Validation of the UNC TRxANSITION Scale™Version 3 Among Mexican Adolescents With Chronic Kidney Disease.

BACKGROUND: There is a lack of valid health care transition readiness (HCT) scales in Spanish. OBJECTIVE: To provide initial validation of the UNC TRxANSITION Scale™ among Mexican adolescents and young adults (youth) with chronic kidney disease (CKD). METHODS: We used the professionally translated/back translated, provider-administered UNC TRxANSITION Scale™ (Ferris et al., 2012). This 33-question scale measures HCT in ten sub-scales including knowledge about diagnosis or treatment, diet, reproductive health, school/work, insurance, ability to self-manage and looking for new health providers. Its maximum score is 10. We enrolled 163 Mexican adolescents (48.5% females) with CKD stage≥3, mean age of 15.1years (±2.1) and whose primary language is Spanish. There were 15 patients on hemodialysis (9.2%) and 30 transplant recipients (18.4%). Results were compared to those reported in adolescents with chronic conditions from the USA. RESULTS: Our cohort's overall median total score was 5.9. Patients≥16years old had a median total score of 6.4, whereas younger patients had median score of 5.6 (p<0.05). Transplant patients had greater scores in the total and the sub-scales of medication knowledge, issues of reproduction, insurance, trade/work and adherence (p<0.05). When comparing the total score (by age), results from our Mexican youth were similar to those reported in youth from the USA. CONCLUSIONS: In our Mexican cohort of youth with CKD, health care transition readiness is greater in older patients and in transplant recipients. Our cohort's overall score is low, indicating the need for a health care transition preparation program. The UNC TRxANSITION Scale™ results in Mexican youth with CKD are comparable to findings in youth from the USA.

Allowing access to parents/caregivers into COVID-19 hospitalization areas does not increase infections among health personnel in a pediatric hospital.

Background: At the beginning of the current COVID-19 pandemic, it became critical to isolate all infected patients, regardless of their age. Isolating children has a negative effect on both, them and their parents/caregivers. Nevertheless isolation was mandatory because of the potential risk that visitation might have on COVID-19 dissemination mostly among health personnel. Methods: From the starting of the COVID-19 pandemic in our pediatric hospital visits were forbidden. This 2 months period (April-May) was called P1. In June parents were allowed to visit (P2), under a visiting protocol previously published. Hospital workers were monitored for the presence of COVID-19 symptoms and tested for the infection when clinically justified. The positivity proportion and the relative risk (RR) of COVID-19 among the health personnel between periods were calculated. The caregivers were also followed up by phone calls. Results: Since April 2020 to November 2020, 2,884 health personnel were studied for 234 days, (318,146 workers days). Although the COVID-19/1,000 health personnel days rate decreased from one period to another (1.43 vs 1.23), no statistically significant differences were found. During P1, 16 patients with COVID-19 were treated. During the follow up none of the family members were infected/symptomatic in P1, while in P2, 6/129 (4.65%) were symptomatic or had a positive test. All of them initiated between 2 and 4 days after the patient's admission. As they also had some other infected family members it was not possible to ensure the source of infection. There were no statistically significant differences in the RR of COVID-19 in health personnel, (RR 1, 95% CI 0.69-1.06, p = 0.162). Conclusions: When safely implemented, allowing parents/caregivers to spend time with their hospitalized COVID-19 children does not increase the contagion risk for hospital workers or among themselves.

Implementation of guidelines to integrate the caregiver as a coassistant of health-care personnel during the hospital stay of COVID-19 pediatric patients: adaptation in a Mexican public pediatric hospital.

This paper describes the experience in a public pediatric hospital when implementing the Mexican Health Ministry's recommendations on the inclusion and importance of a chosen caregiver during the hospitalization of a coronavirus disease 2019 (COVID-19) pediatric patient. The implementation includes the adjustments, observations, and limitations made in real practice and process. In conclusion, the value and benefits of the accompaniment of hospitalized children with COVID-19 by a primary or chosen caregiver are evidenced and supported by family-centered care. Furthermore, the recommendations mentioned result in comprehensive bio-psycho-social care for the benefit of pediatric patients.

