Mental Well-being InSciEd Out: Health Partnerships with the Boys & Girls Clubs of Puerto Rico.

BACKGROUND: Mental health care is a top clinical concern for modern Puerto Rico, especially given a dramatically changing economic landscape paired with recurrent natural disasters. Youth are particularly at-risk due to long-term impacts of toxic stress and adverse childhood experiences on health and development. OBJECTIVES: Here we present a novel clinician-community-educator-scientist partnership to address Puerto Rican youth mental well-being and wellness. We deployed pilot health workshops within the Boys & Girls Clubs of Puerto Rico to build youth mental health conceptual understanding and competencies in stress recognition and management. The work in progress herein evaluates acceptability and feasibility of our curricular model. METHODS: Dialogue with community stakeholders guided curricular design of workshops for youth ages 6 to 13 and older. Prior to implementation, educators and volunteers attended a 1-day training on educational strategies. Workshop success was evaluated using qualitative approaches (i.e., narrative feedback, educator and volunteer reflections, youth Talking Drawings) to assess youth engagement, youth conceptual health understanding, and educator/volunteer impressions of feasibility and impact. RESULTS: Initial findings indicate high acceptability and feasibility of our curricular model. Youth engagement and enthusiasm were noted in educator feedback and continue to be sustained post-workshop. Preliminary analysis shows accompanying increases in youth conceptual mental health understanding, particularly for 6- to 12-year-olds in recognition of stress and healthy coping mechanisms. Reciprocal gains were observed for volunteers. CONCLUSIONS: Activities have evolved into a formal partnership called Semilla, which features expanded analysis of mental well-being and wellness outcomes. Our collaborative model continues to engage Puerto Rican youth in the science of their well-being.

Pre- and peri-natal hurricane exposure alters DNA methylation patterns in children.

Hurricane Maria was the worst recorded natural disaster to affect Puerto Rico. Increased stress in pregnant women during and in the aftermath of the hurricane may have induced epigenetic changes in their infants, which could affect gene expression. Stage of gestation at the time of the event was associated with significant differences in DNA methylation in the infants, especially those who were at around 20-25 weeks of gestation when the hurricane struck. Significant differences in DNA methylation were also associated with maternal mental status assessed after the hurricane, and with property damage. Hurricane Maria could have long lasting consequences to children who were exposed to this disaster during pregnancy.

Decreased CSTB, RAGE, and Axl Receptor Are Associated with Zika Infection in the Human Placenta.

Zika virus (ZIKV) compromises placental integrity, infecting the fetus. However, the mechanisms associated with ZIKV penetration into the placenta leading to fetal infection are unknown. Cystatin B (CSTB), the receptor for advanced glycation end products (RAGE), and tyrosine-protein kinase receptor UFO (AXL) have been implicated in ZIKV infection and inflammation. This work investigates CSTB, RAGE, and AXL receptor expression and activation pathways in ZIKV-infected placental tissues at term. The hypothesis is that there is overexpression of CSTB and increased inflammation affecting RAGE and AXL receptor expression in ZIKV-infected placentas. Pathological analyses of 22 placentas were performed to determine changes caused by ZIKV infection. Quantitative proteomics, immunofluorescence, and western blot were performed to analyze proteins and pathways affected by ZIKV infection in frozen placentas. The pathological analysis confirmed decreased size of capillaries, hyperplasia of Hofbauer cells, disruption in the trophoblast layer, cell agglutination, and ZIKV localization to the trophoblast layer. In addition, there was a significant decrease in CSTB, RAGE, and AXL expression and upregulation of caspase 1, tubulin beta, and heat shock protein 27. Modulation of these proteins and activation of inflammasome and pyroptosis pathways suggest targets for modulation of ZIKV infection in the placenta.

Naturalization of the microbiota developmental trajectory of Cesarean-born neonates after vaginal seeding.

BACKGROUND: Early microbiota perturbations are associated with disorders that involve immunological underpinnings. Cesarean section (CS)-born babies show altered microbiota development in relation to babies born vaginally. Here we present the first statistically powered longitudinal study to determine the effect of restoring exposure to maternal vaginal fluids after CS birth. METHODS: Using 16S rRNA gene sequencing, we followed the microbial trajectories of multiple body sites in 177 babies over the first year of life; 98 were born vaginally, and 79 were born by CS, of whom 30 were swabbed with a maternal vaginal gauze right after birth. FINDINGS: Compositional tensor factorization analysis confirmed that microbiota trajectories of exposed CS-born babies aligned more closely with that of vaginally born babies. Interestingly, the majority of amplicon sequence variants from maternal vaginal microbiomes on the day of birth were shared with other maternal sites, in contrast to non-pregnant women from the Human Microbiome Project (HMP) study. CONCLUSIONS: The results of this observational study prompt urgent randomized clinical trials to test whether microbial restoration reduces the increased disease risk associated with CS birth and the underlying mechanisms. It also provides evidence of the pluripotential nature of maternal vaginal fluids to provide pioneer bacterial colonizers for the newborn body sites. This is the first study showing long-term naturalization of the microbiota of CS-born infants by restoring microbial exposure at birth. FUNDING: C&D, Emch Fund, CIFAR, Chilean CONICYT and SOCHIPE, Norwegian Institute of Public Health, Emerald Foundation, NIH, National Institute of Justice, Janssen.

