Interval cancer in the Córdoba Breast Tomosynthesis Screening Trial (CBTST): comparison of digital breast tomosynthesis plus digital mammography to digital mammography alone.

PURPOSE: This work aims to compare the interval cancer rate and interval cancer characteristics between women screened with digital breast tomosynthesis (DBT) + digital mammography (DM) and those screened with DM alone. METHODS: The interval cancer rate and interval cancer characteristics of the study population included in the Córdoba Breast Tomosynthesis Screening Trial (CBTST) were compared to a contemporary control population screened with DM. The tumour characteristics of screen-detected and interval cancers were also compared. Contingency tables were used to compare interval cancer rates. The chi-square test and Fisher's exact test were used to compare the qualitative characteristics of the cancers whereas Student's t test and the Mann-Whitney U test were used to analyse quantitative features. RESULTS: A total of 16,068 screening exams with DBT + DM were conducted within the CBTST (mean age 57.59 ± 5.9 [SD]) between January 2015 and December 2016 (study population). In parallel, 23,787 women (mean age 58.89 ± 5.9 standard deviation [SD]) were screened with DM (control population). The interval cancer rate was lower in the study population than in the control population (15 [0.93‰; 95% confidence interval (CI): 0.73, 1.14] vs 43 [1.8‰; 95% CI: 1.58, 2.04] respectively; p = 0.045). The difference in rate was more marked in women with dense breasts (0.95‰ in the study population vs 3.17‰ in the control population; p = 0.031). Interval cancers were smaller in the study population than in the control population (p = 0.031). CONCLUSIONS: The interval cancer rate was lower in women screened with DBT + DM compared to those screened with DM alone. These differences were more pronounced in women with dense breasts. CLINICAL RELEVANCE STATEMENT: Women screened using tomosynthesis and digital mammography had a lower rate of interval cancer than women screened with digital mammography, with the greatest difference in the interval cancer rate observed in women with dense breasts. KEY POINTS: • The interval cancer rate was lower in the study population (digital breast tomosynthesis [DBT] + digital mammography [DM]) than in the control population (DM). • The difference in interval cancer rates was more pronounced in women with dense breasts. • Interval cancers were smaller in the study population (DBT + DM) than in the control population (DM).

Impact of real-life use of artificial intelligence as support for human reading in a population-based breast cancer screening program with mammography and tomosynthesis.

OBJECTIVES: To evaluate the impact of using an artificial intelligence (AI) system as support for human double reading in a real-life scenario of a breast cancer screening program with digital mammography (DM) or digital breast tomosynthesis (DBT). MATERIAL AND METHODS: We analyzed the performance of double reading screening with mammography and tomosynthesis after implementarion of AI as decision support. The study group consisted of a consecutive cohort of 1 year screening between March 2021 and March 2022 where double reading was performed with concurrent AI support that automatically detects and highlights lesions suspicious of breast cancer in mammography and tomosynthesis. Screening performance was measured as cancer detection rate (CDR), recall rate (RR), and positive predictive value (PPV) of recalls. Performance in the study group was compared using a McNemar test to a control group that included a screening cohort of the same size, recorded just prior to the implementation of AI. RESULTS: A total of 11,998 women (mean age 57.59 years ± 5.8 [sd]) were included in the study group (5049 DM and 6949 DBT). Comparing global results (including DM and DBT) of double reading with vs. without AI support, we observed an increase in CDR, PPV, and RR by 3.2/‰ (5.8 vs. 9; p < 0.001), 4% (10.6 vs. 14.6; p < 0.001), and 0.7% (5.4 vs. 6.1; p < 0.001) respectively. CONCLUSION: AI used as support for human double reading in a real-life breast cancer screening program with DM and DBT increases CDR and PPV of the recalled women. CLINICAL RELEVANCE STATEMENT: Artificial intelligence as support for human double reading improves accuracy in a real-life breast cancer screening program both in digital mammography and digital breast tomosynthesis. KEY POINTS: • AI systems based on deep learning technology offer potential for improving breast cancer screening programs. • Using artificial intelligence as support for reading improves radiologists' performance in breast cancer screening programs with mammography or tomosynthesis. • Artificial intelligence used concurrently with human reading in clinical screening practice increases breast cancer detection rate and positive predictive value of the recalled women.

