Effect of Self-transcendence, Self-distancing, and Family Functionality on Self-care Agency in Older Adults.

Objective: To determine the effect of self-distancing, self-transcendence, and family functioning on self-care agency in Mexican older adults. Methods: Correlational-explanatory design, with a sample of 253 elderly, collecting data through a simple random sampling. A personal data questionnaire was applied, the scale of: self-transcendence, the self-distancing subscale, the family APGAR and the ability to self-care in Mexican population from different demographic groups. Descriptive and inferential statistics were applied (Mann-Whitney U and a structural equation model) and the study was approved by a registered ethics committee. Results: The study had participation from 253 elderly, with a mean age of 68.02 years, with prevalence of the female sex (60.1%); the level of education was primary school or lower (51.4%). It was observed that the group of chronic diseases had lower self-distancing (U = 4.449.5, p = 0.038) and greater self-transcendence (U = 4177.0, p = 0.008), and selfcare (U = 4365.5, p = 0.024) than the group without chronic diseases. It was also found that self-transcendence, self-distancing, and family functionality produce a positive effect of 37% on selfcare. Conclusion: Self-distancing, self-transcendence, and family functionality explain an important proportion of selfcare in the elderly. Said knowledge permits understanding the care behavior of the elderly and, thus, propose future educational interventions by nursing to prevent or avoid functional, cognitive loss and social effects.

Effect of Self-transcendence, Self-distancing, and Family Functionality on Self-care Agency in Older Adults / Efecto de la autotrascendencia, autodistanciamiento y funcionalidad familiar en la agencia de autocuidado en adultos mayores / Efeito da autotranscendência, do autodistanciamento e da funcionalidade familiar na agência do autocuidado em idosos

Objective. To determine the effect of self-distancing, self-transcendence, and family functioning on self-care agency in Mexican older adults. Methods. Correlational-explanatory design, with a sample of 253 elderly, collecting data through a simple random sampling. A personal data questionnaire was applied, the scale of: self-transcendence, the self-distancing subscale, the family APGAR and the ability to self-care in Mexican population from different demographic groups. Descriptive and inferential statistics were applied (Mann-Whitney U and a structural equation model) and the study was approved by a registered ethics committee. Results.The study had participation from 253 elderly, with a mean age of 68.02 years, with prevalence of the female sex (60.1%); the level of education was primary school or lower (51.4%). It was observed that the group of chronic diseases had lower self-distancing (U = 4.449.5, p = 0.038) and greater self-transcendence (U = 4177.0, p = 0.008), and selfcare (U = 4365.5, p = 0.024) than the group without chronic diseases. It was also found that self-transcendence, self-distancing, and family functionality produce a positive effect of 37% on selfcare. Conclusion. Self-distancing, self-transcendence, and family functionality explain an important proportion of selfcare in the elderly. Said knowledge permits understanding the care behavior of the elderly and, thus, propose future educational interventions by nursing to prevent or avoid functional, cognitive loss and social effects.

Objetivo. Determinar el efecto del autodistanciamiento, autotrascendencia y funcionamiento familiar sobre la agencia de autocuidado en adultos mayores mexicanos. Métodos. Diseño correlacional-explicativo, con una muestra de 253 adultos mayores, recolectado mediante un muestreo aleatorio simple. Se aplicó un cuestionario de datos personales, la escala de: autotrascendencia, la subescala de autodistanciamiento, el APGAR familiar y la capacidad de autocuidado en población mexicana de diferentes grupos demográficos. Se aplicó estadística descriptiva e inferencial (U de Mann-Whitney y un modelo de ecuación estructural) y contó con la aprobación de un comité de ética registrado. Resultados. Participaron 253 adultos mayores, con una media de 68.02 años, predominó el sexo femenino (60.1 %) y el grado de estudio de primaria o menor (51.4 %). Se observó que el grupo de enfermedades crónicas tuvo menor autodistanciamiento (U = 4.449,5, p = 0.038) y mayor autotrascendencia (U = 4.177,0, p = 0,008) y autocuidado (U = 4.365,5, p = 0.024) que el grupo sin enfermedades crónicas. También se encontró que la autotrascendencia, autodistanciamiento y funcionalidad familiar producen un efecto positivo de un 37 % sobre el autocuidado. Conclusión. El autodistanciamiento, autotrascendencia y la funcionalidad familiar explican una importante proporción del autocuidado en los adultos mayores. Dicho conocimiento permite entender la conducta del cuidado del adulto mayor y de esta manera proponer a futuro intervenciones educativas por enfermería con miras a prevenir o evitar la pérdida funcional, cognitiva y afectaciones sociales.

Objetivo. Determinar o efeito do autodistanciamento, da autotranscendência e do funcionamento familiar na capacidade de autocuidado em idosos mexicanos. Métodos. Desenho correlacional-explicativo, com amostra de 253 idosos, coletada por meio de amostragem aleatória simples. Aplicou-se um questionário de dados pessoais, a escala de autotranscendência, a subescala de autodistanciamento, o APGAR familiar e a capacidade de autocuidado na população mexicana de diferentes grupos demográficos. Estatísticas descritivas e inferenciais (U de Mann-Whitney e modelo de equações estruturais) foram aplicadas e tiveram aprovação de um comitê de ética registrado. Resultados. Participaram 253 idosos, com idade média de 68.02 anos, predominou o sexo feminino (60.1%) e o nível de escolaridade era fundamental ou inferior (51.4%). Observou-se que o grupo com doenças crônicas apresentou menor autodistanciamento (U=4.449.5, p=0.038) e maior autotranscendência (U=4177.0, p=0.008) e autocuidado (U=4365.5, p= 0.024) que o grupo sem doenças Crônicas. Verificou-se também que a autotranscendência, o autodistanciamento e a funcionalidade familiar produzem um efeito positivo de 37% no autocuidado. Conclusão. O autodistanciamento, a autotranscendência e a funcionalidade familiar explicam uma proporção importante do autocuidado em idosos. Esse conhecimento permite compreender o comportamento de cuidar do idoso e desta forma propor futuras intervenções educativas pela enfermagem com vistas a prevenir ou evitar perdas funcionais, cognitivas e efeitos sociais.

