Engaging Community Health Workers in Primary Care Practices: Provider Understanding of Roles, Benefits, and Barriers.

Community health workers (CHWs) are increasingly addressing health disparities in primary care settings; however, there is little information about how primary care practitioners (PCPs) interact with CHWs or perceive CHW roles. We examined PCP engagement with CHWs in adult primary care settings. Overall, 55% of 1504 PCPs reported working with CHWs; involvement with CHWs differed by some PCP demographic and practice-related factors. While PCPs perceived CHWs as engaging in most nationally endorsed CHW roles, they identified several barriers to integrating CHWs into care teams. Findings can inform ongoing efforts to advance health equity through integrating CHWs into primary care practices.

Artificial Intelligence Simulation of Adolescents' Responses to Vaping-Prevention Messages.

This quality improvement study investigates if a large language model could simulate adolescents' responses to vaping-prevention campaigns and identify the most effective messages to address the public health crisis of adolescent vaping.

Results of the Use of the Teleconsultation Platform After 2 Months of Implementation.

The Ministry of Health (MoH) set the National Digital Health Strategy 2018-2024 as a state policy. It included a National TeleHealth Plan to enhance access and quality of healthcare in a wide territory like Argentina, leveraging more than 20 years of national telemedicine experiences and coordinating it with the territorial integrated health service networks proposed by the Universal Health Coverage strategy. In collaboration with the Ministry of Modernisation, the MoH developed and implemented a new TeleHealth Web Platform to perform eReferrals and eConsultations nationwide. This poster describes the first 2 months of usage.

Prevalencia y caracterización de pacientes con polimiositis dentro de un grupo de enfermedades reumatológicas de un hospital universitario / Prevalence and characterization of patients with polymyositis within a group of rheumatic diseases in a university hospital

Introducción y objetivo: La polimiosistis es una miopatía inflamatoria idiopática cuya etiología es desconocida. Afecta principalmente al músculo esquelético, la piel y otros órganos internos. En cuanto a su frecuencia, pueden considerarse dentro del grupo de enfermedades raras debido a su baja prevalencia. Su incidencia anual media es de 2,1 a 7,7 casos nuevos por millón de habitantes. Métodos: Estudio observacional, descriptivo de corte transversal retrospectivo. La población estudio fueron pacientes con Polimiositis que ingresaron a un hospital universitario de Colombia entre el período comprendido entre los años 2012-2016 en pacientes mayores de 13 años que ingresen a la institución.

Determinación de las variables clínicas, paraclínicas y terapéuticas de los pacientes con anemia hemolítica autoinmune en un hospital de alta complejidad / Determination of the clinical, paraclinical and treatment of patients with autoimmune hemolytic anemia in a high complexity hospital

Introducción y Objetivo: La anemia hemolítica autoinmune (AHA) es una enfermedad en la que ocurre un acortamiento de la vida del eritrocito por un aumento de la destrucción mediada inmunológicamente contra los antígenos de su membrana y que puede estar asociada a otros tipos de enfermedades inmunológicas. Nuestro objetivo es realizar una descripción de las características en una cohorte de pacientes del Hospital de alta complejidad en Colombia. Métodos: Estudio observacional, descriptivo de corte transversal retrospectivo, la población de estudio fueron pacientes con AHA en el Hospital Universitario de Santander entre el 2012 y el 2016 en pacientes mayores de 13 años que ingresaron a la institución.

Perfil clínico y sociodemográfico de pacientes con miastenia gravis en un hospital universitario en Colombia / Clinical profile and socio-demographic of patients with myasthenia gravis in a university hospital in Colombia

ntroducción y objetivo: La miastenia gravis (MG) es una enfermedad neuromuscular cróni-ca causada por el bloqueo, interferencia o destrucción de los receptores de acetilcolina de la unión neuromuscular. La incidencia varía ampliamente de 1.7 a 10.4 por millón de habitantes por año, dependiendo del lugar del reporte. El objetivo del presente estudio fue describir la caracterización de este cuadro clínico en pacientes del Hospital Universitario de Santander. Métodos: Estudio observacional, descriptivo de corte transversal retrospectivo. La población estudio fueron pacientes mayores de 13 años con MG que ingresaron a un hospital universi-tario de Colombia entre el período comprendido entre los años 2012-2016.

Serum levels of interleukin-6 are linked to the severity of the disease caused by Andes Virus.

