Factors That Influence Sleep Behaviors of High School Students: Findings From a Semi-Rural Community in Georgia.

BACKGROUND: Inadequate sleep has been shown to have detrimental effects on academic performance, physical, mental, and emotional health among adolescents. Factors that influence sleep have been identified. However, most literature is currently limited to urban settings. This study sought to identify factors that influence sleep habits among high school students in a semi-rural community. METHODS: Twelve focus groups were conducted in-person with separate groups of students, parents, and school staff in October 2019. Discussions focused on sleep experiences, knowledge, environment, and factors influencing sleep. Data were coded using grounded theory approach. Themes were identified through summative content analysis. RESULTS: Four major themes were identified: (1) inadequate sleep adversely affects academic performance and emotional health; (2) students face a gap in knowledge regarding sleep duration; (3) academic and nonacademic activities compete with sleep needs; and (4) night-time use of technology negatively influences sleep habits. CONCLUSIONS: Our findings suggest that high school students do not get adequate sleep, largely due to the demands of academic and extracurricular activities and the use of electronics at night. These results can guide the development of targeted sleep education and intervention programs.

A qualitative examination of barriers and facilitators of pediatric enhanced recovery protocol implementation among 18 pediatric surgery services.

BACKGROUND: Enhanced recovery protocols (ERPs) are an evidence-based intervention to optimize post-surgical recovery. Several studies have demonstrated that the use of an ERP for gastrointestinal surgery results in decreased length of stay, shortened time to a regular diet, and fewer administered opioids, while also trending toward lower complication and 30-day readmission rates. Yet, implementation of ERPs in pediatric surgery is lagging compared to adult surgery. The study's purpose was to conduct a theory-guided evaluation of barriers and facilitators to ERP implementation at US hospitals with a pediatric surgery service. METHODS: We conducted semi-structured interviews at 18 hospitals with 48 participants, including pediatric surgeons, anesthesiologists, gastroenterologists, nurses, and physician assistants. Interviews were conducted online, audio-recorded, and transcribed verbatim. To identify barriers and facilitators to ERP implementation, we conducted an analysis using deductive logics based on the five Active Implementation Frameworks (AIFs). RESULTS: Effective practices (usable innovations) were challenged by a lack of compliance to ERP elements, and facilitators were having standardized protocols in place and organization support for implementation. Effective implementation (stages of implementation and implementation drivers) had widespread barriers to implementation across the stages from exploration to full implementation. Barriers included needing dedicated teams for ERP implementation and buy-in from hospital leadership. These items, when present, were strong facilitators of effective implementation, in addition to on-site, checklists, protected time to oversee ERP implementation, and order sets for ERP elements built into the electronic medical record. The enabling context (teams) focused on teams' engagement in ERP implementation and how they collaborated to implement ERPs. Barriers included having surgical team members resistant to change or who were not bought into ERPs in pediatric practice. Facilitators included engaging a multi-disciplinary team and engaging patients and families early in the implementation process. CONCLUSIONS: Barriers to ERP implementation in pediatric surgery highlighted can be addressed through providing guidelines to ERP implementation, team-based support for change management, and protocols for developing an ERP implementation team. Future steps are to apply and evaluate these strategies in a stepped-wedge, cluster randomized trial to increase the implementation of ERPs at these 18 hospitals.

Age- and Sex-Specific Needs for Children Undergoing Inflammatory Bowel Disease Surgery: A Qualitative Study.

