Social determinants in the access to health care for Chagas disease: A qualitative research on family life in the "Valle Alto" of Cochabamba, Bolivia.

INTRODUCTION: Chagas disease is caused by the Trypanosoma cruzi infection. It is a neglected tropical disease with considerable impact on the physical, psychological, familiar, and social spheres. The Valle Alto of Cochabamba is a hyperendemic region of Bolivia where efforts to control the transmission of the disease have progressed over the years. However, many challenges remain, above all, timely detection and health-care access. METHODS: Following the Science Shop process, this bottom-up research emerged with the participation of the civil society from Valle Alto and representatives of the Association of Corazones Unidos por el Chagas from Cochabamba. The aim of this study is to explore the social determinants in the living realities of those affected by Chagas disease or the silent infection and how families in the Valle Alto of Cochabamba cope with it. An interdisciplinary research team conducted a case study of the life stories of three families using information from in-depth interviews and performed a descriptive qualitative content analysis and triangulation processes. FINDINGS: Findings provide insights into social circumstances of the research subjects' lives; particularly, on how exposure to Trypanosoma cruzi infection affects their daily lives in terms of seeking comprehensive health care. Research subjects revealed needs and shared their experiences, thus providing an understanding of the complexity of Chagas disease from the socioeconomic, sociocultural, political, and biomedical perspectives. Results enlighten on three dimensions: structural, psychosocial, and plural health system. The diverse perceptions and attitudes toward Chagas within families, including the denial of its existence, are remarkable as gender and ethnocultural aspects. Findings support recommendations to various stakeholders and translation materials. CONCLUSIONS: Intersectional disease management and community involvement are essential for deciding the most appropriate and effective actions. Education, detection, health care, and social programs engaging family units ought to be the pillars of a promising approach.

[Vaccination against community acquired pneumonia in adults. Update 2021 of the position paper by Neumoexpertos en Prevención Group]. / Vacunación frente a la neumonía adquirida en la comunidad del adulto. Actualización 2021 del posicionamiento del Grupo de Neumoexpertos en Prevención.

Community-acquired pneumonia (CAP) continues to be an important cause of morbidity and mortality in adults. The aim of this study is to update the practical prevention guide for CAP through vaccination in Spain developed in 2016 and updated in 2018, based on available vaccines and evidence through bibliographic review and expert opinion. The arrival of COVID-19 as a new cause of CAP and the recent availability of safe and effective vaccines constitutes the most significant change. Vaccines against pneumococcus, influenza, pertussis and COVID-19 can help to reduce the burden of disease from CAP and its associated complications. The available evidence supports the priority indications established in this guide, and it would be advisable to try to achieve a widespread dissemination and implementation of these recommendations in routine clinical practice.

Vacunación frente a la neumonía adquirida en la comunidad del adulto. Actualización 2018 del posicionamiento del Grupo de Neumoexpertos en Prevención / Adult community acquired pneumonia vaccination: 2018 Update of the positioning of the Pneumonia Prevention Expert Group

La neumonía adquirida en la comunidad (NAC) continúa siendo una causa importante de morbimortalidad en adultos. El objetivo de este documento es actualizar la guía práctica de prevención de la NAC mediante vacunación en España desarrollada en 2016 en función de las vacunas y evidencias disponibles mediante revisión bibliográfica y opinión de expertos. Las vacunas frente al neumococo y la gripe continúan siendo las principales herramientas preventivas disponibles frente a la NAC, y pueden contribuir a disminuir la carga de enfermedad por NAC y sus complicaciones asociadas. La evidencia disponible avala las indicaciones prioritarias establecidas en esta guía, y sería recomendable tratar de lograr una difusión e implementación amplia en la práctica clínica rutinaria de estas recomendaciones

Community-acquired pneumonia (CAP) continues to be an important cause of morbidity and mortality in adults. The aim of this study is to update the 2016 practical prevention guidelines for CAP through vaccination in Spain, based on the available vaccines, as well as the evidence using a literature review and expert opinion. Vaccines against pneumococcus and influenza continue to be the main prevention tools available against CAP, and can contribute to reduce the burden of disease due to CAP and its associated complications. The available evidence supports the priority indications established in these guidelines, and it would be advisable to try to achieve a widespread dissemination and implementation of these recommendations in routine clinical practice

[Adult community acquired pneumonia vaccination: 2018 Update of the positioning of the Pneumonia Prevention Expert Group]. / Vacunación frente a la neumonía adquirida en la comunidad del adulto. Actualización 2018 del posicionamiento del Grupo de Neumoexpertos en Prevención.

Community-acquired pneumonia (CAP) continues to be an important cause of morbidity and mortality in adults. The aim of this study is to update the 2016 practical prevention guidelines for CAP through vaccination in Spain, based on the available vaccines, as well as the evidence using a literature review and expert opinion. Vaccines against pneumococcus and influenza continue to be the main prevention tools available against CAP, and can contribute to reduce the burden of disease due to CAP and its associated complications. The available evidence supports the priority indications established in these guidelines, and it would be advisable to try to achieve a widespread dissemination and implementation of these recommendations in routine clinical practice.

