Evaluation of health status of transgender sex workers in Turkey: A qualitative study.

OBJECTIVE: Sex workers can be disadvantaged in terms of overall health due to challenging living and working conditions. This research aimed to evaluate the health status and experiences related to sexually transmitted infections (STDs) of unregistered transgender sex workers in Turkey. DESIGN: It employed a phenomenological qualitative research design. SITE: Data were collected in Istanbul between March 2021 and November 2021. PARTICIPANTS: Data were collected through in-depth interviews involving 24 people (19 sex workers and 5 physicians). METHODS: Key statements were listed during data analysis, and clusters of meanings were formed based on these statements. The participants' statements were used for contextual and structural descriptions. RESULTS: Sex workers suffer from chronic illnesses such as asthma, chronic obstructive pulmonary disease (COPD), diabetes, allergic diseases, and neurological disorders. Among the health issues affecting them, the most notable ones are STDs, psychological problems, and the risk of suicide. Sex workers also face a dilemma between choosing public hospitals and private hospitals. Majority of sex workers undergo regular testing for STDs, with the frequency varying from person to person. Reasons for not undergoing regular testing include lack of social security coverage, financial constraints, lack of information, and feeling undervalued. Some individuals are being subjected to mandatory testing. CONCLUSIONS: It is recommended that sex workers who seek and request healthcare services should be provided with detailed information and education, particularly regarding psychological problems and STDs.

Risk factors associated with higher scores in internalizing and externalizing behaviors in Chilean preschoolers.

Early detection of behavioral disorders in children is necessary for intervention. Available data show a high prevalence of child and adolescent psychiatric disorders in Chile (22.5%), but behavioral problems in younger children have not been evaluated. This work assesses behavioral disorders in preschoolers and their association with sociodemographic variables of the family and the child. The data was collected during the impact assessment of the Biopsychosocial Development Support Program "Chile Crece Contigo", using a multistage and representative random sample of 1377 preschoolers, aged between 30 and 48 months, who attended public health services. Homes were visited to apply a questionnaire and the Child Behavior Checklist (CBCL, 1.5-5 years). Results: Multivariable regression model for total raw scores shows that child's age, the number of chronic diseases in the child, and history of exposure to mother's alcohol consumption in pregnancy, remain significant when adjusted for all variables included (R2 of 17.8% and η2 of .19 (95% CI: .14-.22)). In externalizing and internalizing explanatory models, child's chronic diseases and a higher score of authoritarian beliefs about parenting show the two largest effect sizes. These results add to the evidence of urgent problems in preschool mental health.

La temprana detección de trastornos de comportamiento en los niños es necesaria para la intervención. La información disponible muestra una alta prevalencia de trastornos siquiátricos de niños y adolescentes en Chile (22.5%), pero no se han evaluado los problemas de comportamiento en niños más pequeños. Este trabajo evalúa trastornos de comportamiento en niños de edad prescolar y su asociación con variables sociodemográficas de la familia y del niño. La información se recogió durante la evaluación del impacto del Programa de Apoyo al Desarrollo Biosicosocial "Chile Crece Contigo," usando un grupo muestra de multiniveles representativo de 1,377 niños prescolares, de entre 30 y 48 meses de edad, quienes recibían servicios de salud pública. Se visitaron las casas para dar un cuestionario y la Lista de Comprobación del Comportamiento del Niño (CGCL, 1.5-5 años). Resultados: El modelo de regresión de variables múltiples para el total de la puntuación en bruto muestra que la edad del niño, el número de enfermedades crónicas en el niño, así como el historial de exposición al consumo de alcohol por parte de la madre durante el embarazo permanecen siendo significativos cuando se les ajusta para todas las variables incluidas (R2 de 17.8% y η2 de 0.19 (95% CI 0.14 a 0.22)). En los modelos explicativos de externalización e internalización, las enfermedades crónicas del niño y un más alto puntaje de creencias autoritarias acerca de la crianza demuestran ser las dos con la magnitud de efectos más extensa. Estos resultados contribuyen aun más a la evidencia sobre los problemas urgentes en la salud mental prescolar.

La détection précoce de troubles du comportement chez les enfants est nécessaire afin d'intervenir. Les données disponibles font état d'une forte prévalence de troubles psychiatrique de l'enfant et de l'adolescent au Chili (22,5%) mais les problèmes de comportement chez les plus jeunes enfants ne sont pas évalués. Ce travail évalue les troubles du comportement chez des enfants d'âge préscolaire et leur lien aux variables sociodémographiques de la famille et de l'enfant. Les données ont été recueillies durant l'évaluation de l'impact du programme de Soutien au Développement Biopsychosocial « Chile Crece Contigo ¼, en utilisant un échantillon aléatoire à plusieurs degrés et représentatif de 1 377 enfants d'âge préscolaire, âgés de 30 à 48 mois, qui participaient à des services de santé publique. Les domiciles ont été visités pour appliquer un questionnaire et la Checklist de Comportement de l'Enfant (CBCL, 1,5-5 ans). Résultats: Le modèle de régression multivariable pour les scores bruts totaux montre que l'âge de l'enfant, le nombre de maladies chroniques chez l'enfant et le passé d'exposition à la consommation d'alcool de la mère durant la grossesse restent importants après l'ajustement pour toutes le variables inclues (R2 de 17,8% and η2 de 0,19 (95% CI 0.14 à 0.22)). Dans les modèles explicatifs externalisant et internalisant les maladies chroniques de l'enfant et un score élevé de croyances autoritaire sur le parentage font preuves des plus grands effets de taille. Ces résultats s'ajoutent aux preuves sur les problèmes urgents de santé mentale préscolaire.

