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BACKGROUND: Coinciding with the rising non-communicable disease (NCD) prevalence worldwide is the increasing frequency and severity of natural hazards. Protecting populations with NCDs against natural hazards is ever more pressing given their increased risk of morbidity and mortality in disaster contexts. This investigation examined Hurricane Maria's impacts across ten lower SES municipalities in Puerto Rico with varying community characteristics and hurricane impacts to understand experiences of supporting individuals with NCD management in the six-month period following the hurricane. METHODS: We conducted 40 qualitative interviews with mayors, first responders, faith leaders, community leaders, and municipal employees from 10 municipalities in Puerto Rico. Using QSR NVivo software, we deductively and inductively coded interview transcripts and undertook thematic analysis to characterize community-level hurricane impact and consequences for NCD management, and to identify convergent and divergent themes. RESULTS: Damages to infrastructure, including healthcare facilities and roadways, complicated the provision of timely health care for NCDs, patient transport, and pharmaceutical/medical supply chain continuity. Lengthy power outages at both healthcare facilities and private residences were barriers to healthcare service delivery, use of medical equipment, and storage of prescription medications with refrigeration, and led to a widespread mental health crisis. Cascading failures such as fuel shortages further compounded these challenges. The consequences of these impacts included the reported exacerbation of health conditions and loss of life among NCD patients. CONCLUSIONS: Study findings identify contributors to morbidity and mortality among individuals with NCDs following Hurricane Maria. With the growing frequency of catastrophic disasters from natural hazards, the experiences of communities that endured these impacts offer important lessons regarding policies and practices to better support community disaster resilience and address the evolving preparedness needs of NCD patients.
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Tempestades Ciclônicas , Desastres , Doenças não Transmissíveis , Humanos , Doenças não Transmissíveis/epidemiologia , Porto Rico/epidemiologia , Atenção à SaúdeRESUMO
Liquid drops when subjected to external periodic perturbations can execute polygonal oscillations. In this work, a simple model is presented that demonstrates these oscillations and their characteristic properties. The model consists of a spring-mass network such that masses are analogous to liquid molecules and the springs correspond to intermolecular links. Neo-Hookean springs are considered to represent these intermolecular links. The restoring force of a neo-Hookean spring depends nonlinearly on its length such that the force of a compressed spring is much higher than the force of the spring elongated by the same amount. This is analogous to the incompressibility of liquids, making these springs suitable to simulate the polygonal oscillations. It is shown that this spring-mass network can imitate most of the characteristic features of experimentally reported polygonal oscillations. Additionally, it is shown that the network can execute certain dynamics, which so far have not been observed in a perturbed liquid drop. The characteristics of dynamics that are observed in the perturbed network are polygonal oscillations, rotation of network, numerical relations (rational and irrational) between the frequencies of polygonal oscillations and the forcing signal, and that the shape of the polygons depends on the parameters of perturbation.
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El objetivo de este estudio es analizar desenlaces clínicos de oxigenoterapia con cánula nasal de alto flujo (CNAF) en niños con dificultad respiratoria aguda en un servicio de urgencias. Estudio longitudinal, retrospectivo de datos panel en niños con diagnóstico de dificultad respiratoria moderada- severa. El resultado primario de interés fue ingreso a unidad de cuidados intensivos pediátricos (UCIP) o requerir intubación 24 horas posteriores al inicio de la terapia. Se calcularon medidas de frecuencia y tendencia central. Los grupos se compararon con las pruebas Chi2, Fisher, Wilcoxon y Kruskal-Wallis. El análisis de datos panel balanceados identificó puntos de inflexión en las curvas de normalización de respuesta respiratoria. Un total de 339 niños de 0 a 16 años cumplieron los criterios de inclusión. Mayoría hombres (62,24%), mediana de edad 2 años (RIQ= 0,75-3) y neumonía como principal causa de dificultad respiratoria (33,92%). El ingreso a UCIP (14,5%) y la intubación (0,9%) fue baja en la cohorte. En las primeras tres horas con CNAF se evidenció mejoría en los parámetros respiratorios, sin diferencias significativas entre pacientes con y sin respuesta clínica (frecuencia cardiaca p=0,317; frecuencia respiratoria p=0,423; SatO2 p=0,297; FiO2 p=0,116). No se presentaron eventos adversos ni casos de mortalidad. Los resultados sugieren que la oxigenoterapia con CNAF puede ser una alternativa de soporte respiratorio inicial en niños ≤16 años con dificultad respiratoria moderada a severa. La incidencia de intubación e ingreso a UCIP fue baja. La CNAF fue bien tolerada en los diferentes grupos de edad.
