Perception of risk among children: Exploring the risk of TB-rickettsial disease based on the children's drawing pictures in a Mayan community of Yucatan.

Background: It is important to work on designs of health promotion strategies that involve educational interventions about the risk factors associated to TB-rickettsiosis (Tick-Borne rickettsiosis). Children's drawings provide a window into their thoughts and feelings. The aim was to analyze children's risk perceptions regarding by the presence of ticks in a rural community in southeast Mexico. Methods: The main framework used was a social cognitive perspective under the Health Belief Model. Study was carried out in rural elementary schools and included a drawing contest. A total of 224 children (8-12 years old) participated. Drawings were coded and classified; descriptive trend analysis was performed using counts and percentages. The qualitative data was analyzed by researcher experts in TB- rickettsiosis and using Atlas ti V.8. Results: Results are presented in seven categories that consider environmental elements, actors, and cognitive aspects. The environmental context, 99.1% of the drawings represent sites outside the home (92% include vegetation with the presence of ticks in their immediate external environment). In the actors' category, 69.6% included people carrying out activities (prevention and risk). As for the cognitive aspects, 70% included domestic pets and 13.4% farmyards animals. Conclusion: The children expressed their ideas about risk factors and preventive measures against TB-rickettsiosis with a self-care approach. They acquired knowledge about preventive strategies and clinical symptoms. It is necessary to evaluate what happens after an intervention and how they implement in their lives what they have learned.

Índice de riesgo nutricional geriátrico en pacientes hospitalizados por enfermedades vasculares periféricas / Geriatric nutritional risk indexes in patients hospitalized due to peripheral vascular diseases

Introducción: El índice de riesgo nutricional geriátrico es un instrumento simple y exacto que permite identificar a pacientes hospitalizados con este riesgo. Objetivo: Valorar la prevalencia de riesgo nutricional en pacientes ingresados por presentar una enfermedad vascular. Métodos: Se evaluaron de forma transversal 102 pacientes mayores de 18 años (65 % hombres) ingresados de forma consecutiva entre octubre y diciembre de 2018 en el Instituto Nacional de Angiología y Cirugía Vascular en La Habana Cuba, independientemente de la enfermedad de base y que estuvieran de acuerdo en participar en el estudio. La variable principal de salida fue la proporción de pacientes con riesgo nutricional: riesgo alto (< 82), moderado (82-92), bajo (93-98) y sin riesgo (> 98); las variables secundarias resultaron la edad, el sexo, el índice de masa corporal y la concentración de albúmina. Resultados: El 12,9 por ciento (intervalo de confianza 95 por ciento: 6,2-19,6); el 16,8 por ciento (9,4-24,2) y el 22,8 por ciento (14,5-31,3) de los pacientes presentaron un riesgo nutricional alto, moderado y ligero, respectivamente. Solo el 47,5 por ciento (37,6-57,4), de los pacientes no presentó riesgo nutricional. La edad y el sexo no mostraron correlación con el riesgo nutricional; la concentración de albúmina y el índice de masa corporal y el índice de riesgo nutricional sí se asociaron de forma importante (R2: 0,98 y 0,59, respectivamente). Conclusiones: La prevalencia de pacientes con riesgo nutricional es elevada en el ámbito hospitalario y puede evaluarse por intermedio del índice de riesgo nutricional geriátrico(AU)

Introduction: The Geriatric nutritional risk index is a simple and accurate instrument that allows identifying hospitalized patients with this risk. Objective: To assess the prevalence of nutritional risk in patients admitted for presenting a vascular disease. Methods: There were evaluated in cross-sectional way 102 patients older than 18 years (65% male) admitted consecutively from October to December, 2018 at the National Institute of Angiology and Vascular Surgery in Havana, Cuba, regardless of the underlying disease and who agreed to participate in the study. The main variable was the proportion of patients with nutritional risk: high risk (<82), moderate (82-92), low (93-98) and without risk (>98); secondary variables were age, sex, body mass index and the concentration of albumin. Results: The 12.9 percent (95 percent confidence interval: 6,2-19,6); the 16.8 percent (9,4-24,2) and the 22.8 percent (14,5-31,3) of the patients had high, moderate, and light nutritional risks, respectively. Only 47.5 percent (37,6-57,4) of the patients did not present nutritional risk. The age and sex showed no correlation with the nutritional risk; the concentration of albumin and body mass index and the index of nutritional risk were significantly associated (R2: 0.98 and 0.59, respectively). Conclusions: The prevalence of patients with nutritional risk is high in the hospital scope and it can be evaluated through the geriatric nutritional risk index(AU)

