Impacto de las posturas forzadas en los docentes odontólogos de la Universidad Regional Autónoma de Los Andes

Introducción: Muy poco se habla acerca de las malas posturas en la práctica clínica diaria y sus consecuencias en la salud de los profesionales odontólogos a corto y largo plazo, el ejercicio de esta profesión implica estar expuestos constantemente a presentar ciertos problemas de salud ocupacional. Objetivo: Determinar la frecuencia de las diferentes posturas que generan molestias corporales en relación con la especialidad y el análisis de los trastornos musculoesqueléticos y su asociación con los años de la profesión en docentes odontólogos de la Universidad Regional Autónoma de Los Andes. Método: La investigación fue de tipo observacional, transversal y descriptivo. Se aplicó una encuesta en enero de 2023 a un grupo de 46 profesionales de Odontología, determinada como una muestra de tipo intencional no probabilística de forma intencionada. Se consideró la prueba no paramétrica de Ji cuadrado de Pearson, que por la naturaleza de sus variables de tipo cualitativo probó posibles asociaciones entre las estas. Resultados: De todas las posibles asociaciones entre las variables, la que se mostró notablemente significativa correspondió al tiempo de profesión y las molestias principalmente detectadas en la parte baja de la espalda y cuello; lo que denotaría que a mayor tiempo tenga el ejercicio clínico, mayores serán las molestias detectadas como parte de posturas forzadas que adoptan los profesionales. Conclusiones: Se encontró asociación o relación significativa entre los años de profesión y los síntomas detectados en los profesionales de Odontología encuestados; lo que indica que a mayor tiempo en el ejercicio clínico pueden devenir mayores problemas a nivel ergonómico. Es importante considerar la aplicación de medidas interventoras para mejorar los aspectos de salud ocupacional, ergonomía e higiene postural.

Introduction: Very little is said about bad posture in daily clinical practice and its consequences on the health of dental professionals in the short and long term; the practice of this profession implies being constantly exposed to certain occupational health problems. Objective: To determine the frequency of the different postures that generate body discomfort in relation to the specialty and the analysis of musculoskeletal disorders and their association with the years of the profession in dental teachers at the Universidad Regional Autónoma de Los Andes. Method: The research was observational, transversal and descriptive. A survey was applied in January 2023 to a group of 46 dental professionals, determined as an intentional non-probabilistic sample. The non-parametric Pearson's Chi-square test was considered, which due to the nature of its qualitative variables tested possible associations between them. Results: Of all the possible associations between the variables, the one that was notably significant corresponded to the time of profession and the discomforts mainly detected in the lower back and neck; which would denote that the longer the clinical practice lasts, the greater the discomfort detected as part of forced postures adopted by professionals. Conclusions: A significant association or relationship was found between years of profession and the symptoms detected in the dental professionals surveyed; which indicates that the longer the time spent in clinical practice, the greater the potential for ergonomic problems. It is important to consider the application of intervention measures to improve aspects of occupational health, ergonomics and postural hygiene.

Introdução: Muito pouco se fala sobre a má postura na prática clínica diária e suas consequências na saúde dos profissionais de odontologia a curto e longo prazo; o exercício desta profissão implica estar constantemente exposto a determinados problemas de saúde ocupacional. Objetivo: Determinar a frequência das diferentes posturas que geram desconforto corporal em relação à especialidade e a análise dos distúrbios musculoesqueléticos e sua associação com os anos de profissão em professores de odontologia da Universidad Regional Autónoma de Los Andes. Método: A pesquisa foi observacional, transversal e descritiva. Uma pesquisa foi aplicada em janeiro de 2023 a um grupo de 46 profissionais de odontologia, determinado como uma amostra não probabilística intencional. Foi considerado o teste não paramétrico Qui-quadrado de Pearson, que pela natureza de suas variáveis qualitativas testou possíveis associações entre elas. Resultados: De todas as associações possíveis entre as variáveis, a que se mostrou significativamente significativa correspondeu ao tempo de profissão e aos desconfortos detectados principalmente na região lombar e pescoço; o que denotaria que quanto mais tempo dura a prática clínica, maior é o desconforto detectado nas posturas forçadas adotadas pelos profissionais. Conclusões: Foi encontrada associação ou relação significativa entre os anos de profissão e os sintomas detectados nos profissionais de odontologia pesquisados; o que indica que quanto maior o tempo gasto na prática clínica, maior o potencial para problemas ergonômicos. É importante considerar a aplicação de medidas de intervenção para melhorar aspectos de saúde ocupacional, ergonomia e higiene postural.

