Residents' Perspectives of Pregnancy and Growing a Family During Surgical Training: A Review of the Literature.

As more female surgical residents choose to start families during training, concerns regarding program support and peer perceptions emerge. Delayed parenthood, stress, and even attrition can result from inadequate support systems. Database search (MEDLINE, PubMed, EMBASE) in June 2022 identified 17 relevant studies published between 2012-2022, including systematic reviews and qualitative surveys, focused on surgical residents/fellows and program directors. The thematic analysis explored themes related to supporting residents navigating parenthood. Thematic analysis of 17 studies (systematic reviews and qualitative surveys with residents/fellows and program directors) identified key recurring themes related to challenges experienced by surgical residents navigating parenthood. The themes included modified work schedules, mentorship programs, cross-coverage plans, lactation support, childcare options, and clear leave policies. By understanding these challenges and implementing tailored support strategies, surgical residency programs can foster a more inclusive and supportive environment for residents starting families. This can improve resident well-being, reduce attrition, and create a significantly more enjoyable training experience for all involved. This review aims to provide insight into residents' difficulties while pregnant or considering pregnancy and identify changes programs could implement to promote a more supportive culture for pregnant residents.

Adenocarcinoma of the Breast Presenting as Occult Breast Cancer With Axillary and Supraclavicular Lymph Node Metastasis: A Case Report.

Breast cancer is a leading cause of cancer-related mortality in women, with over 250,000 new cases diagnosed annually in the United States. Although mortality rates have decreased, breast cancer remains the second most common cause of cancer death in women. Occult breast cancer (OBC), a rare form of breath cancer that typically presents as axillary lymphadenopathy with no evidence of primary disease, accounts for less than 1% of all breath cancer diagnoses. To date, only three cases of OBC treated with radical mastectomy have been documented in the literature. This case presents a 76-year-old female with a benign left breast mass who was subsequently diagnosed with metastatic estrogen receptor/progesterone receptor (ER/PR)-positive ductal cell breast carcinoma after a visible axillary lymph node was detected on follow-up imaging. Due to the rarity of OBC, standardized treatment guidelines have not been established. Our patient underwent a left radical mastectomy with axillary and cervical lymph node dissection. Clinicians should maintain a high index of suspicion for biopsying axillary lymph nodes in females without evidence of breast malignancy, even though OBC has a low incidence rate. This case report aims to present a documented case of OBC and comprehensibly review the existing literature, discussing the available diagnostic and treatment approaches for this condition. We describe the case of a 76-year-old woman referred to surgery consultation due to a mammographic finding of a left superior lateral mass. The mass was biopsied and found to have no malignancy. On follow-up imaging, she was found to have a left axillary lymph node visible. Her only complaints at this time were breast tenderness and swelling. She underwent fine needle aspiration of the mass, which showed atypical cells that led to an excisional biopsy of the detected axillary node. The biopsy pathology report showed ER/PR-positive ductal cell breast carcinoma. The patient underwent left modified radical mastectomy with left axillary and cervical lymph node dissection. It was during this procedure that the pathology report revealed a 2 cm lesion on the left breast that showed ER/PR-positive infiltrating ductal carcinoma with 32 out of the 37 lymph nodes positive for metastatic disease. This case illustrates the importance of having a low imaging threshold in patients with vague breast symptoms. Surgeons should have a high level of suspicion when metastatic breast cancer is found, even if there is no clinical or radiographic evidence of a primary lesion. This includes conducting lymph node biopsies in patients who present with lymphadenopathy without the initial presence of primary breast cancer. Many studies agree that a modified radical mastectomy with lymph node recession is the treatment of choice for metastatic breast cancer without evidence of primary lesion. However, the efficacy of adjuvant treatments like radiation therapy or chemotherapy should be further studied.

Oral Microbiome as a Tool of Systemic Disease on Cleft Patients: A New Landscape.

