Relación entre la enfermedad periodontal y la enfermedad pulmonar obstructiva crónica: revisión bibliográfica / Relationship between periodontal disease and chronic obstructive pulmonary disease: a bibliographic review

Introducción: la enfermedad periodontal y la enfermedad pulmonar obstructiva crónica son patologías de origen inflamatorio crónico y progresivo que afectan a pacientes de edad avanzada, fumadores con mal estado de salud oral, encontrándose una correlación por el grado de severidad en la enfermedad periodontal sobre aquellos individuos con presencia de enfermedad pulmonar obstructiva crónica (EPOC) y exacerbaciones. Objetivos: determinar la relación de la enfermedad periodontal y la enfermedad pulmonar obstructiva crónica, explicando los factores de riesgo que intervienen en estas enfermedades. Material y métodos: se realizó una búsqueda en los principales buscadores de datos digitales: PubMed, SciELO, Science Direct, BMC, Journal of Periodontology, Web of Science y Scopus. Se escogieron artículos publicados en los últimos cinco años; se excluyeron artículos incompletos y que no se relacionan al tema. En el resultado de la búsqueda, 45 artículos cumplieron con el propósito de la revisión bibliográfica. Resultados: en esta revisión bibliográfica, se obtuvo que 18 artículos comprueban la relación de la enfermedad periodontal y la enfermedad pulmonar obstructiva crónica. Conclusiones: se ha comprobado la relación entre la enfermedad periodontal y enfermedad pulmonar obstructiva crónica. Se requiere el análisis de más estudios para determinar una relación directa entre estas dos enfermedades e incluir variables como la edad y el tratamiento (AU)

Introduction: periodontal disease and chronic obstructive pulmonary disease are diseases of chronic and progressive inflammatory origin that affect elderly patients, smokers with poor oral health, finding a correlation by the degree of severity in periodontal disease on those individuals with the presence of chronic obstructive pulmonary disease (COPD) and exacerbations. Objectives: to determine the relationship between periodontal disease and chronic obstructive pulmonary disease explaining the risk factors involved in these diseases. Material and methods: a search was carried out in the main digital data search engines: PubMed, SciELO, Science Direct, BMC, Journal of Periodontology, Web of Science, and Scopus, articles published in the last 5 years were chosen, incomplete articles and those not related to the subject were excluded, in the result of the search 45 articles fulfilled the purpose of the bibliographic review. Results: in this literature review it was obtained that 18 articles, prove the relationship between periodontal disease and chronic obstructive pulmonary disease. Conclusions: the relationship between periodontal disease and chronic obstructive pulmonary disease has been proved. More studies are needed to determine a direct relationship between these two diseases and to include variables such as age and treatment (AU)

Actitudes hacia el aborto deseado en estudiantes de ciencias de la salud chilenos / Attitudes towards wanted abortion among Chilean health sciences students

Introducción: La interrupción del embarazo mediando principalmente la voluntad de la mujer, es decir, cuando una mujer desea abortar para terminar su embarazo por cualquier razón, es un procedimiento controversial. Las actitudes individuales de los profesionales de la salud hacia este procedimiento influirían sobre la aceptación o el rechazo de realizarlo y, por ende, afectarían su acceso en el sistema de salud. Objetivo: Relacionar actitudes hacia la interrupción del embarazo con características sociodemográficas y académicas de estudiantes chilenos de enfermería, medicina y obstetricia y puericultura. Método: Estudio cuantitativo con diseño observacional, transversal y descriptivo. Reclutamos estudiantes universitarios con un muestreo no probabilístico. Recolectamos datos mediante cuestionarios virtuales autoadministrados. Preguntamos por la intención de realizar o asistir un aborto médico o quirúrgico frente a 15 escenarios distintos y creamos un índice con estas respuestas. Calculamos estadísticas descriptivas básicas y creamos modelos de regresión lineal. Consideramos significancia estadística si p < 0,05. Resultados: Participaron 229, 306 y 233 estudiantes de enfermería, medicina y obstetricia y puericultura, respectivamente (en total, 768). En el modelo de regresión lineal múltiple, declararse cristiano (β = −0,248) y afirmar que la religión es muy o totalmente importante en la vida (β = −0,269) se asociaron más fuertemente y de manera inversa y significativa con el índice de intención de realizar o asistir un aborto médico o quirúrgico. Conclusiones: La religión es un factor que influiría decisivamente sobre las actitudes hacia la interrupción del embarazo. Los escenarios más positivamente valorados podrían explicarse considerando que las leyes reflejarían los valores predominantes de una sociedad.

Introduction: Termination of pregnancy mediated primarily by the womans will, i.e., when a woman wishes to have an abortion to terminate her pregnancy for any reason, is a controversial procedure. The individual attitudes of health professionals towards this procedure would affect the degree of acceptance or rejection of performing this procedure and, therefore, would affect its accessibility in the health system. Objective: To relate attitudes towards abortion with sociodemographic and academic characteristics of Chilean nursing, medicine and midwifery students. Method: Quantitative study with observational, cross-sectional and descriptive design. We recruited university students with non-probabilistic sampling. We collected data through self-administered virtual questionnaires. We asked about the intention to perform an abortion in 15 different scenarios and created an index with these responses. We calculated basic descriptive statistics and created linear regression models. We considered statistical significance if p < 0.05. Results: 229, 306 and 233 students from nursing, medicine and midwifery participated, respectively (total: 768). In the multiple linear regression model, declaring oneself a Christian (β = −0.248) and stating that religion is very or totally important in life (β = −0.269) were inversely and significantly associated with the index of intention to perform an abortion. Conclusions: Religion is a factor that would decisively influence attitudes toward termination of pregnancy. The more positively valued scenarios could be explained by considering that laws would reflect the predominant values of a society.