Dengue Vaccine Booster in Healthy Adolescents and Adults in Latin America: Evaluation 4-5 Years After a Primary 3-Dose Schedule.

BACKGROUND: The tetravalent dengue vaccine (CYD-TDV, Dengvaxia, Sanofi Pasteur) demonstrated efficacy in 2 previous phase III trials conducted in endemic countries. Neutralizing antibodies (NAbs) elicited by 3 doses of this vaccine have been associated with efficacy. Long-term follow-up data has shown that NAb immune responses tend to wane over time, after the third dose. This study compared the immune response elicited by a booster (4th) dose of CYD-TDV with the immune responses from the same participants obtained post-dose 3 of the primary series administered 4-5 years earlier. METHODS: This multicenter, observer-blind, randomized, placebo-controlled, phase II noninferiority trial was conducted in healthy adolescents and adults in dengue endemic countries of Latin America (Colombia, Honduras, Brazil, Mexico and Puerto Rico). All participants had been immunized with 3 doses of CYD-TDV in phase II studies conducted 4-5 years earlier. NAb levels against each dengue virus serotype 28 days postbooster or placebo injection were reported. RESULTS: A total of 187 participants received CYD-TDV and 64 received placebo. Prospectively defined noninferiority criteria for dengue NAbs after the booster dose compared with postdose 3 were met for all 4 serotypes. Prospectively defined superiority criteria were met for 3 of the 4 serotypes. CONCLUSIONS: Antidengue NAb levels can be boosted to levels at least as high as, or higher than those observed after completion of the primary 3-dose series, with an additional dose of CYD-TDV 4-5 years after the standard 3-dose vaccination schedule.

Autopercepción de capacidades de autocuidado en estudiantes universitarios sobre enfermedades crónicas, sexualidad y adicciones / Self-perception of self-care skills in university students concerning chronic diseases, sexuality and addictions

Introducción: en el mundo hay aproximadamente 1800 millones de jóvenes entre los 10 y 24 años de edad, los cuales constituyen 25% del total de la población mundial. Esto genera un potencial de avance económico y social y, en consecuencia, un incremento en la incidencia de enfermedades crónicas no transmisibles (ECNT), infecciones de transmisión sexual (ITS) y adicciones. Objetivo: analizar en estudiantes universitarios de nuevo ingreso el nivel de autopercepción de capacidades de autocuidado (CAc) ante las ECNT, la salud sexual y reproductiva (SSyR) y prevención de adicciones con base en la teoría del déficit de autocuidado. Métodos: estudio analítico correlacional en una muestra por conveniencia de 2342 estudiantes de nuevo ingreso. Se utilizó un instrumento diseñado y validado en el año 2015 para identificar las CAc en ECNT, SSyR, y prevención de adicciones, con un alfa de Cronbach de 0.88. Asimismo, se hizo un análisis bivariado, con las pruebas no paramétricas U de Mann-Whitney, H de Kruskal-Wallis y ANOVA de Kruskal-Wallis. También se empleó la prueba de correlación Rho de Spearman (p < 0.05). Resultados: el nivel de autopercepción de los estudiantes en cuanto a sus CAc fue bueno (61%) ante las ECNT, la SSyR y la prevención de adicciones. Se encontró que el nivel de autopercepción de CAc es diferente entre los estudiantes de las tres divisiones académicas (p = 0.000). Conclusiones: aunque la autopercepción de las CAc en los estudiantes tiene un nivel bueno, es necesario que durante la trayectoria académica se promuevan hábitos de vida saludables.

Introduction: In the world there are approximately 1800 million young people between 10 and 24 years, which constitute 25% of total world population. This creates a potential for economic and social advance and, consequently, an increase in the incidence of chronic non- communicable diseases (CNCDs), sexually transmitted infections (STIs) and addictions. Objective: To analyze the level of self-perception of self-care skills (SCS) in new university students in the presence of CNCDs, sexual and reproductive health (SRH) and addiction prevention. Methods: Correlational analytical study in a convenience sample of 2342 new students. An instrument designed and validated in 2015 was used to identify SCSs in CNCDs, SRH, and addiction prevention, with a Cronbach's alpha of 0.88. It was performed a bivariate analysis, with non-parametric tests Mann-Whitney U, Kruskal-Wallis H, and Kruskal-Wallis ANOVA. It was used Rho Spearman's correlation test (p < 0.05) as well. Results: The level of self-perception of the students in terms of their SCSs was good (61%) in the face of CNCDs, SRH and addiction prevention. It was found that the level of self-perception of SCSs is different among the students of the three academic divisions (p = 0.000). Conclusions: Although self-perception of SCS in the students is at a good level, it is necessary the promotion of healthy habits of living during the academic career.

