Valoración de las relaciones interdisciplinarias entre la Farmacología y las asignaturas clínicas en Estomatología

RESUMEN Introducción: Establecer relaciones interdisciplinarias entre la Farmacología y las asignaturas clínicas de la Disciplina Principal Integradora en la carrera Estomatología requiere de un trabajo metodológico sistemático y coherente entre estos colectivos docentes, así como la actualización permanente de los profesores. Objetivo: Valorar el estado de las relaciones interdisciplinarias entre la Farmacología y las asignaturas clínicas de la Disciplina Principal Integradora en la carrera de Estomatología. Método: Se realizó un estudio observacional, descriptivo, transversal entre noviembre y diciembre de 2020 en la Facultad de Estomatología, Universidad de Ciencias Médicas de Santiago de Cuba. El universo estuvo constituido por los profesores responsables de impartir las asignaturas clínicas de la referida disciplina en la citada carrera, seleccionándose una muestra (n=34) por muestreo probabilístico aleatorio simple. Se analizaron las variables: categoría docente, categoría científica, grado académico/científico, grado de especialización, estado de las relaciones interdisciplinarias con la Farmacología y opinión docente. Se aplicó un cuestionario conformado por diecinueve preguntas y se empleó el porcentaje como medida de resumen. Resultados: El estado de las relaciones interdisciplinarias con la Farmacología en las dimensiones didáctica y académica obtuvo una puntuación de 1,9, y en la dimensión metodológica e investigativa obtuvo puntuaciones de 1,5 y 1,1, respectivamente. La proporción esperada de opinión docente desfavorable fue de un 50,0 %. Conclusiones: El estado de las relaciones interdisciplinarias que establecen las asignaturas clínicas de la Disciplina Principal Integradora con la Farmacología de, manera general, resulta no adecuado, con peso causal en las dimensiones metodológica e investigativa.

ABSTRACT Introduction: Establishing interdisciplinary relationships between Pharmacology and the clinical subjects of the Main Integrative Discipline (MID) in the Stomatology major requires a systematic and coherent methodological work between teaching groups and the permanent updating of the teachers. Objective: To assess the state of interdisciplinary relationships between Pharmacology and the clinical subjects of MID in the Stomatology major. Method: An observational, descriptive, cKross-sectional study was carried out between November and December 2020, at the Facultad de Estomatología, Universidad de Ciencias Médicas de Santiago de Cuba. By simple random probability sampling, a sample of 34 professors of the clinical subjects of the MID was selected. The variables analyzed were: state of interdisciplinary relations with Pharmacology, category and teaching opinion. A questionnaire consisting of nineteen questions was applied and the percentage was used as a summary measure. Results: The state of interdisciplinary relations with Pharmacology in the didactic and academic dimensions obtained a score of 1.9, and in the methodological and investigative dimensions it obtained scores of 1.5 and 1.1, respectively. The expected proportion of unfavorable teacher opinion was 50.0%. Conclusions: The state of interdisciplinary relationships established by the clinical subjects of MID with Pharmacology, in general, is not adequate, especially in the methodological and investigative dimensions; which points to the need of designing a strategy to promote such relationships in order to achieve a more comprehensive training in students.

RESUMO Introdução: o estabelecimento de relações interdisciplinares entre a Farmacologia e as disciplinas clínicas da Disciplina Integrativa Principal (DPI) na carreira de Estomatologia requer um trabalho metodológico sistemático e coerente entre estes grupos de ensino e a atualização permanente dos docentes. Objetivo: avaliar o estado das relações interdisciplinares entre a Farmacologia e as disciplinas clínicas do DPI na carreira de Estomatologia. Método: estudo observacional, descritivo e transversal, realizado entre novembro e dezembro de 2020, na Faculdade de Estomatologia da Universidad de Ciencias Médicas de Santiago de Cuba. Por amostragem probabilística aleatória simples, foi selecionada uma amostra de 34 professores das disciplinas clínicas do DPI. As variáveis analisadas foram: estado das relações interdisciplinares com a Farmacologia, categoria e opinião docente. Foi aplicado um questionário com dezenove questões e o percentual utilizado como medida resumida. Resultados: o estado das relações interdisciplinares com a Farmacologia nas dimensões didática e acadêmica obteve escore de 1,9, e nas dimensões metodológica e investigativa obteve escores de 1,5 e 1,1, respectivamente. A proporção esperada de opinião desfavorável do professor era de 50,0%. Conclusões: o estado das relações interdisciplinares estabelecidas pelos sujeitos clínicos da DPI com a Farmacologia, em geral, não é adequado, com peso causal nas dimensões metodológica e investigativa; o que aponta para a necessidade de se traçar uma estratégia para promover tais relações, a fim de se conseguir uma formação mais abrangente dos alunos.

