Recurso audiovisual para el desarrollo de competencias interculturales en salud en estudiantes de enfermería / Audiovisual resources for developing intercultural competences in health in nursing students

Introducción: Se ha reconocido la importancia de los aspectos socioculturales de los individuos en la atención en salud para brindar cuidados centrados en las personas. En este sentido, los profesionales de salud requieren el desarrollo de competencia interculturales. Objetivo: Diseñar una estrategia didáctica a través de un recurso audiovisual para contribuir a la formación de competencia intercultural en salud en estudiantes de enfermería en la asignatura Fundamentos Socioantropológicos. Métodos: Se tuvo en cuenta un diseño no experimental, descriptivo y comparativo. Se elaboró una intervención educativa sobre la base de videos, acompañada de trabajo reflexivo y feedback de profesores, con medición pre- y posintervención, mediante la Escala de Capacidad Cultural. Resultados: Se obtuvo un total de 77 respuestas válidas; 91,2 por ciento del género femenino. El 56,1 por ciento no presentaba formación previa en diversidad cultural. Al realizar la evaluación de la competencia intercultural pre- y posintervención, los estudiantes tuvieron un mayor puntaje posintervención (p< 0,05), lo que implicó un aumento en la competencia intercultural de estos. Conclusiones: Es posible contribuir a la formación de competencia intercultural en estudiantes de enfermería mediante videos (AU)

Introduction: The importance of sociocultural aspects of individuals in healthcare has been recognized with respect to providing person-centered care. In this sense, health professionals require the development of intercultural competences. Objective: To design a didactic strategy through an audiovisual resource to contribute to the development of intercultural competences in healthcare in Nursing students in the subject Socioanthropological Foundations. Methods: A nonexperimental, descriptive and comparative design was used. An educational intervention was elaborated upon the basis of videos, accompanied by reflective work and feedback from professors, with pre- and postintervention measurement using the Cultural Capacity Scale. Results: Seventy-seven valid responses were obtained; 91.2 percent belonged to the female gender. 56.1 percent had no previous training in cultural diversity. When performing the pre- and postintervention intercultural competence assessment, the students had a higher postintervention score (p< 0.05), which meant an increase in their intercultural competence. Conclusions: It is possible to contribute to the formation of intercultural competence in Nursing students through videos (AU)

The efficacy of genotype-based dietary or physical activity advice in changing behavior to reduce the risk of cardiovascular disease, type II diabetes mellitus or obesity: a systematic review and meta-analysis.

CONTEXT: Despite clear evidence that adherence to dietary and physical activity advice can reduce the risk of cardiometabolic disease, a significant proportion of the population do not follow recommendations. Personalized advice based on genetic variation has been proposed for motivating behavior change, although research on its benefits to date has been contradictory. OBJECTIVE: To evaluate the efficacy of genotype-based dietary or physical activity advice in changing behavior in the general population and in individuals who are at risk of cardiovascular disease (CVD) or type II diabetes mellitus (T2DM). DATA SOURCES: MEDLINE, EMBASE, PsycInfo, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched up to January 7, 2022. Randomized controlled trials of a genotype-based dietary and/or physical activity advice intervention that aimed to change dietary and/or physical activity behavior were included. DATA EXTRACTION: Abstracts of 7899 records were screened, and 14 reports from 11 studies met the inclusion criteria. DATA ANALYSIS: Genotype-based dietary or physical activity advice was found to have no effect on dietary behavior in any of the studies (standardized mean difference [SMD] .00 [-.11 to .11], P = .98), even when analyzed by subgroup: "at risk" (SMD .00 [-.16 to .16, P = .99]; general population (SMD .01 [-.14 to .16], P = .87). The physical activity behavior findings were similar for all studies (SMD -.01 [-.10 to .08], P = .88), even when analyzed by subgroup: "at risk" (SMD .07 [-.18 to .31], P = .59); general population (SMD -.02 [-.13 to .10], P = .77). The quality of the evidence for the dietary behavior outcome was low; for the physical activity behavior outcome it was moderate. CONCLUSIONS: Genotype-based advice does not affect dietary or physical activity behavior more than general advice or advice based on lifestyle or phenotypic measures. This was consistent in studies that recruited participants from the general population as well as in studies that had recruited participants from populations at risk of CVD or T2DM. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42021231147.