Behaviour of aerosols and their role in the transmission of SARS-CoV-2; a scoping review.

Covid-19 has triggered an unprecedented global health crisis. The highly contagious nature and airborne transmission route of SARS-CoV-2 virus requires extraordinary measures for its containment. It is necessary to know the behaviour of aerosols carrying the virus to avoid this contagion. This paper describes the behaviour of aerosols and their role in the transmission of SARS-CoV-2 according to published models using a scoping review based on the PubMed, Scopus, and WOS databases. From an initial 530 references, 9 papers were selected after applying defined inclusion criteria. The results reinforce the airborne transmission route as a means of contagion of the virus and recommend the use of face masks, extending social distance to more than 2 metres, and natural ventilation of enclosed spaces as preventive measures. These results contribute to a better understanding of SARS-CoV-2 and help design effective strategies to prevent its spread.

The carbon footprint of healthcare settings: A systematic review.

Healthcare systems are responsible for 4%-5% of the emissions of greenhouse gases worldwide. The Greenhouse Gas Protocol divides carbon emissions into three scopes: scope 1 or direct emissions secondary to energy use; scope 2 or indirect emissions secondary to purchased electricity; and scope 3 for the rest of indirect emissions. AIM: To describe the environmental impact of health services. DESIGN: A systematic review was conducted in the Medline, Web of Science, CINAHL, and Cochrane databases. Studies that focused their analysis on a functional healthcare unit and which included. This review was conducted from August to October 2022. RESULTS: The initial electronic search yielded a total of 4368 records. After the screening process according to the inclusion criteria, 13 studies were included in this review. The reviewed studies found that between 15% and 50% of the total emissions corresponded to scopes 1 and 2 emissions, whereas scope 3 emissions ranged between 50% and 75% of the total emissions. Disposables, equipment (medical and non-medical) and pharmaceuticals represented the higher percentage of emissions in scope 3. CONCLUSION: Most of the emissions corresponded to scope 3, which includes the indirect emission occurring as a consequence of the healthcare activity, as this scope includes a wider range of emission sources than the other scopes. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Interventions should be carried out by the healthcare organizations responsible of Greenhouse Gas emissions, and also every single individual that integrates them should make changes. The use of evidence-based approaches to identify carbon hotspots and implement the most effective interventions in the healthcare setting could lead to a significant reduction of carbon emissions. IMPACT: This literature review highlights the impact that healthcare systems have on climate change and the importance of adopting and carrying out interventions to prevent its fast development. REPORTING METHOD: This review adhered to PRISMA guideline. PRISMA 2020 is a guideline designed for systematic reviews of studies that analyse the effects of heath interventions, and aim is to help authors improve the reporting of systematic review and meta-analyses. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Validation of hemoglobin measurement in venous blood using HemoCue for the Ensanut 2022.

OBJECTIVE: To validate hemoglobin (Hb) concentration in venous blood (VB) using the HemoCue 201+ in a subsample of children and women from the Mexican National Health and Nutrition Survey 2022. MATERIALS AND METHODS: Prior to field work 50 HemoCue 201+ devices were verified using venous blood. During the field work 57 children (aged 1-11) and 62 women (aged 12-49) donated 3 mL of VB each. Hb was measured in each device of HemoCue 201+ and in a hematologic autoanalyzer for the validation. RESULTS: No significant bias was found in most of the devices. An adjustment criterion was used for 22 devices. Hb mean difference results were -0.049±0.578 g/dL in children and -0.098±0.628 g/dL in women. CONCLUSIONS: The HemoCue 201+ is a valid tool for estimating Hb concentration to produce reliable estimates of anemia prevalence when using venous blood.

Short-term outcomes in the upper airway with tooth-bone-borne vs bone-borne rapid maxillary expanders.

