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The objective of this research was to assess and quantify the potential vitamin A losses that occur during the manufacturing of pet feed and premix, as well as during their extended storage periods. This trial was conducted at a commercial feeder mill that utilized a standard commercial dog feed along with a corresponding vitamin-mineral premix. The calculated amount of vitamin A supplemented in the feed, in addition to the endogenous vitamins present in the ingredients, was adjusted to 18,000 IU/kg of feed. Five 500 g feed samples were collected at each of the predefined critical points throughout the manufacturing process (after mixing, milling, preconditioner, and extrusion/drying processes) to verify the stability of vitamin A during feed production. Additionally, various samples were collected at regular intervals of 30, 60, 90, 120, and 180 days during the storage of the premix to assess the stability of vitamin A. Vitamin A analyses in the samples were performed using high-performance liquid chromatography. The variables were assessed for normality using the Shapiro-Wilk test, followed by analysis of variance (ANOVA) and Tukey's test to compare the differences between the manufacturing process and premix shelf life. The statistical significance was set at 95%. The vitamin losses during the pre-conditioning process were 26%, and during the extrusion-drying processes, the losses were 34% when compared to the initial analyzed value. However, no differences were observed in other processes. There were no significant differences observed in recovered vitamin levels in the premix during its shelf-life (p = 0.484). The study indicated that the primary vitamin A losses in pet feed manufacturing processes occur during the pre-conditioning and drying/extrusion steps. However, it is worth noting that no significant losses of vitamin A were found during the premix storage phase.

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The historical and geographical properties of the archipelagos allow a detailed study of species diversification, and phenotypic traits can indicate the extent of such processes. Eupelmus pulchriceps (Cameron, 1904) is an exotic species to the Galapagos archipelago, and generalist parasitoid that attacks a beetle species that consumes the seeds of the invasive shrub Leucaena leucocephala (Lam.) de Wit. Despite extensive sampling, the wasp is recorded only in Santa Cruz and San Cristobal islands of the Galapagos archipelago. Thus, using 112 female wasps, we compare body size, proportion, and allometric differentiations within and between the two islands. There were no body size differences between islands. A PerMANOVA indicates differences between the islands and a single differentiation between two localities of one island. Allometric differences between islands were not the same for all structures. These results are consistent with the greater distance between islands than between localities and suggest a differentiation process. The variables with allometric differentiation are associated with wings and ovipositor, possibly responding to different ecological pressures. It is interesting that this parasitoid, recently arrived at the archipelago, is already showing differentiation. Also, it is essential to monitor the behavior of these wasps in the archipelago, given their potential to access other species affecting the trophic interactions of the local biota.

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Introduction: HPV infection is a common risk factor for all anogenital cancers. However, there are important differences in the epidemiology of anogenital cancers and these have not been compared considering diverse epidemiological indicators over a long period of time. To fill this gap, we investigated incidence, mortality, and survival trends of anogenital cancers over a period of three decades. Methods: We conducted an observational registry-based study using data from the population-based cancer registry of Granada in southern Spain. We collected data on all incident cases of anogenital cancer (cervical, anal, penile, vulvar, and vaginal cancer) diagnosed between 1985 and 2017. We calculated crude and age-standardized incidence and mortality rates, and 1, 3, and 5-year overall and net survival. We further conducted time-trend analysis calculating annual percent changes (APC) for each cancer site. Results: The incidence of anogenital cancers decreased slightly during the past 30 years, with the exception of vulvar cancer, where a slight increase was observed. Mortality decreased significantly for cervical cancer over the study period but increased non-significantly for the remaining cancer sites. Survival rates were similar to those reported in comparable countries and increased for cervical and vulvar cancer. Discussion: Cervical cancer was the greatest contributor to the burden of anogenital cancers and showed a marked improvement in all indicators in comparison to the remaining cancer sites.

