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Background: Practice-based experiences documenting development and implementation of nutrition and health surveillance systems are needed. Objectives: To describe processes, methods, and lessons learned from developing and implementing a population-based household nutrition and health surveillance system in Guatemala. Methods: The phases and methods for the design and implementation of the surveillance system are described. Efforts to institutionalize the system in government institutions are described, and illustrative examples describing different data uses, and lessons learned are provided. Results: After initial assessments of data needs and consultations with officials in government institutions and partners in the country, a population-based nutrition surveillance system prototype with complex sampling was designed and tested in 5 Guatemalan Highland departments in 2011. After dissemination of the prototype, government and partners expanded the content, and multitopic nutrition and health surveillance cycles were collected in 2013, 2015, 2016, 2017/18, and 2018/19 providing nationally representative data for households, women of reproductive age (15-49 y), and children aged 0-59 mo. For each cycle, data were to be collected from 100 clusters, 30 households in each, and 1 woman and 1 child per household. Content covered â¼25 health and nutrition topics, including coverage of all large-scale nutrition-specific interventions; the micronutrient content of fortifiable sugar, salt, and bread samples; anthropometry; and biomarkers to assess annually, or at least once, â¼25 indicators of micronutrient status and chronic disease. Data were collected by 3-5 highly trained field teams. The design was flexible and revised each cycle allowing potential changes to questionnaires, population groups, biomarkers, survey design, or other changes. Data were used to change national guidelines for vitamin A and B-12 interventions, among others, and evaluate interventions. Barriers included frequent changes of high-level government officials and heavy dependence on US funding. Conclusions: This system provides high-quality data, fills critical data gaps, and can serve as a useful model for others.
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La COVID-19 ha desatado una emergencia internacional en Salud Pública al afectar millones de personas, provocar muertes, y causar una crisis humanitaria nunca antes vista. Esto ha saturado los sistemas de información en salud de los países afectados, donde resultan de utilidad las herramientas informáticas para el manejo de un gran número de casos, al menor costo económico posible. En este contexto resalta el paquete de programas epidemiológicos Epi InfoTM, que permite crear formularios electrónicos para la recolección de datos. La presente investigación tiene como objetivo describir las ventajas y facilidades de implementar Epi InfoTM para los casos de COVID-19. Con módulos para analizar la información mediante cálculos y representaciones de medidas epidemiológicas, además de crear mapas de casos sospechosos o confirmados, Epi InfoTM cuenta también con complementos para dispositivos móviles y la web; todos con experiencias probadas en situaciones de epidemias como la del Ébola, VIH y el MERS. Por lo que Epi InfoTM es una aplicación robusta y libre de costo muy útil para su implementación en los sistemas de información en salud para el manejo adecuado de casos de COVID-19(AU)
COVID-19 has unleashed an international Public Health emergency by affecting millions of people, causing deaths, and a humanitarian crisis never seen before. This has saturated the health information systems of the affected countries, where computer tools are useful for managing a large number of cases, at the lowest possible economic cost. In this context, the Epi InfoTM package of epidemiological programs which allows creating electronic forms for data collections, stands out in addition with modules to analyze the information through calculations and representations of epidemiological measures. It also allows creating maps of suspected or confirmed cases and has applications for mobile devices and web; all with proven experiences in epidemic situations such as Ebola, HIV, and the previous outbreaks of Coronavirus. Therefore, Epi InfoTM is a robust and free of cost application, very useful for its implementation in health information systems for the adequate management of COVID-19 cases(AU)
Assuntos
Humanos , Masculino , Feminino , Sistemas de Informação Geográfica/normas , Epidemias/história , Monitoramento Epidemiológico , Sistemas de Informação em Saúde/organização & administração , COVID-19/transmissãoRESUMO
