Validation of Nursing Outcome Indicators in Patients with Postsurgical Delirium / Validación de indicadores de resultados enfermeros en pacientes con delirium postquirúrgico / Validação de indicadores de resultados de enfermagem em pacientes com delirium pós-cirúrgico

Objective. To validate the content of the indicators proposed from the Nursing Outcome Classification in a care plan for delirium management in older adults. Methods. Content validity study, conducted under the expert judgment technique. The procedure was developed in five moments: organization of indicators that respond to the nursing outcome classification for delirium management, support with literature of the indicators that responds to the result, selection of experts, establishment of agreements, and discussion. Quality criteria evaluated: pertinence and relevance, the Content Validity Coefficient and average scores assigned by the experts were calculated. Results. The study had the participation of 14 experts. The indicators, according to criteria of pertinence and relevance evaluated by experts showed a global average content index value of 0.93; 97.05% (66) of the indicators had Content Validity Coefficient > 0.75. Conclusion. The quantitative findings of the indicator validation process showed high relevance and pertinence index, which favors their being applied to measure care changes in patients with delirium.

Objetivo. Validar el contenido de los indicadores propuestos a partir de Nursing Outcome Classification en un plan de cuidados para el manejo de delirium en los adultos mayores. Métodos. Estudio de validación de contenido realizado bajo la técnica de juicio de expertos. El procedimiento se desarrolló en cinco momentos: organización de los indicadores que responden a la clasificación de resultados de enfermería para manejo de delirium, soporte con literatura de los indicadores que responde al resultado, selección de expertos, establecimiento de acuerdos y discusión. Criterios de calidad evaluados: pertinencia y relevancia. Se calculó el Coeficiente de Validez de Contenido, así como los promedios de los puntajes asignados por los expertos. Resultados. Se contó con la participación de 14 expertos. Los indicadores según los criterios de pertinencia y relevancia evaluados por expertos mostraron un valor global promedio de índice de contenido de 0.93. El 97.05% (66) de los indicadores presentaron Coeficiente de Validez de Contenido mayor a 0.75. Conclusión. Los hallazgos cuantitativos del proceso de validación de los indicadores mostraron alto índice de relevancia y pertinencia lo que favorece que puedan ser aplicados para medir cambios de cuidado en los pacientes con delirium.

Objetivo. Validar o conteúdo dos indicadores propostos pela Classificação dos Resultados de Enfermagem em um plano de cuidados para o manejo do delirium em idosos. Métodos. Estudo de validação de conteúdo, realizado através da técnica de julgamento de especialistas. O procedimento foi desenvolvido em 5 momentos: organização dos indicadores que respondem à classificação dos resultados de enfermagem para manejo do delirium, suporte com literatura dos indicadores que respondem ao resultado, seleção de especialistas, estabelecimento de acordos e discussão. Foram calculados os critérios de qualidade avaliados: relevância e pertinência, o Coeficiente de Validade de Conteúdo e as médias das notas atribuídas pelos especialistas. Resultados. Participaram 14 especialistas. Os indicadores segundo os critérios de relevância e pertinência avaliados por especialistas apresentaram valor médio do índice de conteúdo global de 0.93. O 97.05% (66) dos indicadores apresentaram Coeficiente de Validade de Conteúdo superior a 0.75. Conclusão. Os achados quantitativos do processo de validação dos indicadores apresentaram alto índice de relevância e pertinência, o que favorece sua aplicação para mensurar mudanças no cuidado de pacientes com delirium.

Panorama de la producción investigativa de enfermería en Colombia / Panorama of nursing research production in Colombia

La investigación ha marcado un antes y un después para la enfermería, lo que ha permitido mostrar al mundo el cuidado como objeto de la disciplina desde los diferentes campos de desempeño de la profesión, así como el trabajo interdisciplinario con otras profesiones que se complementan, para lograr el objetivo cuya meta es el promover bienestar del ser humano en todas sus dimensiones. Los avances en el conocimiento disciplinar a través del desarrollo investigativo además de cumplir con un método científico riguroso, se hace cargo de la difusión del conocimiento a la comunidad científica, lo que representa un aporte a la competitividad deseada en la sociedad, que busca no solo la ampliación conceptual de la profesión, sino contribuir con un mejor ejercicio en la práctica profesional.

Research has marked a before and after for nursing, which has made it possible to show care as the nursing discipline's object to the world from its different fields of action and the interdisciplinary work with other professions that complement each other to achieve the goal of promoting human well-being in all its dimensions. In addition to adhering to a rigorous scientific method, advances in disciplinary knowledge through research development are responsible for disseminating knowledge to the scientific community. That is a contribution to the desired competitiveness in a society, which not only seeks to expand the profession conceptually but also contributes to better professional practice.