[Vaccination against the herpes zoster virus]. / Vacunación frente al virus del herpes zóster.

OBJECTIVE: To review the latest published evidence on the vaccine used in our country against the herpes zoster virus, breaking down the results according to the efficacy, efficiency, effectiveness and safety of the vaccine. Include the current recommendations for vaccination. DESIGN: Secondary review. Descriptive qualitative review. Review using the search term "herpes zoster vaccine" and "Adjuvanted recombinant Herpes Zoster subunit vaccine". Retrospective observational study. DATA SOURCES: Embase, Medline and Google Scholar. Selection of studies Search criterion with the terms "Shingrix vaccine" and "Adjuvanted Herpes Zoster Subunit Vaccine". Search period 2013-2023. Studies classified as clinical trials or randomized clinical trials were selected. 21 published studies were evaluated. There were no exclusions. RESULTS: The evaluated studies were found to be coherent and in all of them efficacy in adult individuals in preventing viral reactivation and in preventing complications was higher than 80%. The effectiveness of the vaccine after two doses was also higher than 80%. Cost-effectiveness studies were always favourable in adults, immunodepressed patients and individuals with chronic pathology. The safety of the vaccine was evaluated in the pivotal studies and in the post-commercialization studies that were undertaken (although there were few of the latter due to the short period of time studied). The safety profile of the vaccine is very high and in the case of severe adverse effects, their frequency was similar to that of a placebo. CONCLUSIONS: We have a safe and effective vaccine against the herpes zoster virus that allows us to protect the most vulnerable population groups against this virus.

Changing legislative thinking in China to better protect wild animals and human health.

The COVID-19 pandemic has exposed the inadequacy of China's legal protection of wildlife. Long-standing illegal wildlife trade in China and worldwide increases the risk of zoonotic infectious diseases. We sought to improve the understanding of China' legal system for the protection of wildlife, which has at its core the wildlife protection law, by systematically evaluating the laws and regulations of China's Wildlife Protection Framework. We examined how existing legal documents (e.g., the Wildlife Protection Law 2018) are directly or indirectly related to wildlife conservation. The inherent defects of wildlife protection legislation include a narrow scope of protection, insufficient public participation, and inconsistent enforcement among responsible agencies. Solutions to improve China's Wildlife Protection Law include expanding the legal protection of wildlife, and improving monitoring of wildlife protection. Strengthening legislation will be the basis for effective regulation of the use of wild animals. We advocate the establishment of a sound wildlife protection legal system for resolving conflicts between humans and wild animals and preventing zoonotic disease, such a system will have a profound impact on the sustainable development of China's wildlife resources.

Cambios en el Pensamiento Legislativo en China para Mejorar la Protección a los Animales Silvestres y la Salud Humana Resumen La pandemia de COVID-19 ha expuesto la insuficiencia de la protección legal de la fauna en China. El prolongado mercado ilegal de fauna en China y en todo el mundo incrementa el riesgo de enfermedades zoonóticas infecciosas. Buscamos mejorar el entendimiento del sistema legal de China para la protección de la fauna, el cual tiene como núcleo la ley de protección de fauna, mediante la evaluación sistemática de las leyes y regulaciones del Marco de Protección a la Fauna de China. Examinamos cómo los documentos legales existentes (p. ej.: la Ley de Protección de Fauna 2018) están relacionados directa o indirectamente con la conservación de la fauna. Los defectos inherentes de la legislación para la protección de fauna incluyen una visión reducida de la protección, una participación pública insuficiente y el cumplimiento inconsistente entre las agencias responsables. Las soluciones para mejorar la Ley de Protección de Fauna incluyen la expansión de la protección legal de fauna y el aumento al monitoreo de la protección de fauna. El fortalecimiento de la legislación será la base para la regulación efectiva del uso de animales silvestres. Abogamos por el establecimiento de un firme sistema legal de protección a la fauna para resolver los conflictos entre los humanos y los animales silvestres y también para prevenir las enfermedades zoonóticas. Dicho sistema tendrá un impacto profundo sobre el desarrollo sustentable de los recursos faunísticos de China.

Wild meat trade over the last 45 years in the Peruvian Amazon.

