Learning to Communicate: A Photovoice Study With Intensive Care Residents During Night Shifts in the Intensive Care Unit.

This study explored the learning experiences of intensive care residents in an intensive care unit (ICU) during night shifts and the development of communication skills in this community of practice. This action research qualitative study used the photovoice method in four workshops. A group of nine residents shared their learning experiences and collectively analyzed, built, and presented proposals to improve residents' communication skills in the community of practice in which they become intensivists. Participatory thematic analysis was conducted. Students concluded that night shifts in the ICU offered a perfect situational learning environment for communication with one-on-one resident-teacher relationships, less administrative work, and more resident responsibility, improving intensivist identity. Role models, reflective thinking, and teamwork are essential for fostering communication skills among intensivist community members and are all trainable. The results and student suggestions were presented to teachers and decision-makers in the clinic. These photovoice strategies developed students' abilities to share their critical views and suggestions with decision-makers for subsequent implementation, enhancing their confidence in their learning process, strengthening trust-based relationships with teachers, and improving future intensivists' practice communities.

Pretreatment with glycomacropeptide reduces allergen sensitization, alleviates immediate cutaneous hypersensitivity and protects from anaphylaxis.

Allergic disorders are characterized by the involvement of allergen-specific immunoglobulin (Ig)E antibodies and T helper type 2 (Th2) cells. The search for new therapies for allergic diseases has been the primary focus of interest for many investigators in recent years. Glycomacropeptide (GMP) is a biologically active component of milk that exhibits a range of immunomodulatory functions. We examined whether oral administration of GMP could affect the development of allergic sensitization and the severity of immediate cutaneous hypersensitivity reactions and of anaphylaxis. Rats treated with or without GMP were ovalbumin (OVA)-sensitized and several indicators of allergy were evaluated. Pretreatment with GMP resulted in reduction of antigen-specific IgE titre in rats when sensitized with OVA. GMP administration also markedly suppressed the proliferative response of splenocytes to antigen and the production of interleukin (IL)-13 by splenocytes of sensitized animals. In addition, GMP pretreatment attenuated the intensity of the immediate cutaneous reaction induced by antigen and protected the sensitized rats from severe anaphylaxis. These data demonstrate, for the first time, that the administration of GMP prevents allergen sensitization and reduces the severity of the early-phase reaction induced by antigen in cutaneous hypersensitivity and in anaphylaxis. GMP may be used as a novel prophylactic agent for the control of allergic diseases.

Genotipificación y resistencia antibacteriana de cepas de Campylobacter spp aisladas en niños y en aves de corral / Genotyping and antibacterial resistance of Campylobacter spp strains isolated in children and in free range poultry

Poultry is a main reservoir and source of human infection in campylobacteriosis. Three hundred and forty one stool samples (291 human, 50 avian) were analyzed. In the human group, 220 samples were collected from children with acute diarrheal disease (183 inpatients, 37 outpatients) and 71 from healthy children. Erythromycin and ciprofloxacin agar dilution MIC tests, Penner serotyping and RAPD-PCR genotyping were performed on 23 strains isolated. C. jejuni was reported only in patients with acute diarrhea (5.4 percent inpatients, 2.2 percent outpatients). Campylobacter prevalence in poultry was 34 percent. Cross-resistance to nalidixic acid and ciprofloxacin was found in 33.3 percent of human samples and 11.8 percent of animal samples. Human samples could not be typed using the Penner method. F serotype was the most expressed in poultry. We obtained a total of 14 genotypes (4 / 5 human and 10/15 avian). In conclusion, the predominant species in poultry and humans was C. jejuni, a significant amount of quinolone-resistant human and avian samples were obtained, and avian genotypes and serotypes were not found in human samples. The latter would mean that another source of infection could exist; therefore other reservoirs must be studied.

