Training physiotherapy students in basic wheelchair provision. Experiences at two universities in Colombia.

Wheelchair provision training is essential to overcome barriers related to the lack of knowledge of health professionals on this topic. Appropriate knowledge of the service provision process may lead to higher quality service and products, and thus be more likely to help people with mobility impairments achieve the fundamental human right of personal mobility. This study aimed to describe a training intervention for two groups of future physiotherapists in Colombia, assess cohort differences in performance on a knowledge test, and explore their post-training perceptions. A quantitative retrospective study with a historical, descriptive-comparative design was conducted. 525 sixth-semester participants completed the International Society of Wheelchair Professionals Wheelchair Service Provision - Basic Test online in Spanish after curriculum modifications were implemented. The test assesses knowledge in seven domains: Assessment; Prescription; Products; Fitting; User training; Follow-up, maintenance, and repairs; and Process. The training intervention was successfully implemented with Physiotherapy students from two institutions, resulting in a 57% increase in test approval rates. Participants demonstrated increased knowledge, satisfaction with the course content, and application of learning to their current work. These results suggest implications for what pedagogical approach to employ, when curricular change may be warranted, and specific considerations for the Colombian context. Furthermore, identifying the minimal knowledge basis for undergraduate programs and facilitating its dissemination can support interprofessional education and enhance professionals' capacity to support wheelchair provision services.

Developing pedagogical materials and resources should address academic needs while also being adaptable to the healthcare system and cultural and economic resources.Establishing minimal knowledge bases for physiotherapists and facilitating their dissemination to support interprofessional education are crucial steps.Sharing pedagogical experiences that improve health workforce training promotes the quality of wheelchair service provision, benefiting the functional independence and well-being of people with disabilities.The use of international resources such as the ISWP test in the training of the health workforce contributes to the standardization of the training process regardless of the context.

Effect of Sample Sources on Heavy Metal Concentration Measured in Beta Vulgaris Organs.

Aim: Heavy metal concentration [mg/dL, MP] in soil and the transfer to vegetable organs may have a sampling effect. We compared the [MP] in soil and organ samples of Beta vulgaris collected in sites with socioeconomic differences potentially inducing phytotoxicity. Materials and Methods: Samples of Beta vulgaris and soils (n = 4 per sample of soil and plant material) were randomly collected from two distant geographic areas (Mosquera and Sibaté, Cundinamarca, Colombia). We determined the [MP] using acid digestion of HCl : HNO3 [1 : 1]; the [MP] was obtained by atomic absorption in Varian AA-140 and Shimadzu AA-7000 equipment. A two-way ANOVA estimated the effect (partial η2) of the sampling site and metal type on the [MP] and transfer to the vegetable. Results: In Sibaté, the means (SD) of As_1.44 (0.18), Co_1.09 (0.51), Cr_6.21 (0.33), Ni_0.22 (0.02), and Pb_4.17 (0.87) were higher than in Mosquera (As_1.06 (0.21), Co_0.81 (0.19), Cr_3.72 (0.51), Ni_0.13 (0.04), and Pb_1.69 (0.40)) (p value <0.05). The effect of the interaction between the metal type and Beta vulgaris organs on the [MP] (0.801) in Sibaté was more meaningful than in Mosquera (0.430). Additionally, there was a strong correlation (Spearman's ρ > 0.8, p value <0.001) between [MP_soil] and [MP_plants] and between the transfer of metals to the plant and to the leaves. Discussion. The sampling location has a differential effect on the [MP] in soil and the transfer to Beta vulgaris. Given the differential effect described, the monitoring and phytoremediation strategies must be adjusted to scenarios with potentially phytotoxic conditions.

Intra- and inter-rater reliability of Fugl-Meyer Assessment of Lower Extremity early after stroke.

BACKGROUND: The Fugl-Meyer Assessment of Lower Extremity (FMA-LE) is a widely used and recommended scale for evaluation of post-stroke motor impairment. However, the reliability of the scale has only been established by using parametric statistical methods, which ignores the ordinal properties of the scale. OBJECTIVE: To determined intra- and inter-rater reliability of the FMA-LE at item and summed score level early after stroke. METHODS: Sixty patients (mean age 65.9 years, median FMA-LE 29 points) admitted to the hospital due to stroke were included. The FMA-LE was simultaneously, but independently, scored by three experienced and trained physical therapists randomly assigned into pairs, on two consecutive days, between 4 to 9 days post stroke. A rank-based statistical method for paired ordinal data was used to assess the level of agreement and systematic and random disagreements. RESULTS: The item-level reliability was high (percentage of agreement [PA] ≥75%). Two items (ankle dorsiflexion during flexor synergy and normal reflex activity) showed some systematic disagreement in intrarater analysis. A satisfactory intrarater reliability (PA ≥70%) was reached for all summed scores when a 1- or 2-point difference was accepted between ratings. CONCLUSION: The FMA-LE is a reliable tool for assessment of motor impairment both within and between raters early after stroke. The scale can be recommended not only for use in Spanish speaking countries, but also internationally. A unified international use of FMA-LE would allow comparison of stroke recovery outcomes worldwide and thereby potentially improve the quality of stroke rehabilitation.