BACKGROUND: This study compared the area and minimal section of the nasal cavity, nasopharynx, oropharynx, and hypopharynx in cases treated with different methods of microimplant-assisted expansion. METHODS: Based on a pilot study to calculate the sample size, 30 patients with transverse maxillary deficiency over 14 years of age were retrospectively selected. These patients had received two different types of microimplant-assisted maxillary expansion treatment (MARPE and BAME). The patient underwent Cone-Beam computed tomography (CBCT) before and after treatment (mean time 1.5 months) with MARPE or BAME and upper airway measurements (volume and minimum cross-sectional area) were taken to assess upper airways changes and compare changes between the groups. A paired sample t-test was performed to evaluate the T0-T1 change of airway measurements obtained with MARPE and BAME, and a student t-test to compare changes in airway measurements between MARPE and BAME. RESULTS: This investigation shows a statistically significant increase in total nasopharyngeal airway volume (0.59 ± 1.42 cm3; p < 0.01), total oropharyngeal airway volume (3.83 ± 7.53 cm3; p < 0.01) and minimum oropharyngeal cross-section (53.23 ± 126.46 mm2; p < 0.05) in all cases treated with micro-screw assisted expansion. The minimal cross-sectional area of the oropharynx ((79.12 ± 142.28 mm2; p < 0.05) and hypopharynx (59.87 ± 89.79 mm2; p < 0.05) showed significant changes for cases treated with BAME. As for the comparison between cases treated with MARPE and BAME, no differences in upper airway changes have been observed, except for the minimum cross-sectional area of the nasal cavity, which increases for MARPE (52.05 ± 132.91 mm2) and decreases for BAME (-34.10 ± 90.85 mm2). CONCLUSIONS: A significant increase in total area and minimal section at the level of nasopharynx and oropharynx was observed in cases treated with BAME. Regarding the comparison of MARPE and BAME treatments, no differences were found in the total airway volume and minimal section in upper airway except for the minimum cross section of the nasal cavity that increases for MARPE and decreases for BAME.

Limited Humoral and Specific T-Cell Responses After SARS-CoV-2 Vaccination in PWH With Poor Immune Reconstitution.

BACKGROUND: We analyzed humoral and cellular immune responses induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccines in people with human immunodeficiency virus (HIV; PWH) who had CD4+ T-cell counts <200/µL (HIV<200 group). METHODS: This prospective cohort study included 58 PWH in the HIV<200 group, 36 with CD4+ T-cell counts >500/µL (HIV>500 group), and 33 HIV-1-negative controls (control group). Antibodies against the SARS-CoV-2 spike protein (anti-S immunoglobulin [Ig] G) and the receptor-binding domain (anti-RBD IgG) were quantified before and 4 weeks after the first and the second doses of BNT162b2 or mRNA-1273 (at week 8). Viral neutralization activity and T-cell responses were also determined. RESULTS: At week 8, anti-S/anti-RBD IgG responses increased in all groups (P < .001). Median (interquartile range) anti-S and anti-RBD IgG levels at week 8 were 153.6 (26.4-654.9) and 171.9 (61.8-425.8) binding antibody units (BAU)/mL, respectively, in the HIV<200 group, compared with 245.6 (145-824) and 555.8 (166.4-1751) BAU/mL in the HIV>500 group and 274.7 (193.7-680.4) and 281.6 (181-831.8) BAU/mL in controls (P < .05). Neutralizing capacity and specific T-cell immune responses were absent or reduced in 33% of those in the HIV<200 group, compared with 3.7% in the HIV>500 group (P < .01). CONCLUSIONS: One-third of PWH with CD4+ T-cell counts <200/µL show low anti-S/anti-RBD IgG levels, reduced in vitro neutralization activity against SARS-CoV-2, and no vaccine-induced T cells after receiving coronavirus disease 2019 mRNA vaccines.

Stand-Alone Use of Artificial Intelligence for Digital Mammography and Digital Breast Tomosynthesis Screening: A Retrospective Evaluation.