Las aves de consumo constituyen uno de los principales reservorios y fuente de infección humana de la campilo-bacteriosis. Se analizaron 341 muestras de deposiciones, 291 humanas y 50 aviares. De las muestras, 220 de niños con síndrome diarreico agudo-SDA (183 hospitalizados y 37 consultantes ambulatorios) y 71 niños sanos. A las 23 cepas obtenidas se les realizó CIM por dilución en agar a eritromicina y ciprofloxacina, serotipificación de Penner y genotipiicación por RAPD-PCR. Se encontró Campylobacterjejuni sólo en pacientes con SDA, de ellos 5,4 por ciento ambulatorios y 2,2 por ciento hospitalizados. En aves, la prevalencia de Campylobacter spp., fue de 34 por ciento. Hubo resistencia cruzada a ácido nalidixico y ciprofloxacina en 33,3 por ciento cepas de origen humano y 11,8 por ciento animal. Las cepas humanas fueron no tipiicables por el método de Penner. Predominó entre las aves el serotipo F. Se obtuvo un total de 14 genotipos (4/5 humanos y 10/15 aviares). En conclusión, la especie predominante en aves de corral y en humanos fue C. jejuni, existiendo una alta prevalencia de cepas de origen humano y aviar resistentes a quinolonas. Los genotipos y serotipos aviares no fueron encontrados en cepas de origen humano, lo que indica que podría existir otra fuente de infección, por lo que se requiere estudiar otros reservorios.

[Genotyping and antibacterial resistance of Campylobacter spp strains isolated in children and in free range poultry]. / Genotipificación y resistencia antibacteriana de cepas de Campylobacter spp aisladas en niños y en aves de corral.

Poultry is a main reservoir and source of human infection in campylobacteriosis. Three hundred and forty one stool samples (291 human, 50 avian) were analyzed. In the human group, 220 samples were collected from children with acute diarrheal disease (183 inpatients, 37 outpatients) and 71 from healthy children. Erythromycin and ciprofloxacin agar dilution MIC tests, Penner serotyping and RAPD-PCR genotyping were performed on 23 strains isolated. C. jejuni was reported only in patients with acute diarrhea (5.4% inpatients, 2.2% outpatients). Campylobacter prevalence in poultry was 34%. Cross-resistance to nalidixic acid and ciprofloxacin was found in 33.3% of human samples and 11.8% of animal samples. Human samples could not be typed using the Penner method. F serotype was the most expressed in poultry. We obtained a total of 14 genotypes (4 / 5 human and 10/15 avian). In conclusion, the predominant species in poultry and humans was C. jejuni, a significant amount of quinolone-resistant human and avian samples were obtained, and avian genotypes and serotypes were not found in human samples. The latter would mean that another source of infection could exist; therefore other reservoirs must be studied.

[Descriptive analysis about a group of patients with recurrent acute pancreatitis]. / Análisis descriptivo de un grupo de enfermos con pancreatitis aguda recidivante.

BACKGROUND: Recurrent acute pancreatitis (RAP) represents a diagnostic and treatment challenge. Although it's real frequency is difficult to establish some works have reported 25-60% prevalence. In most, the etiology is recurrent biliary stones untreated or consumption of alcohol. The information we have about the RAP in our midst is scarce. AIM: To review the clinical characteristics and follow-up of a group of patients with RAP. METHODS: Clinical charts of all patients with AP admitted to our Institute from January 1, 1995 to December 31, 2005 were reviewed. The diagnosis of RAP was established when two o more episodes of AP were documented. In each case clinical, biochemical, imaging, treatment and follow-up until the last visit to our hospital was analyzed. RESULTS: The diagnosis of AP was established in 406 patients. Forty of them had RAP (9.8%). Mean age was 32 years old (13-63). The majority was male (72.5%). A mean of 3.5 episodes of AP was presented for each subject (2-14). High levels of triglycerides (n = 15), alcoholism (n = 11) and gallstones (n = 8) were the most frequent cause of RAP. In some cases more than one factor was presented. In 5 of the 15 subjects with RAP due to hypertriglyceridemia other causes of AP were identified (two alcohol consumption,two idiopathic chronic pancreatitis and one gallstone disease). In three patients with RAP supposedly secondary to alcohol, gallstone disease was diagnosed during the follow-up. All of them were operated on. One has had four events of AP after the cholecistectomy. Four of the 8 subjects submitted to cholecistectomy for RAP associated to gallstone disease have had new episodes of AP: 2 for triglycerides and in two a chronic pancreatitis was diagnosed by endoscopic ultrasound or MRI. Two patients died (5%). CONCLUSIONS: This series represents probably the first analysis that exists on PAR in Mexico. The frequency found was 9% and the most common causes were hypertriglyceridemia, chronic alcohol consumption and gallstones.

