La aplicación del saber médico. Hipertensión y daño cognitivo

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Introduction: High blood pressure (HBP) is the leading cause of death from cardiovascular disease. Despite the advances, the percentage of undiagnosed and untreated hypertensive patients is 58.4%. The evaluation of cognitive damage in HBP focuses on preventing stroke, while functional damage is ignored. This inadequate management may be multifactorial. The objective was to analyze the opinions that doctors have about the relationship between high blood pressure and cognitive damage. Methodology: Observational, descriptive, cross-sectional study developed in the period between August 2020 and August 2023. Analysis of data obtained from a self-administered, anonymous and voluntary questionnaire. Revealing information on the professional profile, knowledge of HBP, its link with cognitive impairment (CD), diagnosis and treatment. Results: 222 professionals were included, 215 (96.8%) agree with the existence of a link between HBP and other cardiovascular risk factors in CD, and 218 (98.1%) acknowledge assisting patients at risk of suffering from CD. The CD evaluation is carried out in selected cases by 132 (59.4%) participants and 59 (26.7%) always do it. Of those who perform evaluation, 103 (54%) use the Mini Mental State Examination (MMSE), 10 (5.2%) use the Montreal Cognitive Assessment (MoCA) and 9 (4.7%) use the Clock Drawing Test. Regarding the decrease in blood pressure in elderly patients and the link with risk of CD: 54 (24.3%) do not recognize risk and 65 (29.2%) recognize a moderate-high risk. In reference to the implication of the treatment of cardiovascular disease and CD: 217 (97.7%) recognized a beneficial effect. Discussion: Given the recognition of the link between HBP and CD, it would be expected that CD would be investigated in the vast majority, however only 26.7% always evaluate it. There is no consensus on the method, the MMSE being the most used, with a low application of the MoCA test and/or Clock Drawing Test, the latter being the ones that evaluate executive function, mostly altered in CD linked to HBP. Although the treatment of cardiovascular disease is recognized as beneficial with respect to CD, the control of HBP in older adults is considered risky. A diagnosis is made of a situation where a disparity is evident between what one recognizes as knowing and what one claims to do. Conclusions: The role of vascular disease in functional brain damage is recognized, considering it necessary to know the cognitive status of patients, however there is a low application of screening tests that evaluate executive function. In this context, a gap between medical knowledge and practice is shown.

Introdução: A hipertensão arterial (HA) é a principal causa de morte por doenças cardiovasculares. Apesar dos avanços, o percentual de hipertensos não diagnosticados e não tratados é de 58,4%. A avaliação do dano cognitivo na hipertensão concentra-se na prevenção do acidente vascular cerebral, enquanto o dano funcional é ignorado. Esse manejo inadequado pode ser multifatorial. É objetivo fue analisar a opinião dos médicos sobre a relação entre hipertensão arterial e danos cognitivos. Metodologia: Estudo observacional, descritivo, transversal desenvolvido no período entre agosto de 2020 e agosto de 2023. Análise de dados obtidos a partir de questionário autoaplicável, anônimo e voluntário. Revelar informações sobre o perfil profissional, conhecimento sobre a HA, sua ligação com o comprometimento cognitivo (DC), diagnóstico e tratamento. Resultados: Foram incluídos 222 profissionais, 215 (96,8%) concordam com a existência de ligação entre hipertensão e outros fatores de risco cardiovascular na DC e 218 (98,1%) reconhecem ajudar pacientes com risco de sofrer de D.C. A avaliação da DC é realizada em casos selecionados por 132 (59,4%) participantes e 59 (26,7%) a fazem sempre. Dos que realizam avaliação, 103 (54%) utilizam o Mini Exame do Estado Mental (MEEM), 10 (5,2%) utilizam a Avaliação Cognitiva de Montreal (MoCA) e 9 (4,7%) utilizam o Clock Drawing Test. Em relação à diminuição da pressão arterial em pacientes idosos e a ligação com o risco de DC: 54 (24,3%) não reconhecem risco e 65 (29,2%) reconhecem risco moderado-alto. Em referência à implicação do tratamento de doenças cardiovasculares e DC: 217 (97,7%) reconheceram o efeito benéfico. Discussão: Dado o reconhecimento da ligação entre hipertensão e DC, seria de esperar que a DC fosse investigada na grande maioria, no entanto apenas 26,7% sempre a avaliam. Não há consenso sobre o método, sendo o MEEM o mais utilizado, com baixa aplicação do teste MoCA e/ou Clock Drawing Test, sendo estes últimos os que avaliam a função executiva, majoritariamente alterada nos DC vinculados à HA. Embora o tratamento das doenças cardiovasculares seja reconhecido como benéfico em relação à DC, o controle da HA em idosos é considerado arriscado. É feito um diagnóstico de uma situação em que é evidente uma disparidade entre o que se reconhece como saber e o que se afirma fazer. Conclusões: O papel da doença vascular no dano cerebral funcional é reconhecido, considerando-se necessário conhecer o estado cognitivo dos pacientes, porém há baixa aplicação de testes de triagem que avaliam a função executiva. Nesse contexto, evidencia-se uma lacuna entre o conhecimento e a prática médica.