Respuesta de los sujetos con hipertensión arterial a los fármacos antiagregantes plaquetarios / Response of hypertensive subjects to antiplatelet drugs

Introducción: La terapia con antiagregantes plaquetarios es recomendada como prevención secundaria de eventos cardiovasculares en personas con hipertensión arterial. Sin embargo, en la práctica clínica se encuentran personas que no responden al tratamiento y presentan recurrencia de eventos vasculares. Objetivo: Evaluar la respuesta de los sujetos hipertensos a los fármacos antiagregantes plaquetarios. Material y Métodos: Estudio transversal, observacional descriptivo y comparativo, con 299 sujetos con hipertensión arterial esencial y 96 no hipertensos (como control), que estaban consumiendo antiagregantes plaquetarios. Los sujetos hipertensos fueron agrupados de acuerdo con el consumo de fármacos antihipertensivos. Se les determinó su agregación plaquetaria al colágeno en plasma, rico en plaquetas, según el Método de Born. La respuesta a la terapia antiplaquetaria se clasificó en cuatro categorías (óptima, moderada, pobre y no respuesta) de acuerdo con la agregación plaquetaria. Resultados: Se observó una ligera mejor respuesta a los antiagregantes plaquetarios, aunque no estadísticamente significativa, por parte de los hipertensos sin fármacos antihipertensivos (35,7 por ciento óptima y 42,9 por ciento moderada), en relación con los hipertensos que usaban antihipertensivos (32,7 por ciento óptima y 26,5 por ciento moderada) y los no hipertensos (30,2 por ciento óptima y 30,2 por ciento moderada). Además, se encontró que 17,7 por ciento de los sujetos no hipertensos, 14,3 por ciento de los hipertensos sin fármacos antihipertensivos y 13,2 por ciento de los hipertensos con antihipertensivos no estaban respondiendo a los antiagregantes plaquetarios. Conclusiones: La respuesta a los fármacos antiagregantes plaquetarios de los sujetos hipertensos consuman o no fármacos antihipertensivos es heterogénea y similar a la de los sujetos no hipertensos(AU)

ABSTRACT Introduction: Therapy with antiplatelet drugs is recommended as secondary prevention of cardiovascular events in people with arterial hypertension. However, in the clinical practice, there are people who do not respond to treatment and evidence a recurrence of vascular events. Objective: To evaluate the response of hypertensive patients to antiplatelet drugs. Material and Methods: Cross-sectional, observational, descriptive and comparative study that included 299 subjects with arterial hypertension and 96 non-hypertensive subjects (control group) who were taking antiplatelet drugs. The hypertensive subjects were grouped according to the consumption of antihypertensive drugs. Platelet aggregation collagen in platelet-rich plasma was determined using the turbidimetric Born's method. The response to the antiplatelet therapy was classified in four categories (good, moderate, poor and non-responsiveness) in accordance with the platelet aggregation. Results: There was a slightly better response to antiplatelet drugs, although it was not statistically significant in hypertensive subjects without antihypertensive drugs (35,7 percent good and 42,9 percent moderate) in relation to hypertensive subjects who were taking antihypertensive drugs (32,7 percent good and 26,5 percent moderate) and the non-hypertensive ones (30,2 percent good and 30,2 percent moderate).Besides, it was found that 17,7 percent of non-hypertensive subjects and 14,3 percent of the hypertensive ones without antihypertensive drugs and 13,2 percent of hypertensive subjects with antihypertensive drugs were not responding to the treatment with antiplatelet drugs. Conclusions: The response of hypertensive patients to antiplatelet drugs, either taking antihypertensive drugs or not, is heterogeneous and similar to the response of the non-hypertensive subjects(AU)

¿Qué motiva a las personas con alcoholismo a seguir en Alcohólicos Anónimos? / What motivates alcoholics to remain inAlcoholics Anonymous?

