Tabla de la normalidad de las pruebas psicométricas para el diagnóstico de encefalopatía hepática subclínica en la población Dominicana / Score of normality psychometric tests for the diagnosis of subclinical hepatic encephalopathy in the Dominican Population

Introducción: La encefalopatía hepática mínima (EHM), es una enfermedad definida por la existencia de varias alteraciones neurofisiológicas, indetectables a la exploración neurológica y el examen clínico. Dentro de las estrategias diagnosticas para la EHM se contemplan las pruebas psicométricas (PHE), pero para su aplicación es indispensable la estandarización previamente en la población de estudio. Objetivo: El estudio se propuso determinar la tabla de la normalidad de las PHE para diagnosticar la encefalopatía hepática subclínica en una muestra de la población dominicana. Método: Se realizó un estudio descriptivo, prospectivo y transversal en un hospital de referencia nacional. Se analizaron 134 personas clasificados por grupos de edades (18-70 años de edad) y años de escolaridad. Se diseñó una tabla de 5x5. Se estudió la influencia de la edad, sexo, uso de espejuelo y de los años de escolarización en el rendimiento de cada uno de las PHE, para lo cual se utilizaron las siguientes pruebas estadísticas: análisis de varianza (ANOVA), prueba t de Student y regresión lineal. Resultado: La escolaridad y la edad fueron variables determinantes en el desempeño de las 5 pruebas psicométricas. Pero, la correlación univariable de la edad con el desempeño de la prueba TMS no hubo diferencias intra e inter grupos estadísticamente significativas (p>0.171). Conclusión: se confecciono la fórmula de predicción de resultados de los test psicométricos. Ninguno sobrepasó el punto de corte de la puntuación que oscila entre los -4 y los +2 puntos.

Introduction: Minimal hepatic encephalopathy (MHE) is a disease defined by the existence of several neurophysiological alterations, undetectable by neurological examination and clinical examination. Among the diagnostic strategies for EHM, psychometric tests (PHE) are contemplated, but for their application, prior standardization in the study population is essential. Objective: The study will need to determine the normality table of PHE to detect subclinical hepatic encephalopathy in a sample of the Dominican population. Method: A descriptive, prospective and cross-sectional study was carried out in a national reference hospital. 134 people classified by age groups (18-70 years of age) and years of schooling were analyzed. A 5x5 board is recommended. The influence of age, sex, use of glasses and years of schooling on the performance of each one of the PHEs was studied, for which the following statistical tests were used: analysis of variance (ANOVA), Student's t test and linear regression. Result: Schooling and age were determining variables in the performance of the 5 psychometric tests. But, the univariate coincidence of age with the performance of the TMS test, there were no statistically significant intra and inter group differences (p>0.171). Conclusion: the formula for predicting the results of the psychometric tests was made. None exceeded the cut-off point of the score that oscillates between -4 and +2 points.

Use of vinasse and coffee waste as chelating agent of photo-Fenton landfill leachate treatment.

This research studies the use of vinasse (VS) coming from Pisco and caffeic acid (Caa) from solid coffee waste as chelating agents of this process, to carry out a photo-Fenton process using UVc lamps of 254-nm wavelength for 60 min, at the natural pH of the landfill leachate (8.9). Without the chelating agent, there was a removal of UV 254 and COD of 54.2% and 54.7%, respectively, when the photo-Fenton reaction was carried out at pH 3; at pH 6, the removal of UV 254 and COD was 13.1% and 39.2%, respectively, and at pH 8.9, the elimination of UV 254 and COD was 10.8% and 16.1%, respectively. When Caa was used in the landfill leachate (LL) for the photo-catalytic processes carried out at pH 8.9, a removal of 24.1%, 43.0%, and 47.4% of UV 254 was obtained using 5 mg/L, 50 mg/L, and 100 mg/L of Caa. The removal of UV 254 was 27.3%, 30.7%, and 36.3% using 5 mg/L, 50 mg/L, and 100 mg/L of VS, respectively, and the removal of COD was 32.2%, 35.4%, and 39.2% using 5 mg/L, 50 mg/L, and 100 mg/L of VS, respectively. When Caa was used in the LL at pH 8.9, the concentration of total Fe went from 37.5 to 33.2, from 40.2 to 36.8, and from 45.2 to 42.1, using 5 mg/L, 50 mg/L, and 100 mg/L of caffeic acid, respectively. Using VS in the LL at pH 8.9, the concentration of total Fe along the run went from 35.1 to 32.2, from 39.4 to 34.8, and from 42.1 to 40.2, using 5 mg/L, 50 mg/L, and 100 mg/L of VS, respectively. As a result of these processes, it was noted that the use of Caa and VS increases the solubility of Fe at a higher pH.

