Evaluación de los comedores comunitarios en Tizimín, Yucatán, México: percepciones y propuestas del personal y beneficiarios / Assessment of the communitarian dining facilities in Tizimin, Yucatán, México: staff and beneficiaries perceptions and proposals

Objetivo: Evaluar las instalaciones y servicios en los comedores comunitarios e identificar percepciones y propuestas del personal y beneficiarios respecto al programa, en Tizimín, Yucatán, México. Métodos: Enfoque mixto para datos cuantitativos, se utilizaron instrumentos que evalúan condiciones e higiene, participaron 41 cocineras y 177 beneficiarios; para datos cualitativos, guía de entrevista semiestructurada, participaron 15 cocineras y 12 beneficiarios. Para el análisis cuantitativo se utilizó el paquete estadístico SPSS® versión 19 y el programa Excel® versión 2007; para el análisis cualitativo el sistema de categorización de datos. Resultados: Las condiciones de higiene e infraestructura no son adecuadas, las dietas no cubren las calorías para cada grupo de edad; resultados cualitativos: los menús contienen alimentos saludables pero la cantidad no es la ideal, para las cocineras y beneficiarios el programa es bueno, pero sugieren mejoras en las instalaciones y los materiales. Conclusiones: Los resultados cuantitativos y cualitativos concuerdan, se sugiere mejorar los espacios para cumplir con las normas básicas de funcionamiento.

Objective: To assess installations and services in the communitarian dining facilities, and identify staff and beneficiaries perceptions and proposals regarding the Tizimín program, Yucatán, México. Methods: Mixed focus; for quantitative data the hygiene and instruments conditions were used with the participation of 41 cooks and 177 beneficiaries; while for qualitative data, a semi-structured interview was used with 15 cooks and 12 beneficiaries. For qualitative analysis, the SPSS® version 19 and Excel® version 2007 software programs were used; while for qualitative analysis, the data categorization system was used. Quantitative results: hygiene conditions and infrastructure are not adequate; diets do not cover the required calories for each age group. Results: Menus contain healthy meals but the amounts are not ideal. Cooks and beneficiaries consider that the program is good, but suggest improvements in the installations and materials. Conclusions: Both quantitative and qualitative results are in agreement. Improve the spaces is suggested in order to fulfill the basic functioning Norms.

An implantable drug delivery system (IDDS) for refractory cancer pain provides sustained pain control, less drug-related toxicity, and possibly better survival compared with comprehensive medical management (CMM).

BACKGROUND: The randomized clinical trial of implantable drug delivery systems (IDDS) plus comprehensive medical management (CMM) versus CMM alone showed better clinical success at 4 weeks for IDDS patients. This 'as treated' analysis assessed if improvements in pain control, drug toxicity and survival were maintained over time. PATIENTS AND METHODS: We compared those who received IDDS with those who did not receive IDDS (non-IDDS). All patients had Visual Analogue Scores (VAS) for pain > or =5/10 on at least 200 mg morphine or equivalent daily. RESULTS: At 4 weeks, 46 of 52 (88.5%) IDDS patients achieved clinical success compared with 65 of 91 (71.4%; P=0.02) non-IDDS patients, and more often achieved > or =20% reduction in both pain VAS and toxicity [35 of 52 (67.3%) versus 33 of 91 patients (36.3%); P=0.0003]. By 12 weeks, 47 of 57 (82.5%) IDDS patients had clinical success compared with 35 of 45 (77.8%; P=0.55) non-IDDS patients, and more often had a > or =20% reduction in both pain VAS and toxicity [33 of 57 (57.9%) versus 15 of 45 patients (33.3%); P=0.01]. At 12 weeks the IDDS VAS pain scores decreased from 7.81 to 3.89 (47% reduction) compared with 7.21 to 4.53 for non-IDDS patients (42% reduction; P=0.23). The 12 week drug toxicity scores for IDDS patients decreased from 6.68 to 2.30 (66% reduction), and for non-IDDS patients from 6.73 to 4.13 (37% reduction; P=0.01). All individual drug toxicities improved with IDDS at both 4 and 12 weeks. At 6 months, only 32% of the group randomized to CMM and who did not cross over to IDDS were alive, compared with 52%-59% for patients in those groups who received IDDS. CONCLUSIONS: IDDS improved clinical success, reduced pain scores, relieved most toxicity of pain control drugs, and was associated with increased survival for the duration of this 6 month trial.