Zika and dengue but not chikungunya are associated with Guillain-Barré syndrome in Mexico: A case-control study.

Background Zika, dengue and chikungunya viruses (ZIKV, CHIKV and DENV) are temporally associated with neurological diseases, such as Guillain-Barré syndrome (GBS). Because these three arboviruses coexist in Mexico, the frequency and severity of GBS could theoretically increase. This study aims to determine the association between these arboviruses and GBS in a Mexican population and to establish the clinical characteristics of the patients, including the severity of the infection. A case-control study was conducted (2016/07/01-2018/06/30) in Instituto Mexicano del Seguro Social (Mexican Social Security Institute) hospitals, using serum and urine samples that were collected to determine exposure to ZIKV, DENV, CHIKV by RT-qPCR and serology (IgM). For the categorical variables analysis, Pearson's χ2 or Fisher exact tests were used, and the Mann-Whitney U test for continuous variables. To determine the association of GBS and viral infection diagnosis through laboratory and symptomatology before admission, we calculated the odds ratio (OR) and 95% confidence intervals (95%CI) using a 2x2 contingency table. A p-value ≤ 0.05 was considered as significant. Ninety-seven GBS cases and 184 controls were included. The association of GBS with ZIKV acute infection (OR, 8.04; 95% CI, 0.89-73.01, p = 0.047), as well as laboratory evidence of ZIKV infection (OR, 16.45; 95% CI, 2.03-133.56; p = 0.001) or Flavivirus (ZIKV and DENV) infection (OR, 6.35; 95% CI, 1.99-20.28; p = 0.001) was observed. Cases of GBS associated with ZIKV demonstrated a greater impairment of functional status and a higher percentage of mechanical ventilation. According to laboratory results, an association between ZIKV or ZIKV and DENV infection in patients with GBS was found. Cases of GBS associated with ZIKV exhibited a more severe clinical picture. Cases with co-infection were not found.

On surmounting the barriers to HPV vaccination: we can do better.

The major impediment to increased human papillomavirus (HPV) vaccination coverage in young males and females is lack of health care provider recommendation. Despite its efficacy in preventing cervical cancer, HPV vaccination in females (49.5%) and males (37.5%) ages 13 through 17 falls well below the Centers for Disease Control and Prevention's (CDC) Healthy People 2020 target of 80% coverage. Parents' willingness to vaccinate their child has been shown to be much higher when physicians share personal vaccination decisions for their own children as well as what other parents have done at that particular clinic. Furthermore, the vaccine must be presented presumptively as a "bundle" along with the rest of the standard adolescent vaccine panel. Multiple exemplars presented including in several European countries, low-income countries and Rwanda, demonstrate that school-based health care systems dramatically increase vaccination coverage. Finally, acceptability for vaccination of males must improve by increasing provider recommendation and by presenting the HPV vaccine as a penile, anal and oropharyngeal cancer prevention therapy in males and not merely a vaccine to prevent cervical cancers in females. Paediatricians, obstetrician/gynaecologists and primary care physicians should consider these data as a call-to-action. Key messages • Despite recent efforts in the US, only 49.5% of females and only 37.5% of males ages 13 through 17 have received all recommended HPV vaccine doses. These numbers fall well below the 80% target set forth by the Healthy People 2020 initiative. • According to the CDC, if health care providers increase HPV vaccination rates in eligible recipients to 80%, it is estimated that an additional 53,000 cases of cervical cancer could be prevented during the lifetime of those younger than 12 years. Furthermore, for every year that the vaccination rate does not increase, an additional 4400 women will develop cervical cancer. • First and foremost, healthcare providers (HCPs) must make a strong recommendation to vaccinate patients and these recommendations must become routine, including for males. • It is clear that HPV vaccination rates improve significantly when vaccine administration occurs at designated, well-organized sites such as school-based vaccination programmes. Furthermore, HPV vaccination should be a high school requirement and offered in the standard adolescent vaccine panel as a bundle with Tdap and MenACWY vaccines in order to promote maximum adherence. • Finally, research on immunogenicity and antibody titre longevity needs to be done in newborns. The HPV vaccine may be recommended in the newborn panel of vaccines to avoid any issues of sexualization and misplaced fears of sexual disinhibition, akin to the success of the Hepatitis B vaccine in the 1980s. • The HPV vaccine is a vaccine against cancer and should be aggressively marketed as such. As healthcare providers, we need to make every effort to overcome barriers, real or perceived, to protecting our population from potential morbidity and mortality associated with this virus.