Sistema CAD/CAM en la confección de prótesis totales dentales / The CAD/CAM system in the fabrication of total dental prostheses

La técnica CAD/CAM es un sistema que ha facilitado los procesos de toma de impresiones totales e incorpora registros intraorales y requisitos apropiados para lograr bases protésicas adecuadas, lo cual permite óptimos resultados en clínica dental, como son el ahorro de tiempo y la comodidad para el especialista y el paciente, razones que llevan al profesional estomatológico a dar el paso hacia una odontología digital. El objetivo del estudio fue analizar el sistema CAD/CAM en la confección de prótesis totales dentales. La búsqueda se realizó en las bases de datos Google Scholar, Pubmed y Scopus, intentando responder a la pregunta orientadora: ¿Cuáles son los aspectos más significativos para el sistema CAD/CAM en la confección de prótesis totales dentales? Como resultados, se pudo interpretar que, consiguiendo registros tridimensionales producidos en un escáner, se proporciona una mejor adaptación de estructuras respecto a los métodos convencionales, por lo que induce estética y precisión, que son factores importantes en la odontología. Se concluyó que el sistema CAD/CAM disminuye el margen de error humano y conduce a mayores éxitos odontológicos, al brindar un mejor soporte para la toma decisiones y conseguir mejores resultados estéticos y funcionales en las prótesis totales de los pacientes(AU)

The CAD/CAM technique is a system that has facilitated the process of taking total impressions and incorporates intraoral records and appropriate requirements to achieve adequate prosthetic bases, which allows optimal results in the dental clinic, such as time savings and comfort for the specialist and the patient, reasons that lead the dental professional to take the step towards digital dentistry. The objective of the study was to analyze the CAD/CAM system in the fabrication of total dental prostheses. The search was carried out in Google Scholar, Pubmed and Scopus databases, trying to answer the guiding question: What are the most significant aspects for the CAD/CAM system in the manufacture of total dental prostheses? As results, it was possible to interpret that, by obtaining three-dimensional records produced in a scanner, it provides a better adaptation of structures compared to conventional methods, thus inducing esthetics and precision, which are important factors in dentistry. It was concluded that the CAD/CAM system reduces the margin of human error and leads to greater dental success by providing better support for decision making and achieving better esthetic and functional results in the total prostheses of patients(AU)

Immunohistochemistry, Quality Control, and Principles of Validation in the Central Nervous System.

The conventional hematoxylin and eosin stain (H&E) is vital for the histological diagnosis but the role of immunohistochemistry (IHC) in the central nervous system is undeniable. Immunohistochemical techniques detect antigens in tissue sections by immunological and chemical reactions. This chapter reviews the preanalytic, analytic, and postanalytic phases of immunohistochemistry, as well as the principles of quality control and validation.

Relación entre características sociodemográficas y estadios de la enfermedad de Alzheimer desde una perspectiva enfermera / Relationship between Sociodemographic Characteristics and Stages of Alzheimer's disease from Nursing Perspective

Introducción: Los cambios demográficos de las últimas décadas favorecen el incremento de personas mayores, este panorama muestra aumento de enfermedades no transmisibles, entre las más frecuentes está la enfermedad de Alzheimer. Los pacientes que la padecen requieren cuidados de enfermería en la atención primaria de salud. Objetivo: Establecer la relación entre características sociodemográficas y estadios de la enfermedad de Alzheimer desde una perspectiva enfermera. Métodos: Estudio descriptivo correlacional en 81 pacientes con enfermedad de Alzheimer, del Policlínico Docente "Julio Antonio Mella" del municipio Guanabacoa, La Habana, Cuba, durante abril-mayo del 2018. Las variables estudiadas fueron: edad, sexo, estadio de la enfermedad, estado civil y nivel educacional. La información se obtuvo del cuestionario sociodemográfico y clínico. Se utilizó frecuencia absoluta, porcentaje, media y desviación estándar para la edad; se comprobó la relación del estadio de la enfermedad con variables sociodemográficas con la prueba coeficiente de correlación de Pearson. Resultados: Pacientes con edad media de 79,22 años; 63,00 por ciento, mujeres; 45,70 por ciento, viudos(as); 64,20 por ciento con escolaridad de secundaria terminada; 63,00 por ciento en estadio moderado de la enfermedad. Se evidenció correlación negativa y positiva entre el estadio de la enfermedad y las características sociodemográficas; con niveles de significancia del 0,01 y 0,05. Conclusiones: Predominaron los pacientes con enfermedad de Alzheimer en el estadio moderado de la enfermedad, femeninas, viudas, con nivel educacional de secundaria terminada y una edad media de 79,22 años. Se identificó correlación entre el estadio de la enfermedad y las características sociodemográficas de los pacientes(AU)