El grupo de autoayuda para alcohólicos más extendido en todo el mundo es Alcohólicos Anónimos (AA). Por esta razón, se decidió estudiar los motivos de los alcohólicos para seguir acudiendo a las reuniones de esta comunidad. Así pues, se realizó un estudio cualitativo exploratorio con cuatro personas con más de diez años de abstinencia que forman parte de un grupo de AA de Cataluña, a partir de grabar, transcribir y analizar una entrevista semiestructurada. Los resultados indican que todos los motivos de los participantes para seguir acudiendo a las reuniones de la comunidad son: miedo a recaer, para ayudar, para seguir creciendo y por la relación con el grupo

The most widespread group of self-help for alcoholics in the world is Alcoholics Anonymous (AA). For this reason, it was decided to study the motives of alcoholics to continue attending the meetings of this community. Thus, a qualitative exploratory study was conducted with four people with more than ten years of abstinence who are part of an AA group in Catalonia, by recording, transcribing and analyzing a semi-structured interview. The results indicate that all participants agreed that the reasons to continue attending community meetings are: fear of relapse, to help, to continue growing and because of the relationship with the group

Sistematización de experiencias de un programa de tratamiento cognitivo-conductual para la atención de la ludopatía en Mérida Yucatán, México / Systematization of experiences of a program of cognitive-behavioral treatment for the attention of pathological gambling in Mérida Yucatán, México

La adicción al juego es un problema que está incrementando en la población de varios países; México y particularmente Yucatán, no son la excepción. En México, los juegos de azar son un tema poco estudiado como problema de salud pública, pues se trata de una situación relativamente nueva. Objetivo: Sistematizar la experiencia de un Programa de Tratamiento Cognitivo-Conductual para Personas con Adicción al Juego desarrollado por una organización mexicana, desde la vivencia de los profesionales responsables y las personas beneficiarias. Método. Participaron 13 personas con adicción al juego, 3 profesionales responsables del programa y el director de la organización en su sede Yucatán. El método es la Sistematización de Experiencias con técnicas de análisis de historias clínicas y entrevistas semiestructuradas; así como la construcción de lecciones aprendidas de la experiencia. Resultados: Para los profesionales, el programa ha traído resultados positivos para superar la ludopatía a través de la restructuración cognitiva y el trabajo conductual. Se identifican debilidades en el proceso, ligadas al contenido y organización de los expedientes y la falta de compromiso de los beneficiarios para concluir con cada actividad propuesta. Para los participantes, el programa, al estar sustentado científicamente y dirigirse por especialistas en el campo, les permitió superar ideas limitantes y asumir conductas que les permitieron dejar de jugar. Conclusiones: Se evidencia la necesidad de participar en procesos constantes de evaluación y establecer el trabajo en Red para dar la atención necesaria a las personas que están pasando por un proceso de adicción al juego en casinos

Gambling addiction is a problem that is increasing in the populations of several countries; Mexico and particularly Yucatan are no exception. In Mexico, games of chance are a little studied subject as a public health problem, because it is a relatively new situation. Objective: To systematize the experience of a Cognitive-Behavioral Treatment Program for People with Gambling Addiction developed by a Mexican organization, from the experience of responsible professionals and the beneficiaries. Method: 13 gambling addicts participated, three professionals responsible for the program and the director of the organization in its Yucatan headquarters. The method is the Systematization of Experiences employing clinical history analysis techniques and semi-structured interviews; as well as the construction of lessons learned from experience. Results: For professionals, the program has brought positive results to overcome gambling through cognitive restructuring and behavioral work. Weaknesses are identified in the process, linked to the content and organization of the files and the lack of commitment of the beneficiaries to conclude with each proposed activity. Since the program is scientifically supported and directed by specialists in the field, the participants were able to overcome limiting ideas and assume behavior that allowed them to stop gambling. Conclusions: There is evidence of the need to participate in constant evaluation processes and establish work in the Network to provide people who are going through a gambling addiction process in casinos with the necessary care

Ansiedad, depresión y actividad física asociados a sobrepeso/obesidad en estudiantes de dos universidades mexicanas / Anxiety, depression and physical activity associated with overweight/obesity in students from two mexican universities / Ansiedade, depressão e atividade física associada ao excesso peso/obesidade em estudantes de duas universidades mexicanas