Association Between Caregiver Strain and Self-Care Among Caregivers With Diabetes.

Importance: Caregiver strain has been shown to be associated with adverse effects on caregivers' health, particularly among those with cardiovascular disease. Less is known about the association of caregiver strain with health behaviors among caregivers with diabetes, a disease that requires a high degree of self-care. Objective: To examine the association between caregiver strain and diabetes self-care among caregivers with diabetes. Design, Setting, and Participants: This cohort study was conducted between July 13, 2018, and June 25, 2020, using data on 795 US caregivers aged 45 years or older with self-reported diabetes from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, which comprised 30 239 Black and White adults 45 years or older throughout the US enrolled from January 2003 to October 2007. Exposures: Caregiver strain, assessed by self-report in response to the question, "How much of a mental or emotional strain is it to provide this care?" Response options were no strain, some strain, or a lot of (high) strain. Main Outcomes and Measures: Diabetes self-care, which was assessed across 4 domains (Mediterranean diet adherence, physical activity, smoking status, and medication adherence), and a composite self-care score summing performance across these domains. The association between caregiver strain and diabetes self-care was examined with multivariable Poisson regression adjusting for demographic, clinical, physical and mental functioning, and caregiving covariates. Results: Among the 795 caregivers with diabetes included in the study, the mean (SD) age was 63.7 (8.6) years, 469 (59.0%) were women, and 452 (56.9%) were Black individuals. Overall, 146 caregivers (18.4%) reported high caregiver strain. In unadjusted models, high caregiver strain was associated with less physical activity (prevalence ratio [PR], 0.66; 95% CI, 0.45-0.97), low medication adherence (PR, 0.80; 95% CI, 0.68-0.94), and worse self-care (PR, 0.65; 95% CI, 0.44-0.98). In adjusted models, the association between some and high caregiving strain with low medication adherence remained significant (adjusted PR: some strain, 0.88 [95% CI, 0.78-0.99]; high strain, 0.83 [95% CI, 0.69-0.99]). Conclusions and Relevance: In this cohort study of US adult caregivers with diabetes, a high level of strain was associated with low medication adherence. Increased awareness of the prevalence of caregiver strain and potential ramifications on caregivers' self-care appears to be warranted among health care professionals and caregivers.

Creating a Canadian Indigenous Research Network Against Cancer to Address Indigenous Cancer Disparities.

PURPOSE: In Canada, indigenous peoples' cancer rates have increased, but cancer screening rates tend to be lower. When coupled with poor cancer prognosis, treatment barriers, and inaccessible health care, indigenous patients with cancer experience many unmet needs. Further complicating their journey is a multijurisdictional system that complicates cancer control services, treatments, patient supports, and cancer surveillance. To address these issues, the Canadian Indigenous Research Network Against Cancer (CIRNAC) was developed. This article describes the forerunners and consultative process that created the network and the consensus model developed to ground this network with, by, and for indigenous peoples. METHODS: A consultative workshop was held to (1) establish and increase network membership, (2) enhance partnerships with indigenous communities and other researchers, and (3) develop an indigenous-led research program, new funding, and related initiatives. RESULTS: Participants viewed the CIRNAC as a reflective parallel network led by indigenous peoples that would identify research priorities within Canada, assess how these priorities align with indigenous patients' cancer care and research needs, and cross-check to see if these priorities align with each other. The network would also advocate for indigenous elders/knowledge holders and community grassroot processes to drive research and training, thus demonstrating the power of the community voice and lived experience in research. In addition, the network would foster research partnerships to investigate alternative indigenous models for cancer prevention, care, treatment, and support. CONCLUSION: The CIRNAC evolved as a viable vehicle to address cancer with, for, and by indigenous peoples. The network is guided by a preamble, a set of aims, and an inclusion engagement circle model. It is evolving through major world initiatives, with the aim of formally becoming an internationally linked national network.

Endoscopic Injection of Low Dose Triamcinolone: A Simple, Minimally Invasive, and Effective Therapy for Interstitial Cystitis With Hunner Lesions.

