Viscoelastic coagulation monitoring parameters in cats with acute arterial thromboembolism.

BACKGROUND: Hypercoagulability has been documented in cats with cardiac disease. However, hemostatic parameters, including viscoelastic coagulation monitoring (VCM) have not been reported in cats with arterial thromboembolism (ATE). HYPOTHESIS/OBJECTIVES: Compare VCM parameters in cats with acute cardiogenic ATE and in control cats. ANIMALS: Sixteen cats with ATE and 30 control cats. METHODS: Multicenter university-based prospective study. Cardiogenic ATE was diagnosed based on physical examination and by ultrasonographically-diagnosed left atrial enlargement. Viscoelastic coagulation monitor analysis, CBC, serum biochemistry profile and coagulation profile were performed at admission in cats with ATE. Analysis from healthy control cats was performed using blood collected by direct venipuncture. Our objective was comparison of VCM parameters clot time (CT), clot formation time (CFT), alpha angle (Angle), maximum clot formation (MCF), amplitude at 10 and 20 minutes (A10 and A20, respectively) and clot lysis index at 30 and 45 minutes (LI30 and LI45, respectively) between ATE and control cats. RESULTS: Cats with ATE had a decreased angle compared to control cats, with a median (range) of 43° (30-48°) compared to 47° (14-59°; P = .01). The parameters A10, A20 and MCF were decreased in ATE cats compared to control cats with a median (range) of 19 units (8-32) compared to 22 units (6-38), 24.5 units (11-40) compared to 29 units (10-47) and 29.5 units (13-44) compared to 33.5 units (14-53), respectively (P = .01, .01 and .01, respectively). The parameters CT, CFT, LI30 and LI45 were similar between groups (P = .22, .09, .62 and .34, respectively). CONCLUSIONS AND CLINICAL IMPORTANCE: Cats with cardiogenic ATE cats have VCM parameters consistent with hypocoagulability compared with healthy cats.

Case report: Resolution of oligo-anuric acute kidney injury with furosemide administration in a cat following lily toxicity.

Objective: To describe the successful outcome of a case of oligo-anuric acute kidney injury in a cat secondary to lily ingestion. Case summary: A 12-week-old intact male domestic short-hair cat weighing 1.64 kg (3.6 lb) presented with a 12-h duration of vomiting and lethargy after exposure to lilies of the genera Lilium species 24 h prior to presentation. Severe azotemia (Creatinine 5.8 mg/dL, BUN > 100 mg/dL) and hyperkalemia (9.36 mmol/L) were noted on the day of presentation. Treatment of hyperkalemia was instituted with calcium gluconate, lactated ringers solution, dextrose, regular short-acting insulin, albuterol, and sodium bicarbonate, Oliguria to anuria was highly suspected based on a lack of urine production 21 h after hospitalization with intravenous fluid administration and a static bladder size. The cat was administered 4 mg/kg of furosemide, and urinated at 6 h following administration and continued to produce over 6 ml/kg/h of urine in the next 24 h. Two days following furosemide administration, the cat's hyperkalemia and azotemia resolved. The cat was discharged after 4 days of hospitalization, and a recheck revealed no persistent azotemia or hyperkalemia. Unique information: Anuric acute kidney injury secondary to lily toxicity is associated with a poor prognosis, and the only treatment modality previously described is hemodialysis. The cat in this report was successfully managed with medical intervention and furosemide administration, with complete resolution of the acute kidney injury.

Core-shell chitosan/Porphyridium-exopolysaccharide microgels: Synthesis, properties, and biological evaluation.

