Healthy Universities: Concepts, Dimensions and Approaches for the Construction of Healthy University Environments / Universidades saludables: conceptos, dimensiones y enfoques para la construcción de entornos universitarios saludables / Universidades saudáveis: conceitos, dimensões e enfoques para a construção de entornos universitários saudáveis

Abstract The purpose of this study was to analyse the health paradigms that prevail in the actions of the current university world by specifying the dimensions to guide interventions within the framework of Healthy Universities and by proposing a comprehensive and integrated vision of health for the construction of these interventions. Thus, a systematic review of the main available scientific databases based on an interpretative perspective was carried out. Forty-four articles, published between 2007 and 2018 and related to university environments or some of their stakeholders that included the addressed dimensions of Health: physical, mental, social, environmental and spiritual were selected. The results show that this field of study is growing, most studies point to the physical and mental dimension of the students. Few studies were found in the other addressed dimensions for teachers, employees and pensioners. In conclusion, the relevance of the five dimensions was identified; although the least studied were environmental and spiritual, they have great potential for the development of interventions. Healthy universities must articulate the five dimensions with the stakeholders that make up their communities from the holistic and salutogenic approach to overcome the bio-medical trend of current interventions.

Resumen El objetivo de este estudio fue analizar los paradigmas de salud que predominan en las acciones del mundo universitario actual, concretando las dimensiones para orientar intervenciones en el marco de Universidades Saludables, así mismo proponer una visión integral e integrada de lo saludable para la construcción de estas intervenciones. Para ello desde una perspectiva interpretativa se realizó una revisión sistemática de las principales bases de datos científicas disponibles, se seleccionaron 44 artículos publicados entre el año 2007 al 2018, con relación a entornos universitarios o con algunos de sus stakeholders que incluyeran las dimensiones de la salud abordadas: física, mental, social, ambiental y espiritual. Se encontró que este campo de estudio es incipiente, la mayoría de los estudios apuntan a la dimensión física y mental de los estudiantes, se encontraron pocos estudios en las otras dimensiones abordadas y para los docentes, empleados y pensionados. Como conclusión se identificó la relevancia de las cinco dimensiones, siendo las menos estudiadas la social, la ambiental y la espiritual, no obstante, con un gran potencial para el desarrollo de intervenciones. Las universidades saludables deben articular las cinco dimensiones y stakeholders que componen sus comunidades desde el enfoque holístico y el salutogénico, superando la tendencia bio-médica de las actuales intervenciones.

Resumo O objetivo deste estudo foi analisar os paradigmas da saúde que predominam nas ações do mundo universitário atual, concretando as dimensões para orientar intervenções no marco de Universidades Saudáveis, mesmo assim propor uma visão integral e integrada de o saudável para a construção destas intervenções. Para isto desde uma perspectiva interpretativa se fez uma revisão sistemática das principais bases de dados científicas disponíveis, se selecionaram 44 artigos publicados entre o ano 2007 ao 2018, com relação a entornos universitários ou com alguns de seus stakeholders que incluíram as dimensões da saúde abordadas: física, mental, social, ambiental e espiritual. Encontrou-se que este campo de estudo é incipiente, a maioria dos estudos apontam à dimensão física e mental dos estudantes, encontraram-se poucos estudos nas outras dimensões abordadas e para os docentes, empregados e aposentados. Como conclusão se identificou a relevância das cinco dimensões, sendo as menos estudadas a social, a ambiental e a espiritual, não obstante, com um grande potencial para o desenvolvimento de intervenções. As universidades saudáveis devem articular as cinco dimensões e stakeholders que compõem suas comunidades desde o enfoque holístico e o salutogênico, superando a tendencia biomédica das atuais intervenções.

Supraclavius muscle observed during anterior scalenectomy for thoracic outlet syndrome: A report of two cases and review of the literature.

Background: Thoracic outlet syndrome (TOS) is a clinical diagnosis caused by compression of neurovascular structures in the thoracic outlet. There are a variety of structures that cause compression implicated in TOS. TOS patients frequently require surgical decompression. Various structural anomalies encountered during decompression have been reported in the literature. Case Description: We present two females (ages 42 and 45) that each underwent anterior scalenectomy for thoracic outlet decompression through a supraclavicular approach. A supraclavius muscle anomaly was observed in both patients. Analogous to the two reports previously described in the literature, the muscle inserted, along the medial superior undersurface of the clavicle and originated dorsally along the trapezius muscle. This is not to be confused with the subclavius posticus muscle, which originates from the first rib and inserts on the upper border of the scapula. Conclusion: These two cases represent just the third and fourth ever descriptions of a supraclavius muscle anomaly encountered during TOS surgery. Due to the wide variety of anatomical variations encountered during TOS surgery, it is not only crucial for continued reporting of such anatomical variations to be reported in the literature but equally important for clinicians that treat TOS to be aware of such variations.

