Barriers and facilitators to mental health promotion for Mexican immigrants in the U.S. through the Ventanillas de Salud program

IntroductionMental health promotion and screenings are recommended as part of standard preventive care. Mexican immigrants in the U.S. are at high risk for mental health illness especially after the COVID-19 pandemic, however access to mental health prevention for this population has been limited, which results in important implementation and equity gaps. The Ventanilla de Salud (VDS) program provides preventive services through Mexican consulates in the U.S.ObjectiveThe objective of this study was to assess capability, opportunity, and motivation for promotores to implement mental health programming through the VDS, leveraging early experiences of ongoing mental health prevention efforts.MethodsThis was a qualitative study using the Capability, Opportunity, and Motivation for Behavior Change model (COM-B). We conducted 9 focus groups with 40 VDS promotores and 6 semi-structured interviews with program stakeholders. Data were analyzed using inductive and deductive coding.ResultsWe found high levels of interest from the leadership, partners, and promotores to provide mental health services through the VDS. Early implementation of a mental health strategy that included training sessions for promotores and mental health promotion, screenings and referrals for VDS users was ongoing. We identified facilitators and barriers that could affect capability, opportunity, and motivation to provide mental health services. Facilitators included promotores’ extensive knowledge about the importance of mental health, promotores service mindset and commitment to provide services to VDS users, and general support from the VDS network and partners. Barriers included promotores’ turnover, need for additional economic compensation, burnout, competing priorities, and lack of mental health professionals to provide clinical services or supervision. Additional investments are recommended to support promotores’ well-being.ConclusionThe main lesson learned from this study was that investing in VDS promotores’ training, resources, and well-being is key to their capability, opportunity and motivation to provide mental health services for Mexican immigrants in the US. Results from this study can be applied to improve the ongoing VDS mental health strategy and increase its impact on the mental health of Mexican immigrants

O fenômeno da violência de gênero à mulher a partir da produção científica da enfermagem

In order to identify and analyze the scientific production in the area of nursing on violence against women in the period from 2000 to 2009, a study was made of scientific literature in which the first page of nursing journals of the Virtual Health Library of Brazil was consulted. Based on the criteria of inclusion, 10 publications that explicitly described the relationship of gender violence and its implications in w omen’s care were identified. On considering the thematic analysis, four categories emerged: attempts to quantify and explain the phenomenon of violence; phenomenon related to the health professional; the learning of violence and the relationship with a partner. The knowledge acquired offers a view from nurse’s perspective on the analyzed topic; however, the study does not manage to outline a complete perspective of care, which stimulates the production of other studies on this subject.Con el objetivo de identificar y analizar la producción científica de Enfermería sobre la violencia contra la mujer en el período 2000 a 2009, se realizó una revisión de la literatura científica en el portal de revistas de enfermería de la Biblioteca Virtual en Salud de Brasil. A partir de los criterios de inclusión, fueron identificadas 10 publicaciones que describían explícitamente la relación de la violencia de género y sus implicaciones en el cuidado de la mujer. A partir del análisis temático de los artículos se obtuvieron cuatro categorías: intentar cuantificar y explicar el fenómeno de la violencia; el fenómeno relacionado con el profesional de la salud; el aprendizaje de la violencia, y la relación con el compañero. El conocimiento obtenido sobre el tema en estudio da una visión desde la perspectiva de la enfermera, sin embargo, no aborda de lleno la perspectiva del cuidado, lo que estimula a la producción de otros estudios sobre este tema.Com o objetivo de identificar e analisar a produção científica na área da enfermagem sobre violência contra a mulher no período de 2000 a 2009, realizou-se uma revisão bibliográfica da produção científica consultando o portal de revistas de enfermagem da Biblioteca Virtual em Saúde do Brasil. A partir dos critérios de inclusão, foram identificadas 10 publicações que descreviam explicitamente a relação da violência de gênero e suas implicações no cuidado à mulher. A partir da análise temática, emergiram quatro categorias: tentativa de quantificar e explicar o fenômeno da violência; fenômeno relacionado ao profissional de saúde; a aprendizagem da violência e a relação com o companheiro.O conhecimento obtido oferece uma visão desde a perspectiva da enfermeira sobre o tema em estudo, entretanto não aborda por completo a perspectiva do cuidado, o que estimula a produção de outros estudos nesta temática

Options. Journal of the UNAB Financial Engineering Program. Volume 5 No.9 June 2011

