Prevention and Treatment of Malnutrition in Older Adults Living in Long-Term Care or the Community: an Evidence-based Nutrition Practice Guideline.

Malnutrition in older adults can decrease quality of life and increase risk of morbidities and mortality. Accurate and timely identification of malnutrition, as well as subsequent implementation of effective interventions, are essential to decrease poor outcomes associated with malnutrition in older adults. The Academy of Nutrition and Dietetics Evidence Analysis Center conducted a systematic review of the literature to develop an evidence-based nutrition practice guideline for the prevention and treatment of malnutrition in older adults. The objective of this guideline was to provide evidence-based recommendations to identify, prevent, or treat protein-energy malnutrition in older adults (mean age ≥65 years) living in long-term care and community settings. This guideline provides 11 nutrition recommendations to inform shared decision making among dietitians, members of the health care team, family members or caregivers, and older adults living in long-term care or the community to prevent or treat malnutrition. Topics include dietitian effectiveness, nutrition assessment tools, oral nutrition supplements, food fortification, and home-delivered and congregate meals. Guideline implementation should include consideration of the importance of comprehensive individualized nutrition care for older adults. Future research is needed to address gaps that were identified related to the validity, reliability, and feasibility of nutrition assessment tools, as well as the effectiveness of dietitian interventions on outcomes of interest in older adults living in long-term care and the community.

The Impact of Malnutrition on Skin Integrity and Wound Healing.

GENERAL PURPOSE: To recognize valuable resources from the Malnutrition Quality Improvement Initiative for acute care patients and malnutrition quality improvement measures for postacute care residents. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Distinguish the prevalence of malnutrition among acute care patients.2. Explain the assessment guidelines for identifying malnutrition.3. Identify the resources available for measuring malnutrition quality improvement.

Malnutrition is a global health issue that occurs in individuals across all weight categories and irrespective of healthcare resources. Researchers report that poor diet contributed to approximately 11 million deaths worldwide in 2017. Nutrition status is a modifiable risk factor in individuals at risk of or with impaired skin integrity. Incorporating best practices in identifying and treating malnutrition in a timely manner improves clinical outcomes. Valuable resources from the Malnutrition Quality Improvement Initiative for acute care patients and malnutrition quality improvement measures for post acute care residents are discussed, as well as sources for additional reimbursement.

Best-practices for preventing skin injury beneath personal protective equipment during the COVID-19 pandemic: A position paper from the National Pressure Injury Advisory Panel.

COVID-19 has infected millions of patients and impacted healthcare workers worldwide. Personal Protective Equipment (PPE) is a key component of protecting frontline clinicians against infection. The benefits of PPE far outweigh the risks, nonetheless, many clinicians are exhibiting skin injury caused by PPE worn incorrectly. These skin injuries, ranging from lesions to open wounds are concerning because they increase the susceptibility of viral infection and transmission to other individuals. Early into the COVID-19 pandemic (April 2020), the U. S. National Pressure Injury Advisory Panel (NPIAP) developed a series of position statements to improve wear-ability of PPE and protect healthcare professionals and their patients as safe from harm as possible under the circumstances. The NPIAP positions, which were formed by conducting a systematic review of what was known at the time, include: (a) Prepare skin before and after wearing PPE with skin sealants, barrier creams and moisturisers; (b) Frequent PPE offloading to relieve pressure and shear applied to skin; (c) treat visible skin injuries immediately caused by PPE to minimise future infection; (d) non-porous dressings may provide additional skin protection, but lack evidence; (e) health systems should take care to educate clinicians about placement and personal hygiene related to handling PPE. Throughout all of these practices, handwashing remains a top priority to handle PPE. These NPIAP positions provided early guidance to reduce the risk of skin injury caused by PPE based on available research regarding PPE injuries, a cautious application of evidence-based recommendations on prevention of device-related pressure injuries in patients and the expert opinion of the NPIAP Board of Directors. Clinicians who adhere to these recommendations reduce the prospects of skin damage and long-term effects (e.g. scarring). These simple steps to minimise the risk of skin injury and reduce the risk of coronavirus infection from PPE can help.

Nutrition and Wound Care.