Andes virus (ANDV) is the etiological agent of hantavirus cardiopulmonary syndrome in Chile. In this study, we evaluated the profile of the pro-inflammatory cytokines IL-1ß, IL-12p70, IL-21, TNF-α, IFN-γ, IL-10 and IL-6 in serum samples of ANDV-infected patients at the time of hospitalization. The mean levels of circulating cytokines were determined by a Bead-Based Multiplex assay coupled with Luminex detection technology, in order to compare 43 serum samples of healthy controls and 43 samples of ANDV-infected patients that had been categorized according to the severity of disease. When compared to the controls, no significant differences in IL-1ß concentration were observed in ANDV-infected patients (p = 0.9672), whereas levels of IL-12p70 and IL-21 were significantly lower in infected cases (p = <0.0001). Significantly elevated levels of TNF-α, IFN-γ, IL-10, and IL-6 were detected in ANDV-infected individuals (p = <0.0001, 0.0036, <0.0001, <0.0001, respectively). Notably, IL-6 levels were significantly higher (40-fold) in the 22 patients with severe symptoms compared to the 21 individuals with mild symptoms (p = <0.0001). Using multivariate regression models, we show that IL-6 levels has a crude OR of 14.4 (CI: 3.3-63.1). In conclusion, the serum level of IL-6 is a significant predictor of the severity of the clinical outcome of ANDV-induced disease.

No Change in 24-Hour Hydration Status Following a Moderate Increase in Fluid Consumption.

PURPOSE: To investigate changes in 24-hour hydration status when increasing fluid intake. METHODS: Thirty-five healthy males (age 23.8 ± 4.7 years; mass 74.0 ± 9.4 kg) were divided into 4 treatment groups for 2 weeks of testing. Volumes of 24-hour fluid ingestion (including water from food) for weeks 1 and 2 was 35 and 40 ml/kg body mass, respectively. Each treatment group was given the same proportion of beverages in each week of testing: water only (n = 10), water + caloric cola (n = 7), water + noncaloric cola (n = 10), or water + caloric cola + noncaloric cola + orange juice (n = 8). Serum osmolality (Sosm), total body water (TBW) via bioelectrical impedance, 24-hour urine osmolality (Uosm), and volume (Uvol) were analyzed at the end of each 24-hour intervention. RESULTS: Independent of treatment, total beverage consumption increased 22% from week 1 to 2 (1685 ± 320 to 2054 ± 363 ml; p < 0.001). Independent of beverage assignment, the increase in fluid consumption between weeks 1 and 2 did not change TBW (43.4 ± 5.2 vs 43.0 ± 4.8 kg), Sosm (292 ± 5 vs 292 ± 5 mOsm/kg), 24-hour Uosm (600 ± 224 vs 571 ± 212 mOsm/kg), or 24-hour Uvol (1569 ± 607 vs 1580 ± 554 ml; all p > 0.05). CONCLUSIONS: Regardless of fluid volume or beverage type consumed, measures of 24-hour hydration status did not differ, suggesting that standard measures of hydration status are not sensitive enough to detect a 22% increase in beverage consumption.

Association of Single-Nucleotide Polymorphisms in IL28B, but Not TNF-α, With Severity of Disease Caused by Andes Virus.

BACKGROUND: Andes virus (ANDV) is the sole etiologic agent of hantavirus cardiopulmonary syndrome (HCPS) in Chile, with a fatality rate of about 35%. Individual host factors affecting ANDV infection outcome are poorly understood. In this case-control genetic association analysis, we explored the link between single-nucleotide polymorphisms (SNPs) rs12979860, rs8099917 and rs1800629 and the clinical outcome of ANDV-induced disease. The SNPs rs12979860 and rs8099917 are known to play a role in the differential expression of the interleukin 28B gene (IL28B), whereas SNP rs1800629 is implicated in the expression of tumor necrosis factor α gene (TNF-α). METHODS: A total of 238 samples from confirmed ANDV-infected patients collected between 2006 and 2014, and categorized according to the severity of the disease, were genotyped for SNPs rs12979860, rs8099917, and rs1800629. RESULTS: Analysis of IL28B SNPs rs12979860 and rs8099917 revealed a link between homozygosity of the minor alleles (TT and GG, respectively), displaying a mild disease progression, whereas heterozygosity or homozygosity for the major alleles (CT/CC and TG/TT, respectively) in both IL28B SNPs is associated with severe disease. No association with the clinical outcome of HCPS was observed for TNF-α SNP rs1800629 (TNF -308G>A). CONCLUSIONS: The IL28B SNPs rs12979860 and rs8099917, but not TNF-α SNP rs1800629, are associated with the clinical outcome of ANDV-induced disease, suggesting a possible link between IL28B expression and ANDV pathogenesis.

Hydration Status over 24-H Is Not Affected by Ingested Beverage Composition.

