Improving the ability to discriminate medical multiple-choice questions through the analysis of the competitive examination to assign residency positions in Spain.

INTRODUCTION: Psychometrics plays a vital role in evaluating educational research, including the analysis of multiple-choice exams. This study aims to improve the discriminatory ability of the "Médico Interno Residente" (MIR) medical exam in Spain, used to rank candidates for specialized healthcare training, through psychometric analysis. METHODS: We analyzed 2,890 MIR exam questions from 2009 to 2021 (totaling 147,214 exams), categorizing them based on methodology and response type. Evaluation employed classical test theory and item response theory (IRT). Classical test theory determined difficulty and discrimination indices, while IRT assessed the relationship between knowledge levels and question performance. RESULTS: Question distribution varied across categories and years. Frequently addressed knowledge areas included various medical specialties. Non-image-associated clinical cases were the easiest, while case-based clinical questions exhibited the highest discriminatory capacity, differing significantly from image-based case or negative questions. High-quality questions without images had longer stems but shorter answer choices. Adding images reduced discriminatory power and question difficulty, with image-based questions being easier. Clinical cases with images had shorter stems and longer answer choices. CONCLUSIONS: For improved exam performance, we recommend using a clinical case format followed by direct short-answer questions. Questions should be of low difficulty, providing clear and specific answers based on scientific evidence and avoiding ambiguity. Typical clinical cases with key characteristic features should be presented, excluding uncertain boundaries of medical knowledge. Questions should have lengthy stems and concise answer choices, minimizing speculation. If images are used, they should be typical, clear, consistent with the exam, and presented within clinical cases using clinical semiotics and propaedeutics.

Skin Microbial Community Associated to Strawberry Disease in Farmed Rainbow Trout (Oncorhynchus mykiss Walbaum, 1792).

Aquaculture plays a crucial role in addressing the growing global demand for food. However, diseases associated with intensive aquaculture practices, especially those affecting the skin, can present significant challenges to both fish health and the industry as a whole. Strawberry disease (SD), also known as red-mark syndrome, is a persistent and non-lethal skin condition observed in Rainbow Trout (Oncorhynchus mykiss) in the United States and various European countries. SD is a nonlethal skin condition of an unclear etiology that affects rainbow trout reared in freshwater close to the harvest period. We used a RNA-based approach to examine active microbiota in the SD skin lesions and compared to non-injured skin. Our results, based on using 16S rRNA gene next-generation sequencing, showed that the skin microbiota was dominated by the phyla Firmicutes, Proteobacteria, and Actinobacteria. The comparisons of the skin microbiota between injured and non-injured samples showed differences in the alpha diversity (Fisher index) and beta diversity metrics (ANOSIM). At the genus level, both Pseudomonas and Candidatus Midichloria were highlighted as the most abundant taxa detected in samples obtained from fish affected with strawberry diseases. In contrast, the most abundant taxa in non-injured skin were Escherichia-Shigella, Streptococcus, and Pseudoalteromonas. In conclusion, our study on SD revealed distinct differences in the microbiota composition between skin lesions and non-injured skin. This is the first description of microbiota associated with SD-injured skin samples using an RNA approach.

Occurrence of Antimicrobial-Resistant Bacteria in Intestinal Contents of Wild Marine Fish in Chile.

Antimicrobial-resistant bacteria (ARB) from the intestinal contents of wild fish may have a relevant ecological significance and could be used as indicators of antimicrobial-resistance dissemination in natural bacterial populations in water bodies impacted by urban contamination. Thus, the occurrence of ARB in the intestinal contents of pelagic and demersal wild fishes captured in anthropogenic-impacted Coquimbo Bay in Chile was studied. Culturable counts of total and antimicrobial-resistant bacteria were determined by a spread plate method using Trypticase soy agar and R2A media, both alone and supplemented with the antimicrobials amoxicillin, streptomycin, florfenicol, oxytetracycline and ciprofloxacin, respectively. Heterotrophic plate counts of pelagic and demersal fishes ranged from 1.72 × 106 CFU g-1 to 3.62 × 109 CFU g-1, showing variable proportions of antimicrobial resistance. Representative antimicrobial-resistant isolates were identified by 16S rRNA gene sequencing, and isolates (74) from pelagic fishes mainly belonged to Pseudomonas (50.0%) and Shewanella (17.6%) genera, whereas isolates (68) from demersal fishes mainly belonged to Vibrio (33.8%) and Pseudomonas (26.5%) genera. Antimicrobial-resistant isolates were tested for susceptibility to 12 antimicrobials by an agar disk diffusion method, showing highest resistance to streptomycin (85.2%) and amoxicillin (64.8%), and lowest resistance to oxytetracycline (23.2%) and ciprofloxacin (0.7%). Only furazolidone and trimethoprim/sulfamethoxazole were statistically different (p < 0.05) in comparisons between isolates from pelagic and demersal wild fishes. Furthermore, an important number of these isolates carried plasmids (53.5%) and produced Extended-Spectrum-ß-lactamases (ESBL) (16.9%), whereas the detection of Metallo-ß-Lactamases and class 1-integron was rare. This study provides evidence that wild fish are important reservoirs and spreading-vehicles of ARB, carrying plasmids and producing ESBLs in Chilean marine environments.

Lysin and Lytic Phages Reduce Vibrio Counts in Live Feed and Fish Larvae.

