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Introduction: Updating recommendations for guidelines requires a comprehensive and efficient literature search. Although new information platforms are available for developing groups, their relative contributions to this purpose remain uncertain. Methods: As part of a review/update of eight selected evidence-based recommendationsfor type 2 diabetes, we evaluated the following five literature search approaches (targeting systematic reviews, using predetermined criteria): PubMed for MEDLINE, Epistemonikos database basic search, Epistemonikos database using a structured search strategy, Living overview of evidence (L.OVE) platform, and TRIP database. Three reviewers independently classified the retrieved references as definitely eligible, probably eligible, or not eligible. Those falling in the same "definitely" categories for all reviewers were labelled as "true" positives/negatives. The rest went to re-assessment and if found eligible/not eligible by consensus became "false" negatives/positives, respectively. We described the yield for each approach and computed "diagnostic accuracy" measures and agreement statistics. Results: Altogether, the five approaches identified 318 to 505 references for the eight recommendations, from which reviewers considered 4.2 to 9.4% eligible after the two rounds. While Pubmed outperformed the other approaches (diagnostic odds ratio 12.5 versus 2.6 to 5.3), no single search approach returned eligible references for all recommendations. Individually, searches found up to 40% of all eligible references (n = 71), and no combination of any three approaches could find over 80% of them. Kappa statistics for retrieval between searches were very poor (9 out of 10 paired comparisons did not surpass the chance-expected agreement). Conclusion: Among the information platforms assessed, PubMed appeared to be more efficient in updating this set of recommendations. However, the very poor agreement among search approaches in the reference yield demands that developing groups add information from several (probably more than three) sources for this purpose. Further research is needed to replicate our findings and enhance our understanding of how to efficiently update recommendations.

Introducción: La actualización de recomendaciones de las guías de práctica clínica requiere búsquedas bibliográficas exhaustivas y eficientes. Aunque están disponibles nuevas plataformas de información para grupos desarrolladores, su contribución a este propósito sigue siendo incierta. Métodos: Como parte de una revisión/actualización de 8 recomendaciones basadas en evidencia seleccionadas sobre diabetes tipo 2, evaluamos las siguientes cinco aproximaciones de búsqueda bibliográfica (dirigidas a revisiones sistemáticas, utilizando criterios predeterminados): PubMed para MEDLINE; Epistemonikos utilizando una búsqueda básica; Epistemonikos utilizando una estrategia de búsqueda estructurada; plataforma (L.OVE) y TRIP . Tres revisores clasificaron de forma independiente las referencias recuperadas como definitivamente o probablemente elegibles/no elegibles. Aquellas clasificadas en las mismas categorías "definitivas" para todos los revisores, se etiquetaron como "verdaderas" positivas/negativas. El resto se sometieron a una nueva evaluación y, si se consideraban por consenso elegibles/no elegibles, se convirtieron en "falsos" negativos/positivos, respectivamente. Describimos el rendimiento de cada aproximación, junto a sus medidas de "precisión diagnóstica" y las estadísticas de acuerdo. Resultados: En conjunto, las cinco aproximaciones identificaron 318-505 referencias para las 8 recomendaciones, de las cuales los revisores consideraron elegibles el 4,2 a 9,4% tras las dos rondas. Mientras que Pubmed superó a las otras aproximaciones (odds ratio de diagnóstico 12,5 versus 2,6 a 53), ninguna aproximación de búsqueda identificó por sí misma referencias elegibles para todas las recomendaciones. Individualmente, las búsquedas identificaron hasta el 40% de todas las referencias elegibles (n=71), y ninguna combinación de cualquiera de los tres enfoques pudo identificar más del 80% de ellas. Las estadísticas Kappa para la recuperación entre búsquedas fueron muy pobres (9 de cada 10 comparaciones pareadas no superaron el acuerdo esperado por azar). Conclusiones: Entre las plataformas de información evaluadas, Pubmed parece ser la más eficiente para actualizar este conjunto de recomendaciones. Sin embargo, la escasa concordancia en el rendimiento de las referencias exige que los grupos desarrolladores incorporen información de varias fuentes (probablemente más de tres) para este fin. Es necesario seguir investigando para replicar nuestros hallazgos y mejorar nuestra comprensión de cómo actualizar recomendaciones de forma eficiente.

