Procedimiento para la emisión y actualización de documentos normativos / Procedure for the Issuance and Update of Procedure for the Issuance and Update of Regulatory Documents

Con el propósito de armonizar las actividades del proceso de emisión y actualización de documentos normativos, es necesario contar con un documento que defina de manera precisa los pasos para la emisión y actualización de los mismos...(AU)

Preserving quantifiable ethnographic records of disappearing human lifeways.

The human evolutionary sciences place high value on quantitative data from traditional small-scale societies that are rapidly modernizing. These data often stem from the sustained ethnographic work of anthropologists who are today nearing the end of their careers. Yet many quantitative ethnographic data are preserved only in summary formats that do not reflect the rich and variable ethnographic reality often described in unpublished field notes, nor the deep knowledge of their collectors. In raw disaggregated formats, such data have tremendous scientific value when used in conjunction with modern statistical techniques and as part of comparative analyses. Through a personal example of longitudinal research with Batek hunter-gatherers that involved collaboration across generations of researchers, we argue that quantifiable ethnographic records, just like material artifacts, deserve high-priority preservation efforts. We discuss the benefits, challenges, and possible avenues forward for digitizing, preserving, and archiving ethnographic data before it is too late.

Asking for Identification and Retail Tobacco Sales to Minors.

BACKGROUND AND OBJECTIVES: A previous single-county study found that retail stores usually asked young-looking tobacco customers to show proof-of-age identification, but a large proportion of illegal tobacco sales to minors occurred after the customers had shown identification proving they were too young to purchase tobacco. We sought to investigate these findings on a larger scale. METHODS: We obtained state reports for federal fiscal years 2017 and 2018 from a federal agency that tracks tobacco sales to supervised minors conducting compliance checks in retail stores. We used descriptive and multivariable logistic regression methods to determine (1) how often stores in 17 states requested identifications, (2) what proportion of violations occurred after identification requests, and (3) if violation rates differed when minors were required versus forbidden to carry identification. RESULTS: Stores asked minors for identification in 79.6% (95% confidence interval: 79.3%-80.8%) of compliance checks (N = 17 276). Violations after identification requests constituted 22.8% (95% confidence interval: 20.0%-25.6%; interstate range, 1.7%-66.2%) of all violations and were nearly 3 times as likely when minors were required to carry identification in compliance checks. Violations were 42% more likely when minors asked for a vaping product versus cigarettes. CONCLUSIONS: Stores that sell tobacco to underage customers are more likely to be detected and penalized when youth inspectors carry identification during undercover tobacco sales compliance checks. The new age-21 tobacco sales requirement presents an opportunity to require identifications be carried and address other long-standing weaknesses in compliance-check protocols to help combat the current adolescent vaping epidemic.

[Suggestion for recommendations for the wise use of social media in French internal medicine - take control of online reputation]. / Utilisation avisée des réseaux sociaux pour la gestion de la e-réputation des médecins internistes français ­ proposition de recommandations.

Social networks (or SoMe) expanded exponentially over the last ten years, including healthcare. SoMe have changed the doctor's daily life and the relationship with patients. Poor management of SoMe can impact on "e-reputation". On the other hand, the proper use of SoMe allows the opening up of new functionalities in both clinical and research settings. Several scientific societies have made recommendations for the proper handling of SoMe in order to protect the personal information and privacy of physicians. Professionals are advised to differentiate between a professional account and a personal account. Confidentiality settings and certain "codes" for managing publications must be followed. Physicians must be aware that their publications are indelible and can damage their "e-reputation". The proper handling of SoMe will allow internists to organize their bibliographic monitoring, increase the altmetric of their articles, facilitate communication between researchers and modify the relationship with their patients.

Measuring incremental line width and appearance in the tooth cementum of recent and archaeological human teeth to identify irregularities: First insights using a standardized protocol.