Advanced materials used in the biomedicine field comprises a diverse group of organic molecules, including polymers, polysaccharides, and proteins. A significant trend in this area is the design of new micro/nano gels whose small size, physical stability, biocompatibility, and bioactivity could lead to new applications. Herein a new synthesis route is described to obtain core-shell microgels based on chitosan and Porphyridium exopolysaccharides (EPS) crosslinked with sodium tripolyphosphate (TPP). First, the synthesis of EPS-chitosan gels through ionic interactions was explored, leading to the formation of unstable gels. Alternatively, the use of TTP as crosslinker agent led to stable core-shell structures. The influence of reaction temperature, sonication time, and exopolysaccharide concentration, pH and TPP concentration were determined as a function of particle size and polydispersity index (PDI). The obtained EPS-chitosan gels were characterized by TEM, TGA, and FTIR; followed by the assessment of protein load capacity, stability upon freezing, cytotoxicity, and mucoadhesivity. Experimentation revealed that the core-shell particles size ranges 100-300 nm, have a 52 % loading capacity for BSA and a < 90 % mucoadhesivity, and no toxic effects in mammalian cell cultures. The potential application of the obtained microgels in the biomedical field is discussed.

Usefulness of Acceptability and Feasibility Assessment in Studies of Nursing Interventions

Nursing interventions constitute an essential component in the discipline and play a central role in the distinction of the nursing practice with regards to other health professionals. In light of the theory, authors like Burns and Grove,(1) define nursing interventions as deliberate cognitive, physical or verbal activities, which are implemented in individuals and families, seeking therapeutic objectives that contribute to health and wellbeing. In turn, for Sidani and Braden,(2) these are described as treatments, therapies, procedures, or actions developed by health professionals within a specific situation of the patient, for the purpose of modifying current conditions and leading to beneficial health outcomes. These approaches aim, in addition to guiding professional to respond to the needs of individuals and/or families, to move towards evaluating the achievement of the results; for this, structured, systematic and rigorous evaluation processes of the interventions are required.

Assessing eating disorder symptoms in low and middle-income countries: a systematic review of psychometric studies of commonly used instruments.

BACKGROUND: Various well-validated interview and self-report instruments are available to assess eating disorder symptomatology. However, most psychometric studies have been conducted in high-income countries. The aim of the present study was to systematically review the available psychometric studies conducted in low- and middle-income countries on well-known measures for assessing eating disorder symptoms. METHODS: Psychometric studies with the following instruments were included: the Eating Disorder Examination (EDE), the Eating Disorder Examination Questionnaire (EDE-Q), the Eating Disorder Inventory (EDI), the Eating Attitudes Test (EAT), and the Children's Eating Attitudes Test (ChEAT). Searches were conducted on August 30, 2021, in the following databases: MEDLINE, EMBASE, LILACS, Web of Science, PsycINFO, and CABI. The methodological quality of the studies was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The studies were considered to have conducted the minimum psychometric evaluation if they assessed at least the three types of validity (content, criteria, and construct) or diagnostic performance. The psychometric properties were also evaluated considering the cut-off points described in the literature for each of the analysis methods used to evaluate validity and reliability and two reviewers independently selected the studies and evaluated the quality criteria. RESULTS: A total of 28 studies were included. The studies were conducted in 13 countries (10 middle income and 3 low income). The instruments that were most used in the studies were the EAT and EDE-Q. According to the overall COSMIN assessment, in most (57%) of the studies the psychometric properties assessed were not described. Forty-three percent of the studies conducted the minimum psychometric evaluation. However, according to the described cut-off points, the results for the psychometric properties assessed showed, in general, acceptable validity and reliability. CONCLUSION: The results of this review suggest a lack of studies with the recommended psychometric properties in low- and middle-income countries on these commonly used instruments. With the steady increase in the prevalence of eating disorders globally, psychometric investigations of instruments for measuring eating disorder symptoms in these countries should be encouraged to promote their early detection and treatment.