A pesquisa marcou um antes e um depois para a enfermagem, o que permitiu ao mundo mostrar o cuidado como objeto da disciplina a partir dos diferentes campos de atuação da profissão, bem como o trabalho interdisciplinar com outras profissões que se complementam, para alcançar o objetivo cujo objetivo é promover o bem-estar do ser humano em todas as suas dimensões. Os avanços no conhecimento disciplinar por meio do desenvolvimento de pesquisas, além de obedecerem a um rigoroso método científico, são responsáveis pela disseminação do conhecimento à comunidade científica, o que representa uma contribuição para a desejada competitividade na sociedade, que busca não apenas a expansão conceitual da profissão, mas sim contribuir para um melhor desempenho na prática profissional.

Validación de una Intervención para Fortalecer el Autocuidado en Estudiantes de Enfermería / Validation of an intervention to strengthen nursing students' self-care

Introducción: El autocuidado es uno de los conceptos a fortalecer en futuros profesionales de enfermería desde la formación centrada en el aprendiente. Objetivo: Estimar la validación de una estrategia educativa a través del juicio de expertos y de la población objetivo. Materiales y Métodos: La investigación se desarrolla bajo un enfoque mixto cual-cuant en paralelo convergente secuencial. En la fase cualitativa 6 estudiantes, un análisis lexicometrico de similitud y fenomelogico hermeneutico. La fase cuantitativa con juicio de 10 expertos, se calculo IVC y media artimetica para pertinencia, coherencia, relevancia y claridad, para concordancia se utilizó la prueba de Brennan and Prediger. Resultados: Se identifica las relaciones entre la inducción a la acción y la introspección de conductas de autocuidado. El IVC general fue 0.96, una media de 3.7±0.4. En concordancia el item "objetivos especificos" fue el que presento valor p=0.054, coef=0.37, en claridad presenta los menores puntajes en la media (3.4±0.8) e IVC (0.8), los restantes items presentan valor p>0.05 Discusión: En la validación por parte de los jueces de la intervención educativa, se obtuvo un índice de validez de contenido con valores superiores a lo deseable, lo cual es similar a lo reportado por otros autores donde se obtuvo una valoración de la información como suficiente y necesaria. Conclusion: Se considera que la intervención educativa cuenta con los criterios de validación de contenido tanto por jueces expertos como de la población objetivo, manifestado por la reflexión hacia la transformación de algunos comportamientos de autocuidado en los estudiantes de enfermería.

Introduction: Self-care is one of the concepts to be strengthened in future nurses from a learner-centered education perspective. Objective: To estimate the validation of an educational strategy through both experts and the target population judgment. Materials and Methods: The research followed a convergent parallel sequential mixed qualitative-quantitative approach. In the qualitative phase, analysis of lexical similarities and hermeneutic phenomenological analysis was carried out with six students. The quantitative phase included opinions from ten experts; CVI and arithmetic mean were calculated to assess pertinence, coherence, relevance, and clarity. The Brennan-Prediger coefficient was used for measuring agreement. Results: Relationships between action inducement and introspection of self-care behaviors are identified. Overall CVI was 0.96, with a mean of 3.7±0.4. Regarding agreement, the item 'specific objectives' was the one that showed a p-value of 0.054 and a coefficient of 0.37. Concerning clarity, the lowest mean (3.4±0.8) and CVI (0.8) values were observed. The remaining items have a p-value >0.05. Discussion: In validating the educational intervention by the experts, a content validity index was obtained with values higher than desirable. This result is similar to that reported by other authors whose information was rated as sufficient and necessary. Conclusion: The educational intervention has the criteria for content validity according to both experts and the target population, as manifested by the reflection on the transformation of some self-care behaviors in nursing students.

