Sociodemographic Barriers to Physical Activity and Healthy Diet Through Social Networks in Mexican Breast Cancer Survivors.

Introduction Female breast cancer (BC) survivors are affected by poor eating habits and physical inactivity due to certain environmental, physical, and social barriers to healthy lifestyles. This study aimed to identify the sociodemographic, physical, and economic barriers hindering the adoption of physical activity (PA) and a healthy diet, as well as providing insights into how BC survivors cope with these barriers using social networks. Methods A cross-sectional mixed-methods study was conducted, with a self-administered questionnaire and open-ended questions to determine the barriers to PA and healthy eating, while in the second phase, an interpretive qualitative study was carried out with semi-structured interviews. Descriptive statistics, odds ratios (ORs), correspondence analysis, and multivariate analysis were used to estimate the association between moderate to vigorous PA and fruit and vegetable consumption and BC covariates. Results During the COVID-19 lockdown, 150 Mexican BC survivors were studied. The multivariate analysis showed that age (OR = 2.7, 95% CI: 1.0 to 7.03), socioeconomic level (OR = 3.2, 95% CI: 1.3 to 8.2), and overweight (OR = 3.6, 95% CI: 1.5 to 9.7) were significantly associated with low schooling. BC diagnosis of less than three years and age > 40 years were associated with lack of exercise. Survivors individually addressed the challenges associated with BC without the support of specialists. As a result, they sought information on social networks. Conclusions Regarding BC survivors, age > 40 years, low socioeconomic status, and being overweight were important gaps to PA and a healthy diet. In the testimonials, the primary obstacle to engaging in PA was lack of time, while the high cost of food was the most frequently cited reason for not following a healthy diet. Many of the individuals maintained a poor diet with a low intake of fruits and vegetables. Thus, appropriate information must be provided using technologies to develop skills to deal with BC.

Understanding university teachers' digital competencies: a systematic mapping study.

Being digitally competent is an imperative requirement for the 21st century university teacher, a fact recognized by both the literature and policymakers. Although this topic has been addressed in different reviews and critical studies recently, none of them have systematically and explicitly addressed the factors that explain, or are explained by, the digital competencies of university teachers. Examples of these factors include, among others, demographic, professional and psychological aspects of university teachers, as well as very specific digital competencies. The present study seeks to close this gap through a systematic mapping of the literature published until 2021 in journals indexed by Scopus and Web of Science (WOS). Based on the selection of 53 primary studies, we characterized the literature and summarized the main results reported so far. The analysis allowed us to conclude the following: 1) there is a growing number of contributions aimed at understanding the acquisition of digital competencies, especially from external factors; 2) European, and more specifically Spanish, university teachers from multiple disciplines are the most studied population; 3) most studies adopted quantitative approaches to explain but not prove causality; 4) there is a great heterogeneity of relationships and results that explain the digital competencies of university professors. The implications of these results are discussed with a view to identifying the gaps that provide scope for future research.

On the Technological Acceptance of Moodle by Higher Education Faculty-A Nationwide Study Based on UTAUT2.

Moodle is an open-source learning management system that is widely used today, especially in higher education settings. Although its technological acceptance by undergraduate students has been extensively studied in the past, very little is known about its acceptance by university professors. In particular, as far as we know, the literature contains no previous experiences related to South American teachers. This paper aims to bridge this gap by quantifying and analyzing the drivers of Moodle's technological acceptance among Ecuadorian academic staff. Considering the responses of 538 teachers and taking a modified UTAUT2 model as a theoretical basis, we found that Ecuadorian teachers have high levels of acceptance of Moodle, regardless of their age, gender, ethnicity, or discipline. However, this acceptance is significantly higher in teachers with high levels of education and with considerable previous experience with e-learning systems. The main determinants of this acceptance are attitude strength, effort expectancy, performance expectancy, and facilitating conditions. We found no moderating effects in relation to the age, gender, or previous experience of the participants (including second- and third-order interactions derived from these variables). We conclude that, albeit moderately (e.g., adjusted R2=0.588), the model tested confirms the predictive power of the part of UTAUT2 that was inherited from UTAUT.

Prevalence of frailty and its association with oral hypofunction in older adults: a gender perspective.

