A Practical Overview of the Articular Manifestations of Systemic Lupus Erythematosus.

Although it is widely known that joint involvement is the most frequent and prevalent manifestation of systemic lupus erythematosus (SLE), not having a validated organ-specific index for this domain in order to guide its treatment has been a major limitation. In addition, its clinical importance had been underestimated since it was not a vital risk domain; it was never the center of treatment, under the premise that in most cases its progression was slow and did not lead to significant functional disability. However, this concept has been changing due to the greater description of erosions both in ultrasonography and in osteoarticular magnetic resonance, so their identification can establish a more appropriate treatment time and thus avoid joint deformities, which in some cases can become irreversible. Recently, anifrolumab and belimumab have been able to significantly reduce the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and British Isles Lupus Assessment Group (BILAG) index scores, along with improvement in quality of life indices and a significant decrease in the required dose of glucocorticoids. Despite this, the ideal moment to consider biological therapy in this domain is not clear, since the clinical examination can sometimes be biased by the pain associated with fibromyalgia or the fatigue associated with SLE. For this reason, perhaps ultrasonography or magnetic resonance imaging, apart from differentiating the joint phenotype, can identify patients in time to define the onset of disease-modifying antirheumatic drugs and rationalize the use of glucocorticoids. The objective of this review is to characterize in detail the joint manifestations of SLE to offer the clinician a practical view of its diagnosis and treatment.

Mitochondria during T cell aging.

Mitochondrial dysfunction is a hallmark of aging that contributes to inflammaging. It is characterized by alterations of the mitochondrial DNA, reduced respiratory capacity, decreased mitochondrial membrane potential and increased reactive oxygen species production. These primary alterations disrupt other interconnected and important mitochondrial-related processes such as metabolism, mitochondrial dynamics and biogenesis, mitophagy, calcium homeostasis or apoptosis. In this review, we gather the current knowledge about the different mitochondrial processes which are altered during aging, with special focus on their contribution to age-associated T cell dysfunction and inflammaging.

Interstitial Lung Disease in Mixed Connective Tissue Disease: An Advanced Search.

The spectrum of pulmonary manifestations associated with mixed connective tissue disease ranges from pulmonary hypertension and interstitial lung disease to pleural effusions, alveolar hemorrhage, and complications from the thromboembolic disease. Interstitial lung disease in mixed connective tissue disease is a frequently occurring entity, although in most cases it tends to be self-limited or slowly progressive. Despite this, a significant percentage of patients may present a progressive fibrosing phenotype, thus posing a great challenge regarding its therapeutic approach, given the scarcity of clinical studies that compare the efficacy of immunosuppressants available to date. Due to this, many recommendations are extrapolated from other diseases with similar characteristics such as systemic sclerosis and systemic lupus erythematosus. That is why it is proposed to carry out an advanced search of the literature in order to clarify its clinical, radiological, and therapeutic characteristics to achieve its evaluation from a holistic point of view.

Perimyocarditis With Acute Heart Failure as the First Manifestation of Systemic Lupus Erythematosus.

Cardiac abnormalities are common in patients with systemic lupus erythematosus (SLE). However, many of them tend to be mild or asymptomatic and can be recognized by non-invasive studies such as transthoracic echocardiography and cardiac magnetic resonance imaging (CMR). However, heart failure secondary to perimyocarditis as the initial manifestation of SLE remains an extremely rare form of presentation. Below, we present the case of an adult female patient who initially consulted due to symptoms of acute dyspnea, atypical chest pain, and edema of the lower limbs, who underwent a chest X-ray as part of the initial studies, which described an increase in the cardiac silhouette associated with diffuse opacities in both lung fields. The admission electrocardiogram only showed sinus tachycardia and nonspecific alterations of the T wave, with an initial report of frankly elevated cardiac biomarkers compatible with acute myocardial injury together with the positivity of specific antibodies for SLE.

Characteristics, treatment, and nursing care of patients infected by Sars-CoV-2 hospitalized in intensive care units: multicenter study of colombian hospitals.