OBJECTIVE: To investigate the efficacy of low dose triamcinolone injection for effectiveness and durability in patients with interstitial cystitis/bladder pain syndrome (IC/BPS) with Hunner lesions (HL). MATERIALS AND METHODS: Clinical data from patients with HL who underwent endoscopic submucosal injection of triamcinolone were reviewed. Demographics, pre- and postoperative pain and nocturia scores, and long-term clinical outcomes were assessed. Duration of response was estimated by time to repeat procedure. Kaplan-Meier estimator was used to evaluate time to repeat procedure. RESULTS: A total of 36 patients who received injections of triamcinolone between 2011 and 2015 were included. Median age ± standard deviation of patients was 61.5 ± 12.0 years; 28 (77.8%) were female patients and 8 (22.2%) were male patients. Twenty six patients (72.2%) received only 1 set of injections, 8 (22.2%) received 2 sets of injections, and 2 (5.56%) received 3 or more sets of injections. Average time between injections in those receiving more than 1 set of injections was 344.9 days (median: 313.5, range: 77-714). Preprocedural pain scores were 8.3 ± 1.2 (mean ± standard deviation) on Likert pain scale (0-10), and mean postprocedural pain scores at approximately 1 month were 3.8 ± 2.2, P <.001. Mean preprocedural nocturia bother scores was 7.5 ± 2.0 and mean postprocedural nocturia bother scores was 5.1 ± 2.5, P <.001. CONCLUSION: Endoscopic submucosal injection of low dose triamcinolone in patients with IC/BPS with HL is an effective and durable adjunct to existing treatment modalities. This approach is associated with low morbidity and can be performed on an outpatient basis.

Elevated lead level from a tobacco source requiring chelation in a 12-year-old child.

CONTEXT: Across the world, tobacco is used in a variety of forms, including being smoked or added to a "quid" that is then chewed. We report a case of lead poisoning in a child from tobacco imported from Thailand. CASE DETAILS: A 12-year-old Thai immigrant boy had a blood lead level (BLL) of 6 mcg/dL on routine testing upon arrival to the United States, but which increased to 72 mcg/dL six months after his arrival. He was asymptomatic with unremarkable workup. At this time his father, mother and two siblings were also found to have elevated BLLs of 53, 16, 22, and 11 mcg/dL, respectively. Water, paint, food and cookware sources tested negative for lead, whereas samples of the father's dried tobacco leaves imported from Thailand contained 36.12 ppm (mcg/g) of lead. The mother admitted that both she and the patient used the tobacco as well. The child was chelated with oral succimer and his BLL decreased. DISCUSSION: In our case, the source of the lead exposure was from the tobacco that the patient was chewing. Tobacco is often overlooked as a source of lead exposure, though it has been reported in the literature, both from direct smoking and from chewing, as well as through secondhand smoke. Toxicologists and health care professionals should consider cultural practices when evaluating patients with elevated BLLs.

6th Canadian Symposium on Hepatitis C Virus: Delivering a cure for hepatitis C infection-What are the remaining gaps?

Estimates are that more than 250,000 people in Canada are chronically infected with hepatitis C virus (HCV), and many more are unaware of their infection status. If untreated, chronic HCV infection can lead to cirrhosis and subsequent complications such as hepatocellular carcinoma. The Canadian Network on Hepatitis C, supported by the Public Health Agency of Canada and the Canadian Institutes of Health Research, has been committed to the scientific study of chronic hepatitis C and to supporting the advocacy work to improve diagnosis and access to HCV care in Canada. Although the treatment of HCV infection has been greatly advanced with direct-acting antivirals, with cure rates as high as 95%, many challenges remain in the implementation of HCV care. These issues include the lack of an effective vaccine, infection screening, treatment failure or resistance, post-cure health issues, limitations of treatment access despite increased provincial subsidization, complex needs of at-risk populations (ie, injection drug users, societal obstacles). At the 6th Canadian Symposium on HCV in March 2017, the theme "Delivering a Cure for Hepatitis C Infection: What Are the Remaining Gaps?" provided a framework in which basic scientists, clinicians, epidemiologists, social scientists, and community members interested in HCV research in Canada could showcase how they are working to address these ongoing challenges.