Myocardial Strain for the Differentiation of Myocardial Involvement in the Post-Acute Sequelae of COVID-19-A Multiparametric Cardiac MRI Study.

Myocardial involvement was shown to be associated with an unfavorable prognosis in patients with COVID-19, which could lead to fatal outcomes as in myocardial injury-induced arrhythmias and sudden cardiac death. We hypothesized that magnetic resonance imaging (MRI) myocardial strain parameters are sensitive markers for identifying subclinical cardiac dysfunction associated with myocardial involvement in the post-acute sequelae of COVID-19 (PASC). This study evaluated 115 subjects, including 65 consecutive COVID-19 patients, using MRI for the assessment of either post-COVID-19 myocarditis or other cardiomyopathies. Subjects were categorized, based on the results of the MRI exams, as having either 'suspected' or 'excluded' myocarditis. A control group of 50 matched individuals was studied. Along with parameters of global cardiac function, the MRI images were analyzed for measurements of the myocardial T1, T2, extracellular volume (ECV), strain, and strain rate. Based on the MRI late gadolinium enhancement and T1/T2/ECV mappings, myocarditis was suspected in 7 out of 22 patients referred due to concern of myocarditis and in 9 out of 43 patients referred due to concern of cardiomyopathies. The myocardial global longitudinal, circumferential, and radial strains and strain rates in the suspected myocarditis group were significantly smaller than those in the excluded myocarditis group, which in turn were significantly smaller than those in the control group. The results showed significant correlations between the strain, strain rate, and global cardiac function parameters. In conclusion, this study emphasizes the value of multiparametric MRI for differentiating patients with myocardial involvement in the PASC based on changes in the myocardial contractility pattern and tissue structure.

Real-Time Strain-Encoding Cardiovascular MRI for Assessment of Regional Heart Function in Tetralogy of Fallot Patients.

BACKGROUND: Tetralogy of Fallot (ToF) is the most common form of cyanotic congenital heart disease, where right ventricular (RV) function is an important determinant of subsequent intervention. OBJECTIVE: In this study, we evaluate the feasibility of fast strain-encoding (fastSENC; a one-heartbeat sequence) magnetic resonance imaging (MRI) for assessing regional cardiac function in ToF. METHOD: FastSENC was implemented to characterize regional circumferential (Ecc) and longitudinal (Ell) strains in the left ventricle (LV) and RV in post-repair ToF. Data analysis was conducted to compare strain measurements in the RV to those in the LV, as well as to those generated by the MRI Tissue-Tracking (MRI-TT) technique, and to assess the relationship between strain and ejection fraction (EF). RESULTS: Despite normal LVEF (55±8.5%), RVEF was borderline (46±6.4%), but significantly lower than LVEF. RV strains (RV-Ell=-20.2±2.9%, RV-Ecc=-15.7±6.4%) were less than LV strains (LV-Ell=-21.7±3.7%, LV-Ecc=-18.3±4.7%), and Ell was the dominant strain component. Strain differences between fastSENC and MRI-TT were less significant in RV than in LV. There existed moderate and weak correlations for RV-Ecc and RV-Ell, respectively, against RVEF. Compared to LV strain, RV strain showed regional heterogeneity with a trend for reduced strain from the inferior to anterior regions. Inter-ventricular strain delay was larger for Ell (64±47ms) compared to Ecc (36±40ms), reflecting a trend for contraction dyssynchrony. CONCLUSION: FastSENC allows for characterizing subclinical regional RV dysfunction in ToF. Due to its sensitivity for evaluating regional myocardial contractility patterns and real-time imaging capability without the need for breath-holding, fastSENC makes it more suitable for evaluating RV function in ToF.

Comportamiento planificado para la práctica de ejercicio físico en un adulto mayor en tiempos de COVID-19 / Planned Exercise Behavior in an Older Adult in Times of COVID-19

Introducción: El cuerpo del ser humano está creado para estar en activación constante. Sin embargo, las conductas sedentarias en las personas adultas mayores son cada vez más comunes. Lo anterior es preocupante, ya que este grupo etario tiene la creencia de que al llegar a esa etapa de su vida no se debe realizar ejercicio físico, a pesar de que esta necesidad no disminuye con el paso de los años. Objetivo: Describir las vivencias del comportamiento planificado para la práctica de ejercicio físico en un adulto mayor durante la pandemia de la COVID-19. Métodos: Estudio de caso único con abordaje fenomenológico, el referente utilizado fue la fenomenología de la percepción de Maurice Merleau-Ponty, bajo la perspectiva de la teoría comportamiento planificado. Se realizó una entrevista a profundidad. Para el análisis cualitativo de la información se utilizó el referente propuesto por Taylor-Bogdan. Resultados: Se obtuvieron tres categorías y ocho subcategorías, se definieron con base al fenómeno de estudio seleccionado, la teoría del comportamiento planificado: Experiencia al ejercicio; Control percibido; Norma subjetiva. Conclusiones: La experiencia de practicar ejercicio físico en la vejez es vivida con una actitud positiva; sin embargo, esta se tornó negativa, porque debido a la pandemia por COVID-19 fue obligatorio interactuar a través de la tecnología para poder realizar ejercicio físico(AU)