BACKGROUND: Previous studies have indicated an association between oral hypofunction and frailty in community-dwelling older adults. However, this issue has not been evaluated in institutionalized older patients. We aimed to determine the prevalence of physical frailty in this particularly vulnerable group and evaluate its association with oral hypofunction, analyzing possible differences by gender. METHODS: This cross-sectional study was conducted in private and public care homes in Guayaquil (Ecuador) from January 2018 until December 2019. Participants were classified as robust, pre-frail, and frail according to the Fried's frailty phenotype. Oral hypofunction was defined as the presence of at least three positive items in the following list: poor oral hygiene, oral dryness, reduced occlusal force, decreased masticatory function, and deterioration of swallowing function. The relationships between frailty and oral hypofunction were analyzed using logistic regression models for the whole sample and stratified by gender. Statistical analyses were performed using STATA 15.0 software (Stata Corp. LP, College Station, TX, USA). RESULTS: Among the 589 participants analyzed (65% women), the median age was 72 years (interquartile range: 66-82). Pre-frailty and frailty were presented in 66.7% and 28.9% of them respectively. Weakness was the most frequent item (84.6%). There was a significant relationship between frailty and oral hypofunction in women. In the overall sample, the frequency of frailty was 2.06 times higher (95% CI 1.30-3.29) in patients with oral hypofunction, and this association was maintained in women (ORa: 2.18; 95% CI 1.21-3.94). Reduced occlusal force and decreased swallowing function were items significantly associated with the presence of frailty (ORa: 1.95; 95% CI 1.18-3.22 and ORa: 2.11; 95% CI 1.39-3.19, respectively). CONCLUSION: The prevalence of frailty and pre-frailty was high among institutionalized older people and was associated with the presence of hypofunction, especially in women. Decreased swallowing function was the most strongly item associated with frailty.

Afecciones bucales y nivel de información de niños de primer grado, padres y personal docente / Oral diseases and level of information of first -grade children, parents and teaching personnel

Introducción: Las afecciones bucales se incrementan con la edad, y su resolución implica un costo elevado no solo a nivel presupuestario, sino también en cuanto a calidad de vida se refiere, lo cual motiva a buscar soluciones a través de políticas de salud que implementen planes especialmente diseñados a tal efecto. Objetivo: Determinar las afecciones bucales de los escolares de primer grado de la escuela «13 de Marzo», del municipio Santa Clara, así como el nivel de información de los niños, padres y personal docente. Métodos: Se realizó una investigación con metodología mixta, en el período comprendido entre marzo de 2017 y septiembre de 2018. Se trabajó en dos etapas y se utilizaron métodos e instrumentos para la obtención de la información, entre los que se destacaron la observación y las entrevistas. La muestra, conformada por 57 infantes, igual cantidad de padres y cuatro docentes, fue seleccionada de manera intencional por criterios. Se realizaron entrevistas, observación, lluvia de ideas, priorización de problemas por método de ranqueo, así como la triangulación de los resultados. Resultados: Presencia de afecciones en más del 80 % de la muestra, donde sobresalen las maloclusiones en mayor porciento que las caries; un nivel de información sobre salud bucodental inadecuado en los individuos estudiados; ausencia de actividades relacionadas con la promoción y educación para la salud bucal; así como la no existencia de áreas de juego relacionadas con este tema, ni cepilleros en la escuela. Conclusiones: Los niños, padres y personal docente mostraron un nivel de información sobre salud bucal insuficiente, y las maloclusiones resultaron ser la afección más frecuente encontrada.

Introduction: oral diseases increase with age, and their resolution implies a high cost not only at the budget level but also in terms of quality of life, which motivates the search for solutions through health policies that implement plans especially designed for this purpose. Objective: to determine oral diseases in first- grade students from "13 de Marzo" school in Santa Clara municipality, as well as the level of information of these children, their parents and teaching personnel. Methods: a mixed- method research was conducted between March 2017 and September 2018. It was carried out in two stages; methods and instruments were used to obtain the information, among which observation and interviews stand out. The sample made up of 57 infants, the same number of parents and 4 teachers was intentionally selected by criteria. We carried out interviews, observation, brainstorming, ranking method for prioritizing problems and triangulation of results. Results: presence of oral diseases in more than 80% of the sample where malocclusions stand out in a greater percentage than caries; an inadequate level of information on oral health in the studied individuals; absence of activities related to the promotion and education for oral health, as well as non-existence of play areas related to this subject, or brushing areas in the school. Conclusions: the children, parents and teaching personnel showed an insufficient level of information on oral health, and malocclusions were the most common condition found.

Association between obesity and atopic dermatitis in children: A case-control study in a high obesity prevalence population.

