Primary health care as a space for the integration of university substantive processes

The substantive processes of medical education represent a challenge to meet the social commitment of universities. It implies achieving quality in its management, satisfaction with the comprehensive training of students and the care provided to the population. The training process in health sciences has particularities in the context of primary health care, which is a field of action par excellence for the application of research and the solution of health problems in the communities. To strengthen the knowledge and skills of the profession, integrated processes and efficient academic management are required. This article aims to argue the relevance of primary health care for the integration of substantive processes; it is based on the particularities of this health context. It is concluded that primary health care is the adequate space for the integration of substantive processes, which generate innovative proposals, leading to the solution of health problems of individuals, families and the community

Modelo para la evaluación de la profesionalización de los docentes de enfermería y tecnología

Introducción:La profesionalización de los docentes constituye una tarea para las Universidades médicas en Cuba y el mundo. Los adelantos informáticos y el desarrollo de los medios de enseñanza hacen necesaria la evaluación de estos profesionales de la salud.Objetivo:Diseñar un modelo para la evaluación de la profesionalización de los docentes de enfermería y tecnología de la salud.Métodos:Se realizó un estudio descriptivo, prospectivo, en la Facultad de Enfermería-Tecnología de la Salud de la Universidad de Ciencias Médicas de Santiago de Cuba. Se declaró como única variable, la profesionalización de los docentes de enfermería y tecnología. El universo de estudio fueron 144 docentes, 11 jefes de departamentos como evaluadores, y se seleccionaron de forma aleatoria 74 docentes, los evaluados; en la implementación participaron los 144 docentes en activo. Se aplicó una escala de actitud para el grado de satisfacción con el modelo.Resultados:El Modelo para la evaluación constó de dos niveles: Nivel No.1 Evaluación de la profesionalización y Nivel No.2 La implementación de la estrategia de profesionalización. La valoración general del modelo por los evaluadores fue de 95.58 % como óptimamente satisfactorio y 4.42 % de satisfactorio. La utilización del Modelo para la evaluación de la profesionalización fue valorada por los docentes como ¨algo adecuado¨.Conclusiones:El modelo para la evaluación de la profesionalización de los docentes de enfermería y tecnología diseñado, posibilita el desarrollo de la profesionalización de los docentes de la Universidad de Ciencias Médicas de Santiago de Cuba a partir de sus dos niveles

Invariant procedural skills for diagnosis and treatment of postoperative peritonitis

Introduction: invariant procedural skills in postoperative peritonitis allow surgeons an early diagnosis and the performance of urgent abdominal resurgery. Objective: to design invariant procedural skills to be implemented for surgeons on the diagnostic and therapeutic care of postoperative peritonitis. Method: a qualitative research was conducted at the Hospital Clínico Quirúrgico "Ambrosio Grillo" of Santiago de Cuba in the quarter period of May-July 2022. The study population consisted of 33 specialists on postoperative peritonitis: 22 physicians (12 surgeons and 10 intensivists) and 11 graduated bachelor in nursing. Systematization was used as the theoretical method and the empirical methods used were the document analysis supported with the review of clinical histories and the observation with the main author's attentional-teaching practice. Results: it was designed an invariant procedural skills for the early diagnosis and therapy of postoperative peritonitis with special emphasis on the clinical method. The self-preparation on the subject makes possible the complementation of both knowledge and skills learned, as well as an update of knowledge that guarantees the surgical clinical care of these complex patients. Conclusions: the design of invariant procedural skills for the early diagnosis and therapy of postoperative peritonitis in the necessary permanent and continuous knowledge improvement of surgeons represents a care-teaching tool that contributes to improve the professional performance at the time to attend to this type of patient

Intervención comunitaria como pesquisa preventiva para la malnutrición en niños en edad escolar

Objetivo: Determinar la valoración nutricional de los niños de una escuela rural de la zona Mazahua del norte del Estado de México. Material y métodos: Estudio descriptivo transversal basado en una valoración antropométrica y actividades didácticas sobre hábitos alimentarios a 185 escolares (población del estudio) de entre siete y 11 años de una escuela rural de la zona Mazahua del norte del Estado de México, de septiembre a noviembre de 2022; el estudio se realizó en el total de la población. Resultados: La valoración del índice de masa corporal predominante fue normal, destacándose este dato en los niños de sexto grado; seguido de la malnutrición por defecto, destacándose este fenómeno en los niños de segundo grado. En cuanto al completamiento de roles familiares, se obtuvo el predominio de hogares con madres o padres solteros para 76 niños (42,22 %). En cuanto al nivel escolar se obtuvo que solo 26 tutores (14,4 %) poseían nivel de preparatoria y 9 de los tutores (5 %), nivel universitario. Sobre el nivel de preferencia de los niños, en cuanto a los alimentos, prevalecieron los granos integrales (el pan y pizzas) en 162 niños (90 %). Conclusión: La actividad interventora permitió demostrar que la malnutrición continúa siendo un problema de salud de nuestras comunidades infantiles, determinada por la selección inadecuada de los alimentos, el inadecuado complimiento de roles en los hogares y el bajo nivel educacional de padres y tutores

