Tubal Sterilization and Cervical Cancer Underscreening in the United States.

Background: Tubal sterilization is more commonly utilized by racial/ethnic minority groups and has been implicated in underscreening for cervical cancer. The objective is to determine if prior tubal sterilization is a risk factor for cervical cancer underscreening. Methods: National Survey of Family Growth dataset from 2015 to 2019 used for analysis; data were weighted to represent the 72 million women in the U.S. population aged 22-49. Chi-square tests, Fisher exact tests, and logistic regression were used for analysis. The primary predictor variable was tubal sterilization which was categorized into no previous sterilization, sterilization completed <5 years ago, and sterilization completed ≥5 years ago. The outcome variable was underscreened versus not underscreened. Other predictor variables included age, household income as a percent of federal poverty level, previous live birth, primary care provider, and insurance status. Results: Prevalence of tubal sterilization completed 5 or more years ago was 12.5% and varied by most measured characteristics in univariate analyses. Approximately 8% of women were underscreened for cervical cancer. In multivariable analyses, women with a tubal sterilization 5 or more years ago had 2.64 times the odds (95% confidence interval = 1.75-4.00) of being underscreened for cervical cancer compared with women who did not have a tubal sterilization. Conclusions: Approximately 4.3 million women ages 22-49 in the United States are potentially underscreened for cervical cancer and women with previous tubal ligation ≥5 years ago are more likely to be underscreened. These results may inform the need for culturally sensitive public health messages informing people who have had these procedures about the need for continued screening.

Prevalence of Potentially Unnecessary Bimanual Pelvic Examinations and Papanicolaou Tests Among Adolescent Girls and Young Women Aged 15-20 Years in the United States.

Importance: Pelvic examination is no longer recommended for asymptomatic, nonpregnant women and may cause harms such as false-positive test results, overdiagnosis, anxiety, and unnecessary costs. The bimanual pelvic examination (BPE) is an invasive and controversial examination component. Cervical cancer screening is not recommended for women younger than 21 years. Objectives: To estimate prevalence of potentially unnecessary BPE and Papanicolaou (Pap) tests performed among adolescent girls and women younger than 21 years (hereinafter referred to as young women) in the United States and to identify factors associated with receiving these examinations. Design, Setting, and Participants: A cross-sectional analysis of the National Survey of Family Growth from September 2011 through September 2017 focused on a population-based sample of young women aged 15 to 20 years (n = 3410). The analysis used survey weights to estimate prevalence and the number of people represented in the US population. Data were analyzed from December 21, 2018, through September 3, 2019. Main Outcomes and Measures: Receipt of a BPE or a Pap test in the last 12 months and the proportion of potentially unnecessary examinations and tests. Results: Responses from 3410 young women aged 15 to 20 years were included in the analysis with 6-year sampling weights applied. Among US young women aged 15 to 20 years represented during the 2011-2017 study period, 4.8% (95% CI, 3.9%-5.9%) were pregnant, 22.3% (95% CI, 20.1%-24.6%) had undergone STI testing, and 4.5% (95% CI, 3.6%-5.5%) received treatment or medication for an STI in the past 12 months (Table 1). Only 2.0% (95% CI, 1.4%-2.9%) reported using an IUD, and 33.5% (95% CI, 30.8%-36.4%) used at least 1 other type of hormonal contraception in the past 12 months. Among US young women aged 15 to 20 years who were surveyed in the years 2011 through 2017, approximately 2.6 million (22.9%; 95% CI, 20.7%-25.3%) reported having received a BPE in the last 12 months. Approximately half of these examinations (54.4%; 95% CI, 48.8%-59.9%) were potentially unnecessary, representing an estimated 1.4 million individuals. Receipt of a BPE was associated with having a Pap test (adjusted prevalence ratio [aPR], 7.12; 95% CI, 5.56-9.12), testing for sexually transmitted infections (aPR, 1.60; 95% CI, 1.34-1.90), and using hormonal contraception other than an intrauterine device (aPR, 1.31; 95% CI, 1.11-1.54). In addition, an estimated 2.2 million young women (19.2%; 95% CI, 17.2%-21.4%) reported having received a Pap test in the past 12 months, and 71.9% (95% CI, 66.0%-77.1%) of these tests were potentially unnecessary. Conclusions and Relevance: This analysis found that more than half of BPEs and almost three-quarters of Pap tests performed among young women aged 15 to 20 years during the years 2011 through 2017 were potentially unnecessary, exposing women to preventable harms. The results suggest that compliance with the current professional guidelines regarding the appropriate use of these examinations and tests may be lacking.