BACKGROUND: Flaviviruses are important pathogens for humans and animals (Dengue viruses, Yellow fever virus, Zika virus and West Nile virus). Culex flavivirus (CxFV) is an insect-specific virus of the genus Flavivirus, detected in a wide variety of mosquito species. OBJECTIVE: To detect Flavivirus in mosquitoes of a tropical region of the Colombian Caribbean. METHODS: In 2014, an entomological surveillance of arboviruses was conducted in the department of Cordoba area of the Caribbean, Colombia. A total of 8270 mosquitoes were captured as follow: Mansonia (n = 3271/39.5%), Culex (n = 2668/32.26%), Anopheles (n = 840/10.15%), Aedeomyia (n = 411/4.9%), Psorophora (n = 397/4.8%), Coquilletidia (n = 369/4.46%), Uranotaenia (n = 261/3.15%) and Aedes (n = 53/0.6%). All mosquito species were collected in dry tropical forest of the Caribbean area. Universal primers for NS5 gene (958 pb), RT-PCR for flavivirus and sequencing were used for molecular identification of viruses detected. RESULTS: Two pools belonging to Culex coronator were positive for flavivirus RNA sequence by RT-PCR. The sequences of the PCR amplicons, matched that of the Culex flaviviruses, CxFv COL PM_149 (GenBank: KR014201) and CxFv COL PM_212 (GenBank: KT307717). Phylogenetic analysis of the NS5 protein sequences of the Culex flaviviruses sequences with those of reference sequences available in GenBank indicated viruses of Genotype II, closely related to the Brazilian strain, BR_SJRP_01_ (GenBank: KT726939), from Culex sp. The alignment of Culex flavivirus sequences CxFv COL_ PM 212 and CxFv COL_ PM 149 with sequences of strains detected in different geographical regions grouped the strains in a Latin American clade reported in Brazil, Argentina and Mexico. CONCLUSIONS: The present work illustrated that CxFV was circulating among vectors of human pathogenic arboviruses in Colombia, but the impact of CxFV on other flaviviruses which are endemic in the study area still remains to be explored.
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Culicidae/virologia , Flavivirus/classificação , Mosquitos Vetores/virologia , Aedes/virologia , Animais , Anopheles/virologia , Região do Caribe , Colômbia , Feminino , Flavivirus/isolamento & purificação , Genótipo , Sequenciamento de Nucleotídeos em Larga Escala , Masculino , Filogenia , Estudos Prospectivos , Clima Tropical , Proteínas não Estruturais Virais/genéticaRESUMO
INTRODUCTION: The Caribbean area of Colombia has been severely affected by a Chikungunya virus (CHIKV) outbreak since 2014. METHODOLOGY: The study was carried out on 100 patients during a fever outbreak from August to September 2014 in two small rural villages in the northern Caribbean area of Colombia. The molecular assays performed by reverse transcription polymerase chain reaction (RT-PCR) on acute patient sera were collected within one to five days of the appearance of symptoms. Sequence analyses were carried out based on phylogenetic analyses of genes NS1 and E2. For serological assays, 49 (49%) patients at ≥ 6 days of disease onset were tested with NovaLisa Chikungunya IgG/IgM µ-capture enzyme-linked immunosorbent assay (ELISA). RESULTS: The main signs or symptoms associated with Chikungunya infection were arthralgia of the lower limbs (96%), fever (91%), arthralgia of the upper limbs (85%), rash (64%), and headache (57%). Ninety-four percent (46/49) of patients were positive for either IgM or IgG; the remaining three (6%) patients were seronegative. Viral loads were detected in 25 patients. Based on phylogenetic analysis of NS1 and E2, the characterization of the Colombian CHIKV indicated that it was a strain closely related to the British Virgin Islands strain and to the Asian genotype. CONCLUSIONS: This study shows the phylogenetic and clinical description of CHIKV in Colombia. The main symptoms shown were: arthralgia, fever, and rash. CHIKV sequences detected in Colombian patients were within the Asian genotype and closely related to the British Virgin Islands strain.
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Febre de Chikungunya/epidemiologia , Febre de Chikungunya/patologia , Vírus Chikungunya/classificação , Vírus Chikungunya/isolamento & purificação , Surtos de Doenças , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Região do Caribe/epidemiologia , Vírus Chikungunya/genética , Criança , Colômbia/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Filogenia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Análise de Sequência de DNA , Homologia de Sequência , Adulto JovemRESUMO
El objetivo del presente estudio fue proponer un instrumento para medir el clima laboral en la Fuerza Aérea Colombiana. Para ello se diseñó el cuestionario de clima laboral, se evaluaron las características psicométricas y se estableció su utilidad como instrumento de medida. El estudio fue de tipo instrumental, con la participación de 3272 de sus funcionarios, diferenciados por grupos de rango, dependencia, jefatura y bases en el ámbito nacional. Se realizó el análisis de ítems para identificar la potencia discriminativa de cada uno de los ítems, para diferenciar entre quiénes tienen alta percepción de un buen clima laboral y los que no la tienen; la homogeneidad y la consistencia interna. Todas las escalas obtuvieron un alpha mayor a 0,72 y del análisis de cada ítem, se propone una escala de 58 elementos. Se concluye que el cuestionario de clima laboral tiene buena capacidad discriminativa y de homogeneidad.
