Pain-Reducing Effects of Physical Therapist-Delivered Interventions: A Systematic Review of Randomized Trials Among Older Adults With Dementia.

BACKGROUND AND PURPOSE: Pain is common among older adults with dementia. There are nonpharmacological options for managing pain in this population. However, the effects of physical therapist-delivered interventions have not been summarized. The purpose of this systematic review was to summarize the literature on physical therapist-delivered interventions in randomized trials for reducing pain among older adults with dementia. METHODS: A systematic search of MEDLINE/PubMed, CINAHL, PsycINFO, and Web of Science was conducted for randomized trials of pain management in individuals 60 years or older with medically diagnosed dementia of any severity. Included studies addressed the effects of nonpharmacological physical therapist-delivered interventions on pain outcomes. Pain outcomes included patient or caregiver self-report, observational or interactive measures. Independent reviewers extracted relevant data and assessed methodological quality using the PEDro scale. RESULTS AND DISCUSSION: Three studies (total = 222 participants; mean age range = 82.2-84.0 years; 178 [80.2%] females) met inclusion criteria. PEDro scores ranged from 4 to 8/10. Interventions included passive movement and massage. Pain outcomes included the observational measures Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC), Pain in Advanced Dementia (PAINAD), and Doloplus-2 Scale. Passive movement did not show better results when compared with no treatment, while massage showed pain-reducing effects in 1 study compared with no treatment. CONCLUSIONS: The evidence supporting pain-reducing physical therapy interventions for patients with dementia is limited. There is a clear gap in knowledge related to evidence-based physical therapy for managing pain in this population. Future studies should examine active physical therapist-delivered interventions and utilize interactive pain measures.

Uncommon patterns of antinuclear antibodies recognizing mitotic spindle apparatus antigens and clinical associations.

Antinuclear antibodies (ANA) are key biomarkers in the evaluation of rheumatic diseases. The prevalence and clinical significance of uncommon or rare patterns, particularly those directed at the mitotic spindle apparatus (MSA), are not well understood. We aimed to investigate the prevalence and clinical significance of anti-MSA patterns in a Colombian population.During 2013 and 2014, 113,491 consecutive determinations of ANA were studied for the presence of uncommon patterns. Clinical and laboratory data of anti-MSA positive patients were retrospectively collected and analyzed.Of the 113,491 patients tested, 60,501 (53%) were positive for ANA, of which 834 (1.3%) were positive for uncommon/rare patterns of ANA (anti-MSA in 592 cases). Of these 592 cases, complete data were available in 329 patients, of whom 116 had an established diagnosis. Anti-MSA antibodies were the only ANA positive test in 81% patients. At least one fine reactivity was identified in 19/116 (16.3%) of ANA-positive patients, of which anti-Ro was the most prevalent (18/116, 15.5%).The most frequent patterns were nuclear mitotic apparatus (NuMA) (56%) and MSA-2 (25%). The NuMA pattern had the highest ANA titers: mean 320 (range 80-2560) and behaved as monospecific antibodies. The most frequent systemic autoimmune diseases were Sjögren syndrome (SS) (18.1%), rheumatoid arthritis (RA) (13.8%), and systemic lupus erythematosus (SLE) (11%). Undifferentiated connective tissue disease (UCTD) was associated with the centrosome (P < .001), NuMA (P < .02) and MSA-2 (P < .45) patterns. Chronic idiopathic urticaria (CIU) was associated with the NuMA pattern (P < .02) and sensorineural hearing loss (SNHL) was associated with the MSA-2 (P < .001), centrosome (P < .68) and CENP-F (P < .38) patterns, previously unreported findings. Malignancies were found in 8 patients (50% were papillary thyroid cancer).In a large cohort of ANA determinations, uncommon patterns were found in around 1% of cases. The most frequent anti-MSA patterns found were NuMA and MSA-2. More than 50% of patients with anti-MSA had an associated CTD, mainly SS, RA and SLE, and anti-MSA behaved as monospecific antibodies. Other entities of presumed autoimmune origin, like CIU and SNHL, might be associated with these patterns.