The oral cavity microbiome comprises benign and pathogenic bacteria, with more than 700 species identified. However, the current literature regarding resident bacterial flora in the oropharyngeal cavities in cleft lip/palate (CLP) patients still needs to be completed. This review aims to evaluate the role of the oral microbiome of cleft patients as an indicator in systemic diseases for which cleft patients might be at higher risk in the short or long term. A literature review was performed in July 2020 using Biomedical Reference Collection Comprehensive, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Dentistry & Oral Sciences Source via Elton B. Stephens Company/Online Database (EBSCO), Turning Research into Practice (TRIP), and PubMed. The keywords used were "oral, bacteria, microbiome, biota, flora, cleft, palate." The resulting 466 articles were deduplicated using Endnote. The total amount of articles' abstracts without duplicates was filtered using a set criterion. The title and abstract filter criteria included 1) cleft lip (CL) and/or cleft palate (CP) patients, 2) changes in the oral microbiome in CL and/or CP patients, 3) male and female patients 0-21 years old, and 4) English language. The full-text filter criteria included 1) CL and/or CP patients vs. non-cleft control patients, 2) oral bacteria, 3) nonprocedural measurements of microorganisms, and 4) case-control studies. A Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) flow chart was created using the EndNote data results. The final five articles of the systematic search indicated that the oral cavity of cleft lip and/or palate patients resulted in 1) contradicting levels of Streptococcus mitis and Streptococcus salivarius; 2) lower levels of Streptococcus gordonii, Bordetella dentium, Fusobacterium nucleatum, Veillonella parvula, Bacillus and Lautropia when compared to the control group; 3) higher levels of Staphylococcus epidermidis and Methicillin-sensitive Staphylococcus aureus compared to the control group; 4) presence of Enterobacter cloacae 36.6%, Klebsiella pneumoni 53.3%, and Klebsiella oxytoca 76.6% vs. absence in the control non-cleft group. Patients with CL and/or CP are at higher risk for caries, periodontal diseases, and upper and lower respiratory infections. The results from this review indicate that relative levels of certain bacteria may be associated with these issues. The lower levels of S. mitis, S. salivarius, S. gordini, and F. nucleatum in the oral cavity of cleft patients could be linked as a possible cause of the higher incidence of tooth decay, gingivitis and periodontal disease as high levels of these bacteria are associated with oral disease. Further, the higher incidence of sinusitis in cleft patients might be linked to low levels of S. salivarius in the oral profile of these patients. Likewise, E. cloacae, K. oxycota, and K. pneumoni have been linked with pneumonia and bronchiolitis, both of which are increased in cleft patients. The oral bacterial dysbiosis of cleft patients observed in this review may play a vital function in the oral microbiome's diversity, which could play a role in disease progression and disease markers. The pattern seen in cleft patients potentially demonstrates how structural abnormalities can lead to the onset of severe infection.

Cathepsin K inhibition preserves compressive load in lumbar vertebrae of osteoporotic monkeys.

Anti-resorptive drugs treat bone loss by blocking osteoclast activity through a variety of mechanisms of action. Once significant bone loss has occurred, the ability to restore biomechanical function may differ based on the drug chosen. To assess this question, bisphosphonate (alendronate, ALN) and cathepsin K inhibitor (MK-0674, CatKi) were employed in treatment mode to compare the relative changes to cancellous bone microstructure and mechanical properties in ovariectomized (OVX) cynomolgus monkeys. Lumbar vertebrae (LV) bone mineral density (BMD) values taken two years post-surgery prior to drug treatment show a 10-15% decrease (p < 0.05) for all OVX animals. OVX animals were then treated with vehicle (VEH), ALN (0.03 mg/kg weekly), or CatKi MK-0674 (0.6 or 2.5 mg/kg daily, CatKi-L and H respectively) for two years and compared to a control Sham surgery group. Ex-vivo microcomputed tomography (µCT) of LV2 and compression testing of LV4-6 were used to measure cancellous bone microstructure and changes in bone mechanics, respectively. After two years of treatment, ALN-treated animals showed no significant difference in µCT or biomechanical parameters when compared to Veh. However, treatment with CatKi-H resulted in a 30% increase in yield and peak loads, and apparent peak and yield stress as compared to Veh (p < 0.05) and gave average mechanical values greater than the Sham sample. Treatment with CatKi-L exhibited a similar trend of increase to CatKi-H (p < 0.08). Intriguingly, these changes were realized despite no significant differences in mean values of trabecular bone morphologic parameters. Together these data suggest matrix-level changes in bone composition that are unique to the CatK inhibition mechanism, resulting in the preservation of bone compressive load with treatment.

Proteomic definition of human mucosal-associated invariant T cells determines their unique molecular effector phenotype.

Mucosal-associated invariant T cells (MAIT) constitute the most abundant anti-bacterial CD8+ T-cell population in humans. MR1/TCR-activated MAIT cells were reported to organize cytotoxic and innate-like responses but knowledge about their molecular effector phenotype is still fragmentary. Here, we have examined the functional inventory of human MAIT cells (CD3+ Vα7.2+ CD161+ ) in comparison with those from conventional non-MAIT CD8+ T cells (cCD8+ ) and NK cells. Quantitative mass spectrometry characterized 5500 proteins of primary MAIT cells and identified 160 and 135 proteins that discriminate them from cCD8+ T cells and NK cells donor-independently. Most notably, MAIT cells showed a unique exocytosis machinery in parallel to a proinflammatory granzyme profile with high levels of the granzymes A, K, and M. Furthermore, 24 proteins were identified with highest abundances in MAIT cells, including CD26, CD98, and L-amino-oxidase (LAAO). Among those, expression of granzyme K and CD98 were validated as MAIT-specific with respect to non-MAIT CD8+ effector subsets and LAAO was found to be recruited together with granzymes, perforin, and CD107a at the immunological synapse of activated MAIT cells. In conclusion, this study complements knowledge on the molecular effector phenotype of MAIT cells and suggest novel immune regulatory functions as part of their cytotoxic responses.

