Piloting a mental health intervention for young adults in poverty enrolled in post-secondary education in post-conflict regions in Colombia: a study protocol.

Background: Colombia has endured more than five decades of internal armed conflict, which led to substantial costs for human capital and mental health. There is currently little evidence about the impact of incorporating a mental health intervention within an existing public cash transfer program to address poverty, and this project aims to develop and pilot a mental health support intervention embedded within the human capital program to achieve better outcomes among beneficiaries, especially those displaced by conflict and the most socioeconomically vulnerable. Methods: The study will consist of three phases: semi-structured one-to-one interviews, co-design and adaptations of the proposed intervention with participants and pilot of the digital intervention based on cognitive behavioral therapy and transdiagnostic techniques to determine its feasibility, acceptability, efficacy, and usefulness in 'real settings'. Results will inform if the intervention improves clinical, educational and employment prospects among those who use it. Results: Knowledge will be generated on whether the mental health intervention could potentially improve young people's mental health and human capital in conflict-affected areas? We will evaluate of the impact of potential mental health improvements on human capital outcomes, including educational and employment outcomes. Conclusion: Findings will help to make conclusions about the feasibility and acceptability of the intervention, and it will assess its effectiveness to improve the mental health and human capital outcomes of beneficiaries. This will enable the identification of strategies to address mental health problems among socioeconomically vulnerable young people that can be adapted to different contexts in in low and middle-income countries.

Healthcare and Social Organizations' Disaster Preparedness, Response, and Recovery Experience: Lessons Learned From Hurricanes Irma and Maria.

BACKGROUND: Healthcare and social organizations (HSOs) are first respondents after natural disasters. Hence, their preparedness and resilience are critical components for addressing future disasters. However, little is known about HSOs' experiences prior to, during, and after hurricanes. OBJECTIVE: To describe preparedness, response, and recovery experiences from hurricanes Irma/ Maria among HSOs in Puerto Rico and the US Virgin Islands. METHODS: Using a convenience sample, semi-structured interviews were conducted with 52 key-informants. Content analysis for common and recurring themes and patterns was performed by HSO type. RESULTS: Most HSOs (80.8%) had a preparedness plan and 55.8% responded providing emergency supplies. HSOs' human resources (61.2%) was the main recovery facilitator/ enabler, while 36.5% identified the lack of economic resources and the lack of an integrated emergency plan as the top barriers. The main lesson learned include understanding the need to make improvements to their emergency preparedness plans (56.3%), and to establish an integrated/ centralized plan between relevant parties. CONCLUSION: Lessons learned after hurricanes allowed HSOs to identify gaps and opportunities to become more resilient. Infrastructure capacity, human resources, communication systems, and economic support, as well as training, partnerships, and new policies should be defined, revised, and/ or integrated into the HSOs' preparedness plans to mitigate the impact of future disasters.

Multidimensional poverty and adolescent mental health: Unpacking the relationship.

Extensive research suggests that poverty is associated with adolescent mental health problems. However, studies typically focus on monetary poverty and have not examined how other dimensions of poverty relate to adolescent mental health. This study examines the association between multidimensional poverty and mental health among adolescents using a Multidimensional Poverty Index. Based on data from the National Mental Health Survey in Colombia, we show that adolescents living in multidimensionally poor households have 50% higher risk of having mental health problems compared to adolescents in non-poor households. We unpack and assess the relation between each of the dimensions of poverty and mental health, and whether deprivations directly experienced by the adolescent are more strongly associated with mental health problems than deprivations experienced by other household members. Individual deprivations associated with human capital linked to schooling, work, health insurance and employment are more strongly associated with adolescent mental health problems than material deprivations. Lagging behind in school and working while studying has the strongest association with adolescent mental health problems. Results suggest that public policies that address dimensions of poverty associated with adolescents human capital accumulation may be critical to address mental health problems among adolescents.

