Evaluación docente en los programas quirúrgicos de residentado médico mediante el instrumento MEDUCPG14

Objetivos : Determinar la validez y confiabilidad de los resultados del instrumento MEDUCPG14 y describir los resultados de la evaluación docente en los programas quirúrgicos de residentado médico de una universidad privada. Material y métodos : Estudio de tipo transversal de validación del instrumento MEDUCPG14. El instrumento fue aplicado a 77 médicos residentes de los programas quirúrgicos de residentado médico de la Universidad Peruana Cayetano Heredia (UPCH) y se evaluaron a 41 profesores. Resultados : Se obtuvo un coeficiente de confiabilidad de 0,959. Se encontraron dos dominios: Enseñanza y evaluación y retroalimentación (EER) (11 ítems) con confiabilidad de 0,957 y Trato respetuoso a pacientes y equipo de salud (TR) (3 ítems) con confiabilidad de 0,923. El porcentaje de respuesta fue mayor al 90%. No hubo diferencias significativas en los puntajes promedio por sexo, edad, especialidad y sede docente. Conclusión : El instrumento MEDUCPG-14 tiene una adecuada validez y confiabilidad en los programas quirúrgicos del residentado médico. Se requieren 4 o más evaluaciones por docente; no hubo diferencias en la evaluación de los docentes quirúrgicos en relación al sexo, sede docente y especialidad quirúrgica del médico residente.

SUMMARY Objectives : To determine the validity and reliability of results obtained using the MEDUCPG14 instrument as well as to describe the results of the academic evaluation of surgical resident programs of a private university. Methods : A cross- sectional study was performed; the instrument was applied to 77 residents of surgical programs of Universidad Peruana Cayetano Heredia and to 41 professors. Results : A reliability coefficient of 0.959 was obtained. Two domains were found: teaching, feedback and evaluation (11 items) attained a coefficient of 0.957 and respectful treatment (3 items) attained a coefficient of 0.923. Answer rate was higher than 90%. No difference by age, gender and subspecialty was found. Conclusion : MEDUCPG-14 has adequate validity and reliability to evaluate academic performance in surgical resident programs. Four or more evaluations per professor are needed; no difference by age, sex and subspecialty was found.

Representaciones sociales de estudiantes de enfermer¡a en torno a su proyecto de vida y valores / Social representations of nursing students about their proyect authors

Objetivos: conocer los datos sociodemográficos de los estudiantes del cuarto año de enfermería de la Universidad Peruana Cayetano Heredia, así como la escala de valores y metas de su proyecto de vida. Material y Métodos: se aplicó una encuesta anónima y voluntaria sólo a estudiantes de 18 años o más del cuarto año de estudios de la Universidad Peruana Cayetano Heredia, se analizaron los datos utilizando el programa STATA v12 y la prueba de chi cuadrado con una significancia estadística de 0,05. Resultados: un 60,71% de estudiantes de enfermería encuestados han nacido en Lima, la mayoría se considera de clase media o media baja; 70% de sus padres nacieron en provincias fuera de Lima y cerca al 80% tiene por lo menos un abuelo de la sierra peruana. Respecto a su proyecto de vida y valores, los encuestados manifiestan que quieren un trabajo interesante aunque no sea en su profesión y no consideran que sea importante mandar y decir a otros lo que tienen que hacer, a diferencia de la mayoría de estudiantes de otras Facultades. Ellos están en desacuerdo con el aborto y las prácticas homosexuales. Ellos se muestran colectivistas y aprecian el orden, la limpieza, la humildad y el respeto a lo tradicional. Conclusiones: los estudiantes de enfermería se encuentran entre los más tradicionales de la Universidad Peruana Cayetano Heredia, son hijos de migrantes con tradición de la cultura andina y colectivista, pero su iniciativa para convertirse en profesionales nos permite comprender su apertura al cambio y la autodirección.

