Resilience, sleep quality and sleepiness in Peruvian medical students: a multicenter study.

Background: Resilience can mitigate the negative impact produced by the COVID-19 pandemic. Medical students endure significant academic stress, so adjusting to sudden changes can present greater mental health challenges. The aim is to identify the level and prevalence of resilience and to know what are the educational variables and is sleep quality associated with resilience. Methods: A cross-sectional study was conducted using an online questionnaire. The survey was elaborated in Google Forms and shared through social networks. The outcome was resilience, measured with the Connor Davidson Resilience Scale. Its association was assessed with sleep quality (measured with the Pittsburgh Sleep Quality Index), daytime sleepiness (measured with the Epworth Sleepiness Scale), and selected academic/sociodemographic variables. Generalized linear models were used to identify the association between the variables. Results: Of 1277 participants, 35.7% experienced high resilience. Poor sleep quality and sleepiness were present in 88.4% and 36.0% of students, respectively. High resilience was associated with good sleep quality (PR:1.56; 95%CI: 1.34 - 1.83; p-value<0.001), absent sleepiness (PR:1.59; 95%CI: 1.32-1.91; p-value<0.001), male sex (PR: 1.21; 95%CI: 1.05-1.39; p-value 0.006), working (PR:1.14), having family responsibilities (PR: 1.36; 95%CI: 1.09-1.70; p-value 0.005) and spending more than 6 hours studying (PR: 1.35; 95%CI: 1.17-1.54; p-value<0.001). Conclusion: 4 out of 10 students presented high levels of resilience. The development of resilience depended on multiple individual and sociodemographic factors. These findings are important to support universities in developing resilience-building measures and strategies that can be implemented to mitigate the adverse pandemic event.

Parents' Perceptions of Schools' COVID-19 Mitigation Strategies: A Phenomenological Study.

BACKGROUND: At the onset of the COVID-19 pandemic, schools closed across the United States. Given the impact of virtual learning and lost access to school resources, schools eventually reopened with COVID-19 mitigation protocols in place. This qualitative study sought to understand parental perceptions of school-based COVID-19 mitigation strategies. METHODS: Using a phenomenology approach, nine focus groups were completed with 40 parents of children in grades K-8 representing eight Maryland counties. Based on acceptance of masking policies (as indicated on a survey), parents were sorted into 2 groups-lower and higher masking acceptance. A thematic analysis was conducted for each group and themes were compared between the 2 groups. RESULTS: The main themes were related to parents' general sentiments regarding COVID-19, compliance, pandemic-related changes over time, changes in personal opinions, and in-person learning. Both groups described challenges related to inconsistent COVID-19 mitigation policies and practices, the challenges of rapid and frequent changes in guidelines during the pandemic, and the benefits of in-person learning. CONCLUSIONS: Parents of elementary and middle school children, regardless of general acceptance of masking policies, shared concerns about implementation and guidance regarding school-based mitigation strategies.

Effect of a Comprehensive School-Based Health Center on Academic Growth in K-8th Grade Students.

OBJECTIVE: School-based health centers (SBHCs) improve health care access, but associations with educational outcomes are mixed and limited for elementary and middle school students. We investigated whether students enrolled in a comprehensive SBHC demonstrated more growth in standardized math and reading assessments over 4 school years versus nonenrolled students. We also explored changes in absenteeism. METHODS: Participants were students enrolled in 2 co-located Title I schools from 2015-19 (1 elementary, 1 middle, n = 2480). Analysis of math and reading was limited to students with baseline and postbaseline scores (math n = 1622; reading n = 1607). Longitudinal regression models accounting for within-subject clustering were used to estimate the association of SBHC enrollment with academic scores and daily absenteeism, adjusting for grade, sex, body mass index category, health conditions, baseline outcomes (scores or absenteeism), and outcome pretrends. RESULTS: More than 70% of SBHC-enrolled students had math (1194 [73.6%]) and reading 1186 [73.8%]) scores. Enrollees were more likely than nonenrollees to have asthma (39.7% vs 19.6%) and overweight/obesity (42.4% vs 33.6%). Adjusted baseline scores were significantly lower in math and reading for enrollees. Mean change from baseline for enrollees exceeded nonenrollees by 3.5 points (95% confidence interval [CI]: 2.2, 4.8) in math and 2.1 points (95% CI: 0.9, 3.3) in reading. The adjusted rate of decrease in daily absenteeism was 10.8% greater for enrollees (incident rate ratio 0.772 [95% CI: 0.623, 0.956]) than nonenrollees (incident rate ratio 0.865 [95% CI: 0.696, 1.076]). CONCLUSIONS: SBHC enrollees had greater health and educational risk but demonstrated more growth in math and reading and less absenteeism than nonenrollees.

