Sociocultural Responsive Frameworks to Increase Engagement in Service Systems Through a Peer-to-Peer Model.

Service engagement is critical when working with children and families experiencing chronic adversities because of their socially marginalized status. Further, sociodemographic disparities exist in service engagement within service systems including Community-Based Behavioral Health; likely in part, a result of structural issues driving unresponsive service systems. Despite this knowledge, a large proportion of the family engagement literature continues to be approached through a deficit-based and family-centric lens leaving out important systemic considerations and furthering health inequities. Drawing from a Socio-Ecological Framework (Stokols, 1996), this study focuses on exploring the value of peer support providers (PSPs) to understand how sociocultural responsiveness functions under this service model. Individual interviews and focus group data were collected from both families and PSPs. Thematic analysis (Braun & Clarke in Qualitative Research in Psychology, 3(2), 77-101, 2006) was utilized to code and synthetize the data collected. Findings highlight the importance of capitalizing on meaningful and trusting relationships to foster family engagement in services. These findings solidify the understanding that family engagement is a function of crucial relationships between family, provider, and systems. This work also illustrates how PSPs organic embodiment of sociocultural responsiveness through cultural humility is an avenue through which family engagement can be sustained.

School-Family Partnerships to Support Attendance: Advancing an Equity-Centered Theoretical Framework.

BACKGROUND: Since returning to in-person instruction after the emergence of COVID-19 schools have seen a dramatic increase in the number of students chronically absent, with data indicating a greater increase for low-income, Black, and Hispanic students. Given the role of school attendance in both promoting positive educational outcomes as well as providing students with physical and mental health supports, it is critical to identify ways to re-engage families in a manner that is culturally responsive and equitable. CONTRIBUTIONS TO THEORY: Current attendance interventions focus primarily on school-based academic and behavioral supports for students while excluding the family. Additionally, traditional family engagement models do not address the sociocultural realities of low-income and/or minoritized families. We present a strengths-based model of family engagement to support attendance. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Along with our model, we provide concrete supports that schools can provide, including example measurement items. In this way, schools and districts can self-assess as well as identify action steps to promote positive school-family partnerships for equitable family engagement. CONCLUSIONS: Without consistent attendance, schools cannot support positive educational outcomes nor provide important safety net services for students. Attendance is a family engagement challenge, which addressing holistically can reduce racial and socioeconomic educational and health disparities.

Binocular vision parameters and visual performance in bilateral keratoconus corrected with spectacles versus rigid gas-permeable contact lenses.

PURPOSE: To analyze binocular vision of individuals aged 18 to 35 years diagnosed with keratoconus, utilizing spectacles and rigid gas-permeable (RGP) contact lenses. Research was led by the Universidad Autónoma de Aguascalientes, México and Fundación Universitaria del Área Andina Pereira, Colombia. METHODS: A single center, prospective non-randomized, comparative, interventional, open-label study, in which the differences in binocular vision performance with both spectacles and RGP contact lenses was carried out from December 2018 to December 2019. Sampling was performed according to consecutive cases with keratoconus that met the inclusion criteria until the proposed sample size was reached. RESULTS: Rigid gas-permeable (RGP) contact lenses notably enhanced distance and near visual acuity in keratoconus patients compared to spectacles. Visual alignment analysis shows exophoria at both distances and is slightly higher with RGP contact lenses. The difference was statistically significant (p<0.05), with 82.5 % presenting compensated phoria with spectacles and pnly 42.50% with RGP contact lenses. Stereoscopic vision improved while wearing RGP contact lenses (42.59 %), although accommodation and accommodative flexibility remained within normal ranges. CONCLUSIONS: Patients with keratoconus fitted with RGP contact lenses have improved binocular vision skills such as visual acuity, stereopsis, and accommodative flexibility. However, even when the vergence and motor system is decompensated with respect to normal ranges, the range between break and recovery points for both fusional reserves and the near point of convergence (NPC) improves with the use of RGP contact lenses, giving indications of an adaptive condition of the motor system from the medium to the long term.

