Early-life external exposome in children 2-5 years old in Colombia.

Exposome studies are advancing in high-income countries to understand how multiple environmental exposures impact health. However, there is a significant research gap in low- and middle-income and tropical countries. We aimed to describe the spatiotemporal variation of the external exposome, its correlation structure between and within exposure groups, and its dimensionality. A one-year follow-up cohort study of 506 children under 5 in two cities in Colombia was conducted to evaluate asthma, acute respiratory infections, and DNA damage. We examined 48 environmental exposures during pregnancy and 168 during childhood in eight exposure groups, including atmospheric pollutants, natural spaces, meteorology, built environment, traffic, indoor exposure, and socioeconomic capital. The exposome was estimated using geographic information systems, remote sensing, spatiotemporal modeling, and questionnaires. The median age of children at study entry was 3.7 years (interquartile range: 2.9-4.3). Air pollution and natural spaces exposure decreased from pregnancy to childhood, while socioeconomic capital increased. The highest median correlations within exposure groups were observed in meteorology (r = 0.85), traffic (r = 0.83), and atmospheric pollutants (r = 0.64). Important correlations between variables from different exposure groups were found, such as atmospheric pollutants and meteorology (r = 0.76), natural spaces (r = -0.34), and the built environment (r = 0.53). Twenty principal components explained 70%, and 57 explained 95% of the total variance in the childhood exposome. Our findings show that there is an important spatiotemporal variation in the exposome of children under 5. This is the first characterization of the external exposome in urban areas of Latin America and highlights its complexity, but also the need to better characterize and understand the exposome in order to optimize its analysis and applications in local interventions aimed at improving the health conditions and well-being of the child population and contributing to environmental health decision-making.

Characterization of the external exposome and its contribution to the clinical respiratory and early biological effects in children: The PROMESA cohort study protocol.

BACKGROUND: Air pollution contains a mixture of different pollutants from multiple sources. However, the interaction of these pollutants with other environmental exposures, as well as their harmful effects on children under five in tropical countries, is not well known. OBJECTIVE: This study aims to characterize the external exposome (ambient and indoor exposures) and its contribution to clinical respiratory and early biological effects in children. MATERIALS AND METHODS: A cohort study will be conducted on children under five (n = 500) with a one-year follow-up. Enrolled children will be followed monthly (phone call) and at months 6 and 12 (in person) post-enrolment with upper and lower Acute Respiratory Infections (ARI) examinations, asthma development, asthma control, and genotoxic damage. The asthma diagnosis will be pediatric pulmonologist-based and a standardized protocol will be used. Exposure, effect, and susceptibility biomarkers will be measured on buccal cells samples. For environmental exposures PM2.5 will be sampled, and questionnaires, geographic information, dispersion models and Land Use Regression models for PM2.5 and NO2 will be used. Different statistical methods that include Bayesian and machine learning techniques will be used for the ambient and indoor exposures-and outcomes. This study was approved by the ethics committee at Universidad Pontificia Bolivariana. EXPECTED STUDY OUTCOMES/FINDINGS: To estimate i) The toxic effect of particulate matter transcending the approach based on pollutant concentration levels; ii) The risk of developing an upper and lower ARI, based on different exposure windows; iii) A baseline of early biological damage in children under five, and describe its progression after a one-year follow-up; and iv) How physical and chemical PM2.5 characteristics influence toxicity and children's health.

Visión humanística de los cuidados de Enfermería / A humanistic view of nursing care

La Enfermería es una ciencia reconocida desde mediados del siglo XIX, posee un cuerpo teórico conceptual propio que sustenta sus principios y objetivos, y se encuentra en constante renovación a través de la investigación científica, procedimientos particulares y uso de las nuevas tecnologías dirigidas al cuidado de la salud de las personas. Este análisis pretende describir una serie de aspectos que identifican a la Enfermería como ciencia y el uso de la tecnología en su proceder humanista en la prestación de los cuidados. Se realizó una revisión bibliográfica que incluyó diversos libros de textos y artículos. Se consultaron expertos en esta temática para ampliar los conocimientos relacionados con los fundamentos dela Enfermería, mediante el estudio analítico de la bibliografía consultada. La Enfermería se ha desarrollado científica y tecnológicamente en el devenir de los años, pero este hecho no debe perjudicar su profundo sentido humanista. Hay una corriente de pensamiento, cada vez mayor, preocupada por sustentar lo que se da en llamar un “humanismo tecnológico” y ya son muchos los que comparten la esperanza de la presencia de un humanismo donde las personas acierten a utilizar la técnica y la tecnología siempre en beneficio de los seres humanos y al servicio de los mismos (AU)

Nursing is a science acknowledged since mid 19th century, it has its own conceptual theoretic body which supports its principles and objectives, and it is in constant renovation through scientific research, personal procedures, and the use of new technologies targeted at the healthcare of people. This analysis intends to describe a series of aspects which identify Nursing as a science, and the use of technology in its humanistic behavior in care provision. A bibliographic review was conducted, which included various textbooks and articles. Experts in this subject were consulted, in order to broaden the knowledge associated with the Nursing basics, through the analytic study of the bibliography reviewed. Nursing has developed scientific and technologically throughout the years, but this fact should not be detrimental to its deep humanistic aspect. There is a line of thought, gradually increasing, which is concerned with supporting what has been called a “technological humanism”, and there are many people who already share the hope of a type of humanism where persons tend to use techniques and technology always for the benefit of human beings, and at their service (AU)

Manifestaciones Reumáticas en pacientes con Sindrome de Inmunodeficiencia Adquirida

La infección por el virus de la Inmunodeficiencia Humana (VIH), presenta una amplia variedad de manifestaciones clínicas, como resultado de la depresión selectiva del subgrupo de células T CD4+ ayudadoras/inductoras. Las manifestaciones reumáticas han sido reconocidas, y se ha desarrollado un creciente interés por la presentación clínica y por la explicación fisiopatológica del fenómeno. Estas manifestaciones se presentan como rasgos clínicos aislados: artralgias, dolor óseo; o simulando sindromes o entidades específicas: Sindrome de Reiter, Polimiositis, Dermatomiositis, Sindrome de Sjögren y otros. En el Hospital Simón Bolivar de Bogotá se realizó un estudio prospectivo de Abri a Junio de 1990 en 41 pacientes infectados por VIH. 21 pacientes (51.2 por ciento), presentaron hallazgos reumáticos, no como entidades clínicas definidas sino como complicaciones músculo-esqueléticas. Las manifestaciones se tornan más comunes mientras más comprometido se encuentra el paciente

Relación anestesiólogo paciente / Anesthesiologist-patient relation

Se entrevistaron 280 pacientes, que habían recibido anestesia recientemente en entidades privadas e institucionales, divididos en sendos grupos de 140 pacientes cada uno. Las encuestas estaban dirigidas a evaluar la actitud y conocimiento del paciente respecto del anestesiólogo. Se confrontan los resultados del sector institucional y privado para evaluar la ingerencia de la visita preanestésica sobre la sensación de miedo previa al procedimiento anestésico. Sorprende que el 18.6% de los pacientes no identifican al anestesiólogo comparado con el cirujano tiene un porcentaje menor de identificación. Apenas un 62.1% de los pacientes son vistos en la preanestesia por el anestesiólogo y sólo un 35% lo son en la postanestesia. Un 10% de los pacientes se quejaron del anestesiólogo y las quejas son en general de falta de relaciones interpersonales. Se recomienda hacer un pequeño curso de relaciones humanas aplicado a la especialidad en el primer semestre de la residencia universitaria para anestesiología