Construction of an intercultural care program for international migrants in northwestern Mexico.

OBJECTIVE: To describe the construction process of an intercultural care program for international migrants in northwestern Mexico. METHOD: Report of professional experiences, according to what was suggested by Daltro and Faria. RESULTS: The development and evolution of care for international migrants has favored the elaboration of a community-like Social Service Program for students of a public university in northwestern Mexico, so that intercultural health and health care for this population become part of the curricular training of the new generations of nursing graduates, in a context in which international migration is a topic of great social and cultural relevance. CONCLUSION: The construction and application of the Salud-Migrante program will enhance compliance with international recommendations on universal health for migrants, promoting respect for identity and cultural diversity in their actions.

Construction of an intercultural care program for international migrants in northwestern Mexico / Construção de um programa de atenção intercultural para migrantes internacionais no noroeste do México / Construcción de un programa de cuidado intercultural para personas migrantes internacionales en el noroeste de México

ABSTRACT Objective: To describe the construction process of an intercultural care program for international migrants in northwestern Mexico. Method: Report of professional experiences, according to what was suggested by Daltro and Faria. Results: The development and evolution of care for international migrants has favored the elaboration of a community-like Social Service Program for students of a public university in northwestern Mexico, so that intercultural health and health care for this population become part of the curricular training of the new generations of nursing graduates, in a context in which international migration is a topic of great social and cultural relevance. Conclusion: The construction and application of the Salud-Migrante program will enhance compliance with international recommendations on universal health for migrants, promoting respect for identity and cultural diversity in their actions.

RESUMO Objetivo: Descrever o processo de construção de um programa de atendimento intercultural para migrantes internacionais no noroeste do México. Método: Relato de experiências profissionais, conforme sugerido por Daltro e Faria. Resultados: O desenvolvimento e a evolução do atendimento aos migrantes internacionais favoreceu a estruturação de um Programa de Serviço Social de tipo comunitário para estudantes de uma universidade pública do noroeste do México, de modo que a saúde intercultural e a atenção à saúde dessa população tornem-se parte da formação curricular do novas gerações de graduados em enfermagem, em um contexto em que a migração internacional é um tema de grande relevância social e cultural. Conclusão: A construção e aplicação do programa Salud-Migrante fortalecerá o cumprimento das recomendações internacionais sobre saúde universal para migrantes, promovendo o respeito à identidade e à diversidade cultural em suas ações.

RESUMEN Objetivo: Describir el proceso de construcción de un programa de cuidado intercultural a personas migrantes internacionales en el noroeste de México. Método: Relato de experiencias profesionales, acorde a lo sugerido por Daltro y Faria. Resultados: El desarrollo y evolución del cuidado a personas migrantes internacionales ha favorecido la estructuración de un Programa de Servicio Social de tipo comunitario para estudiantes de una universidad pública en el noroeste de México, por lo que la salud intercultural y el cuidado a la salud a esta población se vuelve parte en la formación curricular de las nuevas generaciones de licenciados en enfermería, en un contexto en que la migración internacional es tema de gran relevancia social y cultural. Conclusión: La construcción y aplicación del programa Salud-Migrante fortalecerán el cumplimiento de las recomendaciones internacionales en materia de salud universal para personas migrantes, promoviendo en sus acciones el respeto a la identidad y diversidad cultural.

Prevalência de doenças crônicas não transmissíveis em pessoas vivendo com HIV / Prevalencia de enfermedades crónicas no transmisibles en personas que viven con el VIH / Prevalence of chronic non-communicable diseases in people living with HIV