OBJECTIVE: Irregular incremental lines (ILs) in the tooth cementum were previously associated with pregnancy and certain diseases. This study aims to identify irregular ILs and assess their patterns and reproducibility. MATERIALS: 24 recent and 32 archaeological teeth from the nineteenth century with known birth history. METHODS: Histological sections of tooth roots were microscopically assessed. The width and appearance of 16,605 ILs were measured according to a standardized protocol. RESULTS: Irregular appearing ILs were present in earlier deposited ILs, which correspond to younger years in life. Irregular appearances decreased as the IL number increased, whereas irregular width was spread evenly across all ILs. Within-section reproducibility was relatively high for irregular appearance (intra class correlation close to 0.70 in recent and archaeological teeth) and irregular width (intra class correlation: recent: 0.49; archaeological: 0.58), whereas the across-section reproducibility was moderate. CONCLUSIONS: Irregular width and appearance in ILs were identified successfully with within-section reproducibility. The moderate reproducibility across sections needs to be addressed in further studies by more systematic sampling of sections. SIGNIFICANCE: The proposed protocol identifies irregularities in a reproducible manner and may suggest that irregular ILs could be used in paleopathology to identify pregnancies and diseases. LIMITATIONS: The correlation between the identified irregular ILs and known pregnancies has not been assessed as part of this study. SUGGESTIONS FOR FURTHER RESEARCH: The identified irregular ILs need to be validated by correlating them with known life history data.

The Washtenaw ID Project: A Government-Issued ID Coalition Working Toward Social, Economic, and Racial Justice and Health Equity.

Introduction. The policing of identities through policies that restrict access to IDs issued by U.S. governmental entities disparately affects communities of color; communities who identify as low-income, immigrant, older, and/or transgender; and community members who experience chronic mental illness, housing instability, or incarceration. Yet government-issued IDs are increasingly needed to access health-promoting resources such as housing, banking, social services, and health care, and in interactions with law enforcement. Methods. Since 2012, the Washtenaw ID Project's coalition-building process has involved communities affected by restrictive ID policies, advocates, and institutional stakeholders to enact community and systems change regarding inequities in government-issued IDs. We discuss the coalition-building process that culminated in the implementation of a photo ID issued by Washtenaw County government as a policy change strategy. We also highlight the community-academic research partnership evaluating the effectiveness of the Washtenaw ID in order to ensure equity in Washtenaw ID access and acceptance. Results. In 2015, 77% of Washtenaw ID holders reported having no other locally accepted ID. At follow-up, Washtenaw ID holders reported favorable Washtenaw ID acceptance rates in several domains (e.g., health care, school), but not when accessing banking services and housing. Additionally, community discussions suggested racial inequities in carding and ID acceptance. We discuss next steps for policy improvement to ensure equitable impact of the ID. Conclusions. Without national policy reform instating access to government-issued IDs for all, the social movement to establish local IDs may improve access to health-related resources contingent on having an ID. Careful attention must be paid to community organizing processes, policy implementation, and evaluation to ensure equity.

Technological Advances in Herpetoculture.

Technology plays a vital role in herpetoculture because ectothermic animals rely on their environment to carry out basic physiologic functions. Controlling the environment appropriately ensures the health and welfare of captive reptiles and amphibians. This article summarizes some of the technological advances and products currently available, including lighting, climate control, and recordkeeping.

Evaluation of a surgical task sharing training programme's logbook system in Sierra Leone.

BACKGROUND: Personal logbooks are universally applied for monitoring and evaluation of surgical trainees; however, the quality and accuracy of such logbooks in low income countries (LICs) are poorly examined. Logbooks are kept by the individual trainee and detail every surgical procedure they perform and their role during the procedure. The aim of this study was to evaluate the quality of such a logbook system in Sierra Leone and to identify areas of improvement. METHODS: The last 100 logbook entries for students and graduates participating in a surgical task sharing training programme were compared with hospital records (HRs). The logbook entries were categorized as matching, close matching or over-reported. Moreover, HRs were checked for under-reported procedures. Semi-structured interviews were conducted with the study participants on logbook recording routines. The results were analysed using mixed effects logistic regression models. RESULTS: Three thousand one hundred sixty-nine database entries from 35 participants were analysed. Of that amount, 62.2% of the entries matched the HRs, 10.4% were close matches and 26.9% were over-reported. 20.7% of the investigated HRs were under-reported. CONCLUSIONS: Information gathered from surgical logbook systems must be applied with care, and great efforts must be made to ensure that the logbook systems used provide reliable data. Based on analysis of the logbook data and interviews, focus areas are suggested to ensure reliable logbook data in LICs. Clear instructions and proper training should be provided when introducing the logbook system to the users. The importance of logging all procedures, including minor ones, should be emphasized. The logbook system should be user friendly and only as extensive as necessary. Lastly, keeping the logbooks exclusively digital is recommended, combined with sufficient IT equipment and training.

