RESUMO
BACKGROUND: In Mexico, the number of people living with HIV (PLWH) receiving antiretroviral therapy (ART) has increased in the last 20 years. The elimination of a CD4 threshold to initiate publicly funded ART was a major policy implemented in 2014. The study objective was to assess the determinants of Virologic Failure (VF) in Mexican PLWH on first-line ART between 2008 and 2017 and to evaluate the effects of changes following the 2014 policy. METHODS: A 10-year patient-level data analysis was conducted using the Mexican SALVAR database. The main outcome was the proportion of PLWH with VF. A multivariable logistic regression was conducted to identify the association between covariates and VF before and after the 2014 policy implementation. RESULTS: We found a lower proportion of people with VF in 2014-2017 compared with 2008-2013 (50% vs 33%, p<0.001). The multivariable analysis showed a reduction in the odds of virologic failure after 2014 (Odds ratio: 0.50 [95% CI: 0.48-0.51]). Place of treatment and level of deprivation were significant predictors of VF in during 2014-2017, but not before. CONCLUSION: This study indicates that, by lowering threshold levels of CD4 required for treatment initiation in Mexico, a higher number of PLWH initiated treatment during 2014-2017, compared to 2008-2013 and the odds of VF were reduced.
Assuntos
Fármacos Anti-HIV , Infecções por HIV , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , México/epidemiologia , Inquéritos e Questionários , Falha de Tratamento , Carga ViralRESUMO
BACKGROUND: In 2007-2012 the Mexican government launched the National HIV program and there was a major change in HIV policies implemented in 2013-2018, when efforts focused on prevention, increase in early diagnosis and timely treatment. Still, late HIV diagnosis is a major concern in Mexico due to its association with the development of AIDS development and mortality. Thus, the objectives of this study were to identify the determinants of late HIV diagnosis (i.e. CD4 count less than 200 cells/mm3) in Mexico from 2008 to 2017 and to evaluate the impact of the 2013-2017 National HIV program. METHODS: Using patient level data from the SALVAR database, which includes 64% of the population receiving HIV care in Mexico, an adjusted logistic model was conducted. Main study outcomes were HIV late diagnosis which was defined as CD4 count less than 200 cells/mm3 at diagnosis. RESULTS: The study included 106,830 individuals newly diagnosed with HIV and treated in Mexican public health facilities between 2008 and 2017 (mean age: 33 years old, 80% male). HIV late diagnosis decreased from 45 to 43% (P < 0.001) between 2008 and 2012 and 2013-2017 (i.e. before and after the implementation of the 2013-2017 policy). Multivariable logistic regressions indicated that being diagnosed between 2013 and 2017 (odds ratio [OR] = 0.96 [95% Confidence interval [CI] [0.93, 0.98]) or in health facilities specialized in HIV care (OR = 0.64 [95% CI 0.60, 0.69]) was associated with early diagnosis. Being male, older than 29 years old, diagnosed in Central East, the South region of Mexico or in high-marginalized locality increased the odds of a late diagnosis. CONCLUSIONS: The results of this study indicate that the 2013-2017 National HIV program in Mexico has been marginally successful in decreasing the proportion of individuals with late HIV diagnosis in Mexico. We identified several predictors of late diagnosis which could help establishing health policies. The main determinants for late diagnosis were being male, older than 29 years old, and being diagnosed in a Hospital or National Institute.
Assuntos
Infecções por HIV , Adulto , Contagem de Linfócito CD4 , Diagnóstico Tardio , Diagnóstico Precoce , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Masculino , México/epidemiologiaRESUMO
Introdução: Com o avanço das redes sociais e acesso instantâneo às informações, nunca foi tão importante buscar as fontes certas e entender como utilizar cada rede para divulgar evidências científicas. Objetivo: Relatar um caso de experiência em que a divulgação científica em Odontologia foi realizada através da integração das redes sociais de uma instituição pública de ensino superior. Relato do caso: O Núcleo de Teleodontologia da Faculdade de Odontologia (NTO) da Universidade do Estado do Rio de Janeiro, desde 2015 utiliza as redes sociais para promover comunicação, difusão e alcance do conhecimento científico na área de Odontologia. Inicialmente começou pelo Facebook com apenas posts informativos e ao longo dos anos expandiu para criação de conteúdos em diferentes formatos como vídeos curtos e longos, entrevistas com profissionais, web-conferência, divulgação de artigos científicos e criação da Jornada Acadêmica Online voltada a aprendizagem continuada. Para isso, adicionou outras redes sociais em seu portfólio como Instagram e YouTube. Para a criação dos conteúdos, princípios pedagógicos foram seguidos concomitante à capacitação profissional de alunos às novas ferramentas tecnológicas. Resultados: Ao final de 2020, com a pandemia do Covid-19 a procura por capacitação através de meios digitais aumentou o acesso aos conteúdos de nossas redes em 700%. Conclusões: A integração das redes sociais potencializou o alcance dos conteúdos elaborados pela instituição de ensino, através do uso de diferentes plataformas, sendo mais um canal que pode ser usado para a comunicação e divulgação científica por centros acadêmicos.