Parents' and Caregivers' Support for in-School COVID-19 Mitigation Strategies: A Socioecological Perspective.

Informed by the social ecological model, which asserts that health behaviors and beliefs are the result of multiple levels of influence, we examined factors related to parents' support for in-school COVID-19 mitigation strategies. Using data from a survey of 567 parents/caregivers of public elementary and middle school students in eight Maryland counties, we employed regression models to examine relationships between parent-, child-, family-, school-, and community-level factors and acceptability of mitigation strategies. Acceptance of COVID-19 mitigation strategies was positively correlated with child- and family-level factors, including child racial identity (parents of Black children were more accepting than those of White children, odds ratio [OR]: 2.5, 95% confidence interval [CI] = [1.5, 4.1]), parent receipt of the COVID-19 vaccine (OR: 2.4, 95% CI = [1.5, 3.7]), and parent Democrat or Independent political affiliation (compared with Republican affiliation, OR: 4.2, 95% CI = [2.6, 6.7]; OR: 2.2, 95%CI = [1.3, 3.8], respectively). Acceptance was also positively associated with parents' perceptions of their school's mitigation approach, including higher school mitigation score, indicating more intensive mitigation policies (OR: 1.1, 95% CI = [1.0, 1.1]), better school communication about COVID-19 (OR: 1.7, 95% CI = [1.4, 1.9]) and better school capacity to address COVID-19 (OR: 1.9, 95% CI = [1.5, 2.4]). Community-level factors were not associated with acceptance. Child- and parent-level factors identified suggest potential groups for messaging regarding mitigation strategies. School-level factors may play an important role in parents' acceptance of in-school mitigation strategies. Schools' capacity to address public health threats may offer an underappreciated and modifiable setting for disseminating and reinforcing public health guidance.

Parents' Trust in COVID-19 Messengers and Implications for Vaccination.

PURPOSE: To characterize factors associated with parents' trust in messengers of COVID-19 guidance and determine whether trust in their doctors is associated with COVID-19 vaccination. DESIGN: Web-based and mailed survey (January-June 2022). SETTING: Maryland, USA. SUBJECTS: 567 parents/caregivers of public elementary and middle school students. MEASURES: Parents rated trust in 9 messengers on a 4-point scale ["not at all" (0) to "a great deal" (3)], dichotomized into low (0-1) vs high (2-3). They reported on health insurance, income, race, ethnicity, education, sex, urbanicity, political affiliation, and COVID-19 vaccination. ANALYSIS: ANOVA and t-tests were computed to compare overall trust by parent characteristics. Multivariable logistic regression was run to evaluate factors associated with high trust for each messenger. Multivariable logistic regression was used to evaluate the relationship between trust in doctors and odds of COVID-19 vaccination. RESULTS: Most trusted messengers were doctors (M = 2.65), family members (M = 1.87), and schools (M = 1.81). Parents' trust varied by racial identity, sex, urbanicity, health insurance, and political affiliation. Greater trust in their or their child's doctor was associated with greater odds of child (aOR: 2.97; 95% CI: 1.10, 7.98) and parent (aOR: 3.30; 95% CI: 1.23, 1.47) vaccination. CONCLUSION: Parent characteristics were associated with trust, and trust was linked to vaccination. Public health professionals should anticipate variability in trusted messengers to optimize uptake of public health guidance.

Pesticides and PPCPs in aquatic ecosystems of the andean central region: Occurrence and ecological risk assessment in the Uco valley.