Completeness of a newly implemented general cancer registry in northern France: Application of a three-source capture-recapture method.

BACKGROUND: Completeness, timeliness and accuracy are important qualities for registries. The objective was to estimate the completeness of the first two years of full registration (2008/2009) of a new population-based general cancer registry, at the time of national data centralisation. METHODS: Records followed international standards. Numbers of cases missed were estimated from a three-source (pathology labs, healthcare centres, health insurance services) capture-recapture method, using log-linear models for each gender. Age and place of residence were considered as potential variables of heterogeneous catchability. RESULTS: When data were centralized (2011/2012), 4446 cases in men and 3642 in women were recorded for 2008/2009 in the Registry. Overall completeness was estimated at 95.7% (95% CI: 94.3-97.2) for cases in men and 94.8% (95% CI: 92.6-97.0) in women. Completeness appeared higher for younger than for older subjects, with a significant difference of 4.1% (95% CI: 1.4-6.7) for men younger than 65 compared with their older counterparts. Estimates were collated with the number of cases registered in 2014 for the years 2008/2009 (4566 cases for men/3755 for women), when additional structures had notified cases retrospectively to the Registry. These numbers were consistent with the stratified capture-recapture estimates. CONCLUSION: This method appeared useful to estimate the completeness quantitatively. Despite a rather good completeness for the new Registry, the search for cases among older subjects must be improved.

Work injuries in internal migrants to Alberta, Canada. Do workers' compensation records provide an unbiased estimate of risk?

INTRODUCTION: It is not known whether out-of-province Canadians, who travel to Alberta for work, are at increased risk of occupational injury. METHODS: Workers' compensation board (WCB) claims in 2013 to 2015 for those injured in Alberta were extracted by home province. Denominator data, from Statistics Canada, indicated the numbers from Alberta and Newfoundland and Labrador (NL) employed in Alberta in 2012. Both datasets were stratified by industry, age, and gender. Logistic regression estimated the risk of a worker from NL making a WCB claim in 2013 or 2014, stratified by time lost from work. Bias from under-reporting was examined in responses to injury questions in a cohort of trades' workers across Canada and in a pilot study in Fort McMurray, Alberta. RESULTS: Injury reporting rate in workers from NL was lower than those from Alberta, with a marked deficit (odds ratio [OR] = 0.17; 95% confidence interval [CI], 0.12-0.27) for injuries resulting in 1 to 30 days off work. Among the 1520 from Alberta in the trades' cohort, 327 participants reported 444 work injuries: 34.5% were reported to the WCB, rising to 69.4% in those treated by a physician. A total of 52 injuries in Alberta were recorded by 151 workers in the Fort McMurray cohort. In logistic regression, very similar factors predicted WCB reporting in the trades and Fort McMurray cohorts, but those from out-of-province or recently settled in Alberta were much less likely to report (OR = 0.02; 95% CI, 0.00-0.40). CONCLUSION: Differential rates of under-reporting explain in part the overall low estimates of injuries in interprovincial workers but not the deficit in time-loss 1 to 30 days.

The effects of herd size on the welfare of dairy cows in a pasture-based system using animal- and resource-based indicators.