Failure to repair endogenous DNA damage in ß-cells causes adult-onset diabetes in mice.

Age is the greatest risk factor for the development of type 2 diabetes mellitus (T2DM). Age-related decline in organ function is attributed to the accumulation of stochastic damage, including damage to the nuclear genome. Islets of T2DM patients display increased levels of DNA damage. However, whether this is a cause or consequence of the disease has not been elucidated. Here, we asked if spontaneous, endogenous DNA damage in ß-cells can drive ß-cell dysfunction and diabetes, via deletion of Ercc1, a key DNA repair gene, in ß-cells. Mice harboring Ercc1-deficient ß-cells developed adult-onset diabetes as demonstrated by increased random and fasted blood glucose levels, impaired glucose tolerance, and reduced insulin secretion. The inability to repair endogenous DNA damage led to an increase in oxidative DNA damage and apoptosis in ß-cells and a significant loss of ß-cell mass. Using electron microscopy, we identified ß-cells in clear distress that showed an increased cell size, enlarged nuclear size, reduced number of mature insulin granules, and decreased number of mitochondria. Some ß-cells were more affected than others consistent with the stochastic nature of spontaneous DNA damage. Ercc1-deficiency in ß-cells also resulted in loss of ß-cell function as glucose-stimulated insulin secretion and mitochondrial function were impaired in islets isolated from mice harboring Ercc1-deficient ß-cells. These data reveal that unrepaired endogenous DNA damage is sufficient to drive ß-cell dysfunction and provide a mechanism by which age increases the risk of T2DM.

Behavioral design interventions for the promotion of wellbeing among Filipino healthcare workers during the COVID-19 pandemic.

Frontline healthcare workers (HCWs) in hospitals have been among the most vulnerable members of the population since the COVID-19 pandemic, affecting not only physical but also mental health. Complementary approaches to providing information for HCWs on taking care of their mental health need development and scaling-up. Behaviorally designed interventions take into consideration the context, resistance, and impact in facilitating behavior change in a specific target segment towards an intended aspiration. The behaviorally designed interventions sought to build individual resilience aligned with the Mental Health and Psychosocial Support Services framework. These included strengthening the provision of non-specialized services and community support among the range of interventions that address mental health problems. These benefit the vulnerable sectors of the population who are at most risk of experiencing chronic stress. Scaling-up of low-cost and subtle tools is a worthy investment for government institutions to ensure that HCWs are continuously supported so they can continue to provide adequate and quality care to those afflicted by COVID-19.

MUlticenter STudy of tissue plasminogen activator (alteplase) use in COVID-19 severe respiratory failure (MUST COVID): A retrospective cohort study.

Background: Few therapies exist to treat severe COVID-19 respiratory failure once it develops. Given known diffuse pulmonary microthrombi on autopsy studies of COVID-19 patients, we hypothesized that tissue plasminogen activator (tPA) may improve pulmonary function in COVID-19 respiratory failure. Methods: A multicenter, retrospective, observational study of patients with confirmed COVID-19 and severe respiratory failure who received systemic tPA (alteplase) was performed. Seventy-nine adults from seven medical centers were included in the final analysis after institutional review boards' approval; 23 were excluded from analysis because tPA was administered for pulmonary macroembolism or deep venous thrombosis. The primary outcome was improvement in the PaO2/FiO2 ratio from baseline to 48 h after tPA. Linear mixed modeling was used for analysis. Results: tPA was associated with significant PaO2/FiO2 improvement at 48 h (estimated paired difference = 23.1 ± 6.7), which was sustained at 72 h (interaction term p < 0.00). tPA administration was also associated with improved National Early Warning Score 2 scores at 24, 48, and 72 h after receiving tPA (interaction term p = 0.00). D-dimer was significantly elevated immediately after tPA, consistent with lysis of formed clot. Patients with declining respiratory status preceding tPA administration had more marked improvement in PaO2/FiO2 ratios than those who had poor but stable (not declining) respiratory status. There was one intracranial hemorrhage, which occurred within 24 h following tPA administration. Conclusions: These data suggest tPA is associated with significant improvement in pulmonary function in severe COVID-19 respiratory failure, especially in patients whose pulmonary function is in decline, and has an acceptable safety profile in this patient population.