Background Use of artificial intelligence (AI) as a stand-alone reader for digital mammography (DM) or digital breast tomosynthesis (DBT) breast screening could ease radiologists' workload while maintaining quality. Purpose To retrospectively evaluate the stand-alone performance of an AI system as an independent reader of DM and DBT screening examinations. Materials and Methods Consecutive screening-paired and independently read DM and DBT images acquired between January 2015 and December 2016 were retrospectively collected from the Tomosynthesis Cordoba Screening Trial. An AI system computed a cancer risk score (range, 1-100) for DM and DBT examinations independently. AI stand-alone performance was measured using the area under the receiver operating characteristic curve (AUC) and sensitivity and recall rate at different operating points selected to have noninferior sensitivity compared with the human readings (noninferiority margin, 5%). The recall rate of AI and the human readings were compared using a McNemar test. Results A total of 15 999 DM and DBT examinations (113 breast cancers, including 98 screen-detected and 15 interval cancers) from 15 998 women (mean age, 58 years ± 6 [standard deviation]) were evaluated. AI achieved an AUC of 0.93 (95% CI: 0.89, 0.96) for DM and 0.94 (95% CI: 0.91, 0.97) for DBT. For DM, AI achieved noninferior sensitivity as a single (58.4%; 66 of 113; 95% CI: 49.2, 67.1) or double (67.3%; 76 of 113; 95% CI: 58.2, 75.2) reader, with a reduction in recall rate (P < .001) of up to 2% (95% CI: -2.4, -1.6). For DBT, AI achieved noninferior sensitivity as a single (77%; 87 of 113; 95% CI: 68.4, 83.8) or double (81.4%; 92 of 113; 95% CI: 73.3, 87.5) reader, but with a higher recall rate (P < .001) of up to 12.3% (95% CI: 11.7, 12.9). Conclusion Artificial intelligence could replace radiologists' readings in breast screening, achieving a noninferior sensitivity, with a lower recall rate for digital mammography but a higher recall rate for digital breast tomosynthesis. Published under a CC BY 4.0 license. See also the editorial by Fuchsjäger and Adelsmayr in this issue.

Model-Driven Impact Quantification of Energy Resource Redundancy and Server Rejuvenation on the Dependability of Medical Sensor Networks in Smart Hospitals.

The spread of the Coronavirus (COVID-19) pandemic across countries all over the world urges governments to revolutionize the traditional medical hospitals/centers to provide sustainable and trustworthy medical services to patients under the pressure of the huge overload on the computing systems of wireless sensor networks (WSNs) for medical monitoring as well as treatment services of medical professionals. Uncertain malfunctions in any part of the medical computing infrastructure, from its power system in a remote area to the local computing systems at a smart hospital, can cause critical failures in medical monitoring services, which could lead to a fatal loss of human life in the worst case. Therefore, early design in the medical computing infrastructure's power and computing systems needs to carefully consider the dependability characteristics, including the reliability and availability of the WSNs in smart hospitals under an uncertain outage of any part of the energy resources or failures of computing servers, especially due to software aging. In that regard, we propose reliability and availability models adopting stochastic Petri net (SPN) to quantify the impact of energy resources and server rejuvenation on the dependability of medical sensor networks. Three different availability models (A, B, and C) are developed in accordance with various operational configurations of a smart hospital's computing infrastructure to assimilate the impact of energy resource redundancy and server rejuvenation techniques for high availability. Moreover, a comprehensive sensitivity analysis is performed to investigate the components that impose the greatest impact on the system availability. The analysis results indicate different impacts of the considered configurations on the WSN's operational availability in smart hospitals, particularly 99.40%, 99.53%, and 99.64% for the configurations A, B, and C, respectively. This result highlights the difference of 21 h of downtime per year when comparing the worst with the best case. This study can help leverage the early design of smart hospitals considering its wireless medical sensor networks' dependability in quality of service to cope with overloading medical services in world-wide virus pandemics.

Contralateral orbicularis oculi muscle transposition in facial paralysis: functional, aesthetic and electromyographic outcomes. A case report and literature update.