BACKGROUND/OBJECTIVE: Atopic dermatitis (AD) is a chronic inflammatory skin disease. Research suggests an association between obesity and AD, although evidence is lacking from Latin American populations. This study evaluated the association of obesity with AD in children from Chile, a country with high obesity prevalence. METHODS: A case-control study was performed in children with active AD (cases) and healthy controls (HCs) from Santiago, Chile. Body mass index was evaluated by z-score (z-BMI), with overweight defined as z-BMI ≥+1 and <+2, and obesity as z-BMI ≥+2. Abdominal obesity was defined by a waist circumference-to-height ratio (WHR) ≥0.5. AD severity was evaluated by Scoring AD (SCORAD) index. RESULTS: A total of 174 children with AD and 101 controls were included. AD patients had similar overweight (27% vs. 28%) and obesity (21% vs. 26%) rates as HCs (p = .65). Abdominal obesity rates were also comparable (64% vs. 62%, p = .81). In sex-specific analyses, girls with AD had higher abdominal obesity rates than HCs (71% vs. 53%, p < .05) while boys with AD had lower abdominal obesity rates than HCs (53% vs. 75%, p = .03). Among children with AD, higher z-BMI or WHR did not correlate with higher SCORAD, eosinophil counts or total IgE. CONCLUSION: In our study, Chilean children with AD had high but similar rates of obesity as HCs, but showed sex-specific associations of abdominal obesity and AD. Further research is needed to evaluate these associations and the roles that weight excess and weight loss could play in the pathogenesis and treatment of AD.

Short-term complications and post-acute sequelae in hospitalized paediatric patients with COVID-19 and obesity: A multicenter cohort study.

BACKGROUND: Obesity increases the severity of coronavirus disease 2019 illness in adults. The role of obesity in short-term complications and post-acute sequelae in children is not well defined. OBJECTIVE: To evaluate the relationship between obesity and short-term complications and post-acute sequelae of SARS-CoV-2 infection in hospitalized paediatric patients. METHODS: An observational study was conducted in three tertiary hospitals, including paediatric hospitalized patients with a confirmatory SARS-CoV-2 RT-PCR from March 2020 to December 2021. Obesity was defined according to WHO 2006 (0-2 years) and CDC 2000 (2-20 years) growth references. Short-term outcomes were intensive care unit admission, ventilatory support, superinfections, acute kidney injury, and mortality. Neurological, respiratory, and cardiological symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms were considered as post-acute sequalae. Adjusted linear, logistic regression and generalized estimating equations models were performed. RESULTS: A total of 216 individuals were included, and 67 (31.02%) of them had obesity. Obesity was associated with intensive care unit admission (aOR = 5.63, CI95% 2.90-10.94), oxygen requirement (aOR = 2.77, CI95% 1.36-5.63), non-invasive ventilatory support (aOR = 6.81, CI95% 2.11-22.04), overall superinfections (aOR = 3.02 CI95% 1.45-6.31), and suspected bacterial pneumonia (aOR = 3.00 CI95% 1.44-6.23). For post-acute sequalae, obesity was associated with dyspnea (aOR = 9.91 CI95% 1.92-51.10) and muscle weakness (aOR = 20.04 CI95% 2.50-160.65). CONCLUSIONS: In paediatric hospitalized patients with COVID-19, severe short-term outcomes and post-acute sequelae are associated with obesity. Recognizing obesity as a key comorbidity is essential to develop targeted strategies for prevention of COVID-19 complications in children.

The risk of treatment-induced QT interval prolongation.

OBJECTIVE: QT interval prolongation can increase patients' hospital stay and  mortality rate. This study aims to determine the incidence of drug-induced QT  interval prolongation and establish which QT interval measurement method is  the most appropriate for electrocardiographic monitoring. METHOD: A retrospective observational study was conducted of patients admitted to the Clínica Bíblica Hospital during 2018. The electronic  medical records of patients hospitalized for longer than 48 hours and whose drug regimen included at least one drug potentially able to prolong the  QT interval were reviewed. Manually-measured QT intervals were corrected using Fridericia's and Rautaharju's formulae, while automatically- measured QT intervals were corrected with Bazett's formula. Risk was assessed  using the RISQ-PATH scale. RESULTS: Of the 141 patients analyzed, 23 had arrhythmia as per their clinical  history and 14 suffered a complication during their stay in hospital. A total of  113 (80%) had a high RISQ-PATH score and only 64 were subjected to an  electrocardiogram on admission. Patients received a mean of three potentially  QT interval prolonging drugs. Most of the QT intervals measured automatically  were shorter than those obtained manually. Of all corrections, the longest QTc  interval values were obtained with Bazett's formula, and the shortest with  Rautaharju's formula. None of the patients developed TdP or complex  ventricular tachycardia. CONCLUSIONS: Every effort should be made to implement strategies conducive to more effective monitoring of the QT interval to prevent QT  nterval prolongation related complications in hospitalized patients.