The Effects of Multiple Micronutrient Fortified Beverage and Responsive Caregiving Interventions on Early Childhood Development, Hemoglobin, and Ferritin among Infants in Rural Guatemala.

Undernutrition and a lack of learning opportunities can jeopardize long-term growth and development among infants in low- and middle-income countries. We conducted a 6-month 2 × 2 cluster-randomized trial to assess the effects of multiple micronutrient-fortified beverages and responsive caregiving interventions among infants 6-18 months in 72 community sectors in southwest Guatemala. We administered baseline and endline assessments of childhood development (Bayley Scales of Infant and Toddler Development) and socioemotional development (Brief Infant Toddler Socio-Emotional Assessment) and measured ferritin and hemoglobin on a subsample. The trial was analyzed using linear mixed models. At the baseline, the mean age (SD) was 13.0 (4.6) months, including 49% males, 32% who were stunted, 55% who were anemic, and 58% who were iron deficient. At the endline (n = 328/386, 85% retention), there was no synergistic effect on the fortified beverage and responsive caregiving intervention. Compared to the non-fortified beverage group, socioemotional development improved in the fortified beverage group. There were no intervention effects on other measures of child development, hemoglobin, or ferritin. In a setting with high rates of anemia and iron deficiency, a multiple micronutrient-fortified beverage improved infants' socioemotional development.

Children Receiving a Nutrition and High-Quality Early Childhood Education Intervention Are Associated with Greater Math and Fluid Intelligence Scores: The Guatemala City Municipal Nurseries.

Background: About 47% of children < 5 years of age are stunted in Guatemala. In this study, the investigators aimed to compare growth and cognitive outcomes between children in second grade that attended five Guatemala City Municipal Nurseries (GCMN) vs. same sex, grade, and age-matched children. Methods: A cross-sectional design nested in a retrospective cohort was implemented between 2015 and 2019. Children that attended the GCMN and matched controls completed a math test and validated receptive language and fluid intelligence tests. The primary caregivers completed a sociodemographic survey. General and generalized linear mixed effect models were used to compare children that attended the GCMN vs. controls. The models were adjusted by maternal education, sex, asset score, and other relevant covariates. Results: Children that attended the GCMN exhibited greater math and fluid intelligence scores relative to the controls in the adjusted models (ß = 6.48; 95% CI (2.35−10.61)) and (ß = 1.20; 95% CI (0.12−2.29)), respectively. Lower odds of stunting were significant for children who went to any early childcare institution (AOR = 0.28; 95% CI (0.09−0.89)). Conclusions: The importance of integrating nutrition and high-quality early childhood education interventions in cognitive and growth outcomes is highlighted in this study. The GCMN model may be a scalable model in similar low-resource settings.

Eficacia en la reducción de carga viral Bucal (SARS-CoV-2) de tres tipos de colutorios. Revisión de literatura / Efficacy in reducing oral viral load (SARS-CoV-2) of three types of mouthwashes.Literature review

En Wuhan-China se identificó en diciembre del 2019 un brote de neumonía de origen idiopático; aislandosé en enero del 2020 el agente causal; una nueva variante de coronavirus (SARS-CoV-2) declarandoló por la Organización Mundial de la Salud (OMS) la enfermedad por coronavirus 2019( COVID-19). Debido a las vías de transmisión este virus a mostrado una alta facilidad de contagios, expandiéndose rápidamente, se conoce que aproximadamente 148 millones de infectados y 3.012 millones de fallecidos por SARS-CoV-2, afectando a más de 190 países en 5 continentes. Importante para el personal de salud debido a las condiciones de trabajo a los que se encuentra expuesto,siendo este a fin a las condiciones óptimas para la adquisición de esta patología. Objetivo: Comparar la eficacia y eficiencia del uso de enjuagues bucales: peróxido de hidrógeno, yodo povidona y clorhexidina frente a la carga viral de SARS-CoV-2. Materiales y métodos: Se efectuó una búsqueda en las bases de datos de PubMed, SAGE JOURNAL, ACP, Medigraphic, PMC los cuales fueron seleccionados acorde a los criterios de inclusión obteniendo 30 estudios Resultados: La Clorhexidina (CHX) en concentraciones 0.12% y 2% no mostró un índice significativamente estadístico capaz de inactivar la carga viral del SARS-CoV-2, el Peróxido de hidrógeno (H2O2) mostró una inactivación mínima ante el virus SARS-CoV-2 en concentraciones de 0.5%, 1.25% o 1.5%, la Yodo povidona (PVP-I) es capaz de inactivar el SARS-CoV-2, en concentraciones 0,5%, 1,25% y 1,5 %, en períodos de contacto de 60 segundos, lo cual reduce la transmisión del SARS-CoV-2. Conclusión: Se puede evidencia que los diferentes enjuagues bucales con efectos bactericidas o bacteriostáticos son un referente importante con el objetivo de proteger al profesional como así también a la comunidad. El enjuague que mostró mayor efectividad frente al virus SARS-CoV-2, fue la yodopovidona con la capacidad para inactivar el virus y así evitar su propagación.

Importancia del examen físico cardiovascular en el diagnóstico de la coartación de la aorta

RESUMEN En el estudio de las enfermedades cardiovasculares no se puede subvalorar la importancia de la historia clínica y el examen físico. El médico de la atención primaria juega un papel importante en la valoración de los neonatos y en ello es muy importante el empleo del método clínico. El objetivo de este trabajo es hacer un llamado de atención sobre la importancia del método clínico en el diagnóstico de las cardiopatías congénitas.