Female control of sperm ejection and retention in the cornsilk fly Euxesta eluta (Diptera: Ulidiidae).

Promiscuous mating systems provide the opportunity for females to bias fertilization toward particular males. However, distinguishing between male sperm competition and active female sperm choice is difficult for species with internal fertilization. Nevertheless, species that store and use sperm of different males in different storing structures and species where females are able to expel all or part of the ejaculates after copulation may be able to bias fertilization. We report a series of experiments aimed at providing evidence of female sperm choice in Euxesta eluta (Hendel), a species of ulidiid fly that expels and consumes ejaculates after copulation. We found no evidence of greater reproductive success for females mated singly, multiply with the same male, or mated multiply with different males. Female E. eluta possesses two spherical spermathecae and a bursa copulatrix for sperm storage, with a ventral receptacle. There was no significant difference in storing more sperm in spermathecae 24 h after copulation than immediately after copulation. Females mated with protein-fed males had greater reproductive success than similar females mated to protein-deprived males. Protein-fed females prevented to consume the ejaculate, retained more sperm when mated to protein-fed males than when mated to protein-deprived males. Our results suggest that female E. eluta can exert control of sperm retention of higher quality males through ejaculate ejection.

The mediating role of work-family conflict in the relationship between organizational justice and work-related stress / Rol mediador del conflicto trabajo-familia en la relación entre justicia organizacional y estrés laboral

Abstract Although the effects of overall organizational justice on perceptions of work-related stress have been demonstrated in previous studies, the mechanisms underlying this relationship are not explicit. Current research suggests that supervisors who are perceived as fair enhance employees' ability to balance their work and family roles, positively impacting their stress levels. The aim of this research is to examine the mediating role of work-family conflict in the relationship between perceptions of overall organizational justice and work-related stress in a Latin-American work context; also analyze gender differences in work-family/work-family conflict. 129 workers belonging to a Chilean public institution participated and answered a self-report questionnaire. Analyses were done using bivariate correlations of Pearson, Tau-b of Kendall, Student t-test and structural equation modeling. The results showed the existence of a significant negative correlation between perceptions of overall organizational justice and work-related stress. Furthermore, this relationship was partially mediated by work-family conflict, which means, perceptions of organizational justice were directly and indirectly associated with work-related stress, through work-family conflict. With respect to the gender variable and the work-family, no significant differences were found. This study contributes empirical evidence regarding the importance of perceptions of overall organizational justice and the work-family conflict on work-related stress, and the results obtained guide the diagnosis and the design of more specific models of prevention and intervention from the perspective of occupational health psychology.

Resumen Si bien los efectos de las percepciones de justicia organizacional global sobre las percepciones de estrés laboral han sido demostrados en estudios previos, los mecanismos que subyacen a esta relación no resultan explícitos. La investigación actual plantea que las jefaturas percibidas como más justas potencian la capacidad del trabajador para conciliar sus roles laborales y familiares, impactando positivamente sus niveles de estrés. El objetivo de este estudio es analizar, en un contexto laboral latinoamericano, el rol mediador del conflicto trabajo-familia en la relación entre las percepciones de justicia organizacional global y estrés laboral; y analizar diferencias entre hombres y mujeres respecto al conflicto trabajo-familia. Participaron 129 trabajadores pertenecientes a una institución pública chilena, quienes contestaron un cuestionario de autoreporte. Se efectuaron correlaciones bivariadas de Pearson, Tau-b de Kendall, prueba t de Student y modelamiento de ecuaciones estructurales. Los resultados mostraron la existencia de una correlación negativa y significativa entre las percepciones de justicia organizacional global y el estrés laboral. Además, esta relación estuvo mediada parcialmente por el conflicto trabajo-familia, es decir, las percepciones de justicia organizacional se asociaron de manera directa e indirecta al estrés laboral, a través del conflicto trabajo-familia. Respecto de la variable género y el conflict trabajo-familia, no se encontraron diferencias significativas. Este estudio aporta evidencia empírica sobre la importancia de las percepciones de justicia organizacional global, y sus resultados orientan el diagnóstico y la elaboración de modelos de prevención e intervención más específicos desde el campo de la psicología de la salud ocupacional.

