Building the foundation for a community-generated national research blueprint for inherited bleeding disorders: research priorities in health services; diversity, equity, and inclusion; and implementation science.

BACKGROUND: The National Hemophilia Foundation (NHF) conducted extensive all-stakeholder inherited bleeding disorder (BD) community consultations to inform a blueprint for future research. Sustaining and expanding the specialized and comprehensive Hemophilia Treatment Center care model, to better serve all people with inherited BDs (PWIBD), and increasing equitable access to optimal health emerged as top priorities. RESEARCH DESIGN AND METHODS: NHF, with the American Thrombosis and Hemostasis Network (ATHN), convened multidisciplinary expert working groups (WG) to distill priority research initiatives from consultation findings. WG5 was charged with prioritizing health services research (HSR); diversity, equity, and inclusion (DEI); and implementation science (IS) research initiatives to advance community-identified priorities. RESULTS: WG5 identified multiple priority research themes and initiatives essential to capitalizing on this potential. Formative studies using qualitative and mixed methods approaches should be conducted to characterize issues and meaningfully investigate interventions. Investment in HSR, DEI and IS education, training, and workforce development are vital. CONCLUSIONS: An enormous amount of work is required in the areas of HSR, DEI, and IS, which have received inadequate attention in inherited BDs. This research has great potential to evolve the experiences of PWIBD, deliver transformational community-based care, and advance health equity.

Research into how people get their health care, called health services research, is important to understand if care is being delivered equitably and efficiently. This research figures out how to provide the best care at the lowest cost and finds out if everyone gets equally good care. Diversity and inclusion research focuses on whether all marginalized and minoritized populations (such as a given social standing, race, ethnicity, sex, gender identity, sexuality, age, income, disability status, language, culture, faith, geographic location, or country of birth) receive equitable care. This includes checking whether different populations are all getting the care they need and looking for ways to improve the care. Implementation science studies how to make a potential improvement work in the real world. The improvement could be a new way to diagnose or treat a health condition, a better way to deliver health care or do research, or a strategy to remove barriers preventing specific populations from getting the best available care. The National Hemophilia Foundation focuses on improving the lives of all people with bleeding disorders (BD). They brought BDs doctors, nurses, physical therapists, social workers, professors, and government and industry partners together with people and families living with BDs to discuss research in the areas described above. The group came up with important future research questions to address racism and other biases, and other changes to policies, procedures, and practices to make BD care equitable, efficient, and effective.

Knowledge, Attitudes and Practices on Cholera and Water, Sanitation, and Hygiene among Internally Displaced Persons in Cabo Delgado Province, Mozambique.

In disaster situations, cholera outbreaks represent a public health emergency due to their high fatality rates and high spreading risk through camps for refugees and internally displaced persons (IDPs). The aim of this study is to examine water, sanitation, and hygiene attitudes and cholera knowledge, attitude, and practice (KAP) among people living in resettlement sites in Cabo Delgado, the northernmost province of Mozambique. Between January 1 and March 31, 2022, a cross-sectional survey was conducted by administering a face-to-face interview to IDPs and residents in six relocation sites in Cabo Delgado Province. A total of 440 people were enrolled in the study. Overall, 77.8% (N = 342) were female, 61% (N = 268) were younger than 35 years old, and 60.5% (N = 266) reported primary school to be the highest education level. Seventy-five percent (N = 334) of participants lived with children under 5 years old. Thirty-one percent (N = 140) and 11.8% (N = 52) of the respondents reported, respectively, at least one cholera case and at least one diarrheal-related death among their family members in the previous 2 years. In multivariate analysis, being female, being younger than 35 years old, having attained a higher education level, owning a phone, or having soap at home were factors significantly associated with improved cholera KAP. In severely deconstructed social contexts, continuous education and community sensitization are crucial to achieve and maintain positive cholera prevention attitudes.

Malaria, HIV and Malnutrition among Internally Displaced People in Mozambique During COVID-19 Pandemic: Results from a Community-Based Intervention.