Introduction: The human body is created to be in constant activation. However, sedentary behaviors in older adults are increasingly common. This is worrisome, since this age group has the belief that when they reach this stage of their life they should not do physical exercise, even though this need does not diminish with the passing of the years. Objective: To describe the experiences of planned physical exercise behavior in an older adult during the COVID-19 pandemic. Methods: Single case study with phenomenological approach, the reference used was Maurice Merleau-Ponty's phenomenology of perception, under the perspective of the planned behavior theory. An in-depth interview was conducted. For the qualitative analysis of the information, the referent proposed by Taylor-Bogdan was used. Results: Three categories and eight subcategories were obtained, they were defined based on the selected study phenomenon, the theory of planned behavior: experience to exercise; perceived control; subjective norm. Conclusions: The experience of practicing physical exercise in old age is lived with a positive attitude; however, this became negative, because due to the pandemic by COVID 19 it was mandatory to interact through technology to be able to perform physical exercise(AU)

Calidad de vida en adultos mayores cuidadores de nietos del norte y suroeste de México / Quality of life in older caregivers of grandchildren in northern and southwestern Mexico

Objetivo: Determinar la relación de las características personales con la calidad de vida en adultos mayores cuidadores de nietos del norte y suroeste de México. Métodos: Descriptivo-correlacional y comparativo, con una muestra de 326 adultos mayores cuidadores de nietos, recolectado mediante muestreo a conveniencia y que cumpla con los criterios de inclusión. Se aplicó una cedula de datos personales y la escala de Calidad de Vida Autopercibida en Adultos Mayores en Comunidad (α=0.93). Los datos se analizaron con estadística descriptiva e inferencial como pruebas de U de Mann-Whitney, Chi cuadrada y Spearman. Contó con la aprobación del Comité de ética, acatándose los reglamentos nacionales e internacionales. Resultados: La población tuvo una de M=68.56 años, siendo el 54.9% hombre y el 45.1% mujer, con una de M=9.10 horas del cuidado del nieto. Se halló asociación de la calidad de vida con la zona geográfica de México (Chi=35.695, p<0.05). Se observó relación de la edad (r=-0.155) y el número de hijos (r=-0.279) con la calidad de vida. Conclusiones: Se observó que, a mayor edad y número de hijos, menor calidad de vida. De igual manera, la calidad de vida se asocia con la zona geográfica. Se recomienda prestar atención en la salud física, psicológica y social de este grupo vulnerable. (AU)

Objective: Determine the relationship of personal characteristics with the quality of life in elderly people who care for their grandchildren from northern and southwestern Mexico. Method: Descriptive-correlational and comparative method, using a sample of 326 older adults who take care of their grandchildren; this sample was collected through convenience sampling and making sure that people met the inclusion criteria. A personal data card and the self-perceived quality of life scale were applied in elderly people in the community (α=0.93). The data were analyzed with descriptive and inferential statistics such as U Mann-Whitney, Chi Square, and Spearman tests. It was approved by the Ethics Committee, in compliance with national and international regulations. Results: The population had an M of 68.56 years, being 54.9% male and 45.1% female, with one M of 9.10 hours of care of the grandchild. The association of quality of life with the geographical area of Mexico was found (Chi=35,695, p<0.05). The relationship between age (r=-0,155) and number of children (r=-0,279) and quality of life was seen. Conclusions: It was seen that the older the age and number of children, the lower the quality of life. Similarly, quality of life is associated with the geographical area. It is recommended that care be given within physical, psychological, and social health of this vulnerable group. (AU)

Factores conductuales y biológicos que influye sobre el riesgo de pie diabético en adultos en etapa de prevejez y vejez

Objetivo: Determinar la influencia de los factores conductuales y biológicos sobre el riesgo para pie diabético en adultos etapa de prevejez y vejez que asisten a grupos de ayuda mutua. Material y métodos: Correlacional-predictivo, con una muestra de 105 personas seleccionado por muestreo a conveniencia en grupos de ayuda mutua de tres municipios de Coahuila, México. Se aplicó una cédula de datos personales, el instrumento IMEVID (α=.81), la escala EBADE (α =.78), la recolección de medidas antropométricas, biomarcadores metabólicos y se realizó la valoración de riesgo para pie diabético. Se aplicó estadística descriptiva, correlación de spearman y modelos de regresión. Resultados: Participaron 87 (82.9 %) mujeres y 18 (17.1 %) hombres con una M= 62.60 años (DE=10.330) años. El riesgo para pie diabético se relacionó con las barreras de autocuidado en diabetes (r=.224, p<0.5) y el índice de masa corporal (r=.255, p<0.5). El modelo predice un 19.6 % el riesgo (F=6.803, R 2 =19.6, p=0.001), siendo las variables predictoras las barreras de autocuidado en diabetes, el colesterol de baja densidad y el índice de masa corporal. Conclusión: Los factores conductuales y biológicos predicen el aumento del riesgo para pie diabético, por lo que nos da una valoración general de salud de los grupos de ayuda mutua de México.