Introduction: The demographic changes of the last decades favor the increase of the elderly; this panorama shows an increase in non-communicable diseases, among the most frequent is Alzheimer's disease. Patients who suffer from it require nursing care in primary health care. Objective: To establish the relationship between sociodemographic characteristics and stages of Alzheimer's disease from a nursing perspective. Methods: Descriptive correlational study in 81 patients with Alzheimer's disease were carried out at Julio Antonio Mella Teaching Polyclinic in Guanabacoa municipality, Havana, Cuba, from April to May 2018. The variables studied were age, sex, stage of the disease, marital status and schooling level. We took information from the sociodemographic and clinical questionnaire. Absolute frequency, percentage, mean and standard deviation for age were used; the relationship of the stage of the disease with sociodemographic variables was verified with the Pearson correlation coefficient test. Results: We found a predominance of patients with mean age of 79.22 years; 63.00 percent, women; 45.70 percent, widowers; 64.20 percent with secondary schooling completed; 63.00 percent in moderate stage of the disease. A negative and positive correlation was evidenced between the stage of the disease and the sociodemographic characteristics; and significance levels of 0.01 and 0.05. Conclusions: Patients with Alzheimer's disease prevailed in the moderate stage of the disease, female, widowed, with high school education level and mean age of 79.22 years. A correlation was identified between the stage of the disease and the sociodemographic characteristics of the patients(AU)

Teoría de Kristen M. Swanson vinculada al cuidado del cuidador principal de pacientes con enfermedad de Alzheimer / Kristen M. Swanson Theory linked under the care to the principal caregiver of patient with Alzheimer disease

Introducción: La enfermedad de Alzheimer es causa frecuente de demencia, esta tiene impacto social y económico para los pacientes, los sistemas de salud y las familias, lo cual provoca que los enfermos sean atendidos por familiares, amigos o vecinos, que no siempre son personas capacitadas y se les denomina cuidadores informales. Objetivo: Exponer la vinculación de la teoría de Kristen M. Swanson al cuidado del cuidador principal de pacientes con enfermedad de Alzheimer. Métodos: Revisión bibliográfica descriptiva para un análisis crítico reflexivo de contenido de artículos originales, artículos de revisión, libros de la especialidad y tesis de grado. Las palabras clave identificadas en DeCS y operadores booleanos utilizados fueron: "enfermedad de Alzheimer" OR "demencia" AND "cuidadores" AND "teoría de enfermería". La búsqueda fue realizada en las bases de datos SciELO (Scientific Electronic Library Online) y el motor de búsqueda Google académico, desde mayo hasta junio del 2019. Se consideró como criterio de inclusión los artículos publicados en idioma español e inglés y los disponibles a texto completo en las bases de datos seleccionadas. Se utilizó el diagrama de flujo (PRISMA) para contribuir a la formulación de la estrategia de búsqueda. Conclusiones: Se expuso la teoría de los cuidados de Kristen M. Swanson, representante de la escuela de la interacción, su vínculo en el cuidado del paciente con enfermedad de Alzheimer, así como su posible vinculación en otros contextos en los que se desempeña el personal de enfermería. Se constató la carencia en el contexto cubano de estudios sustentados en esta teoría(AU)

Introduction: Alzheimer's disease is frequent cause of dementia; this has a great social and economic impact for the patients, the health's systems and the families; that which causes that the sick persons are assisted by relatives, friends or neighbors that are not always qualified people and they are denominated informal caregivers. Objective: to present Kristen M. Swanson theory to the principal caregivers care of patient suffering from Alzheimer's disease. Methods: a descriptive bibliographic review was carried out for a critical reflexive analysis of the content of original and review articles, books of the specialty and grade thesis. The keywords identified in DeCS and Boolean operators used: "Alzheimer diseases" OR "dementia" AND "caregivers" AND "nursing theory" The search was carried out in the SciELO (Scientific Electronic Library Online) and the search motor academic Google database, from May until June of the 2019. It was considered as inclusion criteria articles published in Spanish and English language and, the available ones to complete text in the selected databases. The flow chart (PRISMA) was used to contribute to the formulation of the search strategy. Conclusions: the theory of caring of Kristen M. Swanson was presented, representative of the interaction school, its linking in the Alzheimer disease patient's care, as well as its possible link in other contexts in those that the nursing personnel works. It was confirmed the deficient in the Cuban context of studies sustained in this theory(AU)

Meaning of well-being of older institutionalized persons in abandonment situation.

OBJECTIVE: To understand the meaning of well-being of older persons in situation of abandonment. METHODS: a qualitative phenomenological study, carried out in a nursing home in Tepic, Nayarit, from 2017 to 2019. Intentional sampling with 12 older persons aged 60 and above. Data collection occurred by phenomenological interview. The ethical criteria of the General Health Law were respected. Participants signed the Informed Consent Form. Data analysis took place through phenomenological analysis. RESULTS: four themes have emerged: 1. Living Activities of Daily Living; 2. Attention to physical needs; 3. Coexistence; 4. Spirituality experience. CONCLUSION: for older persons, living institutionalized implies a process of adaptation and transformation to their context and state of life, restructuring their needs that provide well-being. It is important to approach these scenarios to establish ways of experiencing aging that favor a full quality of life.

