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OBJECTIVE: To measure dietary and urinary changes in sodium (Na) intake and excretion through the implementation of family gardens with aromatic herbs and workshops for cooking, using the herbs as a substitute for salt and seasoning powder. METHODS: Thirty-five participants from a neighborhood of Mexico City were included. A general questionnaire was administered to collect information on sociodemographic factors. At baseline and 3 months later, a dietary evaluation was conducted, and 24-hour urine samples were collected. Food items reported were classified according to the NOVA classification. Visits to participants´ houses were conducted to measure the amount of salt and seasoning powder added to food during the preparation of meals as well as a home food inventory. All participants were given a family garden with 6 aromatic herbs and a recipe book. The intervention included 7 cooking and 3 garden care workshops. Qualitative information on the experience was also collected. Linear regression models were run in order to estimate the contribution of each NOVA group, salt, and seasoning powder to total dietary Na intake. RESULTS: Participants were 44 years old on average and were mainly women (91.4%). The participation compliance in the workshops was 69.5%. After 3 months, there was a Na intake mean reduction of 976 mg. There was also a reduction in the excreted urinary Na of 325 mg per day. CONCLUSION: A positive level of involvement in this program had a direct influence on dietary habits to lower Na consumption.

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OBJECTIVE: To examine the associations of maternal and child overweight status across multiple time-points with liver fat content in the offspring during young adulthood. DESIGN: Cohort study. SETTING: ELEMENT Cohort in Mexico City. POPULATION: Pregnant women with singleton births (n = 97). METHODS: We quantified hepatic triglyceride content (liver fat content) by proton magnetic resonance spectroscopy (1H MRS) and conventional T2-weighted MRIs (3T scanner) in 97 young adults from the ELEMENT birth cohort in Mexico City. Historical records of the cohort were used as a source of pregnancy, and childhood and adolescence anthropometric information, overweight and obesity (OWOB) were defined. Adjusted structural equation models were run to identify the association between OWOB in different life stages with liver fat content (log-transformed) in young adulthood. MAIN OUTCOME: Maternal OWOB at the time of delivery was directly and indirectly associated with the liver fat content in the offspring at young adulthood. RESULTS: Seventeen percent of the participants were classified as having NAFLD. We found a strong association of OWOB between all periods assessed. Maternal OWOB at time of delivery (ß = 1.97, 95% CI 1.28-3.05), and OWOB status in the offspring at young adulthood (ß = 3.17, 95% CI 2.10-4.77) were directly associated with the liver fat content in the offspring. Also, maternal OWOB was indirectly associated with liver fat content through offspring OWOB status. CONCLUSION: We found that maternal OWOB status is related to fatty liver content in the offspring as young adults, even after taking into account OWOB status and lifestyle factors in the offspring. TWEETABLE ABSTRACT: There was an association between pre-pregnancy overweight and the development of NAFLD in adult offspring.

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OBJECTIVE: We aimed to identify the coverage rates and use of health care and to explore barriers and facilitators of access in rural Mexico. STUDY DESIGN: Systematic review of the literature. METHODS: We undertook a structured search in the electronic databases EMBASE, Medline, and Scopus. Inclusion criteria comprised articles published in Spanish and English during the period 1986-2018. The studies were screened and selected by two independent reviewers in accordance with predefined criteria. RESULTS: The review included 14 studies. Over the last 30 years, the rates of health-care coverage have increased from 30% to >50% in rural Mexico. Although the rates of health-care coverage increased, aspects such as lack of resources, language, and health-care professionals remained important barriers to health care. Cash transfer programs were identified as a facilitator. CONCLUSIONS: Despite increased health-care coverage of >50% in the last three decades, action is needed to fulfill the needs of rural Mexican populations. It is important to increase the number of trained health professionals who practice in rural areas. Moreover, health programs should be developed and adapted to meet the needs of rural and indigenous populations.

