RESUMEN

The emergence, spread, and persistence of antimicrobial resistance (AMR) remains a pressing global concern. Increased promotion of commercial small-scale agriculture within low-resource settings has facilitated an increased use in antimicrobials as growth promoters globally, creating antimicrobial-resistant animal reservoirs. We conducted a longitudinal field study in rural Ecuador to monitor the AMR of Escherichia coli populations from backyard chickens and children at three sample periods with approximately 2-month intervals (February, April, and June 2017). We assessed AMR to 12 antibiotics using generalized linear mixed effects models (GLMM). We also sampled and assessed AMR to the same 12 antibiotics in one-day-old broiler chickens purchased from local venders. One-day-old broiler chickens showed lower AMR at sample period 1 compared to sample period 2 (for 9 of the 12 antibiotics tested); increases in AMR between sample periods 2 and 3 were minimal. Two months prior to the first sample period (December 2016) there was no broiler farming activity due to a regional collapse followed by a peak in annual farming in February 2017. Between sample periods 1 and 2, we observed significant increases in AMR to 6 of the 12 antibiotics in children and to 4 of the 12 antibiotics in backyard chickens. These findings suggest that the recent increase in farming, and the observed increase of AMR in the one-day old broilers, may have caused the increase in AMR in backyard chickens and children. Small-scale farming dynamics could play an important role in the spread of AMR in low- and middle-income countries.

RESUMEN

BACKGROUND: Globally, diarrhea is a leading cause of child morbidity and mortality. Although latrines are integral for reducing enteric pathogen transmission, several studies have shown no evidence that latrine ownership improved child health. There are a number of explanations for these results. One explanation is that latrine access does not equate to latrine use. Latrine use, however, is difficult to accurately ascertain, as defecation behavior is often stigmatized. To address this measurement issue, we measure latrine use as a latent variable, indicated by a suite of psychosocial variables. METHODS: We administered a survey of 16 defecation-related psychosocial questions to 251 individuals living in rural Ecuador. We applied latent class analysis (LCA) to these data to model the probability of latrine use as a latent variable. To account for uncertainty in predicted latent class membership, we used a pseudo-class approach to impute five different probabilities of latrine use for each respondent. Via regression modeling, we tested the association between household sanitation and each imputed latrine use variable. RESULTS: The optimal model presented strong evidence of two latent classes (entropy = 0.86): consistent users (78%) and inconsistent users (22%), predicted by 5 of our 16 psychosocial variables. There was no evidence of an association between the probability of latrine use, predicted from the LCA, and household access to basic sanitation (OR = 1.1, 95% CI = 0.6-2.1). This suggests that home access to a sanitation facility may not ensure the use of the facility for every family member at all times. CONCLUSION: Effective implementation and evaluation of sanitation programs requires accurate measurement of latrine use. Psychosocial variables, such as norms, perceptions, and attitudes may provide robust proxy-measures. Future longitudinal studies will help to strengthen the use of these surrogate measures, as many of these factors may be subject to secular trends. Additionally, subgroup analyses will elucidate how our  proxy indicators of latrine defecation vary by individual-level characteristics.

Asunto(s)

Análisis de Clases Latentes , Propiedad/estadística & datos numéricos , Saneamiento/estadística & datos numéricos , Cuartos de Baño/estadística & datos numéricos , Adulto , Niño , Salud Infantil/estadística & datos numéricos , Defecación , Ecuador , Composición Familiar , Femenino , Humanos , Masculino , Probabilidad , Población Rural/estadística & datos numéricos , Estereotipo , Encuestas y Cuestionarios , Adulto Joven

RESUMEN

Here, we present the complete genome sequences of two Zika virus (ZIKV) strains, EcEs062_16 and EcEs089_16, isolated from the sera of febrile patients in Esmeraldas City, in the northern coastal province of Esmeraldas, Ecuador, in April 2016. These are the first complete ZIKV genomes to be reported from Ecuador.

