Resources for the practice of pediatric neuro-oncology in Mexico: a cross-sectional evaluation.

Background: The evaluation of existing resources and services is key to identify gaps and prioritize interventions to expand care capacity for children with central nervous system (CNS) tumors. We sought to evaluate the resources for pediatric neuro-oncology (PNO) in Mexico. Methods: A cross-sectional online survey with 35 questions was designed to assess PNO resources and services, covering aspects including number of patients, infrastructure, human resources, and diagnostic and treatment time intervals. The survey was distributed to the members of the Mexican Association of Pediatric Oncology and Hematology (AMOHP) who belong to the nation's many different health systems. Results: Responses were obtained from 33 institutions, distributed throughout the country and part of the many health systems that exist in Mexico. Twenty-one (64%) institutions had less than 10 new cases of pediatric CNS tumors per year. Although 30 (91%) institutions saw pediatric patients up to the age of 18 years, 2 (6%) had a cutoff of 15 years. Twenty-four (73%) institutions had between 1 and 3 pediatric oncologists providing care for children with CNS tumors. Six (18%) institutions did not have a neurosurgeon, while 19 (57%) institutions had a pediatric neurosurgeon. All centers had a pathology department, but 13 (39%) institutions only had access to basic histopathology. Eleven (33%) institutions reported histopathological diagnoses within one week, but 3 (9%) took more than 4 weeks. Radiotherapy for pediatric CNS tumors was referred to outside centers at 18 (55%) institutions. All centers had access to conventional cytotoxic chemotherapy, but only 6 (18%) had access to targeted therapy. Eighteen (55%) respondents estimated a survival rate of less than 60%. Fifteen (45%) centers attributed the main cause of mortality to non-tumor related factors, including infection and post-surgical complications. Conclusions: This is the first national assessment of the resources available in Mexico for the treatment of CNS tumors. It shows disparities in resource capacity and a lack of the specific and efficient diagnoses that allow timely initiation of treatment. These data will enable the prioritization of collaborative interventions in the future.

Healthcare personnel early return-to-work program after higher-risk SARS-CoV-2 exposure: A learning health system quality improvement project.

BACKGROUND: Incidence of health care personnel (HCP) with a higher-risk SARS-CoV-2 exposure and subsequent 14-day quarantine period adds substantial burden on the workforce. Implementation of an early return-to-work (RTW) program may reduce quarantine periods for asymptomatic HCP and reduce workforce shortages during the COVID-19 pandemic. METHODS: This observational quality improvement study included asymptomatic HCP of a multi-facility health care system with higher-risk workplace or non-household community SARS-CoV-2 exposure ≤4 days. The program allowed HCP to return to work 8 days after exposure if they remained asymptomatic through day 7 with day 5-7 SARS-CoV-2 nucleic acid amplification test result negative. RESULTS: Between January 4 and June 25, 2021, 384 HCP were enrolled, 333 (86.7%) remained asymptomatic and of these, 323 (97%) tested negative and were early RTW eligible. Mean days in quarantine was 8.16 (SD 2.40). Median day of early RTW was 8 (range 6-9, IQR 8-8). Mean days saved from missed work was 1.84 (SD 0.52). A total of 297 (92%) HCP did RTW ≤10 days from exposure and days saved from missed work was 546.48. CONCLUSIONS: Implementing an HCP early RTW program is a clinical approach for COVID-19 workplace safety that can increase staffing availability, while maintaining a low risk of SARS-CoV-2 transmission.

Evaluación de la capacidad y percepción de autocuidado del adulto mayor en la comunidad / Assessment of the capability and perception of self-care of elderly in community

Medir salud en el paciente anciano resulta complejo, pues es medir la resultante de diversas variables de carácter biológico, psicológico y social, por lo que la salud del anciano debe medirse en correspondencia con su funcionabilidad. Motivado por esto se realizó un estudio descriptivo transversal en el municipio Holguín con el objetivo de evaluar la capacidad y percepción de autocuidado del Adulto Mayor en la comunidad. De un universo de 354 ancianos de 3 consultorios, se seleccionaron 195, a los cuales se les aplicó un Instrumento diseñado al efecto para medir su nivel de autocuidado. Los resultados arrojaron que el 50,5 por ciento de los hombres y el 43,3 por ciento de las mujeres no se cuida adecuadamente, existe un déficit de autocuidado cognoscitivo-perceptivo en el 46,7 por ciento, un 9,8 por ciento tienen déficit parcial y 5,6 por ciento déficit total. De los 121 pacientes cuyo nivel de autocuidado es inadecuado el 75,2 por ciento son independientes y el 63,6 por ciento perciben su estado de salud aparentemente sano, concluyéndose que no obstante la gran mayoría de los adultos mayores estudiados ser independientes para realizar las actividades de la vida diaria, estos no desarrollan adecuadamente sus capacidades de autocuidado, por lo que el grado funcional independiente es una condición necesaria pero no suficiente para un buen autocuidado, los adultos mayores que perciben algún riesgo para su salud se cuidan más que los que se perciben sanos. El instrumento aplicado define la actividad de autocuidado en las personas mayores, recomendándose su introducción en la evaluación gerontológica en la Atención Primaria de Salud(AU)

To measure health in the old patient is complex, because it is to measure the resultant of diverse variables of biological, psychological and social character, for what the health in old man should be measured in correspondence with their functional state. Motivated for this reason was carried out a traverse descriptive study in the municipality Holguin, with the objective of evaluating the capacity and perception of self-care of the old men in the community. Of an universe of 354 elderly people of 3 clinics, 195 were selected, to which were applied an Instrument designed to the effect to measure their level of self-care. The results indicated that 50,5 percent of the men and 43,3 percent of the women don't their care appropriately, a deficit of cognitive-perceptive self-care exists in 46,7 percent, 9,8 percent has partial deficit and 5,6 percent total deficit. Of the 121 patients whose level of self-care is inadequate, 75,2 percent is independent and 63,6 percent perceives its seemingly healthy state of health, being concluded that nevertheless the great majority of the studied old men to be independent to carry out the activities of the daily life, they don't develop its capacities of self-care appropriately, for what the independent functional degree is a necessary but not enough condition for a good self-care, the elderly people that perceive some risk for its health take care more than those that are perceived healthy. The applied instrument defines the activity of self-care in the study patients, being recommended its introduction in the geriatric evaluation in the Primary Attention of Health(AU)