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BACKGROUND: Bisphenol A (BPA) and phthalates metabolites are linked to a variety of adverse health consequences but studies have not explored their association with growth trajectories. OBJECTIVE: Explore body mass index (BMI) trajectories for tertile exposures to BPA and phthalates metabolites in the third trimester of pregnancy. METHODS: We constructed BMI (kg/m2 ) trajectories from birth to 14 years in a birth cohort of 249 children from Mexico City using tertiles of third trimester maternal urinary concentrations of BPA and phthalates metabolites. Fractional age polynomials and mixed effects models were fit separately by sex. Predicted models were plotted for each metabolite tertile with the covariates mother's education and BMI centered at average values. RESULTS: Highest predicted BMI trajectories for female children were observed for third tertile exposure to the phthalate metabolite mono(2-ethyl-5-carboxypentyl) phthalate. In male children, first tertile exposure to mono-isobutyl phthalate and monobenzyl phthalate and second tertile exposure to mono(2-ethylhexyl) phthalate and mono(2-ethyl-5-hydroxyhexyl) phthalate predicted the highest BMI trajectory by adolescence. There was no relationshsip between BPA and child growth trajectory. CONCLUSIONS: These results suggest sex-specific differences in BMI trajectories by levels of metabolite exposure. Additional studies are needed to consider growth through adolescence in assessing the association of pregnancy exposures on child's BMI.

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BACKGROUND: Consumption of sugar-sweetened beverages (SSB) has been associated with risk of obesity, but little evidence exists to evaluate if age of introduction and cumulative SSB consumption increases risk in children. OBJECTIVES: The objective of the study was to estimate the relationship between age of introduction and cumulative SSB consumption with risk of obesity in 227 Mexican children. METHODS: SSB intake was measured every 6 months; age of introduction and cumulative consumption during the pre-school period were calculated. Height, weight, waist circumference, SSB intake and other relevant variables were measured at age 8-14 years and obesity defined using standard criteria. RESULTS: All participants were introduced to SSB before age 24 months and most (73%) before 12 months. Early SSB introduction (≤12 months) was not significantly associated with increased odds of obesity (odds ratio [OR] = 2.00, 95% confidence interval [CI]: 0.87, 4.59). However, children in the highest tertile of cumulative SSB consumption, compared with the lowest, had almost three times the odds of general (OR = 2.99, 95% CI: 1.27, 7.00) and abdominal (OR = 2.70, 95% CI: 1.03, 7.03) obesity at age 8-14 years. CONCLUSIONS: High SSB consumption increased the likelihood of obesity in 8-14-year-old children. Our results suggest that SSB intake should be delayed and excessive SSB consumption in pre-school period should be avoided.

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Introducción: la presencia de un evento adverso durante el proceso de hospitalización aumenta la morbimortalidad, se generan mayores tiempos de estancia hospitalaria, costos y deterioro de la calidad de atención. Objetivo: conocer la frecuencia de ocurrencia de los eventos adversos en las Áreas Pediátricas de Cuidados Intensivos para identificar los factores intrínsecos, extrínsecos y del sistema en un Hospital Público de Tercer Nivel de Atención. Material y métodos: estudio descriptivo, transversal y observacional, durante un año, del 2013 al 2014, se utilizó una ficha de notificación de eventos adversos tomada y adaptada del Proyecto de Incidentes y Eventos Adversos en Medicina Intensiva, Seguridad y Riesgo del Enfermo Crítico (SYREC 2007). Resultados: en total se presentaron 105 eventos adversos, 71% en la Unidad de Terapia Intensiva Pediátrica, 18% en la Unidad de Cuidados Intensivos Neonatales y 11% en la Unidad de Cuidados Intensivos Cardiovasculares, 62% de los pacientes presentaron durante su proceso de hospitalización un evento adverso, el 30% presentó dos eventos adversos y el 8% más de tres. Más frecuente en el sexo masculino en un 50.5% y en las alteraciones cardiovasculares en un 22%. El 30% de los eventos adversos ocurrió dentro de las primeras 48 horas de ingreso a la unidad. Conclusiones: el conocer este tipo de accidentes permite implantar estrategias para disminuir o controlar las posibles causas. Para el profesional de enfermería es de suma importancia identificar estos detonantes para participar de forma activa en los programas de seguridad y calidad de atención.