OBJECTIVES: To describe the clinical characteristics, treatment, evolution, and nursing care of adult patients with severe acute respiratory distress syndrome who were positive for SARS-CoV-2 and hospitalized in intensive care units (ICUs) during the first peak of the pandemic in Colombia, 2020. METHODS: Multicenter descriptive study of four high-complexity hospitals in Colombia, which included 473 consecutive adult patients admitted to intensive care units with a confirmed diagnosis of SARS CoV-2. Sociodemographic and clinical information - comorbidities, treatment and evolution - and nursing care provided were included. RESULTS: Of the patients included, 43.7% died, 88.8% had pneumonia, and 60.2% developed respiratory distress syndrome. Most of those who died were men. Those who died had a median age of 68.4 years and a higher frequency of comorbidities (hypertension, cardiovascular disease, chronic obstructive pulmonary disease, and higher body mass index). They were admitted to the ICU with higher rate of dyspnea, lower oxygen saturation, and higher score of multiorgan failure. They also more often required mechanical ventilation and pronation therapy and were given more vasopressors and renal replacement therapy. CONCLUSIONS: People with severe acute respiratory distress syndrome due to COVID-19 who were hospitalized in the ICU had a high risk of death, especially older patients; males; those with cardiovascular, respiratory, and hypertension comorbidities; those who needed mechanical ventilation; and those with an elevated SOFA score. The nursing care of these critically ill patients focused on respiratory care and the prevention of associated complications.

A Practical Perspective of the Hematologic Manifestations of Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease with an unknown etiology that can affect any organ or system of the human body. Hematological, renal, or central nervous system manifestations in these patients result in great morbidity because high doses of glucocorticoids, cytotoxic medications, or biological drugs are required to control these manifestations. It is noteworthy that hematological involvement predominates during the first years of the disease and tends to last over time, with the premise that it may be the initial manifestation of the disease. Clear examples of this are the cases of hemolytic anemia and immune thrombocytopenia that can be initially classified as idiopathic or primary to be later classified as secondary when associated with infections, medications, neoplasms, or autoimmune diseases. The spectrum of hematologic manifestations in SLE is very broad, including lymphopenia, anemia, thrombocytopenia, or pancytopenia. In some cases, lymphadenopathy and splenomegaly are also identified. The vast majority of these manifestations denote high disease activity. However, many of these alterations have a multifactorial cause that must be taken into account to adopt a more complete therapeutic approach. The objective of this review is to characterize in detail the hematological manifestations of SLE to offer clinicians a practical vision of its diagnosis and treatment.

Characteristics, treatment, and nursing care of patients infected by Sars-CoV-2 hospitalized in intensive care units: multicenter study of colombian hospitals / Características, tratamiento y cuidados de enfermería de pacientes infectados por SARS-CoV-2 hospitalizados en unidades de cuidados intensivos: estudio multicéntrico de hospitales colombianos / Características, tratamento e cuidados de enfermagem de pacientes infectados por SARS-CoV-2 hospitalizados em unidades de tratamento intensivos: estudo multicêntrico de hospitais colombianos

Objective. To describe the clinical characteristics, treatment, evolution, and nursing care of adult patients with severe acute respiratory distress syndrome who were positive for SARS-CoV-2 and hospitalized in intensive care units (ICUs) during the first peak of the pandemic in Colombia, 2020. Methods. Multicenter descriptive study of four high-complexity hospitals in Colombia, which included 473 consecutive adult patients admitted to intensive care units with a confirmed diagnosis of SARS CoV-2. Sociodemographic and clinical information - comorbidities, treatment and evolution - and nursing care provided were included. Results. Of the patients included, 43.7% died, 88.8% had pneumonia, and 60.2% developed respiratory distress syndrome. Most of those who died were men. Those who died had a median age of 68.4 years and a higher frequency of comorbidities (hypertension, cardiovascular disease, chronic obstructive pulmonary disease, and higher body mass index). They were admitted to the ICU with higher rate of dyspnea, lower oxygen saturation, and higher score of multiorgan failure. They also more often required mechanical ventilation and pronation therapy and were given more vasopressors and renal replacement therapy. Conclusion. People with severe acute respiratory distress syndrome due to COVID-19 who were hospitalized in the ICU had a high risk of death, especially older patients; males; those with cardiovascular, respiratory, and hypertension comorbidities; those who needed mechanical ventilation; and those with an elevated SOFA score. The nursing care of these critically ill patients focused on respiratory care and the prevention of associated complications.