Evolución de pacientes con adicción al alcohol con el uso de acamprosato / Progression of patients with alcohol dependence using acamprosate

Introducción: los efectos del consumo excesivo de bebidas alcohólicas para el individuo, la familia y la sociedad son un problema de salud, convertido en la más trascendente toxicomanía en la actualidad. En el mercado existen tres fármacos que reducen el deseo de beber y son el disulfiram, la naltrexona y el acamprosato. El acamprosato es el medicamento que se propone estudiar, ya que en Cuba no existen referencias anteriores de estudios de la efectividad del acamprosato. Objetivo: valorar la evolución del alcoholismo y su tratamiento con acamprosato. Métodos: se diseñó un Estudio de Utilización de Medicamentos observacional y descriptivo, basado en las consecuencias prácticas del uso del acamprosato en pacientes diagnosticados con adicción al alcohol, con una dosis de dos cápsulas de 33,3 mg diarias por vía oral, durante seis meses de tratamiento, desde septiembre de 2012 a febrero de 2013. Resultados: de 44 pacientes evaluados, el 90,9 por ciento no tuvo recaídas, solamente el 9,1 por ciento de los pacientes tuvo deseos de consumir alcohol al inicio del tratamiento. Un paciente mostró intranquilidad como efecto adverso al acamprosato. La autovaloración de todos los pacientes fue positiva, refiriendo en su totalidad que cambiaron para una persona mejor. El 68,2 por ciento de los pacientes tuvieron una evolución excelente, lo que coincide con otros estudios internacionales con el acamprosato. Conclusiones: el tratamiento con acamprosato es efectivo para la prevención de las recaídas y la reducción del consumo de alcohol en el alcoholismo(AU)

Introduction: the effects of the excessive intake of alcohol beverages for the individual, the family and the society represent a health problem turned into the most transcendental toxicomania at present times. There are three drugs on the market which reduce the desire of drinking and are called disulfiram, naltrexone and acamprosate. The latter is the drug to be studied since there are no previous references in Cuba about effectiveness study of acamprosate. Objective: to assess the progression of alcoholism and its treatment with acamprosate. Methods: adescriptive and observational Study of Drug Use was designed on the basis of the practical consequences of the use of acamprosate in patients diagnosed with alcohol dependence, at a dose of two caplets of 33.3mg to be taken daily for six months from September 2012 to February 2013. Results: of 44 evaluated patients, 90.9 percent had no relapses, just 9.1 percent felt the desire of taking alcohol beverages at the onset of treatment. One patient showed restlessness as adverse effect of the drug. The self-assessment of all the patients was positive, stating that they changed into a better person after treatment. In the group, 68.2 percent had an excellent progress which agrees with other international study on this drug. Conclusions: the treatment with acamprosate is effective for the prevention of relapses and the reduction of alcohol dependence(AU)

Use of family planning and related medical services among women aged 15-44 in the United States: National Survey of Family Growth, 2006-2010.

OBJECTIVE: This report presents national estimates of the use of family planning services and related medical services among women aged 15-44 in the United States in 2006-2010. Selected indicators are compared with similar measures for 2002 and 1995 to examine changes over time. METHODS: Data for this report come primarily from the 2006-2010 National Survey of Family Growth (NSFG), which included 12,279 interviews with women aged 15-44. The response rate for women in the 2006-2010 NSFG was 78%. RESULTS: In 2006-2010, 43 million women aged 15-44 received a family planning or related medical service in the previous 12 months. A Pap test and a pelvic exam were the most common services received by women in the previous year, followed by receipt of a method of birth control. About 18% of women received a family planning or related medical service from a clinic in the past 12 months and one-half of these women received it from a Title X-funded clinic. In contrast, 53% of women received a family planning or related medical service in the past 12 months from a private doctor. Use of Title X-funded clinics was more common among women in cohabiting unions, black and Hispanic women, those who lived in nonmetropolitan areas, those below the poverty level, and those without health insurance.

Changes to cervical cancer prevention guidelines: effects on screening among U.S. women ages 15-29.

OBJECTIVE: A shift toward later initiation of cervical cancer screening for women began in 2002. We generated national estimates of screening prevalence rates and guideline-consistent screening among U.S. women ages 15-29 before and after the first evidence-based recommendations for reduced cervical cancer screening. METHOD: We used National Survey of Family Growth data to compare self-reported cervical cancer screening in 2002 and 2006-2008, stratified by age (15-17, 18-20, 21-29) and sexual activity. We also assessed receipt of guideline-consistent screening by selected demographic variables. RESULTS: Among females ages 15-17, the proportion screened decreased from 23% to 12%, and screening was significantly more likely to be guideline-consistent. Among females ages 18-20, 24% were screened too early in 2006-2008, but among those not yet sexually active, screening declined to 8%, appropriately reflecting new guidelines. In multivariable analysis, private health insurance, pregnancy, and hormonal contraceptive use were associated with guideline-consistent screening among sexually-active women. CONCLUSION: Fewer adolescents were being screened before sexual initiation, representing newer guidelines. However, sexually-active young adult women also should have later screening initiation. Factors related to health care access contribute to receipt of screening. Monitoring and provider education are needed to improve guideline-consistent screening, as newer guidelines call for less screening.

