Teachers' teaching and professional competences assessment.

This research is part of a project led by the Catholic University of Santiago de Guayaquil (Ecuador) and the National Distance Education University - UNED (Spain) aiming at designing a teaching/professional competences training model for teachers. The purpose of this study is to assess the meaning of professional competences and their significance within teachers' teaching and training processes. Using the mixed methods approach, an ad hoc questionnaire was designed and given to discussion groups, achieving participation of more than a hundred teachers. Quantitative data analysis was carried out using the Logit model while Atlas ti 23 allowed analysis of the qualitative data. The results evidenced high scores in the competences evaluated, being leadership and research the lowest. In general, the teachers value, preferably, planning, communication, evaluation, methodology, digital, and tutoring competences, with a lower value among teachers ranging from 25 to 30 years old; those older than 55 stressed the importance of digital and innovation competences. Thus, it is recommended that training programs for teachers should focus on the set of related competences, especially on the digital competence, considering the challenges represented by investigation and pedagogical leadership.

Prevalence of caregiver burden syndrome in formal caregivers of institutionalised patients with psychiatric illness.

INTRODUCTION: Caregiver burden syndrome has been highlighted as a neglected problem, in which a dependent person's caregiver must change their lifestyle while facing a range of stressors which they cannot always overcome. This leads to a state of physical and mental exhaustion, hindering the caregiver's performance at their work environment. OBJECTIVE: To define the caregiver burden syndrome prevalence among formal caregivers of mentally-ill dependent patients at Clínica del Oriente in the period 2016 II (July-December) and 2017 I (January-June). MATERIALS AND METHODS: A descriptive cross-sectional observational study was carried out in a population of formal caregivers of with mental illness institutionalised at either of the two facilities of Clínica del Oriente, La Ceja and El Carmen de Viboral. We used a survey with sociodemographic, clinical and work-related variables, and the Zarit Burden Interview. RESULTS: 53 caregivers were analysed; 11 had the syndrome (20.8%), 17% had mild burden and 3.8% severe burden. CONCLUSION: The prevalence of caregiver burden syndrome in formal caregivers was lower than found in studies on informal caregivers.

Sex and Gender Disparities in the Management and Outcomes of Acute Myocardial Infarction-Cardiogenic Shock in Older Adults.

OBJECTIVE: To evaluate outcomes by sex in older adults with cardiogenic shock complicating acute myocardial infarction (AMI-CS). MATERIALS AND METHODS: A retrospective cohort of older (≥75 years) AMI-CS admissions during January 1, 2000, to December 31, 2014, was identified using the National Inpatient Sample. Interhospital transfers were excluded. Use of angiography, percutaneous coronary intervention (PCI), mechanical circulatory support (MCS), and noncardiac interventions was identified. The primary outcome was in-hospital mortality stratified by sex, and secondary outcomes included temporal trends of prevalence, in-hospital mortality, use of cardiac and noncardiac interventions, hospitalization costs, and length of stay. RESULTS: In this 15-year period, there were 134,501 AMI-CS admissions 75 years or older, of whom 51.5% (n=69,220) were women. Women were on average older, were more often Hispanic or nonwhite race, and had lower comorbidity, acute organ failure, and concomitant cardiac arrest. Compared with older men (n=65,281), older women (n=69,220) had lower use of coronary angiography (55.4% [n=35,905] vs 49.2% [n=33,918]), PCI (36.3% [n=23,501] vs 34.4% [n=23,535]), MCS (34.3% [n=22,391] vs 27.2% [n=18,689]), mechanical ventilation, and hemodialysis (all P<.001). Female sex was an independent predictor of higher in-hospital mortality (adjusted odds ratio, 1.05; 95% CI, 1.02-1.08; P<.001) and more frequent discharges to a skilled nursing facility. In subgroup analyses of ethnicity, presence of cardiac arrest, and those receiving PCI and MCS, female sex remained an independent predictor of increased mortality. CONCLUSION: Female sex is an independent predictor of worse in-hospital outcomes in older adults with AMI-CS in the United States.

Association between the Charlson comorbidity index and outcomes after implantable cardioverter defibrillator generator replacement.