Contamination of staple crops by heavy metals in Sibaté, Colombia.

Heavy metal contamination in water resources, soil, and food sources is an issue that compromises food safety in Sibaté, Colombia. In the present study concentration of heavy metals [HMs], such as Cu, As, Pb, Cr, Zn, Co, Cd and Ni, present in vegetables included in the typical Colombian diet were measured. The study was conducted as follows: samples of parsley, artichoke and carrots produced in a location near the Muña dam were collected, where the Bogotá River water is treated for use as a water resource. To determine food safety, national and international [HMs] established limits were compared with quantified [HMs] in samples of different vegetable parts and of the surrounding soil. Fresh samples were separated in their respective parts for cold acid digestion with HCl and HNO3 (1:1) for 15 days. Heavy metal mean ± standard error (SE) were as follows (mg/kg) As 2.36 ± 0.185, Cd 0.16 ± 0.009, Co 0.43 ± 0.019, Cr 12.1 ± 0.453, Cu 13.1 ± 1.68, Ni 0.00, Pb 7.07 ± 0.482 and Zn 3.976 ± 0.332. Cd, Cr, As, Co and Ni showed high transfer factor in Cynara scolymus. Moreover, high Pb, Cu and Zn transfer factor were present in Petroselinum crispum. Except for Daucus carota roots, there was a high metal transfer specifically in Petroselinum crispum leaves and other different plant parts, with high transfer factor for Cr, As, Co, Pb, Cu and Zn.

Undergraduate physiotherapy students' basic wheelchair provision knowledge: a pilot study in two universities in Colombia.

Purpose: Access to an appropriate wheelchair is a human right. Only between 5-15% of people who need a wheelchair have access to one. One of the key barriers to access is the lack of appropriately trained rehabilitation professionals. The objective of this study was to evaluate basic manual wheelchair provision knowledge in final-year physiotherapy undergraduate students in two programs in Colombia.Materials and methods: Students took the International Society of Wheelchair Professionals Wheelchair Service Provision - Basic Test which was administered online and in Spanish. The minimum score to pass the test is 70%; it assesses seven domains: Assessment; Prescription; Products; Fitting; User training; Follow-up, maintenance, and repairs; and Process.Results and conclusions: One-hundred sixteen students took the test and no one passed the test. The highest median domain scores were in Assessment and Process while the lowest were in Fitting and Products. The limitations of this study include that this sample does not represent all physiotherapy programmes or students in Colombia, there may be potential errors in the Spanish translation of the outcome measure, and students encountered Internet connectivity issues during the test that may have impacted their scores. Immediate interventions are required to improve teaching and students' learning outcomes related to basic manual wheelchair provision in these two programs. This study may serve as a foundation for future regional or national studies that assess the situation of wheelchair provision training in rehabilitation programs that will inform improvement actions. This manuscript is also available in Spanish as Supplemental Material.Implications for rehabilitationThis study indicates that students' current knowledge on basic appropriate manual wheelchair provision from two physiotherapy programs in Colombia is insufficient. Students' knowledge does not align with the minimum guidelines recommended for wheelchair service provision by the World Health Organization.Objectively identifying the gap in knowledge in rehabilitation trainees (i.e., physiotherapy students) is a strategy to promote the inclusion of assistive technology related content in formal academic training.The need to include formal training of appropriate wheelchair provision persists and without this training, people with disabilities who require a wheelchair for mobility will continue to face barriers to full participation in society.

Intra- and inter-rater reliability of Fugl-Meyer Assessment of Upper Extremity in stroke.

