HIV/AIDS infection in critical care: epidemiological profile and risk factors for mortality in a Colombian cohort.

INTRODUCTION: Outcomes of human immunodeficiency virus (HIV) infected patients admitted to intensive care units (ICU) have improved with antiretroviral therapy (ART). However, whether the outcomes have improved in low- and middle-income countries, paralleling those of high-income countries is unknown. The objective of this study was to describe a cohort of HIV-infected patients admitted to ICU in a middle-income country and identify the risk factors associated with mortality. METHODOLOGY: A cohort study of HIV-infected patients admitted to five ICUs in Medellín, Colombia, between 2009 and 2014 was done. The association of demographic, clinical and laboratory variables with mortality was analyzed using a Poisson regression model with random effects. RESULTS: During this time period, 472 admissions of 453 HIV-infected patients were included. Indications for ICU admission were: respiratory failure (57%), sepsis/septic shock (30%) and central nervous system (CNS) compromise (27%). Opportunistic infections (OI) explained 80% of ICU admissions. Mortality rate was 49%. Factors associated with mortality included hematological malignancies, CNS compromise, respiratory failure, and APACHE II score ≥ 20. CONCLUSIONS: Despite advances in HIV care in the ART era, half of HIV-infected patients admitted to the ICU died. This elevated mortality was associated to underlying disease severity (respiratory failure and APACHE II score ≥ 20), and host conditions (hematological malignancies, admission for CNS compromise). Despite the high prevalence of OIs in this cohort, mortality was not directly associated to OIs.

Genetic Diversity of Multidrug-Resistant Pseudomonas aeruginosa Isolates Carrying bla VIM-2 and bla KPC-2 Genes That Spread on Different Genetic Environment in Colombia.

Pseudomonas aeruginosa is an opportunistic Gram-negative pathogen with an increase in the frequency of infections caused by multidrug resistant (MDR) and extensively drug resistant (XDR) strains, limiting the available therapeutic options. The most troublesome resistance is the acquisition and production of carbapenemases such as Verona integron-encoded metallo-ß-lactamases (VIM), the most frequent and widespread, and the Klebsiella pneumoniae carbapenemases (KPC), which has continuously spread in the last decade. Its dissemination is linked to their location on mobile genetic elements (MGEs). In Colombia, VIM and KPC have been increasing in its frequency showing major successful dissemination. In this article, we molecularly characterized and analyzed the genetic context of bla VIM and bla KPC in carbapenem-resistant P. aeruginosa (CRPA) isolates from infected and colonized patients in two tertiary-care hospitals, one in Medellín and the other in a municipality close to Medellín, both areas with high carbapenemase endemicity in Colombia (2013-2015). Using whole-genome sequencing (WGS), we identified a remarkable variety of genetic backgrounds in these MDR P. aeruginosa isolates carrying bla KPC- 2 and bla VIM- 2. There were a diversity of class 1 integron and variations in the gene cassettes associated to bla VIM- 2, as well as a possible event of spread of bla KPC- 2 mediated by a plasmid that contained part of Tn4401b in one infection case. The dissemination of bla VIM- 2 and bla KPC- 2 in P. aeruginosa in this area in Colombia has been strongly influenced by successful international clones, carrying these genes and additional determinants of resistance on MGEs, accompanied by gene rearrangement under an antimicrobial selection pressure. These findings emphasize the need to implement control strategies based on rational antibiotic use.

Linfadenitis cervical por Salmonella no Typhi en una paciente diabética / Cervical lymphadenitis caused by no typhoid Salmonella in a diabetic patient

Resumen La infección por Salmonella no Typhi es una de las enfermedades transmitidas por alimentos más común y ampliamente extendida en el mundo. Aunque la mayoría de los casos se limitan al tracto gastrointestinal, el compromiso extraintestinal no es infrecuente. Sin embargo, la adenitis como manifestación aislada, es una forma inusual de presentación de la enfermedad. Comunicamos el caso clínico de una mujer de 67 años de edad con diagnóstico de diabetes mellitus y una linfadenitis cervical por Salmonella no Typhi tratada con ciprofloxacina y y que requirió resección quirúrgica.

