Diversity, equity, and inclusion in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy Position Statement.

1: The European Society of Gastrointestinal Endoscopy (ESGE) adheres to the overarching principles of equality of opportunity, fair treatment, nondiscrimination, and diversity of health care professionals. 2: ESGE strongly supports the creation of collaborations within and between national and international endoscopy societies to disseminate the principles of diversity, equality, and inclusion (DEI) in the field of gastrointestinal (GI) endoscopy. 3: ESGE aims to reflect the diversity of its membership in all its scientific and educational activities. 4: ESGE supports the fostering of collaborative work settings that empower all members of the endoscopy team to reach their full potential. 5: ESGE supports international and national endoscopy societies in promoting equitable access to high quality endoscopy training. 6: ESGE recommends the implementation of ergonomic principles in endoscopy units to prevent injuries and to provide adapted workplace conditions for personnel with disabilities and/or special needs. 7: ESGE recommends comprehensive mentorship, that includes diverse backgrounds, and equitable sponsorship for professional development, training, and academic excellence. 8: ESGE recommends that endoscopists actively identify, discuss, and attempt to accommodate reasonable patient preferences and expectations regarding endoscopy procedures. 9: ESGE advocates for educational and awareness campaigns targeting both health care professionals and patients, as well as the adoption of cost-effective health care strategies to address disparities and enhance equity in endoscopy care. 10: ESGE is committed to increasing support for underrepresented scholars and minorities pursuing research in endoscopy. 11: ESGE identifies mentorship and sponsorship as factors that may mitigate the barriers to academic careers for underrepresented endoscopy scholars. 12: ESGE recognizes the need to increase awareness of diversity, equity, and inclusion (DEI) in the field of endoscopy and supports publications on these topics.

Autoestima y consumo de cannabis en adolescentes: Una revisión integrativa / Self-esteem and cannabis use in adolescents: An integrative review

Resumen Objetivo: Identificar la evidencia científica relacionada con la influencia que tiene la autoestima en el consumo de cannabis de los adolescentes. Materiales y método: Durante el periodo de febrero-abril de 2022 se realizó una revisión integrativa de la literatura científica publicada en los últimos diez años (2012-2022). Se utilizó la metodología de seis pasos propuesta por Toronto y Remington en los motores de búsqueda de la BVS, PubMed, TRIP y Dialnet, así como, en las bases de datos de Redalyc, Cochrane, EBSCOhost, Web of Science y CUIDEN. Se encontraron un total de 1,491 artículos, al aplicar criterios de inclusión y eliminación se contemplaron un total de diez estudios cuantitativos en la muestra final. Resultados: Se encontró que los adolescentes con baja autoestima están propensos a influencias que fomentan el inicio de consumo de cannabis. Al considerarse como una actitud positiva de la persona hacia sí misma, favorece el sentimiento de seguridad y regula la conducta mediante un proceso de autoevaluación, de modo que posibilita la adecuación de los adolescentes a su entorno. En este sentido se observaron tres categorías principales: variable moderadora en el consumo de cannabis; variable predictora del consumo de cannabis; y componente de intervención. Conclusiones: Se demostró el papel protector y predictivo de la autoestima para el consumo de cannabis en los adolescentes, asimismo, la detección temprana y las intervenciones dirigidas a mejorar las habilidades para la regulación de emociones influenciadas por factores cognitivos son efectivas en la promoción y prevención de consumo de cannabis en el adolescente.

Abstract Objective: To identify the scientific evidence related to the influence of self-esteem on adolescent cannabis use. Materials and method: During the period of february-april 2022, an integrative review of the scientific literature published in the last ten years (2012-2022) was carried out. The sixstep methodology proposed by Toronto and Remington was used in the BVS, PubMed, TRIP and Dialnet search engines, as well as in the Redalyc, Cochrane, EBSCOhost, Web of Science and CUIDEN databases. A total of 1,491 articles were found, when applying inclusion and elimination criteria, a total of ten quantitative studies were considered in the final sample. Results: It was found that adolescents with low self-esteem are prone to influences that encourage the initiation of cannabis use. When considered as a positive attitude of the person towards himself, it favors the feeling of security and regulates behavior through a process of self-evaluation, so that it enables adolescents to adapt to their environment. In this sense, three main categories were observed: moderator variable in cannabis use; predictor variable of cannabis use; and intervention component. Conclusions: The protective and predictive role of self-esteem for cannabis use in adolescents was demonstrated, likewise, early detection and interventions aimed at improving skills for the regulation of emotions influenced by cognitive factors are effective in the promotion and prevention of cannabis use in adolescents.

