Consistency Between Administrative Health Records and Self-Reported Health Status and Health Care Use Among Indigenous Wayuu Health Insurance Enrollees: La Guajira, Colombia.

The objective of the study was to assess the consistency between self-reported demographic characteristics, health conditions, and healthcare use, and administrative healthcare records, in a sample of enrollees of an Indigenous health organization in Colombia. We conducted a phone survey of a random sample of 2113 enrollees September-2020/February-2021. Administrative health records were obtained for the sample. Using ICD-10 diagnostic codes, we identified individuals who had healthcare visits for diabetes, hypertension, and/or pregnancy. Using unique identifiers, we linked their survey data to the administrative dataset. Agreement percentages and Cohen's Kappa coefficients were calculated. Logistic regressions were performed for each health condition/state. Results showed high degree of agreement between data sources for sex and age, similar rates for diabetes and hypertension, 10% variation for pregnancy. Kappa statistics were in the moderate range. Age was significantly associated with agreement between data sources. Sex, language, and self-rated health were significant for diabetes. This is the first study with data from an Indigenous population assessing the consistency between self-reported data and administrative health records. Survey and administrative data produced similar results, suggesting that Anas Wauu can be confident in using their data for planning and research purposes, as part of the movement toward data sovereignty.

Social robotics as an adjuvant during the hospitalization process in pediatric oncology patients.

OBJECTIVE: To describe the experience of implementing social robotics as an adjuvant during the hospitalization process in pediatric oncology patients. METHODS: Before and after cohort study, applying an intervention with the Lego Mindstorms EV3 kit in patients between 8 and 17 years old that are hospitalized with a cancer diagnosis. We excluded patients from the intensive care unit or when their treating physician recommended so. The intervention consisted of a three-phase workshop: an open architecture story, building a car robot using the Lego Mindstorm EV3 kit, and cooperative playing activities such as races and passing obstacles. RESULTS: Thirteen patients received the intervention with robotic lego. The median age was 15 years (IQR = 3), and 84.6% of the population (n = 11) were male. We found significant improvement in the language (topic management p = .011 and communicative intention p = .034). Other characteristics improved, but not significantly (self-care activities index, catching). No adverse events occurred during the intervention. CONCLUSIONS: The results of this pilot study suggest that implementing social robotics during hospitalization in children with cancer is a therapeutic adjuvant and safe intervention that promotes better communication, self-care, and a physical activity improvement. For future studies, the impact of this intervention could be measured in hospitalized pediatric cancer patients.

Drebrin Regulates Collateral Axon Branching in Cortical Layer II/III Somatosensory Neurons.

Proper cortical lamination is essential for cognition, learning, and memory. Within the somatosensory cortex, pyramidal excitatory neurons elaborate axon collateral branches in a laminar-specific manner that dictates synaptic partners and overall circuit organization. Here, we leverage both male and female mouse models, single-cell labeling and imaging approaches to identify intrinsic regulators of laminar-specific collateral, also termed interstitial, axon branching. We developed new approaches for the robust, sparse, labeling of Layer II/III pyramidal neurons to obtain single-cell quantitative assessment of axon branch morphologies. We combined these approaches with cell-autonomous loss-of-function (LOF) and overexpression (OE) manipulations in an in vivo candidate screen to identify regulators of cortical neuron axon branch lamination. We identify a role for the cytoskeletal binding protein drebrin (Dbn1) in regulating Layer II/III cortical projection neuron (CPN) collateral axon branching in vitro LOF experiments show that Dbn1 is necessary to suppress the elongation of Layer II/III CPN collateral axon branches within Layer IV, where axon branching by Layer II/III CPNs is normally absent. Conversely, Dbn1 OE produces excess short axonal protrusions reminiscent of nascent axon collaterals that fail to elongate. Structure-function analyses implicate Dbn1S142 phosphorylation and Dbn1 protein domains known to mediate F-actin bundling and microtubule (MT) coupling as necessary for collateral branch initiation upon Dbn1 OE. Taken together, these results contribute to our understanding of the molecular mechanisms that regulate collateral axon branching in excitatory CPNs, a key process in the elaboration of neocortical circuit formation.SIGNIFICANCE STATEMENT Laminar-specific axon targeting is essential for cortical circuit formation. Here, we show that the cytoskeletal protein drebrin (Dbn1) regulates excitatory Layer II/III cortical projection neuron (CPN) collateral axon branching, lending insight into the molecular mechanisms that underlie neocortical laminar-specific innervation. To identify branching patterns of single cortical neurons in vivo, we have developed tools that allow us to obtain detailed images of individual CPN morphologies throughout postnatal development and to manipulate gene expression in these same neurons. Our results showing that Dbn1 regulates CPN interstitial axon branching both in vivo and in vitro may aid in our understanding of how aberrant cortical neuron morphology contributes to dysfunctions observed in autism spectrum disorder and epilepsy.

