La experiencia de la persona adulta con la infección por virus del papiloma humano: una revisión panorámica / The experience of the adult with human papillomavirus infection: A scoping review

Resumen Objetivo: explorar qué se ha investigado sobre la experiencia de ser diagnosticado y el vivir con la infección por Virus del Papiloma Humano (VPH) en personas adultas. Metodología: se realizó una revisión de literatura basada en el diseño de scoping review de Arksey y O´Malley. Resultados: la experiencia de la persona adulta con la infección por VPH implica considerar principalmente cuatro áreas: la psicosocial, la sexual, la cognitiva y la atención a la salud. Discusión: aunque la mayoría de los hallazgos se centran en aspectos negativos del VPH, algunos muestran evidencia de beneficios o aspectos positivos a partir del diagnóstico. Conclusiones: el VPH conlleva un impacto considerable desde el momento de su detección hasta el tratamiento, lo que implica afecciones en las distintas áreas de la vida de las personas que van desde cuestiones emocionales hasta el seguimiento adecuado del proceso de atención.

Abstract Objetivo: Explore what has been investigated about the experience of being diagnosed and living with Human Papillomavirus (HPV) infection in adults. Metodología: A literature review was done based on the scoping review design of Arksey and O'Malley. Resultados: The experience of the adult with HPV infection involves mainly considering four areas: psychosocial, sexual, cognitive and health care. Discusión: Although most of the findings focus on negative aspects of HPV, some show evidence of benefits or positive aspects from the diagnosis. Conclusiones: HPV carries a considerable impact from the time of its detection until the treatment, which implies affections in the different areas of the life of patients ranging from emotional issues to the adequate follow-up of the care process.

Sexo y prevención: representaciones sociales del condón en adultos mexicanos / Sex and prevention: social representations of condom among Mexican adults / Sexo e prevenção: representações sociais do preservativo em adultos mexicanos / Sexe et prévention: représentations sociales du préservatif chez les adultes mexicains

Resumen Objetivo: Analizar las representaciones sociales del condón en adultos mexicanos. Material y métodos: Se llevó a cabo un estudio desde una perspectiva pluri metodológica, ya que se realizaron procedimientos cuantitativos y cualitativos con el apoyo de las técnicas de listados libres y elecciones sucesivas con bloques, las cuales fueron aplicadas a 176 personas adultas de las ciudades de Guadalajara y San Luis Potosí, México. Resultados: Las palabras que fueron asociadas con mayor frecuencia a condón fueron protección, seguridad y sexo; mientras que las menos referidas fueron salud, embarazo y enfermedades. La estructura y la organización de las representaciones sociales del condón se agrupan en tres bloques alusivos a los usos del condón, los aspectos valorativos y los riesgos sexuales; a su vez, el concepto de prevención es delimitado como núcleo central. Conclusiones: Los hallazgos encontrados a partir de la realización de este estudio permiten comprender el concepto del condón a partir de aspectos propios del contexto social, lo que posibilita considerar elementos para las acciones en materia de salud sexual desde un análisis que ha sido diferenciado por sexo.

Abstract Objective: To analyze social representations of condom among Mexican adults. Material and methods: A study was carried out from a pluri-methodological aproche, since quantitative and qualitative procedures were done with the support of free listing techniques and successive block choices, which were applied to 176 adults from the cities of Guadalajara and San Luis Potosí, Mexico. Results: Words that were most frequently associated with the condom were protection, safety and sex; while the less referred were health, pregnancy and diseases. The structure and organization of the social representations of the condom are grouped in three blocks referring to the condom uses, the evaluative aspects and the sexual risks; therefore, the concept of prevention is defined as the central core. Conclusions: The results found from the realization of this study allow us to understand the concept of condom from aspects of the social context, which makes it possible to consider elements for sexual health actions from an analysis that has been differentiated by sex.