ntrodução: O autocuidado é um dos conceitos a reforçar nos futuros profissionais de enfermagem a partir da formação centrada no aprendente. Objetivo: Estimar a validação de uma estratégia educacional por meio do julgamento de especialistas e da população-alvo. Materiais e Métodos: A pesquisa é realizada sob uma abordagem qualitativa e quantitativa, mista em paralelo convergente sequencial. Na fase qualitativa 6 alunos, uma análise lexicométrica de similaridade e fenomenológica hermenêutica. A fase quantitativa com julgamento de 10 especialistas, IVC e média aritmética foram calculados para relevância, coerência, relevância e clareza, para concordância foi utilizado o teste de Brennan e Prediger. Resultados: Identificam-se as relações entre a indução à ação e a introspeção dos comportamentos de autocuidado. O IVC geral foi de 0,96, com média de 3,7 ±0,4. Nesse sentido, o item " objetivos específicos " foi o que apresentou valor p=0,054, coef =0,37, claramente apresenta as menores pontuações na média (3,4 ±0,8) e IVC (0,8), os demais itens apresentam valor p>0,05 Discussão: Na validação pelos juízes da intervenção educacional, obteve-se um índice de validade de conteúdo com valores acima do desejável, o que é semelhante ao relatado por outros autores onde foi obtida uma avaliação da informação como suficiente e necessária. Conclusão: Considera-se que a intervenção educativa tem os critérios de validação de conteúdo tanto por juízes especialistas como pela população-alvo, manifestada pela reflexão para a transformação de alguns comportamentos de autocuidado em estudantes de enfermagem.

Validation of Nursing Outcome Indicators in Patients with Postsurgical Delirium.

Objective: To validate the content of the indicators proposed from the Nursing Outcome Classification in a care plan for delirium management in older adults. Methods: Content validity study, conducted under the expert judgment technique. The procedure was developed in five moments: organization of indicators that respond to the nursing outcome classification for delirium management, support with literature of the indicators that responds to the result, selection of experts, establishment of agreements, and discussion. Quality criteria evaluated: pertinence and relevance, the Content Validity Coefficient and average scores assigned by the experts were calculated. Results: The study had the participation of 14 experts. The indicators, according to criteria of pertinence and relevance evaluated by experts showed a global average content index value of 0.93; 97.05% (66) of the indicators had Content Validity Coefficient > 0.75. Conclusion: The quantitative findings of the indicator validation process showed high relevance and pertinence index, which favors their being applied to measure care changes in patients with delirium.

Factors related to healthcare costs of road traffic accidents in Bucaramanga, Colombia.

OBJECTIVE: To determine the factors related to overall healthcare costs of road traffic accidents in Bucaramanga, Colombia. METHODS: A descriptive cross-sectional study was conducted through the analysis of road traffic accident records that took place in 2019 in Bucaramanga, Colombia. Cost quartiles in dollars were compared using Pearson's chi-squared and Fisher's exact tests. Odds ratios were also calculated in logistic regression. RESULTS: 3,150 road accidents were reported in 2019 involving 7,038 people, of which 812 had information related to healthcare costs in health care institutions. The median cost was 56.59 USD (RI = 29.35-140.15), average cost of 290.11 USD ± 731.22 (95%CI: 239.74-340.48). A higher possibility to be in the 4th quartile was found when persons were under 18 years of age (OR = 4.88; 95%CI: 1.30-18.32) or 46-60 years (OR = 3.66; 95%CI: 1.01-13.30), the type of vehicle involved is motorcycle (OR = 2.79; 95%CI: 1.25-6.24), bicycle (OR = 7.66; 95%CI: 2.70-21.68), having a head injury (OR = 4.50; 95%CI: 2.61-7.76) and hypothetical drunk driving (OR = 12.44; 95%CI: 2.01-76.87). CONCLUSIONS: Relevant factors in healthcare costs were riding a motorcycle or bicycle, having a head injury, being under 18 years of age or 46 to 60 years of age and hypothetical drunk driving. It is important to implement prevention measures based on identified factors to reduce road accident rate and therefore, its socioeconomic costs.

Efecto de una intervención educativa sobre la agencia de autocuidado en estudiantes de Enfermería / Impact of an educational intervention on the self-care agency among Nursing students

mediante el Aprendizaje Basado en Problemas (ABP) y basada en la Teoría de Autocuidado de Orem sobre la agencia de autocuidado en estudiantes de Enfermería de dos universidades colombianas. Método: estudio cuasiexperimental antes/después multicéntrico realizado en 2019. La población fueron los 56 estudiantes del primer semestre de Enfermería de dos universidades colombianas. Se realizó la intervención “Hacia el cuidado de la vida” con 12 sesiones de dos horas durante 13 semanas sobre autocuidado mental y espiritual, estilos de vida saludable, autocuidado corporal y autocuidado social mediante ABP. Se midieron variables sociodemográficas, académicas y de hábitos de consumo. La agencia de autocuidado se midió basal (B) y en la última sesión (P) mediante la escala ASA-B (muy baja: 1-24, baja: 25-48, buena: 49-72 o muy buena: 73-96 puntos). Se efectuó estadística descriptiva y bivariante. Resultados: completaron el estudio 40 personas. El 82,1% era mujer, con una edad mediana de 18. La puntuación global de la escala ASA-B se incrementó de manera estadísticamente significativa de manera global [B: X= 71,1 (DE= 0,73) y P: X= 75,6 (DE= 1,07); p< 0,001] y en las mujeres, de 18 a 20 años, solteras, con puntuación en Prueba Saber 11 en cuartil 1 o 2, antecedentes de ingesta de alcohol o de bebidas energizantes (p< 0,05). No varió la puntuación en función de la pertenencia a equipos deportivos, federaciones estudiantiles o grupos religiosos. Conclusión: la intervención educativa basada en la Teoría de Autocuidado y ABP aplicada a estudiantes de primer semestre de Enfermería mejoró su agencia de autocuidado.(AU)

