Loss of microRNA-135b Enhances Bone Metastasis in Prostate Cancer and Predicts Aggressiveness in Human Prostate Samples.

About 70% of advanced-stage prostate cancer (PCa) patients will experience bone metastasis, which severely affects patients' quality of life and progresses to lethal PCa in most cases. Hence, understanding the molecular heterogeneity of PCa cell populations and the signaling pathways associated with bone tropism is crucial. For this purpose, we generated an animal model with high penetrance to metastasize to bone using an intracardiac percutaneous injection of PC3 cells to identify PCa metastasis-promoting factors. Using genomic high-throughput analysis we identified a miRNA signature involved in bone metastasis that also presents potential as a biomarker of PCa progression in human samples. In particular, the downregulation of miR-135b favored the incidence of bone metastases by significantly increasing PCa cells' migratory capacity. Moreover, the PLAG1, JAKMIP2, PDGFA, and VTI1b target genes were identified as potential mediators of miR-135b's role in the dissemination to bone. In this study, we provide a genomic signature involved in PCa bone growth, contributing to a better understanding of the mechanisms responsible for this process. In the future, our results could ultimately translate into promising new therapeutic targets for the treatment of lethal PCa.

Trascender la muerte del niño con cáncer: Experiencias profesionales de la salud

Objetivo: Develar la percepción del apoyo en duelo de los profesionales de las unidades de oncología pediátrica, tras el fallecimiento de los pacientes. Método: Estudio fenomenológico cualitativo. Se realizaron 22 entrevistas en profundidad a profesionales de 5 unidades de oncología pediátrica de hospitales públicos de Santiago de Chile. Una vez transcritas las narraciones, se realizó el análisis comprensivo y posteriormente la triangulación de los datos, hasta lograr su saturación. Resultados: Los profesionales se perciben apoyados en su duelo al poder experimentar las pérdidas en un ambiente protegido y sentirse apoyados por su entorno. Reconocen la existencia de factores externos e internos que facilitan el proceso de duelo. Sin embargo, este apoyo se percibe como insuficiente, ya que falta un apoyo formal por parte de la institución, así como un periodo de duelo protegido, o el apoyo de los profesionales de la salud mental a los equipos. Todas las experiencias de muerte permiten a los profesionales trascender su dolor a partir del aprendizaje permanente y dar sentido a su trabajo. Conclusión: El apoyo en duelo que sienten los profesionales se genera a partir de sus propias iniciativas de reencuentro dentro de los equipos, lo cual es insuficiente. Por ello, es necesaria la formación en el afrontamiento de la muerte desde el pregrado, lo que permitiría una mayor cohesión en el afrontamiento y un mayor autocuidado dentro de los equipos.

Objetivo: Desvelar a percepção do apoio ao luto dos profissionais das unidades de oncologia pediátrica, após o óbito dos pacientes. Método: Estudo fenomenológico qualitativo. Foram realizadas vinte e duas entrevistas aprofundadas com profissionais de cinco unidades de oncologia pediátrica de hospitais públicos de Santiago. Uma vez transcritas as narrativas, realizou-se à análise compreensiva e posteriormente à triangulação dos dados, alcançando a saturação destes. Resultados: Os profissionais percebem-se amparados em seu luto, pois podem vivenciar perdas em um ambiente protegido e sentir-se amparados por seu ambiente. Eles reconhecem a existência de fatores externos e internos que facilitam o processo de luto. Contudo, este apoio é percebido como insuficiente, visto que falta um apoio formal da instituição, bem como um período de luto protegido, ou o apoio dos profissionais de saúde mental para as equipes. Todas as experiências de morte permitem aos profissionais transcender sua dor por meio da aprendizagem ao longo da vida e dar sentido ao seu trabalho. Conclusão: O apoio no luto, sentido pelos profissionais, é gerado a partir das suas próprias iniciativas de reencontro com as equipes, o que é insuficiente. Portanto, o treinamento no enfrentamento da morte desde a graduação faz-se necessário, o que possibilitaria maior coesão no enfrentamento e maior autocuidado dentro das equipes.