Objective. To determine the influence of behavioral and biological agents on the risk for diabetic foot in adult stages of pre and old age who attend mutual aid groups. Material and methods: Correlational-predictive, with a sample of 105 people collected by convenience in mutual aid groups from three counties of Coahuila, Mexico. A personal data card, the IMEVID instrument (α = .81), the EBADE scale (α = .78), the collection of anthropometric measurements, metabolic biomarkers were applied and the risk assessment for diabetic foot was performed. Descriptive statistics, spearman correlation and regression models were applied. Results: 87 (82.9%) women and 18 (17.1%) men participated with an M = 62.60 years (SD = 10,330) years. The risk for diabetic foot was related to the barriers to self-care in diabetes (r = .224, p <0.5) and the body mass index (r = .255, p <0.5). The model predicts the risk of 19.6% (F = 6.803, R2 = 19.6, p = 0.001), the predictor variables being the barriers to self-care in diabetes, low-density cholesterol and the body mass index. Conclution: Behavioral and biological factors predict the increased risk for diabetic foot, so it gives us a general assessment of the health of mutual aid groups in Mexico.

Myocardial Contractility Pattern Characterization in Radiation-Induced Cardiotoxicity Using Magnetic Resonance Imaging: A Pilot Study with ContractiX.

Radiation therapy (RT) plays an integral role in treating thoracic cancers, despite the risk of radiation-induced cardiotoxicity. We hypothesize that our newly developed magnetic resonance imaging (MRI)-based contractility index (ContractiX) is a sensitive marker for early detection of RT-induced cardiotoxicity in a preclinical rat model of thoracic cancer RT. Adult salt-sensitive rats received image-guided heart RT and were imaged with MRI at 8 weeks and 10 weeks post-RT or sham. The MRI exam included cine and tagging sequences to measure left-ventricular ejection fraction (LVEF), mass, myocardial strain, and ContractiX. Furthermore, ventricular torsion, diastolic strain rate, and mechanical dyssynchrony were measured. Statistical analyses were performed between the sham, 8 weeks post-RT, and 10 weeks post-RT MRI parameters. The results showed that both LVEF and myocardial mass increased post-RT. Peak systolic strain and ContractiX significantly decreased post-RT, with a more relative reduction in ContractiX compared to strain. ContractiX showed an inverse nonlinear relationship with LVEF and continuously decreased with time post-RT. While early diastolic strain rate and mechanical dyssynchrony significantly changed post-RT, ventricular torsion changes were not significant post-RT. In conclusion, ContractiX measured via non-contrast MRI is a sensitive early marker for the detection of subclinical cardiac dysfunction post-RT, and it is superior to other MRI cardiac measures.

Análisis confirmatorio de la Escala de Autoevaluación Breve de Bienestar y Autonomía en Adultos Mayores de Coahuila y Yucatán, México / Confirmatory Analysis of the Short Self-Assessment of Wellbeing and Autonomy Scale in Older Adults in Coahuila and Yucatán, Mexico

Resumen El objetivo de este trabajo fue realizar un Análisis Factorial Confirmatorio de la Escala de Bienestar y Autonomía específica para adultos mayores en dos muestras mexicanas, lo que permitió determinar la validez del constructo medido. Se utilizó un diseño cuantitativo, transversal con alcances explicativos. Se analizó una muestra incidental de 895 adultos mayores, de los cuales 59.8 % eran habitantes de la ciudad de Saltillo, Coahuila, México y 40.2 % de Tizimín, Yucatán, México. Se utilizó la Escala de Autoevaluación Breve de Bienestar y Autonomía para Adultos Mayores. Se procesó el Análisis Factorial Exploratorio, Paralelo y Confirmatorio con el método de Mínimos Cuadrados Generalizados, además de obtener la confiabilidad y los estadísticos descriptivos de las dimensiones. La estructura que se identificó presentó indicadores de ajuste estadístico adecuado. Originalmente, la estructura consideraba dos dimensiones: la autonomía y el bienestar, sin embargo, los resultados mostraron la separación en tres dimensiones de la medición de bienestar.

Abstract The objective of this work was to carry out a Confirmatory Factorial Analysis of the Scale of Wellbeing and Specific Autonomy for Older Adults in two Mexican samples, which allowed to establish the validity of the measured construct. A quantitative, transversal design with explanatory scopes was used. An incidental sample of 895 aging adults was obtained, from which 59.8% were inhabitants of the Saltillo city, Coahuila, Mexico, and 40.2%, of Tizimín city, Yucatán, Mexico. We used the Short SelfAssessment of Wellbeing and Autonomy for Older Adults. The Exploratory, Parallel and Confirmatory Factor Analysis was processed with the Generalized Least Squares Method, in addition to obtaining the reliability and descriptive statistics of dimensions. The identified structure showed adequate statistical adjustment indicators. Initially, the structure considered two dimensions: autonomy and wellbeing; however, the results showed the separation in three dimensions of the wellbeing measurement.

Riesgo de diabetes de una comunidad rural en México: un estudio observacional / Diabetes Risk in a Rural Community in Mexico: an Observational Study

Introducción. La rápida transición del medio rural a la adopción de hábitos alimenticios de zonas urbanas, el sedentarismo, las dificultades de acceso a la salud, ponen a la población en mayor riesgo de desarrollo de diabetes, sin embargo, son pocos los estudios que se enfocan en este fenómeno a nivel rural. Conocer el riesgo permite identificar las áreas problemáticas y revertir la situación a través de modelos de atención para esta población. El objetivo de este estudio fue describir los factores de riesgo presentes en una comunidad rural de Guanajuato. Material y Métodos: Estudio descriptivo, observacional, transversal; muestra no probabilística de 164 personas sin diabetes, se calculó con Epidat 3.1, intervalo de confianza al 95%, precisión del 3%; se aplicó el Cuestionario de Factores de Riesgo para la Diabetes Mellitus. Para la colecta se hizo un recorrido de casa por casa hasta completar la muestra, para el análisis estadístico se utilizó la chi cuadrada y cálculo de odds ratio. Resultados: El 71%(117) de la población fueron mujeres; el promedio para la edad fue de 43 años; el 85% de los sujetos presentaron un alto riesgo de padecer diabetes; los tres principales factores de riesgo fueron: 57.9% (95) con sobrepeso y obesidad, el 77.4%(127) de la muestra con cintura superior al parámetro recomendado, 75.6% (124) de la muestra presentó antecedentes heredofamiliares; en cuestión de género las mujeres presentaron 3 veces más riesgo de diabetes (p=<.05). Conclusión: Los entornos rurales muy contrario a lo que se observaba, tienen alto riesgo de desarrollo de diabetes, probablemente va de la mano con los cambios de hábitos de las comunidades, pues la industrialización las ha invadido, con todo lo que conlleva, como lo señala Moreno L