RESUMEN

OBJECTIVES: To determine the effect of repeated doses of aerosolized recombinant human deoxyribonuclease (rhDNase) on the development of anti-rhDNase antibodies, acute allergic reactions, and pulmonary function in patients with cystic fibrosis. DESIGN: A multicenter, open-label study in which 184 patients received 10 mg aerosolized rhDNase twice a day for 14 days followed by a 14-day washout period for a total of 6 treatment cycles. Serial determinations of anti-rhDNase antibodies and pulmonary functions were performed. RESULTS: Detectable anti-rhDNase antibodies developed in 16 (8.7%) patients. These patients had no changes in their symptoms from the time they entered the trial. Antibodies detected were all of the IgG isotype. Increases in both forced expired volume in 1 second and forced vital capacity were noted from the beginning to the end of each cycle of treatment returning to baseline during the off-treatment period of each cycle. Seropositivity to rhDNase was not associated with allergic reactions and had no relationship on improvement in pulmonary function. CONCLUSIONS: Development of anti-rhDNase antibodies occurred in a small number of patients and was not associated with side effects. Intermittent administration of rhDNase for 24 weeks to patients with cystic fibrosis was well tolerated and was not associated with anaphylaxis in any patient. Pulmonary function improved significantly during the 14-day cycles while rhDNase was administered and returned to baseline when rhDNase was discontinued.

Asunto(s)

Fibrosis Quística/tratamiento farmacológico , Desoxirribonucleasas/uso terapéutico , Adolescente , Adulto , Aerosoles , Anciano , Formación de Anticuerpos , Hiperreactividad Bronquial/inducido químicamente , Niño , Fibrosis Quística/inmunología , Fibrosis Quística/fisiopatología , Desoxirribonucleasas/administración & dosificación , Desoxirribonucleasas/inmunología , Esquema de Medicación , Hipersensibilidad a las Drogas/etiología , Disnea/tratamiento farmacológico , Femenino , Estudios de Seguimiento , Volumen Espiratorio Forzado/efectos de los fármacos , Humanos , Inmunoglobulina G/biosíntesis , Isotipos de Inmunoglobulinas/biosíntesis , Pulmón/efectos de los fármacos , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Calidad de Vida , Proteínas Recombinantes , Seguridad , Capacidad Vital/efectos de los fármacos

RESUMEN

This paper reports on The Hospital of the University of Pennsylvania's experience and concerns as a participating primary care site in a Medicaid managed care program (HealthPASS), which was established in 1986. Enrollment is mandatory for approximately half of Philadelphia's medical assistance population. Participating primary care sites receive monthly capitation for enrollees and serve as "gatekeepers" for specialty and inpatient services. The report discusses why the academic medical center chose to participate in the program and how existing activities were modified to meet both increased demand for primary care and increased administrative requirements. It also identifies characteristics of the HealthPASS program and of the medical center that have impeded effective case management of care for the urban poor population that the program serves. Improving the quality of care for the medically indigent while controlling costs is essential, but political realities and the special needs of the Medicaid population must be acknowledged. Increased attention must be given to the impact that political compromises have on the design and effectiveness of a managed care program.

Asunto(s)

Centros Médicos Académicos/organización & administración , Programas Controlados de Atención en Salud/organización & administración , Medicaid , Indigencia Médica/economía , Atención Primaria de Salud/métodos , Centros Médicos Académicos/economía , Adolescente , Adulto , Anciano , Actitud del Personal de Salud , Capitación , Control de Costos , Femenino , Humanos , Programas Controlados de Atención en Salud/economía , Medicaid/economía , Pennsylvania , Política , Atención Primaria de Salud/economía , Evaluación de Programas y Proyectos de Salud , Calidad de la Atención de Salud/economía , Estados Unidos , Salud Urbana

