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HIV prevalence among transgender women (TW) in Tijuana, Mexico is estimated at 22%. Pre-exposure prophylaxis (PrEP) reduces the risk of HIV acquisition by > 90%, though uptake in Tijuana has been low due to limited availability. The interplay between PrEP and gender stigmas may also serve as a barrier to PrEP uptake among TW in Tijuana. Experiences of gender- and PrEP- stigmas were assessed quantitatively (Quan) among 110 HIV-negative TW and qualitatively (Qual) among 17 TW through semi-structured interviews guide by the Health Stigma and Discrimination Framework. Qual findings were triangulated with Quant data to identify factors that may support gender affirmation and reduce PrEP stigma in an explanatory sequential Quan â Qual fashion. Most participants were < 40 years of age (80%), while approximately half had at least a high school education (48.2%) and were accessing gender-affirming hormone therapy (56.4%). Mean expectations of gender stigma were greatest for endorsing negative future expectations from others (M = 17.69; possible range 0-36). PrEP stigma was prominent among those who associated negative stereotypes with PrEP users, such as poor judgment (M = 45.91; possible range 14-70) and high personal risk attributes (M = 28.61; possible range 12-60). While PrEP knowledge was low among the qualitative sample, participants identified gender-, PrEP-, and intersectional- stigmas as potential barriers to PrEP uptake. Participants suggested that resilience strategies used to combat gender stigma could also mitigate PrEP stigma. Enhancing resilience skills at the intersection of gender and PrEP stigma may reduce these barriers, facilitating greater PrEP uptake as it becomes more available in Mexico.
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Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Estigma Social , Pessoas Transgênero , Humanos , Pessoas Transgênero/psicologia , Pessoas Transgênero/estatística & dados numéricos , México/epidemiologia , Feminino , Infecções por HIV/prevenção & controle , Adulto , Masculino , Fármacos Anti-HIV/uso terapêutico , Fármacos Anti-HIV/administração & dosagem , Pesquisa Qualitativa , Entrevistas como Assunto , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Adulto JovemAssuntos
Transtornos Mentais , Humanos , Adolescente , Transtornos Mentais/epidemiologia , ComorbidadeRESUMO
The organization in hospital medicine services is characterized by its hierarchy, where the difference in knowledge and status between medical directors, heads of service, specialist doctors and residents implicitly entail a power dynamic that generates abuse. According to Bourdieu's symbolic theory, the framework that underlies abuse is formed by symbolic violence that materializes in complex relationships in which each person knows their hierarchical position and does not question it. But this symbolic violence is experienced unconsciously, where abuse is perceived as an attitude that is part of an established order where the abuser and the abused act without questioning the abuse and perpetuating the historically inherited model. To eradicate abuse of residents, it is necessary to become aware of the symbolic foundation of abuse that legitimizes and perpetuates it to unmask the relationship between the abuser and the abused, proposing a new relational framework based on respect and dialogue.
La organización en los servicios de medicina hospitalaria se caracteriza por su jerarquización, donde la diferencia de conocimientos y de estatus entre directores médicos, jefes de servicio, médicos especialistas y residentes conlleva implícitamente una dinámica de poder generadora de maltrato. Según la teoría simbólica de Bourdieu el entramado que subyace al maltrato está formado por la violencia simbólica que se materializa en unas relaciones complejas en las que cada uno conoce su posición jerárquica y no la cuestiona. Pero está violencia simbólica es experimentada de forma inconsciente, donde el maltrato se percibe como una actitud que forma parte de un orden establecido donde el maltratador y el maltratado actúan sin cuestionar el maltrato y perpetuando el modelo heredado históricamente. Para erradicar el maltrato a los residentes es preciso tomar conciencia de la fundamentación simbólica del maltrato que lo legitima y perpetua para desenmascarar la relación entre el maltratador y el maltratado, proponiendo un nuevo marco relacional basado en el respeto y el diálogo.
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Internato e Residência , Humanos , Estudos RetrospectivosRESUMO
The COVID-19 pandemic has greatly impacted the Americas, the continent with the highest number of COVID-related deaths according to WHO statistics. In Latin America, strict confinement conditions at the beginning of the pandemic put recycling activity to a halt and augmented the consumption of plastic as a barrier to stop the spread of the virus. The lack of data to understand waste management dynamics complicates waste management strategy adjustments aimed at coping with COVID-19. As a novel contribution to the waste management data gap for Latin America, this study uses a virtual and participatory methodology that collects and generates information on household solid waste generation and composition. Data was collected between June and November 2021 in six countries in Latin America, with a total of 503 participants. Participants indicated that the pandemic motivated them to initiate or increase waste reduction (41%), waste separation (40%), and waste recovery (33%) activities. Forty-three percent of participants perceived an increase in total volume of their waste; however, the quantitative data showed a decrease in household waste generation in Peru (-31%), Honduras (-25%), and Venezuela (-82%). No changes in waste composition were observed. Despite the limited sample size, this data provides a much-needed approximation of household waste generation and composition in the pandemic situation during 2021.
