja maior prevalência de cárie é de 41,73%, e a menor registrada no Jardin I com 3,11%. Isso se deve principalmente à idade, relacionada diretamente ao período em que iniciou o Programa Básico de Atenção a Saúde Bucal nas creches, uma vez que as crianças mais velhas já apresentavam altas taxas de cárie quando o programa preventivo foi institucionalizado para controlar ocorrências de cárie e promoção da saúde bucal. Ainda existe alta prevalência de cárie em pré-escolares, entretanto, a abordagem multidisciplinar mostrou-se efetiva e capaz de alcançar os índices preconizados pela Agenda 2030 da ONU para o controle e prevenção da cárie dentária. (AU)

Sistema de procedimientos metodológicos para la superación profesional del rehabilitador sanitario en terapia ocupacional / System of methodological procedures for the professional training of the health rehabilitator in Occupational Therapy

Teniendo en cuenta el insuficiente nivel de actualización del rehabilitador en salud en terapia ocupacional, lo cual atenta contra la atención a pacientes con discapacidades, se elaboró un sistema de procedimientos metodológicos que facilitarán la adquisición, ampliación y perfeccionamiento continuo de los conocimientos y habilidades necesarios para un mejor desempeño en la rehabilitación integral, a partir del carácter científico-tecnológico-asistencial en este proceso.

Keeping in mind the scarce updating level of the health rehabilitator in Occupational Therapy, which is against the care to patients with disabilities, a system of methodological procedures was elaborated that will facilitate the acquisition, amplification and continuous improvement of knowledge and necessary skills for a better acting in the comprehensive rehabilitation, starting from the scientific-technological-assistance character in this process.

Efecto de intervenciones con ejercicio y/o suplementación sobre la masa muscular de personas mayores con sarcopenia: un metaanálisis / Effect of interventions with exercise and/or supplementation on muscle mass of elderly people with sarcopenia: a meta-analysis / Efeito das intervenções com o exercício e / ou a suplementação na massa muscular de idosos com sarcopenia: uma meta-análise

Resumen Solano-García, W. & Carazo-Vargas, P. (2019). Efecto de intervenciones con ejercicio y/o suplementación sobre la masa muscular de personas mayores con sarcopenia: Un metaanálisis. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 17(1), 1-22. La sarcopenia se caracteriza por la pérdida de la masa muscular y la fuerza. El objetivo fue determinar el tamaño del efecto global del tratamiento con ejercicio y/o suplementación sobre la masa muscular de personas adultas mayores diagnosticadas con sarcopenia, así como identificar las variables que moderan el efecto del tratamiento. Con respecto al método, se realizó una búsqueda de literatura en las bases de datos EBSCOhost, Ovid, ProQuest, PubMed, ScienceDirect, SpringerLink, Embase. De 4770 estudios recuperados, se incluyeron los 14 que cumplieron los criterios de inclusión: analizar la masa muscular, emplear diseños experimentales, aportar la estadística descriptiva, administrar un programa de ejercicio, suplementación o combinado de estas intervenciones e incluir personas mayores de 60 años diagnosticadas con sarcopenia. Los estudios debían estar publicados en texto completo en inglés o español. El cálculo del tamaño de efecto global se siguió utilizando el modelo de efectos aleatorios. En los resultados, fueron analizados 818 sujetos pertenecientes al grupo experimental y 284 al grupo control. Se obtuvo un tamaño de efecto global de 0.16 (p=0.005), procedente de 38 tamaños de efecto. El gráfico de funnel plot y la prueba de Egger no evidenciaron la presencia de sesgo general, ni publicación. Se necesitan 23 estudios para que el tamaño de efecto global sea no significativo. En la conclusión, se evidencia un cambio significativo en la masa muscular de personas adultas mayores diagnosticadas con sarcopenia, utilizando el tipo de intervención de ejercicio contra-resistencia con o sin suplementación; asimismo, se establece una guía de recomendaciones sobre prescripción de ejercicio y suplementación.