No Typhoid Salmonella infection is one of the most common and widely spread foodborne diseases worldwide. Although most cases are limited to the gastrointestinal tract, extraintestinal involvement is not uncommon. However, adenitis as an isolated manifestation, is an unusual form of the disease. We report a case of Salmonella no Typhoid cervical lymphadenitis in a 67-year-old female with a recent diagnosis of diabetes mellitus, who was treated with surgery and ciprofloxacin.

[Cervical lymphadenitis caused by no typhoid Salmonella in a diabetic patient]. / Linfadenitis cervical por Salmonella no Typhi en una paciente diabética.

No Typhoid Salmonella infection is one of the most common and widely spread foodborne diseases worldwide. Although most cases are limited to the gastrointestinal tract, extraintestinal involvement is not uncommon. However, adenitis as an isolated manifestation, is an unusual form of the disease. We report a case of Salmonella no Typhoid cervical lymphadenitis in a 67-year-old female with a recent diagnosis of diabetes mellitus, who was treated with surgery and ciprofloxacin.

Malignant Transformation of Hymenolepis nana in a Human Host.

Neoplasms occur naturally in invertebrates but are not known to develop in tapeworms. We observed nests of monomorphic, undifferentiated cells in samples from lymph-node and lung biopsies in a man infected with the human immunodeficiency virus (HIV). The morphologic features and invasive behavior of the cells were characteristic of cancer, but their small size suggested a nonhuman origin. A polymerase-chain-reaction (PCR) assay targeting eukaryotes identified Hymenolepis nana DNA. Although the cells were unrecognizable as tapeworm tissue, immunohistochemical staining and probe hybridization labeled the cells in situ. Comparative deep sequencing identified H. nana structural genomic variants that are compatible with mutations described in cancer. Invasion of human tissue by abnormal, proliferating, genetically altered tapeworm cells is a novel disease mechanism that links infection and cancer.

Long-term/bioinert labeling of rat mesenchymal stem cells with PVA-Gd conjugates and MRI monitoring of the labeled cell survival after intramuscular transplantation.

Noninvasive in vivo imaging of transplanted stem cells is an effective method to clarify the mechanisms involved in stem cell transplantation therapy. We labeled rat mesenchymal stem cells (MSCs) with water-soluble magnetic resonance imaging (MRI) contrast agent poly(vinyl alcohol)-gadolinium (PVA-Gd) in order to ascertain the fate of transplanted MSCs in vivo. PVA-Gd was retained and localized in the cytosolic compartment of MSCs for a longer period of time. The effect of PVA-Gd labeling on MSC proliferation was much less than that of the commercially available contrast agent ProHance, and the labeled MSCs were found to have osteoblastic differentiation ability. To study the MSC lifetime in vivo, MSCs were seeded and trapped in the cytocompatible three-dimensional porous scaffolds of Spongel and transplanted. The MRI signal attributed to MSCs was eliminated from the transplanted site in 14 days. Because free PVA-Gd was rapidly eliminated from the site, this signal reduction indicated MSC death in the transplantation site. The low efficiency of MSC transplantation for ischemic tissue may be due to their short lifetime, making it important to develop highly effective stem cell transplantation systems that address cell number, injection position, and cell formulation (suspension, sheet, and aggregates). Our cell survival tracking system would be a very powerful tool to this end and would be applicable in clinical cell therapies.

Magnetic resonance imaging detection of an uncommon granuloma formation after endothelial progenitor cells transplantation.