OBJETIVO: La prolongación del intervalo QT puede aumentar la estancia hospitalaria y la tasa de mortalidad de los pacientes. Esta  investigación determina la incidencia de prolongación del intervalo QT debido al  uso de medicamentos y evalúa el método más apropiado para realizar el  monitoreo electrocardiográfico.Método: Se realizó un estudio observacional retrospectivo en pacientes hospitalizados en el Hospital Clínica Bíblica durante el año 2018. Se revisaron los expedientes de los pacientes con hospitalización superior a 48  horas cuya historia clínica incluyera al menos tratamiento con un medicamento que prolongara el intervalo QT y que las medidas manuales del intervalo QT  fueran corregidas con la fórmula Fridericia y Rautaharju, y las medidas  automáticas con la fórmula Bazett. La valoración del riesgo se realizó con la  escala RISQ-PATH. RESULTADOS: De los 141 pacientes analizados, 23 tenían una arritmia previa en  su historia clínica y 14 de ellos sufrieron complicaciones durante la  hospitalización. Un total de 113 (80%) pacientes tenían un valor alto  RISQ­PATH y sólo a 64 se les realizó un electrocardiograma al ingreso. En  promedio, los pacientes recibieron tres medicamentos que aumentaban el  intervalo QT. La mayoría de los QT obtenidos automáticamente fueron más  cortos que aquellos obtenidos en forma manual. De todas las correcciones, los  valores del intervalo QT más largos se obtuvieron con la fórmula de Bazett, y  los más cortos con la fórmula Rautaharju. No ocurrieron eventos como  taquicardia ventricular compleja o torsade de pointes durante el estudio. CONCLUSIONES: Es necesario implementar estrategias que permitan una mejor  monitorización del intervalo QT con el fin de prevenir las complicaciones derivadas en los pacientes hospitalizados.

Abordaje rehabilitador de paciente con distrofia facioescapulohumeral y fractura de cadera / Rehabilitative Approach to a Patient with Facioscapulohumeral Dystrophy and Hip Fracture

La distrofia facioescapulohumeral es una miopatía progresiva de base genética, con gran variabilidad fenotípica. Se caracteriza por la progresión de cambios distróficos en la dirección cráneo-caudal con lesiones asimétricas de los músculos faciales, cintura escapular, hombros y piernas. Se expone este caso con el objetivo de demostrar la importancia de la rehabilitación en el manejo integral de pacientes con distrofia muscular y fractura de cadera. Se presenta el abordaje rehabilitador en una paciente con distrofia facioescapulohumeral y fractura de cadera tratada mediante artroplastia total de cadera. El tratamiento rehabilitador precoz contribuyó a mejorar el control del dolor y su recuperación funcional(AU)

Facioscapulohumeral dystrophy is a genetically based progressive myopathy (4q35), with great phenotypic variability. It is characterized by the progression of dystrophic changes in the craniocaudal direction with asymmetric lesions of the facial muscles, shoulder girdle, shoulders, and legs. We report the rehabilitation approach in a female patient with facioscapulohumeral dystrophy and hip fracture treated by total hip arthroplasty. A rehabilitation program was included and improvement in pain control and functionality was observed. Rehabilitation is a fundamental pillar in the comprehensive management of patients with muscular dystrophy and hip fracture(AU)

Enfoque rehabilitador de paciente con artritis reumatoide evolucionada e ictus / Rehabilitation approach to patients with advanced rheumatoid arthritis and stroke

La artritis reumatoide es una enfermedad crónica, sistémica, inflamatoria, que afecta de forma predominante a las articulaciones periféricas y produce una sinovitis inflamatoria con distribución simétrica. El objetivo de este artículo es describir una experiencia en el tratamiento rehabilitador de una paciente con artritis reumatoide evolucionada e ictus. Se presenta el caso de una mujer de 71 años que ingresó en la unidad de recuperación funcional tras un ictus agudo de perfil lacunar, con clínica sensitivomotora de miembro inferior derecho y antecedentes de artritis reumatoide evolucionada. Se incluyó en un programa de rehabilitación, donde se constató la mejoría de la funcionalidad y reeducación de la marcha con ayudas técnicas. La rehabilitación es fundamental en la atención integral de pacientes con artritis reumatoide e ictus(AU)

