Extracorporeal membrane oxygenation and microaxial left ventricular assist device in cardiogenic shock: Choosing the right mechanical circulatory support to improve outcomes.

Objective: To evaluate the outcomes of patients supported with Impella (CP/5.0) or venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock according to shock phenotype. The primary end point was 30-day survival. Methods: A retrospective study of patients supported with Impella (CP/5.0) or VA-ECMO between 2010 and 2020 was performed. Patients were grouped according to 1 of 2 shock phenotypes: isolated left ventricular (LV) dysfunction versus biventricular dysfunction or multiple organ failure (MOF). The local practice favors Impella for isolated LV dysfunction and VA-ECMO for biventricular dysfunction or MOF. Results: Among the 75 patients included, 17 (23%) had isolated LV dysfunction. Patients with biventricular dysfunction or MOF had a greater median lactate level compared with those with isolated LV dysfunction (7.9 [2.9-11.8] vs 3.8 [1.1-5.8] mmol/L, respectively). Among patients with isolated LV dysfunction, 30-day survival was 46% for the Impella group (n = 13) and 75% for VA-ECMO (n = 4). Among patients with biventricular dysfunction or MOF, 30-day survival was 9% for the Impella group (n = 11) and 28% for VA-ECMO (n = 47). Patients supported with Impella 5.0 had better 30-day survival compared with those supported with Impella CP, for both shock phenotypes (83% vs 14% and 14% vs 0%, respectively). Conclusions: In this small cohort, patients supported with Impella for isolated LV dysfunction and VA-ECMO for biventricular dysfunction or MOF had acceptable survival at 30 days. Patients with biventricular dysfunction or MOF who were supported by Impella had the lowest survival rates. Patients with isolated LV dysfunction who were supported with VA-ECMO had good 30-day survival.

Labor migration is associated with lower rates of underweight and higher rates of obesity among left-behind wives in rural Bangladesh: a cross-sectional study.

BACKGROUND: Among Bangladeshi men, international labor migration has increased ten-fold since 1990 and rural to urban labor migration rates have steadily increased. Labor migration of husbands has increased household wealth and redefined women's roles, which have both positively and negatively impacted the health of wives "left behind". We examined the direct and indirect effects of husband labor migration on chronic disease indicators and outcomes among wives of labor migrants. METHODS: We collected survey, anthropometric, and biomarker data from a random sample of women in Matlab, Bangladesh, in 2018. We assessed associations between husband's migration and indicators of adiposity and chronic disease. We used structural equation modeling to assess the direct effect of labor migration on chronic disease, undernutrition, and adiposity, and the mediating roles of income, food security, and proportion of food purchased from the bazaar. Qualitative interviews and participant observation were used to help provide context for the associations we found in our quantitative results. FINDINGS: Among study participants, 9.0% were underweight, 50.9% were iron deficient, 48.3% were anemic, 39.6% were obese, 27.3% had a waist circumference over 35 in., 33.1% had a high whole-body fat percentage, 32.8% were diabetic, and 32.9% had hypertension. Slightly more women in the sample (55.3%) had a husband who never migrated than had a husband who had ever migrated (44.9%). Of those whose husband had ever migrated, 25.8% had a husband who was a current international migrant. Wives of migrants were less likely to be underweight, and more likely to have indicators of excess adiposity, than wives of non-migrants. Protection against undernutrition was attributable primarily to increased food security among wives of migrants, while increased adiposity was attributable primarily to purchasing a higher proportion of food from the bazaar; however, there was a separate path through income, which qualitative findings suggest may be related to reduced physical activity. CONCLUSIONS: Labor migration, and particularly international labor migration, intensifies the nutrition transition in Bangladesh through increasing wealth, changing how foods are purchased, and reducing physical activity, which both decreases risk for undernutrition and increases risk for excess adiposity.

First Responder Resiliency ECHO: Innovative Telementoring during the COVID-19 Pandemic.

