Effectiveness of Superior Hypogastric Plexus Neurolysis for Pelvic Cancer Pain.

BACKGROUND: The superior hypogastric plexus block has been indicated for visceral pelvic pain treatment associated with malignancy. The first international report of this technique was published by Plancarte et al, in which a posterior percutaneous approach guided by fluoroscopy was described by applying neurolytic agents. The considerable variability in the data reported gave rise to 2 clinical approaches to those who performed the blockade early and those who executed it at a later stage of cancer. OBJECTIVES: The present study aims to provide more evidence regarding the effectiveness of this procedure. STUDY DESIGN: This is a retrospective, longitudinal, descriptive study. SETTING: The study was held at the pain unit service of the National Cancer Institute, Mexico City. METHODS: A nonprobabilistic sample was selected; the data collection took place from January 2006 to December 2016 with patients diagnosed with pelvic pain, confirmed by imaging and biopsy studies. Patients who received any other type of intervention of the sympathetic axis, patients with a different approach than the classic or paravertebral technique, and patients with low survival rate were excluded. The Student t test was used to measure the significant difference between Visual Analog Scale (VAS) and morphine equivalent daily dose. The Cochran-Mantel-Haenszel test and the Gamma test were used to measure the association between the initial Karnofsky and blockade success. RESULTS: The study included a total of 180 patients. The success rate was 59.4% at 1 month, 55.5% at 3 months, and 48.8% at 6 months. There was a sustained and significant VAS reduction that was 49.55% at 3 months. A significant reduction in opioid consumption of 12.55% was found at 3 months. There was no significant statistical evidence related to either opioid consumption or the functionality of the patient before the blockade as an influential variable in the success of the procedure. LIMITATIONS: Retrospective study, developed in a single center. CONCLUSIONS: Although opioids remain the cornerstone of cancer pain treatment, they produce many deleterious side effects. The superior hypogastric plexus neurolysis represents a reproducible and effective alternative in the management of pain in this group of patients. KEY WORDS: Pelvic pain, neoplasms, chemical neurolysis, pain management, cancer pain, palliative care, analgesia, nerve block.

Risk of New Fractures in Vertebroplasty for Multiple Myeloma. A Retrospective Study.

OBJECTIVE: Vertebroplasty is a percutaneous minimally invasive procedure indicated for vertebral collapse pain treatment. Among the known complications of the procedure is the augmented risk of new vertebral fractures. There are no specific studies in this patient population describing the risk of new vertebral fractures after vertebroplasty. This study analyzed risk factors associated with new vertebral fractures after vertebroplasty in patients with multiple myeloma. METHODS: Observational retrospective study in patients with multiple myeloma. The data collection took place from January 1, 2010, to December 30, 2017, at the National Cancer Institute. Clinical data and procedural variables such as cement volume, cement leaks, fracture level, number of treated vertebrae, pedicular disease, and cement distribution pattern, with two years follow-up, were analyzed with the Wilcoxon test, and a logistic regression model was used to identify risk factors related to new vertebral fractures. A confidence interval of 95% was used for analysis. RESULTS: At one-year follow-up, 30% of fractures were reported after vertebroplasty, most of them at low thoracic and lumbar level (50% adjacent level). Vertebroplasty was most commonly performed at the thoracolumbar and lumbar area. We demonstrated a 70.7% median numerical rating scale reduction at one-year follow-up; a significant decrease in opioid consumption occurred only during the first month. CONCLUSIONS: Pedicle involvement, disc leakage, cement volume, thoracolumbar and lumbar level, and number of treated vertebrae by intervention are important risk factors when performing vertebroplasty. Prospective randomized studies are needed to evaluate these factors in this specific population.

Body image of people over 50 in Spain measured using the BSQ test.

OBJECTIVES: To show the body image of people over 50 in Spain using the Body Shape Questionnaire test (BSQ), taking into account attribute variables of great interest such as age, gender, sentimental status, habitat (rural or urban) and the season of the year in which the test is done (winter or summer). DATA DESCRIPTION: The results obtained show the current state of the body image of 176 people in the process of ageing in Spain. The data collected from the participants are organised taking into account attribute variables of significant impact on body image such as age, gender, having a stable partner, habitat (rural or urban) and the season of the year in which the test is done (winter or summer). These data are especially useful to show how body image changes over the time, depending on the different attributes and according to diverse emotional and social situations. They can be used in studies on body image, eating disorders or studies that assess the importance of physical appearance in someone's self-esteem regardless of age group, geographic area or personal emotional circumstances.