Sexual functioning after treatment for testicular cancer--review and meta-analysis of 36 empirical studies between 1975-2000.

Literature concerning sexual functioning after treatment for testicular cancer from 1975-2000 is reviewed. After a literature search in Medline and Psylit was conducted, as well as a search for cross-references made, a meta-analysis was performed. To describe sexual functioning, several aspects of the sexual response cycle were used: sexual desire, sexual arousal, erection, and orgasm; ejaculatory function, sexual activity, and sexual satisfaction were used as well. The number of patients included in the studies as well as treatment modalities were taken into account. A total of 36 relevant studies was screened (28 retrospective and 7 prospective studies), concerning 2,786 cases of testicular cancer. Meta-analysis revealed that ejaculatory dysfunction was reported most frequently and was related to surgery in the retroperitoneal area. Erectile dysfunction was related to irradiation, but was reported least frequently. Other sexual functions were not related to treatment modality. Meta-analysis revealed no deterioration of sexual functioning in the course of time, except a decrease in sexual desire and an increase in sexual satisfaction. Retrospective studies reported more sexual dysfunction than did prospective studies. Detailed analysis of separate studies, however, revealed a wide variation in reported sexual morbidity, as well as in assessment methods. Somatic consequences of disease and treatment may reduce ejaculation; however, other aspects of sexual functioning are not clearly related to disease- or treatment-related factors and may instead refer to a psychological vulnerability caused by one's confrontation with a life-threatening, genito-urinary disease, such as testicular cancer.

Polyunsaturated fatty acids enhance the heat induced stress response in rainbow trout (Oncorhynchus mykiss) leukocytes.

The heat shock response has been studied extensively, yet the molecular signals that trigger the response remain elusive. The dogma of the heat shock response contends that denatured proteins initiate the response, but evidence is accumulating to point to a more complex system in which at least more than one signal is involved in this process. Thermal stress initiates changes in cellular phospholipid membrane physical state, which when acted upon by phospholipases may release lipid mediators that could serve as triggering signals during the heat shock response. We have examined the heat shock response in freshly isolated leukocytes from the pronephros of rainbow trout (Oncorhynchus mykiss). In this study, we show that leukocytes isolated from rainbow trout acclimated to 5 or 19 degrees C express elevated levels of heat shock protein 70 (hsp70) mRNA when heat shocked at 5 degrees C above their respective acclimation temperature and supplementation with exogenous docosahexaenoic acid or arachidonic acid followed by heat shock enhanced levels of hsp70 mRNA. The time course for docosahexaenoic acid induced enhancement of hsp70 mRNA was accelerated compared with heat shock alone, and staurosporine inhibited the docosahexaenoic acid induced increase of hsp70 mRNA. We also provide evidence that phospholipase A2 is involved in the heat shock response.

A comparison of the influence of conflictual and supportive social interactions on psychological distress.

Following a quantitative review examining the relative influence of positive and negative social exchanges on emotional health, a second-order factor model of negative social exchange was tested and supported in a sample of 906 college students. Structural equation analysis exploring the unique effects of negative social exchange and perceived support satisfaction on depression revealed both variables to predict this outcome, over and above the contribution of personality and coping variables. In addition to the direct effects of the Big Five personality dimensions on depression, indirect effects of the Big Five via negative social exchange, support satisfaction, and avoidant coping also were observed. Although the prevailing belief among support researchers is that the negative effects of conflictual social interactions outweigh the positive effects of social support, the results of the quantitative review suggest boundary conditions that qualify this conclusion. In addition to corroborating a hierarchical measurement model of negative social exchange, the results of the present investigation suggest that how social support and social negativity are measured substantially influences conclusions concerning their relative impact on psychological distress.

Subcellular localization of enzyme activities involved in the metabolism of platelet-activating factor in rainbow trout leukocytes.