Resumo Objetivo Identificar a prevalência de doenças crônicas não transmissíveis e fatores associados em pessoas vivendo com HIV (PVHIV). Métodos Trata-se de um estudo transversal retrospectivo realizado por meio de uma análise secundária dos dados coletados entre outubro de 2014 a maio de 2018. O banco analisado incluiu amostra de 550 pessoas, provenientes de cinco Serviços de Atendimento Especializado. Foi realizado teste qui-quadrado, Odds Ratio (OR), Razão de Prevalência (RP) e seus respectivos Intervalos de Confiança (IC) de 95%, teste de Wald da estimativa e valor p<0,05. Resultados As doenças crônicas não transmissíveis mais prevalentes foram hipertensão arterial (17,89%), diabetes mellitus (7,51%) e Doença Renal Crônica (4,83%). Ter doença crônica foi associado ao sexo feminino (RP=1,18, OR=1,3, p=0,022), idade maior que 45 anos (RP=2,15, OR=6,36, p=0,001), tempo de estudo menor ou igual a oito anos (RP=1,23, OR=1,92, p=0,005), ter dislipidemia (RP=1,16, OR=2,01, p=0,001), carga viral detectável (RP=2,32, OR=2,59, p=0,001) e a contagem de células TCD4+ menor que 350 células/mm3 (RP=1,5, OR= 1,6, p=0,019), o padrão se repetiu com a razão de prevalência. Conclusão Identificou-se alta prevalência de doenças crônicas não transmissíveis entre pessoas vivendo com HIV e diversos fatores associados, considerando assim uma exposição multifatorial. Neste contexto, ressalta-se o importante papel da equipe multiprofissional na prevenção das comorbidades.

Resumen Objetivo Identificar la prevalencia de enfermedades crónicas no transmisibles y factores asociados en personas que viven con el VIH (PVVIH). Métodos Se trata de un estudio transversal retrospectivo realizado mediante un análisis secundario de los datos recopilados entre octubre de 2014 y mayo de 2018. El banco analizado incluyó la muestra de 550 personas provenientes de cinco Servicios de Atención Especializada. Se realizó la prueba χ2 de Pearson, Odds Ratio (OR), Razón de Prevalencia (RP) y sus respectivos Intervalos de Confianza (IC) del 95 %, prueba de Wald de la estimación y valor p<0,05. Resultados Las enfermedades crónicas no transmisibles más prevalentes fueron la hipertensión arterial (17,89 %), diabetes mellitus (7,51 %) y enfermedad renal crónica (4,83 %). Padecer enfermedad crónica estuvo asociado al sexo femenino (RP=1,18, OR=1,3, p=0,022), edad superior a 45 años (RP=2,15, OR=6,36, p=0,001), tiempo de estudio inferior o igual a ocho años (RP=1,23, OR=1,92, p=0,005), padecer dislipidemia (RP=1,16, OR=2,01, p=0,001), carga viral detectable (RP=2,32, OR=2,59, p=0,001) y el recuento de células TCD4+ inferior a 350 células/mm3 (RP=1,5, OR= 1,6, p=0,019), el patrón se repitió con la razón de prevalencia. Conclusión Se Identificó alta prevalencia de enfermedades crónicas no transmisibles en personas que viven con el VIH y distintos factores asociados, considerando, de esa forma, una exposición multifactorial. En este contexto, se destaca el importante papel del equipo multiprofesional para la prevención de las comorbilidades.

Abstract Objective To identify the prevalence of chronic non-communicable diseases and associated factors in people living with HIV (PLHIV). Methods This is a retrospective cross-sectional study carried out through a secondary data analysis, collected between October 2014 and May 2018. The analyzed database included a sample of 550 people from five Specialized Care Services. Chi-square test, Odds Ratio (OR), Prevalence Ratio (PR) and their respective Confidence Intervals (CI) of 95%, Wald test of the estimate and p-value <0.05 were performed. Results The most prevalent chronic non-communicable diseases were hypertension (17.89%), diabetes mellitus (7.51%) and chronic kidney disease (4.83%). Having a chronic disease was associated with being female (PR=1.18, OR=1.3, p=0.022), age greater than 45 years (PR=2.15, OR=6.36, p=0.001), study time less than or equal to eight years (PR=1.23, OR=1.92, p=0.005), having dyslipidemia (PR=1.16, OR=2.01, p=0.001), detectable viral load (PR=2.32, OR=2.59, p=0.001) and TCD4+ cell count less than 350 cells/mm3 (PR=1.5, OR= 1.6, p=0.019). The pattern was repeated with the Prevalence Ratio. Conclusion A high prevalence of chronic non-communicable diseases was identified among people living with HIV and several associated factors, thus considering a multifactorial exposure. In this context, the important role of a multidisciplinary team in comorbidity prevention is emphasized.