Objective: to determine the impact of an educational intervention through Problem-Based Learning (PBL) and based on Orem’s Self-Care Theory on the self-care agency in Nursing students from two Colombian universities. Method: a multicentre quasi-experimental before-and-after study conducted on 2019. The population included the 56 students of the first Nursing semester from two Colombian universities. The “Hacia el cuidado de la vida” (“Towards Life Care”) intervention was conducted, with 12 two-hour sessions during 13 weeks on mental and spiritual self-care, healthy lifestyles, body self-care and social self-care through PBL. Sociodemographic and academic variables were measured, as well as consumer habits. The Self-Care Agency was measured at baseline (B) and at the last session (P) through the ASA-B scale (very low: 1-24, low: 25-48, good: 49-72 or very good: 73-96 scores). Descriptive and bivariate statistics were applied. Results: forty (40) persons completed the study; 82.1% were female, with 18 years as median age. The overall score in the ASA-B scale was increased overall in a statistically significant way [B: X= 71.1 (SD= 0.73) and P: X= 75.6 (SD= 1.07); p< 0.001] and in 18-to-20-year old single women, with a score of 11 in knowledge test in first or second quartile, past history of using alcohol or energy drinks (p< 0.05). There was no variation in score in terms of affiliation to sport teams, student federations or religious groups. Conclusion: the educational intervention based on the self-care theory and PBL applied to students in their first Nursing semester improved their self-care agency.(AU)

Aerosol box for intubation of patients with suspected COVID-19: simulation study / Caja de aerosol para la intubación de pacientes con sospecha de COVID-19: Un estudio de simulación

Abstract Introduction Endotracheal intubation is a procedure associated with a high level of exposure to the COVID-19 virus. This has led to the search of alternatives to reduce the risk of contamination, including the so-called aerosol box. Objective To compare time and difficulty of orotracheal intubation when using the aerosol box in a simulated setting. Methodology Observational study conducted with the participation of 33 anesthetist physicians and anesthesia residents; groups were compared in terms of time and intubation difficulty using a conventional Macintosh laryngoscope and the McGRATH™ MAC (Medtronic) videolaryngoscope with or without aerosol box. In order to determine performance with the intubation maneuver, crude hazard ratios were estimated, and a Cox multivariate regression model was built, adjusted by anesthetist years of experience and difficulties during the procedure. Results On average, the aerosol box increased intubation time by 7.57 seconds (SD 8.33) when the videolaryngoscope was used, and by 6.62 (SD 5.74) with the Macintosh. Overall, 132 intubations were performed, with 121 successful and 6 failed first-time attempts (4 with the use of the aerosol box); 16 participants (48.48%) reported difficulty handling the box. With the use of the Macintosh, intubation was found to be faster than with the videolaryngoscope (cHR: 1.36 [95% CI 0.64-2.88]; adjusted HR: 2.20 [95% CI 0.73-6.62]). Conclusions The use of the aerosol box and personal protective equipment in a simulation setting hinders the intubation maneuver and may result in protracted execution time.