Integrated probabilistic risk assessment in sites contaminated with arsenic and lead by long-term mining liabilities in San Luis Potosi, Mexico.

Mining environmental liabilities (MEL) in San Luis Potosi are the result of more than 450 years of mining activity, which has contaminated the soil mainly with arsenic (As) and lead (Pb) in several areas. Risk assessments are used to estimate the possibility of the occurrence of adverse effects on human health or on ecological receptors; and the most accessible way of performing them is through probabilistic estimates such as the Latin Hypercube Sampling (LHS) model. Therefore, the aim of this study was to carry out an Integrated Probabilistic Environmental Risk Assessment (IPERA) for the estimation of health risks in infants and rodents. The mean concentrations of As and Pb in soil were significantly higher (p<0.05) in all contaminated sites than in their respective reference sites. Villa de la Paz was the site with the highest mean concentration of As (1374 mg/kg), while Charcas was the one with the highest level of Pb (12,929 mg/kg). The Hazard Quotient (HQ) was calculated and Villa de la Paz had the highest values of As in both rodents (11.994) and children (39.32), and Charcas showed the highest values of Pb in both (24.971 and 31.668 for rodents and children respectively). The cumulative hazard Index (HI) reveals there is a very significant health risk due to As and Pb exposure for both rodents and children in contaminated areas of these mining communities.

Meaning of well-being of older institutionalized persons in abandonment situation / Significado de bem-estar do idoso institucionalizado em situação de abandono / Significado de bienestar del anciano institucionalizado en situación de abandono

ABSTRACT Objective: To understand the meaning of well-being of older persons in situation of abandonment. Methods: a qualitative phenomenological study, carried out in a nursing home in Tepic, Nayarit, from 2017 to 2019. Intentional sampling with 12 older persons aged 60 and above. Data collection occurred by phenomenological interview. The ethical criteria of the General Health Law were respected. Participants signed the Informed Consent Form. Data analysis took place through phenomenological analysis. Results: four themes have emerged: 1. Living Activities of Daily Living; 2. Attention to physical needs; 3. Coexistence; 4. Spirituality experience. Conclusion: for older persons, living institutionalized implies a process of adaptation and transformation to their context and state of life, restructuring their needs that provide well-being. It is important to approach these scenarios to establish ways of experiencing aging that favor a full quality of life.

RESUMO Objetivo: Compreender o significado de bem-estar do idoso em situação de abandono. Métodos: estudo qualitativo fenomenológico, realizado em uma casa de repouso em Tepic, Nayarit, de 2017 a 2019. Amostragem intencional ocorreu com 12 idosos com 60 anos ou mais, homens e mulheres. Coleta de dados por entrevista fenomenológica. Os critérios éticos da Lei Geral de Saúde foram respeitados. Os participantes assinaram o Termo de Consentimento Livre e Esclarecido. Análise de dados ocorreu por meio de análise fenomenológica. Resultados: emergiram quatro temas: 1. Vivenciando as atividades diárias da vida diária; 2. Atenção às necessidades físicas; 3. Coexistência; 4. Experiência de Espiritualidade. Conclusão: para o idoso, viver institucionalizado implica um processo de adaptação e transformação ao seu contexto e estado de vida, reestruturando suas necessidades que proporcionem bem-estar, sendo importante a abordagem desses cenários para estabelecer formas de vivenciar o envelhecimento que favoreçam uma qualidade de vida plena.

RESUMEN Objetivo: Comprender el significado de bienestar del anciano en una situación de abandono. Métodos: Estudio cualitativo fenomenológico, realizado en asilo de Tepic, Nayarit, de 2017 a 2019. Muestreo intencional con 12 adultos mayores, con 60 años en adelante, hombres y mujeres. Recolección de datos por entrevista fenomenológica. Se respetaron criterios éticos de la Ley General de Salud, participantes firmaron consentimiento informado. Análisis de datos a través de análisis fenomenológico. Resultados: Emergieron cuatro temas: 1. Vivir lo cotidiano de las actividades de la vida diaria; 2. La atención en las necesidades físicas; 3. La convivencia y 4. Vivencia de la Espiritualidad. Conclusión: Para el anciano vivir institucionalizado implica un proceso de adaptación y transformación a su contexto y estado de vida, reestructura sus necesidades que lo proveen de bienestar, es importante el acercamiento a estos escenarios para establecer formas de vivencia del envejecimiento que favorezcan la calidad de vida plena.

Providing quality care for children and adolescents with diabetes from lower-income families in Mexico.