Polimorfismos asociados con la susceptibilidad para pie diabético: una revisión integrafiva / Polymorphism associated with diabetic foot susceptibility: a integrative review

INTRODUCCIÓN: La presencia del pie diabético es una complicación frecuente en la persona que vive con diabetes. En su etiopatogenia confluyen factores conductuales, ambientales y el control de la enfermedad; no obstante, se reconoce la influencia de factores genéticos en su desarrollo y evolución. OBJETIVO: Sistematizar la asociación de los polimorfismos genéticos como riesgo para el desarrollo de pie diabético a través de la producción científica indexada. METODOLOGÍA: Revisión bibliográfica de los años 2010 a 2018; se realizó mediante la búsqueda sistemática en las bases de datos PubMed, Scopus, CONRICYT y WOS. Los descriptores fueron tres: "polymorphism" AND "diabetic foot" OR "foot ulcer diabetic". Se incluyeron artículos a texto completo en inglés con metodología de casos y controles, y que midieran estadísticamente factores de riesgo mediante la odds ratio y los riesgos relativos. Se utilizó la plataforma FLC 2.0 para evaluar la calidad del estudio. RESULTADOS: 13 artículos cumplieron con los criterios de inclusión; se identificaron 9 polimorfismos como factores para la aparición de pie diabético: HIF-1α, MCP-1-2518A/G, TLR9-1237 T/C, MAPK14 rs80028505, LOX G473A, gen FokI del receptor VDR, MMPs-1562C>T, TCF7L2, HIF-1α p582s y 4 como factores protectores: VEGF rs699947, VEGF-634G/C, eNOS Glu298Asp y VEGF 2578 C/A. CONCLUSIÓN: La susceptibilidad, gravedad y aparición del pie diabético está asociado con factores genéticos implicados en distintos mecanismos fisiopatológicos

INTRODUCTION: Diabetic foot is a frequent complication in patients with diabetes. The risk factors associated with its development and evolution are related to the behavioral, environmental and disease control characteristics, however, the influence of genetic factors in the development of this complication has been recognized. OBJECTIVE: To analyze the available evidence on the association of genetic polymorphisms in the risk of presenting diabetic foot. METHODOLOGY: Articles were reviewed in English, not older than 10 years, with a methodology of cases and controls that statistically measure risk factors through odds ratio and relative risk. Therefore the search was performed in databases such as PubMed, Scopus, CONRICYT and WOS with maximum date until January 31, 2018. Controlled descriptors "polymorphism" AND "diabetic foot" OR "foot ulcer diabetic" were applied. The FLC 2.0 platform was used to evaluate the quality of the study. RESULTS: Thirteen articles were selected, there being 9 polymorphisms with risk factors such as HIF-1α, MCP-1-2518A/G, TLR9-1237 T/C, MAPK14 rs80028505, LOX G473A, FokI gene of the VDR receptor, MMPs-1562C>T, TCF7L2, HIF-1α p582s and 4 protective factors such as VEGF rs699947, VEGF-634G/C, eNOS Glu298Asp and VEGF 2578 C/A. CONCLUSION: The susceptibility, severity and appearance of diabetic foot they are associated with genetic factors that are involved in different physiopathological mechanisms

Factores de riesgo de Bronquiolitis en pacientes menores de 2 años

Resumen Introducción: Se estima que a nivel mundial, cada año alrededor del 10% de los lactantes tienen bronquiolitis. Se produce un pico entre los 2 y los 6 meses de edad. Objetivo: Determinar los factores de riesgo de bronquiolitis en menores de dos años que consultaron al servicio de Pediatría del Instituto de Medicina Tropical entre el 2018 y 2019. Método: Estudio de tipo descriptivo, transversal en el que se incluyeron pacientes menores de 2 años internados en el Servicio de Pediatría del Instituto de Medicina Tropical de enero de 2018 a febrero de 2019 con diagnóstico de bronquiolitis en el que se analizaron los factores de riesgo de la enfermedad. Resultados: Se estudió una población de 38 pacientes que presentaron bronquiolitis antes de los 2 años, 19 fueron niños (50%) La edad media al ingreso fue de 3,5 ± 2,8 meses (límites, 1-10 meses). No se han encontrado datos de tabaco en el embarazo. Se detectó VRS en el aspirado nasofaríngeo de 8 niños (21%), la detección viral fue negativa en 14 niños (37%) y no se realizó la determinación en 18 casos (47%). Los siguientes factores de riesgo se asociaron de forma independiente con la bronquiolitis: Asma de los padres, infección por VSR, sibilancia, cianosis y hacinamiento. Los factores de riesgo estudiado, exposición al tabaco, sexo, edad en el momento de la bronquiolitis o lactancia materna exclusiva, no se asociaron con el ingreso a UTI de los pacientes con bronquiolitis. Conclusión: Hemos encontrado factores de riesgo asociado relacionados al huésped como asma de los padres, y otros como sibilancia, cianosis, hacinamiento e infección por VRS.

