Estimados colegas, aqui encontraremos un curso básico de Epi Info en español con videos muy claro y útil.
Aqui estan los links.
Parte I. http://www.cure4kids.org/private/lectures/ppt2059/zip_C4K-2046-0MX-Dise_Creacion_Datos_I.zip/player.html
Parte II. http://www.cure4kids.org/private/lectures/ppt2060/zip_C4K-2047-0MX-Dise_Creacion_Datos_II.zip/player.html
Parte III. http://www.cure4kids.org/private/lectures/ppt2057/zip_C4K-2044-0MX-Codigo_check.zip/player.html
Parte IV. http://www.cure4kids.org/private/lectures/ppt2061/zip_C4K-2048-0MX_Grabar_Datos%202.zip/player.html
Parte V. http://www.cure4kids.org/private/lectures/ppt2062/zip_C4K-2049-0MX-Analyze_Data.zip/player.html
Parte VI. http://www.cure4kids.org/private/lectures/ppt2063/zip_C4K-2050-0MX-Importar_Exportar.zip/player.html
Parte VII. http://www.cure4kids.org/private/lectures/ppt2064/zip_C4K-2051-0MX_Generando_Informe.zip/player.html
Pueden obtener el curso y bajarse los documentos en esta dirección.
http://www.phconnect.org/group/epiinfo/forum/topics/epi-info-online-tutorials-in
Este link le llevará a una presentación del curso básico de EPI INFO.
Saludos
Dr. Carlos Erazo
domingo, 10 de abril de 2011
viernes, 8 de abril de 2011
HIV and injecting drug use: a global call for action
HIV and injecting drug use: a global call for action When world leaders meet in New York at the UN High-Level Meeting on AIDS (June 8–10, 2011), they will review the past decade’s progress and chart the future course of the global HIV response. There are some advances to celebrate, with global HIV incidence falling and access to treatment improving. But there are also unmitigated failures to be addressed moving forward. As a Lancet Series emphasised last year, people who inject drugs have been left behind in global eff orts to scale up access to HIV prevention, treatment, care, and support. Their needs have been neglected, and their rights have been ignored, and, in many cases, horribly
violated as governments have chosen to pursue punitive, disproportionate drug laws instead of evidence-based health strategies to address drug-related harm. The June meeting represents a unique opportunity to correct these injustices. A new document—the Beirut Declaration on HIV and Injecting Drug Use: A Global Call for Action—released at the 22nd International Harm Reduction Conference, Beirut, Lebanon (April 3–7, 2011), sets out how the international community has failed people who inject drugs and the actions now required by governments. Crucially, evidence-based programmes (needle and syringe exchange programmes, opioid substitution, and antiretroviral treatment) targeting the 16 million people who inject drugs worldwide need to be fi nanced, implemented, and scaled up across all settings to prevent and treat HIV infection. Ineff ective drug policies also need to end, funding for harm reduction needs to be vastly increased, and vulnerable groups who inject drugs (including women, young people, and people in prison) need access to integrated health and harm-reduction services. These actions should be explicitly included in the new global declaration on
HIV/AIDS that will be drafted at the June meeting with measurable targets to hold governments accountable. Misplaced moral judgments have underpinned the neglect of people who inject drugs in the global HIV response. Yet it is wholly immoral to let people become infected with HIV or die when evidence-based interventions exist to prevent these outcomes. A bold and humane response is needed from governments at the June meeting and beyond. Millions of lives are at stake.
