RESUMEN
Rocky Mountain spotted fever (RMSF) is a potentially fatal tickborne disease caused by the bacterium, Rickettsia rickettsii and transmitted primarily by the brown dog tick (Rhipicephalus sanguineus) in the southwestern United States and Mexico. RMSF can be rapidly fatal if not treated early with doxycycline, making healthcare worker awareness and education critical to reduce morbidity and mortality. During 2008-2019, Mexicali experienced a RMSF epidemic with 779 confirmed cases, and an 11-year case-fatality rate of 18% (N = 140). A cross-sectional study was conducted with 290 physicians and physicians-in-training across 12 medical facilities in Mexicali. They were asked to complete a 23-item questionnaire to assess knowledge, attitudes, and practices for clinical, epidemiologic, and preventive aspects of RMSF. Half of participants were female, the largest age group was aged 25 to 44 (47%), and median time in practice was 6 years (interquartile rate: 1-21.5). Less than half (48%) surveyed were confident where diagnostic testing could be performed, and two-thirds did not regularly order serology (67%) or molecular diagnostic (66%) tests for RMSF when a patient presented with fever. Sixty-four percent knew doxycycline as first-line treatment of children < 8 years with suspected RMSF. When comparing healthcare workers with < 6 years of experience to those with ≥ 6 years, more experience was associated with greater confidence in where to have diagnostic testing performed (prevalence odds ratio [prevalence odds ratios [pOR]] = 2.3; P = 0.004), and frequency of ordering laboratory tests (serology, pOR = 3.3; P = 0.002; polymerase chain reaction, pOR = 3.9; P = 0.001). Continued education, including information on diagnostic testing is key to reducing morbidity and mortality from RMSF.
Asunto(s)
Médicos , Rhipicephalus sanguineus , Fiebre Maculosa de las Montañas Rocosas , Animales , Estudios Transversales , Perros , Doxiciclina/uso terapéutico , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , México/epidemiología , Rhipicephalus sanguineus/microbiología , Rickettsia rickettsii , Fiebre Maculosa de las Montañas Rocosas/diagnóstico , Fiebre Maculosa de las Montañas Rocosas/tratamiento farmacológico , Fiebre Maculosa de las Montañas Rocosas/epidemiologíaRESUMEN
OBJECTIVE: From 2011 to 2013, the Global Fund (GF) supported needle and syringe programmes in Mexico to prevent transmission of HIV among people who inject drugs. It remains unclear how GF withdrawal affected the costs, quality and coverage of needle and syringe programme provision. DESIGN: Costing study and longitudinal cohort study. SETTING: Tijuana, Mexico. PARTICIPANTS: Personnel from a local needle and syringe programme (n=6) and people who inject drugs (n=734) participating in a longitudinal study. PRIMARY OUTCOME MEASURES: Provision of needle and syringe programme services and cost (per contact and per syringe distributed, in 2017 $USD) during GF support (2012) and after withdrawal (2015/16). An additional outcome included needle and syringe programme utilisation from a concurrent cohort of people who inject drugs during and after GF withdrawal. RESULTS: During the GF period, the needle and syringe programme distributed 55 920 syringes to 932 contacts (60 syringes/contact) across 14 geographical locations. After GF withdrew, the needle and syringe programme distributed 10 700 syringes to 2140 contacts (five syringes/contact) across three geographical locations. During the GF period, the cost per harm reduction contact was approximately 10-fold higher compared with after GF ($44.72 vs $3.81); however, the cost per syringe distributed was nearly equal ($0.75 vs $0.76) due to differences in syringes per contact and reductions in ancillary kit components. The mean log odds of accessing a needle and syringe programme in the post-GF period was significantly lower than during the GF period (p=0.02). CONCLUSIONS: Withdrawal of GF support for needle and syringe programme provision in Mexico was associated with a substantial drop in provision of sterile syringes, geographical coverage and recent clean syringe utilisation among people who inject drugs. Better planning is required to ensure harm reduction programme sustainability is at scale after donor withdrawal.
Asunto(s)
Programas de Intercambio de Agujas/economía , Programas de Intercambio de Agujas/estadística & datos numéricos , Agujas/provisión & distribución , Abuso de Sustancias por Vía Intravenosa/epidemiología , Jeringas/provisión & distribución , Costos y Análisis de Costo , Infecciones por VIH/prevención & control , Hepatitis C/prevención & control , Humanos , Estudios Longitudinales , México/epidemiología , Agujas/economía , Jeringas/economíaRESUMEN
Este artículo expone los procedimientos aplicados para la conservación y restauración de una escultura policromada perteneciente a la colección permanente de la Casa Museo "Pablo Neruda" en Isla Negra, Chile. La intervención se decidió atendiendo a su avanzado y progresivo estado de deterioro, ocasionado por manejos incorrectos, inadecuadas condiciones físicas y atmosféricas del lugar, así como también, las características deteriorantes provenientes de la factura y materialidad de la pieza. Se ubicaron datos históricos y estilísticos de la obra, orientados a esclarecer su posibles origen y período de manufactura, recuperar sus tiempos de existencia y determinar técnicas de elaboración e influencias estéticas, para luego intervenirla con el conocimiento adecuado de sus antecedentes y estructuras. Se aplicaron métodos instrumentales y no instrumentales de análisis, bajo el criterio de mínima intervención en la toma de muestras. Se logró el rescate técnico, material, estilístico y estético de la obra, el cual permitió recuperar una lectura integral de la misma y su permanencia en exposición.