Curricular and pedagogical approaches for physical activity prescription training: a mixed-methods study of the "Exercise is Medicine" workshops in Colombia.

BACKGROUND: The physical activity (PA) prescription workshop for physicians, through the global health initiative "Exercise is Medicine" (EIM), has trained more than 4000 health care professionals (HCPs) in Latin America. It has shown to be effective in increasing PA prescription knowledge and awareness among HCPs. The purpose of this paper is to evaluate the curricular and pedagogical approach used by EIM Colombia at the PA prescription workshops implemented between 2014 and 2015. METHODS: A mixed methods study, with a sequential explanatory design was implemented among a convenience sample of HCPs attending twenty-six PA prescription workshops. HCPs health status, PA personal habits, and medical practices were collected using a questionnaire at baseline among 795 participants (pre-test measurement), and subsequently quantitatively analyzed. A workshop satisfaction survey was administered after the completion of the workshop among 602 HCPs. The curricular and pedagogical approach of the workshop, the designers' and students' contextual factors, and perceptions about the workshop were measured using qualitative methods (analysis of the procedures manual, two workshop observations, three semi-structured interviews, and one focus group including 8 HCPs). RESULTS: The workshop is student-centered and guided by an expert with an academic and clinical background. Learning was achieved with theoretical and practical components using authentic performance and collaborative learning. An active teaching and learning approach was used with strategies such as interactive lectures, hands-on elements, and role-playing (patient-counselor). The workshop emphasized an individual approach when prescribing PA integrating in clinical practice not only health benefits but also patient´s beliefs, motivations, needs, and barriers. CONCLUSIONS: Evidence-based practices and authentic performance were the most salient pedagogical elements used by EIM Colombia at the PA prescription workshop. A knowledge assessment that includes the practical aspect is suggested for future workshops. The curricular and pedagogical approach of the PA prescription workshop implemented in Colombia is well received by the medical community and a useful continuing medical education intervention with a potential contribution to current, and future health promotion needs.

Sumoylation in astrocytes induces changes in the proteome of the derived small extracellular vesicles which change protein synthesis and dendrite morphology in target neurons.

Emerging evidence highlights the relevance of the protein post-translational modification by SUMO (Small Ubiquitin-like Modifier) in the central nervous system for modulating cognition and plasticity in health and disease. In these processes, astrocyte-to-neuron crosstalk mediated by extracellular vesicles (EVs) plays a yet poorly understood role. Small EVs (sEVs), including microvesicles and exosomes, contain a molecular cargo of lipids, proteins, and nucleic acids that define their biological effect on target cells. Here, we investigated whether SUMOylation globally impacts the sEV protein cargo. For this, sEVs were isolated from primary cultures of astrocytes by ultracentrifugation or using a commercial sEV isolation kit. SUMO levels were regulated: 1) via plasmids that over-express SUMO, or 2) via experimental conditions that increase SUMOylation, i.e., by using the stress hormone corticosterone, or 3) via the SUMOylation inhibitor 2-D08 (2',3',4'-trihydroxy-flavone, 2-(2,3,4-Trihydroxyphenyl)-4H-1-Benzopyran-4-one). Corticosterone and 2-D08 had opposing effects on the number of sEVs and on their protein cargo. Proteomic analysis showed that increased SUMOylation in corticosterone-treated or plasmid-transfected astrocytes increased the presence of proteins related to cell division, transcription, and protein translation in the derived sEVs. When sEVs derived from corticosterone-treated astrocytes were transferred to neurons to assess their impact on protein synthesis using the fluorescence non-canonical amino acid tagging assay (FUNCAT), we detected an increase in protein synthesis, while sEVs from 2-D08-treated astrocytes had no effect. Our results show that SUMO conjugation plays an important role in the modulation of the proteome of astrocyte-derived sEVs with a potential functional impact on neurons.

