Factors influencing witnesses' perception of patient safety during pre-hospital health care from emergency medical services: A multi-center cross-sectional study.

AIM: To determine the factors related with the perception of feeling safe during pre-hospital emergency care. METHODS: A multi-centred, cross-sectional study. Data collection from April 2021 to March 2022, in the Centro de Emergencias Sanitarias 061 (Andalusia, Spain). INCLUSION CRITERIA: witnesses of health care by emergency medical services. EXCLUSION CRITERIA: minors, or communication barriers. OUTCOME VARIABLE: Witness Perceived Safety Scale ESPT10. The variables studied were related with sociodemographic data, the request for health care, the patient, the hospital transfer and patient safety incidents. A multivariate linear regression model was constructed for the dependent variable. The study followed STROBE statement. RESULTS: Responses were obtained from 1400 witnesses. The linear regression model showed that the score on the scale increased as the witnesses felt more satisfied (B = 1.302; p < 0.001). On the contrary, the score was lower when the witness reported a patient safety incident (B = -2.856; p < 0.001 and B = -3.166; p < 0.001), or when the assistance took place in a public space (B = -0.722; p = 0.017). CONCLUSIONS: The level of satisfaction, the occurrence of a patient safety incident, and the place of health care are related factors with the perception of the witnesses. The Witness Perceived Safety Scale ESPT10 could be considered a valid and useful patient safety indicator.

Factores relacionados con la percepción de los pacientes de sentirse seguros en emergencias extrahospitalarias: estudio transversal multicéntrico / Factors related to patients’ perception of feeling safe in pre-hospital emergencies: a multicenter cross-sectional study

Objetivos: Conocer los factores que se relacionan con la percepción de los pacientes de sentirse seguros en emergencias extrahospitalarias. Método: Estudio observacional descriptivo, transversal, multicéntrico, en los equipos de emergencias 061 de Andalucía. Se recogieron los datos desde abril 2021 hasta marzo 2022. Criterios de inclusión fueron pacientes asistidos y trasladados por equipos de emergencias, y los criterios de exclusión fueron menores de edad, deterioro cognitivo, alteración de consciencia, o barreras comunicativas. Se calculó un tamaño muestral mínimo de 644 sujetos. La variable resultado fue la puntuación de la Escala de Seguridad Percibida (ESP16). Se estudiaron variables sociodemográficas y relacionadas con la demanda asistencial, el paciente y el traslado. Además, se recogieron notificaciones de incidentes relacionados con la seguridad del paciente (IRSP). Se construyó un modelo de regresión lineal multivariable para la variable dependiente. Se siguieron las recomendaciones STROBE. Resultados: Se obtuvieron 1.756 respuestas. La puntuación media en la ESP16 fue 77,7 (DE 5,6), con mediana de 80. El modelo de regresión lineal mostró que el nivel de satisfacción (B = 2,799; p < 0,001), la notificación de error, caída, daño o lesión (B = –6,097; p < 0,001), la notificación de cualquier otro IRSP (B = –2,742; p < 0,001), la transferencia protocolizada (B = 2,538; p = 0,001), el tipo de recurso asistencial (B = 1,157; p < 0,001), un diagnóstico final cardiológico (B = 0,726; p = 0,014) y un nivel de dolor intenso (B = 1,195; p = 0,003) influían en la escala ESP16. Conclusiones: La percepción de seguridad del paciente es muy alta, y está condicionada por el nivel de satisfacción, la notificación de IRSP, la transferencia protocolizada, el recurso asistencial, el diagnóstico final y el nivel de dolor. (AU)

Aim: To identify factors related to patients’ feeling of safety during prehospital emergencies. Methods: Descriptive, multicenter cross-sectional study in the context of “061” emergency response services of Andalusia, Spain. Data were collected from April 2021 to March 2022. Patients attended and transported by emergency responders were eligible for inclusion. Patients were excluded if they were minors or in an altered state of consciousness, or had cognitive impairment or any barrier to communication. We calculated that a minimum sample size of 644 patients would be required. The outcome variable was the score on a 16-item scale of patient-perceived safety (ESP16, as abbreviated in Spanish). Sociodemographic, emergency service response, patient, and hospital transfer variables were studied in relation to ESP16 score. We also collected patient safety incident reports.Multivariate linear regression was used to analyze associations between the independent variables and the dependent outcome variable. Guidelines for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) were followed. Results: We received 1756 responses. The mean (SD) ESP16 score was 77.7 (5.6); the median score was 80. The b coefficients derived from the linear regression model were as follows for the variables associated with the ESP16 score: 2.799 (P < .001) for satisfaction; –6.097 (P < .001) for incident reports of errors, falls, harm, or injury; –2.742 (P < .001) for reports of any other incident during attendance; 2.538 (P = .001) for use of the transport protocol; 1.157 (P < .001) for type of emergency transport used; 0.726 (P = .014) for a cardiology diagnosis; and 1.195 (P = .003) for pain intensity. Conclusions: Patients’ perception of safety is very high, as reflected by level of satisfaction, incident reports, use of a transport protocol, means of transport used, diagnosis, and pain level. (AU)

Factors related to patients' perception of feeling safe in pre-hospital emergencies: a multicenter cross-sectional study. / Factores relacionados con la percepción de los pacientes de sentirse seguros en emergencias extrahospitalarias: estudio transversal multicéntrico.