La revisión por pares y la selección de artículos para publicación / A revisão por pares e a seleção de artigos para publicação / Peer review and selection of articles for publishing

La revisión de manuscritos científicos por pares evaluadores pretende evaluar la originalidad, calidad y pertinencia de datos asociados a una investigación. Con algunas variaciones, este sistema se ha institucionalizado, ha sido parte central en la validación de publicaciones científicas y es aceptado por la mayoría de científicos como la mejor opción de evaluación entre las disponibles. En este artículo se describen brevemente las fortalezas y debilidades de este sistema de evaluación y se reflexiona sobre algunas alternativas para su mejoramiento, lo cual es valioso para revistas de habla española.

Peer review of scientific manuscripts aims to evaluate the originality, quality, and relevance of research data. Although with some variations, this system has been institutionalized, is still a central part in the validation of scientific publications, and is accepted by most scientists as the best evaluation option available. The article briefly describes this evaluation system’s strengths and weaknesses, and reflects on alternatives for its improvement, some of which may prove to be useful for journals published in Spanish.

A revisão de manuscritos científicos por pares avaliadores pretende examinar a originalidade, qualidade e pertinência de dados associados a uma pesquisa. Com algumas variações, este sistema se institucionalizou e é parte central na validação de publicações científicas e é aceito pela maioria dos cientistas como a melhor opção de avaliação entre as disponíveis. Neste artigo, descrevem-se brevemente as fortalezas e debilidades desse sistema de avaliação e se reflete sobre algumas alternativas para seu melhoramento, o que é valioso para revistas de língua espanhola.

Factores laborales psicosociales y calidad de vida laboral de los trabajadores de la salud de ASSBASALUD ESE Manizales (Colombia) / Psyco-social occupational factors and quality of life in employees of ASSBASALUD E.S.E. Manizales (Colombia)

Antecedentes: La Calidad de Vida Laboral, tiene que ver con el impacto del trabajo sobre las personas y sobre la eficacia organizacional, se fundamenta en aspectos como: participación de los empleados en las decisiones, reestructuración del trabajo,innovación en el sistema de recompensas para influir en el clima organizacional y mejoramiento del ambiente de trabajo. Materiales y métodos: Estudio de corte transversal, con una muestra total de 89 trabajadores de servicios de urgencias de las unidades intermedias de San Cayetano, Enea y Centro. El estudio determina los factores laborales psicosociales y calidadde vida laboral de los trabajadores de la salud de ASSBASALUD E.S.E Manizales y como se relacionan. Resultados: En los participantes, 81% son mujeres, la edad promedio 36 años, estrato socioeconómico medio 72% (3-4), 61% auxiliares de enfermería, 19% médicos, se evidenció que 55% perciben bastante Calidad de vida laboral, 11% satisfacción laboral, se encontraron relaciones de la calidad de vida laboral con el estrato socioeconómico, motivación intrínseca, apoyo directivo, satisfacción laboral, y salud general. Conclusiones:Los trabajadores perciben bastante carga de trabajo, bastante apoyodirectivo, mucha motivación intrínseca y un nivel medio de calidad de vida. Se encontró que algunos trabajadores están insatisfechos con su estabilidad en el empleo y con el salario que reciben...

Diagnóstico histológico de la hepatitis viral crónica B / Histological diagnosis of chronic viral hepatitis B

Actualmente existen alrededor de 350 millones de personas con hepatitis crónica B en el mundo, ésta es causa frecuente de la hepatitis crónica, cirrosis hepática y carcinoma hepatocelular. Objetivos: caracterizar las alteraciones histopatológicas de hepatitis B crónica en el Hospital General Docente "Abel Santamaría Cuadrado" desde enero de 2002 hasta diciembre de 2009. Diseño: se estudiaron las biopsias con el diagnóstico de hepatitis viral crónica mediante un diseño retrospectivo y transversal. Método: universo: 259 biopsias diagnosticadas como hepatitis viral crónica. Muestra: 126 biopsias diagnosticadas como hepatitis B crónica. Se determinaron la edad, el sexo, lesión histológica y correspondencia diagnóstica entre grado de lesión histológica y estadio de fibrosis con la edad. Se usó la estadística descriptiva para resumir las variables categóricas y cuantitativas, cálculos de comprobación de frecuencias y/o asociaciones de variables X², OR. Resultados: se elaboraron dibujos histológicos representativos de la clasificación de hepatitis viral crónica (Ishak, 1995). La hepatitis B crónica se diagnosticó más en los hombres de 35 a 44 años en el período estudiado. En todos los parámetros de necrosis e inflamación fue más frecuente el de 1 punto, predominó la actividad necroinflamatoria mínima que alcanzó el 34,9 %. Se observó más la fibrosis ligera. Conclusión: se comprobó que el sistema de dibujos posibilita mejor estandarización del diagnóstico en un colectivo. La hepatitis B crónica fue más frecuente entre 35-44 años, sexo masculino, con un predominio de la actividad necroinflamatoria mínima y fibrosis ligera.