Introduction: the presence of an adverse event during the process of hospitalization increases morbidity and mortality, longer hospital stay times, costs and deterioration of the quality of care arise. Objective: to know the frequency of occurrence of the adverse event in pediatric intensive care to identify the intrinsic, extrinsic factors and areas of the system in a public tertiary care hospital. Material and methods: descriptive, transversal and observational study, for a year from 2013 to 2014, we used an information notice of adverse event taken and adapted from the project of incidents and adverse events in intensive medicine, safety and risk of the sick critic (SYREC 2007). Results: in total were 105 adverse event, 71% in unit therapy intensive Pediatric, 18% in neonatal intensive care unit and 11% at the unit of cardiovascular intensive care, 62% of the patients presented during their hospitalization an adverse event, 30% presented two adverse event and 8% more than three. More common in males in 50.5% and 22% cardiovascular alterations. 30% of the adverse event occurred within the first 48 hours entering the unit. Conclusions: know this type of accidents allows to implement strategies to decrease or control the possible causes. For nursing professional it is important to identify these triggers to participate actively in the programs of safety and quality of care.

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La atención a la salud a veces puede representar un riesgo para los pacientes, que puede derivar en daño físico, psicológico, social, económico, e incluso la muerte. Estos incidentes se denominan eventos adversos (EA) y se presentan durante el proceso de atención. Objetivo: Determinar la ocurrencia de los EA en las áreas de cuidados intensivos y conocer los factores intrínsecos, extrínsecos y del sistema que están presentes en la aparición de un EA, así como su evitabilidad y gravedad. Métodos: Estudio multicéntrico, analítico, transversal y observacional, en siete instituciones de salud de carácter público y de alta especialidad en México. La muestra estuvo compuesta por 137 personas durante el periodo comprendido del 1-04-2012 al 31-01-2013. Los datos se recolectaron con la ficha de notificación de EA tomada y adaptada del proyecto SYREC 2007. Se utilizó el programa estadístico SPSS versión 17. Se realizaron pruebas de correlación de Spearman y phi, U de Mann-Witney, Kruskal-Wallis y Chi2. Resultados: El 58% de los EA se presentaron en pacientes masculinos, el 60% en edad pediátrica. Los EA relacionados con el cuidado fueron los más frecuentes con un 29.9%. En el 51% estuvieron relacionados con invalidez temporal. En un 75% de los casos se pudieron evitar. Sobresalen los factores del sistema con un 98%.Conclusiones: La población más vulnerable son los niños y los adultos mayores, los EA están relacionados directamente con el cuidado de enfermería y su mayoría son evitables. Es necesario implementar estrategias para la gestión de la seguridad del paciente para detectar, registrar, prevenir y minimizar su frecuencia.

Health treatment can sometimes involve risk for patients, which can result in physical, psychological, social, or financial damage, and even death. These incidents are called adverse events (AE) and occur during the treatment process.ObjectiveTo determine the occurrence of AE in intensive care areas, and identify the intrinsic, extrinsic, and systemic factors involved in an AE, and to assess their severity and how to avoid them. Methods Multi-centric, analytic, transversal, and observational study conducted on 7 public and high specialty health institutions in Mexico with a sample of 137 individuals. The study was carried out from 04/01/2012 to 01/31/2013. Data were collected through SYREC 2007 project adapted AE notification charts. SPSS version 17 was used. Spearman, Phi, Mann-Whitney U, Kruskal-Wallis and Chi2 tests were performed. Results:58% of AE occurred among male patients, 60% among the pediatric population. The most frequent AE were those related to care (29.9%). 51% were related to temporal disability. 75% of the cases could not be avoided. Systemic factors were the prevalent ones with 98%. Conclusions: The most vulnerable populations are children and the elderly. AE are directly related to nursing care and most are avoidable. It is necessary to implement strategies to manage patient safety in order to detect, register, prevent, and minimize the frequency of AE.

