Mapping stages, barriers and facilitators to the implementation of HEARTS in the Americas initiative in 12 countries: A qualitative study

The World Health Organization (WHO) Global Hearts Initiative offers technical packages to reduce the burden of cardiovascular diseases through population-wide and targeted health services interventions. The Pan American Health Organization (PAHO) has led implementation of the HEARTS in the Americas Initiative since 2016. The authors mapped the developmental stages, barriers, and facilitators to implementation among the 371 primary health care centers in the participating 12 countries. The authors used the qualitative method of document review to examine cumulative country reports, technical meeting notes, and reports to regional stakeholders. Common implementation barriers include segmentation of health systems, overcoming health care professionals' scope of practice legal restrictions, and lack of health information systems limiting operational evaluation and quality improvement mechanisms. Main implementation facilitators include political support from ministries of health and leading scientific societies, PAHO's role as a regional catalyst to implementation, stakeholder endorsement demonstrated by incorporating HEARTS into official documents, and having a health system oriented to primary health care. Key lessons include the need for political commitment and cultivating on-the-ground leadership to initiate a shift in hypertension care delivery, accompanied by specific progress in the development of standardized treatment protocols and a set of high-quality medicines. By systematizing an implementation strategy to ease integration of interventions into delivery processes, the program strengthened technical leadership and ensured sustainability. These study findings will aid the regional approach by providing a staged planning model that incorporates lessons learned. A systematic approach to implementation will enhance equity, efficiency, scale-up, and sustainability, and ultimately improve population hypertension control.

Effect of hydraulic retention time on microbial community in biochemical passive reactors during treatment of acid mine drainage

The effect of hydraulic retention time (HRT) on the microbial community during acid mine drainage (AMD) treatment was investigated. Physicochemical and molecular (illumina and qPCR) analyses were performed on reactive mixtures collected from seven bioreactors in three-operation period (8, 17 and 36weeks). Long HRT (4day) favored the relative abundance of SRB, causing the increase of residual sulfides and short HRT (1day) affected the anaerobic conditions of the bioreactors and favored the presence the acidophilic chemolithotrophic microorganisms. Besides qPCR indicated that genes related to cellulose degradation were present in low copy numbers and were affected by the HRT. Finally, environmental factors (pH, organic source, metal sulfides, and sulfate concentrations) had significant impact on relative abundance of the phylogenetic lineages, rather than the types of lineages present in the reactive mixture. The findings of this study indicate that HRT affects the stability of passive bioreactors and their microbial communities.

Biochemical passive reactors for treatment of acid mine drainage: Effect of hydraulic retention time on changes in efficiency, composition of reactive mixture, and microbial activity

Biochemical passive treatment represents a promising option for the remediation of acid mine drainage. This study determined the effect of three hydraulic retention times (1, 2, and 4 days) on changes in system efficiency, reactive mixture, and microbial activity in bioreactors under upward flow conditions. Bioreactors were sacrificed in the weeks 8, 17 and 36, and the reactive mixture was sampled at the bottom, middle, and top layers. Physicochemical analyses were performed on reactive mixture post-treatment and correlated with sulfate-reducing bacteria and cellulolytic and dehydrogenase activity. All hydraulic retention times were efficient at increasing pH and alkalinity and removing sulfate (>60%) and metals (85-99% for Fe(2+) and 70-100% for Zn(2+)), except for Mn(2+). The longest hydraulic retention time (4 days) increased residual sulfides, deteriorated the quality of treated effluent and negatively impacted sulfate-reducing bacteria. Shortest hydraulic retention time (1 day) washed out biomass and increased input of dissolved oxygen in the reactors, leading to higher redox potential and decreasing metal removal efficiency. Concentrations of iron, zinc and metal sulfides were high in the bottom layer, especially with 2 day of hydraulic retention time. Sulfate-reducing bacteria, cellulolytic and dehydrogenase activity were higher in the middle layer at 4 days of hydraulic retention time. Hydraulic retention time had a strong influence on overall performance of passive reactors.

