Applying systems thinking to identify enablers and challenges to scale-up interventions for hypertension and diabetes in low-income and middle-income countries: protocol for a longitudinal mixed-methods study.

INTRODUCTION: There is an urgent need to reduce the burden of non-communicable diseases (NCDs), particularly in low-and middle-income countries, where the greatest burden lies. Yet, there is little research concerning the specific issues involved in scaling up NCD interventions targeting low-resource settings. We propose to examine this gap in up to 27 collaborative projects, which were funded by the Global Alliance for Chronic Diseases (GACD) 2019 Scale Up Call, reflecting a total funding investment of approximately US$50 million. These projects represent diverse countries, contexts and adopt varied approaches and study designs to scale-up complex, evidence-based interventions to improve hypertension and diabetes outcomes. A systematic inquiry of these projects will provide necessary scientific insights into the enablers and challenges in the scale up of complex NCD interventions. METHODS AND ANALYSIS: We will apply systems thinking (a holistic approach to analyse the inter-relationship between constituent parts of scaleup interventions and the context in which the interventions are implemented) and adopt a longitudinal mixed-methods study design to explore the planning and early implementation phases of scale up projects. Data will be gathered at three time periods, namely, at planning (TP), initiation of implementation (T0) and 1-year postinitiation (T1). We will extract project-related data from secondary documents at TP and conduct multistakeholder qualitative interviews to gather data at T0 and T1. We will undertake descriptive statistical analysis of TP data and analyse T0 and T1 data using inductive thematic coding. The data extraction tool and interview guides were developed based on a literature review of scale-up frameworks. ETHICS AND DISSEMINATION: The current protocol was approved by the Monash University Human Research Ethics Committee (HREC number 23482). Informed consent will be obtained from all participants. The study findings will be disseminated through peer-reviewed publications and more broadly through the GACD network.

Estado de las tendencias profesionales del Instrumentador Quirúrgico graduado de una Institución de Educación Superior de Colombia (IES) / Professional trends of the surgical instrument technician program graduates from a higher education institution in colombia

Introducción: los actuales desafíos del sector salud demandan profesionales más participativos y competitivos, por ende los programas académicos realizan el seguimiento a sus graduados con el fin de conocer la situación contextual, económica, laboral y académica. Esta información es un insumo que permite a la comunidad académica y al sector productivo y social conocer la pertinencia en términos curriculares y tendencias profesionales. Objetivo: identificar las tendencias profesionales del instrumentador quirúrgico graduado de una Institución de Educación Superior en el periodo 2012-1 a 2019-1. Materiales y métodos: estudio descriptivo de corte transversal en 274 egresados del programa de instrumentación quirúrgica (2012-1 a 2019-1) de una universidad en Bogotá, con una muestra de 251 egresados. Para la recolección de la información se incluyeron variables sociodemográficas, tendencias laborales y de formación posgradual o complementaria. Resultados: 90% corresponden al sexo femenino, 87.6% se encuentran laboralmente activos. El mayor porcentaje se encuentra en el área clínica(45.0%) y en la asesoría quirúrgica (32.3%), también han incursionado en otros campos como el comercial, administrativo, la docencia y la investigación, 15.0% continuaron su formación educativa. Conclusiones: se encuentra coherencia con el perfil del instrumentador quirúrgico que brinda la formación en este programa y los campos de desempeño identificados, es necesario que las instituciones de educación superior propongan estrategias que promuevan la formación posgradual en las diferentes modalidades existentes (presencial, virtual o combinadas).

Introduction: current challenges in the health sector demand more participative and competitive professionals, thus, academic programs track their graduates in order to know about their contextual, economic, labor and academic situation. This data provides an input allowing the academic community and the productive and social sector to identify the relevant curricula and professional trends. Objective: to identify the professional trends of a surgical instrument technician graduating from a higher education institution in the period from 2012-1 to 2019-1. Materials and methods: descriptive cross-sectional study in 274 graduates from the surgical instrument technician program (2012-1 to 2019-1) of a university in Bogota, in a sample of 251 graduates. Data on sociodemographic variables, employment trends and postgraduate or complementary training was collected. Results: 90% were females, 87.6% were currently working. The top percent work in the clinical area (45.0%) and 32.3% as surgical technologists. They had also ventured into other fields such as the commercial, administrative, teaching and research fields, 15.0% continued their skills development. Conclusions: there is coherence between the surgical instrument technician professional profile developed in this training program and the fields of performance identified. Higher education institutions need to formulate strategies promoting postgraduate training using current education modalities (on-campus, online or hybrid).