A Person-centered Approach to Violence Exposure in Postwar Colombian Youth: Demographic Covariates and Positive Youth Development Outcomes.

While the negative impact of extensive exposure to community violence and armed conflict is known, less emphasis has been focused on outcomes supportive of resilience. It is critical to begin exploring these constructs to both promote healing from decades-long conflict and to inform targeted interventions that focus on positive youth development in contexts of adversity. This study thus utilized a person-centered approach to estimate violence exposure profiles among 3,443 Colombian youth to explore what demographic covariates and positive youth development outcomes, such as school engagement, hope, goals, social competence, future expectations, and barriers to education were associated with each violence exposure profile. Four profiles emerged: a low exposure profile, a high community violence profile, a some combined exposure profile, and a high combined exposure profile, each with various levels of community violence witnessing and victimization as well as armed conflict exposure. Demographic covariance results showed older, urban, male youth were more likely to be in the high violence exposure profiles compared to the low exposure group. Youth in the high combined exposure profile were more likely to have lower hope, educational expectations, and social competence compared to the low exposure group. Findings highlight that a person-centered approach provides a more multidimensional view of adolescent violence exposure. Demographic differences suggested the importance of tailoring violence prevention initiatives to the local context. Finally, results concerning positive youth development outcomes suggest that resiliency-oriented constructs, which can be instrumental toward youth's postwar healing and growth, should be emphasized among populations who experience high levels of co-occurring exposure.

School racial-ethnic discrimination, rule-breaking behaviors and the mediating role of trauma among Latinx adolescents: Considerations for school mental health practice.

Much of the literature linking adversity to trauma fails to account for racialized experiences, including racial-ethnic discrimination, which is a highly prevalent form of adversity for youth of color in the U.S. Adversity and trauma often result in students experiencing elevated rule-breaking behaviors, exacerbating existing racial-ethnic disparities in disproportionate school discipline. Drawing from race-based trauma theory, the present study explored trauma as a mediator of the longitudinal association between racial-ethnic discrimination from teachers, other adults, and students in schools and rule-breaking behaviors among Latinx youth. Data were from a longitudinal study of 547 Latinx students in a southeastern U.S. state. Across gender and nativity groups, school racial-ethnic discrimination and trauma positively predicted later rule-breaking behaviors. Additionally, for girls only, increased levels of trauma partially explained the association between school racial-ethnic discrimination and rule-breaking behaviors. The study highlights the importance of addressing school racial-ethnic discrimination and trauma in equitable school metal health systems. Indeed, efforts aimed at reducing disproportionate school discipline among Latinx students should focus on reducing their exposure to school racial-ethnic discrimination and increasing access to trauma-informed and restorative justice approaches.

Increased insulin sensitivity and diminished pancreatic beta-cell function in DNA repair deficient Ercc1d/- mice.