Stigma, burden, social support, and willingness to care among caregivers of PLWHA in home-based care in South Africa

Despite its benefits for people living with HIV/AIDS (PLWHA), home-based care (HBC) may have negative effects on caregivers. Caregivers experience high levels of burden and may be targets of HIV-related prejudice and discrimination. In this cross-sectional survey of 358 caregivers from five hospices across KwaZulu-Natal, South Africa, 49 (13.7%) caregivers personally experienced discrimination as a result of caring for PLWHA. One hundred and seventy (47.5%) marked one or more items on the HIV stigma scale. Eighty-eight percent had low to moderate levels of caregiver burden. People with higher level of burden and higher income were more likely to hold stigmatizing beliefs. Caregivers with the following characteristics: support from a nurse, support from community careworker, HIV stigmatizing beliefs, and personal experience of discrimination as result of caring for PLWHA and low caregiver burden, had more than twice the odds of wanting to care for another PLWA in the future. Overall, caregivers in HBC experience low level of severe caregiver burden. The support offered to caregivers from the hospice and relatively low levels of discrimination encourage expansion of HBC programs for PLWHA.

Diversity of Colombian strains of Bacillus thuringiensis with insecticidal activity against dipteran and lepidopteran insects

AIM

To evaluate the genetic and molecular diversity and insecticidal activity of Bacillus thuringiensis isolates from all the natural regions of Colombia.

METHODS AND RESULTS

A total of 445 isolates from a collection of B. thuringiensis were characterized. The parasporal crystal morphology that was most abundant was bipyramidal (60%). Almost 10% of the isolates were toxic to Spodoptera frugiperda and 5.6% against Culex quinquefasciatus larvae. cry gene content determined by PCR indicated that 10.6% of the isolates contained cry1 genes and 1.1% contained cry2, cry4 or cry11 genes. Protein content of the parasporal crystal was determined by SDS-PAGE; 25 and 18 different protein profiles were found in isolates active against S. frugiperda and C. quinquefasciatus, respectively.

CONCLUSIONS

Bacillus thuringiensis presents great genetic and molecular diversity even in isolates from the same soil sample. Moreover, the diversity and activity of the isolates might have a relationship with the geographical origin of the samples.

SIGNIFICANCE AND IMPACT OF THE STUDY

The results obtained here indicate that some of the B. thuringiensis isolates characterized in this study are potential control agents that could be used in programmes against mosquitoes and S. frugiperda.

Recurrent congenital heart block in neonatal lupus

Congenital heart block (CHB) is the main complication of neonatal lupus (NL) and is strongly associated with the presence of anti-SSA/Ro and anti-SSB/La antibodies. The recurrence of CHB in subsequent pregnancies in mothers with these antibodies is uncommon, occurring in approximately 15% of cases. We describe here a case of recurrent CHB in a previously asymptomatic mother with Sjögren syndrome and discuss the current strategies for the prevention and treatment of CHB in NL.

[Myths about the prevention and control of non-communicable diseases in Latin America]

Given the increase of the burden of non-communicable diseases (NCD) and the possibility to avoid it, it is urgent to implement or strengthen NCD preventive programs in Latin America. However, many myths hinder the implementation of NCD programs. Myths on NCD include: a) NCD are degenerative and incurable; b) they are diseases of the elderly; c) they are diseases of the rich. Like wise there are myths about NCD preventive programs are: a) difficult to implement, b) expensive, and c) ineffective. We present data that demonstrate how these myths are untrue and discuss the challenges to find a balanced health policy that emphasizes the importance of NCD without overlooking other diseases.

[Risk factors for non communicable diseases: methods and global results of the CARMEN program basal survey]

BACKGROUND

In the last decades, chronic non communicable diseases are becoming the main cause of disability and mortality among adults. The risk factor surveillance and management is the most efficient mean of reducing the impact of these diseases.

AIM

To report the results of a non communicable disease risk factor surveillance program in Valparaiso, Chile.

MATERIAL AND METHODS

A random samples of people aged 25 to 64 years old living in Valparaiso, Chile was studied. Subjects were questioned about smoking and physical activity habits. Blood pressure, height and weight were measured using standardized techniques at their homes and blood samples were obtained to measure serum lipid levels and oral glucose tolerance test at the nearest outpatient clinic.

RESULTS

Of the initial 3852 homes selected, 752 individuals did no agree to answer the inquiry, therefore 3120 subjects were finally interviewed. Of these, 40.6% were smokers, 15% drank alcohol in two or more occasions per month, 84.6% were physically inactive, 19.7% had a body mass index over 30 kg/m2, 11.1% had high blood pressure, 3.9% were diabetic and 46.9% had high serum cholesterol levels.