Nowadays 350 millions of people suffer from chronic hepatitis B all over the world; this is a frequent cause of chronic hepatitis, hepatic cirrhosis and hepatocellular carcinoma. Objective: to characterize the histopathological alterations of chronic hepatitis B at "Abel Santamaria Cuadrado" University Hospital from January 2002 to December 2009. Design: biopsies having the diagnosis of chronic viral hepatitis by means of a retrospective and cross-sectional design were analyzed. Method: the target group included 259 biopsies with the diagnosis of chronic viral hepatitis and the sample contained 126 biopsies with the diagnosis of chronic hepatitis B. Age, sex, histological lesion and in correspondence with the diagnosis between the histological degree of the lesion and fibrosis stage according to the age. Descriptive statistics was used to sum up categorical and quantitative variables as well as calculations to confirm frequencies and/or associations of variables X² and odds ratio (OR). Results: representative histological draws for the classification of chronic viral hepatitis were created (Ishak, 1995). Chronic hepatitis B was mainly diagnosed in men (35-44 years old) during the period studied. In all the parameters analyzed of necrosis and inflammation, that one of the point 1 was the most frequent, minimal necrotic-inflammatory activity reached 34, 9%. Mild fibrosis was highly observed. Conclusions: it was confirmed that the system of draws makes possible a better standardization of the diagnosis in a group. Chronic hepatitis B was more frequent between 35-44 years old, prevailing minimal necrotic-inflammatory activity and mild fibrosis.

PATRONES DE ALIMENTACIÓN, SUEÑO Y ACTIVIDAD REPRODUCTIVA EN JERBOS DE MONGOLIA (Meriones unguiculatus) / PATTERNS OF FEEDING, SLEEP AND REPRODUCTIVE BEHAVIOR IN MONGOLIAN GERBILS (Meriones unguiculatus)

Los jerbos de Mongolia son roedores utilizados como excelente modelo biológico. A pesar de esto, su clasificación como especie diurna, nocturna o crepuscular no ha sido clara. Los experimentos que se presentan en este artículo evaluaron patrones de alimentación, sueño-actividad y actividad reproductiva y copulativa en condiciones de luz/oscuridad 12:12 en Jerbos de Mongolia. Los resultados de los experimentos sugieren un patrón nocturno de comportamiento en estos roedores.

Mongolian Gerbils are often used as a biological model, but it remains unclear whether these rodents display nocturnal, diurnal, or crepuscular patterns of behavior. The experiments presented below studied patterns of sleep-activity, feeding, and reproductive behavior under 12:12 light dark cycles. All data from these experiments suggest a nocturnal pattern of behavior in these rodents.

Seleção de ideótipos de espécies florestais de múltiplo uso em planícies fluviais do Baixo Amazonas, Pará / Selection of multipurpose forest species ideotypes of the floodplains in the Low Amazon Basin, Pará

A pesquisa objetivou selecionar ideótipos arbóreos de múltiplo uso, baseado em informações etnobotânicas de comunidades ribeirinhas de planícies fluviais do Baixo Amazonas, Pará, para uso em sistemas silvipastoris. Como essas áreas foram antropizadas pela agricultura seguida da pecuária, esses sistemas são considerados alternativas viáveis para sua recuperação. Por meio de pesquisa participativa junto aos ribeirinhos, foi utilizado um questionário semi-estruturado para determinar as espécies arbóreas de maior importância para essas populações, enfocando sua finalidade e formas de uso, consumidor destino e a abundância nas comunidades estudadas. As espécies florestais de interesse dos ribeirinhos concentraram-se nas frutíferas, para alimentação humana e animal, seguidas daquelas com função madeireira. Em sua grande maioria, essas espécies são utilizadas internamente na propriedade, não gerando produtos excedentes e foram consideradas, pelos entrevistados como de "grande" abundância na região.

The objective of this research was to select multipurpose arboreal ideotypes for use in silvipastoral systems. Selection of ideotypes was based on ethnobotanical information from riverside communities of Lower Amazon river floodplains, in Pará. Since these areas had been impacted by agriculture followed by ranching, the silvipastoral systems are considered viable alternatives for recuperating them. Through participatory research among the riverside inhabitants, a semi-structured questionnaire was used to determine the tree species of greatest importance to those populations, with focus on their purpose and forms of use, consumer destination and abundance in the communities studied. The forest species of interest to riverside people are most often fruit-producing species for human and animal food, followed by those for timber. The great majority of these species are employed internally on the property. They do not generate surplus products and were considered by the interviewees to be "greatly" abundant in the region.