Objetivo. Describir las características clínicas, tratamiento, evolución y cuidados de enfermería de los pacientes adultos con síndrome de dificultad respiratoria aguda grave, positivos para SARS-CoV-2, hospitalizados en Unidades de Cuidados Intensivos (UCI) durante el primer pico de pandemia en Colombia en 2020. Métodos. Estudio descriptivo multicéntrico con la participación de cuatro hospitales de alto nivel de complejidad en Colombia, que incluyó 473 pacientes adultos, admitidos de forma consecutiva en unidades de cuidados intensivos -UCI-, con diagnóstico confirmado para SARS CoV-2. Se incluyó información sociodemográfica, clínica, comorbilidades, tratamiento y evolución, además de los cuidados de enfermería brindados. Resultados. Del total de pacientes incluidos fallecieron el 43.7%, presentaron neumonía el 88.8% y un 60.2% desarrollaron síndrome de dificultad respiratoria. Las personas que fallecieron en su mayoría fueron hombres, con una mediana de edad de 68.4 años, con mayor frecuencia de comorbilidades (hipertensión, enfermedad cardiovascular, enfermedad pulmonar obstructiva crónica y mayor índice de masa corporal); además ingresaron a UCI con mayor presencia de disnea, menor saturación de oxígeno, y con puntaje mayor de falla multiorgánica. Así mismo, requirieron con más frecuencia de ventilación mecánica, terapia de pronación, uso de vasopresores y terapia de reemplazo renal. Los cuidados de enfermería de estos pacientes en estado crítico se enfocaron al cuidado respiratorio y la prevención de complicaciones asociadas. Conclusión. Las personas con síndrome de dificultad respiratoria aguda grave por COVID-19 que se hospitalizaron en UCI tuvieron un riesgo elevado de fallecer, especialmente los pacientes de mayor edad, sexo masculino y con comorbilidades cardiovasculares, respiratorias e hipertensión arterial, uso de ventilación mecánica y un puntaje puntaje de SOFA elevado. Los cuidados de enfermería de estos pacientes en estado crítico se enfocaron al cuidado respiratorio y la prevención de complicaciones asociadas.

Objetivo. Descrever as características clínicas, tratamento, evolução e cuidados de enfermagem dos pacientes adultos com síndrome de dificuldade respiratória aguda grave, positivos para SARS-CoV-2, hospitalizados nas Unidades de tratamentos Intensivos (UTI) durante o primeiro pico de pandemia na Colômbia em 2020. Métodos. Estudo descritivo multicêntrico com a participação de quatro hospitais de alto nível de complexidade na Colômbia, que incluiu 473 pacientes adultos, admitidos de forma consecutiva nas unidades de tratamentos intensivos -UTI-, com diagnóstico confirmado para SARS CoV-2. Se incluiu informação sociodemográfica, clínica, comorbilidades, tratamento e evolução, além dos cuidados de enfermagens brindados. Resultados. Do total de pacientes incluídos faleceram 43.7%, apresentaram pneumonia 88.8% e um 60.2% desenvolveram síndrome de dificuldade respiratória. As pessoas que faleceram em sua maioria foram homens, com uma média de idade de 68.4 anos, com maior frequência de comorbilidades (hipertensão, doença cardiovascular, doença pulmonar obstrutiva crónica e maior índice de massa corporal); ademais ingressaram a UTI com maior presença de dispneia, menor saturação de oxigeno, e com pontuação maior de falha multiorgânica. Assim mesmo, requereram com mais frequência de ventilação mecânica, terapia de pronação, uso de vasopressores e terapia de substituição renal. Os cuidados de enfermagem destes pacientes em estado crítico se enfocaram ao cuidado respiratório e a prevenção de complicações associadas. Conclusão. As pessoas com síndrome de dificuldade respiratória aguda grave por COVID-19 que se hospitalizaram em UTI tinham um elevado risco de morte, especialmente os pacientes mais velhos; os homens; aqueles com comorbilidades cardiovasculares, respiratórias e hipertensão; aqueles que precisavam de ventilação mecânica; e aqueles com um escore SOFA elevado. Os cuidados de enfermagem destes pacientes criticamente doentes concentraram-se nos cuidados respiratórios e na prevenção de complicações associadas.

Obstetric Antiphospholipid Syndrome From the Perspective of a Rheumatologist.

Antiphospholipid syndrome (APS) is an autoimmune disease that can lead to thrombotic or obstetric complications. Recent histopathological studies have shown the absence of placental thrombosis, leading to the consideration of other pathophysiological pathways such as inflammation and complement activation. Due to this, various clinical studies are being carried out with different drug agents in order to avoid their complications. The combination of prophylactic heparin treatment and low doses of aspirin today result in successful pregnancies in most cases. Despite this, a minority of patients require alternative therapies to avoid recurrent miscarriage and decrease obstetric morbidity. Thanks to the better understanding of its pathophysiology, other treatments such as low doses of glucocorticoids, hydroxychloroquine (HCQ), immunoglobulin, pravastatin, and plasmapheresis have been considered in refractory cases, achieving favorable results. Despite the great advances regarding its treatment, unfortunately, there are no treatments with a good level of evidence to reduce late obstetric complications. The evaluation of preconception risk factors, as well as the antiphospholipid antibody profile, is necessary to establish individual risk and thus anticipate possible complications.

HIV and COVID-19 Coinfection: A Synergism That Results in More Severe Forms of Reactive Arthritis.

