Compassionate communities: How to assess their benefit? A protocol of a collaborative study between different countries.

Background: Communities and local governments invest in compassionate communities (CCs) a great deal of time, money, effort, and work. However, it is not known whether the CCs are having the effect they are expected to have, so the value of continuing with these initiatives is unknown, and there is a need for a model for evaluating CCs to solve the question. Objectives: To identify a set of core outcomes or benefits that should be measured to assess the impact of the CCs. Design: Multiple-methods study involving three communities, each in a different country (Argentina, Colombia, and Switzerland). Methods and analysis: To identifying the set of core outcomes, which is the first step in developing the CC evaluation model, five phases will follow: online meetings, literature review, fieldwork, Delphi survey, and social transfer. We will involve members of the local communities of Bern, Buenos Aires, and Medellin at three different levels: (1) citizens (e.g. patients, caregivers, and family members), (2) organizations and institutions involved in the program implementation (e.g. health care organizations, churches, non-governmental organizations, and schools), and (3) political and governmental sectors. Ethics: The study will be conducted following existing international regulations and guidance such as the Declaration of Helsinki. The ethics committee of Pallium Latin America and the ethics committee of the canton of Bern considered our application exempt from the need for approval. Ethics approval in Bern and Buenos Aires is in the process of being obtained. The ethics committee of the Pontifical Bolivarian University approved this protocol. Discussion: We expect that this project will help bridge the gap in knowledge regarding the measurable impact of the CCs and enhance more CC development.

Influencia del estado nutricional sobre el peso al nacer en el tercer trimestre de la gestación / Influence of nutritional status on birth weight in the third trimester

Introducción: el estado nutricional materno es un factor determinante en el crecimiento fetal y en el peso del recién nacido. Existe evidencia científica de que el inadecuado estado nutricional y la anemia en la gestación, generan efectos deletéreos en la salud materno-fetal. Objetivo: determinar la influencia del estado nutricional en el 3er. trimestre sobre el peso al nacer en gestantes del municipio Bayamo. Métodos: se realizó un estudio observacional analítico y longitudinal en una muestra de 53 gestantes en las áreas de salud del municipio Bayamo, Granma, en el período comprendido desde diciembre de 2011 hasta abril de 2012. Se estudió la influencia de indicadores antropométricos como: índice de masa corporal a la captación, la evolución ponderal realizada en el 3er. trimestre, así como el consumo de energía y nutrientes e indicadores bioquímico-nutricionales y metabólicos sobre el peso al nacer. Resultados: los parámetros del índice de masa corporal a la captación y la evolución ponderal se asociaron de manera significativa con los grupos de peso al nacer. De los indicadores nutricionales, el índice de masa corporal a la captación y el consumo de vitamina E correlacionaron positiva y significativamente con el peso al nacer, mientras que el consumo de hierro lo hizo de forma inversa y significativa. Conclusiones: los resultados confirman que los parámetros de los indicadores antropométricos del estado nutricional de las gestantes se asocian con el peso al nacer, no así los del consumo de energía, proteínas y algunos micronutrientes en las embarazadas del estudio, así como, los indicadores bioquímicos nutricionales y metabólicos estudiados.

Introduction: maternal nutritional status is a factor in fetal growth and weight of the newborn. There is scientific evidence that inadequate nutritional status and anemia in pregnancy generate deleterious effects on maternal and fetal health. Objective: to determine the influence of nutritional status at the 3rd. trimester on birth weight in pregnant in Bayamo. Methods: a longitudinal observational study was conducted in a sample of 53 pregnant women from the health areas of Bayamo municipality, Granma, from December 2011 to April 2012. The influence of anthropometric indicators such as body mass index at enrollment, weight changes made in the 3rd. quarter as well as energy and nutrient intake, biochemical indicators of nutritional and metabolic-birth weight were studied. Results: the parameters of body mass index at enrollment and weight changes were significantly associated with birth weight groups. Nutritional indicators, body mass index at enrollment and consumption of vitamin E significantly positively correlated with birth weight, whereas iron intake significantly did inversely. Conclusions: the results confirm that the parameters of anthropometric indicators of nutritional status of pregnant women are associated with birth weight, but not the consumption of energy, protein and some micronutrients in pregnant women in this study, as well as biochemical indicators nutritional and metabolic studied.