Background The objective of this study was to determine the demographic and clinical features of youth supported by member associations of the Federación Mexicana de Diabetes and the Life for a Child Program (LFAC). Methods An analysis of 2017 Annual Clinical Data Sheets of 306 subjects from five Mexican centers was performed. Results Type 1 diabetes (T1D) was diagnosed in 292 subjects; 54.6% were female, with six diagnosed aged <6 months (genetic tests not yet conducted). Type 2 diabetes (T2D) or other types were diagnosed in 11 and three subjects, respectively. T1D diagnosis age ranged 0.0-22.6 years with a peak at 8 years. The mean ± standard deviation (SD) diabetes duration was 5.3 ± 3.5 years (range 0.0-21.0 years), with a mean ± SD subject age at check-up of 13.3 ± 4.3 years. Of the T1D subjects, 1.0%, 6.7%, 13.7% and 78.6% were receiving 1, 2, 3 and ≥4 insulin injections/day with a mean ± SD daily dose of 0.92 ± 0.34 U/kg. The median number of blood glucose tests/week was 40. The mean/median hemoglobin A1c (HbA1c) levels for those with duration ≥6 months were 8.7/8.4% (72/68 mmol/mol) and were higher in adolescents vs. children. Elevated body mass index SD, triglycerides (≥150 mg/dL) and non-high-density lipoprotein (HDL)-cholesterol (≥130 mg/dL) were common: 7.6%, 11.0% and 12.7% (n = 288, 218 and 180, respectively). Serum creatinine levels were normal in all tested subjects (n = 194). Conclusions Youth with diabetes in less-resourced families in Mexico are achieving reasonable glycemia. Most T1D patients use a basal bolus insulin regimen and test blood glucose several times daily. Some subjects have adverse vascular risk factor profiles. Further attention is needed to prevent chronic complications. Monogenic diabetes is very likely in some youth, and genetic testing is indicated.

Concepto de Envejecimiento en voz de un grupo focal de adultos mayores: Relato de experiencia / Concept of Aging in the voice of a focal group of elders: Experience report / Conceito de Envelhecimento na voz de um grupo focal de idosos: Relato de experiência

El objetivo del presente trabajo es relatar la experiencia de acercamiento al concepto de envejecimiento desde de la voz de los adultos mayores a través de un grupo focal. Se llevó a cabo un estudio de tipo cualitativo con la técnica de grupo focal constituido por diez adultos mayores que acuden a Grupos de Convivencia en una comunidad de Aguascalientes, México. Surgieron las categorías: Etapa de vida, Cambios físicos, Cambios sociales, Cambios emocionales, Motivación, Convivencia. Los adultos mayores definen el envejecimiento como una etapa de vida en donde se experimentan cambios físicos, cambios sociales y cambios emocionales.

The objective of this work is to relate the experience of approaching the concept of aging from the voice of the elderly through a focus group. A qualitative study was carried out with the technique of a focal group consisting of ten elderly people who attend Coexistence Groups in a community in Aguascalientes, Mexico. The following categories emerged: Stage of life, Physical changes, Social changes, Emotional changes, Motivation, Coexistence. Older adults define aging as a stage of life where physical changes, social changes and emotional changes are experienced.

O objetivo deste trabalho é relatar a experiência da aproximação ao conceito de envelhecimento na voz do idoso por meio de um grupo focal. Um estudo qualitativo foi realizado com a técnica de um grupo focal composto por dez idosos que freqüentam Grupos de Convivência em uma comunidade em Aguascalientes, México. Emergiram as seguintes categorias: Estágio de Vida, Mudanças Físicas, Mudanças Sociais, Mudanças Emocionais, Motivação, Convivência.

Conocimiento, actitud y barreras en enfermeras hacia las medidas de prevención de úlceras por presión / Knowledge, attitude and barriers in nurses towards prevention measures of pressure ulcers

RESUMEN Objetivo: Identificar el nivel de conocimiento, actitud y barreras hacia las medidas de prevención de las úlceras por presión en el personal de enfermería que labora en servicios de hospitalización adultos. Material y método: Estudio descriptivo y transversal realizado en un hospital de Seguridad Social, en una muestra de 119 enfermeras y auxiliares de enfermería que laboran con pacientes adultos en riesgo de desarrollar úlceras por presión. Se aplicaron tres cuestionarios autocumplimentados: Valoración de conocimientos hacia la prevención de úlceras por presión (PUKAT); Actitud hacia la prevención de las úlceras por presión (APuP) y un apartado de Barreras de prevención e intervención. Se respetó el reglamento de la Ley General de Salud en Materia de Investigación de México. Resultados: Se identificó un 53,78% de respuestas correctas, lo que mostró un conocimiento bajo hacia las medidas de prevención. La actitud mostrada fue positiva con una media de 40,1 DE 3,5. Las barreras identificadas en prevención fueron "falta de personal" (81,51%), "pacientes que no cooperan" (67,22%) y "falta de tiempo" (64,70%); en intervención: "falta de ayudantes para la movilización" (91,59%), "falta de enfermeras" (80,67%) y "falta de tiempo" (72,26%). Conclusiones: Las enfermeras y auxiliares de enfermería mostraron un conocimiento bajo hacia las medidas de prevención de las úlceras por presión, con una actitud positiva. El personal de enfermería que labora en UCI y Medicina interna mostró tener una mejor actitud y las barreras más identificadas corresponden a falta de enfermeras, tiempo y personal que las asista en la movilización.