OBJECTIVE: The Fugl-Meyer Assessment of Upper Extremity (FMA-UE) is recommended for evaluation of sensorimotor impairment post stroke, but the item-level reliability of the scale is unknown. The study aims to determine intra- and inter-rater reliability of the FMA-UE at item-, subscale- and total score level in patients with early subacute stroke. DESIGN: Intra/inter-rater reliability. SUBJECTS: Sixty consecutively included patients with stroke (mean age 65.9 years) admitted to Central Military Hospital of Colombia, Bogota. METHODS: Two physiotherapists scored FMA-UE independently on 2 consecutive days within 10 days post stroke. A rank-based statistical method for paired ordinal data was used to assess the level of agreement, systematic and random disagreements. RESULTS: Systematic disagreements either in position or concentration were detected in 4 items of the shoulder section. The item level intra- and inter-rater agreement was high (79100%). The 70% agreement was also reached for the subscales and the total score when 13-point difference was accepted. CONCLUSION: The FMA-UE is reliable both within and between raters in patients with stroke in the early subacute phase. A wider international use of FMA-UE will allow comparison of stroke recovery between regions and countries and thereby potentially improve the quality of care and rehabilitation in persons with stroke worldwide.

Translation and cultural validation of clinical observational scales - the Fugl-Meyer assessment for post stroke sensorimotor function in Colombian Spanish.

Purpose: Fugl-Meyer Assessment (FMA) is the most widely used and recommended clinical scale for evaluation of sensorimotor impairment post stroke, but an official Spanish version is not available today. This study aimed to establish methodological structure for translation and cultural adaptation process and perform a transcultural validation of the upper and lower extremity FMA to Colombian Spanish. Methods: Procedures included forward and backward translation, step-wise reviewing by bilingual and professional experts to ensure conceptual and semantic equivalence. Validation included a pilot evaluation of item-level agreement on 10 individuals with stroke at the Central Military Hospital of Colombia. Results: Comprehensive step-wise procedure for transcultural validation was established. Low agreement (less than 70%) was detected for items assessing arm movements within synergies and for coordination/speed subscale. All points of disagreement were systematically reviewed and agreed upon when drafting the final version of the Spanish FMA. Conclusions: Use of FMA will allow unified description of stroke severity and motor recovery in Spanish speaking countries. This will open up possibility to compare stroke and rehabilitation outcomes with other countries and regions world-wide. Comprehensive methodological procedures provided can facilitate introduction of well-established clinical scales in other languages. Implications for Rehabilitation The Fugl-Meyer Assessment (FMA) of upper and lower extremity is the most used and recommended clinical scale for evaluation of sensorimotor impairment after stroke. The Spanish version of FMA, validated in this study, is now first time available for use in research and clinical practice. Use of FMA will allow unified description of stroke severity and motor recovery in Spanish speaking countries, which in turn opens up possibility to compare stroke and rehabilitation outcomes with other countries and regions world-wide.

Síntomas depresivos en familiares cuidadores de recién nacidos en una Unidad de Cuidado Intensivo Neonatal y factores asociados / Depressive symptoms and associated factors in caregivers of newborn infants hospitalized in a neonatal intensive care unit

Introducción. Se hanreportado altas prevalencias de síntomas depresivos en familiares de recién nacidos hospitalizados en unidades de cuidado intensivo neonatal. Esto ocasiona un alto impacto negativo para el vínculo familiares-recién nacido. Objetivo. Determinar la prevalencia de síntomas depresivos y sus factores asociados en cuidadores de recién nacidos hospitalizados en una Unidad de Cuidado Intensivo Neonatal en Colombia. Materiales y métodos. Estudio de corte transversal analítico en una institución de salud de alto nivel de complejidad especializada en patologías cardiovasculares. Se aplicó el Inventario de Depresión de Beck-II al ingreso y ocho días después. Se consideró presencia de síntomas depresivos cuando los cuidadores presentaban depresión intermitente, moderada, grave o extrema. Se realizaron análisis bivariados y multivariados usando modelos de regresión binomial. Resultados. Se analizó un total de 107 niños con sus cuidadores. La prevalencia de síntomas depresivos fue 20,56% (IC 95%: 12,77-28,34) en la medición basal y 12,86% (IC 95%: 4,120,89) al octavo día. Los cuidadores de sexo masculino y de 30 años de edad o más tuvieron menor riesgo de presentar síntomas depresivos, mientras que ser cabeza de familia, tener nivel de primaria o ningún grado de escolaridad y que sus hijos hubieran tenido Apgar al nacer de 1-6 representaron factores de riesgo para síntomas depresivos. Conclusiones. La prevalencia de síntomas depresivos fue alta. Ser cabeza de familia, tener baja escolaridad y Apgar al nacer entre 1 y 6 fueron factores asociados a síntomas depresivos en los cuidadores.