Satisfacción de los padres o tutores sobre la calidad de atención recibida, unidad de cuidados intensivos pediátricos. Hospital Militar Escuela Dr. Alejandro Dávila Bolaños. Managua, Nicaragua. Febrero-Marzo 2017 / Satisfaction of parents or guardians about the quality of care received, pediatric intensive care unit. Military Hospital Dr. Alejandro Dávila Bolaños School. Managua Nicaragua. February-March 2017

OBJETIVO: Evaluar el grado de satisfacción de los padres o tutores sobre la calidad de atención recibida en la Unidad de Cuidados Intensivos Pediátricos, del Hospital Militar Escuela Dr. Alejandro Dávila Bolaños. Managua, Nicaragua, febrero- marzo 2017. Los objetivos específicos fueron describir las características sociodemográficas, identificar las expectativas del servicio que poseen los padres o tutores, conocer la percepción que tienen los padres o tutores sobre la calidad de atención recibida en la Unidad de Cuidados Intensivos Pediátricos y categorizar los niveles de calidad, según expectativas y percepción. DISEÑO METODOLÓGICO: Estudio descriptivo de corte transversal; el universo estuvo constituido por 23 padres o tutores de los pacientes, las variables por objetivos contenían características sociodemográficas y las 5 dimensiones de la encuesta SERVQUAL para percepción y expectativas, la fuente de información fue primaria. La información se recolectó por una Licenciada Jefa de Unidad en Open Data Kit (ODK) y se procesaron los datos en Excel 2010 y ODK Aggregate. RESULTADOS: Se realizaron 23 encuestas, de las cuales el 56.5% de los encuestados correspondieron a las edades entre 21 a 30 años, el 73.9% fueron del sexo femenino y el 47.8% universitarios y el 82.6% del área urbana. Las expectativas de los padres o tutores de los pacientes se encontraron entre un índice 4.16 ­ 4.25 para todas las dimensiones, siendo 5 el nivel más alto en cuanto a la satisfacción; para percepción de 4.14 ­ 4.41, siendo 5 el nivel más alto en cuanto a satisfacción El índice de calidad del servicio fue de -0.0.5 CONCLUSIONES El índice de calidad del servicio muestra en términos generales el posicionamiento de la calidad de un servicio tomando en cuenta este resultado y la escala correspondiente, la calidad del servicio de la Unidad de Cuidados Intensivos Pediátricos se aleja levemente de cero, por lo que la calidad a consideración es buena, aun teniendo el signo negativo

Vivencias del egresado de enfermería en la toma de decisiones clínicas / Nursing graduate experiences in clinical decision making

La complejidad de la práctica clínica en enfermería demanda egresados que tomen decisiones basadas en conocimiento, reflexión y las mejores fuentes de información. Desafortunadamente éstos no siempre son sus principales sustentos, al encontrarse que están basados primordialmente en imitación del personal de salud y el saber práctico. Factores como las relaciones de poder, la disociación teoría-practica y la propia formación del egresado influyen como limitantes en el proceso de la toma de decisiones clínica de los futuros licenciados en enfermería. El objetivo fue explorar las vivencias del egresado de licenciatura de la Escuela Nacional de Enfermería y Obstetricia de la UNAM, con relación a los factores que influyen en el proceso de toma de decisiones clínicas durante el servicio social, así como los aspectos en que las sustenta. Se trató de un estudio cualitativo, fenomenológico. La recolección de los datos fue mediante grupo focal conformado por siete recién egresados de la licenciatura en enfermería de una universidad pública de México. Se utilizó una guía semi-estructurada para la entrevista sobre el proceso y fuentes de información en la toma de decisiones clínicas, de acuerdo a Marshall, en el año 2008. Se transcribió la audiograbación y se realizó el análisis de cada una de los discursos para descubrir categorías y subcategorías, enmarcándolos de una manera global y contextualizada de acuerdo a Minayo, en el año 2009. Surgieron dos categorías, la primera fue: En qué sustentan sus decisiones, emergiendo que se basan más en el saber práctico sin llegar a relacionarlo con el teórico, la información proporcionada por el personal institucional sin cuestionarla, la consulta de libros desactualizados, así como la escasa búsqueda de evidencias científicas actualizadas para la fundamentación de las mismas. La segunda categoría encontrada fueron los factores que influyen en el proceso de toma de decisiones clínicas, encontrándose el mantenimiento de la formación en enfermería bajo el paradigma educativo tradicional, donde se excluyen las habilidades y competencias necesarias para la toma de decisiones clínicas en el profesional de enfermería. Así mismo las relaciones de poder que se dan en el entorno laboral; el quedarse sólo frente a un paciente sin la figura del personal de enfermería como un facilitador en este importante proceso; y la disociación teoría-práctica, lo cual genera grandes limitaciones para tomar las decisiones. La toma de decisiones del egresado de enfermería estuvo basada en el conocimiento práctico y opinión de otros profesionales, más que en la consulta de evidencia científica actualizada; sin reflexión y criticidad. Se propone la renovación de planes de estudio que permitan el fortalecimiento de herramientas que realmente garanticen el papel del profesional de enfermería como tomador de decisiones, así como el apoyo de tutores en los campos clínicos. También la inclusión transversal de materias en los programas de estudio que promuevan habilidades para la consulta y evaluación de las mejores evidencia científicas como sustento de las decisiones clínicas.

