A mHealth intervention to promote hand-washing and cell phone cleaning in medical residents of a public hospital in Peru.

INTRODUCTION: We explore the limitations to adherence of hand-washing and evaluate the impact of a mHealth intervention for hand hygiene in residents. METHODOLOGY: We explore resident's perspectives about Hospital-acquired infections (HAI) and hand washing. In baseline, participants completed socio-demographic characteristics and hand-washing habits survey. The intervention consisted of sending SMS three times a week for two months about hand hygiene and "five moments" for hand washing. The cultures of hands and cell phones were analyzed at baseline, 2 months and 4 months. We used chi-square and adjusted Generalized Estimating Equations. RESULTS: Five physicians were interviewed and 33 participants were included for quantitative analysis. Critical barriers that hinder hand washing were identified. The proportion of Staphylococcus aureus in hands was 54.5% at baseline and was significantly reduced at 2 months follow-up (p = 0.009), but, benefit was lost when the intervention was discontinued; Escherichia coli and Klebsiella sp. were observed in 22.2% of hands, no changes were noted with intervention. In cell phones, there was a tendency to lower values of bacterial colonization after intervention for Staphylococcus aureus growth. CONCLUSIONS: High prevalence of contamination in hands and phones in medical residents were found. Serious barriers to compliance with hand washing must be overcome. It is possible that prolonged or continuous interventions could be necessary to optimize hand washing and reduce hand and cell phones contamination.

Influência de parâmetros da estimulação elétrica funcional na contração concêntrica do quadríceps / Influence of functional electrical stimulation parameters in quadriceps concentric contraction

INTRODUÇÃO: Sistemas de estimulacão elétrica funcional (FES) são usados na pràtica clínica para o fortalecimento muscular, assim como para a recuperacão e preservacão funcional dos músculos enfraquecidos. Porém, uma das dificuldades encontradas na sua aplicacão é a falta de padrões adequados para a realizacão de um movimento pré-estabelecido, uma vez que os parâmetros da estimulacão (frequência, intensidade de corrente e duracão do pulso) são variados heuristicamente. O presente trabalho investigou a influência dos paraêmetros da FES usada no estabelecimento da posicão angular e forca produzida na extensão de joelho. MÉTODOS: O procedimento experimental foi dividido em duas fases chamadas Fase I e Fase II. A amostra total do estudo foi composta por 41 voluntàrios saudàveis de ambos os sexos (27 na Fase I e 14 na Fase II). Durante a Fase I cada voluntàrio foi estimulado com 18 combinacões diferentes de parâmetros para a FES, com o objetivo de determinar um modelo capaz de prever o movimento realizado para cada padrão de estimulacão. RESULTADOS: As diferentes duracões de pulso aplicadas não resultaram em alteracões significativas nos movimentos produzidos. Dentre os valores de frequência investigados, 50 Hz foi escolhida para a Fase II, por ter apresentado maior diferenca estatisticamente significativa para os valores de intensidade de corrente avaliados. Durante a Fase II, a intensidade de corrente da FES foi ajustada segundo um modelo linear estabelecido durante a primeira fase e que considerou características antropométricas dos sujeitos; encontrando-se um coeficiente de correlação r = 0,798 entre o ângulo pré-estabelecido e o ângulo alcancado. CONCLUSÃO: Este trabalho apresenta um modelo para a determinação de parâmetros de FES que permitem estabelecer variações angulares da articulação do joelho associadas à eletroestimulação. Considerando a frequência e a duração de pulsos constantes, se estima, usando uma equação de primeira ordem ...

INTRODUCTION: Functional electrical stimulation (FES) is used in clinical practice for muscle strengthening, as well as for functional recovery and preservation of weakened muscles. However, one of the problems in clinical application is the lack of adequate standards for determining the attainment of a predetermined movement, since the stimulation parameters are often adjusted heuristically. The present study investigated the influence of some parameters (frequency, current intensity and pulse duration) of the FES used to establish the joint angle and force produced in knee extension. METHODS: The experimental procedure was divided in two phases (Phase I and Phase II). The total sample included 41 healthy volunteers of both sexes (27 and 14 in Phase I and Phase II). During Phase I 18 profiles of FES were applied in the quadriceps muscle of subjects, changing the above-mentioned FES parameters. RESULTS: It was observed that the pulse duration of the electrical stimulation pulse did not exhibit significant relevance in the evoked movements. Among the discrete values of frequency investigated, the stimulation at 50 Hz was selected because it showed higher statistical significant difference considering the values of current intensity measured. During the Phase II, devoted to place the knee joint angle in a pre-determined value, the current intensity of the FES was adjusted according to the linear model established during the Phase I, which considered anthropometric characteristics of the subjects. In this Phase we found a correlation coefficient r = 0,798 between the pre-determined angle and the reached one. CONCLUSION: This paper presents a model for the determination of FES parameters for establishing angular variations of the knee associated with electrical stimulation. Considering frequency and pulse duration constants we estimate, using a first order equation and correlation coefficient of 0.72, the current intensity dependent of desired angle variation.