PURPOSE: Many surgical approaches have been described for achieving satisfactory functionality in patients with facial paralysis, to ensure the protection of the cornea and the highest degree of physiological blinking. Out of all those available, dynamic techniques are indicated when motion recovery and synchrony are the goals pursued. Orbicularis oculi transposition (OOT) allows a genuine restoration of blinking by means of contralateral reinnervation, with minimal insult for the donor site. METHODS: We present the case of a 64-year-old man with unilateral facial paralysis. A physical examination revealed a lagophthalmos of more than 5 mm. A neurophysiological study showed a mild-to-moderate axonal injury of the left facial nerve. Contralateral OOT was indicated as the first therapy option since it can restore involuntary blinking. The orbicularis muscle flap was not divided into branches, as described previously by other authors; the whole flap was transposed to the paralysed upper eyelid to achieve the highest level of potential reinnervation. RESULTS: Lagophthalmos was fully corrected after the surgery. The patient reported subjective improvement of symptoms, less frequent instillation of artificial tear drops and, especially, synchronous blinking with significant improvement in involuntarity. These improvements were maintained after 1 year of follow-up. Postoperative electromyographic studies confirmed the improvement in neural function. CONCLUSIONS: OOT can be a safe and effective option for the treatment of patients with peripheral facial paralysis, as it achieves a good restoration of blinking function with minimal morbidity in the healthy donor eye.

AI-based Strategies to Reduce Workload in Breast Cancer Screening with Mammography and Tomosynthesis: A Retrospective Evaluation.

Background The workflow of breast cancer screening programs could be improved given the high workload and the high number of false-positive and false-negative assessments. Purpose To evaluate if using an artificial intelligence (AI) system could reduce workload without reducing cancer detection in breast cancer screening with digital mammography (DM) or digital breast tomosynthesis (DBT). Materials and Methods Consecutive screening-paired and independently read DM and DBT images acquired from January 2015 to December 2016 were retrospectively collected from the Córdoba Tomosynthesis Screening Trial. The original reading settings were single or double reading of DM or DBT images. An AI system computed a cancer risk score for DM and DBT examinations independently. Each original setting was compared with a simulated autonomous AI triaging strategy (the least suspicious examinations for AI are not human-read; the rest are read in the same setting as the original, and examinations not recalled by radiologists but graded as very suspicious by AI are recalled) in terms of workload, sensitivity, and recall rate. The McNemar test with Bonferroni correction was used for statistical analysis. Results A total of 15 987 DM and DBT examinations (which included 98 screening-detected and 15 interval cancers) from 15 986 women (mean age ± standard deviation, 58 years ± 6) were evaluated. In comparison with double reading of DBT images (568 hours needed, 92 of 113 cancers detected, 706 recalls in 15 987 examinations), AI with DBT would result in 72.5% less workload (P < .001, 156 hours needed), noninferior sensitivity (95 of 113 cancers detected, P = .38), and 16.7% lower recall rate (P < .001, 588 recalls in 15 987 examinations). Similar results were obtained for AI with DM. In comparison with the original double reading of DM images (222 hours needed, 76 of 113 cancers detected, 807 recalls in 15 987 examinations), AI with DBT would result in 29.7% less workload (P < .001), 25.0% higher sensitivity (P < .001), and 27.1% lower recall rate (P < .001). Conclusion Digital mammography and digital breast tomosynthesis screening strategies based on artificial intelligence systems could reduce workload up to 70%. Published under a CC BY 4.0 license.

Language development in children of adolescent mothers by residence area, Ensanut 100k / Desarrollo del lenguaje en hijos e hijas de madres adolescentes por área de residencia, Ensanut 100k.

Objective: To evaluate the association between adolescent pregnancy and language development in children living in socioeconomically vulnerable areas of Mexico. Materials and methods: We estimated the standardized language score of children aged 12-59 months who participated in the Ensanut 100k. Teenage mothers (TM) were those who at delivery was between 12-19 years old. The association was estimated using multivariate linear regression; moreover, we evaluated an interaction between type of mother and place of residence. Results: Children of TM who lived in urban areas had lower standardized language scores than those of adult mothers (ß= -0.33 95%CI: -0.65 a -0.01; p for interaction<0.01). However, book availability and/or mother's support for learning significantly reduce this difference. Conclusions: Sociocultural pressures towards TM in urban areas could explain the results; nevertheless, this population could be susceptible to strategies aimed to improve the mother-child relationship and support for learning.