violated as governments have chosen to pursue punitive, disproportionate drug laws instead of evidence-based health strategies to address drug-related harm. The June meeting represents a unique opportunity to correct these injustices. A new document—the Beirut Declaration on HIV and Injecting Drug Use: A Global Call for Action—released at the 22nd International Harm Reduction Conference, Beirut, Lebanon (April 3–7, 2011), sets out how the international community has failed people who inject drugs and the actions now required by governments. Crucially, evidence-based programmes (needle and syringe exchange programmes, opioid substitution, and antiretroviral treatment) targeting the 16 million people who inject drugs worldwide need to be fi nanced, implemented, and scaled up across all settings to prevent and treat HIV infection. Ineff ective drug policies also need to end, funding for harm reduction needs to be vastly increased, and vulnerable groups who inject drugs (including women, young people, and people in prison) need access to integrated health and harm-reduction services. These actions should be explicitly included in the new global declaration on
HIV/AIDS that will be drafted at the June meeting with measurable targets to hold governments accountable. Misplaced moral judgments have underpinned the neglect of people who inject drugs in the global HIV response. Yet it is wholly immoral to let people become infected with HIV or die when evidence-based interventions exist to prevent these outcomes. A bold and humane response is needed from governments at the June meeting and beyond. Millions of lives are at stake.
Health of lesbian, gay, bisexual, and transgender populations
The Lancet Institute of Medicine
http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673611604820.pdf
Health of lesbian, gay, bisexual, and transgender populations The past 20 years have seen dramatically increased visibil ity of people who are lesbian, gay, bisexual, and transgendered (LGBT) in US society. This diverse and vibrant group are now active and welcome members of many communities
across the country and are well recognised and praised for being a major force in the positive global response to the HIV/AIDS epidemic. Substantial achievements to advance their health status, such as the established partnership between LGBT organisations and foundations or corporations to access funding to address the HIV/AIDS epidemic, have been achieved. Yet, there is still a great deal to learn. Basic demographic data are lacking for LGBT populations in the USA. Many health practitioners are not well informed about how to care for LGBT populations, or about what constitutes healthy development of LGBT adolescents, and they do not understand enough about the development of sexual orientation, diverse gender identities, LGBT families, or the eff ect of stigma and discrimination on health. To develop a more complete picture of the health status of people who are LGBT and to identify research gaps, the Institute of Medicine (IOM) released The Health of Lesbian,
Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Using a life-course perspective, the report examines the health status of these populations in three stages: childhood and adolescence, early and middle adulthood, and later adulthood. The IOM fi nds that, although these populations share the full range of health risks with the rest of society, they are also exposed to a unique yet poorly understood set of additional threats.
For instance, compared with their heterosexual peers, members of the LGBT community are at increased risk of suicide, depression, harassment, and victimisation, and they may have higher rates of smoking and alcohol use. It is worth noting that for teenage lesbian and bisexual girls, pregnancy rates may be higher than those of heterosexual girls. Girls may deliberately attempt to get pregnant in an eff ort to defi ne and strengthen an identity for themselves. In early and middle adulthood, lesbians and bisexual women may also be at higher risk for breast cancer and for obesity, while men who have sex with men, especially those who are HIV-positive, are at increased risk for anal cancer. Meanwhile, in some studies, lesbians were signifi cantly more likely than heterosexual women to receive a diagnosis of heart disease. In later adulthood, LGBT are less likely to have a partner or children to provide them with health and social care, resulting in their greater dependence on friends, caregivers, and LGBT organisations. There has been clinical concern about rates of diabetes, ovarian disease, and stroke among transgender older people potentially as a result of longterm hormone treatments. Furthermore, HIV/AIDS re mains a crucial health issue for gay or bisexual men, transgender women, and LGBT who inject drugs. Additionally, people who are LGBT face barriers to equitable health services in
the USA, such as diffi culty in obtaining health insurance, fear of discrimination from providers, and a shortage of providers who are well trained in their health needs. When addressing health issues for people who are LGBT, researchers are confronted with many challenges, one of which is a lack of systematically or accurately collected data. The LGBT community make up a sometimes hidden minority of the population and it is hard to recruit suffi cient numbers to studies to yield meaningful results. Moreover, the LGBT acronym does not represent a homogeneous group, and it can be
diffi cult to defi ne and measure sexual orientation and gender identity. Additionally, some LGBT individuals are reluctant to disclose details about themselve s and take part in research, because research topics may be sensitive and can be perceived as intruding on privacy. The availability of high-quality evidence is central to improvement of knowledge. The report calls for a research agenda to collect data, examine appropriate method ology, train researchers, and develop policy on
