Association Between Depressive Symptoms and Cardiac Structure and Function in a Peruvian Population.

Depressive disorders are a leading cause of disability and are globally pervasive. It is estimated that 80% of depression occurs in low-income and middle-income countries. Depression is associated with worse outcomes in patients with cardiac disease including heart failure (HF); however, mechanistic understanding to explain heightened risk in HF remains poorly characterized. We examined the association between depressive symptoms and cardiac structure and function by transthoracic echocardiography. We selected a random sample of adult participants in Puno and Pampas de San Juan de Miraflores, Peru, from the CRONICAS cohort study. Depression symptoms were self-reported and measured with the Center for Epidemiological Studies Depression Scale in 2010. Participants underwent transthoracic echocardiography in 2014. Multivariable linear regression was used to examine the relationship between depressive symptoms and echocardiographic measures of cardiac structure and function and was adjusted for relevant covariates. Three hundred and seventy-three participants (mean age 56.7 years, 57% female) were included in this analysis of which 91 participants (24%) had clinically significant depressive symptoms. After adjustment, clinically significant depressive symptoms were associated with a reduced diastolic relaxation velocity compared to non-depressed subjects (-0.72 cm/s, 95% CI -1.21 to -0.24, p = 0.004). Other differences between depressed and non- depressed participants were less obvious. In conclusion, clinically significant depressive symptoms were associated with a lower septal e' velocity in the Peruvian population. Depressive symptoms were not obviously associated with other abnormalities in cardiac structure or function.

Conocimientos y percepciones de niñas, niños y adolescentes sobre la sexualidad / Notions and perceptions of girls, boys and adolescents about sexuality / Noções e percepções de meninas, meninos e adolescentes sobre sexualidade

Resumen Objetivo: Explorar los conocimientos y las percepciones de algunas niñas, niños y adolescentes respecto a la sexualidad, el ejercicio de los derechos sexuales y reproductivos, y la educación sexual. Metodología: se realizó un estudio cualitativo, a partir de 25 entrevistas semiestructuradas apersonas de entre 9 y 14 años, en 8 municipios priorizados de Colombia. Resultados: En todos los municipios se encontró un desconocimiento generalizado de los temas abordados, así como significados reducidos y percepciones en extremo negativas sobre la sexualidad, la educación sexual, los derechos sexuales y reproductivos, y la salud sexual, a lo que se suman fuertes estereotipos de género. Conclusiones: Los conocimientos y las connotaciones negativas asignadas a los conceptos por los que se preguntó dan cuenta de la limitada y precaria educación sexual que han recibido niñas, niños y adolescentes de estos municipios, lo que significa que aunque en el país existe un marco legal propicio y unas metas relacionadas con el abordaje integral de la sexualidad desde la primera infancia, estos no se están cumpliendo.

Abstract Objective: To explore children knowledge and perceptions about sexuality, exercise of sexual and reproductive rights and sex education. Methodology: A qualitative study was conducted through 25 semi-structured interviews with girls, boys and adolescents from 9 to 14 years old, in eight prioritized municipalities in Colombia. Results: In all the municipalities there was a widespread ignorance about the issues addressed, as well as reduced meanings and extremely negative perceptions about sexuality, sex education and sexual and reproductive rights and health; additionally were found strong gender stereotypes. Conclusions: perceptions and negative connotations assigned to the concepts that were inquired, accounted the limited and precarious sex education that girls and boys from these municipalities have received, which mean that, despite that in the country there is a favorable legal framework and goals related to the comprehensive approach of sexuality from early childhood, these are not being met.

Resumo Objetivo: Explorar o conhecimiento e as percepções de meninas e meninos sobre a sexualidade, o exercício dos direitos sexuais e reprodutivos e a educação sexual. Metodologia: Estudo qualitativo realizado por meio de entrevistas semiestruturadas com 25 meninas, meninos e adolescentes entre os nove e os 14 anos, em oito municípios priorizados da Colômbia. Resultados: Em todos os municípios foi encontrado um desconhecimiento generalisado sobre as questões abordadas, bem como significados reduzidos e percepções extremadamente negativas sobre a sexualidade, a educação sexual, os direitos esxuais e reprodutivos e a saúde sexual, e também fortos estereótipos de gênero. Conclusões: Os conhecimentos e as conotações negativas atribuídas aos conceitos o que foram preguntados, dão conta da educação sexual limitada e precária recebida por meninos, meninas e adolescentes desses municipios, o que significa, que a pesar de que o país tem um marco legal favorável e metas relacionadas com o abordagem integral da sexualidade desde a prmeira infancia, estes não estão sendo atendidos.

Uso de servicios de salud y enfermedades transmisibles de la población migrante y refugiada venezolana / Use of health services and communicable diseases of the Venezuelan migrant and refugee population

Resumen Introducción: Colombia es el principal país receptor de población migrante venezolana. Esto ha implicado identificar las necesidades en salud de esta población, como la atención y tratamiento de enfermedades infecciosas. Objetivo: Analizar el uso de servicios de salud relacionados con VIH/SIDA, malaria y hepatitis virales en migrantes y refugiados venezolanos en Colombia durante 2018 y 2019. Metodología: Estudio de investigación mixto. Se desarrollaron 12 grupos focales con mujeres y hombres venezolanos y se realizó un análisis del uso de servicios de salud por diagnósticos de VIH/SIDA, malaria y hepatitis virales, durante 2018 y 2019, en seis ciudades con un alto flujo de migración: Barranquilla, Bogotá, Cartagena, Cúcuta, Santa Marta y Riohacha. Resultados: El uso de servicios de salud por enfermedades infecciosas en migrantes venezolanos aumentó de 2018 (n=1,519) a 2019 (n=3,988). Los hombres fueron los que más usaron los servicios de salud por estas enfermedades. Aun así, la situación irregular migratoria, deficiencias en la atención primaria y acceso limitado a protección y detección temprana de enfermedades transmisibles, constituyen las principales barreras para migrantes y refugiados respecto a la atención en salud. Conclusiones: La migración expone a las personas al riesgo de contraer enfermedades infecciosas, así como a desigualdades y exclusión social en el acceso a servicios de salud para el control y tratamiento de estas enfermedades. Por ello, en contextos de migración se debe fortalecer la equidad en los servicios de salud con el fin de asegurar el acceso de las personas a la atención primaria, insumos, pruebas diagnósticas y tratamiento de enfermedades infecciosas.

