Economic costs of severe seasonal influenza in Colombia, 2017-2019: A multi-center analysis.

OBJECTIVE: To estimate the economic burden of Severe Acute Respiratory Infection (SARI) in lab-confirmed influenza patients from a low-income country setting such as Colombia. METHODS: A bottom-up costing analysis, from both third payer and social perspectives, was conducted. Direct costs of care were based on the review of 227 clinical records of lab-confirmed influenza inpatients in six facilities from three main Colombian cities. Resources were categorized as: length of stay (LOS), diagnostic and laboratory tests, medications, consultation, procedures, and supplies. A survey was designed to estimate out-of-pocket expenses (OOPE) and indirect costs covered by patients and their families. Cost per patient was estimated with the frequency of use and prices of activities, calculating median and 95% confidence intervals (95% CI) with bootstrapping. Total costs are expressed as the sum of direct medical costs, OOPE and indirect costs in 2018 US dollars. RESULTS: The media direct medical cost per SARI lab-confirmed influenza patient was US$ 700 (95% CI US$ 552-809). Diagnostic and laboratory tests correspond to the highest cost per patient (37%). Median OOPE and indirect costs per patient was US$ 147 (95% CI US$ 94-202), with the highest costs for caregiver expenses (27%). Total costs were US$ 848 (95% CI US$ 646-1,011), OOPE and indirect costs corresponded to 17.4% of the total. The median of direct medical costs per patient was three times higher in elderly patients. CONCLUSION: SARI influenza costs impose a high economic burden on patients and their families. The results highlight the importance of strengthening preventive strategies nationwide in the age groups with higher occurrence and incurred health costs.

Significados y retos de la Terapia Ocupacional en cuidados paliativos: una perspectiva desde la experiencia práctica estudiantil / Meanings and challenges of Occupational Therapy in Palliative Care: a perspective from the student fieldwork experience / Significados e desafios da Terapia Ocupacional em cuidados paliativos: uma perspectiva a partir da experiência prática estudantil

Los cuidados paliativos buscan impactar en el bienestar de las personas que cursan una condición de salud crónico-degenerativa u otras que acorten su esperanza de vida. Considerando la escasez de terapeutas ocupacionales con formación en esta especialidad en Colombia y otros países, este artículo presenta reflexiones sobre los significados y retos que planteó a dos estudiantes de pregrado en Terapia Ocupacional y sus docentes, su experiencia en una práctica formativa en cuidados paliativos con personas adultas y adultas mayores hospitalizadas. Enlazando la subjetividad de cada estudiante con este contexto surgieron cinco ejes alrededor de los cuales se desarrolla el texto: relación terapéutica; ocupación significativa y espiritualidad; fatiga por compasión; reflexiones éticas, y formación profesional. Se concluye que en la formación de terapeutas ocupacionales es necesario implementar estrategias pedagógicas que enriquezcan el hacer humanizado, ético, crítico y centrado en la persona.

Palliative care seeks to impact the well-being of people with a chronic-degenerative health condition or others that shorten life expectancy. Considering the shortage of occupational therapists trained in this specialty in Colombia and other countries, this paper presents the reflections of two undergraduate Occupational Therapy students and their professors on the meanings and challenges of their fieldwork in palliative care training for practice with hospitalized adults and older adults. By linking the students' subjectivity with this formative context, five axes emer- ged: the therapeutic relationship, meaningful occupation and spirituality, compassion fatigue, ethical reflections, and professional training. The conclusion is that it is necessary to establish pedagogical strategies that enrich a humanized, ethical, critical, and person-centered practice in occupational therapists' training.