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Introduction Updating recommendations for guidelines requires a comprehensive and efficient literature search. Although new information platforms are available for developing groups, their relative contributions to this purpose remain uncertain. Methods As part of a review/update of eight selected evidence-based recommendationsfor type 2 diabetes, we evaluated the following five literature search approaches (targeting systematic reviews, using predetermined criteria): PubMed for MEDLINE, Epistemonikos database basic search, Epistemonikos database using a structured search strategy, Living overview of evidence (L.OVE) platform, and TRIP database. Three reviewers independently classified the retrieved references as definitely eligible, probably eligible, or not eligible. Those falling in the same "definitely" categories for all reviewers were labelled as "true" positives/negatives. The rest went to re-assessment and if found eligible/not eligible by consensus became "false" negatives/positives, respectively. We described the yield for each approach and computed "diagnostic accuracy" measures and agreement statistics. Results Altogether, the five approaches identified 318 to 505 references for the eight recommendations, from which reviewers considered 4.2 to 9.4% eligible after the two rounds. While Pubmed outperformed the other approaches (diagnostic odds ratio 12.5 versus 2.6 to 5.3), no single search approach returned eligible references for all recommendations. Individually, searches found up to 40% of all eligible references (n = 71), and no combination of any three approaches could find over 80% of them. Kappa statistics for retrieval between searches were very poor (9 out of 10 paired comparisons did not surpass the chance-expected agreement). Conclusion Among the information platforms assessed, PubMed appeared to be more efficient in updating this set of recommendations. However, the very poor agreement among search approaches in the reference yield demands that developing groups add information from several (probably more than three) sources for this purpose. Further research is needed to replicate our findings and enhance our understanding of how to efficiently update recommendations.

Introducción La actualización de recomendaciones de las guías de práctica clínica requiere búsquedas bibliográficas exhaustivas y eficientes. Aunque están disponibles nuevas plataformas de información para grupos desarrolladores, su contribución a este propósito sigue siendo incierta. Métodos Como parte de una revisión/actualización de 8 recomendaciones basadas en evidencia seleccionadas sobre diabetes tipo 2, evaluamos las siguientes cinco aproximaciones de búsqueda bibliográfica (dirigidas a revisiones sistemáticas, utilizando criterios predeterminados): PubMed para MEDLINE; Epistemonikos utilizando una búsqueda básica; Epistemonikos utilizando una estrategia de búsqueda estructurada; plataforma (L.OVE) y TRIP . Tres revisores clasificaron de forma independiente las referencias recuperadas como definitivamente o probablemente elegibles/no elegibles. Aquellas clasificadas en las mismas categorías "definitivas" para todos los revisores, se etiquetaron como "verdaderas" positivas/negativas. El resto se sometieron a una nueva evaluación y, si se consideraban por consenso elegibles/no elegibles, se convirtieron en "falsos" negativos/positivos, respectivamente. Describimos el rendimiento de cada aproximación, junto a sus medidas de "precisión diagnóstica" y las estadísticas de acuerdo. Resultados En conjunto, las cinco aproximaciones identificaron 318-505 referencias para las 8 recomendaciones, de las cuales los revisores consideraron elegibles el 4,2 a 9,4% tras las dos rondas. Mientras que Pubmed superó a las otras aproximaciones (odds ratio de diagnóstico 12,5 versus 2,6 a 53), ninguna aproximación de búsqueda identificó por sí misma referencias elegibles para todas las recomendaciones. Individualmente, las búsquedas identificaron hasta el 40% de todas las referencias elegibles (n=71), y ninguna combinación de cualquiera de los tres enfoques pudo identificar más del 80% de ellas. Las estadísticas Kappa para la recuperación entre búsquedas fueron muy pobres (9 de cada 10 comparaciones pareadas no superaron el acuerdo esperado por azar). Conclusiones Entre las plataformas de información evaluadas, Pubmed parece ser la más eficiente para actualizar este conjunto de recomendaciones. Sin embargo, la escasa concordancia en el rendimiento de las referencias exige que los grupos desarrolladores incorporen información de varias fuentes (probablemente más de tres) para este fin. Es necesario seguir investigando para replicar nuestros hallazgos y mejorar nuestra comprensión de cómo actualizar recomendaciones de forma eficiente.

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BACKGROUND: Routine blood pressure (BP) self-monitoring is recommended for patients already diagnosed with hypertension. How often these patients can report their BP levels is unknown, particularly in low-and-middle income countries. METHODS: We surveyed (January 2021 to May 2022) representative samples of patients with established diagnosis of hypertension from 3 health care networks (involving 74 outpatient clinics) and 2 university hospitals in Bogotá, Colombia. Trained health care professionals conducted a telephone survey including questions on demographics, medical history, and general understanding about hypertension and its potential complications. The outcome variables were the self-report of participant's BP levels (primary) and monitoring practices among participants. RESULTS: Out of 2609 consecutively contacted patients sampled from institutional records, 2323 were invited and 1566 (mean age 66.5, SD = 12.1 years, 74.4% females, 64.0% living low socio-economic strata) gave consent to participate. While 66% of participants had over 5 years of diagnosis, 39.5% had most (≥ 60%) of their follow-up visits with the same doctor. Overall, 645 (41.5%, 95%CI 39.1 -43.9) participants reported their BP levels. This proportion was independent of time from diagnosis, but higher among those of younger age, living in higher socio-economic strata, having more years of education and using more information technologies. Also, more patients reported their BP levels if seen ≥ 60% of the times by the same physician (43.4% Vs. 36.7%). Those reporting closer BP self-monitoring more often used electronic devices, received 2 + medications, and had better knowledge about hypertension. CONCLUSION: A minority of hypertensive patients seen in Bogotá were aware of their own BP levels. Those in such capacity were in a better social position, more often seen by the same doctor, knew their condition better and handled more complex treatments. Hypertensive patients from Bogotá may benefit from a more continuous medical care, patient education programs and promoting BP home monitoring.