The First Responder ECHO (Extension for Community Outcomes) program was established in 2019 to provide education for first responders on self-care techniques and resiliency while establishing a community of practice to alleviate the enormous stress due to trauma and substance misuse in the community. When the SARS-CoV-2 (COVID-19) pandemic hit the United States (US) in March 2020, a tremendous strain was placed on first responders and healthcare workers, resulting in a program expansion to include stress mitigation strategies. From 31 March 2020, through 31 December 2020, 1530 unique first responders and frontline clinicians participated in the newly expanded First Responder Resiliency (FRR) ECHO. The robust curriculum included: psychological first aid, critical incident debriefing, moral distress, crisis management strategies, and self-care skills. Survey and focus group results demonstrated that, while overall stress levels did not decline, participants felt more confident using psychological first aid, managing and recognizing colleagues who needed mental health assistance, and taking time for self-care. Although first responders still face a higher level of stress as a result of their occupation, this FRR ECHO program improves stress management skills while providing weekly learning-listening sessions, social support, and a community of practice for all first responders.

Recent cocaine use and memory impairment in HIV.

Both Human Immunodeficiency Virus (HIV) and cocaine use have been associated with impairment in neuropsychological functioning. The high comorbidity between HIV and cocaine use highlights the importance of ascertaining whether there is a compounding effect of cocaine use in individuals with HIV. Among neuropsychological domains impacted by HIV, verbal memory deficits have received substantial attention partly because they have been associated with declines in functional status in HIV positive individuals. We collected California Verbal Learning Test-II data from HIV participants who met lifetime diagnostic criteria of cocaine abuse and/or dependence (HIV/CocDx+, N = 80 & HIV/CocDx-, N = 30, respectively) and those with and without recent cocaine use, which was confirmed by toxicology analysis (HIV/Coc+, N = 56 & HIV/Coc-, N = 57, respectively). The Item Specific Deficit Approach (ISDA) was employed to determine any additional cocaine-associated deficits in encoding, consolidation, and retrieval, which attempts to control for potential confounding factors of memory such as attention. Using conventional methods of evaluating memory profiles, we found that the HIV/Coc + group demonstrated worse learning, immediate and delayed free recall, and recognition in contrast to the HIV/Coc - group; although using the ISDA, we found that encoding was the only significant difference between HIV/Coc + and HIV/Coc-participant, with HIV/Coc - performing better. Our data suggest that for individuals with HIV, cocaine use is associated with a temporary decline in verbal memory, is characterized by greater encoding deficits, and these effects may reduce with abstinence. Clinically, our findings suggest that reduced encoding is the likely contributor to verbal memory decline in HIV/Coc + and these effects are partially reversible-at least to the level of their HIV/Coc - counterparts.

The project ECHO first responder resiliency program: curriculum development, listening groups and lessons learned to support providers virtually during a pandemic.

The First Responder (FR) Resilience ECHO Program continues as a virtual telementoring platform supporting FRs both within New Mexico and internationally. The program began initially to support FRs through the opioid epidemic, and as the COVID-19 pandemic grew, the curriculum and audience broadened to include self-care and resilience skills to participants around the world. The notion of a FR was changed as providers everywhere were facing new challenges in their front-facing experience, whether this be a sense of overwhelm, an experience of detachment or of overload. The curriculum was altered with ongoing input from participants to address the needs of those working to help others during the COVID-19 pandemic, and included didactics in psychological first aid, self-care and resilience, peak performance skills, communication methods, diagnostic and systems descriptions, as well as the development of effective peer support programs around the nation. Perhaps the most important innovation was the development of listening groups, where participants could connect with one another in breakout rooms (15-20 min) to witness one another's account of their current situation. Project ECHO is a well-established and renowned telementoring program that assists clinicians in the treatment of disease through the demonopolization of knowledge. The FR Resiliency ECHO Program grew out of the core ECHO model to assist FRs in developing skills to work with various crises that our society currently faces, in particular, the opioid epidemic and later, the COVID-19 pandemic. The project created a unique online experience and curriculum to facilitate both skill development and a sense of ongoing connection to a community of peers. This article describes the curriculum, the development of the listening group experience, and the feedback received from participants through focus groups.