Vibrio species are naturally found in estuarine and marine ecosystems, but are also recognized as significant human enteropathogens, often linked to seafood-related illnesses. In aquaculture settings, Vibrio poses a substantial risk of infectious diseases, resulting in considerable stock losses and prompting the use of antimicrobials. However, this practice contributes to the proliferation of antimicrobial-resistant (AMR) bacteria and resistance genes. Our investigation aimed to explore the potential of biological agents such as bacteriophage CH20 and endolysin LysVPp1 in reducing Vibrio bacterial loads in both rotifer and fish larvae. LysVPp1's lytic activity was assessed by measuring absorbance reduction against various pathogenic Vibrio strains. Phage CH20 exhibited a limited host range, affecting only Vibrio alginolyticus GV09, a highly pathogenic strain. Both CH20 and LysVPp1 were evaluated for their effectiveness in reducing Vibrio load in rotifers or fish larvae through short-setting bioassays. Our results demonstrated the significant lytic effect of endolysin LysVPp1 on strains of Vibrio alginolyticus, Vibrio parahaemolyticus, and Vibrio splendidus. Furthermore, we have showcased the feasibility of reducing the load of pathogenic Vibrio in live feed and fish larvae by using a non-antibiotic-based approach, such as lytic phage and endolysin LysVPp1, thus contributing to the progress of a sustainable aquaculture from a One Health perspective.

Maternal Overweight and Obesity and Their Effect on the Growth of the Newborn During the First Six Months of Life.

INTRODUCTION:  Maternal overweight and obesity during pregnancy have been shown to have multiple negative effects on the mother's health, which can even affect the infant's growth by increasing weight gain and altering various indicators, such as weight for age, length for age and weight for length. While breast milk on the other hand reduces these risks, and it's the best and most complete food for the newborn. It's a dynamic fluid capable of being modified to meet the needs of each stage of the newborn, but despite this capacity and the fact that maternal body mass index can have an impact on its components, through complex biological mechanisms, it manages to reduce the negative effects accumulated during pregnancy and even promotes a healthy state in the baby. In a country like Mexico, where overweight and obesity affect a large part of the population, it is important to study their causes and which could be the effect of this increased maternal overweight during pregnancy and lactation on newborns. OBJECTIVE: Identify the alterations associated with increased maternal body mass index during pregnancy and breastfeeding on mothers' health and their possible effect on the growth of the newborn during the first six months of life. MATERIAL AND METHODS: This was a prospective cohort study. Forty-two healthy binomials (mother and child), without problems during delivery and without serious illnesses during the breastfeeding period, were included. Maternal body mass index at the beginning of pregnancy allowed us to create two comparison groups between mothers: one with adequate weight, another with overweight or obesity. Follow-up was carried out once a month during the first six months of life, evaluating the somatometric development of mothers and children. All mothers completed the six-month period of exclusive breastfeeding. RESULTS:  There were differences between both groups of women. The one that included overweight and obese women compared to the group of women with adequate weight had a higher number of pregnancies, abortions, plasma glucose levels in the third trimester of pregnancy, and a lower number of prenatal control visits and plasma platelet levels (all with p<0.05). Regarding the baby's growth, there was a difference between the weight for length classification at 60-, 120-, 150- and 180-day follow-ups. The group to which the mother was assigned with respect to her body mass index at the beginning of pregnancy (adequate weight group and overweight/obese group) was the only factor associated with the risk of the baby being overweight according to weight for length indicator at the 180-day follow-up, with an OR = 5.2 (95%CI 1.02-26.59). CONCLUSIONS: Maternal overweight and obesity during pregnancy have a negative effect on the mother's health and baby's weight gain in its weight-for-length classification during the first six months of life. Although breastfeeding has been shown to have a positive effect on the growth of the baby, exposure to a higher maternal body mass index during pregnancy triggers important metabolic alterations that promote the development of diseases. It is important to establish weight control guidelines in women who wish to become pregnant to reduce the negative effects on the mother and offspring.

Prevalence of allergic sensitization to Platanus occidentalis among adults with allergic rhinitis: A multicenter study.

Background: In the Americas there are few studies that have evaluated the frequency of allergic sensitization to Platanus occidentalis or sycamore pollen in adult patients with allergic rhinitis (AR). Objective: To determine the prevalence of allergic sensitization to P. occidentalis and to identify factors associated with its presentation. Methods: A cross-sectional study was carried out in 3 centers distributed in the northwest, west, and southeast of Mexico. Allergic sensitization to P. occidentalis was determined with a skin prick test. Prevalence and 95% confidence intervals (CI) were estimated. Results: A total of 404 patients were included, women were 233 (57.7%); the age mean was 33.8 ± 12.9 years. The overall prevalence of sensitization to P. occidentalis was 20.8% (95% CI, 17.1%-25.0%); in the northwestern: 15.9% (95% CI, 9.6%-25.1%); in the western: 21.8% (95% CI, 15.4%-29.9%); and in the southeastern: 22.4% (95% CI, 17.1%-38.8%). Multivariate analysis showed to the following allergens as factors associated with sycamore allergic sensitization: tree pollens (OR, 3.19; P = 0.001), weeds (OR, 2.49; P = 0.004), fungi (OR, 1.96; P = 0.014), and dog or cat epitheliums (OR, 1.88; P = 0.018). Conclusion: Allergic sensitization to P. occidentalis pollen in AR patients is not an infrequent event; consequently, we recommend doing the challenge test in all patients with this allergen, especially in those regions where the tree is present.