Infecciones postoperatorias tras la extracción de terceros molares incluidos / Postoperative infections after the extraction of impacted third molars

Las extracciones quirúrgicas de terceros molares pueden, si no son atendidas oportunamente, conllevar infecciones postoperatorias de gravedad. Este estudio se realizó sobre una población de 103 pacientes provenientes de la Provincia de Chimborazo, Ecuador con el fin de estudiar posibles infecciones postoperativa después de la extracción de terceros molares. Para ello, se realizó la estratificación de la población en función de la edad (15 a 25, 26 a 30, 31 a 40, 41 a 50 y 51 a 60 años), sexo, estudios escolares (inicial, básica, bachiller y profesional) y nivel socioecónomico (bajo, medio y alto). A la par, se estudió la presencia de bacterias altamente patógenas como la S. mutans y P. gingivalis en la cavidad bucal de las personas con infección postoperatoria. Los resultados revelaron que las molestias asociadas a la extracción de estos terceros molares son más frecuentes entre la población de 15 a 30 años, y es la población femenina la más proclive a tales inflamaciones. Los pacientes de menores recursos económicos fueron lo que acudieron a estos centros asistencias asociados al bajo costo de los mismos. Al analizar la posición del tercer molar respecto al segundo se observó una mayor frecuencia en la posición B. Asimismo, se determinó la presencia de S. mutans y P. gingivali en más de la mitad de la población tratada que debe ser atendida en el menor tiempo posible a fin de evitar males mayores. Se hace un llamado a los padres de familia y maestros para que sea orientadores de estas enfermedades(AU)

Surgical extractions of third molars can, if not treated promptly, lead to serious postoperative infections. This study was conducted on a population of 103 patients from the Province of Chimborazo, Ecuador in order to study possible postoperative infections after the extraction of third molars. For this, the population was stratified according to age (15 to 25, 26 to 30, 31 to 40, 41 to 50 and 51 to 60 years), sex, school studies (initial, basic, high school and professional) and socioeconomic level (low, medium and high). At the same time, the presence of highly pathogenic bacteria such as S. mutans and P. gingivalis in the oral cavity of people with postoperative infection was studied. The results revealed that the discomfort associated with the extraction of these third molars is more frequent among the population aged 15 to 30 years, and the female population is the most prone to such inflammation. Patients with lower economic resources were the ones who attended these assistance centers associated with their low cost. When analyzing the position of the third molar regard to the second, a higher frequency was observed in position B. Likewise, the presence of S. mutans and P. gingivali was determined in more than half of the treated population that should be treated in the minor time possible in order to avoid greater problems. A call is made to parents and teachers to guide these diseases(AU)

Teaching Intersectionality of Sexual Orientation, Gender Identity, and Race/Ethnicity in a Health Disparities Course.

Introduction: Intersectionality considers how different identities simultaneously affect an individual's experiences. Those of multiple minority statuses may experience effects of intersecting systems of oppression. Most health disparities curricula do not focus on intersectionality. We studied the impact of an innovative module teaching intersectionality of sexual orientation, gender identity, and race/ethnicity issues in the required Pritzker School of Medicine course Health Care Disparities: Equity and Advocacy. Methods: A short lecture reviewed sexual and gender minority (SGM) health disparities, intersectionality, minority stress, and shared decision making (SDM) to establish shared language among 83 first-year medical students. Students then viewed four videos of SGM patients of color (POC) describing their health care experiences, each followed by moderated discussion about how compounded minority stress affects lived experiences and health and how to improve SDM for SGM POC. One video interviewee attended the session and answered students' questions. Evaluation was performed using pre- and postsurveys. Results: Feeling somewhat/completely confident in defining intersectionality increased from 57% to 96%. Prior to the session, 62% of respondents reported feeling somewhat/completely confident in identifying barriers to care for SGM patients, and 92% after. Thirty-three percent felt somewhat/completely confident in asking SGM patients about their identities before the session, and 81% after. Eighty-four percent rated the session as very good or excellent. Discussion: The session was well received, improved student knowledge of intersectionality, and improved confidence in communicating with and caring for SGM patients. Future iterations could include condensing the lecture and including a patient panel and/or small-group discussion.