The complexity of clinical practice in nursing demands graduates to make decisions based on knowledge, reflection and the best sources of information. Unfortunately, these are not always their main livelihoods, since they are based primarily on imitation of health personnel and practical knowledge. Factors such as power relations, theory-practice dissociation and the graduate's own training influence the clinical decision-making process of future nursing graduates as limiting. The objective was to explore the experiences of the graduate of the National School of Nursing and Obstetrics of the UNAM, in relation to the factors that influence the process of clinical decision making during the social service, as well as the aspects in which it supports them . It was a qualitative, phenomenological study. The data was collected through a focus group made up of seven recent graduates of the nursing degree from a public university in Mexico. A semi-structured guide was used for the interview about the process and sources of information in clinical decision making, according to Marshall, in 2008. The audio recording was transcribed and the analysis of each of the speeches was made to discover categories and subcategories, framing them in a global and contextualized way according to Minayo, in 2009. Two categories emerged, the first was: What do they support their decisions, emerging that they are based more on practical knowledge without relating it to the theoretical, the information provided by the institutional staff without questioning it, the consultation of outdated books, as well as the little search for updated scientific evidence for the foundation of them. The second category found were the factors that influence the clinical decision-making process, being the maintenance of nursing training under the traditional educational paradigm, which excludes the skills and competencies necessary for clinical decision making in the professional of Nursing. Likewise, the power relations that occur in the work environment; staying alone in front of a patient without the figure of the nursing staff as a facilitator in this important process; and theory-practice dissociation, which creates great limitations for making decisions. The decision of the nursing graduate was based on the practical knowledge and opinion of other professionals, rather than on the consultation of updated scientific evidence; Without reflection and criticality. It is proposed to renew curricula that allow the strengthening of tools that really guarantee the role of the nursing professional as a decision maker, as well as the support of tutors in the clinical fields. Also the cross-sectional inclusion of subjects in the study programs that promote skills for the consultation and evaluation of the best scientific evidence to support clinical decisions. Decision making, nursing graduate, experiences of graduates.

Dialectical behavior therapy for adolescents with bipolar disorder: results from a pilot randomized trial.

OBJECTIVE: The purpose of this study was to conduct a pilot randomized trial of dialectical behavior therapy (DBT) versus psychosocial treatment as usual (TAU) for adolescents diagnosed with bipolar disorder (BP). METHODS: We recruited participants 12-18 years of age with a primary BP diagnosis (I, II, or operationalized not otherwise specified [NOS] criteria) from a pediatric specialty clinic. Eligible patients were assigned using a 2:1 randomization structure to either DBT (n=14) or psychosocial TAU (n=6). All patients received medication management from a study-affiliated psychiatrist. DBT included 36 sessions (18 individual, 18 family skills training) over 1 year. TAU was an eclectic psychotherapy approach consisting of psychoeducational, supportive, and cognitive behavioral techniques. An independent evaluator, blind to treatment condition, assessed outcomes including affective symptoms, suicidal ideation and behavior, nonsuicidal self-injurious behavior, and emotional dysregulation, quarterly over 1 year. RESULTS: Adolescents receiving DBT attended significantly more therapy sessions over 1 year than did adolescents receiving TAU, possibly reflecting greater engagement and retention; both treatments were rated as highly acceptable by adolescents and parents. As compared with adolescents receiving TAU, adolescents receiving DBT demonstrated significantly less severe depressive symptoms over follow-up, and were nearly three times more likely to demonstrate improvement in suicidal ideation. Models indicate a large effect size, for more weeks being euthymic, over follow-up among adolescents receiving DBT. Although there were no between-group differences in manic symptoms or emotional dysregulation with treatment, adolescents receiving DBT, but not those receiving TAU, evidenced improvement from pre- to posttreatment in both manic symptoms and emotional dysregulation. CONCLUSIONS: DBT may offer promise as an adjunct to pharmacotherapy in the treatment of depressive symptoms and suicidal ideation for adolescents with BP. The DBT focus on commitment to treatment may be important for the treatment of early-onset BP. Larger controlled trials are needed to establish the efficacy of this approach, examine impact on suicidal behavior, and demonstrate cost effectiveness.