A atenção à saúde representa em vários momentos um risco para os pacientes, que pode derivar em dano físico, psicológico, social, económico, inclusivé a morte. Estes incidentes denominam-se eventos adversos (EA), apresentam-se durante o processo de atenção. Objetivo Determinar a ocorrência dos EA nas áreas de cuidados intensivos e conhecer fatores intrínsecos, extrínsecos e do sistema que estão presentes no aparecimento de um EA, bem como a possibilidade de evita-los e a sua gravidade. Métodos: Estudo multicêntrico, analítico, transversal e observacional, em 7 instituições de saúde pública e de alta especialidade no México. A amostra foi de (n = 137) durante o periodo compreendido entre 01-04-2012 e 31-01-2013. Os dados foram recolhidos com a ficha de notificação de EA tomada e adaptada do projeto SYREC 2007. Utilizou-se o programa estatístico SPSS versão 17. Realizaram-se testes de correlação de Spearman e Phi, U de Mann-Witney, Kruskal-Wallis e Chi2. Resultados: Os 58% dos EA apresentaram-se nos pacientes masculinos, os 60% na idade pediátrica. Os EA mais frequentes foram relacionados com o cuidado, com 29.9%. 51% estiveram relacionados com incapacidade temporária. Em 75% dos casos pôde-se evitar. Sobressaem os fatores do sistema com 98%. Conclusões: A população mais vulnerável são as crianças e os idosos, os EA relacionam-se diretamente com o cuidado da enfermagem e a sua maioria são evitáveis. É necessário implementar estratégias para a gestão da segurança do paciente para detectar, registrar, prevenir e minimizar a sua frequência.

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Introducción: Un número significativo de pacientes que asisten a instituciones de salud tienen riesgo de caída en cualquier momento de su hospitalización, cuidarlos implica una serie de intervenciones que requieren una previa valoración clínica. Objetivo: Adaptar y validar un instrumento de valoración de caídas en el paciente pediátrico hospitalizado. Métodos: Se adaptó y validó el instrumento J. H. Downton. Se realizó evaluación de la sensibilidad, especificidad, valor predictivo positivo y negativo, así como la consistencia interna del instrumento por medio de la prueba Kuder-Richardson (KR) y resumen de curvas ROC, mediante el programa estadístico SPSS® versión 15 y Epidat 3.1. Resultados: Se obtuvo consistencia interna por KR de 0.92, sensibilidad de 86.92, especificidad de 99.4, valor predictivo positivo (PP) 99.56, y valor predictivo negativo (PN) 81.52, con un índice de confianza del 95%. Conclusiones: Las escalas validadas como la St. Thomas, se encuentra con buena sensibilidad y especificidad 93% y 88%, respectivamente, sin embargo está adaptada para pacientes mayores. La escala validada en el presente estudio tuvo mejores valores de sensibilidad y especificidad que otras 2 escalas específicas de población pediátrica, la escala Humpty Dumpty y la escala CHAMPS, por lo que se concluye que la escala J. H. Downton modificada es altamente sensible y específica para predecir riesgo de caídas en el paciente pediátrico hospitalizado.

Introduction: A significant number of patients who attend health institutions have a risk of fall anytime during their hospitalization. Taking care of these patients requires diverse interventions and clinical assessments. Objective: To adapt and validate a hospitalized pediatric patient fall risk assessment instrument. Methods: The J. H. Downton instrument was adapted and validated. Specificity and sensibility tests, negative and positive predictive value, and Kuder-Richardson (KR) and ROC curve analysis internal consistency were all assessed using the SPSS® v. 15 and Epidat 3.1 statistics programs. Results: KR internal consistency of 0.92, sensibility of 86.92, specificity of 99.4, PP of 99.56, and PN of 81.52 with a confidence interval of 95% were obtained. Conclusions: Validated scales such as the St. Thomas have good sensibility and specificity values (93% and 88%), but this scale is adapted for elder patients. The validated scale of this study had better sensibility and specificity values than two other hospitalized pediatric population scales: the Humpty Dumpty and the CHAMPS, suggesting that the modified H. Downton scale is highly sensible and specific to predict hospitalized pediatric patient fall risks.

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La elaboración del presente trabajo tiene la finalidad de aplicar el modelo teórico de Dorothea Orem como fundamento teórico para la aplicación del proceso enfermero a una paciente con diagnóstico clínico de osteogénesis imperfecta (OI), mismo que afecta sus requisitos de autocuidado universal. Para la elaboración de los diagnósticos de Enfermería se utilizó el formato PES (Problema, Etiología, Signos y síntomas), se realizó una jerarquización de los mismos con base en prioridades, y posteriormente, para la elaboración del plan de cuidados, recurrimos a la Enfermería Basada en Evidencia, para lo cual se consultaron diferentes bibliotecas virtuales. La evaluación de las intervenciones de Enfermería fue favorable, colaborando a la resolución de los requisitos alterados y a la adquisición de competencias necesarias en la familia para compensar las deficiencias.