Factors Associated With Poor Sleep Quality Among Primary Healthcare Workers During the SARS-CoV-2 Pandemic.

INTRODUCTION: Sleep is one of the most important activities for health and the processes related to the central nervous system. Healthcare workers commonly present alterations in the sleep-wake cycle due to complex work schedules because 24-hour attention to the population is required in public health institutions. The increase in care needs caused by the COVID-19 pandemic caused changes in work schedules; as in Mexico, the number of patients requiring consultation in all public health units increased. Chronic partial sleep deprivation (< 7 hours of sleep in the 24-hour cycle) is the most frequent sleep alteration in Mexican health workers. However, it has not been explored whether work modifications due to the pandemic had an impact on the sleep quality of workers. OBJECTIVE: We aimed to describe the prevalence of poor sleep quality and the associated factors in workers (clinical and non-clinical) of a primary care medical unit. MATERIAL AND METHODS: We conducted an analytical and cross-sectional study during November and December 2022. We used the following tools for studying clinical and non-clinical staff working at a family medicine primary care unit: Pittsburgh Sleep Quality Index, Hamilton Anxiety Scale, Beck Depression Inventory, Maslach Burnout Inventory, and Graffar-Méndez-Castellanos socioeconomic level scale, as well as a data collection sheet and a survey of workers' knowledge, attitudes, fears, and needs regarding COVID-19. RESULTS: A total of 233 workers were surveyed. The prevalence of poor sleep quality was 56.7%. A higher score on the Beck Depression Inventory (OR: 1.21, CI 95%: 1.13-1.29), being a doctor (OR: 3.48, CI 95%: 1.5-8.01), and frequent alcohol consumption (OR: 2.4, CI 95%: 1.13-5.2) were identified as risk factors for poor sleep quality. A lower score in the depersonalization dimension of the Maslach Burnout Inventory (OR: 0.5, CI 95%: 0.26-0.99) was identified as a protective factor for poor sleep quality. CONCLUSIONS: During the pandemic, the stress of health workers increased due to work alterations that were necessary to treat the greatest number of patients, so their quality of sleep decreased. Unfortunately, the mental health of healthcare workers is often under-assessed in many institutions. Thus, it is relevant to identify risk factors for alterations (especially those of sleep), since by identifying the target population, comprehensive interventions can be carried out, which can reduce the prevalence of burnout, anxiety, and depression, but if not addressed, the alterations can lead to inadequate care for users of health units.

Mental Disorders Among Healthcare Workers During the Coronavirus Pandemic.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a disease that has become a regular part of care by health services. In the beginning, health services faced immense pressure due to new disease exposure, irregular schedules, and high work stress for healthcare workers. Unfortunately, their mental health was not adequately safeguarded, and there are few healthcare units that screen staff for depression and anxiety. OBJECTIVE: The objective of this study is to describe the prevalence and factors associated with anxiety and depression diagnoses among healthcare workers during the coronavirus pandemic. MATERIALS AND METHODS: A cross-sectional study was conducted in which depression (Beck questionnaire) and anxiety (Hamilton questionnaire) were investigated in health staff, after providing informed consent. This study was carried out during November and December 2022. All workers in all areas of a first-level unit were invited to participate in this research, so no sample calculation or sampling technique was required. Statistical analysis was performed using X2 and Student's t-test. RESULTS: Among the 232 workers surveyed, the prevalence of mild anxiety, severe anxiety, and certain levels of depression was 42.1%, 33.5%, and 18.9%, respectively. The study revealed that smoking is associated with a higher risk of anxiety diagnosis (OR=4; CI95%=1.3-12.7). A higher score on the Hamilton Anxiety Scale (OR=1.07; CI95%=1.04-1.11) as well as not being permanent staff (OR=3.34; CI95%=1.2-9.3) was found associated with depression diagnosis. CONCLUSION: The SARS-CoV-2 pandemic increased the stress and pressure on healthcare workers. Thus, early detection, timely treatment, and effective prevention measures are necessary for safeguarding health status and the provision of healthcare services.

Red Meat Hypersensitivity and Probable Alpha-Gal Syndrome: Prevalence Among Adolescents.

INTRODUCTION: It is unknown whether late adolescents represent a particular risk group for the development of red meat hypersensitivity (RMH) and alpha-gal syndrome (AGS). This age group's physiological changes and eating habits could play a determining role. This study aimed to estimate the self-reported prevalence of RMH and probable AGS among late adolescents. METHODS: A cross-sectional study analyzed a sample of 1992 Mexican adolescents between 15 and 18 years of age. The data were obtained with a previously validated questionnaire that asked about the clinical manifestations related to red meat intake. Confidence intervals at 95% (95% CI) were estimated for proportions. RESULTS: In total, there were 19 adolescents with RMH, a prevalence of 1.0% (95% CI: 0.6-1.5%). The main red meats related to symptoms were pork (89.5%), beef (21.1%), lamb (10.5%), and mutton (5.1%). The most frequent manifestations of RMH were gastrointestinal (73.7%), respiratory (63.2%), and cutaneous (63.2%). Once the symptoms were grouped, there were two cases of urticaria (2/19, 10.5%) and six cases with probable anaphylaxis (6/19, 31.6%). Finally, three adolescents were considered probable cases of AGS, which represents a prevalence of 0.15% (95% CI: 0.1-0.4%). CONCLUSION: Although the prevalence of RMH in late adolescents is low, early detection is justified because approximately one-third present with severe symptoms.