BACKGROUND: Recipients of implantable cardioverter defibrillator (ICD) generator replacement with multiple medical comorbidities may be at higher risk of adverse outcomes that attenuate the benefit of ICD replacement. The aim of this investigation was to study the association between the Charlson comorbidity index (CCI) and outcomes after ICD generator replacement. METHODS: All patients undergoing first ICD generator replacement at Mayo Clinic, Rochester and Beth Israel Deaconess Medical Center, Boston between 2001 and 2011 were identified. Outcomes included: (a) all-cause mortality, (b) appropriate ICD therapy, and (c) death prior to appropriate therapy. Multivariable Cox regression analysis was performed to assess association between CCI and outcomes. RESULTS: We identified 1421 patients with mean age of 69.6 ± 12.1 years, 81% male and median (range) CCI of 3 (0-18). During a mean follow-up of 3.9 ± 3 years, 52% of patients died, 30.6% experienced an appropriate therapy, and 23.6% died without experiencing an appropriate therapy. In multivariable analysis, higher CCI score was associated with increased all-cause mortality (Hazard ratio, HR 1.10 [1.06-1.13] per 1 point increase in CCI, P < .001), death without prior appropriate therapy (HR 1.11 [1.07-1.15], P < .0001), but not associated with appropriate therapy (HR 1.01 [0.97-1.05], P = .53). Patients with CCI ≥5 had an annual risk of death of 12.2% compared to 8.7% annual rate of appropriate therapy. CONCLUSIONS: CCI is predictive of mortality following ICD generator replacement. The benefit of ICD replacement in patients with CCI score ≥5 should be investigated in prospective studies.

Building a Network of Health Professionals for Breast and Cervical Cancer Control in the Andean Region.

PURPOSE: Cancer mortality is approximately twice as high in Latin American countries than in more developed countries. In particular, the countries of the high Andean region of Latin America carry a double burden of breast and cervical cancers. In these countries, there are disproportionately higher mortality to incidence ratios compared with other regions in Latin America. The US National Cancer Institute's Center for Global Health, the Pan American Health Organization, and the Ministry of Health in Peru collaborated to design and execute an education and advocacy workshop in Lima, Peru. The workshop was convened to discuss regional challenges and practices, as well as to support the implementation of Plan Esperanza, Peru's national cancer control plan. METHODS: Workshop participants included local and international experts to present the state of the science, health practitioners, and advocacy groups to discuss unique barriers that women in the region experience. RESULTS: Inequalities in access to and distribution of medical expertise, lack of continuity of cancer control plans, and the need for sustained public buy-in emerged as obstacles. CONCLUSION: The workshop provided a forum to discuss key issues regarding breast and cervical cancer control among health professionals and advocates in Peru and the region. This article outlines the resulting recommendations.

Outcomes of Nonagenarians Admitted to the Cardiac Intensive Care Unit by the Elders Risk Assessment Score for Long-Term Mortality Risk Stratification.

There are limited data on outcomes of older adults admitted to cardiac intensive care units (CICU), and there are no data on outcomes after admission to the CICU in nonagenarians. Our purpose was to identify whether the Elders Risk Assessment (ERA) index could risk stratify older adults after CICU admission. We retrospectively identified 453 nonagenarians admitted to the CICU between 2004 and 2013. End points included mortality, length of stay, incidence of delirium, and discharge disposition. Average age of the cohort was 92 ± 2 years, and the average ERA score was 13 ± 6. A total of 258 patients were female (57%). Most common admission indication was acute decompensated heart failure (57%) followed by acute myocardial infarction (49%). Loss of independence was observed after CICU admission, with 66% of patients living independently before admission, decreasing to 47% at discharge. Overall length of stay was 6 ± 5 days and CICU stay was 2 ± 2 days. Fifteen percent of patients died before hospital discharge. Median survival was 452 (interquartile range 40 to 1,371) days. ERA score effectively predicted survival (log-rank test, p = 0.002). ERA score of 16 or greater and ERA score of 9 to 15 were both associated with increased risk of mortality compared with the reference (score 4 to 8): hazard ratio 2.00, 95% confidence interval 1.37 to 2.90, p = 0.003, and hazard ratio 1.48, 95% confidence interval 1.06 to 2.08, p = 0.02, respectively. In conclusion, nonagenarians admitted to CICU experience reasonable outcomes. The ERA score effectively risk stratifies nonagenarians admitted to the CICU and may help with identification of vulnerable patients at risk of adverse outcomes.

Resource and cost considerations in treating hypoplastic left heart syndrome.

Hypoplastic left heart syndrome (HLHS) was a uniformly fatal diagnosis before 1983, when surgical treatment was first undertaken with the Norwood I operation as the first of 3-staged operations. Since then, operative survival rate of stage I has risen from 53% to over 90% in the current era, not only thanks to technical advances in surgery but also through prenatal diagnosis and imaging, enhanced cardiopulmonary bypass technology, better perioperative intensive care, and closer interstage monitoring. The improvements in patient outcomes achieved through rigorous multidisciplinary teamwork have come at a tremendous cost in manpower and resources, making HLHS still a challenge to all congenital heart programs, established or emerging. We review the various surgical steps to treat HLHS and their current expected outcomes, and put into perspective cost considerations compared to other more "simple" congenital heart defects.

A Decade of Change: Training and Career Paths of Cardiothoracic Surgery Residents 2003 to 2014.

