Exploring the mechanistic pathways of how social network influences social norms in adolescent smoking prevention interventions.

We know little about how smoking prevention interventions might leverage social network structures to enhance protective social norms. In this study we combined statistical and network science methods to explore how social networks influence social norms related to adolescent smoking in school-specific settings in Northern Ireland and Colombia. Pupils (12-15 years old) participated in two smoking prevention interventions in both countries (n = 1344). A Latent Transition Analysis identified three groups characterized by descriptive and injunctive norms towards smoking. We employed a Separable Temporal Random Graph Model to analyze homophily in social norms and conducted a descriptive analysis of the changes in the students' and their friends' social norms over time to account for social influence. The results showed that students were more likely to be friends with others who had social norms against smoking. However, students with social norms favorable towards smoking had more friends with similar views than the students with perceived norms against smoking, underlining the importance of network thresholds. Our results support the notation that the ASSIST intervention takes advantage of friendship networks to leverage greater change in the students' smoking social norms than the Dead Cool intervention, reiterating that social norms are subject to social influence.

Intervención educativa sobre las neumonías extrahospitalarias en el adulto mayor. Policlínico Docente Mario Muñoz Monroy. 2019-2020

Introducción: las neumonías extrahospitalarias en el anciano son un problema de salud mundial en el marco del envejecimiento poblacional, lo que hace necesario su prevención y diagnóstico precoz. Objetivo: implementar una estrategia de intervención educativa dirigida a elevar los conocimientos sobre el tema, en adultos mayores de 60 años del Consultorio no. 27 del Policlínico Docente Mario Muñoz Monroy. Materiales y métodos: se realizó un estudio cuasiexperimental de tipo intervención educativa, en el municipio Rafael Freyre, de la provincia de Holguín, entre enero de 2019 y diciembre de 2020. Se trabajó con una muestra de 50 representantes de la comunidad, seleccionados de modo intencional, en los que se indagó su nivel de información sobre el tema antes y después de aplicar la intervención educativa. El método estadístico utilizado fue la prueba de McNemar, utilizando el paquete estadístico SPSS. Resultados: los conocimientos sobre los síntomas y signos de las neumonías extrahospitalarias que fueron evaluados de bueno, se incrementaron de 18 a 80 %, y sobre las medidas preventivas los resultados fueron de 22 a 94 %. El indicador con mejores resultados fue factores de riesgo, donde el valor de la escala de bueno aumentó a 96 % tras la intervención. Conclusiones: la intervención educativa aplicada con la finalidad de elevar los conocimientos de los pacientes mayores de 60 años del Consultorio no. 27 del Policlínico Docente Mario Muñoz Monroy, posibilitó enriquecer su conocimiento sobre las neumonías extrahospitalarias.

Introduction: community-acquired pneumonia in the elderly is a global health problem in the context of population aging, which makes its prevention and early diagnosis necessary. Objective: to implement an educational intervention strategy aimed at increasing knowledge on the subject in elder people over 60 years from the Doctor's Office nr. 27 of the Mario Munoz Monroy Teaching Polyclinic. Materials and methods: a quasi-experimental study of educational intervention type was conducted in the municipality Rafael Freyre, in the province of Holguin, between January 2019 and December 2020. A sample of 50 community representatives, intentionally selected, was worked on to investigate their level of information on the subject before and after applying the educational intervention. The statistical method used was the McNemar's test, using the SPSS statistical package. Results: the knowledge on the symptoms and signs of community-acquired pneumonias that were evaluated as good, increased from 18 to 80%, and on preventive measures the results increased from 22 to 94%. The indicator with the best results was risk factors, where the good value of the scale increased to 96% after the intervention. Conclusions: the educational intervention applied with the aim of increasing the knowledge of patients over 60 years of age from the Doctor's Office nr. 27 of the Mario Muñoz Monroy Teaching Polyclinic, made it possible to enrich their knowledge about community-acquired pneumonias.

Cross-sector co-creation of a community-based physical activity program for breast cancer survivors in Colombia.

Benefits of physical activity (PA) in breast cancer survivors (BCS) are well established. However, programs to promote PA among BCS tailored to real-world contexts within low- to middle-income countries are limited. Cross-sector co-creation can be key to effective and scalable programs for BCS in these countries. This study aimed to evaluate the networking process to engage multisector stakeholders in the co-creation of a PA program for Colombian BCS called My Body. We employed a mixed-methods design including semistructured interviews, workshops and a social network analysis of centrality measures to assess stakeholders' engagement, resources and skills enabling the collaborative work, challenges, outcomes and lessons learned. The descriptive analysis and the centrality measures of the network revealed that 19 cross-sector stakeholders engaged in the My Body collaborative network. Through ongoing communication and cooperation, My Body built relationships between the academic lead institutions (local and international), and local and national public, private and academic institutions working in public health, sports and recreation, social sciences and engineering fields. The outcomes included the co-creation of the community-based PA program for BCS, its implementation through cross-sector synergies, increased relationships and communications among stakeholders, and successful dissemination of evidence and project results to the collaboration partners and other relevant stakeholders and community members. The mixed-methods assessment enabled understanding of ways to advance cross-sector co-creation of health promotion programs. The findings can help to enable continued development of sustainable cross-sector co-creation processes aimed at advancing PA promotion.