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Resumen Objetivo: Evaluar la implementación de una intervención educativa con elementos de Educación Popular en Salud sobre el empoderamiento y los cambios en salud para la prevención de la picadura de alacrán, en mujeres del municipio de Tetecala, Morelos. Material y métodos: La intervención educativa se realizó en mujeres adscritas al programa PROSPERA, con 16 participantes, así, consistió en cinco sesiones de manera semanal, con tiempo de dos horas, aproximadamente, cada una. Se realizó un triple diagnóstico sobre los conocimientos y las causas de la picadura de alacrán, con esa información, se diseñan los principales componentes de la estrategia educativa (1. Conocimiento del alacrán; 2. Riesgos para la picadura de alacrán; 3. Prevención de la picadura de alacrán), lo que se lleva a cabo en los meses de febrero y marzo del 2019. Se evalúan dos categorías, empoderamiento y cambios en salud, ahondando en elementos descritos por Noelle Wiggins, mediante metodología mixta. Las mediciones se realizan al mismo grupo previo y posterior a la intervención educativa; la evaluación cualitativa se realiza mediante el análisis de registro etnográfico, asimismo, la parte cuantitativa se aplica cuestionario sobre conocimientos y prácticas. Resultados: Se identifican cambios en elementos de empoderamiento, así como cambios en salud. Conclusiones: Emplear elementos de Educación Popular en Salud tiene efectos similares a estrategias donde se emplea la metodología pura, así, en la prevención de la picadura de alacrán, muestra resultados similares con otros problemas en salud.

Abstract Objective: To evaluate implementation of an educational initiative with elements of Popular Health Education on empowerment and changes in health for prevention of scorpion stings, in women from municipality of Tetecala, Morelos. Material and methods: Educational initiative was carried out in women assigned to PROSPERA program, with 16 participants. It consisted of 5 weekly sessions, with a time of approximately 2 hours each. A diagnosis was made on the knowledge and causes of the scorpion sting, with this information the main components of educational strategy were designed (1. Knowledge of scorpion; 2. Risks for scorpion sting; 3. Prevention of scorpion sting). It was carried out in the months of February and March 2019. Two categories, empowerment and changes in health, were evaluated, delving into elements described by Noelle Wiggins, using a mixed methodology. The measurements were made to the same group before and after educational initiative. Qualitative evaluation was carried out by analyzing ethnographic record. Quantitative part was applied questionnaire on knowledge and practices. Results: Changes in elements of empowerment were identified, as well as changes in health. Conclusions: Using elements of Popular Health Education has similar effects than strategies where pure methodology is used. In the prevention of Scorpion stings, it showed similar results to other health problems.

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BACKGROUND: Photovoice is a form of visual ethnography intended to engage impacted communities in research followed by action to ameliorate the injustices under study. Photovoice has increased in use, especially in collaboration with Latinx communities addressing health inequities. The Latinx population comprises nearly 18% of the overall United States population and according to the census is projected to reach just under 30% by 2060. This diverse panethnic community faces significant structural barriers in accessing services. Racism and the resulting marginalization, specifically, contributes to limited access to recovery services and treatment. Making meaningful advances in substance use disorder training, intervention and policy necessitates learning alongside the Latinx community. METHODS: We partnered with a Latinx serving integrated behavioral health and primary care setting in Boston Massachusetts to explore barriers and facilitators to recovery using photovoice. Spanish-speaking Latinx adults with a substance use disorder participated. The group met for three photovoice sessions over a six-week period. Together group members critically analyzed photographs using the SHOWeD method. RESULTS: Findings indicate a sense of purpose and meaning, security, faith and housing are important elements of recovery. The results illustrated the importance of sources of connection in maintaining sobriety. Through this photovoice project, Latinx Spanish speaking participants highlighted barriers and facilitators to their substance use disorder recovery which spanned individual, community, and structural levels. CONCLUSIONS: The experiences and voices of the Latinx community are crucial to drive discussions that advance policy (e.g., housing stability and access), enhance providers' understanding of Latinx Spanish-speakers' substance use disorder recovery, and inform culturally and linguistically appropriate services. This study demonstrated that photovoice is highly acceptable and feasible among Latinx clients receiving substance use disorder services. Visual images related to housing, faith, etc. communicate challenges, power structures, as well as hopes to policymakers at multiple levels (e.g., institution/ agency, state).