Lo propio, lo foráneo y lo diverso: salud y nuevas rutas de curación en Chile / The own, the foreign and the diverse: health and new healing routes in Chile

La tesis "Lo propio, lo foráneo y lo diverso: salud y nuevas rutas de curación en Chile" aborda el estudio de situaciones etnográficas y casos relacionados con la introducción de prácticas terapéuticas no alópatas en el sistema público de salud, considerando, por un lado, las medicinas indígenas -particularmente la medicina mapuche- y, por otro, las medicinas alternativas y complementarias. La pregunta de investigación que guió la tesis inquiere acerca del impacto cultural y social que dicho fenómeno ha tenido sobre la estructura tradicional del sistema sanitario chileno, tanto en lo que refiere a las prácticas de las personas como de las instituciones alópatas, y explora en las motivaciones que hay detrás de dichas prácticas. La hipótesis que articula esta investigación sostiene que en el escenario social actual, caracterizado por la fluidez y la interconexión, los individuos y las instituciones médicas optan por diversificar las alternativas en el cuidado de la salud, articulando diversas corrientes terapéuticas a las que se acogen. La cuestión de fondo es, entonces, hasta qué punto esto representa un empoderamiento que se refleja en la manera en que los individuos se enfrentan al sistema médico, tanto en sus elecciones como en la toma de decisiones, y, en este caso, generan una identificación transitoria que orienta conductas flexibles y mecanismos de adhesión efímeros y contingentes. O es más bien una nueva forma de dominación institucional puesto que el sistema biomédico, y los seguros privados que implican, reorientan el sistema de cuidado en la dirección de abaratar costes acercándolos a las medicinas tradicionales. Metodológicamente la investigación la realicé a través de etnografías multisituadas. El trabajo de campo lo realicé en centros de salud y hospitales públicos, y en comunidades indígenas rurales y urbanas. En estos escenarios realicé entrevistas en profundidad y observación participante. El análisis de la información me permitió concluir y plantear una serie de temas, entre ellos, la construcción de una nueva interculturalidad en salud, y los alcances de dicho fenómeno desde una perspectiva bioética hoy adjetivada como intercultural. La nueva interculturalidad en salud planteada en la tesis, caracterizada por ser plural, está estrechamente vinculada con las tensiones que existen entre lo local y lo global, y con la forma en que a partir de elementos provenientes de ambas dimensiones se generan productos terapéuticos inéditos. En este territorio fluctuante y excepcionalmente activo conviven todas las prácticas de salud que los sujetos activan, desde ritos chamánicos, atenciones alópatas, hasta prácticas importadas de culturas lejanas como podría ser la medicina oriental. Esta interculturalidad plural en salud se caracteriza por incentivar lo que en mi investigación denomino prácticas de tanteo, donde los sujetos prueban diversas terapias, entran y salen de ellas, sin que ello implique poner en juego identidades o pertenencias específicas. Cabe destacar que no sólo los sujetos transitan entre diversos sistemas médicos, sino que los mismos sistemas de salud incorporan elementos de otras tradiciones terapéuticas, transformándose en "cuerpos permeables", vale decir, dúctiles, con fronteras blandas y flexibles, características que se contraponen a la rigidez propia de algunos de los sistemas involucrados. Respecto al segundo tema, me pareció relevante introducir el análisis desde la perspectiva bioética ya que ésta advierte sobre una posible contradicción presente en el fenómeno estudiado: por un lado, el reconocimiento de los avances en términos de democratización y apertura que implica la introducción de terapias no alópatas dentro del sistema biomédico. Por otro lado, la necesidad de observar dicho fenómeno con una cuota de escepticismo, con una mirada crítica atenta a las cuestiones de autonomía, justicia social y defensa de la privacidad frente a la imposición de terapias y estrategias de diagnóstico que no tienen en cuenta la diversidad cultural, pero también la apropiación indebida por parte de los sistemas de poder de ciertos saberes en torno a la salud, sobre todo en lo que respecta a los saberes indígenas en el proceso de introducción de terapéuticas no alópatas dentro del quehacer biomédico.

Cholecystokinin knockout mice are resistant to high-fat diet-induced obesity.