Objective: To reveal the perception of grief support of professionals in pediatric oncology units, after the death of the patients. Method: Qualitative phenomenological study. 22 in-depth interviews were conducted with professionals from 5 pediatric oncology units of public hospitals in Santiago. Once the narratives were transcribed, the comprehensive analysis and subsequent triangulation of the data was performed, achieving saturation. Results: Professionals perceive themselves supported in their grief by being able to experience the losses in a protected environment and feeling supported by their surroundings. They recognized the existence of external and internal factors that facilitated the process of grief. However, this support is perceived as insufficient, as there is a lack of formal support from the institution, as well as a protected grief period, or support from mental health professionals to the teams. All death experiences allow professionals to transcend their pain based on lifelong learning and to give meaning to their work. Conclusion: Grief support felt by the professionals is generated from their own initiatives of re-encounter within the teams, which is insufficient. Therefore, training in coping with death is necessary from undergraduate level, which would allow greater cohesiveness in coping and greater self-care within the teams.

Perception of support in professional's and technician's grief of pediatric intensive care units in public hospitals. / Percepción de apoyo en duelo por profesionales y técnicos de cuidados intensivos pediátricos de hospitales públicos.

INTRODUCTION: Death in childhood is a reality faced by health professionals, especially in highly com plex units such as intensive care ones. This leads to feelings of helplessness and frustration in health professionals, compromising their physical, emotional, and mental health, which is worsened by the feeling of low social support and poor preparation for coping with death and support for the patient's family. OBJECTIVE: To expose the perception of sorrow support of professionals and techni cians in pediatric intensive care units of public hospitals, after the death of the patients. SUBJECTS AND METHOD: Qualitative study with a phenomenological approach. 16 in-depth interviews were conduc ted with pediatric intensive care professionals and technicians from five public hospitals in Santiago, Chile. Inclusion criteria considered working for more than a year in the Unit, having experienced the death of patients, and recognizing that they have gone through a professional sorrow. The in terview focused on the following question: How have you experienced the sorrow support received after the death of patients in your unit? Once the narratives were transcribed, the phenomenological analysis and subsequent data triangulation were carried out, achieving saturation. RESULTS: It was observed that the participants feel little supported in their sorrows after the death of the patients, where there are obstacles to face the situation. Although facing death is something complex for the participants, they recognize that they can generate protection strategies and also feel supported by the people around them. Despite the complexity of this experience, the participants consider that there are lessons learned in facing death which leads them to give meaning to their professional work. CONCLUSION: Professionals need the recognition of deaths in the workplace and, therefore, formal and continuous support from their work team and institution.

Percepción de apoyo en duelo por profesionales y técnicos de cuidados intensivos pediátricos de hospitales públicos / Perception of support in professional's and technician's grief of pediatric intensive care units in public hospitals

INTRODUCCIÓN: La muerte en la infancia es una realidad a la que se ven enfrentados los profesionales de salud, especialmente en unidades de alta complejidad como son los cuidados intensivos. Esto genera en los profesionales impotencia y frustración, comprometiendo su salud física, emocional y mental, agravada por la sensación de bajo soporte social y deficiente preparación para el afrontamiento de la muerte y el apoyo a los familiares de sus pacientes. OBJETIVO: Develar la percepción de apoyo en duelo de profesionales y técnicos en unidades de cuidado intensivo pediátrico de hospitales públicos, tras la muerte de los pacientes. SUJETOS Y MÉTODO: Estudio cualitativo con enfoque fenomenológico. Se realizaron 16 entrevistas en profundidad a profesionales y técnicos de cuidados intensivos pediátricos de cinco hospitales públicos de Santiago. Como criterios de inclusión se consideraron el trabajar por más de un año en la unidad, haber vivenciado la muerte de pacientes, y reconocer que ha cursado un duelo profesional. La entrevista fue guiada por la siguiente pregunta: ¿Cómo ha vivenciado usted el apoyo en duelo recibido, tras la muerte de pacientes en su unidad? Una vez trascritas las narrativas se realizó el análisis fenomenológico y posterior triangulación de los datos, logrando la saturación. RESULTADOS: Se develó que los participantes se sienten poco apoyados en sus duelos tras la muerte de los pacientes, existiendo obstáculos para su afrontamiento. Aunque enfrentar la muerte es algo complejo para ellos, reconocen que son capaces de generar estrategias de protección y además se sienten apoyados por personas de su entorno. A pesar de lo complejo de esta experiencia, ellos consideran que existen aprendizajes al enfrentar la muerte que los lleva a dar sentido a su labor profesional. CONCLUSIÓN: Los profesionales requieren que las pérdidas en el ámbito laboral sean reconocidas, y por ello, contar con un apoyo formal y continuo de su equipo de trabajo e institución.