Os cuidados paliativos buscam impactar o bem-estar das pessoas que têm uma condição de saúde crônico-degenerativo ou outras que reduzem sua expectativa de vida. Considerando a escassez de terapeutas ocupacionais formados nesta especialidade na Colômbia e em outros países, este artigo apresenta reflexões sobre os significados e desafios colocados a dois alunos de graduação em Terapia Ocupacional e seus docentes, tendo em vista sua vivência numa prática discente em cuidados paliativos com adultos e idosos hospitalizados. Vinculando a subjetividade de cada aluno a esse contexto, emergiram cinco eixos em torno dos quais o texto se desenvolve: relação terapêutica, ocupação significativa e espiritualidade, fadiga por compaixão, reflexões éticas e formação profissional. Conclui-se que, na formação de terapeutas ocupacionais, é necessário implementar estratégias pedagógicas que enriqueçam o fazer humanizado, ético, crítico e centrado na pessoa.

Burden of influenza-associated respiratory hospitalizations in the Americas, 2010-2015.

BACKGROUND: Despite having influenza vaccination policies and programs, countries in the Americas underutilize seasonal influenza vaccine, in part because of insufficient evidence about severe influenza burden. We aimed to estimate the annual burden of influenza-associated respiratory hospitalizations in the Americas. METHODS: Thirty-five countries in the Americas with national influenza surveillance were invited to provide monthly laboratory data and hospital discharges for respiratory illness (International Classification of Diseases 10th edition J codes 0-99) during 2010-2015. In three age-strata (<5, 5-64, and ≥65 years), we estimated the influenza-associated hospitalizations rate by multiplying the monthly number of respiratory hospitalizations by the monthly proportion of influenza-positive samples and dividing by the census population. We used random effects meta-analyses to pool age-group specific rates and extrapolated to countries that did not contribute data, using pooled rates stratified by age group and country characteristics found to be associated with rates. RESULTS: Sixteen of 35 countries (46%) contributed primary data to the analyses, representing 79% of the America's population. The average pooled rate of influenza-associated respiratory hospitalization was 90/100,000 population (95% confidence interval 61-132) among children aged <5 years, 21/100,000 population (13-32) among persons aged 5-64 years, and 141/100,000 population (95-211) among persons aged ≥65 years. We estimated the average annual number of influenza-associated respiratory hospitalizations in the Americas to be 772,000 (95% credible interval 716,000-829,000). CONCLUSIONS: Influenza-associated respiratory hospitalizations impose a heavy burden on health systems in the Americas. Countries in the Americas should use this information to justify investments in seasonal influenza vaccination-especially among young children and the elderly.

Role of Muscarinic Acetylcholine Receptors in Breast Cancer: Design of Metronomic Chemotherapy.

BACKGROUND: muscarinic acetylcholine receptors (mAChRs) have attracted interest as targets for therapeutic interventions in different illnesses like Alzheimer´s disease, viral infections and different tumors. Regarding the latter, many authors have studied each subtype of mAChRs, which seem to be involved in the progression of distinct types of malignancies. METHODS: We carefully revised research literature focused on mAChRs expression and signaling as well as in their involvement in cancer progression and treatment. The characteristics of screened papers were described using the mentioned conceptual framework. RESULTS: Muscarinic antagonists and agonists have been assayed for the treatment of tumors established in lung, brain and breast with beneficial effects. We described an up-regulation of mAChRs in mammary tumors and the lack of expression in non-tumorigenic breast cells and normal mammary tissues. We and others demonstrated that muscarinic agonists can trigger anti-tumor actions in a dose-dependent manner on tumors originated in different organs like brain or breast. At pharmacological concentrations, they exert similar effects to traditional chemotherapeutic agents. Metronomic chemotherapy refers to the administration of anti-cancer drugs at low doses with short intervals among them, and it is a different regimen applied in cancer treatment reducing malignant growth and angiogenesis, and very low incidence of adverse effects. CONCLUSION: The usage of subthreshold concentrations of muscarinic agonists combined with conventional chemotherapeutic agents could be a promising tool for breast cancer therapy.

The DosR dormancy regulator of Mycobacterium tuberculosis stimulates the Na(+)/K (+) and Ca (2+) ATPase activities in plasma membrane vesicles of mycobacteria.