Background: The spread of COVID-19 poses an unprecedented challenge to care delivery in post-disaster and conflict situations. In Mozambique, the 2019 cyclone Idai and the violence by Non-State-Armed-Groups devastated the province of Sofala and Cabo Delgado respectively and led to the displacement of thousands of people living in poor and overcrowded conditions. The pandemic has further aggravated the situation. Doctors with Africa CUAMM (University college for aspiring missionary doctors) implemented surveillance activities in these regions between October 2020 and September 2021. The aim of this study is to give an overview of the prevalence of malaria, malnutrition, COVID-19 related symptoms and access to HIV testing. Methods: Data were collected in targeted internally displaced people (IDP) sites in Sofala and Cabo Delgado province between 31st January and 25th September 2021. The tool used enabled to assess COVID-19 symptoms, risk of HIV infection, malaria cases and malnutrition in children under five. Results: The project reached 93 503 people. During the study period, 13.6% people reported at least one symptom suggestive of COVID-19 infection. Malaria Rapid Diagnostic Tests (RDT) were administered to 86% of the recruited people (n = ?), with a positive diagnosis in the 4.5% of them (n = ?). Among the recruited Internally Displaced Persons (IDP), 23.1% were considered eligible for HIV screening, but only 1.4% were referred for testing. Acute malnutrition was found in 6.3% of children screened and, among these, a higher prevalence of concurrent COVID-19 symptoms was reported. Discussion: Our study highlights the importance of mass clinical screening for COVID-19 infection in this target population to enact prevention behavior, although this may not be enough, due to the pivotal role played by asymptomatic transmissions. Considering the overlap of the symptoms of COVID-19 and malaria, a combined diagnostic algorithm is urgently needed to avoid underdiagnosing malaria. Moreover, the high prevalence of respiratory symptoms in malnourished children confirmed the known correlation between malnutrition and respiratory infection. Finally, access to HIV screening needs to be implemented, given the high prevalence of people with HIV risk factors to avoid diagnostic delay. Conclusions: Population-specific needs make necessary to develop new screening methods that respond to the specific characteristics of the target population.

Necesidad del desarrollo de competencias en cuidados paliativos durante el pregrado de la carrera de medicina / Need for the development of competencies in palliative care during the undergraduate of the medical career

Sr. Editor: Los Cuidados Paliativos (CP) tienen como finalidad mejorar la calidad de vida y aliviar el sufrimiento de los pacientes con padecimientos graves e incurables. Con el envejecimiento de la población y la mayor prevalencia de las enfermedades crónicas, el número de personas con necesidad de estos cuidados se ha incrementado. Los CP tienen carácter multidimensional e interdisciplinario, se pueden brindar en diferentes niveles de atención y están a cargo tanto de médicos generales como especialistas. Se requiere por lo tanto de una adecuada formación en esta disciplina durante el pregrado de la carrera de medicina, que permita el desarrollo de las competencias necesarias para su aplicación en la práctica médica.

Dear editor, Palliative Care (PC) aims to improve the quality of life and alleviate the suffering of patients with serious and incurable conditions. With the aging of the population and the higher prevalence of chronic diseases, the number of people in need of this care has increased. PC is multidimensional and interdisciplinary; and can be provided at different levels of care by both general practitioners and specialists. Therefore, adequate training in this discipline must be required during the medicine degree to allow the development of the necessary skills for its application in medical practice.

High Prevalence of Mental Health Disorders in Adolescents and Youth Living with HIV: An Observational Study from Eight Health Services in Sofala Province, Mozambique.

Adolescent mental health (MH) is a significant global health concern, which is extremely relevant when referring to adolescents and youth living with HIV (AYHIV). In Mozambique, ∼52% of the population is <18 years and the country has the world's eighth highest HIV prevalence (insert citation). We performed an observational study to evaluate anxiety, depression, post-traumatic stress disorder (PTSD) and alcohol-drug abuse in adolescents and youth assessing health services in Sofala Province, Mozambique. From November 20, 2019, to November 20, 2021, all adolescents and youth (10-24 years) accessing one of the psychological services offered at 8 Servicios Amigos dos Adolescentes (SAAJ) of the Sofala Province were screened by a psychologist using the following standardized tools: Generalized Anxiety Disorder-7 (GAD-7) for anxiety, Patient Health Questionnaire-9 (PHQ-9) for depression, Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) for PTSD, and Cut down, Annoyed, Guilty, and Eye-opener Adapted to Include Drugs (CAGE-AID) for alcohol-drug abuse. Overall, 2108 adolescents and youth were included in the study (63% female, median age: 19 years). Of them, 1096 (52%) were HIV positive. AYHIV had higher scores at the four tools tested and for concomitant MH disorders (GAD-7, PHQ-9, PTSD-5, and CAGE). The multivariable logistic regressions showed a greater probability to be GAD-7 > 10 for women, [adjusting odds ratio (AOR): 1.46, 95% confidence interval (CI): 1.01-2.10], for workers (AOR: 2.18, 95% CI: 1.12-4.23) and people living with HIV (AOR: 1.78, 95% CI: 1.25-2.54). Higher values of CAGE (≥2) and PTSD (≥3) seemed to be associated only with HIV-positive status (AOR: 4.87, 95% CI: 3.72-6.38 and AOR: 1.73, 95% CI: 1.28-237). These data further reinforce the urgent need for a global health policy action with focused intervention on MH in AYHIV patients.