Estructura factorial, confiabilidad y validez de la prueba de percepción del funcionamiento familiar en adultos angolanos / Factor-related structure, reliability and validity of the perception test of family functioning in Angolan adults

Introducción: la familia constituye el espacio por excelencia para el desarrollo del hombre, en el contexto es necesario angolano la existencia de pruebas validadas que permitan su evaluación. Objetivo: validar la Prueba de Percepción del Funcionamiento Familiar para la población angolana. Método: se efectuó un estudio instrumental, bajo un paradigma cuantitativo, con una muestra de 326 sujetos seleccionados aleatoriamente. El procesamiento de datos se llevó a cabo mediante el paquete estadístico SPSS/Windows 21.0, aplicándose el coeficiente Alpha de Crombach y el Análisis Factorial Exploratorio. Resultados: se reveló el ajuste a un solo factor de la prueba que explicó el 36,52 por5 ciento de la varianza acumulada, además de excelentes comunalidades y una elevada consistencia interna. Conclusiones: puede afirmarse que la prueba posee adecuadas propiedades psicométricas, permitiendo la evaluación del constructo funcionamiento familiar en la población angolana(AU)

Introduction: The family constitutes the space per excellence for the man's development; in the Angolan context, the existence is necessary of validated tests that permit its assessment. Objective: Validate the perception test of family functioning for the Angolan population. Methods: An instrumental study with a qualitative paradigm was carried out on a sample of 326 individuals randomly chosen. Data processing was performed using the statistical package SPSS in Windows 21.0, applying the Cronbach's Alpha and exploratory factor analysis. Results: An adjustment to one factor only was shown for the test, which explained the 36.52 percent of accumulated variance, as well as excellent communalities and a high internal consistency. Conclusions: We can affirm that the test has adequate psychometric properties, which permits assessing the family functioning construct in the Angolan population(AU)

Particularidades del afrontamiento familiar al niño con diagnóstico y rehabilitación por parálisis cerebral / Particularities of the family coping with a child diagnosed as cerebral palsy patient and under rehabilitation

Introducción: la parálisis cerebral es considerada la primera causa de invalidez en la infancia, afecta la organización familiar y la inserción social. Requiere rehabilitación prolongada y una intensa labor de cuidados para mejorar la calidad de vida del menor. Objetivo: describir las particularidades del afrontamiento familiar ante el diagnóstico y rehabilitación de niños con parálisis cerebral. Métodos: estudio descriptivo transversal de tipo cualitativo. La unidad de análisis fue la familia. Se realizaron entrevista en profundidad a familiares de los pacientes, niños 0 a 4 años de edad ingresados en el Hospital de Rehabilitación Julio Díaz González en el 2013. Se indagó el comportamiento familiar ante el diagnóstico de la enfermedad y el proceso de rehabilitación. Para el procesamiento de datos se empleó el enfoque de análisis en progreso de Taylor-Bogdan. Resultados: las regularidades establecidas a partir de las configuraciones emergentes especificaron el afrontamiento a la enfermedad de las familias estudiadas: duda, búsqueda de información, esfuerzo familiar, contradicciones en la reorganización de la vida en el hogar, demanda de apoyo y agotamiento familiar. Conclusiones: el afrontamiento familiar está transversalizado por un eje motivacional. El balance familiar, entre las expectativas de mejora de la situación de salud del niño, su lenta evolución en el proceso de rehabilitación y el sobreesfuerzo que representa enfrentar la discapacidad del menor en el contexto de la vida cotidiana, provoca el tránsito gradual desde un afrontamiento familiar motivado a uno desmotivado. Tal comportamiento potencializa una acción destructiva en la salud del grupo familiar(AU)

Introduction: cerebral palsy is considered as the first cause of disability in childhood, but it also affects family organization and social insertion. It requires rehabilitation for long time and intensive care to improve the quality of life of a child. Objective: to describe the particularities of the family coping with the child diagnosed as cerebral palsy patient under rehabilitation. Methods: qualitative-type descriptive and cross-sectional study in which the unit of analysis was the family. In-depth interviews were made to families of patients aged 0 to 4 years, who were admitted to "Julio Diaz Gonzales" rehabilitation hospital in 2013. The family behaviors in facing the diagnosis of the disease and the process of rehabilitation were ascertained. For the data processing, the Taylor-Bogdam's in-progress analysis approach was used. Results: the set regularities from the emerging configurations characterize the family coping with the disease: doubts, search for information, family efforts, contradictions in family life reorganization at home, demand for support, family worn-out. Conclusions: the family coping is being crossed by a motivational axis. The family balance, the expectations for improvement of the child's health situation, the slow progress of the rehabilitation process and the extreme efforts that are needed to face the disability of a child in everyday life brings about the gradual transition from motivated to demotivated family coping. This behavior potentiates harmful actions affecting the health of the family group(AU)

Bosquejo del desarrollo de la psicología y su relación con la salud en Cuba 1900-1958 / Outline of psychology development and its relationships with health in Cuba in the 1900-1958 period