The subcellular distribution of an alkyllyso-GPC: acetyl-CoA acetyltransferase (EC 2.3.1.67) and transacylase, two important enzyme activities involved in the remodeling pathway for the biosynthesis of platelet-activating factor (1-O-alkyl-2-acetyl-sn-glycero-3-phosphocholine, PAF) have been examined in leukocytes isolated from the pronephros of the rainbow trout, Oncorhynchus mykiss. Contrary to mammalian systems, in which the acetyltransferase is localized to intracellular membranes, the subcellular distribution of an acetyltransferase activity in rainbow trout leukocytes was localized to the plasma membrane. Analysis of the acetyltransferase products by thin-layer chromatography (TLC) and high performance liquid chromatography (HPLC) confirmed synthesis of two subclasses of PAF, 1-O-alkyl-2-acetyl-sn-glycero-3-phosphocholine and 1-acyl-2-acetyl-sn-glycero-3-phosphocholine. The transacylase activity in this study was detected in membrane fractions in two domains of the intermediate density region which also contained the NADH dehydrogenase activity, a marker enzyme for the endoplasmic reticulum. Acylation of lysoPAF (1-O-alkyl-2-lyso-sn-glycero-3-phosphocholine) exhibited approximately 95% specificity for omega-3 fatty acids. Acylation patterns were not significantly different in either domain of the endoplasmic reticulum. A model is proposed herein for the metabolism of PAF in rainbow trout leukocytes.

The self-esteem motive in social influence: agreement with valued majorities and disagreement with derogated minorities.

This research provides evidence for the role of self-esteem in social influence; it demonstrates that the positions taken by self-relevant social groups can threaten people's self-esteem. Participants who wished to align themselves with a majority group and who learned that the group held a counterattitudinal position suffered a reduction in self-esteem. Similarly, participants who wished to differentiate themselves from a derogated minority group and who learned that the group held attitudes similar to theirs experienced reduced self-esteem. Group attitudes, however, did not affect the self-esteem of participants who were indifferent to the group. In addition, this study demonstrates that self-relevant motivations direct the way people process influence appeals. Participants adopted interpretations of the issues that allowed them to align themselves with valued majorities and differentiate themselves from derogated minorities.

Dietary iron elevates LDL-cholesterol and decreases plasma antioxidant levels: influence of antioxidants.

High body iron and LDL-cholesterol concentrations, and antioxidant deficiency, are regarded as risk factors for ischemic heart disease. Iron is well known for causing oxidative damage and antioxidants for their beneficial effects on radical scavenging. It is, however, unknown whether or not dietary iron causes depletion of plasma antioxidants; causes lipid peroxidation; alters HDL- and LDL-cholesterol, and triglyceride concentrations. Rats received diets differing only in iron concentration--15 mg/Kg, 35 mg/Kg, 150 mg/Kg or 300 mg/Kg diet. The second group of rats received antioxidants (alpha-tocopherol and beta-carotene) in their drinking water. Increasing dietary iron increased plasma lipid hydroperoxide and LDL-cholesterol concentrations, but did not affect HDL-cholesterol or triglyceride concentrations. It decreased antioxidants, alpha-tocopherol and retinol. Antioxidant supplementation inhibited the above changes.

Dietary iron concentration alters LDL oxidatively. The effect of antioxidants.

Low-density lipoprotein (LDL) cholesterol participates in the atherosclerotic process only after oxidative modification (o-LDL). Persons with elevated body iron concentrations are at higher risk of atherosclerosis. Iron in vitro is capable of oxidizing LDL, but it is unknown whether or not high dietary iron concentrations alter LDL in vivo. The aim of this study was, therefore, to investigate (i) whether dietary iron concentrations cause LDL-cholesterol oxidation and (ii) whether antioxidants can prevent such changes. Rats received diets differing only in iron concentration: 35 mg/kg, 150 mg/kg or 300 mg/kg diet. A LDL-VLDL particle was isolated and the following parameters measured: malondialdehyde and lipid hydroperoxide concentrations (as an indication for lipid peroxidation); alpha-tocopherol and retinol concentrations (as antioxidants); protein sulfhydryl and carbonyl concentrations (as an indication of protein modification); agarose gel electrophoresis and cholesterol/protein ratio. Dietary iron increased LDL-VLDL lipid peroxidation (malondialdehyde and lipid hydroperoxide concentrations), protein modification (sulfhydryl concentration), agarose migration distance and band width as well as cholesterol/protein ratio. Increased quantities of dietary iron led to a higher degree of oxidative change in LDL-VLDL. Lipid peroxidation, as well as protein modification, occurred, suggesting apoB changes. This was probably due to diminished antioxidant concentrations of alpha-tocopherol and beta-carotene. Antioxidant supplementation (alpha-tocopherol and beta-carotene), however, prevented all the above changes and could be helpful in the prevention of atherosclerosis.

