Older adult psychopathology: international comparisons of self-reports, collateral reports, and cross-informant agreement.

OBJECTIVES: To conduct international comparisons of self-reports, collateral reports, and cross-informant agreement regarding older adult psychopathology. PARTICIPANTS: We compared self-ratings of problems (e.g. I cry a lot) and personal strengths (e.g. I like to help others) for 10,686 adults aged 60-102 years from 19 societies and collateral ratings for 7,065 of these adults from 12 societies. MEASUREMENTS: Data were obtained via the Older Adult Self-Report (OASR) and the Older Adult Behavior Checklist (OABCL; Achenbach et al., ). RESULTS: Cronbach's alphas were .76 (OASR) and .80 (OABCL) averaged across societies. Across societies, 27 of the 30 problem items with the highest mean ratings and 28 of the 30 items with the lowest mean ratings were the same on the OASR and the OABCL. Q correlations between the means of the 0-1-2 ratings for the 113 problem items averaged across all pairs of societies yielded means of .77 (OASR) and .78 (OABCL). For the OASR and OABCL, respectively, analyses of variance (ANOVAs) yielded effect sizes (ESs) for society of 15% and 18% for Total Problems and 42% and 31% for Personal Strengths, respectively. For 5,584 cross-informant dyads in 12 societies, cross-informant correlations averaged across societies were .68 for Total Problems and .58 for Personal Strengths. Mixed-model ANOVAs yielded large effects for society on both Total Problems (ES = 17%) and Personal Strengths (ES = 36%). CONCLUSIONS: The OASR and OABCL are efficient, low-cost, easily administered mental health assessments that can be used internationally to screen for many problems and strengths.

The generalizability of Older Adult Self-Report (OASR) syndromes of psychopathology across 20 societies.

OBJECTIVES: As the world population ages, psychiatrists will increasingly need instruments for measuring constructs of psychopathology that are generalizable to diverse elders. The study tested whether syndromes of co-occurring problems derived from self-ratings of psychopathology by US elders would fit self-ratings by elders in 19 other societies. METHODS/DESIGN: The Older Adult Self-Report (OASR) was completed by 12 826 adults who were 60 to 102 years old in 19 societies from North and South America, Asia, and Eastern, Northern, Southern, and Western Europe, plus the United States. Individual and multigroup confirmatory factor analyses (CFAs) tested the fit of the seven-syndrome OASR model, consisting of the Anxious/Depressed, Worries, Somatic Complaints, Functional Impairment, Memory/Cognition Problems, Thought Problems, and Irritable/Disinhibited syndromes. RESULTS: In individual CFAs, the primary model fit index showed good fit for all societies, while the secondary model fit indices showed acceptable to good fit. The items loaded strongly on their respective factors, with a median item loading of .63 across 20 societies, and 98.7% of the loadings were statistically significant. In multigroup CFAs, 98% of items demonstrated approximate or full metric invariance. Fifteen percent of items demonstrated approximate or full scalar invariance, and another 59% demonstrated scalar invariance across more than half of societies. CONCLUSIONS: The findings supported the generalizability of OASR syndromes across societies. The seven syndromes offer empirically based clinical constructs that are relevant for elders of different backgrounds. They can be used to assess diverse elders and as a taxonomic framework to facilitate communication, services, research, and training in geriatric psychiatry.

Rhinovirus is an important pathogen in upper and lower respiratory tract infections in Mexican children.

BACKGROUND: Most of the studies characterizing the incidence of rhinovirus (RV) have been carried out in hospitalized children and in developed countries. In those studies, RV-C has been associated with more severe respiratory tract infections than RV species A and B. In this study we determined the frequency and diversity of RV strains associated with upper and lower respiratory tract infections (URTI, LRTI) in Mexico, and describe the clinical characteristics of the illness associated with different RV species. METHODS: A prospective surveillance of 526 and 250 children with URTI and LRTI was carried out. Respiratory samples were analyzed by RT-PCR for viruses. The 5' untranslated region of the RV genome was amplified and sequenced. RESULTS: In the case of URTI, 17.5% were positive for RV, while this virus was found in 24.8% of LRTI. The RV species was determined in 73 children with URTI: 61.6% were RV-A, 37% RV-C and, 1.4% RV-B; and in 43 children with LRTI: 51.2% were RV-A, 41.8% RV-C, and 7% RV-B. No significant differences in clinical characteristics were found in patients with RV-A or RV-C infections. A high genetic diversity of RV strains was found in both URTI and LRTI. CONCLUSIONS: Both RV-A and RV-C species were frequently found in hospitalized as well as in outpatient children. This study underlines the high prevalence and genetic diversity of RV strains in Mexico and the potential severity of disease associated with RV-A and RV-C infections.