The trade in wild meat is an important economic component of rural people's livelihoods, but it has been perceived to be among the main causes of the decline of wildlife species. Recently, the COVID-19 pandemic has brought to light an additional concern of wildlife markets as a major human-health challenge. We analyzed data from the largest longitudinal monitoring (1973-2018) of the most important urban wild-meat markets in Iquitos, Peru, to examine the trends in and impacts of these markets on people's livelihoods. Over the last 45 years, wild meat sales increased at a rate of 6.4 t/year (SD 2.17), paralleling urban population growth. Wild meat sales were highest in 2018 (442 t), contributing US$2.6 million (0.76%) to the regional gross domestic product. Five species of ungulates and rodents accounted for 88.5% of the amount of biomass traded. Vulnerable and Endangered species represented 7.0% and 0.4% of individuals sold, respectively. Despite growth in sales, the contribution of wild meat to overall urban diet was constant: 1-2%/year of total meat consumed. This result was due to greater availability and higher consumption of cheaper meats (e.g., in 2018, poultry was 45.8% cheaper and was the most consumed meat) coupled with the lack of economic incentives to harvest wild meat species in rural areas. Most wild meat was sold salted or smoked, reducing the likelihood of foodborne diseases. Community-based wildlife management plans and the continued trade bans on primates and threatened taxa may avoid biodiversity loss. Considering the recent COVID-19 pandemic, future management plans should include potential viral hosts and regulation and enforcement of hygiene practices in wild-meat markets.

Comercio de Carne de Monte en los Últimos 45 Años en la Amazonia Peruana Resumen El comercio de carne de monte es un componente económico importante del sustento de habitantes de zonas rurales, pero se ha percibido como una de las principales causas de la declinación de especies de vida silvestre. Recientemente, la pandemia de COVID-19 ha traído a la luz una preocupación adicional de los mercados de vida silvestre como un reto importante para la salud humana. Analizamos datos del monitoreo longitudinal más extenso (1973-2018) de los mercados urbanos de carne de monte más importantes en Iquitos, Perú, para examinar las tendencias y los impactos de estos mercados sobre el sustento de los habitantes. Las ventas de carne de monte incrementaron en los últimos 45 años a una tasa de 6.4 t/año (DS 2.17), en paralelo con el crecimiento de la población. Las ventas de carne de monte fueron más altas en 2018 (442 t), aportando U.S. $2.6 millones (0.76%) al producto interno bruto de la región. Cinco especies de ungulados y roedores comprendieron el 88.5% de la biomasa comercializada. Especies vulnerables y en peligro representaron 7.0% y 0.4% de los individuos vendidos, respectivamente. A pesar del incremento de las ventas, la contribución de la carne de monte al total de la dieta urbana fue constante: 1-2%/año del total de carne consumida. Este resultado se debió a una mayor disponibilidad y consumo de carnes más baratas (e. g., en 2018 la carne de pollo fue 45.8% más barata y fue la más consumida) aparejado con la falta de incentivos económicos para cosechar carne de especies silvestres en áreas rurales. La mayor parte de la carne de monte se vendía salada o ahumada, reduciendo con ello la probabilidad de enfermedades transmitidas por alimentos. Los planes de manejo de vida silvestre basados en comunidades y la prohibición continua del comercio de primates y taxa amenazados pueden evitar la pérdida de biodiversidad. Considerando la reciente pandemia de COVID-19, los planes de manejo futuros deben incluir potenciales huéspedes virales y la regulación y aplicación de prácticas de higiene en los mercados de carne de especies silvestres.

What is post-COVID-19 syndrome? Definition and update.

This work addresses the origin and development of post-COVID-19 syndrome, which consists of the persistence of different symptoms over time as a consequence of SARS-CoV-2 infection. Based on a narrative review of the scientific literature, a brief analysis of the new term is made, specifying the conceptual definition, characteristic symptoms, the various implications for people's health, and the responses to specific care measures that have been implemented. It concludes with a wake-up call to the governments of Latin America and the Caribbean in order for care and surveillance to be provided to this public health problem.

Este trabajo aborda el origen y el desarrollo del síndrome pos-COVID-19, el cual consiste en la persistencia a través del tiempo de diferentes síntomas como consecuencia de la infección por SARS-CoV-2. A partir de una revisión narrativa de la literatura científica, se realiza un breve recorrido sobre el nuevo término y se precisa la definición conceptual, los síntomas característicos, las diversas implicaciones en la salud de las personas y las respuestas de atención específica que se han implementado. Se concluye con una llamada de atención a los gobiernos de América Latina y el Caribe para dar tratamiento y seguimiento a este problema de salud pública.

Lipoatrophia semicircularis: Clinical study and follow-up of 76 cases in Madrid, Spain. Classification proposal. / Lipoatrofia semicircular: estudio y seguimiento clínico de 76 casos en Madrid, España. Propuesta de clasificación.