Objectives: to know socio demographic data of students from 4th nursing course of Cayetano Heredia University, as well as value scale and goals of their life project. Material and methods: an anonymous survey has been applies only for students in their eighteens and so on from the fourth year of studies of the Cayetano Heredia Peruvian University, datas were of analyzed wing the STATA v12 scherme and the proof of chi-square with a significance stadistic of 0.005. Results: 60,71% of nursing students surveyed have born in Lima, the vait mayority from middle status or low categority 70% of their parents were born in provinces abroad / outside Lima and almost 80% have at least and grandfather from Peruvian highlands. About life proyects and values, respondents manifest wantig a interesting job althought it is not their profesion and they do not consider being a boss or telling what to do to people in opposite to the mayority students from another schools they are disagreed with and homosexual activities. They are collectivist and they appreciate the order, cleaning, humility, and respect for tradition. Conclusions: nursing students are the most traditionals in Cayetano Heredia Peruvian University, they are like children of traditional migrants of Aridean culture and collectivisit, but their instiative to become professional let us undertand their opening to changuig and self-direction.

Multicity study of air pollution and mortality in Latin America (the ESCALA study).

INTRODUCTION: The ESCALA* project (Estudio de Salud y Contaminación del Aire en Latinoamérica) is an HEI-funded study that aims to examine the association between exposure to outdoor air pollution and mortality in nine Latin American cities, using a common analytic framework to obtain comparable and updated information on the effects of air pollution on several causes of death in different age groups. This report summarizes the work conducted between 2006 and 2009, describes the methodologic issues addressed during project development, and presents city-specific results of meta-analyses and meta-regression analyses. METHODS: The ESCALA project involved three teams of investigators responsible for collection and analysis of city-specific air pollution and mortality data from three different countries. The teams designed five different protocols to standardize the methods of data collection and analysis that would be used to evaluate the effects of air pollution on mortality (see Appendices B-F). By following the same protocols, the investigators could directly compare the results among cities. The analysis was conducted in two stages. The first stage included analyses of all-natural-cause and cause-specific mortality related to particulate matter < or = 10 pm in aerodynamic diameter (PM10) and to ozone (O3) in cities of Brazil, Chile, and México. Analyses for PM10 and O3 were also stratified by age group and O3 analyses were stratified by season. Generalized linear models (GLM) in Poisson regression were used to fit the time-series data. Time trends and seasonality were modeled using natural splines with 3, 6, 9, or 12 degrees of freedom (df) per year. Temperature and humidity were also modeled using natural splines, initially with 3 or 6 df, and then with degrees of freedom chosen on the basis of residual diagnostics (i.e., partial autocorrelation function [PACF], periodograms, and a Q-Q plot) (Appendix H, available on the HEI Web site). Indicator variables for day-of-week and holidays were used to account for short-term cyclic fluctuations. To assess the association between exposure to air pollution and risk of death, the PM10 and O3 data were fit using distributed lag models (DLMs). These models are based on findings indicating that the health effects associated with air pollutant concentrations on a given day may accumulate over several subsequent days. Each DLM measured the cumulative effect of a pollutant concentration on a given day (day 0) and that day's contribution to the effect of that pollutant on multiple subsequent (lagged) days. For this study, exposure lags of up to 3, 5, and 10 days were explored. However, only the results of the DLMs using a 3-day lag (DLM 0-3) are presented in this report because we found a decreasing association with mortality in various age-cause groups for increasing lag effects from 3 to 5 days for both PM10 and O3. The potential modifying effect of socioeconomic status (SES) on the association of PM10 or O3 concentration and mortality was also explored in four cities: Mexico City, Rio de Janeiro, São Paulo, and Santiago. The methodology for developing a common SES index is presented in the report. The second stage included meta-analyses and metaregression. During this stage, the associations between mortality and air pollution were compared among cities to evaluate the presence of heterogeneity and to explore city-level variables that might explain this heterogeneity. Meta-analyses were conducted to combine mortality effect estimates across cities and to evaluate the presence of heterogeneity among city results, whereas meta-regression models were used to explore variables that might explain the heterogeneity among cities in mortality risks associated with exposures to PM10 (but not to O3). RESULTS: The results of the mortality analyses are presented as risk percent changes (RPC) with a 95% confidence interval (CI). RPC is the increase in mortality risk associated with an increase of 10 microg/m3 in the 24-hour average concentration of PM10 or in the daily maximum 8-hour moving average concentration of O3. Most of the results for PM10 were positive and statistically