Impacto de la capacitación en la mejora continua de la calidad del diagnóstico citológico / The effect of technical training for the continuous improvement of the quality in cytological diagnosis

Los indicadores generales de la eficacia en los programas de prevención del cáncer cervical se mantienen altos en nuestro país. Objetivos: Evaluar el impacto de la capacitación técnica en la mejora continua del diagnóstico citológico del cuello uterino en el Hospital "Abel Santamaría Cuadrado", período 2005-2007. Diseño: Se realizó un estudio de intervención-acción para medir el efecto de la capacitación en la calidad del diagnóstico de los citotecnólogos, medido mediante la correlación entre un primer diagnóstico emitido por el personal técnico y un segundo por un especialista en Anatomía Patológica, de una muestra de 22864 citologías. Se utilizaron las variables de concordancia en general y por el tipo de lesión, y aplicó la estadística descriptiva para variables cualitativas categóricas, expresadas en frecuencias absolutas y relativas porcentuales. Las comparaciones de frecuencias se verificaron mediante el estadígrafo de Ji cuadrado al 95 % de confianza y la prueba de kappa para la correlación entre observadores. Resultados. Se encontró un incremento de la concordancia en el 2007 con relación al periodo 2005-2006, resultado altamente significativo (X² = 75.0; gdl = 1; p = 0.00000001). La concordancia de acuerdo al diagnóstico se incrementó con la excepción del NIC-III. Conclusión. Se comprobó que la capacitación influyó en la mejoría continua de la calidad del diagnóstico citológico.

In our country general indicators to assess the effectiveness of Programs for the Prevention of Cervical Cancer keep high. Objectives: To evaluate the effects of the technical training for the continuous improvement of cytological diagnosis of the cervical cancer at "Abel Santamaria Cuadrado" University Hospital, during 2005-2007. Design: An intervention-action research was conducted in order to assess the effectiveness of the technical training process for improving quality in the diagnosis performed by the technicians of the specialty, measured through the correlation between the first diagnosis issued by technical personnel and a second one by the Pathologist, taken from a sample of 22864 cytologies. General concordance and the type of lesion were the variables used, applying descriptive statistics for categorical qualitative variables expressed in absolute frequencies and relative percentages. Frequency comparisons were verified by means of a chi square test, 95% of confidence and Kappa test for the correlation among observers. Results: An enhancement of concordance was found in 2007 in relation to the period of 2005-2006, highly significant (X² = 75.0; gdl =1; p = 0.00000001). Concordance regarding the diagnosis increased, except in NIC-III. Conclusion: It was proved that technical training process influenced on the continuous improvement of the quality for cytological diagnosis.

Correlación cito-histológica de las lesiones premalignas y malignas de cuello uterino / Cyto-histological correlation of the pre-malignant and malignant lesions of the cervix

El control de la calidad es obligatorio para cualquier programa. Es importante en el diagnóstico de lesiones de cuello uterino puesto que el cáncer cervical es la segunda causa de mortalidad en la mujer. Objetivos: Determinar la correlación cito-histológica de las lesiones premalignas y malignas de cuello uterino. Hospital Clínico Quirúrgico "Abel Santamaría" en el período 2004-2007 Diseño: Se realizó un estudio de validación externa de la citología orgánica del cuello uterino mediante un diseño observacional, descriptivo y transversal. Sujetos y método. Universo: 7174 mujeres con biopsia del cuello uterino, de las cuales 3240 provenían del Programa de Detección Precoz del Cáncer Cérvico-Uterino (PDPCCU). Se determinó la edad, correspondencia diagnóstica entre citología y biopsia y el rendimiento de la citología orgánica según tipo de lesión. Se usó la estadística descriptiva para resumir las variables categóricas y cuantitativas continuas. Se calculó la sensibilidad y la especificidad de los diagnósticos. Resultados. Se produjo un aumento progresivo de las biopsias de cuello realizadas, con un incremento significativo de los casos del PDPCCU. Predominó el diagnóstico de lesiones premalignas; las más frecuentes fueron las NIC I. La correlación cito-histológica y la sensibilidad aumentaron con la severidad de las lesiones. La especificidad se mantuvo constante para todas las lesiones. Conclusión. Se comprobó que la calidad se mantiene entre los estándares internacionales.