Resumo Objetivo: Analisar as representagoes sociais do preservativo em adultos mexicanos. Material e métodos: Realizou-se um estudo a partir de uma perspectiva pluri-metodológica, uma vez que os procedimentos quantitativos e qualitativos foram realizados com o apoio de técnicas de listagem livre e escolhas sucessivas de blocos, aplicadas a 176 adultos nas cidades de Guadalajara e San Luis Potosí, México. Resultados: As palavras mais frequentemente associadas ao preservativo foram protegao, seguranga e sexo; enquanto as menos referidas foram saúde, gravidez e doengas. A estrutura e organizagao das representagoes sociais do preservativo foram agrupadas em tres blocos, relacionado com o uso do preservativo, os aspetos avaliativos e os riscos sexuais. O conceito de prevengao é considerado como o núcleo central. Conclusoes: Os dados encontrados a partir da realizagao deste estudo permitem compreender o conceito do preservativo a partir do contexto social, o que possibilita considerar elementos fundamentais para a realizagao de agoes no ambito da saúde sexual a partir de uma análise que tem sido diferenciada por sexo.

Résumé Objectif: Analyser les représentations sociales du préservatif chez les adultes mexicains. Matériel et méthodes: Une étude a été réalisée dans une perspective pluri-méthodologique, puisque des procédures quantitatives et qualitatives ont été effectuées avec le support des techniques de référencement gratuit et des choix successifs par blocs, qui ont été appliqués à 176 adultes des villes de Guadalajara et de San Luis Potosí, au Mexique. Résultats: Les mots les plus fréquemment associés au préservatif étaient protection, sécurité et sexe; tandis que les moins ont été renvoyés à la santé, la grossesse et les maladies. La structure et l'organisation des représentations sociales du préservatif sont regroupées en trois blocs faisant référence à l'utilisation du préservatif, les aspects évaluatifs et les risques sexuels; à son tour, le concept de prévention est défini comme le noyau central. Conclusions: Les résultats tirées de la réalisation de cette étude permettent de comprendre le concept de préservatif à partir d'aspects du contexte social, ce qui permet de considérer des éléments pour des actions de santé sexuelle à partir d'une analyse différenciée par sexe.

Analysis of complications after Whipple's procedure using ERAS protocols / Análisis de complicaciones después de protocolos ERAS para cirugía con procedimiento Whipple

Abstract Background: The administration of perioperative fluids is a controversial issue that can be associated with the development of postoperative pancreatic fistula (POPF) after Whipple procedure. Objective: To evaluate whether intraoperative fluid management along with Enhanced Recovery after Surgery (ERAS) protocols affect outcomes following major pancreatic resection. Methods: A retrospective cohort study was conducted from January 2012 to January 2017, collecting all patients scheduled for duodenopancreatectomy (DP). Patients were divided into 2 groups according to the use of ERAS protocols and the use of a fluid therapy algorithm. Results: A total of 67 patients were analyzed, 49.3% of which were females. The most frequent diagnoses were Pancreatic Cancer n:48 (71.6%), followed by intraductal papillary mucinous neoplasm n:6 (9%). The majority of patients were in the ERAS group n:46 (68.7%); 80.4% and 95.7% of them did not develop pancreatic fistula or delayed gastric emptying (DGE) respectively, and the incidence for both was 11.94%. Fluid therapy was below 5000 mL (P=0.001) with blood loss less 300 mL (P = 0.001) in the ERAS group. The length of stay was shorter in the ERAS group (7 days, interquartilel range 5-12, P < 0.001). No differences in 30 days mortality were found. Conclusion: The implementation of ERAS protocols in DP did show a decrease in intraoperative blood loss, intravenous fluids therapy, need for transfusion, DGE, or total hospital stay. However, intraoperative fluid restriction in DP did not show a reduction in the development of POPF.