Renal Replacement Knowledge and Preferences for African Americans With Chronic Kidney Disease.

BACKGROUND: Renal replacement therapies (RRT) other than in-centre haemodialyses are underutilised by African Americans with end-stage renal disease (ESRD) even though they are associated with reduced costs, morbidity and mortality as well as improved quality of life for patients. OBJECTIVES: To understand African American patients' knowledge of RRT options and how patient, provider and system-factors contribute to knowledge and preferences. Participants' interviews were conducted at the University of Chicago Medical Center with African American patients with chronic kidney disease (CKD). The final analysis included 28 interviews; 22 patients had CKD not yet on dialysis or having received a transplant, while 6 had reached ESRD and were receiving treatment for kidney failure. Approach Transcripts were uploaded into NVivo8 for coding. Thematic analysis was used for data interpretation. RESULTS: Four themes were identified: (1) limited knowledge of home modalities and deceased donor options, (2) CKD patients gave little thought to choosing RRT options, (3) CKD patients relied on doctors for treatment decisions, and (4) while patients reported knowledge of living kidney donation transplants (LKDT), it did not translate to receiving an LKDT. CONCLUSION: African Americans face significant knowledge and access barriers when deciding on their RRT treatment. Even patients with advanced CKD were still in the early stages of RRT selection. Understanding the knowledge gaps and barriers patients face will inform our subsequent intervention to educate and motivate patients to increase CKD self-care and improve communication between patients, their families and their providers about different RRT treatments.

Improving Shared Decision Making For Asian American Pacific Islander Sexual and Gender Minorities.

BACKGROUND: Asian American Pacific Islander (AAPI) sexual and gender minorities (SGM) face unique challenges in mental health and accessing high-quality health care. OBJECTIVE: The objective of this study was to identify barriers and facilitators for shared decision making (SDM) between AAPI SGM and providers, especially surrounding mental health. RESEARCH DESIGN: Interviews, focus groups, and surveys. SUBJECTS: AAPI SGM interviewees in Chicago (n=20) and San Francisco (n=20). Two focus groups (n=10) in San Francisco. MEASURES: Participants were asked open-ended questions about their health care experiences and how their identities impacted these encounters. Follow-up probes explored SDM and mental health. Participants were also surveyed about attitudes towards SGM disclosure and preferences about providers. Transcripts were analyzed for themes and a conceptual model was developed. RESULTS: Our conceptual model elucidates the patient, provider, and encounter-centered factors that feed into SDM for AAPI SGM. Some participants shared the stigma of SGM identities and mental health in their AAPI families. Their AAPI and SGM identities were intertwined in affecting mental health. Some providers inappropriately controlled the visibility of the patient's identities, ignoring or overemphasizing them. Participants varied on whether they preferred a provider of the same race, and how prominently their AAPI and/or SGM identities affected SDM. CONCLUSIONS: Providers should understand identity-specific challenges for AAPI SGM to engage in SDM. Providers should self-educate about AAPI and SGM history and intracommunity heterogeneity before the encounter, create a safe environment conducive to patient disclosure of SGM identity, and ask questions about patient priorities for the visit, pronouns, and mental health.

"I Try Not to Even Think About My Health Going Bad": a Qualitative Study of Chronic Kidney Disease Knowledge and Coping Among a Group of Urban African-American Patients with CKD.

CONTEXT: African-Americans with chronic kidney disease (CKD) are more likely to progress to end-stage renal disease (ESRD). However, African-Americans are less likely to receive care to delay progression of their CKD and to prepare for ESRD treatment. OBJECTIVE: The objectives of the study are to understand knowledge among urban, African-American patients diagnosed with CKD and to discover ways they managed their illness and prepared for kidney disease progression. DESIGN: A qualitative study was conducted using structured interviews. Thematic analysis was used for data interpretation. All 23 participants identified as African-American and had CKD but had not yet reached ESRD requiring renal replacement therapy (RRT). Over half of the participants were women (57%), and the mean age was 53 years old. RESULTS: Three themes emerged from the data. African-Americans often did not know the severity of their CKD. They struggled to complete all of the diet, exercise, and medication tasks recommended to manage their health conditions, including CKD. Finally, participants, even those with stage 5 CKD, viewed progression to RRT in the next 12 months as unlikely. CONCLUSION: African-Americans face many barriers to CKD self-care and preparation for ESRD. Improving outcomes requires clinicians to help patients understand the severity of their CKD, to make informed choices about their care, all the while motivating patients to take actions to prevent CKD progression.