Encuesta de acceso a servicios de salud para hogares colombianos / Health services access survey for Colombian households

Objetivo: Diseñar y validar una encuesta de acceso a servicios de salud dirigida a hogares en Colombia para aportar una herramienta metodológica de país que permita ir acumulando evidencia sobre las condiciones de acceso real que tiene la población colombiana. Método: Se realizó un estudio de validación con personas expertas y prueba piloto aplicada en el municipio de Jamundí, en el departamento del Valle del Cauca, Colombia. Se realizó un muestreo probabilístico, polietápico, estratificado y por conglomerados. La muestra final fue de 215 hogares. Resultados: La encuesta quedó conformada por 63 preguntas distribuidas en cinco módulos: perfil sociodemográfico del jefe/a del hogar o adulto/a informante, perfil socioeconómico del hogar, acceso a servicios preventivos, acceso a servicios curativos y de rehabilitación, y gasto de bolsillo en acceso. En términos descriptivos, la promoción de servicios preventivos solo alcanzó valores del 44%; el uso de estos servicios siempre fue mayor, en especial en los grupos del primer año de vida y hasta los 10 años. Para los servicios de urgencias y hospitalización, la percepción de atención de la necesidad estuvo entre el 82% y el 85%. No obstante, hubo percepción de mala y muy mala calidad de la atención hasta en un 36%. Por su parte, la oportunidad de la atención de consulta médica general y con especialista presentó demoras. Discusión: La encuesta diseñada es válida, relevante y representativa del constructo acceso a servicios de salud en Colombia. En términos empíricos, la prueba piloto mostró debilidades institucionales en un municipio del país, indicando además que la cobertura en salud no significa acceso real y efectivo a los servicios (AU)

Objective: The aim of this study was to design and validate a health services access survey for households in Colombia to provide a methodological tool that allows the country to accumulate evidence of real-life access conditions experienced by the Colombian population. Methods: A validation study with experts and a pilot study were performed. It was conducted in the municipality of Jamundi, located in the department of Valle del Cauca, Colombia. Probabilistic, multistage and stratified cluster sampling was carried out. The final sample was 215 households. Results: The survey was composed of 63 questions divided into five modules: socio-demographic profile of the head of the household or adult informant, household socioeconomic profile, access to preventive services, access to curative and rehabilitative services and household out of pocket expenditure. In descriptive terms, the promotion of preventive services only reached 44%; the use of these services was always highest among children younger than one year old and up to the age of ten. The perceived need for emergency medical care and hospitalisation was between 82% and 85%, but 36% perceived the quality of care to be low or very low. Delays were experienced in medical visits with GPs and specialists. Discussion: The designed survey is valid, relevant and representative of access to health services in Colombia. Empirically, the pilot showed institutional weaknesses in a municipality of the country, indicating that health coverage does not in practice mean real and effective access to health services (AU)

[Health services access survey for Colombian households]. / Encuesta de acceso a servicios de salud para hogares colombianos.

OBJECTIVE: The aim of this study was to design and validate a health services access survey for households in Colombia to provide a methodological tool that allows the country to accumulate evidence of real-life access conditions experienced by the Colombian population. METHODS: A validation study with experts and a pilot study were performed. It was conducted in the municipality of Jamundi, located in the department of Valle del Cauca, Colombia. Probabilistic, multistage and stratified cluster sampling was carried out. The final sample was 215 households. RESULTS: The survey was composed of 63 questions divided into five modules: socio-demographic profile of the head of the household or adult informant, household socioeconomic profile, access to preventive services, access to curative and rehabilitative services and household out of pocket expenditure. In descriptive terms, the promotion of preventive services only reached 44%; the use of these services was always highest among children younger than one year old and up to the age of ten. The perceived need for emergency medical care and hospitalisation was between 82% and 85%, but 36% perceived the quality of care to be low or very low. Delays were experienced in medical visits with GPs and specialists. DISCUSSION: The designed survey is valid, relevant and representative of access to health services in Colombia. Empirically, the pilot showed institutional weaknesses in a municipality of the country, indicating that health coverage does not in practice mean real and effective access to health services.

Infección por Bordetella pertussis en contactos domiciliarios de casos de tosferina en el suroriente de la ciudad de Cali, Colombia 2006-2007 / Bordetella pertussis infection in household contacts of cases of pertussis in the southeast zone of the city of Cali, Colombia, 2006-2007