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School performance and cognitive competence can be conceptualized as social and relational constructs. Thus, we expect their association to vary as a function of other socially-embedded variables which have proven meaningful in the academic domain. The present study takes a critical theory approach to assess gender-related and contextual variability in the association between peer-assessed school performance and self-perceived cognitive competence. The sample consisted of 719 preadolescents (M age = 9.5 years, range = 9 to 12.5 years) living in lower- and upper-middle-class neighborhoods in Montreal, Canada and Barranquilla, Columbia. Multigroup comparisons revealed that (a) peer-assessed school competence was more strongly associated with self-perceived cognitive competence for upper-middle-class than lower-middle-class participants from Barranquilla, whereas the opposite pattern was observed with Montreal participants, and (b) that the association between communal orientation and self-perceived cognitive competence was stronger for girls than for boys across the sample, especially in the upper-middle-class school in Montreal. These findings highlight the nuanced degree of gender differences in preadolescents' perceived academic competence and emphasize the role of SES in shaping self-perceptions.

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Introducción: La hospitalización domiciliaria nace como un servicio que proporciona intervenciones agudas, domiciliarias y complejas a corto plazo. En el Hospital Regional de Talca esta unidad tiene 7 años, este estudio busca determinar en la población que ingresa a la unidad, características clínicas y comorbilidades.Método:Estudio retrospectivo, analítico descriptivo, información recolectada mediante entrevista, se recolectan datos durante el año 2019, con un análisis descriptivo de las variables del estudio, las variables continuas se describieron como media y desviaciones estándar, las variables categóricas como frecuencias absolutas y porcentajes, para el análisis estadístico se usó Microsoft Excel 2016.Resultados:La Unidad de Hospitalización Domiciliaria durante el año 2019 ingresa 484 pacientes, representando un aumento del 233,8%. Dentro de las variables del estudio, el mes con más ingresos fue julio con 50 pacientes, la edad promedio son 64,9 años (DE 3,34 años), sexo femenino (60,95%), Casados (47,3%), no realizaban actividad física (76,5%), con Índice de Masa Corporal (IMC) normal (34,7%), dentro de las comorbilidades tuvo mayor incidencia la hipertensión arterial (HTA) y diabetes mellitus (DM) con 329 y 209 diagnósticos respectivamente, la patología más derivada fueron las infecciones urinarias (32,2%).Conclusiones:el presente trabajo muestra la variabilidad de los pacientes ingresados, se redujeron los costos y la menor utilización de insumos médicos, mejora de la actividad física y reducción de la discapacidad adquirida, disminuye la readmisión, siendo una modalidad de atención eficaz, eficiente, segura, con una alta tasa de satisfacción sin mermar la calidad y la seguridad del paciente. (AU)

Introduction: Home hospitalization was born as a service that provides acute, home and complex interventions in the short term. In the Regional Hospital of Talca this unit is 7 years old, this study seeks to determine in the population that enters the unit, clinical characteristics and comorbidities.Method:Retrospective, descriptive analytical study, information collected by interview, data are collected during the year 2019, with a descriptive analysis of the study variables, continuous variables were described as mean and standard deviations, categorical variables as absolute frequencies and percentages, for the statistical analysis was used Microsoft Excel 2016Results:The Home Hospitalization Unit during 2019 admitted 484 patients, representing an increase of 233.8%. Within the study variables, the month with the most admissions was July with 50 patients, the average age was 64.9 years (SD 3.34 years), female (60.95%), Married (47.3%) , did not perform physical activity (76.5%), with normal BMI (34.7%), within the comorbidities, HT and DM had a higher incidence with 329 and 209 diagnoses respectively, the most derived pathology was urinary infections (32.2%).Conclusions:The present work shows the variability of admitted patients, reduced costs and less use of medical supplies, improved physical activity and reduced acquired disability, decreased readmission, being an effective, efficient, safe care modality, with a high satisfaction rate without compromising quality and patient safety. (AU)

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Desde el marco de comprensión de los jóvenes como actores, sujetos de derecho y autónomos, a partir de una revisión realista de la literatura, se buscó recolectar información que permitiera encontrar estrategias en América Latina para favorecer un consumo consciente de alcohol en jóvenes. Método: Se realiza búsqueda en bases de datos y otras fuentes. Resultados: Tras el cribado y selección se incluyeron 13 documentos. Se planteó una teoría de cambio. Conclusiones: Algunas estrategias se identifican con la participación social y el ocio como elementos centrales tanto en lo individual como en lo colectivo. Se reconoce, como la autonomía y la potencialidad de los sujetos para actuar sobre sí son el punto de partida para acompañar las acciones que los jóvenes realizan en la transformación de sus propias vidas y que las estrategias para la disminución del consumo de alcohol en jóvenes deben permitirle reconocerse como sujeto sociohistórico y agente de cambio.(AU)