Intervenciones al cuidador familiar del niño con discapacidad intelectual: Revisión integrativa / Interventions for the family caregiver of a child with intellectual disability: Integrative review

Resumen Objetivo: Describir las intervenciones realizadas al cuidador familiar del niño con discapacidad intelectual. Materiales y métodos: Revisión integradora en las bases de datos PubMed, LILACS, BVS y Scielo, considerando los criterios de inclusión: antigüedad ≤ 10 años, en idioma inglés, español y portugués, que la intervención estuviera dirigida al cuidador familiar (madres o padres). Se utilizaron los descriptores intervention, caregiver, intelectual disability, child y el operador booleano AND. Se identificaron 233 artículos, 210 fueron discriminados porque las intervenciones estuvieron dirigidas a los niños, quedando 23 artículos y de estos se eliminaron 17 por no cumplir su totalidad los criterios de inclusión, solo quedó una muestra de 6. Resultados: Las intervenciones identificadas fueron psicosocial, psicoeducativa, musicoterapia y terapia ocupacional, logrando disminuir síntomas como depresión, ansiedad, tristeza y estrés, así como niveles de sobrecarga e indiferencia. Conclusiones: Las intervenciones impactan positivamente en la salud del cuidador familiar del niño con discapacidad intelectual. El profesional de enfermería debe encaminarse en el diseño e implementación de intervenciones dirigidas al cuidador familia para su cuidado integral.

Abstract Objective: To describe the interventions carried out on the family caregiver of a child with intellectual disability. Material and methods: Integrative review in the PubMed, LILACS, VHL and Scielo databases, considering the inclusion criteria: seniority ≤ 10 years, in English, Spanish and Portuguese, that the intervention was aimed at the family caregiver (mothers or fathers). The descriptors intervention, caregiver, intellectual disability, child and the boolean operator AND were used. 233 articles were identified, 210 were discriminated against because the interventions were aimed at children, leaving 23 articles and of these 17 were eliminated because they did not fully meet the inclusion criteria, only a sample of 6 remained. Results: The identified interventions were psychosocial, psychoeducational, music therapy and occupational therapy, managing to reduce symptoms such as depression, anxiety, sadness and stress, as well as levels of overload and indifference. Conclusions: The interventions have a positive impact on the health of the family caregiver of the child with intellectual disability. The nursing professional should be guided in the design and implementation of interventions aimed at the family caregiver for her comprehensive care.

Incidence of opioid-induced esophageal dysfunction.

BACKGROUND: Retrospective studies have suggested that long-term use of opioids can cause esophageal motility dysfunction. A recent clinical entity known as opioid-induced esophageal dysfunction (OIED) has been postulated. There is no data from prospective studies assessing the incidence of opioid-induced effects on the esophagus. AIM: Evaluate the incidence of OIED during chronic opioid therapy. METHODS: From February 2017 to August 2018, all patients seen in the Pain Unit of the hospital, who started opioid treatment for chronic non-neoplastic pain and who did not present esophageal symptoms previously, were included. The presence of esophageal symptoms was assessed using the Eckardt score after 3 months and 1 year since the start of the study. In February 2021, the clinical records of all included patients were reviewed to assess whether esophageal symptoms were present and whether opioid therapy was continued. In patients presenting with esophageal symptoms, an endoscopy was performed and, if normal, a high-resolution esophageal manometry was performed. For a confidence level of 95%, a 4% margin of error and an estimated prevalence of 4%, a sample size of 92 patients was calculated. RESULTS: 100 patients were included and followed while taking opioids, for a median of 31 months with a range between 4 and 48 months. Three women presented with dysphagia during the first 3 months of treatment, being diagnosed with esophagogastric junction outflow obstruction; type II and type III achalasia. The cumulative incidence of OIED was 3%; 95%-CI: 0-6%. CONCLUSIONS: Chronic opioid therapy in patients with chronic non-neoplastic pain is associated with symptomatic esophageal dysfunction.