Evaluación de la calidad de vida relacionada con la salud pre y post trasplante hepático, en pacientes de un hospital de alta complejidad / Health- related quality of life evaluation pre and post liver transplant in patients of a high complexity hospital

Resumen El trasplante hepático es la alternativa terapéutica indicada en pacientes con enfermedad hepática terminal para mejorar su sobrevida y calidad de vida. El objetivo de este estudio fue evaluar la calidad de vida relacionada con la salud (CVRS) de pacientes con cirrosis hepática antes y después de trasplante hepático. Se incluyeron 33 personas adultas que estaban en lista de espera para trasplante en la institución, se aplicó una serie de cuestionarios antes y después del trasplante: para evaluar la calidad de vida se utilizaron el LDQOL-1 (específico para enfermedad y trasplante hepático) y SF36 (para población general); para evaluar los síntomas depresivos y ansiosos, se utilizaron el BDI y STAI, respectivamente. Los resultados señalan una mejoría en la CVRS, así como disminución de los síntomas ansiosos y depresivos posterior al trasplante.

Abstract Liver transplantation is the therapeutic intervention of choice in patients with terminal liver disease to improve survival rate and quality of life. The aim of this study was to assess health related quality of life (HRQOL) in liver cirrhosis patients before and after liver transplantation. Thirty-three patients in waiting list for transplant in the institution were included; some questionnaires were applied before and after transplantation: to assess HRQOL were used LDQOL-1 (specific for liver disease and transplant) and SF36 (for general population); to assess depressive and anxious symptoms, BDI and STAI were used, respectively. Results showed an improvement in HRQOL and reduction in depressive and anxious symptoms after transplantation.

Becoming another: Transformations in the therapist who works with gay and lesbian couples / Devenir otro: transformaciones del terapeuta que atiende a parejas lesbianas y gais

ABSTRACT Objective: To recognise the changes experienced by the therapist who works with gay and lesbian couples. Method: Qualitative with biographical-narrative method. Seven therapists were interviewed in Medellin. Results: Three moments in the life trajectory of the participants were identified: Before: close ness and distances between families and the school were found (distances, makes reference, among others, to discourses about homosexuality). During: showed the conspiracy of silence in the undergraduate and postgraduate training of therapists, and in the clinical approach with homosexual couples they perceive in the reasons for consultation, a spectrum between everyday conflict and imposed exclusion. After: makes reference to the changes that this clinical work has generated in them, how they have become different, while others have been defined as: political subjects who resist normalisation and become learners of artistic territories and artisans of their own lives. Conclusions: The task of becoming another is a poetic, aesthetic and ethical process like the beautiful creation of the own existence. These transformations are connected with presence, social, politic and artistic contexts, reflexive labour and criticism about themselves.

RESUMEN Objetivo: Reconocer las transformaciones que han tenido los terapeutas a partir de la aten ción a parejas lesbianas y gais. Método: Enfoque cualitativo con método biográfico narrativo. Se realizaron entrevistas a siete terapeutas de la ciudad de Medellín. Resultados: Se identificaron tres momentos en la trayectoria de vida de los participantes: el antes, donde se encontraron cercanías y distancias en relación con sus familias de origen y la escuela (las distancias hacen referencia, entre otros, a los discursos sobre la homo sexualidad); el durante, que evidenció el complot del silencio en la formación de pregrado y posgrado de los terapeutas y en el abordaje clínico con las parejas homosexuales que perciben en los motivos de consulta, un abanico que oscila entre el conflicto cotidiano y la exclusión impuesta; el después, que hace referencia a las transformaciones que dicha labour clínica ha generado en ellos, cómo van siendo diferentes en tanto han ido deviniendo otros como sujetos políticos que se resisten a la normalización y se hacen aprendices de territorios artísticos y artesanos de la propia vida. Conclusiones: La labour de devenir otro es un proceso poético, estético y ético en tanto creación bella de la propia existencia. Estas transformaciones se vinculan con presencias, contextos sociales, políticos, artísticos, labour reflexiva y crítica sobre sí mismo.

[Becoming Another: Transformations in the Therapist Who Works with Gay and Lesbian Couples]. / Devenir otro: transformaciones del terapeuta que atiende a parejas lesbianas y gais.