Implementation of guidelines to integrate the caregiver as a coassistant of health-care personnel during the hospital stay of COVID-19 pediatric patients: adaptation in a Mexican public pediatric hospital / Implementación de guías para integrar al cuidador como coauxiliar del equipo de salud durante la estancia hospitalaria del paciente pediátrico con COVID-19: adaptación en un hospital pediátrico público mexicano

Abstract This paper describes the experience in a public pediatric hospital when implementing the Mexican Health Ministry’s recommendations on the inclusion and importance of a chosen caregiver during the hospitalization of a coronavirus disease 2019 (COVID-19) pediatric patient. The implementation includes the adjustments, observations, and limitations made in real practice and process. In conclusion, the value and benefits of the accompaniment of hospitalized children with COVID-19 by a primary or chosen caregiver are evidenced and supported by family-centered care. Furthermore, the recommendations mentioned result in comprehensive bio-psycho-social care for the benefit of pediatric patients.

Resumen Se describe cómo el Hospital Infantil de México Federico Gómez pone en funcionamiento las recomendaciones publicadas por la Secretaría de Salud sobre la inclusión y la importancia del acompañamiento de un cuidador primario durante la hospitalización del paciente pediátrico con COVID-19. Se incluyen las adecuaciones, las observaciones y las limitaciones del proceso. Se concluye acerca de la importancia de la flexibilidad y el buen uso de los recursos en la implementación de la guía. Además, se examinan la atención biopsicosocial integral en beneficio de los menores y la importancia del acompañamiento, que se sustenta en la atención centrada en la familia y la integración del cuidador como auxiliar en el equipo médico.

[Usefulness of the Delphi method for reaching consensus in the allocation of deceased donor kidneys in six Mexican hospitals]. / Utilidad del método Delphi para la construcción de acuerdos en la asignación de riñones de donante fallecido en seis hospitales de México.

OBJECTIVE: To ascertain medical criteria and their priority in the allocation of deceased patient kidneys in pediatrics among members of Internal Transplant Committees of six hospitals. To assess if, by using the Delphi method, it is possible to reach consensus to reduce heterogeneity of criteria in the allocation of renal transplant organs among physicians ascribed to Nephrology and Surgery services in six hospital centers in Mexico. METHODOLOGY: A study was carried out by the Delphi method of independent experts panel, with three stages and two rounds. The method makes possible iteration and controlled feedback from experts to identify behaviors and trends with the synergy of the debate in a group. Kappa index was applied to assess results agreement. RESULTS: Results of first round show the criteria heterogeneity for the allocation of cadaveric origin organs within each hospital, and among hospitals compared to each other. With the results of the second round, consensus increased in four hospitals for the selection of both first and second recipient. Kappa coefficient shows the reliability of results. CONCLUSION: Our Country needs a point-score system to allocate deceased donor organs, ideally including HLA matching. Expecting that the Internal Transplant Committees throughout the Mexican territory may have available a useful tool as this, the Delphi method makes it possible to reach consensus in this task, in order to minimize subjectivity in the staff involved in the decision-making process.

Escala de Satisfacción Familiar por Adjetivos (ESFA) en escolares y adolescentes mexicanos: datos normativos / Family Satisfaction by Adjetives Scale (FSAS) in Mexican children and adolescents: normative data

