Palliative care national plan implementation through stakeholder analysis.

BACKGROUND: National palliative care plans depend upon stakeholder engagement to succeed. Assessing the capability, interest, and knowledge of stakeholders is a crucial step in the implementation of public health initiatives, as recommended by the World Health Organisation. However, utilising stakeholder analysis is a strategy underused in public palliative care. OBJECTIVE: To conduct a stakeholder analysis characterising a diverse group of stakeholders involved in implementing a national palliative care plan in three rural regions of an upper-middle-income country. METHODS: A descriptive cross-sectional study design, complemented by a quantitative stakeholder analysis approach, was executed through a survey designed to gauge stakeholders' levels of interest and capability in relation to five fundamental dimensions of public palliative care: provision of services, accessibility of essential medicines, palliative care education, financial support, and palliative care vitality. Stakeholders were categorised as promoters (high-power, high-interest), latent (high-power, low-interest), advocates (low-power, high-interest), and indifferent (low-power and low-interest). Stakeholder self-perceived category and knowledge level were also assessed. RESULTS: Among the 65 surveyed stakeholders, 19 were categorised as promoters, 34 as advocates, 9 as latent, and 3 as indifferent. Stakeholders' self-perception of their category did not align with the results of the quantitative analysis. When evaluated by region and palliative care dimensions the distribution of stakeholders was nonuniform. Palliative care funding was the dimension with the highest number of stakeholders categorised as indifferent, and the lowest percentage of promoters. Stakeholders categorised as promoters consistently reported a low level of knowledge, regardless of the dimension, region, or their level of interest. CONCLUSIONS: Assessing the capability, interest, and knowledge of stakeholders is a crucial step when implementing public health initiatives in palliative care. It allows for a data-driven decision-making process on how to delegate responsibilities, administer financial resources, and establish governance boards that remain engaged and work efficiently.

Comparing the Need and Development of Pediatric Palliative Care in Mexico: A Geographical Analysis.

CONTEXT: The Global Atlas of Palliative Care (GAPC) ranked Mexico's palliative care services at a preliminary integration stage into mainstream healthcare services. However, this data does not reflect pediatric palliative care (PPC) development. OBJECTIVES: To analyze the current need and level of development of PPC within Mexico. METHODS: PPC need was estimated using causes of death associated with serious health-related suffering from national mortality data from the General Directorate of Health Information. The level of development was measured through six indicators involving access to PPC services and opioids, then classified using the GAPC development categories adapted to regional territories based on available data. RESULTS: In 2021, 37,444 children died in Mexico. Of those, 10,677 (28.29%) died from conditions with serious health-related suffering, averaging a need for PPC of 25/100,000 children. Out of Mexico's 32 states, two (6.2%) had no PPC activity (category 1), twenty (62.6%) were in a capacity-building phase (category 2), eight (25%) had isolated PPC provision (category 3a), while two (6.2%) had generalized PPC provision (category 3b). No state had early (category 4a) or advanced PPC integration (category 4b). Overall, Mexico was classified as category 2. CONCLUSIONS: PPC services are distributed unevenly across the country, leading to inequitable access to care and an inability to meet the needs of patients and families. There is a disparity between the level of development of adult palliative care services and the underdevelopment of PPC in Mexico. This information can help stakeholders guide the development of PPC where it is needed most.

Palliative care education in undergraduate medical and nursing programs in Colombia: a cross-sectional analysis.

BACKGROUND: The number of people suffering from chronic diseases requiring palliative care (PC) is increasing rapidly. Therefore, PC teaching in undergraduate health science programs is necessary to improve primary PC based on international recommendations and available scientific evidence. METHODS: A descriptive cross-sectional study was conducted. Active undergraduate medical and nursing programs that were approved by the Colombian Ministry of Education and integrated PC teaching into their curricula were included in the study. The total sample consisted of 48 programs: 31 nursing and 17 medical programs. RESULTS: PC competencies are distributed throughout the curriculum in 41.67% of programs, in elective courses in 31.25%, and in mandatory courses in 27.08% of the programs. The average PC teaching hours is 81 for nursing and 57.6 for medicine. PC clinical rotations are not offered in 75% of the programs. For undergraduate nursing programs, the most frequent competencies taught are the definition and history of PC and identifying common symptoms associated with advanced disease. In undergraduate medicine, the most common competencies are pharmacological and non-pharmacological pain management and identification of PC needs. CONCLUSIONS: PC teaching in undergraduate health science programs mainly addresses the conceptual and theoretical aspects of PC, which are part of the competencies present throughout the programs' curricula. Low availability of PC clinical rotations was identified. Future studies should assess whether the low availability of clinical rotations in PC limits the ability of students to develop the practical competencies necessary to provide quality PC. TRIAL REGISTRATION: Not applicable.

Automated Monitoring of Human-Computer Interaction for Assessing Teachers' Digital Competence Based on LMS Data Extraction.