ABSTRACT In the study of cardiovascular diseases, the importance of the medical history and physical examination cannot be underestimated. The primary care physician plays an important role in the assessment of neonates and the use of the clinical method is very important in this regard. The objective of this work is to call attention to the importance of the clinical method in the diagnosis of congenital heart disease.

Differences in factors associated with anemia in Haitian children from urban and rural areas.

BACKGROUND: In Haiti, differences in the prevalence of anemia between urban and rural areas have been observed. OBJECTIVE: To identify moderating factors that may help explain the difference in the prevalence of anemia in children from poor urban vs. rural areas of Haiti. METHODS: This cross-sectional study used secondary data from urban and rural school-based trials that assessed the effectiveness of a nutrition intervention. The study was registered at ClinicalTrials.gov as NCT02747524. A total of 300 rural- and 981 urban- children between 2.5-13 years of age were included in this analysis. Effect modification in a binary logistic generalized linear mixed model was conducted using sample weights in SPSS® version 26. Models were adjusted for age and income. School cluster was included as random effect. RESULTS: In rural areas, stunting was more prevalent in children with anemia vs. no anemia, (16.6%, and 6.3%, P = 0.008), respectively. Also, rural children with anemia lived with fewer adults vs. rural children with no anemia, ([Formula: see text] = 2.83±1.29, and 3.30±1.54, P = 0.005), respectively. In poor urban areas, helminth morbidities were more frequent in children with anemia vs. no anemia, (21.9% vs. 13.9, P = 0.011), respectively. In the combined sample, stunting, [AOR = 2.05; 95%CI (1.32-3.18)], age [AOR = 0.89; 95%CI (0.85-0.93)], and households with more adults [AOR = 0.77; 95%CI (0.67-0.87)] were associated with anemia. Effect modification by place of residence was observed in households with more adults (t = 3.83, P<0.001). No other nutritional, dietary, sanitation or morbidity factors or effect modifiers were observed. CONCLUSIONS: In this sample, factors associated with anemia differed in poor urban and rural children from Haiti including family structure and helminth morbidities. Stunting and lower age increased the odds of anemia in the combined sample. Family structure appears to have an important role in anemia, and further research understanding the influence of family structures in anemia is needed.

Influence of sodium chlorate, ferulic acid, and essential oils on Escherichia coli and porcine fecal microbiota.

The influence of sodium chlorate (SC), ferulic acid (FA), and essential oils (EO) was examined on the survivability of two porcine diarrhetic enterotoxigenic Escherichia coli (ETEC) strains (F18 and K88) and populations of porcine fecal bacteria. Fecal bacterial populations were examined by denaturing gradient gel electrophoresis (DGGE) and identification by 16S gene sequencing. The treatments were control (no additives), 10 mM SC, 2.5 mg FA /mL, a 1.5% vol/vol solution of an EO mixture as well as mixtures of EO + SC, EO + FA, and FA + SC at each of the aforementioned concentrations. EO were a commercial blend of oregano oil and cinnamon oil with water and citric acid. Freshly collected porcine feces in half-strength Mueller Hinton broth was inoculated with E. coli F18 (Trial 1) or E. coli K88 (Trial 2). The fecal-E. coli suspensions were transferred to crimp top tubes preloaded with the treatment compounds. Quantitative enumeration was at 0, 6, and 24 h. All treatments reduced (P < 0.05) the counts of E. coli F18 at 6 and 24 h. With the exception of similarity coefficient (%SC), all the other treatments reduced (P < 0.05) the K88 counts at 24 h. The most effective treatments to reduce the F18 and K88 CFU numbers were those containing EO. Results of DGGE revealed that Dice percentage similarity coefficients (%SC) of bacterial profiles among treatment groups varied from 81.3% to 100%SC. The results of gene sequencing showed that, except for SC at 24 h, all the other treatments reduced the counts of the family Enterobacteriaceae, while Lactobacillaceae and Ruminococcaceae increased and Clostridiaceae decreased in all treatments. In conclusion, all treatments were effective in reducing the ETEC, but EO mixture was the most effective. The porcine microbial communities may be influenced by the studied treatments.

Zinc deficiency associated with anaemia among young children in rural Guatemala.

One in four children younger than age five in Guatemala experiences anaemia (haemoglobin <11.0 g/dl). This study characterized the factors and micronutrient deficiencies associated with anaemia in a baseline cross-sectional sample of 182 Guatemalan infants/toddlers and 207 preschoolers, using generalized linear mixed models. Associations between anaemia and maternal, child and household variables, and biomarkers (soluble transferrin receptor, ferritin, zinc, folate, vitamin B12, C-reactive protein, and α1-acid glycoprotein) were explored. Rates of anaemia were 56% among infants/toddlers and 12.1% among preschoolers. In children with anaemia, rates of iron deficiency (low ferritin based on inflammation status, and/or high soluble transferrin receptor, ≥1.97 mg/L) and zinc deficiency (serum zinc <65 µg/dl) were 81.1% and 53.7%, respectively. Folate deficiency (either plasma folate <3 ng/ml or erythrocyte folate <100 ng/ml) was 3.3%. Vitamin B12 deficiency (plasma vitamin B12 <148 pmol/L) was 7.5%. For infants and toddlers (<24 months), the odds ratio of anaemia was lower when higher number of adults lived in the household (OR = 0.69; 95% CI [0.53, 0.90]), and higher when children were zinc deficient (OR = 3.40; 95% CI [1.54, 7.47]). For preschoolers (36-60 months), the odds ratio of anaemia was lower for every additional month of age (OR = 0.90; 95% CI [0.81, 1.00]). Findings suggest that micronutrient deficiencies coexist in Guatemalan rural children, and zinc deficiency is associated with anaemia in children <24 months, highlighting the need of continued multidisciplinary interventions with multiple micronutrients. Further research examining how household composition, feeding practices, and accessibility to micronutrient supplements and to animal source foods is needed to incorporate strategies to improve the nutritional status of Guatemalan children.

