Attitudes and beliefs about sleep health among a racially and ethnically diverse sample of overweight/obese adults.

OBJECTIVES: To identify and compare how sleep-related attitudes and beliefs vary among racially and ethnically diverse adults with risk factors for cardio-metabolic disease. METHODS: This exploratory qualitative study used online focus group discussions (N = 4 groups among 17 individuals) to collect information about sleep attitudes, beliefs, and practices following participation in the Mindfulness Intervention to Improve Sleep and Reduce Diabetes Risk Among a Diverse Sample in Atlanta (MINDS) study. A rapid analyses approach was used to identify shared themes related to attitudes and beliefs about sleep health and sleep practices across participants. RESULTS: Participants on average were 31years old, 88% female, and identified as Black/African American (52.9%), White (17.7%), Asian (11.8%), and Hispanic (17.7%). Three themes related to attitudes and beliefs about sleep health were identified: prioritization of sleep to improve one's overall health, re-evaluating sleep needs, and interpersonal barriers to sleep. For Black/African American participants prioritizing sleep was coupled with a want to minimize stress as a long-term health promotion strategy, whereas individuals of other races/ethnicities were more focused on the immediate benefits of getting sufficient sleep. Individuals had reappraised their sleep needs and worked to improve their sleep hygiene accordingly, yet still experienced barriers to sleep. The most common barrier to sleep was sharing a sleep environment with someone who had conflicting sleep routines and practices. CONCLUSION: The results of this study suggest perceived benefits of and barriers to sleep vary by race/ethnicity, thus future interventions should be culturally tailored to enhance effectiveness.

Hip fracture registries in low- and middle-income countries: a scoping review.

PURPOSE: The study aims to identify, describe, and organize the currently available evidence regarding hip fracture (HF) registries in low- and middle-income countries (LMICs). METHODS: We conducted a scoping review adhering to PRISMA-ScR guidelines. We searched MEDLINE (PubMed), Google Scholar, Global Index Medicus, websites related to HF, and study references for eligible studies. Two reviewers independently performed the study selection and data extraction, including studies describing the use of individual patient records with the aim to improve the quality of care in older people with HF in LMICs. RESULTS: A total of 222 abstracts were screened, 59 full-text articles were reviewed, and 10 studies regarding 3 registries were included in the analysis. Malaysia and Mexico implemented a HF registry in public hospitals whereas Argentina implemented a registry in the private setting. The Mexican registry, the most recent one, is the only one that publishes annual reports. There was significant variability in data fields between registries, particularly in functional evaluation and follow-up. The Ministry of Health finances the Malaysian registry, while Argentinian and Mexican registries founding was unclear. CONCLUSION: The adoption of HF registries in LMICs is scarce. The few experiences show promising results but higher support is required to develop more registries. Long-term sustainability remains a challenge.

Alliance for the development of the Argentinian Hip Fracture Registry.

Age expectancy has significantly increased over the last 50 years, as well as some age-related health conditions such as hip fractures. The development of hip fracture registries has shown enhanced patient outcomes through quality improvement strategies. The development of the Argentinian Hip Fracture Registry is going in the same direction. INTRODUCTION: Age expectancy has increased worldwide in the last 50 years, with the population over 64 growing from 4.9 to 9.1%. As fractures are an important problem in this age group, specific approaches such as hip fracture registries (HFR) are needed. Our aim is to communicate the Argentinian HFR (AHFR) development resulting from an alliance between Fundación Trauma, Fundación Navarro Viola, and the Argentinian Network of Hip Fracture in the elderly. METHODS: Between October 2020 and May 2021, an iterative consensus process involving 5 specialty-focused meetings and 8 general meetings with more than 20 specialists was conducted. This process comprised inclusion criteria definitions, dataset proposals, website deployment with data protection and user validation, the definition of hospital-adjusted registry levels, implementation planning, and sustainability strategies. RESULTS: By June 2021, we were able to (1) outline data fields, including epidemiological, clinical, and functional dimensions for the pre-admission, hospitalization, discharge, and follow-up stages; (2) define three levels: basic (53 fields), intermediate (85), and advanced (99); (3) identify 21 benchmarking indicators; and (4) make a correlation scheme among fracture classifications. Simultaneously, we launched a fundraising campaign to implement the AHFR in 30 centers, having completed 18. CONCLUSION: AHFR development was based on four pillars: (1) representativeness and support, (2) solid definitions from onset, (3) committed teams, and (4) stable funding. This tool may contribute to the design of evidence-based health policies to improve patient outcomes, and we hope this experience will help other LMICs to develop their own tailored-to-their-needs registries.