Prevención primaria del VIH en población inmigrante: análisis de concepto / Prevenção primária do HIV na população imigrante: análise conceitual / Primary HIV prevention in the immigrant population: concept analysis

The strategies established for HIV prevention directed at immigrant populations are diverse and not very specific about the characteristics of these groups. Objective: To analyze the concept of "primary prevention of HIV in the immigrant population". Methodology: The steps suggested by Walker and Avant were followed, so a structured review of the literature in dictionariesand databases (Embase, Pubmed and Ebsco) was carried out. Results: There is no evidence of theexistence of a definition on the specific term, so a proposal is made that encompasses the strategiesidentified in the literature, specific in this population. Conclusions: primary prevention of HIV inmigrants is identified as a great opportunity to strengthen coverage of universal access to vulnerablepopulations, as well as being a complex process that requires a multidisciplinary approach in structural, biomedical and behavioral areas that are developed with the axis being adaptations to cultural needs. (AU)

Las estrategias establecidas para la prevención de VIH dirigidas a poblaciones inmigrantes, son diversas y poco específicas sobre las características de estos grupos. Objetivo: Analizar elconcepto de “prevención primaria del VIH en población inmigrante”. Metodología: Se siguieron lospasos sugeridos por Walker y Avant, por lo que Se realizó una revisión estructurada de la literaturaen diccionarios y bases de datos (Embase, Pubmed y Ebsco). Resultados: No se reporta evidencia dela existencia de una definición sobre el termino especifico, por lo que se realiza una propuesta queenglobe las estrategias identificadas en la literatura, especifica en esta población. Conclusiones: laprevención primaria del VIH en migrantes se identifica como una gran oportunidad para fortalecerla cobertura de acceso universal a poblaciones vulnerables, además de ser un proceso complejo querequiere de un abordaje multidisciplinario en esferas estructurales, biomédicas y conductuales quese desarrollen con el eje ser de adaptaciones a las necesidades culturales. (AU)

As estratégias estabelecidas para a prevenção do HIV direcionadas às populações imigrantes são diversas e pouco específicas sobre as características desses grupos. Objetivo: Analisar o conceito de "prevenção primária do HIV na população imigrante". Metodologia: Foram seguidas asetapas sugeridas por Walker e Avant, sendo realizada uma revisão estruturada da literatura emdicionários e bancos de dados (Embase, Pubmed e Ebsco. Resultados: Não há evidências da existência de uma definição sobre o termo específico, portanto é feita uma proposta que engloba as estratégias identificadas na literatura, específicas nessa população. Conclusões: A prevenção primária doHIV em migrantes é identificada como uma grande oportunidade para fortalecer a cobertura doacesso universal a populações vulneráveis, além de ser um processo complexo que requer uma abordagem multidisciplinar em áreas estruturais, biomédicas e comportamentais desenvolvidas com oeixo sendo adaptações às necessidades culturais. (AU)

Percepciones sobre el uso del condón en migrantes haitianos en la frontera noroeste de México / Perceptions of condom use in Haitian migrants on the northwestern border of México

Resumen Objetivo: Identificar las percepciones sobre el uso de condón en migrantes haitianos en la frontera noroeste de México. Materiales y métodos: Estudio de enfoque cualitativo y diseño etnográfico, en el abordo a siete migrantes haitianos en la zona fronteriza de la ciudad de Mexicali, Baja California, México, con quienes se desarrolló una entrevista semiestructurada, la información fue analizada por el programa NVivo, para comprender frecuencia y estructura de los datos; posteriormente se realizó un proceso de categorización, interpretación y teorización del fenómeno de estudio. De un total de 281 unidades de análisis, se realizó un proceso de categorización, que permitió estructurar dos categorías, seis subcategorías y 12 códigos. Resultados: Se identifica que el uso del condón en migrantes haitianos, es interpretado como un elemento de protección a la salud sexual en la prevención de embarazos no planeados; no obstante, se identifican barreras y consecuencias del uso a nivel personal, cultural y religioso. La construcción de la idea de usarlo, recae en el tipo de relación y nivel de confianza que se tiene de la pareja sexual por lo que estar casado o vivir en concubinato, exime de la obligación o del compromiso social de usar el condón. Así mismo la idea de protección, no refleja la preocupación sobre la transmisión de las ITS. Conclusiones: El condón se percibe como un elemento de importancia para la prevención de embarazos no planeados y del VIH, sin embargo, la presencia de factores personales, sensoriales e ideológicos limitan el uso constante del condón; por lo que el desarrollo de intervenciones culturalmente adaptadas, a la población de migrantes haitianos, en el contexto de la frontera norte de México, pueden fortalecer el uso del condón y la prevención del VIH