BACKGROUND: During the past decade, cardiothoracic surgery (CTS) education has undergone tremendous change with the advent of new technologies and the implementation of integrated programs, to name a few. The goal of this study was to assess how residents' career paths, training, and perceptions changed during this period. METHODS: The 2006 to 2014 surveys accompanying the Thoracic Surgery Residents Association/Thoracic Surgery Directors' Association in-training examination taken by CTS residents were analyzed, along with a 2003 survey of graduating CTS residents. Of 2,563 residents surveyed, 2,434 (95%) responded. RESULTS: During the decade, fewer residents were interested in mixed adult cardiac/thoracic practice (20% in 2014 vs 52% in 2003, p = 0.004), more planned on additional training (10% in 2003 vs 41% to 47% from 2011 to 2014), and the frequent use of simulation increased from 1% in 2009 to 24% in 2012 (p < 0.001). More residents recommended CTS to potential trainees (79% in 2014 vs 65% in 2010, p = 0.007). Job offers increased from a low of 12% in 2008 with three or more offers to 34% in 2014. Debt increased from 0% with more than $200,000 in 2003 to 40% in 2013 (p < 0.001). Compared with residents in traditional programs, more integrated residents in 2014 were interested in adult cardiac surgery (53% vs 31%) and congenital surgery (22% vs 7%), fewer were interested in general thoracic surgery (5% vs 31%, p < 0.001), and more planned on additional training (66% vs 36%, p < 0.001). CONCLUSIONS: With the evolution in CTS over the last decade, residents' training and career paths have changed substantially, with increased specialization and simulation accompanied by increased resident satisfaction and an improved job market.

Factores de riesgo socioeconómicos de la tuberculosis pulmonar en el municipio de Santiago de Cuba / Social and economic risk factors of the lung tuberculosis in Santiago de Cuba municipality

Se realizó un estudio de casos y controles (con 12 integrantes en cada grupo) sobre los principales factores de riesgo socioeconómicos de la tuberculosis pulmonar en la población de 15 y más años del municipio de Santiago de Cuba durante el 2005. Las variables de interés analizadas fueron: edad, sexo, escolaridad, ocupación, per cápita familiar, condiciones de la vivienda, hacinamiento, evaluación nutricional, hábito de fumar y alcoholismo. Se determinaron la asociación entre variables cualitativas mediante la prueba estadística de Ji al cuadrado, la fuerza de asociación a través de la razón de productos cruzados y el cálculo de los intervalos de confianza al 95 por ciento, así como el impacto de la exposición por medio del riesgo atribuible porcentual. Los factores de riesgo socioeconómicos asociados causalmente con la tuberculosis pulmonar resultaron ser: el consumo de bebidas alcohólicas, la evaluación nutricional con un índice de masa corporal de ≤19,9 y la exposición al tabaco.

A case-control study (12 people in each group) on main social and economic risk factors of the lung tuberculosis was carried out in the population aged 15 and over of Santiago de Cuba municipality during 2005. The analyzed variables of interest were age, sex, educational status, occupation, family income, and housing conditions, overcrowding, nutritional evaluation, smoking habit and alcoholism. Association among qualitative variables by means of the chi-square test, association strength through the odds ratio and estimate of 95 percent confidence intervals were determined, as well as the exposure impact by means of the percent age attributable risk. The social and economic risk factors causally associated with the lung tuberculosis were consumption of alcoholic drinks, nutritional evaluation with a 19,9 body mass index and exposure to the cigar.

[Differences in the use of family planning methods by adolescent females according to the education model utilized during pregnancy. Monterrey, Mexico]. / Diferencias en la utilización de métodos de planificación familiar por mujeres adolescentes en Monterrey, Mexico, segújn el modelo de educación sanitaria utilizado.

BACKGROUND: The objective was to compare the use of family planning methods during the immediate postpartum period and two years following childbirth among the adolescent females who had followed two different intervention programs during their pregnancies. METHODS: A quasi-experimental study was designed. A total of 62 pregnant adolescents were selected to comprised two intervention groups, the PRECEDE model and the Health Belief model (MCS) groups. Non-parametric statistical tests were employed and 95% confidence intervals estimated. RESULTS: The average starting knowledge in the MCS groups was 69.12 points (95% CI 63.27-74.97) and ending 89.71 points (95% CI 86.24-93.17), while the starting knowledge for the PRECEDE group was 49.39 points (95% Cl 42.24-56.54) and ending 75.25 points (95% CI 71.12-79.38). IN the immediate postpartum, 93% (95% CI 83.5-100) of the adolescents in the PRECED group accepted the use of a family planning method similar to that employed by the MCS group, of 94.2 (95% CI 86.3-100). As regards the continued use of the method, that is, two years later, the PRECEDE strategy had a greater effect that the MCS strategy, respectively 92% (95% Cl 82-100) and 72% (95% CI 56.9-87.1). CONCLUSIONS: A difference was found to exist between models as regards the use of family planning methods 2 years following childbirth. The PRECEDE program is proposed as the education strategy for preventing a second pregnancy among adolescent females.