Reactive arthritis is defined as arthritis that arises after infection, where pathogens cannot grow in the affected joints. Although the human immunodeficiency virus and severe acute respiratory syndrome coronavirus 2 are not among the most commonly implicated pathogens, there is growing evidence that they have major implications in the genesis of reactive arthritis. However, there are no described cases of coinfection of both entities that cause reactive arthritis at the same time, and the alterations involved in the immune system that could cause the change of certain clinical characteristics to more severe forms of the disease are unknown. The following describes the case of a male patient in his third decade of life who has an unusual and severe presentation of reactive arthritis associated with coinfection by COVID-19 and the human immunodeficiency virus.

Prevalencia de Infección por Trypanosoma Cruzi en donantes de un banco de sangre de Boyacá, Colombia / Prevalence of Trypanosoma cruzi infection in donors from a blood bank in Boyacá, Colombia

Resumen Introducción: La Enfermedad de Chagas también conocida como Tripanosomiasis americana es un problema de salud pública. Se calcula que en el mundo hay entre 6 y 7 millones de personas infectadas por Trypanosoma cruzi, la mayoría de ellas en América Latina. Objetivo: Identificar la prevalencia de infección por Trypanosoma cruzi en donantes de un banco de sangre del departamento de Boyacá 2016-2018. Materiales y métodos: Estudio descriptivo retrospectivo realizado en 25.920 donantes de sangre del departamento de Boyacá. La fuente de información fue secundaria. Se determinó la prevalencia de la infección por Trypanosoma cruzi y se compararon según sexo, grupo etario y tipo de donante a través de análisis de frecuencias. Resultados: Se evaluaron 9187 donantes durante el año 2016; 8517 en el 2017 y 8216 en el 2018, de los cuales 56,1% eran de sexo femenino y 43,9% masculino. La prevalencia de la infección por Trypanosoma cruzi fue 0,17 % en la tamización y 0,08 % con las pruebas confirmatorias de las cuales el 70,0% eran mujeres, el 85,0% donantes voluntarios por primera vez, el rango de edad en el que se presentó mayor prevalencia de este marcador serológico fue de 41 a 50 y de 51 a 65 años con un 35,0% cada uno . La prevalencia de la infección de Chagas presentó asociación estadísticamente significativa con la edad (p < 0,05). Conclusiones: Los bancos de sangre resultan ser una de las fuentes de información disponibles para monitorear el comportamiento de la enfermedad de Chagas y evaluar la toma de decisiones en salud pública, teniendo en cuenta que la enfermedad se caracteriza de manera asintomática y sin compromiso clínico en la mayoría de los casos.

Abstract Introduction: Chagas Disease, also known as American Trypanosomiasis, is a public health problem. It is estimated that in the world there are between 6 and 7 million people infected with Trypanosoma cruzi, most of them in Latin America. Objectives: To identify the prevalence of Trypanosoma cruzi infection in donors from a blood bank in the department of Boyacá 2016-2018. Materials and methods: Retrospective-descriptive study carried out in 25,920 blood donors from the department of Boyacá (Colombia). The source of information was secondary. The prevalence of Trypanosoma cruzi infection was determined and compared according to sex, age group and type of donor through frequency analysis. Results: 9187 donors were evaluated during 2016; 8,517 in 2017 and 8,216 in 2018, of which 56.1% were female and 43.9% male. The prevalence of Trypanosoma cruzi infection was 0.17% in screening and 0.08% with confirmatory tests of which 70.0% were women, 85.0% first-time volunteer donors, the range of The age at which the highest prevalence of this serological marker was found was 41 to 50 and 51 to 65 years with 35.0% each. The prevalence of Chagas infection showed a statistically significant association with age (p <0.05). Conclusions: Blood banks turn out to be one of the sources of information available to monitor the behavior of Chagas disease and evaluate decision-making in public health, taking into account the characteristics of the disease in which the majority of cases they are asymptomatic and without clinical compromise.

A Semiautomated Classification System for Producing Service Directories in Social and Health Care (DESDE-AND): Maturity Assessment Study.

BACKGROUND: DESDE-LTC (Description and Evaluation of Services and DirectoriEs for Long-Term Care) is an international classification system that allows standardized coding and comparisons between different territories and care sectors, such as health and social care, in defined geographic areas. We adapted DESDE-LTC into a computer tool (DESDE-AND) for compiling a directory of care services in Andalucia, Spain. OBJECTIVE: The aim of this study was to evaluate the maturity of DESDE-AND. A secondary objective of this study is to show the practicality of a new combined set of standard evaluation tools for measuring the maturity of health technology products. METHODS: A system for semiautomated coding of service provision has been co-designed. A panel of 23 domain experts and a group of 68 end users participated in its maturity assessment that included its technology readiness level (TRL), usability, validity, adoption (Adoption Impact Ladder [AIL]), and overall degree of maturity [implementation maturity model [IMM]). We piloted the prototype in an urban environment (Seville, Spain). RESULTS: The prototype was demonstrated in an operational environment (TRL 7). Sixty-eight different care services were coded, generating fact sheets for each service and its geolocation map. The observed agreement was 90%, with moderate reliability. The tool was partially adopted by the regional government of Andalucia (Spain), reaching a level 5 in adoption (AIL) and a level 4 in maturity (IMM) and is ready for full implementation. CONCLUSIONS: DESDE-AND is a usable and manageable system for coding and compiling service directories and it can be used as a core module of decision support systems to guide planning in complex cross-sectoral areas such as combined social and health care.

