Associations between the social environment and early childhood developmental outcomes of Puerto Rican children with prenatal Zika virus exposure: a cross-sectional study.

BACKGROUND: Prenatal exposure to the Zika virus can lead to microcephaly and adverse developmental outcomes, even in children without evident birth defects. The social environment plays a crucial role in infant health and developmental trajectories, especially during periods of heightened brain plasticity. The study aimed to assess socioenvironmental factors as predictors of developmental outcomes of 36-month-old children exposed to Zika virus prenatally. STUDY DESIGN: This cross-sectional study included 53 mothers and 55 children enrolled in the Pediatric Outcomes of Prenatal Zika Exposure cohort study in Puerto Rico. The study performs follow-up developmental assessments of children born to mothers with confirmed and probable Zika virus infection during pregnancy. Mothers completed socioenvironmental questionnaires (e.g., Perceived Neighborhood Scale and US Household Food Insecurity Survey). Children's developmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development: Third Edition, the Ages and Stages Questionnaires: Third Edition, the Ages and Stages Questionnaire-Socioemotional: Second Edition, and the Child Adjustment and Parent Efficacy Scale. RESULTS: Linear regression models, adjusting for a child's sex and age and maternal education, revealed that early life exposure to food insecurity and maternal pregnancy stressors were significantly associated with poorer developmental outcomes in Zika virus-exposed children at 36 months of age. Maternal resilience representation of adaptive ability was associated with the preservation of adequate developmental outcomes in children. CONCLUSIONS: Pregnancy and early childhood are critical life periods for ensuring optimal brain development in children. While the mechanisms in the interaction of children with their environment are complex, the risk and protective factors identified in the study are modifiable through public policy and preventive initiatives. Implementation of comprehensive strategies that improve access to social support programs, educational and nutritional interventions, and mental health services during pregnancy and early childhood can enhance the developmental potential of vulnerable children.

Early Childhood Neurodevelopmental Outcomes in Children with Prenatal Zika Virus Exposure: A Cohort Study in Puerto Rico.

OBJECTIVE: To describe anthropometric, sensory, and neurodevelopmental outcomes of children who were Zika virus-exposed from birth to 36 months. STUDY DESIGN: The study cohort included 114 children born to mothers with confirmed and probable Zika virus pregnancy infection in 2016-2017. Children attending study visits from May 2017 through February 2020 underwent physical/neurologic, sensory examinations, and neurodevelopmental assessments with the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) and Ages and Stages Questionnaires, Third Edition (ASQ-3). RESULTS: Three of the 114 children (2.6%) had microcephaly (z-score for head circumference ≤-2) at birth, 19 of 35 (54.3%) had posterior eye abnormalities in retinal images, and 11 of 109 (10.1%) had nonspecific findings on brain ultrasound. Three of 107 children (2.8%) failed hearing screening at birth. Of those children with follow-up data, 17 of 97 (17.5%) failed age-appropriate vision screening. The BSID-III identified developmental delay in at least 1 domain in at least one-third of children, with higher prevalence in the language domain. ASQ-3 screen positive delay peaked at around 24 or 36 months, with some domains showing a decrease at older ages. Correlations among BSID-III and ASQ-3 scores were observed, representing professional and parental perspectives at 24 and 36 months (r = 0.32-0.78; P < .05). CONCLUSIONS: The presence of neurodevelopmental sequelae in early childhood suggests that identification of long-term impairment remains critical to attaining optimal child development. Long-term follow-up highlights vulnerability in the language domain, which likely could be influenced by early intervention, promoting cognitive development and school readiness in exposed children.

Factores que influyen en el destete precoz de lactantes pertenecientes al Centro de Salud Augusto Egas, Ecuador / Fatores que influenciam o desmame precoce em bebês pertencentes ao Centro de Saúde Augusto Egas, Equador / Factors that influence the early weaning on infants belonging to the Augusto Egas Health Center, Ecuador