Calidad percibida sobre la atención de enfermería en el servicio de Cardiología de la UMAE-Mérida / Perceived quality of nursing attention in a Cardiology Service from UMAE-Mérida

Introducción: La calidad en la atención de los pacientes es un requisito fundamental en los sistemas de salud encargados de otorgar seguridad a sus usuarios. Objetivo: Determinar el nivel de la calidad percibida en la atención de Enfermería por los pacientes del servicio de Cardiología en el Hospital de Especialidades del CMN "Ignacio García Téllez". Metodología: Estudio descriptivo y transversal. Con una muestra de 60 pacientes hospitalizados de la especialidad de Cardiología en quienes se evaluó la percepción de la calidad de atención de enfermería con el cuestionario SERVQHOS-E, previo consentimiento informado. El análisis se llevó a cabo con estadística descriptiva. Resultados: La percepción de la calidad de la atención de enfermería fue satisfactoria, el 85% de los pacientes indicó que fue Mejor y Mucho mejor de lo que esperaba. Las propuestas de los pacientes para mejorar la calidad de atención, fueron: completar la plantilla de enfermería por turno, mejorar la comunicación enfermera-paciente y mejorar las condiciones físicas del servicio. Conclusiones: Más de la mitad de los pacientes percibe la calidad de la atención de enfermería como Mucho mejor de lo que esperaba, la dimensión mejor evaluada fue el trato personalizado que otorga el personal de enfermería.

Introduction: The quality of patient care ¡s a fundamental requirement ¡n health systems aimed at providing safety to users. Objective: To determine the level of perceived quality of nursing care by the patients of the cardiology Service in a Specialty Hospital. Methods: Descriptive and transversal study. With a sample of 60 hospitalized patients in the specialty of Cardiology in whom the perception of the quality of nursing care was evaluated with the SERVQHOS-E questionnaire, with prior informed consent. The analysis was performed with descriptive statistics. Results: The perception of the quality of the nursing care was satisfactory, 85% of the patients indicated that it was: Better and Much better than expected. The proposaIs of the patients to improve the quality of care were: Complete the nursing staff in turn, improve the Nurse-patient communication and improve the physical conditions of the Service. Conclusions: More than half of patients perceive the quality of nursing care as Much better than expected, the best evaluated dimensión was the personalized treatment provided by the nursing staff.

[Disparities in mental health associated with sexual orientation among Mexican adolescents]. / Disparidades en salud mental asociadas a la orientación sexual en adolescentes mexicanos.

The aim of this study was to document disparities in mental health related to discrimination based on sexual orientation in Mexican adolescents. A representative national sample of secondary school students was analyzed. Criteria for homosexual orientation were having had a same-sex boyfriend or girlfriend and having had same-sex sexual relations. The events were: depression, low self-esteem, suicidal ideation, attempted suicide, smoking, alcohol abuse, and drug use. Teenagers with same-sex relationships or sexual relations had an increased risk of depressive symptoms, suicidal ideation, attempted suicide, and alcohol abuse. These differences were particularly related to having experienced violence in the family and in school. Despite institutional and legal progress in acknowledging the rights of the lesbian, bisexual, and gay population, health inequities persist due to discrimination based on sexual orientation.

Disparidades en salud mental asociadas a la orientación sexual en adolescentes mexicanos / Disparities in mental health associated with sexual orientation among Mexican adolescents / Desigualdades em saúde mental associada com a orientação sexual em adolescentes mexicanos

El objetivo de este estudio fue documentar las disparidades en salud mental relacionadas con la discriminación por orientación sexual en adolescentes de México. Se estudió una muestra nacional representativa de estudiantes de bachillerato. Se usaron dos indicadores de orientación homosexual: haber tenido un novio del mismo sexo y haber tenido relaciones sexuales con alguien del mismo sexo. Los eventos fueron: depresión, autoestima, ideación suicida e intento de suicidio y consumo de cigarros, alcohol y otras drogas. Los adolescentes que habían tenido noviazgos o relaciones sexuales con personas de su mismo sexo tuvieron un riesgo incrementando de síntomas depresivos, ideación e intento de suicidio y consumo problemático de alcohol. Estas diferencias sobre todo se relacionaron con la experiencia de violencia en la familia y la escuela. A pesar de los avances institucionales y legales para el reconocimiento de los derechos de la población lésbica, bisexual y homosexual, persisten inequidades en salud relacionadas con la discriminación por orientación sexual.

The aim of this study was to document disparities in mental health related to discrimination based on sexual orientation in Mexican adolescents. A representative national sample of secondary school students was analyzed. Criteria for homosexual orientation were having had a same-sex boyfriend or girlfriend and having had same-sex sexual relations. The events were: depression, low self-esteem, suicidal ideation, attempted suicide, smoking, alcohol abuse, and drug use. Teenagers with same-sex relationships or sexual relations had an increased risk of depressive symptoms, suicidal ideation, attempted suicide, and alcohol abuse. These differences were particularly related to having experienced violence in the family and in school. Despite institutional and legal progress in acknowledging the rights of the lesbian, bisexual, and gay population, health inequities persist due to discrimination based on sexual orientation.

O objetivo deste estudo foi avaliar disparidades em saúde mental relacionadas com a discriminação baseada na orientação sexual em adolescentes do México. Estudou-se uma amostra nacional e representativa dos alunos do ensino médio. Foram utilizados dois indicadores de orientação homossexual: ter um namorado do mesmo sexo e tendo relações sexuais com alguém do mesmo sexo. Os eventos foram: depressão, autoestima, ideação suicida, e tentativa de suicídio e consumo de cigarros, álcool e outras drogas. Adolescentes que tinham compromissos ou relações sexuais com pessoas do mesmo sexo tiveram risco aumentado de sintomas depressivos, ideação suicida, tentativa de suicídio e consumo problemático de álcool. Essas diferenças foram relacionadas com a experiência da violência na família e na escola. Apesar dos desenvolvimentos institucionais e legais para o reconhecimento dos direitos da população lésbica, bissexual e homossexual, persistem desigualdades na saúde relacionadas com a discriminação por orientação sexual.