Disminución del riesgo cardiovascular en pacientes obesos que participaron en un programa de medicina de estilo de vida / Decrease of cardiovascular risk in obese patients who participated in a lifestyle medicine program

La Medicina de estilo de vida en el manejo de enfermedades crónicas como la obesidad, es fundamental para disminuir el riesgo cardiovascular y para revertir el proceso de enfermedad (1) . Objetivo: Determinar si un programa de Medicina de Estilo de Vida logra disminuir el riesgo cardiovascular en adultos obesos de Colombia. Material y Métodos: Estudio observacional descriptivo tipo serie de casos seguidos por 6 meses en una Clínica de Medicina de Estilo de Vida. Se incluyeron 9 pacientes teniendo en cuenta 2 medidas del riesgo cardiovascular como parámetro para completar el programa. Se tomaron los siguientes mediciones: el riesgo cardiovascular mediante la calculadora de la organización panamericana de la Salud (OPS), Índice de Masa Corporal (IMC), perfil lipídico, antecedentes de tabaquismo, antecedentes de diabetes y presión arterial sistólica. Resultados: De los 9 pacientes obesos, el 22% tuvo un riesgo cardiovascular intermedio y 78% presentaron riesgo bajo al inicio del estudio. Luego de 6 meses, se logró que el 100% de los participantes tuvieran un riesgo cardiovascular bajo; además, el 11% de los pacientes lograron normalizar los valores de presión arterial y un 20% evidenciaron disminución de valores elevados de presión arterial. Además, el 22%, pasaron de obesidad tipo 3 a obesidad tipo 2. Por último, mediante la consulta psicológica se logró disminuir los niveles de ansiedad de alto a intermedio en al menos el 44% de los participantes. Conclusiones: El programa de Medicina de Estilo de vida, en un grupo de obesos, logró disminuir el riesgo cardiovascular, logrando la disminución y normalización de las cifras tensionales y la reducción del IMC en los participantes que concluyeron el estudio.

Lifestyle Medicine in the management of chronic diseases such as obesity is essential to reduce cardiovascular risk and to reverse the disease process (1). Objective: To determine if a Lifestyle Medicine program can reduce cardiovascular risk in obese adults in Colombia. Material and methods: Descriptive observational study cases series type followed for 6 months in a Lifestyle Medicine Clinic. 9 patients were included taking into account 2 measures of cardiovascular risk as a parameter to complete the program. The following measurements were taken: cardiovascular risk using the Pan American Health Organization (PAHO) calculator, Body Mass Index (BMI), lipid profile, history of smoking, history of diabetes, and systolic blood pressure. Results: Of the 9 obese patients, 22% had an intermediate cardiovascular risk and 78% had a low risk at the beginning of the study. After 6 months, it was achieved that 100% of the participants had a low cardiovascular risk; Furthermore, 11% of the patients managed to normalize their blood pressure values ​​and 20% showed a decrease in high blood pressure values. In addition, 22% went from type 3 obesity to type 2 obesity. Finally, through psychological consultation, it was possible to reduce anxiety levels from high to intermediate in at least 44% of the participants. Conclusions: The Lifestyle Medicine program, in a group of obese patients, managed to achieve a low cardiovascular risk, the decrease and normalization of blood pressure figures and reduction in BMI in participants who completed the study.

Factors associated with mortality in hospitalized elders in an internal medicine department. / Factores asociados a mortalidad de adultos mayores hospitalizados en un servicio de Medicina Interna.

The aim of this prospective cohort study was to determine the factors associated with mortality in elders admitted to an Internal Medicine Department of a public hospital in Lima. During 2019, 360 patients over 60 years of age were consecutively evaluated by applying the Comprehensive Geriatric Assessment tools and reviewing their medical records. During hospitalization, 45 (12.5%) died. There was a higher frequency of anemia (p = 0.043), hypoalbuminemia (p = 0.006), pressure ulcers (p = 0.003), high comorbidity (p < 0.001), functional dependence (p < 0.001) and malnutrition (p = 0.002) among deceased patients compared to non-deceased. In the multivariate model, the presence of delirium on admission was associated with a higher risk of hospital mortality (RR = 3.64; 95% CI: 1.51 - 8.76, p = 0.004). Additional studies are required in our country to assess the prognostic value of delirium and other geriatric syndromes on mortality and other adverse outcomes.

El presente estudio prospectivo de cohorte tuvo como objetivo determinar los factores asociados a la mortalidad de los adultos mayores admitidos en un servicio de Medicina Interna de un hospital público de Lima. Durante el 2019 se evaluaron consecutivamente 360 pacientes mayores de 60 años mediante la aplicación de las herramientas de la Valoración Geriátrica Integral y la revisión de sus historias clínicas. Del total, 45 (12,5%) fallecieron durante el internamiento. En el modelo multivariado, la presencia de delirio al ingreso se asoció con un mayor riesgo de mortalidad hospitalaria (RR = 3,64; IC95%: 1,51-8,76, p = 0,004). Hubo una mayor frecuencia de anemia (p = 0,043), hipoalbuminemia (p = 0,006), úlceras por presión (p = 0,003), comorbilidad alta (p < 0,001), dependencia funcional (p < 0,001) y malnutrición (p = 0,002) entre los pacientes fallecidos respecto a los no fallecidos. Se requieren estudios adicionales en nuestro país para evaluar el valor pronóstico del delirio, otros síndromes geriátricos sobre la mortalidad y otros desenlaces adversos.