La preparación metodológica del profesor universitario de Educación Física a través del tratamiento de temas medioambientales

La formación de la cultura ambiental en el profesor de Educación Física resulta ser un factor de importancia en la preparación integral de este profesional. El objetivo de este estudio se centra en: proponer un sistema de talleres metodológicos orientados a la apropiación de la cultura ambiental del profesor de la disciplina Educación Física en la Universidad de Oriente de Santiago de Cuba. La investigación posee un enfoque mixto de tipo explicativa. Se aplicaron métodos teóricos y empíricos, técnicas e instrumentos que permitieron acopiar la información necesaria para el estudio. Se efectuó un diagnóstico a 15 profesores de la disciplina Educación Física en la Universidad de Oriente. Sus resultados expresaron las insuficiencias en la cultura ambiental del profesor de la disciplina Educación Física. En el procesamiento de los datos, se utilizó la estadística de contraste: prueba W de Kendall y prueba de T-Student, con un nivel de significación establecido en 0.05. La concordancia de los criterios emitidos por los especialistas consultados y la diferencia de los resultados entre el pretest y postest y con el grupo control, ambos con una significación de 0.00, permitió valorar de factible y funcional la propuesta.

A conformação da cultura ambiental no professor de Educação Física é um importante fator para a preparação integral deste profissional. O objetivo deste estudo é: propor um sistema de oficinas metodológicas orientadas para a apropriação da cultura ambiental do professor de Educação Física na Universidade de Oriente, em Santiago de Cuba. A pesquisa tem uma abordagem explicativa mista. Métodos, técnicas e instrumentos teóricos e empíricos foram utilizados para coletar as informações necessárias para o estudo. Foi realizado uma diagnose em 15 professores de educação física na Universidade de Oriente. Os resultados revelaram as deficiências na cultura ambiental dos professores de Educação Física. No processamento dos dados, foram usadas estatísticas de contraste: teste W de Kendall e teste T de Student, com um nível de significância fixado em 0,05. A coincidência dos critérios formulados pelos especialistas consultados e a diferença de desempenho entre o pré-teste e o pós-teste e com o grupo de controle, ambos com um significado de 0,00, nos permitiu avaliar a proposta como viável e funcional.

The formation of environmental culture in the Physical Education teacher turns out to be an important factor in the comprehensive preparation of this professional. The objective of this study is focused on: proposing a system of methodological workshops aimed at the appropriation of the environmental culture of the professor of the Physical Education discipline at the Universidad de Oriente de Santiago de Cuba. The research has a mixed explanatory approach. Theoretical and empirical methods, techniques and instruments were applied that made it possible to collect the necessary information for the study. A diagnosis was made to 15 professors of the Physical Education discipline at the Universidad de Oriente. Their results expressed the insufficiencies in the environmental culture of the professor of the Physical Education discipline. In data processing, the contrast statistic was used: Kendall's W test and Student's T test, with a level of significance set at 0.05. The concordance of the criteria issued by the specialists consulted and the difference in the results between the pre-test and post-test and with the control group, both with a significance of 0.00, allowed the proposal to be assessed as feasible and functional.

The relationship between multidimensional poverty, income poverty and youth depressive symptoms: cross-sectional evidence from Mexico, South Africa and Colombia.

Whereas monetary poverty is associated with increased risk of depressive symptoms in young people, poverty is increasingly understood as a multidimensional problem. However, it is yet to be understood how the associations between different dimensions of poverty and youth mental health differ across countries. We examine the relationship between multidimensional, as well as income poverty, and depressive symptoms in young people (age 11-25 years) across three middle-income countries. Based on harmonised data from surveys in Colombia, Mexico and South Africa (N=16 173) we constructed a multidimensional poverty index that comprised five deprivations We used Poisson regression to examine relationships between different forms of poverty with depressive symptoms across the countries. Multidimensional poverty was associated with higher rates of depressive symptoms in the harmonised dataset (IRR (incidence rate ratio)=1.25, 95% CI 1.10 to 1.42), in Mexico (IRR=1.34, 95% CI 1.11 to 1.64) and Colombia (IRR=2.01, 95% CI 1.30 to 3.10) but not in South Africa, a finding driven by a lack of associations between child labour and health insurance coverage with depressive symptoms. There was only an association with income poverty and depressive symptoms in South Africa, not in Colombia or Mexico. Depressive symptoms were associated with individual deprivations such as school lag, child labour and lack of access to health services in the harmonised dataset, but not with household deprivations, such as parental unemployment and housing conditions, though the opposite pattern was observed in South Africa. Our findings suggest that the importance of specific dimensions of poverty for mental health varies across countries, and a multidimensional approach is needed to gain insights into the relationship between youth depression and poverty.

