Evaluación del dolor durante la movilización y la aspiración endotraqueal en pacientes críticos / Evaluation of pain during mobilization and endotracheal aspiration in critical patients

OBJETIVOS: 1) Evaluar la prevalencia de dolor durante 2 procedimientos de enfermería, y 2) analizar la utilidad de ciertos signos vitales y del índice biespectral (BIS) para detectar dolor. MÉTODOS: Estudio prospectivo, observacional y analítico de medidas repetidas en pacientes con ventilación mecánica y sedación. Los procedimientos evaluados fueron la aspiración endotraqueal y la movilización con giro. El dolor se evaluó mediante la Behavioral Pain Scale. Valores más o igual se consideraron dolorosos. Se registraron distintos signos fisiológicos y los valores del BIS. Una variación porcentual > 10% se consideró clínicamente relevante. RESULTADOS: Se analizaron 146 procedimientos en 70 pacientes. La prevalencia de dolor durante los procedimientos fue del 94%. Los signos vitales y los valores del BIS aumentaron significativamente durante los procedimientos respecto el reposo, pero solo la variación del BIS alcanzó relevancia clínica. En un subgrupo de pacientes que recibieron analgesia preventiva antes de los procedimientos, el dolor disminuyó significativamente respecto a los pacientes que no recibieron analgesia preventiva (−2 [RIQ: {−5}-0] vs. 3 [RIQ: 1-4]; p<0,001, respectivamente). CONCLUSIONES: Los procedimientos evaluados son dolorosos. La variación de los signos vitales no es un buen indicador de dolor. La variación del BIS podría ser útil, pero precisa nuevas investigaciones. La administración de analgesia preventiva disminuye la prevalencia de dolor durante los procedimientos

OBJECTIVES: 1) To assess the prevalence of pain during nursing care procedures, and 2) to evaluate the usefulness of certain vital signs and the bispectral index (BIS) in detecting pain. METHODS: A prospective, observational analytical study was made of procedures (endotracheal aspiration and mobilization with turning) in critically ill sedated patients on mechanical ventilation. The Behavioral Pain Scale was used to assess pain, with scores of more or equal 3 indicating pain. Various physiological signs and BIS values were recorded, with changes of > 10% being considered clinically relevant. RESULTS: A total of 146 procedures in 70 patients were analyzed. Pain prevalence during the procedures was 94%. Vital signs and BIS values increased significantly during the procedures compared to resting conditions, but only the changes in BIS were considered clinically relevant. In the subgroup of patients receiving preemptive analgesia prior to the procedure, pain decreased significantly compared to the group of patients who received no such analgesia (−2 [IQR: {−5}-0] vs. 3 [IQR: 1-4]; P<.001, respectively). CONCLUSIONS: The procedures evaluated in this study are painful. Changes in vital signs are not good indicators of pain. Changes in BIS may provide useful information about pain, but more research is needed. The administration of preemptive analgesia decreases pain during the procedures

[Evaluation of pain during mobilization and endotracheal aspiration in critical patients]. / Evaluación del dolor durante la movilización y la aspiración endotraqueal en pacientes críticos.

OBJECTIVES: 1) To assess the prevalence of pain during nursing care procedures, and 2) to evaluate the usefulness of certain vital signs and the bispectral index (BIS) in detecting pain. METHODS: A prospective, observational analytical study was made of procedures (endotracheal aspiration and mobilization with turning) in critically ill sedated patients on mechanical ventilation. The Behavioral Pain Scale was used to assess pain, with scores of ≥3 indicating pain. Various physiological signs and BIS values were recorded, with changes of >10% being considered clinically relevant. RESULTS: A total of 146 procedures in 70 patients were analyzed. Pain prevalence during the procedures was 94%. Vital signs and BIS values increased significantly during the procedures compared to resting conditions, but only the changes in BIS were considered clinically relevant. In the subgroup of patients receiving preemptive analgesia prior to the procedure, pain decreased significantly compared to the group of patients who received no such analgesia (-2 [IQR: {-5}-0] vs. 3 [IQR: 1-4]; P<.001, respectively). CONCLUSIONS: The procedures evaluated in this study are painful. Changes in vital signs are not good indicators of pain. Changes in BIS may provide useful information about pain, but more research is needed. The administration of preemptive analgesia decreases pain during the procedures.