Sexual functioning after multimodality treatment for disseminated nonseminomatous testicular germ cell tumor.

PURPOSE: We determined sexual functioning after chemotherapy for disseminated nonseminomatous testicular germ cell tumor, and evaluated the impact of resection of post-chemotherapy residual retroperitoneal tumor. MATERIALS AND METHODS: A total of 155 consecutive patients treated with chemotherapy for disseminated nonseminomatous testicular germ cell tumor (between 1980 and 1994) was questioned about their sexual functioning. The patients were divided in 2 subgroups: patients treated with or without resection of post-chemotherapy residual retroperitoneal tumor. Volume and location (divided into left para-aortal or right paracaval/interaortacaval) of the resected tumor were related to absence of ejaculation as well as decreased semen amount. In addition, libido, arousal, erection and orgasm were related to ejaculatory dysfunction. RESULTS: A total of 43 patients (27.7%) was treated with chemotherapy only and 112 (72.3%) had additional resection of post-chemotherapy residual retroperitoneal tumor mass. Overall, 22.4% reported loss of libido, 14.1% decreased arousal, 16% erectile dysfunction, 23.1% decreased orgasmic intensity, 17.4% decreased semen amount and 18.7% complete absence of antegrade ejaculation. With exception of absence of ejaculation, sexual dysfunctions were reported in similar frequencies in both treatment subgroups. In the resection of post-chemotherapy residual retroperitoneal tumor subgroup, 25.9% of the patients had complete absence of ejaculation. The other sexual dysfunctions were related neither to decreased semen amount nor to complete absence of ejaculation. The mean volume of resected tumor was higher (95 cm.3) in patients with absence of ejaculation than in those without (40 cm.3), and patients with right paracaval/interaortacaval tumor (20 of 58, 34.5%) reported more often absence of ejaculation than those with left para-aortal tumor (9 of 54, 16.7%). CONCLUSIONS: In patients treated for disseminated nonseminomatous testicular germ cell tumor, post-chemotherapy sexual morbidity cannot be neglected. Except for loss of antegrade ejaculation, sexual dysfunctions are not related to resection of post-chemotherapy residual retroperitoneal mass. A high volume of tumor and a right paracaval/interaortacaval location predispose to loss of antegrade ejaculation.

Sexual functioning after treatment for testicular cancer: comparison of treatment modalities.

BACKGROUND: This retrospective study evaluates changes in sexual functioning after treatment for testicular cancer and investigates whether there is a relationship with different treatment modalities. METHODS: A self-reported questionnaire was sent to 337 men who had been treated for testicular cancer at the University Hospital Groningen between 1977 and 1994. Medical information was obtained from the patient records. RESULTS: A response was received from 287 men (85%); 264 patients were included in this study (78%). The mean patient age at follow-up was 37.7 years (range, 17-71 years). The mean follow-up period was 6.7 years (range, 0.25-18 years). Decrease in sexual functions was reported by 40% of patients (decrease in libido: 19%; arousal: 12% erection: 12.5%; orgasm: 19%; and ejaculation: 26%). Moreover, 23.5% of patients responding reported decreased sexual activity and 12.5% were dissatisfied with their sexual functioning. Patients with Stage II-IV nonseminoma who had been treated with polychemotherapy (PCT) with or without resection of residual retroperitoneal tumor mass (RRRTM) (PCT +/- RRRTM) reported a significantly sharper decrease in sexual functioning than patients who had been followed with a wait-and-see policy (W & S) (Stage I nonseminoma patients). It was noteworthy that patients treated by PCT alone reported more sharply decreased sexual functioning than patients treated by PCT + RRRTM. Patients treated by radiotherapy (Stage I-IIA seminoma) did not report findings significantly different from the W & S group. CONCLUSIONS: Testicular cancer patients are at risk for reduced sexual functioning, especially when treated by chemotherapy, with or without resection of residual tumor. Although chemotherapy may influence somatic aspects of sexual functioning, it appears that psychologic factors arising from the confrontation with testicular cancer play a strongly mediating (if not determining) role.