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COVID-19 , Resíduos Sólidos , Humanos , COVID-19/epidemiologia , Pandemias , América Latina/epidemiologia , Monitoramento AmbientalRESUMO
RESUMEN Fundamento: los hábitos de estudio constituyen herramientas esenciales que permiten al estudiante mejores resultados académicos y desarrollar su creatividad e independencia. Objetivo: caracterizar los hábitos de estudio en estudiantes de segundo año de la carrera de Medicina. Métodos: se realizó un estudio descriptivo de corte transversal en la Facultad de Ciencias Médicas de Sagua la Grande, Universidad de Ciencias Médicas de Villa Clara, Cuba. Se emplearon métodos teóricos: análisis-síntesis; inducción-deducción; y empírico: cuestionario de hábitos de estudio a estudiantes. Resultados: a partir de los indicadores analizados, se encontraron dificultades en el desarrollo de los hábitos de estudio: distribución del tiempo, toma de notas, optimización de la lectura, las actitudes y condiciones productivas ante el estudio; como aspecto positivo se constató que se encuentran motivados por la carrera. Conclusiones: se caracterizaron varios indicadores vinculados a los hábitos de estudio sobre los que es necesario incidir de forma concreta para obtener una mejora en la actividad de estudio y el tránsito por la universidad.
ABSTRACT Background: study habits are essential tools that allow the student better academic results and develop their creativity and independence. Objective: to characterize study habits in second-year Medicine students. Methods: a descriptive cross-sectional study was carried out at the Faculty of Medical Sciences of Sagua la Grande, Villa Clara University of Medical Sciences, Cuba. Theoretical methods were used: analysis-synthesis; induction-deduction; and empirical one: study habits questionnaire for students. Results: from the analyzed indicators, difficulties were found in the development of study habits, distribution of time, note taking, optimization of reading, attitudes and productive conditions before the study; as a positive aspect, it was found that they are motivated by the career. Conclusions: several indicators linked to study habits were characterized on which it is necessary to influence in a concrete way to obtain an improvement in their studies and other curricular activities of the university.
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Hábitos , Estudantes , Educação MédicaRESUMO
Desde 1982 hasta 2017, el CIESUNAN Managua ha entregado a la Región Meso Americana um aproximado de 1532 Profesionales Graduados de Posgrado, donde el 64% son mujeres, y el resto varones. 930 son nicaragüenses (60.7%), y el resto son graduados de otros países de la Región Mesoamericana. Estos Graduados han aprobado uno o más de los cinco programas de Maestrías (Administración de la Salud y Epidemiología desde 1982, Salud Pública desde 1990, Economía de la Salud desde 2005 y Salud Ocupacional desde 2010). En el 2015 es abierto el Programa de Doctorado en Ciencias de la Salud. La Gestión Institucional basada en la Extensión Universitaria y la Internacionalización se constituyen en las bases imprescindibles de la Formación de Recursos Humanos en ambientes complejos y a veces hasta conflictivos. Es posible identificar diferentes momentos o kayros en los 35 años del CIES, y deducir las lecciones aprendidas en este proceso, condición necesaria para comprender y emprender los retos del futuro de la Educación de Posgrado en Salud Pública en función del impacto tecnológico y epistemológico que caracteriza a la determinación social de la Salud y la necesaria Intersectorialidad a construir en el marco de la Iniciativa Salud en Todas las Políticas y de los Objetivos de Desarrollo Sostenibles. Se exploran los diferentes períodos (kayros) de desarrollo y las lecciones aprendidas en cada uno de ellos, especialmente en los aspectos relacionados con la internacionalización de estos procesos, las relaciones establecidas con los actores surgidos y los espacios abiertos en estos processos.