Magnetic resonance imaging (MRI) has been recognized as a non-invasive technique for visualizing the ultrastructure of a tissue at high resolution. The work reported here showed the utility of MRI for visualizing the fate of EPCs, and demonstrate how it can be used to further our understanding of angiogenesis mechanisms.The recently developed contrast agent dextran mono-N-succinimidyl 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetate-gadolinium³âº (Dex-DOTA-Gd³âº) was used to label endothelial progenitor cells (EPCs). The faith of the transplanted labeled cells in the rat models of ischemic hind limbs was studied by images obtained by MRI.The pattern of migration of Dex-DOTA-Gd³âº-labeled EPCs could be observed and tracked by MRI for a long time and analyzed the change in the migration of the labeled cells. The ability of Dex-DOTA-Gd³âº to provide a clear pattern of cell migration to the limb was confirmed and most importantly, a different behavioral pattern was identified in the migration of labeled cells when an anomaly appeared in the MRI acquisition images 5 days post transplantation.

Synthesis, properties, and endothelial progenitor cells labeling stability of dextranes as polymeric magnetic resonance imaging contrast agents.

Magnetic resonance imaging is one of the most important fields for cellular imaging due to its non-invasive capacity, spatial resolution, and sensibility to visualized transplanted cells. An enhanced magnetic resonance image can be achieved by using contrast agents containing paramagnetic gadolinium chelates, which have the widest clinical use. To obtain a better contrast-enhancement and reduce the concentration of Gd for payload, one strategy is to conjugate the gadolinium(III) chelate to polymeric materials that will lead into an increase in the rotational correlation time and therefore improve the relaxivity. Four series of dextran gadolinium chelates were synthesized which are of interest as potential MRI contrast agents to track bone marrow-derived endothelial progenitor cells in vivo. The dextranes with molecular weights were characterized, introduced into the endothelial progenitor cells by electroporation, and injected in aqueous solution into rats to acquire the MR images. We have shown that by selecting polymers of the appropriate molecular weight, stability into the cell after labeling, relaxivity, and retention into the body can be accomplished.

Tuberculosis and histoplasmosis co-infection in AIDS patients.

Abstract. Coinfection with tuberculosis in some countries occurs in 8-15% of human immunodeficiency virus (HIV) -infected patients who have histoplasmosis. This coinfection interferes with prompt diagnosis, and treatment is difficult because of drug interactions. We retrospectively reviewed the cases of 14 HIV-infected patients who had concomitant tuberculosis and histoplasmosis. The most frequent clinical manifestations were weight loss (85.7%), asthenia (78.5%), and fever (64.2%). The diagnosis of histoplasmosis was made primarily by histopathology (71.4%), and the diagnosis of tuberculosis was made by means of direct microscopic examination (71.4%). Death occurred in two patients, and relapse of both infections occurred in one patient. Moxifloxacin was substituted for rifampicin in six patients, with good outcomes noted for both infections. The clinical presentation does not readily identify acquired immunodeficiency syndrome (AIDS) patients who have tuberculosis and histoplasmosis. The use of a fluoroquinolone as an alternative agent in place of rifampicin for tuberculosis allows effective therapy with itraconazole for histoplasmosis.

The use of magnetic resonance cell tracking to monitor endothelial progenitor cells in a rat hindlimb ischemic model.

A water-soluble magnetic resonance imaging (MRI) contrast agent, Dextran mono-N-succinimidyl 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetate-gadolinium(3+) (Dex-DOTA-Gd(3+)), was shown to enable monitoring of the anatomical migration and the survival period of transplanted stem cells for up to 1 month. Gadolinium molecules in the cells were rapidly eliminated from the site and excreted upon cell death. Endothelial progenitor cells (EPCs) transplanted into the inguinal femoral muscle of rats migrated distally through the knee in rats after hindlimb ischemia but did not migrate in non-ischemic rats. Interestingly, the survival period of transplanted EPCs was notably prolonged in the ischemic limb, indicating that EPCs are required by the ischemic tissues and that the fate of transplanted EPCs was affected by the disease. Compared to the commonly used particle type of MRI contrast agents, the system described in this study is expected to be invaluable to help clarifying the process of stem cell transplantation therapy.