BACKGROUND: Type 2 diabetes (T2DM) is an age-associated disease characterized by hyperglycemia due to insulin resistance and decreased beta-cell function. DNA damage accumulation has been associated with T2DM, but whether DNA damage plays a role in the pathogenesis of the disease is unclear. Here, we used mice deficient for the DNA excision-repair gene Ercc1 to study the impact of persistent endogenous DNA damage accumulation on energy metabolism, glucose homeostasis and beta-cell function. METHODS: ERCC1-XPF is an endonuclease required for multiple DNA repair pathways and reduced expression of ERCC1-XPF causes accelerated accumulation of unrepaired endogenous DNA damage and accelerated aging in humans and mice. In this study, energy metabolism, glucose metabolism, beta-cell function and insulin sensitivity were studied in Ercc1d/- mice, which model a human progeroid syndrome. RESULTS: Ercc1d/- mice displayed suppression of the somatotropic axis and altered energy metabolism. Insulin sensitivity was increased, whereas, plasma insulin levels were decreased in Ercc1d/- mice. Fasting induced hypoglycemia in Ercc1d/- mice, which was the result of increased glucose disposal. Ercc1d/- mice exhibit a significantly reduced beta-cell area, even compared to control mice of similar weight. Glucose-stimulated insulin secretion in vivo was decreased in Ercc1d/- mice. Islets isolated from Ercc1d/- mice showed increased DNA damage markers, decreased glucose-stimulated insulin secretion and increased susceptibility to apoptosis. CONCLUSION: Spontaneous DNA damage accumulation triggers an adaptive response resulting in improved insulin sensitivity. Loss of DNA repair, however, does negatively impacts beta-cell survival and function in Ercc1d/- mice.

Culturally Responsive Trauma-Informed Services: A Multilevel Perspective from Practitioners Serving Latinx Children and Families.

Using a multilevel ecological framework, we take a qualitative approach to examining important cultural considerations that support successful implementation of trauma-informed services within the Latinx community. We conducted key informant interviews with community practitioners recruited primarily in the Phoenix, AZ metro area. Themes that emerged from interviews captured societal, community, and individual barriers to effective implementation of a culturally responsive trauma-informed approach. Specifically, multilevel barriers included socioeconomic circumstances, normalization of trauma exposure, and the transgenerational impact of trauma. Practitioners also reported approaching their work using relationship-focused and family-centered frameworks as facilitators to service engagement. We highlight the critical need for a culturally responsive trauma-informed approach that stresses the importance of context, recognizes transgenerational vulnerabilities, and promotes equity and the utilization of cultural humility in order to lessen the multilayered disparities in service accessibility experienced by minoritized communities.

Hematology and Serum Biochemistry Values of Healthy Free-Ranging Panamanian White-Faced Capuchins (Cebus imitator) in Costa Rica.

We describe the hematology and serum biochemistry values for 26 free-ranging Panamanian white-faced capuchins (Cebus imitator) in Costa Rica. Howell-Jolly bodies and microfilariae were observed in some animals. This baseline information is a tool for health assessment and species conservation.

Maternal transfer of anti HPV 6 and 11 antibodies upon immunization with the 9-valent HPV vaccine.

BACKGROUND: This exploratory analysis was conducted to characterize the level of HPV types 6/11 antibodies in peripartum maternal blood and in cord blood of infants born to women who received 9-valent HPV (9vHPV) vaccine or quadrivalent HPV (qHPV) vaccine in a pivotal efficacy study (V503-001, NCT 00543543). METHODS: A total of 21 mother-infant pairs had evaluable HPV 6/11 results available for analysis. HPV6/11 antibodies were assessed using competitive Luminex immunoassay. The distribution of the ratios of infant to mother anti-HPV antibodies (i.e., infant-anti-HPV/mother- anti-HPV) was summarized. RESULTS: All mothers and infants were seropositive to HPV 6 and HPV 11. Anti-HPV 6/11 geometric mean titers (GMTs) in peripartum maternal blood and in cord blood of infant born to study participants were highly correlated. A 100% of infants born to seropositive mothers were also seropositive. The GMT ratios of peripartum maternal blood vs. those in cord blood were HPV 6: 1.23 [0.43, 3.49] and HPV 11: 1.29 [0.54, 3.07] in the 9vHPV vaccine group and HPV 6: 1.33 [0.41, 4.29] and HPV 11: 1.19 [0.45, 3.13] in the qHPV vaccine group, respectively. CONCLUSIONS: These results indicate that antibodies induced by the 9vHPV vaccine cross the placenta, which could potentially be beneficial against HPV6/11 infection and related disease such as recurrent respiratory papillomatosis.

Rheology, acceptability and texture of wheat flour tortillas supplemented with soybean residue.