INTRODUCTION: The clinical presentations of Lipoatrophia semicircularis (LS) vary, and diagnostic criteria are unclear. Several etiopathogenic factors, including occupational environmental ones, have been suggested. We aimed to describe a cluster of cases of suspected LS that started to appear in May 2008 among employees of the city council of Madrid, Spain. We report the actions taken by the council's Occupational Health Service and propose clinical categories with prognostic implications. MATERIAL AND METHOD: Retrospective observational case series study including prospectively collected data from patients evaluated between 2008 and 2021 at the Madrid City Council STI/Dermatology Department. Information on measures taken by the Occupational Health Service is detailed. The recording of clinical variables for statistical analysis and the proposal of defined clinical patterns were carried out. RESULTS: We studied the cases of 75 women and one man, most of whom attended follow-up visits for a median of 37 months. Local symptoms were observed in just 14.5% of patients. The cases were classified into 4 groups: typical LS, unilateral LS, band-like lipoatrophy in the lower limbs, and nonspecific LS. Clinical outcomes were more often favorable in the first 2 groups, in which 76% of patients achieved total or partial improvement of lesions (vs. 25.8% in the last 2 groups). LS was negatively associated with the presence of hypertrophic subcutaneous adipose tissue (P<.001). DISCUSSION: Typical LS, which can often be unilateral, generally has a satisfactory outcome. The clinical characteristics of this form distinguish it from other types of lipoatrophy. Measures taken by the Occupational Health Service contributed to favorable outcomes. In this series, LS was not associated with marked subcutaneous adipose tissue hypertrophy in the thighs. Our proposed categories may help distinguish between cases of LS with a favorable prognosis and other cases presenting with skin surface depressions, which are often persistent.

[Public Service Motivation of the professionals of the primary care centers: What is more important the environment or the perceived supervisor support?] / Motivación por el servicio público de los profesionales de los centros de atención primaria: ¿qué es más importante el entorno o el apoyo directivo?

OBJECTIVE: Explain the Public Service Motivation of health professionals based on (a) the social environment of their workplace and (b) the perceived supervisor support. DESIGN: Observational, cross-sectional, quantitative, retrospective, and uncontrolled study. SETTING: Forty primary care centers belonging to the Gran Canaria health area, primary care. PARTICIPANTS: Six hundred and five health professionals from primary care centers. 46% doctors and 54% nurses. Non-probability convenience sampling with a response rate of 53.3%. MAIN MEASUREMENTS: The dependent variable is the Public Service Motivation of health professionals. The independent variables are the social environment of the primary care centers and the perceived supervisor support. Data were analyzed using multilevel linear regression and multiple linear regression. RESULTS: The following variables of the environment of the healthcare centers: income of the population, percentage of people older than 65 years, and the amount of population assigned to the centers, do not influence the Public Service Motivation of health professionals. On the contrary, the support they receive from their superiors does have a significant impact on both the compassion factor (ß: 0.38; CI: 0.21-0.32) and the commitment to the public interest (ß: 0.37; CI: 0.20-0.31). CONCLUSIONS: The perceived supervisor support has a significant influence on the Public Service Motivation of health professionals. However, the social environment does not affect this type of motivation.

Primary health care response in the management of pandemics: Learnings from the COVID-19 pandemic.

Primary care is an essential foundation for the global response to COVID-19 pandemic. It plays a significant role in the health care response: identifying and triaging potential COVID-19 cases, making an early diagnosis, helping vulnerable people cope with their anxiety about the virus, strengthening compliance with prevention and protection measures, and reducing the demand for hospital services. Primary care teams have continued to address citizens' health problems during the pandemic, adapting to strict social control measures imposed by governments such as closing of borders, lockdowns and self-isolation of cases and contacts. We describe the COVID-19 response from primary care in Hong Kong and China, based on their recent pandemic experiences. We also present that of a European country, United Kingdom, less experienced in pandemic management, but with universal and highly developed primary care with great social recognition. Finally, we point out some crucial learning for future pandemic management, highlighting the crucial need to improve the relationship between primary care and public health to improve pandemics response.

Incubation period of COVID-19: A systematic review and meta-analysis. / Período de incubación de la COVID-19: revisión sistemática y metaanálisis.

BACKGROUND AND OBJECTIVE: The incubation period of COVID-19 helps to determine the optimal duration of the quarantine and inform predictive models of incidence curves. Several emerging studies have produced varying results; this systematic review aims to provide a more accurate estimate of the incubation period of COVID-19. METHODS: For this systematic review, a literature search was conducted using Pubmed, Scopus/EMBASE, and the Cochrane Library databases, covering all observational and experimental studies reporting the incubation period and published from 1 January 2020 to 21 March 2020.We estimated the mean and 95th percentile of the incubation period using meta-analysis, taking into account between-study heterogeneity, and the analysis with moderator variables. RESULTS: We included seven studies (n = 792) in the meta-analysis. The heterogeneity (I2 83.0%, p < 0.001) was significantly decreased when we included the study quality and the statistical model used as moderator variables (I2 15%). The mean incubation period ranged from 5.6 (95% CI: 5.2 to 6.0) to 6.7 days (95% CI: 6.0 to 7.4) according to the statistical model. The 95th percentile was 12.5 days when the mean age of patients was 60 years, increasing 1 day for every 10 years. CONCLUSION: Based on the published data reporting the incubation period of COVID-19, the mean time between exposure and onset of clinical symptoms depended on the statistical model used, and the 95th percentile depended on the mean age of the patients. It is advisable to record sex and age when collecting data in order to analyze possible differential patterns.