El objetivo de este trabajo es describir algunos antecedentes de la psicología en Cuba relacionados con la salud. Se utilizaron los métodos heurístico, hermenéutico y de la historia crítica; la consulta de fuentes primarias y secundarias de información así como testimonios de los autores. Se consultó bibliografía en bibliotecas públicas y privadas, hemerotecas, centros de información y en Internet. Se obtuvo una descripción documentada y crítica de los orígenes de la psicología y su relación con la salud en Cuba durante el periodo de 1900-1958, los escenarios de formación, algunos profesionales destacados en lo científico y lo político así como las teorías y explicaciones del papel de lo psicológico en la determinación de la salud, la afiliación a paradigmas de las ciencias, publicaciones, los primeros puntos de encuentro de la psicología o de los psicólogos relacionados con la salud en Cuba así como los inicios de la enseñanza de la psicología hasta la fundación de las primeras escuelas. Se concluye que existió un determinado nivel de desarrollo de la psicología clínica y psicopedagógica en el periodo estudiado, que predominó el positivismo como concepción teórica aunque existieron algunos críticos a esta corriente y al mercantilismo en la salud, proveniente de la influencia norteamericana durante la república mediatizada. Las personalidades relevantes descritas posibilitaron la posterior formación masiva de psicólogos que constituyen antecedentes del surgimiento de la psicología de la salud en Cuba en la década de los 60 del siglo XX(AU)

The objective of this paper is to describe some antecedents of psychology related to health in Cuba. The heuristics, hermeneutic and critical history methods were used in addition to consulting primary and secondary data sources and authors´ testimonies. Bibliography found in public and private libraries, newspaper and periodical archives, information centers and Internet was reviewed. There was obtained documented critical description of the origins of psychology and its relationship with health in Cuba in the 1900-1958 period, the formative settings, some outstanding professionals in the scientific and the political fields as well as theories and explanations about the role of the psychological elements in determination of health, about the affiliation to paradigms of sciences; publications, the first points of meeting of psychology and of psychologists related to health in Cuba, and the beginning of psychology teaching in Cuba until the foundation of the first schools. It was concluded that there was certain level of development of clinical and psychopedagogic psychology in the studied period when positivism prevailed as a theoretical concept, although there were some people who criticized this trend and health mercantilism as a result of the US influence before 1959. The outstanding personalities described in this paper made the subsequent massive formation of psychologists possible, which represent antecedents of the emergence of health psychology in Cuba in the 60´s of the 20th century(AU)

Principales características psicosociales de adolescentes con intento suicida / Major Psychosocial Characteristics of Adolescents with Suicide Attempt

Introducción: la investigación sobre el intento suicida en la adolescencia reviste mayor importancia, por la inmadurez, vulnerabilidad psicológica y las particularidades de la relación familiar. Objetivo: describir el acto suicida y las características socio familiares y psicológicas de los adolescentes que intentaron contra su vida. Métodos: se realizó estudio descriptivo transversal con los 23 adolescentes atendidos por intento suicida en el Centro de Salud Mental de Playa Baracoa, Artemisa, en el período 2008 ­ 2011. Se utilizaron las técnicas: entrevista semiestructurada, encuesta de declaración obligatoria para el intento suicida, inventario de problemas juveniles, una composición sobre "Mi mayor problema", la prueba de percepción de funcionamiento familiar FF ­ SIL y el inventario de ansiedad y depresión rasgo - estado para niños y adultos. Se contó con el consentimiento informado, se respetó la confidencialidad de la información, la privacidad y el anonimato. Resultados: el método más utilizado por los adolescentes para el intento suicida fue la ingestión de medicamentos combinados y no abundó la recurrencia del acto. La frecuencia mayor fue en las adolescentes mujeres, de piel blanca, entre los 16 y 19 años que proyectaron subvaloración, marcada ansiedad y depresión; viven en áreas urbanas con bajos ingresos económicos, en malas condiciones materiales de la vivienda, en familias reconstituidas y disfuncionales(AU)

Introduction: Researching on adolescent suicide attempt is of greater importance due to immaturity, psychological vulnerability, and the peculiarities of family relationship. Objective: Describe the suicidal act, family and socio- psychological characteristics of those adolescents who attempted on their life. Methods: a descriptive study was conducted with 23 adolescents treated for suicide attempt at the Mental Health Center in Playa Baracoa, Artemisa, from 2008 to 2011. Several techniques were used such as semi-structured interview, survey for notifiable to the suicide attempt, a short essay on "My biggest problem", test of family functioning perception FF ­ SIL, and inventory on trait anxiety and depression - state for children and adults. Informed consent was obtained. Confidentiality of information, privacy and anonymity was respected. Results: the method mostly used by adolescents for their suicidal attempt was combined ingestion of drugs and it did not elaborate recurrence of the act. The highest frequency was in white-skinned adolescent women, aging 16 and 19 who projected undervaluation, marked anxiety, and depression; they live in urban areas with low income, poor housing conditions, reconstituted and dysfunctional families(AU)

Implicaciones familiares y sanitarias del envejecimiento poblacional en la cobertura universal / Familial and health implications of the population aging for the universal health coverage

