[Results of abdominal wall closure using the 4:1 suture/wound lenght technique]. / Resultados del cierre de pared abdominal utilizando técnica longitud sutura/herida 4:1.

Background: Laparotomy is a daily procedure for the general surgeon and its main complication is the formation of hernias. Objective: To determine if the suture length to wound length ratio 4:1 for wall closure decreases the incidence of hernia. Material and methods: Data from patients (n = 86) in whom abdominal wall closure was performed from August 2017 to January 2018 were prospectively reviewed. Patients who could not undergo adequate follow-up, those managed with open abdomen, or those with use of non-absorbable suture materials were excluded. 2 groups were formed: in one, the suture length to wound length ratio 4:1 technique was used as wall closure, and in the other it was used conventional suture; the length of the wound-suture length was measured, and the follow-up was post-surgical. For statistical analysis it was used descriptive statistics and inferential statistics (chi-squared and Mann-Withney's U). Results: The 2 groups had similar characteristics in all the inclusion criteria. There was a statistically significant difference in dehiscence and hernias. For both complications, the 4:1 suture is a protective factor. For the first it was obtained: p = 0.000, relative risk (RR) 0.114 with 95% confidence interval (95% CI) 0.030-0.437, and for the second, p = 0.000, RR .091, 95% CI 0.027-0.437. Conclusions: Abdominal wall closure using 4:1 suture/wound length was shown to decrease the incidence of hernia.

Introducción: la laparotomía es un procedimiento cotidiano del cirujano general y una su principales complicaciones es la formación de hernias. Objetivo: determinar si la relación 4:1 longitud de sutura-largo de herida para cierre de pared disminuye la incidencia de hernia. Material y métodos: datos de pacientes (n = 86) en quienes se realizó cierre de pared abdominal de agosto de 2017 a enero de 2018 fueron revisados prospectivamente. Fueron excluidos los pacientes a quienes no se les pudo realizar el seguimiento adecuado, los manejados con abdomen abierto, o en los que se utilizaron de materiales de sutura no absorbibles. Se formaron 2 grupos: en uno se utilizó la técnica 4:1 longitud de sutura-largo de herida como cierre de pared, y en el otro la sutura convencional; se midió la longitud de herida-largo de sutura y el seguimiento fue en el postquirúrgico. Para el análisis estadístico, se usó estadística descriptiva y estadística inferencial (chi cuadrada y U de Mann-Withney). Resultados: los 2 grupos tuvieron características semejantes en todos los criterios de inclusión. Hubo diferencia estadísticamente significativa en dehiscencia y hernias; para ambas complicaciones, la sutura 4:1 es un factor protector. Para la primera se obtuvo una p = 0.000, razón de riesgo (RR) 0.114 con intervalo de confianza del 95% (IC 95%) 0.030-0.437 y en la segunda una p = 0.000, RR 0.091, IC 95% 0.027-0.437. Conclusiones: el cierre de pared abdominal con longitud sutura/herida 4:1 demostró que disminuye la incidencia de hernia.

Corrección del prolapso de cúpula vaginal mediante colpopexia vía abdominal

Introducción: Las disfunciones del suelo pélvico se consideran un problema de salud en el mundo y constituyen una de las indicaciones de operaciones ginecológicas más comunes. Entre sus variantes está el prolapso de la cúpula vaginal. Objetivos: Evaluar los resultados de la corrección del prolapso de cúpula vaginal por la técnica de colpopexia, mediante fijación con tiras aponeuróticas a la pared abdominal anterior. Métodos: Se realizó un estudio observacional, descriptivo. Las variables utilizadas fueron la edad, presencia de comorbilidades, el número de cirugías previas y el grado de satisfacción subjetivo de las pacientes, luego del procedimiento. Resultados: Hubo predominio de edades avanzadas en la muestra estudiada con 89,5 % de pacientes mayores de 55 años. En la mayoría de las pacientes se encontró una o más comorbilidades que favorecieron la presencia de esta afección. Un total de 8 pacientes habían sido sometidas a una cirugía correctora previa para el prolapso (30,7 %). Al mes de la cirugía el 80,7 % tenía una puntuación de 1-3 de la escala de evaluación PGI-I, valor que fue en ascenso y alcanzó el 96,1 % a los 3 meses, el 100 % a los 6 meses y al año. Conclusiones: La corrección del prolapso de la cúpula vaginal, mediante colpopexia por vía abdominal es una alternativa de tratamiento para las pacientes, fundamentalmente jóvenes o que quieren conservar la funcionalidad vaginal y la vida sexual activa.