INTRODUCTION: Death in childhood is a reality faced by health professionals, especially in highly com plex units such as intensive care ones. This leads to feelings of helplessness and frustration in health professionals, compromising their physical, emotional, and mental health, which is worsened by the feeling of low social support and poor preparation for coping with death and support for the patient's family. OBJECTIVE: To expose the perception of sorrow support of professionals and techni cians in pediatric intensive care units of public hospitals, after the death of the patients. SUBJECTS AND METHOD: Qualitative study with a phenomenological approach. 16 in-depth interviews were conducted with pediatric intensive care professionals and technicians from five public hospitals in Santiago, Chile. Inclusion criteria considered working for more than a year in the Unit, having experienced the death of patients, and recognizing that they have gone through a professional sorrow. The in terview focused on the following question: How have you experienced the sorrow support received after the death of patients in your unit? Once the narratives were transcribed, the phenomenological analysis and subsequent data triangulation were carried out, achieving saturation. RESULTS: It was observed that the participants feel little supported in their sorrows after the death of the patients, where there are obstacles to face the situation. Although facing death is something complex for the participants, they recognize that they can generate protection strategies and also feel supported by the people around them. Despite the complexity of this experience, the participants consider that there are lessons learned in facing death which leads them to give meaning to their professional work. CONCLUSION: Professionals need the recognition of deaths in the workplace and, therefore, formal and continuous support from their work team and institution.

Cuidados de enfermería basados en evidencia y modelo de Betty Neuman, para controlar estresores del entorno que pueden ocasionar delirium en unidad de cuidados intensivos / Evidence -and Betty Neuman's model- based nursing care to prevent deilrium in the intensive care unit

Antecedentes: El Delirium es una alteración del estado de conciencia, frecuente en las unidades de cuidado intensivo. En la UCI adultos del Hospital Universitario de Neiva se tiene una incidencia del 28%, esto aumenta la morbimortalidad; sin embargo es prevenible y requiere intervención. Objetivo: Determinar la efectividad de los cuidados aplicados, según la Guía de enfermería elaborada con evidencia y en base al Modelo de Betty Neuman, para controlar estresores del entorno que pueden ocasionar Delirium, en pacientes hospitalizados en la unidad de cuidados intensivos adulto. Metodología: Se realizó un estudio cuantitativo, transversal, pre-experimental, donde se aplicó la Guía de cuidados de enfermería a 49 pacientes. Se utilizó el diseño de preprueba y postprueba para conocer la percepción que tenían los pacientes de los estresores del entorno. Resultados: Los cuidados aplicados según la Guía propuesta, fueron efectivos, ya que previnieron el delirium en el 94% de los pacientes, sólo tres presentaron el evento, representando una incidencia acumulada de 6.12 casos X 100 pacientes intervenidos (IC 95%: 1.67 - 16.1), evidenciado en la curva de Kaplan-Meier. La prueba de hipótesis de proporciones (Z0.05= -1.65) indica que la presencia de delirium es significativamente menor a la de 2011 (28%).Conclusiones: Los cuidados aplicados según la Guía propuesta, lograron prevenir la aparición de delirium en 94% de los pacientes a pesar de sus antecedentes de factores de riesgo desencadenantes de delirium. De tal forma que, al minimizar la presencia de estresores del entorno, se favorece un ambiente creado agradable y familiar, y se constituye en un cuidado de enfermería fundamental para la prevención de delirium en UCI (AU)

Background: Delirium is a fluctuating disturbance in consciousness that is highly prevalent in the intensive care unit. The adult ICU of the Hospital Universitario de Neiva shows an incidence of 28% of delirium patients, this increases morbidity and mortality rates among critical ones; nonetheless, this can be prevented if intervention occurs. Objective: Determine the effectiveness of To determine the effectiveness of care applied, according to guide nursing care nursing care to prevent delirium in patients, who were hospitalized in the adult intensive care unit, the patients were exposed to environmental stressors. Methodology: A quantitative, prospective and pre-experimental study was carried out to 49 patients who received assessment with the help of a nursing care guide. Besides the guide, a pretest and a posttest were carried out to evaluate the patients’ perception on environmental stressors. Results: Three out of the 49 patients experienced delirium; this represents a cumulative incidence of 6.12 delirium cases x 100 patients (CI 95%: 1.67-16.1), evident with the Kaplan-Merier curve. Based on the proportion hypothesis testing (Z ₀.₀₅ = -1.65) and in contrast to previous results where the incidence of delirium was of 28%, the statistical evidence suffices to demonstrate that the presence of the syndrome is much less frequent in patients to whom the nursing care guide. Conclusions: The guide prevented the occurrence of delirium in 94% of the patients, regardless of their deliriogenic history, by controlling the continuous noise and artificial light. This is why, minimizing environmental stressors, which results in a more pleasant environment, is a fundamental part of nursing care for the prevention of such a syndrome (AU)

ATR-FTIR spectroscopy for the determination of Na4EDTA in detergent aqueous solutions.