El movimiento de cobertura sanitaria universal llama la atención a los gobiernos del mundo, sobre el derecho a la salud para todos los estratos sociales y los grupos más vulnerables. El objetivo es examinar las implicaciones familiares y sanitarias del proceso de envejecimiento de la población cubana que constituyen desafíos para el sostenimiento de la cobertura de salud con calidad. Se hizo análisis e interpretación crítica de indicadores de salud seleccionados y de resultados de investigaciones revisadas. Resultados. Las políticas de salud, los logros que ilustran los indicadores de salud en Cuba, dan cuenta de las fortalezas de la CSU en Cuba, y de la protección a la salud del adulto mayor. El proceso de envejecimiento poblacional tiene serias implicaciones a la sociedad, al sistema de salud y a la familia. La prolongación de la vida, el incremento de la morbilidad y la discapacidad, unido a las políticas de equidad y justicia social, elevan las demandas de atención a los ancianos en el hogar y la necesidad de servicios. No obstante, la voluntad política, ciertas condiciones sociales, económicas y organizativas, rebasan la capacidad resolutiva del sistema de salud y de la asistencia social que requieren las personas de edad avanzada, lo que genera desafíos importantes para mantener la cobertura con calidad, la sostenibilidad del sistema y la satisfacción de los usuarios y sus familias(AU)

The universal health coverage movement appeals to the governments of the world to recognize the right to health for all the social strata and for the most vulnerable groups. The objective of the paper was to examine the familial and health implications of the Cuban population aging that represent real challenges for the sustainability of the quality health coverage. Critical analysis and interpretation of the selected health indicators and of the results of reviewed research studies were made. The health policies and the achievements shown in the health indicators of Cuba prove the advances in terms of the universal health coverage and protection of the older adult's health. The population aging process has serious implications for the society, the health system and the family. Longer lifespan, increase of morbidity and disability rates together with the equity and social justice policies raise the demands for care of the elderly at home and for services. Despite the political willingness of the government, certain economic, social and organizational conditions exceed the capacities of the health system to find solutions for and the social assistance required by the aged persons, which creates huge challenges to keep quality coverage, sustainability of the system and the meeting of requirements from the users and their families(AU)

Addition of mesalazine for subclinical post-surgical endoscopic recurrence of Crohn's disease despite preventive thiopurine therapy: A case-control study.

BACKGROUND AND AIM: Thiopurines prevent Crohn's disease (CD) endoscopic recurrence (ER) at least in 50% of patients 1 year after surgery. This study aimed to evaluate the value of adding mesalazine in patients with subclinical ER despite preventive thiopurine therapy. METHODS: Crohn's disease patients with ileocecal resection treated with thiopurines for postsurgical recurrence prevention in whom mesalazine was added (cases) to treat ER without clinical recurrence (CR) were identified and compared with those in whom no treatment was added to thiopurines (controls). All patients were followed up for at least 1 year from the index endoscopy. Development of CR as well as evolution of mucosal lesions was evaluated. RESULTS: Thirty-seven patients were included (19 cases and 18 controls). Initial Rutgeerts' score was i2 in 16 patients (9 cases and 7 controls), and i3 in 21 patients (10 cases and 11 controls). After a median clinical follow-up of 59 months (interquartile range 22-100) from the index endoscopy, six cases (32%) and two controls (11%) developed CR (P = 0.2). After a median time to last endoscopic follow-up of 23 months (interquartile range 17-71), 18 patients (49%) showed improvement in Rutgeerts' score, 11 patients (30%) demonstrated progression of mucosal lesions, and 8 (22%) had no changes, with no differences between study groups. CONCLUSIONS: The addition of mesalazine seems to be of no benefit in patients with subclinical endoscopic recurrence while on thiopurine prevention. Moderate endoscopic postsurgical recurrence while on thiopurines may even revert with no additional therapy in some patients.

Afrontamiento familiar a la epilepsia / Family coping with epilepsy

Introducción: el afrontamiento familiar a la epilepsia se refiere al comportamiento grupal relativamente estable que exhibe una familia ante la presencia de esta enfermedad en uno de sus integrantes. Objetivo: describir las características del afrontamiento familiar a la epilepsia. Métodos: investigación descriptiva de corte transversal realizada en pacientes y familiares que acudieron a la consulta multidisciplinaria de epileptología del Hospital Psiquiátrico de La Habana entre 2005 y 2007. Para la recogida de la información se aplicó al paciente la escala de historia familiar del Washington Psichosocial Inventory y la prueba de evaluación de las relaciones intrafamiliares. Se realizaron entrevistas no estructuradas a un informante clave del grupo familiar de convivencia del paciente. Resultados: a pesar de que la mayoría de los pacientes estudiados refirieron una adaptación familiar aceptable a su enfermedad, se obtuvo un predominio de familias disfuncionales. La categoría Valoración positiva de la sobreprotección familiarconstituyó el dato cualitativo de mayor relevancia en el análisis de contenido de las entrevistas con el informante clave del grupo familiar. Conclusiones: los pacientes epilépticos perciben la presencia de problemas en su historia familiar, aunque la atribución de significado varía entre un limitado y un claro impacto para la adaptación familiar, lo cual puede ser un indicativo de la idealización de la familia en la infancia. Las relaciones intrafamiliares de convivencia actual se perciben disfuncionales, lo cual se expresa a través de las dificultades en el cumplimiento de los roles, la armonía y la comunicación