Introducción: La lactancia materna exclusiva aporta macro y micronutrientes que son suficientes para un correcto desarrollo y crecimiento del lactante. La promoción de la lactancia materna exclusiva debe ser óptima, puesto que en la actualidad el destete precoz ha aumentado en gran magnitud. Objetivo: Determinar qué factores influyen en el destete precoz en madres con lactantes de 0 a 11 meses en el Centro de Salud Augusto Egas, de la ciudad de Santo Domingo, Ecuador. Método: Se utilizó un estudio correlacional, descriptivo, con enfoque cuantitativo, durante el periodo de julio hasta inicios de agosto de 2021, en una población de 252 madres que asistieron dicha unidad de salud. Se realizó un muestreo por conveniencia donde se obtuvo una muestra de 153 madres. Las variables medidas, fueron: dificultades a inicio de la lactancia materna, alimentos con los que complementaron la lactancia materna exclusiva, abandono precoz, mitos que influyeron en el abandono parcial o completo de la lactancia materna exclusiva y madres que recibieron información después del parto. Resultados: El 85 por ciento de las madres refirió dificultades en la cantidad suficiente de leche. Las madres no abandonaron la lactancia por decisión propia, el 64,7 por ciento expresó no creer en los mitos. Hubo mayoría de acuerdo en haber recibido una correcta información después del parto por parte del personal de salud (64,7 por ciento). Conclusión: La insuficiente cantidad de leche en las madres es el factor que más influye en esta unidad de salud, por lo que optan por una alimentación mixta(AU).

Introduction: Exclusive breastfeeding provides macro and micronutrients that are sufficient for the correct development and growth of the infant. The promotion of exclusive breastfeeding should be optimal, since early weaning has greatly increased nowadays. Objective: To determine what factors influence early weaning in mothers with infants from 0 to 11 months at the Augusto Egas Health Center, in the city of Santo Domingo, Ecuador. Method: A descriptive correlational study was undertaken, with a quantitative approach, during the period from July to the beginning of August 2021, in a population of 252 mothers who attended this health unit. A convenience sampling was carried out, and a sample of 153 mothers was obtained. The variables measured were: difficulties at the beginning of breastfeeding, foods that supplemented exclusive breastfeeding, early abandonment, myths that influenced the partial or complete abandonment of exclusive breastfeeding, and mothers who received information after delivery. Results: 85 percent of the mothers reported difficulties in the sufficient quantity of milk. Mothers did not abandon breastfeeding by their own decision, 64.7 percent expressed not believing in the myths. There was a majority of agreement in having received correct information after delivery from health personnel (64.7 percent). Conclusion: The insufficient amount of milk in mothers is the factor that influences the most in this health unit, so they opted for a mixed diet(AU).

Introdução: O aleitamento materno exclusivo fornece macro e micronutrientes suficientes para o correto desenvolvimento e crescimento da criança. A promoção do aleitamento materno exclusivo deve ser ótima, pois hoje o desmame precoce aumentou muito. Objetivo: determinar quais fatores influenciam o desmame precoce de mães com bebês de 0 a 11 meses no Centro de Saúde Augusto Egas, na cidade de Santo Domingo, Equador. Método: Foi utilizado um estudo descritivo correlacional, com abordagem quantitativa, no período de julho a início de agosto de 2021, em uma população de 252 mães atendidas nesta unidade de saúde. Realizou-se uma amostragem por conveniência, obtendo-se uma amostra de 153 mães. As variáveis mensuradas foram: dificuldades no início da amamentação, alimentos que complementavam a amamentação exclusiva, abandono precoce, mitos que influenciaram no abandono parcial ou total do aleitamento materno exclusivo e mães que receberam informações após o parto. Resultados: 85 porcento das mães relataram dificuldade na quantidade suficiente de leite. As mães não abandonaram a amamentação por decisão própria, 64,7 porcento expressaram não acreditar nos mitos. Houve maior concordância em ter recebido informações corretas do pessoal de saúde após o parto (64,7 porcento). Conclusão: A quantidade insuficiente de leite das mães é o fator que mais influencia esta unidade de saúde, por isso optam por uma alimentação mista(AU).

Evaluación de los recursos de información en el Centro de Estudio, Documentación e Información de Medicamentos, Villa Clara / Assessment of information resources in the Center of Study, Documentation and Drug Information in Villa Clara province