Nonelective cesarean section is associated with the prevalence of asthma among Mexican children who attended childcare centers.

Background: The cesarean section (CS) mode of delivery can influence the prevalence of bronchial asthma (BA), allergic rhinitis (AR), or atopic dermatitis (AD) by promoting modifications in the infantile microbiome. Objective: To analyze the prevalence of asthma in children who were born through CS and attended childcare centers. Methods: The data were obtained through an online survey that was answered anonymously by one of the parents; the survey inquired about the route of delivery of the child and the prevalence of BA, AR, and AD. Results: A total of 525 children were included. The frequency of births by vaginal, elective CS, or nonelective CS was 34.1%, 37.9%, and 28.0%, respectively, and the prevalence of BA, AR, and AD was 4.8%, 19.8%, and 12.4%, respectively. Multivariate analyses identified nonelective CS as a factor associated with the prevalence of BA (odds ratio: 3.51, P = 0.026). Conclusion: Our study shows that being born through nonelective CS can increase the probability of BA in children who attended daycare centers.

Revisión bibliométrica de la producción científica de salud bucal en América Latina y el Caribe durante la pandemia deCOVID-19 / Bibliometric review of the scientific production of oral health in Latin America and The Caribbean during COVID-19pandemic

Introducción: El análisis bibliométrico de la producción científica en salud permite detallar el interés de autores, instituciones, organizaciones y revistas que coadyuvaron a un mejor entendimiento de la historia natural del SARS-CoV-2, con relación a la salud bucal. Objetivo: Caracterizar la bibliometría de la producción científica en salud bucal, relacionada con la pandemia de la COVID-19 en América Latina y el Caribe. Métodos: Se analizaron 143 artículos de la base de datos Scopus, publicados durante los años 2020 y 2021. Se consideró la producción científica anual, los diez autores e instituciones y organizaciones con mayor actividad en publicación, las diez principales revistas involucradas en publicaciones de artículos del tema, así como los términos bibliométricos más citados. Resultados: En el año 2020 se publicaron 73 artículos sobre el tema, que disminuyeron en 5,47 por ciento para el año 2021. Las instituciones más involucradas en publicaciones pertenecieron a Estados Unidos, Perú y Brasil. El autor más activo fue Machado R.A. La revista Investigación Brasileña en Odontopediatría y Clínica Integrada fue la más citada con 8,47 por ciento, el artículo más citado fue "Impactos del coronavirus COVID-19 en la Odontología y el potencial salival" con 119 citas y los descriptores más utilizados fueron "los humanos", "pandemia" y "odontología". Conclusión: La mayor producción científica de artículos citados, autores con más número de citaciones y revistas de gran publicación en salud bucal de América Latina y el Caribe está en Brasil. En EE.UU. se encuentra la institución con mayor actividad de apoyo para la publicación de artículos científicos y los descriptores más utilizados "pandemia", "humano" y "enfermedad coronavirus 2019"(AU)

Introduction: The bibliometric analysis of the scientific production in health allows detailing the interest of authors, institutions, organizations and journals that contributed to a better understanding of the natural history of SARS-CoV-2, in relation to oral health. Objective: To characterize the bibliometrics of scientific production in oral health, related to COVID-19 pandemic in Latin America and the Caribbean. Methods: One hundred forty-three articles were analyzed from Scopus database, which were published in 2020 and 2021. This study considered the annual scientific production, the ten authors, institutions and organizations with the greatest publication activity, the ten main journals involved in article publications on the subject, as well as the most cited bibliometric terms. Results: In 2020, seventy three articles on the subject were published, which decreased by 5.47 percent for 2021. The institutions most involved in publications were from the United States, Peru, and Brazil. The most active author was Machado R.A. The journal Pesquisa Brasileira em Odontopediatria e Clínica Integrada was the most cited with 8.47 percent, the most cited article was "Impacts of coronavirus COVID-19 on Dentistry and salivary potential" with 119 citations and the most used descriptors were "the humans", "pandemic" and "dentistry". Conclusion: The largest scientific production of cited articles, authors with the highest number of citations, and highly-published journals on oral health in Latin America and the Caribbean is in Brazil. The institution with the greatest support activity for the publication of scientific articles and the most used descriptors "pandemic", "human" and "2019 coronavirus disease" are in the United States(AU)

Efficacy of nutrition therapy with food rich in methionine for treating nonalcoholic fatty liver / Eficacia de la terapia nutricional con alimentos ricos en metionina para el tratamiento de hígado graso no alcohólico

Non-Alcoholic Fatty Liver disease (NAFLD) can lead to Non Alcoholic steatohepatitis (NASH), cirrhosis, and liver cancer. The treatment for NAFLD involves modification of caloric intake and physical activity. NAFLD has a pro-oxidant nature; therefore, it is logical to suppose that the antioxidant methionine can be used as a treatment for this disease. Aim. This study aimed to evaluate the effect of high-methionine dietary therapy on patients with NAFLD. Materials and methods. A randomized clinical study was conducted over three months. In this study, 121 NAFLD patients participated, and the age of the participants was ≥ 20 years (experimental group included 56 and control group 65), all of whom were randomized and matched by sex, recluted from the ISSSTE hospital in Xalapa, Mexico. The patients were instructed to consume food to cover the recommended methionine daily doses, and the daily amount consumed was calculated. Methionine effect was measured as NAFLD regression and quality of life improvement. Results. Nutritional therapy induced NAFLD regression and diminished central fat accumulation, blood pressure, and the fatty liver index. Some parameters, such as liver enzymes, did not changed. The quality of life of patients improved after treatment. Conclusions. In this study, we show a hepatoprotective effect induced only in three months of chances in the diet, thus, a longer diet may generate more relevant benefits in the resistant parameters of our study(AU)