Abstract Solano-García, W. & Carazo-Vargas, P. (2019). Effect of interventions with exercise and/or supplementation on muscle mass of elderly people with sarcopenia: a meta-analysis. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 17(1), 1-22. Sarcopenia is characterized by the loss of muscle mass and strength. The objective of this paper was to determine the size of the overall effect of a treatment based on exercise and/or supplementation on muscle mass in elderly adults diagnosed with Sarcopenia, as well as identify the variables that can moderate the effect of the treatment. Regarding the method used, the EBSCOhost, Ovid, ProQuest, PubMed, ScienceDirect, SpringerLink, and Embase databases were consulted. Out of the 4770 studies recovered, 14 met the following criteria: analysis of muscle mass; use of experimental designs; use of descriptive statistics; administration of a program based on exercise, supplementation, or both; and subjects being over 60 diagnosed with sarcopenia. The studies were also required to be published completely in English or Spanish. The size of the global effect was calculated following the random effects model. A total of 818 and 284 subjects were analyzed in the experimental group and in the control group, respectively. An overall effect size of 0.16 (p = 0.005) was obtained from 38 effect sizes. The Funnel Plot graph and the Egger test did not reveal any evidence of presence of general bias or publication. A total of 23 studies are needed for the global effect size not to be significant. In conclusion, a significant change in the muscle mass of elderly adults diagnosed with sarcopenia was evident when having a resistance exercise intervention, with or without supplementation. A guide of recommendations on supplementation and exercise prescription was also established in the paper.

Resumo Solano-García, W. & Carazo-Vargas, P. (2019). Efeito das intervenções com o exercício e / ou a suplementação na massa muscular de idosos com sarcopenia: Uma meta-análise. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 17(1), 1-22. A sarcopenia é caracterizada pela perda de massa e força muscular. O objetivo foi determinar o tamanho do efeito global sobre a massa muscular no tratamento com exercício e/ou suplementação em idosos diagnosticados com sarcopenia e identificar as variáveis que moderam o efeito do tratamento. Com relação ao método, foi realizada uma pesquisa bibliográfica nas bases de dados EBSCOhost, Ovid, ProQuest, PubMed, ScienceDirect, SpringerLink, Embase. Dentre os 4770 estudos recuperados foram incluídos 14 que preencheram os critérios de inclusão, ou seja, analisar a massa muscular, usar desenhos experimentais, fornecer estatísticas descritivas, administrar um programa de exercício, suplementação ou a combinação dessas intervenções e incluir pessoas com mais de 60 anos de idade diagnosticadas com sarcopenia. Os estudos deveriam ter sido publicados em texto completo em inglês ou espanhol. Para o cálculo do tamanho do efeito global continuou-se usando o modelo de efeitos aleatórios. Nos resultados, 818 indivíduos pertencentes ao grupo experimental e 284 ao grupo controle foram analisados. Obteve-se um tamanho de efeito global de 0,16 (p = 0,005), a partir de 38 tamanhos de efeito. O gráfico de funnel plot e o teste de Egger não mostraram a presença de viés geral ou publicação. São necessários 23 estudos para que o tamanho do efeito global não seja significativo. Na conclusão, há uma mudança significativa na massa muscular de idosos diagnosticados com sarcopenia, utilizando o tipo de intervenção do exercício contrarresistência com ou sem suplementação; igualmente, fica estabelecido um guia de recomendações sobre prescrição de exercícios e suplementação.