From the framework of understanding young people as actors, subjects of law and autonomous, based on a Realist review of the literature we sought to collect information that would allow us to find strategies in Latin America to promote conscious consumption of alcohol in young people. Method: A search is made in databases and other sources. Results: After screening and selection, 13 documents were included. A theory of change was raised. Conclusions: Some strategies are identified with social participation and leisure as central elements both individually and collectively. It is recognized, how the autonomy and the potentiality of the subjects to act on themselves are the starting point to accompany the actions that young people carry out in the transformation of their own lives and that the strategies for the reduction of alcohol consumption in young people must allow him to recognize himself as a sociohistorical subject and an agent of change.(AU)

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Data from 790 older school-age (Mage = 10.2 years, SD = 1.2 years) girls (N = 427) and boys from Barranquilla, Colombia (N = 449) and Montréal, Canada (N = 331) were used to replicate findings reported by Valdivia et al. (2005). This prior study revealed contextual variations in the association between two measures of social behavior, specifically aggression and withdrawal, and two measures of effective functioning with peers, specifically sociometric preference and friendship. The Montréal participants were primarily from families with European backgrounds. The ethnicity of the participants from Barranquilla can be described as Latinx/Caribbean. Multilevel analyses provided evidence of replication of place differences only for the associations between measures of aggression and sociometric preference. Stronger negative associations were observed between (a) measures of aggression and sociometric preference, (b) measures of withdrawal and sociometric preference, and (c) withdrawal and friendship in peer groups that were high in collectivism. These findings are interpreted as largely replicating the deep structure of the findings from the Valdivia et al. study. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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The transition to kindergarten can be stressful as children adjust to novel separations from their caregivers and become accustomed to their peer group. A 9-month study of 96 children (Mage  = 5.37 years, SD = 0.42) from Barranquilla, Colombia, assessed socioeconomic differences in hypothalamic-pituitary-adrenal (HPA) axis functioning across the kindergarten year. Children were from four different classrooms in one school. Saliva samples were collected twice a day across 3 consecutive days at the beginning and end of the school year. We examined whether change in HPA axis activation across the year varied as a function of a child's socioeconomic status (SES) and experience in the peer group. We found that rejected children and lower SES children had lower cortisol levels early in the morning. Rejected children had a flatter morning cortisol slope. Lower SES children had higher cortisol than their higher SES peers at the end of the school year and a flatter morning cortisol slope. Taken together, these findings suggest that diurnal cortisol in children beginning kindergarten may be influenced by both peer rejection and SES.

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Objective: The real burden of (congenital heart defects [CHD]) and the improvement after surgical correction or palliation is both reflected in the quality of life (QoL). There are few studies in Latin-America that evaluate QoL in the CHD population. The purpose of this study was to measure the QoL after corrective or palliative surgery for CHD. Materials and methods: An observational, cross-sectional, and comparative study was carried out at the Miguel Hidalgo Centennial Hospital. Patients from 8 to 18 years old who underwent surgery for CHD were included during a period of 8 months. A total of 40 patients were included, together with a group of 80 healthy controls. From all participants, a KIDSCREEN-52 questionnaire was taken. A comparative analysis of the results was performed. Results: Overall, patients with cardiac surgery had better QoL indexes than healthy controls (p < 0.0001). The difference was greatest in moods and emotions, autonomy, and parent relations. Conclusions: Self-perception of QoL in post-operative patients for congenital heart disease is similar and in certain dimensions higher than the healthy population, possibly due to socioeconomic differences, parental care, and styles of coping with their disease. Higher complexity studies that include psychosocial variables and parental perception are required, and a better understanding of the QoL determinants will improve the attention provided to the patient and their families. Objetivo: Los efectos de las cardiopatías congénitas en los pacientes, así como la mejoría después de la paliación o la corrección quirúrgica, se reflejan en la calidad de vida (CV). Hay pocos estudios en Latinoamérica que evalúen la CV en esta población. El objetivo de este artículo es notificar la CV posterior a la operación paliativa o correctiva para defectos cardíacos congénitos. Material y métodos: Se llevó a cabo un estudio observacional, transversal y comparativo en el Centenario Hospital Miguel Hidalgo. Durante un período de ocho meses se incluyó a pacientes de 8 a 18 años sometidos a una intervención para cardiopatías congénitas. Se reunió a dos grupos de 40 pacientes y 80 controles sanos, pareados por edad y sexo. A cada participante se le aplicó el cuestionario KIDSCREEN-52 y se realizó un análisis comparativo de los resultados. Resultados: Los pacientes sometidos a operación cardíaca tuvieron mejores índices de CV que los controles sanos (p < 0.0001). La mayor diferencia se obtuvo en los aspectos de estado de ánimo y emociones, autonomía y relación con los padres. Conclusiones: La autopercepción de la CV después de una intervención para cardiopatías congénitas es similar y, en ciertas dimensiones, mejor que la de la población sana, tal vez por diferencias socioeconómicas, atención de los padres y modelos de adaptación a la enfermedad. Se requieren estudios más extensos que incluyan variables psicosociales y percepción parental. Una mayor comprensión de los determinantes de la CV podría mejorar la atención ofrecida al paciente y su familia.

