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.

Dosis Diaria Definida de antibióticos en pacientes atendidos en hospitales públicos de Panamá

Objetivo: Determinar la Dosis Diaria Definida (DDD) de antibióticos utilizados en los Servicios de Medicina Interna de cuatro hospitales públicos en Panamá. Métodos: Se escogió una muestra a conveniencia de 4 hospitales públicos de segundo nivel de atención de la seguridad social y Ministerio de Salud, atendiendo características en cuanto a ubicación en provincias, población atendida, servicios médicos ofrecidos y con Dosis Unitaria en funcionamiento. Se obtuvieron datos de los pacientes hospitalizados entre los meses de enero a marzo del 2017 y la información era registrada en una base de datos anotándose generales del paciente, diagnósticos, antibióticos, dosis, frecuencia, tiempo de tratamiento. Igualmente se anotaron los consumos y costos unitarios de todos los antibióticos usados en los hospitales durante el año 2016, para calcular la DDD y Dosis Diaria Prescrita. Resultados: La oxacilina fue el antibiótico con mayor DDD días cama con 60.5, luego le siguen ceftriaxona (45.2), cefalotina (35.5), clindamicina (35.5). Por grupo farmacológico, las cefalosporinas tienen consumos más altos con 87.6 DDD días cama, la penicilina MRSA 60.5, la lincosamidas con 35.5 DDD días cama, seguido de las quinolonas con 29.3. Conclusiones: Los resultados pueden ser utilizados para implementar programas para mejorar el uso racional y gasto de antibióticos a nivel hospitalario y que la DDD se use para medir el consumo y a la vez propiciar el control de antibióticos a través de comunicaciones escritas con los médicos tratantes. Se deben realizar estudios de DDD días cama relacionando con los aspectos microbiológicos para relacionar mejor el uso de los antibióticos. (provisto por Infomedic International)

Objective. Determine the Defined Daily Dose of antibiotics used in the Internal Medicine Services of 4 public hospitals in Panama. Methods. A convenience sample of 4 public hospitals of the second level of social security care and the Ministry of Health was chosen, considering characteristics in terms of location in the provinces, population served, medical services offered and with Unit Dose in operation. Data were obtained from hospitalized patients between the months of January to March 2017 and the information was recorded in a database, noting general patient reports, diagnoses, antibiotics, dose, frequency, treatment time. Likewise, the consumptions and unit costs of all antibiotics used in hospitals during 2016 were recorded to calculate the DDD and Prescribed Daily Dose. Results. Oxacillin was the antibiotic with the highest DDD bed days with 60.5, followed by ceftriaxone (45.2), cephalothin (35.5), and clindamycin (35.5). By pharmacological group, cephalosporins have higher intakes with 87.6 DDD bed days, penicillin MRSA 60.5, and lincosamides with 35.5 DDD bed days, followed by quinolones with 29.3. Conclusions. The results can be used to implement programs to improve the rational use and expense of antibiotics at the hospital level and that the DDD is used to measure the consumption and at the same time promote the control of antibiotics through written communications with the treating physicians. Bed-day DDD studies should be carried out relating to microbiological aspects to better relate the use of antibiotics. (provided by Infomedic International)

Atributos afectivos y cognitivos hacia la fauna silvestre y su relación con factores sociodemográficos en población rural / Affective and cognitive attributes to wildlife and its relationship with sociodemographic factors in the rural population

RESUMEN Las posibles asociaciones entre factores sociodemográficos y el grado de conciencia ambiental, expresado en términos de un subconjunto de atributos afectivos y cognitivos, puede determinar la incidencia de programas de educación ambiental en zonas rurales, sobre la percepción frente a diversas problemáticas ambientales, de carácter local, así como la postura adoptada hacia la conservación de la fauna silvestre. En la zona de estudio, se observaron afectaciones al entorno, cacería ilegal, minería, deforestación, quemas y contaminación por residuos. Por lo anterior, fue importante conocer el nivel de conciencia ambiental de las personas involucradas. Además, este tipo de estudio es muy importante en el país, ya que contribuye en las investigaciones sobre el nivel de conciencia ambiental, por lo que es relevante indagar sobre este aspecto. Se tomó una muestra de 152 habitantes, pertenecientes a las 15 comunidades del área de influencia del trasvase Manso - Caldas, Colombia, a las que se les aplicaron encuestas cara a cara. Para el análisis estadístico, se recurrió a las pruebas de independencia y al análisis de correspondencias múltiples. Dentro de los atributos afectivos, se pudo identificar asociación entre la tenencia de tierra, la permanencia en la zona y el pertenecer a diferentes organizaciones de índole asociativo, con un incremento en el indicador utilizado, para evidenciar la conciencia ambiental. El estudio realizado expone el tratamiento de información empírica, que da cuenta de los avances alcanzados en programas de educación ambiental, ejecutados entre pobladores de zonas rurales, así como su relación con ciertos comportamientos proambientales.