Calidad de vida profesional de quienes laboran en cuidados paliativos y su relación con el autocuidado, la atención plena y el sentido de vida / Professional quality of life of palliative care staff and its relationship with selfcare, mindfulness and meaning of life

Introducción: La calidad de vida profesional (que incluye satisfacción y fatiga por compasión) y sus factores asociados, han sido poco explorados en cuidados paliativos (CP) en Latinoamérica. Objetivo: Determinar la calidad de vida profesional en CP y su relación con el autocuidado, la capacidad de atención plena y el sentido de vida. Método: Estudio observacional, de corte transversal. Participaron profesionales laborando en CP en Colombia. Se empleó el PROQOL para evaluar satisfacción por compasión (SC), Burnout y trauma secundario (TS), el PSCS para examinar autocuidado, el MAAS para examinar atención plena y la Escala dimensional de sentido de vida (EDSV). Se realizaron análisis descriptivos, correlacionales y de regresión múltiple. Resultados: participaron 108 profesionales. Edad promedio 38 años, 55% médicos, 73% mujeres, 32,4% reportaron elevada afectación del bienestar por la Covid-19. El 85% obtuvieron puntuaciones medias o altas en SC, el 75,9% en Burnout y el 81,5% en TS (con medianas de 42.5, 21 y 12, respectivamente). Hubo una correlación positiva y significativa entre PSCS, MAAS y EDSV con SC, pero negativa y significativa con Burnout y TS. En conjunto, la SC, el MAAS y el autocuidado social tuvieron un efecto predictivo negativo sobre los niveles de Burnout (R2=0,535). Conclusiones: Aunque la mayoría de participantes están satisfechos con su labor, los índices de Burnout y TS fueron elevados durante el período de pandemia. El en conjunto, la satisfacción por compasión, la atención plena y el autocuidado social predijeron niveles menores de Burnout, indicando potenciales vías de apoyo para quienes ejercen CP (AU)

Introduction. Professional quality of life (involving compassion satisfaction and compassion fatigue) and its related factors have been poorly explored in Palliative Care (PC). Objectives. To determine the professional quality of life of PC practitioners in Colombia and its relationship with self-care, mindfulness and meaning of life. Methods. Observational cross-sectional study. Practicing professionals of PC of Colombia were invited. Compassion Satisfaction (CS), Burnout, and Secondary Trauma (ST) were assessed using PROQOL; selfcare was examined using PSCS; MAAS was used to assess Mindfulness capacity, and the Dimensional Scale of sense of life (EDSV) was also employed. Descriptive correlational, and multiple regression analyses were performed. Results. One-hundred and eight participants participated; mean age of 38 years, 73% women, 32,4% indicated high impact on their wellbeing due to Covid-19; 85% of participants showed medium-high scores on CS, 75,9% on Burnout, and 81,5% on ST (median scores of 42.5, 21, and 12, respectively). Scores on PSCS, MAAS and EDSV positively and significantly correlated with CS, and were negatively and significantly related with Burnout and ST. Altogether, SC, MAAS and social selfcare had a negative predictive effect on Burnout levels (R2=0.538). Conclusion. Although most participants were satisfied with their jobs, scores on Burnout, and TS were high during the Pandemic. Together, compassion satisfaction, mindfulness and social selfcare were predictive of lower levels of Burnout, signaling potential lines of intervention for PC practitioners (AU)

The vulnerabilities of Venezuelan immigrants in Brazil and Colombia from the perspective of Intervention Bioethics.

OBJECTIVE: To understand the vulnerabilities to which Venezuelan immigrants living in Brazil and Colombia are exposed, from the perspective of Intervention Bioethics. METHOD: Qualitative study, carried out through a semi-structured interview, with 15 immigrants living in Brasília-Brazil and 20 in Medellín-Colombia, analyzed by the IRAMUTEQ software, in the Descending Hierarchical Classification and Similitude Analysis modalities. RESULTS: The first thematic axis dealt with the reasons for immigrating, above all, difficulties in accessing food and health services. The second axis revealed the trajectory of the migration process, especially the adversities faced before arriving in the countries. The third axis highlighted the challenges of integration in the destination countries, with emphasis on the processes of exclusion and discrimination faced. CONCLUSION: It was observed that both Brazil and Colombia need, as proposed by Bioethics of Intervention, to develop policies to reduce the vulnerabilities of immigrants to guarantee a dignified life without discrimination against them.

Ernesto Bustamante Zuleta (1922-2021): pioneering teacher and practitioner of Colombian neurosurgery.

Ernesto Bustamante Zuleta (1922-2021) was an impactful Colombian neurosurgeon whose legacy is inextricably linked with the development of the neurosurgery specialty in Colombia. His detail-oriented approach to treatment complemented his reputation for mastery of the neurosciences. Never simply confined to the operating theater, this calm and considerate physician felt compelled to teach during his entire career. The result of his teaching made a lasting imprint on an entire generation of neurosurgeons who subsequently established a high standard of neurosurgical care in Colombia. A true pioneer, Bustamante comprehensively engaged in his field, from founding the country's first residency program in neurosurgery to successfully implementing technology in his procedures, performing many of Colombia's first neurosurgical interventions, and publishing extensively across various categories of medical science. This historical reflection highlights his enduring contributions to the field and considers his legacy through the witness testimony of many of his students and collaborators. The hope is that his contributions may be acknowledged in full, as he was a reserved person who never boasted of his own accomplishments. The authors also hope that those who did not have the opportunity to know him would be informed by the historical context of the development of Colombian neurosurgery and inspired by his conviction and altruism.

A history of Colombian neurosurgery: events, persons, and outcomes that have shaped the specialty in the country.