From 1982 to 2017, CIESUNAN Managua has delivered to the Mesoamerican Region approximately 1532 Graduate Graduates, where 64% are women. Among those graduates, 930 are Nicaraguans (60.7%), and the rest are graduates coming from other countries of the Mesoamerican Region. These Graduates have approved one or more of the five Master's programs (Health Administration and Epidemiology since 1982, Public Health since 1990, Health Economics since 2005 and Occupational Health since 2010). In 2015 the Doctorate Program in Health Sciences is opened. Institutional Management based on University Extensionand Internationalization constitute the essential bases of Human Resource Training in complex and sometimes even conflicting environments. It is possible to identify different moments or kayros in the 35 years of the CIES, and to deduce the lessons learned in this process, a necessary condition to understand and undertake the future challenges of Postgraduate Education in Public Health according to the technological and epistemological impact that characterizes to the social determination of Health and the necessary intersectorality to be built within the framework of the Health Initiative in All Policies and the Sustainable Development Goals. It explores the different development periods and lessons learned in each one of them, especially in the aspects related to the internationalization of these processes, the established relationships with the actors that have emerged and the open spaces in these processes
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El CIES-UNAN Managua ha desarrollado una tendencia hacia la virtualización de los Programas de Estudios de Postgrado en Salud Pública (5 programas de Maestría -Salud Pública, Administración de la Salud, Epidemiología, Salud Ocupacional, Economía de la Salud- y uno de Doctorado en Ciencias de la Salud) en el último decenio de sus 35 años de servicio. Motivado en las necesidades de sus usuarios (Profesionales de la Salud de la Región Meso Americana, especialmente de Nicaragua, Honduras y El Salvador), surgidas de factores que impulsan un cambio permanente en sus necesidades, ha ido incorporando la Tecnología y la Metodología necesaria para que esta evolución sea siempre en función de las necesidades de los usuarios. Esto ha sido mediado a través de Modalidades mixtas. Los avances evidenciados en este estudio parten del diagnóstico sobre el uso de la tecnología de los estudiantes activos en los programas académicos de Postgrado, llegando a una valoración de los espacios virtuales de aprendizaje a partir de criterios presentes en la literatura existente sobre el tema. Se evidencia la satisfacción de los Estudiantes específicamente en los elementos de virtualización que han sido implementados. El conocimiento previo de la tecnología por su parte permite una mejor utilización de las Plataformas. También es notoria la Evolución satisfactoria de los hábitos de búsqueda de Información de los Estudiantes en Internet, acompañado con el desarrollo de competencias con el aprovechamiento de la Tecnología, lo que les ha permitido emigrar hacia Plataformas y Sitios más reconocidos y más confiables
The CIES-UNAN Managua has developed a trend towards the virtualization of the Postgraduate Studies Programs in Public Health (5 Master's programs - Public Health, Health Administration, Epidemiology, Occupational Health, Health Economics - and one Doctorate in Health Sciences) in the last decade of his 35 years of service. Motivated in the needs of its users (Health Professionals of the Meso-American Region, especially in Nicaragua, Honduras and El Salvador), arising from factors that drive a permanent change in their needs, it has incorporated the Technology and Methodology necessary to that this evolution is always based on the needs of users. This has been mediated through mixed Modalities. The advances evidenced in this study are based on the diagnosis of the use of technology by active students in postgraduate academic programs, reaching an assessment of virtual learning spaces based on criteria present in the existing literature on the subject. The satisfaction of the Students is evidenced specifically in the elements of virtualization that have been implemented. The prior knowledge of the technology allows a better use of the Platforms. It is also notorious the satisfactory evolution of student's information search habits on Internet, accompanied by the development of skills on the use of technology, which has allowed them to migrate to more recognized and reliable platforms and sites.
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Introducción: La Enfermería como disciplina ha tenido un desarrollo científico importante en los últimos años derivados no solo de los procesos de investigación, sino además de la elaboración de modelos, teorías que constituyen referencias para elevar la calidad del cuidado como objeto de la profesión. Objetivo: Analizar los procesos de la internacionalización y la gestión del conocimiento en relación con el desarrollo de la enfermería como profesión. Métodos: Se realizó el análisis documental de la obra de diferentes autores con la utilización de palabras clave como: enfermería, internacionalización, ciencia, educación médica, tendencias, gestión del conocimiento. La búsqueda se realizó en bases de datos como Scielo, Dialnet, Elseiver. Resultados: La comunidad enfermera necesita de los conocimientos que le podamos ofrecer a partir de las investigaciones, que emergen del análisis y la trascendencia de los proyectos, y su aplicabilidad según las características de los contextos en que se da en cada país tanto la formación de pre y posgrado y el cuidado en sí mismo como objeto de la profesión. Conclusiones: La internacionalización como tendencia junto a la gestión del conocimiento consolida la enfermería como ciencia en desarrollo que necesita del esfuerzo de la comunidad enfermera desde los resultados de sus investigaciones y el establecimiento de proyectos de investigación hacia las áreas docentes y clínicas(AU)