ABSTRACT The possible associations between sociodemographic factors and the degree of environmental awareness, expressed in terms of a subset of affective and cognitive attributes, can determine the incidence of environmental education programs in rural areas on the perception of various environmental problems of a local nature, as well as the position adopted towards the conservation of wild fauna. In the study area, effects on the environment, illegal hunting, mining, deforestation, burning and contamination by residues were observed. Therefore, it was important to know the level of environmental awareness of the people involved in these programs. In addition, this type of study is very important in the country since it contributes to research on the level of environmental awareness, so it is relevant to inquire about this aspect. A sample of 152 inhabitants was taken from the 15 communities in the Manso transfer area, Caldas-Colombia, to which face-to-face surveys were applied. For statistical analysis, independence tests and Multiple Correspondence Analysis were used. Within the affective attributes, it was possible to identify an association between land ownership, permanence in the area and belonging to different organizations of an associative nature with an increase in the indicator used to demonstrate environmental awareness. The study carried out exposes the treatment of empirical information that accounts for the progress made in Environmental Education programs carried out among residents of rural areas, as well as its relationship with certain pro-environmental behaviors.

Medication errors involving oral chemotherapy.

BACKGROUND: Given the expanding use of oral chemotherapies, the authors set out to examine errors in the prescribing, dispensing, administration, and monitoring of these drugs. METHODS: Reports were collected of oral chemotherapy-associated medication errors from a medical literature and Internet search and review of reports to the Medication Errors Reporting Program and MEDMARX. The authors solicited incident reports from 14 comprehensive cancer centers, and also collected incident reports, pharmacy interventions, and prompted clinician reports from their own center. They classified the type of incident, severity, stage in the medication use process, and type of medication error. They examined the yield of the various reporting methods to identify oral chemotherapy-related medication errors. RESULTS: The authors identified 99 adverse drug events, 322 near misses, and 87 medical errors with low risk of harm. Of the 99 adverse drug events, 20 were serious or life-threatening, 52 were significant, and 25 were minor. The most common medication errors involved wrong dose (38.8%), wrong drug (13.6%), wrong number of days supplied (11.0%), and missed dose (10.0%). The majority of errors resulted in a near miss; however, 39.3% of reports involving the wrong number of days supplied resulted in adverse drug events. Incidents derived from the literature search and hospital incident reporting system included a larger percentage of adverse drug events (73.1% and 58.8%, respectively) compared with other sources. CONCLUSIONS: Ensuring oral chemotherapy safety requires improvements in the way these drugs are ordered, dispensed, administered, and monitored.

Identificación de estafilococos coagulasa negativos en pacientes hospitalizados / Determination of coagulase negative staphylococcus in hospitalized patients

Se identificaron 114 cepas de estafilococos coagula negativos que habían sido cultivadas de la sangre, de la orina y de secreciones de pacientes hospitalizados en el Complejo Hospitalario Metropolitano de la Caja de Seguro Social (CHMCSS). El sistema de idenficación utilizado fue el de Kloos y Schleifer. Las especies que se encontraram más frecuentemente fueron el Staphylococcus epidermidis, biotipo 1 (74/114, 64,9%), S. simulans (16/114, 14%), S. haemolyticus (14/114, 12.3%) y S. cohnii (6/114, 5.2%). También identificamos, pero con menos frecuencia, S. capitus, S. warneri, S. xylosus y S. epidermidis, biotipo 3 (1/114, 0.9%)