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Aim: This work aimed to synthesize magnesium-doped zinc oxide, silver and gold nanoparticles (Nps) and to evaluate their potential to prevent and eradicate Escherichia coli, Proteus mirabilis, Staphylococcus aureus, Acinetobacter baumannii and Pseudomonas aeruginosa biofilms. Materials & methods: The Nps were synthesized by precipitation and metallic reduction techniques. Physicochemical and biological characterization of Nps was performed. Results: All the Nps tested were able to inhibit the formation of E. coli, P. mirabilis, S. aureus and A. baumannii biofilms. The effects on the eradication of preformed biofilms were variable, although all the Nps tested were able to eradicate A. baumannii biofilms. Conclusion: The observed effects make the Nps suitable for coating surfaces and/or antibiotic carriers with medical interest.

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BACKGROUND: Hepatic encephalopathy (HE) is a common complication of cirrhosis associated with a reduced survival. The presence of high-flux spontaneous porto-systemic shunts can induce HE even in patients with preserved liver function. AIM: To evaluate the effect of spontaneous porto-systemic shunt embolization (SPSE) over HE and its long-term evolution. MATERIAL AND METHODS: Retrospective analysis of 11 patients (91% males) with severe HE non-responsive to medical treatment in whom a SPSE was performed. The grade of HE (employing West Haven score), survival, MELD and Child-Pugh score, ammonia levels, degree of disability (employing the modified Rankin scale (mRs)) were evaluated before and at thirty days after procedure. RESULTS: The most common etiology found was non-alcoholic steatohepatitis (63.6%). A reduction of at least two score points of HE was observed in all patients after thirty days. There was a significant reduction on median (IQR) West Haven score from 3 (2-3) at baseline to 1 (0-1) after the procedure (p < 0.01). Twelve months survival was 63.6%. There was a decrease in median ammonia level from 106.5 (79-165) (ug/dL) to 56 (43-61) after SPSE (p = 0.006). The median mRS score before and after the procedure was 3 (3-5) and 1 (1-2.5), respectively (p < 0.01). Conclusions: According to our experience, SPSE is a feasible and effective alternative to improve HE and functionality of patients with refractory EH.

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Background: Depression, anxiety, well-being, and suicidality are highly associated during adolescence and greatly predict mental health outcomes during adulthood. This study explored relationships between these variables among students from Mexico City.Methods: This representative cross-sectional study was carried out in education centers in Mexico City during the 2019-2020 academic year. Using a smartphone app, we implemented validated questionnaires for depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), well-being (World Health Organization 5 Well-Being Index), and risk of suicide (Columbia-Suicide Severity Rating Scale). Partial least squares structural equation modeling was performed for the entire sample and after stratifying by gender.Results: Out of 3,042 students, 1,686 were females; mean age of the sample was 17.3 years. Compared to males, females had higher levels of anxiety, depressive symptoms, and suicidal ideation and lower levels of self-perceived well-being. Structural equation models indicated that depression was the main predictor of the rest of the outcomes in the overall sample. The role of anxiety was heterogeneous across genders and not clearly correlated to suicidal behavior or well-being.Conclusions: Large-scale mental health screening using an online tool proved feasible, with high response rates. Depression was the most important factor influencing anxiety, suicidal behavior, and well-being in Mexican high school students. The roles of depression and anxiety were heterogeneous across genders.Trial Registration: ClinicalTrials.gov Identifier: NCT04067076.

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Although there are several pathways to ensure that proteins are folded properly in the cell, little is known about the molecular mechanisms regulating histone folding and proteostasis. In this work, we identified that chaperone-mediated autophagy (CMA) is the main pathway involved in the degradation of newly synthesized histones H3 and H4. This degradation is finely regulated by the interplay between HSC70 and tNASP, two histone interacting proteins. tNASP stabilizes histone H3 levels by blocking the direct transport of histone H3 into lysosomes. We further demonstrate that CMA degrades unfolded histone H3. Thus, we reveal that CMA is the main degradation pathway involved in the quality control of histone biogenesis, evidencing an additional mechanism in the intricate network of histone cellular proteostasis.