The prevalence of eating disorders has increased worldwide. Various instruments are available to assess eating disorder symptomatology, but most psychometric studies have been conducted in high-income countries. The current study aimed to systematically review studies from low- and middle-income countries that have examined the psychometric properties of commonly used measures for assessing eating disorder symptoms. The findings of this study suggest a lack of research in low- and middle-income countries on the psychometric properties of commonly used eating disorder instruments. To promote the early detection and treatment of eating disorder symptoms, instruments with adequate psychometric properties must be available worldwide.

Eficacia de una intervención de enfermería de soporte social al adulto para el autocontrol de la diabetes mellitus tipo 2 / Efficacy of a social support nursing intervention for adults for the self-management of type 2 diabetes mellitus

Objetivo: Determinar la eficacia de una intervención de enfermería de soporte social al adulto para el autocontrol de la diabetes mellitus tipo 2. Método: Ensayo Clínico Aleatorizado de tipo paralelo en una muestra de 94 sujetos, 47 sujetos asignados al grupo de intervención y 47 sujetos asignados al grupo control, que recibió la atención convencional. Los desenlaces primarios fueron el autocontrol y el soporte social, evaluados en tres momentos (pre - post y seguimiento al mes de finalizada la intervención) con las etiquetas de resultados de enfermería Autocontrol: diabetes (1619) y Soporte social (1504). La intervención de enfermería de soporte social fue diseñada con base en la Teoría de Autocontrol Individual y Familiar, y en evidencia científica; posteriormente validada por consenso de expertos. Resultados: El efecto de la intervención para el resultado Autocontrol: diabetes, mostró una diferencia estadísticamente significativa (p = <0.001) entre los grupos, en las mediciones pre - post, y pre - seguimiento. Para el resultado Soporte Social, también hubo una diferencia estadísticamente significativa (p = <0.001) entre los grupos, en las mediciones pre - post, y pre - seguimiento. Conclusiones: se pudo comprobar que la intervención de enfermería de soporte social en el adulto es más eficaz para el autocontrol de la diabetes mellitus tipo 2 que la atención convencional. De esta manera, se hace necesario considerar la implementación de esta intervención en la práctica de enfermería.

Objective: To determine the effectiveness of a social support intervention for adults for the self-management of type 2 diabetes mellitus. Method: Randomized clinical trial of parallel type in a sample of 94 subjects, 47 subjects assigned to the intervention group and 47 subjects assigned to the control group, who received conventional care. The primary outcomes were self-management and social support, evaluated in three moments (pre-post and follow-up one month after the end of the intervention) with the nursing result labels Self-management: diabetes (1619) and Social support (1504). The social support intervention was designed based on the Individual and Family Self-management Theory, and on scientific evidence; subsequently validated by expert consensus. Results: The effect of the intervention for the outcome Self-management: diabetes, showed a statistically significant difference (p = <0.001) between the groups, in the pre-post and pre-follow-up measurements. For the Social Support outcome, there was also a statistically significant difference (p = <0.001) between the groups, in the pre-post and pre-follow-up measurements. Conclusions: it was found that social support intervention in adults is more effective for self-management of type 2 diabetes mellitus than conventional care. Thus, it is necessary to consider the implementation of this intervention in nursing practice.

Valoración pre y posquirúrgica de la vía aérea superior por tomografía computarizada, en pacientes con síndrome de apnea-hipopnea obstructiva del sueño sometidos a cirugía de avance maxilomandibular / Pre-Surgical and Post-Surgical Assessment of the Upper Airway by Computed Tomography, In Patients with Obstructive Sleep Apnea Hypopnea Syndrome Undergoing Maxillomandibular Advancement Surgery

