Diabetes Surrounding Stigma: Conceptual Issues, Mechanisms Involved and Challenges

La diabetes es una epidemia a nivel mundial. Los factores psicosociales han sido reconocidos como un elemento importante en el manejo y control de la enfermedad. El estigma aso-ciado a la diabetes ha emergido recientemente como un nuevo factor psicosocial que afecta negativamente la salud de los pacientes con diabetes. Sin embargo, la evidencia reciente en torno a este fenómeno aún no ha sido sintetizada. Esta revisión narrativa de literatura aborda: (i) elementos conceptuales y epidemiológicos que contribuyen a la comprensión del fenómeno y su magnitud; (ii) los factores psicosociales, conductuales y fisiológicos involucrados en la relación entre el estigma asociado a la diabetes y los resultados en salud en pacientes con la enfermedad; (iii) desafíos y posibles áreas de investigación.

A Cross-Sectional Analysis of the Stigma Surrounding Type 2 Diabetes in Colombia

Type 2 diabetes is a global epidemic, and many people feel stigmatized for having this disease. The stigma is a relevant barrier to diabetes management. However, evidence in this regard is scarce in Latin America. This study aimed to analyze the level of stigma surrounding type 2 diabetes in the Colombian population and its relationships with sociodemographic, clinical, psychosocial variables and behaviors related to management of the disease (self-management behaviors). This cross-sectional study included 501 Colombian adults with type 2 diabetes. We estimated the relation between stigma and selected variables through linear regression models. Additionally, we analyzed the mediator role of psychosocial variables in the relationship between stigma and self-management behaviors through structural equation models. A total of 16.4% of patients showed concerning levels of stigma. The time elapsed since diagnosis (β = -0.23) and socioeconomic status (β = -0.13) were significant predictors of the level of stigma. Stigma was negatively correlated with self-efficacy (β = -0.36), self-esteem (β = -0.37), and relationship with health care provider (β = -0.46), and positively correlated with stress (β = 0.23). Self-efficacy, self-esteem, and the relationships with health care providers had a mediation role in the relationship between stigma and self-management behaviors. These variables would be part of the mechanisms through which the perception of stigma harms self-management behaviors. The stigma of type 2 diabetes is frequent in the Colombian population and negatively associated with important aspects of disease management.

Reconsidering the 'Decline' of Dental Student Empathy within the Course in Latin America

INTRODUCTION

The controversy over the presence of empathic decline within the course in students of medicine, dentistry and health sciences in general, has not fully been studied. This controversy could be partially solved if massive studies of empathy levels are made in similar cultural, social and economic contexts.

MATERIAL AND METHODS

Empathy levels within the course were studied in eighteen dental schools from six countries in Latin America (2013). The mean of the empathy levels were used to study the behavior between first and fifth academic years. The values of empathy levels within the course were observed by applying the Jefferson Scale of Physician Empathy, the Spanish version. All these studies were cross-sectional. The value of means observed, were subjected to regression studies and further adjustment curves were obtained and the coefficient of determination were calculated.

RESULTS

Six different models of behavior were observed, which found that five of them suffer empathic decline within the course, but with different final results: in some the decline persists until the fifth academic year and in others, this decline 'recovers' persistently until the fifth academic year. The sixth model is characterized by a constant and persistent increase of levels of empathy within the course until the last academic year.

DISCUSSION

There are six different models for the behavior of means of levels of empathy within the course evaluated by a common methodology in eighteen dental schools from six countries of Latin America. These findings support the existence of variability of empathic response and a comprehensive approach is needed to find the causes that give rise to this variability.

CONCLUSION

In dental students of Latin America, there is variability in the behavior of the distribution in means between the academic years of the dentistry schools examined in this study.

Orientación empática en estudiantes de medicina de las Universidades Libre y San Martín, Barranquilla, Colombia