The preparation of this paper aims to apply the theoretical model of Dorothea Orem as theoretical foundation for the application of the nursing process in a patient with clinical diagnosis of osteogenesis imperfect (OI), it affects their universal self-care requirements. For the development of nursing diagnoses used the PES format (Problem, Etiology, Signs and Symptoms), there was a hierarchy of them on a priority basis, and subsequently, to the development of the care plan based nursing resort to in evidence, to which were consulted different virtual libraries. Evaluating nursing interventions was favorable, contributing to the resolution of the changed requirements and the acquisition of skills needed in the family to compensate for deficiencies.

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Se ha relacionado la satisfacción laboral con el desempeño y en los servicios de salud además, con la calidad del cuidado que se brinda. Objetivos. Establecer el grado de satisfacción laboral e identificar los factores asociados a ésta en personal de enfermería de cuatro Instituciones públicas de salud del tercer nivel de atención. Metodología: Estudio transversal, observacional y descriptivo. La muestra comprendió 594 profesionales de enfermería. Se aplicó una encuesta integrada por dos apartados, uno de datos socio-demográficos y otro para medir los factores intrínsecos y extrínsecos relacionados con la satisfacción laboral de acuerdo al instrumento de Font Roja ampliado (9 factores con 26 ítems en total). Resultados: Se obtuvo una confiabilidad del instrumento de 0.8 de alfa de Cronbach, 35% de los encuestados es personal especializado, la calificación de Satisfacción Laboral tuvo un promedio global de 101±10. Los factores identificados con insatisfacción fueron la promoción y competencia profesional, los mejor calificados la relación interpersonal con los jefes y con los compañeros. Los factores extrínsecos no mostraron diferencias estadísticamente significativas. Discusión: Los resultados concuerdan con la literatura, la promoción profesional y la competencia laboral son los que más se observan afectados. La institución "C" es la que tiene mayor nivel de satisfacción, también se resalta que el profesional que labora en áreas críticas se encuentra más satisfecho. Conclusiones: El personal de enfermería en estas instituciones tiene una calificación de nivel medio a alto de SL, la identificación de factores de insatisfacción así como de satisfacción son importantes para fundamentar mejoras e incidir en la calidad de los cuidados.

Job satisfaction has been linked to performance and, in the health services, to the quality of the care being given. Objectives.To establish the job satisfaction grade and to identify the factors associated to it in nursing staff of four tertiary care public health institutions. Methodology. Cross-sectional, observational, and descriptive study. The sample comprised 594 nursing professionals. A survey was applied, it consisted of two sections, one of socio-demographic data and the other to measure the intrinsic and extrinsic factor relate to job satisfaction in accordance to the extended Font Roja questionnaire (9 factors with 26 total items). Results. Instrument reliability with a cron bach's alpha value of 0.8 was obtained. 35% of the respondents are specialized personnel; the job satisfaction score had a. global mean of 101±10. Factor associated with dissatisfaction were job promotion and professional competence, factors with highest marks were interpersonal relationship with boss and workmates. Extrinsic factors did not show statistically significant differences. Discussion. Results are consistent with the literature; professional promotion and job competence are the most affected factors. Institution "C" has the highest ranks in job satisfaction, the fact that a professional working in critical areas is more satisfied is highlighted too. Conclusions. Nursing staff in the surveyed institutions have a medium to high level of job satisfaction, the identification of dissatisfaction and satisfaction factors is important to establish improvements in the health care quality.