Factores asociados a depresión, ansiedad y estrés en el contexto de la pandemia por covid-19 en policías de lima metropolitana, Perú / Factors associated with depression anxiety and stress in the context of covid-19 pandemic in police officers of metropolitan lima, Peru

Objetivos: Determinar los factores asociados al desarrollo de depresión, ansiedad y estrés en el contexto de la pandemia por COVID-19 en policías de Lima, Perú. Métodos: Estudio transversal analítico realizado en 210 policías a quienes se les aplicó la Escala de Depresión, Ansiedad y Estrés -DASS-21 en octubre de 2020, así como un formulario vía Google Forms para obtener datos sociodemográficos y clínicos. Se realizó análisis bivariado y multivariado, utilizando razones de prevalencia crudas y ajustadas, con un intervalo de confianza >95% y un nivel de significancia de p≤0.05. Resultados: Las prevalencias de depresión, ansiedad y estrés fueron 11.43%, 10% y 7.62%, respectivamente. En el análisis bivariado, la ansiedad se asoció con el número de hijos (RPc:3.18; IC95% [1.10-9.17]; p:0.032) y comorbilidades (RPc:2.50; IC95% [1.08-5.75]; p:0.031). Para depresión y estrés no se encontraron factores asociados significativamente. En el análisis multivariado se encontró una asociación entre depresión y edad (RPa:2.50; IC95%[1.02-6.10]; p:0.044), y entre estrés y situación sentimental (RPa:3.10; IC95%[1.08-8.95]; p:0.034), diagnóstico de COVID-19 (RPa:3.18; IC95%[1.02-9.92]; p:0.045) y comorbilidades (RPa:4.19; IC95%[1.22-14.36]; p:0.022). Conclusiones: Se observó una baja prevalencia de depresión, ansiedad y estrés en la población de estudio. Además, según análisis multivariado, los factores de riesgo de estrés fueron: ser soltero, haber sido diagnosticado con COVID-19 y tener comorbilidades, mientras que tener 40 años o menos fue un factor de riesgo de depresión.

Objectives: To determine the factors associated with the development of depression, anxiety and stress in the context of the COVID-19 pandemic in police officers in Lima, Peru. Methods: Analytical cross-sectional study conducted in 210 police officers who were administered the Depression Anxiety and Stress Scale-21 (DASS-21) in October 2020, as well as a form, via Google Forms, to obtain sociodemographic and clinical data. A bivariate and a multivariate analysis were performed using crude and adjusted prevalence ratios, with a confidence interval >95% and a significance level of p≤0.05. Results: Depression, anxiety and stress prevalence rates were 11.43%, 10% and 7.62%, respectively. In the bivariate analysis, anxiety was associated with the number of children (cPR:3.18; 95% CI [1.10-9.17]; p:0.032) and history of disease (cPR:2.50; 95%CI[1.08-5.75]; p:0.031). For depression and stress, no significantly associated factors were found. In the multivariate analysis, an association between depression and age (aPR:2.50; 95%CI[1.02-6.10]; p:0.044) was found, as well as an association between stress and emotional situation (aPR:3.10; 95%CI[1.08-8.95]; p:0.034), COVID-19 diagnosis (aPR:3.18; 95%CI[1.02-9.92]; p:0.045) and history of disease (aPR:4.19; 95%CI[1.22-14.36]; p:0.022). Conclusions: A low prevalence of depression, anxiety and stress was observed in the study population. In addition, according to the multivariate analysis, the risk factors for stress were being single, having been diagnosed with COVID-19 and having a history of disease, while being 40 years old or younger was a risk factor for depression.

Mozambican Adolescents and Youths during the COVID-19 Pandemic: Knowledge and Awareness Gaps in the Provinces of Sofala and Tete.

(1) Background: Mozambique has an average population age of 17 years and adolescents and youths have a pivotal role in SARS-CoV-2 pandemic control. (2) Methods: We conducted a cross-sectional study in order to assess the awareness and information needs with regard to COVID-19 among a sample of adolescents and youths from two different Mozambican provinces. (3) Results: Only 25% of adolescents and youths had a high level of awareness and only 543/2170 participants reported a high level of knowledge regarding COVID-19. In our multivariate model, significant predictors of reporting a high level of knowledge about COVID-19 include female sex (O.R. = 1.47; 95% confidence interval (CI) 1.23-2.89), having a house without a thatched roof (O.R. = 1.85; 95% CI 1.02-2.95) and HIV-positive status (O.R. = 1.56; 95% CI 1.36-2.87). (4) Conclusions: Our study highlights an important and relevant knowledge gap in adolescents and youths with respect to the COVID-19 pandemic. Involving young people and adolescents in the fight against SARS-CoV-2 is an essential strategy, especially in countries where the national average age is young, such as Mozambique, and where this epidemic can aggravate an already fragile health system.