Introduction: the family confrontation to the epilepsy refers to the group behavior relatively stable that exhibits a family in connection with the presence of this illness in one of its members. Objective: to describe the characteristics from the family coping with epilepsy. Methods: this is a descriptive investigation of traverse court in patients that suffer it assisted in the consultation multidisciplinary of Epileptology of the Psychiatric Hospital of Havana 2005-2007. For the collection of the information the Scale of Family History of Washington Psichosocial Inventory (HFS-WPSI) and the Test of evaluation of the relationships interfamily (FF-SIL) was applied to patients. We also apply the not structured interview to a key informant of the family group of the patient's coexistence. Results: although most of the studied patients referred a family acceptable adaptation to their illness, a prevalence of non functional families was obtained. The category positive Positive valuation of the family too much protection constituted the qualitative fact of more relevance in the analysis of content of the Interview to a key informant of the family group. Conclusions: the epileptic patients perceive the presence of problems in their family history, although the meaning attribution varies between a limited one and a clearing impact for the family adaptation, that which can be an indicative of the idealization of the family in the childhood. The relationships inside the family of current coexistence are perceived dysfunctional, what is expressed through the difficulties in the execution of the lists, the harmony and the communication

Addition of metronidazole to azathioprine for the prevention of postoperative recurrence of Crohn's disease: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: Endoscopic recurrence occurs in up to 80% of patients with Crohn's disease 1 year after intestinal resection. Imidazole antibiotics, thiopurines, and particularly their combination have proven efficacy in preventing endoscopic recurrence. The aim of the study was to compare the efficacy of the addition of metronidazole (for 3 months after the surgical treatment) to azathioprine for the prevention of postsurgical endoscopic recurrence. METHODS: A pilot study was made of 50 patients with Crohn's disease undergoing intestinal resection with ileocolic anastomosis and treated with 2 to 2.5 mg/kg of azathioprine per day for 1 year. The patients were randomized to receive additional 15 to 20 mg/kg of metronidazole per day or placebo for the first 3 months (n = 25 per arm). Endoscopic assessment was performed 6 and 12 months after the surgical resection. The primary end point was the prevention of endoscopic recurrence as defined by a Rutgeerts score of <2 at 6 months. The initial sample size had an 80% statistical power in detecting an absolute risk reduction of ≥30%. RESULTS: Endoscopic recurrence occurred in 28% and 44% of the patients at 6 months (P = 0.19) and in 36% and 56% (P = 0.15) at 12 months in the metronidazole and placebo groups, respectively. No statistically significant differences were found between the treatment groups regarding severe endoscopic recurrence (Rutgeerts score ≥ 3) at 6 and 12 months. Likewise, there were no differences in the rate of adverse events between the treatment groups. CONCLUSIONS: The addition of metronidazole to azathioprine did not significantly reduce the risk of endoscopic recurrence beyond azathioprine alone in this study but does not worsen its safety profile.

Ejecución del Programa de Prevención y Control de la Conducta Suicida en Nueva Paz / Implementation of the Prevention and Control Program of Suicidal Behaviours in Nueva Paz municipality

Introducción: el suicidio se ubica entre las 10 primeras causas de muerte en el mundo. La OMS estima que al menos 1 110 personas se suicidan cada día y lo intentan cientos de miles, independientemente de la geografía, cultura, religión, etnia, y alerta además, sobre el incremento de las tasas de suicidio como una tendencia creciente sobre todo en la población joven. Objetivo: valorar la ejecución del Programa de Prevención y Control de la Conducta Suicida en el municipio de Nueva Paz en el año 2010. Métodos: estudio descriptivo y transversal. Se aplicaron cuestionarios, entrevistas, guías de observación y exploración de conocimientos sobre el Programa por un grupo de 65 trabajadores de la salud. Se establecieron criterios, indicadores y estándares para la evaluación de las variables de estructura, proceso y resultado. Resultados: el suicidio ocupó la séptima causa de muerte en el municipio y los intentos suicidas incidieron en el sexo femenino y en los grupos de 60 años y más y de 10 a 19 años. No existió un adecuado funcionamiento del Centro Comunitario de Salud Mental ni de los Equipos de Salud Mental. No se realizaron actividades de capacitación sobre el Programa y eran insuficientes los conocimientos para ejecutarlo. Las tarjetas de Enfermedades de Declaración Obligatoria carecían de calidad y el flujo de información era inadecuado. Se realizaba una deficiente dispensarización de los pacientes, en lo que incidía la baja calidad de la primera consulta, la no realización de interconsultas y la no periodicidad establecida en las visitas de terreno. Conclusiones: las deficiencias encontradas en la estructura y el proceso conllevaron a que la ejecución del Programa de Prevención y Control de la Conducta Suicida en Nueva Paz en el 2010, fuera inadecuada.