Sexual dysfunction in nonseminoma testicular cancer patients is related to chemotherapy-induced angiopathy.

PURPOSE: To establish the prevalence of sexual dysfunctions after different treatment modalities for nonseminomatous testicular germ cell tumor (NSTGCT) and to investigate whether treatment-induced angiopathy and neuropathy is related to sexual dysfunction. PATIENTS AND METHODS: A questionnaire assessing sexual dysfunction was sent to 255 NSTGCT survivors. Polychemotherapy (PCT) regimens (cisplatin, vinblastine, and bleomycin [PVB], vinblastine substituted by etoposide [BEP], or cisplatin substituted by carboplatin [CEB], etoposide combined with cisplatin [EP], or with ifosfamide and cisplatin [VIP] were compared regarding treatment-induced angiopathy and neuropathy. Sexual dysfunctions were related to Raynaud's phenomenon and acral paresthesia. RESULTS: Among the 215 responders, 56 (26%) had been treated by orchidectomy and surveillance, 42 (19.6%) by PCT, and 117 (54.4%) by PCT and resection of residual retroperitoneal tumor mass (RRRTM). Overall, loss of libido was reported by 19.1%, decreased arousal by 11.2%, erectile dysfunction by 12.1%, decreased intensity of orgasm by 20%, and ejaculatory problems by 28%. Patients treated with PVB suffered more often from Raynaud's phenomenon compared with those treated with other regimens (40.4% v 29%; P < .05) and from paresthesia (31.6% v 14.7%; P < .05). Patients with Raynaud's phenomenon had more often erectile dysfunction (28.8%) compared with those without (8.4%) (P < .05). CONCLUSION: Compared with orchidectomy alone, PCT, with or without RRRTM, induced more often posttreatment sexual dysfunction. Compared with other chemotherapeutic regimens, signs of angiopathy and neuropathy were most prevalent in those treated with PVB. Erectile dysfunction was related to the chemotherapy-induced Raynaud's phenomenon but not to acral paresthesia.

Sexual functioning in testosterone-supplemented patients treated for bilateral testicular cancer.

OBJECTIVE: To determine the effects of intramuscular injections with testosterone (Sustanon) on sex-hormone levels, sexual functioning and general well-being in patients treated with orchidectomy for bilateral testicular cancer. PATIENTS AND METHODS: The study comprised seven men (median age 38 years, range 25-46) who had undergone orchidectomy for bilateral testicular cancer. Patients received intramuscular injections with testosterone every 3 weeks and blood samples for hormone analysis were collected from each patient at three times: one day after testosterone injection (t1), halfway between subsequent injections (t2) and just before injection (t3). Plasma hormone levels were then related to sexual function, as assessed by self-reported data on sexuality and general well-being, measurements of nocturnal penile tumescence and rigidity (NPTR) and erectile function elicited by visual erotic stimulation (VES), determined at t1, t2 and t3. RESULTS: During the 3-week interval between injections, there was a sixfold decrease in plasma testosterone level (mean testosterone 35.8, SD 7.8, and 6.0, SD 2.5 nmol/L, at t1 and t3, respectively). At t1, five of the men had a plasma testosterone level above the upper normal limit (> 35 nmol/L) and at t2 and t3, testosterone levels were below the reference range (< 10 nmol/L) in three and six men, respectively. Oestradiol (E2) levels showed the same pattern: at t1 the mean (SD) E2 level was 0.17 (0.07) nmol/L and at t3 0.07 (0.01) nmol/L. In contrast to follicle-stimulating hormone, luteinizing hormone (LH) mirrored the decline in plasma testosterone after injection, with the lowest levels at t1 and the highest at t3. Other hormone levels remained unchanged. Three patients reported loss of libido, decreased arousal, erectile dysfunction, fatigue and mood depression. However, neither the arousal nor the erectile problems could be verified by VES. There was no relationship between plasma testosterone levels, the reported sexual dysfunctions and the results of NPTR and VES measurements. Although unrelated to a specific testosterone level, three patients reported increased irritability, excessive sweating, hot flushes and heat intolerance at the end of the injection interval. These adverse effects of declining plasma testosterone were related to loss of libido and other sexual problems. CONCLUSION: In most patients castrated for bilateral testicular cancer and receiving intramuscular injections with testosterone, plasma testosterone levels were outside the normal range. After injection, there was a rapid decline of plasma testosterone to levels below the lower normal limit. With the exception of oestradiol, sex-hormone levels were not correlated to testosterone levels. Sexual functioning was not affected by the fluctuations of plasma testosterone level. However, at the end of the injection interval, adverse psychological and physical effects had a significant impact on libido and arousal.