Dry soybean (Glycine max) residue (SBR) is a byproduct rich in dietary fibre and protein with high levels of essential amino acids. The effects due to the substitution of refined wheat flour with 5% or 10% SBR in dough rheology and hot-press tortilla texture, dimensions, colour, protein and dietary fibre contents were studied. Substitution of 10% SBR improved flour in terms of gluten strength and sedimentation without significantly affecting dough hardness, cohesiveness, adhesiveness, and extensibility. The dimensions, colour and sensory acceptance of the supplemented tortillas were not affected by the addition of the SBR. The 10% SBR tortillas contained 1.77 times more insoluble dietary fibre, protein content of 9.3%, in vitro protein digestibility of 84% and protein digestibility corrected amino acid score (PDCAAS) of 52.63%. Results indicated that wheat flour tortillas with 10% SBR an excellent alternative to regular counterparts owing to their higher dietary fibre and protein quantity and quality.

Efficacy, immunogenicity, and safety of a 9-valent human papillomavirus vaccine in Latin American girls, boys, and young women.

BACKGROUND: A 9-valent human papillomavirus (HPV6/11/16/18/31/33/45/52/58; 9vHPV) vaccine was developed to expand coverage of the previously developed quadrivalent (HPV6/11/16/18; qHPV) vaccine. METHODS: Efficacy, immunogenicity, and safety outcomes were assessed in Latin American participants enrolled in 2 international studies of the 9vHPV vaccine, including a randomized, double-blinded, controlled with qHPV vaccine, efficacy, immunogenicity, and safety study in young women aged 16-26 years, and an immunogenicity and safety study in girls and boys aged 9-15 years. Participants (N=5312) received vaccination at Day 1, Month 2, and Month 6. Gynecological swabs were collected regularly in young women for cytological and HPV DNA testing. Serum was analyzed for HPV antibodies in all participants. Adverse events (AEs) were also monitored in all participants. RESULTS: The 9vHPV vaccine prevented HPV 31-, 33-, 45-, 52-, and 58-related high-grade cervical, vulvar, and vaginal dysplasia with 92.3% efficacy (95% confidence interval 54.4, 99.6). Anti-HPV6, 11, 16, and 18 geometric mean titers at Month 7 were similar in the 9vHPV and qHPV vaccination groups. Anti-HPV antibody responses following vaccination were higher among girls and boys than in young women. Most (>99%) 9vHPV vaccine recipients seroconverted for all 9 HPV types at Month 7. Antibody responses to the 9 HPV types persisted over 5 years. The most common AEs were injection-site related, mostly of mild to moderate intensity. CONCLUSIONS: The 9vHPV vaccine is efficacious, immunogenic, and well tolerated in Latin American young women, girls, and boys. These data support 9vHPV vaccination programs in Latin America, a region with substantial cervical cancer burden.

Antibody persistence and evidence of immune memory at 5years following administration of the 9-valent HPV vaccine.

BACKGROUND: The 9-valent HPV (9vHPV) vaccine was developed to prevent infection and disease related to 9 HPV types (HPV6/11/16/18/31/33/45/52/58) which cause approximately 90% of cervical cancers, HPV-related vulvar, vaginal and anal cancers, and genital warts worldwide. In a pivotal efficacy study, the 9vHPV vaccine prevented infection and disease due to the 9 vaccine types. Duration of protection remains to be determined. Vaccines that induce long-term protection are generally characterized by the generation of immune memory. The purpose of this report is to assess the persistence of HPV antibody response and existence of immune memory at 5years post-vaccination. METHODS: A subset of subjects (N=150) who received 3 doses of 9vHPV vaccine at day 1, month 2 and month 6 in the pivotal efficacy study continued in a study extension and received a fourth dose of 9vHPV vaccine at month 60. Serum HPV antibody levels were measured pre-dose 4 and at 7 and 28days post-dose 4 by competitive Luminex immunoassay. Adverse events were assessed using a vaccination report card. RESULTS: HPV antibodies induced following the 3-dose series of 9vHPV vaccine in the base study persisted through month 60 with seropositivity rates ranging from 77.5% to 100%. Geometric mean titers at 1week and 1month post-dose 4 were 1.25-4.10 and 1.65-4.88-fold higher, respectively, than levels observed 1month following the completion of the three-dose primary series. Seropositivity rates were >99% and 100% at 1week and 1month post-dose 4, respectively. The fourth dose of 9vHPV vaccine was generally well tolerated. CONCLUSIONS: A three-dose regimen of the 9vHPV vaccine induced persistent HPV antibody response through 5years post-vaccination. Administration of a fourth dose resulted in a strong anamnestic response to all 9 vaccine types. These findings suggest that the efficacy of the 9vHPV vaccine will be long lasting. Clinical Trials.gov Identifier:NCT00543543.