[Natural history of breast cancer diagnostic procedures]. / Historia natural del proceso diagnóstico del cáncer de mama.

OBJECTIVE: To build a model that explains the natural history of breast cancer diagnostic procedures. METHODS: Descriptive cross-sectional study of 245 women between 40 and 69 years of age, selected by simple random sampling, who underwent a mammography and met the requirements of the breast cancer diagnostic procedure. Diagnosis was made by biopsy. For the diagnostic procedure, an estimate was made of the percentage of patients seen by each service, the total number of patients per service, and the total number of consultations in each service, with 95% confidence intervals. RESULTS: Of the patients who initiated the breast cancer diagnostic procedure in preventive medicine services, 20% underwent a mammography; 23.7% were seen in family medicine services and of these patients, 70.9% were referred to a breast clinic, where 7.3% underwent a harpoon biopsy. The prevalence of breast cancer confirmed by biopsy was 0.48% (95%CI: 0.0-1.3). Per 1 000 patients who initiated the procedure, 47.4 were seen in family medicine services and 33.6 in a breast clinic, and open biopsies were performed on 2.4. Per 1 000 patients who initiated the procedure, there were 211.4 consultations in radiology services, 51.6 in family medicine services, and 54.6 in a breast clinic. CONCLUSIONS: The model described here may be useful in planning and evaluation activities.

Determinants of self-reported health status during COVID-19 lockdown among surveyed Ecuadorian population: A cross sectional study.

OBJECTIVE: To examine the associations of sociodemographic, socioeconomic, and behavioral factors with depression, anxiety, and self-reported health status during the COVID-19 lockdown in Ecuador. We also assessed the differences in these associations between women and men. DESIGN, SETTING, AND PARTICIPANTS: We conducted a cross-sectional survey between July to October 2020 to adults who were living in Ecuador between March to October 2020. All data were collected through an online survey. We ran descriptive and bivariate analyses and fitted sex-stratified multivariate logistic regression models to assess the association between explanatory variables and self-reported health status. RESULTS: 1801 women and 1123 men completed the survey. Their median (IQR) age was 34 (27-44) years, most participants had a university education (84%) and a full-time public or private job (63%); 16% of participants had poor health self-perception. Poor self-perceived health was associated with being female, having solely public healthcare system access, perceiving housing conditions as inadequate, living with cohabitants requiring care, perceiving difficulties in coping with work or managing household chores, COVID-19 infection, chronic disease, and depression symptoms were significantly and independently associated with poor self-reported health status. For women, self-employment, having solely public healthcare system access, perceiving housing conditions as inadequate, having cohabitants requiring care, having very high difficulties to cope with household chores, having COVID-19, and having a chronic disease increased the likelihood of having poor self-reported health status. For men, poor or inadequate housing, presence of any chronic disease, and depression increased the likelihood of having poor self-reported health status. CONCLUSION: Being female, having solely public healthcare system access, perceiving housing conditions as inadequate, living with cohabitants requiring care, perceiving difficulties in coping with work or managing household chores, COVID-19 infection, chronic disease, and depression symptoms were significantly and independently associated with poor self-reported health status in Ecuadorian population.

Family with systemic arterial hypertension: epidemiological profile. / Familia con hipertensión arterial sistémica: perfil epidemiológico.

The aim of this study was to determine the epidemiological profile of the family with systemic arterial hypertension. A descriptive cross-sectional study was carried out in 268 families with this disease, the epidemiological profile included seven dimensions, sociodemographic, economic, family functionality, life cycle, family roles, health and use of services. The mean age of the families was 49.09 (SD: 15.57) years; 47.0% of the families had paid economic activity, 65.0% were functional, 52.4% were in the retirement and death stages, 43.1% presented obesity, in 50.0% the predominant role of the hypertensive patient was assumed by the mother, and the average annual number of family medicine consultations was 10.37 (SD: 4.31). The family with arterial hypertension is functional, although most of them are in the stage of retirement and death.