El bajo consumo de alimentos ricos en hierro y potenciadores de su absorción se asocia con anemia en preescolares cubanos de las provincias orientales: 2005-2011 / Low consumption of iron-containing foods and enhancer of iron absorption are associated with anemia in preschool children of the eastern provinces of Cuba: 2005-2011

Anemia in children less than five years of age is the main nutritional problem in Cuba. The aim of this study was to assess the intake of iron-rich foods (IRF) and of enhancers of iron absorption (EIA) in children living in the five eastern provinces of Cuba and its association with anemia in 2005, 2008 and 2011. A food frequency questionnaire of 6 months and hemoglobin determination were used. Intake increased in red meat and poultry (44.2% to 60.4%), eggs (38.7% to 58.6%) and vegetables (47.6% to 56.2%); decreased in fruit (73.2% to 55.8%) and legumes (87.7% to 57.7%). The prevalence of anemia in children 6 to 11 months old showed a decrease (62.1% to 44.3%). A reduction in the prevalence of anemia in infants 12-23 months old was found in 2008 compared with 2005 and reversed slightly in 2011, a similar finding was observed in children 2-5 years old. There was a consistent association of anemia with low intake of eggs, vegetables and fruits, but and not with low intake of legumes. Children who attended daycare center ate more iron-rich foods and enhancers of iron absorption than those who did not. The group of children younger than 24 months old remains the most vulnerable group for anemia.

La anemia en niños menores de 5 años constituye el principal problema nutricional en Cuba. El objetivo de este estudio fue estimar el consumo de alimentos ricos en hierro y potenciadores de su absorción en niños residentes en las cinco provincias orientales de Cuba y la asociación con la anemia en los años 2005, 2008 y 2011. La evaluación se realizó mediante una encuesta de frecuencia de consumo de alimentos en el período de 6 meses anterior a la fecha del estudio y determinación de hemoglobina mediante HemoCue. El consumo frecuente entre 2005 a 2011 incrementó en cárnicos (44.2% a 60.4%), huevos (38.7% a 58.6%) y vegetales (47.6% a 56.2%); con un descenso en frutas (73.2% a 55.8%) y leguminosas (87.7% a 57.7%). La prevalencia de anemia disminuyó en niños de 6 a 11 meses de 2005 a 2011 (62.1% a 44.3%). Se observó disminución de la anemia en el grupo de 12 a 23 meses en 2008 que revierte ligeramente el 2011, de manera similar ocurrió en el grupo de 24 a 59 meses. Se encontró asociación de la anemia con el bajo consumo de huevo, vegetales y frutas; no con el consumo de leguminosas. Los niños que asisten a guardería consumían alimentos ricos en hierro y potenciadores de su absorción con mayor frecuencia que los que no asistían, por lo que la asistencia a guardería constituye un factor protector para la anemia en esta población. El grupo de niños menores de 24 meses se mantiene como el grupo de mayor vulnerabilidad para la anemia.

Evidencias de la regulación del estado redox materno entre las 30 y 36 semanas de gestación / Evidences of the maternal redox state regulation among the 30 and the 36 weeks of pregnancy