Introduction: suicide is one of the 10 first causes of death worldwide. The World Health Organization estimates that at least one thousand and one hundred ten (1 110) people commit suicide every day and other hundreds of thousands attempted suicide, regardless of geography, culture, religion and race, and this organization also alerts to the increase of suicidal rates as a growing trend in the young population. Objective: to assess the implementation of the program of prevention and control of suicidal behavior in Nueva Paz municipality in 2010. Methods: cross-sectional and descriptive study. A group of 65 health workers administered questionnaires, interviews, observational guides and knowledge exploration guides about the Program. Criteria, indicators and standards for the evaluation of structure, process and outcome variables were set. Results: suicide was the 7th cause of death in the municipality and the attempted suicides had an incidence on the females and on the 60 years and over group and on the 10-19 years-old group. Neither the community center of mental health nor the mental health teams worked properly. Training activities on the program were not carried out and the knowledge for its implementation was really poor. The compulsory notification disease cards lacked good quality and the flow of information was inadequate. The classification of patients was deficient due to low quality of the first doctor's consultation, the non compliance with inter-consultation schedules and the irregular visits paid to the patients' houses Conclusions: the problems found in the structure and in the process led to the negative evaluation of the implementation of the program of suicidal behavior prevention and control in Nueva Paz municipality.

Afrontamiento familiar a la drogodependencia en adolescentes / The family facing up to drug dependency in adolescents

Objetivo Describir el afrontamiento familiar a la drogodependencia en adolescentes atendidos en el Centro de Deshabituación de Adolescentes en La Habana, 2009. Métodos Investigación descriptiva de corte transversal realizada en el 2009 en el contexto de la mencionada institución, sitio donde se ofrece un servicio multidisciplinario e integral dirigido a tratar la drogodependencia y sus complicaciones en adolescentes y jóvenes. La exploración del afrontamiento familiar a la enfermedad se realizó mediante entrevistas en profundidad. La unidad de análisis en la investigación fue el grupo familiar de convivencia de los pacientes drogodependientes. La fuente de información fue primaria a partir de la selección de un informante clave de la familia. El amplio volumen de datos recolectados fue procesado siguiendo el algoritmo propuesto por Taylor-Bogdan. Resultados Emergieron categorías de análisis, conceptos y proposiciones a través de los cuales se perfiló la descripción de un afrontamiento familiar a la drogodependencia desde antes de ser confirmada la enfermedad, hasta el momento del estudio. Sobresalió la figura materna, como moderadora de la relación de los familiares con el hijo enfermo en diferentes momentos de la vida de este, comportamientos familiares de justificación y encubrimiento de conductas relacionadas con el consumo de drogas de los adolescentes, percepción familiar de pérdida de control así como comportamientos de negación de responsabilidad familiar con la enfermedad del paciente y su tratamiento. Conclusiones Se identificó un estilo de Afrontamiento Familiar Evasivo a la drogodependencia, comportamiento grupal predominante, manifiesto ante las situaciones relacionadas con la historia del consumo de sustancias en los adolescentes, en el tránsito de la salud a la enfermedad

Objective To describe the various ways in which the family faces up to drug dependency in teenagers seen at the Havana's Center for Treatment of Drug Dependency in Adolescents. Methods Cross-sectional descriptive research study conducted in this institution in 2009, a place where a comprehensive multidisciplinary service is offered to treat drug dependency and its complications in adolescents and young people. The exploration of the various ways in which the family faced up to this problem was based on in-depth interviews. The analytical unit was the group of relatives living with the drug-dependent patients. The primary source of information was the chosen family key informant. The wide range of data was processed by the Taylor-Bogdanïs algorithm. Results Several analysis categories, concepts and proposals emerged, which helped to make a description of the ways the family faced up to drug dependency before the confirmation of the disease up to the moment of the study. It could be observed that the mother prevailed as the regulator of the family relationships with the sick son/daughter at different times of his/her life; there were some family behaviours in favour of justifying and covering up actions associated to drug consumption by adolescents, the family perception of loss of control over them as well as the denial of family responsibility over the patient's disease and treatment. Conclusions This research identified a sort of evasive way of family facing up to drug dependency as well as predominant group behaviour before the situations linked to the history of substance consumption by adolescents in the process of transition from health to disease

Estrategia de preparación para la evaluación externa de maestrías / Preparation strategy for the external evaluation of master´s studies

OBJETIVO: Describir la estrategia de preparación para la evaluación externa de las maestrías de la Escuela Nacional de Salud Pública. MÉTODOS: Se revisaron los documentos normativos del posgrado para extraer la visión de excelencia y se aplicó la técnica grupo focal para la generación de ideas entre las coordinadoras de las maestrías. RESULTADOS: La estrategia de preparación para la evaluación externa se estructuró en tres fases denominadas: Planificación, Ejecución y Evaluación. En cada fase se identificaron momentos clave y acciones específicas articuladas mediante un proceso de control que actúa como eje transversal de la propia estrategia. CONCLUSIONES: Se relacionaron las fuentes de información necesarias. Las acciones desplegadas por los comités académicos tuvieron carácter científico, metodológico y administrativo. La estrategia utilizada tuvo carácter institucional y contribuyó al logro de la excelencia en las Maestrías de Atención Primaria de Salud, Economía de la Salud y Promoción y Educación para la Salud