significant, showing an increased risk of mortality with increased ambient concentrations. Results for O3 also showed a statistically significant increase in mortality in the cities with available data. With the distributed lag model, DLM 0-3, PM10 ambient concentrations were associated with an increased risk of mortality in all cities except Concepci6n and Temuco. In Mexico City and Santiago the RPC and 95% CIs were 1.02% (0.87 to 1.17) and 0.48% (0.35 to 0.61), respectively. PM10 was also significantly associated with increased mortality from cardiopulmonary, respiratory, cardiovascular, cerebrovascular-stroke, and chronic obstructive lung diseases (COPD) in most cities. The few nonsignificant effects generally were observed in the smallest cities (Concepción, Temuco, and Toluca). The percentage increases in mortality associated with ambient O3 concentrations were smaller than for those associated with PM10. All-natural-cause mortality was significantly related to O3 in Mexico City, Monterrey, São Paulo and Rio de Janeiro. Increased mortality risks for some specific causes were also observed in these cities and in Santiago. In the analyses stratified by season, different patterns in mortality and O3 were observed for cold and warm seasons. Risk estimates for the warm season were larger and significant for several causes of death in São Paulo and Rio de Janeiro. Risk estimates for the cold season were larger and significant for some causes of death in Mexico City, Monterrey, and Toluca. In an analysis stratified by SES, the all-natural-cause mortality risk in Mexico City was larger for people with a medium SES; however we observed that the risk of mortality related to respiratory causes was larger among people with a low SES, while the risk of mortality related to cardiovascular and cerebrovascular-stroke causes was larger among people with medium or high SES. In São Paulo, the all-natural-cause mortality risk was larger in people with a high SES, while in Rio de Janeiro the all-natural-cause mortality risk was larger in people with a low SES. In both Brazilian cities, the risks of mortality were larger for respiratory causes, especially for the low- and high-SES groups. In Santiago, all-natural-cause mortality risk did not vary with level of SES; however, people with a low SES had a higher respiratory mortality risk, particularly for COPD. People with a medium SES had larger risks of mortality from cardiovascular and cerebrovascular-stroke disease. The effect of ambient PM10 concentrations on infant and child mortality from respiratory causes and lower respiratory infection (LRI) was studied only for Mexico City, Santiago, and São Paulo. Significant increased mortality risk from these causes was observed in both Santiago (in infants and older children) and Mexico City (only in infants). For O3, an increased mortality risk was observed in Mexico City (in infants and older children) and in São Paulo (only in infants during the warm season). The results of the meta-analyses confirmed the positive and statistically significant association between PM10 and all-natural-cause mortality (RPC = 0.77% [95% CI: 0.60 to 1.00]) using the random-effects model. For mortality from specific causes, the percentage increase in mortality ranged from 0.72% (0.54 to 0.89) for cardiovascular disease to 2.44% (1.36 to 3.59) for COPD, also using the random-effects model. For O3, significant positive associations were observed using the random-effects model for some causes, but not for all natural causes or for respiratory diseases in people 65 years or older (> or = 65 years), and not for COPD and cerebrovascular-stroke in the all-age and the > or = 65 age groups. The percentage increase in all-natural-cause mortality was 0.16% (-0.02 to 0.33). In the meta-regression analyses, variables that best explained heterogeneity in mortality risks among cities were the mean average of temperature in the warm season, population percentage of infants (< 1 year), population percentage of children at least 1 year old but < 5 years (i.e., 1-4 years), population percentage of people > or = 65 years, geographic density of PM10 monitors, annual average concentrations of PM10, and mortality rates for lung cancer. CONCLUSIONS: The ESCALA project was undertaken to obtain information for assessing the effects of air pollutants on mortality in Latin America, where large populations are exposed to relatively high levels of ambient air pollution. An important goal was to provide evidence that could inform policies for controlling air pollution in Latin America. This project included the development of standardized protocols for data collection and for statistical analyses as well as statistical analytic programs (routines developed in R by the ESCALA team) to insure comparability of results. The analytic approach and statistical programming developed within this project should be of value for researchers carrying out single-city analyses and should facilitate the inclusion of additional Latin American cities within the ESCALA multicity project. Our analyses confirm what has been observed in other parts of the world regarding the effects of ambient PM10 and 03 concentrations on daily mortality. They also suggest that SES plays a role in the susceptibility of a population to air pollution; people with a lower SES appeared to have an increased risk of death from respiratory causes, particularly COPD. Compared with the general population, infants and young children appeared to be more susceptible to both PM10 and O3, although an increased risk of mortality was not observed in these age groups in all cities. (ABSTRACT TRUNCATED)