The history of Colombian neurosurgery is a collective legacy of neurosurgeon-scientists, scholars, teachers, innovators, and researchers. Anchored in the country's foundational values of self-determination and adaptability, these pioneers emerged from the Spanish colonial medical tradition and forged surgical alliances abroad. From the time of Colombian independence until the end of World War I, exchanges with the French medical tradition produced an emphasis on anatomical and systematic approaches to the emerging field of neurosurgery. The onset of American neurosurgical expertise in the 1930s led to a new period of exchange, wherein technological innovations were added to the Colombian neurosurgical repertoire. This diversity of influences culminated in the 1950s with the establishment of Colombia's first in-country neurosurgery residency program. A select group of avant-garde neurosurgeons from this period expanded the domestic opportunities for patients and practitioners alike. Today, the system counts 10 recognized neurosurgery residency programs and over 500 neurosurgeons within Colombia. Although the successes of specific individuals and innovations were considered, the primary purpose of this historical survey was to glean relevant lessons from the past that can inform present challenges, inspire new opportunities, and identify professional and societal goals for the future of neurosurgical practice and specialization.

Motivaciones y migración venezolana: análisis desde la bioética de intervención / Motivations and Venezuelan migration: bioethics of intervention-based analysis / Motivações e migração venezuelana: análise a partir da bioética da intervenção

Resumen Este estudio cualitativo tuvo como objetivo analizar, desde la perspectiva de la bioética de intervención, las motivaciones de la migración de venezolanos que residen en la ciudad de Medellín, Colombia. Se entrevistaron a 20 personas, de las cuales 9 son hombres y 11 mujeres, y los datos recolectados se procesaron en el software IRAMUTEQ. Los ejes que resultaron del análisis de las entrevistas fueron: 1) acceso a los servicios de salud en Venezuela y Colombia; 2) acceso a los medicamentos y alimentos; y 3) proceso migratorio para Colombia, que sirvieron como referentes que dialogan con la perspectiva bioética de intervención. En conclusión, la alimentación y la salud tienen un papel preponderante en la vida de los sujetos como derechos humanos de primera necesidad, y se refuerza el papel del Estado en la promoción de políticas que garanticen los derechos civiles, económicos, sociales y culturales a los migrantes.

Abstract This qualitative study aimed to analyze from the perspective of intervention bioethics, the motivations for migration in Venezuelans residing in the city of Medellín-Colombia. Twenty people were interviewed, being 9 men and 11 women. The collected data was processed through the IRAMUTEQ software. The thematic axes that resulted from the analysis of the interviews; the first thematic axis, access to health services in Venezuela and Colombia; the second thematic axis, access to medicines and food; the third and last axis, the migratory process for Colombia, it served as references that dialogue with the selected bioethical perspective. In conclusion, food and health have a preponderant role in the lives of people, as essential human rights, the role of States is reinforced in promoting policies that guarantee civil, economic, social and cultures rigths of migrants.

Resumo Este estudo qualitativo teve como objetivo analisar, na perspectiva da bioética de intervenção, as motivações para a migração de venezuelanos residentes na cidade de Medellín, Colômbia. Foram entrevistadas 20 pessoas, sendo nove homens e 11 mulheres, e os dados coletados foram processados por meio do software Iramuteq. Os eixos que resultaram da análise das entrevistas foram: 1) acesso aos serviços de saúde na Venezuela e na Colômbia; 2) acesso a medicamentos e alimentação; e 3) processo migratório para a Colômbia, que serviram de referencial que dialoga com a perspectiva bioética de intervenção. Em conclusão, a alimentação e a saúde têm um papel preponderante na vida dos sujeitos como direitos humanos básicos, sendo papel do Estado promover políticas que garantam os direitos civis, econômicos, sociais e culturais aos migrantes.

Estrategias de acceso a los alimentos implementadas en Venezuela por un grupo de venezolanos que viven en Cuiabá, Brasil / Food access strategies implemented in Venezuela by a group of Venezuelans living in Cuiabá, Brazil

Resumen La crisis sociopolítica de Venezuela ha generado diversos problemas como la inseguridad alimentaria, la escasez de productos básicos y medicinas, el aumento del desempleo y la migración masiva hacia otros países de la región. Este estudio tuvo por objetivo identificar las estrategias de acceso a los alimentos vividas en Venezuela por los inmigrantes venezolanos que residen en Cuiabá, en Mato Grosso, Brasil. Esta investigación se realizó bajo el enfoque cualitativo para indagar cómo fue el impacto respecto al acceso y consumo de alimentos en Venezuela vivido por los inmigrantes venezolanos desde la documentación, descripción y comprensión de las experiencias que ellos enfrentan. Se incluyeron 13 participantes, la técnica de recolección de datos que se utilizó fueron las entrevistas individuales. Entre los principales hallazgos encontrados se evidenció que la mayoría de los entrevistados no se sentía a gusto con la alimentación que tenía en Venezuela, dadas las pocas condiciones de acceso y disponibilidad de alimentos, muchos de estos manifestaron percepciones de hambre y angustia por la falta de alimentos, y estas situaciones llevaron a buscar mejores condiciones de vida. La crisis en Venezuela que produjo la poca disponibilidad y acceso a los alimentos les generó estrategias para poder garantizar una alimentación permanente dentro de los hogares donde muchas veces estas estrategias no son acordes a una alimentación saludable y adecuada.