Reemplazo mandibular con prótesis personalizada de titanio posterior a la exéresis de ameloblastoma / Mandibular replacement with a customized titanium prosthesis after ameloblastoma excision

Introducción: El ameloblastoma es un tumor odontogénico epitelial benigno con tendencia a la recurrencia local si no se elimina adecuadamente. Las alternativas reconstructivas incluyen el uso de colgajos libres microvascularizados, placas y prótesis personalizada de titanio. Objetivo: Describir un reemplazo hemimandibular con prótesis personalizada de titanio posterior a la exéresis de ameloblastoma. Presentación del caso: Mujer de 44 años de edad, que presentó un hallazgo radiográfico durante la realización de tratamiento pulporradicular del diente número 37. Al realizársele el reconocimiento físico facial mostró aumento de volumen en región geniana izquierda mientras que el examen intrabucal detectó expansión de las corticales en la arcada posteroinferior del mismo lado. Se realizó una radiografía panorámica y tomografía axial computarizada con la que se constató la presencia de imagen radiolúcida, multiloculada, en forma de "pompas de jabón" extendiéndose desde el cuerpo mandibular hasta el cóndilo del lado izquierdo. Se tomó muestra para biopsia, con la cual se constató que se trataba de ameloblastoma con patrón folicular. Se realizó abordaje cervical, segmentaria mandibular con margen de seguridad y exarticulación. Se reemplazó la porción eliminada con prótesis personalizada de titanio. Se mantuvo el chequeo posoperatorio en el que se comprobó una buena evolución. Conclusiones: La cirugía constituyó el pilar de tratamiento utilizado. Una vez realizada la resección quirúrgica se reconstruyó el defecto con prótesis personalizada de titanio, proceder de gran novedad en nuestro medio y útil para restablecer la función y estética(AU)

Introduction: Ameloblastoma is a benign tumor of odontogenic epithelium with a tendency to local recurrence if not removed appropriately. Reconstruction alternatives include the use of microvascularized free flaps, plates and customized titanium prostheses. Objective: Describe a case of mandibular replacement with a customized titanium prosthesis after ameloblastoma excision. Case presentation: A case is presented of a female 44-year-old patient who presented a radiographic finding during pulporadicular treatment of tooth 37. Facial physical examination found an increase in volume in the left genian region, and intraoral observation detected expansion of the corticals in the lower posterior arch of the same side. Panoramic radiography and computed axial tomography showed a multilocular radiolucid image resembling soap bubbles which extended from the mandibular body to the left condyle. A sample was taken for biopsy, which confirmed the diagnosis of follicular pattern ameloblastoma. Segmental mandibular surgery was performed by cervical approach with a safety margin and exarticulation. The portion removed was replaced with a customized titanium prosthesis. Post-operative control showed a good evolution. Conclusions: Surgery was the basic component of the treatment applied. Surgical resection was followed by reconstruction of the defect with a customized titanium prosthesis, a procedure of great novelty in our environment useful to restore function and esthetic appearance(AU)

Examining the dynamics between young people's mental health, poverty and life chances in six low- and middle-income countries: protocol for the CHANCES-6 study.