Uco valley (Mendoza, Argentina) suffers the concomitant effect of climate change, anthropic pressure and water scarcity. Moreover chemical pollution to aquatic ecosystems could be another pressuring factor, but it was not studied enough to the present. In this sense, the aim of this study was to assess the occurrence of pesticides, pharmaceuticals and personal care products (PPCPs) in aquatic ecosystems of the Uco Valley and to perform an ecological risk assessment (ERA). The presence of several insecticides (mainly neonicotinoids), herbicides (atrazine, diuron, metolachlor, terbutryn) and fungicides (strobilurins, triazolic and benzimidazolic compounds) in water samples in two seasons, related to crops like vineyards, garlic or fruit trees was associated to medium and high-risk probabilities for aquatic biota. Moreover, PPCPs of the group of non-steroidal anti-inflammatory drugs, parabens and bisphenol A were detected in all the samples and their calculated risk quotients also indicated a high risk. This is the first record of pesticides and PPCPs with an ERA in this growing agricultural oasis. Despite the importance of these findings in Uco Valley for decision makers in the region, this multilevel approach could bring a wide variety of tools for similar regions in with similar productive and environmental conditions, in order to afford actions to reach Sustainable Development Goals. SYNOPSIS: Aquatic ecosystems in arid mountain regions are threatened worldwide. This study reports relevant data about chemical pollution in Central Andes, which could be a useful tool to enhance SDGs' accomplishment.

Development of a community-informed communication toolkit to prevent spread of viral illness in schools, including SARS-COV-2.

Introduction: Schools were uniquely impacted during the COVID-19 (SARS-COV-2) pandemic. We sought to elucidate how parents/guardians of elementary and middle school students in Maryland navigated the return to in-person school following remote instruction. We also sought to understand how they perceived communication about school-based COVID-19 mitigation strategies and their preferences for the content and format of public health communication about COVID-19 mitigation in schools. Methods: We engaged a community advisory board comprised of key partners and implemented a survey and focus groups. Results: Results indicated that parents/guardians wanted clearer communication about COVID-19 mitigation policies in schools and were experiencing fatigue and confusion. These insights informed the development of a tailorable communication toolkit. The toolkit was designed to (1) inform parents/guardians about the importance and effectiveness of mitigation strategies for preventing viral spread to keep children in school, (2) promote a sense of community and support, and (3) help school communication teams effectively communicate information about mitigation strategies being implemented. Discussion: We describe a process for leveraging schools as a trusted messenger, engaging school communities in the development of communication messages, and utilizing a tailorable communication toolkit in the context of shifting public health guidance and local needs. The toolkit development and dissemination process offers a model for targeting public health messaging to parents/guardians in school settings.

Identifying and preventing fraudulent responses in online public health surveys: Lessons learned during the COVID-19 pandemic.

Web-based survey data collection has become increasingly popular, and limitations on in-person data collection during the COVID-19 pandemic have fueled this growth. However, the anonymity of the online environment increases the risk of fraudulent responses provided by bots or those who complete surveys to receive incentives, a major risk to data integrity. As part of a study of COVID-19 and the return to in-person school, we implemented a web-based survey of parents in Maryland between December 2021 and July 2022. Recruitment relied, in part, on social media advertisements. Despite implementing many existing best practices, we found the survey challenged by sophisticated fraudsters. In response, we iteratively improved survey security. In this paper, we describe efforts to identify and prevent fraudulent online survey responses. Informed by this experience, we provide specific, actionable recommendations for identifying and preventing online survey fraud in future research. Some strategies can be deployed within the data collection platform such as careful crafting of survey links, Internet Protocol address logging to identify duplicate responses, and comparison of client-side and server-side time stamps to identify responses that may have been completed by respondents outside of the survey's target geography. Other strategies can be implemented during the survey design phase. These approaches include the use of a 2-stage design in which respondents must be eligible on a preliminary screener before receiving a personalized link. Other design-based strategies include within-survey and cross-survey validation questions, the addition of "speed bump" questions to thwart careless or computerized responders, and the use of optional open-ended survey questions to identify fraudsters. We describe best practices for ongoing monitoring and post-completion survey data review and verification, including algorithms to expedite some aspects of data review and quality assurance. Such strategies are increasingly critical to safeguarding survey-based public health research.

[Prevalence and factors associated with eating disorders in Peruvian Human Medicine students in the context of the COVID-19 pandemic: a multicentre study]. / Prevalencia y factores del trastorno de conducta alimentaria en estudiantes de Medicina Humana del Perú en el contexto de la pandemia de COVID-19: estudio multicéntrico.