Animal welfare assessments were conducted on 50 Australian pasture-based dairy farms of varying herd sizes: 16 small (<300 cows), 15 medium-sized (300-500 cows), 11 large (501-750 cows), and 10 very large (751+ cows). A protocol based on elements of Welfare Quality adapted for Australian conditions was developed to assess the broad categories of good feeding, housing, health, and appropriate behavior. Farm records, body condition scores, integument injuries, fecal plaques, avoidance distance of humans, and fecal pat scoring for acidosis assessment were undertaken. The mean maximum kilograms of grain fed per day significantly increased with herd size, from 5.2 ± 0.38 (small), 7.7 ± 0.29 (medium-sized), 8.8 ± 0.45 (large), to 10.1 ± 0.80 kg (very large). Acidosis was not related to herd size based on either farm records or fecal pat scoring. All cows had access to water for more than 12 h in a 24-h period. More larger farms had water points on the farm tracks or at the dairy. Very large farms (90%) were more likely than others (36-39%) to provide water suitable for human consumption. Integument lesions were not related to herd size and were uncommon; 56 and 84% of farms had no cows with lesions or hairless areas, respectively, and no farm had >6% integument lesions. Heat stress is an important welfare risk in Australia. All farms had some form of cooling strategy; shade in all paddocks was more common on smaller farms (>90%) than others (<75%). Sprinklers were more common on large or very large farms (>80%) than others (<65%). Mastitis and lameness were the most common health conditions, followed by dystocia, downer cows, and gastrointestinal diseases. Prevalence of lameness, mastitis, downer cows, dystocia, and gastrointestinal disease were not related to farm size. Larger farms were more likely to have electronic infrastructure to monitor or electronically draft cows for inspection. We found wide variation in the avoidance distance of humans, but this was not related to farm size. Larger farms had longer walking distances to pasture and longer time away from pasture, which could affect the time available for behaviors such as lying down. Animal welfare risks differ on Australian farms compared with housed cattle. As animal welfare is multidimensional, both animal- and resource-based indicators can be useful. Animal-based indicators have strengths in that, when measured accurately, they genuinely reflect the outcome being measured, but they also have weaknesses in that the point-estimate of a disease prevalence on a given day may not be representative of other times of year or differences in case definition may exist when farm records are used. Similarly, resource-based indicators have strengths in that they may be applicable to longer periods, but weaknesses because the fact a resource is present does not guarantee it is being used. Identifying the major risks to animal welfare on individual farms and ensuring a plan is in place to effectively manage them should be an important element of any on-farm animal welfare assessment protocol.

Public Views on Using Mobile Phone Call Detail Records in Health Research: Qualitative Study.

BACKGROUND: Mobile phone call detail records (CDRs) are increasingly being used in health research. The location element in CDRs is used in various health geographic studies, for example, to track population movement and infectious disease transmission. Vast volumes of CDRs are held by multinational organizations, which may make them available for research under various data governance regimes. However, there is an identified lack of public engagement on using CDRs for health research to contribute to an ethically founded framework. OBJECTIVE: This study aimed to explore public views on the use of call detail records in health research. METHODS: Views on using CDRs in health research were gained via a series of three public workshops (N=61) informed by a pilot workshop of 25 people. The workshops included an initial questionnaire to gauge participants' prior views, discussion on health research using CDRs, and a final questionnaire to record workshop outcome views. The resulting data were analyzed for frequencies and emerging themes. RESULTS: At the outset, most participants (66%, 40/61) knew that location data were collected by operators, but only 3% (2/61) knew they were being used for health research. Initially, the majority of the participants (62%, 38/61) was content for their anonymous CDRs to be used, and this increased (80%, 49/61) after the discussion explained that safeguards were in place. Participants highlighted that terms and conditions should be clearer, as should information to phone users on data collection, privacy safeguards, sharing, and uses in research. CONCLUSIONS: This is the first known study exploring public views of using mobile phone CDRs in health research. It revealed a lack of knowledge among the public on uses of CDRs and indicated that people are generally amenable to the use of anonymized data for research, but they want to be properly informed and safeguarded. We recommend that public views be incorporated into an ethically founded framework for the use of CDRs in health research to promote awareness and social acceptability in data use.

Development and validation of a search filter to identify equity-focused studies: reducing the number needed to screen.

BACKGROUND: Health inequalities, worse health associated with social and economic disadvantage, are reported by a minority of research articles. Locating these studies when conducting an equity-focused systematic review is challenging due to a deficit in standardised terminology, indexing, and lack of validated search filters. Current reporting guidelines recommend not applying filters, meaning that increased resources are needed at the screening stage. METHODS: We aimed to design and test search filters to locate studies that reported outcomes by a social determinant of health. We developed and expanded a 'specific terms strategy' using keywords and subject headings compiled from recent systematic reviews that applied an equity filter. A 'non-specific strategy' was compiled from phrases used to describe equity analyses that were reported in titles and abstracts, and related subject headings. Gold standard evaluation and validation sets were compiled. The filters were developed in MEDLINE, adapted for Embase and tested in both. We set a target of 0.90 sensitivity (95% CI; 0.84, 0.94) in retrieving 150 gold standard validation papers. We noted the reduction in the number needed to screen in a proposed equity-focused systematic review and the proportion of equity-focused reviews we assessed in the project that applied an equity filter to their search strategy. RESULTS: The specific terms strategy filtered out 93-95% of all records, and retrieved a validation set of articles with a sensitivity of 0.84 in MEDLINE (0.77, 0.89), and 0.87 (0.81, 0.92) in Embase. When combined (Boolean 'OR') with the non-specific strategy sensitivity was 0.92 (0.86, 0.96) in MEDLINE (Embase 0.94; 0.89, 0.97). The number needed to screen was reduced by 77% by applying the specific terms strategy, and by 59.7% (MEDLINE) and 63.5% (Embase) by applying the combined strategy. Eighty-one per cent of systematic reviews filtered studies by equity. CONCLUSIONS: A combined approach of using specific and non-specific terms is recommended if systematic reviewers wish to filter studies for reporting outcomes by social determinants. Future research should concentrate on the indexing standardisation for equity studies and further development and testing of both specific and non-specific terms for accurate study retrieval.