OBJECTIVE: To recognise the changes experienced by the therapist who works with gay and lesbian couples. METHOD: Qualitative with biographical-narrative method. Seven therapists were interviewed in Medellin. RESULTS: Three moments in the life trajectory of the participants were identified: Before: closeness and distances between families and the school were found (distances, makes reference, among others, to discourses about homosexuality. During: showed the conspiracy of silence in the undergraduate and postgraduate training of therapists, and in the clinical approach with homosexual couples they perceive in the reasons for consultation, a spectrum between everyday conflict and imposed exclusion. After: makes reference to the changes that this clinical work has generated in them, how they have become different, while others have been defined as: political subjects who resist normalization and become learners of artistic territories and artisans of their own lives. CONCLUSIONS: The task of becoming another is a poetic, aesthetic and ethical process like the beautiful creation of the own existence. These transformations are connected with presence, social, politic and artistic contexts, reflexive labour and criticism about themselves.

Insulin/NFκB protects against ischemia-induced necrotic cardiomyocyte death.

In the heart, insulin controls key functions such as metabolism, muscle contraction and cell death. However, all studies have been focused on insulin action during reperfusion. Here we explore the cardioprotective action of this hormone during ischemia. Rat hearts were perfused ex vivo with an ischemia/reperfusion Langendorff model in absence or presence of insulin. Additionally, cultured rat cardiomyocytes were exposed to simulated ischemia in the absence or presence of insulin. Cytoprotective effects were measured by myocardial infarct size, trypan blue exclusion, released LDH and DNA fragmentation by flow cytometry. We found that insulin protected against cardiac ischemia ex vivo and in vitro. Moreover, insulin protected cardiomyocytes from simulated ischemia by reducing necrotic cell death. Protective effects of insulin were dependent of Akt and NFκB. These novel results show that insulin reduces ischemia-induced cardiomyocyte necrosis through an Akt/NF-κB dependent mechanism. These novel findings clarify the role of insulin during ischemia and further support its use in early GIK perfusion to treat myocardial infarction.

Sentido atribuido por las familias a la muerte por suicidio en gestantes en Antioquia durante 2010-2011 / The Meaning That Families Place on the Suicide of Pregnant Mothers in Antioquia, 2010-2011

Objetivo: Reconocer el sentido atribuido por las familias a la muerte por suicidio de dos mujeres gestantes en el Departamento de Antioquia durante 2010-2011. Método: Investigación cualitativa con método fenomenológico-hermenéutico y específicamente estudio de casos. Se realizaron entrevistas que luego se analizaron con el software Atlas ti. Resultados: En ambas familias emerge la categoría «La tarea de la familia: Tejer una historia que les ayude a comprender¼. En la familia de Bella se encontraron dos tendencias: «La tragedia: tensiones y escenarios¼ y «El vaivén: entre el miedo-culpa y el alivio¼. En la familia de Consentida aparecen tres tendencias: «Atrapada sin salida¼, «el suicidio y la orfandad: la comprensión de Juanita¼ y «Muerte es muerte¼. Conclusiones: Para ambas familias, la condición de la gestación también incidió de manera importante en el evento de la muerte voluntaria. La construcción de significado en las dos familias deja ver dos rutas: la de la diferenciación y la de la muerte en sí, como formas resilientes de sobreponerse a dicha tragedia.

Objective: To identify the meaning that the families of two pregnant women from Antioquia placed on their suicide in 2010-2011. Methodology: A qualitative research using the phenomenological and hermeneutical approach, specifically a case study analysis. Results: The category named "family task: weaving a history that helps them to understand" emerged in both families. Two trends were found in the family of Bella: "tragedy, tensions and scenarios" and "fluctuations: between fear-guilt and relief." The family of Consentida showed three trends: "trapped with no escape", "suicide and orphanhood: the understanding of Juanita" and "death is death." Conclusions: For both families, the fact that the women were pregnant had an important effect on the event of voluntary death. The construction of meaning that took place in both families followed two paths: differentiation and death itself; both can be resilient ways of coping with such a tragedy.