Resumen Introducción: La administración de fluidos durante el perioperatorio es un tema controvertido que puede asociarse a complicaciones como la fístula pancreática después de realizar el procedimiento de Whipple. Objetivo: Evaluar si los protocolos de manejo de líquidos dentro de las recomendaciones de recuperación acelerada después de cirugía (ERAS) afectan los desenlaces después de intervención pancreática mayor. Materiales y métodos: Se realizó un estudio de cohorte retrospectivo entre enero de 2012 y enero de 2017. Se recopilaron todos los pacientes a quienes se les practicó duodenopancreatectomía. Se dividieron en dos grupos según el uso de protocolos ERAS y el uso de algoritmos para terapia hídrica. Resultados: Se analizaron 67 pacientes, el 49,3% correspondió al sexo femenino. Los diagnósticos más frecuentes fueron cáncer de páncreas n: 48 (71,6%), seguido de neoplasia mucinosa papilar intraductal n: 6 (9%). La mayoría de los pacientes se encontraban en el Grupo ERAS n:46(68,7%).En dicho grupo, el 80,4% y el 95,7% no desarrollaron fístula pancreática o retraso del vaciamiento gástrico y la incidencia fue del 11,94%, respectivamente. La terapia hídrica estuvo por debajo de 5000 ml (p = 0,001) con una pérdida sanguínea inferior a 300 ml (p=0,001) en el grupo ERAS. La estancia hospitalaria fue más corta en el grupo ERAS (7 días, rango intercuartil [RIC] 5-12, p =<0,001). No hubo diferencias en la mortalidad a 30 días. Conclusión: La implementación de protocolos ERAS en la duodenopancreatectomía mostró una menor pérdida sanguínea, menor terapia hídrica, menor necesidad de transfusión, menor retraso del vaciamiento gástrico y menor estancia hospitalaria. Sin embargo, la terapia hídrica restrictiva no redujo el desarrollo de fístula pancreática postoperatoria.

Promoción de la salud sexual ante el riesgo del virus del papiloma humano en adolescentes / Promoção da saúde sexual para o risco de papilomavírus humano na adolescência / Promotion of sexual health at the risk of human papilloma virus in adolescents

Objetivo: implementar un proyecto dirigido a la promoción de la salud sexual como alternativa ante el riesgo del virus del papiloma humano (VPH) en adolescentes. Materiales y métodos: se realizó un estudio de investigación acción participativa en tres fases. En la primera se delimitaron temas y estrategias para la promoción de la salud sexual y evitar el riesgo de VPH, con la participación de adolescentes en grupos de discusión. Durante la segunda fase se realizó un programa de intervención en dos etapas: la primera consistió en sesiones informativas a cargo de instituciones, organizaciones no gubernamentales y profesionales de la salud sexual; en la segunda etapa se realizaron actividades dirigidas a promocionar la salud sexual para evitar el riesgo del VPH con el apoyo de los adolescentes. Como última fase se evaluaron las limitaciones y los alcances durante el desarrollo del proyecto. Resultados: la participación de los miembros de la comunidad permitió la definición de temas prioritarios en salud sexual y posibilitó abordarlos desde una perspectiva integral y multidisciplinaria. Conclusión: es urgente la delimitación del concepto de promoción de la salud sexual para comprender claramente cuál es el papel de los adolescentes y de qué manera se puede apostar por una participación genuina.

Objective: implement a project aimed at the promotion of sexual health as an alternative to the risk of Human Papillomavirus (HPV) in adolescents. Materials and methods: A participatory action research study was carried out in three phases. In the first, topics and strategies were defined for the promotion of sexual health and the risk of HPV, with the participation of adolescents in discussion groups. During the second phase, a two-stage intervention program was conducted: the first consisted of information sessions by institutions, non-governmental organizations and sexual health professionals; in the second stage, activities aimed at promoting sexual health were carried out to avoid the risk of HPV with the support of adolescents. The last phase evaluated the limitations and the scope during the development of the project. Results:the participation of the members of the community allowed the definition of priority topics in sexual health and made it possible to approach them from a comprehensive and multidisciplinary perspective. Conclusion: There is an urgent need to define the concept of sexual health promotion in order to clearly understand the role of adolescents and how genuine participation can be positioned.

