Perfil de Inteligencia Espiritual en estudiantes peruanos de Ciencias de la Salud / Spiritual Intelligence Profile in Peruvian Health Sciences Students

Introducción: Los estudiantes de ciencias de la salud tienen el deber de cuidar la salud humana, por tanto, se debe garantizar una formación humanística basada en el desarrollo y cultivo de la Inteligencia Espiritual. Objetivo: Conocer el perfil de Inteligencia Espiritual y sus factores asociados en estudiantes peruanos de ciencias de la salud. Método: Estudio transversal, que incluyó 418 estudiantes de las carreras de enfermería, medicina, odontología, obstetricia y farmacia, seleccionados de manera aleatoria. Mediante una encuesta virtual se recogieron variables socioeducativas y religiosas-espirituales; el perfil de Inteligencia Espiritual fue valorado con la Escala de Inteligencia Espiritual en la Practica Sanitaria. Se realizó un análisis descriptivo y multivariado mediante modelos lineales generalizados de la familia Poisson para evaluar ciertos factores asociados al perfil saludable de Inteligencia Espiritual. Resultados: De los participantes el 21,1% mantienen un perfil saludable de Inteligencia Espiritual; asimismo en la dimensión Vivencia Espiritual en la Práctica (14,1%), Pensamiento Existencial (18,9%), Consciencia Trascendental (15,3%). Se asociaron a mayor perfil saludable de Inteligencia Espiritual, el considerarse una persona espiritual (RPa = 4,77; IC95%: 1,98-11,4) y practicar la oración diaria (RPa = 3,02; IC95%: 1,54-5,92) y de manera semanal (RPa = 2,30; IC95%: 1,12-4,72). No obstante, se identificaron diversas variables que presentaron asociación no ajustada con el perfil saludable de Inteligencia Espiritual. Conclusiones: La proporción de estudiantes de ciencias de la salud con un perfil saludable de Inteligencia Espiritual, es baja; existen ciertos factores asociados modificables que podrían mejorar la Inteligencia Espiritual. (AU)

Introduction: Health science students have a duty to care for human health; therefore, it is necessary to ensure a humanistic education based on the development and cultivation of Spiritual Intelligence.Objective: To know the Spiritual Intelligence profile and its associated factors in Peruvian health science students.Method: A cross-sectional study was conducted, including 418 randomly selected students from nursing, medicine, dentistry, obstetrics, and pharmacy programs. A virtual survey was used to collect socio-educational and religious-spiritual variables. The profile of Spiritual Intelligence was assessed using the Spiritual Intelligence in Healthcare Practice Scale. Descriptive and multivariate analyses were performed using generalized linear models of the Poisson family to evaluate certain factors associated with a healthy profile of Spiritual Intelligence.Results: 21.1% of participants maintain a healthy profile of Spiritual Intelligence; also, in the dimensions of Spiritual Experience in Practice (14.1%), Existential Thinking (18.9%), Transcendental Awareness (15.3%). Considering oneself a spiritual person (RPa = 4.77; 95% CI: 1.98-11.4) and daily prayer practice (RPa = 3.02; 95% CI: 1.54-5.92) and weekly (RPa = 2.30; 95% CI: 1.12-4.72) were associated with a higher healthy profile of Spiritual Intelligence. However, several variables were identified that presented an unadjusted association with a healthy profile of Spiritual Intelligence.Conclusions: The proportion of health science students with a healthy profile of Spiritual Intelligence is low; there are certain modifiable associated factors that could enhance Spiritual Intelligence. (AU)

Seguridad y efectividad del oxihidróxido sucroférrico en pacientes españoles en diálisis: subanálisis del estudio VERIFIE / Safety and effectiveness of sucroferric oxyhydroxide in Spanish dialysis patients: A sub-analysis of the VERIFIE study

Antecedentes y objetivo: En este estudio presentamos los resultados del subgrupo de pacientes españoles del estudio VERIFIE, primer estudio postautorización prospectivo que evalúa la seguridad y efectividad a largo plazo del oxihidróxido sucroférrico (OHS) en pacientes en diálisis con hiperfosfatemia durante la práctica clínica habitual. Pacientes y métodos: Se incluyeron pacientes en hemodiálisis y diálisis peritoneal con indicación de tratamiento con OHS. La duración del seguimiento fue de 12 a 36 meses desde el inicio del tratamiento con OHS. Las variables primarias de seguridad fueron la incidencia de reacciones adversas a medicamentos, eventos médicos de interés especial y variaciones en los parámetros del hierro. La efectividad del OHS se evaluó mediante el cambio en los niveles de fósforo sérico. Resultados: Se reclutaron 286 pacientes y se analizaron los datos de 282. De estos 282 pacientes, 161 (57,1%) abandonaron el estudio de manera prematura y un 52,5% recibieron tratamiento concomitante con otros captores de fósforo. Un 35,1% reportaron reacciones adversas a medicamentos y la mayoría fueron de tipo gastrointestinal (77,1%) y de intensidad leve/moderada (83,7%). Un 14,2% de los pacientes presentaron eventos médicos de interés especial, de los que el 93,7% fueron leves/moderados. Se observó un incremento de la ferritina (386,66 vs. 447,55ng/mL; p=0,0013) y saturación de la transferrina (28,07 vs. 30,34%; p=0,043) desde el inicio hasta la última visita. Los niveles de fósforo sérico disminuyeron progresivamente desde 5,69mg/dL al inicio hasta 4,84mg/dL en la última visita (p<0,0001), aumentando la proporción de pacientes con niveles de fósforo≤5,5mg/dL un 32,2%, y con una dosis diaria media de 1,98 comprimidos/día. (AU)