Abstract The socio-political crisis in Venezuela has generated various problems, such as food insecurity, shortages of basic products and medicines, increased unemployment and massive migration to other countries in the region. To identify the strategies for access to food experienced by Venezuelan immigrants residing in Cuiabá-MT, Brazil. This research was conducted under the qualitative approach, this approach allowed us to investigate how was the impact regarding the access and consumption of food in Venezuela lived by Venezuelan immigrants residing in Cuiabá - Brazil, from the documentation, description and understanding of the experiences they face; 13 participants were included, the data collection technique used were individual interviews. Among the main findings was that most of the interviewees did not feel comfortable with the food they had in Venezuela, given the poor conditions of access and availability of food, many of them expressed perceptions of hunger and anguish due to the lack of food and these situations led them to seek better living conditions. The socio-political crisis in Venezuela that produced the lack of availability and access to food, generated strategies to ensure a permanent food supply within households where often these strategies are not in line with a healthy and adequate diet.

The vulnerabilities of Venezuelan immigrants in Brazil and Colombia from the perspective of Intervention Bioethics / Las vulnerabilidades de los inmigrantes venezolanos en Brasil y en Colombia bajo la perspectiva de la Bioética de Intervención / As vulnerabilidades dos imigrantes venezuelanos no Brasil e na Colômbia na perspectiva da Bioética de Intervenção

ABSTRACT Objective: To understand the vulnerabilities to which Venezuelan immigrants living in Brazil and Colombia are exposed, from the perspective of Intervention Bioethics. Method: Qualitative study, carried out through a semi-structured interview, with 15 immigrants living in Brasília-Brazil and 20 in Medellín-Colombia, analyzed by the IRAMUTEQ software, in the Descending Hierarchical Classification and Similitude Analysis modalities. Results: The first thematic axis dealt with the reasons for immigrating, above all, difficulties in accessing food and health services. The second axis revealed the trajectory of the migration process, especially the adversities faced before arriving in the countries. The third axis highlighted the challenges of integration in the destination countries, with emphasis on the processes of exclusion and discrimination faced. Conclusion: It was observed that both Brazil and Colombia need, as proposed by Bioethics of Intervention, to develop policies to reduce the vulnerabilities of immigrants to guarantee a dignified life without discrimination against them.

RESUMEN Objetivo: Comprender las vulnerabilidades a las que están expuestos los inmigrantes venezolanos que viven en Brasil y Colombia, bajo la perspectiva de la Bioética de la Intervención. Método: Se trata de un estudio cualitativo, llevado a cabo mediante entrevista semiestructurada, entre 15 inmigrantes que viven en Brasilia, Brasil y entre otros 20 en Medellín, Colombia. Los datos se analizaron con el programa IRAMUTEQ, según las modalidades Clasificación Jerárquica Descendente y Análisis de Similitud. Resultados: El primer eje temático abordó las razones para emigrar, especialmente las dificultades para acceder a la alimentación y a los servicios sanitarios. El segundo eje reveló la trayectoria del proceso migratorio, principalmente lo relacionado a las adversidades afrontadas hasta la llegada a los países de destino. El tercer eje destacó los retos de la integración en dichos países, haciendo hincapié en los procesos de exclusión y discriminación a los que se enfrentan los inmigrantes. Conclusión: Se observó que tanto Brasil como Colombia necesitan, conforme la Intervención Bioética, desarrollar políticas para reducir las vulnerabilidades de los inmigrantes con el fin de garantizarles una vida digna y sin discriminación.

RESUMO Objetivo: Compreender as vulnerabilidades a que estão expostos os imigrantes venezuelanos radicados no Brasil e na Colômbia, na perspectiva da Bioética de Intervenção. Método: Estudo qualitativo, realizado por meio de entrevistada semiestruturada, com 15 imigrantes que vivem em Brasília-Brasil e com 20, em Medellín-Colômbia, analisados pelo software IRAMUTEQ, nas modalidades Classificação Hierárquica Descendente e Análise de Similitude. Resultados: O primeiro eixo temático tratou dos motivos para imigrar, sobretudo, as dificuldades de acesso aos alimentos e aos serviços de saúde. O segundo eixo revelou a trajetória do processo migratório, especialmente as adversidades enfrentadas até a chegada aos países. O terceiro eixo evidenciou os desafios da integração nos países de destino, com destaque para os processos de exclusão e discriminação enfrentados. Conclusão: Observou-se que tanto o Brasil como a Colômbia precisam, conforme propõe a Bioética de Intervenção, desenvolver políticas de redução das vulnerabilidades dos imigrantes para garantir uma vida digna e sem discriminação a eles.

Virtual Reality Game for Physical and Emotional Rehabilitation of Landmine Victims.

Landmine victims require an engaging and immersive rehabilitation process to maintain motivation and therapeutic adherence, such as virtual reality games. This paper proposes a virtual reality exercise game called Exogames, which works with Nukawa, a lower limb rehabilitation robot (LLRR). Together, they constitute the general Kina system. The design and development process of Exogames is reported, as well as the evaluation of its potential for physical and emotional rehabilitation. In an initial survey designed ad-hoc, 13 health professionals evaluated compliance with various requirements. They agreed that Exogames would help the user focus on rehabilitation by providing motivation; 92.3% said that the user will feel safe in the virtual world, 66.7% of them agreed or totally agreed that it presents characteristics that may enhance the physical rehabilitation of lower limbs for amputees, 83.3% stated that it would promote the welfare of landmine victims, and 76.9% responded that the graphical interface and data report are useful for real-time assessment, and would be helpful for four interventional areas in all rehabilitation stages. In a second evaluation, using standardized surveys, five physical therapists and one lower limb amputee tried the Kina system as users. They filled out the System Usability Scale (SUS), the Physical Activity Enjoyment Scale (PACES), and the Game Experience Questionnaire (GEQ). The usability of the Kina system overall score was 69 (66, 79) out of 100, suggesting an acceptable though improvable usability. The overall PACES score of 110 (108, 112) out of 126 suggests that users enjoyed the game well. Finally, users indicated a positive effect with a good sense of immersion and smooth of gameplay during the tests, as indicated by the GEQ results. In summary, the evaluations showed that Exogames has the potential to be used as a virtual reality game for the physical and emotional rehabilitation of landmine victims.