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BACKGROUND: Hepatic encephalopathy (HE) is a common complication of cirrhosis associated with a reduced survival. The presence of high-flux spontaneous porto-systemic shunts can induce HE even in patients with preserved liver function. AIM: To evaluate the effect of spontaneous porto-systemic shunt embolization (SPSE) over HE and its long-term evolution. MATERIAL AND METHODS: Retrospective analysis of 11 patients (91% males) with severe HE non-responsive to medical treatment in whom a SPSE was performed. The grade of HE (employing West Haven score), survival, MELD and Child-Pugh score, ammonia levels, degree of disability (employing the modified Rankin scale (mRs)) were evaluated before and at thirty days after procedure. RESULTS: The most common etiology found was non-alcoholic steatohepatitis (63.6%). A reduction of at least two score points of HE was observed in all patients after thirty days. There was a significant reduction on median (IQR) West Haven score from 3 (2-3) at baseline to 1 (0-1) after the procedure (p < 0.01). Twelve months survival was 63.6%. There was a decrease in median ammonia level from 106.5 (79-165) (ug/dL) to 56 (43-61) after SPSE (p = 0.006). The median mRS score before and after the procedure was 3 (3-5) and 1 (1-2.5), respectively (p < 0.01). CONCLUSIONS: According to our experience, SPSE is a feasible and effective alternative to improve HE and functionality of patients with refractory EH.

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There is a growing evidence describing a decline in adaptive homeostasis in aging-related diseases affecting the central nervous system (CNS), many of which are characterized by the appearance of non-native protein aggregates. One signaling pathway that allows cell adaptation is the integrated stress response (ISR), which senses stress stimuli through four kinases. ISR activation promotes translational arrest through the phosphorylation of the eukaryotic translation initiation factor 2 alpha (eIF2α) and the induction of a gene expression program to restore cellular homeostasis. However, depending on the stimulus, ISR can also induce cell death. One of the ISR sensors is the double-stranded RNA-dependent protein kinase [protein kinase R (PKR)], initially described as a viral infection sensor, and now a growing evidence supports a role for PKR on CNS physiology. PKR has been largely involved in the Alzheimer's disease (AD) pathological process. Here, we reviewed the antecedents supporting the role of PKR on the efficiency of synaptic transmission and cognition. Then, we review PKR's contribution to AD and discuss the possible participation of PKR as a player in the neurodegenerative process involved in aging-related pathologies affecting the CNS.

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Objetivo. Evaluar la calidad de la atención a neonatos con indicadores de proceso, en patologías seleccionadas. Ma-terial y métodos. Evaluación multicéntrica, transversal de nueve indicadores en 28 hospitales de 11 entidades de México. Se utilizó Lot Quality Assurance Sampling (LQAS) para estándares de calidad y muestra por hospital. Casos seleccio-nados al azar del Subsistema Automatizado de Egresos Hos-pitalarios. Se clasifican hospitales como "cumplimiento con estándar"/"no cumplimiento" por indicador y, cumplimiento con IC95% exacto binomial, regional y nacional, según mues-treo estratificado no proporcional. Resultados. Ningún indicador cumple el estándar de 75% en hospitales, con 0 a 19 hospitales que cumplen, según indicador. Excepto la iden-tificación oportuna de asfixia perinatal e inicio de antibiótico correcto en sospecha de sepsis temprana, el cumplimiento es <50% en todos los demás indicadores. Conclusiones. La calidad de la atención a neonatos en hospitales es heterogé-nea y deficiente. Se proponen indicadores para monitorizar iniciativas de mejora.

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Resumen: Objetivo: Evaluar la calidad de la atención a neonatos con indicadores de proceso, en patologías seleccionadas. Material y métodos: Evaluación multicéntrica, transversal de nueve indicadores en 28 hospitales de 11 entidades de México. Se utilizó Lot Quality Assurance Sampling (LQAS) para estándares de calidad y muestra por hospital. Casos seleccionados al azar del Subsistema Automatizado de Egresos Hospitalarios. Se clasifican hospitales como "cumplimiento con estándar"/"no cumplimiento" por indicador y, cumplimiento con IC95% exacto binomial, regional y nacional, según muestreo estratificado no proporcional. Resultados: Ningún indicador cumple el estándar de 75% en hospitales, con 0 a 19 hospitales que cumplen, según indicador. Excepto la identificación oportuna de asfixia perinatal e inicio de antibiótico correcto en sospecha de sepsis temprana, el cumplimiento es <50% en todos los demás indicadores. Conclusiones: La calidad de la atención a neonatos en hospitales es heterogénea y deficiente. Se proponen indicadores para monitorizar iniciativas de mejora.