Fourier transform infrared spectroscopy in the attenuated total reflectance mode (ATR-FTIR) combined with partial last square (PLS) algorithms was used to design calibration and prediction models for a wide range of tetrasodium ethylenediaminetetraacetate (Na4EDTA) concentrations (0.1 to 28% w/w) in aqueous solutions. The spectra obtained using air and water as a background medium were tested for the best fit. The PLS models designed afforded a sufficient level of precision and accuracy to allow even very small amounts of Na4EDTA to be determined. A root mean square error of nearly 0.37 for the validation set was obtained. Over a concentration range below 5% w/w, the values estimated from a combination of ATR-FTIR spectroscopy and a PLS algorithm model were similar to those obtained from an HPLC analysis of NaFeEDTA complexes and subsequent detection by UV absorbance. However, the lowest detection limit for Na4EDTA concentrations afforded by this spectroscopic/chemometric method was 0.3% w/w. The PLS model was successfully used as a rapid and simple method to quantify Na4EDTA in aqueous solutions of industrial detergents as an alternative to HPLC-UV analysis which involves time-consuming dilution and complexation processes.

Capacidad de afrontamiento y adaptación de los familiares del paciente adulto hospitalizado en una unidad de cuidado intensivo / Ability to Cope and Adapt in Relatives of Adult Patients Hospitalized at an Intensive Care Unit / Capacidade de enfrentamento e adaptação dos familiares do paciente idoso hospitalizado em uma unidade de tratamento intensivo

Objetivo: identificar la capacidad de afrontamiento y adaptación de los familiares del paciente adulto hospitalizado en la unidad de cuidado intensivo de la Clínica Universidad de La Sabana, en Chía, Colombia. Materiales y métodos: estudio de tipo cuantitativo descriptivo desarrollado en el segundo semestre del 2010, que incluyó 61 familiares. Para la recolección de la información se utilizó el instrumento Escala de Medición del Proceso de Afrontamiento y Adaptación de Callista Roy. Para el análisis de datos se utilizaron medidas de tendencia central, test estadísticos de Mann-Whitney y KrusKal-Wallis. Los rangos de edad de los participantes oscilaron entre 18 y 65 años, con una participación mayoritaria del género femenino (67,2%) sobre el masculino (32,8%). Resultados: se consideró que la capacidad de afrontamiento y adaptación fue alta al obtener un puntaje del 85,2% y baja con puntaje del 14,8%. Se observó que en una gama de estrategias de afrontamiento y adaptación las utilizadas con mayor frecuencia por los familiares fueron: las de factor físico y enfocado (factor 2, relacionado con bajo afrontamiento), y factores combinados recursivo y centrado (factores 1 y 3, relacionados con alta capacidad de afrontamiento). Conclusiones: las estrategias de afrontamiento utilizadas por los familiares fueron las dirigidas a la solución del problema, caracterizándose por hacer frente a la situación desde un principio, planeando actividades dirigidas a modificar la conducta y desarrollar objetivos específicos que contribuyan con la solución del mismo.

Objective: The study identifies the ability of relatives of adult patients in the intensive care unit at Clínica Universidad de La Sabana, in Chía, Colombia, to cope and adapt. Materials and methods: This was a quantitative descriptive research initiative developed during the second half of 2010. It included 61 family members. Callista Roy's Coping and Adaptation Process Scale was used to collect the data, which was analyzed with measures of central tendency and Mann-Whitney and Kruskal-Wallis statistical tests. The age of the participants ranged from 18 to 65 years, with the majority being females (67.2%) as opposed to male (32.8%). Results: In terms of the capacity to cope and adapt, 85.2% scored high and 14.8% scored low. It was found that, within a range of strategies for coping and adapting, those used most frequently by family members were the physical and focused factor (factor 2, associated with a limited ability to cope), and the recursive and centered factors combined (factors 1 and 3, associated with a high ability to cope). Conclusions: The coping strategies used by family members were aimed at solving the problem and were distinguished by dealing with the situation from the beginning, planning activities to change behavior, and pursuing specific objectives that contribute to a solution.