Introduction: Nursing as a discipline has had a significant scientific development in recent years derived not only from the research processes, but also the development of models, theories that are references to raise the quality of care as an object of the profession. Objective: To analyze the processes of internationalization and knowledge management in relation with the development of nursing as a profession. Methods: The documentary analysis of the work of different authors was carried out with the use of keywords such as nursing, internationalization, science, medical education, trends, knowledge management. The search was performed in databases such as Scielo, Dialnet, Elsevier. Results: The nursing community needs the knowledge that we can offer based on research, which emerges from the analysis and transcendence of projects, and their applicability according to the characteristics of the contexts in which each country presents undergraduate and postgraduate training and self-care as an object of the profession. Conclusions: Internationalization as a trend, along with knowledge management, consolidates nursing as a developing science that needs the efforts of the nursing community based on their research outcome and the establishment of research projects in the teaching and clinical areas(AU)
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Humanos , Educação em EnfermagemRESUMO
In the title compound, also known as 3,5-lutidine N-oxide dihydrate, C7H9NO·2H2O, the N-O bond is weakened due to the involvement of the O atom as an acceptor of hydrogen bonds from the two water mol-ecules of crystallization present in the asymmetric unit. Fused R35(10) ring motifs based on O-Hâ¯O hydrogen bonds form chains in the [010] direction, which are further connected by weak C-Hâ¯O inter-molecular contacts. As a result, the lutidine mol-ecules are stacked in an efficient manner, with π-π contacts characterized by a short separation of 3.569â (1)â Å between the benzene rings.
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Fundamento: el perfeccionamiento de la competencia comunicativa de los estudiantes no hispanohablantes en las universidades de ciencias médicas cubanas constituye hoy una necesidad. Objetivo: perfeccionar el proceso enseñanza aprendizaje del español como lengua extranjera a partir del rediseño del programa, basado en el desarrollo de las competencias con énfasis en el uso de tareas integradoras. Métodos: la investigación se desarrolló en la Filial de Ciencias Médicas "Lidia Doce Sánchez" de Sagua la Grande, en el período comprendido entre los cursos escolares 2011-2012 y 2012-2013. Se realizó un estudio descriptivo transversal. Para ello se utilizaron los métodos teóricos: análisis-síntesis e inductivo-deductivo, y empíricos: análisis documental y encuesta en forma de cuestionario a estudiantes y docentes. La propuesta fue sometida a criterios de especialistas. Resultados: se constató la necesidad del empleo de nuevos métodos para desarrollar las competencias comunicativas en el idioma español para los estudiantes no hispanohablantes a través de novedosas y pertinentes formas de aprendizaje. Se rediseñó el programa Español I adicionándole tareas integradoras, que responden al enfoque desarrollador basado en competencias. La propuesta se sometió a criterios de especialistas. Conclusiones: los especialistas consultados valoran la propuesta como pertinente y factible de aplicar por su nivel de actualización y el tratamiento científico y metodológico de sus contenidos.
Background: the improvement of the communicative competence of non Spanish-speaking students in the Cuban universities of medical sciences constitutes a necessity nowadays. Objective: to improve the teaching-learning process of Spanish as a foreign language starting from the redesign of the program based on competences with emphasis in the use of integrative tasks. Methods: the research work was carried out in "Lidia Doce Sánchez" University site from Sagua la Grande, in the academic years 2011-2012 and 2012-2013. It was carried out a cross-sectional descriptive study, within the quantitative-qualitative approach. Theoretical methods were used; analysis and synthesis, inductive-deductive and empiric ones: documental analysis, interviews in questionnaire form to students and professors. The proposal was analyzed using the specialists' criteria. Results: it was noted the necessity of the employment of new methods to develop the communicative competence in the Spanish language for non Spanish-speaking students through novel and pertinent learning forms. The syllabus for Spanish I subject was redesigned adding it integrative tasks that respond to the developing competence based approach which contributed to elevate the quality of the teaching-learning process of the mentioned language. Conclusions: the consulted specialists value the proposal so its application is feasible in order to perfect the teaching-learning process of the Spanish language for non Spanish-speaking students.
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Ensino , AprendizagemRESUMO
BACKGROUND: An intercultural birthing house was established in the Highlands of Chiapas, Mexico, as an intervention to reduce maternal mortality among indigenous women. This birth center, known locally as the Casa Materna, is a place where women can come to give birth with their traditional birth attendant. However, three months after opening, no woman had used the birthing house. METHODS: This study reports on the knowledge, attitudes and practices related to childbirth and use of the Casa Materna from the perspective of the health workers, traditional birth attendants and the program's target population. Structured interviews, in-depth interviews and focus group discussions were conducted with participants from each of these groups. Data was searched for emerging themes and coded. RESULTS AND CONCLUSIONS: Findings show that the potential success of this program is jeopardized by lack of transport and a strong cultural preference for home births. The paper highlights the importance of community participation in planning and implementing such an intervention and of establishing trust and mutual respect among key actors. Recommendations are provided for moving forward the maternal health agenda of indigenous women in Chiapas.