OBJETIVO: Determinar la asociación entre los trastornos afectivos (ansiedad, depresión), la actividad física y la prevalencia combinada de sobrepeso/obesidad en un grupo de estudiantes universitarios. MATERIALES Y MÉTODOS: Estudio descriptivo transversal realizado de mayo de 2013 a noviembre de 2014 en una muestra aleatoria de 450 estudiantes de enfermería y nutrición de dos universidades mexicanas. Se aplicó un cuestionario estructurado sobre actividad física y síntomas presuntivos de ansiedad y depresión, se midieron peso, talla y se calculó el índice de masa corporal (IMC). Los datos obtenidos se procesaron y analizaron en el software estadístico SPSS. RESULTADOS: La prevalencia combinada de sobrepeso/obesidad estimada según el IMC fue 32,4% en el total de la población de estudio; mayor en la Universidad Autónoma de Yucatán (UADY, 41%) que en la Universidad Autónoma de San Luis Potosí (UASLP, 27,5%), la diferencia entre universidades es estadísticamente significativa (p<0,05) la prevalencia es mayor en hombres (38,5%) que en mujeres (30,5%). Las variables que indagan sobre alteraciones en el apetito según el estado emocional advierten asociación estadísticamente significativa (p<0,05) entre sobrepeso/obesidad y aumento del apetito ante el estrés, ansiedad y tristeza. No existe suficiente evidencia estadística en los datos para establecer asociación entre sobrepeso-obesidad y la realización de actividad física, ni se encontraron diferencias en características de la actividad física entre universidades. CONCLUSIÓN: Se evidencian síntomas de ansiedad y depresión en estudiantes universitarios del área de salud, los cuales, asociados a una ingesta alimentaria excesiva y una actividad física leve predisponen al sobrepeso y la obesidad

OBJECTIVE: To decide the association between affective disorders (anxiety, depression), physical activity and combined prevalence of overweight/obesity in a group of university students. MATERIAL AND METHODS: Cross-sectional descriptive study conducted from May 2013 to November 2014 in a random sample of 450 nursing and nutrition students from two Mexican universities. A structured questionnaire on physical activity and presumptive symptoms of anxiety and depression was applied, weight and height were measured, and body mass index (BMI) was calculated. The data obtained was processed using the SPSS statistical software. RESULTS: The combined prevalence of overweight-obesity estimated by BMI was 32.4% in the total study population; it was higher in the Universidad Autónoma de Yucatán (UADY) (41%) than in the Universidad Autónoma San Luis Potosí (UASLP) (27.5%). The difference between universities is statistically significant (p<0.05), prevalence is higher in men (38.5%) than in women (30.5%). Variables that investigate alterations in appetite according to the emotional state show statistically significant association (p<0.05) between overweight-obesity and increased appetite for stress, anxiety and sadness. There is insufficient statistical evidence in the data to establish an association between overweight-obesity and physical activity and differences in physical activity characteristics between universities were not found. CONCLUSION: Symptoms of anxiety and depression in university students in the health area are evident, which, associated with excessive food intake and mild physical activity, lead to overweight and obesity

OBJECTIVO: Determinar a associação entre transtornos afetivos (ansiedade, depressão), atividade física e prevalência combinada de sobrepeso/obesidade em um grupo de estudantes universitários em duas universidades no México. MATERIAIS E MÉTODOS: De maio de 2013 a novembro de 2014, um estudo descritivo transversal foi realizado em uma amostra aleatória de 450 estudantes de enfermagem e nutrição em dois universidades mexicanas. Foi aplicado um questionário estruturado de atividade física e sintomas presuntivos de ansiedade e depressão, foram medidos peso, altura e índice de massa corporal (IMC) foi calculado. Os dados obtidos foram processados no software estatístico SPSS. RESULTADOS: A prevalência combinada de excesso de peso a obesidade é estimada pelo IMC de 32,4% na população total do estudo; maior na Universidade Autônoma de Yucatán (UADY) (41%) do que na Universidade Autônoma de San Luis Potosí (UASLP) (27,5%), a diferença entre universidades é estatisticamente significativa (p<0.05). A prevalência é maior em homens (38,5%) do que mulheres (30,5%). As variáveis que investigam alterações no apetite como o estado emocional alertar associação estatisticamente significativa (p<0,05) entre o excesso de peso à obesidade e aumento do apetite ao estresse, ansiedade e tristeza. Não há evidências estatísticas suficientes nos dados para estabelecer associação entre o excesso de peso à obesidade e atividade física, não há diferenças nas características da atividade física entre universidades. CONCLUSÃO: Se mostram sintomas de ansiedade e depressão em estudantes universitários da área de saúde, que, associada à ingestão excessiva de alimentos e atividade física uma ligeira vantagem ao sobrepeso e à obesidade