Características del mentor en cirugía y su contribución en la educación del futuro / Characteristics Of The Mentor In Surgery And Its Contribution In The Education Of The Future

La mentoría en cirugía, es al arte de guiar a un futuro cirujano hacia objetivos académicos y profesionales específicos que determinarán probablemente el éxito en su carrera. Esta mentoría requiere una sólida relación mentor-residente y un mentor con ciertas características como: la productividad en investigación, la comprensión de la pedagogía y la aplicación de la tecnología educativa. El mentor en cirugía es el encargado de canalizar adecuadamente las diversas experiencias clínico-quirúrgicas del residente para lograr un aprendizaje significativo; así mismo, la experiencia y la motivación son las principales características de un buen mentor. La disponibilidad del mentor es fundamental para fomentar una relación mentor-residente sólida, con la finalidad de lograr el éxito académico y profesional del futuro especialista; valiéndose no solo de métodos teóricos-prácticos, sino también del uso de la tecnología educativa que permitirá el máximo desarrollo del mentoreado.

Mentoring in surgery is the art of guiding a future surgeon toward specific academic and professional goals that are likely to determine career success. This mentoring requires a solid mentor-resident relationship and a mentor with certain characteristics such as: research productivity, understanding of pedagogy and the application of educational technology. The mentor in surgery is in charge of properly channeling the resident's various clinical-surgical experiences to achieve meaningful learning; likewise, experience and motivation are the main characteristics of a good mentor. The availability of the mentor is essential to foster a solid mentor-resident relationship, in order to achieve the academic and professional success of the future specialist; using not only theoretical-practical methods, but also the use of educational technology that will allow the maximum development of the mentee

Factores asociados a mortalidad de adultos mayores hospitalizados en un servicio de Medicina Interna

El presente estudio prospectivo de cohorte tuvo como objetivo determinar los factores asociados a la mortalidad de los adultos mayores admitidos en un servicio de Medicina Interna de un hospital público de Lima. Durante el 2019 se evaluaron consecutivamente 360 pacientes mayores de 60 años mediante la aplicación de las herramientas de la Valoración Geriátrica Integral y la revisión de sus historias clínicas. Del total, 45 (12,5%) fallecieron durante el internamiento. En el modelo multivariado, la presencia de delirio al ingreso se asoció con un mayor riesgo de mortalidad hospitalaria (RR = 3,64; IC95%: 1,51-8,76, p = 0,004). Hubo una mayor frecuencia de anemia (p = 0,043), hipoalbuminemia (p = 0,006), úlceras por presión (p = 0,003), comorbilidad alta (p < 0,001), dependencia funcional (p < 0,001) y malnutrición (p = 0,002) entre los pacientes fallecidos respecto a los no fallecidos. Se requieren estudios adicionales en nuestro país para evaluar el valor pronóstico del delirio, otros síndromes geriátricos sobre la mortalidad y otros desenlaces adversos.

The aim of this prospective cohort study was to determine the factors associated with mortality in elders admitted to an Internal Medicine Department of a public hospital in Lima. During 2019, 360 patients over 60 years of age were consecutively evaluated by applying the Comprehensive Geriatric Assessment tools and reviewing their medical records. During hospitalization, 45 (12.5%) died. There was a higher frequency of anemia (p = 0.043), hypoalbuminemia (p = 0.006), pressure ulcers (p = 0.003), high comorbidity (p < 0.001), functional dependence (p < 0.001) and malnutrition (p = 0.002) among deceased patients compared to non-deceased. In the multivariate model, the presence of delirium on admission was associated with a higher risk of hospital mortality (RR = 3.64; 95% CI: 1.51 - 8.76, p = 0.004). Additional studies are required in our country to assess the prognostic value of delirium and other geriatric syndromes on mortality and other adverse outcomes.

Nivel de ansiedad de estudiantes de medicina de primer año de una universidad privada del Perú en tiempos de Covid-19 / Anxiety Level Of First-Year Medical Students From A Private University In Peru In Times Of Covid-19

Introducción: La actual pandemia por un nuevo coronavirus (SARS-Cov-2) ha cobrado la salud y la vida de muchas personas mundialmente. Esto genera un impacto negativo en la salud mental del personal de salud, lo cual incluye a estudiantes de medicina. Objetivo: Determinar el grado de ansiedad presente en estudiantes de medicina del primer año de una universidad privada, Lima-Perú. Métodos: La muestra estuvo conformada por 57 estudiantes de una universidad privada en Lima-Perú. Se aplicó la escala para medir el Desorden de Ansiedad Generalizada-7 (GAD-7). Los datos fueron analizados mediante tablas de frecuencias y de contingencia, además se realizó el análisis bivariado aplicando las pruebas estadísticas X2 y T de Student. Resultados: El 75,4% de los estudiantes de medicina manifestaron algún grado de ansiedad. Se encontró asociación estadísticamente significativa entre el sexo femenino y ansiedad (p = 0,045). Así mismo, no hubo asociación entre las variables edad y ansiedad (p = 0,058). Conclusión: Los estudiantes de medicina de primer año evidenciaron niveles altos de ansiedad durante la actual pandemia, siendo las mujeres entre quienes la ansiedad se presenta con mayor frecuencia. Se hace oportuno el desarrollo de estrategias de intervención en los centros universitarios para el cuidado de la salud mental de los estudiantes de ciencias de la salud.