Background and aims: In this study, we show the results of the subset of Spanish patients of the VERIFIE study, the first post-marketing study assessing the long-term safety and effectiveness of sucroferric oxyhydroxide (SFOH) in patients with hyperphosphatemia undergoing dialysis during clinical practice. Patients and methods: Patients undergoing hemodialysis and peritoneal dialysis with indication of SFOH treatment were included. Follow-up duration was 12–36 months after SFOH initiation. Primary safety variables were the incidence of adverse drug reactions, medical events of special interest, and variations in iron-related parameters. SFOH effectiveness was evaluated by the change in serum phosphorus levels. Results: A total of 286 patients were recruited and data from 282 were analyzed. Among those 282 patients, 161 (57.1%) withdrew the study prematurely and 52.5% received concomitant treatment with other phosphate binders. Adverse drug reactions were observed in 35.1% of patients, the most common of which were gastrointestinal disorders (77.1%) and mild/moderate in severity (83.7%). Medical events of special interest were reported in 14.2% of patients, and 93.7% were mild/moderate. An increase in ferritin (386.66ng/mL vs 447.55ng/mL; P=.0013) and transferrin saturation (28.07% vs 30.34%; P=.043) was observed from baseline to the last visit. Serum phosphorus levels progressively decreased from 5.69mg/dL at baseline to 4.84mg/dL at the last visit (P<.0001), increasing by 32.2% the proportion of patients who achieved serum phosphorus levels≤5.5mg/dL, with a mean daily SFOH dose of 1.98pills/day. (AU)

Impact of the COVID pandemic on vascular access creation for haemodialysis in 16 Spanish haemodialysis centres.

Background: The coronavirus disease (COVID) pandemic has resulted in a major disruption in healthcare that has affected several medical and surgical specialties. European and American Vascular Societies have proposed deferring the creation of an elective vascular access (VA) [autologous or prosthetic arteriovenous fistula (AVF) or arteriovenous graft (AVG)] in incident patients on haemodialysis (HD) in the era of the COVID pandemic. The aim of this study is to examine the impact of the COVID pandemic on VA creation and the central venous catheter (CVC)-related hospitalizations and complications in HD patients dialyzed in 16 Spanish HD units of three different regions. Methods: We compared retrospectively two periods of time: the pre-COVID (1 January 2019-11 March 2020) and the COVID era (12 March 2020-30 June 2021) in all HD patients (prevalent and incident) dialyzed in our 16 HD centres. The variables analysed were type of VA (CVC, AVF and AVG) created, percentage of CVC in incident and prevalent HD patients, CVC-related hospitalizations and complications (infection, extrusion, disfunction, catheter removal) and percentage of CVC HD sessions that did not reach the goal of Kt (>45) as a marker of HD adequacy. Results: A total of 1791 VAs for HD were created and 905 patients started HD during the study period. Patients who underwent vascular access surgery during the COVID period compared with pre-COVID period were significantly younger, with a significant decrease in surgical activity to create AVFs and AVGs in older HD patients (>75 and >85 years of age). There was a significant increase in CVC placement (from 59.7% to 69.5%; P < 0.001) from the pre-COVID to the COVID period. During the COVID pandemic, a significantly higher number of patients started HD through a CVC (80.3% versus 69.1%; P < 0.001). The percentage of CVC in prevalent HD patients has not decreased in the 19 months since the start of the pandemic [414 CVC/1058 prevalent patients (39.4%)]. No significant changes were detected in CVC-related hospitalizations between the pre-COVID and COVID periods. In the COVID period, a significant increase in catheter replacement and the percentage of HD session that did not reach the HD dose objective (Kt > 45) was observed. Conclusions: COVID has presented a public health system crisis that has influenced VA for HD, with an increase in CVCs relative to AVFs. A decrease in HD sessions that did not reach the HD dose objective was observed in the COVID period compared with a pre-COVID period.

Costo social de las muertes prematuras por COVID-19 en el Perú / Social cost of premature deaths due to COVID-19 in Peru

Introducción: El costo humano de la pandemia por COVID-19 es significativo, pero el verdadero impacto aún es incierto. Objetivo: Determinar los años de vida potencial perdidos y el costo social por fallecimiento como consecuencia de la enfermedad COVID-19 en la población peruana. Material y Métodos: Se realizó un estudio observacional y descriptivo, mediante el análisis secundario de los fallecimientos por COVID-19 en el Perú entre el 01 de enero del 2020 y el 31 de julio del 2021, reportados por el Ministerio de Salud del Perú. Resultados: Durante el año 2020 se perdieron 926 343,5 años de vida en el Perú; sin embargo, entre el 01 de enero y el 31 de julio del 2021 ya se habían perdido 1 116 553,1 años. Desde el inicio de la pandemia hasta el 31 de julio del 2021, el costo social por fallecimientos a consecuencia de COVID-19 ha ascendido a USD 18 807 942 464,6. Conclusión. La pandemia por COVID-19 ha ocasionado elevada pérdida de años potenciales de vida y alto costo social, principalmente en los territorios urbanos con mayor desarrollo económico.

Background:The human cost of the COVID-19 pandemic is significant, but the true impact is still uncertain. OBJECTIVE: To determine the years of potential life lost and the social cost of death due to the COVID-19 disease in the Peruvian population. : An Material and Methods observational and descriptive study was carried out, through the secondary analysis of deaths due to COVID-19 in Peru between January 1, 2020, and July 31, 2021, reported by the Ministry of Health of Peru.: During Results2020, 926,343.5 years of life were lost in Peru; however, between January 1 and July 31, 2021, 1,116,553.1 years had already been lost. From the start of the pandemic until July 31, 2021, the social cost of deaths due to COVID-19 has amounted to USD 18,807,942,464.6.. The ConclusionCOVID-19 pandemic has caused a high loss of potential years of life and high social cost, mainly in urban territories with higher economic development.