PURPOSE: Poverty and poor mental health are closely related and may need to be addressed together to improve the life chances of young people. There is currently little evidence about the impact of poverty-reduction interventions, such as cash transfer programmes, on improved youth mental health and life chances. The aim of the study (CHANCES-6) is to understand the impact and mechanisms of such programmes. METHODS: CHANCES-6 will employ a combination of quantitative, qualitative and economic analyses. Secondary analyses of longitudinal datasets will be conducted in six low- and middle-income countries (Brazil, Colombia, Liberia, Malawi, Mexico and South Africa) to examine the impact of cash transfer programmes on mental health, and the mechanisms leading to improved life chances for young people living in poverty. Qualitative interviews and focus groups (conducted among a subset of three countries) will explore the views and experiences of young people, families and professionals with regard to poverty, mental health, life chances, and cash transfer programmes. Decision-analytic modelling will examine the potential economic case and return-on-investment from programmes. We will involve stakeholders and young people to increase the relevance of findings to national policies and practice. RESULTS: Knowledge will be generated on the potential role of cash transfer programmes in breaking the cycle between poor mental health and poverty for young people, to improve their life chances. CONCLUSION: CHANCES-6 seeks to inform decisions regarding the future design and the merits of investing in poverty-reduction interventions alongside investments into the mental health of young people.

Flexibility in the Critical Period of Nutrient Sequestration in Bumble Bee Queens.

SYNOPSIS: Bumble bee queens undergo a nutrient storage period prior to entering diapause wherein they sequester glycogen and lipids that are metabolized during overwintering. In the laboratory under optimal food availability conditions, the majority of nutrients are sequestered during the first few days of adulthood. However, if food resources are scarce during this narrow window of time, wild queen bumble bees might be limited in their ability to obtain adequate food resources for overwintering. Here we used a laboratory experiment to examine whether queen bumble bees exhibit flexibility in the timing of pre-overwintering nutrient sequestration, by limiting their access to either nectar (artificial) or pollen, the two primary foods for bumble bees, for varying periods of time. In response to these treatments, we quantified queen survival, changes in weight, and glycogen and lipids levels. We found evidence that queens are able to recuperate almost entirely from food resource limitation, with respect to nutrient storage, especially when it is experienced for shorter durations (up to 6 days). This study sheds light on how bumble bee queens are impacted by food resource availability at a critical life stage. PORTUGUESE: As abelhas rainhas do gênero Bombus armazenam nutrientes antes de entrarem em diapausa, sequestrando o glicogênio e os lipídios que serão metabolizados durante o inverno. Em condições ideais de disponibilidade de alimento no laboratório, a maioria dos nutrientes é sequestrada nos primeiros dias de vida adulta. No entanto, em condições de escassez de alimento na natureza, as rainhas podem sofrer limitações em sua capacidade de obter recursos para o inverno. Nesse contexto, em condições controladas, examinamos se as rainhas exibem variações no sequestro de nutrientes, limitando o acesso ao néctar (artificial) ou pólen, seus principais alimentos, em diferentes intervalos de tempo. Em resposta a esses tratamentos, quantificamos a taxa de sobrevivência das rainhas, as mudanças no peso e os níveis de glicogênio e lipídios. Encontramos evidências de que as rainhas são capazes de recuperar a capacidade de armazenar nutrientes quase inteiramente, especialmente em períodos mais curtos de escassez de alimento (até 6 dias). Este estudo lança luz sobre como as rainhas são afetadas pela variação na disponibilidade de recursos alimentares em um estágio crítico da vida. SPANISH: Las abejas reinas de generó Bombus, mejor conocidas como reinas de abejorro se someten a un período de almacenamiento de nutrientes antes de entrar en diapausa, en el cual secuestran glucógeno y lípidos que se metabolizan durante el invierno. En el laboratorio, en condiciones óptimas de disponibilidad de alimentos, la mayoría de los nutrientes se secuestran durante los primeros días de la edad adulta. Sin embargo, si los recursos alimenticios son escasos durante esta estrecha ventana de tiempo, las abejas reinas silvestres podrían verse limitadas en su capacidad para obtener recursos alimenticios adecuados para pasar el invierno. Aquí utilizamos un experimento de laboratorio para examinar si las abejas reinas exhiben flexibilidad en el momento del secuestro de nutrientes antes de la hibernación, al limitar su acceso al néctar (artificial) o al polen, los dos alimentos principales de los abejorros, durante períodos variables. En respuesta a estos tratamientos, cuantificamos la supervivencia de la reina, los cambios de peso y los niveles de glucógeno y lípidos. Encontramos evidencia de que las reinas pueden recuperarse casi por completo de la limitación de los recursos alimenticios, con respecto al almacenamiento de nutrientes, especialmente cuando se experimenta por períodos más cortos (hasta 6 días). Este estudio arroja luz sobre cómo las abejas reinas se ven afectadas por la disponibilidad de recursos alimenticios en una etapa crítica de la vida.