The purpose of the study was to propose an instrument in order to measure the work environment in the Colombian Air Forces. In order to do this, a questionnaire of work environment was designed; then the psychometric characteristics were evaluated and the utility as an instrument of measurement was established. This study was instrumental and 3272 military servants took part in it and were classified according to their rank, branch where they work, if they were the chief of a division and location in the national territory. In order to identify the discriminative potential of each one of the items to differentiate among the military servants who have a high perception of a good work environment and those who do not have it, each item was analyzed. Homogeneity and inner consistency were also studied. All the scales got an alpha bigger than 0,72 and according to each item, a scale of 58 items is proposed. It was concluded that the questionnaire of work environment has a good homogeneity and discriminative capacity.
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An anticancer-bioassay guided isolation of the ethanol extract and fractions of two plants from the Peruvian rainforest, Mikania decora and Cremastosperma microcarpum, led to the characterization of one abundant diterpene, ent-pimara-8(14),15-dien-19-oic acid (1), three thymol derivatives, 10-acetoxy-8,9-dehydro-6-methoxythymol butyrate (2), 10-acetoxy-8,9-epoxy-6-methoxythymol isobutyrate (3), and acetylschizoginol (4), as well as one neolignan, (±)-trans-dehydrodiisoeugenol (5). Only the latter was isolated from C. microcarpum. These compounds exhibited significant cytotoxic activity against a panel of human tumor cell lines. Compounds 3 and 4 were also investigated for their in vitro antileishmanial and trypanocidal activity against Leishmania amazonensis axenic amastigotes and Trypanosoma cruzi trypomastigotes.
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Annonaceae/química , Anti-Infecciosos/farmacologia , Mikania/química , Extratos Vegetais/química , Animais , Anti-Infecciosos/química , Linhagem Celular Tumoral , Sobrevivência Celular , Diterpenos/química , Diterpenos/farmacologia , Feminino , Humanos , Leishmania/efeitos dos fármacos , Lignanas/química , Lignanas/farmacologia , Macrófagos/efeitos dos fármacos , Masculino , Camundongos , Testes de Sensibilidade Parasitária , Peru , Folhas de Planta/química , Raízes de Plantas/química , Caules de Planta/química , Timol/química , Timol/farmacologia , Árvores , Trypanosoma cruzi/efeitos dos fármacosRESUMO
A pharmacological screening of the ethanol extract and fractions of two Peruvian medicinal plants, Plagiochila disticha and Ambrosia peruviana, led to the isolation and characterization of three ENT-2,3-secoaromadendrane-type sesquiterpenoids, named plagiochiline A ( 1), I ( 2), and R ( 3), as well as of two pseudoguaianolids, damsin ( 4) and confertin ( 5), which exhibited significant cytotoxic activity against a panel of human tumor cell lines. Compounds 1, 4, and 5 were also investigated for their in vitro antileishmanial, trypanocidal, and antituberculosis activity against Leishmania amazonensis axenic amastigotes and Trypanosoma cruzi trypomastigotes, as well as against MDR and sensitive strains of Mycobacterium tuberculosis, respectively.
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Anti-Infecciosos/isolamento & purificação , Antineoplásicos Fitogênicos/isolamento & purificação , Asteraceae/química , Azulenos/isolamento & purificação , Compostos de Epóxi/isolamento & purificação , Piranos/isolamento & purificação , Sesquiterpenos/isolamento & purificação , Linhagem Celular Tumoral , Avaliação Pré-Clínica de Medicamentos , Humanos , Peru , Plantas Medicinais/químicaRESUMO
A multidisciplinary and international team of scientists was assembled in the early 1990s to conduct an ethnobotanical study of plants used by the Aguaruna people of the Peruvian Amazon forest. The initial ethnobotanical project, carried out under the auspices of an International Cooperative Biodiversity Grant (ICBG), led to the collection of approximately 4000 plant species. Some members of the original team of scientists have continued this collaboration by focusing on potential sources of new anticancer, anti-infective, and wound-healing agents. This effort has uncovered several secondary metabolites representing a wide variety of chemical diversity. In this short review we describe some bioactive compounds of interest as part of our continuing collaboration.