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Abstract Objective: The real burden of (congenital heart defects [CHD]) and the improvement after surgical correction or palliation is both reflected in the quality of life (QoL). There are few studies in Latin-America that evaluate QoL in the CHD population. The purpose of this study was to measure the QoL after corrective or palliative surgery for CHD. Materials and methods: An observational, cross-sectional, and comparative study was carried out at the Miguel Hidalgo Centennial Hospital. Patients from 8 to 18 years old who underwent surgery for CHD were included during a period of 8 months. A total of 40 patients were included, together with a group of 80 healthy controls. From all participants, a KIDSCREEN-52 questionnaire was taken. A comparative analysis of the results was performed. Results: Overall, patients with cardiac surgery had better QoL indexes than healthy controls (p < 0.0001). The difference was greatest in moods and emotions, autonomy, and parent relations. Conclusions: Self-perception of QoL in post-operative patients for congenital heart disease is similar and in certain dimensions higher than the healthy population, possibly due to socioeconomic differences, parental care, and styles of coping with their disease. Higher complexity studies that include psychosocial variables and parental perception are required, and a better understanding of the QoL determinants will improve the attention provided to the patient and their families.

Resumen Objetivo: Los efectos de las cardiopatías congénitas en los pacientes, así como la mejoría después de la paliación o la corrección quirúrgica, se reflejan en la calidad de vida (CV). Hay pocos estudios en Latinoamérica que evalúen la CV en esta población. El objetivo de este artículo es notificar la CV posterior a la operación paliativa o correctiva para defectos cardíacos congénitos. Material y métodos: Se llevó a cabo un estudio observacional, transversal y comparativo en el Centenario Hospital Miguel Hidalgo. Durante un período de ocho meses se incluyó a pacientes de 8 a 18 años sometidos a una intervención para cardiopatías congénitas. Se reunió a dos grupos de 40 pacientes y 80 controles sanos, pareados por edad y sexo. A cada participante se le aplicó el cuestionario KIDSCREEN-52 y se realizó un análisis comparativo de los resultados. Resultados: Los pacientes sometidos a operación cardíaca tuvieron mejores índices de CV que los controles sanos (p < 0.0001). La mayor diferencia se obtuvo en los aspectos de estado de ánimo y emociones, autonomía y relación con los padres. Conclusiones: La autopercepción de la CV después de una intervención para cardiopatías congénitas es similar y, en ciertas dimensiones, mejor que la de la población sana, tal vez por diferencias socioeconómicas, atención de los padres y modelos de adaptación a la enfermedad. Se requieren estudios más extensos que incluyan variables psicosociales y percepción parental. Una mayor comprensión de los determinantes de la CV podría mejorar la atención ofrecida al paciente y su familia.

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AIM: To evaluate the long-term clinical effect of continuous subcutaneous insulin infusion (CSII) in adult type 1 diabetes mellitus (T1DM) patients in a regional public healthcare system real-world scenario. METHODS: All adult T1DM patients on CSII for ≥10 years subjected to follow-up in the regional Castilla-La Mancha Public Health Service were included. The primary efficacy outcome was the variation in HbA1c during follow-up. Direct patient data were compiled through the web-based Spanish national registry on CSII therapy. RESULTS: A total of 69 T1DM adult patients were treated with insulin pumps for ≥10 years in our region. The mean age was 45.0±10.5 years, with a T1DM duration of 13.9±8.5 years. The mean duration of CSII therapy was 11.4±2.1 years. The main indications for treatment were high glucose variability (39%), problematic hypoglycemia (26%), and HbA1c >53mmol/mol (7%) on multiple daily injections (20%). Sensor-augmented pump therapy was used by 31% of the patients. Glycosylated hemoglobin did not change during follow-up (58±11mmol/mol vs. 58±11mmol/mol; 7.5±1.0 vs. 7.5±1.0; p=0.66). However, the percentage of patients with at least one episode of severe hypoglycemia during the last year and unnoticed hypoglycemia decreased from 36% to 7% (p=0.006) and from 38% to 32% (p<0.001), respectively. The proportion of subjects with ≥1 episode of diabetic ketoacidosis in the last year decreased from 30% to 6% (p=0.045). CONCLUSIONS: The reduction of severe hypoglycemia without deterioration of glycemic control can be sustained over long-term CSII therapy.