Habilidades pre-escolares de los niños nacidos prematuramente y con bajo peso / Preschool abilities of children born preterm and low weight

El objetivo de este estudio fue conocer el nivel de desarrollo en la etapa pre-escolar de un grupo de niños nacidos prematuramente y con bajo peso. Se evaluó un grupo 20 niños de cuatro años nacidos prematuramente y con bajo peso y un grupo de 20 niños nacidos luego de gestación completada y peso deseado utilizando la prueba de integración visual-motora Beery-Buktenica. Además, se administró el cuestionario del desarrollo Ages and Stages (ASQ-3) a las 40 madres. El análisis estadístico se llevó a cabo mediante una prueba t de studentpara grupos independientes. El grupo de niños nacidos prematuramente obtuvo puntuaciones significativamente inferiores en las pruebas que medían las habilidades de percepción visual (µ1 83.65 ; µ2 93.7) (p=0.0001), integración visual-motora (µ1 93.6 ; µ2 104.8) (p=0.001) y motor fina (µ1 36.00 ; µ2 44.25) (p=0.033) al ser comparados con el grupo de niños nacidos luego de una gestacióncompletada.El estudio sugiere que los niños nacidos prematuramente y con bajo peso presentan menor ejecución en el desarrollo sensorio-motor durante la etapa pre-escolar. Estas desventajas pasan desapercibidas y pueden representar rezago en las tareas escolares futuras que requieren de dichas habilidades. Es importante fomentar la evaluación y estimulación ambiental temprana en esta población aún en ausencia de indicadores de riesgo.

The purpose of this study was to evaluate the development among a group of pre-school children born premature and with low weight. We evaluated a group of four years old children; 20 children born prematurely and 20 children born after a full gestation and desired weight, using the Beery-Buktenica visual-motor integration test. We also administered the Ages and Stages Questionnaire (ASQ-3) development test to all 40 mothers. Statistical analysis was performed using student t test for independent groups. The group of children born prematurely scored significantly lower on tests measuring visual perception skills (µ1 83.65 ; µ2 93.7) (p = 0.0001), visual-motor integration (µ1 93.6 ; µ2 104.8) (p = 0.001) and fine motor (µ1 36.00 ; µ2 44.25) (p=0.033) (p = 0.033), when compared to the group of children born after a full term. This study suggests that premature low weight born children have lower performance in the sensory-motor development during the preschool years. These disadvantages go unnoticed and may represent future delays on school tasks that require these skills. It is important to promote an early assessment and environmental stimulation among this population even in the absence of risk indicators

A multi-country study of intussusception in children under 2 years of age in Latin America: analysis of prospective surveillance data.

BACKGROUND: Intussusception (IS) is a form of acute intestinal obstruction that occurs mainly in infants and is usually of unknown cause. An association between IS and the first licensed rotavirus vaccine, a reassortant-tetravalent, rhesus-based rotavirus vaccine (RRV-TV), led to the withdrawal of the vaccine. New rotavirus vaccines have now been developed and extensively studied for their potential association with IS. This study aimed to describe the epidemiology and to estimate the incidence of IS in Latin American infants prior to new vaccine introduction. METHODS: Children under 2 years of age representing potential IS cases were enrolled in 16 centers in 11 Latin American countries from January 2003 to May 2005. IS cases were classified as definite, probable, possible or suspected as stated on the Brighton Collaboration Working Group guidelines. RESULTS: From 517 potential cases identified, 476 (92%) cases were classified as definite, 21 probable, 10 possible and 10 suspected for intussusception. Among the 476 definite IS cases, the median age at presentation was 6.4 months with 89% of cases aged <1 year. The male to female ratio was 1.5:1. The incidence of definite IS per 100,000 subject-years ranged from 1.9 in Brazil to 62.4 in Argentina for children <2 years of age, and from 3.8 in Brazil to 105.3 in Argentina for children aged <1 year. Median hospital stay was 4 days with a high prevalence of surgery as the primary treatment (65%). Most cases (88%) made a complete recovery, but 13 (3%) died. No clear seasonal pattern of IS cases emerged. CONCLUSIONS: This study describes the epidemiology and estimates the incidence of IS in Latin American infants prior to the introduction of new rotavirus vaccines. The incidence of IS was found to vary between different countries, as observed in previous studies. TRIAL REGISTRATION: Clinical study identifier 999910/204 (SERO-EPI-IS-204).