Índice de Higiene Oral en los Escolares de 12 años de la Parroquia Checa en el Cantón Cuenca, Provincia del Azuay - Ecuador, 2016 / Oral hygiene index in 12-year-old schoolchildren of the Checa parish in Canton Cuenca, Province of Azuay, Ecuador, 2016

Objetivo: Determinar el Índice de Higiene Oral en escolares de 12 años, de la Parroquia Checa del Cantón Cuenca, Provincia del Azuay ­ Ecuador, 2016. Materiales y métodos: Estudio descriptivo de corte transversal; la técnica empleada para determinar el estado del perfil epidemiológico fue observacional. Los indicadores se lograron obtener por una encuesta estructurada. Resultados: De los 109 escolares de 12 años encuestados se observó un ligero predominio del sexo femenino (58%) sobre el sexo masculino (42%). Además, se determinó que el 47,7% presenta una buena higiene oral, el 36,7% una higiene oral excelente, el 14,7% una higiene oral regular y el 0,9% una mala higiene oral, dando como resultado que más de la mitad de los escolares presentan un IHO bueno y excelente. Conclusión: Existe un mayor número de escolares con higiene oral buena sin encontrar variación significativa en cuanto al sexo masculino con el femenino.

Objective: To determine the Oral Hygiene Index in schoolchildren aged 12,from the Checa parish of Canton Cuenca, Province of Azuay, Ecuador, 2016. Materials and methods: Descriptive crosssectional study; the observational technique was applied to determinethe state of the epidemiological profile. The indicators were obtained through astructured survey. Results: In the 109 schoolchildren surveyed, there was as light predominance of females (58%) over males (42%). In addition, 47.7% presented good oral hygiene, 36.7% excellent oral hygiene, 14.7% regular oralhygiene and 0.9% poor oral hygiene, therefore, over half the students presenta good or excellent OHI. Conclusion: Most schoolchildren have good oral hygiene, and there are no significant variations in terms of sex.

Objetivo: Determinar o Índice de Higiene Oral em escolares de 12 anos, da Vila Checa do cidade de Cuenca, Estado de Azuay- Equador, 2016. Materiais e métodos: Estudo descritivo transversal; A técnica utilizada para determinar o status do perfil epidemiológico foi observacional. Os indicadores foram obtidos por meio de uma pesquisa estruturada. Resultados: Dos 109 escolares de 12 anos pesquisados, observouse discreto predomínio do sexo feminino (58%) em relação ao sexo masculino (42%). Além disso, determinou-se que 47,7% apresentavam boa higiene bucal, 36,7% excelente higiene bucal, 14,7% higiene bucal regular e 0,9% má higiene bucal, resultando em mais da metade dos estudantes apresentam um bom e excelente IHO.Conclusão: Existe um número maior de escolares com boa higiene bucal sem encontrar variação significativa no sexo masculino com o feminino.

Experience of Perinatal Death From the Father's Perspective.

BACKGROUND: Although perinatal deaths are still a common pregnancy outcome in developing countries, little is known about the effect perinatal death has on fathers. OBJECTIVE: The aim of the study was to understand and describe the meaning of perinatal death in a sample of fathers from northeastern Colombia. METHODS: Using purposive and snowball sampling approaches, we identified 15 participants from northeastern Colombia who agreed to participate. We used a descriptive phenomenological design. Data were collected through in-depth, semistructured interviews. RESULTS: Men suffer in solitude and hide their emotions as they feel the need to be the main supporters of their partners. Three major themes emerged: experience of loss, coming to terms with an irreparable loss, and overcoming the loss. DISCUSSION: While women are receiving care, health staff may neglect or forget men. Men suffer alone while seeking ways of attunement with their partners' emotions to support them during the grieving process. Fathers can overcome and adjust to the loss when they transcend it and find new meaning. Men felt neglected and marginalized at hospitals while their partners were receiving treatment. Health professionals should recognize and acknowledge the pain of fathers who face perinatal death and include them as much as possible in the standard of care. The results identify opportunities for healthcare providers in clinical and outpatient settings to acknowledge the importance of men within the context of pregnancy and to learn about their pain and suffering when they face a perinatal death.