Introducción: el SAHOS secundario a malformaciones craneofaciales conlleva aumento en la morbilidad y deterioro en la calidad de vida del paciente. Objetivo: describir las características prequirúrgicas y cambios posquirúrgicos en la vía aérea, en pacientes sometidos a cirugía de avance maxilomandibular por SAHOS secundario a malformaciones craneofaciales. Metodología: Estudio observacional descriptivo en adultos con SAHOS secundario a malformaciones craneofaciales sometidos a cirugía de avance maxilomandibular entre diciembre del 2013 y octubre del 2018. Se analizaron las medidas prequirúrgicas y posquirúrgicas, así como la magnitud del cambio postintervención. Resultados: En la muestra se encontró el 57,17 % de los pacientes con 2 a 4 malformaciones, seguido del 42,86 % con 5 o más. Los reparos anatómicos con cambios significativos en las medidas posquirúrgicas, en el primer grupo fueron: espacio faríngeo superior, 4,78 mm (DE 1,92); espacio faríngeo inferior, 4,5 mm (DE 3,25); base de la epiglotis, 3,21 mm (DE 2,80); paladar blando, 4,92 mm (DE 2,84); punto medio entre el paladar blando y la base de la epiglotis en su diámetro AP, 4,42 mm (DE 3,13); y transverso, 5,42 mm (DE 4,83). Todos los pacientes con un grado de SAHOS severo tuvieron cambios posquirúrgicos con valores de diferencias estadísticamente significativas que varían entre 6,27 mm (p 0,0011) y 4,72 mm (p 0,0000). Conclusiones: Se caracterizó el cambio en las medidas pre y posquirúrgicas de los puntos de reparo de la vía aérea en los pacientes con SAHOS. Estos hallazgos pueden ser una guía para el radiólogo al momento de escribir el informe de un estudio, para ayudar en la planeación quirúrgica y el seguimiento de los pacientes.

Introduction: Obstructive sleep apnea-hypopnea syndrome (OSAHS) secondary to craniofacial malformations increases morbidity and decreases quality of life of the patient. Objective: To describe the anatomical characteristics of the airway before and after surgery, in patients with OSAHS secondary to craniofacial malformations undergoing maxillo-mandibular advancement surgery. Methodology: This was a descriptive observational study in adults with OSAHS secondary to craniofacial malformations, attending the Clínica Universitaria Colombia, whom underwent maxillo-mandibular advancement surgery between December 2013 and October 2018. Pre-surgical and post-surgical measures at predefined anatomical repair points were analyzed, as well as the magnitude of the post-intervention change. Results: 57.17 % of the patients presented between 2 to 4 malformations, and the remaining 42.86 % presented 5 or more. The anatomical landmarks that presented significant changes in the post-surgical measures in subjects with 2 to 4 malformations were: The upper pharyngeal space 4.78 mm (SD 1.92), lower pharyngeal space 4.5 mm (SD 3.25), base of the epiglottis 3.21 mm (SD 2.80), the soft palate 4.92 mm (SD 2.84), the midpoint between the soft palate and the base of the epiglottis in its AP diameter 4.42 mm (SD 3.13) and transverse diameter 5.42 mm (SD 4.83). All patients with severe OSAHS presented post- surgical changes with statistically significant differences values that vary between 6.27 mm (p value 0.0011) and 4.72 mm (p value 0.0000). Conclusions: The changes in the pre- and post-surgical measures of airway anatomic landmark patients with OSAHS were characterized. These findings can be a guide for the radiologist at the time of reporting a study for this purpose, helping in the surgical planning and follow up of patients.

Evaluación ecográfica de los parámetros estructurales del músculo en pacientes con lupus eritematoso sistémico / Ultrasound Evaluation of the Muscular Structural Parameters in Patients with Systemic Lupus Erythematosus