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Plantas Medicinais/química , Etnobotânica , Humanos , Medicina Tradicional , Estrutura Molecular , PeruRESUMO
The antiproliferative bioassay-guided fractionation of five Peruvian plants, Doliocarpus dentatus, Picramnia sellowii, Strychnos mitscherlichii, Iryanthera juruensis, and Croton alnifolius, led to the isolation and identification of their different major cytotoxic constituents, betulinic acid (1), nataloe-emodin (2), bisnordihydrotoxyferine (4), 2',4'-dihydroxy-6'-methoxy-3,4-methylenedioxydihydrochalcone (5), and 2',4'-dihydroxy-4,6'-dimethoxydihydrochalcone (6) and 12-O-tetradecanoylphorbol-13-acetate (7), respectively. Eight human tumor cell lines and two nontumorigenic cell lines were used in this investigation. Their in vitro activity against Mycobacterium tuberculosis is also reported.
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Antineoplásicos Fitogênicos/isolamento & purificação , Antineoplásicos Fitogênicos/farmacologia , Mycobacterium tuberculosis/efeitos dos fármacos , Plantas Medicinais/química , Strychnos/química , Triterpenos/isolamento & purificação , Triterpenos/farmacologia , Antineoplásicos Fitogênicos/química , Ensaios de Seleção de Medicamentos Antitumorais , Humanos , Testes de Sensibilidade Microbiana , Estrutura Molecular , Triterpenos Pentacíclicos , Peru , Triterpenos/química , Células Tumorais Cultivadas , Ácido BetulínicoRESUMO
Presentamos el caso de una rara anomalía congénita debido a un desorden my severo de la querantinizació de la piel, caracterizado por una piel rígida y gruesa con agrietamiento profundos que la dividían en plcas, lo cual daba la apariencia de una figura arlequín. El nacimiento ocurrió en el Hospital Dr. LUis E. Aybar en Santo Domingo, República Dominicana, en una madre de 19 años GL, P I. La criatura pesó 1871 G, con una edad gestacional de 33 semanas
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Humanos , Masculino , Recém-Nascido , Queratinas/genética , Ceratose/congênito , MudaRESUMO
Presentamos el caso de una rara y fatal anomalía congénita caracterizada por un enanismo con acortamiento de extremidades, un torax muy pequeño, cabeza grande en comparación al resto del cuerpo, puente nasal levemente plano, branquidactilia, frente prominente y fontanela amplia. El nacimiento ocurrio el 15 de abril 1998 en el Hospital Dr. Luis E. Aybar en Santo Domingo, República Dominicana, de una madre de 17 años G 1; la criatura peso 3402 gramos al nacer con una edad gestacional de 37 semanas
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Humanos , Recém-Nascido , Masculino , Displasia TanatofóricaRESUMO
En este trabajo se analiza el concepto integral de salud y se plantea la necesidad de ensayar esquemas complementarios de atención a la salud para contribuir a disminuir la brecha de polarización epidemiológica, proponiendo la atención primaria a la salud como una estrategia primordial. Asimismo, se destaca la importancia de que, a través del sistema de salud, se practique una atención basada en el cuidado de las poblaciones. Se proponen alternativas a fin de estabilizar el estado de salud de la población, entre las que destacan la formación de recursos humanos con un enfoque preventivo, además de curativo. Se destaca el papel del psicólogo como miembro importante y desaprovechado del equipo de salud, y, por último, se presenta el programa de la Maestría en Salud Mental en Poblaciones y Residencia de Psicología en Atención Integral a la Salud, como una opción para contribuir a las propuestas anteriores
This paper takes as its basis the concept of comprehensive health care. The need to try out complementary approaches to health care is emphasized in order to ameliorate the effects of the epidemiological transition. The approach of Primary Health Care as a basic strategy is also presented. The importance of applying health system population approach to health care is also analyzed. A number of health care alternatives are presented in order to stabilize the health of a community. Within these alternatives the training of human resources with a focus on prevention as well as the curative approach are presented. The role that the psychologist plays within the comprehensive health care is also described. Also the authors describe an innovative training program directed to Psychologists at this stage, that integrates a Master on Public Health with emphasis in mental health with a residence program in Comprehensive Health Care as an option to contribute to replicate the alternatives of care presented in the paper. Finally, the programs and their advances are presented.