Introducción: Bordetella pertussis causa tos ferina o tos convulsiva, enfermedad contagiosa e inmunoprevenible, una de las primeras 10 causas de muerte entre niños menores de 1 año, al no estar completamente inmunizados. Se considera reemergente en varios países, con altas tasas de complicaciones y hospitalizaciones.Objetivo: conocer la proporción de infección por B. pertussis, entre casos sospechosos de tosferina y sus contactos domiciliarios entre niños del suroriente de Cali, área geográfica con mayor demanda de consulta por esta infección.Metodología: Estudio descriptivo de corte transversal. Se tomaron datos epidemiológicos y muestras nasofaringeas a 24 casos sospechosos y sus 109 contactos domiciliarios. Las muestras se analizaron por la reacción en cadena de la polimerasa en tiempo real (Q-PCR) y por cultivo.Resultados: La proporción de positividad entre los casos por la técnica de Q-PCR fue de 50% (12/24) y 40% por la técnica de cultivo (8/20), con buena concordancia entre las dos técnicas (Kappa 0.61). En cuanto a los contactos, 30.3% (33/109) (IC 95%: 21.8%-39.8%) resultaron positivos. Los contactos hermanos (7/15) y las madres (7/22) presentaron la mayor proporción de positividad. En cuanto a la edad, 60% con 4 años (3/5) y 50% en el grupo de 45- 64 años. No se encontraron diferencias significativas entre la presencia o ausencia de síntomas y la presencia de infección por B. pertussis, excepto en la presencia de flujo nasal (moquiadera) (27%) y tos (36%) durante el último mes.Conclusiones: El estudio confirma la alta prevalencia de infección asintomática por B. pertussis entre contactos domiciliarios de niños con sintomatología de tosferina y la transmisión domiciliaria de la misma. En Cali es necesario revisar la efectividad de las estrategias de control implementadas y la utilización de un esquema de vacunación que no cubre a la población adolescente y adulta como control del foco de infección.

Introduction: Bordetella pertussis causes whooping cough or convulsive cough, a contagious and immune-preventable disease. It is one of the 10 leading causes of death among children younger than one year of age, when not completely immunized. It is considered reemerging in several countries, with high rates of complications and hospitalizations.Methodology: This is a cross-sectional descriptive study. Epidemiological data and nasopharyngeal samples were taken from 24 suspected cases and from their 109 household contacts. The samples were analyzed via real-time polymerase chain reaction (Q-PCR) and through culture.Results: The proportion of positivity among the cases via the Q-PCR technique was at 50% (12/24) and at 40% via the culture technique (8/20), with good agreement between both techniques (Kappa 0.61). Regarding the household contacts, 30.3% (33/109) (CI 95%: 21.8%-39.8%) tested positive. The sibling contacts (7/15) and the mothers (7/22) presented the greatest proportion of positivity. Regarding age, 60% were 4 years of age (3/5) and 50% were in the group comprised of individuals 45 to 64 years of age. No significant differences were found among the presence or absence of symptoms and the presence of B. pertussis infection, except for the presence of nasal secretions (runny nose) (27%) and coughing (36%) during the last month.Conclusions: The study confirms the high prevalence of asymptomatic infection by B. pertussis among household contacts of children with whooping cough symptomatology and its household transmission. In Cali, health authorities need to review the effectiveness of implemented control strategies and the use of a vaccination scheme that does not cover adolescent and adult populations as a focus of infection control.

Effect of the exposure to Fasciola hepatica (Trematoda: Digenea) on life history traits of Lymnaea cousini and Lymnaea columella (Gastropoda: Lymnaeidae).

The snails Lymnaea columella and Lymnaea cousini have both been reported as intermediate hosts of Fasciola hepatica in Colombia. The effect of the exposure to the parasite on survival, fecundity and size of these snails was evaluated by means of experimental infections and the life history traits of control and exposed groups were compared. Infection rates were 82.2 and 34% for L. columella and L. cousini, respectively. A reduction in fitness was observed in both species when exposed to the parasite: fecundity alone was reduced in L. columella whereas in L. cousini there was also a decline in survival rate. Unlike other studies, increased size was not observed in either species. On the contrary, a reduction in growth rate was observed in L. columella.

[Does the lack of availability of information represent a bottleneck for research and evaluation in health policy?]. / Disponibilidad de información: un cuello de botella para investigación y evaluación en politicas de salud?

OBJECTIVES: This article describes the difficulties encountered in obtaining information about health services, sanitation and health insurance coverage supply, use and coverage regarding a sample of Colombian municipalities during 1991-2000. The availability of information is also analysed in terms of decentralisation and municipal development. METHOD: This was a cross-sectional study of a random stratified sample of 495 Colombian municipalities; information regarding the variables of interest was requested at municipal and departmental level and from national sources. A scale was constructed for measuring the availability of information at local level. Non-parametric statistics were used for testing differences in availability of information in terms of certification and municipal category. RESULTS: Applying the scale revealed 51% availability of data regarding health service supply, 39% for data regarding service use and 45% for both types of information (supply and demand taken together). No information was available in 32% of the municipalities. Information was more readily available in non-certified and less developed municipalities. CONCLUSIONS: Study findings provided indirect evidence of difficulty in obtaining information regarding health systems at both municipal and departmental levels; this represents an important obstacle for health system management and evaluating performance, as well as for research and widening knowledge (and availability to such knowledge) in this area.