OBJECTIVES: To identify factors related to patients' feeling of safety during prehospital emergencies. MATERIAL AND METHODS: Descriptive, multicenter cross-sectional study in the context of "061" emergency response services of Andalusia, Spain. Data were collected from April 2021 to March 2022. Patients attended and transported by emergency responders were eligible for inclusion. Patients were excluded if they were minors or in an altered state of consciousness, or had cognitive impairment or any barrier to communication. We calculated that a minimum sample size of 644 patients would be required. The outcome variable was the score on a 16-item scale of patient-perceived safety (ESP16, as abbreviated in Spanish). Sociodemographic, emergency service response, patient, and hospital transfer variables were studied in relation to ESP16 score. We also collected patient safety incident reports. Multivariate linear regression was used to analyze associations between the independent variables and the dependent outcome variable. Guidelines for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) were followed. RESULTS: We received 1756 responses. The mean (SD) ESP16 score was 77.7 (5.6); the median score was 80. The ßô€€ƒ coefficients derived from the linear regression model were as follows for the variables associated with the ESP16 score: 2.799 (P .001) for satisfaction; -6.097 (P .001) for incident reports of errors, falls, harm, or injury; -2.742 (P .001) for reports of any other incident during attendance; 2.538 (P = .001) for use of the transport protocol; 1.157 (P .001) for type of emergency transport used; 0.726 (P = .014) for a cardiology diagnosis; and 1.195 (P = .003) for pain intensity. CONCLUSION: Patients' perception of safety is very high, as reflected by level of satisfaction, incident reports, use of a transport protocol, means of transport used, diagnosis, and pain level.

OBJETIVO: Conocer los factores que se relacionan con la percepción de los pacientes de sentirse seguros en emergencias extrahospitalarias. METODO: Estudio observacional descriptivo, transversal, multicéntrico, en los equipos de emergencias 061 de Andalucía. Se recogieron los datos desde abril 2021 hasta marzo 2022. Criterios de inclusión fueron pacientes asistidos y trasladados por equipos de emergencias, y los criterios de exclusión fueron menores de edad, deterioro cognitivo, alteración de consciencia, o barreras comunicativas. Se calculó un tamaño muestral mínimo de 644 sujetos. La variable resultado fue la puntuación de la Escala de Seguridad Percibida (ESP16). Se estudiaron variables sociodemográficas y relacionadas con la demanda asistencial, el paciente y el traslado. Además, se recogieron notificaciones de incidentes relacionados con la seguridad del paciente (IRSP). Se construyó un modelo de regresión lineal multivariable para la variable dependiente. Se siguieron las recomendaciones STROBE. RESULTADOS: Se obtuvieron 1.756 respuestas. La puntuación media en la ESP16 fue 77,7 (DE 5,6), con mediana de 80. El modelo de regresión lineal mostró que el nivel de satisfacción (B = 2,799; p 0,001), la notificación de error, caída, daño o lesión (B = ­6,097; p 0,001), la notificación de cualquier otro IRSP (B = ­2,742; p 0,001), la transferencia protocolizada (B = 2,538; p = 0,001), el tipo de recurso asistencial (B = 1,157; p 0,001), un diagnóstico final cardiológico (B = 0,726; p = 0,014) y un nivel de dolor intenso (B = 1,195; p = 0,003) influían en la escala ESP16. CONCLUSIONES: La percepción de seguridad del paciente es muy alta, y está condicionada por el nivel de satisfacción, la notificación de IRSP, la transferencia protocolizada, el recurso asistencial, el diagnóstico final y el nivel de dolor.

Total Design in the Design and Development Process of a Remotely Operated Vehicle (ROV) with Particular Consideration of Sensorization.

This paper provides a methodological proposal for the design and development process of a remotely operated vehicle (ROV). The design core and product design specifications (PDS) of Pugh's Total Design model are considered, with a focus on the early stages of the product design and development process. A modularization of the functional groups of an ROV is proposed, focusing attention on the sensor system. The main concepts regarding ROVs are presented, Pugh's Total Design model is explained, justifying the application interest in technological projects, a methodological proposal adapted to ROV projects is provided, based on Pugh's Total Design model, with special interest in the early stages of the new product development process (NPD), the suitability of applying our own model of industrial design engineering in an ROV system is analyzed, and the contribution of this study is evaluated, proposing future work and lines of research.

Development and Validation of a Safety Scale Perceived by the Witness of Prehospital Emergency Care.

OBJECTIVE: The aim of the study was to design and validate a new tool to measure the security perceived by witnesses of patient care and hospital transfers, after requesting urgent assistance via the "061" phone number. METHODS: This is a descriptive observational, cross-sectional, design, and validation study of a scale conducted by telephone interview. Witnesses of urgent assistance and transfers by prehospital emergency medical services in the province of Cadiz, in the south of Spain, were the subjects of study. A questionnaire was designed after focus groups with patients, witnesses, and professionals. It consisted of 10 items, with Likert-type answers, and a range of 0 to 50 points. In addition to basic criteria (frequency of endorsement and ability to discriminate between groups), their validity (content and construct) and reliability (stability and homogeneity) were evaluated. Stability was evaluated by test-retest and homogeneity by means of two properties: internal consistency of items (corrected item-scale correlation coefficient) and internal consistency of the scale (Cronbach α coefficient). RESULTS: A total of 849 questionnaires were obtained, with scores between 0 and 50 points, with an average of 47.31 (median of 50). The exploratory factor analysis detected a component that explained 61.1% of the total variance. The intraclass correlation coefficient was 0.933 with 95% confidence interval between 0.900 and 0.954. The corrected item-scale correlation coefficient was greater than 0.596, and the Cronbach α coefficient was 0.927 (95% confidence interval, 0.919-0.934). CONCLUSIONS: The ESPT10 Witness Perceived Safety Scale is valid and reliable for quantifying the safety perception of witnesses of emergency assistance and transfers.