Objetivo: implementar um projecto que visa a promoção da saúde sexual como uma alternativa para o risco de papilomavírus humano (HPV) na adolescência. Materiais e métodos: Um estudo de pesquisa-ação participativa realizada em três fases. As primeiras questões prioritárias e estratégias de promoção da saúde sexual e HPV de risco, com a participação de adolescentes em grupos de discussão foram levantadas. Durante a segunda fase de um programa de intervenção foi realizada em duas etapas: a primeira consistiu de sessões de informação por parte das instituições, associações civis e profissionais de saúde sexual; no segundo estágio, foram feitas atividades para promover sexual HPV risco para a saúde, com o apoio de adolescentes , como as restrições de fase final e escopo para o projeto foram avaliados. Resultados: A participação de membros da comunidade permitiu a definição das questões prioritárias na área da saúde sexual e permitiu resolvê-los de uma perspectiva holística e multidisciplinar. Conclusão: Há uma delimitação urgente do conceito de promoção da saúde sexual para entender claramente o que é o papel dos adolescentes e como você pode apostar em uma participação genuína.

Dominios culturales de Salud Sexual y Virus del Papiloma Humano en adolescentes mexicanos / Cultural Domains of Sexual Health and Human Papillomavirus in Mexican Adolescents

Resumen El objetivo del presente artículo es explorar la percepción de la salud sexual y del Virus del Papiloma Humano (VPH) en adolescentes del municipio de Santa María del Río, en San Luis Potosí, México. Se aplicaron las técnicas de listados libres y sorteo por montones. Las palabras higieney protección reportaron mayor frecuencia en el concepto de salud sexual, mientras que enfermedad y mortal en el concepto de VPH. La higiene como elemento dentro de los dominios de salud sexual y VPH muestra la visión acerca de quienes gozan de una buena salud sexual y de quienes padecen de una mala salud sexual. Se recomienda generar intervenciones basadas en una visión promocional de la salud sexual para el riesgo del VPH en los adolescentes.

Abstract This study was conducted to explore the perception of adolescents about sexual health and HPV in the municipality of Santa Maria del Rio, San Luis Potosi, Mexico. Two phases were undertaken using free lists and pile sorts. The words hygiene and protection were more frequently associated to the concept of sexual health, while deadly and diseases were more frequently associated to the concept of HPV. Hygiene as an element in sexual health conception and HPV shows the vision of those who enjoy a good sexual health and of those who present poor sexual health. It is important to develop interventions based on a promotional perspective of health to prevent HPV in adolescents.

Tratamiento laparoscópico de la hidatidosis hepática: experiencia inicial / Laparoscopic approach to liver hydatidosis: Initial experience

INTRODUCCIÓN: La hidatidosis hepática es una enfermedad que se presenta frecuentemente en algunas provincias de Argentina. El tratamiento quirúrgico sigue siendo aún el que ofrece los mejores resultados. El tratamiento laparoscópico es controvertido debido a la poca experiencia con esta técnica. OBJETIVO: Evaluar la factibilidad y eficacia del tratamiento laparoscópico de esta enfermedad y presentar la experiencia obtenida en un centro de Argentina. Material y métodos Se evaluó de manera prospectiva a los pacientes con hidatidosis hepática no complicada mayores de 15 años cuyos quistes tenían las siguientes características: quiste único, menor de 5 cm, situado en segmentos anteriores o de fácil exposición. Fueron evaluados los siguientes datos: sexo, edad, localización del quiste, tratamiento, tiempo operatorio, morbimortalidad y recurrencia. RESULTADOS: Nueve pacientes fueron operados por laparoscopia, los quistes estuvieron localizados en los segmentos III, IV anterior, V y VI. Seis pacientes fueron operados con neumoperitoneo y 3 con un sistema de tracción parietal, en todos ellos el primer gesto fue realizar un PAIR laparoscópico. Se efectuaron 7 procedimientos de Mabit-Lagrot y 2 periquistectomías. El tiempo operatorio medio fue de 89,7 min y la estancia hospitalaria de 52 h. La morbilidad fue de 22,2% y la mortalidad de 0%. La media de seguimiento fue de 19 meses sin recidivas. CONCLUSIÓN: Un mayor número de casos y un seguimiento más prolongado son necesarios para evaluar mejor su eficacia; el abordaje laparoscópico parece ser seguro. Nuestros resultados coinciden con la mayoría de los publicados