Introduction: Pelvic floor dysfunctions are considered a health problem in the world, and constitute one of the most common indications for gynecological surgery. Among its variants is the prolapse of the vaginal vault. Objectives: To evaluate the results of the correction of the vaginal vault prolapse by the colpopexy technique by means of fixation with aponeurotic strips to the anterior abdominal wall. Methods: An observational, descriptive, retrospective study was carried out. The variables used were age, presence of comorbidities, the number of previous surgeries and the degree of subjective satisfaction of the patients after the procedure. Results: There was a predominance of advanced ages in the sample studied with 89.5% of patients older than 55 years. In most of the patients, one or more comorbidities were found that favored the presence of this condition. A total of 8 patients had undergone previous corrective surgery for the prolapse (30.7%). One month after surgery, 80.7% had a score of 1-3 on the evaluation, a value that increased and reached 96.1% at 3 months, and 100% at 6 months, and one year. Conclusions: Vaginal vault prolapse correction by mean of abdominal way colpopexy is therapeutic alternative, mainly young, and those who want to preserve vaginal functionality, and active sexual life.

Genomic and Evolutionary Analysis of Salmonella enterica Serovar Kentucky Sequence Type 198 Isolated From Livestock In East Africa.

Since its emergence in the beginning of the 90's, multidrug-resistant (MDR) Salmonella enterica subsp. enterica serovar Kentucky has become a significant public health problem, especially in East Africa. This study aimed to investigate the antimicrobial resistance profile and the genotypic relatedness of Salmonella Kentucky isolated from animal sources in Ethiopia and Kenya (n=19). We also investigated population evolutionary dynamics through phylogenetic and pangenome analyses with additional publicly available Salmonella Kentucky ST198 genomes (n=229). All the 19 sequenced Salmonella Kentucky isolates were identified as ST198. Among these isolates, the predominant genotypic antimicrobial resistance profile observed in ten (59.7%) isolates included the aac(3)-Id, aadA7, strA-strB, blaTEM-1B, sul1, and tet(A) genes, which mediated resistance to gentamicin, streptomycin/spectinomycin, streptomycin, ampicillin, sulfamethoxazole and tetracycline, respectively; and gyrA and parC mutations associated to ciprofloxacin resistance. Four isolates harbored plasmid types Incl1 and/or Col8282; two of them carried both plasmids. Salmonella Pathogenicity islands (SPI-1 to SPI-5) were highly conserved in the 19 sequenced Salmonella Kentucky isolates. Moreover, at least one Pathogenicity Island (SPI 1-4, SPI 9 or C63PI) was identified among the 229 public Salmonella Kentucky genomes. The phylogenetic analysis revealed that almost all Salmonella Kentucky ST198 isolates (17/19) stemmed from a single strain that has accumulated ciprofloxacin resistance-mediating mutations. A total of 8,104 different genes were identified in a heterogenic and still open Salmonella Kentucky ST198 pangenome. Considering the virulence factors and antimicrobial resistance genes detected in Salmonella Kentucky, the implications of this pathogen to public health and the epidemiological drivers for its dissemination must be investigated.

Revisiting the Biological Behavior of Salmonella enterica in Hydric Resources: A Meta-Analysis Study Addressing the Critical Role of Environmental Water on Food Safety and Public Health.