The impact of cash transfers on mental health in children and young people in low-income and middle-income countries: a systematic review and meta-analysis.

INTRODUCTION: Although cash transfer programmes are not explicitly designed to improve mental health, by reducing poverty and improving the life chances of children and young people, they may also improve their mental health. This systematic review and meta-analysis assessed the evidence on the effectiveness of cash transfers to improve the mental health of children and young people in low-income and middle-income countries. METHODS: We searched Pubmed, EBSCOhost, Scientific Electronic Library Online, ISI Web of Science and Social Sciences Citation Index and grey literature (from January 2000 to July 2020) for studies which quantitatively assessed the impact of cash transfers on mental health in young people (aged 0-24 years), using a design that incorporated a control group. We extracted Cohen's d effects size and used a random-effects model for the meta-analysis on studies that measured depressive symptoms, I2 statistic and assessment of study quality. RESULTS: We identified 12 116 articles for screening, of which 12 were included in the systematic review (covering 13 interventions) and seven in the meta-analysis assessing impact on depressive symptoms specifically. There was high heterogeneity (I2=95.2) and a high risk of bias (0.38, 95% CIs: -5.08 to 5.85; p=0.86) across studies. Eleven interventions (85%) showed a significant positive impact of cash transfers on at least one mental health outcome in children and young people. However, no study found a positive effect on all mental health outcomes examined, and the meta-analysis showed no impact of cash transfers on depressive symptoms (0.02, 95% CIs: -0.19 to 0.23; p=0.85). CONCLUSION: Cash transfers may have positive effects on some mental health outcomes for young people, with no negative effects identified. However, there is high heterogeneity across studies, with some interventions showing no effects. Our review highlights how the effect of cash transfers may vary by social and economic context, culture, design, conditionality and mental health outcome.

Integrating youth mental health into cash transfer programmes in response to the COVID-19 crisis in low-income and middle-income countries.

Social protection measures can play an important part in securing livelihoods and in mitigating short-term and long-term economic, social, and mental health impacts of the COVID-19 pandemic. In particular, cash transfer programmes are currently being adapted or expanded in various low-income and middle-income countries to support individuals and families during the pandemic. We argue that the current crisis offers an opportunity for these programmes to focus on susceptible young people (aged 15-24 years), including those with mental health conditions. Young people living in poverty and with mental health problems are at particular risk of experiencing adverse health, wellbeing, and employment outcomes with long-term consequences. They are also at risk of developing mental health conditions during this pandemic. To support this population, cash transfer programmes should not only address urgent needs around food security and survival but expand their focus to address longer-term mental health impacts of pandemics and economic crises. Such an approach could help support young people's future life chances and break the vicious cycle between mental illness and poverty that spirals many young people into both socioeconomic and mental health disadvantage.

Medicamentos homeopáticos e inmunidad en la Covid 19 en Cuba / Homeopathic medicines and immunity in Covid 19 in Cuba

Introducción: Desde los Lineamientos de la Política Económica y Social del Partido y la Revolución se evidencia la voluntad política de impulsar la implementación de la Medicina Natural y Tradicional, a partir del aseguramiento de la producción, comercialización de productos naturales y asistencia médica. El cuadro básico de productos naturales creció a 172 surtidos siendo hoy la medicina natural y tradicional una de las vertientes del enfrentamiento a la Covid-19 en Cuba, y sus aplicaciones se amplían en el contexto de la contingencia epidemiológica generada por la peligrosa enfermedad. Su aplicación no sustituye los tratamientos indicados contra la enfermedad ni la asunción de las medidas higiénicas establecidas, sino que es un elemento más para reducir la propagación del nuevo coronavirus.