ABSTRACT Objective: To identify the level of knowledge, attitude and barriers in nursing staff working in adult in patient services towards prevention measures of pressure ulcers. Material and Methods: Quantitative, descriptive and transversal study conducted in a hospital of Social Security, in a sample of 119 nurses and nursing assistants who work with adult patients at risk of developing pressure ulcers. For data collection three self-filled questionnaires were applied: "Knowledge Rating of the pressure ulcers prevention"(PUKAT); "Attitude towards prevention of pressure ulcers" (APuP) and a section of barriers to prevention and intervention. The guidelines about informed consent and risks for research in Mexico were complied. Results: 56.63 % of correct answers were identified, which showed a low awareness towards prevention measures. Positive attitude was shown, with a mean of 40.10. The barriers identified in prevention were "lack of staff" (81.51%), "uncooperative patients" (67.22%), "lack of time" (64.70%); and in intervention: "lack of helpers for mobilization" (91.59%), "lack of nurses" (80.67%) and "lack of time" (72.26%). Conclusions: Nurses and nursing assistants showed low knowledge, but showed positive attitude, nursing staff working in ICU and internal medicine showed a better attitude, and the main identified barriers in the study are a lack of nurses, time and personnel that assist in the mobilization.

Underweight, overweight and obesity prevalence among adolescent school children in the Province of La Pamp Argentina.

INTRODUCTION: While different epidemiological studies as part of their survey include data of adolescents of the province of La Pampa regarding overweight and obesity prevalence, their experimental designs have certain limitations as far as the description of the regional reality. OBJECTIVE: To obtain a diagnosis of the situation regarding the body composition profile among 13 year old adolescents in the Province of La Pampa. POPULATION AND METHODS: A cross-sectional study was conducted in a sample of male and female adolescents born in 2001. Weight, height, waist circumference, scapular and tricipital skinfolds were measured. RESULTS: Of the 711 adolescents assessed, 5 subjects (0.7%) had a weight below the third percentile for age and sex. In relation to overweight and obesity, the sample values were 26.4% and 14.1%, respectively (27.5% and 16.9% of male; 25.5% and 11.7% of female adolescents). Of the total sample, 15.8% (16.5% of male and 15.6% of female adolescents) had waist circumference values compatible with abdominal obesity. As far as body fat values, 36.8% (37.4% of male and 36% of female adolescents) had above normal values according to skinfold thickness measurements. CONCLUSIONS: In contrast with the small prevalence of low weight in the region, overweight and obesity are a significant problem among the studied population in La Pampa.

INTRODUCTION: Introducción. Mientras que diversos estudios epidemiológicos incluyen como parte de su relevamiento datos de jóvenes de la provincia de La Pampa en relación con la prevalencia de sobrepeso y obesidad, sus diseños experimentales presentan ciertas limitaciones en cuanto a la descripción de la realidad regional. OBJECTIVE: Obtener un diagnóstico de situación acerca del perfil de composición corporal de adolescentes de 13 años de edad de la provincia de La Pampa. POBLACIÓN Y MÉTODOS: Se realizó un estudio de corte transversal en una muestra de varones y niñas nacidos en el año 2001, a los que se les tomó peso, tall perímetro de cintur pliegue subescapular y tricipital. RESULTS: De los 711 varones y niñas evaluados, 5 sujetos (0,7%) presentaron un peso por debajo del percentilo 3 para sexo y edad. En lo que hace a sobrepeso y obesidad, los valores de la muestra fueron 26,4% y 14,1%, respectivamente (27,5% y 16,9% en varones; 25,5% y 11,7% en niñas). Un 15,8% del total de la muestra (16,5% de los varones y 15,6% de las niñas) presentó valores de perímetro de cintura compatibles con obesidad abdominal. Un 36,8% (37,4% de varones y 36% de mujeres) mostró valores de grasa por encima de lo normal de acuerdo con la evaluación realizada a partir de los pliegues cutáneos. CONCLUSIÓN: En contraposición a la pequeña prevalencia de bajo peso en la región, el sobrepeso y la obesidad constituyen una problemática de magnitudes elevadas en nuestra provincia en lapoblación estudiada.

Cardio-metabolic risk factors in Argentine children. A comparative study.