Abstract: Objective: To evaluate the quality of care to newborns with process indicators, in selected pathologies. Materials and methods: Multi-centric, cross-sectional evaluation of 9 indicators in 28 hospitals in 11 States of Mexico. Lot Quality Assurance Sampling (LQAS) was used for quality standards and sample per hospital. Randomly selected cases from the Automated Hospital Discharge Subsystem. The hospitals are classified as "standard compliance"/"non-compliance" by indicator and, compliance with 95%CI exact binomial, regional and national, according to non-proportional stratified sampling. Results: No indicator meets the standard of 75% in hospitals, with range from 0 to 19 hospitals that meet, according to indicator. Except for timely identification of perinatal asphyxia and onset of correct antibiotics in suspected early sepsis, the compliance is <50% on all other indicators. Conclusions: The quality of care for newborns in hospitals is heterogeneous and poor. Indicators are proposed to monitor improvement initiatives.

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INTRODUCTION: Mental disorders represent the second cause of years lived with disability worldwide. Suicide mortality has been targeted as a key public health concern by the WHO. Smartphone technology provides a huge potential to develop massive and fast surveys. Given the vast cultural diversity of Mexico and its abrupt orography, smartphone-based resources are invaluable in order to adequately manage resources, services and preventive measures in the population. The objective of this study is to conduct a universal suicide risk screening in a rural area of Mexico, measuring also other mental health outcomes such as depression, anxiety and alcohol and substance use disorders. METHODS AND ANALYSIS: A population-based cross-sectional study with a temporary sampling space of 9 months will be performed between September 2019 and June 2020. We expect to recruit a large percentage of the target population (at least 70%) in a short-term survey of Milpa Alta Delegation, which accounts for 137 927 inhabitants in a territorial extension of 288 km2.They will be recruited via an institutional call and a massive public campaign to fill in an online questionnaire through mobile-assisted or computer-assisted web app. This questionnaire will include data on general health, validated questionnaires including Well-being Index 5, Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale 2, Alcohol Use Disorders Identification Test, selected questions of the Drug Abuse Screening Test and Columbia-Suicide Severity Rating Scales and Diagnostic and statistical manual of mental disorders (DSM-5) questions about self-harm.We will take into account information regarding time to mobile app response and geo-spatial location, and aggregated data on social, demographical and environmental variables. Traditional regression modelling, multilevel mixed methods and data-driven machine learning approaches will be used to test hypotheses regarding suicide risk factors at the individual and the population level. ETHICS AND DISSEMINATION: Ethical approval (002/2019) was granted by the Ethics Review Board of the Hospital Psiquiátrico Yucatán, Yucatán (Mexico). This protocol has been registered in ClinicalTrials.gov. The starting date of the study is 3 September 2019. Results will serve for the planning and healthcare of groups with greater mental health needs and will be disseminated via publications in peer-reviewed journal and presented at relevant mental health conferences. TRIAL REGISTRATION NUMBER: NCT04067063.

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OBJECTIVE: To analyze quantity and quality of the information reported by Mexico to OECD in relation to health indicators. MATERIALS AND METHODS: Analysis of frequency of indicators reporting, data quality, and comparison of reported values in the OECD environment. RESULTS: We analyzed 191 indicators. Mexico reported annually (2010-2016) 52.9% of them. Never reported 45.5%. The highest frequency of not reported (84%) is in the "Quality of care" group. Among the reported, information is of poor quality in 28.7% of them. Comparatively, Mexico holds the worst results in OECD indicators on screening of cancer, child and in-hospital mortality from myocardial infarction, and hospitalization for diabetes, among others. CONCLUSIONS: Mexico has problems of lack and quality of reported information, and frequently unfavorable values among OECD countries. The information system needs improvement, in both quantity and quality of data, and its effective utilization.