Estimation of the number of preventable COVID-19 deaths in relation to the restrictive measures adopted in America.

INTRODUCTION: In America, the United States was particularly affected by the COVID-19 pandemic. OBJECTIVES: To estimate how many daily COVID-19 deaths per 100,000 population would have been avoided if each one of five restrictive measures had been implemented at the time of diagnosis and to estimate a multiple linear regression model predictive of the number of deaths per 100,000 population based on the measures adopted by the countries. METHODS: A simple linear regression was performed between the days elapsed since the first COVID-19 diagnosed case and the implementation of each one of the five restrictive measures by the 27 American countries studied and the number of COVID-19 deaths per 100,000 population. RESULTS: For each day between the first COVID-19 reported case and the adoption of restrictive measures, between 0.250 (p = 0.021) and 0.600 (p = 0.001) patients per 100,000 population died, depending on the measure in question. CONCLUSIONS: Adoption of restrictive measures and social distancing are necessary for reducing the number of people infected with COVID-19 and their mortality. In addition, promptness of their establishment is essential in order to reduce the number of deaths.

INTRODUCCIÓN: En América, Estados Unidos se vio particularmente afectado por la pandemia de COVID-19. OBJETIVOS: Estimar cuántas muertes diarias por COVID-19 por 100 000 habitantes se hubiesen evitado si cada una de las cinco medidas restrictivas se hubiera implementado en el momento del diagnóstico, así como estimar un modelo de regresión lineal múltiple predictivo del número de muertes por 100 000 habitantes basado en las medidas adoptadas por los países. MÉTODOS: Se realizó una regresión lineal simple entre los días transcurridos desde el primer caso diagnosticado de COVID-19 y la implantación de cada una de las cinco medidas restrictivas llevadas a cabo por los 27 países americanos estudiados y el número de muertes por COVID-19 por cada 100 000 habitantes. RESULTADOS: Por cada día entre el primer caso reportado de COVID-19 y la adopción de medidas restrictivas, fallecieron entre 0.250 (p = 0.021) y 0.600 (p = 0.001) pacientes por cada 100 000 habitantes, dependiendo de la medida en cuestión. CONCLUSIONES: La adopción de medidas restrictivas y la distancia social son necesarias para reducir el número de personas infectadas con COVID-19 y su mortalidad; además, la velocidad de su establecimiento es esencial para reducir el número de muertes.

Estimation of the number of preventable COVID-19 deaths in relation to the restrictive measures adopted in Europe.

INTRODUCTION: In December 2019, a new coronavirus emerged in Wuhan, China, which has become a global health problem. OBJECTIVES: To estimate how many daily COVID-19 deaths per 100,000 population could have been avoided if each one of five restrictive measures had been implemented at the time the first case was diagnosed, and to estimate a multiple linear regression model predictive of the number of deaths per 100,000 population. METHODS: A simple linear regression was performed between the days elapsed since the first COVID-19 diagnosed case, implementation of each one of the five restrictive measures carried out by the 39 European studied countries, the number of hospital beds per 1,000 population (independent variables) and the number of COVID-19 deaths per 100,000 population. RESULTS: For each day elapsed from the first COVID-19 reported case to the adoption of restrictive measures, between 0.611 (p = 0.004) and 1.863 (p = 0.000) patients died per 100,000 population, depending on the implemented measure. CONCLUSIONS: Restrictive measures and social distancing, as well as promptness of their implementation, are necessary for achieving a decrease in COVID-19 infections and mortality.

INTRODUCCIÓN: En diciembre de 2019 surgió un nuevo coronavirus en Wuhan, China, que se ha convertido en un problema de salud global. OBJETIVO: Estimar cuántos fallecimientos diarios atribuibles a COVID-19 por cada 100 000 habitantes se podrían haber evitado si se hubiese llevado a cabo cada una de las cinco medidas restrictivas al momento del diagnóstico del primer caso, así como estimar un modelo de regresión lineal múltiple predictivo del número de fallecimientos por cada 100 000 habitantes. MÉTODOS: Se realizó un modelo de regresión lineal simple entre los días transcurridos desde el primer caso diagnosticado de COVID-19, la implantación de cada una de las cinco medidas llevadas a cabo por los 39 países europeos estudiados, el número de camas hospitalarias por 1000 habitantes (variables independientes) y el número de fallecimientos por COVID-19 por 100 000 habitantes. RESULTADOS: Por cada día transcurrido desde el primer caso notificado de COVID-19 hasta la adopción de las medidas restrictivas, fallecieron entre 0.611 (p = 0.004) y 1.863 (p = 0.000) pacientes por cada 100 000 habitantes, dependiendo de la medida implementada. CONCLUSIONES: Las medidas restrictivas y el distanciamiento social, así como la celeridad de su instauración, son necesarios para lograr el descenso del número de contagios de COVID-19 y su mortalidad.