INTRODUCTION: Eating disorders (ED) are serious conditions that have diverse consequences, associated with high morbidity and mortality: Among the factors associated with their development are, being female, and stress, which increased during the pandemic, and was higher in medical students. Our objective was to identify the prevalence and factors associated with ED in medical students. METHODS: Cross-sectional study, conducted with an online questionnaire, between January 1 and 31, 2021, in 22 universities, using the Eating Disorder Scale (EAT-26) and the Family Communication Scale (FCS). Generalized logistic regressions were used to identify the association between variables. RESULTS: A total of 1224 participants were recruited, and the prevalence was 12.5%. Associated factors included a poor perception of health in 34.3%, having a family and/or social environment member with an eating disorder in 21.7%, and medium or low satisfaction with family communication in 57.3% and 34.9% respectively, in addition to the academic year, dieting, concern for body image and the perception of inadequate eating. CONCLUSIONS: Our results show that, in the context of the COVID-19 pandemic, 1-2 out of 10 Human Medicine students had an ED. The associated factors that influenced development of the condition included a fair or poor perception of health, the academic year completed, and medium or low satisfaction with family communication.

Human Papillomavirus, Cytomegalovirus Infection and P16 Staining in Breast Tumors from Peruvian Women.

OBJECTIVE: To evaluate the frequency distribution of viral infections in Peruvian Breast Cancer (BC) lesions and its association with clinicopathological features. Additionally, a prospective evaluation of p16 and Tumor-infiltrating lymphocytes (TIL) levels were performed for developing a comprehensive analysis. METHODS: Detection of high risk- human papillomavirus (HR- HPV) through qPCR was performed in 447 BC and 79 non-cancer frozen samples. Paired paraffin samples from 238 BC were stained with Human cytomegalovirus (HCMV) and p16 immunohistochemistry. TIL was calculated in 397 BC cases. RESULTS: HCMV was positive in 72.5%. HR- HPV was detected in 2.9% of BC and 1.3% of non-malignant samples. P16+ was found in 28.15% and median TIL percentage was 30. HR- HPV infection was associated with non-ductal histology (p=0.003) and p16+ (p=0.017). Positive P16+ was associated with higher T stage (p=0.022), grade (p=0.009), TIL level (p=0.002), and triple-negative phenotype (p=0.021). CONCLUSION: HCMV is frequent, but HR- HPV infection is unusual in Peruvian BC. P16+ is associated with HR- PVH infection, high TIL and aggressive features.

Valores de referencia del Senior Fitness Test en mujeres adultas mayores físicamente activas / Reference values of the Senior Fitness Test for physically active elderly women

Introducción: El proceso de envejecimiento en los adultos mayores puede conducir a la disminución de la condición física funcional. Por ello resulta importante su valoración para poder establecer programas de ejercicio físico que mejoren las capacidades físicas, así como la funcionalidad y calidad de vida en esta población. Objetivo: Establecer los valores de referencia de la condición física funcional en las mujeres físicamente activas pertenecientes a Centros Vida de la ciudad de Bucaramanga. Métodos: Estudio descriptivo transversal en 113 mujeres mayores entre 60-85 años. Se evalúo la condición física funcional con el Senior Fitness Test y medidas antropométricas de talla y peso. Los valores de referencia están en percentiles y distribuidos por rangos de edad. Resultados: Según los valores de referencia del Senior Fitness Test, las mujeres de nuestro estudio se encuentran por encima en los valores de fuerza de miembros inferiores y superiores. En la prueba de resistencia cardiovascular y flexibilidad en miembros inferiores y superiores se encuentran por debajo. En los valores de la prueba de agilidad el tiempo de ejecución es mayor. Conclusiones: Se observa una disminución en las capacidades físicas funcionales conforme avanza la edad, sin embargo, la capacidad física que menos disminuye es la fuerza(AU)

Introduction: The aging process may lead to a reduction of functional physical condition in the elderly. Its analysis is therefore necessary to implement physical exercise programs aimed at improving physical capacities, functionality and quality of life in this population. Objective: Establish the reference values for functional physical condition in physically active women from Life Centers in the city of Bucaramanga. Methods: A cross-sectional descriptive study was conducted of 113 elderly women aged 60-85 years. Functional physical condition was evaluated with the Senior Fitness Test and anthropometric measurements of height and weight. Reference values are expressed in percentiles and distributed by age ranges. Results: The women in our study are above the reference values of the Senior Fitness Test in upper and lower limb force. Upper and lower limb cardiovascular resistance and flexibility are below SFT reference values. Values for the agility test show a longer performance time. Conclusions: A reduction is observed in functional physical capacities as people grow older. However, force is the physical capacity that diminishes the least(AU)

Ecological risk assessment of current-use pesticides and biocides in soils, sediments and surface water of a mixed land-use basin of the Pampas region, Argentina.