In-person later abortion accompaniment: a feminist collective-facilitated self-care practice in Latin America.

In Argentina, Chile and Ecuador, abortion at later durations of pregnancy is legally restricted. Feminist collectives in these contexts support people through self-managed medical abortion outside the healthcare system. The model of in-person abortion accompaniment represents an opportunity to examine a self-care practice that challenges and reimagines abortion provision. We formed a collaborative partnership built on a commitment to shared power and decision-making between researchers and partners. We conducted 28 key informant interviews with accompaniers in Argentina, Chile and Ecuador in 2019 about their model of in-person abortion accompaniment at later durations of pregnancy. We iteratively coded transcripts using a thematic analysis approach. Accompaniers premised their work in a feminist activist framework that understands accompaniment as addressing inequalities and expanding rights, especially for the historically marginalised. Through a detailed description of the process of in-person accompaniment, we show that the model, including the logistical considerations and security mechanisms put in place to ensure favourable abortion outcomes, emphasises peer-to-peer provision of supportive physical and emotional care of the accompanied person. In this way, it represents supported self-care through which individuals are centred as the protagonists of their own abortion, while being accompanied by feminist peers. This model of supported self-care challenges the idea that "self-care" necessarily means "solo care", or care that happens alone. The model's focus on peer-to-peer transfer of knowledge, providing emotional support, and centring the accompanied person not only expands access to abortion, but represents person-centred practices that could be scaled and replicated across contexts.

Guía de práctica clínica basada en la evidencia para el manejo de trombocitopenia inmune primaria en población pediátrica / Evidence-based clinical practice guideline for the management of primary immune thrombocytopenia (ITP) in pediatric population

Primary immune thrombocytopenia (ITP) is the most common cause of thrombocytopenia in children, with a reported incidence of 1.1-12.5 cases per 100 000 children. However, currently, there are several definitions of ITP, as well as diagnostic and therapeutic approaches. To develop an evidence-based clinical practice guideline (CPG) to standardize the definition of ITP and, in this way, reduce the variability of its diagnosis, and to provide indications for the treatment of acute, persistent, and chronic ITP in patients under 18 years of age. The CPG was prepared by a multidisciplinary group that followed the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines for developing CPGs, formulated PICO clinical questions, and conducted systematic reviews. GRADE evidence profiles were created and recommendations, with their corresponding level of evidence and strength, were made after a panel of experts assessed the benefit-risk balance, the quality of evidence, the patients' values and preferences, and the context in which they should be implemented. A total of 23 recommendations were made to pediatricians, hematologists, and health professionals working in emergency services for treating acute, persistent, and chronic ITP. Overall, the CPG has low quality of evidence, and the recommendations were made in order to improve the success rate of ITP treatment and the prognosis of children with this condition. Although ITP is the main cause of thrombocytopenia in pediatrics, to date there is not enough high-quality evidence that supports the recommendations presented here for its proper classification and treatment in children. Thus, further studies providing high-quality evidence on this issue are required.

La púrpura trombocitopénica inmunológica (PTI) es la causa más frecuente de trombocitopenia en población pediátrica, con una incidencia de 1.1 a 12.5 casos por cada 100 000 niños. Sin embargo, en la actualidad hay diferentes definiciones de PTI, así como enfoques diagnósticos y terapéuticos. Desarrollar una guía de práctica clínica (GPC) basada en la evidencia para unificar las definiciones de PTI, y de esta forma reducir la variabilidad de su diagnóstico, y para proporcionar indicaciones para el tratamiento de la PTI aguda, persistente y crónica en pacientes menores de 18 años. La GPC fue desarrollada por un grupo multidisciplinario, el cual siguió las guías GRADE para la realización de GPC, formuló preguntas clínicas PICO y realizó revisiones sistemáticas. Se crearon perfiles de evidencia GRADE y se realizaron las recomendaciones, con su respectivo nivel de evidencia y fortaleza, luego de que un panel de expertos evaluara el equilibrio beneficio-riesgo, la calidad de la evidencia, las preferencias y valoraciones de los pacientes y el contexto en el que debieran implementarse. Se formularon 23 recomendaciones para el tratamiento de la PTI aguda, persistente y crónica dirigidas a pediatras, hematólogos y profesionales de la salud que trabajan en servicios de urgencias. En general, la evidencia de la guía es de baja calidad y las recomendaciones fueron formuladas para mejorar la tasa de éxito del tratamiento de la PTI y el pronóstico de estos pacientes. A pesar de que la PTI es la principal causa de trombocitopenia en población pediátrica, actualmente no hay suficiente evidencia de alta calidad que respalde las recomendaciones aquí presentadas para su adecuada clasificación y tratamiento en niños. Por lo anterior, se requiere realizar nuevos estudios que brinden evidencia de alta calidad en el tema.