Consenso colombiano de expertos sobre recomendaciones basadas en evidencias para el diagnóstico, el tratamiento y el seguimiento de la enfermedad de Fabry con compromiso renal

Contexto: la enfermedad de Fabry se comporta como una enfermedad crónica con compromiso multisistémico y alto costo en salud. Objetivo: generar recomendaciones basadas en la evidencia para el diagnóstico, el tratamiento y el seguimiento de la enfermedad de Fabry con compromiso renal mediante un consenso de expertos. Metodología: a partir de la búsqueda de evidencia en Pubmed, Embase y Google Scholar entre 2010 y agosto 2020, se formulan recomendaciones sobre la definición, el diagnóstico y el tratamiento de la enfermedad de Fabry en población adulta, las cuales se consultan a un panel de expertos a través de la metodología de consenso Delphi modificado. La calidad de los documentos se evaluó por equipo metodológico aplicando herramientas en función del tipo de documento incluido. Resultados: se formularon 53 recomendaciones sobre la definición, el diagnóstico y el tratamiento. Un panel de cinco expertos clínicos nacionales e internacionales externos al grupo desarrollador participaron en la consulta preconsenso y 50 recomendaciones fueron acordadas para su inclusión, para tres de ellas se requirió una sesión formal de consenso que se dio en una ronda, incorporando tres nuevas recomendaciones. Conclusiones: las recomendaciones basadas en evidencia y experticia clínica permitirán orientar de manera estandarizada a nivel nacional y regional, el diagnóstico y el tratamiento de pacientes con sospecha o enfermedad de Fabry con compromiso renal.

Background: Fabry disease behaves like a chronic condition, with multisystem involvement and high health care costs. Objective: To generate evidence-based recommendations for the diagnosis, treatment and follow-up of the Anderson-Fabry disease with renal commitment, through an expert consensus. Methodology: Based on the search of evidence in PubMed, Embase and Google Scholar between 2010 and August, 2020, recommendations on the definition, diagnosis and treatment of Fabry Disease in adult population were formulated after consulting with an expert panel through the modified Delphi consensus methodology. The quality of the documents was assessed by methodological team applying tools according to the type of document included. Results: 53 recommendations for the definition, diagnosis and treatment were formulated. A panel of five national and international clinical experts external to the developer group participated in the pre-consensus consultation and 50 recommendations were agreed upon for their inclusion. For 3 recommendations, a formal consensus session which took place in one round was required, and 3 new recommendations were incorporated. Conclusions: The recommendations based on evidence and clinical expertise will allow us to guide the diagnosis and treatment of patients with Fabry disease with renal involvement or suspicion thereof in a standardized manner at national and regional levels.

A Review on Deep Learning Techniques for Video Prediction.

The ability to predict, anticipate and reason about future outcomes is a key component of intelligent decision-making systems. In light of the success of deep learning in computer vision, deep-learning-based video prediction emerged as a promising research direction. Defined as a self-supervised learning task, video prediction represents a suitable framework for representation learning, as it demonstrated potential capabilities for extracting meaningful representations of the underlying patterns in natural videos. Motivated by the increasing interest in this task, we provide a review on the deep learning methods for prediction in video sequences. We first define the video prediction fundamentals, as well as mandatory background concepts and the most used datasets. Next, we carefully analyze existing video prediction models organized according to a proposed taxonomy, highlighting their contributions and their significance in the field. The summary of the datasets and methods is accompanied with experimental results that facilitate the assessment of the state of the art on a quantitative basis. The paper is summarized by drawing some general conclusions, identifying open research challenges and by pointing out future research directions.

Prevalence and characteristics of patients with heart failure needing palliative care.

BACKGROUND: Few hospitals and heart failure (HF) clinics offer concurrent palliative care (PC) together with life-prolonging therapies. To know the prevalence of patients in HF clinics needing PC and useful tools to recognize them are the first steps to extending PC in those settings. However, it is still unknown whether tools commonly used to identify patients with HF needing PC can correctly distinguish them. Two systematic reviews found that the NECesidades PALiativas (NECPAL) tool was one of the two most commonly used tools to asses PC needs in HF patients. Therefore, we assessed 1) the prevalence of PC needs in HF clinics according to the NECPAL tool, and 2) the characteristics of the patients identified as having PC; mainly, their quality of life (QoL), symptom burden, and psychosocial problems. METHODS: This cross-sectional study was conducted at two HF clinics in Colombia. We assessed the prevalence of PC in the overall sample and in subgroups according to clinical and demographic variables. We assessed QoL, symptom burden, and psychosocial problems using the 12-Item Short-Form Health Survey (SF-12), the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Edmonton Symptom Assessment System (ESAS). We compared the results of these tools between patients identified as having PC needs (+NECPAL) and patients identified as not having PC needs (-NECPAL). RESULTS: Among the 178 patients, 78 (44%) had PC needs. The prevalence of PC needs was twice as nigh in patients NYHA III/IV as in patients NYHA I/II and almost twice as high in patients older than 70 years as in patients younger than 70 years. Compared to -NECPAL patients, +NECPAL patients had worse QoL, more severe shortness of breath, tiredness, drowsiness, and pain, and more psychosocial problems. CONCLUSION: The prevalence of PC needs in outpatient HF clinics is high and is even higher in older patients and in patients at more advanced NYHA stages. Compared to patients identified as not having PC needs, patients identified as having PC needs have worse QoL, more severe symptoms, and greater psychosocial problems. Including a PC provider in the multidisciplinary team of HF clinics may help to assess and cover these needs.