INTRODUCTION: Hepatic hydatidosis is a pathology that has a worldwide distribution, and is frequent in some rural areas in Argentina. Surgical treatment still offers the best results. The laparoscopic approach is controversial because of lack of experience with this technique. OBJECTIVE: To evaluate the feasibility and efficacy of the laparoscopic approach in this pathology and to present the experience obtained in a medical center in Argentina. MATERIAL AND METHODS: We prospectively evaluated patients with a diagnosis of non complicated hydatidosis, over 15 years of age whose cyst had the following characteristics: unique cyst, size less than 5 centimeters, located in the anterior segments or easy access. Analyzed data were: sex, age, cyst localization, treatment, operating time, morbidity and mortality and recurrence. RESULTS: Nine patients were operated using a laparoscopic approach. The cysts were localized in the segments III, IV, V and VI. Six patients were operated with pneumoperitoneum and 3 with a parietal traction device, in all the patients the first approach was a laparoscopic PAIR (punction, aspiration, injection and reaspiration). Seven Mabit-Lagrot procedures were performed and 2pericystectomies. The operative time was a mean of 89.7 min and a hospital stay of 52 h. The morbidity was 22.2% and the mortality was 0%. Mean follow-up of 19 months showed no recurrences. CONCLUSION: A higher number of patients and a longer follow-up are necessary to evaluate the efficacy of approach; the laparoscopic approach seems to be safe. Our results coincide with the majority of other publications

Laparoscopic approach to liver hydatidosis: initial experience.

INTRODUCTION: Hepatic hydatidosis is a pathology that has a worldwide distribution, and is frequent in some rural areas in Argentina. Surgical treatment still offers the best results. The laparoscopic approach is controversial because of lack of experience with this technique. OBJECTIVE: To evaluate the feasibility and efficacy of the laparoscopic approach in this pathology and to present the experience obtained in a medical center in Argentina. MATERIAL AND METHODS: We prospectively evaluated patients with a diagnosis of non complicatedhydatidosis, over 15 years of age whose cyst had the following characteristics: unique cyst, size less than 5 centimeters, located in the anterior segments or easy access. Analyzed data were: sex, age, cyst localization, treatment, operating time, morbidity and mortality and recurrence. RESULTS: Nine patients were operated using a laparoscopic approach. The cysts were localized in the segments iii, iv, v and vi. Six patients were operated with pneumoperitoneum and 3 with a parietal traction device, in all the patients the first approach was a laparoscopic PAIR (punction, aspiration, injection and reaspiration). Seven Mabit-Lagrot procedures were performed and 2pericystectomies. The operative time was a mean of 89.7min and a hospital stay of 52h. The morbidity was 22.2% and the mortality was 0%.Mean follow-up of 19 months showed no recurrences. CONCLUSION: A higher number of patients and a longer follow-up are necessary to evaluate the efficacy of approach; the laparoscopic approach seems to be safe. Our results coincide with the majority of other publications.

[Liver resections as radical surgery for hepatic hydatidosis: results in 50 patients]. / Resultados de las resecciones hepáticas como tratamiento radical de la hidatidosis hepatica en 50 pacientes.

INTRODUCTION: Among several regions in the world hepatic hydatidosis can be considered endemic. Currently there are many available treatments for this disease, been surgery the most effective one. Surgical procedures can be divided in two main groups, radical and non-radical procedures. The goal of this work is to evaluate the morbidity, mortality and percentage of recurrence in patients treated with hepatectomies, comparing them with other publications. MATERIAL AND METHODS: This retrospective study was carried out in a series from Spain and Argentina. We analyzed the following data: sex, age, type of resection, associated surgical gestures, presence of liver disease, operative time, blood transfusion, morbidity, mortality, hospital stay, re-hospitalization, recurrence and follow up. Dindo--Clavien classification was used for complications, and International Hepato-Pancreato-Biliary Association (IHPBA) Brisbane classification for hepatectomies. Mortality was considered until 90 days after surgery. To evaluate the recurence we only included patients followed over 6 months. RESULTS: Indications for liver resections were performed in patients with cysts larger than 5 centimeters, multiple cysts, large cysts, with bile duct communicated or suspicion of this communication. Five patients required blood transfusions (10%) with a median for these 5 patients of 740 ml and 74 ml for the complete series. The median operative time was 186 minutes (range 45 to 1,050 minutes). Median hospital stay was 7.7 days. Monitoring more than 6 months was conducted in 38 patients. CONCLUSIONS: We believe that hepatic hydatid disease is a multifaceted disease and requires more than one therapeutic approach. Hepatectomy with complete resection of the parasite offers the possibility of doing so in a controlled and safe way by experienced hands, ensuring good results in the treatment of this disease.