Graphics Processing Unit-Enhanced Genetic Algorithms for Solving the Temporal Dynamics of Gene Regulatory Networks.

Understanding the regulation of gene expression is one of the key problems in current biology. A promising method for that purpose is the determination of the temporal dynamics between known initial and ending network states, by using simple acting rules. The huge amount of rule combinations and the nonlinear inherent nature of the problem make genetic algorithms an excellent candidate for finding optimal solutions. As this is a computationally intensive problem that needs long runtimes in conventional architectures for realistic network sizes, it is fundamental to accelerate this task. In this article, we study how to develop efficient parallel implementations of this method for the fine-grained parallel architecture of graphics processing units (GPUs) using the compute unified device architecture (CUDA) platform. An exhaustive and methodical study of various parallel genetic algorithm schemes-master-slave, island, cellular, and hybrid models, and various individual selection methods (roulette, elitist)-is carried out for this problem. Several procedures that optimize the use of the GPU's resources are presented. We conclude that the implementation that produces better results (both from the performance and the genetic algorithm fitness perspectives) is simulating a few thousands of individuals grouped in a few islands using elitist selection. This model comprises 2 mighty factors for discovering the best solutions: finding good individuals in a short number of generations, and introducing genetic diversity via a relatively frequent and numerous migration. As a result, we have even found the optimal solution for the analyzed gene regulatory network (GRN). In addition, a comparative study of the performance obtained by the different parallel implementations on GPU versus a sequential application on CPU is carried out. In our tests, a multifold speedup was obtained for our optimized parallel implementation of the method on medium class GPU over an equivalent sequential single-core implementation running on a recent Intel i7 CPU. This work can provide useful guidance to researchers in biology, medicine, or bioinformatics in how to take advantage of the parallelization on massively parallel devices and GPUs to apply novel metaheuristic algorithms powered by nature for real-world applications (like the method to solve the temporal dynamics of GRNs).

Avances en el desarrollo infantil temprano: desde neuronas hasta programas a gran escala / Advances in early childhood development: from neurons to big scale programs

Resumen: El desarrollo infantil temprano (DIT) es la base del desarrollo económico y social de los países y de su capacidad de cumplir con los Objetivos de Desarrollo Sostenible (ODS). La gestación y los primeros 3 años de vida son fundamentales para que los niños tengan un desarrollo físico, psicosocial, emocional y cognitivo adecuado para el resto de sus vidas. La crianza y el cuidado cariñoso y sensible a las necesidades de los niños durante la gestación y la primera infancia son esenciales para el desarrollo de los billones de neuronas y trillones de sinapsis necesarias. El DIT requiere de acceso a buena nutrición y servicios de salud desde la gestación, crianza sensible de acuerdo a la etapa de desarrollo del niño, protección social y del bienestar del niño, y oportunidades de estimulación y aprendizaje temprano. Para mejorar el DIT a nivel nacional se recomiendan seis acciones con fuerte participación de la sociedad civil: expandir la voluntad política y financiamiento, crear un entorno de políticas favorables basadas en evidencia, construir capacidad con coordinación intersectorial, asegurar una gobernanza justa y transparente de los programas y servicios, aumentar apoyo a la investigación multidisciplinaria y promover el desarrollo de líderes. México ha logrado avances importantes en DIT bajo el liderazgo del Sector Salud, pero enfrenta retos significativos para implementar estas recomendaciones. La reciente creación de un marco nacional intersectorial favorable al DIT con apoyo de los organismos internacionales y la participación de la sociedad civil pueden ayudar a sobreponer estos retos.

Abstract: Early childhood development (ECD) is the basis of countries' economic and social development and their ability to meet the Sustainable Development Goals (SDGs). Gestation and the first three years of life are critical for children to have adequate physical, psychosocial, emotional and cognitive development for the rest of their lives. Nurturing care and protection of children during gestation and early childhood are necessary for the development of trillions of neurons and trillions of synapses necessary for development. ECD requires access to good nutrition and health services from gestation, responsive caregiving according to the child's developmental stage, social protection and child welfare, and early stimulation and learning opportunities. Six actions are recommended to improve national ECD programs: expand political will and funding; create a supportive, evidence-based policy environment; build capacity through intersectoral coordination; ensure fair and transparent governance of programs and services; increase support for multidisciplinary research; and promote the development of leaders. Mexico has made significant progress under the leadership of the Health Ministry, but still faces significant challenges. The recent creation of a national intersectoral framework to enable ECD with support of international organizations and the participation of civil society organizations can help overcome these challenges.

Asociación entre el tiempo de permanencia en el Programa de Estancias Infantiles para niños en situación de pobreza y el nivel de desarrollo infantil / Association between time of permanence at early education program (Estancias Infantiles) and developmental level for children in situation of poverty