Cholangiopathy After Severe COVID-19: Clinical Features and Prognostic Implications.

INTRODUCTION: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 virus, is a predominantly respiratory tract infection with the capacity to affect multiple organ systems. Abnormal liver tests, mainly transaminase elevations, have been reported in hospitalized patients. We describe a syndrome of cholangiopathy in patients recovering from severe COVID-19 characterized by marked elevation in serum alkaline phosphatase (ALP) accompanied by evidence of bile duct injury on imaging. METHODS: We conducted a retrospective study of COVID-19 patients admitted to our institution from March 1, 2020, to August 15, 2020, on whom the hepatology service was consulted for abnormal liver tests. Bile duct injury was identified by abnormal liver tests with serum ALP > 3x upper limit of normal and abnormal findings on magnetic resonance cholangiopacreatography. Clinical, laboratory, radiological, and histological findings were recorded in a Research Electronic Data Capture database. RESULTS: Twelve patients were identified, 11 men and 1 woman, with a mean age of 58 years. Mean time from COVID-19 diagnosis to diagnosis of cholangiopathy was 118 days. Peak median serum alanine aminotransferase was 661 U/L and peak median serum ALP was 1855 U/L. Marked elevations of erythrocyte sedimentation rate, C-reactive protein, and D-dimers were common. Magnetic resonance cholangiopacreatography findings included beading of intrahepatic ducts (11/12, 92%), bile duct wall thickening with enhancement (7/12, 58%), and peribiliary diffusion high signal (10/12, 83%). Liver biopsy in 4 patients showed acute and/or chronic large duct obstruction without clear bile duct loss. Progressive biliary tract damage has been demonstrated radiographically. Five patients were referred for consideration of liver transplantation after experiencing persistent jaundice, hepatic insufficiency, and/or recurrent bacterial cholangitis. One patient underwent successful living donor liver transplantation. DISCUSSION: Cholangiopathy is a late complication of severe COVID-19 with the potential for progressive biliary injury and liver failure. Further studies are required to understand pathogenesis, natural history, and therapeutic interventions.

Cuidados enfermeros para el abordaje de la salud comunitaria en población indígena de la Amazonia peruana / Nursing care to address community health of the indigenous population in the Peruvian Amazon

La comunidad nativa Shonori la componen familias asháninkas de la Amazonia peruana. Este trabajo aborda la salud comunitaria mediante una valoración y plan de cuidados de enfermería basado en el modelo de competencia cultural de Purnell y la taxonomía estandarizada enfermera (NANDA, NIC, NOC). La valoración se sustenta en 12 dominios relacionados con la herencia y ecología biocultural, comunicación, roles y organización familiar, conductas de riesgo, nutrición, embarazo, rituales de muerte y espiritualidad y prácticas y proveedores de cuidados de salud. Se detecta como diagnóstico una «salud deficiente de la comunidad relacionada con recursos insuficientes y manifestada por problemas de salud padecidos por la comunidad». Los criterios de resultados esperados en el plan de cuidados son: competencia social, estado de salud de la comunidad y control del riesgo social relacionado con las enfermedades transmisibles. Las intervenciones consisten en fomentar la salud comunitaria, analizar e identificar la situación de salud y riesgos, y controlar y proteger de enfermedades transmisibles y de riesgos ambientales. Intervenciones de la red pública de abastecimiento de agua y subvenciones para el apoyo agrícola y a las viviendas permitieron disminuir vectores, sufragar gastos del abastecimiento de agua segura y comprar alimentos para mejorar la nutrición infantil. El uso de la medicina tradicional fue potenciado y se desarrollaron campañas de salud y educación sexual en coordinación con el sistema oficial de salud. Se hizo un seguimiento durante 40 días, que corroboró la mejora de la salud comunitaria y la necesidad de un abordaje grupal con todos los actores

