Scoping health literacy in Latin America.

Studies evaluating the influence of health literacy on patient behavior and outcomes suggest a positive relationship between health literacy and health knowledge, health behaviors, and health status. In Latin American countries, studies assessing health literacy are few, regional, and demonstrate considerable variation, with reported rates of adequate health literacy ranging from 5.0% to 73.3%. In this paper, we examine and explore the state of health literacy and efforts to promote it in Latin America. Key challenges to those efforts include socioeconomic inequality, social/geographic isolation, and cultural-, language-, and policy-related barriers, many of which disproportionately affect indigenous populations and others living in rural areas. Greater use of infographics, videos, and mobile apps may enhance health literacy and patient empowerment, especially when language barriers exist. This paper provides strategies and tools for tailored programming, examples of successful health literacy interventions, and policy recommendations to improve health literacy in Latin America, intending to spur additional discussion and action. Centrally organized collaboration across multiple sectors of society, with community involvement, will enhance health literacy and improve health and well-being across Latin America.

Interactions Between Nutrition and Infections With Haemonchus contortus and Related Gastrointestinal Nematodes in Small Ruminants.

Interactions between host nutrition and feeding behaviour are central to understanding the pathophysiological consequences of infections of the digestive tract with parasitic nematodes. The manipulation of host nutrition provides useful options to control gastrointestinal nematodes as a component of an integrated strategy. Focussed mainly on the Haemonchus contortus infection model in small ruminants, this chapter (1) illustrates the relationship between quantitative (macro- and micro-nutrients) and qualitative (plant secondary metabolites) aspects of host nutrition and nematode infection, and (2) shows how basic studies aimed at addressing some generic questions can help to provide solutions, despite the considerable diversity of epidemiological situations and breeding systems.

Use of the Internet by physicians in Puerto Rico

OBJECTIVE: To determine the extent of the use of the Internet by physicians in Puerto Rico to support their clinical practice. METHODS: Personal interviews were conducted among a representative sample of 385 physicians from different specialties and geographical regions in Puerto Rico. RESULTS: Eighty-one percent physicians who participated in the survey reported the use the Internet in their practices. Rheumatologists, endocrinologists and cardiologists were the specialties with the highest usage rate. Internet use decreased as age of the physicians increased. The great majority of those who use the Internet do it from home (81%) followed by the office (68%). Almost two-thirds used dial-up to connect to the Internet at home or at office. The Internet was used mainly for professional purposes to look for references (92%), communicate with colleagues (33%) and obtain continuing education (31%). CONCLUSION: There was a high Internet utilization rate among physicians in Puerto Rico, regardless of the specialty. The utilization rate was similar to that reported among physicians from other countries.

Perceptions about the management of dyslipidaemia among physicians in Jamaica and Trinidad

BACKGROUND: Proper management of dyslipidaemia in patients may reduce morbidity and mortality related to coronary heart disease. OBJECTIVE: To determine physician perceptions of the management of dyslipidaemia in Jamaica and Trinidad METHODS: Personal interviews were conducted from March to May, 2005, by an independent research firm using a structured questionnaire. RESULTS: A total of 111 interviews were conducted, 61 in Jamaica and 50 in Trinidad Respondents were mostly primary care physicians (PCP) or internal medicine physicians (76.5%) and 58% were in private practice. The most important factors for prescribing a drug for dyslipidaemia were related to efficacy (76%), safety (59%) and price (36%). The majority (92%) reported using treatment guidelines. The National Cholesterol Education Program (NCEP) guidelines were the most widely mentioned by physicians but there were reports of using guidelines from other organizations and physician groups. Nearly a third of all physicians, most of whom were PCPs, had not heard of the NCEP The LDL-C level at which drug therapy should be started and the LDL-C treatment goals were higher among Jamaican physicians. CONCLUSIONS: Physicians are aware of the existence of treatment guidelines for dyslipidaemia. However, the source and adherence to the guidelines varies according to country and specialty. Information about the proper management of dyslipidaemia must be reinforced by professional societies and government agencies.

Perceptions about the management of dyslipidaemia among physicians in Jamaica and Trinidad.