The fast-paced evolution of technology has compelled the digitalization of education, requiring educators to interact with computers and develop digital competencies relevant to the teaching-learning process. This need has prompted various organizations to define frameworks for assessing digital competency emphasizing teachers' interaction with computer technologies in education. Different authors have presented assessment methods for teachers' digital competence based on the video analysis of recorded classes using sensors such as cameras, microphones, or electroencephalograms. The main limitation of these solutions is the large number of resources they require, making it difficult to assess large numbers of teachers in resource-constrained environments. This article proposes the automation of teachers' digital competence evaluation process based on monitoring metrics obtained from teachers' interaction with a Learning Management System (LMS). Based on the Digital Competence Framework for Educators (DigCompEdu), indicators were defined and extracted that allow automatic measurement of a teacher's competency level. A tool was designed and implemented to conduct a successful proof of concept capable of automating the evaluation process of all university faculty, including 987 lecturers from different fields of knowledge. Results obtained allow for drawing conclusions on technological adoption according to the teacher's profile and planning educational actions to improve these competencies.

Prevalence and Risk Factors Associated with Chronic Occupational Low Back Pain among Healthcare Professionals Working at Hospitals: Exploratory Survey Study.

Objective This study aimed to describe the methodological process for developing a questionnaire to identify the prevalence and risk factors for chronic occupational low back pain in healthcare professionals working at hospitals. Method An exploratory crossectional survey study was carried out in Belo Horizonte, MG, Brazil, and its metropolitan region, in two stages. Initially, the authors prepared a questionnaire based on the Roland Morris disability questionnaire and sent it to a committee of low back pain specialists for validation using the Delphi technique. The second stage consisted of sending the final questionnaire to health professionals working in a hospital environment for at least 2 years and presenting chronic low back pain for at least 3 months. Results Validation occurred in two rounds of questionnaire adjustments by a panel consisting of physical therapists and physician experts in the field (orthopedists with more than 3 years of experience). Both rounds had 13 participants. The questionnaire initially consisted of 27 items, and, after validation, it had 19 items. The study included 65 subjects, with an average age of 40.91 years old and an average time working at a hospital of 40 hours per week. The total sample had 76.9% of physicians, 10.8% of physical therapists, and 12.3% of nurses or nursing technicians. Most (52.3%) subjects reported staying in uncomfortable positions affecting the lower back for 5 to 10 hours per day. Conclusion We developed and validated, using the Delphi technique, a questionnaire on the prevalence and risk factors associated with chronic occupational low back pain among healthcare professionals working at hospitals. This unprecedented tool can benefit the population studied since the questionnaires currently used to evaluate chronic low back pain are not specific for investigating the occupational cause of this condition.

Factores de riesgo de Hipertensión Arterial en adultos. Río Cauto2018–2019 / Risk factors of Hypertension in adults. Cauto River 2018–2019

Se realizó un estudio observacional y analítico, con un diseño longitudinal (caso-control), con el objetivo de determinar los principales factores de riesgo asociados a hipertensión arterial en adultos de la Comunidad Fernando Echenique del municipio Río Cauto, en el período comprendido de octubre 2018 a enero 2019. El universo estuvo constituido por 650 pacientes. La muestra de estudio se constituyó de 60 pacientes diagnosticados con hipertensión arterial y los controles de 180 pacientes que no presentaban la enfermedad. Se determinó en el estudio realizado que las edades comprendidas entre 41 y 50 años y 51–60 fueron las más representativas de la muestra de estudio. De acuerdo al sexo predominó el femenino con 42 pacientes hipertensas para un 70 por ciento y un 68.7 por ciento de la muestra control. Las razas negra y mestiza fueron las que predominaron en la muestra de estudio. En cuanto a presentar Antecedente Patológico Familiar de Hipertensión Arterial el mismo resultó ser el factor de riesgo más significativo ya que el cálculo del OR=5.71 así lo refleja. En el caso del hábito de fumar resultó ser otro factor de riesgo importante pues más del 30 por ciento de la muestra de estudio presentaba éste hábito tóxico. El sedentarismo resultó ser el segundo factor de riesgo más importante siendo el OR=3.1(AU)

An observational and analytical study was conducted, with a longitudinal design (case-control), with the objective of determining the main risk factors associated with arterial hypertension in adults of the Fernando Echenique Community of the Río Cauto municipality, in the period from October 2018 to January 2019. The universe consisted of 650 patients. The study sample consisted of 60 patients diagnosed with arterial hypertension and the controls of 180 patients who did not present the disease. It was determined in the study that the ages between 41 and 50 years and 51-60 were the most representative of the study sample. According to sex, the female predominated with 42 hypertensive patients for 70 percent and 68.7 percent of the control sample. The black and mestizo races were those that predominated in the study sample. As for presenting a Family Pathological History of Arterial Hypertension, it proved to be the most significant risk factor since the OR calculation = 5.71 reflects this. In the case of smoking, it turned out to be another important risk factor since more than 30 percent of the study sample presented this toxic habit. Sedentary lifestyle turned out to be the second most important risk factor being the OR=3.1(EU)

Calidad de vida en los niños que viven con enfermedad renal crónica / Quality of Life in Children Living with Chronic Kidney Disease / Qualidade de vida em crianças vivendo com doença renal crônica