Abstract Introduction: It is estimated that globally, each year around 10% of infants have bronchiolitis. A peak occurs between 2 and 6 months of age Objective: To determine the risk factors of bronchiolitis in children less than two years of age who admitted at the pediatric service of the Institute of Tropical Medicine between 2017 and 2019 Method: A descriptive, cross-sectional study in which patients under 2 years of age admitted to the Pediatric Service of the Institute of Tropical Medicine from January 2018 to February 2019 were included with a diagnosis of bronchiolitis in which the risk factors of the disease were analyzed. Results: We studied a population of 38 patients who presented bronchiolitis before 2 years, 19 were children (50%) The average age at admission was 3.5 ± 2.8 months (range, 1-10 months). No tobacco data were found in pregnancy. RSV was detected in the nasopharyngeal aspirate of 8 children (21%), viral detection was negative in 14 children (37%) and the determination was not made in 18 cases (47%). The following risk factors were independently associated with bronchiolitis: Asthma of the parents, RSV infection, wheezing, cyanosis and overcrowding. The risk factors studied exposure to tobacco, sex, age at the time of bronchiolitis or exclusive breastfeeding were not associated with admission to the ICU of patients with bronchiolitis. Conclusion: We have found associated risk factors related to the host such as asthma of the parents, and others such as wheezing, cyanosis, overcrowding and RSV infection.

Características clínicas y de laboratorio en pacientes pediátricos ambulatorios con Fiebre Dengue

RESUMEN Introducción: La fiebre dengue (FD) ha representado en nuestro país una de las causas más frecuentes de consulta en la última década. Objetivos: Describir las características clínicas y de laboratorio de los pacientes con dengue observados en la unidad de atención ambulatoria de un centro de referencia. Materiales y Métodos: Se incluyeron todos los casos de dengue en pacientes menores de 20 años asistidos en la unidad de consulta ambulatoria del Instituto de Medicina Tropical, en el período entre noviembre de 2015 y marzo 2016. En función a una base estructurada de colección de datos, se analizaron las características demográficas, clínicas y de laboratorio. Resultados: Se incluyeron 1491 casos de dengue. La edad media fue de 12±5 años, correspondiendo 58 casos (4%) al grupo etario 2-9 años y 995 (67%) al grupo >9 años (p9 años, constatándose en el 79%, 60% y 55% de los casos (p9 años) al compáralos con los menores de 2 años (p9 años. Se identificaron variables clínicas (exantema más frecuente en lactantes y algias en niños >9 años) y laboratoriales (citopenias poco frecuentes en lactantes) que dependen del grupo etario. La sensibilidad de la antigenemia ha sido excelente y similar en los grupos etarios.

ABSTRACT Introduction: Dengue fever (DF) represents one of the most frequent causes of consultation during the last decade in our country. Objectives: To describe the clinical and laboratory characteristics of dengue patients presenting to the ambulatory care unit of a pediatric reference center. Materials and Methods: We included all cases of dengue in patients under 20 years of age who presented to the outpatient consultation unit of the Institute of Tropical Medicine between November 2015 and March 2016. Based on a structured collection of data, we analyzed their demographic, clinical and laboratory characteristics. Results: 1491 cases of dengue were included. The mean age was 12 ± 5 years, 58 cases (4%) were in patients aged 2-9 years and 995 (67%) aged > 9 years (p 9 years old, reported in 79%, 60% and 55%, respectively, of cases (p 9 years) when compared with those under 2 years (p 9 years. Clinical variables (rashes in infants and algias in children > 9 years old) and laboratory variables (rare cytopenias in infants) were identified depending on the age group. The sensitivity of antigenemia testing was excellent and similar in all age groups.

Saberes y prácticas de una población rural maya con diabetes tipo 2 sobre plantas medicinales / Knowledge and practices of a rural maya population with type 2 diabetes on medicinal plants

Objetivo Describir los saberes y prácticas en el uso de plantas medicinales para el control de la diabetes tipo 2 en pobladores de una comunidad rural. Método Estudio cualitativo, con enfoque fenomenológico; participaron 8 personas con diabetes tipo 2 de una comunidad rural maya de Tekit, Yucatán, a quienes se les realizó una entrevista semiestructurada. La información fue analizada mediante el proceso cognitivo de Morse hasta la saturación de datos. Resultados Se obtuvo la categoría central "saberes y prácticas sobre plantas medicinales para el control y las complicaciones de la diabetes" y seis subcategorías: saberes para el control de la glucosa, prácticas tradicionales ante problemas ocasionados por la enfermedad, efectividad sanadora de las plantas, transmisión de saberes, factores que influyen en el uso y respeto a las prácticas tradicionales por los profesionales de salud. Conclusión La herbolaria es un factor importante para la recuperación y conservación de la salud en la población de estudio, además representa un elemento que fortalece su identidad cultural como pueblo maya yucateco, pues forma parte de su tradición. El cuidado enfermero con enfoque cultural es necesario para el entendimiento y comprensión de las prácticas de la herbolaria y se debe incorporar en la atención integral a la persona.

Cost-effectiveness analysis of pneumococcal conjugate vaccine introduction in Paraguay.