Abstract Objective: To identify the perceptions of condom use in Haitian migrants in the northwestern border of Mexico. Materials and methods: Study with a qualitative approach and ethnographic design, on board seven Haitian migrants in the border area of the city of Mexicali, Baja California, Mexico, with whom a semi-structured interview was developed, the information was analyzed by the NVivo program, to understand the frequency and structure of the data; later a process of categorization, interpretation and theorization of the study phenomenon was carried out. Out of a total of 281 units of analysis, a categorization process was carried out, which made it possible to structure two categories, six subcategories and 12 codes. Results: It is identified that the use of condoms in Haitian migrants is interpreted as an element of protection of sexual health in the prevention of unplanned pregnancies; however, barriers and consequences of use are identified on a personal, cultural and religious level. The construction of the idea of using it relies on the type of relationship and level of trust that one has in the sexual partner, so being married or living in a common-law relationship exempts the obligation or social commitment of using the condom. Likewise, the idea of protection does not reflect the concern about the transmission of STIs. Conclusions: The condom is perceived as an important element for the prevention of unintended pregnancies and HIV, however, the presence of personal, sensory and ideological factors limit the constant use of the condom; Therefore, the development of culturally adapted interventions for the Haitian migrant population, in the context of the northern border of Mexico, can strengthen condom use and HIV prevention.

Evaluating the patient experience of an emergency burns assessment service in a UK burn unit using a service user evaluation questionnaire and process mapping.

An evaluation of the patient experience, from referral to first assessment, at an outpatient emergency burns assessment service in a UK burn unit. All patients attending their first appointment were invited to complete a questionnaire, covering patient expectations following referral, their journey to the hospital and an evaluation of the appointment. Process mapping was used to map the patient journey within the department and identify functional bottlenecks and waits. 35 new patients completed the questionnaire over a four-week period in February 2019. 70% of respondents had received no printed information about their condition or the hospital prior to the appointment and 28% of patients did not know what to expect from attending the clinic. Patients incurred high direct and indirect costs in order to attend their appointments. 86% patients felt more confident about looking after their injury following their appointment. The patient journey through the clinic was observed for 19 patients; four functional bottlenecks were identified. The longest waits were for clinical photography and completion of nursing paperwork. A multimodal approach to this quality improvement project has enabled the service to identify process bottlenecks and through consultation with stakeholders, develop staff training and patient information to improve the service.

The case for rejecting the memristor as a fundamental circuit element.

The memory resistor with the moniker memristor was a harmless postulate in 1971. Since 2008 a device that claims to be the memristor is on the prowl, seeking recognition as a fundamental circuit element, sometimes wanting electronics textbooks to be rewritten, always promising remarkable digital, analog and neuromorphic computing possibilities. A systematic discussion about the fundamental nature of the device is almost absent within the memristor community. Advocates use incomplete constitutive relationships, ignore concepts of activity/passivity and aver that nonlinearity is central to their case. Few researchers have examined these claims. Our report investigates the assertion that the memristor is a fundamental passive circuit element, from the fresh perspective that electrical engineering is the science of charge management. We demonstrate with a periodic table of fundamental elements that the 2008 memristor is not the 1971 postulate and neither of them is fundamental. The ideal memristor is an unphysical active device and any physically realizable memristor is a nonlinear composition of resistors with active hysteresis. We also show that there exists only three fundamental passive circuit elements.

Quasi-linear vacancy dynamics modeling and circuit analysis of the bipolar memristor.