Safety and effectiveness of sucroferric oxyhydroxide in Spanish patients on dialysis: sub-analysis of the VERIFIE study.

BACKGROUND AND AIMS: In this study, we show the results of the subset of Spanish patients of the VERIFIE study, the first post-marketing study assessing the long-term safety and effectiveness of sucroferric oxyhydroxide (SFOH) in patients with hyperphosphatemia undergoing dialysis during clinical practice. PATIENTS AND METHODS: Patients undergoing hemodialysis and peritoneal dialysis with indication of SFOH treatment were included. Follow-up duration was 12-36 months after SFOH initiation. Primary safety variables were the incidence of adverse drug reactions (ADRs), medical events of special interest (MESIs), and variations in iron-related parameters. SFOH effectiveness was evaluated by the change in serum phosphorus levels. RESULTS: A total of 286 patients were recruited and data from 282 were analyzed. Among those 282 patients, 161 (57.1%) withdrew the study prematurely and 52.5% received concomitant treatment with other phosphate binders. ADRs were observed in 35.1% of patients, the most common of which were gastrointestinal disorders (77.1%) and mild/moderate in severity (83.7%). MESIs were reported in 14.2% of patients, and 93.7% were mild/moderate. An increase in ferritin (386.66ng/mL vs 447.55ng/mL; p=0.0013) and transferrin saturation (28.07% vs 30.34%; p=0.043) was observed from baseline to the last visit (p=0.0013). Serum phosphorus levels progressively decreased from 5.69mg/dL at baseline to 4.84mg/dL at the last visit (p<0.0001), increasing by 32.2% the proportion of patients who achieved serum phosphorus levels ≤5.5mg/dL, with a mean daily SFOH dose of 1.98 pills/day. CONCLUSIONS: SFOH showed a favorable effectiveness profile, a similar safety profile to that observed in the international study with most adverse events of mild/moderate severity, and a low daily pill burden in Spanish patients in dialysis.

Validez de contenido de un protocolo de Buenas Prácticas en la evaluación del desarrollo psicomotor / Content validity of a guide of Good-Practices in the psychomotor development assessment

Introducción: Las pruebas para evaluar el desarrollo de un niño tienen la finalidad de monitorear sus logros de acuerdo a su edad, y para asegurar su efectiva evaluación se debe contar con un adecuado entrenamiento al personal de salud. Objetivos: Obtener evidencias de validez de contenido del protocolo de aplicación de pruebas de desarrollo psicomotor, respecto a la relevancia y claridad de los indicadores. Métodos: Se construyó el protocolo luego de la revisión de la literatura, la sistematización de experiencias y entrevistas a enfermeras dedicadas a la evaluación del desarrollo infantil. Luego de cumplir con criterios de competencia profesional y pragmáticos, fueron seleccionadas 10 enfermeras. Se cuantificaron los resultados mediante el coeficiente de validez de contenido V e intervalos de confianza asimétricos; previamente, se verificó la homogeneidad de las calificaciones de los jueces. Resultados: Los jueces mostraron predominantemente calificaciones homogéneas. Los indicadores fueron evaluados favorablemente por los jueces, respecto a la relevancia y claridad de su contenido; los coeficientes fueron generalmente altos (> 0.70). Un par de ítems tuvieron validez marginal, pero fue asociado al modo en que los enfermeros aplican las evaluaciones. Conclusiones: El protocolo desarrollado obtuvo evidencias satisfactorias de la relevancia y la claridad de sus indicadores, cumpliendo el criterio de evidencia de validez de contenido. (AU)

Introduction: The tests to evaluate the development of a child have the purpose of monitoring their achievements according to their age, and to ensure their effective evaluation, adequate training must be provided to health personnel. Objectives: Obtain evidence of validity of content of the protocol of application of psychomotor development tests, regarding the relevance and clarity of the indicators. Methods: The protocol was constructed after reviewing the literature, systematizing experiences and interviews with nurses dedicated to the evaluation of child development. After fulfilling professional and pragmatic competence criteria, 10 nurses were selected. The results were quantified using the content validity coefficient V and asymmetric confidence intervals; Previously, the homogeneity of the judges' grades was verified. Results: The judges showed predominantly homogeneous grades. The indicators were evaluated favourably by the judges, regarding the relevance and clarity of their content; The coefficients were generally high (> 0.70). A couple of items had marginal validity, but it was associated with the way nurses apply the assessments. Conclusions: The developed protocol obtained satisfactory evidence of the relevance and clarity of its indicators, fulfilling the criterion of evidence of content validity. (AU)

Prevalencia de la infección por el VHC en un área sanitaria de Madrid: el primer paso para la microeliminación / Prevalence of HCV infection in a health area of Madrid (Spain): The first step towards microelimination