La enfermedad del hígado graso no alcohólico (NAFLD) puede conducir a la esteatohepatitis no alcohólica (NASH), la cirrosis y el cáncer de hígado. El tratamiento para NAFLD es la modificación de la ingesta calórica y la actividad física. Debido a que NAFLD tiene una naturaleza pro-oxidante; es lógico suponer que el antioxidante metionina puede utilizarse en el tratamiento de esta enfermedad. Objetivo. el presente trabajo evaluó el papel de la terapia nutricional con alimentos ricos en metioninaen pacientes con NAFLD. Materiales y Métodos. Se realizó un ensayo clínico aleatorizado durante tres meses. Participaron en el estudio 121 pacientes con NAFLD con edad ≥ 20 años (56 en el grupo experimental y 65 en el control), todos aleatorizados y pareados por sexo, reclutados de la Clínica Hospital ISSTE en la ciudad de Xalapa, México, en el año 2015. Se instruyó a los pacientes en consumir los alimentos hasta completar la dosis diaria recomendada de metioninay se calculó la cantidad diaria consumida. Su efecto se midió como la regresión de NAFLD y la mejora de la calidad de vida. Resultados. La terapia nutricional retrocedió NAFLD; disminuyó la acumulación de grasa central, la presión arterial y el índice de hígado graso. Algunos parámetros, como las enzimas de la función hepática, no se modificaron con el tratamiento. Otro parámetro fue la mejora de la calidad de vida de los pacientes tratados. Conclusiones. En este trabajo mostramos un impacto hepatoprotector producido con tan solo tres meses de cambios en la dieta, por lo que una dieta más prolongada podría generar beneficios aún más significativos en los parámetros resistentes en nuestro protocolo(AU)

Asthma and COVID-19 Among Healthcare Workers from a Mexican Hospital: Is There an Association?

ABSTRACT Background: Asthma does not appear to be a risk factor for developing COVID-19. Objective: The objective of the study was to analyze the role of asthma as a factor associated with COVID-19 among healthcare workers (HW). Methods: A cross-sectional study was conducted in HW from a Mexican hospital. Data were obtained through an epidemiological survey that included age, sex, and history of COVID-19. Multivariate logistic regression analysis was performed to identify factors associated with COVID-19. Results: In total, 2295 HW were included (63.1% women; mean age 39.1 years); and 1550 (67.5%) were medical personnel. The prevalence of asthma in HW with COVID-19 was 8.3%; for the group without COVID-19, the prevalence was 5.3% (p = 0.011). The multivariate analyses suggested that asthma was associated with COVID-19 (OR 1.59, p = 0.007). Conclusion: Our study suggests that asthma could be a factor associated with COVID-19 in HW.

Prevalence of allergic diseases and their symptoms in schoolchildren according to the birth mode / Prevalencia de enfermedades alérgicas y síntomas en escolares de acuerdo con la vía de nacimiento

Abstract Background: The relationship between birth by cesarean section (CS) and allergic diseases’ prevalence continues to be controversial. We aimed to investigate if being born by CS is associated with the prevalence of allergic diseases and their symptoms in schoolchildren. Methods: This study included children between 6 and 7 years of age, selected by population-based sampling. We investigated the presence of allergic diseases and their symptoms, family history of asthma, smoking in parents, breastfeeding, exposure to pets, the season of birth, number of siblings, consumption of unpasteurized cow’s milk, and mode of birth. Results: We included 1003 subjects (526 girls), of which 44.2% were born through CS. The prevalence of allergic diseases did not differ according to birth mode. Asthma in either parent, current smoking by the mother, breastfeeding, and unpasteurized cow’s milk consumption were associated with wheezing at some time in life. Conclusions: No association between CS birth mode and allergic diseases and their symptoms was found.

Resumen Introducción: La relación entre el nacimiento por operación cesárea y las enfermedades alérgicas es controversial. El objetivo del presente estudio fue investigar si el nacimiento por cesárea se asocia con la prevalencia de las enfermedades alérgicas y sus síntomas en escolares. Métodos: Estudio transversal que incluyó una muestra probabilística de niños de 6 a 7 años. Se registraron la presencia de enfermedades alérgicas y sus síntomas, la historia familiar de asma, el tabaquismo en los padres, la alimentación al seno materno, la exposición a mascotas, la estación de nacimiento, el número de hermanos, el consumo de leche no pasteurizada de vaca y la vía de nacimiento. Resultados: Se incluyeron 1003 sujetos (526 niñas), de los cuales el 44.2% nacieron por cesárea. La prevalencia de enfermedades alérgicas no difirió según la vía de nacimiento. El antecedente de asma en alguno de los progenitores, el tabaquismo actual en la madre, la lactancia materna y el consumo de leche no pasteurizada de vaca se asociaron con sibilancias presentes alguna vez en la vida. Conclusiones: No se demostró asociación entre el nacimiento por cesárea y las enfermedades alérgicas y sus síntomas.