Objetivo: identificar a capacidade de enfrentamento e adaptação dos familiares do paciente idoso hospitalizado na unidade de tratamento intensivo da Clínica Universidad de La Sabana, em Chía (Colômbia). Materiais e métodos: estudo de tipo quantitativo descritivo desenvolvido no segundo semestre de 2010, que incluiu 61 familiares. Para a coleta da informação, utilizou-se o instrumento Escala de Medição do Processo de Enfrentamento e Adaptação de Callista Roy. Para a análise dos dados, utilizaram-se medidas de tendência central, teste estatísticos de Mann-Whitney e KrusKal-Wallis. A faixa etária dos participantes oscilou entre 18 e 65 anos, com uma participação maioritária do gênero feminino (67,2%) contra 32,8% do masculino. Resultados: considerou-se que a capacidade de enfren-tamento e adaptação foi alta ao obter uma pontuação de 85,2% e baixa com pontuação de 14,8%. Observou-se que, em uma série de estratégias de enfrentamento e adaptação, as utilizadas com maior frequência pelos familiares foram: as de fator físico e enfocado (fator 2, relacionado com baixo enfrentamento) e fatores combinados recursivo e centrado (fatores 1 e 3, relacionados com alta capacidade de enfrentamento). Conclusões: as estratégias de enfrentamento utilizadas pelos familiares foram as dirigidas à solução do problema e se caracterizavam por enfrentar a situação desde um princípio, ao planejar atividades direcionadas a modificar a conduta e desenvolver objetivos específicos que contribuíssem com a solução deste.

Are all skilled birth attendants created equal? A cluster randomised controlled study of non-physician based obstetric care in primary health care clinics in Mexico.

BACKGROUND: the great majority of births in Mexico are attended by physicians. Non-physician health professionals have never been evaluated or compared to the medical model of obstetric care. This study evaluates the relative strengths of adding an obstetric nurse or professional midwife to the physician based team in rural clinics. METHODS: we undertook a cluster-randomised trial in 27 clinics in 2 states with high maternal mortality. Twelve non-physician providers (obstetric nurses (4) and professional midwives (8)) were randomly assigned to clinics; 15 clinics served as control sites. Over an 18-month period in 2009-2010, we evaluated quality of care through chart review and monthly interviews with providers about last three deliveries performed. We analysed practices by creating indices using WHO care guidelines for normal labour and childbirth. Volume of care was assessed using administrative reporting forms. FINDINGS: two thousand two hundred fifty-four pregnancies were followed, and a total of 461 deliveries occurred in study sites. Intervention clinics were more likely to score highly on the index for favourable practices on admission (OR=3.6, 95% CI 2.3-5.8), and during labour, childbirth, and immediately post partum (OR=8.6, 95% CI 2.9-25.6) and less likely to use excessively used or harmful practices during labour, childbirth and immediately post partum (OR=0.2, 95% CI 0.1-0.4). There was a significant increase in volume of care in intervention clinics for antenatal visits (incidence rate ratio (IRR) 1.3, 95% CI 1.2-1.4), deliveries (IRR=2.5, 95% CI 1.7-3.7) and for postpartum visits (IRR=1.4, 95% CI 1.1-1.7). INTERPRETATION: the addition of non-physician skilled birth attendants to rural clinics in Mexico where they independently provided basic obstetric services led to improved care and higher coverage than clinics without. The potential value of including a professional midwife or obstetric nurse in all rural clinics providing obstetric care should be considered. FUNDING: Mexican National Institute for Women, Mexican National Center for Gender Equity and Reproductive Health, MacArthur Foundation, Bill and Melinda Gates Foundation.

[Use of contraception and family planning in adolescent and adult women in Mexico]. / Inicio de vida sexual, uso de anticonceptivos y planificación familiar en mujeres adolescentes y adultas en México.