Resumen Introducción La intubación endotraqueal es un procedimiento que se relaciona con alto nivel de exposición al virus de COVID-19, llevando a la búsqueda de alternativas para disminuir el riesgo de contaminación, entre ellas la llamada Caja de aerosoles. Objetivo Comparar el tiempo y dificultad en la intubación orotraqueal usando la caja de aerosoles en escenarios simulados. Metodología Estudio observacional, con participación de 33 médicos anestesiólogos y residentes de anestesia; se compararon los grupos en tiempo y dificultad de intubación con uso de laringoscopio convencional Macintosh y videolaringoscopio McGRATH™ MAC (Medtronic) utilizando la caja de aerosoles y sin ella. Para determinar el rendimiento en la maniobra de intubación se calcularon Hazard ratios crudos, se construyó modelo multivariado de Regresion de Cox ajustado por años de experiencia como anestesiólogo y dificultades durante el procedimiento. Resultados La caja de aerosoles aumentó en promedio el tiempo en segundos para la intubación con video-laringoscopio en 7,57 (DE: 8,33) y con Macintosh 6,62 (DE: 5,74). Se llevaron a cabo 132 intubaciones, 121 exitosas en el primer intento y 6 fallidas (4 con el uso de la caja de aerosoles). 16 participantes reconocieron alguna dificultad al manipular la caja (48,48 %). Con el uso de Macintosh se identificó tendencia a la intubación más rápido que con el videolaringoscopio (HRc: 1,36 [IC 95 %: 0,64-2,88]; HR ajustado: 2,20 [IC 95 %: 0,73-6,62]). Conclusiones Utilizar la caja de aerosoles y equipo de protección personal en un escenario simulado dificulta la maniobra de intubación y puede prolongar el tiempo de ejecución.

Efectos de una intervención de enfermería en el control del dolor posoperatorio del paciente adulto / Effects of a Nursing Intervention on Postoperative Pain Control in the Adult Patient

ntroducción: El control apropiado del dolor es un desafío crucial y necesario de abordar en el campo quirúrgico, al producir un gran impacto en la recuperación del paciente. Objetivo: Evaluar el efecto de una intervención de enfermería aplicada en el periodo perioperatorio para el control del dolor del paciente adulto en el posoperatorio inmediato. Métodos: Estudio cuantitativo, cuasi experimental, con grupo experimental y control de adultos intervenidos en el quirófano de una institución de salud en Bucaramanga - Colombia en el primer semestre de 2017, con un universo de 3240 pacientes y muestra calculada de 120. La intervención constó de tres fases, enmarcada en la teoría de síntomas desagradables. Para evaluar el dolor se utilizó la Escala Visual Análoga. Se realizó análisis descriptivo, bivariado y múltiple, se calcularon Betas con modelos de regresión lineal con los puntajes de la escala de dolor a los 10-20 y 30 minutos, 1- 1,5 y 2 horas. Resultados: Los grupos presentaron características similares, en el grupo experimental disminuyeron los puntajes en la escala de dolor a los 10 minutos en -0,98 (IC 95 por ciento: -2,0; 0,02), a la hora de -0,77(IC 95 por ciento: -1,60; 0,05), a las 1,5 horas de -0,71(IC 95 por ciento: -1,13; -0,12) y las 2 horas de -0,60(IC 95 por ciento: -1,09; -0,10). Conclusiones: La intervención de enfermería en perioperatorio, más allá de la administración de analgésicos, es fundamental para modificar las respuestas, como lo refiere la teoría de Swanson, se mejora o controlan los síntomas desagradables y sus efectos negativos, en este caso el dolor posoperatorio(AU)

Introduction: Appropriate pain control is a crucial and necessary challenge to address in the surgical field, since it would produce a great impact patient recovery. Objective: To assess the effect of a nursing intervention applied during the perioperative period for pain control in the adult patient in the immediate postoperative period. Methods: Quantitative and quasiexperimental study carried out with two groups, an experimental and a control group, of adults operated on in the surgical room of a health institution in Bucaramanga, Colombia, in the first semester of 2017. The universe consisted of 3240 patients, while the calculated sample was 120. The intervention consisted in three phases, framed within the theory of unpleasant symptoms. The visual analog scale was used to assess pain. Descriptive, bivariate and multiple analyses were performed. Betas were calculated with linear regression models and using the scores of the pain scale at ten to twenty and thirty minutes; as well as at one to one and half hours, and two hours. Results: The groups presented similar characteristics: in the experimental group, the scores of the pain scale decreased at ten minutes by 0.98 (95 percent CI: -2.0; 0.02); at one hour, by 0.77 (95 percent CI: -1.60; 0.05; at one and a half hours, by 0.71 (95 percent CI: -1.13; -0.12); and at two hours, by 0.60 (95 percent CI: -1.09; -0.10). Conclusions: The nursing intervention in the perioperative period, beyond the administration of analgesics, is fundamental to modify responses, as referred by Swanson's theory, unpleasant symptoms and their negative effects are improved or controlled; in this case, postoperative pain(AU)

Cultura de seguridad en profesionales del quirófano en una institución de atención materno infantil / Safety Culture in Operating Room Professionals from a Mother and Child Care Institution