Lugar de residencia y grado de marginación como factores pronóstico de supervivencia al cáncer de próstata en Veracruz, México / Place of residence and social marginalization as prognostic factors for prostate cancer survival in Veracruz, Mexico

Resumen Objetivos: Determinar si el lugar de residencia y el grado de marginación se encuentran asociados a la supervivencia al cáncer de próstata. Materiales y métodos: Se incluyeron a todos los pacientes diagnosticados con cáncer de próstata (CP) en el periodo 2013-2017 en un hospital de tercer nivel de atención de Veracruz, México. Los casos expuestos fueron los pacientes que habitualmente residían en zonas rurales, los no expuestos fueron los de zonas urbanas. Se recolectaron variables según características clínico epidemiológicas e histopatológicas. Para medir la supervivencia se utilizó el método de Kaplan Meier y la prueba de Log Rank. Los factores pronósticos fueron determinados calculando hazard ratio ajustado (HRa) en un análisis multivariado mediante el método de riesgos proporcionales de Cox. Resultados: Se analizaron 186 casos de CP. La supervivencia global a 5 años fue de 48,3%. Los hombres que residían en zonas urbanas tuvieron una probabilidad de supervivencia mayor que quienes residían en zonas rurales (HRa 1,67; IC 95%: 1,16-2,41). Asimismo, las personas que vivían en lugares catalogados como zonas de baja marginación tuvieron una mayor probabilidad de supervivencia que quienes vivían en zonas de alta marginación (HRa 2,32; IC 95%: 1,47-3,66). Conclusiones: El lugar de residencia rural se identificó como un factor de mal pronóstico para la supervivencia de pacientes con CP independientemente de otras variables sociodemográficas y clínicas; los pacientes que vivían en lugares con grados de marginación más elevados tuvieron un pronóstico desfavorable de supervivencia.

ABSTRACT Objectives: To determine if the place of residence and the level of social marginalization are associated with prostate cancer survival. Materials and methods: All patients diagnosed with prostate cancer (PC) in the period from 2013 to 2017 in a tertiary healthcare hospital in Veracruz, Mexico were included. Patients resided in rural and urban areas. Variables were collected according to clinical-epidemiological and histopathological characteristics. The Kaplan Meier method and the Log Rank test were used to measure survival. Prognostic factors were determined by calculating the adjusted hazard ratio (HRa) in a multivariate analysis using the Cox proportional risk method. Results: A total of 186 PC cases were analyzed. Overall, after 5 years, 48.3% of the patients survived. Men living in urban areas had a higher probability of survival than those living in rural areas (HRa 1.67, 95% CI 1.16-2.41). Similarly, people living in areas classified as low- marginalization zones had a higher probability of survival than those living in areas with a high level of social marginalization (HRa 2.32, 95% CI 1.47-3.66). Conclusions: To reside in a rural place was identified as a negative prognostic factor for the survival of patients with PC regardless of other sociodemographic and clinical variables; patients living in high-marginalization places had an unfavorable survival prognosis.

Uso de tecnologías de la información en la gestión de un centro de medicina integrativa especializado en adicciones / Use of information technologies in the management of an integrative medicine center specialized in drug-addiction

Objetivo. Describir el perfil de usuarios, pacientes atendidos y tratamientos brindados en el Centro Takiwasi por medio del sistema de información PPLUS, entre los años 2013-2018. Materiales y métodos. Estudio descriptivo. De acuerdo con los objetivos bajo los cuales el sistema PPLUS ha sido concebido, se recolectó información sobre la cantidad de registros, número de usuarios del sistema, áreas involucradas, modalidad de egreso de la comunidad terapéutica, prácticas de medicina tradicional amazónica, uso de los módulos del sistema, y perfiles de usuarios por fines de investigación. Resultados. Se encontró una tendencia irregular de registros de información, siendo registrado el pico máximo en el año 2016. Ciento ochenta y ocho pacientes egresaron de la comunidad terapéutica, de los cuales el 45,2% (85) recibió alta médica. Entre el 54,8% de los pacientes de Takiwasi que no terminaron el tratamiento, un 33,5% no lo hicieron por solicitar retiro voluntario, en su mayoría durante el primer mes de tratamiento. Se registraron 19 620 prácticas de medicina tradicional amazónica, de las cuales las sesiones de ayahuasca representaron el 36,1% y las sesiones de purga, el 39,1%. Se observó que el 46,5% de perfiles de investigación correspondieron a practicantes de psicología, mientras que el 29,8% (34) fueron investigadores externos. Conclusiones. La implementación y uso del sistema PPLUS en el Centro Takiwasi, durante los años 2013 a 2018, ha sido gradual, pero no lineal; sin embargo, la información obtenida y la capacitación del personal en su uso hacen que se convierta en una herramienta tecnológica con potencial para la investigación y desarrollo a corto plazo.