Quality control is compulsory for any programs, being of a great importance the diagnosis of the lesions in the cervix, cervical cancer is the second cause of death in women. Objectives: To determine the cyto-histological correlation of the pre-malignant and malignant lesions of the cervix. This research paper was carried out at "Abel Santamaria Cuadrado" University Hospital during 2004-2007. Design: An external validation study was conducted on the organic cytology of the cervix by means of an observation, descriptive and cross-sectional design. Subjects and method: Universe: 7174 women with cervix biopsy specimen, out of them 3240 came from the "Programa de Deteccion Precoz del Cancer Cervico-Uterino (PDPCCU)" (Program for the Early Detection of Cervical Cancer). Age, diagnostic correspondence with the cytology and the biopsy; as well as the yield of the organic cytology according to the type of lesion; using Descriptive Statistics to sum up the categorical and continuing quantitative variables. Sensitivity and specificity of the diagnosis was calculated. Results: A progressive increase in the cervix biopsies performed and a significant increment of the cases recorded in the Program for the Early Detection of Cervical Cancer were observed; diagnosis of the premalignant lesions prevailed and the most frequent were those identified of Cervical Intraepithelial Neoplasia (CIN-1). Cyto-histological correlation and sensitivity increased with the severity of the lesions. Conclusion: It was proved that the quality control maintains the international standards.

Aplasia cutis asociada a infartos placentarios / Aplasia cutis associated with placental infarcts

La aplasia cutis congénita (ACC) se define como la ausencia congénita parcial o total de piel que puede presentarse en forma aislada o asociada a otras anomalías o síndromes. Se clasifica en nueve grupos de acuerdo al sitio anatómico donde asienta, a la configuración que adopta, a las anomalías asociadas y etiologías probables. Presentamos un recién nacido, pretérmino extremo, con una ulceración de gran extensión, de forma estelar ubicada en la región lumbosacra. El estudio anatomopatológico de la placenta informó microinfartos isquémicos múltiples. Habiendo descartado otras causas (farmacológicas, hereditarias, tóxicas e infecciosas) así como la ausencia de anomalías del desarrollo, se llegó al diagnóstico de ACC grupo 5, relacionada con microinfartos placentarios. La ACC es una patología poco frecuente y la importancia de su diagnóstico radica en descartar anomalías del desarrollo u otras asociaciones subyacentes.

Congenital aplasia cutis (CAC) is the complete or partial absence of skin that might present alone or associated with others abnormalities or syndromes. It is classified in nine groups, according to the anatomic site where it settles, the lesions appearance, the presence or absence of associated malformations and the probable aetiology. We present an extremely preterm new born with extensive and stellate ulceration, located in the lumbosacral area. The placenta histological findings revealed multiple ischemic infarcts. After ruling out pharmacologic, toxic, infectious causes, or family history, and without evidence of malformation syndromes, we arrived to the diagnose group 5 CAC, associated with placental microinfarctions. Aplasia cutis is a rare clinical finding and it is important to make the correct diagnosis due to the possible associated abnormalities and syndromes than we can found.

Histopatología de la Hepatitis Viral Crónica C, Pinar del Río, enero 2002-julio 2008 / Histopathology of Chronic Viral Hepatitis-C, Pinar del Rio. January 2002- July 2008

A pesar de ser la hepatitis por virus C (HCVC) un problema de salud en el mundo y ser la causa más frecuente de hepatitis crónica, cirrosis hepática y carcinoma hepatocelular no se dispone de un sistema de puntaje práctico para el diagnóstico histopatológico. Objetivos: Incrementar el desempeño de los patólogos en el diagnóstico de la HCVC en el Hospital "Abel Santamaría Cuadrado" desde enero 2002 hasta julio 2008.Diseño: Se realizó una innovación tecnológica con la confección de un libro de esquemas procesados electrónicamente y se estudiaron las biopsias con HCV mediante un diseño descriptivo y transversal. Sujetos y Método. Universo: 236 biopsias diagnosticadas como HCV. Muestra: 117 biopsias diagnosticadas como HCVC (el total en el período). Se determinó edad, sexo, tipo de lesión histológica y correspondencia diagnóstica entre el grado de lesión histológica y el estadio de fibrosis con la edad. Se usó la Estadística Descriptiva para resumir variables categóricas y cuantitativas continuas, cálculos de comprobación de frecuencias y/o asociaciones de variables X², OR al 95 % de certeza. Resultados. Se elaboró un sistema de dibujos histológicos representativos de la clasificación de las hepatitis virales crónicas. La HCVC fue más frecuente entre 35-54 años, sexo femenino, con actividad necroinflamatoria moderada que alcanzó el 60.6 %. La fibrosis severa se presentó preferentemente entre 35 y 44 años. Conclusión. Se comprobó que el sistema de dibujos confeccionados posibilita una mejor estandarización del diagnóstico en un colectivo y facilita el aprendizaje de la entidad.