Rheumatoid arthritis is a chronic, systemic, inflammatory disease that predominantly affects the peripheral joints producing an inflammatory synovitis with a symmetrical distribution. The objective of this article is to describe an experience in the rehabilitative treatment of a patient with advanced rheumatoid arthritis and stroke. We present a 71-year-old woman who was admitted to the functional recovery unit after acute lacunar-profile stroke, with sensorimotor symptoms of the right lower limb and a history of advanced rheumatoid arthritis. He was included in a rehabilitation program, where functional improvement and gait reeducation with technical aids were observed. Rehabilitation is essential in the comprehensive management of patients with rheumatoid arthritis and stroke(AU)

Síndrome de Hamman: a propósito de un caso / Hamman Syndrome, a case study / Sindrome de Hamman, relato de caso

Introducción: el síndrome de Hamman es la aparición de neumomediastino espontáneo asociado a enfisema, patología poco frecuente en pediatría. Sus síntomas principales son dolor torácico agudo, disnea y enfisema subcutáneo. Objetivo: describir una experiencia clínica en la que se sospechó este síndrome analizando el proceso diagnóstico, estudios complementarios y el tratamiento. Caso clínico: varón de 4 años, con antecedentes personales de laringitis a repetición. Presenta laringitis aguda severa, requirió ventilación no invasiva por 12 horas. A las 24 horas del ingreso instaló de forma brusca estridor inspiratorio, dificultad respiratoria, edema de cuello y cara con crepitación a nivel de cuello y cara anterior del tórax que se fue extendiendo a ambos brazos. Se realiza radiografía de tórax que evidencia enfisema subcutáneo extenso. Se realiza tomografía de cuello y tórax que descarta lesión en vía aérea. Con el planteo de síndrome de Hamman en un niño que presentaba como factor predisponente el episodio de laringitis aguda, se decidió no continuar con estudios complementarios. Se realizó tratamiento fisiopatológico con buena evolución clínica. Alta a la semana del ingreso. Conclusiones: el diagnóstico en la urgencia del neumomediastino espontáneo puede representar un desafío, con una variedad de diagnósticos diferenciales potencialmente mortales. La alta sospecha permitirá realizar una evaluación clínica e imagenológica adecuada que permitan confirmar su diagnóstico y evitar procedimientos invasivos innecesarios.

Introduction: Hamman's syndrome involves the appearance of spontaneous pneumomediastinum associated with emphysema, a rare pathology in pediatrics. Its main symptoms include acute chest pain, dyspnea and subcutaneous emphysema. Objective: to describe a clinical case of this suspected syndrome by analyzing the diagnostic process, supplementary studies, and treatment. Clinical case: 4-year-old male with personal history of repeated laryngitis. He presented severe acute laryngitis, requiring non-invasive ventilation for 12 hours. Twenty-four hours after admission he developed abrupt inspiratory stridency, respiratory distress, neck, and face edema with crepitation at neck level and front of thorax spreading to both arms. A chest X-ray shows extensive subcutaneous emphysema. A neck and chest CT scan rules out airway injury. With the suggestion of Hamman's syndrome in a child who presented acute laryngitis as a predisposing factor the episode, it was decided not to continue with additional studies. Physio-pathological treatment was carried out with good clinical evolution. He was discharged a week after admission. Conclusions: diagnosis of spontaneous pneumomediastinum can be challenging in an emergency setting and having a variety of potentially life-threatening differential diagnoses. High suspicion levels will enable an adequate clinical and imaging assessment to confirm its diagnosis and avoid unnecessary invasive procedures.

Introdução: síndrome de Hammam é o aparecimento de pneumomediastino espontâneo associado ao enfisema, uma patologia rara na pediatria. Seus principais sintomas são dor aguda no peito, dispneia e enfisema subcutâneo. Objetivo: descrever um caso clínico com suspeita dessa síndrome por meio da análise do processo diagnóstico, estudos complementares e tratamento. Caso clínico: menino de 4 anos com histórico pessoal de laringite recorrente. Teve laringite aguda grave, o que exigiu ventilação não invasiva por 12 horas. Dentro de 24 horas após a internação, instalou-se abruptamente estridor inspirador, dificuldade respiratória, edema do pescoço e rosto com estalos ao nível do pescoço e face anterior do peito, estendido para ambos braços. Raios-x do tórax mostram enfisema subcutâneo extenso. Tomografia do pescoço e tórax exclui lesões nas vias aéreas. Com a sugestão da síndrome de Hammam em uma criança que apresentou como fator predisponente o episódio de laringite aguda, decidiu-se não continuar com estudos complementares. O tratamento fisiopatológico mostrou boa evolução clínica. A alta teve lugar dentro de uma semana da data da internação. Conclusões: o diagnóstico na urgência do pneumomediastino espontâneo pode representar um desafio, além do mais quando existem uma variedade de diagnósticos diferenciais que ameaçam a vida. A alta suspeita permitirá uma avaliação clínica e de imagem adequada para confirmar o diagnóstico e evitar procedimentos invasivos desnecessários.