OBJECTIVE: To investigate the 24-h hydration status of healthy, free-living, adult males when given various combinations of different beverage types. METHODS: Thirty-four healthy adult males participated in a randomized, repeated-measures design in which they consumed: water only (treatment A), water+cola (treatment B), water+diet cola (treatment C), or water+cola+diet cola+orange juice (treatment D) over a sedentary 24-h period across four weeks of testing. Volumes of fluid were split evenly between beverages within each treatment, and when accounting for food moisture content and metabolic water production, total fluid intake from all sources was equal to 35 ± 1 ml/kg body mass. Urine was collected over the 24-h intervention period and analyzed for osmolality (Uosm), volume (Uvol) and specific gravity (USG). Serum osmolality (Sosm) and total body water (TBW) via bioelectrical impedance were measured after the 24-h intervention. RESULTS: 24-h hydration status was not different between treatments A, B, C, and D when assessed via Uosm (590 ± 179; 616 ± 242; 559 ± 196; 633 ± 222 mOsm/kg, respectively) and Uvol (1549 ± 594; 1443 ± 576; 1690 ± 668; 1440 ± 566 ml) (all p > 0.05). A -difference in 24-h USG was observed between treatments A vs. D (1.016 ± 0.005 vs. 1.018 ± 0.007; p = 0.049). There were no differences between treatments at the end of the 24-h with regard to Sosm (291 ± 4; 293 ± 5; 292 ± 5; 293 ± 5 mOsm/kg, respectively) and TBW (43.9 ± 5.9; 43.8 ± 6.0; 43.7 ± 6.1; 43.8 ± 6.0 kg) (all p > 0.05). CONCLUSIONS: Regardless of the beverage combination consumed, there were no differences in providing adequate hydration over a 24-h period in free-living, healthy adult males. This confirms that beverages of varying composition are equally effective in hydrating the body.

Análisis filogenético de las cepas de rotavirus y virus de la hepatitis A encontradas en agua de consumo en el municipio de Quibdó, Chocó / DNA sequence analysis indicates human origin of rotavirus and hepatitis A virus strains from western Colombia

Introducción. Quibdó, capital del departamento del Chocó, se ha caracterizado por ser una de las regiones más deprimidas en Colombia. La presencia de virus entéricos tipo rotavirus y virus de la hepatitis A en el agua de consumo, además de ser un indicador de su mala calidad, es una importante fuente de contaminación para los individuos que la consumen. Objetivo. Demostrar la presencia de estos dos agentes virales en el agua de consumo para contribuir con la explicación de la morbilidad por enfermedad diarreica aguda y hepatitis en la región, y aclarar que el origen de estos virus es por contaminación de desechos humanos más que por la materia fecal de bovinos o porcinos. Materiales y métodos. Se procesaron 4.000 litros de agua que se llevaron a ultrafiltración tangencial y a centrifugación con filtros Centriprep Ultracel YM-50. Se aplicó la prueba de RT-PCR a 60 muestras de agua no tratada y a 20 muestras de agua tratada por el acueducto. Las muestras positivas fueron secuenciadas y con el análisis de dichas secuencias se elaboraron árboles filogenéticos. Resultados. Seis de las muestras resultaron positivas para rotavirus y dos más para virus de la hepatitis A. Éstos aparecieron tanto en aguas tratadas como no tratadas. Los análisis filogenéticos demostraron que el rotavirus pertenece al serotipo G2 humano y que el virus de la hepatitis A fue también de origen humano. Conclusión. El agua analizada presenta un alto nivel de contaminación, demostrado por la presencia de virus patógenos para el hombre.

Introduction. Quibdó, the capital of Chocó Province, is one of the poorest cities in Colombia. Enteric viruses such as rotavirus and hepatitis A virus was found to occur commonly in city drinking water and indicated poor water quality and high risk of becoming infected. The source of these viruses was unknown, but humans and cattle were suspect sources. Objective. City water was assessed to determine source and persistence of diarrhea and hepatitis among the human populations in the environs of Quibdó. Material and methods. Four thousand liters of water were collected, filtered by tangential ultrafiltration and centrifuged in Centriprep Ultracel YM-50 tubes. Sixty samples of untreated and 20 of treated water were probed by RT-PCR. Results. Six samples were positive for rotavirus and 2 for hepatitis A virus in both, treated and non treated water. DNA sequence analysis identified the presence of human G2 rotavirus and human hepatitis A virus. Conclusion. The evidence indicated a high level of contamination with pathogenic viruses in consumable water sources in Quibdó, Colombia.

[Phylogenetic analysis indicates human origin of rotavirus and hepatitis A virus strains found in the drinking water of western Colombia]. / Análisis filogenético de las cepas de rotavirus y virus de la hepatitis A encontradas en agua de consumo en el municipio de Quibdó, Chocó.

INTRODUCTION: Quibdó, the capital of Chocó Province, is one of the poorest cities in Colombia. Enteric viruses such as rotavirus and hepatitis A virus was found to occur commonly in city drinking water and indicated poor water quality and high risk of becoming infected. The source of these viruses was unknown, but humans and cattle were suspect sources. OBJECTIVE: City water was assessed to determine source and persistence of diarrhea and hepatitis among the human populations in the environs of Quibdó. MATERIAL AND METHODS: Four thousand liters of water were collected, filtered by tangential ultrafiltration and centrifuged in Centriprep Ultracel YM-50 tubes. Sixty samples of untreated and 20 of treated water were probed by RT-PCR. RESULTS: Six samples were positive for rotavirus and 2 for hepatitis A virus in both, treated and non treated water. DNA sequence analysis identified the presence of human G2 rotavirus and human hepatitis A virus. CONCLUSION: The evidence indicated a high level of contamination with pathogenic viruses in consumable water sources in Quibdó, Colombia.