Efecto de Uncaria tomentosa (Uña de gato) sobre la población y activación decélulas dendríticas en sangre periférica de pacientes con artritis reumatoidea / Effect of Uncaria tomentosa (Catïs claw) over dendritic cells population and activation in peripheral blood of rheumatoid arthritis patients

Introducción: la artritis reumatoide (AR) es una enfermedad autoinmune caracterizada por un proceso inflamatorio crónico articular. En los últimos años se está resaltando la importancia de las células dendríticas en AR, debido a su capacidad de presentar autoantígenos y estimular a linfocitos T autoreactivos. En este estudio se ensayó la capacidad de Uncaria tomentosa (Uña de Gato, UG), una planta peruana con propiedades inmunomoduladoras, sobre la población de células dendríticas circulantes y sobre la expresión de sus moléculas de maduración y coestimulación. Objetivos: determinar la población de células dendríticas (DC) de origen mieloide (DCm) y plasmocitoide (DCp) por citometría de flujo en pacientes con AR. Evaluar la variación en la expresión de moléculas HLA-DR y CD86 en ambas subpoblaciones celulares expuestas a diferentes concentraciones de un extracto hidroalcohólico de UG con 5 por ciento de alcaloides oxindólicos pentacíclicos (UG-POA). Material y método: se evaluaron DC a partir de muestras de sangre periférica de pacientes con AR y adultos controles sanos, enfrentadas a diferentes concentraciones de UG. Las muestras fueron marcadas con anticuerpos monoclonales específicos, evaluadas por citometría de flujo y analizadas con el software Summit 4.3. El análisis estadístico fue realizado mediante Test de rangos de Friedman para muestras relacionadas, Test T de student y Prueba de Tendencias y Análisis de Medidas Repetidas. Resultados: encontramos que UG-POA disminuyó de manera dosis dependiente la subpoblación de DCm de sangre periférica de pacientes con AR, sin afectar la subpoblación de DCp y aumentó la expresión de las moléculas HLA-DR y CD86 en DCm. Conclusiones: la UG-POA disminuye la subpoblación de DCm, mientras incrementa la expresión de moléculas HLA-DR y CD86 en pacientes con AR definida. Estos hallazgos añadirían un mecanismo adicional al efecto inmuno-modulador de la UG en procesos inflamatorios crónicos.

Introduction: Rheumatoid arthritis (RA) is an autoimmune disease characterized by a chronic inflammatory process with in the joints. Recently, the importance of dendritic cells (DC) has been emphasized in this condition due to their remarkable ability for presenting autoantigens and for stimulating auto-reactive T-cells. The ability of Uncariatomentosa (CatÆs claw), a native Peruvian plant with immune-modulating properties on the circulating dendritic cell population and on their maturation and co-stimulation capacities was assessed. Objectives: To determine subsets of myeloid and plasmacytoid dendritic cells (mDC and pDC, respectively) in patients with RA with the use of flow cytometry. To evaluate variations in the expression of HLA-DRand CD86 molecules in both subsets of DC in response to different concentrations of a hydro-alcoholic extract of Catïs claw with 5 per cent of pentacyclic oxindole alkaloids. Materials and methods: Peripheral blood dendritic cells were taken from RA patients and healthy controls, and they were incubated with different concentrations of Catïs claw. Then, cells were labeled with specific monoclonal antibodies and they were separated using flow cytometry and they were analyzed with a Summit 4.3. software. Statistical analysis was performed using Friedmanïs, T-student, trends and repeat measure analysis tests. Results: We found that Catïs claw extract decreased in a dose-dependent fashion mDC population in the peripheral blood of RA patients without affecting pDC, and it also increased HLA-DR and CD86 expression on mDC. Conclusions: Catïs claw reduced the mDC subset, while it increased HLA-DR and CD86 expression in RA patients. This is an additional mechanism for the known immune-modulating effect of Catïs claw in chronic inflammatory conditions.

Impact of traffic flow on the asthma prevalence among school children in Lima, Peru.