OBJETIVO: Estimar la prevalencia de la infección por VHC en la población general de un área sanitaria a través de una intervención en Atención Primaria, diferenciando entre nuevos diagnósticos e infecciones previamente diagnosticadas pero no tratadas. MÉTODOS: Se seleccionaron participantes mediante un cuestionario de evaluación de riesgo, realizando un test rápido a todos aquellos con alguna respuesta afirmativa y a todos los mayores de 50 años. Las pruebas positivas se confirmaron en el laboratorio mediante determinación de anticuerpos frente al VHC por enzimoinmunoensayo de micropartículas quimioluminiscente y determinación de la viremia. RESULTADOS: Del total de 7.991 participantes, el 36,2% presentó cuestionario de riesgo para VHC. Se realizaron 4.717 test, encontrando una proporción de anti-VHC de 0,65% en la población cribada, quedando en 0,46% de infecciones activas. El 51,9% de las personas con test positivo tenían un diagnóstico previo conocido pero no habían recibido tratamiento, por no ser conscientes de ello o no encontrarse vinculados al sistema sanitario, y el 19,2% tuvo un resultado positivo por primera vez. La prevalencia de infección oculta fue mayor en hombres, mayores de 50 años, y personas procedentes de Europa del Este. CONCLUSIÓN: Encontramos una prevalencia de infecciones activas superior a la descrita recientemente a nivel nacional, y con mayor porcentaje de pacientes nuevamente diagnosticados que en trabajos similares en otras áreas. Estas diferencias justifican la necesidad de realizar evaluaciones locales de la prevalencia de infección por VHC en cada una de las áreas de salud donde se plantee implementar y monitorizar un programa de microeliminación

OBJECTIVE: To estimate the prevalence of HCV infection in the general population of a health area through an intervention in Primary Care, differentiating between new diagnoses and infections previously diagnosed but not treated. METHODS: Participants were selected through a risk assessment questionnaire, with all those who gave at least one affirmative answer and all those over 50 years of age undergoing a rapid test. Positive tests were confirmed in the lab by determination of anti-HCV antibodies by chemiluminescent microparticle immunoassay and determination of viraemia. RESULTS: Of the 7,991 participants, 36.2% presented a positive HCV risk questionnaire. 4,717 tests were performed, finding an anti-HCV percentage of 0.65% in the screened population, with 0.46% of active infections. Among the individuals with a positive test result, 51.9% had a known prior diagnosis but had not received treatment, because they were not aware of it or were not linked to the health system, and 19.2% had a positive result for the first time. The prevalence of hidden infection was higher in men, those over 50 years of age and people from Eastern Europe. CONCLUSION: We found a prevalence of active infections higher than recently described nationwide, and a higher percentage of newly diagnosed infections than recent similar studies in other areas. These differences justify the need to perform local assessments of the prevalence of HCV infection in each of the health areas where it is planned to implement and monitor a microelimination programme

Factores asociados al maltrato físico en menores de cinco años de edad perpetrado por sus progenitoras / Factors Associated with Physical Mistreatment against Children under the Age of Five and Performed by their Mothers

Introducción: El castigo físico en contra del niño dentro del seno familiar y ejercido por la madre es un problema de salud pública en América Latina. Objetivo: Determinar los factores asociados al maltrato físico en menores de cinco años de edad perpetrado por sus madres. Métodos: Se realizó un estudio observacional basado en el análisis secundario de los datos de la Encuesta Nacional de Salud y Demografía (ENDES), 2017. La muestra estuvo conformada por 13 565 niños menores de cinco años. Se calculó el chi cuadrado y el valor de p, así como el odds ratio crudo (ORc) y su intervalo de confianza al 95 por ciento. Resultados: Existió menor riesgo de maltrato en los niños menores de cinco años que resideían en la selva, cuando el esposo o conviviente de la madre vivía en la casa y cuando existía violencia psicológica o física en contra de la mujer. Existió mayor riesgo de maltrato físico cuando las madres hablaban aymara u otra lengua indígena/originaria, cuando la pareja tenía instrucción secundaria o superior o cuando la mujer agredía a su pareja. Conclusiones: La violencia física contra el niño menor de cinco años resultó más probable cuando la madre estaba expuesta a situaciones estresantes, posiblemente mediadas por las condiciones de vulnerabilidad económica o pobreza que vive, sobre todo cuando tenía raíces indígenas y residía en la costa, todo esto exacerbado por la incapacidad para la solución de problemas que, finalmente, derivan en violencia, incluso contra el esposo o conviviente(AU)

Introduction: Physical punishment against the child within the family and performed by her or his mother is a public health concern in Latin America. Objective: To determine the factors associated with physical mistreatment in children under five years of age performed by their mothers. Methods: We carried out an observational study based on the secondary analysis of the data from the 2017 National Survey of Health and Demography (ENDES, as it stands in Spanish for Encuesta Nacional de Salud y Demografía). The sample consisted of 13,565 children under the age of five. Chi square and the P value were calculated, together with the crude odds ratio (ORc) and its 95 percent confidence interval. Results: There was a lower risk of mistreatment in children under the age of five who lived in the jungle, when the mother's husband or partner lived in the house and when there was psychological or physical violence against the woman. There was an increased risk of physical abuse when the mothers spoke Aymara or another indigenous or native language, when the couple had secondary or higher education, or when the woman attacked her partner. Conclusions: Physical violence against children under five years of age was more likely when the mother was exposed to stressful situations, possibly mediated by the conditions of economic vulnerability or poverty that she lives through, especially when she had indigenous roots and lived on the coast, all this exacerbated by the inability to solve problems that ultimately lead to violence, even against the husband or partner(AU)

Good Practices and Learning Strategies of Undergraduate University Students.

The educational models currently in use in higher education aim to make students active participants in their learning process, while the lecturer is seen more as a facilitator of the said process. Students' learning strategies (superficial approach-memorizing, deep approach-looking for meaning, and achievement approach-aimed at results) and their good practices are gaining in importance and the aim of this study is to identify university students' good practices, which are related to their learning strategies. To do so, our research covered 610 students from different science degree courses at the University of Extremadura who anonymously completed the University Students' Good Practice Inventory (IBPEU) and the University students' Questionnaire to Evaluate Study and Learning Processes (CEPEA). The influence of context, understood here as the center or scientific field, was discarded. The factor 'Actively learning' was positively associated with the deep and achievement approaches; the factor 'Interaction with lecturers' was positively associated with the superficial approach and negatively with the deep approach; the factor 'Cooperative work' was also associated with the deep approach; while the achievement approach was positively associated with the factor 'Optimizing time' and negatively with 'respect for different capacities'. These associations are promising as good practices can be learnt and evaluated.