BACKGROUND: Proper management of dyslipidaemia in patients may reduce morbidity and mortality related to coronary heart disease. OBJECTIVE: To determine physician perceptions of the management of dyslipidaemia in Jamaica and Trinidad METHODS: Personal interviews were conducted from March to May, 2005, by an independent research firm using a structured questionnaire. RESULTS: A total of 111 interviews were conducted, 61 in Jamaica and 50 in Trinidad Respondents were mostly primary care physicians (PCP) or internal medicine physicians (76.5%) and 58% were in private practice. The most important factors for prescribing a drug for dyslipidaemia were related to efficacy (76%), safety (59%) and price (36%). The majority (92%) reported using treatment guidelines. The National Cholesterol Education Program (NCEP) guidelines were the most widely mentioned by physicians but there were reports of using guidelines from other organizations and physician groups. Nearly a third of all physicians, most of whom were PCPs, had not heard of the NCEP The LDL-C level at which drug therapy should be started and the LDL-C treatment goals were higher among Jamaican physicians. CONCLUSIONS: Physicians are aware of the existence of treatment guidelines for dyslipidaemia. However, the source and adherence to the guidelines varies according to country and specialty. Information about the proper management of dyslipidaemia must be reinforced by professional societies and government agencies.

Características clínicas y utilización de naltrexona en la deshabituación alcohólica: Estudio stop / Clinical characteristics and use of naltrexone to the treatment alcohol dependence: Studio Stop

OBJETIVOS: Describir el perfil de pacientes alcohólicos a los que se prescribe Naltrexona para tratamiento. METODOLOGÍA: Prospectiva, para estudio descriptivo transversal. Evalúa 802 pacientes mediante cuestionario específicamente diseñado. Es aplicado por 401 médicos durante la primavera y verano de 1998. RESULTADOS: Predominio de 4 hombres por mujer, edad promedio de 41'6 años, residentes en ciudad (75 por ciento), con su familia (77 por ciento) y trabajadores activos (50 por ciento). Sus alcoholismo tiene una evolución de 14'9 años. Beben preferentemente destilados (63'3 por ciento) cerveza (57'8 por ciento) y vino (52 por ciento). Frecuentemente refieren "pérdida de control" (66'2 por ciento), tomar 25-100 Bebidas (UBE) por semana y una cuarta parte más de 15 UBE al día. Un 83 por ciento presentaba otra psicopatología asociada y el 33'2 por ciento historia de abuso de drogas. DISCUSIÓN: Perfil clínico desplazado con respecto al grupo general de alcohólicos en el sentido de ser una población más joven, con cierta preservación del funcionamiento social, laboral y familiar y con un tiempo de evolución menor. Destaca la alta frecuencia de la presencia de "pérdida de control" en estos pacientes como criterio de selección (AU)

Lymphocyte subpopulations in patients with primary fibromyalgia.

OBJECTIVE: Fibromyalgia (FM) is a clinical entity of unknown etiology frequently diagnosed in rheumatology. The potential involvement of the immune system in its pathogenesis has been suggested. Studies of abnormal T cell subpopulations often have been inconclusive. We attempted to clear this point by comparing lymphocyte subpopulations, including some of the newer activation markers, in patients with FM and healthy controls. METHODS: Sixty-five patients with FM and 56 healthy controls were studied. Flow cytometry was used as a quantification technique to measure lymphocyte subpopulations, CD3 (T cells), CD19 (B cells), CD16 (natural killer cells), CD4 (T helper/inducer cells), CD8 (T cytotoxic/suppressor cell), CD25 (interleukin 2 receptor), CD69 (activation inducer molecule marker), CD71 (transferrin receptor) and CD54 (ICAM-1); CD4/CD8 ratios were also estimated. RESULTS: The number of T cells expressing activation markers CD69 and CD25 was decreased in patients with FM; the other subpopulations were similar in patients and controls. CONCLUSION: Our results suggest a defect in T cell activation in patients with FM.

[Diffuse leiomyomatosis of the esophagus. Analysis of a case and review of the literature]. / Léiomyomatose diffuse de l'oesophage. Analyse d'un cas et revue de la littérature.

Diffuse leiomyomatosis of the esophagus is a rare affection which is characterized by a diffuse hypertrophy of esophageal muscles, without involvement of the muscularis mucosae. This disease involves children and young adults, occasionally associated with other localisations of leiomyomatosis. The case of a 21 year old female, successfully treated by total esophagectomy, is reported herein. In this patient, proteinuria and hematuria led to the discussion of an aspect of Alport's syndrome which is characterized by association of leiomyomatosis, deafness, cataract, and hematuria.

Status epilepticus in pregnancy. A case report.

A 34-year-old woman, epileptic since childhood, was admitted during the 26th-27th week of her second pregnancy because of status epilepticus. Effective treatment of the seizures allowed the pregnancy to reach term, and a healthy infant was born. A conservative treatment regimen involving seizure control and preservation of pregnancy is recommended.