Health care workers' protection and psychological safety during the COVID-19 pandemic in Spain.

AIMS: To analyse the relationship between work engagement, sense of coherence and psychological distress levels in Spanish health professionals who were active during the COVID-19 pandemic lockdown. BACKGROUND: Work engagement and sense of coherence can help professionals to cope with work-related psychological distress due to the harsh conditions of the COVID-19 working environment. METHODS: Cross-sectional observational study of 1,459 health care professionals. The Utrecht Work Engagement Scale, the Sense of Coherence Scale and Goldberg's General Health Questionnaire were distributed and analysed with descriptive and multiple linear regression methods. RESULTS: High levels of work engagement, especially in the dedication dimension, of sense of coherence, in particular in the meaningfulness dimension, and psychological distress were obtained. Significant correlations (p < .001) were identified between all the variables. CONCLUSIONS: Work engagement and sense of coherence correlated positively with each other and both negatively with psychological distress. So, health care professionals, despite presenting psychological distress, perceive their work satisfactorily and positively despite the severity of the situation and the harsh conditions. IMPLICATIONS FOR NURSING MANAGEMENT: Sense of coherence and work engagement are protective factors against psychological distress. Preventive measures for professionals should go through the dimensionalization of the problem and the adaptation of practical measures for daily management.

Work engagement and psychological distress of health professionals during the COVID-19 pandemic.

AIMS: To describe the level of work engagement of active health care professionals during the COVID-19 pandemic, and its relationship with psychological distress according to the professional category. BACKGROUND: Health care professionals working on the front line of the COVID-19 pandemic are at risk of psychological distress, and work engagement could be a positive attitude that could serve as a protective factor. METHODS: Cross-sectional observational study of 1,459 health care professionals. Psychological distress was measured with the General Health Questionnaire and work engagement with the Utrecht Work Engagement Scale. Data were analysed with bivariate analyses and correlations. RESULTS: Psychological distress was reported by 80.6% of health care professionals. Work engagement as high with a total mean score of 5.04 (SD = 1.14). The results showed that distressed professionals showed significantly lower levels of work engagement. CONCLUSIONS: The present study identified psychological distress and work engagement experienced by health care professionals during the COVID-19 pandemic. Most of the variables included in the study revealed a significant relationship with psychological distress and work engagement. IMPLICATIONS FOR NURSING MANAGEMENT: The relationship between the working conditions with psychological distress and work engagement suggests that improvements in the workplace are needed to promote protective measure for the mental health of health care professionals.

Children's acute respiratory symptoms associated with PM2.5 estimates in two sequential representative surveys from the Mexico City Metropolitan Area.

BACKGROUND: Respiratory diseases are a major component of morbidity in children and their symptoms may be spatially and temporally exacerbated by exposure gradients of fine particulate matter (PM2.5) in large polluted urban areas, like the Mexico City Metropolitan Area (MCMA). OBJECTIVES: To analyze the association between satellite-derived and interpolated PM2.5 estimates with children's (≤9 years old) acute respiratory symptoms (ARS) in two probabilistic samples representing the MCMA. METHODS: We obtained ARS data from the 2006 and 2012 National Surveys for Health and Nutrition (ENSaNut). Two week average exposure to PM2.5 was assessed for each household with spatial estimates from a hybrid model with satellite measurements of aerosol optical depth (AOD-PM2.5) and also with interpolated PM2.5 measurements from ground stations, from the Mexico City monitoring network (MNW-PM2.5). We used survey-adjusted logistic regressions to analyze the association between PM2.5 estimates and ARS reported on children. RESULTS: A total of 1,005 and 1,233 children were surveyed in 2006 and 2012 representing 3.1 and 3.5 million children, respectively. For the same years and over the periods of study, the estimated prevalence of ARS decreased from 49.4% (95% CI: 44.9,53.9%) to 37.8% (95% CI: 34,41.7%). AOD-PM2.5 and MNW-PM2.5 estimates were associated with significantly higher reports of ARS in children 0-4 years old [OR2006 = 1.29 (95% (CI): 0.99,1.68) and OR2006 = 1.24 (95% CI: 1.08,1.42), respectively]. We observed positive non-significant associations in 2012 in both age groups and in 2006 for children 5-9 years old. No statistically significant differences in health effect estimates of PM2.5 were found comparing AOD-PM2.5 or MNW-PM2.5 for exposure assessment. CONCLUSIONS: Our findings suggest that PM2.5 is a risk factor for the prevalence of ARS in children and expand the growing evidence of the utility of new satellite AOD-based methods for estimating health effects from acute exposure to PM2.5.