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OBJETIVO: Evaluar el efecto de una intervención multidimensional en la percepción y el manejo de factores de riesgo intrínsecos y extrínsecos de caídas y en la frecuencia de caídas en personas mayores autovalentes que viven en la comunidad. DISEÑO: Ensayo clínico aleatorizado controlado. Emplazamiento: Centro público de salud familiar, nivel primario de atención. PARTICIPANTES: Personas mayores autovalentes que viven en la comunidad. Intervención: Intervención educativa multidimensional de visita domiciliaria y seguimiento telefónico mensual por 5 meses para el grupo intervenido (GI, n = 77) y los asignados al grupo control (GC, n = 77) atención habitual en su centro de salud. Mediciones principales: Percepción de riesgo de caídas, número de factores de riesgo caídas y número de caídas en el periodo. RESULTADOS: En ambos grupos aumenta la percepción de los factores de riesgo de caídas asociadas con la deambulación (GI: p ≤ 0,001 y GC: p ≤ 0,001). Pertenecer al GI se asocia significativamente con una disminución en los factores de riesgo asociados con las superficies (r = 0,25) y los zapatos (r = 0,24); un aumento en la percepción de riesgo de caídas asociadas a la deambulación (r = 0,21) y la presencia de objetos o muebles (r = 0,36). En GI, 5 participantes (7,9%) sufrieron al menos una caída en el periodo de 5 meses y en el GC 18 (27,7%) (p = 0,004). CONCLUSIONES: La intervención multidimensional fue efectiva para reducir la frecuencia de caídas y para el manejo de factores de riesgo extrínsecos asociados con las superficies, la iluminación y los dispositivos de apoyo

OBJECTIVE: To evaluate the effect of a multidimensional intervention on the perception and management of risk factors and frequency of falls in independent elderly people living in the community. DESIGN: Randomised clinical trial. SETTING: Family health centre, primary care. PARTICIPANTS: Independent elderly people living in the community. INTERVENTION: For intervention group (IG) a multidimensional intervention, consisting of home visits and telephone follow-up was carried out for 5 months (n = 77), and those assigned to the control group (CG, n = 77) received usual care in the family health centre. MAIN MEASUREMENTS: Perception of risk of falls, number of risk factors and number of falls in the study period. RESULTS: In both groups there were increases in the perception of risk factors for falling associated with walking (IG: P < .001 and CG: P < .001). Belonging to the IG was significantly associated with a decrease in the risk factors associated with surfaces (r = 0.25) and shoes (r = 0.24), as well as an increase in the perception of risk of falls associated with walking (r = 0.21) and the presence of objects or furniture (r = 0.36). In the IG, 5 participants (7.9%) suffered at least one fall in the 5-month period and 18 (27.7%) patients in the CG (P = .004). CONCLUSIONS: The Multidimensional intervention was effective in reducing the frequency of falls and in the management of extrinsic risk factors associated with surfaces, lighting, and support devices

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INTRODUCCIÓN: Los objetivos son analizar las alteraciones neuropsicológicas a medio plazo de los niños intervenidos del arco aórtico mediante perfusión cerebral selectiva (PCS) y detectar posibles factores modificables en la técnica quirúrgica que pueden ayudar a minimizar la afectación neurológica posterior. MATERIAL Y MÉTODOS: Se establecieron como criterios de inclusión: patología del arco aórtico intervenida mediante PCS durante el primer año de vida, entre el 10 de agosto del 2004 y el 24 de mayo del 2016, fisiología biventricular y edad gestacional mayor de 31 semanas. En ausencia de cromosomopatía, se clasificaron desde el punto de vista neurológico siguiendo el modified Rankin score. En mayores de 4 años se realizaron estudios de inteligencia, nivel de atención, maduración y aptitudes psicolingüísticas. RESULTADOS: Se incluyeron ochenta y dos pacientes, cuya edad media en el momento de la cirugía fue de 1,8 meses. El flujo medio en PCS fue de 32 ml/kg/min. El tiempo medio de PCS fue de 31 min. La mortalidad global de la serie fue del 14,8%. Con disfunción neurológica se observaron un 35,9% y se detectaron como factores de riesgo: cirugía en menores de 10 días de edad, duración de PCS mayor de 40 min y la duración del enfriamiento o calentamiento. Un 35,2% de los pacientes mayor de 5 años fueron diagnosticados de déficit de atención. CONCLUSIONES: Los pacientes intervenidos en el primer año de vida con PCS precisan un seguimiento neuropsicológico y hay factores modificables quirúrgicos que pueden influir en el desarrollo neurológico

INTRODUCTION: The aims of this article are to analyse the neuropsychological changes in the medium-term in children subjected to aortic arch surgery using selective cerebral perfusion (SCP), as well as to detect any modifiable factors in the surgical technique that may contribute to minimising the subsequent neurological involvement. MATERIAL AND METHODS: Inclusion criteria were established as: aortic arch disease operated on using SCP during the first year of life, between 10 August 2004 and 24 May 2016, biventricular physiology, and gestational age greater than 31 weeks. In the absence of a chromosomal disease, they were classified, from a neurological point of view, using the Rankin score. Children over 4-years of age were subjected to intelligence studies, including attention level, development, and psycho-lingual skills. RESULTS: The study included a total of 82 patients with a mean age of 1.8 months. The mean SCP flow was 32 ml/kg/min. The mean time of SCP was 31 minutes. The overall mortality of the series was 14.8%. Neurological dysfunction was observed in 35.9% of patients, and the following were detected as risk factors: surgery in patients less than 10-days-old, duration of SCP greater than 40minutes, and the time required for the cooling down and/or warming-up. Attention deficit was diagnosed in 35.2% of patients greater than 5-years-old. CONCLUSIONS: Patients operated on using SCP in in the first year of life required a neuropsychological follow-up, and there are modifiable surgical factors that may have an influence on neurological development