Síntomas inicialesen niños con maltrato infantil / Initial symptoms in children with child maltreatment

Introducción: Alrededor de 300 millones de niños y niñas en el mundo viven en situación de violencia, 70 millones de ellos en Latinoamérica, constituye uno de los problemas principales de salud pública en todo el mundo. Objetivo: Identificar los síntomas iniciales de niños con maltrato infantil atendidos en Sala de Primera Acogida del Hospital General Docente Ambato en el año 2017, para la obtención de un diagnóstico presuntivo. Métodos: Estudio retrospectivo, observacional, descriptivo, a través de entrevistas a los médicos que atendieron los niños maltratados y se realizó una observación científica. En una población de 437 niños atendidos en el año 2017, teniendo como muestra de estudio 50 pacientes elegidos por criterios de inclusión y exclusión. Resultados: Se obtuvo como resultado síntomas conductuales (95%), miedo (75%), depresión (65%), trastornos del sueño y alimentación (45%), como síntomas principales de un niño maltratado. Se elaboró una guía de detección y diagnóstico que facilite al personal de salud un diagnóstico temprano de maltrato infantil. Conclusiones: Los síntomas iniciales en niños maltratados demostraron afectación en el desenvolvimiento psicológico y físico normal del paciente menor de edad, en la que influyen varios factores del entorno social, familiar y los situacionales, en especial las variables cognitivas de las víctima que han permitido explicar la gravedad de la sintomatología, de la cual requiere un tratamiento, seguimiento adecuado y oportuno en un lapso de tiempo ideal

Introduction: Around 300 million children in the world live in a situation of violence, 70 million of them in Latin America, which constitutes one of the main problems of public health in the whole world. Objective: To identify the initial symptoms of children with child abuse treated in the First Reception Room of the Ambato General Teaching Hospital in 2017, in order to obtain a presumptive diagnosis. Methods: A retrospective study, observational, and descriptive, through interviews with the doctors who treated the abused children. In a population of 437 children attended in the year 2017, having as sample of study 50 patients chosen by inclusion and exclusion criteria. Results: Behavioral symptoms (95%), fear (75%), depression (65%), sleep disorders and feeding (45%) were the main symptoms of a battered child. A screening and diagnosis guide was developed to provide health personnel with an early diagnosis of child maltreatment. Conclusions: The initial symptoms in abused children showed affectation in the normal psychological and physical development of the minor patient, in which several factors of the social, familiar and situational environment influence, especially the cognitive variables of the victims that have allowed to explain the severity of the symptomatology, which requires treatment, adequate and timely follow-up in an ideal period of time.

Ligature of the Left Main Coronary Artery after Surgery in Kawasaki Disease: Case Report.

We report a case of a 23-year-old man who was diagnosed with Kawasaki disease that progressed to a coronary aneurysm in the left main coronary artery (LMA). He had suffered from acute coronary syndrome and then underwent an emergent percutaneous coronary angioplasty, in which a polyurethane-covered stent was placed inside the aneurysm. The stent was thrombosed one year later, despite the patient had been treated with anticoagulant and antiplatelet therapy. Emergency percutaneous intervention was then performed. LMA was reopened and stent malposition was observed. Therefore, urgent coronary bypass grafting was performed in which a high degree of competitive flow was observed through the reopened stent. LMA was ligated at the inflow of the aneurysm, resulting in an improvement of graft flow. Left main ligature has not been previously reported.

Ligature of the left main coronary artery after surgery in kawasaki disease: case report

Abstract We report a case of a 23-year-old man who was diagnosed with Kawasaki disease that progressed to a coronary aneurysm in the left main coronary artery (LMA). He had suffered from acute coronary syndrome and then underwent an emergent percutaneous coronary angioplasty, in which a polyurethane-covered stent was placed inside the aneurysm. The stent was thrombosed one year later, despite the patient had been treated with anticoagulant and antiplatelet therapy. Emergency percutaneous intervention was then performed. LMA was reopened and stent malposition was observed. Therefore, urgent coronary bypass grafting was performed in which a high degree of competitive flow was observed through the reopened stent. LMA was ligated at the inflow of the aneurysm, resulting in an improvement of graft flow. Left main ligature has not been previously reported.

Intervención para el aprendizaje en clases didácticas prolongadas de asignaturas clínicas / Intervention for learning in lengthened didactic lessons of clinical subjects

Introducción: las clases didácticas o magistrales son utilizadas frecuentemente en educación médica, aunque se sabe que la atención de los estudiantes disminuye progresivamente y la retención de la información es limitada. Las clases interactivas reducen estos inconvenientes, pero su efecto sólo se ha evaluado en clases de una hora o menos de duración y predominantemente en el ciclo básico de medicina. Objetivo: evaluar la intervención implementada para el alcance de un mayor aprendizaje en clases didácticas prolongadas de asignaturas clínicas. Método: la intervención se realizó en un módulo educativo del ciclo clínico de la carrera de medicina de una universidad privada chilena. Participaron 60 estudiantes de 5to año. Las clases de la unidad intervenida se impartieron en 4 h académicas sucesivas de 45 min cada una. Al inicio de cada clase, los estudiantes respondieron un cuestionario con sentencias en formato verdadero o falso referidas a los objetivos centrales de cada temática. Las clases se estructuraron con el método clásico y el estilo docente predominante fue proveedor visual de información. La evaluación se realizó después de 3 meses mediante un test de conocimientos con 40 preguntas de opción múltiple (11 de cardiología). Se incluyó una selección de sentencias de verdadero y falso de aquellas utilizadas durante las clases y una encuesta de satisfacción en formato Likert. Además, se aplicó una escala diferencial semántica para recolectar información sobre las clases de las demás unidades con el propósito de controlar el efecto halo atribuido a preferencias de docentes participantes. Resultados: el promedio de las calificaciones en las preguntas de cardiología del test de conocimientos fue significativamente superior al promedio de las otras unidades de geriatría [t(59)=-28,3; p< 0,001]. El porcentaje promedio de aciertos del post-test fue 45,2 por ciento superior al pretest [t(59)= -24,9; p< 0,001]. La metodología fue bien evaluada: 100 por ciento de estudiantes estimó que mantuvo su atención durante las clases. La apreciación de las clases impartidas por los diferentes docentes del módulo de geriatría fue positiva, sin diferencias entre ellos. Conclusiones: el uso de cuestionarios con sentencias de verdadero y falso, referidas a los objetivos educacionales, antes de cada sesión de clases prolongadas es una estrategia que permite mantener la atención de los estudiantes y favorece el rendimiento cognitivo en asignaturas clínicas del pregrado de Medicina(AU)