The increasing number of studies reporting the presence of Salmonella in environmental water sources suggests that it is beyond incidental findings originated from sparse fecal contamination events. However, there is no consensus on the occurrence of Salmonella as its relative serovar representation across non-recycled water sources. We conducted a meta-analysis of proportions by fitting a random-effects model using the restricted maximum-likelihood estimator to obtain the weighted average proportion and between-study variance associated with the occurrence of Salmonella in water sources. Moreover, meta-regression and non-parametric supervised machine learning method were performed to predict the effect of moderators on the frequency of Salmonella in non-recycled water sources. Three sequential steps (identification of information sources, screening and eligibility) were performed to obtain a preliminary selection from identified abstracts and article titles. Questions related to the frequency of Salmonella in aquatic environments, as well as putative differences in the relative frequencies of the reported Salmonella serovars and the role of potential variable moderators (sample source, country, and sample volume) were formulated according to the population, intervention, comparison, and outcome method (PICO). The results were reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyzes statement (PRISMA). A total of 26 eligible papers reporting 148 different Salmonella serovars were retrieved. According to our model, the Salmonella frequency in non-recycled water sources was 0.19 [CI: 0.14; 0.25]. The source of water was identified as the most import variable affecting the frequency of Salmonella, estimated as 0.31 and 0.17% for surface and groundwater, respectively. There was a higher frequency of Salmonella in countries with lower human development index (HDI). Small volume samples of surface water resulted in lower detectable Salmonella frequencies both in high and low HDI regions. Relative frequencies of the 148 serovars were significantly affected only by HDI and volume. Considering that serovars representation can also be affected by water sample volume, efforts toward the standardization of water samplings for monitoring purposes should be considered. Further approaches such as metagenomics could provide more comprehensive insights about the microbial ecology of fresh water and its importance for the quality and safety of agricultural products.

Genomic surveillance of antimicrobial resistance shows cattle and poultry are a moderate source of multi-drug resistant non-typhoidal Salmonella in Mexico.

Multi-drug resistant (MDR) non-typhoidal Salmonella (NTS) is a public health concern globally. This study reports the phenotypic and genotypic antimicrobial resistance (AMR) profiles of NTS isolates from bovine lymph nodes (n = 48) and ground beef (n = 29). Furthermore, we compared genotypic AMR data of our isolates with those of publicly available NTS genomes from Mexico (n = 2400). The probability of finding MDR isolates was higher in ground beef than in lymph nodes:χ2 = 12.0, P = 0.0005. The most common resistant phenotypes involved tetracycline (40.3%), carbenicillin (26.0%), amoxicillin-clavulanic acid (20.8%), chloramphenicol (19.5%) and trimethoprim-sulfamethoxazole (16.9%), while more than 55% of the isolates showed decreased susceptibility to ciprofloxacin and 26% were MDR. Conversely, resistance to cephalosporins and carbapenems was infrequent (0-9%). MDR phenotypes were strongly associated with NTS serovar (χ2 = 24.5, P<0.0001), with Typhimurium accounting for 40% of MDR strains. Most of these (9/10), carried Salmonella genomic island 1, which harbors a class-1 integron with multiple AMR genes (aadA2, blaCARB-2, floR, sul1, tetG) that confer a penta-resistant phenotype. MDR phenotypes were also associated with mutations in the ramR gene (χ2 = 17.7, P<0.0001). Among public NTS isolates from Mexico, those from cattle and poultry had the highest proportion of MDR genotypes. Our results suggest that attaining significant improvements in AMR meat safety requires the identification and removal (or treatment) of product harboring MDR NTS, instead of screening for Salmonella spp. or for isolates showing resistance to individual antibiotics. In that sense, massive integration of whole genome sequencing (WGS) technologies in AMR surveillance provides the shortest path to accomplish these goals.