<p class="p1"><strong>Antecedentes. </strong>La empatía es un importante atributo que los estudiantes de medicina deben tener y ha sido poco estudiado en América Latina. </p><p class="p2"> </p><p class="p1"><strong>Objetivo.</strong> Determinar el nivel de orientación empática de los estudiantes de medicina de las universidades Libre, seccional Barranquilla, y San Martín, sede Puerto Colombia, Barranquilla.</p><p class="p1"><strong>Materiales y métodos.</strong> La orientación empática de los estudiantes se midió mediante la aplicación de la Escala de Empatía Médica de Jefferson en español, diseñada para estudiantes <span class="s1">—</span>versión S<span class="s1">—</span>, validada en otros países de Latinoamérica y adaptada culturalmente a Colombia. La comparación de los datos se realizó mediante análisis de varianza bifactorial <span class="s1">—</span>Modelo III<span class="s1">—</span>. </p><p class="p1"><strong>Resultados.</strong> El nivel de orientación empática de los estudiantes tiene valores bajos, ubicados por encima del valor central del rango de la escala, 20 a140. Las diferencias entre las puntuaciones, según cursos y género, no fueron estadísticamente significativas al comparar los promedios de las sumatorias del puntaje de los estudiantes; sin embargo, se observó, un comportamiento diferente según el género entre las universidades: el femenino tuvo valores de orientación empática mejores que el masculino en la Universidad San Martín, mientras que en la Universidad Libre sucedió, relativamente, lo contrario. La comparación de las respuestas permitió observar que existen diferencias entre ellas.  </p><p class="p1"><strong>Conclusiones.</strong> Los resultados de este estudio no explican la contradicción encontrada en relación a las diferencias de género y cursos entre universidades; sin embargo, estos resultados son consistentes con otros trabajos, especialmente realizados en Latinoamérica, que muestran variabilidad de la respuesta empática en estudiantes de medicina. Las diferencias entre las universidades no pueden atribuirse a causas psicológicas solamente, sino a la presencia de otros factores que también influyen en la respuesta empática.</p>

Characterization of treatment failure in HIV positive patients in the Colombian Caribbean region

Objectives: Treatment failure in patients receiving antiretroviral therapy against human immunodeficiency virus (HIV) is always a concern. The major aim of the present work was to examine the correlates associated with treatment failure in patients living in the Colombian Caribbean city of Barranquilla, an aspect that was poorly studied in this region. Methods: Treatment failure was evaluated in a cross-sectional study from virological, immunological and clinical standpoints. Results: It was established that 29.5% of patients under highly active antiretroviral therapy (HAART) could be considered in treatment failure. Among those, virological failure was most frequent (20.9%), followed by immunological- (14.0%) and clinical failure (4.7%). In patients showing lack of adherence to the treatment, the likelihood of suffering from treatment- and virogical-failure were respectively increased by 6.67-fold and 12.19-fold, compared with patients showing good adherence. Although there was no statistically significant association, treatment failure tended to be more frequent in young adults and in patients with low income or low level of education. When antiretroviral therapies (ART) regimens were compared, there was no apparent difference in treatment failure between regimens based on non-nucleoside reverse transcriptase inhibitors and those based on protease inhibitors. This is very important in the context of recent ART strategies, such as early-initiated ART, aimed at achieving long-term infection control. Conclusions: The current study confirms the importance of treatment adherence to avoid treatment failure and further highlights the importance of educating HIV-infected patients in all parts of the world, especially those individuals with a lower socio-economic status.

Characterization of treatment failure in HIV positive patients in the Colombian Caribbean region

BACKGROUND

Treatment failure (TF) in patients receiving antiretroviral therapy against human immunodeficiency virus (HIV) is always a concern.

OBJECTIVE

To examine the correlates associated with TF in patients living in the Colombian Caribbean city of Barranquilla, an aspect that was poorly studied in this region.

METHODS

Treatment failure was evaluated in a cross-sectional study from virological, immunological and clinical standpoints.

RESULTS

It was established that 29.5% of patients under highly active antiretroviral therapy (ART) could be considered in TF. Among those, virological failure was most frequent (20.9%), followed by immunological- (14.0%) and clinical failure (4.7%). In patients showing lack of adherence to the treatment, the likelihood of suffering from TF and virogical failure were respectively increased by 6.67-fold and 12.19-fold, compared with patients showing good adherence. Although there was no statistically significant association, TF tended to be more frequent in young adults, in patients with low income and, low level of education. When ART regimens were compared, there was no apparent difference in TF between regimens based on non-nucleoside reverse transcriptase inhibitors and those based on protease inhibitors. This is very important in the context of recent ART strategies, such as early-initiated ART, aimed at achieving long-term infection control.

CONCLUSIONS

Is confirmed the importance of treatment adherence to avoid TF and further highlights the importance of educating HIV-infected patients in all parts of the world, especially those individuals with a lower socio-economic status.

