Factores de riesgo en infecciones del tracto urinario asociadas a instalación de catéter vesical en adultos / Risk factors in urinary tract infections associated with bladder catheter installation in adults

Introducción: las infecciones de las vías urinarias relacionadas con la instalación de catéter vesical son de las infecciones asociadas a la atención sanitaria más comunes en México y el mundo. Representan un riesgo latente para el desarrollo de complicaciones y pueden ocasionar la muerte. Objetivo: analizar los factores de riesgo que se asocian directamente a la infección del tracto urinario en la instalación del catéter vesical. Metodología: estudio observacional, descriptivo y transversal, con muestra de 90 pacientes de un hospital de segundo nivel de atención en el que se identificaron los factores de riesgo de infección de vías urinarias asociadas a la instalación de sonda vesical. Resultados: se observó un tipo de cumplimiento de los indicadores de calidad durante la instalación de sonda vesical con frecuencia en el 52.22% de los participantes. Un tipo de cumplimiento con frecuencia en el 48.90% de los participantes durante el mantenimiento de la sonda vesical, y un tipo de cumplimiento con frecuencia del 47.78% al momento del retiro de la sonda. Los principales factores de riesgo identificados asociados a la infección del tracto urinario fueron: a) que la sonda sea instalada por un médico interno, b) una estancia mayor a 3 días en urgencias y c) que la sonda sea instalada por una enfermera general. Conclusiones: se encontraron indicadores de cumplimiento cercano al 50%, lo que se considera muy bajo en la medición de los indicadores de calidad durante la instalación, mantenimiento y retiro de la sonda vesical, incluso estos están por debajo del porcentaje nacional.

Introduction: Urinary tract infections related to the installation of a bladder catheter are the most common infections associated with health care in Mexico and the world. They represent a latent risk for the development of complications and can cause death. Objective: To analyze the risk factors that are directly associated with urinary tract infection in the installation of the bladder catheter. Methods: Observational, descriptive and cross-sectional study; with a sample of 90 patients from a second-level care hospital in which the risk factors for urinary tract infection associated with the installation of a urinary catheter were identified. Results: A type of compliance with the quality indicators was observed during the urinary catheter installation with a frequency of 52.22% of the participants. A type of compliance with a frequency of 48.90% of the participants during the maintenance of the urinary catheter, and a type of compli- ance with a frequency of 47.78% at the time of catheter removal. The main risk factors identified associated with urinary tract infection were: a) that the catheter is installed by an intern, b) a stay of more than 3 days in the emergency room, and c) that the catheter is installed by a general nurse. Conclusions: Compliance indicators were found close to 50%, which is considered very low in the measurement of quality indicators during the installation, maintenance and removal of the urinary catheter, even these are below the national percentage.

El sentir del cuidador familiar en una institución de tercer nivel / O sentimento do cuidador familiar em uma instituição de terceiro nível / The feeling of the family caregiver in a third level institution

Introducción: Las instituciones son áreas en donde el Cuidador familiar permanece portiempo indefinido, interactuando con el personal de enfermería en el proceso de cuidado. Lamayoría de las veces no contempla sus necesidades y miedos. Objetivo: Describir el sentir delcuidador familiar en una institución de tercer nivel. Método: Estudio descriptivo con orientaciónhermenéutica de corte interpretativo-inductivo, realizado en un hospital de tercer nivel de la Cd.de México. Se realizaron nueve entrevistas semiestructuradas; seis a cuidadores familiares y tresa enfermeras, además para tener un acercamiento en tiempo real de conductas y procesos se apoyóde la observación no estructurada. Resultados: Se obtuvieron dos categorías con sus respectivassubcategorías. 1. La institución como desarrollador del cuidador familiar: La dinámica del cuidadoformal e informal y las aportaciones en el cuidar/cuidado del cuidador familiar. 2. La necesidad decuidado del cuidador familiar: La implicación del cuidador familiar en el sistema institucional.Conclusiones: A pesar de contar con una presencia activa en los hospitales realizando un abanicode actividades en el proceso de cuidado, el cuidador familiar se sigue sintiendo “invisible” para elsistema sanitario.(AU)

Introduction: Institutions are areas where the family caregiver remains indefinitely,interacting with the nursing staff in the care process. Most of the time you do not consider yourneeds and fears. Objective: To describe the feelings of the family caregiver in a third levelinstitution. Method: Descriptive study with hermeneutic orientation of interpretive-inductive cut,performed in a third level hospital in Mexico City. Nine semi-structured interviews wereconducted; six to family caregivers and three to nurses, in addition to having a real-time approachto behaviors and processes was supported by unstructured observation. Results: Two categorieswere obtained with their respective subcategories. 1. The institution as a family caregiverdeveloper: The dynamics of formal and informal care and contributions in the care / care of thefamily caregiver. 2. The need for family caregiver care: The involvement of the family caregiverin the institutional system. Conclusions: Despite having an active presence in hospitals carryingout a range of activities in the care process, the family caregiver continues to feel “invisible” tothe health system.(AU)