Introducción: la enfermedad renal en los niños causa diferentes cambios que pueden alterar su calidad de vida; por esta razón, es importante que el profesional de salud busque estrategias que contribuyan a disminuir las secuelas y mejorar la calidad de vida del niño. Objetivo: caracterizar la calidad de vida de los niños de 8 a 18 años, con diagnóstico de enfermedad renal crónica, según el instrumento KIDSCREEN-27 de una institución de salud de la ciudad de Bogotá (Colombia). Método: estudio descriptivo de corte transversal con una población de estudio de 62 niños con diagnóstico de enfermedad renal crónica con edades entre 8 y 18 años que asistieron a la consulta de nefrología pediátrica. Resultados: se analizaron cinco dimensiones, donde cada una tuvo un puntaje ponderado mayor a 70, que se relaciona con una buena calidad de vida; la dimensión con menor puntaje, la de actividad física, tuvo un puntaje de 70,1, y la dimensión de estado de ánimo y sentimientos obtuvo el mayor puntaje, 80,8. Conclusiones: la enfermedad renal crónica puede alterar la calidad de vida, sobre todo en la dimensión de actividad física y entorno escolar. Es primordial que se planteen programas que tengan en cuenta las cinco dimensiones, especialmente las que obtuvieron menor puntaje, con el fin de mejorar la calidad de vida de los niños con esta enfermedad.

Introduction: In children the kidney disease causes different changes that may affect their quality of life. Therefore, it is important for a health professional to find a strategy contributing to reduce the sequelae and improve their quality of life. Objective: To characterize the quality of life in children with ages of 8-18 years who were diagnosed with chronic kidney disease, based on the instrument KIDSCREEN-27 prepared by health center in Bogotá (Colombia). Method: This is a cross-sectional descriptive study with a study population of 62 children diagnosed with chronic kidney disease, with ages from 8 to 18 years, who attended to pediatric nephrology treatment. Results: Five dimensions were analyzed, each with a weighted score above 70, which indicates a good quality of life. The dimensions with the lowest score [70.1] is the physical activity. The highest score [80.8] was found in the dimension of mood and feelings. Conclusions: The chronic kidney disease may alter the quality of life, mostly regarding the dimension of physical activity and the school environment. It is crucial to set out programs that consider the five dimensions, especially those with the lowest scores, in order to improve the quality of life among the ill children.

Introdução: A doença renal nas crianças causa diferentes alterações que podem mudar sua qualidade de vida; por tal razão, é importante que o profissional de saúde procure estratégias que contribuam para reduzir sequelas e melhorar a qualidade de vida da criança. Objetivo: Caracterizar a qualidade de vida das crianças de 8 a 18 anos com diagnóstico de doença renal crônica, segundo o instrumento KIDSCREEN-27 de uma instituição de saúde da cidade de Bogotá (Colômbia). Método: Estudo descritivo transversal com população de estudo de 62 crianças com diagnóstico de doença renal crônica, entre 8 e 18 anos de idade, que atendidas no ambulatório de nefrologia pediátrica. Resultados: Foram analisadas cinco dimensões, nas quais cada uma obteve pontuação ponderada maior que 70, relacionada à boa qualidade de vida; a dimensão com menor pontuação, a de atividade física, obteve pontuação de 70,1, e a dimensão de humor e sentimentos obteve a maior pontuação, 80,8. Conclusões: A doença renal crônica pode alterar a qualidade de vida, especialmente na dimensão de atividade física e entorno escolar. É essencial projetar programas que levem em conta as cinco dimensões, especialmente as que obtiveram pontuações mais baixas a fim de melhorar a qualidade de vida das crianças com esta doença.

Long term studies of depression: what is relevant for the physician?

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Following a meticulous review of long term studies of depression, we conclude that prolonging antidepressant medication after full recovery is clearly beneficial. In this article, we examine recent long term studies that reveal substantial evidence in this sense. However, we advise physicians to keep in mind that this prophylactic effect has been proven for a restricted population, i.e., patients showing recurrent depressive disorders with low comorbidity on axis 1, and having revealed a satisfying response to antidepressant agents during the acute phase of the index episode. This does not mean that antidepressant agents are not useful for patients showing other characteristics, but more studies are needed to assert this possible advantage. We also examine the limited data on chronic forms of depressive disorders. The effect of long term prescription is believed to be advantageous as long as the medication is taken; it has been demonstrated for up to 5 years. Full dosage is indicated even if the effect of active drug over placebo persists at lower doses. The differences between antidepressant agents appear minor and physicians should be more concerned about the long term tolerance of these drugs than their efficacy when choosing the appropriate medication for maintenance treatment. Physicians should also be aware of the greater risk of recurrence during the 6 months following the discontinuation of medication. This risk occurs regardless of the total length of prescription. The possibility that recurrence may be mistaken for withdrawal symptoms cannot be ruled out. Finally, the side-effects of antidepressant drugs are a major concern, particularly when extending the length of prescription. Even though the newer generation medications display a more favorable short-term side-effect profile, the effects of chronic use of these agents are still unclear. Therefore, the decision to extend treatment over several years requires comprehensive discussion with patients and cautious clinical monitoring to identify potential late-onset side effects (AU)