Hybrid Organizations in Health Systems: The Corporatization of Malaysia's National Heart Institute.

Health system reforms across high- and middle-income countries often involve changes to public hospital governance. Corporatization is one such reform, in which public sector hospitals are granted greater functional independence while remaining publicly owned. In theory, this can improve public hospital efficiency, while retaining a public service ethos. However, the extent to which efficiency gains are realized and public purpose is maintained depends on policy choices about governance and payment systems. We present a case study of Malaysia's National Heart Institute (IJN), which was created in 1992 by corporatization of one department in a large public hospital. The aim of the paper is to examine whether IJN has achieved the goals for which it was created, and if so, whether it provides a potential model for further reforms in Malaysia and other similar health systems. Using a combination of document analysis and key informant interviews, we examine key governance, health financing and payment, and equity issues. For governance, we highlight the choice to have IJN owned by and answerable to a Ministry of Finance (MOF) holding company and MOF-appointed board, rather than the Ministry of Health (MOH). On financing and payment, we analyze the implications of IJN's combined role as fee-for-service provider to MOH as well as provider of care to private patients. For equity, we analyze the targeting of IJN care across publicly-referred and private patients. These issues demonstrate unresolved tensions between IJN's objectives and public service goals. As an institutional innovation that has endured for 28 years and grown dramatically in size and revenue, IJN's trajectory offers critical insights on the relevance of the hybrid public-private models for hospitals in Malaysia as well as in other middle-income countries. While IJN appears to have achieved its goal of establishing itself as a commercially viable, publicly owned center of clinical excellence in Malaysia, the value for money and equity of the services it provides to the Ministry of Health remain unclear. IJN is accountable to a small Ministry of Finance holding company, which means that detailed information required to evaluate these critical questions is not published. The case of IJN highlights that corporatization cannot achieve its stated goals of efficiency, innovation, and equity in isolation; rather it must be supported by broader reforms, including of health financing, payment, governance, and transparency, in order to ensure that autonomous hospitals improve quality and provide efficient care in an equitable way.

Vulnerabilidad al estrés en pacientes adultos hipertensos / Vulnerability to the stress in hypertensive adult patients

RESUMEN Introducción: En la hipertensión, el estrés constituye un factor sicosocial de riesgo. Objetivo: establecer la relación entre vulnerabilidad al estrés con variables sociodemográficas y clínicas en pacientes hipertensos adultos del Policlínico Santa Cruz. Métodos: Estudio descriptivo, transversal. El universo lo conformaron 65 hipertensos, diagnosticados de enero a junio del 2019. La muestra intencional fue de 58 hipertensos. Para la recogida de información se emplearon: la Historia Clínica Individual y familiar y el Test de Vulnerabilidad al Estrés. Resultados: Predominio del 70,7 % de hipertensos en la tercera subetapa de la adultez, supremacía femenina (69,0 %); la mayoría con secundaria básica terminada (36,2 %); casados (44,8 %) y trabajadores estatales (51,7 %); predominaron los fumadores (81 %); prevaleció la hipertensión arterial grado II (69 %) y dieron cumplimiento al tratamiento el 53,4 %. La mayoría presentó vulnerabilidad al estrés (65,5%); mejor representado en la tercera subetapa de la adultez (81,6 %), mujeres (63,2 %), con secundaria básica terminada (39,5 %), casados (42,1 %), trabajador estatal (55,3 %), fumadores (76,3 %), con hipertensión arterial grado II el 76,3 %; cumplieron el tratamiento siempre el 55,3 %; presentaron nivel vulnerable al estrés el 68,4 % de los hipertensos. Existió asociación entre el nivel seriamente vulnerable al estrés y la escolaridad primaria (p= 0,007). La mayoría de los hipertensos presentaron vulnerabilidad al estrés. El nivel vulnerable al estrés predominó; mejor representado en la tercera subetapa de la adultez, en las mujeres, los fumadores, los hipertensos grado II y los que siempre cumplían con el tratamiento. Existió asociación entre el nivel seriamente vulnerable al estrés y la escolaridad primaria.