OBJETIVO: Analizar cantidad y calidad de la información sobre indicadores de salud reportada por México a la Organización para la Cooperación y el Desarrollo Económicos (OCDE). MATERIAL Y MÉTODOS: Análisis de frecuencia de indicadores reportados, calidad de los datos y comparación de valores reportados en el entorno OCDE. RESULTADOS: Se analizan 191 indicadores. México reportó anualmente (2010-2016) 52.9% de ellos. Nunca reportó 45.5%. La mayor frecuencia de no reportados (84%) es en el grupo "Calidad de la atención". En los reportados, la información es de calidad deficiente en 28.7%. Comparativamente, México ostenta los peores resultados de OCDE en indicadores sobre tamizaje de cáncer, mortalidad infantil e intrahospitalaria por infarto de miocardio y hospitalización por diabetes, entre otros. CONCLUSIONES: México tiene problemas de carencia y calidad de la información reportada y valores frecuentemente desfavorables en el entorno OCDE. Se requiere mejorar el sistema de información incidiendo tanto en cantidad como en calidad de los datos, y su utilización efectiva.

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Resumen: Objetivo: Analizar cantidad y calidad de la información sobre indicadores de salud reportada por México a la Organización para la Cooperación y el Desarrollo Económicos (OCDE). Material y métodos: Análisis de frecuencia de indicadores reportados, calidad de los datos y comparación de valores reportados en el entorno OCDE. Resultados: Se analizan 191 indicadores. México reportó anualmente (2010-2016) 52.9% de ellos. Nunca reportó 45.5%. La mayor frecuencia de no reportados (84%) es en el grupo "Calidad de la atención". En los reportados, la información es de calidad deficiente en 28.7%. Comparativamente, México ostenta los peores resultados de OCDE en indicadores sobre tamizaje de cáncer, mortalidad infantil e intrahospitalaria por infarto de miocardio y hospitalización por diabetes, entre otros. Conclusiones: México tiene problemas de carencia y calidad de la información reportada y valores frecuentemente desfavorables en el entorno OCDE. Se requiere mejorar el sistema de información incidiendo tanto en cantidad como en calidad de los datos, y su utilización efectiva.

Abstract: Objective: To analyze quantity and quality of the information reported by Mexico to OECD in relation to health indicators. Materials and methods: Analysis of frequency of indicators reporting, data quality, and comparison of reported values in the OECD environment. Results: We analyzed 191 indicators. Mexico reported annually (2010-2016) 52.9% of them. Never reported 45.5%. The highest frequency of not reported (84%) is in the "Quality of care" group. Among the reported, information is of poor quality in 28.7% of them. Comparatively, Mexico holds the worst results in OECD indicators on screening of cancer, child and in-hospital mortality from myocardial infarction, and hospitalization for diabetes, among others. Conclusions: Mexico has problems of lack and quality of reported information, and frequently unfavorable values among OECD countries. The information system needs improvement, in both quantity and quality of data, and its effective utilization.

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BACKGROUND: Research and different organizations have proposed indicators to monitor the quality of maternal and child healthcare, such indicators are used for different purposes. OBJECTIVE: To perform a systematic review of indicators for the central phases of the maternal and child healthcare continuum of care (pregnancy, childbirth, newborn care and postpartum). METHOD: A search conducted using international repositories, national and international indicator sets, scientific articles published between 2012 and 2016, and grey literature. The eligibility criteria was documents in Spanish or English with indicators to monitor aspects of the continuum of care phases of interest. The identified indicators were characterized as follows: formula, justification, evidence level, pilot study, indicator type, phase of the continuum, intended organizational level of application, level of care, and income level of the countries. Selection was based on the characteristics associated with scientific soundness (formula, evidence level, and reliability). RESULTS: We identified 1791 indicators. Three hundred forty-six were duplicated, which resulted in 1445 indicators for analysis. Only 6.7% indicators exhibited all requirements for scientific soundness. The distribution by the classifying variables is clearly uneven, with a predominance of indicators for childbirth, hospital care and facility level. CONCLUSIONS: There is a broad choice of indicators for maternal and child healthcare. However, most indicators lack demonstrated scientific soundness and refer to particular continuum phases and levels within the healthcare system. Additional efforts are needed to identify good indicators for a comprehensive maternal and child healthcare monitoring system.