[Perception of epidemiological competencies by public health students in Mexico and Colombia during the influenza A (H1N1) epidemic]. / Percepción de competencias en epidemiología en México y Colombia durante la epidemia de influenza A (H1N1) entre estudiantes de salud pública.

OBJECTIVE: Learn about the perception of public health students in Mexico and Colombia regarding the management of the influenza A (H1N1) epidemic to determine which curriculum contents in epidemiological education can be improved. METHODS: Survey administered to graduate students during the epidemic, from June to August 2009. The 30 epidemiological competencies for "intermediate epidemiologists" of the Council of State and Territorial Epidemiologists were evaluated. The results were described through stratification by covariables, and the less developed competencies were identified through exploratory factor analysis. RESULTS: A total of 154 students participated, 55.8% of whom were in Mexico. Significant differences in the student profile from each country were observed, which partially explains the perception of response to the epidemic. The first factor, which explains 21.5% of the variance, had lower scores in the factor analysis. This factor was associated with competencies related to the links between health personnel and the community, in which knowledge of the social sciences and communication skills are relevant. CONCLUSIONS: The students perceived that the response to the epidemic could have been better. It is suggested that public health human resources education include subjects related to the impact of culture on behavior and thinking, recognition of the prejudices of experts, effective community-level communication, and the ability to adapt to new situations. The "natural experiment" of the epidemic facilitated the identification of areas of opportunity to improve the teaching of epidemiology to health personnel.

Percepción de competencias en epidemiología en México y Colombia durante la epidemia de influenza A (H1N1) entre estudiantes de salud pública / Perception of epidemiological competencies by public health students in Mexico and Colombia during the influenza A (H1N1) epidemic

OBJETIVO: Conocer la percepción que los estudiantes de salud pública en México y en Colombia tuvieron sobre el manejo de la epidemia de influenza A (H1N1), como una forma para indagar qué contenidos curriculares pueden ser mejorados en la formación en epidemiología. MÉTODOS: Encuesta durante la epidemia, entre junio y agosto de 2009, a estudiantes de posgrado. Se evaluaron las 30 competencias epidemiológicas del Council of State and Territorial Epidemiologists para "epidemiólogos intermedios". Se describieron los resultados estratificando por covariables, y se identificaron las competencias con menor desarrollo mediante análisis factorial exploratorio. RESULTADOS: Participaron 154 estudiantes, de los cuales 55,8 por ciento estaban en México. Se observaron diferencias importantes en el perfil de los estudiantes de ambos países, lo cual explica parcialmente la percepción de respuesta a la epidemia. En el análisis factorial el primer factor, que explica 21,5 por ciento de la varianza, presentó menores puntajes y se asoció con competencias relacionadas con el vínculo entre el personal sanitario y la comunidad, donde resultan relevantes conocimientos de ciencias sociales y habilidades de comunicación. CONCLUSIONES: Los estudiantes percibieron que la respuesta frente a la epidemia podría haber sido mejor. Se sugiere incorporar en la educación de los recursos humanos en salud pública temáticas sobre cultura y sus efectos sobre conductas y pensamientos, el reconocimiento de los prejuicios de los expertos, la comunicación efectiva con las comunidades, y la habilidad para adaptarse ante nuevas situaciones. El "experimento natural" de la epidemia facilitó la identificación de áreas de oportunidad para mejorar la enseñanza de la epidemiología ante contingencias sanitarias.