Despite being hepatitis caused by C virus (HCV) a worldwide health problem and the most frequent cause of chronic hepatitis, liver cirrhosis and hepatocelular carcinoma, a practical score system to perform the histopathologic diagnosis does not exist. Objective: To increase the competence of pathologists in the diagnosis of HCV at "Abel Santamaria Cuadrado" University Hospital from January 2002 to July 2008. Design: A technological innovation was created writing a book with electronically- processed diagrams and the study of HCV-biopsies by means of a descriptive and cross-sectional design. Subjects and Method: Universe: 236 biopsies with the diagnosis of HCV. Sample: 117 biopsies having the diagnosis of Chronic- HCV (the total during the period). Age, sex, type of histological lesion; diagnostic correspondence, the degree of the lesion and stage of the fibrosis in respect of the age were considered. Descriptive Statistics was used to sum up the categorical and continuing quantitative variables and the verification of frequencies through calculation and/or association of variables X², OR. Results: A system of representative histological draws for the classification of chronic viral hepatitis (Ishak, 1995) was created. Chronic-HCV was more frequent between ages 35-54, female sex, and moderate necro-inflammatory activityreached up to 60.6% between 35 and 44 years old. Conclusion: It was confirmed that the system of draws makes possible a better standardization of the diagnosis in teams and provides a more suitable learning of the disease.

Pap testing and sexual activity among young women in the United States.

OBJECTIVE: To understand whether and how recency of sexual activity is associated with Pap testing rates among young women. METHODS: We analyzed data on self-reported receipt of Pap testing and initiation of sexual activity among young women and girls aged 15 to 24 years using the 2002 National Survey of Family Growth, an in-person, population-based survey of reproductive-aged men and women in the United States. The primary outcome was receiving a Pap test and its relationship to initiation of sexual activity. A multivariable model was used to predict the probability of having had a Pap test in the previous 12 months. RESULTS: Thirty-three percent of the 2,513 women had never had sex. Of these, 13.9% had had a Pap test in the previous year. Sixty-seven percent of sexually-active women aged 15-24 reported receiving a Pap test (corresponding to 13.1 million tests). Approximately 59% women aged 15-20 years old who reported having initiated sexual activity in the previous 3 years also reported a Pap test in the previous year. CONCLUSION: The current guidelines recommend screening 3 years after initiation of vaginal intercourse or at age 21, whichever is earlier. Contrary to the current guidelines, many young women who have not had sex or who initiated sex within the previous 3 years reported having had a Pap test. Assuming that the patterns observed in this study persist, there is an urgent need for education regarding the need to adhere to guidelines to reduce the burden of potentially unnecessary Pap tests in young women. LEVEL OF EVIDENCE: III.

Regulación circadiana del comportamiento: diferencias entre especies diurnas y nocturnas / Circadian regulation of behavior: differences between diurnal and nocturnal species

La mayoría de los organismos, incluyendo los humanos, exhiben ritmos diarios de aproximadamente 24 horas en fisiología, funciones hormonales y conducta. En mamíferos, estos ritmos son controlados por un marcapasos circadiano endógeno ubicado en el núcleo supraquiasmático (NSQ) del hipotálamo que determina la organización temporal de varias conductas y procesos fisiológicos. El control circadiano de ritmos diarios difiere en especies diurnas y nocturnas pero los mecanismos que pueden explicar dichas diferencias se desconocen aún. El objetivo de esta revisión es resumir el estado actual del conocimiento sobre los relojes circadianos y de las diferencias entre especies diurnas y nocturnas.

Most organisms, including humans, show daily rhythms of about 24 hours in physiology, hormonal function, and behavior. In mammals, these rhythmsare controlled by an endogenous circadian pacemaker localized in the suprachiasmatic nucleus (SCN) of the hypothalamus that determines thetemporal organization of several behaviors and physiological processes.Circadian control of daily rhythms differs in diurnal and nocturnal speciesbut many of the mechanisms that may explain these differences remain stillunknown. The aim of this review is to summarize our current knowledge of the circadian clocks and the differences between diurnal and nocturnal species.

Mecanismos neurobiológicos de la conducta paterna / Neurobiological mechanisms of paternal behavior

En muchas especies de mamíferos (incluyendo a los humanos) las tareas del cuidado de las crías,excepto la lactancia, son compartidas por el padre y la madre. Aunque se sabe bastante sobre losefectos de la conducta materna en el desarrollo de las crías, poco se sabe acerca de la contribucióndel padre en el desarrollo neural y de comportamiento de las mismas, ni sobre los cambios hormonaleso mecanismos neurobiológicos que hacen posible el despliegue de la conducta paterna. Elpresente artículo presenta una revisión del estado actual de la investigación en esta área.

In many mammal species (including humans) both male and female engage in similar behaviors toprotect and care for the offspring, with the exception of lactation. Although much is known aboutthe effects of maternal behavior on pup development, very little is known about the contribution ofthe male on neural development and behavior of the offspirng or about hormonal changes andneurobiological mechanisms that allow the male to display paternal behavior. This article reviewsthe status of research in these topics.