OBJECTIVE: To describe a cost-effectiveness analysis of 10- or 13-valent pneumococcal conjugate vaccine (PCV10 or 13) introduction in Paraguay compared to no vaccination. METHODS: The integrated TRIVAC vaccine cost-effectiveness model (version 2.0) jointly developed by the Pan American Health Organization's ProVac Initiative and the London School of Hygiene & Tropical Medicine was applied from the government and societal perspectives to estimate the cost-effectiveness (CE) of PCV introduction during 2010 and 2011. The cost-effectiveness ratios of PCV10 and PCV13 were separately compared to non-vaccination. The model calculated health and economic benefits of vaccination for 10 birth cohorts of children <5 years of age. A base case scenario with two primary doses at 2 and 4 months and a booster dose at 12 months (2+1 schedule) and alternate scenarios with varying parameters were considered. RESULTS: With PCV10 introduction, the incremental costs of the vaccination program would be approximately US$ 67 million to vaccinate all 10 cohorts of children; with PCV13, US$ 87 million. Health services costs avoided by the government with PCV10 would be US$ 19.5 million; with PCV 13, US$ 17.7 million. From the societal perspective, savings were much greater: with PCV10, US$ 43 million; with PCV13, US$ 35 million. For the higher priced PCV13, the average cost-effectiveness ratio was better than for PCV10 when compared to no vaccination, but regardless both were cost effective for government and society based on a threshold of 3× GDP per capita in Paraguay (2009 US$ 2516). The number of averted meningitis and all-cause pneumonia cases and deaths was greater with PCV13 than with PCV10 when compared to no vaccination. CONCLUSION: The introduction of either PCV10 or PCV13 would be cost effective when compared to no vaccination, and in some scenarios, highly cost effective in Paraguay. The outcomes of these analyses demonstrate that a pneumococcal vaccine could substantially reduce morbidity and mortality in children <5 years in Paraguay.

Guía para el diseño del plan de cuidados de enfermería en personas con diabetes mellitus tipo 2 / Guide for designing nursing plans for people with type 2 diabetes

Resumen:

La guía para diseñar planes de cuidados de enfermería en personas que viven con diabetes mellitus tipo 2 permite la evaluación continua de las respuestas humanas. Se basa en la interrelación de tres lenguajes estandarizados reconocidos por la American Nurses Association: etiquetas diagnósticas desarrolladas por la North American Nursing Diagnosis Association, clasificación de las intervenciones de enfermería y clasificación de los resultados esperados. Se presenta un listado de las etiquetas diagnósticas, intervenciones y resultados, con base en lo que la Asociación Americana de Diabetes recomienda como el ABC del cuidado de la diabetes. El propósito es fortalecer la habilidad de pensamiento crítico en el personal de enfermería que cotidianamente toma decisiones en el cuidado a las personas, además de facilitar el desarrollo de habilidades intelectuales, interpersonales y técnicas para el diseño, implementación y evaluación del plan de cuidados de enfermería. La guía es de consulta rápida y de utilidad para docentes, profesionales, estudiantes o cualquier profesional de la salud que requiera información para el cuidado de personas que viven con diabetes mellitus.

Abstract:

The guide to designing nursing care plans for people living with type 2 diabetes allows continuous assessment of human responses. It is based on the interplay of three standardized languages recognized by the American Nurses Association: a) Diagnosis labels developed by North American Nursing Diagnosis Association, Nursing Interventions Classification, and Nursing Outcomes Classification. A list of diagnosis labels, interventions and outcomes is presented, based on what the American Diabetes Association recommends for ABC diabetes care. The purpose is to strengthen the critical thinking ability in nursing staff in day to day decision making in the care of people; also to facilitate the development of intellectual and interpersonal skills as well as techniques to design, implement and assess the nursing care plan. The quick reference guide is useful for teachers and professionals, students or any health professional who requires information for the care of people living type 2 diabetes.

Un enfoque cualitativo a las barreras de adherencia terapéutica en enfermos crónicos de Guanajuato, México / A Qualitative Approach to Barriers to Adherence to Therapy among the Chronically Ill in Guanajuato, Mexico / Um enfoque qualitativo nas barreiras de adesão terapêutica em doentes crônicos de Guanajuato, México

Introducción: el perfil epidemiológico en México está dominado por enfermedades crónico-degenerativas y lesiones, estas a su vez están asociadas a las condiciones de vida actual. La OPS y la OMS aconsejan el estudio de barreras que impiden la atención de calidad. Objetivo: explorar la percepción de las barreras personales y sociales hacia el tratamiento de personas con estados crónicos: diabetes e hipertensión. Materiales y métodos: estudio cualitativo, con un componente descriptivo. La muestra estuvo conformada por diabéticos e hipertensos de colonias marginales. Muestreo de tipo intencional. La recolección de la información se realizó por medio de entrevistas semiestructuradas y audio-grabadas. Se trabajó con 3 grupos focales de 3 personas por grupo. Un 77% casado, 77% analfabeta, 77% labores del hogar, 56% diabéticos tipo 2,22% hipertensos, 22% diabéticos con hipertensión. Las barreras percibidas encontradas fueron: creencias relacionadas con el tratamiento, falta de conocimientos y habilidades para la dieta, descontento con la dieta, falta de apoyo familiar, dificultades económicas, falta de conocimientos sobre la medicación, indiferencia hacia el ejercicio, desconfianza y temor a los estudios de laboratorio. Discusión y conclusión: para Rosentock, en tanto que las claves para la acción incitan a las actividades preventivas para la salud, las barreras percibidas indican los caminos para la acción. Es necesario superar barreras y ayudar al enfermo crónico a convivir con la enfermedad.