Qualitative evaluation: a critical and interpretative complementary approach to improve health programs and services.

This short essay aims at commenting on the origin, development, rationale, and main characteristics of qualitative evaluation (QE), emphasizing the value of this methodological tool to evaluate health programs and services. During the past decades, different approaches have come to light proposing complementary alternatives to appraise the performance of public health programs, mainly focusing on the implementation process involved rather than on measuring the impact of such actions. QE is an alternative tool that can be used to illustrate and understand the process faced when executing health programs. It can also lead to useful suggestions to modify its implementation from the stakeholders' perspectives, as it uses a qualitative approach that considers participants as reflective subjects, generators of meanings. This implies that beneficiaries become involved in an active manner in the evaluated phenomena with the aim of improving the health programs or services that they receive. With this work we want to encourage evaluators in the field of public health to consider the use of QE as a complementary tool for program evaluation to be able to identify areas of opportunity to improve programs' implementation processes from the perspective of intended beneficiaries.

Impacto del crecimiento industrial en la salud de los habitantes de una ciudad minera del Perú / Industry growth health impact on a mining Peruvian mountain city inhabitants

Objetivo: Evaluar el impacto que sobre la salud de los habitantes de una ciudad minera de la sierra norte del Perú pudiera haber tenido su incipiente industrialización. Material y Métodos: Empleamos el método retrospectivo descriptivo para revisar las historias clínicas de los pacientes atendidos en el Hospital Regional de la ciudad durante el periodo 1 996 al 2 001; buscamos enfermedades relacionadas a contaminación ambiental. Luego, por regresión logística las comparamos estadísticamente con los indicadores de desarrollo industrial de la ciudad. Usamos el programa SPSS/6,1. Resultados: La comparación muestra significancia estadística entre desarrollo industrial y salud de los habitantes: alta cuando correlaciona número de vehículos con enfermedad respiratoria (p=0,0001), vehículos con enfermedad dermatológica (p=0,0003) y vehículos con conjuntivitis (p=0,0001). La significancia es menor cuando se compara con producción minera de plomo (p=0,03, 0,001 y 0,39, respectivamente) y con producción minera oro/plata (p=0,01, 0,003 y 0,0045, respectivamente). No encontramos significancia al comparar desarrollo industrial con incremento de población ni con producción lechera (p=0,019, 0,04). Conclusiones: Existe correlación estadísticamente significativa entre crecimiento industrial de la ciudad e incremento de enfermedades de sus habitantes atribuibles a contaminación ambiental. Se recomienda valorar directamente los indicadores de contaminación ambiental a fin de trabajar en su manejo.

Objective: To determine incipient industrialisation health impact on the population of a mining Peruvian mountain city. Material and Methods: Retrospective descriptive study that reviewed Regional City Medical Hospital patientÆs records seen from 1996 through 2001, searching for environmental related illnesses. We used growth indexes and compared them statistically with environmental indexes by logistic regression using the SPSS/6,1. Results: We found significant correlation (95 per cent confidence index) between industrial growth indexes and health status, such as increase of the number of vehicles and respiratory illnesses (p=0,0001), number of vehicles and dermatological illnesses (p=0,0003), number of vehicles and conjunctivitis (p=0,0001). Significance was less when comparing gold/silver production (p=0,01, 0,003 and 0,0045, respectively) with lead mining production (p=0.03, 0,001, and 0,39, respectively). There was no significance when comparing industrial development with dairy production and population increase (p=0,019, 0,04). Conclusions: Increase in industrial activity correlates with environmental illnesses. We recommend performing further scientific studies to assess environmental pollution index to allow the city to properly manage environmental pollution.