El objetivo fue determinar el perfil epidemiológico de grupos familiares con hipertensión arterial sistémica. Se realizó un estudio transversal descriptivo en 268 familias con esta enfermedad, el perfil epidemiológico incluyó siete dimensiones: sociodemográfico, económico, funcionalidad familiar, ciclo de vida, roles familiares, salud y uso de servicios. La edad promedio de las familias fue de 49,09 (DE: 15,57) años. El 47,0% de las familias tuvieron actividad económica remunerada; el 65,0% son funcionales; en el 52,4% predominó la etapa de jubilación y muerte; en el 50,0% la madre asumió el rol predominante del paciente con hipertensión; el 43,1% de las familias presentaron obesidad y el promedio anual de consultas de medicina familiar fue de 10,37 (DE: 4,31). La familia con hipertensión arterial es funcional, no obstante la mayoría se encuentra etapa de jubilación y muerte.

Disability adjusted life years lost due to acute, chronic disability and premature death in arterial hypertension / Vida saludable perdida por discapacidad aguda, crónica y muerte prematura en hipertensión arterial

Objective: To determine the disability adjusted life years in arterial hypertension without diabetes mellitus. Method: Disability adjusted life years was determined from chronic disability (chronic kidney disease, heart disease and cerebral vascular event), acute disability (hypertensive crisis and hypertensive emergency) and premature death. Age of diagnosis, age of the complication, prevalence of the complication, duration of the acute event, number of acute events, time lived with hypertension, age of death and life expectancy were identified. In all cases a 3% discount rate was applied, the estimate was made per 100,000. Results: When the total of women was used as a reference, the disability adjusted life years in women is 198,498.28. In men, using the total number of men as a reference, the value is 204,232.13. If the referent is the total population, in women the disability adjusted life years is 102,028.11 and in men 99,256.98. Conclusions: The disability adjusted life years in arterial hypertension without diabetes is different for men and women; the topic has many edges that must be studied.

Objetivo: Determinar la vida saludable perdida por hipertensión arterial sin diabetes mellitus. Método: La vida saludable perdida se determinó a partir de la discapacidad crónica (enfermedad renal crónica, cardiopatía y evento vascular cerebral), la discapacidad aguda (crisis hipertensiva y emergencia hipertensiva) y la muerte prematura. Se identificaron la edad del diagnóstico, la edad de la complicación, la prevalencia de la complicación, la duración del evento agudo, el número de eventos agudos, el tiempo vivido con hipertensión, la edad de la muerte y la esperanza de vida. En todos los casos se aplicó una tasa de descuento del 3%. La estimación se realizó por 100,000. Resultados: Cuando se utilizó como referencia el total de mujeres, la vida saludable perdida en ellas es de 198,498.28. Empleando como referencia el total de hombres, el valor para ellos es de 204,232.13. Si el referente es el total de la población, para las mujeres la vida saludable perdida es de 102,028.11 y para los hombres es de 99,256.98. Conclusiones: La vida sWaludable perdida por hipertensión arterial sin diabetes es diferente en hombres y mujeres; no obstante, tiene muchas aristas que deben abordarse.

Direct cost of medical care in patients with gonarthrosis. / Costo directo de la atención médica en pacientes con gonartrosis.

OBJECTIVE: To determine the cost of medical care in patients with gonarthrosis. MATERIAL AND METHODS: Cost study in patients over 40 years of age with gonarthrosis, diagnosed according to the radiological classification of Kellgren and Lawrence. The average annual cost (euros) was estimated taking the unit cost plus average use of services such as family medicine, imaging, laboratory, electrodiagnosis, orthopedics, hospitalization, physical therapy, surgery, nutrition, preoperative assessment and medication. Projections based on assumptions were made for three scenarios. RESULTS: Grade 2 gonarthrosis predominated at 39.7% (95% confidence interval, 33.8 - 45.6). The annual cost of care for a patient with gonarthrosis was €108.87 in the intermediate scenario, €86.73 in the lower cost scenario and €132.60 in the higher cost scenario. For a population of 119,530,753 inhabitants, with 10,937,064 gonarthrosis patients, the annual cost in the intermediate scenario was €1,190,685,273 and represented 4.48% of the health expenditure. CONCLUSION: The average annual cost of gonarthrosis is relatively low, but when related to prevalence and prevalence trends, it can become a serious problem for health services.

Zinc Supplementation Promotes a Th1 Response and Improves Clinical Symptoms in Fewer Hours in Children With Pneumonia Younger Than 5 Years Old. A Randomized Controlled Clinical Trial.