[Consensus document on vaccination against influenza in health care workers]

Health care workers (HCW) are included each year among risk groups for vaccination against influenza. However, vaccination coverage among this group in our country is very low, not exceeding 25%. Convinced that one of the best tools to increase this coverage among professionals in our country are the scientific evidence, 19 scientific societies and associations professionals bringing together health professionals more directly related to influenza as an health problem, and the General Nursing Council, met to discuss and develop this consensus document in order to inform HCW about the appropriateness of their vaccination against influenza and the benefits that flow from it for themselves, for their patients and for the rest of the population. This recommendation is based on 3 pillars: argument of necessity, ethics and exemplary.

2E3, a new marker that selectively identifies porcine CD4+ naive T cells

We describe a novel antigen recognized by mAb 2E3 selectively expressed in the periphery by a subset of porcine CD4+ T cells. Both, CD4+CD8alpha- and CD4+CD8alphalow T cell subpopulations express this antigen. CD4+2E3+ T cells show phenotypical and functional characteristics of nai;ve cells. The majority of them are CD29low, CD45RAhigh, CD49dlow, CD11alow, CD18low, and SLA-II-. After mitogen activation CD4+2E3+ T cells express high levels of IL-2 mRNA, but only traces of IFN-gamma or IL-4 mRNA. Indeed a minor percentage of cells stained positive for IFN-gamma when assessed by flow cytometry. Moreover, CD4+2E3+ T cells did not proliferate in response to the recall antigen lysozyme, although they did efficiently to the mitogen ConA. By contrast, CD4+2E3- T cells show phenotypical and functional characteristics of primed cells. They express markers associated to a memory phenotype, respond to the recall antigen lysozyme, and produce high amounts of IFN-gamma and IL-4.

Characterisation of the lpdA gene from Neisseria meningitidis by polymerase chain reaction, restriction fragment length polymorphism and sequencing

P64k protein from Neisseria meningitidis is well recognised in sera from individuals convalescent from meningococcal disease or vaccinated with the Cuban antimeningococcal vaccine VA-MENGOC-BC. The presence of the protein in more than 80 meningococcal strains has also been verified. It is immunogenic in animal models and the antibodies elicited show bactericidal activity against meningococci. To further investigate at the molecular level whether lpdA, the gene coding for P64k protein, is conserved among different N. meningitidis strains, a total of 20 strains isolated from different geographic areas were differentiated on the basis of restriction fragment length polymorphism (RFLP) patterns after polymerase chain reaction (PCR) amplification of the lpdA gene and restriction endonuclease digestion with HpaII. Although a total of five different PCR-RFLP patterns were present, nucleotide sequence determination showed that identity levels were as high as 93-99% among the N. meningitidis strains analysed.

Bronchial epithelium associated to lymphoid tissue does not selectively express vimentin

The existence of a lymphoepithelium containing M cells in the bronchus-associated lymphoid tissue (BALT) of several species has repeatedly been questioned. In previous electron microscopical studies we failed to ultrastructurally identify these cells in the epithelium covering bronchial lymphoid tissue of adult rats. In the present study, we analyze immunohistochemically the expression of vimentin, an intermediate filament, reported to be a sensitive marker for rabbit M cells, in both BALT and Peyer's patches. Our results demonstrate, however, the absence of vimentin expression in the epithelium covering the bronchial lymphoid aggregates as well as in the lymphoepithelium of the Peyer's patches. On the contrary, both epithelia are strongly cytokeratin positive. Furthermore, numerous vimentin-positive lymphocytes appear in both lymphoid organs. Results are discussed from a view of the possible relationship between BALT and the so-called mucosae-associated lymphoid tissue (MALT).

Ultrastructural changes in the adult rat thymus after estradiol benzoate treatment

Although numerous authors have correlated high levels of circulating estrogens with thymic involution, a systematic analysis to date on the histological changes affecting the thymus gland in that situation is lacking. In the present study we report both histological and ultrastructural changes occurring in the thymus of adult Wistar rats which received a single dose either of 100 micrograms or 500 micrograms of estradiol benzoate. Both doses induced thymic involution which correlated well with histological changes observed in the lymphoid populations but also with profound modifications in the thymic epithelial component. Moreover, intrathymic erythro-and granulopoiesis, increased numbers of both macrophages and plasma cells, and important variations in the thymic vascular permeability occurred in estradiol benzoate treated rats. These results are discussed from the perspective that changes in both the non-lymphoid cell components of thymic microenvironments and vascular permeability are essential to understand the general effects of sex steroids on the immune system.