Introducción: En los profesionales de la salud existe la necesidad de liderar la seguridad del paciente como política pública, la cual es un criterio de calidad al evaluar la cultura de seguridad en las instituciones de salud y de cada servicio que ofrece. Objetivo: Valorar las dimensiones de la cultura de seguridad del paciente. Métodos: Estudio de tipo analítico y transversal en área de quirófanos de la clínica Materno Infantil San Luis, desde abril a julio del 2018. Se captaron las respuestas de la cultura de seguridad en 45 profesionales de salud a través del cuestionario Hospital Survey on Patient Safety, versión en español. El análisis estadístico presenta proporciones, medidas de tendencia central, dispersión y rango intercuartílico. Para identificar las diferencias entre los grupos se utilizaron las pruebas: Exacta de Fisher, Anova y Kruskal Wallis. Los análisis se realizaron en el programa STATA 12 (StataCorp College Station, TX, EE. UU.). Resultados: Existen diferencias estadísticamente significativas entre los grupos de profesionales en cuanto al sexo (p = 0,002), formación académica (p = 0,042) y trabajar en otra institución (p = 0,022). El 50 por ciento de los profesionales encuestados calificaron la seguridad del paciente en su servicio con una nota entre 8 y 9. Conclusiones: En la valoración de la cultura de seguridad se logró identificar como fortaleza las dimensiones de aprendizaje organizacional/mejora continua, trabajo en equipo dentro de la unidad/servicio y apoyo de la gerencia del hospital en la seguridad del paciente(AU)

Introduction: There is a need for health professionals to lead patient safety as a public policy, which is a quality criterion to evaluate the safety culture in health institutions and in each service they offer. Objective: To assess the dimensions of culture about patient safety. Methods: Analytical and cross-sectional study carried in the operating room area of ​​San Luis Maternal and Child Clinic, from April to July 2018. The responses about safety culture were taken from 45 health professionals through the Hospital Survey on Patient Safety questionnaire, Spanish version. The statistical analysis presents proportions, measures of central tendency, dispersion and interquartile range. To identify the differences between the groups, the following tests were used: exact Fisher's test, Anova test, and Kruskal Wallis test. The analyzes were performed in the STATA 12 program (StataCorp College Station, TX, USA). Results: There are statistically significant differences between the groups of professionals regarding sex (p=0.002), academic training (p=0.042) and work in another institution (p=0.022). 50 percent of the respondents rated patient safety in their service with a score between 8 and 9. Conclusions: In assessing safety culture, some dimensions were identified as strengths, such as organizational learning/continuous improvement, teamwork within the unit/service, and support of the hospital management to patient safety(AU)

Effectiveness of an Educational Nursing Intervention on Caring Ability and Burden in Family Caregivers of Patients with Chronic Non-Communicable Diseases. A Preventive Randomized Controlled Clinical Trial.

OBJECTIVES: To evaluate the effect of the "Caring for Caregivers" program in the caring ability and burden in family caregivers of patients with chronic diseases at health care institutions. METHODS: A randomized controlled clinical trial was conducted in 34 relatives of patients with chronic diseases that had cared for them for more than 3 months. Zarit scale was used to measure caregiver burden and the CAI (Caring Ability Inventory) was also used to measure caring ability. An educational intervention was applied based on the "Caring for Caregivers" strategy of the Universidad Nacional de Colombia. RESULTS: Although both groups improved their percentage of unburdened caregivers from the first to the second assessment, the difference between the two assessments was 41.2% in the intervention group whereas it was 11.8% in the control group, being only statistically significant the difference for the intervention group. Regarding the caring ability, no significant changes were identified in both groups. CONCLUSIONS: On family caregivers, it was observed that the "Caring for Caregivers" intervention had a positive impact on decreasing burden, but not on improving the caring ability.

Mining leachate contamination and subfecundity among women living near the USA-Mexico border.

The contamination of the Sonora River with 40,000 m3 of toxic leachate released from a copper mine on August 6, 2014, was considered the worst environmental disaster of the mining industry in Mexico, exceeding safety levels in the concentrations of heavy metals and arsenic. To explore the potential association of the toxic release with subfecundity, by comparing time to pregnancy (TTP) of women with different levels of exposure at municipalities located along the Sonora River watershed, just 35 km south of the Arizona-Mexico border. Data from 235 pregnancies were included in a retrospective cohort study. Exposure was measured whether pregnancy occurred before or after the disaster and included a non-exposed community outside the watershed. Pregnancies were also compared between communities according to the concentration-level gradient of water pollutants found in the river. Fecundability odds ratios (fORs) were calculated using discrete time analogue of Cox's proportional hazard models. Multiple analysis included all pregnancies with TTP of no more than 12 months, only first-time pregnancy, or excluding women with TTP = 1. The probability for pregnancy decreased after the disaster (fOR 0.55, 95% CI 0.31, 0.97), when the residency was located mid-or-downstream the watershed (fOR 0.37, 95% CI 0.15, 0.91), when reported chicken consumption, when mining was the father's occupation, and when surface water was reported to be used for crop irrigation and for animal consumption. There was a decrease in fecundity on women exposed to the contaminated river. There is a need for more studies to prove these findings and to broaden the knowledge of other possible adverse health effects associated with this environmental disaster.