Intervenciones con ejercicio contra resistencia en la persona adulta mayor diagnosticada con sarcopenia. una revisión sistemática / Resistance training interventions in elderly diagnosed with sarcopenia. a systematic review / Intervenções com exercício contra resistência nas pessoas idosas diagnosticadas com sarcopenia. uma revisão sistemática

Resumen Solano-García, W. y Carazo-Vargas, P. (2018). Intervenciones con ejercicio contra resistencia en las personas adultas mayores diagnosticadas con sarcopenia. Una revisión sistemática. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 16(1), 1-19. Propósito: Examinar la evidencia generada de las intervenciones basadas en ejercicio contra resistencia en la persona adulta mayor diagnosticada con sarcopenia. Métodos: Se realizó una búsqueda de literatura mediante la combinación de palabras claves en las siguientes bases de datos: EBSCO Host, Ovid, ProQuest, Public Health Database, Research Library, Science Direct, Springer Link, Cochrane Library, PubMed, SciELO, LILACS y PEDro. Se obtuvo 7819 estudios de los cuales seis cumplen con los criterios de inclusión: artículos de carácter experimental, ejercicio contra resistencia como intervención, texto completo, idioma en inglés/español, personas adultas mayores de 60 años diagnosticadas con sarcopenia. Resultados: La mayoría de los estudios reveló aumentos en porcentajes de cambio en variables asociadas a la sarcopenia, masa muscular (3.29%), fuerza muscular (19.16%) y función muscular (18.12%). Al analizar los detalles de las intervenciones se evidenció mejoras trabajando al menos 12 semanas con una frecuencia de 2-3 días durante 60 minutos por sesión, estimulando los principales grupos musculares a intensidades entre 60-85% (1RM) durante 3 series entre 6-15 repeticiones con descansos de 1-2 minutos entre serie; además, se obtienen beneficios similares al ejercitarse con equipo de resistencia o ejercicios con peso libre. Conclusiones: El ejercicio contra resistencia mejora variables físicas asociadas con la sarcopenia en personas que presentan este síndrome. Al analizar las recomendaciones de prescripción de ejercicio para contrarrestar los efectos de la sarcopenia, basadas en personas que no presentaban sarcopenia y compararlas con las encontradas en el presente estudio, se muestra que son similares.

Abstract Solano-García, W. & Carazo-Vargas, P. (2018). Resistance training interventions in elderly diagnosed with sarcopenia. A systematic review. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 16(1), 1-19. Purpose: Examine the evidence generated by resistance exercise-based interventions in elderly diagnosed with sarcopenia. Methods: A literature search was conducted combining keywords in the following databases: EBSCO Host, Ovid, ProQuest, Public Health Database, Research Library, Science Direct, Springer Link, Cochrane Library, PubMed, SciELO, LILACS, and PEDro. A total of 7819 studies were obtained, six of which met the inclusion criteria: experimental articles, resistance exercise as intervention, full text, English-Spanish language, adults over 60 diagnosed with sarcopenia. Results: Most of the studies revealed percentages increased in change in the variables associated with sarcopenia, muscle mass (3.29%), muscle strength (19.16%), and muscle function (18.12%). After analyzing the details of the interventions, improvement was shown when working at least 12 weeks with a frequency of 2 to 3 days with 60-minute sessions, stimulating the major muscle groups at intensities between 60-85% (1RM) for 3 series between 6-15 repetitions with 1-2-minute rest between series. Similar benefits are obtained when exercising with resistance equipment or free weight exercises. Conclusions: Resistance exercise improves physical variables associated with sarcopenia in patients with this syndrome. After analyzing the recommendations of exercise prescription to counteract the effects of sarcopenia based on the people who did not have sarcopenia and compared to those found in the present study, it is shown that results are similar.