BACKGROUND & AIMS: Cholecystokinin (CCK) is a satiation peptide released during meals in response to lipid intake; it regulates pancreatic digestive enzymes that are required for absorption of nutrients. We proposed that mice with a disruption in the CCK gene (CCK knockout [CCK-KO] mice) that were fed a diet of 20% butter fat would have altered fat metabolism. METHODS: We used quantitative magnetic resonance imaging to determine body composition and monitored food intake of CCK-KO mice using an automated measurement system. Intestinal fat absorption and energy expenditure were determined using a noninvasive assessment of intestinal fat absorption and an open circuit calorimeter, respectively. RESULTS: After consuming a high-fat diet for 10 weeks, CCK-KO mice had reduced body weight gain and body fat mass and enlarged adipocytes, despite the same level of food intake as wild-type mice. CCK-KO mice also had defects in fat absorption, especially of long-chain saturated fatty acids, but pancreatic triglyceride lipase did not appear to have a role in the fat malabsorption. Energy expenditure was higher in CCK-KO than wild-type mice, and CCK-KO mice had greater oxidation of carbohydrates while on the high-fat diet. Plasma leptin levels in the CCK-KO mice fed the high-fat diet were markedly lower than in wild-type mice, although levels of insulin, gastric-inhibitory polypeptide, and glucagon-like peptide-1 were normal. CONCLUSIONS: CCK is involved in regulating the metabolic rate and is important for lipid absorption and control of body weight in mice placed on a high-fat diet.

Tumor O(6)-methylguanine-DNA methyltransferase inactivation by oral lomeguatrib.

PURPOSE: A major mechanism of resistance to chlorethylnitrosureas and methylating agents involves the DNA repair protein O(6)-methylguanine-DNA methyltransferase (MGMT). We sought to determine the dose of oral 6-(4-bromo-2-thienyl) methoxy purin-2-amine (lomeguatrib), a pseudosubstrate inactivator of MGMT, required to render active protein undetectable 12 hours after dosing in prostate, primary central nervous system (CNS), and colorectal cancer patients. EXPERIMENTAL DESIGN: Lomeguatrib was administered orally as a single dose (20-160 mg) approximately 12 hours before tumor resection. Dose escalation was projected to continue until grade 2 toxicity or until complete inactivation of tumor MGMT was encountered. Total MGMT protein levels were quantified by ELISA, and active protein levels were quantified by biochemical assay. MGMT promoter methylation was determined in glioblastoma DNA by methylation-specific PCR. RESULTS: Thirty-seven patients were dosed with lomeguatrib, and 32 informative tumor samples were obtained. Mean total MGMT level varied between tumor types: 554 +/- 404 fmol/mg protein (+/-SD) for prostate cancer, 87.4 +/- 40.3 fmol/mg protein for CNS tumors, and 244 +/- 181 fmol/mg protein for colorectal cancer. MGMT promoter hypermethylation did not correlate with total protein expression. Consistent total MGMT inactivation required 120 mg of lomeguatrib in prostate and colorectal cancers. Complete consistent inactivation in CNS tumors was observed only at the highest dose of lomeguatrib (160 mg). CONCLUSIONS: Total MGMT inactivation can be achieved in prostate, primary CNS, and colorectal cancers with a single administration of 120 or 160 mg lomeguatrib. The dose needed did not correlate with mean total MGMT protein concentrations. One hundred twenty to 160 mg/d of lomeguatrib should be administered to achieve total MGMT inactivation in future studies.

Novel activity of an anti-inflammatory cytokine: IL-10 prevents TNFalpha-induced resistance to IGF-I in myoblasts.

IL-10 is an anti-inflammatory cytokine that suppresses synthesis of proinflammatory cytokines and their receptors. Here we tested the possibility that TNFalpha-induced hormone resistance in myoblasts might be overcome by IL-10. We found that IL-10 restores myogenesis by suppressing the ability of exogenous TNFalpha to inhibit IGF-I-induced myogenin. This protection occurs without decreasing global activity of TNF receptors since IL-10 does not impair TNFalpha-induced IL-6 synthesis or ERK1/2 phosphorylation. Instead, IL-10 acts to prevent TNFalpha-induced phosphorylation of JNK. These findings demonstrate that IL-10 serves a previously unrecognized protective role in muscle progenitors by overcoming TNFalpha-induced resistance to IGF-I.