Introduction: didactic or master classes are frequently used in medical education, although the students' attention is known to decrease progressively and information retention is limited. Interactive classes reduce these disadvantages, but their effect has only been evaluated in one-hour or less lessons and predominantly during the basic medical cycle. Objective: to evaluate the intervention implemented for attaining greater knowledge in extended didactic classes on clinical subjects. Method: the intervention was carried out in an educational module of the clinical cycle of the medical major of a Chilean private university. Sixty fifth-year students participated. The lessons of the intervened unit were taught in four consecutive academic hours of 45 minutes each. At the beginning of each lesson, the students answered a questionnaire with statements for the true/false format and referring the central objectives of each subject. The lessons were structured with the classical method and the predominant teaching style was visual information provider. The evaluation was carried out after 3 months through a knowledge test with 40 multiple-choice questions (11 about cardiology). It included a selection of true/false statements from those used during the lessons and a satisfaction survey in the Likert format. In addition, a differential semantic scale was applied to collect information about the lessons of the other units with aim at controlling the halo effect attributed to the preferences of participating teachers. Results: the average of the scores in the cardiology questions of the knowledge test was significantly higher than the average of the other geriatric units (t (59)= -28.3, p< 0.001). The average percentage of correct answers in the post-test was 45.2 percent, higher than the pretest (t (59)= -24.9, p< 0.001). The methodology was evaluated well: 100 percent of students considered that they kept their attention during the lessons. The appreciation of the lessons given by the different teachers of the geriatric module was positive, without differences between them. Conclusions: the use of questionnaires with true/false statements and referring the educational objectives, before each session of extended lessons, is a strategy that allows to keep the students' attention and favors the cognitive performance in undergraduate medical-clinical subjects(AU)

Estudio Cuasi-Experimental: Conocimientos, Actitudes y Prácticas del Autoexamen de Mama en Mujeres Vendedoras de los Mercados de Cuenca ­ Ecuador, 2017 / Quasi-Experimental Study: Improvement of the Knowledge, Attitudes and Practices of Breast Self-Examination in Sellers of the Markets of the City of Cuenca, 2017

INTRODUCCIÓN: El cáncer de mama es un problema de salud pública entre las mujeres; el autoexamen de mama es un método de gran importancia, efectivo, no invasivo y sin costo para la detección oportuna de esta patología. El objetivo que se planteó fue incrementar el nivel de conocimientos, actitudes y prácticas del autoexamen de mama en mujeres vendedoras de los mercados de la ciudad, a través de una intervención educativa participativa basada en su entorno. MÉTODOS: Se realizó un estudio cuasiexperimental, en 115 mujeres vendedoras de los mercados 27 de Febrero y 12 de Abril de la ciudad de Cuenca - Ecuador, durante el periodo de Abril del 2016 a Octubre del 2017. A las cuales se les aplicó un pretest, luego una intervención educativa participativa que constó de 3 sesiones y se aplicó un postest. Se utilizó una encuesta de otro estudio, se adaptó y aplicó para la población seleccionada. Los datos se procesaron en SPSS V 21.0. Para evaluar la diferencia entre el pre y el postest se utilizó la prueba de McNemar para comparar proporciones. RESULTADOS: El rango de edad de las mujeres fue de 18 a 65 años con una media de 40.03 años. El 88.7 % tenían hijos con una mediana de 3 hijos. La media de edad de la menarquia fue 13.15 años y del primer embarazo 20.35 años. Las proporciones de respuestas correctas en el pretest fueron: Conocimientos 54.9 %, actitudes 69.2 %, prácticas 32.2 %; en el postest fueron: Conocimientos 88.4 %; actitudes 83.6 % y prácticas 76.4 %, respectivamente; la diferencia fue significativa en todos los casos. CONCLUSIONES: La intervención educativa mejoró significativamente el conocimiento, las actitudes y las prácticas del autoexamen de mama en la población intervenida.

BACKGROUND: Breast cancer is a public health problem women; Maternal self-examination is a method of great importance, effective, non-invasive and without cost for the timely detection of this pathology. The aim of this approach is to increase the level of knowledge, attitudes and practices of the self-examination of breast in the women sellers of the markets of the city, through a participative educational intervention based on their environment. METHODS: This was a quasi-experimental study was carried out in 115 sellers of the markets February 27 and April 12 in Cuenca - Ecuador, during the period from April 2016 to October 2017. A pretest was applied, then the participative educational intervention was in 3 sessions and a posttest was applied. A survey used in another study was used, adapted and applied for the selected population. The data was processed in SPSS V 21.0. To evaluate the difference between pre and postest, the McNemar test was used to compare proportions. RESULTS: The age range of the women was from 18 to 65 years with an average of 40.03 years. 88.7 % had children with a median of 3 children. The average age of the menarche was 13.15 years and of the first pregnancy of 20.35 years. The proportions of correct answers in the pretest were: knowledge 54.9 %, attitudes 69.2 %, practices 32.2 %; in the subsequent test were: Knowledge 88.4 %; attitudes 83.6 % and practices 76.4 %, respectively; the difference was significant in all cases. CONCLUSIONS: The educational strategy improved significantly the breast self-examination knowledge, attitudes and practices in the intervention population.

Eggs early in complementary feeding increase choline pathway biomarkers and DHA: a randomized controlled trial in Ecuador.