Estudio de Casos y Controles: Cáncer de Mama y su Asociación con la Densidad Mamaria Incrementada Visualizada por Mamografía en el Instituto del Cáncer SOLCA Cuenca ­ Ecuador, 2013 ­ 2015 / Case-Control Study: Breast Cancer and the Association with Increased Breast Density Visualized by Mammography at the Cancer Institute SOLCA Cuenca - Ecuador, 2013 - 2015

INTRODUCCIÓN: En la actualidad el cáncer de mama es el segundo tipo más frecuente de cáncer en el mundo, representando una de las principales causas de mortalidad femenina. El objetivo de este estudio fue determinar la asociación entre cáncer de mama y densidad mamaria incrementada visualizada por mamografía en mujeres de 45 a 70 años del Instituto del Cáncer SOLCA ­ Cuenca. MATERIALES Y MÉTODOS: Se realizó un estudio de casos y controles; el universo incluyó a pacientes que se realizaron un control mamográfico en el Instituto del Cáncer SOLCA ­ Cuenca, durante el período 2013 ­ 2015. La definición de caso o control estuvo dada por el diagnóstico de cáncer de mama confirmado por estudio histopatológico; se investigó la relación entre densidad mamaria de alto riesgo (C y D) y cáncer de mama. Se utilizó estadística descriptiva, análisis de asociación y riesgo; los datos fueron procesados mediante el programa estadístico SPSS versión 22.0. RESULTADOS: El promedio de edad fue 55.3 años (±7,62). La densidad mamaria C y D estuvo asociada a un incremento del riesgo de desarrollar cáncer de mama OR 8.58 (IC 3.5 ­ 20.60, p=0.001). Los principales hallazgos mamográficos presentes en pacientes con patología maligna fueron: calcificaciones amorfas p= 0.014, calcificaciones finas pleomorfas p= ≤0.001, presencia de nódulos irregulares, hiperdensos y espiculados p= ≤0.001, asimetría focal p= ≤0.001, distorsión de la arquitectura del tejido fibroglandular p= ≤0.001, retracción cutánea p= 0.029, engrosamiento cutáneo p= ≤0.001, y la presencia de ganglios linfáticos de morfología sospechosa p= 0.032. CONCLUSIÓN: El patrón de densidad mamaria C y D se asocia a un incremento del riesgo de presentar cáncer de mama. Se requiere implementar políticas de prevención que faciliten la notificación, diagnóstico y manejo específico de estas pacientes.(AU)

BACKGROUND: Breast cancer is the second most frequent type of cancer worldwide, representing one of the main causes of female mortality. The aim of this study was to determine the association between breast cancer and increased breast density visualized by mammography in women from 45 to 70 years old of the Cancer Institute SOLCA ­ Cuenca. METHODS: A case-control study was performed; the universe included patients who underwent a mammographic study at the Cancer Institute SOLCA Cuenca ­ Ecuador during the period 2013 ­ 2015. The definition of case of control was given by the diagnosis of breast cancer confirmed by histopathological study; the relationship between high-risk breast density (C and D) and breast cancer was evaluated. Descriptive statistics, risk and association analysis were used; data were processed using statistical program SPSS version 22.0. RESULTS: The average age was 55.3 years (± 7.62). Mammary density C and D was associated with an increased risk of developing breast cancer OR 8.58 (IC 3.5 - 20.60, p= 0.001). The main mammographic findings present in patients with malignant pathology were: amorphous calcifications p= 0.014, pleomorphic fine calcifications p= ≤0.001, presence of irregular, hyperdense and speculated nodules p= ≤0.001, focal asymmetry p= ≤0.001, distortion of the architecture of fibroglandular tissue p= ≤0.001, cutaneous retraction p= 0.029, cutaneous thickening p= ≤0.001, and the presence of lymph nodes of suspicious morphology p= 0.032. CONCLUSION: Type C and D breast density is associated with an increased risk of breast cancer. It is necessary to implement prevention policies that facilitate timely notification, diagnosis and specific management of these patients.(AU)

The Interactive Trauma Scale: A Web-Based Measure for Children with Autism.

This study examined the feasibility, acceptability, and psychometric characteristics of a web-based touchscreen app prototype designed to assess self-reported trauma exposure and symptoms in children with autism spectrum disorder (ASD). The prototype was piloted with 20 clinically referred children previously diagnosed with ASD and having various known trauma exposures. User satisfaction and reported ease of use was high. The measure was sensitive to reports of teasing and bullying, endorsed by 75% and 70% of participants, respectively. Validity was assessed via comparisons with the UCLA Posttraumatic Stress Disorder Reaction Index and analysis of participants' trauma exposures and symptoms. Clinical implications are discussed including issues of trauma screening, diagnosis, and treatment planning for traumatized youth with ASD.

Dispersal limitation of Tillandsia species correlates with rain and host structure in a central Mexican tropical dry forest.