[The Meaning That Families Place on the Suicide of Pregnant Mothers in Antioquia, 2010-2011]. / Sentido atribuido por las familias a la muerte por suicidio en gestantes en Antioquia durante 2010-2011.

OBJECTIVE: To identify the meaning that the families of two pregnant women from Antioquia placed on their suicide in 2010-2011. METHODOLOGY: A qualitative research using the phenomenological and hermeneutical approach, specifically a case study analysis. RESULTS: The category named "family task: weaving a history that helps them to understand" emerged in both families. Two trends were found in the family of Bella: "tragedy, tensions and scenarios" and "fluctuations: between fear-guilt and relief." The family of Consentida showed three trends: "trapped with no escape", "suicide and orphanhood: the understanding of Juanita" and "death is death." CONCLUSIONS: For both families, the fact that the women were pregnant had an important effect on the event of voluntary death. The construction of meaning that took place in both families followed two paths: differentiation and death itself; both can be resilient ways of coping with such a tragedy.

Evaluacion global de la calidad de vida en un grupo de trabajadores de la Sabana de Bogota / Assessment of global quality of life in workers of Bogota region

Objetivos: evaluar en sujetos adultos de la población general la calidad de vida global y establecer la validez interna y externa de una Encuesta de Evaluación de la Calidad de Vida Global (EECVG), diseñada para tal efecto. Diseño: estudio descriptivo transversal de población general. Marco de referencia: muestra de trabajadores adultos de la Sabana de Bogotá, dependientes, independientes y pertenecientes al sector de la economía informal. Sujetos: 1230 sujetos que aceptaron participar en el estudio y cumplieron los criterios de inclusión. Mediciones: se aplicó la EECVG para ser diligenciada en forma individual. Además se evaluaron por medio de encuestas autoaplicadas validadas, los hábitos y las actitudes alimentarias, la depresión, la ansiedad, la morbilidad y la autoimagen. Resultados: se evaluaron 830 mujeres y 400 hombres, de 29.6±9.1 años con una puntuación de 233.1 ±27.3 en la EECVG. La consistencia interna y la fiabilidad fueron buenas (a de Cronbach > 0.9). Entre las múltiples variables externas correlacionadas, al análisis de regresión multivariado sólo los hábitos y las actitudes alimentarias, la escolaridad, la ansiedad, el antecedente de intento de suicidio, el estrato socioeconómico, el número de almuerzos/semana, el estado civil, la depresión, la ocupación y las secuelas postraumáticas explicaron 33.7 por ciento de la varianza de la EECVG (p<0.00001). Conclusiones: 1) La EECVG actual evalúa en forma consistente la calidad de vida en la población general. 2) La EECVG presenta validez interna y fiabilidad adecuadas para su aplicación en la población general adulta.

Rubéola congénita / Congenital rubella

Se presenta el caso clínico de un recién nacido con rubéola congénita. Se revisó la literatura de esta patología, así como las lesiones cutáneas más frecuentes y los diagnósticos diferenciales ante la presencia de eritropoyesis cutánea

El lavado quirurgico de las manos: revision de un metodo inveterado / Scrubing for surgery: review of an inveterated method

Se realizo un estudio para evaluar el metodo inveterado de lavado quirurgico de las manos con cepillo y por 10 minutos de duracion. Los resultados demuestran que existe diferencia en el crecimiento bacteriano entre usar y no usar el cepillo reesterilizable, y entre 5 y 10 minutos de lavado, cuando se usa yodo polivinil pirrolidona (o yodo povidona) al 8% como jabon antiseptico. La no utilizacion del cepillo reesterilizable y el menor tiempo de lavado resultan en menor trauma para la piel, menor crecimiento bacteriano y considerable ahorro economico. La yodo polivinil pirrolidona en forma de espuma es un agente desinfectante eficaz cuando se utiliza para el lavado quirurgico de las manos sin cepillo por cinco minutos en el primer lavado del dia y por 3 a 5 minutos en lavados subsiguientes.