Pharmaceutical and Botanical Management of Pain Associated with Psychopathology: A Narrative Review

Generally, pain can be described as an unpleasant sensory or emotional experience associated with tissue damage. Chronic pain has become a public health problem because among 35 and 75% of the world population has shown the symptom. In particular, neuropathic pain has shown high comorbidity disorders such as anxiety and depression. Conventional therapies for treating pain include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, tricyclic antidepressants, anticonvulsants, and opioids, which usually cause some side effects such as gastritis, headache, liver and kidney toxicity, and drug dependence. Conventional pharmaceuticals also tend to be expensive, and they cannot be easily afforded in developing countries, which have led to the use of natural products as an alternative treatment. In this chapter, we reviewed the current research of natural products for pain treatment. We also describe preclinical studies that assess the effect of some natural products on pain therapy, phytochemistry research, toxicity, adverse effects, and biosecurity. We also describe how conventional pain is managed and the possible use of compounds obtained from vegetable species for pain treatment

The Effect of Physical Activity and High Body Mass Index on Health-Related Quality of Life in Individuals with Metabolic Syndrome

[EN] The main objective of this study was to examine the relationship between the level of physical activity (PA) and the degree of obesity with health-related quality of life (HRQoL) in individuals with metabolic syndrome (MetS) who participated in the Predimed-Plus study. A total of 6875 subjects between 55 and 75 years of age with MetS were selected and randomized in 23 Spanish centers. Subjects were classified according to categories of body mass index (BMI). PA was measured with the validated Registre Gironi del Cor (REGICOR) questionnaire and subjects were classified according to their PA level (light, moderate, vigorous) and the HRQoL was measured with the validated short-form 36 (SF-36) questionnaire. By using the ANOVA model, we found a positive and statistically significant association between the level of PA and the HRQoL (aggregated physical and mental dimensions p < 0.001), but a negative association with higher BMI in aggregated physical dimensions p < 0.001. Furthermore, women obtained lower scores compared with men, more five points in all fields of SF-36. Therefore, it is essential to promote PA and body weight control from primary care consultations to improve HRQoL, paying special attention to the differences that sex incurs.SIThe Predimed-Plus trial was supported by the Spanish government’s official funding agency for biomedical research, ISCIII, through the Fondo de Investigación para la Salud (FIS), which is co-funded by the European Regional Development Fund (three coordinated FIS projects led by Jordi Salas-Salvadó and Josep Vidal, including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/0147, PI14/00636, PI14/00972, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926, PI19/00957, PI19/00386, PI19/00309, PI19/01032, PI19/00576, PI19/00017, PI19/01226, PI19/00781, PI19/01560, PI19/01,332), the Special Action Project entitled: Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-PLUS grant to Jordi Salas-Salvadó, the European Research Council (Advanced Research Grant 2013–2018; 340918) grant to Miguel Ángel Martínez-Gonzalez, the Recercaixa grant to Jordi Salas-Salvadó (2013ACUP00194), grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013; PS0358/2016; PI0137/2018), the PROMETEO/2017/017 grant from the Generalitat Valenciana, the SEMERGEN grant and FEDER funds (CB06/03 and CB12/03), Olga Castaner is funded by the JR17/00,022 grant, ISCIII. Christopher Papandreou is supported by a postdoctoral fellowship granted by the Autonomous Government of Catalonia (PERIS 2016–2020 Incorporació de Científics i Tecnòlegs, SLT002/0016/00,428). María Rosa Bernal-Lopez was supported by “Miguel Servet Type I” program (CP15/00028) from the ISCIII-Madrid (Spain), cofinanced by the Fondo Europeo de Desarrollo Regional-FEDER, Ignacio M.Giménez-Alba is supported by a FPU predoctoral contract (reference FPU18/01703) from the Ministerio de Ciencia, Innovación y Universidades, Spain