Nutrition is an important component of health and well-being. A compromised nutritional status has been linked to increased risk for wound development, difficulty managing, and decreased wound healing rate. Malnutrition contributes to an immunocompromised system, reduced collagen synthesis, and diminished tensile strength during the wound healing process. This is why assessment and optimization of nutritional status should be incorporated as part of a comprehensive treatment plan for individuals with wounds. The nutrition care plan must include individualized interventions designed to address the individual's nutrition diagnosis. This article reviews the role of nutrition in wound prevention, management, and treatment.

TSIUNAS: A Videogame for Preventing Gender-Based Violence.

Background: Gender-based violence (GBV) is a public health problem worldwide. Nonetheless, in rural areas and low-income countries, the problem may be more difficult to eradicate because there are stereotypes that reinforce negative attitudes toward women, which increase the severity of the problem. Goal: This article presents the development of "Tsiunas," a videogame designed to increase GBV awareness. By implementing game situations that represent attitudes and beliefs that justify unequal and violent relationships between men and women, this videogame attempts to transform attitudes and thoughts entrenched in a patriarchal society model. Results: Tsiunas was evaluated in two phases to: (1) validate the usability and stability of the game and (2) validate the potential change in students' perception regarding GBV situations and recognition of co-responsible masculinities. Both evaluations were carried out through surveys. The results showed that students had a high level of acceptance and appropriation of the content and message of the videogame. Conclusions: The findings allowed to conclude that the game situations presented in Tsiunas influenced changes of opinion in men and women regarding entrenched beliefs about patriarchal patterns, tolerance levels of violence against women, and attitudes toward violence against women. Likewise, the videogame supported the recognition of co-responsible masculinities.

Malnutrition and Pressure Injury Risk in Vulnerable Populations: Application of the 2019 International Clinical Practice Guideline.

ABSTRACT: Nutrition plays a vital role in promoting skin integrity and supporting tissue repair in the presence of chronic wounds such as pressure injuries (PIs). Individuals who are malnourished are at greater risk of polymorbid conditions, adverse clinical outcomes, longer hospital lengths of stay, PI development, and mortality, and incur increased healthcare costs compared with patients who are adequately nourished. In addition, some patient populations tend to be more vulnerable to PI formation, such as neonates, patients with obesity, older adults, and individuals who are critically ill. Accordingly, this article aims to review the latest nutrition care recommendations for the prevention and treatment of PIs, including those recommendations tailored to special populations. A secondary objective is to translate nutrition recommendations into actionable steps for the healthcare professional to implement as part of a patient plan of care.Implementing an evidence-based plan of care built around individualized nutrition interventions is an essential step supporting skin integrity for these populations. The 2019 Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline (CPG) affirms that meeting nutrient requirements is essential for growth, development, maintenance, and repair of body tissues. Many macronutrients and micronutrients work synergistically to heal PIs. Registered dietitian nutritionists play an important role in helping patients identify the most nutrient dense foods, protein supplements, and oral nutrition supplements to meet their unique requirements.

Nutrition strategies for pressure injury management: Implementing the 2019 International Clinical Practice Guideline.

Nutrition is an important component in the prevention and treatment of pressure injuries (PIs). The skin is the largest organ of the body, and macronutrients and micronutrients in specific amounts are required to maintain and repair body tissues. The European Pressure Ulcer Advisory Panel, the National Pressure Injury Advisory Panel, and the Pan Pacific Pressure Injury Alliance Prevention and Treatment of Pressure Ulcers/Injuries: 2019 Clinical Practice Guideline includes nutrition recommendations for PI management. This manuscript identifies the key nutrients required for wound healing, reviews the evidence in the 2019 nutrition recommendations, and translates the recommendations provided into key points to be incorporated into policy and practice that impact patient outcomes.

Pressure Injuries Among Critical Care Patients.

Nutrition is an important component in the prevention and treatment of pressure injuries. Although the point at which insufficient nutrient consumption affects the body's capability to support skin integrity has not been demarcated, what is known is that reduced intake of food and fluids/water and weight loss can increase the risk of developing pressure injuries. Protein and its building blocks, amino acids, are essential for tissue growth and repair during all phases of wound healing. Sufficient macronutrients (carbohydrates, protein, fats, and water) and micronutrients (vitamins and minerals) are vital for the body to support tissue integrity and prevent breakdown.

The Role of Nutrition for Pressure Injury Prevention and Healing: The 2019 International Clinical Practice Guideline Recommendations.