[Factors associated with early childhooddevelopment in mexican children]. / Características infantiles y contextuales asociadas con el desarrollo infantil temprano en la niñez mexicana.

OBJECTIVE: To estimate levels of early childhood develop-ment (ECD) and associated factors in Mexican population aged 19-59 months. MATERIALS AND METHODS: The Ensanut 2018-19 evaluated ECD using the Early Childhood Development Index (ECDI) and level of language develop-ment. We used multivariate models, with logistic or linear regression, depending on the outcome variable. RESULTS: Children of wealthier households and with children's books at home are more likely of having an adequate ECDI; in contrast, children who experienced violent discipline methods are less likely. Children living in rural areas, with more highly educated mothers, who were not undernourished, and with support for learning have higher language scores. CONCLUSIONS: Public policies aimed to enhance early childhood development should take into account the associated modifiable factors.

OBJETIVO: Estimar el nivel de desarrollo infantil temprano (DIT) y sus factores asociados en población mexicana de 19 a 59 meses. MATERIAL Y MÉTODOS: La Encuesta Nacional de Salud Pública y Nutrición 2018-19 evaluó el DIT mediante el Índice de Desarrollo Infantil Temprano (ECDI) y el nivel de desarrollo de lenguaje. Se estimaron modelos multivariados de acuerdo con la variable de resultado, usando modelos de regresión logística o lineal. RESULTADOS: Los niños/as de hogares con mayor nivel socioeconómico y que cuentan con libros infantiles en el hogar tienen mayores posibilidades de DIT adecuado, mientras que los/as niños/as educados con métodos de disciplina violenta tienen menores posibilidades. Además,los niños/as residentes de áreas rurales, hijos/as de madres con mayor escolaridad, sin desnutrición y con oportunidades de aprendizaje tienen un mayor puntaje de lenguaje. CONCLUSIONES: Las políticas públicas encaminadas a mejorar el desarrollo en la primera infancia deben tomar en cuenta los factores modificables asociados.

[Methodological bases of the measurement of earlychildhood development in the Ensanut 100k survey]. / Bases metodológicas de lamedición de desarrollo infantiltemprano en la Ensanut 100k.

OBJECTIVE: The methods that were carried out for the inclusion of the early childhood development module in the Ensanut 100k are presented. MATERIALS AND METHODS: With this module and the questionnaire for children under five years-old, indicators of the state of health, development and well-being of children in the first five years of life are obtained. From November to December 2017, the sample design, instruments and manuals were defined and a test was carried out. Field staff were trained and standardized. The information was collected between January and June 2018. RESULTS: 3 892 children from 0 to 59 months of age were studied in the DIT Module of the Survey. CONCLUSIONS: Training and standardization of field personnel, by trained and standardized personnel, minimizes information biases.

OBJETIVO: Presentar los métodos realizados para la inclu-sión del módulo de Desarrollo Infantil Temprano (DIT) en la Ensanut 100k. MATERIAL Y MÉTODOS: Con dicho módulo y el cuestionario de menores de cinco años, se obtuvieron indicadores del estado de salud, desarrollo y bienestar de niñas/os en los primeros cinco años de vida.De noviembre a diciembre de 2017, se definió el diseño de la muestra, instrumentos y manuales, y se realizó una prueba piloto. Se capacitó y estandarizó al personal de campo. El levantamiento de información se realizó entre enero y junio de 2018. RESULTADOS: Se estudió en el módulo DIT de la encuesta a 3 892 niños/as de 0 a 59 meses de edad. CONCLUSIONES: La capacitación y estandarización del personal de campo, por parte de personal capacitado y estandarizado, minimiza los sesgos de información.