Promoting Policy Development through Community Participatory Approaches to Health Promotion: The Philadelphia Ujima Experience.

BACKGROUND: The Philadelphia Ujima Coalition for a Healthier Community (Philadelphia Ujima) promotes health improvement of girls, women, and their families using a gender framework and community-based participatory research approach to addressing gender-based disparities. Institutional policies developed through community-based participatory research approaches are integral to sustaining gender-integrated health-promotion programs and necessary for reducing gender health inequities. This paper describes the results of a policy analysis of the Philadelphia Ujima coalition partner sites and highlights two case studies. METHODS: The policy analysis used a document review and key informant interview transcripts to explore 1) processes that community, faith, and academic organizations engaged in a community participatory process used to develop policies or institutional changes, 2) types of policy changes developed, and 3) initial outcomes and impact of the policy changes on the target population. RESULTS: Fifteen policies were developed as a result of the funding from the U.S. Department of Health and Human Services Office on Women's Health. Policy changes included 1) healthy food options guidance, 2) leadership training on sexual and relationship violence, and 3) curricula and programming inclusion and expansion of a sex and gender focus in high school and medical school. CONCLUSIONS: Organizational practice changes and policies can be activated through individual-level interventions using a community participatory approach. This approach empowers communities to play an integral role in creating health-promoting policies.

Coalition for a Healthier Community: Lessons learned and implications for future work.

The Coalition for a Healthier Community (CHC) initiative was implemented to improve the health and well-being of women and girls. Underpinning CHC is a gender-based focus that uses a network of community partners working collaboratively to generate relevant behavior change and improved health outcomes. Ten programs are trying to determine whether gender-focused system approaches are cost-effective ways to address health disparities in women and girls. Programs implemented through coalitions made up of academic institutions, public health departments, community-based organizations, and local, regional, and national organizations, are addressing health issues such as domestic violence, cardiovascular disease prevention, physical activity, and healthy eating. Although these programs are ongoing, they have made significant progress. Key factors contributing to their early success include a comprehensive needs assessment, robust coalitions, the diversity of populations targeted, programs based on findings of the needs assessments, evaluations taking into consideration the effect of gender, and strong academic-community partnerships. A noteworthy impact of these programs has been their ability to shape and impact public, social, and health policies at the state and local levels. However, there have been challenges associated with the implementation of such a complex program. Lessons learned are discussed in this paper.

How air influences radiation dose deposition in multiwell culture plates: a Monte Carlo simulation of radiation geometry.

Radiation of experimental culture cells on plates with various wells can cause a risk of underdosage as a result of the existence of multiple air-water interfaces. The objective of our study was to quantify this error in culture plates with multiple wells. Radiation conditions were simulated with the GAMOS code, based on the GEANT4 code, and this was compared with a simulation performed with PENELOPE and measured data. We observed a slight underdosage of ∼ 4% on the most superficial half of the culture medium. We believe that this underdosage does not have a significant effect on the dose received by culture cells deposited in a monolayer and adhered to the base of the wells.

Embedding concepts of sex and gender health differences into medical curricula.