Seed dispersal permits the colonization of favorable habitats and generation of new populations, facilitating escape from habitats that are in decline. There is little experimental evidence of the factors that limit epiphyte dispersion towards their hosts. In a tropical dry forest in central Mexico, we monitored the phenology of dispersion of epiphyte species of the genus Tillandsia; we tested experimentally whether precipitation could cause failures in seed dispersal and whether seed capture differs among vertical strata and between host species with high (Bursera copallifera) and low (Conzattia multiflora) epiphyte loads. With the exception of one species that presents late dispersion and low abundance, all of the species disperse prior to the onset of the rainy season. However, early rains immobilize the seeds, affecting up to 24% of the fruits in species with late dispersion. We observed that Tillandsia seeds reach both Bursera and Conzattia hosts, but found that adherence to the host is 4-5 times higher in Bursera. Furthermore, seeds liberated from Bursera travel shorter distances and up to half may remain within the same crown, while the highest seed capture takes place in the upper strata of the trees. We conclude that dispersion of Tillandsia seeds is limited by early rains and by the capture of seeds within the trees where populations concentrate. This pattern of capture also helps to explain the high concentrations of epiphytes in certain hosts, while trees with few epiphytes can be simultaneously considered deficient receivers and efficient exporters of seeds.

Habilidad de cuidado y sobrecarga en cuidadores familiares de personas con enfermedad crónica / Ability of care and care burden in family caregivers of people with chronic illness

Introducción: la sobrecarga del cuidador ha mostrado ser una variable que se relaciona con factores como el género, funcionalidad del receptor de cuidados, el tiempo dedicado al cuidado, entre otros. Objetivo: determinar si existe relación entre sobrecarga de cuidador y habilidad de cuidado en cuidadores familiares de personas con enfermedad crónica no transmisible y comparar dicha relación en las regiones de Colombia. Métodos: estudio de abordaje cuantitativo, correlacional, la muestra fue de 2040 cuidadores de personas con enfermedad crónica de las regiones Andina, Pacífica, Caribe y Amazonia en Colombia. Los datos fueron recolectados en el Inventario de Habilidad de Cuidado de Nkongho y la escala de sobrecarga del cuidador de Zarit. El estadístico de elección fue el coeficiente Rho de Spearman. Resultados: en Colombia y en las regiones de Amazonia y Pacífico se observa una correlación negativa débil, pero estadísticamente significativa (p<0,01). En la región Caribe, se observa una correlación negativa moderada y estadísticamente significativa (p<0,01). En la región Andina, no existe relación alguna entre la habilidad de cuidado y la sobrecarga del cuidador. Conclusiones: se observó un relación débil pero estadísticamente significativa entre la habilidad de cuidado y la sobrecarga del cuidador en Colombia y sus regiones, excepto en la región Andina. Intervenciones en el fortalecimiento de la habilidad de cuidado podrían demostrar utilidad para disminuir la sobrecarga del cuidador(AU)

Introduction: Caregiver burden has proved to be a variable that is related to gender factors, the functionality of the care recipient, the time spent on care, among others. Additional research to determine if the burden of care is related to the caring ability of the family caregiver is required. Objective: To determine the correlation between burden of care and caring in family caregivers of people with chronic illness and to compare that relationship in the different regions of Colombia. Methods: Quantitative study, with a correlational approach. The sample included 2040 caregivers of people with chronic illness of the Andean, Pacific, Caribbean and Amazon regions in Colombia. Informed consent process was performed. Data were collected with the Caring Ability Inventory of Nkonghoy and with the Zarit Caregiver Burden Interview. The statistical approach was done with the Spearman Rho test. Results : In Colombia and in its Amazonic and Pacific regions, a weak negative statistically significant correlation (p <0.01) was observed. In the Caribbean Region, a moderate and statistically significant negative correlation (p <0.01). In the Andean region, no connection between the ability of care and caregiver burden was found. Conclusion: A weak but statistically significant relationship between the ability of care and caregiver burden was found in Colombia, except in the Andean region were no correlation was founded. Interventions in strengthening the ability of care, could be useful in decreasing caregivers burden with care(AU)

Habilidad de cuidado y sobrecarga en cuidadores familiares de personas con enfermedad crónica / Ability of care and care burden in family caregivers of people with chronic illness

