ABSTRACT
BACKGROUND: Widespread use of antibiotics disrupts the balance in the microbial world and promotes development and spread of antibiotic resistant bacteria. Educational initiatives are important as part of strategies to mitigate antibiotic resistance. The Alforja Educativa is an innovative educational program developed in Ecuador with the aim to teach schoolchildren about antibiotic use and antibiotic resistance. The program places antibiotic resistance within a broader frame of health, well-being, and ecological awareness, highlighting the importance to maintain balance in the microbial world. The objective of this study was to evaluate the effect of the Alforja Educativa on knowledge about bacteria, antibiotics and antibiotic resistance amongst fifth and sixth grade Ecuadorian schoolchildren. METHODS: This pretest-posttest intervention study was conducted between April and June 2017 and comprised fifth and sixth grade schoolchildren from 20 schools in Cuenca, Ecuador, recruited by purposeful sampling. The Alforja Educativa was implemented over twelve 80-minute sessions by trained university students. Schoolchildren's knowledge was assessed before and after participation in the educational program using a structured questionnaire. A mean total score, the proportion of correct responses for each individual knowledge-based question, as well as correct responses for each of the multiple-choice options of the knowledge-based questions were calculated for the pretest and posttest. RESULTS: A total of 1,257 schoolchildren participated in the Alforja Educativa program, of which 980 (78%) completed both the pretest and posttest. Overall, the mean total knowledge score increased from pretest to posttest (2.58/7.00 vs. 3.85/7.00; CI = 0.5, p < 0.001). After participation in the program, the proportion of schoolchildren that correctly identified that bacteria can be both good and bad increased from 35.0 to 84.3%. In addition, scores increased for correctly identifying the meaning of antibiotic resistance (37.4-72.0%); how to prevent antibiotic resistance (63.2-74.6%); and for identifying the meaning of self-medication (46.3-54.3%). CONCLUSION: The Alforja Educativa was effective in improving the knowledge of participating schoolchildren about concepts related to bacteria, antibiotics and antibiotic resistance. The holistic perspective taken to explain the complex relationship between humans and bacteria, as well as the effect of antibiotics on the microbial world, may help provide a foundation for more sustainable antibiotic use.
Subject(s)
Anti-Bacterial Agents , Bacteria , Humans , Child , Ecuador , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Drug Resistance, Microbial , Surveys and Questionnaires , Health Knowledge, Attitudes, PracticeABSTRACT
Background: Breast cancer (BC) is the most common neoplasm in women worldwide. Liquid biopsy (LB) is a non-invasive diagnostic technique that allows the analysis of biomarkers in different body fluids, particularly in peripheral blood and also in urine, saliva, nipple discharge, volatile respiratory fluids, nasal secretions, breast milk, and tears. The objective was to analyze the available evidence related to the use of biomarkers obtained by LB for the early diagnosis of BC. Methods: Articles related to the use of biomarkers for the early diagnosis of BC due to LB, published between 2010 and 2022, from the databases (WoS, EMBASE, PubMed, and SCOPUS) were included. The MInCir diagnostic scale was applied in the articles to determine their methodological quality (MQ). Descriptive statistics were used, as well as determination of weighted averages of each variable, to analyze the extracted data. Sensitivity, specificity, and area under the curve values for specific biomarkers (individual or in panels) are described. Results: In this systematic review (SR), 136 articles met the selection criteria, representing 17 709 patients with BC. However, 95.6% were case-control studies. In 96.3% of cases, LB was performed in peripheral blood samples. Most of the articles were based on microRNA (miRNA) analysis. The mean MQ score was 25/45 points. Sensitivity, specificity, and area under the curve values for specific biomarkers (individual or in panels) have been found. Conclusions: The determination of biomarkers through LB is a useful mechanism for the diagnosis of BC. The analysis of miRNA in peripheral blood is the most studied methodology. Our results indicate that LB has a high sensitivity and specificity for the diagnosis of BC, especially in early stages.