Background: Pneumonia caused 704,000 deaths in children younger than 5 years in 2015. Zinc is an important micronutrient due to its role in immune function. Since 2004, WHO recommends zinc supplementation for children with diarrhea to shorten the duration and decrease severity. Zinc supplementation for children with pneumonia is controversial. Methods: A randomized controlled clinical trial was conducted, and 103 children 1 month to 5 years old with pneumonia were included. Zinc or placebo was given during hospitalization. Clinical symptoms were recorded, and a blood draw was obtained to determine serum zinc levels, lymphoproliferation, and cytokines at hospitalization and at discharge of the patient; a nasal wash was obtained to detect viral or bacterial pathogens by multiplex RT-PCR. Results: Zinc supplementation improved in fewer hours the clinical status (76 ± 7 vs. 105 ± 8, p = 0.01), the respiratory rate (37 ± 6 vs. 57 ± 7, p = 0.04), and the oxygen saturation (53 ± 7 vs. 87 ± 9, p = 0.007) compared to the placebo group. An increase in IFNγ and IL-2 after treatment in the zinc group was observed. Conclusions: Zinc supplementation improved some clinical symptoms in children with pneumonia in fewer hours and induced a cellular immune response. Clinical Trial Registration: The trial was retrospectively registered in ClinicalTrials.gov, identifier NCT03690583, URL https://clinicaltrials.gov/ct2/show/NCT03690583?term=zinc+children&cond=Pneumonia&draw=2&rank=1.

Cravings, sugar and fat consumption as determinant factors of obesity in young adults in Juarez City.

INTRODUCTION: obesity is a global health epidemic and understanding its causes is essential for successful treatment and prevention. Cravings have been associated with the excessive consumption of sugars and fats, and addictive eating behavior. OBJECTIVE: to determine the strength of the relationship between cravings, the consumption of sugar and fat, and its impact on body composition as determined via body mass index (BMI), body fat percentage (BFP) and waist circumference (WC) in a sample of Mexicans who reside close to the México-U.S. border. METHODS: the sample was comprised of 159 young adults with a mean age of 27.96 ± 6.19, 45.9% of which were male, and all residents of Ciudad Juarez, Mexico. Cravings were measured using Trait and State Food Cravings Questionnaires. The consumption of sugars and fats was determined via a 24-hour recall of foods consumed and a food consumption frequency questionnaire. RESULTS: it was demonstrated that BMI and BFP were positively associated with responses to the craving questionnaires and WC with fat consumption. Additionally, higher fat consumption was positively associated with higher rates of obesity. CONCLUSIONS: the results demonstrate the need to identify the presence of cravings and integrate such measures for effective prevention and treatment of obesity.

Asociación entre nivel de conocimiento sobre higiene postural, satisfacción laboral e incapacidad prolongada en pacientes con lumbalgia / Association between level of knowledge about postural hygiene, job satisfaction and prolonged disability in patients with low back pain

Objetivo: Determinar la satisfacción laboral y el nivel de conocimiento sobre higiene postural como factores asocia-dos a incapacidad prolongada en lumbalgia.Métodos: Estudio transversal analítico en pacientes con incapacidad temporal de trabajo por lumbalgia, se inte-graron dos grupos, pacientes con incapacidad prolongada y pacientes con incapacidad no prolongada. El tamaño de la muestra fue 120 por grupo. La satisfacción laboral se evaluó mediante el instrumento adaptado basado en el cuestionario s21/26 y S4/82, para la higiene postural se utilizó el cuestionario sobre higiene postural de Borrás. El análisis estadístico incluyó t student, mann whitney y Chi2. Resultados: No se encontró asociación entre incapacidad prolongada y satisfacción laboral, en el grupo con in-capacidad prolongada 42.5% refieren estar bastante satisfechos y en el grupo sin incapacidad prolongada la pre-valencia es 35.0% (p=0.154). En el grupo con incapacidad prolongada el nivel de conocimiento bajo sobre higiene postural es 87.5% y en el grupo sin incapacidad prolongada el porcentaje es 68.5% (p=0.000). Conclusión: La satisfacción laboral no es factor asociado con incapacidad prolongada por lumbalgia, el nivel de conocimiento sobre higiene postural es factor asociado a incapacidad prolongada por lumbalgia (AU)

Objective: To determine job satisfaction and the level of knowledge about postural hygiene as factors associated with prolonged disability in low back pain.Methods: Analytical cross-sectional study in patients with temporary work disability due to low back pain, two groups were integrated, patients with prolonged disability and patients with non-prolonged disability. The sample size was 120 per group. Job satisfaction was evaluated using the adapted instrument based on the s21/26 and S4/82 questionnaire, for postural hygiene the Borrás postural hygiene questionnaire was used. Statistical analysis includ-ed t student, Mann Whitney and Chi2.Results: No significant association was found between prolonged disability and job satisfaction. In the group with prolonged disability, 42.5% reported being quite satisfied, and in the group without prolonged disability, the prev-alence was 35.0% (p=0.154).In the group with prolonged disability, the low level of knowledge about postural hygiene is 87.5% and in the group without prolonged disability, the percentage is 68.5%, a statistically significant difference (p=0.000).Conclusion: Job satisfaction is not a factor associated with prolonged disability due to low back pain, the level of knowledge about postural hygiene is a factor associated with prolonged disability due to low back pain (AU)