Prevalence of HCV infection in a health area of Madrid (Spain): The first step towards microelimination. / Prevalencia de la infección por el VHC en un área sanitaria de Madrid: el primer paso para la microeliminación.

OBJECTIVE: To estimate the prevalence of HCV infection in the general population of a health area through an intervention in Primary Care, differentiating between new diagnoses and infections previously diagnosed but not treated. METHODS: Participants were selected through a risk assessment questionnaire, with all those who gave at least one affirmative answer and all those over 50 years of age undergoing a rapid test. Positive tests were confirmed in the lab by determination of anti-HCV antibodies by chemiluminescent microparticle immunoassay and determination of viraemia. RESULTS: Of the 7,991 participants, 36.2% presented a positive HCV risk questionnaire. 4,717 tests were performed, finding an anti-HCV percentage of 0.65% in the screened population, with 0.46% of active infections. Among the individuals with a positive test result, 51.9% had a known prior diagnosis but had not received treatment, because they were not aware of it or were not linked to the health system, and 19.2% had a positive result for the first time. The prevalence of hidden infection was higher in men, those over 50 years of age and people from Eastern Europe. CONCLUSION: We found a prevalence of active infections higher than recently described nationwide, and a higher percentage of newly diagnosed infections than recent similar studies in other areas. These differences justify the need to perform local assessments of the prevalence of HCV infection in each of the health areas where it is planned to implement and monitor a microelimination programme.

Outcome of an HIV education program for primary care providers: Screening and late diagnosis rates.

BACKGROUND: Late HIV diagnosis remains one of the challenges in combating the epidemic. Primary care providers play an important role in screening for HIV infection. Our study aims to evaluate the relationship between knowledge and barriers to HIV testing and screening outcomes. The impact of an education program for primary care providers, towards improving HIV testing and late diagnosis rates, is also assessed. METHODS: A self-administered questionnaire that was developed within the framework of the European project OptTEST was used to examine HIV knowledge and barriers to HIV testing scores before and after being involved in an HIV education program. A quasi-experimental design with pre- and post-intervention measures was performed to investigate its impact. We performed multivariable logistic regression analysis to assess the relationship between variables for the HIV testing offer. RESULTS: A total of 20 primary care centers and 454 primary care staff were included. Baseline OptTEST results showed that more knowledgeable staff offered an HIV test more frequently (OR 1.07; CI 95% 1.01-1.13; p = 0.027) and had lower barrier scores (OR 0.89; CI 95% 0.77-0.95; p = 0.005). Nurses had lower scores in knowledge-related items (OR 0.28; CI 95% 0.17-0.46; p<0.001), but higher scores in barrier-related items than physicians (OR 3.28; CI 95% 2.01-5.46; p<0.001). Specific centers with more knowledgeable staff members had a significant association with a greater level of new HIV diagnosis rates (OR 1.61; CI 95% 1.04-2.49; p = 0.032). After the intervention, we found that 12 out of 14 individual questions showed improved scores. In the 6 months after the training program, we similarly found a higher HIV testing rate (OR 1.19; CI 1.02-1.42; p = 0.036). CONCLUSIONS: This study highlights the association between knowledge and barriers to HIV testing, including HIV testing rates. It shows that it is possible to modify knowledge and reduce perceived barriers through educational programs, subsequently improving HIV screening outcomes.

Violencia extrema contra la mujer y feminicidio en el Perú / Extreme violence against women and femicide in Peru

Objetivo: Determinar la incidencia de violencia extrema contra la mujer y feminicidio así como algunos factores riesgo en el Perú. Métodos: Investigación observacional de datos secundarios (2009-2015) del Ministerio de la Mujer y Poblaciones Vulnerables de Perú. Con el programa Microsoft Excell® se calculó la tasa bruta de violencia extrema contra la mujer y de feminicidio por año y por territorio, así como el riesgo de violencia extrema contra la mujer y el riesgo de feminicidio por territorio, año, mes, vínculo, escenario y área. Resultados: En el período 2009-2015, la tasa de violencia extrema contra la mujer aumentó. Tacna (RT= 2,673; IC 95 por ciento= 2,111-3,384), tuvo el mayor riesgo de feminicidio, mientras que Madre de Dios (RT= 2,475; IC 95 por ciento= 1,462-4,188) tuvo el mayor riesgo de violencia extrema contra la mujer. Este riesgo existió en mayor cuantía en enero (RT=1,204; IC 95 por ciento=1,019-1,422) y el mayor riesgo de feminicidio en noviembre (RT=1,463; IC 95 por ciento=1,173-1,826) y enero (RT=1,280; IC 95 por ciento= 1,014-1,616). Existió mayor riesgo que la violencia extrema contra la mujer culmine en feminicidio cuando el agresor es desconocido (ORc= 11,950; IC 95 por ciento= 6,752-23,510), es conocido (ORc= 2,644; IC 95 por ciento= 1,736-4,094) o es un familiar (ORc=1,614; IC 95 por ciento= 1,078-2,433), en un escenario no íntimo (ORc=5,522; IC 95 por ciento=3,611-8,629), en el área rural (ORc=1,692; IC 95 por ciento=1,136-2,525) o urbana-marginal (ORc=1,678; IC 95 por ciento=1,057-2,673). Conclusiones: La incidencia de violencia extrema contra la mujer ha aumentado. El riesgo de feminicidio es mayor en el mes de noviembre, en el área rural y urbana-marginal, en un escenario no íntimo y cuando la violencia extrema contra la mujer no es perpetrada por la pareja o ex-pareja(AU)