The 'Surprise question' in heart failure: a prospective cohort study.

OBJECTIVE: The Surprise Question (SQ) is a prognostic screening tool used to identify patients with limited life expectancy. We assessed the SQ's performance predicting 1-year mortality among patients in ambulatory heart failure (HF) clinics. We determined that the SQ's performance changes according to sex and other demographic (age) and clinical characteristics, mainly left ventricular ejection fraction (LVEF) and the New York Heart Association (NYHA) functional classifications. METHODS: We conducted a prospective cohort study in two HF clinics. To assess the performance of the SQ in predicting 1-year mortality, we calculated the sensitivity, specificity, positive and negative likelihood ratios, and the positive and negative predictive values. To illustrate if the results of the SQ changes the probability that a patient dies within 1 year, we created Fagan's nomograms. We report the results from the overall sample and for subgroups according to sex, age, LVEF and NYHA functional class. RESULTS: We observed that the SQ showed a sensitivity of 85% identifying ambulatory patients with HF who are in the last year of life. We determined that the SQ's performance predicting 1-year mortality was similar among women and men. The SQ performed better for patients aged under 70 years, for patients with reduced or mildly reduced ejection fraction, and for patients NYHA class III/IV. CONCLUSIONS: We consider the tool an easy and fast first step to identify patients with HF who might benefit from an advance care planning discussion or a referral to palliative care due to limited life expectancy.

Muertes por desnutrición en América del Sur en los últimos veinte años / Deaths due to Malnutrition in South America in the last Twenty Years

Resumen Introducción. El hambre es uno de los principales referentes en la política mundial de seguridad alimentaria. Sin embargo, cada año mueren miles de personas a causa de la falta de ingesta de alimentos. Objetivo. Evaluar el número de fallecimientos por desnutrición en América del Sur, en un periodo correspondiente a los últimos veinte años de información. Materiales y métodos. Se empleó el modelo lineal general, incorporando la prueba de Tukey con base en un nivel de significancia estadístico del 5%. Adicionalmente, se llevó a cabo la técnica multivariada clúster. Resultados. El mayor número de muertes por desnutrición ocurrió en los niños menores de cuatro años y en adultos mayores. El mayor porcentaje de muertes por desnutrición en niños menores de un año se presentó en Venezuela (23,9% mujeres; 25,4% hombres). Chile tiene el menor porcentaje de muertes por desnutrición en menores de un año (0,4% mujeres; 0,5% hombres). Conclusión. A pesar de que los países de América del Sur presentan gran disponibilidad de alimentos, las muertes por hambre siguen siendo prevalentes en parte de la región.

Abstract Introduction. Hunger is one of the main issues in the world food security policy, however, thousands of people die every year due to lack of food intake. Objective. To evaluate the number of deaths due to malnutrition in South America, in a period corresponding to the last twenty years of information. Materials and methods. The general linear model was used, incorporating the Tukey test based on a level of statistical significance of 5%. Additionally, the multivariate cluster technique was carried out. Results. The highest number of deaths due to malnutrition occurred in children under four years of age and in older adults. The highest percentage of deaths due to malnutrition in children under one year old occurred in Venezuela (23.9% women; 25.4% men). Chile has the lowest percentage of deaths due to malnutrition in children under one year of age (0.4% women; 0.5% men). Conclusion. Although the countries of South America have high food availability, starvation deaths remain prevalent in part of the region.

Efecto de terapias farmacológicas para el control glicémico en pacientes con diabetes mellitus tipo 2 en los desenlaces vasculares / Effect of pharmacological therapies for glycemic control in patients with type 2 diabetes mellitus on vascular outcomes