Nonintensivist Training to Increase the Staff Capacity of Intensive Care Units During COVID-19 Pandemic Surge in Argentina.

OBJECTIVE: The aim of this study was to report the results of a nationwide critical-care course for non-intensivists to increase staff capacity of intensive care units (ICUs) during the coronavirus disease 2019 (COVID-19) pandemic in Argentina. METHODS: Three academic organizations, with special funding from 55 private companies, developed a short virtual course comprised of Web-based videos, virtual tutorials, and a forum chat. Each state assigned scholarships to non-ICU staff from public hospitals. Students received active follow-up for the completion of the course and took a survey upon course completion. RESULTS: After 4 m, there were 10,123 students registered from 661 hospitals in 328 cities. Of these, 67.8% passed the course, 29.1% were still ongoing, and 3.1% were inactive. Most students were female (74.2%) with a median of 37 y old (IQR 31-44). The group was composed of 56.5% nurses, 36.2% physicians, and 7.4% physiotherapists, of whom 48.3% did not have any experience in critical care. Mean overall satisfaction was 4.4/5 (standard deviation, 0.9), and 90.7% considered they were able to apply the contents to their practice. CONCLUSIONS: This course was effective for rapid training of non-ICU personnel. The assignment strategy, the educational techniques, and the close follow-up led to low dropout and high success rates and satisfaction.

A public-private collaborative model for a trauma program implementation: findings from a prospective trauma registry at 14 hospitals in Buenos Aires, Argentina.

INTRODUCTION: Trauma is a leading cause of mortality and comprises an important cause of functional impairment among young people worldwide. The trauma registry (TR) is an integral component of modern comprehensive trauma care systems. Nevertheless, TRs have not been yet established in most developing countries. The objective of this study was to summarize the challenges, results, and lessons learned from a trauma program including initial results from a TR at tertiary-care public hospitals of Buenos Aires, Argentina. MATERIAL AND METHODS: This is a descriptive study of the implementation of a trauma program in 14 hospitals and analysis of the initial results in the period between January 2010 and December 2018, using data from Fundación Trauma TR. Patients fitting injury definition that remained in hospital for more than 23 h were included. Injured patients were divided by age groups. Data on patients' demographics, mechanism of injury and severity, complications, treatments, and in-hospital mortality were analyzed between groups. A descriptive analysis is presented. RESULTS: There were 29,970 trauma cases during the study period. Median age was 23 years (RIC 12, 39) with a 2.4:1 male-to-female ratio. Road traffic injuries (RTI) were the leading mechanism (30.8%) of admission and head was the most frequently injured body region (33.2%). Two-thirds of RTIs were motorcycle-related. Overall in-hospital mortality was 6.1%. Intentional self-harm in adult males and burns in adult females had the highest mortality rates (17.6% and 17.9%, respectively). CONCLUSIONS AND DISCUSSION: The implementation of a trauma program within a public-private collaborative program in a resource-limited environment is feasible. The hospital-based TR can be used as a tool for injury surveillance, monitoring of the quality of trauma care, development of a trauma system, and to guide public health policies.

La enfermedad trauma / Trauma disease

Reports of the World Health Organization make known that the non-intentional lesions and the violence (intentional injuries) are a threatening possibility for the world's health and they represnt a 9 per cent of the whole mortality. Around 5,804,000 subjects die yearly due to lesions (16,000 subjects each day). Eight of the 15 causes of death, of the persons between 15 through 25 years old are related to violence or non-intentional injuries, whether they are produced by vehicular collisions, suicides, homicides, suffocation, burns, wars, poisoning or fallz. In Argentina, each year 8,000 subjects die due to vehicular collisions. According with the National Ministry of health, this number represents the 25 per cent of the deaths due to trauma. We think that it is interesing to present two aspects that require a conceptualization with a scientific support: The recognition of trauma as a disease (the disease trauma), and the necessity to not use the term accident to design the lesional mechanism described for non-intentional truama. The participation of institutions in the control of the disease trauma is considered by the authors.

La enfermedad trauma / The disease trauma

Reports of the World Health Organization make known that the non-intentional lesions and the violence (intentional injuries) are a threatening possibility for the world's health and they represent a 9% of the whole mortality. Around 5.840.000 subjects die yearly due to lesions (16.000 subjects each day). Eight of the 15 causes of death, of the persons between 15 trough 25 years old are related to violence or non-intentional injuries, whether they are produced by vehicular collisons, suicides, homicides, suffocation, burns, wars, poisoning or falls. In Argentina, each year 8.000 subjects die due to vehicular collisions. According with the National Ministery of Health, this number represents the 25% of the deaths due to trauma. We think that it is interesting to present two aspects that require a conceptualization with a scientific support: The recognition of trauma as a disease (the disease trauma), and the necessity to not use the term accident to design the lesional mechanism described for non-intentional trauma. The participation of Institutions in the control of the disease trauma is considered by the authors.