Resultados de las resecciones hepáticas como tratamiento radical de la hidatidosis hepatica en 50 pacientes. / [Liver resections as radical surgery for hepatic hydatidosis: results in 50 patients].

INTRODUCTION: Among several regions in the world hepatic hydatidosis can be considered endemic. Currently there are many available treatments for this disease, been surgery the most effective one. Surgical procedures can be divided in two main groups, radical and non-radical procedures. The goal of this work is to evaluate the morbidity, mortality and percentage of recurrence in patients treated with hepatectomies, comparing them with other publications. MATERIAL AND METHODS: This retrospective study was carried out in a series from Spain and Argentina. We analyzed the following data: sex, age, type of resection, associated surgical gestures, presence of liver disease, operative time, blood transfusion, morbidity, mortality, hospital stay, re-hospitalization, recurrence and follow up. Dindo--Clavien classification was used for complications, and International Hepato-Pancreato-Biliary Association (IHPBA) Brisbane classification for hepatectomies. Mortality was considered until 90 days after surgery. To evaluate the recurence we only included patients followed over 6 months. RESULTS: Indications for liver resections were performed in patients with cysts larger than 5 centimeters, multiple cysts, large cysts, with bile duct communicated or suspicion of this communication. Five patients required blood transfusions (10

) with a median for these 5 patients of 740 ml and 74 ml for the complete series. The median operative time was 186 minutes (range 45 to 1,050 minutes). Median hospital stay was 7.7 days. Monitoring more than 6 months was conducted in 38 patients. CONCLUSIONS: We believe that hepatic hydatid disease is a multifaceted disease and requires more than one therapeutic approach. Hepatectomy with complete resection of the parasite offers the possibility of doing so in a controlled and safe way by experienced hands, ensuring good results in the treatment of this disease.

Resultados de las resecciones hepáticas como tratamiento radical de la hidatidosis hepatica en 50 pacientes / [Liver resections as radical surgery for hepatic hydatidosis: results in 50 patients].

INTRODUCTION: Among several regions in the world hepatic hydatidosis can be considered endemic. Currently there are many available treatments for this disease, been surgery the most effective one. Surgical procedures can be divided in two main groups, radical and non-radical procedures. The goal of this work is to evaluate the morbidity, mortality and percentage of recurrence in patients treated with hepatectomies, comparing them with other publications. MATERIAL AND METHODS: This retrospective study was carried out in a series from Spain and Argentina. We analyzed the following data: sex, age, type of resection, associated surgical gestures, presence of liver disease, operative time, blood transfusion, morbidity, mortality, hospital stay, re-hospitalization, recurrence and follow up. Dindo--Clavien classification was used for complications, and International Hepato-Pancreato-Biliary Association (IHPBA) Brisbane classification for hepatectomies. Mortality was considered until 90 days after surgery. To evaluate the recurence we only included patients followed over 6 months. RESULTS: Indications for liver resections were performed in patients with cysts larger than 5 centimeters, multiple cysts, large cysts, with bile duct communicated or suspicion of this communication. Five patients required blood transfusions (10

) with a median for these 5 patients of 740 ml and 74 ml for the complete series. The median operative time was 186 minutes (range 45 to 1,050 minutes). Median hospital stay was 7.7 days. Monitoring more than 6 months was conducted in 38 patients. CONCLUSIONS: We believe that hepatic hydatid disease is a multifaceted disease and requires more than one therapeutic approach. Hepatectomy with complete resection of the parasite offers the possibility of doing so in a controlled and safe way by experienced hands, ensuring good results in the treatment of this disease.