Resumen Introducción: en los últimos 5 años la publicación de conocimiento relacionado con la enfermedad vascular y la diabetes mellitus tipo 2 (DT2) ha ido en aumento. Sin embargo, debido a la ausencia de una revisión que recopilara todos los desenlaces vasculares de la DT2, la presente revisión de literatura tiene como objetivo agrupar todos los desenlaces vasculares relacionados con la DT2 y describir cómo la terapia farmacológica hipoglicemiante puede ser eficaz para lograr el control de estos desenlaces. Los eventos cardiovasculares como desenlace principal demuestran que los medicamentos antidiabéticos innovadores como la empagliflozina y la liraglutida pueden agregar un beneficio significativo para pacientes con DT2. Materiales y métodos: búsqueda sistemática de la literatura, de la cual se obtuvieron 141 referencias, después de eliminar duplicados, para la tamización pareada. Posterior a esto, se identificaron 2l referencias que cumplían con los criterios de inclusión para ser considerados en el análisis. Resultados: el efecto de un buen control glucémico, sobre los resultados clínicos, específicamente en la progresión de la enfermedad renal diabética, ha sido objetivo de múltiples estudios a gran escala, tanto en pacientes diabéticos tipo 1 como en diabéticos tipo 2. Los desenlaces micro y macrovasculares son los principales desenlaces de la DMT2, que incrementan la incidencia de comorbilidades y representan, a su vez, una mayor morbilidad. Conclusiones: dentro de las principales causas de morbilidad y mortalidad de los pacientes con DT2, se encuentran las relacionadas con daño vascular, en especial enfermedad cardiovascular y compromiso renal. En este contexto, el tratamiento farmacológico de la diabetes mellitus se ha enfocado en encontrar medicamentos que reduzcan de manera significativa los eventos cardiovasculares y que al mismo tiempo retrasen la aparición de nefropatía o su progresión. Las tiazolidinedionas, los inhibidores de DPP4 (alogliptina, saxagliptina y sitagliptina), la insulina glargina y degludec han demostrado seguridad cardiovascular, pero no beneficio cardiovascular incremental en pacientes con DT2 que tienen alto riesgo de enfermedad cardiovascular aterosclerótica.

Abstract Introduction: In the last 5 years the publication of knowledge related to vascular disease and diabetes mellitus type 2 (DT2) has been increasing. However, due to the absence of a review that collects all the vascular outcomes of T2D, the current review of the literature aims to group all vascular outcomes related to T2D and describe how hypoglycemic drug therapy can be effective for the control of these outcomes. Cardiovascular events as the main outcome show that innovative antidiabetic drugs such as empagliflozin and liraglutide can add significant benefits for patients with T2D. Materials and methods: Systematic search of the literature, from which 141 references were obtained, after eliminating duplicates, for paired screening. Subsequently, 21 references were identified that met the inclusion criteria to be considered in the analysis. Results: The effect of good glycemic control on clinical outcomes, specifically in the progression of diabetic kidney disease, has been the objective of multiple large-scale studies, both in type 1 diabetic patients and type 2 diabetics and macrovascular outcome of the primary DMT2, increasing the incidence of comorbidities and in turn representing greater morbidity. Conclusions: Among the main causes of morbidity and mortality of patients with T2D, are those with vascular damage, especially cardiovascular disease and renal involvement. In this context, the pharmacological treatment of diabetes mellitus has focused on finding drugs that reduce the importance of cardiovascular events and that at the same time delay the onset of nephropathy or its progression. Thiazolidinediones, DPP4 inhibitors (alogliptin, saxagliptin and sitagliptin), insulin glargine and degludec have demonstrated cardiovascular safety, but not incremental cardiovascular benefits, in patients with T2D who are at high risk of atherosclerotic cardiovascular disease.

Consumo de fruta en puestos callejeros de once países iberoamericanos. Estudio multicéntrico / Consumption of fruit in street posts from eleven iberoamerican countries. Multicentric study

INTRODUCCIÓN: La ingesta de comida en la calle es una práctica muy común en personas que trabajan. Hay una gran oferta de comida callejera; Las frutas son siempre parte de esta oferta y se pueden encontrar en diferentes presentaciones. OBJETIVO: Analizar la frecuencia del consumo de fruta en las vías públicas de América Latina. MATERIAL Y MÉTODOS: Se realizó un estudio transversal utilizando un cuestionario de 15 preguntas en formato Google Docs, que fue validado por el método Delphi y aplicado en 11 países: Argentina, Brasil, Chile, Colombia, Costa Rica, Guatemala, Panamá, Paraguay, Perú, Portugal y Uruguay. RESULTADOS: Se encuestó a 8885 personas, más del 50% consume alimentos en la vía pública. Entre los países más consumidores, se destacan Colombia (78%) y Guatemala (76%), seguido de Perú (66%). Con respecto al consumo de fruta en la vía pública, se observa que existe un mayor consumo en Portugal (61%), seguido de Colombia (55%) y Guatemala (51%), y los países con menor consumo son Argentina (26%) y Uruguay (20%). El consumo de fruta en la calle es el mismo en ambos sexos en la mayoría de los países. Por otro lado, en Portugal, Colombia, Argentina, Costa Rica y Chile, el mayor consumo corresponde a personas con educación superior (universitaria o de posgrado). CONCLUSIONES: El consumo de alimentos en la calle es alto en todos los países, incluido el consumo de frutas. Esto puede transformarse en una oportunidad para alentar su consumo, pero los puestos de la calle deben ajustarse a los requisitos necesarios para ofrecer alimentos seguros

INTRODUCTION: The street food intake is a very common practice in working people. There is a great supply of street food; fruits are always part of this offer and can be found in different presentations Objetive: To analyze the frequency of fruit consumption in public roads in Latin America. MATERIAL AND METHODS: A cross-sectional study was carried out using a questionnaire of 15 questions in Google Docs format, which was validated by Delphi method and applied in 11 countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Guatemala, Panama, Paraguay, Peru, Portugal and Uruguay. RESULTS: It was surveyed 8885 people, over 50% consume food on public roads; among the most consuming countries, it is highlighted Colombia (78%) and Guatemala (76%), followed by Peru (66%). With respect to fruit consumption on public roads, it is observed that there is higher consumption in Portugal (61%), followed by Colombia (55%) and Guatemala (51%), and the countries with less consumption are Argentina (26%) and Uruguay (20%). Fruit consumption in the street is the same in both sexes in the most countries. On the other hand, in Portugal, Colombia, Argentina, Costa Rica and Chile, the highest consumption correspond to people with higher education (university or post-graduate). CONCLUSION: Street food consumption is high in all countries, including consumption of fruits. This can be transformed into an opportunity to encourage their consumption, but street posts must be adjusted to the necessary requirements to offer safe food