El embarazo es un estado fisiológico caracterizado por un incremento regulado estrictamente de los procesos oxidativos. El riesgo de estrés oxidativo puede depender del estado antioxidante materno, el cual protege potencialmente a la unidad materno-fetal incrementando el crecimiento intrauterino y el peso del neonato. OBJETIVO: Mostrar evidencias de la regulación del estado redox materno entre las 30 y 36 sem de gestación fisiológica. MÉTODOS: Se realizó un estudio observacional, analítico y transversal que incluyó a 36 gestantes saludables con feto único, similar edad, peso y edades gestacionales entre 30 y 36 sem. Como indicadores de defensa antioxidante se determinaron el potencial reductor férrico del suero, la actividad de la superóxido dismutasa extracelular y la concentración de glutatión reducido en eritrocitos. Como indicador de lipoperoxidación se determinó la concentración de malondialdehído. Se determinó además la concentración de hemoglobina, hierro sérico y la glicemia, así como, el índice de masa corporal (IMC) y su variación. Basados en la metodología de análisis de senderos, se contrastaron modelos de ecuaciones estructurales con las variables estudiadas. RESULTADOS: El potencial reductor férrico y la concentración sérica de malondialdehído correlacionaron positivamente con la actividad sérica de la superóxido dismutasa y con la concentración de glutatión reducido, contribuyendo más el malondialdehído que el potencial reductor férrico a su variación. La glicemia también se relacionó directamente con la peroxidación lipódica y con los indicadores del estado antioxidante. CONCLUSIONES: Las gestantes incluidas en el estudio tuvieron un adecuado balance redox y el malondialdehído o algún otro producto de la peroxidación lipídica pueden estar relacionados con la estimulación de respuestas protectoras para mantener el mismo

Pregnancy is a physiological status characterized by a strictly controlled increase of oxidative processes. The risk of this oxidative process may to depend on the mother antioxidant status, which to potentially protect the mother-fetus unit increasing the intrauterine growth and the neonate weight. OBJECTIVE: To show evidences of mother redox satus regulation among the 30 and the 36 weeks of physiological pregnancy. METHODS: A cross-sectional, analytical and observational study was conducted including 36 healthy pregnants wit a single-fetus, and similar weight and gestational age between 30 and 36 weeks. As antioxidant defense indicators were determined the potential serum-ferric reduction agent, the extracellular superoxide dismutase and malondialdehyde concentration. It was also determined the hemoglobin ,serum ferric and glycemia, as well as the body mass index (BMI) and its variation. Based on the methodology of routes analysis there were structural equations forms with study variable. RESULTS: The ferric redactor potential and the serum concentration of malondialdehye were positively correlated to serum activity of superoxide dismutase and to the reduced glutathione concentration were the malondialdehyde contributes more than the ferric redactor potential and its variation. Glycemia also was directly related to lipid peroxidation and to antioxidant status indicators. CONCLUSIONS: Pregnants included in present study had a suitable redox balance, and the malondialdehyde or some other product of lipid peroxidation may be related to stimulation of protective responses for its maintenance

Patients' needs and satisfiers: applying human scale development theory on end-of-life care.

PURPOSE OF REVIEW: This review considers how needs-based care models have been recently discussed in the scientific literature and proposes the human scale development (HSD) theory to achieve high-quality care (HQC) at the end-of-life (EOL). RECENT FINDINGS: Comprehensive needs-based care models have been developed among terminally ill cancer patients focusing mostly on HQC at the EOL. To achieve this goal, the implementation of several assessment tools has triggered discussions regarding alternatives for addressing the multidimensional nature of EOL care. Uncertainty has been revealed on several research limitations such as unclear definitions, lack of knowledge of healthcare professionals, psychometric problems, patient burden and reported unmet needs. However, there is general consensus about the need to uphold EOL interventions on needs-based-holistic models in order to accomplish HQC at the EOL. SUMMARY: Patients, families and healthcare professionals become part of a process that aims to embrace a unique 'world': the patients' subjectivity, his or her own needs and resources capable of meeting those needs. During the last years, some interesting research has outlined and discussed principal broad domains that geared needs-based (patient-centered) care models; however, reported 'gaps' between desired and current practice in the provision of care reflected the complexity of human needs, specifically at the EOL. As regarding fundamental human needs, an HSD theory exists and it may contribute to improve HQC at the EOL.