Resumen: Introducción: El Programa de Estancias Infantiles (PEI) se enfoca en padres de niños de 1-3 años en situación de pobreza. Incluye educación y cuidado de los niños por 8 h, 5 días por semana. El objetivo del estudio fue evaluar la asociación entre el tiempo de permanencia en el PEI y el nivel de desarrollo infantil. Métodos: Estudio transversal de base poblacional en dos estados de México. Se incluyeron todos los niños de 12-48 meses inscritos al PEI de noviembre de 2014 a enero de 2015. Se evaluó el nivel de desarrollo con la prueba EDI. Se calculó la razón de momios de prevalencia (RMP) para desarrollo normal por tiempo de estancia, ajustado por sexo, edad y discapacidad, teniendo como referencia a los niños que tenían < 30 días en el PEI. Resultados: Se incluyeron 3387 niños de 177 estancias infantiles: 53% de sexo masculino; 22.3% de 12-24 meses, 37.6% de 25-36 meses y 40.1% de 37-42 meses de edad. El RMP ajustado para desarrollo normal fue de 1.90 (IC95%:1.30-2.78) para 6-11 meses, 2.36 (IC95%:1.60-3.50) para 12-17 meses, 2.78 (IC95%:1.65-4.65) para 18-23 meses y 3.46 (2.13-5.60) para > 24 meses. Por área de desarrollo, se observó una mayor probabilidad de desarrollo normal a partir de 6 meses de estancia para lenguaje y social, y a partir de 12 meses para motor grueso, fino y conocimiento. Conclusiones: El tiempo de permanencia en el PEI a partir de 6 meses incrementa, de forma significativa y progresiva, la probabilidad de tener un desarrollo normal independiente del sexo y edad.

Abstract: Background: Early education program (EEP) was created to support parents with 1 to 3 year olds living in poverty situation in Mexico, and includes education and child daycare for 8 h five days per week. The objective of this study was to evaluate the association between length of stay in EEP and the level of development in children. Methods: Cross sectional, population-based study conducted in two Mexican states. All children aged between 12 to 48 months enrolled in EEP from November 2014 to January 2015 were included. Child Development Evaluation (CDE) test was used to screen early development in every child. Normal early development prevalence odds ratio (OR) was calculated adjusted by gender, impairment and state, using as a reference those children with less than 30 days in the program. Results: The study included 3,387 children from 177 EEP nurseries, from which 53% were male; age by group was divided in 12-24 months (22.3%), 25-36 months (37.6%) and 37-42 months (40.1%). Normal development adjusted OR by age was 1.9 (CI95%: 1.30-2.78) for 6-11 months, 2.36 (CI95%: 1.60-3.50) for 12-17 months, 2.78 (CI95%: 1.65-4.65) for 18-23 months and 3.46 (CI95%: 2.13-5.60) for >24 months. By area of development, a greater probability of having a normal result for language and social areas was observed after 6 months in the program, and for motor (both gross and fine) and knowledge areas after 12 months. Conclusion: The length of the stay in the EEP after 6 months significantly and progressively increases the probability of normal development regardless of gender and age.

[Association between time of permanence at early education program (Estancias Infantiles) and developmental level for children in situation of poverty]. / Asociación entre el tiempo de permanencia en el Programa de Estancias Infantiles para niños en situación de pobreza y el nivel de desarrollo infantil.

BACKGROUND: Early education program (EEP) was created to support parents with 1 to 3 year olds living in poverty situation in Mexico, and includes education and child daycare for 8h five days per week. The objective of this study was to evaluate the association between length of stay in EEP and the level of development in children. METHODS: Cross sectional, population-based study conducted in two Mexican states. All children aged between 12 to 48 months enrolled in EEP from November 2014 to January 2015 were included. Child Development Evaluation (CDE) test was used to screen early development in every child. Normal early development prevalence odds ratio (OR) was calculated adjusted by gender, impairment and state, using as a reference those children with less than 30 days in the program. RESULTS: The study included 3,387 children from 177 EEP nurseries, from which 53% were male; age by group was divided in 12-24 months (22.3%), 25-36 months (37.6%) and 37-42 months (40.1%). Normal development adjusted OR by age was 1.9 (CI95%: 1.30-2.78) for 6-11 months, 2.36 (CI95%: 1.60-3.50) for 12-17 months, 2.78 (CI95%: 1.65-4.65) for 18-23 months and 3.46 (CI95%: 2.13-5.60) for >24 months. By area of development, a greater probability of having a normal result for language and social areas was observed after 6 months in the program, and for motor (both gross and fine) and knowledge areas after 12 months. CONCLUSION: The length of the stay in the EEP after 6 months significantly and progressively increases the probability of normal development regardless of gender and age.

[Advances in early childhood development: from neurons to big scale programs]. / Avances en el desarrollo infantil temprano: desde neuronas hasta programas a gran escala.

Early childhood development (ECD) is the basis of countries' economic and social development and their ability to meet the Sustainable Development Goals (SDGs). Gestation and the first three years of life are critical for children to have adequate physical, psychosocial, emotional and cognitive development for the rest of their lives. Nurturing care and protection of children during gestation and early childhood are necessary for the development of trillions of neurons and trillions of synapses necessary for development. ECD requires access to good nutrition and health services from gestation, responsive caregiving according to the child's developmental stage, social protection and child welfare, and early stimulation and learning opportunities. Six actions are recommended to improve national ECD programs: expand political will and funding; create a supportive, evidence-based policy environment; build capacity through inter-sectoral coordination; ensure fair and transparent governance of programs and services; increase support for multidisciplinary research; and promote the development of leaders. Mexico has made significant progress under the leadership of the Health Ministry, but still faces significant challenges. The recent creation of a national inter-sectoral framework to enable ECD with support of international organizations and the participation of civil society organizations can help overcome these challenges.