Objetivo: evaluar los recursos de información disponibles en el Centro de Estudio, Documentación e Información de Medicamentos (CEDIMED). Métodos: se identificaron aquellas fuentes, servicios y sistemas que pudieran llegar a alcanzar la categoría de entidad o recurso de información dentro del CEDIMED, empleando la metodología INFOMAP. Se recolectaron datos sobre el costo de los recursos identificados y se desarrolló un ordenamiento de estos según su característica. Se determinó el índice de valor para cada ERIs y se elaboraron las matrices de usuario, gerente y suministradores, lo que posibilitó conocer el rol de cada miembro de la organización con respecto a los recursos de información. Se analizó la variable fondos de información, en la que se estudiaron un total de 15 indicadores. Resultados: se identificaron 47 entidades o recursos de información disponibles en el centro; de estas 36 internas y 11 externas. Los fondos documentales con los que cuenta el CEDIMED no presentaron un alto grado de actualización; sin embargo, las temáticas contenidas en estos, resultaron altamente pertinentes a las funciones de este tipo de organización. Alrededor de la mitad de los indicadores analizados fue evaluado de excelente; sin embargo, la variable fondos de información fue regular. Conclusiones: todo centro o servicio de información sobre medicamentos debe contar con recursos de información de calidad y fácil acceso por los usuarios; así como establecer una política para el desarrollo de los fondos y la realización de estudios sobre el uso de las diversas colecciones disponibles en la institución(AU)

Objective: to evaluate the information resources available at the Center of Study, Documentation and Information on Drugs (CEDIMED). Methods: identification of those sources, services and systems that might attain the category of entity or of information resource within CEDIMED by using the INFOMAD methodology. Data on the cost of identified resources were collected and ordered according to their characteristics. The value index was determined for each ERI and the user, manager and supplier matrices were prepared, all of which made it possible to know the role of each member of the organization in relation to the information resources. The variable called information stocks was analyzed including the study of 15 indicators. Results: forty seven information entities or resources were available at the center, 36 domestic and 11 external. The documentary stocks of CEDIMED were not highly updated; however, their topics were highly relevant for the functions of this type of organization. The evaluation of almost half of the analyzed indicators was excellent but the variable information stocks were rated as regular. Conclusions: every information center or service on drugs should have quality easy-to-access resources for users and should also set a policy aimed at developing the stocks and at carrying out studies on the use of the various collections located in the institution(AU)

Evaluación de los recursos de información en el Centro de Estudio, Documentación e Información de Medicamentos, Villa Clara / Assessment of information resources in the Center of Study, Documentation and Drug Information in Villa Clara province

OBJETIVO: evaluar los recursos de información disponibles en el Centro de Estudio, Documentación e Información de Medicamentos (CEDIMED). MÉTODOS: se identificaron aquellas fuentes, servicios y sistemas que pudieran llegar a alcanzar la categoría de entidad o recurso de información dentro del CEDIMED, empleando la metodología INFOMAP. Se recolectaron datos sobre el costo de los recursos identificados y se desarrolló un ordenamiento de estos según su característica. Se determinó el índice de valor para cada ERIs y se elaboraron las matrices de usuario, gerente y suministradores, lo que posibilitó conocer el rol de cada miembro de la organización con respecto a los recursos de información. Se analizó la variable fondos de información, en la que se estudiaron un total de 15 indicadores. RESULTADOS: se identificaron 47 entidades o recursos de información disponibles en el centro; de estas 36 internas y 11 externas. Los fondos documentales con los que cuenta el CEDIMED no presentaron un alto grado de actualización; sin embargo, las temáticas contenidas en estos, resultaron altamente pertinentes a las funciones de este tipo de organización. Alrededor de la mitad de los indicadores analizados fue evaluado de excelente; sin embargo, la variable fondos de información fue regular. CONCLUSIONES: todo centro o servicio de información sobre medicamentos debe contar con recursos de información de calidad y fácil acceso por los usuarios; así como establecer una política para el desarrollo de los fondos y la realización de estudios sobre el uso de las diversas colecciones disponibles en la institución(AU)

OBJECTIVE: to evaluate the information resources available at the Center of Study, Documentation and Information on Drugs (CEDIMED). METHODS: identification of those sources, services and systems that might attain the category of entity or of information resource within CEDIMED by using the INFOMAD methodology. Data on the cost of identified resources were collected and ordered according to their characteristics. The value index was determined for each ERI and the user, manager and supplier matrices were prepared, all of which made it possible to know the role of each member of the organization in relation to the information resources. The variable called information stocks was analyzed including the study of 15 indicators. RESULTS: forty seven information entities or resources were available at the center, 36 domestic and 11 external. The documentary stocks of CEDIMED were not highly updated; however, their topics were highly relevant for the functions of this type of organization. The evaluation of almost half of the analyzed indicators was excellent but the variable information stocks were rated as regular. CONCLUSIONS: every information center or service on drugs should have quality easy-to-access resources for users and should also set a policy aimed at developing the stocks and at carrying out studies on the use of the various collections located in the institution(AU)