OBJECTIVE: To offer current evidence about age at sexual initiation and contraceptive use among adolescent and adult women of different age groups, places of residence, and marital status in Mexico. MATERIALS AND METHODS: Data were analyzed from ENSANUT 2006 and 2012 surveys on knowledge and use of contraceptives. RESULTS: In 2012 31.2% of 15-19 year old adolescent women had undergone sexual debut. Condom use increased from 31.8% in 2006 to 47.8% in 2012. Women in rural areas reported lower levels of contraceptive use at last sexual intercourse; 47.9% of 30-34 year-old and 53.2% of 35-49 year-old women reported not using any contraception at last sexual intercourse. A high percentage of women did not adopt contraception after the most recent obstetric event: 52% (15-19 years), 44.2% (20-29 years), 42.5% (30-34 years) and 39% (≥35 years)]. CONCLUSIONS: Equitable policies to promote contraception, particularly after a post-obstetric event, are needed.

Inicio de vida sexual, uso de anticonceptivos y planificación familiar en mujeres adolescentes y adultas en México / Use of contraception and family planning in adolescent and adult women in Mexico

Objetivo. Ofrecer evidencia actualizada sobre inicio de vida sexual y uso de anticonceptivos en mujeres adolescentes y adultas en México por grupos de edad, lugar de residencia y estado civil. Material y métodos. Se analizaron datos de las ENSANUT 2006 y 2012, sobre conocimientos y uso de anticoncepción. Resultados. En 2012, 31.2% de las adolescentes (15-19 años) había iniciado vida sexual; el uso del condón aumentó de 31.8 a 47.8% entre 2006 y 2012. El 47.9% de 30 a 34 años y 53.2% de 35 a 49 años reportaron no haber usado anticonceptivo en su última relación sexual. En las áreas rurales se reporta menor uso de anticonceptivos en la última relación sexual. Un alto porcentaje no optó por anticonceptivo postevento obstétrico: 52% (15-19 años), 44.2% (20-29 años), 42.5% (30-34 años) y 39% (≥35 años). Conclusiones. Se requieren políticas equitativas que promuevan el uso de anticonceptivos, particularmente en el periodo postevento obstétrico.

Objective. To offer current evidence about age at sexual initiation and contraceptive use among adolescent and adult women of different age groups, places of residence, and marital status in Mexico. Materials and methods. Data were analyzed from ENSANUT 2006 and 2012 surveys on knowledge and use of contraceptives. Results. In 2012 31.2% of 15-19 year old adolescent women had undergone sexual debut. Condom use increased from 31.8% in 2006 to 47.8% in 2012. Women in rural areas reported lower levels of contraceptive use at last sexual intercourse; 47.9% of 30-34 year-old and 53.2% of 35-49 year-old women reported not using any contraception at last sexual intercourse. A high percentage of women did not adopt contraception after the most recent obstetric event: 52% (15-19 years), 44.2% (20-29 years), 42.5% (30-34 years) and 39% (≥35 years)]. Conclusions. Equitable policies to promote contraception, particularly after a post-obstetric event, are needed.

Skilled birth attendants in Mexico: how does care during normal birth by general physicians, obstetric nurses, and professional midwives compare with World Health Organization evidence-based practice guidelines?

INTRODUCTION: We evaluated the quality of basic obstetric care provided by Mexican general physicians, obstetric nurses, and professional midwives compared with World Health Organization (WHO) guidelines for evidence-based practices and national guidelines. METHODS: Vaginal births were observed in 5 hospitals in 5 states from June 2006 until July 2007. We created 5 indices based on WHO guidelines and national standards for care during normal birth. These indices included 1) favorable practices at admission, 2) favorable practices during labor, birth, and immediately postpartum, 3) harmful or excessively used practices, 4) newborn practices, and 5) obstetric outcomes. We assessed each provider type's performance as high or low compared with the WHO standard and performed bivariate and multivariate logistic regression analyses to assess the association between indices, patient characteristics, and provider type, adjusting for standard errors for intragroup correlation. RESULTS: We observed 876 independently managed vaginal births. Adjusted regression analyses compared with the general physicians standard revealed significant results for favorable care by obstetric nurses on admission (odds ratio [OR] 6.25; 95% confidence interval [CI], 2.08-18.84); for care by professional midwives (OR 21.08; 95% CI, 4.24-104.94) and obstetric nurses (OR 7.88; 95% CI, 2.76-22.52) during labor, birth, and postpartum; and for newborn practices by obstetric nurses (OR 4.14; 95% CI, 1.08-15.90). Professional midwives were least likely to perform harmful/excessively used practices during labor, birth, and the postpartum period (OR 0.06; 95% CI, 0.00-0.35). DISCUSSION: Professional midwives and obstetric nurses perform equally or better than general physicians when assessed by use or misuse of evidence-based practices. Professional midwives are an underutilized resource in Mexico. If integrated into the mainstream Mexican health system, they may improve the quality of obstetric care.