Esperança e bem-estar psicológico durante a crise sanitária pela COVID-19: estudo com estudantes de enfermagem / Hope and psychological well-being during the sanitary crisis by COVID-19: a study with nursing students / Esperanza y bienestar psicológico durante la crisis sanitaria por COVID-19: estudio con estudiantes de enfermería

Objetivo: analisar as relações entre a esperança e o bem-estar psicológico de estudantes de enfermagem portugueses durante a crise pandêmica pela COVID-19. Método: estudo descritivo-correlacional, com recurso a questionário online para coleta de dados. Participaram 705 estudantes de enfermagem com idade média de 21,74 anos (DP=4,44). Os instrumentos de coleta de dados utilizados foram a Escala de Esperança de Herth (HHI-PT) e a Escala de Medida de Manifestação de Bem-Estar Psicológico (EMMBEP). Foi utilizada a estatística descritiva e inferencial. Resultados: na HHI-PT, o domínio afectivo-comportamental obteve a pontuação média mais alta, 3,30 (DP=0,45); no EMMBEP, foi o domínio sociabilidade, 3,64 (DP=0,77). Havia correlações moderadas a fortes (0,383

Aim: to analyze the relationship between hope and the psychological well-being of Portuguese nursing students during the COVID-19 pandemic crisis. Method: this is a descriptive-correlational study using an online questionnaire for data collection. 705 nursing students participated, with a mean age of 21.74 years (SD=4.44). The data collection instruments used were the Herth Hope Index (HHI-PT) and the Well-Being Manifestations Measure Scale (WBMMS). Descriptive and inferential statistics were used. Results: in the HHI-PT, the affective-behavioral domain had the highest mean score (3.30; SD=0.45), while in the WBMMS, it was the sociability domain, 3.64 (SD=0.77). There were moderate to strong correlations (0.383

Objetivo: analizar la relación entre la esperanza y el bienestar psicológico de los estudiantes portugueses de enfermería durante la crisis pandémica por COVID-19. Método: estudio descriptivo-correlacional mediante cuestionario online para la recogida de datos. Participaron 705 estudiantes de enfermería, con una edad promedio de 21,74 años (DE=4,44). Los instrumentos de recolección de datos utilizados fueron la Escala de Esperanza de Herth (HHI-PT) y la Escala de Medida de Manifestación de Bienestar Psicológico (EMMBEP). Se utilizó estadística descriptiva e inferencial. Resultados: en HHI-PT, fue el dominio afectivoconductual el que obtuvo la puntuación promedio más alta, 3.30 (DE=0.45), en EMMBEP, fue el dominio de sociabilidad, 3.64 (DE=0.77). Hubo correlaciones de moderadas a fuertes (0.383

Genomic surveillance links livestock production with the emergence and spread of multi-drug resistant non-typhoidal Salmonella in Mexico.

Multi-drug resistant (MDR) non-typhoidal Salmonella (NTS) is increasingly common worldwide. While food animals are thought to contribute to the growing antimicrobial resistance (AMR) problem, limited data is documenting this relationship, especially in low and middle-income countries (LMIC). Herein, we aimed to assess the role of non-clinical NTS of bovine origin as reservoirs of AMR genes of human clinical significance. We evaluated the phenotypic and genotypic AMR profiles in a set of 44 bovine-associated NTS. For comparative purposes, we also included genotypic AMR data of additional isolates from Mexico (n = 1,067) that are publicly available. The most frequent AMR phenotypes in our isolates involved tetracycline (40/44), trimethoprim-sulfamethoxazole (26/44), chloramphenicol (19/44), ampicillin (18/44), streptomycin (16/44), and carbenicillin (13/44), while nearly 70% of the strains were MDR. These phenotypes were correlated with a widespread distribution of AMR genes (i.e. tetA, aadA, dfrA12, dfrA17, sul1, sul2, bla-TEM-1, blaCARB-2) against multiple antibiotic classes, with some of them contributed by plasmids and/or class-1 integrons. We observed different AMR genotypes for betalactams and tetracycline resistance, providing evidence of convergent evolution and adaptive AMR. The probability of MDR genotype occurrence was higher in meat-associated isolates than in those from other sources (odds ratio 11.2, 95% confidence interval 4.5-27.9, P < 0.0001). The study shows that beef cattle are a significant source of MDR NTS in Mexico, highlighting the role of animal production on the emergence and spread of MDR Salmonella in LMIC.

Whole genome sequencing reveals widespread distribution of typhoidal toxin genes and VirB/D4 plasmids in bovine-associated nontyphoidal Salmonella.