[Evolution of Smoking According to Social Class in the Adult Population of the Canary Islands During 2000-2015: Follow-up of the CDC-Canary Cohort]. / Evolución del tabaquismo según clase social en la población adulta de las Islas Canarias durante el periodo 2000-2015: seguimiento de la cohorte CDC-Canarias.

OBJECTIVE: To determine the status of tobacco consumption in the Canary Islands during 2000-2015, according to social class. LOCATION: Canary Islands. PARTICIPANTS: General population cohort, with contacts in 2000 (n=6,729), 2008 (n=6,171) and 2015 (n=4,705). MAIN MEASUREMENTS: Smoking, gender, age, and social class. RESULTS: Consumption decreased by 6% (5-7%, P<.001) in general, being more accentuated in the period 2000-2008 (5%). The decrease was greater in men, although they continued to smoke more than women, with a prevalence of 25% (24-26%) compared to 18% (17-19%, P<.001). A decrease in consumption was only observed in the younger groups (6% [3-5%], P=.011) and intermediate ages (7% [6-8%], P<.001). A similar decrease was observed in all the social classes, but there was a higher prevalence of smoking in the upper class: 24% (23-25%) in 2015 (P<.001). By jointly assessing gender, age, and social class, younger and middle age men had the greatest decreases in consumption: 8% (7-9%) low and upper classes, 10% (9-11%) middle class. In the lower social class, younger women continue to smoke more (27%) although more of them quit smoking (14%), a phenomenon that occurred in the middle class at intermediate ages. CONCLUSIONS: The evolution of tobacco consumption in the Canary Islands follows a pattern similar to that of mainland Spain. The abandonment of tobacco consumption has slowed down in the period 2008-2015, especially in men, and middle and upper social classes.

[Nutritional composition of vending foods of public university and hospital buildings in Asturias]. / Composición nutricional de los alimentos de las vending de edificios públicos universitarios y hospitalarios de Asturias.

OBJECTIVE: To evaluate the nutritional composition of food vending machines (VM) located in university public buildings and hospitals in Asturias. DESIGN: Descriptive cross-sectional study. LOCATION: The analysis was made of the contents of VMs located in public buildings, hospitals, and university teaching centres in the Principality of Asturias. MAIN MEASUREMENTS: After the public buildings were mapped, each of them was visited to check for the presence of the VMs. A a photograph was then taken of the food contained in them. The variables analysed were the type of products and their nutritional composition. RESULTS: The VMs of 19 buildings (12 university and 7 hospital), contained 215 foods that were grouped into 11 categories. The most frequent were "chocolates and chocolate bars" (30,2%), "cookies" (11.6%) and "chips" (11.6%). The Kcal average was 216 (SD=133.1). The mean fat, in grams was 12.52 (SD=11.21), saturated fat 4.48 (SD=3,83), sugars 11.88 (SD=31.13), fibre 1.9 (SD=2.47), proteins 3.38 (SD=3.62), and salt 0.3 (SD=0.62). A high excess of fat, saturated fat, and salt was observed, as well as a medium excess of sugars. CONCLUSIONS: The nutritional quality of VM in hospitals and public university centres of the Principality of Asturias cannot be defined as healthy. Therefore, health promotion strategies could be developed with the aim of improving their nutritional composition or guiding the population/users towards the selection and consumption of healthier foods.

[Impact of cardiovascular risk factors in the Extremadura population: HERMEX cohort contributions for a preventive strategy]. / Impacto de los factores de riesgo cardiovascular en la población extremeña: aportación de la cohorte HERMEX para una estrategia preventiva.

OBJECTIVE: To determine the population attributable fraction (PAF) of the major risk factors (RF) for the occurrence of cardiovascular disease in an Extremadura population cohort and therefore recommend priority preventive measures in health. METHODS: Design, Cohort study. LOCATION: Representative population sample of a health area of Extremadura (Spain) PARTICIPANTS: 2833 individuals, from 25 to 79 years old, randomly selected and recruited between 2007 and 2009. Antecedents and clinical parameters were recorded, a follow up until December 31, 2015 were done. MEASUREMENTS: Explanatory variables: Age, sex, obesity, current smoking, arterial hypertension, diabetes mellitus (DM) and hypercholesterolemia. OUTCOME VARIABLE: First event of the combined variable of myocardial infarction, angina pectoris, stroke, peripheral arterial disease and cardiovascular death. Fully adjusted hazard ratios (HR) were calculated by Cox regression. The PAFs were calculated using Levin's formula. RESULTS: 2669 subjects were included, 103 had history of cardiovascular disease and 61 were lost. The follow-up was 6.9 years (IR 6.5-7.5). 134 events were recorded. Incidence rate 7.42/1,000 people-year. Adjusted HR (95% CI) were: hypertension 2.26 (1.40-3.67), hypercholesterolemia 2.23 (1.56-3.18), DM 1.79 (1.24-2.58) and current smoking 1.72 (1.11-2.69). The PAF (95% CI) were: hypertension: 31.1 (12.4-48.8), hypercholesterolemia 27.0% (14.8-40.6), smoking 18.8% (3.3-35.0) and DM 7.9% (2.6-15.2). CONCLUSIONS: Hypertension confers the greatest burden of cardiovascular disease in the population of Extremadura, followed by hypercholesterolemia and smoking. These RF are priority objectives for a population-based preventive strategy.