[Domestic violence against Mexican teenagers]. / La violencia familiar ejercida en contra de los adolescentes mexicanos.

OBJECTIVE: To assess students' perception of domestic violence. METHODS: The study was carried out in a random sample representative (n=5,982) of high-school students aged between 13 and 19 years in Chiapas and San Luis Potosi, Mexico, in 2003. The students answered a self-administered questionnaire on sexual education, sexuality, pregnancy and risk behavior, and domestic violence. Considering the effects of the sample design, a logistic regression analysis was carried out in order to verify the association between socioeconomic and demographic characteristics and risk of domestic violence. RESULTS: The multivariate statistical analysis confirmed that female students are more vulnerable to domestic violence in both states studied (Chiapas: OR=1.87, p=0.01; San Luis: OR=1.53, p=0.00). Moreover, alcohol (Chiapas: OR=2.52, p=0.00; San Luis: OR=1.93, p=0.00) or drug use (Chiapas: OR=2.27, p=0.02; San Luis: OR=1.82, p=0.01) were the two most significant variables for students exposure to domestic violence. The association between alcohol consumption and student's age increases the risk of violence. The youngest students had 51% (Chiapas) and 73% (San Luis) more risk of experience violence by a relative than older students. CONCLUSIONS: Teenagers remain one of the most vulnerable population groups to domestic violence due to their physical, affective, economic and social dependence on other adults. The study was one of the first attempts to measure domestic violence against students.

La violencia familiar ejercida en contra de los adolescentes mexicanos / Domestic violence against Mexican teenagers

OBJETIVO: Analizar la percepción de los estudiantes en torno a la violencia intrafamiliar. MÉTODOS: El estudio se realizó mediante una muestra aleatoria representativa (n=5,982) de estudiantes de secundaria y preparatoria de 13 a 19 años de edad en Chiapas y en San Luis Potosí, México, en el año 2003. Los estudiantes respondieron a un cuestionario de autollenado acerca de temas de educación sexual, sexualidad, embarazo y comportamientos de riesgo de los adolescentes y violencia intrafamiliar. Considerando el efecto del diseño muestral, se efectuó un análisis de regresión logística para ver asociación entre características sociodemoeconómicas y el riesgo de sufrir una agresión en el hogar. RESULTADOS: El análisis estadístico multivariado confirma la mayor vulnerabilidad femenina frente a la violencia familiar en ambas entidades federativas (Chiapas: RM=1.87, p=0.01; San Luis: RM=1.53, p=0.00). Asimismo, el que los estudiantes bebieran alcohol (Chiapas: RM=2.52, p=0.00; San Luis: RM=1.93, p=0.00) o consumieran drogas (Chiapas: RM=2.27, p=0.02; San Luis: RM=1.82, p=0.01) resultaron ser las dos variables más importantes que expusieron a los estudiantes a la violencia intrafamiliar. Se mostró que la interacción del consumo de alcohol con la edad de los estudiantes aumentó el riesgo de violencia. Así, los más jóvenes tuvieron un riesgo del 51 por ciento en Chiapas y del 73 por ciento en San Luis de sufrir una agresión de un familiar que los de mayor edad. CONCLUSIONES: Los adolescentes continúan siendo una de las poblaciones más vulnerables debido a su dependencia física, afectiva, económica y social hacia los adultos a su cargo. Esta encuesta es una de las primeras aproximaciones a la medición de violencia hacia los estudiantes.

OBJECTIVE: To assess students' perception of domestic violence. METHODS: The study was carried out in a random sample representative (n=5,982) of high-school students aged between 13 and 19 years in Chiapas and San Luis Potosi, Mexico, in 2003. The students answered a self-administered questionnaire on sexual education, sexuality, pregnancy and risk behavior, and domestic violence. Considering the effects of the sample design, a logistic regression analysis was carried out in order to verify the association between socioeconomic and demographic characteristics and risk of domestic violence. RESULTS: The multivariate statistical analysis confirmed that female students are more vulnerable to domestic violence in both states studied (Chiapas: OR=1.87, p=0.01; San Luis: OR=1.53, p=0.00). Moreover, alcohol (Chiapas: OR=2.52, p=0.00; San Luis: OR=1.93, p=0.00) or drug use (Chiapas: OR=2.27, p=0.02; San Luis: OR=1.82, p=0.01) were the two most significant variables for students exposure to domestic violence. The association between alcohol consumption and student's age increases the risk of violence. The youngest students had 51 percent (Chiapas) and 73 percent (San Luis) more risk of experience violence by a relative than older students. CONCLUSIONS: Teenagers remain one of the most vulnerable population groups to domestic violence due to their physical, affective, economic and social dependence on other adults. The study was one of the first attempts to measure domestic violence against students.