Objetivo: Detectar las alteraciones estructurales de los músculos peniformes proximales en pacientes con diagnóstico de lupus eritematoso sistémico (LES) y describir su relación con la actividad de la enfermedad y tiempo de tratamiento. Métodos: Pacientes > 18 años con diagnóstico confirmado de LES atendidos durante el periodo comprendido entre enero de 2016 y septiembre de 2018. Se extrajeron de las historias clínicas datos demográficos, clínicos y serológicos previa realización de una ecografía musculoesquelética de los músculos peniformes proximales, tríceps y vasto lateral, para evaluar parámetros cualitativos y cuantitativos de la arquitectura muscular (grosor muscular, longitud del fascículo, ángulo de penación, ecogenicidad, atrofia y edema muscular). Resultados: Se incluyeron 21 pacientes de los cuales 18 eran mujeres (85,7 %), 19 de ellos en el rango de 18-50 años de edad (90,4 %), 15 refirieron mialgia en la entrevista (71 %) y 7 mostraron leve pérdida de la fuerza según la escala Medical Research Council (MRC) (33 %). La mayoría de pacientes recibió tratamiento a base de esteroides (95 %) más un medicamento modificador de la enfermedad. Diez pacientes tenían índice de actividad de la enfermedad leve a moderado (81,2 %). En cuanto a las medidas ecográficas, se encontró una relación significativa entre un ángulo de penación menor a 11,4 grados y atrofia muscular con valores de p = 0,035. Conclusiones: La ecografía musculoesquelética es un método no invasivo útil para la detección de cambios estructurales en la arquitectura muscular del músculo vasto lateral en pacientes con diagnóstico de LES

Objective: To detect muscle structure alterations related to patients diagnosed with Systemic Lupus Erythematosus (SLE) and to describe their relationship with disease activity and time of treatment. Methods: patients > 18 years with diagnosis of SLE affiliated to Sanitas Health System and treated during the period from January 2016 to September 2018. The demographic, clinical and serological information were obtained from the patient's medical records, prior to ultrasound examination from the proximal pennate triceps and vastus lateralis muscles. The qualitative and quantitative variables of the muscular architecture were evaluated (muscle thickness, fascicle length, angle of pennation, echogenicity, atrophy and muscular edema). Results: 21 patients were included of which 18 were women (85.7%), 19 of them in the age range of 18-50 years (90.4%), 15 patients reported myalgia in the interview (71%) and 7 presented loss of their strength in the MRC scale (33%). The majority of patients received a steroid-based treatment (95%) plus a disease-modifying medication. Ten patients presented a mild to moderate disease activity index (81.2%). Regarding ultrasound measurements, we found a relationship between a pennation angle of less than 11.4 degrees and the presence of atrophy with a value of p = 0.035. Conclusions: Musculoskeletal ultrasound is a useful non-invasive method for detecting changes in the muscle architecture of the vastus lateralis muscle in patients diagnosed with SLE.

Artrografía de las extremidades, ¿cómo se hace? / Arthrography of Extremities, How is it Done?

La artrografía, a pesar de ser una técnica antigua, ha recobrado validez en los últimos años por su utilidad en la evaluación de estructuras que no se pueden valorar correctamente mediante técnicas de imagen no invasivas. El propósito de este artículo es realizar una revisión de las técnicas de artrografía por fluoroscopia de las principales articulaciones en las extremidades (hombro, codo, muñeca, cadera, rodilla y tobillo), con el fin de brindar al lector múltiples abordajes para cada una de ellas, con base en la anatomía articular.

Arthrography, despite being an old technique, has regained validity in recent years due to its usefulness in the assessment of structures that cannot be correctly assessed using non-invasive imaging techniques. The purpose of this article is to review the fluoroscopic arthrography techniques of the main joints in the extremities (shoulder, elbow, wrist, hip, knee and ankle), in order to provide the reader with multiple approaches for each of them, based on articular anatomy.