Lupus Cystitis, From Myth to Reality: A Narrative Review.

Systemic lupus erythematosus is a multisystemic disease that usually involves the urinary tract, often in the form of lupus nephritis. However, another form of compromise of this system is lupus cystitis, which, despite being an unusual condition, turns out to be a challenging diagnosis due to the spectrum of nonspecific abdominal and urinary symptoms. Although the exact pathophysiological mechanism of bladder inflammation remains to be established, the role of small vessel vasculitis measured by immune complexes continues to be supported as a central axis for considering possible therapeutic targets. Additionally, there are no clinical studies that dictate a guideline regarding its treatment, however, the evidence from most cases described in the literature suggests the initiation of pulses of methylprednisolone and cyclophosphamide in treatment regimens similar to those of lupus nephritis. Despite its low prevalence, obstructive complications and kidney damage can lead to increased morbidity and mortality.

Current Evidence for IL-17/23 Blockade for the Treatment of Lupus Nephritis.

In the current medical literature, there is increasing evidence for the involvement of the interleukin (IL)-17/23 axis and the potential role of Th17 cells in the pathogenesis of lupus nephritis. Knowledge about the interaction of these immunological pathways in the development of autoimmune diseases has led to the identification of new therapeutic strategies aimed at blocking them. For this reason, the main objective of this review focuses on knowing the recent evidence of the different anti-IL-17/23 treatment strategies in lupus nephritis and their future perspectives. A non-systematic narrative review of the literature was carried out following the objective of having the most representative information on the different anti-IL-17/23 drugs available together with the description of the pathophysiological mechanisms of this pathway involved in systemic lupus erythematosus and lupus nephritis. Despite the great existing theoretical foundation, today few clinical studies support the use of these therapies in both contexts. Nevertheless, the publication of research with a better methodology is expected to approve the indication of some of these drugs in lupus nephritis. However, the clinical response seen with ustekinumab and secukinumab in clinical studies and case reports published to date has been encouraging.

Evaluación del impacto de un plan multisectorial de promoción de la salud y el bienestar social en Andalucía / Impact assessment of a multisectoral plan for the promotion of health and social wellbeing in Andalusia (Spain)

OBJETIVO: Evaluar el impacto del Plan de Promoción de la Autonomía Personal y Prevención de la Dependencia de Andalucía (2016-2020) en 13 organismos públicos participantes tras su primer año, y analizar la usabilidad y la fiabilidad de la escala de evaluación del impacto que se ha empleado. MÉTODO: El Plan aborda la promoción de la autonomía personal y la prevención de la discapacidad y la dependencia con un enfoque multisectorial. Se estructura en líneas, objetivos y actuaciones que han sido evaluadas mediante la escala Adoption Impact Ladder (AIL). El análisis de la validez simple, la viabilidad y la fiabilidad de la escala se ha realizado en 30 actuaciones evaluadas por 20 expertos de la Administración pública y un evaluador externo independiente. RESULTADOS: En 2017 se pusieron en marcha 176 actuaciones y programas del Plan. Se han implementado el 67,2% de las actuaciones propuestas y solo uno de los 16 objetivos no se ha asociado a actuaciones ejecutadas en el primer año. Siete de los 15 objetivos ejecutados fueron enteramente multisectoriales, involucrando a tres o más consejerías. La validez simple, la viabilidad y la fiabilidad interexaminadores de la escala AIL fueron buenas (κ: 0,72). CONCLUSIONES: El Plan ha proporcionado un marco novedoso para coordinar un amplio rango de políticas y actuaciones en la Administración pública de Andalucía. Por primera vez se presenta un análisis del impacto multisectorial que proporciona una guía efectiva para el seguimiento, la planificación y el establecimiento de prioridades públicas en salud, servicios sociales y atención a personas mayores y personas con discapacidad