Establishing the need for family medicine training in intimate partner violence screening.

In 2012, the USPSTF updated its guidelines and now recommends that all women of childbearing age be screened for IPV and services provided for women who screen positive. Based on these recommendations, objectives of this study were to (1) evaluate IPV knowledge, attitudes, and practices of physicians from different specialties and (2) determine significant differences by medical specialty. We recruited (n = 183) Internal Medicine, Emergency Medicine, Family Medicine (FM) and Obstetrics/Gynecology (OB/GYN) residents and attending physicians to complete a 15-question online survey assessing knowledge, attitudes and current IPV screening practices. We evaluated associations between medical specialty and knowledge, attitudes and practice measures before and after controlling for covariates. Knowledge of how often IPV occurs in society, community resources, and screening tools were significantly different by specialty (all p's < 0.05). A majority of FM physicians (88%) reported that it is a physician's responsibility to find and treat IPV and 97% reported that IPV should be included in their training. Compared to OB/GYN physicians in multivariate analyses, FM physicians were less likely to report they were comfortable discussing IPV with their patients in crude (OR = 0.35; 95% CI = 0.13, 0.94) and adjusted models (OR = 0.20; 95% CI = 0.06, 0.60). FM physicians were also less likely to report screening female patients for IPV before (OR = 0.25; 95% CI = 0.08, 0.86) and after adjusting for confounders (OR = 0.11; 95% CI = 0.03, 0.47). Our results indicate that FM physicians have positive attitudes towards finding and treating IPV yet need enhanced training to improve their comfort level with screening for and discussing IPV with their patients.

[Food availability according to food security-insecurity among Mexican households]. / Disponibilidad de alimentos en los hogares mexicanos de acuerdo con el grado de inseguridad alimentaria.

OBJECTIVE: To know the differences in food availability according to food insecurity level among the Mexican households. MATERIALS AND METHODS: We analyzed the database of the National Survey of Household's Incomes and Expenditures (n=27 445 households). Households were classified according to the Latin American and Caribbean Inventory of Food Security. The availability of each food group was estimated as grams per day per equivalent adult. RESULTS: 50.0% of Mexican households experienced some degree of food insecurity. Among households with food insecurity there was high availability of corn, wheat, egg, and sugars; but there was low availability of fresh fruits and vegetables, lean meat, poultry, seafood, milk, cheeses, and sweetened beverages. CONCLUSION: Although in households with food insecurity there is lower availability of most food groups (both with high nutrient density and with high energy density); they have higher availability of cheap foods, which in some cases are only source of energy but do not provide nutrients.

Disponibilidad de alimentos en los hogares mexicanos de acuerdo con el grado de inseguridad alimentaria / Food availability according to food security-insecurity among Mexican households

Objetivo. Analizar las diferencias en la disponibilidad de alimentos en los hogares mexicanos de acuerdo con el grado de inseguridad alimentaria (IA). Material y métodos. Análisis de la Encuesta Nacional de Ingresos y Gastos de los Hogares del año 2010 (n= 27 445 hogares). Los hogares fueron clasificados según la Escala Latinoamericana y Caribeña de Seguridad Alimentaria. La disponibilidad de alimentos se estimó como gramos al día por adulto equivalente. Resultados. En los hogares inseguros existió mayor disponibilidad de maíz, trigo, huevo y azúcares, pero fue menor la disponibilidad de frutas y verduras frescas, carnes magras, pollo, pescados y mariscos, leche, quesos y bebidas azucaradas. Conclusión. Aunque los hogares con IA tienen menor disponibilidad de la mayoría de los grupos de alimentos (tanto de los que tienen alta densidad nutrimental como de los que tienen alta densidad energética), en ellos existe mayor disponibilidad de alimentos que son de bajo costo y que en algunos casos sólo son fuente de energía pero no proporcionan micronutrimentos.

Objective. To know the differences in food availability according to food insecurity level among the Mexican households. Materials and methods. We analyzed the database of the National Survey of Household's Incomes and Expenditures (n=27 445 households). Households were classified according to the Latin American and Caribbean Inventory of Food Security. The availability of each food group was estimated as grams per day per equivalent adult. Results. 50.0% of Mexican households experienced some degree of food insecurity. Among households with food insecurity there was high availability of corn, wheat, egg, and sugars; but there was low availability of fresh fruits and vegetables, lean meat, poultry, seafood, milk, cheeses, and sweetened beverages. Conclusion. Although in households with food insecurity there is lower availability of most food groups (both with high nutrient density and with high energy density); they have higher availability of cheap foods, which in some cases are only source of energy but do not provide nutrients.