Factores asociados a síntomas depresivos en trabajadoras sexuales / Factors associated to depression symptomatology in sex workers

Introducción: Las condiciones de trabajo y la violencia ejercida contra las trabajadoras sexuales han sido relacionadas con el incremento de las tasas de infecciones de transmisión sexual. Sin embargo, también se encuentran enfermedades que afectan su salud mental. Objetivos: Determinar la magnitud de síntomas depresivos y factores asociados en trabajadoras sexuales. Diseño: Estudio transversal-analítico. Lugar: Centro de salud referencial para la prevención y control de infecciones de transmisión sexual. Participantes: Trabajadoras sexuales. Intervenciones: A 117 trabajadoras sexuales, que fueron atendidas durante los meses de mayo y junio del 2010, se aplicó el test de Beck para medir la sintomatología depresiva y una encuesta para medir los siguientes factores: socio-demográficos, sociales (antecedentes de maltrato físico, psicológico y sexual en el trabajo y hábitos nocivos: alcohol y drogas), conductas sexuales de riesgo y características del trabajo (edad de inicio, años de trabajo, satisfacción con el trabajo). Principales medidas de resultados: Porcentaje de síntomas depresivos y fuerza de asociación entre los factores y la presencia de síntomas depresivos. Resultados: El 56,4 por ciento de las trabajadoras sexuales presentó algún nivel de sintomatología depresiva. El nivel de síntomas depresivos graves estuvo presente en 23,9 por ciento. Los factores que se encontraron asociados a depresión, independiente del nivel, fue el antecedente de maltrato físico frecuente, con OR=9,46, IC95 por ciento 1,05 a 85,07; p=0,045. Los factores asociados a nivel de síntomas depresivos graves fueron: ingreso económico menor a S/. 1 000.00, tener hijos, haberse iniciado en el trabajo sexual antes de los 18 años y consumo de drogas (p<0,05). Conclusiones: Más de 50 por ciento de trabajadoras presentó algún nivel de síntomas depresivos, que estuvieron asociados al antecedente de maltrato físico. Para el nivel síntomas depresivos graves, los factores asociados fueron: ingreso económico menor a S/. 1 000.00, tener hijos, haberse iniciado en el trabajo sexual antes de los 18 años y consumir drogas.

Introduction: The working conditions and violence against sex workers has been linked to increasing rates of sexual transmitted diseases. But there are also other diseases that affect their mental health. Objectives: To determine the magnitude of depressive symptoms and associated factors in sex workers. Design: Crossanalytic study. Setting: Health Centre of reference for the prevention and control of sexually transmitted infections. Participants: Sex workers. Interventions: Beck test was applied to 117 sex workers attended between May and June 2010 in order to measure depressive symptoms as well as a survey to determine socio-demographic and social (physical abuse, psychological and sexual labor and harmful habits: alcohol and drug abuse) factors, risky sexual behavior and job characteristics (age at onset, years of work, job satisfaction). Main outcome measures: Percentage of depressive symptoms and weight of association between factors and presence of depressive symptoms. Results: Some level of depressive symptoms was found in 56,4 per cent of sex workers. Severe depressive symptoms were present in 23,9 per cent. Main factor associated with depression was background of frequent physical abuse (OR = 9,46, CI95 per cent: 1,05 to 85,07; p = 0,045). Factors associated with severe depressive symptoms were income less than S/. 1 000.00, having children, having started sex work before age 18, and drug abuse (p <0,05). Conclusions: Over 50 per cent of sex workers had some level of depressive symptoms generally associated with history of physical abuse. Severe depressive symptoms were associated to income less than S/. 1 000.00, having children, having started sex work before age 18, and drug abuse.