The present study aimed to assess the ecological risk of 30 current-use agricultural pesticides and biocides in the soil, sediments and aquatic organisms of a mixed land-use basin located in the Depressed Pampas Region of Argentina. Risk Quotients (RQs) were used to evaluate the chronic risk in soil and aquatic organisms, while Toxic Units (TUs) were used to assess the acute risk in sediment-dwelling organisms and aquatic biota. Acetochlor, hydroxy-atrazine, glyphosate, AMPA, metolachlor, imidacloprid and tebuconazole were the only pesticide residues detected (>30%) and quantified in all the matrices evaluated. Glyphosate and AMPA showed the highest concentrations, being their mean and maximum levels 27.90-176.00 µg kg-1 and 270-712.50 µg kg-1 in soils, 8.28-32.0 µg kg-1 and 6.85-17.50 µg kg-1 in sediments, and 1.88-4.36 µg L-1 and 0.66-1.03 µg L-1 in surface water. The RQs in soils showed high chronic risk, mainly due to AMPA and imidacloprid. The TUs in sediments showed acute risk in dwelling organisms, mainly due to glyphosate and imidacloprid. RQs assessment showed a range of chronic risk levels according to the site/sampling event, with higher contribution of atrazine and its metabolites, and acetochlor, whereas TUs assessment showed no acute risk in aquatic biota. In contrast to Europe, in Argentina, there are no restrictions regarding the use of atrazine, acetochlor, imidacloprid and glyphosate to protect aquatic life. Thus, it is recommended that the current Argentine pesticide regulations should be modified to prevent ecological risk and protect ecosystems.

Effects of the High-Probability Instructional Sequence in Children With Feeding Disorders: A Synthesis.

The high-probability (high-p) instructional sequence is an intervention commonly used to increase compliance in a variety of skill domains, including compliance with low-probability (low-p) mealtime demands in children with pediatric feeding disorders. However, the effects of the high-p sequence on feeding have varied across studies, a systematic synthesis of the literature to guide practice and further research is lacking, and whether the high-p sequence, as an intervention for feeding problems, meets current evidence-based practice standards in special education is unknown. First, we conducted a systematic multistep search, identified seven studies that met inclusion criteria, and synthesized participant and study characteristics. Then we compared the evidence with the 2014 Council for Exceptional Children (CEC): Standards for Evidence-Based Practices in Special Education. The results suggest that (a) the high-p sequence can improve compliance with low-p mealtime demands in young children with feeding disorders but that more research is needed to clarify relevant contexts and for whom the intervention is likely to be effective, (b) additional research should examine the effects of the high-p sequence on feeding in older children or adults with disabilities as more intrusive procedures based on escape extinction become inappropriate, and (c) the evidence falls short of meeting the CEC standards for an evidence-based practice. We conclude with preliminary practice guidelines.

Ecological Risk Assessment (ERA) of pesticides from freshwater ecosystems in the Pampas region of Argentina: Legacy and current use chemicals contribution.

Agricultural production in the Pampas region is one of the most important economic activities in Argentina. However, the possible environmental effects related to the growth of this activity in the last years have not been studied enough. Particularly, the effects of pesticides mixtures are a topic of great concern both for society and regulatory authorities worldwide, given the possible additive and synergistic relationships between these chemicals and their possible effects on aquatic biota. Based on a concentration addition model, this study developed an Ecological Risk Assessment (ERA) of pesticides from freshwater ecosystems in the Pampas region. For this purpose, reported pesticides concentrations available in public bibliography and a Risk Quotients (RQs) approach were used. A cumulative risk map was established to display RQs for current use pesticides (CUPs) and legacy chemicals. The ΣRQs were calculated for 66 sites, using available reported measured environmental concentrations (MECs) and predicted no effect concentrations (PNECs) of pesticides. While ΣRQ for only CUPs resulted in a high and very high risk (ΣRQ > 1) for 29% of the sites, when legacy pesticides were incorporated this percentage reached the 41% of the sites, increasing significantly the absolute values of RQ. Herbicides like glyphosate and atrazine contributed considerably to the ΣRQCUPs while organochlorines were the major contributors for ΣRQs when legacy pesticides were incorporated. Moreover, some active ingredients (acetochlor, carbendazim and fenitrothion) which are approved for their use in Argentina but banned in EU showed high contribution to ΣRQCUPs. The present study is the first attempt to develop an ERA in surface water of the Pampas region of Argentina and it provides a starting point for a more comprehensive pesticides monitoring and a further risk assessment program.