GENERAL PURPOSE: To review the nutrition-related recommendations presented in the 2019 European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline with further discussion of nutrition for pressure injury management in the context of the recommendations. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant should be better able to:1. Distinguish nutrition and malnutrition, especially as they relate to the development and healing of pressure injuries.2. Differentiate the tools and techniques that help clinicians assess nutrition status as well as the causes of pressure injuries in specific populations.3. Identify interventions for improving nutrition status and promoting pressure injury healing. ABSTRACT: Macro- and micronutrients are required by each organ system in specific amounts to promote the growth, development, maintenance, and repair of body tissues. Specifically, nutrition plays an important role in the prevention and treatment of pressure injuries. The purpose of this manuscript is to review the nutrition-related recommendations presented in the 2019 European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. Nutrition for pressure injury management is discussed in the context of the recommendations.

Características de las mujeres de edad mediana / Characteristics of middle-aged women

Introducción: Pocos estudios han sido publicados en relación con las características del climaterio de la mujer de edad mediana. Por la importancia de esta información para realizar acciones de promoción de salud, en este grupo poblacional, se realizó la presente investigación. Objetivo: Describir las características sociodemográficas, identificar alteraciones de la salud y características biológicas relacionadas con el climaterio, en mujeres de edad mediana. Métodos: Se realizó un estudio descriptivo, de corte transversal. Se estudió una muestra aleatoria de 309 mujeres de 40 a 59 años, mediante muestreo por conglomerados bietápico, del área de salud del Policlínico "Julián Grimau", La Habana, en el primer semestre del año 2017. Para recoger los datos se utilizó un cuestionario semiestructurado, aplicado mediante entrevista. Como medida de resumen para las variables cualitativas se utilizó el porcentaje. Resultados: El 52,8 por ciento de las mujeres estudiadas era trabajadora y el 42,7 por ciento tenía escolaridad preuniversitaria. Recibieron información con mayor frecuencia las mujeres universitarias y las preuniversitarias. La hipertensión arterial fue declarada por el 35,0 por ciento de las féminas, la osteoartrosis 25,9 por ciento, diabetes mellitus en el 10,7 por ciento. La mayoría de las hipertensas era obesa o tenía sobrepeso. Conclusiones: Las mujeres de edad mediana del área de salud estudiada, tenían escolaridad preuniversitaria predominantemente, estaban en la perimenopausia, con sobrepeso y obesidad e hipertensión arterial(AU)

Introduction: Few studies have been published in relation to the climacteric characteristics of the middle-aged woman. Due to the importance of this information to carry out health promotion actions, in this population group, the present investigation was carried out. Objective: Describe the sociodemographic characteristics, identify health alterations and biological characteristics related to the climacteric. Methods: The study classifies as descriptive, cross-sectional. A random sample of 309 women aged 40 to 59 years was studied, by means of two-stage cluster sampling, from the health area of Julián Grimau Policlinic, Havana, in the first semester of 2017. To collect the data a semi-structured questionnaire was used, applied through an interview. The percentage was used as a summary measure for the qualitative variables. Results: 52.8 percent of the women studied were working and 42.7 percent had pre-university education. Information was received more frequently by university and pre-university women. Hypertension was declared by 35.0 percent of females, osteoarthrosis 25.9 percent, diabetes mellitus in 10.7 percent. The majority of hypertensive women were obese and overweight. Conclusions: The middle-aged women of the health area studied had predominantly pre-university education, in perimenopause, with overweight and obesity and arterial hypertension(AU)

The KISS1 gene overexpression as a potential molecular marker for cervical cancer cells.

BACKGROUND: Similarities between the pathologic progression of cancer and the physiologic process of placentation have been recognized for many years proposing that both present similar mechanisms and processes. Cervical cancer (CC) is one of the most frequent neoplasia among Mexican women turning it into an important health problem. OBJECTIVE: The aim of this study was to determine the degree of the involvement of pregnancy related genes and in cancer progression by in-silico analysis and validated in CC samples. RESULTS: The data mining analysis resulted in the identification of genes expressed in term placenta, first trimester placenta and normal cervical tissues. Finally, we selected KISS1 for the involvement of pregnancy related gene and also in cancer process. In order to explore KISS1 in CC, we analyzed Copy Number Variation (CNV) and gene expression using microarray experiments. KISS1 showed 20% genomic gain in 1q32.1 on CC samples. Furthermore, microarray analysis showed KISS1 as up-regulated genes. Results were validated showing an overexpression of 85% of KISS1 in CC samples. CONCLUSIONS: Data suggest KISS1 as a great candidate for CC molecular markers or as a therapeutic target for CC. Also, HPV presence does not seem to alter the KISS1 expression in CC.

