OBJECTIVE: This study examines how telerehabilitation becomes part of existing and new clinical routines and identifies factors that enable or constrain its routine use. METHODS: An in-depth case study of a telemedicine program in rehabilitation implemented between an urban specialized rehabilitation center and a rural regional rehabilitation center was conducted. Using a conceptual framework based on Giddens' theory of structuration, a qualitative analysis was carried out using four data sources: focus groups and phone interviews (with health professionals, managers, and patients and their family members); telerehabilitation video recordings; and project documents (e.g., proposals, requests for funding, summaries, agendas of meetings, operating procedures, patient handouts, and tools for clinicians). RESULTS: In two rehabilitation programs for 1) patients who sustained a traumatic brain injury and 2) those who sustained a spinal cord injury, telerehabilitation was successfully incorporated into routine clinical practices for activities such as interdisciplinary care plans. However, for specialized clinical consultations or long-term patient follow-up, telerehabilitation was not successfully incorporated. Factors that facilitated or prevented the integration of telerehabilitation in routine practices stemmed from both the structure (norms, rules, resources, and values) and the agent (e.g., users of telerehabilitation, including clinicians, managers, and patients and their families) and include 1) shared beliefs and assumptions held by patient care team members regarding the nature of the clinical activities, and the perceptions of patients and their family members; 2) clinical and organizational leadership; 3) extent and type of telerehabilitation use; 4) available resources; and 5) collaborations already in place or needing to be developed. CONCLUSIONS: This study provides empirical evidence of how telerehabilitation activities may become integrated into routine day-to-day clinical activities.

OBJETIVO: En este estudio se analiza cómo la telerrehabilitación se convierte en parte de las rutinas clínicas nuevas y las ya existentes, y se determinan los factores que facilitan o limitan su uso habitual. MÉTODOS: Se llevó a cabo un estudio exhaustivo de casos de un programa de telemedicina en el ámbito de la rehabilitación puesto en marcha entre un centro urbano especializado en rehabilitación y un centro regional de rehabilitación en una zona rural. Mediante el empleo de un marco conceptual basado en la teoría de la estructuración de Giddens, se realizó un análisis cualitativo a partir de cuatro fuentes de datos: grupos de discusión y entrevistas por teléfono (dirigidas a profesionales de la salud, gerentes, y pacientes y sus familiares); grabaciones de video de sesiones de telerrehabilitación; y documentos del proyecto (por ejemplo, propuestas, solicitudes de financiamiento, resúmenes, programas de reuniones, procedimientos operativos, folletos dirigidos a los pacientes y herramientas destinadas a los médicos). RESULTADOS: En dos programas de rehabilitación dirigidos a pacientes que habían sufrido un traumatismo cerebral y a pacientes con una lesión de la médula espinal, la telerrehabilitación fue incorporada exitosamente a las prácticas clínicas corrientes de actividades como los planes de atención interdisciplinaria. Sin embargo, cuando se trataba de consultas clínicas especializadas o seguimiento de pacientes a largo plazo, la incorporación de la telerrehabilitación no resultó exitosa. Los factores que facilitaron o impidieron la integración de la telerrehabilitación en las prácticas corrientes provinieron tanto de la estructura (normas, reglas, recursos y valores) como de los agentes (es decir, los usuarios de la telerrehabilitación, incluidos los médicos, los gerentes, y los pacientes y sus familias) e incluyeron: 1) las creencias y suposiciones compartidas por los miembros del equipo asistencial del paciente con respecto a la naturaleza de las actividades clínicas, y las percepciones de los pacientes y sus familiares; 2) el liderazgo clínico y organizativo; 3) el grado y tipo de uso de la telerrehabilitación; 4) los recursos disponibles; y 5) las colaboraciones ya implantadas o que aún debían lograrse. CONCLUSIONES: Este estudio aporta evidencia empírica de cómo las actividades de telerrehabilitación pueden integrarse en las actividades clínicas habituales.

As many metalloproteinases (MMPs), macrophage elastase (MMP-12) is able to degrade extracellular matrix components such as elastin and is involved in tissue remodeling processes. Studies using animal models of acute and chronic pulmonary inflammatory diseases, such as pulmonary fibrosis and chronic obstrutive pulmonary disease (COPD), have given evidences that MMP-12 is an important mediator of the pathogenesis of these diseases. However, as very few data regarding the direct involvement of MMP-12 in inflammatory process in the airways were available, we have instilled a recombinant form of human MMP-12 (rhMMP-12) in mouse airways. Hence, we have demonstrated that this instillation induced a severe inflammatory cell recruitment characterized by an early accumulation of neutrophils correlated with an increase in proinflammatory cytokines and in gelatinases and then by a relatively stable recruitment of macrophages in the lungs over a period of ten days. Another recent study suggests that resident alveolar macrophages and recruited neutrophils are not involved in the delayed macrophage recruitment. However, epithelial cells could be one of the main targets of rhMMP-12 in our model. We have also reported that a corticoid, dexamethasone, phosphodiesterase 4 inhibitor, rolipram and a non-selective MMP inhibitor, marimastat could reverse some of these inflammatory events. These data indicate that our rhMMP-12 model could mimic some of the inflammatory features observed in COPD patients and could be used for the pharmacological evaluation of new anti-inflammatory treatment. In this review, data demonstrating the involvement of MMP-12 in the pathogenesis of pulmonary fibrosis and COPD as well as our data showing a pro-inflammatory role for MMP-12 in mouse airways will be summarized.

In ongoing studies on experimental transmission of Plasmodium falciparum in the city of Yaounde gametocyte carriers are daily being identified among dispensary patients with malaria-like complaints. This species comprises 93 of all parasitemias and because of the selection criteria most patients have it as a recent infection. 17 of all P. falciparum-positives carry detectable gametocytes with little difference between youngsters and adults. Blood of adult carriers is taken and infection of Anopheles gambiae mosquitoes is attempted by membrane feeding; the establishment of infection is judged by the presence of oocysts.