Introducción: la sobrecarga del cuidador ha mostrado ser una variable que se relaciona con factores como el género, funcionalidad del receptor de cuidados, el tiempo dedicado al cuidado, entre otros. Objetivo: determinar si existe relación entre sobrecarga de cuidador y habilidad de cuidado en cuidadores familiares de personas con enfermedad crónica no transmisible y comparar dicha relación en las regiones de Colombia. Métodos: estudio de abordaje cuantitativo, correlacional, la muestra fue de 2040 cuidadores de personas con enfermedad crónica de las regiones Andina, Pacífica, Caribe y Amazonia en Colombia. Los datos fueron recolectados en el Inventario de Habilidad de Cuidado de Nkongho y la escala de sobrecarga del cuidador de Zarit. El estadístico de elección fue el coeficiente Rho de Spearman. Resultados: en Colombia y en las regiones de Amazonia y Pacífico se observa una correlación negativa débil, pero estadísticamente significativa (p<0,01). En la región Caribe, se observa una correlación negativa moderada y estadísticamente significativa (p<0,01). En la región Andina, no existe relación alguna entre la habilidad de cuidado y la sobrecarga del cuidador. Conclusiones: se observó un relación débil pero estadísticamente significativa entre la habilidad de cuidado y la sobrecarga del cuidador en Colombia y sus regiones, excepto en la región Andina. Intervenciones en el fortalecimiento de la habilidad de cuidado podrían demostrar utilidad para disminuir la sobrecarga del cuidador(AU)

Introduction: Caregiver burden has proved to be a variable that is related to gender factors, the functionality of the care recipient, the time spent on care, among others. Additional research to determine if the burden of care is related to the caring ability of the family caregiver is required. Objective: To determine the correlation between burden of care and caring in family caregivers of people with chronic illness and to compare that relationship in the different regions of Colombia. Methods: Quantitative study, with a correlational approach. The sample included 2040 caregivers of people with chronic illness of the Andean, Pacific, Caribbean and Amazon regions in Colombia. Informed consent process was performed. Data were collected with the Caring Ability Inventory of Nkonghoy and with the Zarit Caregiver Burden Interview. The statistical approach was done with the Spearman Rho test. Results : In Colombia and in its Amazonic and Pacific regions, a weak negative statistically significant correlation (p <0.01) was observed. In the Caribbean Region, a moderate and statistically significant negative correlation (p <0.01). In the Andean region, no connection between the ability of care and caregiver burden was found. Conclusion: A weak but statistically significant relationship between the ability of care and caregiver burden was found in Colombia, except in the Andean region were no correlation was founded. Interventions in strengthening the ability of care, could be useful in decreasing caregivers burden with care(AU)

An index predictive of cognitive outcome in retired professional American Football players with a history of sports concussion.

OBJECTIVE: Various concussion characteristics and personal factors are associated with cognitive recovery in athletes. We developed an index based on concussion frequency, severity, and timeframe, as well as cognitive reserve (CR), and we assessed its predictive power regarding cognitive ability in retired professional football players. METHOD: Data from 40 retired professional American football players were used in the current study. On average, participants had been retired from football for 20 years. Current neuropsychological performances, indicators of CR, concussion history, and play data were used to create an index for predicting cognitive outcome. RESULTS: The sample displayed a range of concussions, concussion severities, seasons played, CR, and cognitive ability. Many of the participants demonstrated cognitive deficits. The index strongly predicted global cognitive ability (R(2) = .31). The index also predicted the number of areas of neuropsychological deficit, which varied as a function of the deficit classification system used (Heaton: R(2) = .15; Wechsler: R(2) = .28). CONCLUSIONS: The current study demonstrated that a unique combination of CR, sports concussion, and game-related data can predict cognitive outcomes in participants who had been retired from professional American football for an average of 20 years. Such indices may prove to be useful for clinical decision making and research.

Low serum levels of alpha1 anti-trypsin (α1-AT) and risk of airflow obstruction in non-primary α1-AT-deficient patients with compensated chronic liver disease.