The latency global regulator DosR regulon of Mycobacterium tuberculosis, which is stimulated by hypoxia, comprises approximately fifty genes including ctpF (Rv1997), which encodes a putative alkali/alkaline earth ion transporter of the plasma membrane. In this work, the influence of hypoxia and M. tuberculosis DosR on the ATPase activity of mycobacterial plasma membrane was assessed. We performed bioinformatic analyses which indicated that the pma1 gene product is the M. smegmatis ortholog of the M. tuberculosis cation transporter CtpF. In addition, a possible Na(+), K(+) and/or Ca(2+) pumping mediated by Pma1 was also predicted. Enzymatic analyses indicated that the basal ATPase activity of plasma membrane vesicles from M. smegmatis cells cultured under hypoxia and over-expressing DosR, decreased 30 and 40 % respectively in comparison to oxygenated cells. In contrast, the specific Na(+)/K(+) and Ca(2+) ATPase activities of the plasma membrane increased 2.8- and 3.5-fold, respectively, under hypoxia, similar to that observed for cells over-expressing the DosR regulator. In agreement, RT-qPCR experiments demonstrated that the transcription level of the pma1 gene increased under hypoxia at levels similar to that of M. smegmatis cells over-expressing the M. tuberculosis DosR regulator. The entire findings suggest that hypoxia stimulates Na(+)/K(+) and Ca(2+) ATPase activities in the mycobacterial plasma membrane, and this is possibly mediated by the dormancy regulator DosR.

Cariotipo del tití gris (Saguinus leucopus): similitudes con el cariotipo humano / Karyotype of gray marmoset (Saguinus leucopus): similarities with the human karyotype

El tití gris (Saguinus leucopus) es un primate endémico de Colombia cuyo cariotipo se describe en el presente estudio a partir de una pareja de individuos ubicados en el Centro de Rehabilitación de Fauna Silvestre del Oriente de Caldas, Colombia. Las muestras de sangre fueron recolectadas de la vena femoral y anticoaguladas con heparina de sodio. Los cromosomas se obtuvieron por el método clásico de cultivo de linfocitos y bandeamiento Q y G Los individuos presentan 46 cromosomas (2n = 46: 30Bi, 14A); cromosomas sexuales XX en la hembra y XY en el macho (quimerismo 46,XX/46,XY en este último). Se propone un ideograma para el cariotipo del Tití Gris. Se observan amplias semejanzas en los cromosomas X y 5 de S. leucopus con los cromosomas X y 19 humanos, respectivamente. Otras similitudes parciales se evidenciaron entre los cromosomas 1 de ambas especies, 2 y 14 de S. leucopus con el 7 humano. La comparación del tamaño de regiones exónicas de dos genes de S. leucopus y Homo sapiens no arrojó diferencia.

Manejo de la ansiedad mediante la combinación de desensibilización sistemática con relajación muscular, relación autógena y biorretroalimentación / Handling of anxiety by means of systematic desensititation in combination with muscular relaxation, autogenous relaxation and biofeedback

Se realizó un estudio de tipo cuasiexperiemental sobre el uso de la Desensibilización sistemática en combinación con diferentes técnicas, que pretende comparar la efectividad diferencial de tres métodos para el manejo de la ansiedad: Relajación Muscular Progresiva, Relación Autógena y Biorretroalimentación , en 68 sujetos pertenecientes a la población universitaria de la Fundación Universitaria Konrand Lorenz. Se realizaron medidas de pre y postest utilizando la escala ISRA para la medición de la ansiedad. De acuerdo con el análisis de resultados, se mostró que las tres técnicas fueron efectivas en la disminución de los niveles de ansiedad, siendo significativamente más efectiva la técnica de Biorretroalimentación.

A study of the type quasi-experimental was used upon the usage of the systematic desensitization with the combination of different techniques that tried to compare the differential effectiveness of the three modules for handling the anxiety: Muscular Relaxation, Autegenous relaxion and Biofeedback in 68 subjects that belong to the university. A pre and post test was done using the scale ISRA to measure the anxiety. According to the results of the analysis, it showed that the three tecniques were effective in diminishing the levels of anxiety, but the most effective one was the biofeedback technique.