Objective: To analyze clinical outcomes of oxygen therapy with a high-flow nasal cannula (HFNC) in children with acute respiratory distress in an emergency department. We design a longitudinal retrospective study of panel data in children with a diagnosis of moderate-severe respiratory distress. The primary outcome of interest was admission to the pediatric intensive care unit (PICU) or requiring intubation 24 hours after initiation of therapy.We calculated the statistics of frequency and central tendency. Finally, the Chi2, Fisher, Wilcoxon and Kruskal-Wallis tests were used to compare groups. Balanced panel data analysis identified inflexion points in the respiratory response normalization curves. Children (n = 339) from zero to 16 years old met the inclusion criteria. Most men (62.24%), median age= 2 years (IQR = 0.75-3) and pneumonia as the main cause of respiratory distress (33.92%). Admission to the PICU (14.5%) and intubation (0.9%) was low in the cohort. In the first three hours with HFNC, improvement in respiratory parameters was evidenced, with no significant differences between patients with and without clinical response (heart rate p = 0.317; respiratory rate p = 0.423; SatO2 p = 0.297; FiO2 p = 0.116). There were no adverse events or mortality cases. The results suggest that oxygen therapy with HFNC can be an alternative for initial respiratory support in children ≤16 years of age with moderate to severe respiratory distress. The incidence of intubation and admission to the PICU was low. The HFNC was well tolerated in the different age groups.
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Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Oxigenoterapia/métodos , Insuficiência Respiratória/terapia , Cânula , Unidades de Terapia Intensiva Pediátrica , Estudos Retrospectivos , Estudos Longitudinais , Resultado do Tratamento , Colômbia , EmergênciasRESUMO
BACKGROUND: In Chile there are 22,310 people in Chronic Hemodialysis (CHD), 53% of them older adults (OA). Shared decision-making and advance directives (AD) are especially important in OA with end-stage chronic renal failure, since they have greater levels of disability, morbidity and mortality, raising doubts about the benefit of therapy. AIMS: To understand the experience in decision making and explore ways to express AD, in OA in CHD. MATERIAL AND METHODS: A qualitative phenomenological study, performing 12 in-depth interviews to OA who had been at CHD for at least one year. RESULTS: The analysis revealed four broad comprehensive categories, two related to participation in the decision to enter CHD, namely the experience of subjects as spectators and their lack of interest for decision support and two referred to the expression of AD, namely the difficulty in facing their own finitude and resistance to express AD. CONCLUSIONS: There is little participation of older adults in the decision about their admission to dialysis therapy, and once they enter the CHD program they are not prepared to discuss AD in general, nor an eventual suspension of dialysis in particular.
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Falência Renal Crônica , Diálise Renal , Idoso , Chile , Tomada de Decisões , Hospitalização , HumanosRESUMO
The Granada group in BNCT research is currently performing studies on: nuclear and radiobiological data for BNCT, new boron compounds and a new design for a neutron source for BNCT and other applications, including the production of medical radioisotopes. All these activities are described in this report.
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Terapia por Captura de Nêutron de Boro/métodos , Aceleradores de Partículas , Humanos , Método de Monte Carlo , NêutronsRESUMO
Peroxidases (PODs) have many biological functions during the plant life cycle. In maize kernels, endosperm PODs have been identified as biochemical contributors to resistance against Sitophilus zeamais, but their identities have not been determined. In this study, we identified these PODs and determined whether their contributions are basal or inducible. Semi-purification and LC-MS/MS analyses showed that the protein ZmPrx35 is the predominant soluble endosperm POD from kernels of Pob84-C3R. Subsequent time-course analyses after mechanical damage showed that POD activity was regulated in a fluctuating kinetics pattern and that zmprx35 mRNA expression levels reflected this pattern. After 48 h of infestation with S. zeamais or Prostephanus truncatus, soluble endosperm POD activities were 1.38- or 0.85-fold, respectively. Under the same conditions, zmprx35 expression was induced 1.61-fold (S. zeamais infestation) and 1.17-fold (P. truncatus infestation). These findings suggest that ZmPrx35 contributes to the protective responses of aleurone cells against wounding and pest attacks, which could be enhanced/repressed by insect factors. Our data also provide evidence that the mechanisms of resistance of maize Pob84-C3R kernels toward the insect pests S. zeamais and P. truncatus are independent.