Monitoring program for mammals in a protected area of Colombia / Programa de monitoreo de mamíferos en un área protegida de colombia / Programa de monitoração de mamíferos em uma área protegida em Colômbia

Abstract Between the second semester of 2009 and the first semester of 2011, camera traps were set up in conserved and disturbed habitats in the Otun Quimbaya Flora and Fauna Sanctuary. From a sampling effort of 2,066 camera-days, 673 photographs of 157 independent events were obtained for eight species of wild mammals and a domestic one. Their activity patterns were mainly nocturnal even for those species reported as diurnal. The impact of human interference and exotic species was evident for two species: Tapiruspinchaque and Cerdocyon thous. The former was observed below its altitudinal range with activity patterns mainly crepuscular and nocturnal. The second was observed in the same habitats where domestic dogs were found, with activity patterns mainly crepuscular and nocturnal. These findings suggest that both species have altered their activity patterns. Actions must be focused on decreasing the interaction of these mammals with humans and domestic dogs.

Resumen La información sobre los mamíferos de mediano y gran tamaño que habitan áreas protegidas en Colombia es cada vez más necesaria para impulsar acciones tendientes a su protección. La identificación completa de estas especies, sus números y sus patrones de actividad son esenciales en programas de monitoreo, especialmente por las relaciones entre estos animales y las dinámicas antropogénicas. El presente estudio se llevó a cabo en el Santuario de Flora y Fauna Otún-Quimbaya (Colombia). Entre el segundo semestre de 2009 y el primer semestre de 2011, se colocaron trampas cámara en áreas conservadas y perturbadas del Santuario de Flora y Fauna Otún-Quimbaya. Con un esfuerzo de muestreo de 2066 días-cámara se obtuvieron 673 fotografías de 157 eventos independientes para 8 especies silvestres y una doméstica. Los patrones de actividad observados fueron principalmente nocturnos, incluso para especies reportadas como diurnas. El impacto de la interferencia humana y de las especies exóticas fue evidente en 2 especies: Tapirus pinchaque y Cerdocyon thous. La primera fue observada por debajo de su rango altitudinal con patrones de actividad principalmente crepusculares y nocturnos. La segunda se observó en los mismos hábitats donde se encontraron los perros domésticos, con patrones de actividad principalmente crepusculares y nocturnos. Estos hallazgos sugieren que ambas especies han alterado sus patrones de actividad. Es necesario enfocar acciones en la disminución de la interacción de estos mamíferos con los humanos y con perros domésticos.

Resumen Entre o segundo semestre de 2009 e o primeiro semestre de 2011, câmeras foram armadas em habitats conservados e perturbados no Santuário de Flora e Fauna Otún Quimbaya. A partir de uma amostragem de 2066 dias de instalação da câmera, foram obtidas 673 fotografias de 157 eventos independentes para oito espécies de mamíferos selvagens e uma espécie doméstica. Os padrões de atividade observados eram principalmente noturnos, inclusive para espécies reportadas como diurnas. O impacto da interferência humana e de espécies exóticas foi observado para duas espécies: Tapirus pinchaque e Cerdocyon thous. A primeira foi observada abaixo de seu intervalo de altitude com padrões de atividade majoritariamente crepuscular e noturno. A segunda espécie foi observada nos mesmos habitats em que espécies de cachorros domésticos foram observados, com padrões de atividade majoritariamente crepuscular e noturno. Estes resultados sugerem que ambas as espécies alteraram seus comportamentos padrão. Ações devem ser focalizadas para reduzir a interação de estes mamíferos com os humanos e cães domésticos.