OBJECTIVE: Learn about the perception of public health students in Mexico and Colombia regarding the management of the influenza A (H1N1) epidemic to determine which curriculum contents in epidemiological education can be improved. METHODS: Survey administered to graduate students during the epidemic, from June to August 2009. The 30 epidemiological competencies for "intermediate epidemiologists" of the Council of State and Territorial Epidemiologists were evaluated. The results were described through stratification by covariables, and the less developed competencies were identified through exploratory factor analysis. RESULTS: A total of 154 students participated, 55.8 percent of whom were in Mexico. Significant differences in the student profile from each country were observed, which partially explains the perception of response to the epidemic. The first factor, which explains 21.5 percent of the variance, had lower scores in the factor analysis. This factor was associated with competencies related to the links between health personnel and the community, in which knowledge of the social sciences and communication skills are relevant. CONCLUSIONS: The students perceived that the response to the epidemic could have been better. It is suggested that public health human resources education include subjects related to the impact of culture on behavior and thinking, recognition of the prejudices of experts, effective community-level communication, and the ability to adapt to new situations. The "natural experiment" of the epidemic facilitated the identification of areas of opportunity to improve the teaching of epidemiology to health personnel.

Long-term in vivo magnetic resonance imaging tracking of endothelial progenitor cells transplanted in rat ischemic limbs and their angiogenic potential.

Stem cell therapy has been used to repair ischemic tissues in the limbs, in myocardial infarctions, and in the brain. To understand the mechanisms of healing, a contrast agent capable of inducing sufficient magnetic resonance (MR) contrast would be useful in providing fundamental information about the cell migration and incorporation into the ischemic tissue. A magnetic resonance imaging contrast agent composed of dextran and gadolinium chelate was synthesized. Hydroxyl groups of dextran were activated with 1,1'-carbonylbis-1H-imidazole and reacted with propanediamine to obtain aminated dextran. This modified polymer was then reacted with mono-N-succinimidyl 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetate, then with fluorescein isothiocyanate, and finally reacted with gadolinium chloride solution (Dex-DOTA-Gd3(+)). Endothelial progenitor cells (EPCs) were selected as a stem cell model for magnetic resonance imaging tracking. Cells were isolated from the bone marrow harvested from the femurs and tibias of rats. Dex-DOTA-Gd3(+) was then introduced into the EPCs by electroporation. The intracellular stability and cytotoxicity of Dex-DOTA-Gd3(+) were evaluated in vitro. Dex-DOTA-Gd3(+)-labeled EPCs were transplanted into a rat model of ischemic limb, and MR images were acquired. Dex-DOTA-Gd3(+) was found to efficiently label EPCs over a long duration without significant cytotoxicity. This provides an MR signal sufficient for tracking the EPCs intramuscularly injected into the limb.

Adrenal function status in patients with paracoccidioidomycosis after prolonged post-therapy follow-up.

This study assessed adrenal function in patients with paracoccididioidomycosis who had been treated to determine a possible connection between high antibody titers and adrenal dysfunction attributable to persistence of the fungus in adrenal gland. Adrenal gland function was studied in 28 previously treated patients, 2 (7.1%) of whom were shown to have adrenal insufficiency and 7 (259%) who showed a below normal response to stimuli by adrenocorticotropic hormone. Paracoccidioides brasiliensis was detected in the adrenal gland from one of the patients with adrenal insufficiency. Although the study failed to demonstrate a significant difference between high antibody titers and low cortisol levels, the proportion of adrenal insufficiency detected and the subnormal response to adrenocorticotropic hormone confirmed that adrenal damage is an important sequela of paracoccidioidomycosis. Studies with a larger number of patients should be conducted to confirm the hypothesis of persistence of P. brasiliensis in adrenal gland after therapy.

[Evaluating how health is prioritised in Colombia from the point of view of Bogotá-based research groups]. / Evaluación del proceso de priorización en salud en Colombia: perspectiva de grupos de investigación ubicados en Bogotá

OBJECTIVE: Assessing how priorities are established in Colombia in line with international methodologies and from the perspective of Bogotá-based Category A health research groups. METHODS: This study used a qualitative approach; 14 leaders from groups selected via a propositive sample were given semi-structured interviews to obtain a comprehensive interpretation of priority-setting in Colombia. ATLAS Ti software was used for organising information and producing categories from transcripts. RESULTS: Each group had a different research background and came from health research areas such as basic science, clinical science and the wide field of public health. Some talked about their own definitions of health and establishing priorities as related to their own epistemological frameworks. Other leaders stressed that a bio-medical approach still predominated in health research, priority-setting and the inter-national methodologies used for such end. Many recognised the importance of differ-ent social actors (i.e. apart from researchers) becoming involved in defining health research priorities within a scenario emphasising dialogue and coming to agreement. The leaders criticised the national health science and technology system raising questions regarding defining priorities; they stated that dialogue and involvement must be promoted. DISCUSSION: These findings revealed enormous heterogeneity regarding prioritising health research as every researcher has a different point of view due to their experience and backgrounds and the difficulties in researchers' reaching consensus.