Análisis y comparación curricular de las estrategias o programas para el desarrollo infantil temprano en México / Curriculum analysis and comparison between strategies or programs for early child development in Mexico

Resumen: Introducción: La mayoría de las estrategias o programas que apoyan el desarrollo de la primera infancia en México son esfuerzos independientes que varían en escala, servicios que ofrecen y modo de proporcionarlos. Para la evaluación de la calidad de estos programas, un aspecto de suma importancia es el contenido curricular. El objetivo de este estudio fue realizar un análisis y comparación curricular de las distintas estrategias o programas enfocados en la promoción e intervención del desarrollo infantil temprano que ofrece el Gobierno Federal en los sectores Salud y Educación en México. Método: Se realizó una revisión de la información de los contenidos curriculares de las estrategias o programas. La fase cualitativa consistió en un análisis documental comparativo con un ejercicio hermenéutico donde se identificaron los 75 indicadores propuestos por el Banco Interamericano de Desarrollo. La fase cuantitativa consistió en el análisis descriptivo de los indicadores. Finalmente, se compararon los análisis para establecer el desempeño de cada uno. Resultados: Se identificaron seis estrategias o programas. En el análisis de la presencia de indicadores, la estrategia Oportunidades de Aprendizaje (OA) fue la que presentó un mayor número de indicadores. En el análisis de amplitud, tanto PEI-CONAFE como OA fueron los mejor balanceados. Por último, en el análisis de profundidad de los indicadores, OA y Habilidades para la Vida fueron los mejor balanceados, mientras que PEI-CONAFE resultó el mejor balanceado para el área socio-emocional, CeNSIA para lenguaje y OA para el área cognitiva. Conclusiones: La estrategia OA fue la que garantizó un mayor acercamiento a los contenidos establecidos por el Banco Interamericano de Desarrollo.

Abstract: Background: Most of the strategies or programs that support early child development in Mexico are independent efforts that vary in scale, services offered and means of providing them. For the evaluation of the quality of these programs, an important aspect is the curriculum content. The aim of this study was to analyze and compare the curriculum content of the different strategies or programs focused on the promotion and intervention of early child development, which are offered by the Federal Government in Health and Education sectors in Mexico. Methods: We conducted a review of the curriculum content of the strategies and programs. The qualitative phase consisted of a comparative analysis where 75 indicators proposed by the Inter-American Development Bank were identified. The quantitative phase consisted of a descriptive analysis of the indicators. Finally, the analyses were compared to establish the performance of each one. Results: Six strategies or programs were identified. In the analysis of the presence of indicators, the Oportunidades de Aprendizaje (Learning Opportunities, LO) strategy showed a larger number of indicators. In the amplitude analysis, both PEI-CONAFE and LO were the best balanced. Finally, in-depth analysis of the indicators LO and Skills for life were the best balanced while PEI-CONAFE was the best balanced in the social-emotional area, CeNSIA program for language and LO for cognitive development area. Conclusions: LO strategy showed the closest level of contents established by the Inter-American Development Bank.

[Curriculum analysis and comparison between strategies or programs for early child development in Mexico]. / Análisis y comparación curricular de las estrategias o programas para el desarrollo infantil temprano en México.

BACKGROUND: Most of the strategies or programs that support early child development in Mexico are independent efforts that vary in scale, services offered and means of providing them. For the evaluation of the quality of these programs, an important aspect is the curriculum content. The aim of this study was to analyze and compare the curriculum content of the different strategies or programs focused on the promotion and intervention of early child development, which are offered by the Federal Government in Health and Education sectors in Mexico. METHODS: We conducted a review of the curriculum content of the strategies and programs. The qualitative phase consisted of a comparative analysis where 75 indicators proposed by the Inter-American Development Bank were identified. The quantitative phase consisted of a descriptive analysis of the indicators. Finally, the analyses were compared to establish the performance of each one. RESULTS: Six strategies or programs were identified. In the analysis of the presence of indicators, the Oportunidades de Aprendizaje (Learning Opportunities, LO) strategy showed a larger number of indicators. In the amplitude analysis, both PEI-CONAFE and LO were the best balanced. Finally, in-depth analysis of the indicators LO and Skills for life were the best balanced while PEI-CONAFE was the best balanced in the social-emotional area, CeNSIA program for language and LO for cognitive development area. CONCLUSIONS: LO strategy showed the closest level of contents established by the Inter-American Development Bank.

Impacto de un modelo de capacitación de la prueba Evaluación del Desarrollo Infantil en la atención primaria / Impact of a training model for the Child Development Evaluation Test in primary care

ResumenIntroducción: La prueba Evaluación del Desarrollo Infantil (EDI) es una herramienta de tamiz para la detección oportuna de problemas del desarrollo, diseñada y validada en México. Para que sus resultados sean confiables, se requiere que el personal que la aplique haya adquirido los conocimientos necesarios previamente, a través de un curso de capacitación en la unidad de salud que labore. El objetivo de este trabajo fue evaluar el impacto de un modelo de capacitación impartido al personal que trabaja en atención primaria en seis entidades federativas en México. Lo anterior mediante la comparación de los conocimientos adquiridos en la capacitación.Método: Se realizó un estudio de evaluación de antes y después, considerando como intervención el haber acudido a un curso de capacitación sobre la prueba EDI de octubre a diciembre de 2013.Resultados: Se incluyeron 394 participantes. Las profesiones fueron las siguientes: medicina general (73.4%), enfermería (7.7%), psicología (7.1%), nutrición (6.1%), otras profesiones (5.6%). En la evaluación inicial, el 64.9% obtuvo una calificación menor a 20. En la evaluación final, disminuyó al 1.8%. En la evaluación inicial aprobó el 1.8% comparado con el 75.1% en la evaluación final. Las preguntas con menor porcentaje de respuestas correctas fueron las relacionadas con la calificación de la prueba.Conclusiones: El modelo de capacitación resultó adecuado para adquisición de conocimientos generales sobre la prueba. Para mejorar el resultado global se requiere reforzar los temas de calificación e interpretación de los resultados en futuras capacitaciones, y que los participantes realicen una lectura previa del material de apoyo.