OBJECTIVE: To estimate the impact of traffic flow on the prevalence of asthma among school children of 6 to 7 and 13 to 14-years of age. METHODS: A cross-sectional study consisting of 5,917 children selected in schools of the Cone Norte of Lima, Peru. RESULTS: For the 6- to 7-year age group the prevalence of medical diagnosis of asthma according to the traffic flow index was 8.6% (CI: 6.8-10.8), 10.3% (CI: 8.4-12.4), and 15.3% (CI:13.3-17.5) at low, medium and high, respectively, and for the 13- to 14-year age group, 11.9% (CI: 9.4-14.6), 13.3% (CI: 11.6-15.2), and 17.1% (CI: 14.7-19.6). CONCLUSIONS: For both groups, the prevalence of asthma was significantly related to traffic flow density.

[Infant morbidity caused by respiratory diseases and its relation with the air pollution in Juarez City, Chihuahua, Mexico]. / Morbilidad infantil por causas respiratorias y su relación con la contaminación atmosférica en Ciudad Juárez, Chihuahua, México.

OBJECTIVE: To assess the impact of atmospheric pollutants on the respiratory health of children of different age groups in Juarez City, Chihuahua, Mexico. MATERIAL AND METHODS: Data on emergency room visits between 1997 and 2001 for respiratory diseases in children less than 17 years old were obtained from hospitals in the Juarez City belonging to the Mexican Social Security Institute (IMSS). Diseases were classified into three groups according to ICD 9th and 10th codes: a) upper respiratory diseases, b) lower respiratory diseases, and c) asthma attacks. This information was stratified by age group (< = 5 years and > 5 years). Daily air pollution data (ozone and PM10) and weather conditions were obtained from the Monitoring Network System in Juarez City. Statistical analysis was carried out using a Generalized Additive Model assuming a Poisson distribution. RESULTS: Ozone concentrations, but not PM 10, were statistically associated with emergency room visits for respiratory diseases, mainly among children 5 years old or younger. In this group, an increase of 20 ppb 1-hr maximum for ozone was associated with an increase of 8.3% in the number of emergency room visits for upper respiratory diseases, with a 3-day exposure lag; and an increase of 12.7% in the number of emergency room visits for lower respiratory diseases when considering a 4-day exposure lag in a maximum 8-hr mobile average. The largest effect for the complete sample and for the group 6 to 16 years of age was observed for 3-day lag (5.1% for an increase of 20 ppb 1-hr maximum for ozone). For the 6 to 16 year old group we did not find a significant effect. CONCLUSION: The wide range of risk is quite important and might represent a substantial cost for the health system as well as for the society. Our results emphasize the need to implement preventive and control measures for air pollution and avoid the worsening of the present situation.

Morbilidad infantil por causas respiratorias y su relación con la contaminación atmosférica en Ciudad Juárez, Chihuahua, México / Infant morbidity caused by respiratory diseases and its relation with the air pollution in Juarez City, Chihuahua, Mexico

OBJETIVO: Evaluar el impacto de los contaminantes atmosféricos sobre la salud respiratoria de la población infantil de Ciudad Juárez, Chihuahua, México, considerando diferentes grupos etáreos. MATERIAL Y MÉTODOS: Se obtuvieron datos sobre consultas a urgencias de hospitales por afecciones de vías respiratorias altas, bajas y asma, en unidades del IMSS, de niños menores de 17 años de edad entre 1997 y 2001, y se estratificó por grupos etáreos (<5 años y >5 años). Se obtuvieron datos diarios sobre contaminantes aéreos (Ozono y PM10) y condiciones meteorológicas de la Red de Monitoreo en Ciudad Juárez. Para el análisis estadístico de los datos, se utilizó un Modelo Aditivo Generalizado, asumiendo una distribución de Poisson. RESULTADOS: Las concentraciones de ozono, pero no de PM10, se asociaron significativamente con las consultas a urgencias por afecciones respiratorias, principalmente en niños de 5 años o menores. En este grupo, un incremento de 20 ppb en 1 hr máxima de ozono se asociaron con un incremento de 8.3 por ciento en las consultas por afecciones de vías respiratorias superiores, con un retraso en la exposición de tres días, y un incremento de 12.7 por ciento en las consultas por infecciones de las vías respiratorias inferiores cuando se consideró un retraso de cuatro días en la exposición en el promedio móvil máximo de ocho horas. El efecto mayor para la muestra total, al igual que para el grupo de niños de 6 a 16 años, se observó en el retraso de tres días (5.1 por ciento para un aumento de 20 ppb en un máximo de una hora). Para este grupo no se observó un efecto significativo entre los niveles ambientales de ozono y el riesgo de contraer enfermedades de las vías respiratorias inferiores. CONCLUSION: La amplitud del riesgo es de suma importancia, ya que puede representar un incremento en los costos de atención en el sistema de salud y la sociedad en general. Nuestros resultados destacan la necesidad de instrumentar acciones...