OBJECTIVE: To evaluate the impact of the Plan for the promotion of personal autonomy and prevention of disability in Andalusia (2016-2020) in 13 public administrations during the first year of its implementation; and to analyse the usability and feasibility of the impact assessment ladder used. METHOD: The Plan addresses the promotion of personal autonomy and the prevention of disabilities and dependencies through a multisectoral approach. It is structured in strands or lines of work, objectives and actions that have been assessed through the Adoption Impact Ladder (AIL). The analysis of the face validity, feasibility and inter-rater reliability of the impact assessment ladder was carried out in 30 actions of the Plan that were rated by 20 experts from the 13 ministries and public agencies involved in the Plan, and an external rater. RESULTS: 176 actions and programmes were launched in 2017. Of these, 67.2% were implemented during the first year. Only one of the 16 objectives had no action initiated during the first year. Moreover, 7 out of 15 objectives implemented were fully multisectoral involving more than three Regional Ministries. The face validity, feasibility and inter-rater reliability of the AIL were good (κ: 0.72). CONCLUSIONS: This Plan has provided a novel framework to coordinate a broad range of proposed policies and actions within the public administration of Andalusia. For the first time, a multisectoral impact analysis has been conducted providing an effective guide for monitoring, planning and setting public priorities in health, social services, ageing and disabilities

Ciudadanía activa y personas mayores: viejos conceptos, nuevos abordajes. Una revisión sistemática y metasíntesis cualitativa / Being an active citizen and the elderly: old concepts, new approaches. A systematic review and qualitative meta-synthesis

Las políticas de envejecimiento activo presentan el concepto de «ciudadanía activa» como un desafío clave en el ámbito del envejecimiento para los próximos años. La ciudadanía activa ha sido definida de diferentes maneras, en la mayoría de los casos de forma complementaria, describiendo un eclecticismo de actividades participativas que incluye la política, el mercado y la acción comunitaria y voluntaria. El término se sitúa en diferentes contextos como la política formal, el trabajo remunerado, la sociedad civil y el hogar. Este trabajo, a partir de una revisión sistemática, identifica el contexto en el que emerge este concepto en relación con las personas mayores y las personas con demencia, analizando las diferentes expresiones de ciudadanía activa utilizadas y aportando elementos clave a tener en cuenta en la formulación de políticas en un contexto de acelerado envejecimiento demográfico y donde la demencia es una prioridad de salud pública. La noción de ciudadanía activa en la vejez supone un paso adelante que parte del envejecimiento activo a un concepto más amplio que integra el principio de igualdad entre las personas con independencia del género, edad y necesidad de apoyos

The politics of active ageing present active citizenship of the elderly as a key challenge for the coming years. Active citizenship has been defined in different ways (as complimentary in most cases), outlining an eclecticism of participatory activities that includes political engagement in a participatory and deliberative manner, as well as community and voluntary action. This term is found in different contexts such as formal politics, work, civil society, and the home. This paper, based on a systematic review, identifies the context in which this concept emerges in relation to older people and people with dementia. It also analyses the different expressions of active citizenship used, and provides key elements to be taken into account in the formulation of policies in a context of accelerated demographic ageing and where dementia is a public health priority. The notion of active citizenship in old age is a step forward from active ageing to a broader concept that integrates the principle of equality between people irrespective of gender, age and the need for support

[Being an active citizen and the elderly: Old concepts, new approaches. A systematic review and qualitative meta-synthesis]. / Ciudadanía activa y personas mayores: viejos conceptos, nuevos abordajes. Una revisión sistemática y metasíntesis cualitativa.

The politics of active ageing present active citizenship of the elderly as a key challenge for the coming years. Active citizenship has been defined in different ways (as complimentary in most cases), outlining an eclecticism of participatory activities that includes political engagement in a participatory and deliberative manner, as well as community and voluntary action. This term is found in different contexts such as formal politics, work, civil society, and the home. This paper, based on a systematic review, identifies the context in which this concept emerges in relation to older people and people with dementia. It also analyses the different expressions of active citizenship used, and provides key elements to be taken into account in the formulation of policies in a context of accelerated demographic ageing and where dementia is a public health priority. The notion of active citizenship in old age is a step forward from active ageing to a broader concept that integrates the principle of equality between people irrespective of gender, age and the need for support.

Prevalencia de marcadores serológicos en donantes de sangre de Boyacá, Colombia, 2014-2015 / Prevalence of serological markers in blood donors in Boyaca, Colombia, 2014-2015

