“NIVEL DE RESILIENCIA Y RELACIONES INTRAFAMILIARES EN LOS PACIENTES CON VIH DE RECIÉN DIAGNÓSTICO EN EL PRIMER NIVEL DE ATENCIÓN EN EL AÑO 2015”

I.- RESUMEN ESTRUCTURADO “Nivel de resiliencia y relaciones intrafamiliares en los pacientes con VIH de recién diagnóstico en el primer nivel de atención en el año 2015” Autores: *Pacheco Rueda Paola, **Reyes Jiménez Olivia INTRODUCCIÓN: Laresiliencia es la capacidad de una persona que engloba factores ambientales y personales con los cuales el sujeto afronta y supera las adversidades que acontecen en su vida. Las relaciones intrafamiliaresson expresiones o maniobras a las que se recurre reiteradamente por parte de dos o más miembros de la familia con un significado o intención, son consideradas como las unidades del sistema familiar.OBJETIVO GENERAL: Conocer el nivel de resiliencia y las relaciones intrafamiliares que presentan los pacientes con VIH de recién diagnóstico en el primer nivel de atención.MATERIAL Y MÉTODOS: Diseño descriptivo, observacional, transversal, prospectivo, muestreo a conveniencia, en 50 pacientes mayores de 18 años, aplicando la escala de Resiliencia de Wagnild y Young así como también la escala de Relaciones Intrafamiliares.RESULTADOS: La media de edad 34.4, moda de 24, 26, 31, 33 y 38, mediana 32.5, el sexo predominante masculino 74%, estado civil 30% casados, ocupación profesionistas 62%, escolaridad licenciatura 70%, tipología familiar nuclear 72%, religión católica 84%. El nivel de resiliencia fue alta 68%, las relaciones intrafamiliares alta 62%. CONCLUSIONES: Se observó que mientras mayor sean las relaciones entre la familia, tienen un nivel más alto de resiliencia, por lo tanto se pueden crear más redes de apoyo entre ellos para beneficio de los pacientes con VIH

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic.

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world

FUNCIONALIDAD FAMILIAR Y GRADO DE DETERIORO COGNITIVO DEL ADULTO MAYOR PENSIONADO DE LA UMF 92 EN EL AÑO 2015

RESUMEN Introducción: Disfunción familiar y deterioro cognitivo son problemas frecuentes durante la vejez; El buen o mal funcionamiento familiar es un factor determinante en la aparición de la enfermedad entre sus miembros. La función cognitiva es el conjunto de operaciones mentales que se efectúan mediante la interpretación perceptual de estímulos para transferirla a una respuesta o conducta de desempeño. Objetivo: Identificar la funcionalidad familiar y grado de deterioro cognitivo del adulto mayor pensionado en UMF 92. Material y métodos: Muestra no probabilística, no aleatorizada a conveniencia de adultos mayores pensionados se utilizara la escala de Efectividad en el Funcionamiento familiar E-EFF) y el Examen mini mental de Folstein para identificar el grado de deterioro cognitivo. Resultados. Se realizó un estudio tipo observacional, transversal y descriptivo en un tamaño de muestra de 115 adultos mayores pensionados 89 hombres y 26 mujeres. La edad más frecuente entre 71 a 80 años. Estado civil casados un 62%, escolaridad primaria siendo mayoría con un 41%. Familia funcional 78%, funcionalidad moderada 21%, disfuncional 1%. Deterioro cognitivo normal 16%, deterioro cognitivo leve 68% deterioro moderado 13%, severo en 3%. Conclusiones. En este estudio se muestra que a mayor funcionalidad familiar menor grado de deterioro cognitivo lo que coincide con otros autores. Los pacientes participantes en el estudio integran familias funcionales en su mayoría; su condición tanto de salud como el mismo proceso de envejecimiento y las alteraciones cognitivas, son factores que contribuyen en su calidad de vida y funcionalidad familiar. Palabras clave: funcionalidad familiar, deterioro cognitivo, adulto mayor pensionad