research participation, provided that privacy concerns can be satisfactorily addressed. It also emphasises several priority research areas—demography, social infl uences, health-care inequalities, and intervention research. The IOM report is groundbreaking. Not only does it re view the LGBT community’s health needs comprehen sive ly, but it also brings a sea change in establishing edu cation al and research guidance for LGBT health. Actions in response to the report are already underway,
such as integration of LGBT health education into medical school curricula. The full participation of the LGBT community in their health and wellbeing is crucial. Above all, scientifi c and clinical engagement is essential to improve awareness and understanding of LGBT health issues, and to incorporate them into mainstream health care. The Lancet Institute of Medicine
http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673611604820.pdf
Health of lesbian, gay, bisexual, and transgender populations The past 20 years have seen dramatically increased visibil ity of people who are lesbian, gay, bisexual, and transgendered (LGBT) in US society. This diverse and vibrant group are now active and welcome members of many communities
across the country and are well recognised and praised for being a major force in the positive global response to the HIV/AIDS epidemic. Substantial achievements to advance their health status, such as the established partnership between LGBT organisations and foundations or corporations to access funding to address the HIV/AIDS epidemic, have been achieved. Yet, there is still a great deal to learn. Basic demographic data are lacking for LGBT populations in the USA. Many health practitioners are not well informed about how to care for LGBT populations, or about what constitutes healthy development of LGBT adolescents, and they do not understand enough about the development of sexual orientation, diverse gender identities, LGBT families, or the eff ect of stigma and discrimination on health. To develop a more complete picture of the health status of people who are LGBT and to identify research gaps, the Institute of Medicine (IOM) released The Health of Lesbian,
Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Using a life-course perspective, the report examines the health status of these populations in three stages: childhood and adolescence, early and middle adulthood, and later adulthood. The IOM fi nds that, although these populations share the full range of health risks with the rest of society, they are also exposed to a unique yet poorly understood set of additional threats.
For instance, compared with their heterosexual peers, members of the LGBT community are at increased risk of suicide, depression, harassment, and victimisation, and they may have higher rates of smoking and alcohol use. It is worth noting that for teenage lesbian and bisexual girls, pregnancy rates may be higher than those of heterosexual girls. Girls may deliberately attempt to get pregnant in an eff ort to defi ne and strengthen an identity for themselves. In early and middle adulthood, lesbians and bisexual women may also be at higher risk for breast cancer and for obesity, while men who have sex with men, especially those who are HIV-positive, are at increased risk for anal cancer. Meanwhile, in some studies, lesbians were signifi cantly more likely than heterosexual women to receive a diagnosis of heart disease. In later adulthood, LGBT are less likely to have a partner or children to provide them with health and social care, resulting in their greater dependence on friends, caregivers, and LGBT organisations. There has been clinical concern about rates of diabetes, ovarian disease, and stroke among transgender older people potentially as a result of longterm hormone treatments. Furthermore, HIV/AIDS re mains a crucial health issue for gay or bisexual men, transgender women, and LGBT who inject drugs. Additionally, people who are LGBT face barriers to equitable health services in
the USA, such as diffi culty in obtaining health insurance, fear of discrimination from providers, and a shortage of providers who are well trained in their health needs. When addressing health issues for people who are LGBT, researchers are confronted with many challenges, one of which is a lack of systematically or accurately collected data. The LGBT community make up a sometimes hidden minority of the population and it is hard to recruit suffi cient numbers to studies to yield meaningful results. Moreover, the LGBT acronym does not represent a homogeneous group, and it can be
diffi cult to defi ne and measure sexual orientation and gender identity. Additionally, some LGBT individuals are reluctant to disclose details about themselve s and take part in research, because research topics may be sensitive and can be perceived as intruding on privacy. The availability of high-quality evidence is central to improvement of knowledge. The report calls for a research agenda to collect data, examine appropriate method ology, train researchers, and develop policy on
research participation, provided that privacy concerns can be satisfactorily addressed. It also emphasises several priority research areas—demography, social infl uences, health-care inequalities, and intervention research. The IOM report is groundbreaking. Not only does it re view the LGBT community’s health needs comprehen sive ly, but it also brings a sea change in establishing edu cation al and research guidance for LGBT health. Actions in response to the report are already underway,
such as integration of LGBT health education into medical school curricula. The full participation of the LGBT community in their health and wellbeing is crucial. Above all, scientifi c and clinical engagement is essential to improve awareness and understanding of LGBT health issues, and to incorporate them into mainstream health care. The Lancet Institute of Medicine
HHS Action Plan to Reduce Racial and Ethnic Health Disparities
Estimados colegas , este es el enalce para poder bajar el pdf de los planes para disminuir la desigualdad en salud basados en etnicidad y raza.