Effectiveness of an Educational Nursing Intervention on Caring Ability and Burden in Family Caregivers of Patients with Chronic NonCommunicable Diseases. A Preventive Randomized Controlled Clinical Trial

Objective. To evaluate the effect of the "Caring for Caregivers" program in the caring ability and burden in family caregivers of patients with chronic diseases at health care institutions. Methods. A randomized controlled clinical trial was conducted in 34 relatives of patients with chronic diseases that had cared for them for more than 3 months. Zarit scale was used to measure caregiver burden and the CAI (Caring Ability Inventory) was also used to measure caring ability. An educational intervention was applied based on the "Caring for Caregivers" strategy of the Universidad Nacional de Colombia. Results. Although both groups improved their percentage of unburdened caregivers from the first to the second assessment, the difference between the two assessments was 41.2% in the intervention group whereas it was 11.8% in the control group, being only statistically significant the difference for the intervention group. Regarding the caring ability, no significant changes were identified in both groups. Conclusion. On family caregivers, it was observed that the "Caring for Caregivers" intervention had a positive impact on decreasing burden, but not on improving the caring ability.

Objetivo. Evaluar el efecto del programa "Cuidando a Cuidadores" en la habilidad del cuidado y la carga de los cuidadores familiares de personas con enfermedad crónica que asisten a una institución de salud. Métodos. Ensayo clínico controlado randomizado, realizado en 34 familiares de personas con enfermedad crónica que los hubieran cuidado por más de 3 meses. Se utilizaron las escalas de ZARIT para medir la sobrecarga del cuidador y el CAI (Caring Ability Inventory) para medir la habilidad del cuidado. Se aplicó una intervención educativa basada en la estrategia "cuidando a cuidadores" de la Universidad Nacional de Colombia. Resultados. Aunque ambos grupos mejoraron en el porcentaje de cuidadores sin sobrecarga de la primera a la segunda evaluación, en el grupo de intervención la diferencia entre los dos momentos de evaluación fue de 41.2%, mientras que en el grupo control fue de 11.8%, estadísticamente significante la diferencia para el grupo de intervención. En la habilidad del cuidado no se identificaron cambios significativos en los dos grupos. Conclusión. En los cuidadores familiares se apreció que la intervención "cuidando a los cuidadores" presentó impacto positivo en disminución de la sobrecarga, pero no en la mejora de la habilidad de cuidado.

Objetivo. Avaliar o efeito do programa "Cuidando a Cuidadores" na habilidade do cuidado e a carga dos cuidadores familiares de pessoas com doenças crônica que frequentam a uma instituição de saúde. Métodos. Ensaio controlado randomizado, realizado em 34 familiares de pessoas com doenças crônica que os tiveram cuidado por mais de 3 meses. Se utilizaram as escalas de ZARIT para medir a sobrecarga do cuidador e o CAI (Caring Ability Inventory) para medir a habilidade do cuidado. Se aplicou uma intervenção educativa baseada na estratégia "cuidando a cuidadores" da Universidade Nacional de Colômbia. Resultados. Embora ambos grupos melhoraram na porcentagem de cuidadores sem sobrecarga da primeira à segunda avaliação, no grupo de intervenção a diferença entre os dois momentos de avaliação é de 41.2%, enquanto que no grupo controle é de 11.8%, sendo unicamente estatisticamente significante esta diferença para o grupo de intervenção. Na habilidade do cuidado não se identificaram câmbios significativos nos dos grupos. Conclusão. Nos cuidadores familiares se apreciou que a intervenção "cuidando aos cuidadores" apresentou impacto positivo em diminuição da sobrecarga, mas não na melhora da habilidade de cuidado.