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Background: In Chile there are 22,310 people in Chronic Hemodialysis (CHD), 53% of them older adults (OA). Shared decision-making and advance directives (AD) are especially important in OA with end-stage chronic renal failure, since they have greater levels of disability, morbidity and mortality, raising doubts about the benefit of therapy. Aims: To understand the experience in decision making and explore ways to express AD, in OA in CHD. Material and Methods: A qualitative phenomenological study, performing 12 in-depth interviews to OA who had been at CHD for at least one year. Results: The analysis revealed four broad comprehensive categories, two related to participation in the decision to enter CHD, namely the experience of subjects as spectators and their lack of interest for decision support and two referred to the expression of AD, namely the difficulty in facing their own finitude and resistance to express AD. Conclusions: There is little participation of older adults in the decision about their admission to dialysis therapy, and once they enter the CHD program they are not prepared to discuss AD in general, nor an eventual suspension of dialysis in particular.
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Humanos , Idoso , Diálise Renal , Falência Renal Crônica , Chile , Tomada de Decisões , HospitalizaçãoRESUMO
Resumen Introducción: La participación en el colegio de enfermeras es una instancia relevante para el desarrollo de la profesión a nivel país, debido a la defensa que realiza por la enfermería desde los diferentes ámbitos de actuación; es indispensable inculcar esta visión desde la formación universitaria a través de los profesionales de enfermería que se dedican a la docencia. Materiales y métodos: Se realizó un estudio cuantitativo, transeccional y correlacional, en 49 académicos de las diferentes casas de estudio de la ciudad de Puerto Montt-Chile, en quienes se evaluó su afiliación al colegio de enfermeras, además de sus conocimientos, actitudes y motivaciones respecto a participar en dicha instancia gremial; para tal fin se aplicó un instrumento de elaboración propia (α Cronbach 0.71). Resultados: Se encontró que el 40.9% de los docentes está afiliado al colegio de enfermeras y que existe conocimiento suficiente respecto a esta organización, con una actitud desfavorable hacia el mismo, evidenciándose asociación entre la actitud y aspectos como la dinámica de trabajo (p=0.043 Correlación de Spearman: 0.158) y la afiliación al colegio (p=0.02 Coeficiente de Spearman: 0.142). Discusión: La participación colegiada permite el fortalecimiento de la profesión, además de favorecer la visibilidad, liderazgo e identidad profesional; aunque se reconocen estos aspectos no son suficientes para generar la afiliación o una actitud favorable a ésta. Conclusiones: En la promoción de la afiliación debe considerarse la tendencia a no afiliación de los docentes más jóvenes y los aspectos de motivación, ambos relevantes para destacar la participación colegial como un aspecto deontológico que forma parte del modelaje hacia los enfermeros en formación.
Abstract Introduction: The participation with the College of Nurses is a relevant action to support the development of nursing in Chile because this organization stands as an important defender to the practice. Therefore, it is advisable that nursing teachers promote this vision among the nursing community. Materials and Methods: This is a quantitative, transectional and correlational study with 49 academicians from diverse teaching centers in the city of Puerto Montt, Chile, who were assessed in terms of their affiliation to the College of Nurses, their knowledge, attitudes, and motivations regarding their participation with this organization. A locally-designed instrument (α Cronbach 0.71) was used. Results: 40.9% of the teachers were affiliated to the College of Nurses. Associations between attitudes and working dynamics (Spearman Correlation = 0.158, p =0.043), and affiliation to the College (Spearman Correlation = 0.142, p = 0.02) were found. Discussion: The participation with the College of Nurses can allow the strengthening of the profession by favoring its visibility, leadership, and professional identity, though these important gains are not always sufficient to encourage an affiliation or a positive attitude towards this organization. Conclusions: In order to better promote the affiliation to the College of Nurses, young teachers' indifference attitudes, as well as other overall motivation factors should be considered first.