Introduction. A high prevalence of depressive symptoms has been reported in family members of newborn infants hospitalized in neonatal intensive care units. This causes a high negative impact on the newborn infant-family bond.Objective. To establish the prevalence of depressive symptoms and their associated factors in caregivers of newborn infants hospitalized in a neonatal intensive care unit in Colombia. Materials and Methods. Cross-sectional, analytical study conducted at a tertiary care health facility specialized in cardiovascular disease.The Beck Depression Inventory-II was administered upon admission to the NICU and on Day 8. Depressive symptoms were considered present if caregivers had intermittent, moderate, severe, or extreme depression. Bivariate and multivariate analyses were done using binomial regression models.Results. A total of 107 children and their caregivers were studied. The prevalence of depressive symptoms was 20.56% (95% confidence interval [CI]: 12.77-28.34) at baseline and 12.86% (95% CI: 4.1-20.89) on Day 8. Male caregivers and caregivers older than 30 years old had a lower risk of having depressive symptoms whereas being the head of the household, having completed primary education or no education at all, and having a baby with an Apgar score at birth of 1-6 were risk factors for developing depressive symptoms. Conclusions. The prevalence of depressive symptoms was high. Being the head of the household, having a low level of education, and an Apgar score at birth of 1-6 were associated with depressive symptoms among caregivers.

Depressive symptoms and associated factors in caregivers of newborn infants hospitalized in a neonatal intensive care unit. / Síntomas depresivos en familiares cuidadores de recién nacidos en una Unidad de Cuidado Intensivo Neonatal y factores asociados.

INTRODUCTION: A high prevalence of depressive symptoms has been reported in family members of newborn infants hospitalized in neonatal intensive care units. This causes a high negative impact on the newborn infant-family bond. OBJECTIVE: To establish the prevalence of depressive symptoms and their associated factors in caregivers of newborn infants hospitalized in a neonatal intensive care unit in Colombia. MATERIALS AND METHODS: Cross-sectional, analytical study conducted at a tertiary care health facility specialized in cardiovascular disease. The Beck Depression Inventory-II was administered upon admission to the NICU and on Day 8. Depressive symptoms were considered present if caregivers had intermittent, moderate, severe, or extreme depression. Bivariate and multivariate analyses were done using binomial regression models. RESULTS: A total of 107 children and their caregivers were studied. The prevalence of depressive symptoms was 20.56% (95% confidence interval [CI]: 12.77-28.34) at baseline and 12.86% (95% CI: 4.1-20.89) on Day 8. Male caregivers and caregivers older than 30 years old had a lower risk of having depressive symptoms whereas being the head of the household, having completed primary education or no education at all, and having a baby with an Apgar score at birth of 1-6 were risk factors for developing depressive symptoms. CONCLUSIONS: The prevalence of depressive symptoms was high. Being the head of the household, having a low level of education, and an Apgar score at birth of 1-6 were associated with depressive symptoms among caregivers.

Se han reportado altas prevalencias de síntomas depresivos en familiares de recién nacidos hospitalizados en unidades de cuidado intensivo neonatal. Esto ocasiona un alto impacto negativo para el vínculo familiares-recién nacido.

Caracterización de donantes voluntarios de sangre por grupo sanguíneo A B O y Rh que asistieron a un banco de sangre de la ciudad de Tunja, Colombia / Characterization of voluntary blood donors for blood group ABO and Rh attending a blood bank in the city of Tunja, Colombia

Objetivo: La frecuencia de grupo sanguíneo ABO y factor Rh es un factor importante en relación a las necesidades de los componentes sanguíneos en la población, la identificación un procedimiento de rutina en los bancos de sangre. Materiales y métodos: Se realizó un estudio retrospectivo de corte trasversal descriptivo, periodo entre enero a marzo de 2012 con datos proporcionados por la Fundación Hematológica Colombia provenientes de donantes voluntarios de sangre que asistieron a un punto fijo de recolección de sangre de la ciudad de Tunja – Colombia. Las variables analizadas fueron: edad, género, factor Rh y grupo sanguíneo ABO. Resultados: La población de estudio estuvo conformada por 1678 donantes voluntarios la edad promedio de 28,29 años, el 53,3% (n=894), 62,9% de la población pertenece al grupo O, se encontró mayor proporción de Rh positivo frente al negativo (94,9 vs 5,1), el tipo de sangre O positivo es el 32% (n=532) del total de la población. Conclusiones: El grupo O y A son los que predominan en la población de estudio, comportamiento similar a loa reportado en la literatura, de igual manera el Rh negativo...

Emergence of blaKPC-containing Klebsiella pneumoniae in a long-term acute care hospital: a new challenge to our healthcare system.