OBJECTIVE: To describe the preparation strategy for the external evaluation of the Master´s courses in the National School of Public Health. METHODS: The normative documents of the postgraduate programs to take out the vision of excellence were reviewed and the focal group technique was used to generate ideas from the various coordinators of the master's courses. RESULTS:The preparation strategy for the external evaluation was structured in three phases, that is, planning, implementation and evaluation. Each phase identified key moments and specific actions that were integrated through a control process acting as a supporting point of the strategy as such. CONCLUSIONS: The necessary sources of information were listed. The actions taken by the academic committees were of scientific, methodological and administrative nature. The strategy was institutional and contributed to attain the excellence in master's courses in primary health care, health economics and health promotion and education

Caracterización de la salud familiar en familias de niños con éxito escolar / Characterization of health family members with school success children

Introducción: la salud familiar se concibe como la capacidad de la familia de cumplir con sus funciones, propiciar el desarrollo armónico de sus integrantes y afrontar constructivamente las crisis en determinado contexto. Objetivo: caracterizar la salud familiar en familias de niños con éxito escolar. Métodos: se realizó un estudio descriptivo, de corte transversal en 40 familias nucleares de niños con éxito escolar de las escuelas seminternas del área de salud del Policlínico Universitario 26 de Julio, del municipio Playa, en La Habana. Se utilizó como referente el modelo teórico metodológico para la evaluación de la salud familiar. Para la obtención de los datos se aplicaron las técnicas entrevista familiar, la prueba de percepción de funcionamiento familiar y el inventario de características familiares de riesgo. Resultados: el 77,5 por ciento de las familias fueron funcionales; contribuyeron fundamentalmente los procesos cohesión (77,5 por ciento de las familias respondió en la categoría "casi siempre"), comunicación (72,5 por ciento), armonía (67,5 por ciento) y afectividad (65 por ciento); en el 77,5 por ciento de las familias hubo criticidad nula o leve; el 95 por ciento de estas se agruparon en el primer cuadrante de la matriz de salud familiar. Conclusiones: prevaleció la funcionalidad familiar, a expensas de la cohesión, la comunicación positiva, la armonía y la expresión afectiva; la criticidad familiar fue baja; predominó la situación de ajuste familiar frente a las exigencias de la vida cotidiana; y los afrontamientos fueron orientados a la priorización de las exigencias escolares y a la estimulación de la autonomía en la actividad intelectual

Introduction: health in a family is its ability to fulfill the duties, to create a harmonic development of the family members and to face in a constructive way the crises in a specific context. Objective: to characterize the health family members with school success children. Methods: a cross-sectional and descriptive study was conducted in 40 family nuclei of school success children from semi-internal centers of 26 de Julio University Polyclinic health area in the Playa municipality in La Habana. The theoretical and methodological model was used as reference to assess the family health level. To data collection were applied the techniques of family interview, the perception test of family performance and the risk family characteristic inventory. Results: the 77,5 percent of family were functional; contributing mainly with cohesion processes (the answer in the 77,5 percent of family was of "almost always"), communication (72,5 percent), harmony (67,5 percent) and affectivity (65 percent) and in the 77,5 percent of families there was not criticism if any it was slight; the 95 percent of these families were grouped within the first quadrant of family health matrix. Conclusions: there was predominance of family functional qualities at the expense of cohesion, a positive communication, harmony and the affective expression; the family criticism was low and predominance of a situation of family adjustment in face of the daily life demands and the facing were directed to priority of school demands and the autonomy stimulation in intellectual activity

Manual de evaluacion y orientacion para la salud familiar / Manual evaluation and guidance for family health

El Manual de Intervención en Salud Familiar es valorado muy positivamente por sus destinatarios, fundamentalmente personal médico, de enfermería y psicología, dada su pertinencia para la atención psicosocial familiar en el contexto de salud. Es utilizado, además, para la formación de pre y postgrado de profesionales de la salud y de otros universitarios relacionados con el estudio de la familia, así como en la investigación con efoque familiar. Las experiencias de trabajo asistencial, docente, gerencial y de investigación de un grupo de los autores y consultores de Manual de Intervención en Salud Familiar, en la última década, confluyen en el valor que se le confiere al Manual, y en la necesidad de su actualización, ante los avances de la investgación en la familia y el perfeccionamiento de la Estretategia de la Atención Primaria de Salud en Cuba. Con el propósito de lograr una mayor adecuación del Manual a los procedimientos que requiere la confección de la Historia de Salud Familiar y el Análisis de la Situación de Salud, con la participación familiar tanto en la evalaución como en el Plan de Acción.