Objective: To determine the incidence of extreme violence against women (EVAW) and femicide; and some risk factors in Peru. Methods: Observational research of secondary data (2009-2015) from the Ministry of Women and Vulnerable Populations of Peru. MS Excell® program was used to calculate the gross rate of extreme violence against women and femicide by territory, year, month, bond, scenario, and area. Results: In the period 2009-2015, the rate of extreme violence against women has increased. Tacna (RT=2,673; IC 95 percent=2,111-3,384) had the highest rate of femicide´s risk, and Madre de Dios (RT=2,475; IC 95 percent= 1,462-4,188) had the highest risk of extreme violence against women. There was greater risk of extreme violence against women in January (RT=1.204, IC95 percent=1.019-1.422) and femicide´s risk in November (RT=1.463, IC95 percent=1.173-1.826) and January (RT=1.280, IC95 percent=1.014-1.616). Extreme violence against women is more likely to end in femicide when the aggressor is unknown (ORc= 11.950; IC 95 percent=6.572-23.510), when is an acquaintance (ORc=2,644; IC 95 percvent=1,736-4,094) or a relative (ORc= 1,614; IC 95 percent= 1,078-2,433), in a non-intimate place (ORc= 5,522; IC 95 percent= 3,611-8,629), in the rural area (ORc= 1,692; IC 95 percent= 1,136-2,525), or in the marginal urban area (ORc=1,678; IC 95 percent= 1,057-2,673). Conclusions: Extreme violence against women's incidence has increased. The risk of femicide is higher in November, in the rural and marginal urban areas, in a non-intimate scenario, and when the extreme violence against women is not perpetrated by the partner or ex-partner(AU)

Factores predictores de mortalidad y estrategias de detección precoz de síndrome hepatopulmonar en pacientes trasplantados hepáticos / Predictors of mortality and early detection strategies for hepatopulmonary syndrome in liver transplant patients

Introduction: Hepatopulmonary syndrome (HPS) is a serious, progressive disease. Its pathophysiology resides in a hypoxic intrapulmonary shunt and severe clinical deterioration. Liver transplantation (LT) is the only effective treatment in appropriately selected patients. Objective: To acknowledge the importance of early diagnosis of HPS. Patients and methods: Observational, descriptive, retrospective trial including 8 patients with HPS that received LT between April 2006 and August 2014. The clinical data prior to transplantation and follow-up after the procedure were reviewed. A multivariate analysis (stepwise forward logistic regression analysis) was used to identify the variable that could potentially increase the risk of death. Results: Of the 8 patients, death could only be significantly predicted based on the pre-LT arterial blood partial oxygen pressure (PaO2) (p = 0.002). The average pre-LT PaO2 of the patients that died was 51.5 ±2.49 SD, with a statistically significant difference (p = 0.002). None of the variables was statistically significant for HPS reversibility. The survival rate of patients diagnosed with HPS following the LT was 62.5%. Conclusions: The level of pre-LT hypoxemia is an important predictor for immediate postoperative mortality. Early detection of the condition is critical to reduce the post LT morbidity and mortality so that the indication for transplant is made at the right time, regardless of the stage of liver disease. The most efficient clinical strategy could be the use of appropriate early detection protocols for HPS through screening of hypoxemia in patients with portal hypertension.

Introducción: El síndrome hepatopulmonar (SHP) es una enfermedad grave y progresiva cuya fisiopatología reside en un shunt intrapulmonar con hipoxia y deterioro clínico severo. Como único tratamiento efectivo se ha postulado el trasplante hepático (TH), en pacientes adecuadamente seleccionados. Objetivo: Reconocer la importancia del diagnostico temprano del SHP. Pacientes y métodos: Mediante un estudio observacional, descriptivo, con carácter retrospectivo de 8 pacientes con SHP, a los que se les realizó TH en el período entre Abril 2006-Agosto 2014. Se han revisado los datos clínicos previos al trasplante y el seguimiento tras este. Se empleó un estudio multivariante (stepwise forward logistic regression analisis), para determinar cual variable podría incrementar el riesgo de muerte. Resultados: De los 8 pacientes, el resultado de muerte sólo pudo ser predicho significativamente por el factor presión parcial de oxígeno en sangre arterial (PaO2) pre-TH (p=0,002). La PaO2 pre-TH promedio de los pacientes que fallecieron era de 51,5 +/- 2,49 DS, siendo la diferencia estadísticamente significativa (p=0,002). Ninguna variable resultó estadísticamente significativa para reversibilidad del SHP. La supervivencia de los pacientes con criterio de SHP posterior al TH fue de 62,5%. Conclusiones: El grado de hipoxemia pre-TH es un factor predictor importante de mortalidad en el postoperatorio inmediato. La precocidad en la detección de la entidad es fundamental tanto para disminuir la morbimortalidad post TH como para indicar éste en el momento óptimo independientemente del estadío de la enfermedad hepática. Protocolos adecuados de detección precoz del SHP mediante screening de hipoxemias en pacientes con hipertensión portal, puede ser la estrategia clínica más eficiente.