RESUMEN

We assessed lung function, liver function, and smoking attitudes and behavior in 22 adolescents with homozygous alpha 1-antitrypsin deficiency whose condition had been detected through neonatal screening in the early 1970s. All subjects had normal lung volumes, expiratory flow rates, and diffusing capacity except for two siblings with mild asthma whose values reverted to the normal range after administration of an inhaled bronchodilator. Liver function was normal in all subjects with the exception of one boy who had an isolated elevation of alkaline phosphatase activity. Smoking attitudes, as determined by questionnaire, did not differ from those of 130 control subjects, but smoking initiation rates were significantly lower (p = 0.02). We believe that the issue of neonatal screening for alpha 1-antitrypsin deficiency should be reexamined because augmentation therapy for adults with emphysema is now available, and screening followed by family-based smoking intervention may lead to a nonsmoking life-style. The latter is especially important because the current weight of epidemiologic evidence strongly suggests that in nonsmokers with this condition, severe emphysema may never develop or, if it does, it will do so at a much later age than in smokers.

Asunto(s)

Deficiencia de alfa 1-Antitripsina , Adolescente , Actitud Frente a la Salud , Femenino , Estudios de Seguimiento , Estado de Salud , Humanos , Pruebas de Función Hepática , Masculino , Oregon , Pruebas de Función Respiratoria , Fumar/efectos adversos

RESUMEN

Cost-effectiveness analysis compared four treatments of end-stage renal disease in Brazil: continuous ambulatory peritoneal dialysis (CAPD), in-center hemodialysis (HD), cadaver donor transplantation (CD-Tx), and living related donor transplantation (LR-Tx). After 2 years, the costs per year of survival were CAPD, $12,134; HD, $10,065; CD-Tx, $6,978; and LR-Tx, $3,022. The HD cost was lower than CAPD partially because of the reuse of hemodialyzers in Brazil. Although less cost-effective, both dialysis treatments yielded more years of survival after 2 years. This analysis reveals a trade-off between cost per year of survival and years of survival.

Asunto(s)

Fallo Renal Crónico/economía , Trasplante de Riñón/economía , Diálisis Peritoneal Ambulatoria Continua/economía , Diálisis Renal/economía , Adolescente , Adulto , Brasil , Análisis Costo-Beneficio , Humanos , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/terapia , Persona de Mediana Edad , Tasa de Supervivencia

RESUMEN

CSP #221 is a randomized multiinstitutional clinical trial to assess the efficacy of 10 d of perioperative total parenteral nutrition (TPN) in reducing morbidity and mortality in malnourished patients undergoing intraperitoneal and/or intrathoracic operations. In this paper a detailed protocol for the clinical efficacy trial is presented primarily as a reference document for use in interpretation of the results of the clinical trial. It is also anticipated, however, that review of this protocol may be useful to other investigators planning future clinical nutrition intervention trials.

Asunto(s)

Trastornos Nutricionales/terapia , Nutrición Parenteral Total , Complicaciones Posoperatorias/terapia , Ensayos Clínicos como Asunto/métodos , Humanos , Monitoreo Fisiológico , Trastornos Nutricionales/etiología , Trastornos Nutricionales/mortalidad , Cuidados Preoperatorios , Distribución Aleatoria , Proyectos de Investigación

RESUMEN

A population of Alouatta caraya in northern Argentina had an ecological density of 130 animals per km2 . Mean troop size varied from 7.2 to 8.9 individuals, and the ratio of adult males to adult females from 0.58 to 0.51. Infants comprised from 6% to 14% of the population, juveniles from 16% to 21%. These percentages probably vary seasonally in response to a birth peak at the beginning of the dry season. Males were age-graded in multi-male troops. Sexual dimorphism was extreme in this species. Males were all black and averaged 6.7 kg; females were yellow-brown and averaged 4.4 kg. Juvenile males retained the pelage color of the female until approximately 4.5 yr of age and 5 kg in weight. No genital mimicry or exaggeration occurred in this species. Vocalizations of A. caraya were similar to those of A. seniculus, both of which tend to be lower pitched than those of A. palliata.

Asunto(s)

Técnicas Bacteriológicas