Evaluación de contenidos curriculares y percepción de competencias de estudiantes del área de la salud respecto del Modelo Integral de Atención en Salud en Colombia / Assessment of curricular contents and perception of competencies of health students related to the integrated health care model in Colombia

RESUMEN Objetivo Identificar la percepción de los estudiantes de último nivel de los programas de formación profesional y técnica en salud respecto a sus competencias para desempeñarse en el MIAS, y evaluar la presencia de dichas competencias dentro de los contenidos curriculares de los programas de salud en Santander. Métodos Se realizó un estudio descriptivo transversal en 451 estudiantes y una revisión documental de currículos de 26 programas. Se construyó y validó el contenido de un cuestionario en línea de percepción de competencias en los ámbitos del saber ser, saber conocer y saber hacer. Resultados En la revisión documental se encontró deficiencias en la inclusión de competencias tales como las de ejercer liderazgo (80 %) y realizar un enfoque diferencial en la atención (84 %). En la encuesta de percepción, el 36 % de los estudiantes manifestaron tener un conocimiento regular o deficiente sobre Rutas Integrales de Atención en Salud, planes de beneficios y actores del sistema de salud. Adicionalmente, el 7,5 % afirmaron ser poco competentes para realizar actividades de coordinación intersectorial, vigilancia epidemiológica o investigación en salud pública. Conclusiones Los resultados evidencian la necesidad de incluir en los currículos de programas de salud algunos aspectos fundamentales para la adecuada implementación del MIAS.(AU)

ABSTRACT Objective To identify the perception of the last level students of the professional and technical health training programs regarding their competences to perform in the MIAS, and to evaluate the presence of said competences within the curricular contents of the health programs in Santander. Methods A transversal descriptive study was carried out in 451 students and a documentary review of curricula was performed for 26 programs. The content of an online questionnaire on the perception of competences in the areas of knowledge, attitudes and abilities was constructed and validated. Results In the documentary review, deficiencies were found in the inclusion of competencies such as leadership (80 %) and differential approach in care (84 %). In the perception survey, 36 % of the students stated that they had regular or deficient knowledge about Integral Routes of Health Care, benefit plans and actors of the health system. Additionally, 7.5 % stated they were not competent to carry out intersectoral coordination activities, epidemiological surveillance or public health research. Conclusion: The results show the need to include in the curricula of health programs some fundamental aspects for the proper implementation of MIAS.(AU)

[Assessment of curricular contents and perception of competencies of health students related to the integrated health care model in Colombia]. / Evaluación de contenidos curriculares y percepción de competencias de estudiantes del área de la salud respecto del Modelo Integral de Atención en Salud en Colombia.

OBJECTIVE: To identify the perception of the last level students of the professional and technical health training programs regarding their competences to perform in the MIAS, and to evaluate the presence of said competences within the curricular contents of the health programs in Santander. METHODS: A transversal descriptive study was carried out in 451 students and a documentary review of curricula was performed for 26 programs. The content of an online questionnaire on the perception of competences in the areas of knowledge, attitudes and abilities was constructed and validated. RESULTS: In the documentary review, deficiencies were found in the inclusion of competencies such as leadership (80 %) and differential approach in care (84 %). In the perception survey, 36 % of the students stated that they had regular or deficient knowledge about Integral Routes of Health Care, benefit plans and actors of the health system. Additionally, 7.5 % stated they were not competent to carry out intersectoral coordination activities, epidemiological surveillance or public health research. CONCLUSION: The results show the need to include in the curricula of health programs some fundamental aspects for the proper implementation of MIAS.

OBJETIVO: Identificar la percepción de los estudiantes de último nivel de los programas de formación profesional y técnica en salud respecto a sus competencias para desempeñarse en el MIAS, y evaluar la presencia de dichas competencias dentro de los contenidos curriculares de los programas de salud en Santander. MÉTODOS: Se realizó un estudio descriptivo transversal en 451 estudiantes y una revisión documental de currículos de 26 programas. Se construyó y validó el contenido de un cuestionario en línea de percepción de competencias en los ámbitos del saber ser, saber conocer y saber hacer. RESULTADOS: En la revisión documental se encontró deficiencias en la inclusión de competencias tales como las de ejercer liderazgo (80 %) y realizar un enfoque diferencial en la atención (84 %). En la encuesta de percepción, el 36 % de los estudiantes manifestaron tener un conocimiento regular o deficiente sobre Rutas Integrales de Atención en Salud, planes de beneficios y actores del sistema de salud. Adicionalmente, el 7,5 % afirmaron ser poco competentes para realizar actividades de coordinación intersectorial, vigilancia epidemiológica o investigación en salud pública. CONCLUSIONES: Los resultados evidencian la necesidad de incluir en los currículos de programas de salud algunos aspectos fundamentales para la adecuada implementación del MIAS.