Introduction: The current pandemic due to a new coronavirus (SARS-Cov-2) has claimed the health and lives of many people worldwide. This has a negative impact on the mental health of health personnel, which includes medical students. Objective: To determine the degree of anxiety present in first-year medical students from a private university, Lima-Peru. Methods: The sample consisted of 57 students from private university in Lima Perú. The scale was applied to measure Generalized Anxiety Disorder-7 (GAD-7). The data were analyzed using frequency and contingency tables, in addition bivariate analysis was performed applying the statistical tests X2 and Student's t. Results: 75.4% of the medical students manifested some degree of anxiety. A statistically significant association was found between female sex and anxiety (p = 0.045). Likewise, there was no association between the variables age and anxiety (p = 0.058). Conclusion: First-year medical students showed high levels of anxiety during the current pandemic, with women being among those who anxiety occurs more frequently. The development of intervention strategies in university centers for the care of mental health of health sciences students is timely.

Factores asociados al consumo de tabaco en estudiantes universitarios de Lima metropolitana / Factors Associated With Tobacco Consumption In University Students Of Lima Metropolitan

Introducción: El consumo de tabaco es perjudicial para la salud, según la Organización Mundial de la Salud (OMS) el tabaquismo es la causa de muerte de aproximadamente 8 millones de personas cada año. Objetivo: El propósito de la investigación fue determinar los factores asociados al consumo de tabaco en estudiantes universitarios de Lima Metropolitana. Métodos: La muestra estuvo conformada por 447 estudiantes de diferentes universidades de Lima, se aplicó una encuesta previamente validada: Test de Fagerstrom para medir el consumo de tabaco. Posteriormente los datos fueron analizados utilizando tablas de distribución, frecuencias y contingencia. Además, se aplicó la prueba estadística de regresión para obtener las razones de prevalencias (RP) de las variables de estudio tanto en el análisis bivariado como en el multivariado, con un intervalo de confianza al 95% (IC al 95%). Resultados: Se evidenció que existe asociación significativa entre el sexo masculino y el hábito de fumar (p=0,01), con un RP = 1,67 e IC al 95% = [1,03 ­ 2,23]. También se pudo observar que tener padres fumadores estuvo estadísticamente asociado al hábito tabáquico en los universitarios, con un valor de p=0,00, y un RP = 2,53 con IC al 95% = [1,62 ­ 3,52]. No se encontró asociación significativa entre las variables edad y presión social. Conclusión: Las variables sexo y padres fumadores tienen asociación significativa con el consumo de tabaco enfatizando que tanto nuestro entorno familiar como académico merece ser seguro, saludable y libre del humo de tabaco.

Introduction: Tobacco use is harmful to health, according to the World Health Organization (WHO) smoking is the cause of death for approximately 8 million people each year. Objective: The purpose of the research was to determine the factors associated with tobacco consumption in university students from Metropolitan Lima. Methods: The sample consisted of 447 students from different universities in Lima, a previously validated survey was applied: Fagerstrom test to measure tobacco consumption. Subsequently, the data was analyzed using distribution, frequency and contingency tables. In addition, regression statistical test was applied to obtain the prevalence ratios (PR) of the study variables in both bivariate and multivariate analyzes, with a 95% confidence interval (95% CI). Results: It was evidenced that there is a significant association between male sex and smoking (p = 0.01), with an RP = 1,67 and 95% CI = [1,03 ­ 2,23]. It was also observed that having smoking parents was statistically associated with smoking in university students, with a value of p=0.00, and an RP=2,53 with a 95% CI = [1,62 ­ 3,52]. No significant association was found between the variables age and social pressure. Conclusion: The variables sex and smoking parents have a significant association with tobacco consumption, emphasizing that both our family and academic environment deserve to be safe, healthy and free of tobacco smoke.

Asociación entre características de las calcificaciones mamográficas y neoplasia maligna en un hospital nacional, 2017 / Association Between Characteristics Of Mammographic Calcifications And Malignie Neoplasia In A National Hospital ­ 2017