La ciberviolencia en parejas jóvenes y factores predictores / Cyberviolence in young couples and predictors

Los objetivos de esta investigación fueron analizar la presencia de laciberviolencia en parejas jóvenes, explorar las asociaciones entre la ciberviolencia,la dependencia emocional, la empatía y las relaciones filio parentales, e identificarfactores predictores de la ciberviolencia. Para ello, se seleccionó una muestra deconveniencia compuesta por 469 estudiantes universitarios. Estos completaron la“Escala de violencia de pareja en las redes sociales en adolescentes” el“Instrumento de vínculo parental”, el de “Dependencia emocional en el noviazgode jóvenes y adolescentes” y la “Escala de empatía básica”. El 51,9% de la muestraafirmaba haber sufrido ciberviolencia y el 56,6% admitía haberla ejercido. Loschicos puntuaron más alto que las chicas en ciberviolencia y cibervictimización. Seencontró que a mayor nivel de estudios menos ciberviolencia y, a mayor númerode parejas, mayor posibilidad de sufrir ciberviolencia. La escasa evidencia empíricaacerca de los factores relacionados con la ciberviolencia apunta a la importancia deseguir investigando más profundamente sobre variables individuales y familiares. (AU)

The aims of this research were to analyze the presence of cyberviolence inyoung couples, to explore the associations between cyberviolence, emotionaldependence, empathy, and filioparental relationships, and to identify predictors ofcyberviolence. For this purpose, a convenience sample consisting of 469 universitystudents was selected. They completed the following measures: The AdolescentSocial Network Partner Violence Scale, the Parental Bonding Instrument, the DatingEmotional Dependence in Youth and Adolescents, and the Basic Empathy Scale.51.9% of the sample admitted to having suffered cyber-violence, and 56.6%admitted to having perpetrated it. Boys scored higher than girls on cyberviolenceand cybervictimization. It was found that the higher the level of education, thelower level of cyberviolence and the higher the number of partners, the greater thepossibility of suffering cyberviolence. The scarce empirical evidence about thefactors related to cyberviolence points to the need of further research on individualand family variables. (AU)

Familia con hipertensión arterial sistémica: perfil epidemiológico / Family with systemic arterial hypertension: epidemiological profile

RESUMEN El objetivo fue determinar el perfil epidemiológico de grupos familiares con hipertensión arterial sistémica. Se realizó un estudio transversal descriptivo en 268 familias con esta enfermedad, el perfil epidemiológico incluyó siete dimensiones: sociodemográfico, económico, funcionalidad familiar, ciclo de vida, roles familiares, salud y uso de servicios. La edad promedio de las familias fue de 49,09 (DE: 15,57) años. El 47,0% de las familias tuvieron actividad económica remunerada; el 65,0% son funcionales; en el 52,4% predominó la etapa de jubilación y muerte; en el 50,0% la madre asumió el rol predominante del paciente con hipertensión; el 43,1% de las familias presentaron obesidad y el promedio anual de consultas de medicina familiar fue de 10,37 (DE: 4,31). La familia con hipertensión arterial es funcional, no obstante la mayoría se encuentra etapa de jubilación y muerte.

ABSTRACT The aim of this study was to determine the epidemiological profile of the family with systemic arterial hypertension. A descriptive cross-sectional study was carried out in 268 families with this disease, the epidemiological profile included seven dimensions, sociodemographic, economic, family functionality, life cycle, family roles, health and use of services. The mean age of the families was 49.09 (SD: 15.57) years; 47.0% of the families had paid economic activity, 65.0% were functional, 52.4% were in the retirement and death stages, 43.1% presented obesity, in 50.0% the predominant role of the hypertensive patient was assumed by the mother, and the average annual number of family medicine consultations was 10.37 (SD: 4.31). The family with arterial hypertension is functional, although most of them are in the stage of retirement and death.

Respiratory viruses detected in Mexican children younger than 5 years old with community-acquired pneumonia: a national multicenter study.