Cirugía neonatal inmediata: experiencia inicial en el tratamiento de gastrosquisis y onfalocele en el noroeste de México / Immediate neonatal surgery: initial experience in gastroschisis and omphalocele treatment in Northwestern Mexico

Immediate neonatal surgery (INS) has the purpose of achieving surgical treatment of a congenital malformation in a newborn within the first few minutes after delivery. Since 1993, we have invited 15 pregnant women with sonographic diagnosis of fetal abdominal wall defect to participate in INS. All were treated by means of elective (eight cases) or emergent (seven cases) cesarean section between 33 and 38 gestational weeks. The neonates were immediately operated on the procedure beginning between 17 and 35 min after delivery. Eleven neonates had gastroschisis and primary closure was accomplished in five cases with application of auxiliary plastic patch (45.5) and in four cases with use of native tissues only (36.4); nine neonates survived (81.8), and were able to be fed by mouth at 14 +/- 4.5 days. Four had omphalocele, and in three primary closure and feeding by mouth before 1 week was attained; the fourth neonate died because of coexisting malformations. The present series, even if small, is useful to affirm the safety of a procedure such as INS for both mother and child; it may contribute to improve the results of treatment of fetuses with abdominal wall defects.

[Immediate neonatal surgery: initial experience in gastroschisis and omphalocele treatment in Northwestern Mexico]. / Cirugía neonatal inmediata: experiencia inicial en el tratamiento de gastrosquisis y onfalocele en el noroeste de México.

Immediate neonatal surgery (INS) has the purpose of achieving surgical treatment of a congenital malformation in a newborn within the first few minutes after delivery. Since 1993, we have invited 15 pregnant women with sonographic diagnosis of fetal abdominal wall defect to participate in INS. All were treated by means of elective (eight cases) or emergent (seven cases) cesarean section between 33 and 38 gestational weeks. The neonates were immediately operated on the procedure beginning between 17 and 35 min after delivery. Eleven neonates had gastroschisis and primary closure was accomplished in five cases with application of auxiliary plastic patch (45.5%) and in four cases with use of native tissues only (36.4%); nine neonates survived (81.8%), and were able to be fed by mouth at 14 +/- 4.5 days. Four had omphalocele, and in three primary closure and feeding by mouth before 1 week was attained; the fourth neonate died because of coexisting malformations. The present series, even if small, is useful to affirm the safety of a procedure such as INS for both mother and child; it may contribute to improve the results of treatment of fetuses with abdominal wall defects.

Uso de prostaglandinas E2 por vía vaginal para inducción del trabajo de parto / Use of prostaglandines E2 vaginally for labor induction

Las prostaglandinas se han usado para favorecer, la maduración cervical, la expulsión del producto y diminuir el número de maniobras obstétricas quirúrgicas. En el trabajo se pretende demostrar la utilidad de este fármaco administrado por vía tópica vaginal; en 40 pacientes con embarazo a término, sin trabajo de parto, con un índice de Bishop de 2 (rango o 4) que acudieron al Servicio de Obstetricia, distribuidas en dos grupos de 20 c/u que recibieron prostaglandinas 0.70 mg. por vía intracervical, y 20 con oxitocina 2 ml. unidad por minuto hasta obtener respuesta, se realizó un estudio longitudinal prospectivo y abierto; se excluyó del grupo de pacientes de alto riesgo; en ambos grupos se registraron partogramas en forma cuidadosa, los resultados se validaron obteniendo un promedio y desviación stándar; la edad promedio 25.15 años, edad gestacional 39.4 semanas. Indice de Bishop 2, en el grupo I y en grupo testigo la edad promedio 24.9 años, edad gestacional 40.4 semans y un índice de Bishop de 3.7ñ el tiempo de inducción del ler. grupo fué de 4.65 horas; en el grupo II 7.9 horas P< 0.05, condicionando en 40% menos tiempo de inducción de la maduración cervical, y el trabajo de parto. No se presentaron accidentes fetoplacentarios. La cesárea se redujo, en el grupo de prostaglandinas, un caso contra 6 del grupo testigo, el número de fórceps fué de mayor en este ler. grupo (7 casos contra 2 casos) del testigo. El estado de los poductos no tuvo diferencias significativas. Se puede concluir que es un fármaco de gran ayuda en la práctica obstétrica manejando cuidadosamente considerándolo como un medicamento de elección para la maduración cervical.