El profesional de enfermería especializado. ¿hace el mejor uso de la tecnología en el cuidado? / Compliance with the recommendations for physical activity set by the WHO by public bicycle users in a Spanish municipality

Introducción: La percepción de la integralidad del cuidado se logra cuando el profesional de enfermería integra con elevado nivel las competencias científicas, sociales, éticas y el uso de herramientas tecnológicas con la finalidad de conservar y recuperar la salud, a la medida de las necesidades y expectativas del ser cuidado. Objetivo: Analizar el desarrollo de evidencias científicas sobre el modo en que el profesional de enfermería especialista hace uso de la tecnología en el proceso de cuidado de la persona. Material y Métodos: Se realizó una búsqueda bibliográfica en las bases de datos Scielo, Lilacs, Medline, Redalyc, Scopus y Google Académico, en español, inglés y portugués. La información se consultó durante el periodo de 2019-2020, se utilizó un total de 25 referencias para su desarrollo. Resultados: El profesional de enfermería especialista utiliza los recursos tecnológicos en el proceso de cuidado y en otros pilares de su ejercicio laboral con ello se logra el cuidado integral al ser humano. Conclusiones: el profesional de enfermería especialista realiza dos grandes usos de los recursos tecnológicos en el proceso de cuidados: durante la asistencia del paciente para restaurar, mantener la salud, conservando la interacción con la familia y en los grandes pilares del ejercicio profesional: la gestión de los procesos de tratamiento y continuidad del cuidado; la docencia que asegura la excelencia de futuros profesionales y la investigación, de esta manera se aproxima a la oferta del cuidado humanizado, que constituye el ideal moral de la profesión(AU)

Introduction: The perception of the integrality of care is achieved when the nursing professional integrates, at a high level, the scientific, social, and ethical competencies and the use of technological tools to preserve and recover health, tailored to the needs and expectations of the being cared for. Objective: To analyze the development of scientific evidence on how the specialized nursing professional makes use of technology in the process of caring for the person. Material and Methods: A bibliographic search was carried out in the Scielo, Lilacs, Medline, Redalyc, Scopus, and Google Scholar databases in Spanish, English, and Portuguese. The information was consulted during the 2019-2020 period; a total of 25 references were used for its development. Results: The specialized nursing professional uses technological resources in the care process and other pillars of the work practice that contribute to providing comprehensive care to human beings. Conclusions: The specialized nursing professional makes two major uses of technological resources in the care process: during patient care itself to restore and maintain health, preserving interaction with the family; and in the great pillars of professional practice: management of treatment processes and continuity of care, teaching that ensures the excellence of future professionals, and research, thus approaching the offer of humanized care which is the moral ideal of the profession(AU)

The Development of a New International Generic Measure (EQ-HWB): Face Validity and Psychometric Stages in Argentina.

OBJECTIVES: This study aimed to present the face validity and psychometric stages performed in Spanish in Argentina, the only Spanish-speaking country of an international collaboration that undertook the construction of a new measure that can be used in economic evaluation across health, social care, and public health, the EQ EQ-HWB (EQ Health and Wellbeing). We also explored the relationship among 3-level version EQ-5D (EQ-5D-3L), 5-level version EQ-5D (EQ-5D-5L), and EQ-HWB. METHODS: Face validity was based on semistructured face to face interviews of a purposive sample to explore translatability of language and concepts of 97 candidate items, translated into Argentina Spanish. The psychometric evaluation using an online panel assessed the psychometric properties of 64 items that were carried forward (floor and ceiling effects, item correlations, known-group differences in relevant prespecified subgroups by the international and local teams, exploratory and confirmatory factor analysis, and item response theory). EQ-5D-3L, EQ-5D-5L, and EQ-HWB correlations were explored. RESULTS: In the face validity stage, 24 interviews with carers, general public, patients, and users of social services were included. Most items showed adequate face validity. In the psychometric assessment, 497 participants were recruited (64% reporting a long-term health condition). Most of the items showed adequate psychometrics in an Argentinian context. EQ-5D-3L and EQ-5D-5L had strong correlations, and EQ-HWB was moderately correlated to EQ visual analog scale. The Argentina team recommended 23 of the final 25 items. CONCLUSIONS: The assessment of Spanish items contributed to the overall development of EQ-HWB and helped inform the design of an internationally relevant 25-item and a short 9-item measure intended to be used in economic evaluations.