BACKGROUND: Alpha1 anti-trypsin (α1-AT), a serine protease inhibitor synthesized in the liver, is a major circulating antiprotease that provides defense against proteolytic damage in several tissues. Its deficiency is associated with airflow obstruction. The present study aimed to explore the role of α1-AT as a biomarker of airflow performance in chronic liver disease (CLD). MATERIAL/METHODS: Serum α1-AT levels and lung function (spirometry) were evaluated in non-primary α1-AT-deficient, alcoholic CLD patients without evident respiratory limitations. RESULTS: Thirty-four patients with airflow obstruction (n=11), airflow restriction (n=12), and normal airflow (n=11, age-matched controls) were eligible. α1-AT was decreased in the airflow obstruction group. ROC-cutoff α1-AT=24 mg/dL effectively discriminated airflow obstruction (AUC=0.687) and was associated with a 10-fold higher risk (p=0.0007). CONCLUSIONS: Lower α1-AT increased the risk of airflow obstruction in CLD patients without primary α1-AT deficiency.

Congenital melanocytic nevus: two clinicopathological forms.

Congenital melanocytic nevus (CMN) is a hamartomatous disease for which many attempts at classification have been proposed. This disease is relevant not only because of its functional and esthetic implications but also because it is a well-documented precursor to malignant melanoma. We performed a clinical and pathological prospective study of 200 cases of CMN and were able to identify 2 different forms of CMN, each one with biological, clinical, and histopathological features and criteria that are consistent and repeatable. We propose to name them types I and II. Type I CMN is the most common, usually, if not always, a single lesion, it consists of a plaque that involves only 1 anatomic region and does not go beyond it; type I CNM grows in proportion to the growth of the child, melanoma rarely develops from it, and when it does it usually arises at the dermoepidermal junction. Its histopathology shows cords, strands, nests, and single units of melanocytes spreading between collagen bundles only in the dermis and frequently the epidermis too, but without trespassing to the hypodermis, that is, it is superficial. Type II CMN is always made up of many lesions, one of them being very large and surrounded by many lesions; histopathologically, it involves not only the skin but also deeper structures, sometimes bone and central nervous system; therefore, it is deep; when melanoma develops, it does in the dermal component and usually from the largest plaque. This type of CMN is the one that develops neurocutaneous melanocytosis. This system is not only easy and logical but it also has biologic advantages and the clinical-pathological correlation and criteria are repeatable by clinicians and pathologists.

Soporte social a cuidadores familiares de personas con enfermedad crónica en Cartagena / Social Support for Family Caregivers of Chronically Ill Persons in Cartagena / Suporte social para cuidadores familiares de pessoas com doença crônica em Cartagena

Objetivo: determinar el soporte social percibido en cuidadores familiares de personas con enfermedad crónica en la ciudad de Cartagena, Colombia. Método: estudio descriptivo en 222 cuidadores de familiares, entre octubre de 2009 y octubre 2010; se utilizó el instrumento "inventario" de soporte social en enfermedad crónica, propuesto por Hilbert, integrado por cinco categorías. Los datos se expresan por medio de la estadística descriptiva. Resultados: el 91.4% de los cuidadores son mujeres, 54,35% con edades comprendidas entre los 36 y 59 años y una edad promedio de 43,7 años. Los cuidadores presentaron una percepción de apoyo social satisfactoria, con una media de 148.97 y una desviación estándar de 33.94, la puntuación mínima obtenida fue de 35 puntos, la máxima de 204. En mayor proporción el apoyo a los cuidadores fue brindado por los hermanos (24%), la pareja (22,2%) y los hijos (17.6%). Conclusión: los cuidadores están satisfechos con el apoyo social percibido, especialmente en las categorías: "interacción personal" y "educación e información", recibida por quienes integran su red. Se requieren propuestas innovadoras desde la enfermería para apoyar a las personas en situación de enfermedad crónica y sus cuidadores.

Objective: Determine the social support perceived by family caregivers of chronically ill persons in the city of Cartagena, Colombia. Method: A descriptive study of 222 persons serving, during the period from October 2009 to October 2010, using the social support in chronic illness "inventory" tool proposed by Hilbert, which consists of five categories. The data are expressed through descriptive statistics. Results: 91.4% of the caregivers are women, 54.35% are between 36 and 59 years of age, and their average age is 43.7 years. The caregivers displayed a satisfactory perception of the social support they receive, with a mean of 148.97 and a standard deviation of 33.94. The lowest score was 35 points and the highest was 204. The most support for caregivers was provided by their siblings (24%),spouses (22.2%) and sons and daughters (17.6%). Conclusion: Caregivers are satisfied with their perceived social support, especially in the categories of "personal interaction" and "education and information" received from those who make up their network. Innovative proposals from nursing are required to support chronically ill persons and their caregivers.