Introducción: La presencia de calcificaciones puede ser útil para el diagnóstico de neoplasia de mama. Objetivo: Determinar la asociación entre las características de las calcificaciones mamográficas y neoplasia maligna. Métodos: Estudio observacional, analítico, retrospectivo de casos y controles. Desarrollado en la Unidad de Patología Mamaria de ginecología. Se incluyeron como casos a pacientes mujeres con mamografía sugerente de neoplasia maligna con biopsia positiva a malignidad y como controles a 67 pacientes sin evidencia histológica de neoplasia. Resultados: La edad media de los casos fue de 54,12 años, en los controles 50,34. El 50,9%(59) son mayores o iguales a 50 años, OR 2,399 IC 95% (1,125 ­ 5,114) p=0,022, de estos el 52,5% (31) tenían cáncer de mama. El 9,5%(11) presentaron calcificaciones sospechosas de malignidad, las más frecuentes, la amorfa y la fina pleomórfica. El 37,1% (43) de los casos totales correspondieron a la categoría BI-RADS 0, el 6,9% (8) a BI-RADS 1, el 8,6% (10) a BI-RADS 2, el 7,8% (9) a BI-RADS 3, el 28,4% (33)a BI-RADS 4, el 8,6% (10) a BI-RADS 5 y el 2,6% (3) a BI-RADS 6. El 72,7% (8) de pacientes con calcificaciones sospechosas de malignidad presentó cáncer de mama. En el análisis bivariado se obtuvo un OR de 4,163. IC 95% (1,043 ­ 16,606) p = 0,031. En el análisis multivariado la asociación permaneció inalterada independientemente de la edad y BI-RADS. Conclusión: La edad mayor o igual de 50 años y las calcificaciones mamográficas sospechosas de malignidad son factores asociados para el cáncer de mama.

Introduction: The presence of calcifications may be useful for the diagnosis of breast neoplasia. Objective: To determine the association between the characteristics of mammographic calcifications and malignant neoplasia. Methods: Observational, analytical, retrospective of cases and controls. Developed in the Gynecology Breast Pathology Unit. Female patients with mammogram suggestive of malignant neoplasm with a positive malignancy biopsy were included as cases, and 67 patients without histological evidence of malignancy as controls. Results: The average age of the cases was 54.12 years, in the controls 50.34. 50,.9% (59) are older than or equal to 50 years, OR 2,399 95% CI (1,125-5,114) p = 0.022, of these 52.5% (31) had breast cancer. 9.5% (11) had calcifications suspicious of malignancy, the most frequent, the amorphous and the pleomorphic fine. 37.1% (43) of the total cases have the BI-RADS 0 category, 6.9% (8) BI-RADS 1, 8.6% (10) BI-RADS 2, 7.8 % (9) BI-RADS 3, 28.4% (33) BI-RADS 4, 8.6% (10) BI-RADS 5 and 2.6% (3) BI-RADS 6. 72, 7% (8) of patients with calcifications suspected of malignancy presented breast cancer. In the bivariate analysis, an OR of 4,163 was obtained. 95% CI (1,043-16,606) p = 0,031. In the multivariate analysis the association remained unchanged regardless of age and BI-RADS. Conclusion: Age 50 years or older and mammographic calcifications suspected of malignancy are associated factors for breast cancer.

Factores asociados a la elección de psiquiatría como especialidad en internos de medicina de dos universidades privadas del Perú / Factors associated with choosing psychiatry among medical interns in two private universities in Peru

Objetivo: Determinar los factores asociados a la elección de psiquiatría como especialidad médica en internos de medicina de dos universidades privadas del Perú. Material y métodos: Estudio transversal realizado en internos de medicina de las universidades Ricardo Palma y San Juan Bautista. Se les administró tres instrumentos: El Inventario de Personalidad - Eysenck para adultos (EPI), la Escala de Valoración del Proceso Enseñanza - Aprendizaje, y el Cuestionario General de Salud Mental de Goldberg (QHG-12), para el estudio de las variables personalidad, percepción del proceso enseñanza - aprendizaje del curso de psiquiatría y psicopatología respectivamente. Se utilizó la prueba estadística X2 cuadrado para determinar la existencia de asociación entre las variables. Resultados: De los 223 internos de medicina estudiados, 35 (15,7%) manifestaron que elegirán psiquiatría como especialidad. La elección de psiquiatría como especialidad se asoció con: personalidad sanguínea (p=0,001); extroversión (p=0,02) y ser emocionalmente estable (p=0,03). Por otro lado, el estudio no evidenció asociación significativa entre las variables sexo, parientes con carreras afines al área de la salud mental y psicopatología con la elección de psiquiatría. Conclusiones: Existe asociación estadísticamente significativa entre el tipo de personalidad y la elección de psiquiatría. Los internos de medicina que les interesa especializarse en psiquiatría, por lo general tienen una personalidad tipo sanguínea, además son extrovertidos y emocionalmente estables.

Objective: To determine the factors associated with choosing psychiatry as a specialty among medical interns in two private universities in Peru. Methods: A cross-sectional study was carried-out among medical interns of Ricardo Palma and San Juan Bautista Universities. Three instruments were applied: personality inventory-Eysenck for adults, scale to evaluate the teaching-learning process and the Goldberg´s general survey of mental health to evaluate personality, perception of the teaching-learning process of the psychiatry and psychology courses. The X2 test was used to determine associations. Results: out of 233 medical interns evaluated, 35 (15.7%) said that would elect psychiatry as a specialty. The election of psychiatry was associated with a blood personality (p=0.001); extroversion (p=0.02) and being emotionally stable (p=0.039). On the other hand, the study did not reveal and association with sex, relatives with specialties closed to mental health and psychopathology. Conclusions: there is an association between type of personality and choosing psychiatry as a) specialty. Medical interns interested in becoming psychiatrist have a blood type of personality, are extroverted and emotionally stable.