[Health research priorities in Colombia from the researchers' point of view]. / Prioridades de investigación en salud en Colombia: Perspectiva de los Investigadores.

Colombia lacks experience in identifying health research priorities. A project for identifying health research priorities was begun in 2004 (meaning those arising from weighting and ordering health and disease problems which could be mainly resolved by research and knowledge). The Global Forum for Health Research combined matrix method, and other methods, was used as reference for developing projects and putting two main methodological paths into practice: designing and applying a method for qualitatively and quantitatively weighting and ordering health research problems and building consensus with researchers and scientific community representatives. Two national meetings, two regional meetings and a virtual forum were held for identifying predominant health problems. Once the predominant health problems had been identified (with the respective estimation of disease load), then they were evaluated by politicians and decision-makers and rated by basic science, clinical science and public health researchers in terms of making a contribution towards knowledge for facing, controlling or resolving such problems. Some health research priorities were obtained (by areas and others being overall priorities): chronic diseases, emergent infectious diseases, tuberculosis/leprosy, nosocomial infection and sexually transmitted diseases/HIV/AIDS.

[Scientific writing, scientific communication and open access: an international, multidisciplinary project--NECOBELAC]. / Escritura, comunicación científica y acceso abierto: un proyecto internacional y multidisciplinario--NECOBELAC.

A collaboration network involving 6 countries in Europe, Latin-America and the Caribbean has embarked on a project (Network of Collaboration Between Europe and Latin American Caribbean Countries-NECOBELAC; www.necobelac.eu) aimed at improving scientific writing open access and scholarly communication to spread know-how regarding current and future issues and information related to health. The NECOBELAC project is sponsored by the European Community (7th Framework Programme) and will last for 3 years. The project recognises the challenge arising from socio-cultural differences between the participating countries and will deal with generating networks involving institutions working in close collaboration for carrying out training and know-how exchange programmes aimed at producing open access information and spreading it (including technical and ethical aspects). The NECOBELAC project currently involves the Istituto Superiore di Sanità - ISS from Italy (coordinating the project), the Consejo Superior de Investigaciones Científicas (CSIC) from Spain, the University of Nottingham (SHERPA) from the United Kingdom, BIREME from Brazil, the Instituto de Salud Pública (ISP) from Colombia and the Universidade de Minho from Portugal.

Evaluación del proceso de priorización en salud en Colombia: perspectiva de grupos de investigación ubicados en Bogotá / Evaluating how health is prioritised in Colombia from the point of view of Bogotá-based research groups

Objetivo Evaluar el proceso de priorización de investigaciones en salud llevado a cabo en el país a partir de las metodologías internacionales y desde la perspectiva de los grupos de investigación en salud, categoría A, ubicados en Bogotá. Métodos: A partir de un enfoque cualitativo, se realizaron 14 entrevistas semies­tructuradas a líderes de los grupos seleccionados a través de una muestra propositiva. Con el programa de análisis de información cualitativa Atlas Ti se generaron categorías para comparación. Resultados Cada grupo posee diferentes experiencias en investigación en el campo de la salud. Algunos manifestaron sus propias concepciones sobre la salud y sobre la priorización a partir de sus marcos epistemológicos. Diferentes líderes de los grupos expresaron que hay una fuerte orientación biomédica en los procesos de priorización y de las metodologías utilizadas para tal fin. Un número importante de ellos ha reconocido la importancia de la participación de otros actores sociales en la definición de las prioridades para la investigación en salud, además de los mismos investigadores, dentro de un escenario de dialogo y de concertación. Por último, los líderes entrevistados plantearon algunos cuestionamientos frente a la definición de prioridades y sugirieron la importancia de fomentar un proceso más participativo e incluyente comenzando por los mismos investigadores en salud. Discusión Los hallazgos muestran la enorme heterogeneidad de posiciones frente a la temática de la priorización de investigaciones en salud y las dificultades para alcanzar consensos entre los mismos investigadores.