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Background/Objective: The World Health Organization's diagnostic guidelines for ICD-11 mental and behavioural disorders must be tested in clinical settings around the world to ensure that they are clinically useful and genuinely global. The objective is evaluate the inter-rater reliability and clinical utility of ICD-11 guidelines for psychotic, mood, anxiety- and stress-related disorders in Mexican patients. Method: Adult volunteers exhibiting the selected symptoms were referred from the pre-consultation unit of a public psychiatric hospital to an interview by a pair of clinicians, who subsequently assigned independent diagnoses and evaluated the clinical utility of the diagnostic guidelines as applied to each particular case, on the basis of a scale developed for this purpose. Results: 23 clinicians evaluated 153 patients. Kappa scores were strong for psychotic disorders (.83), moderate for stress-related (.77) and mood disorders (.60) and week for anxiety and fear-related disorders (.43). A high proportion of clinicians considered all diagnostic guidelines to be quite to extremely useful as applied to their patients. Conclusions: ICD-11 guidelines for psychotic, stress-related and mood disorders allow adequate inter-rater consistency among Mexican clinicians, who also considered them as clinical useful tools.

Antecedentes/Objetivo: Las guías diagnósticas CIE-11 para trastornos mentales y del comportamiento de la Organización Mundial de la Salud deben ser evaluadas en pacientes reales alrededor del mundo a fin de asegurar que son clínicamente útiles y genuinamente globales. Se evalúa la consistencia inter-evaluadores y la utilidad clínica de las guías para los trastornos psicóticos, afectivos, de ansiedad y relacionados con el estrés en pacientes mexicanos. Método: Voluntarios con síntomas psicóticos, afectivos, de ansiedad o relacionados con el estrés derivados de una unidad de pre-consulta de un hospital psiquiátrico, para una entrevista con una pareja de clínicos, quienes posteriormente asignaron diagnósticos de manera independiente y evaluaron la utilidad clínica de las guías aplicadas a cada caso en particular, con base en una escala desarrollada para este propósito. Resultados: 23 clínicos evaluaron 153 pacientes. Los coeficientes Kappa fueron fuertes para trastornos psicóticos (0,83), moderados para los relacionados con el estrés (0,77) y afectivos (0,60), y débiles para los de ansiedad y relacionados con el miedo (0,43). Una alta proporción de clínicos consideró que las guías eran bastante o extremadamente útiles. Conclusiones: Las guías CIE-11 para dichos trastornos permiten una adecuada consistencia inter-evaluadores en clínicos mexicanos, quienes les consideran herramientas clínicamente útiles.

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OBJECTIVES: This study was designed to address the current relative void of valid measures by developing evidence-based quality indicators for pain management of chronic nonmalignant pain. METHODS: We performed a 10-year literature search to identify guidelines and review articles on chronic pain management to identify evidence-based recommendations for the different conditions associated to chronic pain. A complementary search of indicators and indicator-related articles was also performed. Then, we built new indicators or adapted existing ones to cover all the evidence-based recommendations we found. The resulting set was pilot tested for feasibility, reliability (kappa), and usefulness to identify quality problems, using the Lot Quality Acceptance method (α ≤ 0.05 and ß ≤ 0.01) for 75% (40% threshold) and 95% (70% threshold) compliance standards, and estimates with binomial exact 95% confidence intervals. We reviewed clinical records from a primary care center, a medium-size hospital (250 beds), and a large hospital (500 beds). RESULTS: Forty-six indicators were developed (6 general and 40 condition specific). Thirty-three were feasible in primary care and/or hospitals. Feasible indicators were also reliable (most kappa > 0.7). Regarding compliance, 4 quality indicators obtained compliance levels over 60%, addressing pharmacological treatment, multimodal approach, and appropriate use of neuro-image tests, while 16 obtained compliance scores under 15% (6 with 0% compliance). CONCLUSIONS: The created set has tested to be feasible, reliable, and useful, with the capacity to serve as the baseline for developing the necessary strategies to improve the management of chronic nonmalignant pain, by monitoring and evaluating quality of care.