Factores de mal pronóstico en pacientes mayores de 70 años con síndromecoronario isquémico agudo / Poor prognostic factors in patients older than 70 years with acute coronary syndrome

La información sobre escalas pronósticas en el paciente geriátrico con síndrome coronario isquémico agudo (SICA) es escasa; por esto, nos planteamos como objetivo identificar a los factores que condicionen un deterioro en la función cardíaca y que fuesen valorables en este grupo de edad, en la población mexicana. Pacientes y método. Estudio descriptivo, retrospectivo. Se captaron los datos de pacientes mayores de 70 años diagnosticados con SICA, en el Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM), durante el periodo 1 de enero de 2006 al 30 de mayo de 2010; estos fueron analizados estadísticamente. Resultados. Se registraron los datos de 119 pacientes, 26 mujeres y 93 hombres, con media de edad de 75,91 +/- 4,68 y rango 70-94. Se encontró que la lesión de la arteria descendente anterior es una predictora, con los modelos de análisis de regresión lineal (método ôintroducirõ), regresión logística multinomial, estimación ponderada (para sexo), ecuación de regresión de Cox y regresión logística binaria (únicamente para el sexo masculino). Conclusiones. Las enfermedades de base no controladas adecuadamente y la lesión de la arteria descendente anterior son las principales variables predictoras de muerte en mayores de 70 años con SICA...

Since the information about prognostic scales in geriatric patients with acute coronary syndrome (ACS) is scarce, our main objective was to search the factors that conditioned deterioration in cardiac function and evaluate them in this age group in the Mexican population. Patients and method. This was a descriptive, retrospective study. Data from patients older than 70 years diagnosed with acute coronary syndrome at the Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM), during the period from January 1 of 2006 to May 30 of 2010 and these were statistically analyzed. Results. The data of 119 patients were recorded, with 26 women and 93 men, with mean age of 75,91 +/- 4,68 and range 70-94. The lesion of the anterior descending artery was found as predictive for mortality with the models linear regression analysis (enter method), multinomial logistic regression, weighted estimation (for sex), Cox regression and binary logistic regression (only for male). Conclusions. The underlying diseases not controlled properly and lesion of the anterior descending artery are the most important predictive variables of death in the Mexican population older of 70 years with acute coronary syndrome...

Valor pronóstico de la PCT y proteína C reactiva como marcadores de gravedad en neumonía adquirida en la comunidad en adultos mayores / Prognostic value of PCT and CRP as markers of severity in community acquired pneumonia in older adults

Introducción: La neumonía adquirida en la comunidad (NAC) es una de las principales causas de mortalidad en el mundo. La proteína C reactiva puede identificar a pacientes críticamente enfermos. La procalcitonina (PCT) ha sido referida como un marcador sensible de gravedad de la infección bacteriana y sepsis. Metodología: Se realizó un estudio cohorte prospectivo en el servicio de geriatría del Centro Médico ISSEMYM, Metepec, Estado de México, con todos los pacientes que ingresaron a hospitalización con diagnóstico de NAC entre mayo 2012 a marzo 2013. Se midieron PCR, PCT y laboratorios de rutina. Para la comparación de variables continuas se utilizó la T de Student ó U de Mann Whitney según su distribución. Para la comparación de variables cate-góricas se utilizo la prueba de X2. Para el análisis de supervivencia se utilizó el estimador de Kaplan-Meier. Para establecer el riesgo de mortalidad se empleó el modelo de regresión de COX obteniendo el Hazard Ratio. Para la correlación entre los niveles séricos de PCT y PCR se utilizó el coeficiente de correlación de Spearman. Resultados: Se registraron los datos de un total de 82 pacientes. La supervivencia media cuando PCT > de 0.5 ng/dl fue de 17 días (IC 95%, 11 a 23 días) versus 26 días (IC 95%, 17 a 35 días) para PCT < de 0.5 ng/dl (p < 0.01). Conclusiones: El nivel sérico de PCT mayor a 0.5 ng/dl mostró ser un marcador pronóstico en pacientes geriátricos con neumonía...(AU)

Postresection parathyroid hormone and parathyroid hormone decline accurately predict hypocalcemia after thyroidectomy.