Resumo Solano-García, W. & Carazo-Vargas, P. (2018). Intervenções com exercício contra resistência nas pessoas idosas diagnosticadas com sarcopenia. Uma revisão sistemática. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 16(1), 1-19. Propósito: Examinar a evidencia gerada das intervenções baseadas em exercício contra resistência na pessoa idosa diagnosticada com sarcopenia. Métodos: Foi realizada uma busca de literatura através da combinação de palavras-chaves nas seguintes bases de dados: EBSCO Host, Ovid, ProQuest, Public Health Database, Research Library, Science Direct, Springer Link, Cochrane Library, PubMed, SciELO, LILACS e PEDro. Foram obtidos 7819 estudos, dos quais seis cumprem com os critérios de inclusão: artigos de caráter experimental, exercício contra resistência como intervenção, texto completo, idioma em inglês/espanhol, pessoas maiores de 60 anos diagnosticadas com sarcopenia. Resultados: A maioria dos estudos revelou aumentos em porcentagens de mudanças nas variáveis associadas à sarcopenia, massa muscular (3.29%), força muscular (19.16%) e função muscular (18.12%). Ao analisar os detalhes das intervenções, ficou evidente as melhoras através de um trabalho de ao menos 12 semanas com uma frequência de 2-3 dias durante 60 minutos por sessão, estimulando os principais grupos musculares a intensidades entre 60-85% (1RM) durante 3 séries entre 6-15 repetições com descansos de 1-2 minutos entre série; além disso, foram obtidos benefícios semelhantes na realização de exercícios com equipamento de resistência ou exercícios com peso livre. Conclusões: O exercício contra resistência melhora variáveis físicas associadas à sarcopenia em pessoas que apresentam esta síndrome. Ao analisar as recomendações de prescrição de exercício para anular os efeitos da sarcopenia, baseadas em pessoas que não apresentavam sarcopenia e compará-las com as encontradas no presente estudo, observa-se que são semelhantes.

A strategy for scaling up access to comprehensive care in adults with Chagas disease in endemic countries: The Bolivian Chagas Platform.

BACKGROUND: Bolivia has the highest prevalence of Chagas disease (CD) in the world (6.1%), with more than 607,186 people with Trypanosoma cruzi infection, most of them adults. In Bolivia CD has been declared a national priority. In 2009, the Chagas National Program (ChNP) had neither a protocol nor a clear directive for diagnosis and treatment of adults. Although programs had been implemented for congenital transmission and for acute cases, adults remained uncovered. Moreover, health professionals were not aware of treatment recommendations aimed at this population, and research on CD was limited; it was difficult to increase awareness of the disease, understand the challenges it presented, and adapt strategies to cope with it. Simultaneously, migratory flows that led Bolivian patients with CD to Spain and other European countries forced medical staff to look for solutions to an emerging problem. INTERVENTION: In this context, thanks to a Spanish international cooperation collaboration, the Bolivian platform for the comprehensive care of adults with CD was created in 2009. Based on the establishment of a vertical care system under the umbrella of ChNP general guidelines, six centres specialized in CD management were established in different epidemiological contexts. A common database, standardized clinical forms, a and a protocolized attention to adults patients, together with training activities for health professionals were essential for the model success. With the collaboration and knowledge transfer activities between endemic and non-endemic countries, the platform aims to provide care, train health professionals, and create the basis for a future expansion to the National Health System of a proven model of care for adults with CD. RESULTS: From 2010 to 2015, a total of 26,227 patients were attended by the Platform, 69% (18,316) were diagnosed with T. cruzi, 8,567 initiated anti-parasitic treatment, more than 1,616 health professionals were trained, and more than ten research projects developed. The project helped to increase the number of adults with CD diagnosed and treated, produce evidence-based clinical practice guidelines, and bring about changes in policy that will increase access to comprehensive care among adults with CD. The ChNP is now studying the Platform's health care model to adapt and implement it nationwide. CONCLUSIONS: This strategy provides a solution to unmet demands in the care of patients with CD, improving access to diagnosis and treatment. Further scaling up of diagnosis and treatment will be based on the expansion of the model of care to the NHS structures. Its sustainability will be ensured as it will build on existing local resources in Bolivia. Still human trained resources are scarce and the high staff turnover in Bolivia is a limitation of the model. Nevertheless, in a preliminary two-years-experience of scaling up this model, this limitations have been locally solved together with the health local authorities.