Introdução: Instituições são espaços onde o cuidador familiar permanece indefinidamente,interagindo com a equipe de enfermagem no processo de cuidar. Na maioria das vezes, você não considera suas necessidades e medos. Objetivo: Descrever os sentimentos do cuidador familiar emuma instituição de terceiro nível. Método: Estudo descritivo com orientação hermenêutica de corteinterpretativo-indutivo, realizado em um hospital de terceiro nível na Cidade do México. Noveentrevistas semiestruturadas foram realizadas; seis para cuidadores familiares e três paraenfermeiros, além de ter uma abordagem em tempo real aos comportamentos e processos, foiapoiada pela observação não estruturada. Resultados: Duas categorias foram obtidas com suasrespectivas subcategorias. 1. A instituição como promotora familiar cuidadora: A dinâmica docuidado formal e informal e as contribuições no cuidado / cuidado do cuidador familiar. 2. Anecessidade do cuidado do cuidador familiar: o envolvimento do familiar cuidador no sistemainstitucional. Conclusões: Apesar de ter presença ativa em hospitais realizando diversas atividadesno processo de cuidar, o cuidador familiar continua se sentindo “invisível” para o sistema de saúde.(AU)

Cuidador familiar: necesidades y experiencias / Family caregiver: needs and experiences

Introducción: el papel del cuidador es una experiencia única y transformadora; al enfrentarse al cuidado, lo hace en un entorno desconocido y demandante de intervenciones que comprometen la vida del ser cuidado. Muchas veces se actúa sin tener preparación alguna, tan sólo con la presuposición de que lo hecho es lo mejor. Objetivo: describir las necesidades y experiencias humanas de los cuidadores familiares de una institución oncológica pública de la Ciudad de México. Metodología: estudio cualitativo de corte interpretativo-fenomenológico; el muestreo fue a conveniencia; se realizaron entrevistas semiestructuradas a seis cuidadores familiares; y la segmentación de los textos se efectuó mediante el programa Aquad 7. Resultados: se obtuvieron dos categorías. La primera fue las necesidades del cuidar/cuidado del cuidador familiar con su correspondiente subcategoría; la segunda categoría fue el cuidador familiar en el ambiente hospitalario con su subcategoría. Conclusiones: los cuidadores familiares son una necesidad real en las instituciones de salud, por lo que deben existir programas dirigidos a fortalecer su participación en el cuidado.

Introduction: The role of the caregiver is a unique and transformative experience, when faced with care, it is performed in an environment, most of the time unknown and demanding of interventions that compromise the life of being cared for. In most of the times caregivers act without having any preparation, only with the intuition that what they do is the best. They develop needs and experiences in relation to the experience learned with the person cared for. Objective: To describe the needs and human experiences of family caregivers of a public oncology institution in Mexico City. Methods: Qualitative study of interpretive-phenomenological cut. Sampling was at convenience. Semi-structured interviews were conducted with six family caregivers. The segmentation of the texts was done through the Aquad 7 program. Results: Two categories were obtained. The first was: "The needs of care of the family caregiver" with its correspondent subcategory. The second category was: "The family caregiver in the hospital environment" with its subcategory. Conclusions: The presence of family caregivers is a real need in health institutions, so there must be programs aimed at strengthening their participation in care.

Disappearing in the Night: An Overview on Trade and Legislation of Night Monkeys in South and Central America.

The international trade in night monkeys (Aotus spp.), found throughout Central and South America, has been regulated by the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) since 1975. We present a quantitative analysis of this trade from all 9 range countries, over 4 decades, and compare domestic legislation to CITES regulations. Night monkeys were exported from 8 of the 9 habitat countries, totalling 5,968 live individuals and 7,098 specimens, with trade of live individuals declining over time. In terms of species, the most commonly traded was Aotus nancymaae (present in Brazil, Colombia, Peru) followed by A. vociferans (Brazil, Colombia, Ecuador, Peru) and A. zonalis (Colombia, Panama). There was no significant correlation between levels of trade and species' geographic range size or the number of countries in which a species occurs. Five countries have legislation that meets CITES requirements for implementation, whereas the other 4 countries' legislation showed deficiencies. Research conducted in Colombia, Peru, and Brazil suggests significant cross-border trade not captured in official international trade registers. Although international trade has diminished, current trends suggest that populations of rarer species may be under unsustainable pressure. Further research is needed to quantify real trade numbers occurring between habitat countries.