Introducción: La infección que se ocasiona por la transfusión sanguínea se produce por una transmisión directa de un agente infeccioso desde una unidad de sangre al receptor susceptible. Esto constituyen una complicación de gran importancia en relación con la morbilidad y mortalidad de los receptores de sangre y un problema de salud pública. Objetivo: Determinar la prevalencia de marcadores serológicos en donantes de sangre del departamento Boyacá y su relación con variables sociodemográficas. Métodos: Estudio descriptivo transversal, realizado en 32 957 donantes del departamento de Boyacá. La fuente de información fue secundaria. Se determinó la seroprevalencia de marcadores de infección y se compararon según sexo, grupo etario y tipo de donante a través de análisis de frecuencias: Chi cuadrado y Fisher. Resultados: La prevalencia de marcadores serológicos fue 1,15 por ciento en la tamización y 0,24 por ciento con las pruebas confirmatorias. El marcador más prevalente fue sífilis con 0,20 por ciento, seguido el virus de la inmunodeficiencia humana 0,02 por ciento, virus de la hepatitis B 0,01 por ciento y virus de la hepatitis C 0,003 por ciento. La prevalencia del VIH y la prevalencia global de infección presentaron asociación estadísticamente significativa con el sexo y con el grupo etario respectivamente. Conclusiones: La identificación de la prevalencia de marcadores serológicos y las variables sociodemográficas permiten establecer un perfil epidemiológico en donantes de sangre del departamento de Boyacá(AU)

Introduction: The infection that is caused by blood transfusion is produced by a direct transmission of an infectious agent from a unit of blood to the sensitive recipient. This represents a complication of great importance in relation to morbidity and mortality of blood recipients and also a public health problem. Objective: To determine the prevalence of serological markers in blood donors of Boyacá department and its relationship to socio-demographic variables. Methods: A cross-sectional descriptive study was conducted in 32 957 donors of Boyacá department. The source of information was secondary. It was determined the seroprevalence of infection´s markers and those were compared according to sex, age group and type of donor through analysis of frequencies: Chi-square and Fisher. Results: The prevalence of serological markers was 1.15 percent in screening and 0.24 percent with the confirmatory tests. The most prevalent marker was syphilis with 0.20 percent, followed by HIV with 0.02 percent, hepatitis B with 0.01 percent and Hepatitis C virus with 0.003 percent. The prevalence of HIV and the infection´s overall prevalence presented statistically significant association with sex and with the age group respectively. Conclusions: The identification of the serological markers prevalence and socio-demographic variables allow setting an epidemiological profile in blood donors of Boyacá department(AU)

Prevalencia de marcadores serológicos en donantes de sangre de Boyacá, Colombia, 2014-2015 / Prevalence of serological markers in blood donors in Boyaca, Colombia, 2014-2015

RESUMEN Introducción: La infección que se ocasiona por la transfusión sanguínea se produce por una transmisión directa de un agente infeccioso desde una unidad de sangre al receptor susceptible. Esto constituyen una complicación de gran importancia en relación con la morbilidad y mortalidad de los receptores de sangre y un problema de salud pública. Objetivo: Determinar la prevalencia de marcadores serológicos en donantes de sangre del departamento Boyacá y su relación con variables sociodemográficas. Métodos: Estudio descriptivo transversal, realizado en 32 957 donantes del departamento de Boyacá. La fuente de información fue secundaria. Se determinó la seroprevalencia de marcadores de infección y se compararon según sexo, grupo etario y tipo de donante a través de análisis de frecuencias: Chi cuadrado y Fisher. Resultados: La prevalencia de marcadores serológicos fue 1,15 % en la tamización y 0,24 % con las pruebas confirmatorias. El marcador más prevalente fue sífilis con 0,20 %, seguido el virus de la inmunodeficiencia humana 0,02 %, virus de la hepatitis B 0,01 % y virus de la hepatitis C 0,003 %. La prevalencia del VIH y la prevalencia global de infección presentaron asociación estadísticamente significativa con el sexo y con el grupo etario respectivamente. Conclusiones: La identificación de la prevalencia de marcadores serológicos y las variables sociodemográficas permiten establecer un perfil epidemiológico en donantes de sangre del departamento de Boyacá.

ABSTRACT Introduction: The infection that is caused by blood transfusion is produced by a direct transmission of an infectious agent from a unit of blood to the sensitive recipient. This represents a complication of great importance in relation to morbidity and mortality of blood recipients and also a public health problem. Objective: To determine the prevalence of serological markers in blood donors of Boyacá department and its relationship to socio-demographic variables. Methods: A cross-sectional descriptive study was conducted in 32 957 donors of Boyacá department. The source of information was secondary. It was determined the seroprevalence of infection´s markers and those were compared according to sex, age group and type of donor through analysis of frequencies: Chi-square and Fisher. Results: The prevalence of serological markers was 1.15 % in screening and 0.24 % with the confirmatory tests. The most prevalent marker was syphilis with 0.20 %, followed by HIV with 0.02 %, hepatitis B with 0.01 % and Hepatitis C virus with 0.003 %. The prevalence of HIV and the infection´s overall prevalence presented statistically significant association with sex and with the age group respectively. Conclusions: The identification of the serological markers prevalence and socio-demographic variables allow setting an epidemiological profile in blood donors of Boyacá department.