The peripartum period involvement in the development of post-partum depression. A prospective cohort study.

PURPOSE: This study explores postpartum depression (PPD) in women who screened negative in mid-pregnancy to assess the impact of the peripartum period on the development of depressive symptoms. METHODS: A prospective cohort study was carried out in two facilities in Argentina. The Edinburgh postnatal depression scale (EPDS) scale was applied to pregnant women between weeks 20-24 gestation, and those screening negative (<10) were included in the cohort. Participants were followed up until the 4th week postpartum, when the EPDS was repeated. If positive, a semi-structured clinical interview was applied (MINI) to define the diagnosis. RESULTS: A total of 112 pregnant women were eligible for the follow-up. At the 4th week postpartum, 14 women (12.5%, CI 95% 7.0; 20.1) screened positive using a cutoff point of 10 or more in the EPDS. Of those screened positive in the EPDS, two participants (1.8%, CI 95% 0.2-6.3) had a Major Depressive Disorder. Newborn admission to the Intensive Care Unit, hospitalization of the newborn after discharge, abuse during childbirth, and lack of company during labor were identified as peripartum risk factors. CONCLUSIONS: This study reinforces the relevance of women and newborn mental health care during the hospitalization process surrounding peripartum. The women and newborn hospitalization process should be better explored to understand the contribution to PPD and design and test strategies to alleviate the impact of maternal depression.

On the quality of quantitative instruments to measure digital competence in higher education: A systematic mapping study.

In this study, we report on a Systematic Mapping Study (SMS) on how the quality of the quantitative instruments used to measure digital competencies in higher education is assured. 73 primary studies were selected from the published literature in the last 10 years in order to 1) characterize the literature, 2) evaluate the reporting practice of quality assessments, and 3) analyze which variables explain such reporting practices. The results indicate that most of the studies focused on medium to large samples of European university students, who attended social science programs. Ad hoc, self-reported questionnaires measuring various digital competence areas were the most commonly used method for data collection. The studies were mostly published in low tier journals. 36% of the studies did not report any quality assessment, while less than 50% covered both groups of reliability and validity assessments at the same time. In general, the studies had a moderate to high depth of evidence on the assessments performed. We found that studies in which several areas of digital competence were measured were more likely to report quality assessments. In addition, we estimate that the probability of finding studies with acceptable or good reporting practices increases over time.

Leishmania spp Epitopes in Humans Naturally Resistant to the Disease: Working Toward a Synthetic Vaccine.

Vaccines are one of the most effective strategies to fight infectious diseases. Reverse vaccinology strategies provide tools to perform in silico screening and a rational selection of potential candidates on a large scale before reaching in vitro and in vivo evaluations. Leishmania infection in humans produces clinical symptoms in some individuals, while another part of the population is naturally resistant (asymptomatic course) to the disease, and therefore their immune response controls parasite replication. By the identification of epitopes directly in humans, especially in those resistant to the disease, the probabilities of designing an effective vaccine are higher. The aim of this work was the identification of Leishmania epitopes in resistant humans. To achieve that, 11 peptide sequences (from Leishmania antigenic proteins) were selected using epitope prediction tools, and then, peripheral blood mononuclear cells (PBMCs) were isolated from human volunteers who were previously divided into four clinical groups: susceptible, resistant, exposed and not exposed to the parasite. The induction of inflammatory cytokines and lymphoproliferation was assessed using monocyte-derived dendritic cells (moDCs) as antigen-presenting cells (APCs). The response was evaluated after exposing volunteers' cells to each peptide. As a result, we learned that STI41 and STI46 peptides induced IL-8 and IL-12 in moDCs and lymphoproliferation and low levels of IL-10 in lymphocytes differentially in resistant volunteers, similar behavior to that observed in those individuals to L. panamensis lysate antigens. We conclude that, in silico analysis allowed for the identification of natural Leishmania epitopes in humans, and also STI41 and STI46 peptides could be epitopes that lead to a cellular immune response directed at parasite control.

Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: a stepped-wedge trial.