CONCLUSIONS

The basal survey for the CARMEN program shows a high prevalence of cardiovascular risk factors among Chileans.

[Prevalence of hypertension in Valparaíso. Results of the base survey of the CARMEN project (Set of measures for the multifactorial reduction of non-transmissible diseases)]

BACKGROUND

There is little information about the real prevalence of hypertension in Chile.

AIM

To assess the adjusted prevalence of hypertension and its main therapeutic measures among adults living in Valparaiso, Chile.

MATERIALS AND METHODS

A random sample of dwellings in Valparaiso was chosen. Among these, an individual of 25 to 64 years old was randomly surveyed for risk factors for chronic diseases and sociodemographic parameters. Blood pressure, weight, height, oral glucose tolerance test, fasting cholesterol and triglycerides were also measured. Prevalence was pondered according to age, sex, and probability of selection in the dwelling interior.

RESULTS

Three thousand one hundred twelve individuals were studied. The adjusted prevalence of hypertension was 11.4% (11.6% among females and 10.6% among men). The prevalence increased along with age from 3 and 1.9% in men and women of 25 to 34 years old respectively, to 18.2 and 27.4% among men and women of 55 to 64 years old (p < 0.01). People of low socioeconomic level had a higher prevalence of hypertension than those of high socioeconomic level (14.2 and 9.3% respectively, P < 0.05). Diabetes, obesity and hypercholesterolemia were significantly more frequent in subjects with hypertension than in the general population. Forty-four percent of diagnosed hypertensives were receiving medications (angiotensin converting enzyme inhibitors 40%, calcium antagonists 34%, beta blockers 22%). Twenty five percent of patients were treated with a combination of medications. Of those treated, only 22% had normal blood pressure levels at the moment of examination.

CONCLUSIONS

High blood pressure is an important public health problem that requires more efficient detection and treatment programs.

[Functional risk assessment of poor Chilean elders using an instrument validated in Canada]

BACKGROUND

Information about medical and social situation of elders is limited in Chile.

AIM

To assess the functional risk of Chilean elders using an instrument validated in Canada.

SUBJECTS AND METHODS

As part of a project aimed to help poor elders, 2,116 subjects living in Santiago, aged 65 to 99 years old (1,334 female, and 625 older than 75 years old), were interviewed.

RESULTS

Thirty percent of these elders were using more than three medications and 13% lived alone. Visual problems were detected in 75%, memory problems were found in 62%, 63% felt depressed, 46% had hearing problems, 42% suffered a fall during the last year, 35% had a health problem that forced them to stay at home, 32% did not count with help in a case of need, 33% referred some type of nutritional problem, 26% needed help for daily living activities and 25% considered to have a worst health than counterparts of the same age. Among subjects older than 75 years old, the frequency of memory problems, auditory impairment, number of falls, health problems that precluded leaving the house, limitation for daily activities and the use of walking aids, was significantly higher. Although men and women had similar ages, men were in worst functional conditions, and had required more admissions to hospitals. There was a higher proportion of women living alone. Females also had a higher frequency of depression, memory disturbances, falls and use of more than three medications.

CONCLUSIONS

Women elders tend to be in better functional conditions than men and people older than 75 years old have a higher functional risk. The applied instrument allowed a better focalization of our geriatric program.

[Professional role of the physician in health care]

The professional role of the doctor in health care was analyzed in terms of the peculiarities of the chilean social reality. Determining factors include tradition, the expectations of society and demands of health policies. Action fields and primary and delegated functions are identified. This may be important to help prevent the take over of some of these functions by other health professionals.

[Changes in dehydrogenase glutamate in the rat brain caused by thyroid hormone deficiency]

The dependent GDH-NADPH activity in adenohypophysis and other cerebral areas, has been studied in hypothyroid rats, in which hypothyroidism has been induced surgically. After thyroidectomy a decrease of GDH activity in limbic system (amygdala, septum and hippocampus), and an increase of this enzyme in cortex and hypothalamus have been found, with no changes in adenohypophysis. The alterations of GDH activity, induced by thyroidectomy, have been corrected, although not uniformly in the different brain areas after L-T3 treatment.