Objetivo: determinar o suporte percebido em cuidadores familiares de pessoas com doença crônica na cidade de Cartagena, Colômbia. Método: estudo descritivo, em 222 cuidadores familiares durante outubro de 2009 a outubro de 2010. Utilizou-se o instrumento "inventário" de suporte social em doença crônica, proposto por Hilbert, integrado por cinco categorias. Os dados se expressam por meio da estatística descritiva. Resultados: 91,4% dos cuidadores são mulheres; 54,35% com idade compreendida entre 36 e 59 anos e uma idade média de 43,7 anos. Os cuidadores apresentaram uma percepção de apoio social satisfatória, com uma média de 148,97 e uma desviaçao padrão de 33,94; a pontuação mínima obtida foi de 35 pontos, e a máxima de 204. Em maior proporção, o apoio aos cuidadores foi oferecido pelos irmãos (24%), pelo companheiro (22,2%) e pelos filhos (17,6%). Conclusão: os cuidadores estão satisfeitos com o apoio social percebido, especialmente nas categorias "interação pessoal" e "educação e informação", recebida pelos que integram sua rede. Requerem-se propostas inovadoras da enfermagem para apoiar as pessoas em situação de doença crônica e seus cuidadores.

La bibliografía médica cubana antes y después de 1959 / The Cuban medical literature before and after 1959

Se realiza una revisión bibliográfica acerca de la bibliografía médica cubana antes y después del 1959 en el Policlínico Universitario Emilio Daudinot Bueno, con el objetivo de brindar a los estudiantes de Gestión de la Información en Salud una fuente de conocimientos a través de la historia de las personalidades médicas cubanas (AU)

The long-term health and economic benefits of DOTS implementation in Ecuador.

BACKGROUND: Between April 2001 and March 2004, the Directly Observed Therapy-Short course (DOTS) program was successfully implemented by the National Tuberculosis control program, with assistance from the Canadian Lung Association, in three provinces of Ecuador, where 52% of the population of the country reside. METHODS: Markov modelling was used to project TB-related morbidity, mortality and costs if the former TB control program (status quo) had continued or if the newly expanded DOTS program is maintained over 20 years. Extensive sensitivity analyses were used to determine the effect on projected outcomes of varying key assumptions. RESULTS: If DOTS is maintained over the next 20 years, we predict that 18,760 cases and 15,812 TB-related deaths will be prevented, resulting in societal savings of dollars 203 million and government savings of dollars 7.1 million (all costs in dollars US). These findings were robust in extensive sensitivity analyses. Given the initial investment of dollars 3 million for DOTS implementation, this would mean a cost of dollars 190 per life saved. CONCLUSIONS: Implementation of DOTS could yield very substantial public health and economic benefits for Ecuador. These results demonstrate the benefits from Canadian government support for DOTS implementation in low- and middle-income countries.

Peripheral muscle composition and health status in patients with COPD.

STUDY OBJECTIVE: The present study evaluated the relationship between health status (HS) and peripheral muscle histochemical characteristics in chronic obstructive pulmonary disease (COPD), and identified selected independent respiratory and extrapulmonary variables that predicted the HS of these patients. DESIGN: Cross-sectional study. SETTING: Outpatient respiratory clinic of a university hospital. PATIENTS AND METHODS: We studied 29 patients (63+/-10 yrs) with a forced expiratory volume in 1s (FEV1) of 39+/-12%. All patients underwent vastus lateralis muscle biopsies for histochemical analysis. They also had spirometry, arterial blood gas analysis, body mass index (BMI), dyspnea determined with the MMRC scale and responded to the St. George's Respiratory Questionnaire (SGRQ) for HS assessment. RESULTS: SGRQ total score correlated with fiber type distribution. A stepwise multiple regression identified three independent predictors of SGRQ total score: type I fiber proportion, BMI, and FEV1; r = 0.78 and r2 = 0.61. CONCLUSIONS: These results indicate that impaired HS in COPD is related to the peripheral muscle changes characterized by less type I fibers proportion. The findings argue in favor of an important contribution of the systemic consequences on the HS in COPD independently from the airflow limitation severity, and help to explain the observation of the poor correlation between the degree of airflow limitation and SGRQ total score.