Relevancia del aprendizaje cooperativo sobre los diferentes perfiles de la dinámica bullying. Un análisis mediante pruebas de tamaño del efecto / Relevance of cooperative learning about the different profiles of the bullying dynamic. An analysis by testing the effect size

Esta investigación pretende determinar sobre qué perfil de la dinámica bullying (Agresor, Víctima, Observador) es más relevante una intervención en aprendizaje cooperativo. Mediante pruebas estadísticas de tamaño del efecto. Con el fin de evaluar las conductas de acoso se diseñó un instrumento para evaluar el acoso escolar entre Iguales desde la perspectivas del Agresor, Víctima y Observador”. Se trabajó con dos grupos de participantes de 3er ciclo de primaria, un primer grupo de 311 alumnos que utilizamos para el análisis psicométrico del instrumento y un segundo grupo de 110 alumnos para la intervención. Los resultados manifiestan que el tamaño del efecto intergrupo ha sido elevado para el factor de exclusión social para los perfiles observador (d =0.64) y agresor (d =0.65). También, obtiene un tamaño elevado el factor agresiones verbales y físicas directas para el perfil observador (d =0.57). En síntesis, tras el análisis del tamaño del efecto podemos afirmar que el aprendizaje cooperativo es eficaz sobre el perfil agresor y, especialmente, sobre el observador

With this research we try to determine which dynamic profile bullying (Aggressor, Victim, Observer) is more relevant in cooperative learning intervention. We will use evidence of effect size. In order to assess bullying behaviors have designed an instrument "Frequency Scale Peer Bullying. Perspective Aggressor, Victim and Observer". We have worked with two groups of participants in the 3rd cycle of primary, a first group of 311 students we used for the psychometric analysis of the instrument and a second group of 110 students for intervention. Our results show that the inter-group effect size was high for the social exclusion factor for observer profiles (d = 0.64) and aggressor (d = 0.65). Also, get a higher size factor direct verbal and physical attacks on observer profile (d = 0.57). In synthesis, after the analysis of the effect size we found that cooperative learning is effective on the offender profile and especially on the observe

[Syncrhonous carcinosarcoma of the extrahepatic bile duct and gallbladder.] / Carcinosarcoma sincrónico de la vesícula y la via biliar extrahepática.

Carcinosarcoma is a malignant neoplasm characterized for intermingled epithelial and mesenchymal components. CASE REPORT: A preoperative suspected diagnosis will allow a radical therapy avoiding a very bad prognosis. We report on a male patient who was operated in our Service with diagnosis of synchronous carcinosarcoma of gallbladder and extrahepatic bile duct and a review of the Medical Literature. DISCUSSION: A gallblader carcinosarcoma showing extension into common bile duct is very rare, a carcinosarcoma of the bile duct is exceptional, and a synchronous carcinosarcoma ofthe bile duct and gallbladder has not been reported previously.

Mesenteric tumor due to chronic anisakiasis.

Intestinal anisakiasis is a rare parasitic disease and difficult to diagnose due to symptoms are not specific, so it is considered an underdiagnosed disease. The clinical suspicion with a correct diagnosis of anisakiasis allows the establishment of a correct treatment; in most cases, the resolution is possible with conservative treatment, avoiding unnecessary surgery to the preoperative differential diagnosis of acute abdomen. We report the case of apatient who required urgent surgery secondary to an exacerbation of chronic anisakiasis.

Tumoración mesentérica secundaria a anisakiasis crónica / Mesenteric tumor due to chronic anisakiasis

La anisakiasis intestinal es una enfermedad parasitaria rara y de difícil diagnóstico, ya que las manifestaciones clínicas son inespecíficas, por lo que se considera una enfermedad infradiagnosticada. La sospecha clínica junto a un correcto diagnóstico de la anisakiasis permite la instauración de un tratamiento correcto, ya que en la mayoría de los casos es posible la resolución del cuadro con tratamiento conservador, evitando cirugías innecesarias ante el diagnóstico diferencial preoperatorio de abdomen agudo. Presentamos el caso clínico de un paciente que precisó una intervención quirúrgica urgente secundaria a una reagudización de anisakiasis crónica

Intestinal anisakiasis is a rare parasitic disease and difficult to diagnose due to symptoms are not specific, so it is considered an underdiagnosed disease. The clinical suspicion with a correct diagnosis of anisakiasis allows the establishment of a correct treatment; in most cases, the resolution is possible with conservative treatment, avoiding unnecessary surgery to the preoperative differential diagnosis of acute abdomen. We report the case of a patient who required urgent surgery secondary to an exacerbation of chronic anisakiasis

Evolución de pacientes con diabetes mellitus en diálisis peritoneal / Outcomes in diabetic patients treated with peritoneal dialysis

En la actualidad, la nefropatía diabética se ha convertido en la primera causa de ingreso en programas de tratamiento sustitutivo renal en los países desarrollados. Este impacto de la diabetes se mantiene a lo largo del seguimiento de los pacientes, de forma tal que los resultados del tratamiento con diálisis en la población con diabetes son inferiores a los de la población no diabética. La diálisis peritoneal es una alternativa en el tratamiento de la enfermedad renal crónica, con ciertas ventajas para el paciente diabético en relación con la mejor preservación de la función renal residual, mejor estabilidad hemodinámica, la no necesidad de creación de acceso vascular para la conexión a la diálisis y las que se derivan de su carácter de técnica domiciliaria. La comorbilidad asociada con la diabetes mellitus, sobre todo cardiovascular, se refleja en un mayor número de ingresos hospitalarios, menor supervivencia y una tasa más alta de infecciones peritoneales, sobre todo en pacientes con diabetes tipo 2. En esta revisión se analizan los resultados de los estudios publicados de supervivencia de pacientes con diabetes mellitus en diálisis peritoneal...