http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf
Saludos
Dr. Carlos Erazo
http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf
Saludos
Dr. Carlos Erazo
Approaching 30 Years of HIV/AIDS in the United States
April 08, 2011
By Ronald Valdiserri, M.D., M.P.H., Deputy Assistant Secretary for Health, Infectious Diseases, U.S. Department of Health and Human Services
In less than two months, we will mark the 30th anniversary of the first reported cases of what we now know as AIDS. In June 1981, the Centers for Disease Control and Prevention (CDC) reported a rare form of pneumonia diagnosed in five, previously healthy, gay men from Los Angeles. The report raised concerns that these five men had been exposed to something that caused their profound immune suppression. Now we know that their disease resulted from infection with HIV.
As we mark this significant milestone, we solemnly mourn the more than 600,000 Americans who have lost their lives to HIV disease. But we also honor, with pride, the men, women, and young people who have made important contributions to 30 years of fighting the HIV/AIDS epidemic in the United States and around the world. And certainly we celebrate the substantial advances in prevention, diagnosis and treatment that have been made in the past three decades. Although our journey hasn’t finished, we’ve come a very long way since those early days when so much was unknown about this deadly new disease.
Perhaps, most importantly, this observance will prompt each of us to consider how we can extend and enhance our individual and collective responses to the epidemic so that it does not persist for another 30 years. For the first time we have a National HIV/AIDS Strategy (NHAS) that all of us can use as a game-plan to better focus and coordinate our individual and organizational efforts. The Strategy was informed by our 30 years of experience with HIV/AIDS. Achieving its goals — reducing new HIV infections, increasing access to HIV care, improving health outcomes for people living with HIV, and reducing HIV-related health disparities — requires the active participation of all sectors of society. This includes not only local, state, tribal and federal governments, but also businesses, faith communities, philanthropy, the scientific and medical communities, educational institutions, people living with HIV, and many others.
Dr. Ronald Valdiserri
As we mark this significant milestone, we solemnly mourn the more than 600,000 Americans who have lost their lives to HIV disease. But we also honor, with pride, the men, women, and young people who have made important contributions to 30 years of fighting the HIV/AIDS epidemic in the United States and around the world. And certainly we celebrate the substantial advances in prevention, diagnosis and treatment that have been made in the past three decades. Although our journey hasn’t finished, we’ve come a very long way since those early days when so much was unknown about this deadly new disease.
Perhaps, most importantly, this observance will prompt each of us to consider how we can extend and enhance our individual and collective responses to the epidemic so that it does not persist for another 30 years. For the first time we have a National HIV/AIDS Strategy (NHAS) that all of us can use as a game-plan to better focus and coordinate our individual and organizational efforts. The Strategy was informed by our 30 years of experience with HIV/AIDS. Achieving its goals — reducing new HIV infections, increasing access to HIV care, improving health outcomes for people living with HIV, and reducing HIV-related health disparities — requires the active participation of all sectors of society. This includes not only local, state, tribal and federal governments, but also businesses, faith communities, philanthropy, the scientific and medical communities, educational institutions, people living with HIV, and many others.