Extrofia vesical: una anomalía congénita / Vesical Exstrophy: a Case Presentation

Se realizó un trabajo descriptivo y representativo de un caso, para el que se utilizó la entrevista, la ultrasonografía y la evaluación del grupo Multidisciplinario de Genética Provincial. La paciente con 23 años de edad, con historia obstetricia de G2 P1 eutócico, clasificado de riesgo genético bajo, se le detectó en el ultrasonido del segundo semestre en la semana de gestación 19.6 una anomalía congénita, diagnosticada como extrofia vesical. Después de encontrado este hallazgo, la gestante fue remitida al Centro Genético Provincial. El equipo facultativo evaluó el caso y decidió la interrupción electiva del embarazo, siendo un feto de 450 gramos del sexo femenino. El resultado final de la anatomía patológica fue: ausencia de fusión del hueso pelviano; malformación de la vulva, clítoris prominente, labios mayores cortos y abiertos; vejiga insertada en la pared abdominal (AU)

A descriptive and representative research on a case was performed where the medical interview, the ultrasonography and the assessment of the Provincial Multidisciplinary Group of Genetics were used. The patient was 23 years old and had an obstetric history of eutectic G2 P1; ranked as a low genetic risk. A congenital anomaly was detected by the second term ultrasound of the 19.6 week of gestation. It was diagnosed as a vesical exstrophy. After finding this, the pregnant woman was referred to the Provincial Genetics Center where the medical team assessed the case and decided an elective termination of the pregnancy. It was a female fetus of 450 grams. The final pathological result was: absence of pelvic bone fusion, malformation of the vulva, prominent clitoris, short and open labia majora and a bladder inserted into the abdominal wall (AU)

Salud intercultural: impacto en la identidad social de mujeres aimaras / Intercultural health: the impact in the aimara women social identity

Este artículo busca determinar el impacto sociocultural de las políticas públicas y la modernización en salud y educación en los pueblos aimaras en Chile, desde un enfoque cultural. Su intención es aproximarse al significado atribuido por las mujeres aimaras de Colchane a las políticas públicas en salud reproductiva y cómo impacta en su cosmovisión. Nuestra hipótesis es que las mujeres aimaras no se apropian de las políticas culturales en salud reproductiva porque no responden al sentido cultural que involucra el proceso reproductivo. Este trabajo quiso indagar sobre el sentido social y la construcción valórica tras estos procesos sociales y determinar cómo afecta a la incorporación de las políticas públicas.

This paper is part of a research project which tries to determine the socio cultural impact of public policies and the modernization process in the health care of the aimara ethnic group in Chile, from a cultural perspective. Its purpose is to approach to the meaning attributed by the aimara women from Colchane to the public policies related to reproductive health and how it impacts their cosmic vision. Our hypothesis is that the aimara women do not appropriate these public policies on reproductive health as proper because they do not respond to their cultural meaning about the reproductive process.

Este artigo procura determinar o impacto socio-cultural das políticas públicas, a modernização em saúde e a educação nos povos Aimaras no Chile, desde um enfoque cultural. Seu objetivo é se aproximar do significado atribuido pelas mulheres Aimaras de Colchane às políticas públicas em saúde reprodutiva e como impacta em sua cosmovisão. Nossa hipótese é que as mulheres Aimaras não se apropriam das políticas culturais em saúde reprodutiva porque não respondem ao sentido cultural que envolve o processo reprodutivo. Este trabalho quis indagar sobre o sentido social e a construção de valores através destes processos sociais e determinar como isto afeta a incorporação das políticas públicas.

Actuaciones medicolegales en la traumatología maxilofacial / Medico-legal actions in maxilofacial traumatology

Se realizó una revisión bibliográfica sobre las actuaciones medicolegales de la atención a pacientes con traumatismos maxilofaciales, por lo que se indagó sobre los procedimientos y las responsabilidades del cirujano maxilofacial y del estomatólogo en el tratamiento de las lesiones bucales y faciales. Se precisó que la certificación, la denuncia y la curación directa de las lesiones son las principales actuaciones medicolegales. La confección del Certificado de Asistencia de Primera Intención de un Lesionado, lleva implícita la denuncia y la clasificación legal de las lesiones, por lo que es responsabilidad del profesional que certifica, declarar la gravedad de las mismas. La deformidad maxilofacial constituye un importante agravante, que solo puede variar de acuerdo con la asistencia y curación de las lesiones, proceso que concluye con la sanidad legal dictaminada por el médico forense(AU)