Use of herbal therapies among midlife Mexican women.

The cultural traditions of Mexican women living in the United States make it likely that some women promote their health and manage their symptoms using various herbal therapies, yet we know little about this phenomenon. The purpose of this study was to describe and compare midlife Mexican women living in the U.S. who were or were not using herbal therapies with regard to the extent of their acculturation, beliefs about herbs, and factors associated with their utilization of health services. A convenience sample of 30 Mexican women between the ages of 40 and 56 years completed face-to-face interviews in either English or Spanish. Nearly half reported using herbal therapies. With the exception of positive beliefs about herbs, we found few differences between herbal users and nonusers on acculturation or access to, and satisfaction with, health services. Although acculturation did not appear to influence whether the women used herbal therapies, it did relate to the types of herbs selected. Women most commonly reported using herbs popular in traditional Mexican culture, including manzanilla (chamomile), savila (aloe vera), ajo (garlic), uña de gato (cat's claw), and yerba buena (spearmint).

[Left ventricular function in pure mitral stenosis. Hemodynamic echocardiographic study]. / La función ventricular izquierda en la estenosis mitral pura. Estudio ecocardiográfico hemodinámico.

We studied the left ventricular performance in 40 patients with pure mitral stenosis, using a M Mode Echocardiographic study. In 19% of the group the left ventricular function was abnormal, however, we were able to distinguish three subsets: small left ventricular dimension, normaland dilated. In the first two subsets, the cardiac performance was normal in almost all the patients (85%). In 15%, the left ventricular function was depressed, probably due to a restricting flow into the cavity, segmental atrophy and fibrosis caused by chronic mitral obstruction. In the last group (dilated left ventricle), the end-systolic dimension was abnormal in 71,4% of the patients. Our study suggests that the increased dimension of the left ventricle is accompanied by poor ventricular performance and represents an intrinsic trace of damage of the myocardium by the previous rheumatic carditis. The importance of detecting this last subset is emphasized due to the high incidence of impairment in left ventricular function. This detection could in some cases prevent the surgical treatment when this function is severely depressed.

Capacity of the Chilean mixed diet to meet the protein and energy requirements of young adult males.

1. The capacity of the Chilean mixed diet to meet the daily protein and energy needs was tested in eight subjects aged from 20 to 31 years using the nitrogen balance method. This diet was tested at the protein levels of 0.40, 0.55 and 0.70 g/kg body-weight per d. 2. An egg reference diet providing 0.30, 0.45 and 0.60 g protein/kg per d was also assayed. 3. The mean daily energy intake was 207 kJ/kg per d according to subjects' previous intake and activity pattern. 4. The N balance response to each dietary protein level was taken as a measure of adequacy of protein intake, and regression analyses of N balance (Y) v. N intake (X) were calculated to estimate protein needs. The equations found were Y = 0.70X - 68.7 for the egg diet, and Y = 0.74X - 92 for the mixed diet. 5. From these equations the mean protein requirements for equilibrium were estimated to be 0.61 g/kg for egg and 0.78 g/kg for the mixed diet. 6. If the coefficient of variation is 15, the protein requirement for N equilibrium of 97.5% of the population would be 0.8 g/kg per d for egg and 1.0 g/kg per d for the mixed diet.

Factors determining effective psychiatric outpatient treatment for Mexican-Americans.

A mental health center offering outpatient services to Mexican-Americans should be centrally located in the Mexican-American community, should have a bicultural and bilingual staff, and should have an informal atmosphere with a minimum number of bureaucratic procedures. The center's services must be publicized in a way that minimizes the stigmatization of mental illness, promotes preventive care, and indicates that staff understand Mexican-Americans' problems. La Frontera, a mental health outpatient clinic serving the Tucson area, operates under those guidelines. Clinic records in March 1973 showed that Mexican-Americans accounted for 61 per cent of the active cases.