COVID 19 comprehensive management in a regional hospital of Northwestern Spain.

INTRODUCTION: The COVID-19 pandemic has brought about a paradigm shift in healthcare. OBJECTIVE: To evaluate the utility of a strategy to comprehensively address the pandemic in a health area that covers 42,000 people. METHOD: Between March 10 and May 15, 2020, the COVID Unit was created in the corresponding regional hospital, and an independent circuit was established for the diagnosis and management of patients with suspected or confirmed COVID-19; social health centers were monitored with PCR testing. RESULTS: Eighteen COVID-19-positive patients (age 72.9 ± 13.2 years) were admitted, out of which 66% were males. All these patients had pneumonia and 67% had respiratory distress syndrome; no one required mechanical ventilation. Mean hospital stay was 9.4 ± 5.3 days, and mortality, 11%. PCR tests were applied to all hospital residents (n = 827) and workers (n = 519), 1,044 phone calls were made and 36 hospital admissions were avoided. Only 50 patients required close follow-up, out of which four (0.48%) were positive for COVID-19. CONCLUSION: Clinical monitoring at the hospital and social health centers showed that patient profile was like that documented in the literature and that the incidence of COVID-19 was low in social health centers.

INTRODUCCIÓN: La pandemia de COVID-19 provocó un cambio de paradigma en la atención médica. OBJETIVO: Evaluar una estrategia para abordar integralmente la pandemia en un distrito de salud que comprende 42 000 personas. MÉTODO: Entre el 10 de marzo y 15 de mayo de 2020 se creó la Unidad COVID en un hospital regional correspondiente al distrito y se estableció un circuito independiente para el diagnóstico y manejo de pacientes con sospecha o confirmación de COVID-19; los centros de salud social fueron monitoreados mediante PCR. RESULTADOS: Ingresaron 18 pacientes positivos a COVID-19 (edad de 72.9 ± 13.2 años), 66 % eran hombres; todos presentaron neumonía, 67 % desarrolló síndrome de dificultad respiratoria y ninguno requirió ventilación mecánica. La estancia hospitalaria fue de 9.4 ± 5.3 días y la mortalidad, de 11 %. Se realizaron pruebas de PCR a todos los residentes (n = 827) y trabajadores (n = 519) del hospital, se realizaron 1044 llamadas telefónicas y se evitaron 36 hospitalizaciones. Solo 50 pacientes necesitaron seguimiento cercano, cuatro (0.48 %) positivos a COVID-19. CONCLUSIÓN: El monitoreo clínico en el hospital y centros de salud social mostró que el perfil de los pacientes fue similar al documentado en la literatura y que la incidencia de COVID-19 fue baja en los centros sociales de salud.

National panorama of adolescent pregnancy in Mexico: lessons learned in a six-year period.

Globally, adolescent pregnancy constitutes a serious public health problem of a multifactorial nature. Specifically for women, it entails various educational, economic and social implications that affect their life project and widen the social gaps in this age group. Furthermore, adolescent girls are more vulnerable because of the health risk involved with pregnancy at a younger age. According to the World Health Organization, "the probability of maternal death is twice as high in adolescents in comparison with women aged between 20 and 30 years, and for those younger than 15 years, the risks are five times higher". In general, adolescents are in great need for education on sexual and reproductive health issues, which should be aimed at increasing information and knowledge about correct use and access to modern contraceptive methods, as well as at demystifying fears and beliefs around their possible side effects. Ensuring proper counseling with trained personnel is equally vital. Public institutions have a social responsibility to support efforts aimed at preventing adolescent pregnancy, based on relevant lines of action and health policies.

En el mundo, el embarazo adolescente constituye un grave problema de salud pública de índole multifactorial. Específicamente para la mujer conlleva diversas implicaciones educativas, económicas y sociales que afectan su proyecto de vida y amplían las brechas sociales en este grupo etario. Asimismo, las adolescentes son más vulnerables por el riesgo en salud que implica un embarazo a corta edad; según la Organización Mundial de la Salud, "la probabilidad de muerte materna es dos veces más en las adolescentes respecto a las mujeres que se encuentran entre los 20 y 30 años de edad, y para las menores de 15 años los riesgos son cinco veces mayores". En general, las y los adolescentes experimentan una gran necesidad de educación en temas sobre salud sexual y reproductiva, la cual debe dirigirse al aumento de información y conocimientos sobre el uso correcto y acceso a métodos anticonceptivos modernos, así como a desmitificar los temores y creencias en torno a sus posibles efectos secundarios. Asegurar una consejería adecuada y con personal capacitado es igualmente vital. Las instituciones públicas tienen la responsabilidad social de respaldar los esfuerzos encaminados a prevenir el embarazo adolescente, con base en las líneas de acción y políticas sanitarias.