An Energy-Reduced Mediterranean Diet, Physical Activity, and Body Composition

[ENG]Importance Strategies targeting body composition may help prevent chronic diseases in persons with excess weight, but randomized clinical trials evaluating lifestyle interventions have rarely reported effects on directly quantified body composition. OBJECTIVE To evaluate the effects of a lifestyle weight-loss intervention on changes in overall and regional body composition. DESIGN, SETTING, AND PARTICIPANTS The ongoing Prevención con Dieta Mediterránea-Plus (PREDIMED-Plus) randomized clinical trial is designed to test the effect of the intervention on cardiovascular disease prevention after 8 years of follow-up. The trial is being conducted in 23 Spanish research centers and includes men and women (age 55-75 years) with body mass index between 27 and 40 and metabolic syndrome. The trial reported herein is an interim subgroup analysis of the intermediate outcome body composition after 3-year follow-up, and data analysis was conducted from February 1 to November 30, 2022. Of 6874 total PREDIMED-Plus participants, a subsample of 1521 individuals, coming from centers with access to a dual energy x-ray absorptiometry device, underwent body composition measurements at 3 time points. INTERVENTION Participants were randomly allocated to a multifactorial intervention based on an energy-reduced Mediterranean diet (MedDiet) and increased physical activity (PA) or to a control group based on usual care, with advice to follow an ad libitum MedDiet, but no physical activity promotion. MAIN OUTCOMES AND MEASURES The outcomes (continuous) were 3-year changes in total fat and lean mass (expressed as percentages of body mass) and visceral fat (in grams), tested using multivariable linear mixed-effects models. Clinical relevance of changes in body components (dichotomous) was assessed based on 5% or more improvements in baseline values, using logistic regression. Main analyses were performed in the evaluable population (completers only) and in sensitivity analyses, multiple imputation was performed to include data of participants lost to follow-up (intention-to-treat analyses). RESULTS A total of 1521 individuals were included (mean [SD] age, 65.3 [5.0] years; 52.1% men). In comparison with the control group (n=761), participants in the intervention arm (n=760) showed greater reductions in the percentage of total fat (between group differences after 1-year, −0.94% [95% CI, −1.19 to −0.69]; 3 years, −0.38% [95% CI, −0.64 to −0.12] and visceral fat storage after 1 year, -126 g [95% CI, −179 to −73.3 g]; 3 years, −70.4 g [95% CI, −126 to −15.2 g] and greater increases in the percentage of total lean mass at 1 year, 0.88% [95% CI, 0.63%-1.12%]; 3-years 0.34% [95%CI, 0.09%-0.60%]). The intervention group was more likely to show improvements of 5% or more in baseline body components (absolute risk reduction after 1 year, 13% for total fat mass, 11% for total lean mass, and 14% for visceral fat mass; after 3-years: 6% for total fat mass, 6% for total lean mass, and 8% for visceral fat mass). The number of participants needed to treat was between 12 and 17 to attain at least 1 individual with possibly clinically meaningful improvements in body composition. CONCLUSIONS AND RELEVANCE The findings of this trial suggest a weight-loss lifestyle intervention based on an energy-reduced MedDiet and physical activity significantly reduced total and visceral fat and attenuated age-related losses of lean mass in older adults with overweight or obesity and metabolic syndrome. Continued follow-up is warranted to confirm the long-term consequences of these changes on cardiovascular clinical end points.S

Risk factors for non-diabetic renal disease in diabetic patients

Background. Diabetic patients with kidney disease have a high prevalence of non-diabetic renal disease (NDRD). Renal and patient survival regarding the diagnosis of diabetic nephropathy (DN) or NDRD have not been widely studied. The aim of our study is to evaluate the prevalence of NDRD in patients with diabetes and to determine the capacity of clinical and analytical data in the prediction of NDRD. In addition, we will study renal and patient prognosis according to the renal biopsy findings in patients with diabetes. Methods. Retrospective multicentre observational study of renal biopsies performed in patients with diabetes from 2002 to 2014. Results. In total, 832 patients were included: 621 men (74.6%), mean age of 61.7 6 12.8 years, creatinine was 2.8 6 2.2 mg/dL and proteinuria 2.7 (interquartile range: 1.2–5.4) g/24 h. About 39.5% (n ¼ 329) of patients had DN, 49.6% (n ¼ 413) NDRD and 10.8% (n ¼ 90) mixed forms. The most frequent NDRD was nephroangiosclerosis (NAS) (n ¼ 87, 9.3%). In the multivariate logistic regression analysis, older age [odds ratio (OR) ¼ 1.03, 95% CI: 1.02–1.05, P < 0.001], microhaematuria (OR ¼ 1.51, 95% CI: 1.03–2.21, P ¼ 0.033) and absence of diabetic retinopathy (DR) (OR ¼ 0.28, 95% CI: 0.19–0.42, P < 0.001) were independently associated with NDRD. Kaplan–Meier analysis showed that patients with DN or mixed forms presented worse renal prognosis than NDRD (P < 0.001) and higher mortality (P ¼ 0.029). In multivariate Cox analyses, older age (P < 0.001), higher serum creatinine (P < 0.001), higher proteinuria (P < 0.001), DR (P ¼ 0.007) and DN (P < 0.001) were independent risk factors for renal replacement therapy. In addition, older age (P < 0.001), peripheral vascular disease (P ¼ 0.002), higher creatinine (P ¼ 0.01) and DN (P ¼ 0.015) were independent risk factors for mortality. Conclusions. The most frequent cause of NDRD is NAS. Elderly patients with microhaematuria and the absence of DR are the ones at risk for NDRD. Patients with DN presented worse renal prognosis and higher mortality than those with NDRD. These results suggest that in some patients with diabetes, kidney biopsy may be useful for an accurate renal diagnosis and subsequently treatment and prognosis

Valoración de las metodologías y herramientas docentes por el alumnado. Impulso del mentoring para profesores en la enseñanza online y presencial

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