Perfiles de la dinámica bullying y clima de convivencia en el aula / Bullying profiles and climate dynamics of coexistence in the classroom

Nuestro trabajo pretende obtener información sobre la relación que puede existir entre una variable contextual (clima de convivencia en el aula) y el acoso escolar entre alumnos de Educación Primaria. En la investigación participaron 320 alumnos de 5º y 6º de primaria de Cáceres ciudad y provincia. Se elaboraron tres escalas que miden la frecuencia de las conductas de acoso escolar desde tres perspectivas (agresor, víctima y observador) y un cuarto cuestionario que evalúa el clima de convivencia en el aula. Todos ellos presentan adecuadas características psicométricas. Respecto a los resultados, podemos concluir que existe relación entre el acoso escolar desde cualquiera de sus perspectivas (agresor, víctima y observador) y una percepción más negativa del clima de convivencia en el aula (AU)

Our work aims to obtain information on the relationship that can exist between a contextual variable, as the Climate of Coexistence in the Classroom, and bullying among Elementary students. Research involved 320 students from 5th and 6th grade from Caceres city and province. Three scales were developed to measure the frequency of bullying behaviors, from three perspectives: Aggressor, Victim and Observer, and fourth questionnaire assessing the Climate of Coexistence in the Classroom. All of them present psychometric properties. Regarding the results of our investigation, we can conclude that there is a relationship between bullying from any of their prospects aggressor, victim and observer, and a more negative perception of the Climate of Coexistence in the Classroom (AU)

Significado de ser licenciada en enfermería después de curso complementario y su tranferencia a la práctica / Meaning of being a graduate in nursing after a complementary course and transfer to practice / Significado de ser graduado em enfermagem após um curso complementar e transferir para a prática

La presente tesis explora el significado que tienen un grupo de enfermeras quienes realizaron curso complementario para ser licenciadas en Enfermería e identificar si reconocen la transferencia de éste a su práctica profesional. Se partió del supuesto que las enfermeras que realizan curso complementario modifican su significado de ser licenciadas en Enfermería, al haber modificaciones en el significado, se espera que modifiquen su hacer como profesional de esta disciplina. Se llevó a cabo una investigación de tipo cualitativa, fenomenología, con una unidad de análisis de siete informantes, a quienes se les aplicó una entrevista semiestructura con cuatro preguntas base. La entrevista fue grabada en audio previo consentimiento informado y transcrita de forma individual, respetando la confidencialidad e identificación de cada informante. De los datos obtenidos, se identificaron conceptos que dieron origen a las categorías: La Enfermería como profesión y estudios complementarios. En la primera categoría, las informantes expresan los motivos que tuvieron para ser enfermeras, el estatus que tiene actualmente de profesión, cómo es su práctica profesional, hablan de la necesidad de contar con conocimientos propios y prestados en la profesión. De la segunda categoría especificaron los motivos que tuvieron para realizar estudios complementarios, cómo fue para ellas este sistema educativo, los logros que ellas reconocen y las dificultades a las que se enfrentaron al realizar este tipo de estudios. Como conclusiones se obtuvo que ser licenciada en Enfermería está representado para las informantes obtener una profesión. En los cursos complementarios se aprenden conocimientos nuevos y se logran cambios en el ser y hacer que han sido difíciles de aplicar en su práctica.

This thesis explores the meaning of a group of nurses who completed a complementary course to be licensed in Nursing and identify if they recognize the transfer of this to their professional practice. It was assumed that the nurses who complete the complementary course modify their meaning of being licensed in Nursing, since there are changes in the meaning, they are expected to modify their work as a professional in this discipline. A qualitative research, phenomenology was carried out, with a unit of analysis of seven informants, who were given a semi-structured interview with four basic questions. The interview was recorded in audio with prior informed consent and transcribed individually, respecting the confidentiality and identification of each informant. From the data obtained, concepts that gave rise to the categories were identified: Nursing as a profession and complementary studies. In the first category, the informants express the reasons they had for being nurses, the status they currently have of profession, how is their professional practice, they speak of the need to have their own knowledge and loaned in the profession. From the second category, they specified the reasons they had to carry out complementary studies, how this educational system was for them, the achievements they recognize and the difficulties they faced when carrying out this type of study. As conclusions, it was obtained that being licensed in Nursing is represented for informants obtaining a profession. In the complementary courses new knowledge is learned and changes are achieved in the being and doing that have been difficult to apply in their practice.

Esta tese explora o significado de um grupo de enfermeiros que completou um curso complementar a ser licenciado em Enfermagem e identifica se reconhece a transferência deste para sua prática profissional. Assumiu-se que os enfermeiros que concluem o curso complementar modificam o seu significado de ser licenciado em Enfermagem, uma vez que há mudanças no significado, espera-se que modifiquem seu trabalho como profissional nesta disciplina. Foi realizada uma pesquisa qualitativa, com fenomenologia, com uma unidade de análise de sete informantes, que receberam uma entrevista semiestruturada com quatro questões básicas. A entrevista foi gravada em áudio com consentimento prévio informado e transcrita individualmente, respeitando a confidencialidade e identificação de cada informante. A partir dos dados obtidos, identificaram-se conceitos que originaram as categorias: Enfermagem como profissão e estudos complementares. Na primeira categoria, os informantes expressam os motivos que tinham para serem enfermeiros, o status que possuem atualmente de profissão, como está sua prática profissional, falam da necessidade de ter conhecimento próprio e emprestado na profissão. A partir da segunda categoria, especificaram as razões pelas quais tiveram que realizar estudos complementares, como esse sistema educacional era para eles, as conquistas que reconhecem e as dificuldades que enfrentavam ao realizar esse tipo de estudo. Como conclusões, obteve-se que ser licenciado em Enfermagem é representado por informantes que obtêm uma profissão. Nos cursos complementares, novos conhecimentos são aprendidos e mudanças são alcançadas no ser e no fazer, que têm sido difíceis de aplicar em sua prática.