The native community Shonori is made up of Ashaninka families of the Peruvian Amazon. This paper addresses community health through an assessment and nursing care plan based on the Purnell cultural competency model and the standardized nurse taxonomy (NANDA, NIC, NOC). The assessment is based on 12 domains related to inheritance and biocultural ecology, communication, roles and family organization, risk behaviours, nutrition, pregnancy, death and spirituality rituals, and health care providers and practices. A diagnosis of «Poor health of the community r /t insufficient resources m/b health problems suffered by the community» is detected. The expected results criteria in the care plan are: social competence, community health status and control of social risk related to communicable diseases. The interventions consist of promoting community health, analyzing and identifying the health situation and risks, and controlling and protecting from communicable diseases and environmental risks. Interventions of the public water supply network and subsidies for agricultural and housing support, allowed vectors to be reduced, costs of safe water supply to be covered, and food to be bought to improve child nutrition. The use of traditional medicine was enhanced and health and sexual education campaigns were carried out in coordination with the official health system. A follow-up was carried out for 40 days, corroborating the improvement of community health, and the need for a group approach with all actors

Nursing care to address community health of the indigenous population in the Peruvian Amazon. / Cuidados enfermeros para el abordaje de la salud comunitaria en población indígena de la Amazonia peruana.

The native community Shonori is made up of Ashaninka families of the Peruvian Amazon. This paper addresses community health through an assessment and nursing care plan based on the Purnell cultural competency model and the standardized nurse taxonomy (NANDA, NIC, NOC). The assessment is based on 12 domains related to inheritance and biocultural ecology, communication, roles and family organization, risk behaviours, nutrition, pregnancy, death and spirituality rituals, and health care providers and practices. A diagnosis of «Poor health of the community r /t insufficient resources m/b health problems suffered by the community¼ is detected. The expected results criteria in the care plan are: social competence, community health status and control of social risk related to communicable diseases. The interventions consist of promoting community health, analyzing and identifying the health situation and risks, and controlling and protecting from communicable diseases and environmental risks. Interventions of the public water supply network and subsidies for agricultural and housing support, allowed vectors to be reduced, costs of safe water supply to be covered, and food to be bought to improve child nutrition. The use of traditional medicine was enhanced and health and sexual education campaigns were carried out in coordination with the official health system. A follow-up was carried out for 40 days, corroborating the improvement of community health, and the need for a group approach with all actors.

Promiscous female Euxesta eluta derive nutrients for ovarian development by expelling and consuming ejaculates.

Seminal gifts range from important material donations to items that provide little direct benefit to females. Promiscuous, female silk corn flies Euxesta eluta expel and consume male ejaculates immediately after mating. The evolution and function of this peculiar behavior are currently unknown. We performed a series of experiments aimed to: determine if females under different dietary regimes derive nutrients or water for survival and/or reproduction from ejaculate consumption, if males suffer a fitness cost from supplying females with ejaculates, and if females prefer to mate and/or are more likely to store sperm from well fed than nutritionally stressed presumably inferior males. Experiments revealed that protein deprived E. eluta females derive nutrients for ovarian development through consumption of ejaculates of protein fed males. No seminal products affecting survival appear to be transferred in the consumed ejaculate. However, ovarian development, in contrast to testes growth, occurs in detriment of longevity. Females preferred to mate with protein fed males, yet sperm retention in spermathecae was extremely rare after a single mating. This finding suggests that females could be exerting post copulatory control. A key question that remained to be addressed for the understanding of this puzzling and promiscuous mating system is what ecological factors or male traits drive females to retain sperm from one or several males in order to achieve and/or maximize fertilization potential.