Addressing Barriers to Shared Decision Making Among Latino LGBTQ Patients and Healthcare Providers in Clinical Settings.

Effective shared decision making (SDM) between patients and healthcare providers has been positively associated with health outcomes. However, little is known about the SDM process between Latino patients who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ), and their healthcare providers. Our review of the literature identified unique aspects of Latino LGBTQ persons' culture, health beliefs, and experiences that may affect their ability to engage in SDM with their healthcare providers. Further research needs to examine Latino LGBTQ patient-provider experiences with SDM and develop tools that can better facilitate SDM in this patient population.

Shared Decision Making Among Clinicians and Asian American and Pacific Islander Sexual and Gender Minorities: An Intersectional Approach to Address a Critical Care Gap.

Shared decision making (SDM) is a model of patient-provider communication. Little is known about the role of SDM in health disparities among Asian American and Pacific Islander (AAPI) sexual and gender minorities (SGM). We illustrate how issues at the intersection of AAPI and SGM identities affect SDM processes and health outcomes. We discuss experiences of AAPI SGM that are affected by AAPI heterogeneity, SGM stigma, multiple minority group identities, and sources of discrimination. Recommendations for clinical practice, research, policy, community development, and education are offered.

Development of a Conceptual Framework for Understanding Shared Decision making Among African-American LGBT Patients and their Clinicians.

BACKGROUND: Enhancing patient-centered care and shared decision making (SDM) has become a national priority as a means of engaging patients in their care, improving treatment adherence, and enhancing health outcomes. Relatively little is known about the healthcare experiences or shared decision making among racial/ethnic minorities who also identify as being LGBT. The purpose of this paper is to understand how race, sexual orientation and gender identity can simultaneously influence SDM among African-American LGBT persons, and to propose a model of SDM between such patients and their healthcare providers. METHODS: We reviewed key constructs necessary for understanding SDM among African-American LGBT persons, which guided our systematic literature review. Eligible studies for the review included English-language studies of adults (≥ 19 y/o) in North America, with a focus on LGBT persons who were African-American/black (i.e., > 50 % of the study population) or included sub-analyses by sexual orientation/gender identity and race. We searched PubMed, CINAHL, ProQuest Dissertations & Theses, PsycINFO, and Scopus databases using MESH terms and keywords related to shared decision making, communication quality (e.g., trust, bias), African-Americans, and LGBT persons. Additional references were identified by manual reviews of peer-reviewed journals' tables of contents and key papers' references. RESULTS: We identified 2298 abstracts, three of which met the inclusion criteria. Of the included studies, one was cross-sectional and two were qualitative; one study involved transgender women (91 % minorities, 65 % of whom were African-Americans), and two involved African-American men who have sex with men (MSM). All of the studies focused on HIV infection. Sexual orientation and gender identity were patient-reported factors that negatively impacted patient/provider relationships and SDM. Engaging in SDM helped some patients overcome normative beliefs about clinical encounters. In this paper, we present a conceptual model for understanding SDM in African-American LGBT persons, wherein multiple systems of social stratification (e.g., race, gender, sexual orientation) influence patient and provider perceptions, behaviors, and shared decision making. DISCUSSION: Few studies exist that explore SDM among African-American LGBT persons, and no interventions were identified in our systematic review. Thus, we are unable to draw conclusions about the effect size of SDM among this population on health outcomes. Qualitative work suggests that race, sexual orientation and gender work collectively to enhance perceptions of discrimination and decrease SDM among African-American LGBT persons. More research is needed to obtain a comprehensive understanding of shared decision making and subsequent health outcomes among African-Americans along the entire spectrum of gender and sexual orientation.

A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients.