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INTRODUCTION: The aims of this article are to analyse the neuropsychological changes in the medium-term in children subjected to aortic arch surgery using selective cerebral perfusion (SCP), as well as to detect any modifiable factors in the surgical technique that may contribute to minimising the subsequent neurological involvement. MATERIAL AND METHODS: Inclusion criteria were established as: aortic arch disease operated on using SCP during the first year of life, between 10 August 2004 and 24 May 2016, biventricular physiology, and gestational age greater than 31 weeks. In the absence of a chromosomal disease, they were classified, from a neurological point of view, using the Rankin score. Children over 4-years of age were subjected to intelligence studies, including attention level, development, and psycho-lingual skills. RESULTS: The study included a total of 82 patients with a mean age of 1.8 months. The mean SCP flow was 32ml/kg/min. The mean time of SCP was 31minutes. The overall mortality of the series was 14.8%. Neurological dysfunction was observed in 35.9% of patients, and the following were detected as risk factors: surgery in patients less than 10-days-old, duration of SCP greater than 40minutes, and the time required for the cooling down and/or warming-up. Attention deficit was diagnosed in 35.2% of patients greater than 5-years-old. CONCLUSIONS: Patients operated on using SCP in in the first year of life required a neuropsychological follow-up, and there are modifiable surgical factors that may have an influence on neurological development.

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OBJECTIVE: To evaluate the effect of a multidimensional intervention on the perception and management of risk factors and frequency of falls in independent elderly people living in the community. DESIGN: Randomised clinical trial. SETTING: Family health centre, primary care. PARTICIPANTS: Independent elderly people living in the community. INTERVENTION: For intervention group (IG) a multidimensional intervention, consisting of home visits and telephone follow-up was carried out for 5 months (n=77), and those assigned to the control group (CG, n=77) received usual care in the family health centre. MAIN MEASUREMENTS: Perception of risk of falls, number of risk factors and number of falls in the study period. RESULTS: In both groups there were increases in the perception of risk factors for falling associated with walking (IG: P<.001 and CG: P<.001). Belonging to the IG was significantly associated with a decrease in the risk factors associated with surfaces (r=0.25) and shoes (r=0.24), as well as an increase in the perception of risk of falls associated with walking (r=0.21) and the presence of objects or furniture (r=0.36). In the IG, 5 participants (7.9%) suffered at least one fall in the 5-month period and 18 (27.7%) patients in the CG (P=.004). CONCLUSIONS: The multidimensional intervention was effective in reducing the frequency of falls and in the management of extrinsic risk factors associated with surfaces, lighting, and support devices.

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Epidemiological studies suggest frequent association of enteropathogenic bacteria with Entamoeba histolytica during symptomatic infection. In this study, we sought to determine if the interaction with enteropathogenic (EPEC) or nonpathogenic Escherichia coli (strain DH5α) could modify the virulence of E. histolytica to cause disease in animal models of amebiasis. In vitro studies showed a 2-fold increase in CaCo2 monolayer destruction when E. histolytica interacted with EPEC but not with E. coli DH5α for 2.5 h. This was associated with increased E. histolytica proteolytic activity as revealed by zymogram analysis and degradation of the E. histolytica CP-A1/5 (EhCP-A1/5) peptide substrate Z-Arg-Arg-pNC and EhCP4 substrate Z-Val-Val-Arg-AMC. Additionally, E. histolytica-EPEC interaction increased EhCP-A1, -A2, -A4, and -A5, Hgl, Apa, and Cox-1 mRNA expression. Despite the marked upregulation of E. histolytica virulence factors, nonsignificant macroscopic differences in amebic liver abscess development were observed at early stages in hamsters inoculated with either E. histolytica-EPEC or E. histolytica-E. coli DH5α. Histopathology of livers of E. histolytica-EPEC-inoculated animals revealed foci of acute inflammation 3 h postinoculation that progressively increased, producing large inflammatory reactions, ischemia, and necrosis with high expression of il-1ß, ifn-γ, and tnf-α proinflammatory cytokine genes compared with that in livers of E. histolytica-E. coli DH5α-inoculated animals. In closed colonic loops from mice, intense inflammation was observed with E. histolytica-EPEC manifested by downregulation of Math1 mRNA with a corresponding increase in the expression of Muc2 mucin and proinflammatory cytokine genes il-6, il-12, and mcp-1 These results demonstrate that E. histolytica/EPEC interaction enhanced the expression and production of key molecules associated with E. histolytica virulence, critical in pathogenesis and progression of disease.

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