Rapid diagnostic tests duo as alternative to conventional serological assays for conclusive Chagas disease diagnosis.

Chagas disease is caused by the parasite Trypanosoma cruzi. It affects several million people, mainly in Latin America, and severe cardiac and/or digestive complications occur in ~30% of the chronically infected patients. Disease acute stage is mostly asymptomatic and infection goes undiagnosed. In the chronic phase direct parasite detection is hampered due to its concealed presence and diagnosis is achieved by serological methods, like ELISA or indirect hemagglutination assays. Agreement in at least two tests must be obtained due to parasite wide antigenic variability. These techniques require equipped labs and trained personnel and are not available in distant regions. As a result, many infected people often remain undiagnosed until it is too late, as the two available chemotherapies show diminished efficacy in the advanced chronic stage. Easy-to-use rapid diagnostic tests have been developed to be implemented in remote areas as an alternative to conventional tests. They do not need electricity, nor cold chain, they can return results within an hour and some even work with whole blood as sample, like Chagas Stat-Pak (ChemBio Inc.) and Chagas Detect Plus (InBIOS Inc.). Nonetheless, in order to qualify a rapidly diagnosed positive patient for treatment, conventional serological confirmation is obligatory, which might risk its start. In this study two rapid tests based on distinct antigen sets were used in parallel as a way to obtain a fast and conclusive Chagas disease diagnosis using whole blood samples. Chagas Stat-Pak and Chagas Detect Plus were validated by comparison with three conventional tests yielding 100% sensitivity and 99.3% specificity over 342 patients seeking Chagas disease diagnosis in a reference centre in Sucre (Bolivia). Combined used of RDTs in distant regions could substitute laborious conventional serology, allowing immediate treatment and favouring better adhesion to it.

Evaluación etnobotánica medicinal de la comunidad de Buenos Aires, Jaén, Cajamarca - Perú / Ethnobotanical medicinal evaluation of the community of Buenos Aires, Jaén, Cajamarca - Peru

El presente trabajo consistió en la evaluación etnobotánica medicinal en la comunidad de Buenos Aires, del Distrito de Jaén. El objetivo fue identificar las principales especies de uso etnobotánico medicinal, se empleó un método Descriptivo - Analítico, programando 3 viajes a la zona de estudio, uno para realizar coordinaciones con las autoridades sobre la investigación y los otros dos para realizar colectas botánicas y aplicar encuestas. El resultado fue la colección de 37 especies medicinales, ordenadas en 4 divisiones, siendo la más representativa Magnoliophyta (Dicotildoneae) con 33 especies. Se clasifico en 29 familias botánicas, predominando la familia Asteraceae con 7 especies, siendo el hábito hierba con 54.05 % el más representativo, la parte empleada más utilizada son hojas y tallo. Los resultados de las encuestas muestran también que los usos más frecuentes son: el modo de aplicación interna (100 %), el empleo en fresca es la más representativa (100 %), la forma de preparación más frecuente es en cocimiento (70.27 %), siendo oral la vía de administración más usada (100%), la forma de aplicación más empleada es en lavados (27.03 %), el recurso humano que más lo practica es el curandero (91.89 %). Se concluye que los pobladores de la comunidad de Buenos Aires conocen la acción, parte y forma de uso tradicional de las plantas medicinales.

Gestión de riesgo para la prescripción de terapias biológicas / Risk management for prescribing biological therapies

(AU) El concepto de «riesgo en salud¼ es relativamente nuevo, surge en el lenguaje epidemiológico británico en los inicios del siglo xx y es definido por la OMS como la probabilidad de un resultado sanitario adverso, o la presencia de un factor que aumenta esa probabilidad. La gestión del riesgo se define, a su vez, como el proceso de identificar, analizar y cuantificar las probabilidades de pérdidas y efectos secundarios que se desprenden de los actos en salud, así como de las acciones preventivas, correctivas y reductivas correspondientes que deben emprenderse. La gestión del riesgo es un proceso gerencial estructurado que tiene por objetivo identificar los principales riesgos en salud de la población o del individuo. Los riesgos identificados son intervenidos mediante estrategias coordinadas que buscan disminuir su ocurrencia

Brazilian community health agents and qualitative primary healthcare information.