Background: Choline status has been associated with stunting among young children. Findings from this study showed that an egg intervention improved linear growth by a length-for-age z score of 0.63.Objective: We aimed to test the efficacy of eggs introduced early in complementary feeding on plasma concentrations of biomarkers in choline pathways, vitamins B-12 and A, and essential fatty acids.Design: A randomized controlled trial, the Lulun ("egg" in Kichwa) Project, was conducted in a rural indigenous population of Ecuador. Infants aged 6-9 mo were randomly assigned to treatment (1 egg/d for 6 mo; n = 80) and control (no intervention; n = 83) groups. Socioeconomic data, anthropometric measures, and blood samples were collected at baseline and endline. Household visits were made weekly for morbidity surveillance. We tested vitamin B-12 plasma concentrations by using chemiluminescent competitive immunoassay and plasma concentrations of choline, betaine, dimethylglycine, retinol, essential fatty acids, methionine, dimethylamine (DMA), trimethylamine, and trimethylamine-N-oxide (TMAO) with the use of liquid chromatography-tandem mass spectrometry.Results: Socioeconomic factors and biomarker concentrations were comparable at baseline. Of infants, 11.4% were vitamin B-12 deficient and 31.7% marginally deficient at baseline. In adjusted generalized linear regression modeling, the egg intervention increased plasma concentrations compared with control by the following effect sizes: choline, 0.35 (95% CI: 0.12, 0.57); betaine, 0.29 (95% CI: 0.01, 0.58); methionine, 0.31 (95% CI: 0.03, 0.60); docosahexaenoic acid, 0.43 (95% CI: 0.13, 0.73); DMA, 0.37 (95% CI: 0.37, 0.69); and TMAO, 0.33 (95% CI: 0.08, 0.58). No significant group differences were found for vitamin B-12, retinol, linoleic acid (LA), α-linolenic acid (ALA), or ratios of betaine to choline and LA to ALA.Conclusion: The findings supported our hypothesis that early introduction of eggs significantly improved choline and other markers in its methyl group metabolism pathway. This trial was registered at clinicaltrials.gov as NCT02446873.

Eggs in Early Complementary Feeding and Child Growth: A Randomized Controlled Trial.

BACKGROUND: Eggs are a good source of nutrients for growth and development. We hypothesized that introducing eggs early during complementary feeding would improve child nutrition. METHODS: A randomized controlled trial was conducted in Cotopaxi Province, Ecuador, from March to December 2015. Children ages 6 to 9 months were randomly assigned to treatment (1 egg per day for 6 months [n = 83]) and control (no intervention [n = 80]) groups. Both arms received social marketing messages to encourage participation in the Lulun Project (lulun meaning "egg" in Kichwa). All households were visited once per week to monitor morbidity symptoms, distribute eggs, and monitor egg intakes (for egg group only). Baseline and end point outcome measures included anthropometry, dietary intake frequencies, and morbidity symptoms. RESULTS: Mothers or other caregivers reported no allergic reactions to the eggs. Generalized linear regression modeling showed the egg intervention increased length-for-age z score by 0.63 (95% confidence interval [CI], 0.38-0.88) and weight-for-age z score by 0.61 (95% CI, 0.45-0.77). Log-binomial models with robust Poisson indicated a reduced prevalence of stunting by 47% (prevalence ratio [PR], 0.53; 95% CI, 0.37-0.77) and underweight by 74% (PR, 0.26; 95% CI, 0.10-0.70). Children in the treatment group had higher dietary intakes of eggs (PR, 1.57; 95% CI, 1.28-1.92) and reduced intake of sugar-sweetened foods (PR, 0.71; 95% CI, 0.51-0.97) compared with control. CONCLUSIONS: The findings supported our hypothesis that early introduction of eggs significantly improved growth in young children. Generally accessible to vulnerable groups, eggs have the potential to contribute to global targets to reduce stunting.

Estágio supervisionado na odontologia: vivência da promoção da saúde e integração multiprofissional / Supervised Training in Dentistry: experience of health promotion and multidisciplinary integration / Prácticas en odontología: vivencia de la promoción de la salud e integración multiprofesional

Objetivo: Relatar a vivência nos estágios supervisionados em Saúde Coletiva por acadêmicos de Odontologia. Síntese dos dados: Relato de experiência a partir da vivência das atividades pelos alunos de estágio supervisionado do curso de Odontologia durante os eventos "Espaço Saúde", realizados no período de 2011 a 2015, que ocorreram nas Unidades Básicas de Saúde (UBS). As turmas eram divididas em grupos na UBS e as atividades educativas, realizadas com as crianças, jovens e adultos, eram desenvolvidas pelos alunos com a supervisão de docentes do Departamento de Odontologia da Universidade Estadual de Maringá, Brasil. O município de Maringá desenvolve atividades de promoção da saúde por meio do Programa Maringá Saudável, incluindo neste programa eventos denominados "Espaço Saúde", organizados pelos profissionais das UBS, com finalidade de interagir com a comunidade. Nesses eventos, os acadêmicos de Odontologia realizam diagnóstico de doenças bucais, instrução de higiene bucal e atividades lúdico-educativas para crianças, além de conhecer os demais serviços da UBS. A partir dessa experiência, percebeu-se um despertar para um novo olhar sobre o papel do profissional que trabalha com saúde, por parte da comunidade, do serviço e academia. Conclusão: A integração ensino-serviço-comunidade beneficia a comunidade local, fortalece o serviço e melhora a formação dos acadêmicos. Desperta também a consciência para promoção da saúde e prevenção das doenças, necessária para a melhoria na qualidade de vida da população.