UNLABELLED: Obesity and its complications are emerging in an epidemic manner in Latin American countries. AIMS: To estimate the prevalence of Cardio-Metabolic Risk Factors (CMRFs) and Metabolic Syndrome (MS) in overweight/obese (OW/OB) and normal weight (NW) adolescents and to examine the associated variables. MATERIAL AND METHODS: A cross-sectional comparative study was conducted in two groups of children, between 10 and 19 years of age, in seven Argentine provinces. A survey on dietary habits, physical activity, anthropometric and biochemical data was collected to identify CMRF and MS. The WHO definition adapted to children was used. RESULTS: 1009 children were assessed; 398 were male (39.4%), 601 (59.6%) were NW and 408 (40.4%) were OW/OB. The OW/OB had a significantly higher proportion of values defined as CMRF: 3.7% impaired fasting glucose >110mg/dl; 27.9% insulin >15 or 20µU/l as they were pubertal/prepubertal; 53.2% Homeostatic Model Assessment (HOMA)>2.5; 45.6% High Density Lipoprotein (HDL)<40mg/dl; 37.7% TG>110mg/dl and 13.5% hypertension (SBP and/or diastolic Blood Pressure percentile >90). Prevalence of the MS in OW/OB patients was 40.3%. The MS was not observed in NW children. Significant differences were found for: family history of OW/OB, birth weight (BW), age at menarche, presence of acanthosis nigricans, waist circumference (WC) >90th percentile. The WC was positively correlated with BP, TG, insulin, HOMA and Body mass index Z score and negatively with HDL in the study population. CONCLUSIONS: We confirm obesity as a major determinant of CMRF and MS (40%), especially fat centralization. We stress the need to address obesity prevention plans in children and adolescents.

Levels of organochlorine pesticides in blood plasma from residents of malaria-endemic communities in Chiapas, Mexico.

Organochlorine (OC) pesticides have been extensively used for pest control in agriculture and against malaria vectors in the region of Soconusco, Chiapas, in southern Mexico. Our study aimed to identify whether the inhabitants of four Soconusco communities at different locations (i.e., altitudes) and with different history of use of OC pesticides, have been similarly exposed to residues of these pesticides. In particular, we analyzed the potential relationship between levels of OC pesticides in plasma and the age, gender, and residence of the study population (n = 60). We detected seven pesticides in total (γ-HCH, ß-HCH, heptachlor, p,p'-DDE, p,p'-DDT, ß-endosulfan, endrin aldehyde). Of these, p,p'-DDE and ß-endosulfan were the most frequently found (in 98% and 38% of the samples, respectively). The low-altitude (<20 m above sea level; masl) and mid-altitude (520 masl) locations had the highest levels of p,p'-DDE, with geometric means of 50.6 µg/L and 44.46 µg/L, respectively. The oldest subjects (>60 years) had the highest p,p'-DDE level (56.94 ± 57.81 µg/L) of all age groups, while men had higher p,p'-DDE (34.00 ± 46.76 µg/L) than women. Our results demonstrate that residents of the Soconusco region are exposed to p,p'-DDE because of high exposure to DDT in the past and current environmental exposure to this DDT-breakdown product.

Occurrence of glyphosate in water bodies derived from intensive agriculture in a tropical region of southern Mexico.

Glyphosate is an agrochemical widely used to control weeds. However, glyphosate spreads to water bodies by spray-drift, run-off and leaching, potentially causing detrimental effects on non-target biota. There is no information on the occurrence of this herbicide in water bodies near crop fields in Mexico, although it is the most commonly used pesticide in this country. To fill this gap, we quantified glyphosate in water bodies from twenty-three locations, including natural protected areas and agricultural areas in southern Mexico, during the dry and the rainy seasons. We expected (1) higher concentrations during the dry season due to reduced dilution by precipitation and, (2) absence of glyphosate in the protected areas. In agreement with our expectation, concentration of glyphosate was higher during the dry season (up to 36.7 µg/L). Nonetheless, glyphosate was detected in all samples-including natural protected areas. These results emphasize the need for an evaluation of the impact of glyphosate on native species as well as regulate its use.

Assessment of persistent organic pollutants levels in blood samples from Quintana Roo, Mexico.

The Stockholm Convention on persistent organic pollutants (POPs) sought to determine baseline exposures to POPs in the general population; however, in developing countries, exposure to these chemicals in hot spots may be an issue of public health considering its magnitude. Therefore, the aim of this study was to assess the levels of POPs in the blood of children living in three communities in the Southeastern Region of Mexico. During 2007, we studied a total of 96 healthy children (aged 6-12 years). Quantitative analyses were performed using gas chromatography coupled with mass spectrometry. High levels of p,p'-DDT and its principal metabolite, p,p'-DDE, were found in the blood of children living in the three communities studied, the levels ranged from 463.5 to 9046.3 ng/g lipid and from 490.8 to 57,712.4 ng/g lipid for DDT and DDE, respectively. In addition, high levels of lindane (γ-HCH) were found, with mean levels ranging between 575.4 and 6580.6 ng/g lipid. Moreover, children living in the study region were also exposed to polychlorinated biphenyls (PCBs), and the levels of these compounds in the blood of children were very similar between the communities with mean levels of around 3000 ng/g lipid (total PCBs). In conclusion, we demonstrated that children living in the studied communities were exposed to complex chemical mixtures (DDT, DDE, lindane and PCBs) rather than to individual compounds. Therefore, in future studies it is important to understand the potential interactions between the components of these mixtures.