Multi-criteria decision model for assessing groundwater pollution risk in the urban-rural interface of Mar del Plata City (Argentina).

In developing countries, conflict between the objectives of environmental policies and those focused on economic development, a low availability of human resources and infrastructure, and the lack of continuity and incentives, contribute to the inability to successfully implement environmental policies. Moreover, in these countries, population growth in the peri-urban areas has resulted in serious water pressures, poor water management, and severe non-point source pollution. The aim of this paper is to implement a procedure of aquifer pollution risk assessment for identifying priority areas in an urban-rural interface based on multi-criteria decision tools. In this sense, a multi-criteria decision model was designed, in terms of environmental and socio-economic criteria and sub-criteria relevant to water resource management, by using the software Criterium Decision Plus 4.0. This model was applied to the northwestern peri-urban area of Mar del Plata City, Argentina, which is embedded in the second most important fruit-horticultural belt of the country. Here, groundwater is the only source of water supply. The proposed decision model allowed establishing a ranking of priority areas for defining action guidelines in order to minimize the risk of pollution of the aquifer. Aquifer pollution hazard criterion mainly contributes to alternatives classified as very high priority whilst in the case of low and very low priority classes, social vulnerability criterion mostly influences the final results. The first alternatives will require an intervention in a short-term time horizon, and the last ones must be monitored in order to avoid their shift to a worse environmental condition.

Trastorno neurocognitivo leve en el climaterio con Evaluación Cognitiva Montreal / Mild neurocognitive disorder in the climacteric with Montreal Cognitive Assessment

Las mujeres en climaterio o transición menopáusica frecuentemente reportan quejas de memoria. El Estudio Esmeralda busca relacionar los Síntomas del Climaterio (SC) femenino en sus diferentes etapas: premenopausia (etapa -2, temprana de la transición menopáusica), perimenopausia (etapas -1 y +1ª, tardía de la transición menopáusica y temprana de postmenopausia) y postmenopausia (etapas +1b, +1c y +2, temprana de postmenopausia con tardía de postmenopausia), con posible deterioro del funcionamiento intelectual, que pudiera llevar a sospechar de Trastorno Neurocognitivo leve (TNCl). La muestra final quedó conformada por 100 mujeres con alto nivel de escolaridad entre 40 y 60 años de edad. Se realizó un estudio no experimental transversal con muestreo no probabilístico, utilizando la Evaluación Cognitiva Montreal (MoCA). Se obtuvieron resultados normativos en 43.27% de la muestra y Deterioro Cognitivo Leve (DCL) en 56.73%, encontrando diferencia de medias significativas al nivel 0.05 en las tres etapas de climaterio, resultando la mayor incidencia en perimenopausia, etapa de mayor disminución de estrógenos. Se concluye que cambios en la función intelectual, pueden estar asociados a variación hormonal. Se puede determinar TNCl en forma temprana, en busca de una atención primaria y puesta en marcha de reactivación de funciones intelectuales.

Women in the climacteric stage or menopausal transition, frequently report complaint in memory. Emerald Study search relate feminine climacteric syndrome in their different steps: premenopause (stage -2 early menopausal transition), perimenopause (stages -1 and +1a late menopausal transition and early postmenopause) and postmenopause (stages +1b, +1 c and +2 early postmenopause with late postmenopause), with a possible mild cognitive impairment, that carry on suspect of Mild Neurocognitve Disorder (mNCD). The final sample were 100 women with high schooling level between 40 and 60 years old. A nonexperimental, non-probability cross-sectional study was conducted through the Montreal Cognitive Assessment (MoCA). Normative results were obtained in 43.27% and mNCD in 56.73%, finding difference of significant means at the 0.05 level in the three stages of climacteric, resulting in the highest incidence in perimenopause, stage of greatest decrease in estrogen. It is concluded that changes in intellectual function may be associated with hormonal variation. mNCD can be determined early, in search of primary care and start-up of reactivation of intellectual functions.