Tabaquismo: un problema que afecta a los jóvenes universitarios a nivel nacional e internacional / Tobacco: A problem that affects young universities at the national and international levels

La Organización Mundial de la Salud define al tabaquismo como una enfermedad adictiva crónica muy extendida a nivel mundial. Representa una de las mayores amenazas para la salud púbica, afectando a niños, jóvenes y adultos. Se calcula que existen 1.300 millones de fumadores en el mundo y alrededor del 80% de estos viven en países en los que existe una alta tasa de morbilidad y mortalidad asociada al tabaco principalmente en consumidores adultos. De manera particular, el consumo de tabaco ente jóvenes universitarios es evidente y preocupante. Diferentes autores en el mundo han planteado factores para el consumo de tabaco entre adolescentes y adultos jóvenes. Tales estudios sostienen que el hábito de fumar inicia, por lo general, durante la adolescencia y se consolida en la etapa universitaria. Además, el tabaquismo en progenitores, familiares y amigos es un factor, quizás el más destacable, que se asocia a la adquisición del hábito tabáquico.

The World Health Organization defines smoking as a chronic addictive disease widespread worldwide. It represents one of the greatest threats to public health, affecting children, youth and adults. It is estimated, that there are 1.300 million smokers in the world and about 80% of these live in countries where there is a high rate of morbidity and mortality associated with tobacco mainly in adult consumers. In particular, the consumption of tobacco among young university students is evident and worrisome. Different authors in the world have raised factors for tobacco use among adolescents and young adults. Such studies argue that the habit of smoking usually begins during adolescence and consolidates in the university stage. Smoking in parents, relatives, and friends is a factor, perhaps the most remarkable, which is associated with the acquisition of smoking as a habit.

Arginine Vasotocin and Neuropeptide Y Vary with Seasonal Life-History Transitions in Garter Snakes.

Transitions between life-history stages are often accompanied by dramatic behavioral switches that result from a shift in motivation to pursue one resource over another. While the neuroendocrine mechanisms that regulate such behavioral transitions are poorly understood, arginine vasotocin (AVT) and neuropeptide Y (NPY) are excellent candidates because they modulate reproductive and feeding behavior, respectively. We asked if seasonal changes in AVT and NPY are concomitant with the seasonal migration to and from the feeding grounds in red-sided garter snakes (Thamnophis sirtalis parietalis). Male and female snakes were collected in different migratory states during both the spring and fall. The total number of AVT- and NPY-immunoreactive (ir) cells was then quantified in each brain region of interest. To correct for potential variation in region volume related to sexually dimorphic body size in this species, we first determined that snout-vent length is an accurate proxy for regional brain volume. We then corrected each individual's ir cell number by its SVL to directly compare seasonal changes in AVT and NPY between males and females. Within the supraoptic nucleus, both males and females had more AVT-ir cells during the fall compared with spring. As predicted, males had significantly more AVT-ir cells during the spring mating season in the hypothalamus (HYP) and bed nucleus of the stria terminalis, brain regions important in regulating reproductive behavior. Females also had significantly more AVT-ir cells in the HYP during the spring, as well as a significantly higher number of hypothalamic AVT cells than males. During the fall, males had significantly more NPY-ir cells in the cortex and posterior HYP compared with spring, possibly reflecting increased feeding behavior during summer foraging. Females did not exhibit significant main effects of season on NPY-ir cell number in any region. Neither AVT- nor NPY-ir cell number varied significantly with migratory status, but we did observe significant changes related to seasonal transitions in reproductive state. Our results indicate that changes in brain AVT and NPY are associated with seasonal transitions in reproductive and foraging behaviors, and may be involved in mediating sex differences in the timing of life-history events.

Legal and regulatory framework for health worker retention in Mozambique: Public health law research to strengthen health systems and services.

Realizing the fundamental contribution of human resources to public health, the World Health Organization (WHO) issued policy recommendations for health worker retention. We reviewed Mozambique's laws and regulations and assessed the extent to which this legal and regulatory framework governing public sector health workers aligns with the WHO health worker retention recommendations. We provide guidance for future analysis of non-binding policies that may fill gaps identified in our review. We also indicate how to link legal analysis to the cycle by which research informs policy, policy informs practice, and practice leads to improvements in health systems and population health. Finally, we demonstrate the relevance of understanding and analyzing the impact of domestic laws on global health. Future research should assess implementation of health worker allowances and any associations with increased hiring, more equitable distribution, and improved retention - all are essential to public health in Mozambique.Journal of Public Health Policy advance online publication, 26 May 2016; doi:10.1057/jphp.2016.22.