Evaluación de los procesos formativos del postgrado cubano­­ en la especialidad de MGI / Evaluation of the training processes of the Cuban postgraduate course in the specialty of General Comprehensive Medicine

Cuba, con una vasta experiencia en la docencia, la pedagogía y la educación de nivel superior, ha ido desarrollando a lo largo de los años una estructura de evaluación de la calidad de sus procesos formativos con una sólida base legal. La evaluación institucional que ejerce el Ministerio de Educación Superior, iniciada en 1978, sin antecedente alguno en Latinoamérica, se ha ido perfeccionando y adecuando al nivel de desarrollo alcanzado por las instituciones de educación superior y al desarrollo logrado en los instrumentos evaluativos establecidos. Se abordan los Sistemas de Evaluación y Acreditación vigentes en Cuba para la educación superior, así como la pertinencia de medir la calidad del proceso formativo del especialista en Medicina General Integral mediante la satisfacción de los residentes, como parámetro subjetivo que permita a los evaluadores un acercamiento rápido y orientador, a los niveles de calidad percibida(AU)

Cuba, with a vast experience in teaching, pedagogy and higher education, has been developing over the years a structure to evaluate the quality of its training processes, with a solid legal basis. The institutional evaluation carried out by the Ministry of Higher Education, begun in 1978, with no precedent in Latin America, has been improved and adapted to the level of development achieved by higher education institutions and to the development achieved in established evaluative instruments. The Evaluation and Accreditation Systems functioning in Cuba for higher education are addressed, as well as the pertinence of measuring the quality of the training process of the specialist in Integral General Medicine through the satisfaction of the residents, as a subjective parameter that allows the evaluators an approach fast and clear, to the levels of perceived quality(AU)

Conductas de riesgo en los adolescentes / Risk behavior in adolescents

La adolescencia es una etapa de cambios que se produce entre la niñez y juventud. Está marcada por un cambio en las expectativas, en relación no solamente con las funciones sexuales y reproductivas, sino también con el status social. En esta etapa se dan con mayor intensidad conductas de riesgo que son aquellas acciones realizadas por el individuo o comunidad, que pueden llevar a consecuencias nocivas. El objetivo de la revisión es describir diferentes criterios de las conductas de riesgo en adolescentes tanto en Cuba como en el mundo, así como realizar un acercamiento en las comunidades cerradas. Para la búsqueda bibliográfica se revisaron libros de texto y revistas biomédicas nacionales e internacionales, así como protocolos, guías y programas existentes en Cuba y en otros países sobre la atención integral a los adolescentes. En la actualidad existe diversidad de criterios al abordar las conductas de riesgo de los adolescentes. Esto ha hecho difícil el abordaje integral de la salud de los adolescentes. En las comunidades cerradas no se ha estudiado a fondo las conductas de riesgo de los adolescentes con un enfoque social. El desconocimiento sobre estos temas constituye una de las causas fundamentales que conllevan a conductas de riesgos en los adolescentes, por lo que debe ser estudiado e implementarse políticas y programas de prevención para disminuir estos comportamientos y sus consecuencias(AU)

Adolescence is a time of change that occurs between childhood and youth. It is marked by a change in expectations, not only in connection with sexual and reproductive functions, but also with social status. At this stage, risk behaviors occur more intensity which are those actions taken by the individual or community that may bring harmful consequences. The objective was to describe different criteria for risk behavior in adolescents both in Cuba and in the world as well as approaching closed communities. Textbooks and national and international biomedical journals, protocols, guidelines and programs in Cuba and from other countries on comprehensive care for adolescents were reviewed. At present, there is diversity of approaches to address risk behaviors of adolescents. This has made it difficult for the comprehensive approach to adolescent health. In closed communities, it has not been thoroughly studied risk behaviors of adolescents with a social focus. Ignorance of these issues is one of the root causes that lead to risk behaviors in adolescents, so these causes should be studied and policies and prevention should be implemented programs to reduce these behaviors and their consequences(AU)