Objective. To describe the profile of users, patients treated, and treatments provided at the Takiwasi Center, through the PPLUS information system, between the years 2013-2018. Materials and methods. A descriptive study. According to the objectives under which the PPLUS system has been conceived, information was collected on the number of registries, system users, areas involved, modality of clinical discharge, practices of traditional Amazonian medicine, use of system modules, and user profiles for research purposes. Results. An irregular trend of information registers was found, with the maximum peak recorded in 2016. 188 patients were discharged from the therapeutic community, of which 45.2% of them (85) received medical discharge. Among 54.8% of Takiwasi patients who did not complete the treatment, 33.5% requested voluntary withdrawal, mostly during the first month of treatment. 19620 practices of traditional Amazonian medicine have been recorded, of which ayahuasca sessions represented 36.1% and purge sessions, 39.1%. It was observed that 46,5% of research profiles corresponded to psychology practitioners, while 29.8% (34) were external researchers. Conclusions. The implementation and use of the PPLUS system at the Takiwasi Center, during the years 2013 to 2018, has been gradual but not linear; However, the information obtained and the training of personnel in its use make it a technological tool with potential for short-term research and development.

Is suicidal ideation associated with allergic asthma and allergic rhinitis? / Ideação suicida apresenta associação com asma e rinite alérgicas?

ABSTRACT Objective: To investigate whether there is an association between suicidal ideation (SI) and allergic diseases in adults. Methods: This was a comparative cross-sectional study involving individuals ranging from 20 to 50 years of age recruited from a university hospital in the city of Guadalajara, Mexico. We included patients with a confirmed diagnosis of allergic asthma, those with a confirmed diagnosis of allergic rhinitis, and healthy controls. All subjects completed the Beck Depression Inventory-II (BDI-II), which includes an item that evaluates the presence of suicidal thoughts or desires within the last two weeks, in order to identify SI. Results: The sample comprised 115 patients with allergic asthma, 111 patients with allergic rhinitis, and 96 healthy controls. The number of individuals identified with SI in the three groups were, respectively, 17 (14.8%), 13 (11.7%), and 8 (8.3%). Regarding the presence of SI, no statistically significant association was found in the allergic asthma group (OR = 1.98; 95% CI: 0.78-4.64; p = 0.154) or in the allergic rhinitis group (OR = 1.46; 95% CI: 0.58-3.68; p = 0.424) when they were compared with the control group. However, the presence of depression was associated with SI in the three groups: allergic asthma (OR = 12.36; 95% CI: 2.67-57.15; p = 0.001); allergic rhinitis (OR = 6.20; 95% CI: 1.66-23.14; p = 0.006); and control (OR = 21.0; 95% CI: 3.75-117.36; p < 0,001). Conclusions: In comparison with the control group, no association was found between SI and the groups with allergic diseases. In contrast, there was association between SI and depression in the three groups.

RESUMO Objetivo: Investigar se existe associação entre ideação suicida (IS) e doenças alérgicas em adultos. Métodos: Estudo transversal comparativo envolvendo indivíduos com idade entre 20 e 50 anos recrutados em um hospital universitário da cidade de Guadalajara, México. Foram incluídos pacientes com diagnóstico confirmado de asma alérgica, aqueles com diagnóstico confirmado de rinite alérgica e controles saudáveis. Todos os sujeitos preencheram o Beck Depression Inventory-II (BDI-II), que inclui um item que avalia a presença de pensamentos ou desejos suicidas nas últimas duas semanas, a fim de identificar IS. Resultados: A amostra foi composta por 115 pacientes com asma alérgica, 111 pacientes com rinite alérgica e 96 controles saudáveis. O número de indivíduos identificados com IS nos três grupos foi de 17 (14,8%), 13 (11,7%) e 8 (8,3%), respectivamente. Quanto à presença de IS, não foi encontrada associação estatisticamente significativa no grupo asma alérgica (OR = 1,98; IC95%: 0,78-4,64; p = 0,154) ou no grupo rinite alérgica (OR = 1,46; IC95%: 0,58-3,68; p = 0,424) quando os mesmos foram comparados com o grupo controle. No entanto, a presença de depressão apresentou associação com IS nos três grupos: asma alérgica (OR = 12,36; IC95%: 2,67-57,15; p = 0,001); rinite alérgica (OR = 6,20; IC95%: 1,66-23,14; p = 0,006); e controle (OR = 21,0; IC95%: 3,75-117,36; p < 0,001). Conclusões: Em comparação com o grupo controle, não foi encontrada associação entre IS e os grupos com doenças alérgicas. Por outro lado, houve associação entre IS e depressão nos três grupos.

Propiedades psicométricas de la escala de Locus de Control de la Salud en Dios en una muestra de mexicanos con diabetes mellitus tipo 2 / Psychometric properties of the God Locus of Health Control scale in a sample of mexicans with type 2 diabetes mellitus

En este estudio se obtuvo evidencia de validez y confiabilidad de la escala de Locus de Control de la Salud en Dios (GLHC) en una muestra de 539 adultos mexicanos con diabetes mellitus tipo 2. El análisis de validez se basó en el análisis del contenido de los ítems y de la estructura interna del GLHC. El primer procedimiento estuvo a cargo de seis expertos, quienes evaluaron la pertinencia de la adaptación de los ítems. El segundo procedimiento fue un análisis factorial confirmatorio de grupo múltiple, de acuerdo al sexo y edad, a fin de evaluar la invarianza de medición del GLHC. Finalmente, la confiabilidad fue calculada mediante los coeficientes ω y H. El análisis factorial confirmatorio demostró una estructura de un solo factor con seis ítems, interpretable para la población de estudio con invarianza de medición por sexo, aunque deben tomarse precauciones al interpretar comparaciones por grupos de edad. La confiabilidad del constructo obtuvo magnitudes elevadas (>.90). Los resultados indican que la GLHC puede brindar información válida y confiable para valorar el locus de control de la salud en Dios para mexicanos con diabetes mellitus tipo 2.