Optimization of Clinical Mastitis Records on Dairies.

Deriving value from clinical mastitis records requires accurate and consistent records and tools for efficient summary and analysis. Variation in clinical mastitis case definition or detection intensity across dairies does not preclude consistent data recording. Dairy management software can improve consistency of clinical mastitis records by prompting users for quarter(s) affected, treatment, and severity. User-defined record systems must establish and follow protocols for clinical mastitis data recording. All records must have the same information in the same order and use the same abbreviations. Clinical mastitis episodes should be recorded at the quarter level. Cow-level recording compromises record consistency and accuracy of outcomes.

Construction and validation of forms: systematization of the care of people under hemodialysis / Construcción y validación de impresos: sistematización del cuidado de personas en hemodiálisis / Construção e validação de impressos: sistematização do cuidado de pessoas em hemodiálise

ABSTRACT Objective: create and validate forms to subsidize the systematization of nursing care with people on hemodialysis. Method: institutional case study to support the systematization of assistance from the construction of forms for data collection, diagnoses, interventions and nursing results, using cross-mapping, Risner's reasoning, Neuman's theory, taxonomies of diagnoses, interventions and nursing results with application in clinical practice and validation by focal group with specialist nurses. Results: 18 people on hemodialysis and 7 nurses participated. Consensus content of form matter with specialist nurses in the area (Crombach 0.86). The papers captured 43 diagnoses, 26 interventions and 78 nursing results depicting human responses in their singularities. Final considerations: the validated forms fill a gap by enabling the capture of human responses from people on hemodialysis and by subsidizing the planning of nursing care on a scientific basis.

RESUMEN Objetivo: crear y validar impresos para subsidiar la sistematización del cuidado de enfermería con personas en hemodiálisis. Método: estudio de caso institucional para subsidiar la sistematización de la asistencia a partir de la construcción de impresos para recolección de datos, diagnósticos, intervenciones y resultados de enfermería, utilizando el mapeo cruzado, el raciocinio de Risner, la teoría de Neuman, taxonomías de diagnósticos, intervenciones y resultados de enfermería con aplicación en la práctica clínica y validación por grupo focal con enfermeras especialistas. Resultados: participaron 18 personas en hemodiálisis y 7 enfermeros. Consensuados contenidos de los impresos con enfermeras especialistas del área (Crombach 0,86). Los impresos captaron 43 diagnósticos, 26 intervenciones y 78 resultados de enfermería retratando respuestas humanas en sus singularidades. Consideraciones finales: los impresos validados llenan una brecha al posibilitar la captación de respuestas humanas de personas en hemodiálisis y al subsidiar la planificación de los cuidados de enfermería en bases científicas.

RESUMO Objetivo: criar e validar impressos para subsidiar a sistematização do cuidado de enfermagem com pessoas em hemodiálise. Método: estudo de caso institucional para subsidiar sistematização da assistência a partir da construção de impressos para coleta de dados, diagnósticos, intervenções e resultados de enfermagem, usando mapeamento cruzado, raciocínio de Risner, teoria de Neuman, taxonomias de diagnósticos, intervenções e resultados de enfermagem com aplicação na prática clínica e validação por grupo focal com enfermeiras especialistas. Resultados: participaram 18 pessoas em hemodiálise e 7 enfermeiros. Consensualizados conteúdos dos impressos com enfermeiras especialistas da área (Crombach 0,86). Os impressos captaram 43 diagnósticos, 26 intervenções e 78 resultados de enfermagem retratando respostas humanas em suas singularidades. Considerações finais: os impressos validados preenchem uma lacuna ao possibilitar a captação de: respostas humanas de pessoas em hemodiálise e ao subsidiar o planejamento dos cuidados de enfermagem em bases científicas.