Impact of the European Society of Gastrointestinal Endoscopy 2020 guidelines on the number of scheduled post-polypectomy surveillance colonoscopies: Meeting presentations: Partial results of this research were published in abstract form at ESGE Days 2020.

Background and study aims In contrast with the European Society of Gastrointestinal Endoscopy (ESGE) 2013 and the US Multi-society Task Force (USMSTF) 2020 guidelines, the ESGE 2020 guideline considers patients with three to four adenomas < 10 mm or an adenoma with villous histology as low risk. The aim of this study was to quantify the influence of the application of the new ESGE 2020 guidelines, as opposed to the ESGE 2013 and USMSTF 2020 guidelines, on the number of scheduled colonoscopies, and to describe the main causes for changes in the surveillance intervals. Patients and methods A retrospective evaluation was conducted of a prospectively maintained fecal immunochemical test (FIT)-based regional colorectal cancer screening program database. Surveillance regimens following ESGE 2020, ESGE 2013, and USMSTF 2020 guidelines were compared. Results Overall, 1284 individuals with a positive FIT and undergoing colonoscopy were consecutively included. When applying the ESGE 2020 guidelines, 10.8 % of patients changed to a "no-surveillance" group (relative reduction in colonoscopies of 82.5 %). The main reason for these changes was considering three to four adenomas as low risk. The proportion of patients from the "3-year surveillance" group who moved to the "no-surveillance" group was lower when a sessile serrated lesion (SSL) was present (ESGE 2013, 32.0% vs 16.3 %; USMSTF 2020 17.2 % vs 6.8 %). Analyzing the 41 patients with SSLs who remained unchanged in the "no-surveillance" group, only in 15 (36.6 %) the cause was the presence of an SSL. Conclusions applying the new ESGE 2020 guidelines could reduce by 11 % the proportion of individuals being offered surveillance. SLLs have not a major influence on the change of surveillance intervals.

Evaluation of the optical criteria for sessile serrated lesions of the colon: A prospective study on a colorectal cancer screening population.

Background and study aims We aimed to describe the presence and combination of Hazewinkel's optical diagnosis (OD) criteria for sessile serrated lesions (SSL), determining which lesion characteristics increase the probability of a correct OD, with a focus on diminutive lesions. Patients and methods This was a prospective study describing the presence of Hazewinkel's OD criteria for SSL in lesions found in consecutive CRC screening colonoscopies. The presence of each OD criterion and their diagnostic combinations in SSL, related to the lesion's NBI International Colorectal Endoscopic (NICE) classification category, size, and location, were described. The presence of two or more optical criteria was considered diagnostic of SSL. The OD was compared to pathology as the gold standard. Results Seventy-nine SSLs (5.6 %) were diagnosed. Cloud-like appearance was the most prevalent OD criterion (35, 44.3 %). OD criteria were more frequently identified in NICE type 1, ≥ 10 mm, and proximal lesions. Only 26 SLLs fulfilled the OD criteria (sensitivity 32.9 %, 95 % CI 29.1 %-36.7 %). The sensitivity for diminutive SSL was 14.7 %, (95 % CI 11.9 %-17.6 %). Eighty-five lesions were optically diagnosed as SSL. However, only in 26 SSL was this the definitive diagnosis (positive predictive value 30.6 %, 95 % CI 26.9 %-34.3 %). Size > 5 mm and proximal location increased the probability of a correct diagnosis. The overall accuracy of the optical criteria was 92.0 % (95 % CI, 89.8 %-94.2 %). Conclusions The Hazewinkel's optical criteria are not reliable for a positive diagnosis of SSL, particularly for diminutive lesions.

Molecular Features of the Serrated Pathway to Colorectal Cancer: Current Knowledge and Future Directions.