Práctica de lavado de manos en la sala de neonatología del Hospital Santa Bárbara Integrado, Departamento de Santa Bárbara, enero 2010-2011 / Hand hygiene practice in the neonatology ward in the Santa Barbara Integrated Hospital, departament of Santa Barbara, in the period of January 2010-January 2011

El lavado de manos es el procedimiento único y más importante en prevención de la diseminación de infecciones. El cumplimiento de lavado de manos subóptimo en el personal de salud a nivel mundial, rara vez excediendo el 50%, y la alta prevalencia de infecciones nosocomiales son las razones para que la OMS lance iniciativa “ Manos Limpias- Salvan Vidas” Objetivo: Describir la práctica de lavado de manos del servicio de neonatología del Hospital Santa Bárbara Integrado, con el propósito de contribuir al logro de las metas de la Secretaría de Salud en disminuir las tasas de mortalidad. Material y Métodos: Tipo de estudio no experimental Pre y Post evaluatorio de intervenciones estandarizadas. Muestreo: No probalístico. Muestra: Inicial 17 y final de 16 trabajadores en salud. Se aplicarón 4 instrumentos estandarizados, el primero evaluó los insumos para el lavado de manos, éste se aplicó en un momento al inicio; el segundo evaluó conocimientos sobre lavado de manos, se aplicó en tres momentos al inicio, un mes y dos meses después de intervenir. Resultados: Deficientes insumos del Hospital Santa Bárbara Integrado para lograr un lavado de manos oportuno y de calidad. El conocimiento del mismo en el personal fue de 65% inicialmente y de 67% en la medición final. Se observó una mejoría en la técnica de lavado de manos con una medición inicial de 57% y final de 85%. Se calculó la tasa de cumplimiento inicial del 44% con mejoría a 53% al final. Conclusiones: Se encontraron tasas subóptimas de cumplimiento de lavado de manos a pesar de la intervención…

Construcción del diagnóstico de enfermería en el alumno de nivel licenciatura / Nursing diagnosis construction by bachelor's degree students

Resumen

Introducción: el diagnóstico enfermero, es un juicio clínico sobre la respuesta de un individuo, familia o comunidad frente a procesos vitales, problemas de salud reales y/o potenciales. Partiendo de la aplicación del razonamiento clínico, razonamiento diagnóstico y pensamiento crítico se pueden llegar a plantear los enunciados diagnósticos. Pero no sólo influyen estos elementos, aunque de ellos dependa en gran parte toda su elaboración, también puede influir factores como: el promedio, grado de estudios del docente, conocimientos fisiopatológicos y el turno.

Objetivo: identificar los factores que influyen en la elaboración adecuada del diagnóstico de enfermería. Metodología: estudio cuantitativo, descriptivo, transversal. Se aplicó un instrumento sobre la construcción del diagnóstico a 103 alumnos de la carrera. El análisis de resultados se hizo en SPSS V 15.0, a través de estadística descriptiva por medio de frecuencias y porcentajes; se aplicó t de student para muestras independientes y χ2.

Resultados: 67 % de los alumnos utiliza razonamiento clínico, 59 % aplica razonamiento diagnóstico y pensamiento crítico; con ello 66 % elaboran adecuadamente el diagnóstico. En relación a los factores como: el promedio, si el alumno labora, grado de estudios del docente y el turno son factores que no influyen en la construcción adecuada del diagnóstico, mientras que los conocimientos teóricos sobre fisiopatología sí influyen en la estructuración del mismo (p > 0.002)

Conclusiones: para que el alumno elabore adecuadamente el diagnóstico de enfermería, debe tener fundamentalmente conocimientos teóricos desde un enfoque fisiopatológico de las distintas enfermedades.

Summary

Introduction: nursing diagnosis is a clinical judgment about the response of an individual, family or community to vital processes and real or potential health problems. Building upon the application of clinical reasoning, diagnostic reasoning, and critical thinking may create the stated diagnoses. They are not only influenced by those elements, although they depend on them in a large part for all of their elaboration; factors may also influence them such as their grade average, the teacher's level of education, knowledge of pathophysiology and their school hours.

Objective: identify factors that influence the development of appropriate nursing diagnosis.

Methodology: this is a quantitative, descriptive, study. An instrument on the construction of nursing diagnosis was applied to 103 students. The analysis of results was done with SPSS v15.0 through descriptive statistics, using frequencies and percentages; Student's t and χ2 were applied for independent samples.

Results: 67 % of students use clinical reasoning, 59 % apply diagnostic reasoning and critical thinking, and with this 66 % adequately develop the nursing diagnosis. In relation to factors such as grade

average, if the student is working, the level of teacher's education, and the school hours are not factors that influence the adequate construction of diagnosis, whereas theoretical knowledge of pathophysiology does affect it (p > 0.002).

Conclusions: fundamental theoretical knowledge of pathophysiology is necessary for the student to adequately prepare a nursing diagnosis.

Influenza and other respiratory viruses in three Central American countries.