Somnolencia y calidad de sueño en estudiantes de medicina durante las prácticas hospitalarias y vacaciones / Somnolence and sleep quality in medical students during hospital practices and holidays

Introducción: se ha descrito alta frecuencia de somnolencia diurna (SD) y mala calidad del sueño (MCS) en estudiantes de medicina durante sus prácticas hospitalarias y desconocemos lo que sucede durante su período de vacaciones. Objetivo: explorar las diferencias en la SD, MCS y hábitos del sueño en estudiantes durante el periodo de prácticas hospitalarias y vacaciones. Material y método: serie de casos de un solo grupo comparativo en dos períodos. Muestra no probabilística de estudiantes de medicina del 6to año de la Universidad Cayetano Heredia (UPCH). Se aplicó la Escala de Somnolencia de Epworth (ESE) y el Índice de Calidad de Sueño de Pittsburgh (ICSP) dos semanas antes de finalizar su período de prácticas hospitalarias (prácticas) y dos semanas después de finalizarlas (vacaciones). Resultados: participaron 76 (72 por ciento) externos en el período de prácticas y 82 (78 por ciento) durante vacaciones. No hubo diferencias entre ambos grupos en la edad y género. Hubo diferencia estadística entre ambos períodos (prácticas vs vacaciones) en los puntajes de ambas escalas: ESE (9,88 vs 8,27 p=0,015) y ICSP (6,53 vs 5,55 p=0,022). Al comparar prácticas con vacaciones, encontramos disminución en el porcentaje de malos durmientes (59 por ciento vs 43 por ciento, p=0,040), excesiva SD (39 por ciento vs 26 por ciento, p=0,086), haber dormido d" 6h (68 por ciento vs 46 por ciento, p=0,006), tener eficiencia subjetiva del sueño < 85 por ciento (59 por ciento vs 22 por ciento, p<0,001) y aumento del número de horas reportadas de sueño (5,97h vs 6,53h, p=0,005) en el periodo de vacaciones. Conclusiones: los estudiantes de medicina tuvieron mala CS y mayor SD durante el período de prácticas cuyos puntajes mejoraron en las vacaciones, aunque la diferencia no alcanzó significancia estadística al comparar excesiva SD. Se observó que en ambos períodos los puntajes de ambas escalas (ESE e ICSP) fueron anormales...

Introduction: Daytime somnolence and poor sleep quality have been described in medical students during their hospital-based practical sessions, and we do not know the occurrence of these situations during holidays. Objective: To explore the differences in daytime somnolence, sleep quality, and sleeping habits in medical students during the hospital-based practical sessions period, and during holidays. Material and method: A case series with a single group that was assessed in two periods. A non-probabilistic sample comprising 6th year medical students was used. Epworth Somnolence Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI) were administered to the study subjects two weeks before finishing their period of hospital based practical sessions, and two weeks after this period had finished (during holidays). Results: 76 (72 per cent) 6th year medical students participated during the hospital-based practical sessions period and 82 (78 per cent) did during holidays. There were no differences between the two groups with respect to age and gender. There was a statistically significant difference between both periods (practical sessions vs. holidays) in the scores for the two scales used: ESS (9,88 vs. 8,27; p= 0,015) and PSQI (6,53 vs. 5,55; p= 0,022). When comparing the practical sessions period against holidays, we found reductions in the percentage of persons with bad sleep quality (59 per cent vs. 43 per cent; p= 0.040), in persons with excessive daytime somnolence (39 per cent vs. 26 per cent; p= 0,086), in sleeping less than 6 hours (68 per cent vs. 46 per cent; p= 0.006), in a subjective <85 per cent sleep efficiency (59 per cent vs. 22 per cent, p<0.001), and an increase in the number of sleeping hours reported (5,97 h vs. 6,53 h; p= 0,005) during holidays. Conclusions: Medical students had poor sleep quality and more daytime somnolence during their hospital based practical sessions period...