Las nuevas exigencias y formas de acción en los escenarios empresariales financieros han llevado al programa de Ingeniería Financiera a repensar metódicamente su naturaleza y objetivos, a construirprocesos académicos y ambientes de enseñanza-aprendizaje flexibles que posibiliten el desarrollo de competencias personales y profesionales. La reflexión y contextualización del medio colombiano y su relación con la economía y mercados internacionales son propósitos continuos en el programa.Editorial. - 5 Las operaciones de mercado abierto oma instrumento eficaz para el control de la base monetaria: trasegar histórico y pertinencia actual. -7 Propuesta de un índice bursátil para el mercado integrado latinoamericano (mila). - 29 Mecanismo de inversión y financiación a través de los certificados de reducción de emisiones de co2 (cer) aplicado a Colombia. - 43 Mercados derivados: Naturaleza jurídica del contrato de opción frente a otros negocios jurídicos. - 61The new demands and forms of action in the financial business scenarios have led the Financial Engineering program to methodically rethink its nature and objectives, to build academic processes and flexible teaching-learning environments that enable the development of personal and professional skills. The reflection and contextualization of the Colombian environment and its relationship with the economy and international markets are continuous purposes in the program

Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines

Background: Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools. Methods: Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, see Supplementary data) concluded the following: Results: Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50–200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico. Conclusions: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Guía de práctica clínica para la prevención, diagnóstico, tratamiento y rehabilitación de la falla cardiaca en población mayor de 18 años, clasificación B, C y D

La falla cardíaca es un síndrome clínico caracterizado por síntomas y signos típicos de insuficiencia cardíaca, adicional a la evidencia objetiva de una anomalía estructural o funcional del corazón. Guía completa 2016. Guía No. 53Población mayor de 18 añosN/

La entrevista clínica: opción para indagar el aprendizaje de límites y continuidad

El proyecto consistió en aplicar una propuesta didáctica con actividades apoyadas en las Tecnologías de la Información y Comunicación para el trabajo en el aula y fuera de ella, con videos explicativos, el trabajo colaborativo y el software WinPlot, para el aprendizaje de los conceptos de límites y continuidad, en estudiantes de Licenciatura en Matemáticas de la Universidad Autónoma de Nayarit (UAN). En el artículo se discuten los resultados de la entrevista clínica realizada a cuatro alumnos, con diferentes calificaciones en el examen postest aplicado al final del estudio, con la finalidad de indagar sobre los procesos cognitivos que guiaron sus respuestas y tratar de descubrir o clarificar la influencia de sus razonamientos como una aportación para fortalecer el efecto positivo de la propuesta, conclusión lograda a partir del análisis estadístico del estudio y de las actividades realizadas.AbstractThe project consisted of applying a didactic proposal supported with information and communication technologies for work in the classroom and beyond, with explanatory videos, collaborative work and WinPlot software for learning the concepts of limits activities and continuity in student’s degree in Mathematics from the Autonomous University of Nayarit (UAN). In the article the results of the clinical interview with four students, with different scores on the posttest exam given at the end of the study, in order to investigate the cognitive processes that guided their answers and try to discover or clarify discussed, the influence their reasoning as an input to strengthen the positive impact of the proposal, successful conclusion from statistical analysis of the study and activities.Recibido: 23 de febrero de 2015Aceptado: 24 de junio de 201

EXPLORATORY PRACTICE AND NEW LITERACY STUDIES: BUILDING EPISTEMOLOGICAL CONNECTIONS

In this paper, we present Exploratory Practice, a critical-reflexive approach to teaching-learning languages and to research, which focuses on quality of classroom life as its main tenet. We understand that the discussions which have been in progress in the area of literacy studies are also of interest to language teachers and learners as exploratory practitioners. According to Miller (2013) and Moraes Bezerra (2012, 2014, 2015), practitioners’ pedagogical work must be directed to the meaning-making possibilities which can empower language users and can contribute to reinventing the social world. We make some theoretical considerations on Exploratory Practice (ALLWRIGHT & HANKS, 2009; MILLER, 2009), as well as on the New Literacy Studies proposal (GEE, 2000; STREET, 2003, 2005; LEA & STREET, 2006; STREET, 2009), to help us establish a dialogue between both areas. In order to best reflect on this dialogue, we present a teaching-learning experience developed with the help of college students who are in the initial teacher education process of becoming teachers of English as a foreign language