BACKGROUND: Despite the disease burden imposed by respiratory diseases on children in Central America, there is a paucity of data describing the etiologic agents of the disease. AIMS: To analyze viral etiologic agents associated with influenza-like illness (ILI) in participants reporting to one outpatient health center, one pediatric hospital, and three general hospitals in El Salvador, Honduras, and Nicaragua Material & METHODS: Between August 2006 and April 2009, pharyngeal swabs were collected from outpatients and inpatients. Patient specimens were inoculated onto cultured cell monolayers, and viral antigens were detected by indirect and direct immunofluorescence staining. RESULTS: A total of 1,756 patients were enrolled, of whom 1,195 (68.3%) were under the age of 5; and 183 (10.4%) required hospitalization. One or more viral agents were identified in 434 (24.7%) cases, of which 17 (3.9%) were dual infections. The most common viruses isolated were influenza A virus (130; 7.4% of cases), respiratory syncytial virus (122; 6.9%), adenoviruses (63; 3.6%), parainfluenza viruses (57; 3.2%), influenza B virus (47; 2.7% of cases), and herpes simplex virus 1 (22; 1.3%). In addition, human metapneumovirus and enteroviruses (coxsackie and echovirus) were isolated from patient specimens. DISCUSSION: When compared to the rest of the population, viruses were isolated from a significantly higher percentage of patients age 5 or younger. The prevalence of influenza A virus or influenza B virus infections was similar between the younger and older age groups. RSV was the most commonly detected pathogen in infants age 5 and younger and was significantly associated with pneumonia (p < 0.0001) and hospitalization (p < 0.0001). CONCLUSION: Genetic analysis of influenza isolates identified A (H3N2), A (H1N1), and B viruses. It also showed that the mutation H274Y conferring resistance to oseltamivir was first detected in Honduran influenza A/H1N1 strains at the beginning of 2008. These data demonstrate that a diverse range of respiratory pathogens are associated with ILI in Honduras, El Salvador, and Nicaragua. RSV infection in particular appears to be associated with severe disease in infants in the region.

Evaluación económica de una eventual incorporación de la vacuna anti-rotavirus en el calendario de vacunación infantil en Honduras / Economic evaluation of an eventual incorporation of anti-rotavirus vaccine into childhood immunology program in Honduras

OBJETIVOS. Se presenta una evaluación económica de la vacunación anti rotavirus en la población hondureña menor de 5 años de edad. Para este fin, se aplicó un modelo económico, cuyo objeto fue compararla implementación de un programa de vacunación anti-rotavirus con la estrategia de no vacunar y tratar la enfermedad por rotavirus según la práctica clínica estándar en dicha población. MATERIAL Y MÉTODOS. El costo-efectividad se evaluó en términos de costo por años de vida ajustados por discapacidad (AVAD),comparando el costo neto del programa de vacunación con su efectividad, desde la perspectiva del servicio de salud. El costo neto del programa de vacunación se calculó restando los costos de vacunación a la reducción de los costos directos médicos de la gastroenteritis por rotavirus. Los costos y beneficios del programa de vacunación se actualizaron para el año 2003 utilizando una tasa de descuento del 3%. Un análisis de sensibilidad univariado se realizó para medir el grado de variabilidad en los resultados con relación a los parámetros que los definen. RESULTADOS. Anualmente en Honduras se gastan aproximadamente $1,8 millones en el manejo hospitalario y ambulatorio de gastroenteritis por rotavirus, en trasporte y costos indirectos. El programa de vacunación anti-rotavirus prevendría el 68% de estos gastos. Desde el punto de vista del servicio de salud, en el cual el precio estimado de la vacuna es de $24 por régimen, se generaría un costo adicional por cada año de vida ajustado por discapacidad de $269. El análisis de sensibilidad muestra como este valor es sensible a la modificación del precio de la vacuna, a la mortalidad por rotavirus, y a la eficacia de la vacuna para prevenir muertes por rotavirus, siendo menos sensibles a los costos médicos directos. CONCLUSIONES. Los resultados de este estudio, demuestran que la vacunación anti-rotavirus puede ser una intervención preventiva de gastroenteritis severa en la población...

Falla terapéutica del antimoniato de meglumina en el tratamiento de la leishmaniasis visceral: informe de caso / Therapeutic failure of meglumine antiminy in visceral leishmaniasis treatment: Report of a case

En los últimos años en Honduras se han documentado casos de falla terapéutica al tratamiento con antimoniato de meglumina (AM), lo que ha originado duda sobre su eficacia. El presente caso ilustra el enfoque diagnóstico y manejo terapéutico de un paciente con leishmaniasis viceral(LV) recurrente, cuyo desenlace fue fatal al no responder adecuadamente al tratamiento. El niño de 3 años de edad, procedente de Reitoca, Francisco Morazán, fue ingresado en cuatro ocasiones en el Hospital Escuela durante el período 1999-2002. El diagnóstico de LV (frote de médula ósea y cultivo) se estableció en el tercer ingreso (mayo 2002), ocasión en que se inició el tratamiento con AM (medicamento genérico, 30mg/Kg/d sal IM por 2 días, seguido por 60 mg/Kg/d sal IM por 19 días) más dexametasona (8 mg/día IV en los primeros 2 días. Su evolución intra-hospitalaria fué satisfactoria. Dos meses después reingresó y nuevamente se identificó Leishmania spp(frote médula ósea y cultivo). Se inició un nuevo ciclo de AM(medicamento original) pero el paciente falleció al decimoséptimo día del tratamiento. La respuesta terapéutica en LV depende de la eficacia del medicamento y del estado inmune del paciente. Es necesario estandarizar y evaluar sistemáticamente la respuesta terapéutica al tratamiento antileishmaniásico en Honduras...