Serrated lesions are the precursor lesions of a new model of colorectal carcinogenesis. From a molecular standpoint, the serrated pathway is thought to be responsible for up to 30% of all colorectal cancer cases. The three major processes of this molecular mechanism are alterations in the mitogen-activated protein kinase pathway, production of the CpG island methylation phenotype, and generation of microsatellite instability. Other contributing processes are activation of WNT, alterations in the regulation of tumor suppressor genes, and alterations in microRNAs or in MUC5AC hypomethylation. Although alterations in the serrated pathway also contribute, their precise roles remain obscure because of the various methodologies and definitions used by different research groups. This knowledge gap affects clinical assessment of precursor lesions for their carcinogenic risk. The present review describes the current literature reporting the molecular mechanisms underlying each type of serrated lesion and each phenotype of serrated pathway colorectal cancer, identifying those areas that merit additional research. We also propose a unified serrated carcinogenesis pathway combining molecular alterations and types of serrated lesions, which ends in different serrated pathway colorectal cancer phenotypes depending on the route followed. Finally, we describe some key issues that need to be addressed in order to incorporate the newest technologies in serrated pathway research and to improve overall knowledge for developing specific prevention strategies and new therapeutic targets.

Cancer prevention programmes in Mexico: are we doing enough?

Cancer has increased in all the countries of the world and Mexico is no exception. The recognised risk factors for the main types of cancer are reviewed and searched through the Mexican government web pages and cancer prevention programmes to tackle the risk factors in the population. The Mexican government, a member of the World Health Organization, shows that the main approach is an early diagnosis rather than prevention, forgetting that an ounce of prevention is better than a pound of cure. Effective public programmes should be promoted to reduce preventable risk factors in the population (smoking, nutrition, obesity, diet, environmental toxicity, sedentary lifestyle) and control the non-preventable factors (genetics) if we really want to control the incidence of different types of cancer.

Evaluation of micronuclei in oral mucosa of individuals exposed to ionizing radiation: a pilot study from Celaya, México.

INTRODUCTION: Occupational exposure to ionizing radiation can potentially lead to adverse health effects, including cancer and genetic defects. Genetic damage caused by radiation can be detected if micronuclei are observed. The objective of this pilot study was to detect the presence of micronuclei in cells of the oral mucosa in inidividuals occupationally exposed to ionizing radiation. METHODS: We implemented a pilot case-control study in which we compared oral mucosa micronuclei in 30 medical and nursing personnel in radiology centers in Celaya, Mexico, with 30 volunteers not exposed to ionizing radiation recruited from a public University. The oral mucosa was brushed and the amount of micronuclei was quantified. Chi-square test or t-test for two proportions were used to compared ionizing radiation and genetic damage between exposed and non-exposed groups. RESULTS: The exposed group had an average of 5.37 ± 3.49 micronuclei and the non-exposed had 0.37 ± 0.61 (P<0.01). In the exposed group, 90% of participants exhibited genetic damage compared to 6.67% in the unexposed group (P<0.05). CONCLUSION: In this pilot study, medical and nursing staff from radiology centers presented with higher genetic damage compared to control group. Further studies are needed to identify the prevalence of genetic damage due to occupational radiation exposure in Mexico.

Dumbbell-Shaped Epidural Capillary Hemangioma Presenting as a Lung Mass: Case Report and Review of the Literature.