Análisis causa-raíz de los factores vinculados a la muerte de recién nacidos internados en maternidades públicas de Argentina / Root cause analysis of factors related to the death of newborns hospitalized in public maternities in Argentina

INTRODUCCIÓN: Las tasas de mortalidad infantil y neonatal en Argentina tienen tendencia decreciente y las desigualdades entre regiones son notables. El 60% de las muertes en <1 año ocurre en el periodo neonatal, 57% de esas muertes son evitables. OBJETIVO: analizar un conjunto de muertes neonatales a través de técnicas estandarizadas y Análisis de Causa-Raíz (ACR). MÉTODO: estudio multicéntrico observacional de corte transversal. Se incluyeron los recién nacidos (RN) ≥ 500 grs que fallecieron ≤ 30 días entre 06/08 y 03/09 en 6 maternidades. La recolección de datos fue prospectiva multidimensional, próxima a la muerte, a partir de todos los actores, con marcación cronológica y evaluación de dimensiones institucional, recursos humanos, equipamiento, ambiente físico y factores externos. Se caracterizó al RN fallecido y un grupo asesor clasificó la muerte como inevitable o reducible. RESULTADOS: se analizaron 369 muertes; las causas de internación fueron dificultad respiratoria (67,7%), malformaciones (16,2%), infecciones y asfixia perinatal (12%). La dimensión de recursos humanos fue la más frecuentemente relacionada con la muerte (59%), seguida por la institucional y organizacional (48%). La condición de derivación (OR 1,97; IC95% 1,01-3,83) y la presencia de complicaciones (OR 8,56; IC 95% 5,03-14,5) y edad >6 días (OR 2,04; IC95% 1,06-3,95) resultaron asociadas en forma independiente a la reducibilidad de la muerte neonatal. CONCLUSIONES: la mayor parte de las muertes neonatales fueron reducibles. Resulta fundamental establecer estrategias de capacitación y fortalecimiento del recurso humano que asiste a esta población.

BACKGROUND: The infant and neonatal mortality rate in Argentina is decreasing but disparities between regions are notable and 60 per cent of the newborn deaths (NB) are preventable. OBJECTIVE: to analyze a set of neonatal deaths through standardized techniques and root cause analysis (RCA). The RCA is a reactive tool to identify factors contributing to the occurrence of an unwanted event in search of system failures. Design: multicentric observational cross-sectional study. METHOD: NB ≥ 500grs who died ≤ 30 days in 2008–2009 in 6 maternity hospitals in Argentina were included. Data collection was multidimensional and close to the death with chronological analysis and assessment of dimension institutional, human resources, equipment, physical environment and external factors. Every NB was epidemiologically characterized and an advisory group classified death as inevitable or reducible. RESULTS: 369 deaths were analyzed; the main hospitalization causes were respiratory distress (67.7%), malformations (16.2%), infections and perinatal asphyxia (12%). The human resources dimension was the most frequently related to the death (59%), followed by the institutional and organizational (48%). 57.7% of deaths were classified as reducible. The neonatal transport condition (OR 1.97CI95% 1, 01-3, 83), the presence of complications (OR 8,56 CI95% 5,03-14,5) and age > 6 days (OR2 CI95% 1,06-3, 95) were associated with neonatal death reducibility independently. CONCLUSIONS: most of neonatal deaths were reducible. It is essential to establish strategies for training and strengthening human resources that assist this population.

Adult male replacement and subsequent infant care by male and siblings in socially monogamous owl monkeys (Aotus azarai).

Owl monkeys (Aotus azarai) are small, territorial, socially monogamous primates that show intense infant care by the adult male in the group. It has been hypothesized that male care may be adaptive because it increases offspring survival and/or reduces the metabolic costs to the female of raising the offspring. Alternatively, males may provide care even when they are not related to the infants to increase future reproductive opportunities. We describe changes in infant care patterns that took place after the eviction of the resident male by a solitary male in an owl monkey population in the Argentinean Chaco. The resident male and mother provided all infant care during the first month of life of the infant, until the male was evicted. During the three-day male replacement event, care of the infant was shared among the mother, a four-year-old sister, and a one-year-old brother. The new male began contributing to infant care soon after entering the group, carrying, and interacting socially with the infant in much the same way as any male regularly does. However, despite receiving biparental care from both the original and new resident males, the infant disappeared at the age of four months and was presumed dead. These are the first reports of care by sibling and by non-putative fathers in wild owl monkeys. Given the significant amount of time that new pairs of owl monkeys spend before reproducing, it is possible that male care in owl monkeys functions as mating effort as much as or more than parenting effort.