Psychological Variables in Children and Adolescents with Cleft Lip and/or Palate.

Objective: This review analyzes the psychological variables most frequently studied over the last 10 years in children and adolescents with cleft lip/palate (CL/P). Such variables are assumed to be the keys to these patients' psychosocial adjustment. Study design: Articles published from January 2007 to February 2017 were retrieved from PubMed to identify the psychological variables most commonly studied in children and adolescents with CL/P, irrespective of gender or type of cleft. The search terms were "cleft palate" and "psychology", with the operator AND. Results: Of the 324 articles retrieved, 26 met the criteria for inclusion in the review. The psychological variables most extensively studied over the years were children's social functioning, quality of life and ability to cope. Conclusion: While CL/P patients' quality of life was unanimously agreed to be affected, no consensus was found in the literature on social functioning or coping. In addition to the cleft, patient adjustment was reported to be governed by individual variables and mediators. The range of ages most frequently studied was 7 to 16.

Cultural adaptation and validation of the nursing students' perceptions of instructor caring into spanish.

OBJECTIVE: This paper aims to provide a Spanish version of the nursing students'' perceptions of instructor caring with content validity and reliability. METHODS: A forward and backward translation procedure was conducted, and a panel of 15 experts assessed face validity. Content validity was established by calculating content validity indexes for each item and for the scale. The internal consistency was assessed in a sample of 120 students. RESULTS: Content validity indexes resulted in higher than 0.78 for all items except Does not reveal any of his or her personal sides and serves as a trusted resource for personal problem solving; content validity index for the scale was 0.9 and Cronbach α was 0.942. DISCUSSION: Results regarding reliability were similar to that of other studies in which the nursing students' perceptions of instructor caring has been used as a measuring tool. Item 12 deletion implies a considerable improvement in internal consistency. CONCLUSION: The Spanish nursing students' perceptions of instructor caring is a valid and reliable tool to be used in the Spanish context. Its use will enhance the understanding of clinical mentors' impact on nursing students.

Psychosocial dental impact in adult orthodontic patients: what about health competence?

BACKGROUND: Several studies have assessed the psychological benefits of orthodontic treatment; however, the impact of competence on psychological benefits remains unknown. AIMS: To analyze the change of the perception of psychosocial dental impact in a sample of adults undergoing orthodontic treatment (mild/moderate dental malocclusions) and to assess the possible moderating effect of health competence level. METHODS: A longitudinal prospective design was used. Three time points were included: baseline (T0), 6 months after starting orthodontic treatment (T1) and once treatment had finished (T2). The pretreatment sample consisted of 78 patients recruited from the Rey Juan Carlos University Dental Clinic, all of whom had moderate malocclusions and were going to undergo orthodontic treatment for approximately 18 months with fixed metal multibrackets. All participants were instructed to complete the Spanish version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) and the aesthetic component of the Index of Orthodontic Treatment Need (IOTN-AC) on the three points of the research. Statistical analysis involved the General Linear Model (GLM) repeated-measures ANOVA to test if the outcome measures of psychosocial dental impact significantly changed over time during orthodontic treatment (baseline, at 6-month evaluation and posttreatment). To assess the effect of the previous health competence levels (high/low) in the change from baseline to the 6-month assessment, for each PIDAQ dimension, a 2*2 (time*group) repeated measures ANOVA was performed. RESULTS: A significant increase was observed in dental self-confidence values (T0-T1 and T0-T2). Similar results were observed for the psychological impact variables and for the IOTN-AC scores, which showed significant decreases between T0 and T1 and between T0 and T2. Finally, significantly decreases were observed between T0 and T2 in aesthetic concern. Interaction effects were found regarding the health competence variable from T0-T1 for the psychological impact, social impact and aesthetic concern and the IOTN-AC index, with significant development results regarding the high competence group. CONCLUSIONS: The first 6 months of orthodontic treatment seemed to be key to the development of psychosocial dental impact perception, during which the role of health competence was of great importance to developing a positive change. It is necessary to follow a biopsychosocial approach towards orthodontic treatment.