Implicaciones éticas y jurídicas de los procedimientos invasivos en cardiología / Ethical and legal implications of invasive procedures in cardiology

La relación clínica entre el médico y el enfermo se ha modificado en los últimos 30 años. A ello han contribuido, entre otros, los nuevos modos de ejercer la medicina por parte de los profesionales sanitarios, y, en particular, de aplicar los avances tecnológicos. En el ámbito de la cardiología existen varios métodos invasivos de diagnóstico y tratamiento, los cuales presentan riesgos para la vida del paciente; por tanto, es necesario una adecuada información y la aplicación del consentimiento informado desde el punto de vista ético y judicial. En Cuba existen aún rezagos de la medicina paternalista, por lo cual la aplicación del consentimiento informado, que constituye mucho más que un documento que se anexa a la historia clínica antes de un estudio invasivo, no se aplica sistemáticamente en las instituciones de salud. En el presente artículo se realiza una revisión sobre los aspectos éticos y jurídicos del consentimiento informado como proceso con implicaciones fundamentalmente éticas, pero también jurídicas, y se sugiere un documento representativo para su aplicación en los servicios de Cardiología del país...

Doctor-patient relationships have changed in the past 30 years. This has been due, among other factors, to the introduction of new forms of health care and in particular to the application of technological advances. In the field of cardiology, several invasive diagnostic procedures and treatments pose a risk to the life of patients. Therefore, in compliance with ethical and legal principles, adequate information and the application of informed consent are crucial. In Cuba some vestiges of medical paternalism have lived on till our days. As a result, informed consent, which is a lot more than a document attached to the medical record before the performance of an invasive study, is not systematically applied in health care institutions. The present paper is a review of the ethical and legal aspects of informed consent as a process with mainly ethical, but also legal implications. A representative document is proposed for the application of informed consent in the country's cardiology services...

Chlorate reduction capacity and characterisation of chlorate reducing bacteria communities in sediments of the rio Cruces wetland in southern Chile.

This study investigated chlorate reduction kinetics in multiple samples of sediments from a longitudinal profile of a wetland located downstream of the effluent discharge of a cellulose plant, including characterisation of the bacterial communities involved. The sediments were exposed to different initial chlorate concentrations in microcosm tests, with and without the addition of acetate as an external electron donor, and in a matrix of natural water or a defined medium. At a high initial chlorate concentration of 100 mg/L, in the absence of an external electron source, the degradation curves presented first-order kinetics, influenced by electron donor availability. The first-order kinetic constant varied between 0.05 and 0.17 day(-1). Subsequently, when the initial chlorate concentration was reduced to 7 mg/L, a zero-order kinetic was obtained, with the kinetic constant presenting values between 1.1 and 1.3 mg/L-day. No correlation was observed between chlorate degradation kinetics and the location of the sampling points or the previous history of exposure to chlorate. Other factors evaluated, such as the availability of organic matter or the chlorate reducing bacteria count, also proved not to have any incidence on the results. The richness of chlorate reducing bacteria species in the different samples analysed were also similar, with the greatest similarity being found between cld genes in the samples from the upstream or downstream sampling points. Additionally, cld genes most similar to those present in PCRB like Dechlorospirillum sp., Alicycliphilus denitrificans, Dechloromonas agitata, Dechloromonas sp. LT1 and Ideonella dechloratans were detected. This study showed that the anaerobic sediments of the Cruces river wetland present a high potential for chlorate natural attenuation, regardless of the previous history of exposure to chlorate. This capacity is associated with the presence of a diverse community of chlorate reducing bacteria.

Assessment of the levels of hexachlorocyclohexane in blood samples from Mexico.

The aim of this study was to evaluate hexachlorocyclohexane (HCH) exposure in children living in nine hot spots in four Mexican states. We analyzed HCH (α, ß, and γ-isomers) in blood using gas chromatography/mass spectrometry. HCH exposure level in 261 children was assessed and approximately 75 % of the children studied had detectable levels of HCH. These levels ranged from 188 to 40,096.7 ng/g lipid. The highest mean levels were found in Lacanja (5,446.9 ng/g lipid), an indigenous community in Chiapas, Mexico. Our data indicate high exposure to HCH in children living in these communities.