Influence of ferritin levels on LDL cholesterol concentration in women.

Various researchers have observed a higher risk for atherosclerosis when body iron concentration is elevated. The exact mechanism, however, is not known, but probably occurs catalytically via iron. Whether or not body iron concentration has an effect on plasma lipoproteins is also unknown. The aim of this study was to investigate whether or not ferritin concentration within the normal range correlate with LDL-cholesterol (an atherosclerotic risk factor), HDL-cholesterol, apoB, triglyceride and the mobility of LDL particles. Blood was drawn from healthy female volunteers and the above parameters measured. LDL-cholesterol, apoB and the electrophoretic mobility of LDL particles were elevated with increasing ferritin concentrations. Both modified or oxidized LDL and elevated LDL concentration are regarded as risks for atherosclerosis and ischemic heart disease, suggesting that higher body iron is important in this process.

Self-definition, defensive processing, and influence: the normative impact of majority and minority groups.

Past research has found that recipients agree with majority group positions and resist minority group positions on direct measures of influence. The authors suggest that these attitude shifts reflect normative pressures to align with valued majorities and to differentiate from derogated minorities. In support of this idea, participants who considered a majority group relevant to their own self-definitions (but not those who judged it irrelevant), on learning that the group held a counterattitudinal position, shifted their attitudes to agree with the source. In a second study, recipients who judged a minority group (negatively) self-relevant, on learning that the group held a similar attitude to their own, shifted their attitudes to diverge from the source. These shifts in attitudes were based on participants' interpretations of the attitude issues.

Detection of enterotoxigenic Escherichia coli in stool samples by using nonradioactively labeled oligonucleotide DNA probes and PCR.

The detection of heat-labile enterotoxin LT-A and heat-stable enterotoxin ST Ia and ST Ib genes from enterotoxigenic Escherichia coli (ETEC) by using oligonucleotide DNA probes and the PCR was evaluated in reconstruction experiments and by testing stool specimens from 29 healthy subjects and from 50 patients with diarrhea who had returned from the (sub)tropics. ETEC strains were detected in concentrations ranging from 10(6) to 10(8) CFU/g of feces when oligonucleotide probes were applied to colony blots from five randomly picked E. coli-like colonies from CLED (cystine lactose electrolyte deficient) agar plates inoculated with the feces. When these probes were applied to blots from whole stool cultures collected from the agar plates (sweep blot), the detection limit was 10(6) CFU/g of feces. PCR of the sweep material could detect toxin genes when the concentration of ETEC strains was 10(2) CFU/g of feces. Results obtained with stool specimens from 29 healthy control subjects were negative. Testing stool specimens from 50 patients confirmed the observation that the number of samples containing ETEC enterotoxin genes was higher when PCR of sweeps was used than when oligonucleotide DNA probe hybridization of either sweep blots or colony blots was used. Furthermore, PCR of sweeps is an easy and rapid method which does not require DNA extraction and purification from fecal specimens.