The validity and reliability of the God Locus of Health Control (GLHC) scale were determined in a sample of 539 Mexican adults with type 2 diabetes mellitus. The validity analysis was based on the analysis of the GLHC scale's items content and internal structure. The first procedure was conducted by six experts who evaluated the pertinence of the items adaptation. The second procedure consisted of a multiple-group confirmatory factor analysis by gender and age, aimed to evaluate the GLHC scale's measurement invariance. Finally, reliability was estimated by means of coefficients ω and H. The confirmatory factor analysis demonstrated a six-item unifactorial structure, interpretable for the study population with measurement invariance by gender. Nevertheless, precautions should be taken when interpreting age-group comparisons. The magnitude of the construct reliability was high (>0.90). The results indicate that the GLHC scale may provide valid and reliable information to assess the God Locus of Health Control in Mexicans with type 2 diabetes mellitus.

Mortalidad y factores sociales del cáncer de próstata para la gestión de políticas públicas. Veracruz, México / Mortality and social factors of prostate cancer for public policy management. Veracruz, Mexic / Mortalidade e factores sociais do cancro da próstata para a gestão de políticas públicas. Veracruz, México

Introducción: las elevadas tasas de mortalidad por cáncer de próstata en Veracruz indican la necesidad de gestionar políticas públicas equitativas para su control. Por ello, es necesario analizar las tendencias de mortalidad y los factores sociales relacionados con la salud de la población. Métodos: cálculo de las tasas de mortalidad a nivel nacional y estatal por edad, y en Veracruz, por regiones económicas; en relación con su grado de rezago social. Resultados: La tasa de mortalidad por cáncer de próstata en Veracruz es mayor que la tasa nacional. Dentro del estado, la región del Papaloapan presentó la mayor mortalidad, y un grado de rezago social medio.

Introduction: the high mortality rates due to prostate cancer in Veracruz indicate the need to manage equitable public policies for its control. Therefore, it is necessary to analyze mortality trends and social factors related to population health. Methods: Calculation of mortality rates at national and state level by age, and in Veracruz, by economic regions; in relation to their degree of social backwardness. Results: The mortality rate for prostate cancer in Veracruz is higher than the national rate. Within the state, the Papaloapan region presented the highest mortality and a medium degree of social backwardness.

Introdução: As elevadas taxas de mortalidade por cancro da próstata em Veracruz indicam a necessidade de políticas públicas equitativas para controlar o cancro da próstata. Por isso, é necessário analisar as tendências de mortalidade e os fatores sociais relacionados à saúde da população. Métodos: Cálculo das taxas de mortalidade a nível nacional e estadual, por idade, e em Veracruz, por regiões económicas, em relação ao seu grau de atraso social. Resultados: A taxa de mortalidade por cancro da próstata em Veracruz é superior à taxa nacional. Dentro do estado, a região de Papaloapan apresentou a maior mortalidade e um grau médio de atraso social.

Mortalidad y factores sociales del cáncer de próstata para la gestión de políticas públicas. veracruz, méxico

Introducción: Las elevadas tasas de mortalidad por cáncer de próstata en Veracruz indican la necesidad de gestionar políticas públicas equitativas para su control. Por ello, es necesario analizar las tendencias de mortalidad y los factores sociales relacionados con la salud de la población. Métodos: Cálculo de las tasas de mortalidad a nivel nacional y estatal por edad, y en Veracruz, por regiones económicas; en relación con su grado de rezago social. Resultados: La tasa de mortalidad por cáncer de próstata en Veracruz es mayor que la tasa nacional. Dentro del estado, la región del Papaloapan presentó la mayor mortalidad, y un grado de rezago social medio. Conclusiones: De acuerdo con los datos analizados, las regiones con las tasas más altas de mortalidad en Veracruz no corresponden a las regiones con alto grado de rezago social.

Introduction: The high rates of mortality caused by prostate cancer in Veracruz indicate the need to manage equitable public policies for its control. For this reason, it is necessary to analyze mortality trends and social factors related to population health. Methods: Calculation of mortality rates at national-state level, by age; and for Veracruz, by economic regions; in relation to its degree of social lag. Results: The mortality rate of prostate cancer in Veracruz is higher than the national rate. Within the state, the Papaloapan region presented the highest mortality, and an average degree of social lag. Conclusions: In Veracruz, according to the data analyzed, the regions with the highest mortality rates do not correspond to regions with a high degree of social lag.

Introdução: As altas taxas de mortalidade por câncer de próstata em Veracruz indicam a necessidade de gerenciar políticas públicas equitativas para seu controle. Para isso, é necessário analisar tendências de mortalidade e fatores sociais relacionados à saúde da população. Métodos: Cálculo das taxas de mortalidade a nível nacional e estatal, por idade; e para Veracruz, por regiões econômicas; em relação ao seu grau de atraso social. Resultados: A taxa de mortalidade por câncer de próstata em Veracruz é superior à taxa nacional. Dentro do estado, a região de Papaloapan apresentou a maior mortalidade e um grau de atraso social médio. Conclusões: De acordo com os dados analisados, em Veracruz, as regiões com maiores taxas de mortalidade não correspondem a regiões com alto grau de atraso social.