Introduction Familiar satisfaction results from the continuous interplay of verbal and/or physical interactions between subjects and the other members of their family. This satisfaction maintain relations to the coherence, fairness, fun, support, lack of conflicts, affective proximity, confidence, cohesion, adaptation, allocation and acceptance of roles and tasks, open communication and the acceptance in general of the own family. The use of developed psychological tests constructed in other countries is a frequent practice in the world. The validation and standardization of the test imply to establish measurement rules and scales of qualification for a determined population, when it is different from the original population in which it was created or where the instrument is used habitually. The objective of this study was to collect the normative data of the Family Satisfaction by Adjectives Scale (FSAS) in children and adolescents of Mexico City. Material and methods A cross-sectional study was performed in 476 men and women; 8 to 15 years 11 months of age. The survey family satisfaction by adjectives scale (FSAS) by Barraca and Lopez-Yarto was applied. The data were analyzed with the Statistical Package for Social Sciences (SPSS v.17). Results The sample was conformed by 226 men (47.5%) and 250 women (52.5%). Of these, 237 were children (8 to 11 years and 11 months of age) and 239 were adolescents (12 to 15 years and 11 months of age). It was found that Family Satisfaction by Adjectives Scale (FSAS) has very good reliability (a=.89), construct (50% total variance), content and discriminative validity among children and adolescents (p.000).

Introducción La satisfacción familiar es el resultado del continuo juego de interacciones verbales y/o físicas que mantiene un sujeto con los otros miembros de su familia y guarda relación con la coherencia, la equidad en el hogar, la diversión, el apoyo, la falta de conflictos, la cercanía afectiva, la confianza, la cohesión, la adaptación, la asignación y aceptación de roles y tareas, la comunicación abierta y la aceptación en general de la propia familia. La utilización de pruebas psicológicas construidas en otros países es una práctica frecuente no sólo en nuestro país sino en todo el mundo. La validación y estandarización de las mismas implica establecer reglas de medición y escalas de calificación para una población determinada, cuando es diferente de la población original en la que se creó o se utiliza habitualmente el instrumento. El objetivo de este estudio fue obtener los datos normativos de la Escala de Satisfacción Familiar por Adjetivos (ESFA) en escolares y adolescentes mexicanos de la Ciudad de México. Material y métodos Se realizó una encuesta transversal a 476 hombres y mujeres, de 8 a 15 años 11 meses, a quienes se les aplicó la escala de satisfacción familiar por adjetivos (ESFA) de Barraca y López-Yarto. Los datos se analizaron con el Paquete Estadístico para las Ciencias Sociales (SPSS v.17). Resultados La muestra se conformó por 226 hombres (47.5%) y 250 mujeres (52.5%). De éstos, 237 fueron escolares de 8 a 11 años 11 meses y 239 adolescentes de 12 a 15 años 11 meses. Se encontró que la escala posee muy buena confiabilidad (a=.89), validez de constructo (varianza total de 50%), de contenido y discriminante entre escolares y adolescentes (p.000).

Análisis de las características sociodemográficas de los pacientes con enfermedad renal crónica terminal: diferencias en un periodo de seis años / Analysis of socio-demographic features of patients with end stage chronic renal disease: differences in a six year period

Introducción. Actualmente, la enfermedad renal crónica es un padecimiento con un gran impacto en la población infantil mexicana, con consecuencias limitantes y graves a corto plazo. La pobreza y la falta de justicia social del entorno influyen en la atención oportuna y rehabilitación a largo plazo. El objetivo de este estudio fue documentar las diferencias relacionadas con las características sociodemográficas de los pacientes que recibieron tratamiento en el Hospital Infantil de México Federico Gómez en un periodo de seis años. Métodos. Se realizó un estudio comparativo retrospectivo de los pacientes con enfermedad renal crónica terminal que fueron diagnosticados en 2003 y en 2009. La información fue proporcionada por el Departamento de Archivo Clínico y Bioestadística. Se registraron los datos de edad, sexo, etiología de la enfermedad renal, nivel socioeconómico, tipo de financiamiento, lugar de origen e ingreso a un programa de rehabilitación (diálisis o trasplante). Resultados. En el 2003 se recibieron 69 pacientes con enfermedad renal crónica terminal, mientras que en el 2009 se recibieron 50 pacientes. No hubo diferencias de edad ni de sexo. Pudo conocerse la etiología de la uremia en 40% de los niños diagnosticados en 2003 y en 54% de los diagnosticados en 2009. La mayoría de los pacientes provinieron de los niveles socioeconómicos más bajos. Hubo una tendencia a la disminución en el número de pacientes de otros estados del país, siendo 30% en 2003 y 16% en 2009. Pudieron ingresar a programa de rehabilitación 23 pacientes en 2003 (33%) y 29 pacientes en 2009 (58%), p = 0.007. Conclusiones. Hubo una disminución de 28% en el número de casos atendidos, del 2003 al 2009. La atención se ha concentrado en pacientes provenientes del Estado de México y el Distrito Federal. A pesar de que, aparentemente, el nivel socioeconómico es similar en ambos grupos, la proporción de niños que ingresaron al programa de rehabilitación a largo plazo aumentó en forma significativa, de 33% en 2003 a 58% en 2009.