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Currently, the use of cefazolin is recommended to determine the susceptibility to first-generation oral cephalosporins in strains of enterobacteria in uncomplicated UTI. We determined susceptibility differences to oral cephalosporins in urinary strains according to cefazolin or cefalotin breakpoints and the correlation of susceptibility between cefazolin and cefadroxil. We studied 52 strains with cefalotin and cefazolin by disk-diffusion and MIC (Kirby-Bauer and Vitek XL) and a subgroup by disk-diffusion for cefadroxil. Agreement among different methods was 100% for K. pneumoniae and Proteus spp. In Escherichia coli, agreement for Vitek and disk-diffusion were 0 and 50% respectively. Susceptibility to first generation cephalosporins in E. coli should be determined with cefazolin. Agreement between cefazolin and cefadroxil suggests that cefazolin could also predict the susceptibility of cefadroxil.

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BACKGROUND: The World Health Organization (WHO) launched the "Safe Childbirth Checklist (SCC) Collaboration" in 2012. The SCC is designed to contribute to quality care by providing reminders of evidence-based practices for the prevention and management of the leading causes of maternal and neonatal morbidity and mortality. However, indicators to monitor the implementation and effectiveness of the SCC have not been defined. This study aimed to produce and pilot test a set of valid, reliable and feasible indicators to assess the implementation and effectiveness of the SCC, with an emphasis on best practices. METHODS: As part of the WHO Collaboration, the SCC was adapted to the Mexican context, and a set of indicators was developed to assess the SCC use and adherence to SCC-related best practices. The indicators were pilot tested in three hospitals for feasibility and reliability using the prevalence- and bias-adjusted kappa index (PABAK) for multiple independent evaluators (initial sample, n = 47; second sample, n = 30 to re-test reliability). The data sources were clinical records and cognitive tests drawn from questionnaires to mothers and health professionals. RESULTS: We generated 53 indicators, and 38 of the indicators (those related to best practices and outcomes) were pilot tested. Of these, 26 relate to care for the mother (20 were measured based on clinical records and 6 via questionnaire), and 12 relate to newborn care (9 were medical record-based and 3 were from questionnaires). Feasible indicators were generally also reliable (PABAK≥0.6). Routine feasibility is affected by the frequency of assessed events. CONCLUSIONS: The generated indicators allow an assessment of the implementation and effectiveness of the SCC and the monitoring of quality of care during childbirth and the immediate postpartum period.

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Resumen Actualmente se recomienda el uso de cefazolina para determinar la susceptibilidad a cefalosporinas orales de primera generación en cepas de enterobacterias en ITU no complicada. Nuestro objetivo fue establecer la susceptibilidad a cefalosporinas orales en cepas urinarias según puntos de corte para cefalotina o cefazolina y la correlación de susceptibilidad entre cefazolina y cefadroxilo. Se estudió la concordancia entre cefalotina y cefazolina en 52 cepas por método de Kirby-Bauer y Vitek XL. En Escherichia coli fue de 0% para VitekXL y 50% para Kirby-Bauer. La concordancia entre cefazolina y cefadroxilo fue 95,6%. En el laboratorio debiera usarse cefazolina para determinar susceptibilidad a cefalosporinas orales de primera generación. La concordancia entre cefazolina y cefadroxilo sugiere que cefazolina podría predecir susceptibilidad para cefadroxilo.

Currently, the use of cefazolin is recommended to determine the susceptibility to first-generation oral cephalosporins in strains of enterobacteria in uncomplicated UTI. We determined susceptibility differences to oral cephalosporins in urinary strains according to cefazolin or cefalotin breakpoints and the correlation of susceptibility between cefazolin and cefadroxil. We studied 52 strains with cefalotin and cefazolin by disk-diffusion and MIC (Kirby-Bauer and Vitek XL) and a subgroup by disk-diffusion for cefadroxil. Agreement among different methods was 100% for K. pneumoniae and Proteus spp. In Escherichia coli, agreement for Vitek and disk-diffusion were 0 and 50% respectively. Susceptibility to first generation cephalosporins in E. coli should be determined with cefazolin. Agreement between cefazolin and cefadroxil suggests that cefazolin could also predict the susceptibility of cefadroxil.

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