INTRODUCTION: The use of enhanced recovery protocols (ERP) is extending to pediatric surgical populations, such as patients with inflammatory bowel diseases (IBDs). Given the variation in age- and sex-specific characteristics of pediatric IBD patients, it is important to understand the unique needs of subgroups, such as male versus female or preadolescent versus older patients, when implementing ERPs. We gathered clinician, patient, and caregiver perspectives on age- and sex-specific needs for children undergoing IBD surgery. METHODS: We used semistructured interviews and focus groups to assess ERP needs and perceived differences in needs between preadolescent (10-13 y), older (14-19 y), male, and female IBD patients. Participants included clinicians, patients who had recent IBD surgery, and patients' caregivers. RESULTS: Forty-eight clinicians, six patients, and eight caregivers participated. Three broad categories of themes emerged: concerns, needs, and experiences related to the (1) surgical care process; (2) continuum of IBD care; and (3) suggestions to make surgical care more patient centered. With regard to surgical care processes, stakeholders reported different communication needs for preadolescent and older children. Key themes about the continuum of IBD care were the need (1) for support from child life specialists and (b) to address young women's health issues. Suggestions to make surgical care more patient centered included providing older children with patient experiences that reflect their perspective as young adults. CONCLUSIONS: The findings highlight the need to adopt a patient-centered approach for ERP use that actively addresses age- and sex-specific factors while engaging patients and caregivers as partners with clinicians to improve surgical care for children with IBD.

Barriers and Facilitators to School-Based Health Centers: pilot Data From 3 Sites in Georgia.

BACKGROUND: School-based health centers (SBHCs) provide opportunities for offering quality service to underserved populations. The objectives of this study were to: (1) document the SBHC process at different locations and evaluate their similarities and differences; (2) explore SBHC clinic staff satisfaction; and (3) identify facilitators and barriers to utilizing SBHCs. METHODS: Three Georgia SBHCs located in either predominantly Caucasian, African American, or Hispanic elementary schools were included in this study. Mixed methods data collection efforts included: (1) observational assessment of each SBHC; (2) interviews with 7 clinic administrators and staff; and (3) focus group discussions (N = 5) with parents of children that do and do not utilize SBHCs. RESULTS: Observational assessments indicated some clinics have more resources available than others. In-depth interviews found that centers are functioning at capacity, with potential for expansion and greater workload. Focus groups revealed that parents are satisfied with services provided, the price of the care, and the convenience of the centers. However, barriers have made utilization difficult for lower income families. CONCLUSIONS: Although most SBHC goals are being met, staff realize that further development and funding must be obtained to meet the needs of their communities.

Diferencia de la presión arterial medida en el brazo vs antebrazo en pacientes con circunferencia de brazo mayor a 34 cm / Difference of blood pressure measured in the arm vs forearm in patients with arm circumference higher than 34 cm

Resumen OBJETIVO Determinar si existe diferencia entre la medición de la presión arterial en el brazo con brazalete de tamaño adecuado para el paciente (circunferencia del brazo > 34 cm) vs medición de la presión arterial en el antebrazo con brazalete estándar (circunferencia de brazo 22-33 cm) en pacientes con circunferencia de brazo > 34 cm. MATERIAL Y MÉTODO Estudio prospectivo, observacional y transversal realizado de enero a junio de 2017. Se incluyeron pacientes de consulta externa del Hospital General de Mexicali con circunferencia del brazo > 34 cm. Se midió la presión arterial en el antebrazo con brazalete estándar, se realizó una segunda toma de la presión arterial en el brazo con brazalete para pacientes con diámetro de brazo mayor a 33 cm. RESULTADOS Se incluyeron 320 pacientes, 67% eran mujeres, con media de edad de 41 años, la circunferencia promedio del brazo fue de 38 cm. En hombres, la media fue de 35 años, con circunferencia promedio del brazo de 38 cm. La media de la presión sistólica en el antebrazo fue de 128.6 ± 12.5 vs 125.5 ± 13.6 mmHg en el brazo, con diferencia de 3.54 con valor p = 0.0007. La media de la presión arterial diastólica en el antebrazo fue de 83.42 ± 8.95 vs 79.21 ± 8.88 mmHg en el brazo, con diferencia entre ambos de 4.21, p ≤ 0.0001. CONCLUSIONES La obtención de la presión arterial en el antebrazo con un brazalete estándar en pacientes con circunferencia del brazo mayor a 34 cm cuando no se cuente con un brazalete apropiado proporcionará cifras similares a las obtenidas con un brazalete adecuado, con lecturas mayores, pero con diferencias por debajo de 5 mmHg.