Background. Chronic renal disease (CRD) is a disease with a strong impact on the childhood Mexican population with short-range limiting and serious consequences. Poverty and a social environment devoid of social justice hinder timely medical attention and long-range rehabilitation. The aim of this study was to determine the differences regarding sociodemographic features in patients under treatment at Hospital Infantil de México Federico Gómez, with a 6-year difference: patients diagnosed in 2003 as compared to those diagnosed in 2009. Methods. A retrospective comparative study was carried out with end-stage chronic renal disease (ESRD) patients with information obtained from the clinical files. Data were obtained on age, gender, renal insufficiency etiology, socioeconomic level, type of financing, place of origin, and whether patient entered a rehabilitation program (dialysis or transplant). Results. In 2003, 69 patients with ESRD were received, whereas 50 patients were received in 2009. There were no differences in age or gender between dates. Etiology of uremia was determined in 40% of the children in 2003 and 50% in 2009. Most patients in the assessed years belong to the lowest socioeconomic levels, coming from the State of Mexico and metropolitan Mexico City. There was a decreasing trend in the number of patients coming from other states of the country: 30% in 2003 and 16% in 2009. Twenty-three patients (33%) entered the rehabilitation program in 2003 and 29 patients (58%) in 2009 (p = 0.007). Conclusions. There was a 28% decrease between 2003 and 2009 in the number of cases being managed. Attention has been focused on the State of Mexico and metropolitan Mexico City area. In spite of socioeconomic level being apparently similar in the studied years, there was a significant increase in the proportion of children entering a long-range rehabilitation program (from 33% in 2003 to 58% in 2009).

Acceso a trasplante renal de donante fallecido en pacientes pediátricos de América Latina y el Caribe / Acesso de pacientes pediátricos a transplante de rim de doadores falecidos na América Latina e no Caribe / Access to deceased donor kidney transplants for pediatric patients in Latin America and the Caribbean

Las condiciones en que se da la asignación de órganos de paciente fallecido para trasplante es motivo de controversia. Objetivo. Conocer los criterios para la asignación de riñones de donante fallecido en el servicio de Pediatría de doce países de América Latina y el Caribe. Resultados. En diez países encuestados las listas de espera en Pediatría para un trasplante renal son regionales, generalmente por razones administrativas más que por disminuir los tiempos de isquemia fría, se realiza el HLA y se toma en cuenta en un sistema de puntaje para la elección del receptor final. En algunos países los riñones de donadores jóvenes (menores de 30 años) no siempre son para receptores pediátricos. Conclusión. La mayoría de los países de Latinoamérica y el Caribe cuentan con sistemas de puntaje para la asignación de órganos de donante fallecido y se privilegia a los niños. Guatemala y Nicaragua no cuentan con programa de donador fallecido, y en el caso de México, si bien tiene una estructura de trasplante en expansión, no se cuenta con un sistema de puntaje, y sólo algunos grupos de trasplante por iniciativa propia privilegian a los pacientes pediátricos. Es deseable que se haga un consenso al respecto en la comunidad de trasplantes latinoamericana para hacer una distribución menos subjetiva y más justa de los riñones de origen no vivo.