[Impact of income strategies on food security in rural Mayan communities in northern Campeche]. / Impacto de las estrategias de ingresos sobre la seguridad alimentaria en comunidades rurales Mayas del norte de Campeche.

This paper examines the effect of income strategies on sufficiency of caloric intake in Mayan domestic groups (DG) of Campeche, Mexico. The analysis was based on the sustainable livelihoods approach. Information was obtained through a survey of households (N = 237) in four communities. The results reveal that all of the DG have diversified income strategies with clearly defined orientations. The caloric sufficiency index (CSI) is different (p < 0.05) among conglomerates (C) of DG and increases with the increase of the proportion of agricultural income in relation to total income. The wage labor strategy (37.6%) corresponding to C1 of DG (CSI-C = 0.69) and the agriculture-wage labor strategy (42.6%; CSI-C2 = 0.87) do not cover energy requirements of the DG. Only the agricultural strategy satisfies caloric intake needs (CSI-C3 = 1.09; CSI-C4 = 1.30) of the DG (19.8%). These results are associated with the heterogeneity of resources of the DG's, particularly, with the quality and extent of land, presence of producer organizations, and current rural policies. Implementation of differentiated local policies, interinstitutional coordination, and community participation could contribute to improving effectiveness of policies aimed at eradicating food insecurity.

Impacto de las estrategias de ingresos sobre la seguridad alimentaria en comunidades rurales Mayas del norte de Campeche / Impact of income strategies on food security in rural Mayan communities in northern Campeche

En este artículo se examina el efecto de las estrategias de ingresos sobre la suficiencia de consumo calórico en grupos domésticos (GD) mayas de Campeche, México. El análisis se basó en el enfoque de modos de vida y la información se obtuvo de una encuesta censal de hogares (N=237) en cuatro comunidades. Los resultados revelan que todos los GD tienen una estrategia de ingreso diversificada con una orientación claramente definida. El índice de seguridad calórica (ISC) es diferente (p <0.05) entre conglomerados (C) de GD y aumenta a medida que se incrementa la proporción del ingreso agrícola en el ingreso total. La estrategia laboral (37.6 por ciento) correspondiente al C1 de GD (ISC-C1= 0.69) y la estrategia agrícolalaboral (42.6 por ciento; ISC-C2= 0.87) no cubren los requerimientos energéticos de los GD. La estrategia agrícola es la única que satisface las necesidades de consumo calórico (ISC-C3= 1.09; ISC-C4= 1.30) de los GD (19.8 por ciento). Estos resultados están relacionados con la heterogeneidad de capitales que poseen los GD, especialmente con la calidad y extensión de la tierra, las organizaciones productivas, y la política rural vigente. La implementación de una política local diferenciada, la coordinación interinstitucional y la participación ciudadana, podrían contribuir a mejorar la eficacia de las políticas orientadas a erradicar la inseguridad alimentaría.

This paper examines the effect of income strategies on sufficiency of caloric intake in Mayan domestic groups (DG) of Campeche, Mexico. The analysis was based on the sustainable livelihoods approach. Information was obtained through a survey of households (N=237) in four communities. The results reveal that all of the DG have diversified income strategies with clearly defined orientations. The caloric sufficiency index (CSI) is different (p<0.05) among conglomerates (C) of DG and increases with the increase of the proportion of agricultural income in relation to total income. The wage labor strategy (37.6 percent) corresponding to C1 of DG (CSI-C1=0.69) and the agriculture- wage labor strategy (42.6 percent; CSI-C2=0.87) do not cover energy requirements of the DG. Only the agricultural strategy satisfies caloric intake needs (CSI-C3=1.09; CSI-C4=1.30) of the DG (19.8 percent). These results are associated with the heterogeneity of resources of the DG´s, particularly, with the quality and extent of land, presence of producer organizations, and current rural policies. Implementation of differentiated local policies, interinstitutional coordination, and community participation could contribute to improving effectiveness of policies aimed at eradicating food insecurity.