Collaborative work among stakeholders and researchers from different governmental sectors and disciplinary fields can be key to design and implement effective and scalable programs to promote physical activity (PA) among breast cancer survivors (BCS). This might be particularly critical in low- to middle-income countries where the implementation of evidence-based health-promoting programs tailored to real-world contexts are limited. This study aimed to evaluate the networking process to engage multisector stakeholders in the co-creation of a PA program for Colombian BCS. We employed qualitative methods and social network analyses to assess stakeholders' engagement, resources and skills enabling the collaborative work, challenges, outcomes and lessons learned. The co-creation of the program improved synergies between research, policy and practice. Communication through several channels including e-mail and workshops was the key resource to advance the collaborative work. Stakeholders underscored that cross-sector networking allowed allocating resources and achieving shared goals. Sustainable cross-sector collaborative processes are key for health promotion.

Revisión del uso de antibióticos de amplio espectro en el ambiente hospitalario privado en Costa Rica / Review of the use of broad spectrum antibiotics in the private hospital environment in Costa Rica

Justificación: los errores de prescripción en los antibióticos de amplio espectro conducen a problemas de resistencia bacteriana, lo que ha disminuido las opciones farmacológicas para tratar a los pacientes, aumentando los días de hospitalización y la mortalidad. Métodos: el estudio incluye pacientes atendidos en el Hospital Clínica Bíblica, en el periodo del 1 de septiembre de 2012 al 28 de febrero de 2013, a quienes se les administró al menos una dosis en forma I.V. de un antibiótico de amplio espectro. Se analizaron 392 expedientes. Se recopilaron los documentos e información necesaria de cada paciente, para el correspondiente análisis. Resultados: Medicina Interna y Medicina Intensiva fueron las especialidades médicas responsables de prescribir mayoritariamente este tipo de antibióticos. En un 68% de los casos, la primera dosis fue prescrita a pacientes hospitalizados, y en un 57% de las ocasiones se utilizaron otros antibióticos junto con el de amplio espectro. En un 52% de los casos analizados no se realizó un cultivo para la utilización de los antibióticos de amplio espectro. De los pacientes que usaron antibióticos de amplio espectro, una proporción que oscila entre un 15% y un 45% presentaba de previo algún historial de alergia a otro antibiótico. En un 36% de los casos, durante el internamiento hubo un cambio en la estrategia antibiótica establecida. Conclusión: existe la necesidad de desarrollar un protocolo de manejo de antibióticos de amplio espectro en el centro hospitalario, en el cual se detallen los criterios para la utilización de cada antibiótico, con el fin de normar su uso.

Background: Errors in prescribing broad spectrum antibiotics lead to problems of bacterial resistance, this has decreased the pharmacological options for treating patients, and increased hospitalization stay and mortality. Methods: This study included patients treated at the Clinica Biblica Hospital from September 1st, 2012 to February 28, 2013 that received at least one IV dose of a broad-spectrum antibiotic. A total of 392 clinical records were analyzed. The documents and information required for the analysis of each patient´s case was gathered. Results: Intensive Care Medicine and Internal Medicine were largely responsible for prescribing the antibiotics included in this study. In 68% of cases, the first dose was prescribed to hospitalized patients and in 57% of cases other antibiotics were used along with the broad spectrum ones. In 52% of the cases analyzed, a bacterial culture was not performed in order to justify the use of a broad-spectrum antibiotic. Regarding patients that used broad spectrum antibiotics, 15% to 45% had a prior history of allergy to other antibiotics. In 36% of cases the antibiotic strategy was modified during hospitalization. Conclusion: It is necessary to develop a protocol to manage broad spectrum antibiotics in this hospital, in which the criteria to use each antibiotic is described in order to standardize such use.

Síndrome de Gorlin (síndrome de carcinoma basocelular nevoide). Presentación de dos casos y revisión de la literatura / Gorlin's symdrome (nevoid basal cell carcinoma syndrome). Presentation of two cases and review of the literature

El síndrome de carcinoma basocelular nevoide fue descrito hace cuatro décadas por Gorlin y Goltz; ha sido caracterizado por múltiples carcinoma basocelulares en áreas expuestas o no al sol. Además, los pacientes con este síndrome cursan con quistes mandibulares, alteraciones esqueléticas (costilla bífida), puntilleo palmoplantar y calcificaciones ectópicas. Este síndrome está asociado con otras alteraciones de cara, de piel y de los sistemas musculoesquelético, genitourinario, neurológico y oftalmológico, así como algunas neoplasias, incluyendo, linfoma de Hodgkin, no-Hodgkin, meduloblastoma, fibromas de ovario y fibrosarcomas, melanoma y rabdomioma fetal. Se ha establecido que para el diagnóstico de síndrome de Gorlin, se requiere de dos características principales, consideradas como criterios mayores, o bien de una alteración mayor y dos menores. Algunos estudios han demostrado que este síndrome es una alteración autosómica dominante en el cromosoma 9, lo cual es relevante como un evento temprano en la carcinogénesis. Esta serie presenta dos casos de síndrome basocelular nevoide. En uno de ellos se efectuó estudio completo familiar y se detecto que había ocho miembros más de la familia que padecían esta enfermedad