BACKGROUND: Acute respiratory infections are the leading cause of mortality in children worldwide, especially in developing countries. Pneumonia accounts for 16% of all deaths of children under 5 years of age and was the cause of death of 935000 children in 2015. Despite its frequency and severity, information regarding its etiology is limited. The aim of this study was to identify respiratory viruses associated with community-acquired pneumonia (CAP) in children younger than 5 years old. METHODS: One thousand four hundred and four children younger than 5 years of age with a clinical and/or radiological diagnosis of CAP in 11 hospitals in Mexico were included. Nasal washes were collected, placed in viral medium, and frozen at -70°C until processing. The first 832 samples were processed using the multiplex Bio-Plex/Luminex system and the remaining 572 samples using the Anyplex multiplex RT-PCR. Clinical data regarding diagnosis, clinical signs and symptoms, radiographic pattern, and risk factors were obtained and recorded. RESULTS: Of the samples tested, 81.6% were positive for viruses. Respiratory syncytial virus (types A and B) was found in 23.7%, human enterovirus/rhinovirus in 16.6%, metapneumovirus in 5.7%, parainfluenza virus (types 1-4) in 5.5%, influenza virus (types A and B) in 3.6%, adenovirus in 2.2%, coronavirus (NL63, OC43, 229E, and HKU1) in 2.2%, and bocavirus in 0.4%. Co-infection with two or more viruses was present in 22.1%; 18.4% of the samples were negative. Using biomass for cooking, daycare attendance, absence of breastfeeding, and co-infections were found to be statistically significant risk factors for the presence of severe pneumonia. CONCLUSIONS: Respiratory syncytial virus (types A and B), human enterovirus/rhinovirus, and metapneumovirus were the respiratory viruses identified most frequently in children younger than 5 years old with CAP. Co-infection was present in an important proportion of the children.

Pain from copper intrauterine device insertion: randomized trial of prophylactic ibuprofen.

OBJECTIVES: This study was undertaken to determine whether 400 mg of prophylactic ibuprofen can alleviate pain from insertion of an intrauterine device (IUD) and to measure level of pain with improved techniques. STUDY DESIGN: We conducted a randomized, double-blind, placebo-controlled trial of 2019 first-time IUD users: 1008 women received placebo and 1011 women received 400 mg of ibuprofen. Participants took the single tablet at least 45 minutes before IUD insertion. Immediately after insertion, participants recorded level of pain by using a 10-cm visual analog scale, with the value of 10 meaning "worst imaginable pain." RESULTS: Median level of pain was 1.0 for both ibuprofen and placebo participants; rank test statistics confirmed no difference. Some subgroups of women experienced higher pain (eg, nulliparous women), but ibuprofen still had no important impact on level of pain. CONCLUSION: Even among first-time users, pain from IUD insertion is generally low. Prophylactic ibuprofen as used in this protocol does not reduce IUD insertion pain.

Pre-exposure to faeces or saliva of Triatoma dimidiata decreases parasitemia in mice challenged with Trypanosoma cruzi: a description of the inflammatory reaction at the inoculation site

Under natural conditions, Trypanosoma cruzi infection is transmitted to mammals when faeces contaminated with metacyclic trypomastigotes gain access through skin lesions, mucosa or bite wounds. Natural infection of bugs with T. cruzi can vary greatly from less than 1% up to 70%, depending on triatomine species: in the case of Triatoma dimidiata, the percentage of infection is around 30%. In this work uses biological fluids (saliva and faeces) from Triatoma dimidiata to inoculate experimental animals once or multiple times, before inoculation with faeces contaminated with metacyclic trypomastigotes discrete type unit Ia (TcI). The site of infection was analyzed for histological changes based on hematoxile-eosine technique and toluide blue stain for mast cells. Inoculation with saliva led to the recruitment of eosinophils and mononuclear cells at the inoculation site, whereas inoculation with faeces led to the recruitment of neutrophils. Mice inoculated multiple times exhibited a strong inflammatory reaction from the first hour. Mono- or multi-exposure to T. dimidiata fluids before inoculation with metacyclic trypomastigotes helped to control the level of parasitemia. Previous contact with saliva or faeces of T. dimidiata reduces parasitemia in T. cruzi I -infected mice.