Sex, a biological variable, and gender, a cultural variable, define the individual and affect all aspects of disease prevention, development, diagnosis, progression, and treatment. Sex and gender are essential elements of individualized medicine. However, medical education rarely considers such topics beyond the physiology of reproduction. To reduce health care disparities and to provide optimal, cost-effective medical care for individuals, concepts of sex and gender health need to become embedded into education and training of health professionals. In September 2012, Mayo Clinic hosted a 2-day workshop bringing together leading experts from 13 U.S. schools of medicine and schools of public health, Health Resources and Services Administration Office of Women's Health (HRSA OWH), the National Institutes of Health (NIH) Office of Research on Women's Health (ORWH), and the Canadian Institute of Health and Gender. The purpose of this workshop was to articulate the need to integrate sex- and gender-based content into medical education and training, to identify gaps in current medical curricula, to consider strategies to embed concepts of sex and gender health into health professional curricula, and to identify existing resources to facilitate and implement change. This report summarizes these proceedings, recommendations, and action items from the workshop.

Conducting a needs assessment for women and girls using a gender analysis framework: the Philadelphia Ujima Coalition for a Healthier Community experience.

INTRODUCTION: Despite a century of work toward gender equality, sex and gender disparities in health remain. Morbidity and mortality rates as well as quality of care received differ between men and women. The Philadelphia Ujima Coalition for a Healthier Community is composed of 23 academic, social service, wellness, faith-based, governmental, and healthcare organizations. The coalition, funded by the U.S. Department of Health and Human Services, Office on Women's Health, used a community participatory framework to conduct a gender-informed needs assessment of priority areas for women's health. METHODS: A four-tiered approach was used: 1) Coalition members identified priority areas; 2) we analyzed data from the Southeastern Pennsylvania 2010 Household Health Survey to identify gender differences in health; 3) using a gender analysis framework, we conducted interviews with "key informant" stakeholders; and 4) we conducted a community health assessment including 160 women. We used a participatory process to rank priority areas. RESULTS: Sex and gender disparities in health outcomes and behaviors were observed. Data were used to identify gender barriers and norms that influence health practices and behaviors, defining priority areas for the health of women and girls. Effective health promotion strategies were also identified. CONCLUSIONS: A gender-integrated needs assessment of girls and women can reveal priority areas and gender-related objectives that should be included in health promotion programming for girls and women.

The heart truth professional education campaign on women and heart disease: needs assessment and evaluation results.

BACKGROUND: Heart disease is the leading cause of death for women in the United States. Research has identified that women are less likely than men to receive medical interventions for the prevention and treatment of heart disease. METHODS AND RESULTS: As part of a campaign to educate healthcare professionals, 1245 healthcare professionals in 11 states attended a structured 1-hour continuing medical education (CME) program based on the 2004 AHA Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women and completed a pretest and posttest evaluation. We identified significant knowledge deficits in the pretest: 45% of attendees would initially recommend lifestyle changes alone, rather than statin therapy, for women diagnosed with coronary artery disease (CAD); 38% identified statin therapy as less effective in women compared with men for preventing CAD events; 27% identified Asian American women at low risk (rather than high risk) for type 2 diabetes mellitus (DM); and 21% identified processed meat (rather than baked goods) as the principal dietary source of trans fatty acids. Overall, healthcare professionals answered 5.1 of 8 knowledge questions correctly in the pretest, improving to 6.8 questions in the posttest (p < 0.001). Family physicians, obstetrician/gynecologists, general internists, nurse practitioners/physician assistants, and registered nurses all statistically significantly improved knowledge and self-assessed skills and attitudes as measured by the posttest. CONCLUSIONS: Significant knowledge deficits are apparent in a cross-section of healthcare providers attending a CME lecture on women and heart disease. A 1-hour presentation was successful in improving knowledge and self-assessed skills and attitudes among primary care physicians, nurse practitioners, physician assistants, and registered nurses.

Multicultural considerations in women's health.

As patient practices continue to diversify, clinical skills need to extend beyond disease manifestation and treatment modalities into awareness of health statistics that highlight disparities, training, cross-cultural health care delivery at the individual and system-based levels. and skills of health care advocacy. Excellent care for multicultural women implies the ability to assess the health issues applicable to all women as well as the issues specific to the women in the clinician's office. It implies enabling the patient to share with her individual and cultural influences. Incorporating both of these influences at the same time and integrating them into her context of care can result in developing the best fit for health care goals, eliminating disparities and improving health outcomes in terms of quantity and quality of lives for all women.