AbstractBackground: The Child Development Evaluation (CDE) Test is a screening tool designed and validated in Mexico for the early detection of child developmental problems. For professionals who will be administering the test in primary care facilities, previous acquisition of knowledge about the test is required in order to generate reliable results. The aim of this work was to evaluate the impact of a training model for primary care workers from different professions through the comparison of knowledge acquired during the training course.Methods: The study design was a before/after type considering the participation in a training course for the CDE test as the intervention. The course took place in six different Mexican states from October to December 2013. The same questions were used before and after.Results: There were 394 participants included. Distribution according to professional profile was as follows: general physicians 73.4%, nursing 7.7%, psychology 7.1%, nutrition 6.1% and other professions 5.6%. The questions with the lowest correct answer rates were associated with the scoring of the CDE test. In the initial evaluation, 64.9% obtained a grade lower than 20 compared with 1.8% in the final evaluation. In the initial evaluation only 1.8% passed compared with 75.15% in the final evaluation.Conclusions:The proposed model allows the participants to acquire general knowledge about the CDE Test. To improve the general results in future training courses, it is required to reinforce during training the scoring and interpretation of the test together with the previous lecture of the material by the participants.

Diseño de un modelo de supervisión para la aplicación de la prueba de Evaluación del Desarrollo Infantil en las unidades de atención primaria en México / Design of a supervision model for administration of the Child Development Evaluation Test at primary care facilities in Mexico

ResumenIntroducción:La prueba Evaluación del Desarrollo Infantil (EDI), diseñada y validada en México, se ha aplicado en las unidades de atención primaria del país. Los resultados han sido heterogéneos entre los estados en que se aplicaron las pruebas, a pesar de haber utilizado un modelo de capacitación estandarizado con la misma metodología para la aplicación. El objetivo de este trabajo fue evaluar un modelo de supervisión que permita identificar la calidad de la aplicación de la prueba EDI a nivel poblacional.Métodos: Se realizó un estudio en la atención primaria tres estados del país para evaluar la aplicación de la prueba EDI por observación directa (estudio de sombra), y verificar la concordancia del resultado a través aplicar la prueba una vez más (estudio de consistencia).Resultados: Se realizaron 380 estudios de sombra a 51 psicólogos. Al comparar el resultado global, se observó una concordancia del 86.1% con el supervisor (n = 327): el 94.5% por resultado verde, el 73.2% por amarillo y el 80.0% por rojo. Se aplicó la prueba nuevamente en 302 casos, con una concordancia del 88.1% (n = 266): el 96.8% por resultado verde, el 71.7% por amarillo y el 81.8% por rojo. No se encontraron diferencias significativas por grupo.Conclusiones: Tanto el estudio de sombra como el de consistencia fueron adecuados para evaluar la calidad de la aplicación de la prueba, y pueden ser de utilidad para supervisar la aplicación de la prueba EDI en atención primaria. La decisión de uno u otro sistema depende de la disponibilidad de supervisores.

AbstractBackground:The Child Development Evaluation (CDE) test designed and validated in Mexico has been used as a screening tool for developmental problems in primary care facilities across Mexico. Heterogeneous results were found among those states where these were applied, despite using the same standardized training model for application. The objective was to evaluate a supervision model for quality of application of the CDE test at primary care facilities.Methods:A study was carried out in primary care facilities from three Mexican states to evaluate concordance of the results between supervisor and primary care personnel who administered the test using two different methods: direct observation (shadow study) or reapplication of the CDE test (consistency study).Results: There were 380 shadow studies applied to 51 psychologists. General concordance of the shadow study was 86.1% according to the supervisor: green 94.5%, yellow 73.2% and red 80.0%. There were 302 re-test evaluations with a concordance of 88.1% (n = 266): green 96.8%, yellow 71.7% and red 81.8%. There were no differences between CDE test subgroups by age.Conclusions: Both shadow and re-test study were adequate for the evaluation of the quality of the administration of the CDE Test and may be useful as a model of supervision in primary care facilities. The decision of which test to use relies on the availability of supervisors.

Evaluación diagnóstica del nivel de desarrollo en niños identificados con riesgo de retraso mediante la prueba de Evaluación del Desarrollo Infantil / Diagnostic evaluation of the developmental level in children identified at risk of delay through the Child Development Evaluation Test

ResumenIntroducción: La prueba Evaluación del Desarrollo Infantil (EDI), diseñada en México, clasifica a los niños de acuerdo con su desarrollo en desarrollo normal, rezago en el desarrollo y riesgo de retraso. La versión modificada se desarrolló y validó, pero no se conocen sus propiedades en base poblacional. El objetivo de este trabajo fue establecer la confirmación diagnóstica en niños de 16 a 59 meses identificados con riesgo de retraso por la prueba EDI.Métodos: Se realizó un estudio transversal de base poblacional en una entidad federativa de México. Se aplicó la prueba EDI a 11,455 niños de 16 a 59 meses, de diciembre de 2013 a marzo de 2014. Se consideró como población elegible al 6.2% (n = 714) que obtuvo como resultado riesgo de retraso. Para la inclusión en el estudio se realizó una aleatorización estratificada por bloques para sexo y grupo de edad. A cada participante se le realizó la evaluación diagnóstica utilizando el Inventario de Desarrollo de Battelle 2ª. edición.Resultados: De los 355 participantes incluidos, el 65.9% fue de sexo masculino y el 80.2% de medio rural. El 6.5% fueron falsos positivos (cociente total de desarrollo ¿ 90) y el 6.8% no tuvo ningún dominio con retraso (cociente de desarrollo de dominio < 80). Se calculó la proporción de retraso en las siguientes áreas: comunicación (82.5%), cognitivo (80.8%), personal-social (33.8%), motor (55.5%) y adaptativo (41.7%). Se observaron diferencias en los porcentajes de retraso por edad y dominio/subdominio evaluado.Conclusiones: Se corroboró la presencia de retraso en al menos un dominio evaluado por la prueba diagnóstica en el 93.2% de la población estudiada.