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Humanos , Psicologia/educação , Psicologia , Mão de Obra em Saúde , Atenção Primária à Saúde , Educação Médica , Participação da Comunidade , Prevenção Primária , Promoção da Saúde , Papel do MédicoRESUMO
Se presenta el análisis de la calidad de la atención prestada en 2,782 encuentros clínicos a partir de la evaluación del cumplimiento de los seis pasos necesarios en una consulta: a) interrogatorio, b) exploración física, c) diagnóstico, d) prescripción, e) información, y f) cita. Se encuentran serias deficiencias en la calidad de la atención en general, con variaciones según el motivo de consulta, el tipo de unidad en la que se prestó el servicio, ectétera. Se presentan algunas recomendaciones de cambio estructural en los servicios de salud y de educación médica para mejorar la calidad
Quality of care was analyzed in 2 782 clinical appointments, focusing on the evaluation of the six basic steps of medical consultation: a) questionnaire, b) physical examination, c) diagnosis, d) prescription, e) information, and f) appointment management. Serious defficiencies were found, with variations depending on the motive of the visit, the type of unit in which the service was given, etcetera. In order to improve the quality of care a structural change is suggested, both in the health care services and in medical education.
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Humanos , Masculino , Feminino , Atenção Primária à Saúde , Qualidade da Assistência à Saúde , Prontuários Médicos/normas , Qualidade dos Medicamentos Homeopáticos , Serviços de Saúde/classificação , México , Educação MédicaRESUMO
Se revisa una alternativa metodológica para establecer prioridades entre los problemas de salud. Esta se basa en el método epidemiológico que para jerarquizar las enfermedades toma en cuenta los factores de magnitud, transcendencia y vulnerabilidad. En primera instancia se desarrolló una serie de indicadores para cada uno de los factores anteriores utilizando la información disponible, a través de los cuales se realizó una transformación escalar para poder calificar y ordenar los problemas de acuerdo a su importancia. Posteriormente se utilizó la técnica Delfos como una alternativa para establecer un ordenamiento en razón de la importancia de los problemas de salud, utilizando los resultados del primer análisis. Como consecuencia de este análisis se generó una lista de 27 problemas prioritarios para la formación de recursos humanos
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Prioridades em Saúde , Doença/classificação , México , Métodos Epidemiológicos , Atenção à Saúde , Técnica DelphiRESUMO
En estos últimos años México se ha abocado a la tarea de revisar y reorganizar los sistemas de prestación de servicios de salud. La planificación de estos servicios requiere efectuar un pronóstico acerca de las necesidades de recursos humanos, en relación con los problemas de salud a los que se ha asignado prioridad. El pronóstico se basó en la delineación de áreas de problemas de salud y en el diseño y las probabilidades de escenarios posibles de prestación de servicios de salud en dos marcos temporales diferentes, 1987 y 1992, seleccionados de acuerdo con el ciclo de seis años de ejercicio del gobierno federal. Un grupo de profesionales-psiquiatras, psicólogos, trabajadoras sociales, enfermeras psiquiátricas, terapeutas ocupacionales-que trabajan en instituciones académicas, públicas y privadas, se reunió y llegó, mediante la técnica Delfos, a un consenso en relación con los parámetros presentados, necesarios para elaborar ese prognóstico. Al observar los resultados obtenidos con la aplicación de dicha técnica en relación con las prioridades en la ejecución de tareas, se advierte que concuerdan el tipo de personal necesario y los grupos de actividades que deben cumplirse en todos los niveles. Con los datos que aporta el pronóstico acerca de la cantidad de recursos humanos y el tipo de personal es posible suministrar a las instituciones académicas información amplia al respecto