Vida saludable perdida por discapacidad aguda, crónica y muerte prematura en hipertensión arterial / Disability adjusted life years lost due to acute, chronic disability and premature death in arterial hypertension

Resumen Objetivo: Determinar la vida saludable perdida por hipertensión arterial sin diabetes mellitus. Método: La vida saludable perdida se determinó a partir de la discapacidad crónica (enfermedad renal crónica, cardiopatía y evento vascular cerebral), la discapacidad aguda (crisis hipertensiva y emergencia hipertensiva) y la muerte prematura. Se identificaron la edad del diagnóstico, la edad de la complicación, la prevalencia de la complicación, la duración del evento agudo, el número de eventos agudos, el tiempo vivido con hipertensión, la edad de la muerte y la esperanza de vida. En todos los casos se aplicó una tasa de descuento del 3%. La estimación se realizó por 100,000. Resultados: Cuando se utilizó como referencia el total de mujeres, la vida saludable perdida en ellas es de 198,498.28. Empleando como referencia el total de hombres, el valor para ellos es de 204,232.13. Si el referente es el total de la población, para las mujeres la vida saludable perdida es de 102,028.11 y para los hombres es de 99,256.98. Conclusiones: La vida sWaludable perdida por hipertensión arterial sin diabetes es diferente en hombres y mujeres; no obstante, tiene muchas aristas que deben abordarse.

Abstract Objective: To determine the disability adjusted life years in arterial hypertension without diabetes mellitus. Method: Disability adjusted life years was determined from chronic disability (chronic kidney disease, heart disease and cerebral vascular event), acute disability (hypertensive crisis and hypertensive emergency) and premature death. Age of diagnosis, age of the complication, prevalence of the complication, duration of the acute event, number of acute events, time lived with hypertension, age of death and life expectancy were identified. In all cases a 3% discount rate was applied, the estimate was made per 100,000. Results: When the total of women was used as a reference, the disability adjusted life years in women is 198,498.28. In men, using the total number of men as a reference, the value is 204,232.13. If the referent is the total population, in women the disability adjusted life years is 102,028.11 and in men 99,256.98. Conclusions: The disability adjusted life years in arterial hypertension without diabetes is different for men and women; the topic has many edges that must be studied.

Antecedente heredofamiliar de hipertensión (padre-madre), factor de riesgo para familia hipertensa (hijos) / Hereditary family history of hypertension (father-mother), risk factor of hypertensive family (children)

OBJETIVO: Identificar el antecedente heredofamiliar de hipertensión (padre-madre) como factor de riesgo para familia hipertensa (hijos).Diseño: Estudio de casos y controles. PARTICIPANTES: Familias con hijos mayores de 18 años, definiendo a la familia como el conjunto de hijos (unidad de análisis). MEDICIONES PRINCIPALES: Se consideró caso a la familia con al menos un hijo hipertenso (familia hipertensa); y control a la familia con hijos sin diagnóstico (familia no hipertensa). Se estudiaron 102 casos y 151 controles. El antecedente heredofamiliar de hipertensión se integró en cuatro categorías: padre hipertenso, madre hipertensa, padre y madre hipertensos y, padre y madre sin hipertensión (grupo de comparación). El análisis incluyó regresión logística múltiple y cálculo de probabilidad. RESULTADOS: El modelo que mejor explicó la hipertensión incluye antecedente heredofamiliar (padre y madre) y edad de la familia (p = 0,001) y= -7,754 +1,428 (padre y madre hipertensos) +0,144 (edad de la familia). Cuando el promedio de edad de la familia es 50 años y existe el antecedente de padre y madre con hipertensión, la probabilidad de que al menos uno de los hijos tenga hipertensión es 70,6 %, con la ausencia de padre y madre hipertensos la probabilidad es 36,5 %. CONCLUSIONES: El antecedente de padre y madre hipertensos asociados con la edad promedio de la familia (hijos) es un factor de riesgo para familia hipertensa (hijos)

OBJECTIVE: To identify the hereditary family history of hypertension (father-mother) as a risk factor for hypertensive family (children). Design: Case-control study. PARTICIPANTS: Families with children over 18, defining the family as the group of children (unit of analysis). MAIN MEASURES: We considered case families when at least one child was hypertensive (hy-pertensive family). We considered control families those whose children had no diagnosis (non-hypertensive family). 102 cases and 151 controls were studied. The hereditary family history of hypertension was divided into four categories: hypertensive father, hypertensive mother, hyper-tensive father and mother, and non-hypertensive father and mother (comparison group). The analysis included multiple logistic regression and probability estimates. RESULTS: The model that best explained hypertension includes hereditary family history (father and mother) and age of the family (p=0.001). y= -7.754 + 1.428 (hypertensive father and mother) +0.144 (age of the family). When the average age of the family is 50 and there is a history of hypertensive father and mother, the probability that at least one of the children is hypertensive is 70.6 %; in the case of non-hypertensive father and mother, the probability is 36.5 %. CONCLUSIONS: A history of hypertensive father and mother associated with the average age of the family (children) is a risk factor for hypertensive family (children)