Resumo Introdução: A participação no colégio de enfermeiras é uma instancia relevante para o desenvolvimento da profissão ao nível do país, devido à defesa que realiza pela enfermagem desde os diferentes âmbitos de atuação; é indispensável inculcar esta visão desde a formação universitária a través dos profissionais de enfermagem que se dedicam à docência. Materiais e métodos: Realizou-se um estudo quantitativo, transecional e correlacional, em 49 docentes das diferentes casas de estudo da cidade de Puerto Montt-Chile, em quem se avaliou sua filiação ao colégio de enfermeiras, além de seus conhecimentos, atitudes e motivações referentes a participar na instância gremial; para tal fim aplicou-se um instrumento de elaboração própria (α Cronbach 0.71). Resultados: Encontrou-se que o 40.9% dos docentes forma parte do colégio de enfermeiras e que existe conhecimento suficiente ao respeito desta organização, com uma atitude desfavorável a ele mesmo, evidenciando-se uma associação entre a atitude e aspectos como a dinâmica de trabalho (p=0.043 Correlação de Spearman: 0.158) e a filiação ao colégio (p=0.02 Coeficiente de Spearman: 0.142). Discussão: A participação colegiada permite o fortalecimento da profissão, além de favorecer a visibilidade, liderança e identidade profissional; ainda que se reconheçam estes aspectos, não são suficientes para gerar a filiação ou uma atitude favorável a esta. Conclusões: Na promoção da filiação deve considerar-se a tendência à não filiação dos docentes mais jovens e os aspectos de motivação, ambos relevantes para salientar a participação colegial como um aspecto deontológico que forma parte da modelagem aos enfermeiros em formação.
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INTRODUCTION: Condylomas or genital warts (GW) are the most frequently diagnosed sexually transmitted infection (STI) in STI centers in Chile, but there are no population statistics available. OBJECTIVES: To describe the prevalence of GW in patients from 18-60 years of age who attend outpatient dermatology, gynecology and urology practice; the demographic characteristics of the patients and the diagnostic and treatment tools. METHODS: A sample of Chilean specialists stratified by region, population and gender of patients was provided with a logbook and answered a questionnaire. RESULTS: The GW prevalence was 2.44% for the whole group; 3.76% for the 18-34 age group and 1.29% for the 35-60 years group (p = 0.0000). The average age of patients with GW was 29.4 years in women and 32.7 years in men (p = 0.019). The distribution by age was different according to gender and health system. Visual inspection was the most frequent diagnostic method used and imiquimod cream the most common treatment, however, there were differences in the use of diagnostic and therapeutic tools according to the patient's gender, specialty of the doctor and health system. CONCLUSIONS: The high prevalence of GW confirmed the need and importance of public health interventions to address this problem.
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Condiloma Acuminado/epidemiologia , Pacientes Ambulatoriais/estatística & dados numéricos , Adolescente , Adulto , Antineoplásicos/uso terapêutico , Chile/epidemiologia , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/tratamento farmacológico , Demografia/estatística & dados numéricos , Dermatologistas/estatística & dados numéricos , Feminino , Ginecologia/estatística & dados numéricos , Instituições Privadas de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Imiquimode/uso terapêutico , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Atenção Primária à Saúde/estatística & dados numéricos , Prática Profissional/estatística & dados numéricos , Urologistas/estatística & dados numéricos , Adulto JovemRESUMO
Taenia solium is a helminth parasite that causes 2 diseases in humans: cysticercosis and taeniasis. The establishment of T. solium metacestodes in the central nervous system causes neurocysticercosis, while development of the adult tapeworm in the small intestine causes taeniasis. Serological diagnosis of neurocysticercosis is performed by Western blot with an enriched fraction of glycoproteins that has been extensively used for clinical diagnosis and epidemiological surveys. The lectin-bound fraction that is used for this assay contains 7 antigenic glycoproteins. These antigenic proteins are considered to be highly specific for cysticercosis when tested with heterologous parasitic diseases. However, recent studies show that people with taeniasis have cross-reactive antibodies against the neurocysticercosis diagnostic glycoproteins and vice versa. Nevertheless, it is not known if these diagnostic proteins are expressed in the adult stage of the parasite. In this paper, we describe the location of 3 of these glycoproteins in T. solium adults and cysticerci using polyclonal antibodies raised against a synthetic peptide based on the amino acid sequence of TS14, a recombinant protein T24H, and the native GP50. The glycoproteins' distribution was different in invaginated and evaginated cysticerci as well as in adult tapeworms. Specifically, the 3 glycoproteins studied were differentially expressed during embryogenesis. Our findings indicate that expression of the diagnostic glycoproteins is developmentally regulated; this is noteworthy since these glycoproteins are considered specific for the diagnosis of neurocysticercosis but nevertheless are present in different structures throughout the development of T. solium. Here we describe the glycoprotein expression and localization, which can be important in understanding their biological functions. In addition, our results help clarify the cross-reaction observed between people with neurocysticercosis and taeniasis to TS14, T24H, and GP50, which are used as diagnostic antigens for neurocysticercosis.