Nontyphoidal Salmonella (NTS) is a common pathogen in food-producing animals and a public health concern worldwide. Various NTS serovars may be present in apparently healthy animals. This could result in carcass contamination during the slaughter process leading to human exposure. While most genomic research has focused on Salmonella pathogenesis, little is known on the factors associated with subclinical infections and environmental persistence. We report here the widespread distribution of typhoidal toxin genes (i. e. the cdtB islet, hlyE, taiA), among NTS strains from a beef slaughter operation (n = 39) and from epidemiologically unconnected ground beef (n = 20). These genes were present in 76% of the strains, regardless of serovar, isolation source or geographical location. Moreover, strains that predominated in the slaughterhouse carry plasmid-borne type IV secretion systems (T4SS), which have been linked to persistent infections in numerous pathogens. Population genomics supports clonal dissemination of NTS along the food production chain, highlighting its role as reservoir of genetic variability in the environment. Overall, the study provides a thorough characterization of serovar diversity and genomic features of beef-associated NTS in Mexico. Furthermore, it reveals how common genetic factors could partially explain the emergence and persistence of certain NTS serovars in the beef industry.

Intraventricular hemorrhage after dural fistula embolization / Hemorragia intraventricular após embolização de fístula dural

Abstract Background and objectives: Dural arteriovenous fistulas are anomalous shunts between dural arterial and venous channels whose nidus is located between the dural leaflets. For those circumstances when invasive treatment is mandatory, endovascular techniques have grown to become the mainstay of practice, choice attributable to their reported safety and effectiveness. We describe the unique and rare case of a dural arteriovenous fistula treated by transarterial embolization and complicated by an intraventricular hemorrhage. We aim to emphasize some central aspects of the perioperative management of these patients in order to help improving the future approach of similar cases. Case report: A 59-year-old woman with a previously diagnosed Cognard Type IV dural arteriovenous fistula presented for transarterial embolization, performed outside the operating room, under total intravenous anesthesia. The procedure underwent without complications and the intraoperative angiography revealed complete obliteration of the fistula. In the early postoperative period, the patient presented with clinical signs of raised intracranial pressure attributable to a later diagnosed intraventricular hemorrhage, which conditioned placement of a ventricular drain, admission to an intensive care unit, cerebral vasospasm and a prolonged hospital stay. Throughout the perioperative period, there were no changes in the cerebral brain oximetry. The patient was discharged without neurological sequelae. Conclusion: Intraventricular hemorrhage may be a serious complication after the endovascular treatment of dural arteriovenous fistula. A close postoperative surveillance and monitoring allow an early diagnosis and treatment which increases the odds for an improved outcome.

Resumo Justificativa e objetivos: Fístulas arteriovenosas durais (FAVD) são comunicações anômalas entre os canais venosos e arteriais da dura-máter cujo centro está localizado entre os folhetos da dura-máter. Para as circunstâncias nas quais o tratamento invasivo é obrigatório, as técnicas endovasculares se tornaram os pilares da prática, escolha atribuível a relatos de sua segurança e eficácia. Descrevemos o caso único e raro de uma FAVD tratada por embolização transarterial (ETA) e complicada por uma hemorragia intraventricular (HIV). Nosso objetivo foi destacar alguns aspectos centrais do manejo perioperatório desses pacientes para ajudar a melhorar uma futura abordagem de casos semelhantes. Relato de caso: Paciente do sexo feminino, 59 anos, com diagnóstico prévio de FAVD tipo IV (Cognard), apresentou-se para ETA, realizada fora da sala de cirurgia soBanestesia venosa total. O procedimento transcorreu sem complicações, e a angiografia intraoperatória revelou obliteração completa da fístula. No período pós-operatório imediato, a paciente apresentou sinais clínicos de aumento da pressão intracraniana (PIC) atribuíveis a uma HIV posteriormente diagnosticada, o que condicionou a colocação de um dreno ventricular, internação em Unidade de Terapia Intensiva (UTI), vasoespasmo cerebral e internação hospitalar prolongada. Durante todo o período perioperatório, não houve alterações na oximetria cerebral. A paciente recebeu alta sem sequelas neurológicas. Conclusão: HIV pode ser uma complicação grave após o tratamento endovascular de FAVD. A observação e o monitoramento cuidadosos no pós-operatório permitem o diagnóstico precoce e o tratamento que aumenta as chances de um resultado melhor.