OBJECTIVES: To characterize isolates of Klebsiella pneumoniae producing KPC carbapenemase (KPC-Kp) associated with an outbreak in a long-term acute care hospital (LTACH) in South Florida. METHODS: During 21 March to 20 April 2008, 241 K. pneumoniae isolates detected at Integrated Regional Laboratories (Ft. Lauderdale, FL) for which the ertapenem MICs were > or =4 mg/L were studied. PCR, cloning and sequence analysis were used to detect bla(KPC) and to characterize the beta-lactamase and outer membrane proteins (Omps). The expression level of KPC enzymes was studied by immunoblotting. Genetic relatedness of isolates was investigated with rep-PCR and PFGE. Clinical records of patients were investigated. RESULTS: Seven KPC-Kp strains were isolated from different patients located at a single LTACH, with a further three isolates being recovered from patients at different hospitals. All KPC-Kp isolates in patients from the LTACH and from one hospital patient were genetically related and shared PFGE patterns that clustered with known sequence type (ST) 258 strains. These strains were highly resistant to carbapenems (MICs > or = 32 mg/L) due to an increased level of KPC expression and loss of Omps. Rectal colonization was documented in all LTACH patients with KPC-Kp isolates. Treatment failures were common (crude mortality rate of 69%). Active surveillance and enhanced infection control practices terminated the KPC-Kp outbreak. CONCLUSIONS: The detection of KPC-Kp in an LTACH represents a serious infection control and therapeutic challenge in a new clinical setting. The speed at which the epidemic of KPC-Kp is spreading in our healthcare system mandates urgent action.

Evaluación de la capacidad probiótica in vitro de una cepa nativa de Saccharomyces cerevisiae / In vitro evaluation of the probiotic capacity of a native strain of saccharomyces cerevisiae

En el presente estudio se evaluó la capacidad probiótica in vitro de una cepa nativa de Saccharomyces cerevisiae (A) y se comparó con una cepa comercial (B) utilizada como probiótico. Para esto se determinó la concentración de melaza de caña (10, 20 y 30 por ciento (p/v)) que permitiera obtener la mayor cantidad de biomasa de las cepas, así mismo se determinaron parámetros cinéticos. La concentración de melaza que arrojó mejores resultados fue 20por ciento (p/v) y se encontró diferencia en la producción de biomasa para la cepa en estudio A (28g/L) y la cepa control B (3g/L) en medio melaza. Se realizaron pruebas in vitro como resistencia a sales biliares, tolerancia a rangos de pH y jugos gástricos, donde no se observaron diferencias entre la cepa A y B al medir el crecimiento. La reducción del colesterol en presencia de sales biliares después de 12 horas de incubación fue de 54 por ciento para la cepa A y 58 por ciento para la B. Por último se realizó una prueba de adherencia en células Caco-2, encontrando adherencia a estas por parte de ambas cepas. De acuerdo con los resultados anteriores se demostró que la cepa A tiene propiedades probióticas in vitro que pueden ser corroboradas con posteriores estudios in vivo que confirmen su utilización como probiótico en nutrición animal.

The in vitro probiotic capacity of a native strain of Saccharomyces cerevisiae (A) was evaluated and compared with a commercial strain (B) used as a probiotic. The effect of the concentration of sugarcane molasses (10, 20 and 30% (w/v)) on the biomass production was investigated and kinetic parameters were determined. The best molasses concentration was 20% (w/v) and differences in biomass production on molasses medium between strain A (28 g/L) and control strain B (3 g/L) were observed. In vitro tests such as tolerance to bile salts, pH and gastric juices were carried out, and no differences in growth between strain A and B were found. Cholesterolreduction on presence of bile salts after 12 hours of incubation was of 54% for strain A and 58% for strain B. Both strains showed adherence to Caco-2 cells. Results reveal that strain A possesses in vitro probiotic propertiesthat can be verified with further in vivo studies to confirm its suitability as probiotic in animal nutrition.

Prevención de lesiones: una estrategia de salvación para la sociedad moderna / Injuries prevention a salvation strategy for modern society

Los programas de prevención en salud pública han disminuido la incidencia de las lesiones y eventos fatales que ocurren en la población joven, involucrada en las colisiones de tráfico en Bogotá - Colombia. Estos programas se basan en la aplicación de la matriz de Haddon. En este artículo se revisan los aspectos y resultados sobre prevención de lesiones que ha venido realizando la Secretaría de Tránsito y Transporte de Bogotá con la colaboración de la Secretaría Distrital de Salud y El Fondo de Previsión Vial Nacional