OBJECTIVE: To assess the impact of atmospheric pollutants on the respiratory health of children of different age groups in Juarez City, Chihuahua, Mexico. MATERIAL AND METHODS: Data on emergency room visits between 1997 and 2001 for respiratory diseases in children less than 17 years old were obtained from hospitals in the Juarez City belonging to the Mexican Social Security Institute (IMSS). Diseases were classified into three groups according to ICD 9th and 10th codes: a) upper respiratory diseases, b) lower respiratory diseases, and c) asthma attacks. This information was stratified by age group (<=5 years and >5 years). Daily air pollution data (ozone and PM10) and weather conditions were obtained from the Monitoring Network System in Juarez City. Statistical analysis was carried out using a Generalized Additive Model assuming a Poisson distribution. RESULTS: Ozone concentrations, but not PM10, were statistically associated with emergency room visits for respiratory diseases, mainly among children 5 years old or younger. In this group, an increase of 20 ppb 1-hr maximum for ozone was associated with an increase of 8.3 percent in the number of emergency room visits for upper respiratory diseases, with a 3-day exposure lag; and an increase of 12.7 percent in the number of emergency room visits for lower respiratory diseases when considering a 4-day exposure lag in a maximum 8-hr mobile average. The largest effect for the complete sample and for the group 6 to 16 years of age was observed for 3-day lag (5.1 percent for an increase of 20 ppb 1-hr maximum for ozone). For the 6 to16 year old group we did not find a significant effect. CONCLUSION: The wide range of risk is quite important and might represent a substantial cost for the health system as well as for the society. Our results emphasize the need to implement preventive and control measures for air pollution and avoid the worsening of the present situation.

Infant mortality and air pollution: modifying effect by social class.

UNLABELLED: Studies link air pollution with increased mortality; however, information on infants is scarce and inconclusive. OBJECTIVE: We studied short-term PM10 exposure, relating to increased respiratory-related infant mortality, and estimated for poor living conditions. METHODS: A case-crossover approach modeled the relationship between infant mortality (1 month-1 year of age), and ambient PM10 levels on days before death in Ciudad Juarez, Mexico (1997-2001). Socioeconomic level (SES) of the deceased was defined by residence location. RESULTS: Overall air pollutants did not affect infant mortality (odds ratio [OR] = 1.02, 95% confidence interval [CI] = 0.94-1.11 for PM10, lag1) but low SES increased risk. Each 20 microg/m3 in PM10 (24-hour average, lag1, cumulative over 2 previous days) increased respiratory-related mortality (OR = 1.61, 95% CI = 0.97-2.66; OR = 2.56; 95% CI = 1.06-6.17, respectively). Ozone levels did not affect infant mortality for any SES. CONCLUSIONS: Worse living conditions among lower SES concurred with increased mortality.

Endometritis post-cesárea: factores de riesgo / Post cesaream endometritis: risk factors

Objetivo: Dterminar los factores de riesgo de endometritis post-cesárea (EPC). Material y métodos: Se realizó un estudio retrospectivo caso-control en el Servicio de Obstetricia del Hospital Nacional Cayetano Heredia del 1 de Enero de 1992 al 31 de julio de 1996. Para el análisis estadístico se utilizó análisis bivariado y multivariado de regresión logística. Resultados: Durante este período se detectaron 82 pacientes con diagnóstico clínico de endometritis, seleccionándose aleatoriamente igual número de pacientes operadas de cesárea con puerperio normal. Los factores relacionados con un riesgo significativo de EPC fueron: edad materna menor de 21 años y valores de hematocrito post-operatorio menor o igual a 30 por ciento. En el grupo de pacientes con endometritis el 45.1 por ciento de las pacientes tuvieron infección concomitante, siendo la infección de herida operatoria (29.3 por ciento) y la del tracto urinario (11 por ciento) las más frecuentes.