Somnolencia y calidad del sueño en estudiantes de medicina de una universidad peruana / Sleepiness and sleep quality in medical students of a Peruvian university

Objetivos: Determinar el grado de somnolencia diurna y calidad del sueño en estudiantes de medicina. Diseño: Estudio transversal. Lugar: Universidad Peruana Cayetano Heredia. Participantes: Estudiantes de medicina. Intervenciones: Muestra no probabilística de estudiantes de medicina del sexto (76 externos) y sétimo (74 internos) años de estudios. Cuestionarios: datos demográficos, escala de somnolencia de Epworth e índice de calidad del sueño Pittsburgh. Principales medidas de resultados: Somnolencia diurna y calidad del sueño. Resultados: No hubo diferencia con respecto a la somnolencia y calidad del sueño entre externos e internos. De todos los encuestados, 58 por ciento tenía mala calidad del sueño y 34 por ciento excesivas somnolencias diurnas. La latencia subjetiva del sueño mayor de 30 minutos, dormir 6 horas o menos, eficiencia subjetiva del sueño menor de 85 por ciento y el uso de medicación hipnótica estuvieron asociados con mala calidad del sueño. Asimismo, dormir 5 horas o menos, consumo de cafeína y tabaquismo estuvieron asociados a mala calidad del sueño y excesiva somnolencia diurna. La correlación entre calidad del sueño y somnolencia diurna fue R=0,426 p menor que 0,001. Conclusiones: Encontramos alta frecuencia de pobre calidad del sueño y excesiva somnolencia diurna en los estudiantes de medicina encuestados. Ambas estuvieron asociadas a consumo de cafeína y tabaco, latencia subjetiva del sueño prolongada, corta duración del sueño, eficiencia subjetiva del sueño menor de 85% y uso de medicación hipnótica. Hubo correlación entre calidad del sueño y somnolencia diurna.

Objective: To determine the degree of excessive daytime sleepiness and sleep quality in medical students. Design: Cross-sectional survey. Setting: Universidad Peruana Cayetano Heredia. Participants: Medical students. Interventions: No probabilistic sample of the sixth (76 externs) and seventh (74 interns) year medical students. Questionnaires: demographic data, Epworth sleepiness scale and Pittsburgh sleep quality index. Main outcome measures: Daytime sleepiness and sleep quality. Results: There was no difference in scores obtained between both populations. Of the participants, 58 per cent had poor sleep quality and 34 per cent had excessive daytime sleepiness. To have a subjective sleep latency more than 30 minutes, to sleep 6 hours or less, sleep efficiency less than 85 per cent and to use hypnotic medication were related with poor sleep quality. Also, to sleep 5 hours or less, to consume caffeine and tobacco were related to poor sleep quality and excessive daytime sleepiness. The correlation between sleep quality and daytime sleepiness was R=0,426 p minor 0,001. Conclusions: We found a high frequency of poor sleep quality and excessive daytime sleepiness in medical students. These parameters were associated to caffeine and tobacco consume, long subjective sleep latency, short sleep duration, sleep efficiency less than 85 per cent and use of hypnotic medication. Also we found correlation between sleep quality and daytime sleepiness.

Evaluation of the World Health Organization's family planning decision-making tool: improving health communication in Nicaragua.

OBJECTIVE: The World Health Organization has led the development of a Decision-Making Tool for Family Planning Clients and Providers (DMT) to improve the quality of family planning counseling. This study investigates the DMT's impact on health communication in Nicaragua. METHODS: Fifty nine service providers in Nicaragua were videotaped with 426 family planning clients 3 months before and 4 months after attending a training workshop on the DMT. The videotapes were coded for both provider and client communication. RESULTS: After the intervention providers increased their efforts to identify and respond to client needs, involve clients in the decision-making process, and screen for and educate new clients about the chosen method. While the DMT had a smaller impact on clients than providers, in general clients did become more forthcoming about their situation and their wishes. The DMT had a greater impact on sessions in which clients chose a new contraceptive method, as compared with visits by returning clients for a check-up or resupply. CONCLUSION: The DMT proved effective both as a job aid for providers and a decision-making aid for clients, regardless of the client's level of education. PRACTICE IMPLICATIONS: Job and decision-making aids have the potential to improve health communication, even or especially when clients have limited education and providers have limited training and supervision.