Reducción de inequidades en el sistema sanitario / Reduction of inequities in the health system

La OMS define el sistema sanitario como un conjunto complejo de elementos interrelacionados que contribuyen a la salud en hogares, lugares de trabajo, lugares públicos y las comunidades, así como en el medio ambiente físico, psicosocial y en el sector de la salud (1). La función principal de un sistema sanitario es asegurar a la población el derecho a la salud, por lo que es fundamental instaurar condiciones que aseguren el acceso a los sistemas sanitarios a todas las personas sin discriminación. Es importante analizar los determinantes sociales de la salud como: clase, género, edad, etnia, que repercuten en las desigualdades en la salud (2). La investigación de las causas de las enfermedades nos permite observar las injusticias sociales (8).Existen varios tipos de desigualdades: las aceptables, que provienen de la libre elección de los individuos; las injustas y evitables, que resultan de la distribución desigual de los recursos y condiciones de vida; y las inevitables, las cuales son consecuencia de la distribución desigual de ciertos factores, como los genéticos/biológicos. Estas desigualdades no tienen por qué causar ningún perjuicio ni discriminación, simplemente existen y habrá que tratarlas (3).Los individuos no partimos de condiciones iguales y en el transcursode la vida nos exponemos a diversos factores que nos colocan en distintos escenarios.

WHO defines the health system as a complex set of interrelated elements that contribute to health in homes, workplaces, public places and communities, as well as in the physical, psychosocial and health sectors (1). The main function of a health system is to guarantee the population the right to health, so it is essential to establish conditions that ensure access to health systems to all people without discrimination. It is important to analyze the social determinants of health such as: class, gender, age, ethnicity, which have an impact on health inequalities (2). The investigation of the causes of diseases allows us to observe social injustices (8). There are several types of inequalities: the acceptable ones, which come from the free choice of individuals; the unfair and avoidable, resulting from the unequal distribution of resources and living conditions; and the inevitable ones, which are a consequence of the unequal distribution of certain factors, such as genetic / biological. These inequalities do not have to cause any harm or discrimination, they simply exist and must be treated (3). Individuals do not start from equal conditions and in the course of life we ​​expose ourselves to various factors that place us in different scenarios.

Estímulos que influyen en el proceso de adaptación de las personas al implante de dispositivos de apoyo cardiovascular / Stimuli that influence the process of adaptation of people to the implantation of cardiovascular support devices

Las enfermedades cardiovasculares son un problema de magnitud mundial y se presentan con mayor frecuencia en países en vía de desarrollo. En Colombia según los Indicadores Básicos de salud, las enfermedades del sistema circulatorio ocuparon uno de los primeros lugares como grupo de causas de muerte en la población general en el 2010. Estas enfermedades pueden producir alteraciones del ritmo cardiaco, que a su vez requieren del implante de marcapasos o cardiodesfibriladores, denominados dispositivos de apoyo cardiovascular (DAC). La revisión de la literatura ha demostrado que dichos implantes pueden producir en los pacientes problemas psicológicos y de adaptación. El profesional de enfermería, juega un papel muy importante en el proceso de ayudar a las personas a adaptarse a los DAC, sin embargo, en la revisión de la literatura no se encontraron estudios que describan los estímulos que influyen en el proceso de adaptación a estos dispositivos, lo cual se considera fundamental para brindar un cuidado holístico y para desarrollar instrumentos que permitan en el futuro, identificar las necesidades educativas y de cuidado de éste tipo de pacientes. Por lo tanto, el propósito este estudio, fue identificar y describir los estímulos que influyen en el proceso de adaptación de las personas al implante de un dispositivo de apoyo cardiovascular (DAC). Se utilizó un diseño cualitativo, descriptivo interpretativo para identificar los estímulos que favorecen y los que interfieren el proceso de adaptación a los dispositivos de apoyo cardiovascular. La información se recolectó por medio de entrevistas de profundidad a 8 personas que eran portadoras de un DAC, por un periodo mayor a seis meses. Estas personas eran residentes de Bogotá; unas se identificaron a través de la Clínica Universitaria Colombia, de la Organización Sanitas Internacional y otras por la estrategia de bola de nieve. Las entrevistas se codificaron y categorizaron, siguiendo los lineamientos de Corbin y Strauss (2006). El análisis de los datos permitió identificar 2 grandes categorías, cada una de ellas con 4 subcategorías. 1. Estímulos que favorecen el proceso de adaptación: Apoyo, Encontrarle sentido al DAC, Conocimiento y Practicas para el cuidado de la salud; y 2. Estímulos que interfieren en el proceso de adaptación: Alteración de la autoimagen, Respuestas emocionales negativas, Restricción en la actividad física y Síntomas desagradables. Con base en los resultados se puede concluir, que al conocerse los estímulos que favorecen o interfieren en el proceso de adaptación de las personas a los DAC, el personal de enfermería puede enfocar sus intervenciones a fortalecer los estímulos que promueven el proceso de adaptación e identificar los problemas que se puedan presentar durante el mismo. (AU)