Community-based participatory research: lessons learned from the Centers for Children's Environmental Health and Disease Prevention Research.

Over the past several decades there has been growing evidence of the increase in incidence rates, morbidity, and mortality for a number of health problems experienced by children. The causation and aggravation of these problems are complex and multifactorial. The burden of these health problems and environmental exposures is borne disproportionately by children from low-income communities and communities of color. Researchers and funding institutions have called for increased attention to the complex issues that affect the health of children living in marginalized communities--and communities more broadly--and have suggested greater community involvement in processes that shape research and intervention approaches, for example, through community-based participatory research (CBPR) partnerships among academic, health services, public health, and community-based organizations. Centers for Children's Environmental Health and Disease Prevention Research (Children's Centers) funded by the National Institute of Environmental Health Sciences and U.S. Environmental Protection Agency were required to include a CBPR project. The purpose of this article is to provide a definition and set of CBPR principles, to describe the rationale for and major benefits of using this approach, to draw on the experiences of six of the Children's Centers in using CBPR, and to provide lessons learned and recommendations for how to successfully establish and maintain CBPR partnerships aimed at enhancing our understanding and addressing the multiple determinants of children's health.

Integrated pest management in an urban community: a successful partnership for prevention.

Pesticides, applied in large quantities in urban communities to control cockroaches, pose potential threats to health, especially to children, who have proportionately greater exposures and unique, developmentally determined vulnerabilities. Integrated pest management (IPM) relies on nonchemical tools--cleaning of food residues, removal of potential nutrients, and sealing cracks and crevices. Least toxic pesticides are used sparingly. To evaluate IPM's effectiveness, the Mount Sinai Children's Environmental Health and Disease Prevention Research Center, in partnership with two community health centers in East Harlem, New York City (NY, USA), undertook a prospective intervention trial. Families (n = 131) enrolled when mothers came to the centers for prenatal care. Household cockroach infestation was measured by glue traps at baseline and 6 months afterward. The intervention group received individually tailored IPM education, repairs, least-toxic pest control application, and supplies, with biweekly pest monitoring for 2 months and monthly for 4 months. The control group, residing in East Harlem and demographically and socioeconomically similar to the intervention group, received an injury prevention intervention. The proportion of intervention households with cockroaches declined significantly after 6 months (from 80.5 to 39.0%). Control group levels were essentially unchanged (from 78.1 to 81.3%). The cost, including repairs, of individually tailored IPM was equal to or lower than traditional chemically based pest control. These findings demonstrate that individually tailored IPM can be successful and cost-effective in an urban community.

Desarrollo de un instrumento para medir la calidad de vida en pacientes con insuficiencia renal crónica y diálisis. Una experiencia en Honduras / Development of an instrument to measure quality of life in patients with chronic renal failure and dialysis. An experience in Honduras

ANTECEDENTES. La insuficiencia renal crónica (IRC) impacta severamente en la calidad de vida del paciente, sin embargo no existe un instrumento uniforme que la evalúe. OBJETIVO. Determinar el impacto de la IRC en la vida de los pacientes hospitalizados para diálisis peritoneal en el Hospital Escuela durante el primer semestre del año 2000. El instrumento evalúa 11 áreas de la vida (emocional, social, laboral, económica, familiar, conyugal, independencia, función cognitiva, energía, efectos secundarios de la diálisis y calidad de vida en general). se siguió los lineamientos de la Organización Mundial de la Salud para el diseño de las escalas de calidad de vida, así como otros parámetros de otras escalas utilizadas internacionalmente para otras enfermedades. RESULTADOS. Se encontró que la IRC impacta todos los aspectos evaluados, especialmente en las áreas social (83), laboral (77), económica y cognitiva (75 cada una) y emocional (73). eL 30.2 calificó su calidad de vida en el último mes como mala, el 41.5 la calificó como regular, el 26.4 de buena y el 1.9 como muy buena. La vida familiar se afecta importantemente en varios aspectos. CONCLUSION. Se encontro que el cuestionario fue comprensible e internamente consistente. La mayoría de los pacientes manifestó afectación en importantes áreas de su vida, por lo que se requiere un manejo integral del problema.