Abstract Introduction: Colombia is the main receiving country of the Venezuelan migrant population. This has involved identifying the health needs of this population, such as the care and treatment of infectious diseases. Objective: To analyze the use of health services related to HIV/AIDS, malaria and viral hepatitis in Venezuelan migrants and refugees in Colombia during 2018 and 2019. Methodology: Mixed research study. Twelve focus groups were held with Venezuelan women and men and an analysis was made of the use of health services for HIV/AIDS, malaria, and viral hepatitis diagnoses during 2018 and 2019 in six cities with a high migration flow: Barranquilla, Bogotá, Cartagena, Cúcuta, Santa Marta, and Riohacha. Results: The use of health services for infectious diseases among Venezuelan migrants increased from 2018 (n=1.519) to 2019 (n=3.988). Men were the greatest users of health services for these diseases. Even so, irregular migration status, deficiencies in primary care, and limited access to protection and early detection of communicable diseases are the main barriers to health care for migrants and refugees. Conclusions: Migration exposes people to the risk of infectious diseases, as well as to inequalities and social exclusion in access to health services for the control and treatment of these diseases. Therefore, in migration contexts, equity in health services should be strengthened by ensuring people's access to primary care, inputs, diagnostic tests and treatment of infectious diseases.

Clinical Utility and Prognostic Value of Right Atrial Function in Pulmonary Hypertension.

Background Although right atrial (RA) enlargement is an established marker for adverse outcomes, the prognostic importance of RA dysfunction independent of RA size in pulmonary arterial hypertension is not known. Methods and Results Study subjects with pulmonary arterial hypertension were prospectively enrolled from 2010 to 2014. RA function was measured using RA speckle-tracking longitudinal strain and strain rate (SR) during each phase of the cardiac cycle: (1) RA reservoir (peak longitudinal strain, peak systolic SR), (2) RA conduit (peak early diastolic SR), and (3) RA active contraction (peak active contraction strain, peak contraction SR). The primary outcome was a composite of time to hospitalization or death assessed on follow-up. A total of 63 subjects had complete echocardiographic data. Of these, 91% were females, and the mean age was 58±12 years. During the follow-up period (range: 1-58 months), 39 were hospitalized or had died. After multivariable adjustment for age, sex, and left atrial size, peak longitudinal strain, peak active contraction strain, and peak early diastolic SR were significantly associated with increased risk of the composite outcome ( P=0.0005, P=0.0167, and P=0.0054, respectively). Conclusions RA dysfunction independently predicts mortality and hospitalizations in patients with pulmonary arterial hypertension.

Clinical and Echocardiographic Predictors of Outcomes in Patients With Pulmonary Hypertension.

In pulmonary hypertension (PH), measurement of various echocardiographic parameters that assess right heart function is recommended by current clinical guidelines. Limited data exists on the combined value of clinical and echocardiographic parameters in precapillary PH in the modern era of therapy. We examined the association of clinical and echocardiographic parameters with surrogate outcomes (6-minute walk distance) and hard outcomes (hospitalization or death) in patients with precapillary PH. A cohort of patients with an established diagnosis of precapillary PH who underwent transthoracic echocardiography at the Duke Echo Lab were prospectively enrolled from 2010 to 2014. Univariable and multivariable models were constructed to examine the relation of clinical and echocardiographic parameters with surrogate and hard outcomes. Of the 98 patients with analyzable echocardiograms with good image quality, 85 were woman, mean age was 59.4 years, and 47% had ≥World Health Organization functional class III symptoms. The mean 6-minute walk distance was 354(±132) m, and 83% were on pulmonary arterial hypertension medications. At 24 months, the cumulative incidence rate for hospitalization or death was 47%. In univariable analyses, the REVEAL (Registry to Evaluate Early and Long-term PAH Disease Management) risk score (HR 1.72 per 1 SD (2.81) increment, 95% CI 1.34, 2.22; p=<0.001), RV global longitudinal strain (RVGLS) (HR 1.54 per 1 SD (5.31) worsening, 95% CI , 2.12; p=0.008) and log-2 NT proBNP (HR 1.43 per 1-fold increase, 95% CI 1.25, 1.63; p=<0.001) were significantly associated with hospitalization or death.

Color Doppler imaging of cardiac catheters using vibrating motors.

A miniature motor rotating at 11,000 rpm was attached onto the proximal end of cardiac electrophysiological (EP) catheters in order to produce vibrations at the tip that were then visualized by color Doppler on ultrasound scanners. The catheter tip was imaged within a vascular graft submerged in a water tank using the Volumetrics Medical Imaging 3D scanner, the Siemens Sonoline Antares 2D scanner and the Philips ie33 3D ultrasound scanner with TEE probe. The vibrating catheter tip was visualized in each case, although results varied with the color Doppler properties of the individual scanner.