Objective: To report Dentistry students' experience in supervised training in Public Health. Data Synthesis: Experience report of activities carried out in events called "Health Space" (Espaço Saúde) by Dentistry students under supervised training. The activities took place in Primary Health Care Centers (Unidades Básicas de Saúde ­ UBS) from 2011 to 2015. The classes were divided into groups and the activities were carried out with children, youth and adults by students under supervision of the faculty of the Department of Dentistry of the State University of Maringá (Universidade Estadual de Maringá), located in the state of Paraná, Brazil. The municipality of Maringá develops health promotion activities through the Healthy Maringá Program (Programa Maringá Saudável), which includes events called "Health Space" organized by UBS professionals with the aim of interacting with the community. In these events, the Dentistry students diagnose oral diseases, teach oral hygiene, and carry out playful educational activities with children; in addition, they get to know the other services offered in the UBS. This experience provided a new understanding of the role of the health professional by the community, the service, and the university. Conclusion: The teaching-service-community integration benefits the local community, strengthens the service, and improves the training of students. It also raises awareness for health promotion and disease prevention, which is necessary to improve the quality of life of the population.

Objetivo: Relatar la vivencia de las prácticas de Salud Colectiva de académicos de Odontología. Síntesis de los datos: Relato de experiencia a partir de la vivencia de las actividades de los alumnos de prácticas del curso de Odontología durante los eventos "Espacio Salud" realizados en el periodo entre 2011 y 2015 en las Unidades Básicas de Salud (UBS). Las clases fueron divididas en grupos en la UBS y las actividades educativas realizadas con los niños, jóvenes y adultos fueron desarrolladas por los alumnos bajo la supervisión de los docentes del Departamento de Odontología de la Universidad Estadual de Maringá, Paraná, Brasil. El municipio de Maringá desarrolla actividades de promoción de la salud a través del Programa Maringá Saludable que incluye en este programa eventos denominados "Espacio Salud" que son organizados por los profesionales de las UBS con el objetivo de interaccionar con la comunidad. En los eventos los académicos de Odontología realizan el diagnóstico de enfermedades de la boca, promueven la explicación sobre la higiene bucal y actividades lúdico-educativas para niños además de conocer los otros servicios de la UBS. A partir de esa experiencia, hubo un despertar para una nueva mirada sobre el papel del profesional sanitario de parte de la comunidad, del servicio e de la academia. Conclusión: La integración enseñanza-servicio-comunidad conlleva beneficio para la comunidad local, fortalece el servicio y mejora la formación de los académicos. Además, despierta la consciencia para la promoción de la salud y la prevención de enfermedades que son necesarias para la mejoría de la calidad de vida de la población

Aceptabilidad de un atole fortificado con 21 micronutrientes e impacto en la salud y nutrición de niños menores de 6 años de edad en la ciudad de guatemala / Acceptability of a 21 micronutrient-fortified atole and its impact on health and nutrition in children under 6 years of age from guatemala city

Con el objetivo de reducir la desnutrición crónica de niños que asisten 6 jardines infantiles en la Ciudad de Guatemala, se utilizó una bebida a base de soya y maíz como vehículo para el aporte de 21 micronutrientes con niveles elevados de hierro (12mg) y zinc (9mg) y se ofreció a 747 niños entre los 6 meses y 6 años. Se realizó seguimiento antropométrico cada 3m, Hb cada 6m y se registró el número de episodios de enfermedad diarreica aguda e infección respiratoria aguda a lo largo de la intervención. Un ANOVA longitudinal de medidas repetidas demostró que la media de la Hb mejoró de manera significativa a los 6 y 12m de recibir la bebida fortificada (11,26, 11,64, y 11,89g/dL, respectivamente), p<0,01; la prevalencia de anemia disminuyó 44,2% después de 12m, p<0,01; la media del puntaje z de talla para la edad también mejoró, -1,25 (0m) y -1,07 (12m), p<0.01; la prevalencia de retardo del crecimiento disminuyó 25% a los 12m. Se observó una disminución significativa en la prevalencia de infección respiratoria aguda y no se observaron cambios en la prevalencia de diarrea. Un estudio de aceptabilidad demostró que los niños consumen más del 98% del producto. Los resultados sugieren que la intervención con el atole fortificado mejora el estado nutricional y de salud de los niños. El producto es aceptado por los niños y el personal de los jardines infantiles(AU)

With the aim to reduce chronic undernutrition in children that attended 6 Guatemala City daycare centers, a corn and soy-based beverage was used as a vehicle to provide 21 micronutrients and high concentrations of iron (12mg) and zinc (9 mg) and was provided to747 children aged 6 to 72 months. Children were followed for anthropometry every 3m, hemoglobin every 6m, and episodes of acute diarrhea and respiratory tract infections were registered throughout the intervention. A longitudinal Repeated Measures ANOVA demonstrated that mean hemoglobin significantly improved at 6 and 12m of receiving the beverage (11.26, 11.64, and 11.89g/dL, respectively), p<0.01; the prevalence of anemia decreased by 44.2% after 12m, p<0.01; mean height-for-age z score improved from -1.25 (0m) to -1.07 (12m), p<0.01; the prevalence of stunting decreased by 25% after 12m. A significant decrease in the prevalence of acute respiratory infection was observed. No changes were observed in the prevalence of diarrhea. Moreover, an acceptability study showed that children consumed more than 98% of the atole. These results suggest that this nutrition intervention with the fortified atole improves the health and nutritional status of children. The product is widely accepted by the children and staff at the nurseries(AU)