Perfil demográfico y epidemiológico de pacientes con Hemofilia y von Willebrand atendidos en el Área de Estomatología del Hospital de Especialidades Carlos Andrade Marín / Demographic and epidemiological profile of patients with Hemophilia and von Willebrand treated in the Stomatology Area of the Carlos Andrade Marín Specialties Hospital

INTRODUCCIÓN. Las alteraciones hereditarias de la hemostasia son patologías raras, dentro de estas se encuentran: Hemofilia A, Hemofilia B y von Willebrand. La hemofilia es un trastorno hereditario, ligado al cromosoma X, causado por ausencia o actividad reducida del factor VIII o IX. La enfermedad de von Willebrand es causada por la deficiencia del factor VIII. OBJETIVO. Determinar el perfil demográfico y epidemiológico de pacientes con Hemofilia y von Willebrand. MATERIALES Y MÉTODOS. Estudio observacional, descriptivo, transversal. La población de estudio fueron 133719 con una muestra de 144 pacientes, los criterios de inclusión fueron: pacientes de ambos sexos entre 2 a 88 años de edad, con diagnóstico de Hemofilia A, B, von Willebrand. Atendidos en la consulta externa del Área de Estomatología del Hospital de Especialidades Carlos Andrade Marín, en el periodo 2015-2018. Datos obtenidos del sistema AS400, analizados en el programa International Business Machines Statistical Package for the Social Sciences, Versión 22.0. RESULTADOS. El 77,0% (111; 144) perteneció al género masculino. El rango de edad fue entre 23 y 33 años con 24,0% (34; 144). Tuvieron Hemofilia A 62,0% (93; 144); Hemofilia B 6,0% (9; 144); von Willerbrand 28,0% (42; 144). El 50,0% (77; 144) recibieron tratamientos odontológicos; preventivos 15,0% (21; 144) y curativos 13,0% (18; 144); siendo la mayor patología caries dental. CONCLUSIÓN. Se determinó el perfil demográfico y epidemiológico de los pacientes con Hemofilia y von Willebrand que permitió brindar un tratamiento integral, interdisciplinario y oportuno.

INTRODUCTION. Hereditary abnormalities of hemostasis are rare pathologies, within these are: Hemophilia A, Hemophilia B and von Willebrand. Hemophilia is an inherited disorder, linked to the X chromosome, caused by absence or reduced activity of factor VIII or IX. Von Willebrand's disease is caused by factor VIII deficiency. OBJECTIVE. Determine the demographic and epidemiological profile of patients with hemophilia and von Willebrand. MATERIALS AND METHODS. Observational, descriptive, cross-sectional study. The study population was 133719 with a sample of 144 patients, the inclusion criteria were: patients of both sexes between 2 and 88 years of age, with a diagnosis of Hemophilia A, B, von Willebrand. Attended in the external consultation of the Stomatology Area of the Carlos Andrade Marín Specialty Hospital, in the period 2015-2018. Data obtained from the AS400 system, analyzed in the International Business Machines Statistical Package for the Social Sciences program, Version 22.0. RESULTS 77,0% (111; 144) belonged to the male gender. The age range was between 23 and 33 years with 24,0% (34; 144). They had hemophilia at 62,0% (93; 144); Hemophilia B 6,0% (9; 144); von Willerbrand 28,0% (42; 144). 50,0% (77; 144) received dental treatments; preventive 15,0% (21; 144) and curative 13,0% (18; 144); being the biggest dental caries pathology. CONCLUSION. The demographic and epidemiological profile of patients with Hemophilia and von Willebrand was determined, which allowed to provide a comprehensive, interdisciplinary and timely treatment.