Proyecto MAPEC-Salta: una nueva modalidad de atención para pacientes hipertensos en el primer nivel de atención de la ciudad de Salta, Argentina / MAPEC-Salta Project: a new care model for hypertense patients in primary health care of Salta city, Argentine

RESUMEN Introducción: La hipertensión arterial (HTA) es la primera causa de morbimortalidad cardiovascular. A menudo es una enfermedad mal controlada porque los sistemas de salud están más orientados a atender enfermedades agudas. El Ministerio de Salud de Argentina propuso un nuevo modelo de atención para pacientes hipertensos conocido como MAPEC, basado en el Modelo de cuidados crónicos. Objetivo: Evaluar el impacto de la implementación del MAPEC en el control de la presión arterial (PA), el cuidado de las medidas higiénico-dietéticas, el conocimiento de la enfermedad y la adherencia al tratamiento en pacientes hipertensos asistidos en tres centros de atención primaria de la ciudad de Salta, Argentina. Material y Métodos: Se midió la PA con tensiómetro digital automático; se evaluó el conocimiento de la HTA y la adherencia al tratamiento con los test de Batalla y Morisky-Green-Levine, respectivamente. Resultados: Se estudiaron 232 pacientes. Hubo diferencias significativas (p <0,0001) luego de la intervención en el control de la PA, el conocimiento de la enfermedad, la adherencia al tratamiento y las medidas higiénico-dietéticas. También en los promedios de PA, con una disminución de 12,97 (IC95: 9,52-16,42) mmHg en la presión sistólica y de 6,93 (IC95: 4,70-9,16) mmHg en la presión diastólica. Conclusiones: Fue evidente la mejoría en los parámetros de salud analizados en los pacientes con la implementación del MAPEC. Este modelo es de fácil aplicación y bajo costo. Además, está en consonancia con los objetivos 25×25 de la OMS, mediante los que se busca una reducción del 25% de las muertes prematuras por enfermedades cardiovasculares hacia el año 2025.

ABSTRACT Background: blood hypertension is the first cause of worldwide cardiovascular morbidity and mortality. Nevertheless, it is a poorly controlled disease, largely because health care systems are oriented to the attention of acute diseases. The Argentine Ministry of Health proposed a new care model for hypertensive patients called MAPEC, based on the Chronic Care Model. Objective: to evaluate the impact made by the implementation of MAPEC to improve the blood pressure control, the treatment adherence and changes in life style, and disease awareness, in three primary health centers of Salta city Argentine. Methods: the blood pressure was measured with automated device, Batalla and Morisky-Green-Levine were used to evaluate the disease awareness and treatment adherence, respectively. Results: 232 patients were included. After model implementation, significant difference (p<0,0001) were found in blood pressure control, disease awareness, treatment adherence and changes in life style. There was a decrease in blood pressure average with reduction of 12,97 (IC 95: 9,52-16,42) mm Hg and 6,93 (IC 95: 4,70-9,16) mm Hg in sistolic and diastolic pressure, respectively. Conclusions: there was evident improvement in the analyzed health parameters after MAPEC implementation. This can be easily adapted for primary health centers and with low cost. This is in order with WHO 25×25 target to reduce 25% cardiovascular premature deaths in 2025.

Two-year performance of a Nestorone-releasing contraceptive implant: a three-center study of 300 women.

A 2-year trial of a single Nestorone (NES) rod implant was conducted at three Latin American centers, each enrolling 100 women. We studied the safety, effectiveness and acceptability of this progestin-releasing contraceptive implant. Three pregnancies occurred, the last at 18 months of use. Because no pregnancies were expected in the first 18 months, the trial was halted. At that time, 224 women had completed at least 18 months of use, and 99 women had used the implant for more than 24 months. Few participants used adjunctive contraception between the time the study was halted and the time they had their implant removed. No additional pregnancies occurred before the removal of the last implant. The 2-year cumulative pregnancy rate was 1.7 per 100 with a Pearl index of 0.6 per 100 for the 2-year period. The 1-year and 2-year continuation rates were 80.5 and 66.7 per 100, respectively. Menstrual and medical disturbances were the principal reasons for discontinuation, followed by planned pregnancy. Headache and weight gain frequently led to discontinuation. The NES implant had little important effect on most clinical chemistry and lipid parameters. Over the study course, the mean change in hemoglobin was <1%. Slight modification of the design of this single 2-year implant, restoring features previously examined in clinical trials, is likely to improve its effectiveness. A single NES implant appears to provide acceptable contraception for women.