STUDY DESIGN: A case report and literature review. OBJECTIVE: We present the fourth case of a spinal epidural capillary hemangioma with a dumbbell-shaped appearance in the magnetic resonance image reported in the literature and the second presented as a lung mass. SUMMARY OF BACKGROUND DATA: Hemangiomas are congenital vascular malformations that pathologists frequently consider to be hamartomatous malformations. Hemangiomas of the spine are usually lesions of the vertebral bodies, but they can sit in other locations such as the intramedullary or epidural space. Purely epidural hemangiomas are rare and most of them are of cavernous type. METHODS: We present a 67-year-old female with a thoracic dumbbell-shaped capillary hemangioma with both foraminal and intrathoracic extensions, whose presentation was pleural effusion associated with mediastinal mass suggestive of pulmonary neoplasia. Surgical treatment consisted of total removal en bloc of the lesion. RESULTS: Microscopic evaluation showed a fibrofatty tissue with a proliferation of vascular structures that were generally of a small size, with areas of myxoid appearance. To date, there have been 8 epidural capillary hemangiomas of the thoracic and lumbar spine reported in the literature, and only 3 of them were dumbbell-shaped with extraforaminal extension. CONCLUSION: It is important to consider the diagnosis of hemangiomas in the differential diagnosis of epidural lesions with dumbbell-shaped appearance in the magnetic resonance image, especially at the thoracic level. It is a benign and potentially curable disease and the most appropriate surgical treatment is en bloc resection of the entire lesion. They are usually presented as a progressive myelopathy, so early treatment may prevent permanent neurological deficits. LEVEL OF EVIDENCE: 5.

Nivel de adaptación: Rol e interdependencia de pacientes en diálisis peritoneal continua ambulatoria / Adaptation Level: Role and Interdependence of patients with continuous ambulatory peritoneal dialysis

Introducción: La Diálisis Peritoneal Continua Ambulatoria es uno de los tratamientos renales sustitutivos con mayor demanda en pacientes con insuficiencia renal crónica. Objetivo: Describir el nivel de adaptación en los modos de desempeño del rol e interdependencia de los pacientes con diálisis peritoneal continua ambulatoria, en la ciudad de Durango. Metodología: Estudio transversal. Se incluyeron 25 personas mayores de 20 años del programa de Diálisis Peritoneal Continua Ambulatoria (DPCA), del Hospital General Regional No. 1, del Instituto Mexicano del Seguro Social, de Durango. Se les midió modos de desempeño del rol y de interdependencia con instrumento denominado "ZERIMAR" cuyo nivel de confiabilidad con alfa de Cronbach fue 0.8701 en el modo de desempeño del rol y 0.9274 en el modo interdependencia. Resultados: Edad de la población estudiada 61.9±13.6 años, 52% hombres, escolaridad 4.6±2.7 años, mediana de tiempo de tratamiento 11 meses y tiempo de diagnóstico 32 meses, 55% de los participantes presentaron nivel de adaptación compensatorio en el modo de desempeño del rol y 60% nivel de adaptación integrado en el modo interdependiente. Discusión: La diálisis peritoneal continua ambulatoria como estímulo focal, impone modificaciones en la adaptación. Conclusiones: Las personas presentaron modos de desempeño del rol y modo de interdependencia en nivel de adaptación compensatorio e integrado respectivamente. Es importante que el profesional de enfermería fortalezca los estímulos positivos y evite, controle o elimine los negativos, para garantizar un óptimo estado de salud de las personas con diálisis peritoneal continua ambulatoria.

Introduction: The Continuos Ambulatory Peritoneal Dialysis (CAPD) is one of the renal substitute treatments (RST) with higher demand in patients with renal chronic insufficiency. This study is sustained in the Model of Adjustment of Callista Roy. Objective: To describe the adjustment level (AL) in the different ways of performing the role (RM) and interdependence (ID) in patients with CAPD, in the city of Durango. Methodology: Descriptive-transversal study. Twenty five (25) persons older than 20 years who were in CAPD program of the IMSS (Durango) were studied. The RM and ID were measured with an instrument developed for this purpose called "ZERIMAR" with a reliability level of 0.8701, obtained by Cronbach alpha in the MDR and of 0.9274 in ID. Results: Age 61.9±13.6 years, 52% was men, education 4.6±2.7 years; median of time of treatment was 11 months and time of diagnosis 32 months. 55% of the participants presented compensatory AL in the RM and 60% had an integrated AL in ID. It was also observed that 100% of the studied subjects lived with their relatives. Discussion: It was observed that the CAPD, as focal stimulus, imposes modifications in the adjustment. Conclusions: The persons presented RM and ID in adaptation compensatory levels and integrated respectively. It is important that the professional nurses strengthen the positive stimuli and control, eliminate, or avoid the negative ones to guarantee an ideal health state in persons with CAPD.