If you have not yet had the opportunity to do so, I encourage you to read the Strategy and other information about its implementation available on AIDS.gov. Being familiar with the details of the Strategy will provide you with an even stronger foundation for engaging in efforts to enhance the HIV prevention, care and treatment, and stigma reduction activities that may be underway in your community. And if these efforts are not taking place in your community, the Strategy can suggest principles and priorities against which to assess current activities as well as opportunities to bring together new partners to help make that happen. A number of activities are being planned in recognition of this 30-year milestone. Shortly, AIDS.gov will post a page so you can follow the commemorative activities planned by various Federal government agencies.
After 30 years of HIV/AIDS, we need to recognize how far we have come but, at the same time, continue to commit ourselves to accomplishing what remains to be done. Then, we will truly achieve the vision of the NHAS:
After 30 years of HIV/AIDS, we need to recognize how far we have come but, at the same time, continue to commit ourselves to accomplishing what remains to be done. Then, we will truly achieve the vision of the NHAS:
“The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.”
jueves, 7 de abril de 2011
High-Grade AIN Among HIV-Infected Men Who Have Sex with Men
In a 3-year prospective study, the cumulative incidence of high-grade anal intraepithelial neoplasia was 37% among HIV-infected MSM receiving ART.
The incidence of anal cancer has been increasing since the introduction of potent combination antiretroviral therapy (ART), but the reasons are unclear. In the present study, researchers evaluated the incidence of high-grade anal intraepithelial neoplasia (AIN) among 247 HIV-infected men who have sex with men (MSM) who were either initiating or already receiving potent ART. Participants underwent anal cytological analysis and high-resolution anoscopy (HRA) at baseline and then every 6 months to 1 year for 3 years.
During follow-up, 17% of participants had high-grade squamous intraepithelial lesions at least once, and 54% of participants had high-grade AIN (AIN2/3) at least once. In two men (1% overall), the condition progressed to invasive anal cancer. At 3 years, the cumulative incidence of high-grade AIN was 37%, and the progression rate from a lesser abnormality at baseline was 12.8 new cases per 1000 person-months. In a multivariate analysis, several factors were significantly associated with high-grade AIN: age 
40, CD4 count <50 cells/mm3 before ART initiation, and infection with human papillomavirus (HPV) type 16 or 18. Treatment with the same ART regimen for at least 4 years was associated with a reduced risk for high-grade AIN.
40, CD4 count <50 cells/mm3 before ART initiation, and infection with human papillomavirus (HPV) type 16 or 18. Treatment with the same ART regimen for at least 4 years was associated with a reduced risk for high-grade AIN.Comment: Although this study was small, it furthers our understanding of the risk for progression of AIN among HIV-infected MSM in the current treatment era. The incidence of new high-grade AIN may have been overestimated if lesions were missed on initial screening. Nevertheless, the data support the need for aggressive screening for AIN in the routine care of individuals who have engaged in receptive anal sex — and the aggressive monitoring of AIN when it is discovered. Although ART may provide some benefit in terms of reducing the risk for progression of AIN, the effect is not overwhelming. What we do not yet know is whether early detection and treatment of AIN in the ART era confers a reduction in the incidence of invasive cancer or improves survival.
Published in Journal Watch HIV/AIDS Clinical Care March 28, 2011
miércoles, 6 de abril de 2011
En breve colocaremos más información para su apoyo
Estimados colegas, esta semana se subirán artículos nuevos relacionados con el tema.
Gracias por su paciencia
Dr. Carlos Erazo
Gracias por su paciencia
Dr. Carlos Erazo
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