Conductas de riesgo en los adolescentes / Risk behavior in adolescents

La adolescencia es una etapa de cambios que se produce entre la niñez y juventud. Está marcada por un cambio en las expectativas, en relación no solamente con las funciones sexuales y reproductivas, sino también con el status social. En esta etapa se dan con mayor intensidad conductas de riesgo que son aquellas acciones realizadas por el individuo o comunidad, que pueden llevar a consecuencias nocivas. El objetivo de la revisión es describir diferentes criterios de las conductas de riesgo en adolescentes tanto en Cuba como en el mundo, así como realizar un acercamiento en las comunidades cerradas. Para la búsqueda bibliográfica se revisaron libros de texto y revistas biomédicas nacionales e internacionales, así como protocolos, guías y programas existentes en Cuba y en otros países sobre la atención integral a los adolescentes. En la actualidad existe diversidad de criterios al abordar las conductas de riesgo de los adolescentes. Esto ha hecho difícil el abordaje integral de la salud de los adolescentes. En las comunidades cerradas no se ha estudiado a fondo las conductas de riesgo de los adolescentes con un enfoque social. El desconocimiento sobre estos temas constituye una de las causas fundamentales que conllevan a conductas de riesgos en los adolescentes, por lo que debe ser estudiado e implementarse políticas y programas de prevención para disminuir estos comportamientos y sus consecuencias.

Adolescence is a time of change that occurs between childhood and youth. It is marked by a change in expectations, not only in connection with sexual and reproductive functions, but also with social status. At this stage, risk behaviors occur more intensity which are those actions taken by the individual or community that may bring harmful consequences. The objective was to describe different criteria for risk behavior in adolescents both in Cuba and in the world as well as approaching closed communities. Textbooks and national and international biomedical journals, protocols, guidelines and programs in Cuba and from other countries on comprehensive care for adolescents were reviewed. At present, there is diversity of approaches to address risk behaviors of adolescents. This has made it difficult for the comprehensive approach to adolescent health. In closed communities, it has not been thoroughly studied risk behaviors of adolescents with a social focus. Ignorance of these issues is one of the root causes that lead to risk behaviors in adolescents, so these causes should be studied and policies and prevention should be implemented programs to reduce these behaviors and their consequences.

Calidad de la atención brindada a personas VIH SIDA con terapia antirretroviral (tar) que ingresaron al servicio de epidemiología e infectología del Hospital Dr. Roberto Calderón Gutiérrez de Managua entre enero a diciembre 2010 / Quality of care provided to HIV-AIDS with antiretroviral therapy (ART) who were admitted to the Hospital epidemiology and infectious diseases Dr. Roberto Calderon Gutierrez from Managua from January to December 2010

Estudio descriptivo de corte transversal. Los resultados señalan que es de vital importancia dar monitoreo y garantizar la calidad en los procesos de atención a las personas con VIH que se encuentran en TAR, o van a iniciar terapia antirretroviral. Así como también, garantizar estrategias para la prevención y evaluación de la farmacorresistencia del VIH para minimizar la aparición de la farmacorresistencia y mantener la eficacia de los esquemas de TAR de primera y segunda línea en los diferentes hospitales del país

Position of the Academy of Nutrition and Dietetics: food and nutrition for older adults: promoting health and wellness.

It is the position of the Academy of Nutrition and Dietetics that all Americans aged 60 years and older receive appropriate nutrition care; have access to coordinated, comprehensive food and nutrition services; and receive the benefits of ongoing research to identify the most effective food and nutrition programs, interventions, and therapies. Health, physiologic, and functional changes associated with the aging process can influence nutrition needs and nutrient intake. The practice of nutrition for older adults is no longer limited to those who are frail, malnourished, and ill. The population of adults older than age 60 years includes many individuals who are living healthy, vital lives with a variety of nutrition-related circumstances and environments. Access and availability of wholesome, nutritious food is essential to ensure successful aging and well-being for the rapidly growing, heterogeneous, multiracial, and ethnic population of older adults. To ensure successful aging and minimize the effects of disease and disability, a wide range of flexible dietary recommendations, culturally sensitive food and nutrition services, physical activities, and supportive care tailored to older adults are necessary. National, state, and local strategies that promote access to coordinated food and nutrition services are essential to maintain independence, functional ability, disease management, and quality of life. Those working with older adults must be proactive in demonstrating the value of comprehensive food and nutrition services. To meet the needs of all older adults, registered dietitians and dietetic technicians, registered, must widen their scope of practice to include prevention, treatment, and maintenance of health and quality of life into old age.