Risk of Giardia intestinalis infection in children from an artificially recharged groundwater area in Mexico City.

The objective of this study was to assess the risk of infection with Giardia intestinalis in children living in an area with artificial groundwater recharge and potable water reuse in Mexico City. Eligible wells and surrounding homesteads were defined by using a geographic information system. Five wells were tested for G. intestinalis cysts per 400 liters of water. A total of 750 eligible households were visited during two cross-sectional surveys. Stool samples were provided by 986 children in the rainy season study and 928 children during the dry season survey for parasitologic tests. Their guardians provided information on water, sanitation, hygiene, and socioeconomic variables. The prevalence rates of G. intestinalis infection were 9.4% in the rainy season and 4.4% in the dry season. Higher rates of infection were observed in older individuals (9.5% and 10.6%) and girls had a lower risk of infection than boys (odds ratio [OR] =0.55, 95% confidence interval [CI] = 0.34, 0.88 in the rainy season and OR = 0.47, 95% CI = 0.25, 0.90 in the dry season). During the wet season survey, a health risk was detected among those storing water in unprotected receptacles (OR = 4.00, 4.69, and 5.34 for those using uncovered jars, cisterns or tanks, and buckets, respectively), and bathing outside the dwelling, i.e., using a tap (OR = 1.93, 95% CI = 1.10, 3.39). A health risk was also detected among children from households with unsafe food hygiene practices (OR =2.41, 95% CI =1.10, 5.30) and those with no hand-washing habits (OR = 2.27, 95% CI = 1.00, 5.20). Groundwater reserves are at risk of fecal pollution, as indicated by the presence of G. intestinalis cysts. However, the endemic pattern of intestinal infection reflects low standards of personal hygiene and unsafe drinking water storage and food-related practices at household level. Prevention activities must address health education and environmental protection policies.

Diarrheal diseases in children from a water reclamation site in Mexico city.

This study was conducted to assess the risk of enteric diseases among children living in a water reclamation area in Mexico City. A geographic information system was used to define eligible wells and surrounding homesteads. Sixty-five water samples from five wells were tested for fecal coliform bacteria per 100 mL (FC/100 mL) during visits to 750 eligible households; caretakers only in those dwellings with children under 5 years old were interviewed throughout repeated cross-sectional surveys, conducted during 1999-2000. Data on diarrheal diseases were obtained from 761 children during the rainy season and 732 children during the dry season; their guardians also provided information on drinking water supply, sanitation, and socioeconomic variables. The presence of indicator organisms in groundwater samples pointed to fecal pollution; bacterial indicators, however, did not predict the health risk. The rates of diarrhea were 10.7% in the dry season and 11.8% in the rainy season. Children 1 year old showed the highest rate of diarrhea during the dry season [odds ratio (OR) = 2.1 with 95% confidence interval (CI), 0.99-4.71], particularly those from households perceiving unpleasant taste of tap water (OR, 1.7; 95% CI, 0.97-2.92) and consuming vegetables washed only with water (OR, 2.2; 95% CI, 1.10-4.39). Lower risk was observed in individuals enjoying full-day water supply (OR, 0.5; 95% CI, 0.27-0.86) and a flushing toilet (OR, 0.3; 95% CI, 0.16-0.67), as well as those storing water in covered receptacles (OR, 0.3; 95% CI, 0.15-0.80). Rainy season data suggested that children from households perceiving a color to their water had a higher rate of diarrhea than did those without such complaint (OR, 1.8; 95% CI, 0.93-3.67); recent consumption of food sold by street vendors was also a significant risk factor (OR, 1.6; 95% CI, 0.98-2.87). Groundwater is at risk of contamination, as indicated by the presence of FC/100 mL. The endemic pattern of diarrhea, however, reflects mostly inadequate housing, sanitation, and water-related practices. Health protection policy must be discussed.