Longevidad y revolución digital. Contribucion de las tecnologías de la información y de la comunicacion al envejecimiento saludable / Longevity and digital revolution. The contribution of information and communication technologies to healthy aging

OBJETIVO: Sintetizar el conocimiento disponible sobre la contribución de las tecnologías de la información y de la comunicación al envejecimiento activo y saludable. METODOLOGÍA: En la primera fase de búsqueda se utilizó la base de datos GERION de la Biblioteca Virtual del Sistema Sanitario Público Andaluz (SSPA). En la segunda fase se realizó una búsqueda en Cochrane Library, PubMed, EMBASE, Medline, SciELO, MedlinePlus y ScienceDirect. Se utilizaron descriptores de lenguaje natural y lenguaje controlado. Se incluyeron estudios publicados en castellano e inglés en el período comprendido entre enero de 2013 y enero de 2018. Se realizó una metasíntesis cualitativa. RESULTADOS: Se seleccionaron 262 estudios; se excluyeron 240: por estar duplicados, por no cumplir con los criterios de inclusión, por no disponer del texto completo y por no guardar relación con el objeto de estudio. Se incluyeron 22 estudios en la síntesis cualitativa. A partir de la identificación de temas emergentes y su agrupación en categorías, se construyó un modelo conceptual que explica la relación entre envejecimiento activo y saludable e innovación tecnológica. CONCLUSIONES: Las tecnologías de la información y de la comunicación contribuyen al empoderamiento de las personas para el autocuidado; mejoran su autoeficacia y ayudan a mantener su autonomía en la toma de decisiones; favorecen su participación efectiva en los sistemas sanitarios y de cuidados, y contribuyen a la democratización de la salud. Su utilización está condicionada por el compromiso y la implicación de las personas mayores en su diseño, la adaptación a los entornos y preferencias de la persona usuaria, su simplicidad, comprensibilidad, utilidad percibida y facilidad de uso

OBJECTIVE: synthesize the available knowledge on the contribution of information and communication technologies to active and healthy ageing. METHODOLOGY: GERION database from the Virtual Library of the Public Health System of Andalusia was used in the first search phase. In the second phase, a search was performed using Cochrane Library, PubMed, EMBASE, MEDLINE, SciELO, MedlinePlus, and Science Direct. Natural language and controlled language descriptors were used. Studies published in Spanish and English in the period January 2013 to January 2018 were included. Qualitative meta-synthesis was carried out. RESULTS: 262 studies were selected; 240 were excluded due to: duplication, not meeting the inclusion criteria, missing the full text, or not related to the object of study.22 studies were included in the qualitative synthesis. From the identification of emerging issues and their grouping into categories, a conceptual model was constructed that explains the relationship between active and healthy ageing and technological innovation. CONCLUSIONS:Information and communication technologies contribute to the empowerment of people for self-care; improve their self-efficacy; help maintain their autonomy in decision-making; favor their effective participation in health and care systems; and contribute to the democratization of health. Its use is conditioned by the commitment and involvement of older people in its design, adaptation to the environments and preferences of the user, its simplicity, comprehensibility, perceived utility and ease of use

[Impact assessment of a multisectoral plan for the promotion of health and social wellbeing in Andalusia (Spain)]. / Evaluación del impacto de un plan multisectorial de promoción de la salud y el bienestar social en Andalucía.

OBJECTIVE: To evaluate the impact of the Plan for the promotion of personal autonomy and prevention of disability in Andalusia (2016-2020) in 13 public administrations during the first year of its implementation; and to analyse the usability and feasibility of the impact assessment ladder used. METHOD: The Plan addresses the promotion of personal autonomy and the prevention of disabilities and dependencies through a multisectoral approach. It is structured in strands or lines of work, objectives and actions that have been assessed through the Adoption Impact Ladder (AIL). The analysis of the face validity, feasibility and inter-rater reliability of the impact assessment ladder was carried out in 30 actions of the Plan that were rated by 20 experts from the 13 ministries and public agencies involved in the Plan, and an external rater. RESULTS: 176 actions and programmes were launched in 2017. Of these, 67.2% were implemented during the first year. Only one of the 16 objectives had no action initiated during the first year. Moreover, 7 out of 15 objectives implemented were fully multisectoral involving more than three Regional Ministries. The face validity, feasibility and inter-rater reliability of the AIL were good (κ: 0.72). CONCLUSIONS: This Plan has provided a novel framework to coordinate a broad range of proposed policies and actions within the public administration of Andalusia. For the first time, a multisectoral impact analysis has been conducted providing an effective guide for monitoring, planning and setting public priorities in health, social services, ageing and disabilities.