AbstractBackground: The Child Development Evaluation (or CDE Test) was developed in Mexico as a screening tool for child developmental problems. It yields three possible results: normal, slow development or risk of delay. The modified version was elaborated using the information obtained during the validation study but its properties according to the base population are not known. The objective of this work was to establish diagnostic confirmation of developmental delay in children 16- to 59-months of age previously identified as having risk of delay through the CDE Test in primary care facilities.Methods:A population-based cross-sectional study was conducted in one Mexican state. CDE test was administered to 11,455 children 16- to 59-months of age from December/2013 to March/2014. The eligible population represented the 6.2% of the children (n = 714) who were identified at risk of delay through the CDE Test. For inclusion in the study, a block randomization stratified by sex and age group was performed. Each participant included in the study had a diagnostic evaluation using the Battelle Development Inventory, 2nd edition.Results: From the 355 participants included with risk of delay, 65.9% were male and 80.2% were from rural areas; 6.5% were false positives (Total Development Quotient ¿90) and 6.8% did not have any domain with delay (Domain Developmental Quotient <80). The proportion of delay for each domain was as follows: communication 82.5%; cognitive 80.8%; social-personal 33.8%; motor 55.5%; and adaptive 41.7%. There were significant differences in the percentages of delay both by age and by domain/subdomain evaluated.Conclusions: In 93.2% of the participants, developmental delay was corroborated in at least one domain evaluated.

Escrutinio poblacional del nivel de desarrollo infantil en menores de 5 años beneficiarios de PROSPERA en México / Population-based study of child developmental screening in Mexican PROSPERA beneficiaries younger than 5 years old

ResumenIntroducción:La prueba de Evaluación del Desarrollo Infantil (EDI), diseñada y validada en México, clasifica a los niños de acuerdo con su desarrollo en desarrollo normal (verde) y desarrollo anormal (amarillo o rojo). No se conocen los resultados de su aplicación en base poblacional. El objetivo de este trabajo fue evaluar el nivel de desarrollo de niños menores de 5 años en situación de pobreza (beneficiarios del Programa PROSPERA) utilizando la prueba EDI.Método:La prueba EDI fue aplicada por personal capacitado y con los estándares para la aplicación de la prueba en menores de 5 años que acudieron al control del niño sano en unidades de atención primaria de noviembre de 2013 a mayo de 2014 en un estado del norte de México.Resultados: Se aplicó la prueba EDI a 5,527 niños de 1-59 meses de edad. El 83.8% (n = 4,632) se encontró con desarrollo normal y el 16.2%, con desarrollo anormal: amarillo con el 11.9% (n = 655) y rojo con el 4.3% (n = 240). La proporción con resultado anormal fue del 9.9% en < 1 año y del 20.8% a los 4 años. Por edad, las áreas más afectadas fueron el lenguaje a los 2 años (9.35%) y el conocimiento a los 4 años (11.1%). Las áreas motor grueso y social tuvieron mayor afección en el área rural. En el sexo masculino, las áreas de motor fino, lenguaje y conocimiento.Conclusiones: La proporción de niños con resultado anormal es similar a lo reportado en otros estudios de base poblacional. La mayor proporción de afección a mayores edades refuerza la importancia de la intervención temprana. La diferencia en las áreas afectadas entre el medio urbano y rural sugiere la necesidad de una intervención diferenciada.

AbstractBackground:Evaluación del Desarrollo Infantil or Child Development Evaluation (CDE) test, a screening tool designed and validated in Mexico, classifies child development as normal (green) or abnormal (developmental lag or yellow and risk of delay or red). Population-based results of child development level with this tool are not known. The objective of this work was to evaluate the developmental level of children aged 1-59 months living in poverty (PROSPERA program beneficiaries) through application of the CDE test.Methods: CDE tests were applied by specifically trained and standardized personnel to children <5 years old who attended primary care facilities for a scheduled appointment for nutrition, growth and development evaluation from November 2013 to May 2014.Results: There were 5,527 children aged 1-59 months who were evaluated; 83.8% (n = 4,632) were classified with normal development (green) and 16.2% (n = 895) as abnormal: 11.9% (n = 655) as yellow and 4.3% (n = 240) as red. The proportion of abnormal results was 9.9% in children <1 year of age compared with 20.8% at 4 years old. The most affected areas according to age were language at 2 years (9.35%) and knowledge at 4 years old (11.1%). Gross motor and social areas were more affected in children from rural areas; fine motor skills, language and knowledge were more affected in males.Conclusions: The proportion of children with abnormal results is similar to other population-based studies. The highest rate in older children reinforces the need for an early-based intervention. The different pattern of areas affected between urban and rural areas suggests the need for a differentiated intervention.