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Las instituciones del más alto nivel de calidad de los servicios de salud se denominan magnéticas por que han obtenido la acreditación desde esta perspectiva, logrando el reconocimiento social y fomentando la satisfacción del personal de enfermería. La Asociación Americana de Enfermeras (ANA) establece los tres criterios para que las instituciones sean certificadas como magnéticas: Ser un hospital con bajo índice de rotación hacia otras instituciones, tener una plantilla completa, y ser un hospital posicionado en un mercado laboral competitivo. Las características que se examinan en estos centros son la satisfacción personal y profesional, el estatus, el rol de la enfermera en la calidad del cuidado del paciente, la relación enfermera(o) paciente, reclutamiento y mantenimiento de las y los profesionales, la relación médico(a) enfermera(o), la descentralización de la toma de decisiones, el liderazgo clínico, autonomía y responsabilidad en el cuidado del paciente y flexibilidad de los horarios de trabajo. La investigación en organizaciones magnéticas ha demostrado baja tasa de morbi-mortalidad, bajo índice de estancia hospitalaria, aumento de la satisfacción de pacientes, aumento de la satisfacción del personal de enfermería, menor incidencia de accidentes de trabajo y gran atracción de enfermeras. No cabe duda que el reconocimiento de los Hospitales Magnéticos" es la mejor iniciativa basada en la evidencia para mejorar el entorno de la práctica de enfermería, posicionando a las instituciones de salud como organizaciones excelentes.

The institutions of the highest quality of health services are called magnetic because they have received accreditation from this perspective, achieving social recognition and fostering nurse satisfaction. The American Association Nursing (AAN) establishing the criteria for institutions to be certified as magnetic are three: Being a hospital with a low turnover rate to other institutions, have a fully staffed and positioned to be a hospital in a competitive job market. The features discussed in these centers are the personal and professional satisfaction, status, the role of the nurse in the quality of patient care, the nurse or patient recruitment and retention of the professional, the relationship medical-Nurse, decentralization of decision making, clinical leadership, autonomy and responsibility in patient care, ad flexible work schedules. Research has shown magnetic organizations: morbidity and mortality rate, low rate of hospital stay, increased patient satisfaction, increased satisfaction with the nursing staff, increased levels of nursing care, lower incidence of accidents and major attraction of nurses. No doubt that the recognition of "Hospitals Magnetic" is the best evidence-based initiative to improve the environment of nursing practice, positioning the health institutions as excellent organizations.

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Este trabajo pretende resaltar el fenómeno de intersubjetividad en la relación Enfermera persona; rescatando la concepción humanista de la práctica profesional del cuidado. Debido a las múltiples visiones teóricas que existen entorno a la intersubjetividad el análisis de este trabajo se centra en la propuesta de Alfred Schütz, sobre la teoría de comprensión intersubjetiva, que se sitúa en el ámbito de las relaciones sociales, y que plantea la interacción sujeto ­ sujeto, donde ambos aprenden, comparten y reconocen su humanidad, que en el terreno de la Enfermería permite tener una visión del ser humano como persona única, singular e indivisible. El fenómeno intersubjetivo, permite el encuentro con el otro u otros, de una forma más integral y humana, por lo que es un elemento indispensable en la relación Enfermera ­ persona, tal cual lo sustentan las teorías disciplinarias de H. Peplau, J. Paterson y L. Zderad, J. Travelbee, J. Watson y R. Parse, donde cada una plantea su propia perspectiva de intersubjetividad. Para ello el ensayo presenta de manera general algunos referentes del fenómeno de intersubjetividad desde la perspectiva de Alfred Schütz, para con ello analizar las teorías de Enfermería de H. Peplau, J. Paterson y L. Zderad, J. Travelbee, J. Watson y R. Parse, y reconocer aspectos de convergencia.

This work tries to emphasize the phenomenon of intersubjectivity in the relation person nurse; rescuing the conception humanist of the professional practice of the care. Due to the multiple theoretical visions that exist surroundings to the intersubjectivity the analysis of this work is centered in the proposal of Alfred Schütz, on the theory of intersubjective understanding, that it locates itself in the scope of the social relations, and which it raises the subject interaction - subject, where both learn, they share and they recognize his humanity, that in the land of the infirmary allow to have a vision of the human being like unique person, singular and indivisible. The intersubjective phenomenon, allows the encounter with the other either others, of one more an integral and human form, reason why it is an indispensable element in the relation nurse - person, so as they sustain the disciplinary theories to it of H. Peplau, J. Paterson and L. Zderad, J. Travelbee, J. Watson and Even R., where each one raises its own perspective of intersubjectivity. For it the test presents/displays of general way some referring ones of the intersubjectivity phenomenon from the perspective of Alfred Schütz, towards it to analyze theories of infirmary of H. Peplau, J. Paterson and L. Zderad, J. Travelbee, J. Watson and Even R. and to recognize aspects of convergence.

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