BACKGROUND: There are only a few studies on handoff quality and adverse events (AEs) rigorously evaluating handoff improvement programmes' effectiveness. None of them have been conducted in low and middle-income countries. We aimed to evaluate the effect of a handoff programme implementation in reducing AE frequency in paediatric intensive care units (PICUs). METHODS: Facility-based, cluster-randomised, stepped-wedge trial in six Argentine PICUs in five hospitals, with >20 admissions per month. The study was conducted from July 2018 to May 2019, and all units at least were involved for 3 months in the control period and 4 months in the intervention period. The intervention comprised a Spanish version of the I-PASS handoff bundle consisting of a written and verbal handoff using mnemonics, an introductory workshop with teamwork training, an advertising campaign, simulation exercises, observation and standardised feedback of handoffs. Medical records (MR) were reviewed using trigger tool methodology to identify AEs (primary outcome). Handoff compliance and duration were evaluated by direct observation. RESULTS: We reviewed 1465 MRs: 767 in the control period and 698 in the intervention period. We did not observe differences in the rates of preventable AE per 1000 days of hospitalisation (control 60.4 (37.5-97.4) vs intervention 60.4 (33.2-109.9), p=0.99, risk ratio: 1.0 (0.74-1.34)), and no changes in the categories or AE types. We evaluated 841 handoffs: 396 in the control period and 445 in the intervention period. Compliance with all items in the verbal and written handoffs was significantly higher in the intervention group. We observed no difference in the handoff time in both periods (control 35.7 min (29.6-41.8) vs intervention 34.7 min (26.5-42.1); difference 1.43 min (95% CI -2.63 to 5.49, p=0.49)). The providers' perception of improved communication did not change. CONCLUSIONS: After the implementation of the I-PASS bundle, compliance with handoff items improved. Nevertheless, no differences were observed in the AEs' frequency or the perception of enhanced communication. TRIAL REGISTRATION NUMBER: NCT03924570.

Design and Effects of the Cinnamic Acids Chemical Structures as Organocatalyst on the Polymerization of Benzoxazines.

This study focuses on the catalytic effect of the two geometric isomers of a cinnamic acid derivative, E and Z-forms of 3-methoxycinnamic acid (3OMeCA), analyzing the influence of their chemical structures. E and Z-3OMeCA isomers show very good catalytic effect in the polymerization of benzoxazines, decreasing by 40 and 55 °C, respectively, the polymerization temperatures, for catalyst contents of up to 10% w/w. Isothermal polymerizations show that polymerizations are easily realized and analyzed at temperatures as low as 130 °C and at much shorter times using Z-3OMeCA instead of E-3OMeCA. Thus, both cinnamic acids are good catalysts, with Z-3OMeCA being better. The molecular reasons for this difference and mechanistic implications in benzoxazine polymerizations are also presented.

Infection profile in neonatal patients during extracorporeal membrane oxygenation.

OBJECTIVES: To describe risk factors for acquired infection during neonatal extracorporeal membrane oxygenation and to examine the predictive value of inflammatory markers in the diagnosis of infection. METHODS: A retrospective study was conducted with data for patients under 30 days supported with extracorporeal membrane oxygenation from 2003 to April 2016, in a neonatal intensive care unit. RESULTS: Our study included 160 neonatal patients, the average age of connection was 8.5 days and the duration of extracorporeal membrane oxygenation support was 9.7 days. The incidence of confirmed infection was 23%. Patients with confirmed infection present more frequently: vaginal delivery, lower birth weight, female sex, diagnosis of congenital diaphragmatic hernia, and longer duration of extracorporeal membrane oxygenation. When comparing the group of patients with confirmed infection and suspicion of infection, there were no significant differences in the inflammatory markers. When calculating the slope for each one, the difference in white blood cell count slope 72 h before the infection is significant; in patients with confirmed infection, the count of white blood cell increases (slope: 0.25), versus the group of patients with suspected infection in whom the count decreases (slope: -0.39). No differences were found in other variables. CONCLUSION: Our study describes that the factors that increase the risk of infection are lower birth weight, vaginal birth, duration of extracorporeal membrane oxygenation, and a positive trend of white blood cell 72 h prior to infection/suspicion. Further studies are necessary to include or definitively rule out the use of these factors and the biomarkers as predictors of infection in neonatal patients supported with extracorporeal membrane oxygenation.

Understanding the role played by protic ionic liquids (PILs) and the substituent effect for enhancing the generation of Z-cinnamic acid derivatives†.

Photoisomerization of a series of substituted E-cinnamic acids in MeCN in their acid forms and as their corresponding protic ionic liquids (PILs) with light of 300 nm is studied. The nature, strength, number, and position effects of substituents on the photochemical behavior of E-cinnamic derivatives are investigated. The photosensitization of the reaction in the presence of Michler's ketone is also studied at 366 nm and it demonstrates that the triplet-excited state is involved in the reaction. As the presence of n-butylamine needed to form the PILs significantly increases the photoproduct yields in all cases, the role of the PILs is also discussed. Thus, understanding of these fundamental aspects has allowed us to establish an excellent and practical synthetic protocol for successfully synthesizing Z-cinnamic acids.