Disponibilidad de información ¿Un cuello de botella para investigación y evaluación en políticas de salud? / Does the lack of availability of information represent a bottleneck for research and evaluation in health policy?

OBJETIVOS: Describir las dificultades para obtener información de oferta, uso, cobertura, saneamiento básico y afiliación a la seguridad social en salud en una muestra de municipios colombianos para el período 1991-2000 y hacer un análisis de la disponibilidad de información en los municipios por estado de certificación y categorías de desarrollo municipal. MÉTODOS: Se realizó un estudio analítico de corte transversal en una muestra aleatoria estratificada de 495 municipios colombianos, en el cual se solicitó información de interés a nivel de las secretarías departamentales y municipales de salud que se complementó con información de fuentes nacionales. Para los datos solicitados a nivel territorial se construyó un indicador de disponibilidad de información. Para establecer si había diferencias en la disponibilidad de información según estado de certificación y categoría municipal, se utilizaron pruebas estadísticas no paramétricas. RESULTADOS: La aplicación del indicador mostró 51 por ciento de disponibilidad de información de las variables de oferta, 39 por ciento de las de uso y 45 por ciento de información total (oferta y uso). En 32 por ciento de los municipios no fue posible obtener información. La disponibilidad de información fue mayor en los municipios no certificados y de menor desarrollo socioeconómico. CONCLUSIONES: Los hallazgos del estudio proveen evidencia indirecta de importantes carencias en los sistemas de información locales y departamentales, que se constituyen en obstáculos no sólo para la gestión y evaluación de los servicios de salud sino para realizar investigación y generar conocimiento.

Morphological and polymerase chain reaction-restriction fragment lenght polymorphism characterization of Biomphalaria kuhniana and Biomphalaria amazonica from Colombia.

In Colombia, five Biomphalaria planorbid species are known: B. kuhniana, B. straminea, B. peregrina, B. canonica and B. oligoza(var. B. philippiana). Among them, B. straminea is intermediate host of Schistosoma mansoni and B. peregrina has been found to be experimentally susceptible to this parasite. B. straminea is commonly confused with B. kuhniana and they have been clustered together with B. intermedia in the complex named B. straminea. The difficulties involved in the specific identification, based on morphological data, have motivated the use of new techniques as auxiliary tools in cases of inconclusive morphological identification of such planorbid. In the present study, five Biomphalaria populations from the Colombian Amazon region and from Interandian Valleys were morphologically identified and characterized by polymerase chain reaction-restriction fragment lenght polymorphism directed at the internal transcribed spacer region of the rRNA gene, followed by digestion of the generated fragment with restriction enzymes (DdeI, AluI, RsaI, MvaI and HaeIII). Known profiles of the Brazilian species B. straminea, B. peregrina, B. kuhniana, B. intermedia and B. amazonica, besides B. kuhniana from Colombia, were used for comparison. The five populations under study were morphologically and molecularly identified as B. kuhniana and B. amazonica.

Morphological and polymerase chain reaction-restriction fragment lenght polymorphism characterization of Biomphalaria kuhniana and Biomphalaria amazonica from Colombia

In Colombia, five Biomphalaria planorbid species are known: B. kuhniana, B. straminea, B. peregrina, B. canonica and B. oligoza(var. B. philippiana). Among them, B. straminea is intermediate host of Schistosoma mansoni and B. peregrina has been found to be experimentally susceptible to this parasite. B. straminea is commonly confused with B. kuhniana and they have been clustered together with B. intermedia in the complex named B. straminea. The difficulties involved in the specific identification, based on morphological data, have motivated the use of new techniques as auxiliary tools in cases of inconclusive morphological identification of such planorbid. In the present study, five Biomphalaria populations from the Colombian Amazon region and from Interandian Valleys were morphologically identified and characterized by polymerase chain reaction-restriction fragment lenght polymorphism directed at the internal transcribed spacer region of the rRNA gene, followed by digestion of the generated fragment with restriction enzymes (DdeI, AluI, RsaI, MvaI and HaeIII). Known profiles of the Brazilian species B. straminea, B. peregrina, B. kuhniana, B. intermedia and B. amazonica, besides B. kuhniana from Colombia, were used for comparison. The five populations under study were morphologically and molecularly identified as B. kuhniana and B. amazonica