Objective Assessing how priorities are established in Colombia in line with international methodologies and from the perspective of Bogotá-based Category A health research groups. Methods This study used a qualitative approach; 14 leaders from groups selected via a propositive sample were given semi-structured interviews to obtain a compre­hensive interpretation of priority-setting in Colombia. ATLAS Ti software was used for organising information and producing categories from transcripts. Results Each group had a different research background and came from health research areas such as basic science, clinical science and the wide field of public health. Some talked about their own definitions of health and establishing priorities as related to their own epistemological frameworks. Other leaders stressed that a bio­medical approach still predominated in health research, priority-setting and the inter­national methodologies used for such end. Many recognised the importance of differ­ent social actors (i.e. apart from researchers) becoming involved in defining health research priorities within a scenario emphasising dialogue and coming to agreement. The leaders criticised the national health science and technology system raising questions regarding defining priorities; they stated that dialogue and involvement must be promoted. Discussion These findings revealed enormous heterogeneity regarding prioritising health research as every researcher has a different point of view due to their experi­ence and backgrounds and the difficulties in researchers' reaching consensus.

Escritura, comunicación científica y acceso abierto: un proyecto internacional y multidisciplinario-NECOBELAC / Scientific writing, scientific communication and open access: an international, multidisciplinary project NECOBELAC

Una red de colaboración entre seis países de Europa, América latina y El Caribe ha iniciado un proyecto para mejorar la comunicación y la diseminación científica en salud pública. El proyecto apunta a fomentar la comunicación científica en aspectos de valor actual y futuro como son la escritura científica y el acceso abierto a la información en salud. El proyecto NECOBELAC (www.necobelac.eu) es auspiciado por la Comunidad Europea (7th Framework Programme) y tiene una duración de tres años. Como un reto, el proyecto reconoce las diferencias socio culturales entre los países que participan y se ocupará de generar redes de instituciones en colaboración estrecha para realizar programas de entrenamiento e intercambio de saberes en producción de información y difusión (incluyendo los aspectos técnicos y éticos). El proyecto NECOBELAC incluye al Istituto Superiore di Sanità (ISS) de Italia, coordinador del mismo, el Consejo Superior de Investigaciones Científicas (CSIC) de España, la Universidad de Nottingham (SHERPA) del Reino Unido, BIREME de Brasil, el Instituto de Salud Pública (ISP) de Colombia y la Universidade de Minho, de Portugal.

A collaboration network involving 6 countries in Europe, Latin-America and the Caribbean has embarked on a project (Network of Collaboration Between Europe and Latin American Caribbean Countries-NECOBELAC; www.necobelac.eu) aimed at improving scientific writing open access and scholarly communication to spread know-how regarding current and future issues and information related to health. The NECOBELAC project is sponsored by the European Community (7th Framework Programme) and will last for 3 years. The project recognises the challenge arising from socio-cultural differences between the participating countries and will deal with generating networks involving institutions working in close collaboration for carrying out training and know-how exchange programmes aimed at producing open access information and spreading it (including technical and ethical aspects). The NECOBELAC project currently involves the Istituto Superiore di Sanità - ISS from Italy (coordinating the project), the Consejo Superior de Investigaciones Científicas (CSIC) from Spain, the University of Nottingham (SHERPA) from the United Kingdom, BIREME from Brazil, the Instituto de Salud Pública (ISP) from Colombia and the Universidade de Minho from Portugal.