ABSTRACT Introduction: In the hypertension, the stress constitutes a psychosocial risk factor. Objective: To establish the relation between vulnerability to the stress with socio-demographics and clinical variables in adult hypertensive patients of the General hospital Santa Cruz. Methods: Descriptive, transverse study. The universe was constituted of 65 hypertensive patients, diagnosed from January until June, 2019. The intentional sample was 58 hypertensive patients. For the information collection, it was used: the Individual and familiar Case history and the Test of Vulnerability to the Stress. Results: Predominance 70.7 % of hypertensive patients in the third sub-stage of the adulthood, feminine supremacy (69.0 %); the majority with secondary school finished (36.2 %); married (44.8 %) and state workpeople (51.7 %); there prevailed the smokers (81 %); the arterial hypertension grade II prevailed (69 %) and they fulfilled the treatment 53.4 %. The majority presented vulnerability to the stress (65.5 %); better represented in the third sub-stage of the adulthood (81.6 %), women (63.2 %), with secondary school finished (39.5 %), married (42.1 %), state worker (55.3 %), smokers (76.3 %), with arterial hypertension grade II 76.3 %; they always fulfilled the treatment 55.3 %; they presented vulnerable level to the stress 68.4 % of the hypertensive patients. Association existed between the level seriously vulnerably to the stress and the primary schooling (p = 0.007). Discussion: Most of the hypertensive patients presented vulnerability to the stress. The vulnerable level to the stress prevailed; better represented in the third sub-stage of the adulthood, in the women, the smokers, hypertensive grade II and those who were always fulfilled with the treatment. Association existed between the level seriously vulnerably to the stress and the primary schooling.

Cemeteries in Miami-Dade County, Florida are important areas to be targeted in mosquito management and control efforts.

Definable habitats at the neighborhood level provide a wide range of favorable habitats with optimal conditions and environmental resources for mosquito survival. Problematic habitats for controlling mosquitoes in urban environments such as tire shops, bromeliad patches, and construction sites must be taken into consideration in the development of effective mosquito management and control in urban areas. Cemeteries are often located in highly urbanized areas serving as a haven for populations of vector mosquito species due to the availability of natural resources present in most cemeteries. Even though Miami-Dade County, Florida was the most affected area in the United States during the Zika virus outbreak in 2016 and is currently under a mosquito-borne illness alert after 14 confirmed locally transmitted dengue cases, the role of cemeteries in the proliferation of vector mosquitoes is unknown. Therefore, our objective was to use a cross-sectional experimental design to survey twelve cemeteries across Miami-Dade County to assess if vector mosquitoes in Miami can be found in these areas. Our results are indicating that vector mosquitoes are able to successfully exploit the resources available in the cemeteries. Culex quinquefasciatus was the most abundant species but it was neither as frequent nor present in its immature form as Aedes aegypti and Aedes albopictus. This study revealed that vector mosquitoes, such as Ae. aegypti, Ae. albopictus, and Cx. quinquefasciatus are successfully exploiting the resources available in these areas being able to thrive and reach high numbers. Mosquito control strategies should consider both long-term strategies, based on changing human behavior to reduce the availability of aquatic habitats for vector mosquitoes; as well as short-term strategies such as drilling holes or adding larvicide to the flower vases. Simple practices would greatly help improve the effectiveness of mosquito management and control in these problematic urban habitats.

The political economy of health financing reform in Malaysia.

There is growing evidence that political economy factors are central to whether or not proposed health financing reforms are adopted, but there is little consensus about which political and institutional factors determine the fate of reform proposals. One set of scholars see the relative strength of interest groups in favour of and opposed to reform as the determining factor. An alternative literature identifies aspects of a country's political institutions-specifically the number and strength of formal 'veto gates' in the political decision-making process-as a key predictor of reform's prospects. A third group of scholars highlight path dependence and 'policy feedback' effects, stressing that the sequence in which health policies are implemented determines the set of feasible reform paths, since successive policy regimes bring into existence patterns of public opinion and interest group mobilization which can lock in the status quo. We examine these theories in the context of Malaysia, a successful health system which has experienced several instances of proposed, but ultimately blocked, health financing reforms. We argue that policy feedback effects on public opinion were the most important factor inhibiting changes to Malaysia's health financing system. Interest group opposition was a closely related factor; this opposition was particularly powerful because political leaders perceived that it had strong public support. Institutional veto gates, by contrast, played a minimal role in preventing health financing reform in Malaysia. Malaysia's dramatic early success at achieving near-universal access to public sector healthcare at low cost created public opinion resistant to any change which could threaten the status quo. We conclude by analysing the implications of these dynamics for future attempts at health financing reform in Malaysia.