Shared decision making (SDM) occurs when patients and clinicians work together to reach care decisions that are both medically sound and responsive to patients' preferences and values. SDM is an important tenet of patient-centered care that can improve patient outcomes. Patients with multiple minority identities, such as sexual orientation and race/ethnicity, are at particular risk for poor SDM. Among these dual-minority patients, added challenges to clear and open communication include cultural barriers, distrust, and a health care provider's lack of awareness of the patient's minority sexual orientation or gender identity. However, organizational factors like a culture of inclusion and private space throughout the visit can improve SDM with lesbian, gay, bisexual, and transgender ("LGBT") racial/ethnic minority patients who have faced stigma and discrimination. Most models of shared decision making focus on the patient-provider interaction, but the health care organization's context is also critical. Context-an organization's structure and operations-can strongly influence the ability and willingness of patients and clinicians to engage in shared decision making. SDM is most likely to be optimal if organizations transform their contexts and patients and providers improve their communication. Thus, we propose a conceptual model that suggests ways in which organizations can shape their contextual structure and operations to support SDM. The model contains six drivers: workflows, health information technology, organizational structure and culture, resources and clinic environment, training and education, and incentives and disincentives. These drivers work through four mechanisms to impact care: continuity and coordination, the ease of SDM, knowledge and skills, and attitudes and beliefs. These mechanisms can activate clinicians and patients to engage in high-quality SDM. We provide examples of how specific contextual changes could make SDM more effective for LGBT racial/ethnic minority populations, focusing especially on transformations that would establish a safe environment, build trust, and decrease stigma.

Endometritis puerperal. Incidencia y factores de riesgo / Puerperal endometritis. Incidence and risk factors

Objetivo: Determinar la incidencia y factores de riesgo para la presentación de endometritis puerperal. Diseño: Estudio prospectivo, longitudinal, comparativo y de observación. Lugar: Departamento de Obstetricia, Hospital Nacional Edgardo Rebagliati Martins, IPSS. Sujetos: 3350 gestantes cuyos partos fueron atendidos en el Hospital en referencia: Resultados: La endometritis puerperal se presentó en 2,6 por ciento de las pacientes estudiadas, siendo mayor su incidencia en las primíparas y grandes multíparas. La rotura de membranas mayor de 6 horas se presenta como el factor de riesgo de mayor importancia, seguida por el parto abdominal, trabajo de parto prolongado, parto inducido, preeclampsia, parto pretérmino y anemia. No hubo relación de la endometritis con la paridad, el control prenatal, número de tactos vaginales y la infección de la vía urinaria. El e. coli fue el microorganismo que mayormente creció en los cultivos. Conclusión: Se señala la importancia de la detección precoz de los factores de riesgo, con el fin de evitar la endometritis puerperal. Palabras clave: Endometritis, puerperio, rotura de membranas, parto, preeclampsia, anemia.

Esterilizaçäo feminina näo cirúrgica: procedimentos clínicos / Non-surgical female sterilization: clinical procedures

Com o propósito de alcançar a meta de "Saúde para todos no ano 2000", têm-se desenvolvido estratégias e técnicas de reduzida complexidade que causem um grande impacto na saúde de nossa populaçäo. Em atençäo a estes objetivos, apresentamos os procedimentos clínicos atuais do método de esterilizaçäo feminina näo cirúrgico com quinacrina desenvolvido no Chile pela equipe pioneira nesta técnica, perfeccionada depois de uma trajetória de ensaios clínicos iniciados na década de 70, como uma alternativa de planejamento familiar, que por suas carecterísticas pode ser incluída dentro das atividades de atençäo primária de saúde

Perfil reprodutivo das mulheres esterelizadas com pellets de quinacrina / Reproductive profile of women sterilized with quinacrine pellets

Com a finalidade de conhecer o perfil reprodutivo da populaçåo feminina que submeteu-se à esterelizaçåo, pelo método nåo cirúrgico com pellets de quinacrina, foram entrevistadas todas as mulheres que optaram por este método definitivo, no período de janeiro a setembro de 1990, na seçåo de planejamento familiar do Hospital Sotero del Rio, Santiago do Chile. Os resultados revelam que estas mulheres iniciaram sua vida sexual ativa no período da adolescência e somente após o primeiro parto comecaram a utilizacåo de métodos de planejamento familiar, tendo como consequência uma história anticoncepcional variada com resultados pouco satisfatórios. No momento de encerar a vida reprodutiva, as mulheres tinham pela frente, em média, ainda 15 anos de vida fértil. A grande maioria pertence a famílias legalmente constituídas com 3,8 filhos vivos, o que ultrapassa o numero de filhos desejados para este grupo, de 3,0 filhos/mulher. As razöes argumentadas para optar por este método definitivo foram principlamente planejamento familiar e saúde da mulher