The quasi-linear transport equation is investigated for modeling the bipolar memory resistor. The solution accommodates vacancy and circuit level perspectives on memristance. For the first time in literature the component resistors that constitute the contemporary dual variable resistor circuit model are quantified using vacancy parameters and derived from a governing partial differential equation. The model describes known memristor dynamics even as it generates new insight about vacancy migration, bottlenecks to switching speed and elucidates subtle relationships between switching resistance range and device parameters. The model is shown to comply with Chua's generalized equations for the memristor. Independent experimental results are used throughout, to validate the insights obtained from the model. The paper concludes by implementing a memristor-capacitor filter and compares its performance to a reference resistor-capacitor filter to demonstrate that the model is usable for practical circuit analysis.

Vaccination of calves with Mycobacteria bovis Bacilli Calmete Guerin (BCG) induced rapid increase in the proportion of peripheral blood gammadelta T cells.

Changes in the proportion of peripheral blood T cell subsets after subcutaneous inoculation of cattle with Mycobacterium bovis Bacille Calmette-Guerin (BCG) were studied. Calves were injected with approximately 8 x 10(6) BCG bacillus and blood samples collected at weekly intervals for flow-cytometric analyses to determine the proportion of CD4+, CD8+ and gammadelta T cells. In addition, whole blood samples were stimulated in vitro with M. bovis purified protein derivative (PPD) and the secreted IFN-gamma quantified by ELISA. Results showed cellular and cytokine changes which could be categorized into three phases. The first phase occurred within the first 2 weeks after vaccination involving an increase in proportion of WC1+ gammadelta T cells and a concomitant increase in the secretion of IFN-gamma. These two responses peaked at 2 weeks and waned thereafter. The second phase involved an increase in the CD4/CD8 ratio as a result of an increase in the proportion of CD4+ T cells between 4 and 6 weeks. The third phase involved a decrease in the CD4/CD8 ratio due to an increase in the proportion of CD8+ T cells between 8 and 10 weeks. Surprisingly, the IFN-gamma response was associated with changes in the gammadelta rather than the CD4+ or CD8+ T cells, suggesting that this cytokine was secreted by gammadelta-T cells. These results are consistent with the reported ability of gammadelta T cells to act rapidly and bridging the innate and classically adaptive immune responses.

Toll-like receptor 2 (TLR2) polymorphisms are associated with reversal reaction in leprosy.

BACKGROUND: Leprosy is characterized by a spectrum of clinical manifestations that depend on the type of immune response against the pathogen. Patients may undergo immunological changes known as "reactional states" (reversal reaction and erythema nodosum leprosum) that result in major clinical deterioration. The goal of the present study was to assess the effect of Toll-like receptor 2 (TLR2) polymorphisms on susceptibility to and clinical presentation of leprosy. METHODS: Three polymorphisms in TLR2 (597C-->T, 1350T-->C, and a microsatellite marker) were analyzed in 431 Ethiopian patients with leprosy and 187 control subjects. The polymorphism-associated risk of developing leprosy, lepromatous (vs. tuberculoid) leprosy, and leprosy reactions was assessed by multivariate logistic regression models. RESULTS: The microsatellite and the 597C-->T polymorphisms both influenced susceptibility to reversal reaction. Although the 597T allele had a protective effect (odds ratio [OR], 0.34 [95% confidence interval {CI}, 0.17-0.68]; P= .002 under the dominant model), homozygosity for the 280-bp allelic length of the microsatellite strongly increased the risk of reversal reaction (OR, 5.83 [95% CI, 1.98-17.15]; P= .001 under the recessive model). These associations were consistent among 3 different ethnic groups. CONCLUSIONS: These data suggest a significant role for TLR-2 in the occurrence of leprosy reversal reaction and provide new insights into the immunogenetics of the disease.

Reducing staff injuries and violence in a forensic psychiatric setting.

Despite the attention given to the issue of violence in the psychiatric literature, very little progress has been made towards improving our understanding of violence by the mentally ill and programs aimed at the prevention of violence are rare. This report describes the administrative and clinical efforts of the staff in a maximum security psychiatric facility when addressing an alarming increase in violence and serious staff injuries. Evaluation data include measures of aggression and violence, seclusion and restraint data, staff injuries, and incident report data.