Pasos para transformar una necesidad en una herramienta válida y útil para la detección oportuna de problemas en el desarrollo infantil en México / Steps to transform a necessity into a validated and useful screening tool for early detection of developmental problems in Mexican children

ResumenUna prueba de tamiz es una herramienta cuya función es identificar individuos presuntamente enfermos en una población aparentemente sana al establecer el riesgo o sospecha de un problema de desarrollo. Debe tenerse precaución y ser muy cuidadoso al utilizar un instrumento de este tipo, por el riesgo de efectuar mediciones que no coincidan con la realidad y retrasar una intervención a quien lo requiere.Antes de incorporar una prueba de este tipo como parte de la práctica clínica rutinaria, es necesario certificar que posee ciertas características que hacen meritoria su utilización. A este proceso de certificación se le denomina validación. El objetivo de este artículo fue describir los diferentes pasos que se llevaron a cabo desde la identificación de una necesidad de detección hasta la generación de una prueba de tamiz validada y confiable, utilizando como ejemplo el proceso del desarrollo de la versión modificada de la prueba Evaluación del Desarrollo Infantil (EDI) en México.

AbstractA screening test is an instrument whose primary function is to identify individuals with a probable disease among an apparently healthy population, establishing risk or suspicion of a disease. Caution must be taken when using a screening tool in order to avoid unrealistic measurements, delaying an intervention for those who may benefit from it.Before introducing a screening test into clinical practice, it is necessary to certify the presence of some characteristics making its worth useful. This "certification" process is called validation. The main objective of this paper is to describe the different steps that must be taken, from the identification of a need for early detection through the generation of a validated and reliable screening tool using, as an example, the process for the modified version of the Child Development Evaluation Test (CDE or Prueba EDI) in Mexico.

Terapia metabólica con yodo 131 en paciente con insuficiencia renal crónica. Caso clínico / Metabolic therapy with iodine 131 in patients with chronic renal failure. clinical case

OBSERVACIÓN CLÍNICA: Varón de 62 años con insuficiencia renal crónica en estadio 5 en programa de diálisis desde el 2012 que es intervenido de carcinoma papilar de tiroides con metástasis ganglionares. Posteriormente el paciente ingresa en la Unidad de Terapia Metabólica de su hospital de referencia donde se le administran 80 milicurios de yodo-131 como tratamiento asociado al quirúrgico. Ante la imposibilidad de practicarle su sesión de diálisis convencional, se le realizan las intervenciones de enfermería requeridas en las distintas etapas de aplicación de las técnicas continuas de depuración extrarrenal (TCDE). PLAN DE CUIDADOS: Se abordan los cuidados orientados a pacientes sometidos a TCDE en tratamiento con I131: material específico, medidas de protección personal y los principales diagnósticos e intervenciones enfermeras. DISCUSIÓN: Las TCDE a pesar de ser propias de pacientes críticos, en un momento dado se pueden extrapolar a otro tipo de pacientes. Las TCDE permiten dializar a este tipo de pacientes en un entorno seguro para el personal, garantizándose la adecuada eliminación de líquidos contaminados. CONCLUSIONES: Las TCDE resultaron ser un tratamiento eficaz para la eliminación del I131, siendo necesaria una única sesión para normalizar los niveles de radiactividad. La coordinación entre servicios permitió garantizar un tratamiento adecuado y eficaz para el paciente

CASE REPORT: 62 year-old male with CKD stage 5 in dialysis program since 2012 who underwent surgery for papillary thyroid carcinoma with lymph node metastasis. Subsequently, the patient was admitted to the Unit of Metabolic Therapy at his reference hospital, where he is administered 80 mill curies of iodine-131 as a treatment associated with the surgery, unable to have his conventional dialysis, nursing interventions required in various stages of implementation of the continuous extrarenal clearance techniques (TCDE) were performed. CARE PLAN: The following care values were addressed targeted to patients undergoing treatment with I131: specific equipment, personal protective measures and major diagnoses and nursing INTERVENTIONS: PROGRESS: TCDE, despite being attributed to very critical patients, they can be extrapolated to other patients in a given time. TCDE allowed these patients to undergo dialysis in a safe environment for staff, ensuring proper disposal of contaminated liquids. CONCLUSIONS: TCDE were an effective treatment for the removal of I131, a single session being necessary to normalize the levels of radioactivity. Coordination between services allowed ensure proper and effective treatment for the patient

[Metabolic therapy with iodine 131 in patients with chronic renal failure. Clinical case]. / Terapia metabólica con yodo 131 en paciente con insuficiencia renal crónica. Caso clínico.

CASE REPORT: 62 year-old male with CKD stage 5 in dialysis program since 2012 who underwent surgery for papillary thyroid carcinoma with lymph node metastasis. Subsequently, the patient was admitted to the Unit of Metabolic Therapy at his reference hospital, where he is administered 80 millicuries of iodine-131 as a treatment associated with the surgery, unable to have his conventional dialysis, nursing interventions required in various stages of implementation of the continuous extrarenal clearance techniques (TCDE) were performed. CARE PLAN: The following care values were addressed targeted to patients undergoing treatment with I(131): specific equipment, personal protective measures and major diagnoses and nursing interventions. PROGRESS: TCDE, despite being attributed to very critical patients, they can be extrapolated to other patients in a given time. TCDE allowed these patients to undergo dialysis in a safe environment for staff, ensuring proper disposal of contaminated liquids. CONCLUSIONS: TCDE were an effective treatment for the removal of I131, a single ssesion being necessary to normalize the levels of radioactivity. Coordination between services allewed ensure proper and effective treatment for the patient.