Intraventricular hemorrhage after dural fistula embolization.

BACKGROUND AND OBJECTIVES: Dural arteriovenous fistulas are anomalous shunts between dural arterial and venous channels whose nidus is located between the dural leaflets. For those circumstances when invasive treatment is mandatory, endovascular techniques have grown to become the mainstay of practice, choice attributable to their reported safety and effectiveness. We describe the unique and rare case of a dural arteriovenous fistula treated by transarterial embolization and complicated by an intraventricular hemorrhage. We aim to emphasize some central aspects of the perioperative management of these patients in order to help improving the future approach of similar cases. CASE REPORT: A 59-year-old woman with a previously diagnosed Cognard Type IV dural arteriovenous fistula presented for transarterial embolization, performed outside the operating room, under total intravenous anesthesia. The procedure underwent without complications and the intraoperative angiography revealed complete obliteration of the fistula. In the early postoperative period, the patient presented with clinical signs of raised intracranial pressure attributable to a later diagnosed intraventricular hemorrhage, which conditioned placement of a ventricular drain, admission to an intensive care unit, cerebral vasospasm and a prolonged hospital stay. Throughout the perioperative period, there were no changes in the cerebral brain oximetry. The patient was discharged without neurological sequelae. CONCLUSION: Intraventricular hemorrhage may be a serious complication after the endovascular treatment of dural arteriovenous fistula. A close postoperative surveillance and monitoring allow an early diagnosis and treatment which increases the odds for an improved outcome.

[Intraventricular hemorrhage after dural fistula embolization]. / Hemorragia intraventricular após embolização de fístula dural.

BACKGROUND AND OBJECTIVES: Dural arteriovenous fistulas are anomalous shunts between dural arterial and venous channels whose nidus is located between the dural leaflets. For those circumstances when invasive treatment is mandatory, endovascular techniques have grown to become the mainstay of practice, choice attributable to their reported safety and effectiveness. We describe the unique and rare case of a dural arteriovenous fistula treated by transarterial embolization and complicated by an intraventricular hemorrhage. We aim to emphasize some central aspects of the perioperative management of these patients in order to help improving the future approach of similar cases. CASE REPORT: A 59-year-old woman with a previously diagnosed Cognard Type IV dural arteriovenous fistula presented for transarterial embolization, performed outside the operating room, under total intravenous anesthesia. The procedure underwent without complications and the intraoperative angiography revealed complete obliteration of the fistula. In the early postoperative period, the patient presented with clinical signs of raised intracranial pressure attributable to a later diagnosed intraventricular hemorrhage, which conditioned placement of a ventricular drain, admission to an intensive care unit, cerebral vasospasm and a prolonged hospital stay. Throughout the perioperative period, there were no changes in the cerebral brain oximetry. The patient was discharged without neurological sequelae. CONCLUSION: Intraventricular hemorrhage may be a serious complication after the endovascular treatment of dural arteriovenous fistula. A close postoperative surveillance and monitoring allow an early diagnosis and treatment which increases the odds for an improved outcome.

Sensibilidade moral e fatores relacionados: percepção de enfermeiros / Moral sensitivity and related factors: the perception of nurses / Sensibilidad moral y factores asociados: percepción de enfermeros

Objetivou-se conhecer a percepção de enfermeiros acerca da sensibilidade moral e seus fatores relacionados. Pesquisa qualitativa, com dados coletados em grupo focal e analisado pela técnica de análise de conteúdo, em março de 2016. Participaram seis enfermeiros das seguintes áreas de atuação - cuidados paliativos, hematologia, urgência, unidade de tratamento intensivo e docente - da cidade de Valência, Espanha. Depreenderam-se quatro categorias: o conceito de sensibilidade moral; a dimensão profissional; a relação com o paciente; e a educação ética. Os enfermeiros investigados apresentaram visão restrita do conceito de sensibilidade moral, porém identificaram fatores que influenciam a sensibilidade moral. Observou-se a percepção deles em relação à necessidade de ampliação e desenvolvimento dos processos formativos em ética, ainda durante a graduação e nos próprios serviços de saúde, com vistas ao aprimoramento dos cuidados de enfermagem.(AU)