ABSTRACT
Advancements in genetic sequencing techniques along with the identification of specific mutations and structural changes in multiple cancer genes, make it possible to identify circulating tumor cells and cell free nucleic acids as blood-based biomarkers, serving as a liquid biopsy (LB) with great utility for the diagnosis, treatment and follow-up of patients with neoplasms. This systematic review focuses on the clinical utility of LB in patients with breast cancer (BC). Articles published between 1990 and 2021 were included. Databases searched: Trip Database, WoS, EMBASE, PubMed, SCOPUS, and Clinical Keys. Variables studied: Publication year, country, number of cases, primary study design, LB detection methods, genes found, overall survival, disease-free survival, stage, response to treatment, clinical utility, BC molecular type, systemic treatment and methodological quality of primary studies. Of 2619 articles, 74 were retained representing 12 658 patients, mainly cohort studies (66.2%), the majority were from China (15%) and Japan (12.2%). All primary studies described clinical stage and type of systemic treatment used. Most used biomarker detection method: DNA (52.7%) and type of analysis: quantification of total cfDNA (35.1%). PIK3CA mutation was most frequent (62.9%). Evidence suggests clinically useful applications of BC. Though heterogeneous, publications suggest that LB will constitute part of the standard diagnostic-therapeutic process of BC.
Subject(s)
Breast Neoplasms , Cell-Free Nucleic Acids , Biomarkers, Tumor/genetics , Breast Neoplasms/diagnosis , Breast Neoplasms/genetics , Breast Neoplasms/pathology , Cell-Free Nucleic Acids/genetics , Female , Humans , Liquid Biopsy , MutationABSTRACT
Justificación: La relación entre Espiritualidad y Salud cada vez tiene más relevancia en los ámbitos académicos y en la práctica médica, dada la creciente evidencia y la búsqueda de mejorar el abordaje integral en salud de las personas. En este sentido el grupo de trabajo de Espiritualidad y Salud de la CIMF se planteó identificar la práctica y conocimiento de CES en residentes y médicos de familia en nuestra región. Objetivo: Evaluar la formación, el conocimiento, interés y práctica de Cuidados Espirituales en Salud (CES) en residentes y Médicos de Familia de Iberoamérica. Métodos: Estudio de corte transversal. Nuestro universo fueron los residentes del postgrado de Medicina Familiar y médicos de familia de Iberoamérica. El muestreo es no probabilístico por conveniencia. Se realizó un pilotaje aplicando una encuesta estructurada. Resultados: Hubo 532 participantes de 17 países de Iberoamérica. El 62.5% negó haber recibido capacitación en cuidados espirituales en salud. Un 15% manifestó haber recibido alguna formación al respecto. El 19,39% aborda la espiritualidad si el paciente lo solicita, mientras que el 19,83% no conoce ninguna forma de hacerlo. Un 29,3% expresa utilizar terapias complementarias espirituales como parte del enfoque holístico que caracteriza la práctica de la Medicina Familiar. El 82,67% de los encuestados no conoce ningún instrumento de valoración espiritual. El 94% reportó interés en recibir información sobre espiritualidad. Conclusión: En este estudio se encontró que el 85% de los médicos especialistas en Medicina Familiar no tuvo formación en temas de espiritualidad durante su residencia, el 17 % conoce instrumentos de valoración espiritual en el contexto clínico, sin embargo al igual que encontraron Balboni y colaboradores, los proveedores de servicios de salud no se creen capaces de realizar esta aproximación en nuestro estudio el 63% negó haber recibido capacitación en cuidados espirituales en salud.
Justification: The relationship between Spirituality and Health is increasingly relevant in academic fields and in medical practice, given the growing evidence and the search to improve the comprehensive approach to people's health. In this sense, the ICPM Working Group on Spirituality and Health considered identifying the practice and knowledge of CES in residents and family doctors in our region. Objective: Evaluate the formation, knowledge, interest and practice of Spiritual Health Care (CES) in residents and Family Physicians of Latin America. Methods: Cross-sectional study. Our universe was the postgraduate residents of Family Medicine and family doctors in Latin America. Sampling is not probabilistic for convenience. A pilot was carried out applying a structured survey. Results: There were 532 participants from 17 Latin American countries. 62.5% denied having received training in spiritual health care. 15% said they received some training in this regard. 19.39% address spirituality if the patient requests it, while 19.83% do not know any way to do it. 29.3% expressed the use of complementary spiritual therapies as part of the holistic approach that characterizes the practice of Family Medicine. 82.67% of respondents do not know any spiritual assessment instrument. 94% reported interest in receiving information about spirituality. Discussion and conclusions: In this study it was found that 85% of doctors specializing in Family Medicine did not have training in spiritual matters during their residency, 17% know instruments of spiritual assessment in the clinical context, however, as Balboni et al. Found, Health service providers do not believe they are capable of making this approach in our study, 63% denied having received training in spiritual health care