Evaluación cuantitativa de riesgos microbiológicos asociado con el consumo de agua del río Chicamocha en Boavita- Boyacá / Quantitative microbiological risks assessment associated with the consumption of water of Chicamocha river in Boavita-Boyacá

RESUMEN Los habitantes del sector El Terrenal, del municipio de Boavita-Boyacá, al no contar con el servicio de acueducto, utilizan las aguas del río Chicamocha, para la preparación de sus alimentos, limpieza y aseo personal. El objetivo de este estudio fue evaluar bacterias y protozoos presentes en el cuerpo de agua del río Chicamocha, a través de un análisis cuantitativo de riesgo microbiológico (ACRM). Para el desarrollo del trabajo, se realizaron cuatro muestreos, de abril a junio de 2016, en los márgenes y centro del río y un quinto muestreo de agua tratada con la planta Opuntia ficus-indica (Tuno). Se realizó el método de recuento en placa, usándose medios selectivos y diferenciales para el aislamiento de Escherichia coli, Salmonella, Enterococcus y la técnica de MacMaster, para la determinación de parásitos gastrointestinales (PGI). Para el análisis de la información, se emplearon los estadísticos no paramétricos de Kruskall-Wallis y U-Mann Whitney. Se determinó que, al menos, un lugar de muestreo es estadísticamente diferente a otro para Enterococcus faecium (P= 0,000) y los ooquistes de Entamoeba histolytica (P= 0,000). Por el contrario, para Escherichia coli no se observaron diferencias significativas entre las zonas, pero sí al menos una fecha de muestreo fue estadísticamente diferente (P= 0,026) a otra. En el agua tratada, se observó una disminución de los ooquistes de E. histolytica y un aumento en el porcentaje de E. faecium (P= 0,035).

ABSTRACT The habitants of the El Terrenal sector of the municipality of Boavita-Boyacá, have no access to the aqueduct service, and use water of the Chicamocha River for preparation of food, housework and personal hygiene. The aim of this study was to evaluate the presence of pathogenic bacteria and protozoa, present in the water body of the Chicamocha River, through a quantitative analysis of microbiological risk (ACRM). For the development of the work, four samples were conducted from April to June 2016, in the margins and center of the river, and a fifth sample of water treated with the plant Opuntia ficus-indica (Tuno). The method of plate count was performed, using selective and differential media for the isolation of Escherichia coli, Salmonella, Enterococcus and the MacMaster technique for the determination of gastrointestinal parasites (PGI). For the analysis of the information the nonparametric statistics of Kruskall Wallis and U-Mann Whitney were used. It was determined that at least one sampling site is statistically different from another for Enterococcus faecium (P = 0.000) and the oocysts of Entamoeba histolytica (P = 0.000). In contrast, for Escherichia coli no significant differences were observed between the zones, but if at least one sampling date was statistically different (P =0.026) to another. In the treated water there was a decrease in the oocysts of E. histolytica and an increase in the percentage of E. faecium (P= 0,035).

El Contractualismo como fundamento de implicación en cuestiones morales sobre la naturaleza y el ambiente / Contractualism as the foundation of involvement in moral issues about nature and the environment / O contratualismo como base para o envolvimento em questões morais sobre a natureza e o meio ambiente

El presente texto busca hacer un recorrido a través de una propuesta ética antropocéntrica, con el fin de establecer un tipo de vínculo moral que incluya a todos los agentes racionales, en el ejercicio de un actuar moral en pro del ambiente y los animales. Para ello, se analiza, define y propone, de manera particular, una ética contractual basada en varios aportes teóricos de diferentes autores contractualistas. Para, posteriormente, derivar las llamadas responsabilidades morales indirectas que recaen sobre los pacientes morales, que, para este caso, son los animales y el medio ambiente, de manera que se confirme la existencia de principios de acción moral, que puedan ser aceptados de manera razonable por todos los agentes contractuales.

The present text seeks to make a journey through an anthropocentric ethical proposal, in order to establish a type of moral bond that includes all rational agents, in the exercise of a moral act in favor of the environment and animals. For this purpose, a contractual ethical proposal based on several theoretical contributions of different contractarian authors is analyzed, defined and established in a particular way. To, subsequently, derive the so-called indirect moral responsibilities that fall on moral patients, which for this case are the animals and the environment, so that the existence of principles of moral action, which can be reasonably accepted by all parties, is confirmed contractual agents.

O presente texto busca fazer uma jornada através de uma proposta ética antropocêntrica, a fim de estabelecer um tipo de vínculo moral que inclua todos os agentes racionais, no exercício de um ato moral a favor do meio ambiente e dos animais. Para isso, uma proposta ética contratual baseada em diversas contribuições teóricas de diferentes autores contratuais é analisada, definida e estabelecida de maneira particular. Para, posteriormente, derivar as chamadas responsabilidades morais indiretas que se enquadram em pacientes morais, que, neste caso, são os animais e o meio ambiente, de modo que a existência de princípios de ação moral, que pode ser razoavelmente aceita por todas as partes, seja confirmada agentes contratuais.