Circadian regulation of dailyrhythms in orexinergic neurons in diurnal and nocturnal rodents / Regulación circadiana de los ritmos diarios en neuronas

The work presented here focuses on the differential regulation of circadian rhythmi city by the central nervous systems of the diurnal Arvicanthis niloticus (or grass rat) and the nocturnal Rattus norvegicus (or lab rat). In grass rats, neurons expressing orexin (ORX) showed a significant daily endogenous rhythm in the expression of Fos that correlated with the rhythm in sleep and wakefulness, and was reversed when compared to that seen in lab rats. Ingrass rats ORX-positive neurons received substantial projections from vasoactive intestinal polypeptide (VIP) neurons of the suprachiasmatic nucleus (SCN). In contrast few VIP positive fibers were seen adjacent to ORX positive neurons in lab rats. This species difference suggests a direct control by the SCN on neurons expressing ORX in grass rats and a more indirect regulation in lab rats. These results are consistent with the hypothesis that differences between diurnal and nocturnal species are dueto differences in the functions of targets of the SCNsuch as the ORX neurons and the dorsomedial hypothalamus.(DMH)

El trabajo que se presenta aquí se centra en la regulación diferencial que ejerce el sistema nervioso central sobre ritmos circadianos en una especie diurna, Arvicanthis niloticus, o rata Nile grass y una especie nocturna, Rattus norvegicus, o rata de laboratorio. En Nile grass, las neuronas que expresan orexina (ORX) mostraron un ritmo endógeno diario en la expresión de Fos, ritmo que correlaciona con el ciclo de sueño y vigilia de esta especie y que es opuesto en comparación con el ritmo visto en ratas de laboratorio. En Nile grass las neuronas de ORX reciben proyecciones sustanciales desde neuronas del núcleo supraquiasmático (SCN) que expresan el péptido vasoactivo intestinal (VIP). En contraste, en ratas de laboratorio se encontraron muy pocas fibras positivas para VIP adyacentes a neuronas de ORX. Esta diferencia entre especies sugiere un control directo por parte del SCN sobre neuronas que expresan ORX en Nile grass y una regulación más indirecta en ratas de laboratorio. Estos resultados son consistentes con la hipótesis según la cual las diferencias entre especies diurnas y nocturnas se deben a diferencias en las funciones de regiones que reciben eferencias del SCN tales como las neuronas de ORX y el hipotálamos dorsomedial.(DMH)

Labor del tutor en la carrera de tecnología de la salud. Consolación del Sur / The Role of the Tutor in the Health Technological Study. Consolación del Sur

El propósito de la presente investigación es evaluar en el municipio Consolación del Sur el trabajo del tutor después de la puesta en marcha de la enseñanza tutelar en la educación médica superior, lo cual es de vital importancia en la formación correcta de los futuros egresados y su formación como recursos humanos. Identificar las principales funciones, sus características y particularidades, así como identificar donde están ubicados los alumnos tutoreados y los diferentes perfiles que existen en el municipio.

The purpose of the present investigation is to assess the role of the Tutor in the High Education in Consolación del Sur which is very important for the proper training of the future graduates and its training as human resources and to identify the main functions and its characteristics and also to identify where the tutored students are, as well as the different profiles existing in the municipality.

La investigación biomédica y el consentimiento informado en el ámbito de las poblaciones e individuos vulnerables / Biomedical investigation and informed consent in vulnerable populations and individuals / A pesquisa biomédica e o consentimento informado no âmbito das populações e indivíduos vulneráveis

El contexto de transnacionalidad económica y política en el que se desarrollan las actuales investigaciones biomédicas favorece el fenómeno conocido como "medicalización" de la vida y promueve la vulnerabilidad tanto de países como de individuos. Si tenemos en cuenta que es responsabilidad asumida por la bioética la preocupación por proteger al sujeto de investigación y, de manera especial, a los más vulnerables, estos aspectos deben ser objeto de una atenta consideración y evaluación que tienda hacia la corrección de los mismos. El artículo plantea también una estrategia a través de la ética del discurso y presenta objeciones a su eficacia procedimental.

The economical and political transnationality context inside which today's biomedical investigations take place favours the phenomenon known as life's medicalization and raises both countries' and individuals' vulnerability. If we assume that the need to protect the subjects of investigation is bioethics' accepted responsibility, and, first of all, of the most vulnerable ones, these aspects should be taken into special consideration and evaluation in order to correct them, if needed.

O contexto de transnacionalidade econômica e política em que se desenvolvem as atuais pesquisas biomédicas, favorece o conhecido fenômeno denominado medicalização" da vida e promove a vulnerabilidade, tanto dos países como dos indivíduos. Se levarmos em conta, que é responsabilidade assumida pela bioética, proteger o sujeito da pesquisa, e de maneira especial os mais vulneráveis, estes aspectos devem ser objeto de uma atenta consideração e avaliação, que vise a correção dos mesmos.