Hypocalcemia is the most frequent complication after total thyroidectomy. Parathyroid hormone (PTH) measurement has been proposed as an early predictor of this condition. Total thyroidectomy was performed in 39 patients. Hypocalcemia was present in 15 cases (38%). Patients undergoing hemithyroidectomy (n = 13) were considered control subjects not developing hypocalcemia. PTH was measured before surgery and 10 minutes after resection of the gland using a rapid (15 minutes) chemiluminescent immunometric assay. Patients developing hypocalcemia had lower calcium and postresection PTH levels and higher PTH decline than patients not developing hypocalcemia (P < .0001). PTH decline (cutoff value, 62.5%) had the better sensitivity (93.3%) for predicting hypocalcemia, allowing for a fairly safe early discharge. However, the best overall results corresponded to the combination of postresection PTH level (< or = 18 pg/mL [< or = 1.9 pmol/L]) and PTH decline (>62.5%), with a sensitivity of 90% and a specificity of 97.9%. Perioperative PTH measures can accurately predict hypocalcemia after thyroidectomy, granting the laboratory a key role in the immediate decision about calcium supplementation for patients at risk.

Angiotensin converting enzyme genotype and chronic allograft nephropathy in protocol biopsies.

Genotype DD of the angiotensin-converting enzyme (ACE) is not associated with an increased incidence of native renal diseases, although it could modulate progression to renal failure in patients who already display chronic lesions. Because its role in renal allograft degeneration is not well characterized, whether ACE genotype was associated with the prevalence of chronic allograft nephropathy (CAN) was studied, in a group of protocol biopsies from 180 patients, or with the incidence of CAN in 152 patients with at least two sequential biopsies. As a control group, ACE genotype was also studied in 41 donors and 72 healthy subjects. For analyzing the influence of ACE genotype in graft survival, patients were grouped into six categories (II-normal biopsy, ID-normal, DD-normal, II-CAN, ID-CAN and DD-CAN). Finally, relative renal ACE mRNA levels were measured in 67 cases by real-time PCR using the delta threshold cycle method. ACE-DD genotype was more frequent in patients who received a transplant than in control subjects (43.3% versus 30.1%, P = 0.026), but prevalence (DD = 42.7% versus non-DD = 42.2%) or incidence (DD = 24.6% versus non-DD = 29.9%) of CAN was not different regarding recipient ACE genotype. Furthermore, patients with the ACE-DD genotype and CAN had the poorest graft survival (II-normal = 100%, ID-normal = 91%, DD-normal = 84%, II-CAN = 100%, ID-CAN = 66%, and DD-CAN = 36%; P = 0.034) and higher ACE mRNA levels than non-DD and CAN (DD = -3.36 +/- 2.35 versus non-DD = -5.65 +/- 1.72-fold in ACE copies; P = 0.012). It is concluded that ACE-DD genotype is not associated with an increased prevalence or incidence of CAN but is actually associated with higher ACE mRNA levels and poorer graft survival in patients who already display CAN.

Altered 5-HT2A and 5-HT4 postsynaptic receptors and their intracellular signalling systems IP3 and cAMP in brains from depressed violent suicide victims.

Serotonin 5-HT2A and 5-HT4 binding parameters and their second messengers 1,4,5-inositol triphosphate (IP3) and cyclic adenosyl monophosphate (cAMP) were studied in the frontal cortex, hippocampus, caudate nucleus and amygdala of 19 control subjects and 19 antidepressant-free, violent suicide victims. A significantly higher number of 5-HT4 receptors and higher second messenger cAMP concentrations were found in the frontal cortex and caudate nucleus of the depressed suicide victims as compared with the control group. Furthermore, significantly increased 5-HT2A binding sites and IP3 concentrations were noted in the caudate nucleus of the suicide victims, together with a significantly reduced number of 5-HT2A binding sites, higher binding affinity and increased IP3 concentrations in the hippocampus. No significant alterations in 5-HT4 and cAMP or in 5-HT2A and IP3 concentrations were observed in the amygdala. The caudate nucleus of depressed suicide victims seems to be the brain region with the highest alteration of the serotonergic system, and hence with the most diagnostic sensitivity. Further studies on suicidality and depression should focus on the functionality of the caudate nucleus.