Risk factors for Chagas disease among pregnant women in El Salvador.

OBJECTIVES: To determine the seroprevalence of Chagas disease among pregnant women and estimate the risk factors for Chagas disease during pregnancies. METHODS: Community-based serological tests on Trypanosoma cruzi and structured interviews on socio-demographic and socio-economic status were conducted with pregnant women registered at three health centres in Sonsonate province, El Salvador. RESULTS: Of 797 pregnant women participating in the study, 29 (3.6%) were infected with Chagas disease. None had clinical symptoms. The results of bivariate analyses showed the significant association between seropositivity and maternal age ≥35 years, anaemia, illiteracy, having no formal school education and having knowledge on Chagas disease (P < 0.05). The results of multivariate analysis indicate that age ≥35 years and anaemia were significantly associated with being infected with Chagas disease among pregnant women (OR = 3.541 and 5.197, respectively). CONCLUSION: We recommend that the national Chagas disease control programme be better coordinated with the national maternal and child health programme to introduce blood screening for T. cruzi during antenatal visits. If financial constraint allows systematic blood screening to be only partially implemented, resources should be focused on pregnant women ≥35 years and women who have anaemia.

Errores médicos: [revisión] / Medical errors: [review]

El error médico es cualquier falla ocurrida durante la atención de salud que haya causado algún tipo de daño al paciente, y cuyo origen puede relacionarse con la organización e implementación del servicio, a través de múltiples y complejos mecanismos. Ninguna especialidad médica está exenta de él. Establecer la responsabilidad médica en casos de error diagnóstico es difícil, pues en muchas ocasiones resultan inevitables. No obstante, una vez analizadas sus causas, ya sean estos cognitivas, del sistema de salud o errores sin culpa, es posible instaurar estrategias que tiendan a su reducción. El punto medular en el enfoque del error médico y diagnóstico es que una vez cometido y más aún si se comprueba algún tipo de responsabilidad médica, este debe ser encarado con seriedad y transparencia.

A medical error is a fault that occurs during the delivery of health care that has caused damage to the patient. It could be related to the organization and implementation of the medical service,through multiple and complex mechanisms. None of the medical areas is exempt of them. The legal analysis of diagnostic errors is difficult because many times they are inevitable. However, as soon as their possible causes–cognitive errors, system errors and no fault errors-are analyzed,it is possible to establish strategies to minimize them. The most important approach to a medical or diagnostic error is to confront it with reliability and clarity.

Determinación de alcohol post mortem: aspectos a considerar para una mejor interpretación / Determination of alcohol post mortem: aspects to consider for a better interpretation

El aumento de los accidentes, especialmente los automovilísticos, ligados al consumo de sustancias alcohólicas hace necesario el establecimiento de normas estandarizadas para la medición adecuada de los niveles alcohol en aquellos casos en que se sospecha el uso-abuso de dicha sustancia como mediador en el desenlace del accidente, esto por cuanto es de suma importancia a la hora de establecer las responsabilidades correspondientes por parte de la Autoridad Judicial. El avance en las diferentes técnicas de laboratorio hacen de la medición de alcohol un procedimiento sencillo, pero su confiabilidad queda supeditada al correcto manejo de las muestras: su toma, embalaje, transporte, conservación y procesamiento y el análisis de las variables del lugar y estado del cadáver del que fueron extraídas las mismas. La correlación de los diferentes resultados obtenidos y su correcta interpretación son necesarios para obtención de las mediciones más cercanas a la realidad en el momento de ocurrido el suceso que se investiga.