Critical review of axillary recurrence in early breast cancer.

Around 2% of early breast cancer cases treated with axillary lymph node dissection (ALND) underwent axillary recurrence (AR) and it has a deleterious effect in prognosis. Different scenarios have incorporated Sentinel Lymph Node (SLN) Biopsy (SLNB) instead of ALND as part of the standard treatment and more effective systemic treatment has also been incorporated in routine management after first curative surgery and after regional recurrence. However, there is concern about the effect of SLNB alone over AR risk and how to predict and treat AR. SLN biopsy (SLNB) has been largely accepted as a valid option for SLN-negative cases, and recent prospective studies have demonstrated that it is also safe for some SLN-positive cases and both scenarios carry low AR rates. Different studies have identified clinicopathological factors related to aggressiveness as well as high-risk molecular signatures can predict the development of locoregional recurrence. Other publications have evaluated factors affecting prognosis after AR and find that time between initial treatment and AR as well as tumor aggressive behavior influence patient survival. Retrospective and prospective studies indicate that treatment of AR should include local and systemic treatment for a limited time.

Síntomas psicológicos en la transición menopáusica / Psychological symptoms in the menopausal transition

RESUMEN OBJETIVO: Conocer los síntomas en la Transición Menopáusica, mediante el autoinforme de la mujer, clasificado en tres grupos: 1er. Temprana de la Transición Menopáusica (etapa −2), 2°. Tardía de la Transición Menopáusica y Temprana de Postmenopausia (etapas −1 y +1a) y 3er. grupo Temprana de Postmenopausia con Tardía de Postmenopausia (etapas +1b, +1c y +2), analizando síntomas psicológicos. MATERIAL Y MÉTODO: Estudio no experimental transversal muestreo no probabilístico. Participantes 116 mujeres en un rango de edad entre 40 y 60 años con alto nivel de escolaridad, mediante la Escala de Clasificación en la Menopausia MRS, el Inventario de Ansiedad y Depresión de Beck. RESULTADOS: La muestra quedó conformada por un total de 100 mujeres con al menos un síntoma, con alto nivel de escolaridad y en el rango de edad de 40 a 60 años, agrupadas por etapa de Transición Menopáusica: 1er. grupo 36 mujeres, 2°. grupo 16 y 3er. grupo con 48 personas. Los síntomas psicológicos medidos con MRS son los más frecuentes en 41.60%; reportan queja subjetiva de pérdida de memoria 57% de las mujeres. Alfa Cronbach de .74 en MRS. CONCLUSIONES: Los síntomas psicológicos están presentes como un continuo a lo largo de la Transición Menopáusica, posiblemente debidos a la disminución de concentración de estrógenos, lo que conlleva en algunos casos al diagnóstico de Trastorno Neurocognitivo Leve.

ABSTRACT OBJECTIVE: To know the symptoms in the Menopausal Transition, through the self-report of the women, classified into three groups: 1st. Early Menopausal Transition (stage −2), 2nd. Late Menopausal Transition and Early Postmenopause (stages −1 and +1a) and 3rd. group Early Postmenopause with Late Postmenopause (stages +1b, +1 c and +2), analyzing psycological symptoms. MATERIAL & METHOD: Non-experimental transversal study, non-probabilistic sampling. The participants were 116 women between 40 and 60 years old with high schooling level, through The Menopause Rating Scale MRS, Beck Anxiety Inventory and Depression Inventory. RESULTS: The final sample consisted of 100 women with at least one symptom, with a high schooling level in the range of 40 to 60 years, grouped by Menopausal Transition stage: 1st. 36 women, 2nd. Group 16 and 3rd. group with 48. The psycological symptoms measured with MRS were the most frequently in 41.60%; report subjective complaint of memory loss 57% of women. Alfa Cronbach of .74 in MRS. CONCLUSION: Psychological symptoms are present as a continuum throughout the Menopausal Transition, possibly due to the decreased concentration of estrogen, which in some cases leads the diagnosis of Mild Neurocognitive Disorder.