AIM: The aim of this study was to explore female community health agents' views about the value of recording qualitative information on contextual health issues they observe during home visits, data that are not officially required to be documented for the Brazilian System of Primary Healthcare Information. BACKGROUND: The study was conducted in community primary healthcare centres located in the cities of Araçatuba and Coroados (state of São Paulo) and Rio de Janeiro (state of Rio de Janeiro), Brazil. METHODS: The design was a qualitative, exploratory study. The purposeful sampling criteria were being female, with a minimum of three years of continuous service in the same location. Data collection with 62 participants was conducted via 11 focus groups (in 2007 and 2008). Audio files were transcribed and submitted to the method of thematic analysis. Four themes guided the analysis: working with qualitative information and undocumented observation; reflecting on qualitative information; integrating/analysing quantitative and qualitative information; and information-sharing with agents and family health teams. In 2010, 25 community health agents verified the final interpretation of the findings. FINDINGS: Participants valued the recording of qualitative, contextual information to expand understanding of primary healthcare issues and as an indicator of clients' improved health behaviour and health literacy. While participants initiated the recording of additional health information, they generally did not inform the family health team about these findings. They perceived that team members devalued this type of information by considering it a reflection of the clientele's social conditions or problems beyond the scope of medical concerns. Documentation of qualitative evidence can account for the effectiveness of health education in two ways: by improving preventative care, and by amplifying the voices of underprivileged clients who live in poverty to ensure the most appropriate and best quality primary healthcare for them.

Acercamiento histórico a la formación y la práctica en Terapia Ocupacional / Historical approach to the training and practice in Occupational Therapy

La carencia de un claro argumento que facilite la identidad común profesional del terapeuta, además de una identidad socialmente reconocida, constituye una buena razón para realizar un estudio que permita dar respuesta y entender el surgimiento de la terapia ocupacional. A tales efectos, fue necesario reparar en los acontecimientos históricos, en sus vertientes políticas, económicas y de estructuras sociales, que favorecieron determinadas acciones y el empleo de esta actividad. Con la presente investigación se persiguió describir diferentes criterios filosóficos que han generado modelos en la práctica y la formación en Terapia Ocupacional, los cuales deben ser asumidos como un proceso histórico, que es dinámico y se ajusta a los cambios culturales, legales y sociales del momento(AU)

The lack of a clear argument which facilitates the therapist's professional common identity, besides a socially grateful identity, constitutes a good reason to carry out a study which allows to give answer and to understand the emergence of the occupational therapy. To such effects, it was necessary to take historical events into account, in their political, economic spheres with social structures, favouring certain actions as well as the use of this activity. The aim of the present investigation was to describe different philosophical criteria which have generated models in the practice and training for Occupational Therapy, what should be assumed as a historical dynamical process, adjusted to the cultural, legal and social changes of the moment(AU)

Limitaciones epistemológicas en el proceso de formación profesional del rehabilitador en salud para su desempeño como terapeuta ocupacional / Epistemological limitations in the process of vocational training of the health rehabilitation therapist for his performance as occupational therapist

En las instituciones de educación superior de ciencias médicas que atienden especificidades en cuanto a la relación funcionamiento-discapacidad-salud, se revelan cambios positivos con vistas a lograr un alto nivel profesional. A tales efectos se realizó la presente investigación, en la cual se describen algunas insuficiencias existentes en el proceso de formación del rehabilitador en salud, que pudiesen dañar su posterior desempeño como terapeuta ocupacional, cuyo quehacer incluye la valoración de necesidades, la estandarización de tratamientos con condiciones específicas de salud, la rehabilitación y la evaluación de los resultados de un individuo con una determinada condición de salud, y sus factores contextuales(AU)