Introduction: The epidemiological profile in Mexico is dominated by chronic degenerative diseases and injuries. These, in turn, are associated with current living conditions. PAHO and WHO recommend the study of barriers to quality care. Objective: The purpose of this research was to explore the perception of personal and social barriers to treatment for persons with chronic illnesses; namely, diabetes and hypertension. Materials and methods: This is a qualitative study with a descriptive component. The sample was comprised of diabetics and hypertensive persons from low-income neighborhoods. Intentional sampling was used. The data were collected through semistructured interviews that were audio-recorded. Work was done with three focus groups of three people each: 77% were married, 77% were illiterate, 77% were homemakers, 56% had type II diabetes, 22% were hypertensive and 22% were diabetics with hypertension. The perceived barriers revealed by the study include treatment-related beliefs, lack of knowledge and skill to pursue the recommended diet, dissatisfaction with the diet, lack of family support, economic hardship, lack of knowledge about the medication, indifference to exercise, and distrust and fear of laboratory exams. Conclusion: For Rosentock, whereas the keys to action encourage preventive activities with respect to health, the perceived barriers signal the path to action. Barriers must be overcome and the chronically ill must receive help to live with their conditions.

Introdução: o perfil epidemiológico no México está dominado por doenças crônico-degenerativas e lesões, estas, por sua vez, estão associadas às condições de vida atual. A ops e a üms aconselham o estudo de barreiras que impedem o atendimento de qualidade. Objetivo: explorar a percepção das barreiras pessoais e sociais ao tratamento de pessoas com estados crônicos: diabete e hipertensão. Materiais e métodos: estudo qualitativo, com um componente descritivo. A amostra esteve conformada por diabéticos e hipertensos de colônias marginais. Amostragem de tipo intencional. A coleta da informação se realizou por meio de entrevistas semiestruturadas e audiogravadas. Trabalhou-se com 3 grupos focais de 3 pessoas por grupo. 77% casados, 77% analfabetas, 77% labores do lar, 56% diabéticos tipo 2, 22% hipertensos, 22% diabéticos com hipertensão. As barreiras percebidas encontradas foram: crenças relacionadas com o tratamento, falta de conhecimentos e habilidades para a dieta, descontentamento com a dieta, falta de apoio familiar, dificuldades econômicas, falta de conhecimentos sobre a medicação, indiferença ao exercício, desconfiança e receio dos estudos de laboratório. Conclusão: para Rosentock, enquanto as chaves para a ação incitam as atividades preventivas para a saúde, as barreiras percebidas indicam os caminhos para a ação. É necessário superar barreiras e ajudar o doente crônico a conviver com a doença.

Estilo de vida y hemoglobina glucosilada en la diabetes mellitus tipo 2 / Lifestyle and glycosilated haemoglobin on type 2 diabetes patients

Resumen

Introducción: la medicación y los estilos de vida son considerados pilares en el control glucémico en la diabetes mellitus tipo 2 (DMT2), cuyo beneficio se refleja en la disminución o retraso de las complicaciones agudas y crónicas.

Metodología: estudio descriptivo, transversal y de relación con la finalidad de determinar la relación entre el estilo de vida y control glucémico a través de la hemoglobina glucosilada (HbA1c) en personas a partir de 40 años de edad con DMT2.

Resultados: fueron 68 personas entre 50 a 59 años de edad (30.1 %), 171 (75.7 %) mujeres, 157 (69.5 %) casados; 148 (65.5 %) eran analfabetas o con primaria incompleta; 148 (65.5 %) mujeres en labores domésticas. La glibenclamida fue el medicamento más usado. Para el estilo de vida: 181 (84.5 %) evita comer alimentos que no debería; 62 (28.9 %) realiza ejercicio; 67 (31.3 %) acuden con algún grupo de ayuda mutua; 172 (80.3 %) no fuman; 175 (81.7 %) no consumen alcohol. En cuanto a HbA1c, solo 52 (24.3 %) tienen un buen control. Para la relación entre las variables, se utilizó el coeficiente de correlación de Pearson que reveló que no existe relación significativa (r = -0.093, p > 0.05), sin embargo, de existir dicha relación significaría que a mejor calificación del estilo de vida menores niveles de HbA1c.

Conclusiones: el mayor problema fue el sedentarismo; la tendencia a no fumar ni consumir alcohol se puede explicar a que la mayoría de la población es femenina, ama de casa y pertenecen a un medio suburbano.

Summary

Introduction: the medication and the life style are considered the stone in the glucemic control in the type 2 diabetes mellitus (DMT2), patients the benefit is reflected in the diminution or delay of the acute and chronic complications.

Methodology: a descriptive, cross-sectional study with the purpose of determining the relation between the life style and the glicemic control throught the glycosilated haemoglobin (HbA1c) in subjets above 40 years with type 2 diabetes mellitus (DMT2).

Results: 68 subjets between 50 to 59 years (30.1 %), 171 (75.7 %) women, 157 (69,5 %) married; (65,5 %) 148 women in domestic workings illiterates and uncompleted basic educatinal level. The glibenclamida was themost used medicine. About life style: 181 (84.5 %) followed the diet prescription; 62 (28.9 %) pratised exercise; 67 (31.3 %) jointed to a group of mutual aid; 172 (80.3 %) quit smoke; 175 (81.7 %) do not consume alcohol. For the HbA1c, 52 (24.3 %) only have a good control. Pearson's correlation revealed that significant relation does not exist between lifestyle factors and glicemic control (r = -0.093, p > 0.05), nevertheless, to exist this relation would mean that to better qualification of the life style smaller levels of HbA1c.

Conclusions: the greater problem was the sedentary lifestyle; the tendency not to smoke nor to consume alcohol can be explained to that the majority of the population is feminine, housewife and belong to suburban way.