Vacunación frente a la neumonía adquirida en la comunidad del adulto. Posicionamiento del Grupo de Neumoexpertos en Prevención / Vaccination against community acquired pneumonia in adult patients. A position paper by Neumoexpertos en Prevención

Introducción. La neumonía adquirida en la comunidad (NAC) es una causa importante de morbimortalidad en adultos. La incidencia anual de NAC en adultos en España varía entre 3 y 14 casos por 1.000 habitantes. Las guías clínicas actuales se centran básicamente en el abordaje terapéutico de la NAC más que en su prevención. El objetivo de este estudio es desarrollar y proponer una guía práctica de prevención de la NAC mediante vacunación en España en función de las vacunas y las evidencias disponibles. Métodos. Revisión bibliográfica y opinión de expertos. Resultados. Las vacunas contra el neumococo y la gripe son las principales herramientas preventivas disponibles frente a la NAC. La edad, las enfermedades crónicas y la inmunosupresión son factores de riesgo para la neumonía, por lo que estas poblaciones deben ser objetivo prioritario de vacunación. Además, se considera recomendable la vacunación antigripal y antineumocócica tanto en el adulto sano de menos de 60 años como en cualquier persona de cualquier edad con condición de riesgo para NAC. La vacuna de la gripe se administrará estacionalmente, mientras que la vacunación antineumocócica podrá administrarse en cualquier momento del año. Conclusiones. La vacunación frente a neumococo y gripe en el adulto puede contribuir a disminuir la carga de enfermedad por NAC y sus complicaciones asociadas. La evidencia disponible avala las indicaciones prioritarias establecidas en esta guía, y sería recomendable tratar de lograr una difusión e implementación amplia en la práctica de estas recomendaciones (AU)

Introduction. Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in adults. The annual incidence of CAP in adults in Spain ranges from 3 to 14 cases per 1,000 inhabitants. Current clinical guidelines primarily focus on the therapeutic approach to CAP rather than its prevention. The aim of this study is to develop and propose a practical guide for CAP prevention through vaccination in Spain according to available vaccines and evidence. Methods. A literature review and expert opinion. Results. Pneumococcal and influenza vaccines are the main preventive tools available against CAP. Age, chronic diseases, and immunosuppression are risk factors for pneumonia, so these populations should be a priority for vaccination. In addition, influenza and pneumococcal vaccination is considered advisable in healthy adults under 60 years of age, and anyone with risk condition for CAP, irrespective of age. The influenza vaccine will be administered seasonally, while pneumococcal vaccination can be administered at any time of the year. Conclusions. Vaccination against pneumococcus and influenza in adults can help to reduce the burden of CAP and its associated complications. The available evidence supports the priority indications set out in this guide, and it would be advisable to try to achieve a wide circulation and practical implementation of these recommendations (AU)

[Vaccination against community acquired pneumonia in adult patients. A position paper by Neumoexpertos en Prevención]. / Vacunación frente a la neumonía adquirida en la comunidad del adulto. Posicionamiento del Grupo de Neumoexpertos en Prevención.

INTRODUCTION: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in adults. The annual incidence of CAP in adults in Spain ranges from 3 to 14 cases per 1,000 inhabitants. Current clinical guidelines primarily focus on the therapeutic approach to CAP rather than its prevention. The aim of this study is to develop and propose a practical guide for CAP prevention through vaccination in Spain according to available vaccines and evidence. METHODS: A literature review and expert opinion. RESULTS: Pneumococcal and influenza vaccines are the main preventive tools available against CAP. Age, chronic diseases, and immunosuppression are risk factors for pneumonia, so these populations should be a priority for vaccination. In addition, influenza and pneumococcal vaccination is considered advisable in healthy adults under 60 years of age, and anyone with risk condition for CAP, irrespective of age. The influenza vaccine will be administered seasonally, while pneumococcal vaccination can be administered at any time of the year. CONCLUSIONS: Vaccination against pneumococcus and influenza in adults can help to reduce the burden of CAP and its associated complications. The available evidence supports the priority indications set out in this guide, and it would be advisable to try to achieve a wide circulation and practical implementation of these recommendations.

Seudoaneurisma y fístula arteriovenosa de la arteria femoral profunda secundario a lesión por arma blanca / Arteriovenous pseudoaneurysm and fistula of the deep femoral artery secondary to a stab wound

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[Analysis of preoperative reserve criteria and intraoperative transfusion of blood derivatives at an anesthesiology and recovery service]. / Análisis de los criterios de reserva preoperatoria y transfusión intraoperatoria de derivados sanguíneos en un servicio de anestesiología y reanimación.

Three hundred and three patients undergoing elective surgery were studied prospectively. Patient data and results of serial blood cell counts were recorded before and after surgery and used to evaluate the criteria used to reserve and transfuse blood and blood products, as well as to assess the outcome of transfusions performed. Six hundred and ninety-nine units were reserved, indicating a reservation-to-transfusion ratio of 1.8. The most often cited reasons for reserving blood were surgical technique, nature of disease and prolonged surgery. A high number of reservations were called for from the ward by the surgeons themselves. A total of 180 patients were given transfusions, the main reason being the anesthesiologist's judgement that the Hb count was low (in 26% of cases). Transfusions because of slight bleeding during surgery and prolonged surgery gave rise to the highest Hb counts. The lowest post-transfusion Hb counts recorded occurred when the reason cited was presence of signs of anemia. We conclude that the ratio of reservations to transfusions in our study was acceptable, as were the reasons justifying reserves. There is an overall tendency to achieve excessively high Hb counts (10-11 g/dl) in the early postoperative period. The best criterion for performing transfusion is the presence of signs of anemia.