In the higher education institutions of medical sciences which are in charge of specificities as for the relationship functioning-disability-health, positive changes are revealed for achieving a high professional level. For this effects, the present investigation was carried out, in which some deficiencies existing in the training process of the health rehabilitation therapist are described that can damage their future performance as occupational therapist, whose tasks include the evaluation of needs, the standardization of treatments with specific health conditions, the rehabilitation and the evaluation of the results of an individual with a certain health condition, and its contextual factors(AU)

Limitaciones epistemológicas en el proceso de formación profesional del rehabilitador en salud para su desempeño como terapeuta ocupacional / Epistemological limitations in the process of vocational training of the health rehabilitation therapist for his performance as occupational therapist

En las instituciones de educación superior de ciencias médicas que atienden especificidades en cuanto a la relación funcionamiento-discapacidad-salud, se revelan cambios positivos con vistas a lograr un alto nivel profesional. A tales efectos se realizó la presente investigación, en la cual se describen algunas insuficiencias existentes en el proceso de formación del rehabilitador en salud, que pudiesen dañar su posterior desempeño como terapeuta ocupacional, cuyo quehacer incluye la valoración de necesidades, la estandarización de tratamientos con condiciones específicas de salud, la rehabilitación y la evaluación de los resultados de un individuo con una determinada condición de salud, y sus factores contextuales.

In the higher education institutions of medical sciences which are in charge of specificities as for the relationship functioning-disability-health, positive changes are revealed for achieving a high professional level. For this effects, the present investigation was carried out, in which some deficiencies existing in the training process of the health rehabilitation therapist are described that can damage their future performance as occupational therapist, whose tasks include the evaluation of needs, the standardization of treatments with specific health conditions, the rehabilitation and the evaluation of the results of an individual with a certain health condition, and its contextual factors.

Explorando potencialidades para a criação de rede de apoio social a mulheres lusófonas com câncer de mama e que vivem em Toronto, Canadá / Exploring potentialities for the creation of a social support network for Portuguese-Speaking women with breast cancer and who live in Toronto, Canada

Introdução: Indicadores gerais de saúde tendem a alterarem-se devido à participação de indivíduos em redes sociais. Objetivo: Conhecer as ideias dos membros de comunidades lusófonas em Toronto, Canadá, sobre a possibilidade da criação de uma rede de apoio social a mulheres com câncer de mama. Método: Estudo etnográfico crítico com 19 participantes que opinaram sobre a construção de uma rede de apoio social, pontos positivos e negativos, bem como pessoas a serem convidadas a ajudar. As discussões foram transcritas, analisadas e codificadas com o auxílio do programa de análise qualitativa Atlas ti 6.0. Resultados: Os componentes fundamentais para a construção da rede de apoio social foram a desmistificação do câncer de mama e de sua prevenção, ênfase na educação em saúde, divulgação da necessidade de voluntários e apoio social direto às mulheres com câncer. Os pontos positivos seriam a participaçãode mulheres mais idosas como líderes, uso do ambiente escolar e das instituições religiosas para a divulgação. Os empecilhos encontrados foram o câncer de mama ser uma doença vivida pelas mulheres, o desconhecimento relativo à cura e à falta de sensibilização. Em relação à participação de lideranças comunitárias, houve sugestão de diplomatas,padres e pastores, diretores de escolas e empresários da área da comunicação. Conclusão: A criação da rede de apoiosocial deve considerar a sensibilidade cultural e a diversidade interna das comunidades lusófonas. A recomendação é de que líderes sociais e profissionais angolanos sejam convidados para delinear a estrutura da rede de apoio conforme seus traços culturais específicos

Introduction:Health indicators tend to be altered due to the participation of people in social networks. Objective:to find out ideas of individuals belonging to Portuguese speaking communities in toronto,canada, about the possibility of creating a social support network for women experiencing breast cancer...