National Cancer Institute scientific production scientometric analysis.

INTRODUCTION: Scientometrics analyzes scientific publications through bibliometric and computational techniques, whereby productivity and impact indicators are generated. OBJECTIVE: To propose a multidimensional methodology in order to obtain the scientometric profile of the National Cancer Institute (INCan), Mexico, and rank it with regard to other national health institutions. METHOD: Using the LabSOM software and the ViBlioSOM methodology based on artificial neural networks, the INCan scientific production indexed in the Web of Science from 2007 to 2017 was analyzed. The multidimensional scientometric profile of the Institute was obtained and compared with that of other national health institutions. RESULTS: In terms of productivity, INCan ranks fourth among the 10 Mexican public health institutions indexed in the Web of Science; in the normalized impact ranking, it ranks sixth. Although out of 1323 articles 683 (51.62 %) did not receive citations, 11 articles classified as excellent (0.83 %) obtained 24 % of 11,932 citations and, consequently, INCan normalized impact rate showed a mean productivity higher than the world mean. CONCLUSION: Multidimensional analysis with the proposed neural network enables obtaining a more reliable and comprehensive absolute and relative institutional scientiometric profile than that derived from measuring isolated variables.

INTRODUCCIÓN: La cienciometría permite analizar la productividad e impacto de las publicaciones científicas mediante técnicas bibliométricas y computacionales. OBJETIVO: Proponer una metodología multidimensional para obtener el perfil cienciométrico del Instituto Nacional de Cancerología (INCan), México, y compararlo respecto a otras instituciones nacionales de salud. MÉTODO: Con el programa LabSOM y la metodología ViBlioSOM, basada en redes neuronales artificiales, se analizó la producción científica del INCan indexada en la Web of Science entre 2007 y 2017. Se obtuvo el perfil cienciométrico multidimensional del Instituto y se comparó con el de otras instituciones nacionales de salud. RESULTADOS: En productividad, el INCan ocupa el cuarto lugar de las 10 instituciones mexicanas de salud pública indexadas en la Web of Science.; en el ranking de impacto normalizado, el sexto lugar. Aun cuando de 1323 artículos, 683 (51.62 %) no recibieron citas, 11 artículos de excelencia (0.83 %) lograron 24 % de 11 932 citas y, consecuentemente, el impacto normalizado del INCan evidenció una productividad media por arriba de la media mundial. CONCLUSIÓN: El análisis multidimensional con la red neuronal propuesta permite obtener un perfil cienciométrico institucional absoluto y relativo más fidedigno e integral que el derivado de conteos de variables aisladas.

COVID-19: implications of SARS-CoV-2 in Colombia.

COVID-19 arrived in Latin America early in March 2020. Currently, strategies are being developed in Colombia focusing on the quarantine and social and economic capital reactivation, whereby the expected results are not being obtained. In this article, we propose to review scientific evidence-based literature where information on the operation and adaptation of health systems, and social, economic and solidarity sectors of Colombia is presented. The purpose is to identify COVID-19 implications in the network that provides health services, quality of life and health-disease prognosis in the country, which is not prepared to face crises of social nature and of health systems, as well as the economic and solidarity impacts that are brought about by pandemics and crude episodes of disease.

COVID-19 llegó a Latinoamérica a principios de marzo de 2020. Actualmente, en Colombia se desarrollan estrategias enfocadas en la cuarentena y la reactivación del capital social y económico, con las cuales no se están obteniendo los resultados esperados. En este artículo se propone revisar literatura basada en evidencia científica en la que se exponga información del funcionamiento y adaptación de los sistemas de salud, sectores sociales, económicos y solidarios de Colombia. El objetivo es identificar las implicaciones de COVID-19 en la red prestadora de servicios de salud, calidad de vida, pronóstico de salud-enfermedad en el país, el cual no está preparado para afrontar crisis de orden social, de sistemas de salud e impactos económicos y solidarios que conllevan las pandemias y episodios graves de enfermedad.

Scientific medical journals in Mexico.

This symposium describes the main characteristics of six Mexican scientific journals indexed in Journal Citation Reports: Archives of Medical Research, Revista de Investigación Clínica-Clinical and Translational Investigation, Gaceta Médica de México, Salud Pública de México, Cirugía y Cirujanos and Salud Mental. Particular emphasis is given to their historical and organizational aspects, as well as to their main achievements recognized by the national and international scientific community.En este simposio se describen las principales características de seis revistas científicas mexicanas reconocidas por el. Journal Citation Reports: Archives of Medical Research, Revista de Investigación Clínica-Clinical and Translational Investigation, Gaceta Médica de México, Salud Pública de México, Cirugía y Cirujanos y Salud Mental. Se hace énfasis en sus aspectos históricos y organizacionales, así como en sus logros principales ante la comunidad científica nacional e internacional.