This study aimed to investigate nurses' perception regarding moral sensitivity and factors related to it. It is a qualitative study, with data collected in focus groups and analyzed using the technique of content analysis, in March 2016. A total of six nurses participated, from the following areas of work ­ palliative care, hematology, urgent care, the intensive care unit, and lecturing ­ from the city of Valencia in Spain. Four categories were surmised: the concept of moral sensitivity; the professional dimension; the relationship with the patient; and ethical education. The nurses investigated presented a restricted view of the concept of moral sensitivity, although they identified factors which influence moral sensitivity.(AU)

Estudio cuyo propósito fue conocer la percepción de enfermeros acerca de la sensibilidad moral, así como de factores asociados a ello. Investigación cualitativa, con datos obtenidos por medio de grupo focal y analizados por la técnica de análisis de contenido, en marzo de 2016. Los participantes fueron seis enfermeros de las siguientes áreas de actuación ­ cuidados paliativos, hematología, urgencia, unidad de tratamiento intensivo y docente ­ de la ciudad de Valencia, España. Del estudio, resultaron cuatro categorías: concepto de sensibilidad moral; dimensión profesional; relación con el paciente; y educación ética. Los enfermeros investigados presentaron visión restricta del concepto de sensibilidad moral; sin embargo identificaron factores que interfieren en la sensibilidad moral. Se observó la percepción de ellos acerca de la necesidade de ampliación y desarrollo de los procesos formativos en ética aun durante la graduación y en los propios servicios de salud, a fin de que los cuidados de enfermería sean perfeccionados.(AU)

Factores asociados al uso de DIU en mujeres de 35 a 49 años en un policlínico de Ciudad de La Habana / Factors associated with the use of IUD in women aged 35-49 in a polyclinic of Havana City

El presente trabajo tuvo como objetivo determinar la frecuencia del uso de dispositivo intrauterino (DIU) y los factores sociodemográficos, reproductivos y de información asociados a este en mujeres de 35 a 49 años de edad. En 1999 se aplicó una encuesta sobre el uso de anticonceptivos a 375 mujeres pertenecientes al policlínico "Moncada", en Ciudad de La Habana. El análisis incluyó regresión logística no condicionada para determinar la asociación entre las variables sociodemográficas, biológicas, reproductivas y educativas o de información y el uso de DIU. La medida de asociación utilizada fue la razón de momios (RM) a un intervalo de confianza del 95 por ciento. Como resultado se obtuvo que el DIU fue utilizado por el 43,4 por ciento de las mujeres que usan anticonceptivos; de ellas, el 61,5 por ciento tenía 1 hijo o ninguno. La probabilidad de uso de DIU fue mayor entre las mujeres de 35 a 39 años (RM = 286, IC: 95 por ciento = 1,43 - 5,75) y de 40 a 44 (RM = 2,42, IC: 95 por cento = 1,13 - 5,45) que en las de 45 a 49. El uso de DIU también fue mayor en mujeres que tenían menos de 2 hijos (RM = 3,22, IC: 95 por ciento = 1,94 - 5,36), y resultó ser aún mayor si estas estaban informadas (RM = 5,22, IC: 95 por ciento = 2,27 - 12,03) o habían recibido orientación médica (RM = 2,35, IC: 95 por ciento = 1,16 - 4,78). Otras variables estuvieron asociadas al uso de DIU, pero solo la paridad y la orientación del método por el médico mantuvieron su significancia en el análisis multivariado. Se concluye que la orientación del médico es una variable que influye positivamente en la decisión de uso de DIU en la población de mujeres estudiadas entre 35 y 49 años de edad, sobre todo si se considera que la paridad está "satisfecha" o "terminada"(AU)