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Atitude do Pessoal de Saúde , Centros de Assistência à Gravidez e ao Parto , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Tocologia , Preferência do Paciente/etnologia , Adulto , Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos , Feminino , Grupos Focais , Acessibilidade aos Serviços de Saúde , Parto Domiciliar , Humanos , Relações Interprofissionais , Entrevistas como Assunto , México , Tocologia/educação , Tocologia/normas , GravidezRESUMO
PURPOSE: To study the role of breast cancer molecular subtypes according to hormone receptors and HER2 status as a predictive factor for pathological complete response (pCR) to neoadjuvant chemotherapy. PATIENTS AND METHODS: Eligible patients received one of the two chemotherapy schedules every two weeks with prophylactic growth factor support; schedule A: epirubicin 90 mg/m2-cyclophosphamide 600 mg/m2 d1 for 3 cycles followed by a second sequence with paclitaxel (P) 150 mg/ m2-gemcitabine (G) 2500 mg/m2 d1+/-trastuzumab (T) 2 mg/kg/week according to HER2 status (n=73); schedule B: adriamycin (40 mg/m2) d1 plus P (150 mg/m2)-G (2000 mg/m2) d2 for 6 cycles (n=54). Subsequently, patients underwent surgery, radiotherapy and/or adjuvant hormonal therapy according to standard practice. RESULTS: A total of 127 patients were evaluated. Forty-three patients (33.9%) achieved a pCR (50% in patients with HER2+tumours treated with T). Patients treated with che - motherapy alone (n=107, 18 HER2+) had a pCR of 32% (p=0.068). The pCR rate for patients with triple negative (HR and HER2-) cancers was 58.3%, 39.5% for HER2+ and 5.4% for ER/PR+ and HER2- (p<0.001). No differences in disease-free survival (DFS) were noted as a function of pCR, HER2 and HR status or treatment received (+/-T). However, statistical differences in DFS were observed as a function of whether patients had + or - axillar lymph nodes. Patients with + lymph node disease did worse (3 years DFS of 53.7% vs. 81.5%, p=0.025). Breast-conserving surgery was performed in 77 patients (60.6%). CONCLUSION: Tumour molecular subtyping defines different pCR to neoadjuvant chemotherapy (NC) but has no impact over DFS in patients with LABC. Although no significant correlation between HER2 status and trastuzumab therapy with pCR was found, probably due to the small number of patients, a favourable trend was observed in the group of HER2+ tumours treated with T.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/tratamento farmacológico , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/tratamento farmacológico , Genes erbB-2 , Receptores Citoplasmáticos e Nucleares/genética , Adulto , Idoso , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/genética , Carcinoma Ductal de Mama/patologia , Progressão da Doença , Intervalo Livre de Doença , Doxorrubicina/administração & dosagem , Epirubicina/administração & dosagem , Feminino , Regulação Neoplásica da Expressão Gênica/fisiologia , Humanos , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular , Terapia Neoadjuvante , Prognóstico , Receptores Citoplasmáticos e Nucleares/análise , Indução de Remissão/métodosRESUMO
BACKGROUND: Atherothrombotic disease is the leading cause of death worldwide. Most casualties are due to acute myocardial infarction (AMI). Patients younger than 45 years account for 5-10% of AMI cases. These patients generally do not display typical atherothrombotic risk factors. METHODS: Our cross-sectional study included adult patients under 45; men and women with AMI were included. A control group of healthy individuals matched for age, sex, and blood group was included to determine the role of several atherothrombotic risk factors on AMI. One hundred and sixty patients were included, the control group was comprised by 77 males (m) and 83 females (f) RESULTS: Our results indicate that 25% of patients (23 m and 18 f) had increased FVIII compared with 8.8% of control subjects. Mean FVIII activity for patients and controls was 134 mg/dl (95%CI=114) vs. 118 mg/dl (95%CI=128-140), respectively (p=0.001). Prevalence of elevated FVIII was higher than the one found for hypertension or diabetes mellitus. HDL cholesterol was higher among patients than controls. Quantitative variables associated with AMI were high FVIII activity, blood monocyte count and HDL cholesterol. CONCLUSIONS: Classical atherothrombotic risk factors do not fully explain AMI events in the young. High levels of FVIII activity is a moderate but common risk factor in young people suffering AMI.