Clinicopathological predictors of long-term benefit in breast cancer treated with neoadjuvant chemotherapy.

AIM: To investigate the survival impact of clinicopathological factors, including pathological complete response (pCR) and tumor-infiltrating lymphocytes (sTIL) levels according to subtypes, in breast cancer (BC) patients who received neo-adjuvant chemotherapy (NAC). METHODS: We evaluated 435 BC patients who presented and received NAC at the Instituto Nacional de Enfermedades Neoplasicas from 2003 to 2014. sTIL was analyzed as the proportion of tumor stroma occupied by lymphocytes, and was prospectively evaluated on hematoxylin and eosin-stained sections of the preNAC core biopsy. pCR was considered in the absence of infiltrating cancer cells in primary tumor and axillary lymph nodes. Analysis of statistical association between clinical pathological features, sTIL, pCR and survival were carried out using SPSSvs19. RESULTS: Median age was 49 years (range 24-84 years) and the most frequent clinical stage was IIIB (58.3%). Luminal A, Luminal B, HER2-enriched and (triple-negative) TN phenotype was found in 24.6%, 37.9%, 17.7% and 19.8%, respectively. pCR was observed in 11% and median percentage of sTIL was 40% (2%-95%) in the whole population. pCR was associated to Ct1-2 (P = 0.045) and to high sTIL (P = 0.029) in the whole population. There was a slight trend towards significance for sTIL (P = 0.054) in Luminal A. sTIL was associated with grade III (P < 0.001), no-Luminal A subtype (P < 0.001), RE-negative (P < 0.001), PgR-negative (P < 0.001), HER2-positive (P = 0.002) and pCR (P = 0.029) in the whole population. Longer disease-free survival was associated with grade I-II (P = 0.006), cN0 (P < 0.001), clinical stage II (P = 0.004), ER-positive (P < 0.001), PgR-positive (P < 0.001), luminal A (P < 0.001) and pCR (P = 0.002). Longer disease-free survival was associated with grade I-II in Luminal A (P < 0.001), N0-1 in Luminal A (P = 0.045) and TNBC (P = 0.01), clinical stage II in Luminal A (P = 0.003) and TNBC (P = 0.038), and pCR in TNBC (P < 0.001). Longer overall survival was associated with grade I-II (P < 0.001), ER-positive (P < 0.001), PgR-positive (P < 0.001), Luminal A (P < 0.001), cN0 (P = 0.002) and pCR (P = 0.002) in the whole population. Overall survival was associated with clinical stage II (P = 0.017) in Luminal A, older age (P = 0.042) in Luminal B, and pCR in TNBC (P = 0.005). CONCLUSION: Predictive and prognostic values of clinicopathological features, like pCR and sTIL, differ depending on the evaluated molecular subtype.

Las Emociones en Niños con Síndrome de Asperger / Emotions on Asperger's Syndrome

Las peculiaridades que presentan las personas con Síndrome de Asperger (SA) han sugerido el abordaje del mismo desde distintas perspectivas, por un lado, aspectos epistemológicos y cognitivos, por otro lado, neurobiológicos que tratan de describir este padecimiento. Dentro de las peculiaridades que se han descrito se encuentran aspectos cognitivos como la memoria, visuoespacialidad, habilidades sociales y emociones. Las emociones son esenciales para el desarrollo de habilidades sociales y se han encontrado peculiaridades al respecto en las personas con SA. De esta manera, el objetivo es revisar los hallazgos existentes sobre el estudio de las emociones en personas con Síndrome de Asperger que, a su vez, permitirán desarrollar posibles niveles de abordaje en el área clínica

The peculiarities presented among the Asperger's Syndrome have suggested approaching it from different perspectives; including epistemological, cognitive and neurobiological, pretending to explain this impairment. Among these peculiarities that have been described are cognitive aspects such as memory, visuospatial skills, social skills, and emotions. The emotion domain is basic to develop social abilities, and there are peculiarities found in the Asperger Syndrome's patients respect to this matter. According to this, the aim of this paper is to review the current findings respect to the emotions in people with the Asperger's Syndrome, as this allows developing tentative approaching levels within the clinic context.