Abstract OBJECTIVE To determine if there is a difference between measuring blood pressure in the arm with and adequate size bracelet for patients (arm circumference > 34 cm) vs measuring blood pressure in the forearm with a standard bracelet (arm circumference < 22-33 cm) in patients with arm circumference > 34 cm. MATERIAL AND METHOD A prospective, observational, cross-sectional study was done from January to June 2017. Sample: patients from external consult of Hospital General de Mexicali with arm circumference > 34 cm. Blood pressure was measured in the forearm of the patient with a standard bracelet, blood pressure was measured again in the arm with an adequate bracelet (for patients with an arm circumference > 33 cm). RESULTS 320 patients were included for this study, 67% were women, with an average age of 41 years, average arm circumference was of 38 cm. In men, the average age was 35 years with an average arm circumference of 38 cm. Average of the systolic pressure in the forearm was 128.6 ± 12.5 vs 125.5 ± 13.6 mmHg in the arm, with a difference of 3.54 with a p = 0.0007. The average of the diastolic pressure in the forearm was 83.42 ± 8.95 vs 79.21 ± 8.88 mmHg in the arm with a difference of 4.21, p ≤ 0.0001. CONCLUSIONS Measurement of blood pressure in the forearm with a standard bracelet in patients with an arm circumference > 34 cm when we don't have the adequate bracelet will give us similar values compared to the blood pressure in the arm with an adequate bracelet, with higher values but differences below 5 mmHg.

Angina mesentérica en un paciente con linfoma de colon y adenocarcinoma prostático / Mesenteric angina in a patient with colonic lymphoma and prostatic adenocarcinoma

Resumen La angina mesentérica es un síndrome causado por la inadecuada perfusión sanguínea por parte de los vasos mesentéricos, que resulta en isquemia y a la larga en gangrena de la pared intestinal. Aunque relativamente poco frecuente, es un padecimiento potencialmente mortal. Reportamos un caso de isquemia mesentérica que inició con plenitud, dolor posprandial temprano, distensión abdominal y pérdida de peso en un paciente previamente diagnosticado y tratado de linfoma de colon y adenocarcinoma prostático.

Abstract Mesenteric angina is a syndrome caused by inadequate perfusion from the mesenteric vessels, resulting in ischemia and eventually gut necrosis. Although relatively rare, it is a potential deadly condition. We report a case of mesenteric ischemia which began with bloating, postprandial pain and weight loss on a patient previously diagnosed and treated from colonic lymphoma and prostatic adenocarcinoma.

Condrodisplasia Rizomélica Punctata: Reporte de 2 casos

La condrodisplasia rizomélica punctata es una enfermedad peroxisomal que se transmite de manera autosómica recesiva, donde se ve afectada la actividad bioquímica de este organillo por defectos en la síntesis y actividad de enzimas que participan en una gran variedad de vías metabólicas, éstas incluyen; La beta oxidación ácidos grasos, síntesis de ácidos biliares y los compuestos isoprenoides. Describimos las manifestaciones clínicas, estudios complementarios y la evolución de dos hermanos atendidos, los cuales presentaban antecedentes y hallazgos en común con este infrecuente padecimiento. De los dos casos, uno fue del sexo femenino y el otro del sexo masculino, el primero falleció por falla respiratoria y el segundo se le realizan los estudios complementarios para el diagnóstico. Desde el punto de vista genético hay consanguinidad del cuarto grado en esta descendencia ya que la pareja son primos y esto aumenta el riesgo de que aparezcan enfermedades hereditarias del tipo autosómico recesivo.

The rhizomelic chondrodysplasia punctata is a peroxisomal disease that is transmitted in an autosomal recessive, where it affected the biochemical activity of this organelle by defects in the synthesis and activity of enzymes involved in a variety of metabolic pathways including the beta oxidation of some fatty acids, bile acid synthesis and isoprenoid compounds. This article describes the clinical manifestations, complementary studies and evolution of 2 brothers served in the Hospital José Domingo de Obaldía in 2009, which had a history and findings in common with this rare condition. Of the 2 cases, one was female and one male, the first died of a respiratory problem and the second study was performed to verify the diagnosis. From the genetic point of view there is a 4th degree consanguinity in the offspring as the pair are cousins and this increases the risk of emerging diseases of autosomal recessive hereditary.