Introduction: Due to the exponential growth of social media and quick access to find any answer online is crucial to recognize reliable sources and understand how to use online network environments to disseminate scientific evidence. Objective: This study reported a six-year experience of a dental public school about the use of social media in dental science communication. Case report: The Núcleo de Teleodontologia da Faculdade de Odontologia (NTO) of the Universidadedo Estado do Rio de Janeiro, since 2015 started to use social media to communicate dental science to promote and disseminate scientific knowledge to the dental community. Firstly we started publishing evidence-based posts on Facebook. Over the years, Instagram and YouTube also were included in our portfolio. Contents were created based on pedagogical principles. They had different formats that include short/long videos, interviews with specialists and web conferences. It also was developed an Online Academic Conference focused on continuing education. During the content creation process, dental students got involved. They were able to develop skills in communication, critical thinking and technology tools. Results: At the end of 2020 online search information increased the access to our content in social media by 700%. Conclusions: Integrating social media to dental science communication expanded the reach of evidence-based contents to the dental community. These platforms could be an additional canal for academic institutions to spread scientific information and promote better information against fakenews.
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Odontologia , Odontologia Baseada em Evidências , Comunicação em Saúde , Rede SocialRESUMO
Chronic recurrent multifocal osteomyelitis (CRMO) is a rare idiopathic inflammatory disease that affects mainly children and young adults. The clinical signs and symptoms are nonspecific, hindering and delaying diagnosis. Radiological and histopathological tests are essential for its definition. A case of CRMO is reported, demonstrating the importance of clinical, laboratory, and radiological data for diagnosis.
Osteomielite crônica multifocal recorrente (OCMR) é uma doença inflamatória idiopática rara que acomete principalmente crianças e adultos jovens. Os sintomas e sinais clínicos são inespecíficos, dificultam e retardam o diagnóstico. Os exames radiológicos e histopatológicos são indispensáveis para sua definição. Neste relato, os autores apresentam um caso de OCMR que demonstra a importância dos dados clínicos, laboratoriais e radiológicos para o diagnóstico.
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Interest in short-term global health experiences to underserviced populations has grown rapidly in the last few decades. However, there remains very little research on what participants can expect to encounter. At the same time, it has been suggested that in order for physicians and workers to provide safe and effective care, volunteers should have a basic understanding of local culture, health systems, epidemiology, and socioeconomic needs of the community before arriving. Our objective was to add to the limited literature on what short-term global health trips can expect to encounter through a cross-sectional study of patient demographics, socioeconomic markers, and the prevalence of diseases encountered on a short-term medical service trip to Lima, Peru. Descriptive analysis was conducted on clinic data collected from patients living in Pamplona Alta and Pamplona Baja, Lima, Peru, in July 2015. We found that volunteers encountered mainly female patients (70.8%), and that there were significant socioeconomic barriers to care including poverty, poor housing, environmental exposures, and lack of continuity of health care. Analysis of the disease prevalence found a high proportion of acute and chronic musculoskeletal pain in the adult populations (18.8% and 11.4%, respectively), and a high presentation of upper respiratory tract infections (25.4%) and parasites (22.0%) in the pediatric group. These findings can be used by future short-term medical service trips to address potential gaps in care including the organization of weekend clinics to allow access to working men, and the use of patient education and nonpharmacological management of acute and chronic disease.
Assuntos
Saúde Global , Qualidade da Assistência à Saúde/organização & administração , Medicina Tropical/organização & administração , Programas Voluntários/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Objetivos Organizacionais , Peru/epidemiologia , Fatores Socioeconômicos , Adulto JovemRESUMO
ABSTRACT Chronic recurrent multifocal osteomyelitis (CRMO) is a rare idiopathic inflammatory disease that affects mainly children and young adults. The clinical signs and symptoms are nonspecific, hindering and delaying diagnosis. Radiological and histopathological tests are essential for its definition. A case of CRMO is reported, demonstrating the importance of clinical, laboratory, and radiological data for diagnosis.,
RESUMO Osteomielite crônica multifocal recorrente (OCMR) é uma doença inflamatória idiopática rara que acomete principalmente crianças e adultos jovens. Os sintomas e sinais clínicos são inespecíficos, dificultam e retardam o diagnóstico. Os exames radiológicos e histopatológicos são indispensáveis para sua definição. Neste relato, os autores apresentam um caso de OCMR que demonstra a importância dos dados clínicos, laboratoriais e radiológicos para o diagnóstico.