Reintroducción del consumo regular de Quinua en Riobamba, Ecuador: estudio piloto / Reintroucción of regular consumptin of quinoa in Riobamba, Ecuador: a piloy study

En Ecuador la incidencia de obesidad, diabetes y otras afecciones crónicas de salud, que se han asociado parcialmente con cambios en los hábitos alimentarios, está aumentando y muchas veces se acentúa en los centros urbanos más pequeños. El consumo omnipresente de arroz blanco es probablemente una práctica alimentaria presente en esta transición nutricional, mientras que el consumo de alimentos tradicionales saludables como la quinua permanece generalmente bajo. En nuestra encuesta realizada en 2013, el 67% de los 240 residentes encuestados en la pequeña ciudad andina de Riobamba informaron que preferirían comer "arroz de quinua" (quinua preparada como arroz) por lo menos dos veces por semana en lugar de arroz blanco. Con el objetivo de reintroducir el consumo regular de quinua en los hogares de esta población, a finales de 2015 se inició una intervención para promover el consumo de arroz de quinua 3 veces por semana, entre 131 adultos en Riobamba. Entre la línea de base y los datos obtenidos al final de la intervención cuatro meses más tarde, no hubo cambios significativos en el IMC observado. Sin embargo, a los 2, 4 y 7 meses post-basal, el 52%, 40% y 47% de los encuestados, respectivamente, informaron haber disfrutado del consumo de arroz de quinua en lugar de arroz blanco, afirmando que les gustaba "mucho" o "en general", y el 64%, 55% y 68% de los encuestados refirieron que "definitivamente" o "muy probablemente" continuarán consumiendo quinua en lugar de arroz, por lo menos a veces. Estos hallazgos sugieren una aceptación modesta de esta (re)introducción de un alimento tradicional y saludable, aunque otras investigaciones más amplias y extensas podrían evaluar con mayor precisión los posibles impactos en la salud de este tipo de cambio reportado en los hábitos alimentarios de la población.

Abstract: In Ecuador the incidence of obesity, diabetes and other chronic health conditions -- which are partly due to changes in dietary behavior -- has been increasing, often most dramatically in smaller urban centers. The ubiquitous consumption of white rice is likely one important factor in this nutritional transition, while the consumption of traditional healthy foods such as quinoa remains generally low. In a 2013 survey we conducted, 67% of the 240 residents surveyed in the small Andean city of Riobamba reported they would prefer eating quinoa "rice" at least twice weekly instead of white rice. With the objective of encouraging more normative household consumption of quinoa in this population, in late 2015 an intervention was begun to promote consumption of quinoa rice 3 times a week among 131 adults in Riobamba. Between the baseline and the termination of the intervention four months later, no significant change in BMI was observed. However, at 2, 4 and 7 months' post-baseline, 52%, 40% and 47% of respondents, respectively, reported enjoying consumption of quinoa rice instead of white rice either "very much" or "in general," and 64%, 55% and 68% of respondents "definitely" or "very likely" planned to continue doing so. Our findings suggest a modest acceptance of this (re)introduction of a traditional and healthy food, though further and more extensive research could assess with greater precision the potential health impacts of such reported changes in dietary habits. Reintroducción del consumo regular de Quinua en Riobamba, Ecuador: estudio piloto.

Reducing pesticide exposure and associated neurotoxic burden in an Ecuadorian small farm population.

The contribution of community-based interventions, including farmer field schools (FFSs) in integrated pest management (IPM), to reducing pesticide exposures and associated neurotoxic burden among small-farm families in Ecuador was assessed in three Andean farming communities in a co-design of targeted action-research. Baseline questionnaire surveys elicited pesticide-related knowledge, practices, and exposure and neurobehavioral assessments were done using an adapted WHO battery. Pesticide applications on plots farmed by FFS versus non-FFS participants were compared. A year later, repeated surveys of participating households (n = 29) and neurobehavioral testing of individuals (n = 63) permitted comparisons of pre- and post-intervention values. The FFS graduates applied pesticides on their plots less frequently (p = 0.171). FFS households had increased pesticide-related knowledge of labels and exposure risk factors (both p < 0.004), better pesticide-handling practices (p < 0.01), and less skin exposure (p < 0.01). Neurobehavioural status had improved, particularly digit span and visuo-spatial function, resulting in overall z-score increases. Thus, community interventions reduced pesticide use, reported skin exposure, and neurotoxic burden among smallholder farm families.