'If she is a good woman ' and 'to be a real man ': gender, risk and access to HIV services among key populations in Tajikistan.

The HIV epidemic continues to grow in Tajikistan, especially among people who inject drugs, sex workers, men who have sex with men and incarcerated populations. Despite their susceptibility to HIV, members of these groups do not always have access to HIV prevention, testing and treatment. The purpose of this study was to identify and understand the gender constraints in accessing HIV services for key populations in Tajikistan. Using focus-group discussions and key-informant interviews the assessment team collected information from members of key populations and those who work with them. Several themes emerged from the data, including: low levels of HIV knowledge, gender constraints to condom use and safer drug use, gender constraints limit HIV testing opportunities, gender-based violence, stigma and discrimination, and the lack of female spaces in the HIV response. The results of this study show that there are well-defined gender norms in Tajikistan, and these gender norms influence key populations' access to HIV services. Addressing these gender constraints may offer opportunities for more equitable access to HIV services in Tajikistan.

Assessing Latin America's Progress Toward Achieving Universal Health Coverage.

Two commonly used metrics for assessing progress toward universal health coverage involve assessing citizens' rights to health care and counting the number of people who are in a financial protection scheme that safeguards them from high health care payments. On these metrics most countries in Latin America have already "reached" universal health coverage. Neither metric indicates, however, whether a country has achieved universal health coverage in the now commonly accepted sense of the term: that everyone--irrespective of their ability to pay--gets the health services they need without suffering undue financial hardship. We operationalized a framework proposed by the World Bank and the World Health Organization to monitor progress under this definition and then constructed an overall index of universal health coverage achievement. We applied the approach using data from 112 household surveys from 1990 to 2013 for all twenty Latin American countries. No country has achieved a perfect universal health coverage score, but some countries (including those with more integrated health systems) fare better than others. All countries except one improved in overall universal health coverage over the time period analyzed.

Síndrome Russel-Silver: presentación de caso / Russel-Silver syndrome: Case presentation

Fundamento: el síndrome de Russell- Silver es un padecimiento congénito con características específicas como restricción del crecimiento prenatal y/o posnatal, una face típica y asimetría corporal. Es una enfermedad genética rara y de baja prevalencia, que aparece esporádicamente y se caracteriza por múltiples signos dismórficos. Presentación del caso: se informa el caso clínico de un niño de dos años, quien reveló al examen clínico características físicas compatibles con el síndrome, una somatometría inadecuada a la edad gestacional (35 semanas), macrocefalia relativa debido a desproporción craneofacial, cara triangular, asimetría facial y corporal del hemicuerpo izquierdo y hemihipertrofia de ese lado. Conclusiones: se hizo el diagnóstico del síndrome de Russell-Silver basado en los criterios clínicos presentes en el paciente y los antecedentes prenatales(AU)

Background: Russell- Silver syndrome is a congenital ailing with specific characteristics like the restriction of prenatal and postnatal growth; they have a typical face and body asymmetry. It is a rare genetic disease with low prevalence which appears by fits and starts and is characterized by many dimorphic signs. Care presentation: A clinical case of a 2 year old child was reported, on physical examination he revealed physical characteristics compatible with this syndrome, an unsuitable samotrometry at 35 weeks gestation, relative macrocephaly due to craneumfacial disproportion, triangular face, facial and corporal asymmetry of the left hemicorpus and hemihypertrophia of this side.. Conclusion: A diagnosis of the Russell-Silver syndrome was carried out due to clinical criteria present in the patient and prenatal antecedents(AU)