HPV vaccine delay and refusal among unvaccinated Mexican American young adult women: a qualitative investigation of Mexican-born and US-born HPV vaccine decision narratives.

Low HPV vaccination rates among Latina young adults perpetuate HPV-associated cancer disparities. Using qualitative methods, this study explored individual, interpersonal, and community factors that influence HPV vaccine delay and refusal among Mexican- and U.S.-born Mexican American young adult women. Participants (N = 30) between 18 and 26 years old were purposively sampled from two federally qualified health centers in Orange County, California. The National Institute on Minority Health and Health Disparities research framework and narrative engagement theory guided semi-structured phone interviews coded inductively and deductively. Participants primarily attributed vaccine status to individual and interpersonal reasons. Emerging themes included low HPV vaccine knowledge, insufficient provider communication, negative perceptions about HPV and the vaccine, motherhood responsibilities, mother's communication about HPV, cultural family norms, health care access, and misinformation. Compared to U.S.-born Latinas, Mexican-born participants more frequently expressed avoiding health care discussions with family. HPV vaccine recommendations for young Mexican American women should include socioculturally tailored messages that may improve HPV vaccination acceptance and uptake.

BLK and BANK1 variants and interactions are associated with susceptibility for primary Sjögren's syndrome and with some clinical features.

BLK and BANK1 in primary Sjögren's syndrome (pSS) have scarcely been evaluated and the results are inconclusive. The aim of our study was to determine whether single nucleotide variants (SNVs) located within BLK or BANK1 are associated with susceptibility, clinical and serological features, and smoking in pSS. BLK rs13277113A/G, BANK1 rs10516487G/A and rs3733197G/A were genotyped in 203 cases and 424 controls using a TaqMan® SNP genotyping assay. The BLK rs13277113A allele showed association with pSS under the allelic (OR 1.35, p = 0.02), and recessive (OR 1.83, p = 0.003) model, while, BANK1 rs3733197G/A showed association under the dominant model (OR 2.90, p = 0.043). Interactions between BANK1 and BLK genotypes also showed association (OR 2.36, p < 0.0001). In addition, BLK rs13277113A/G was associated with protection against arthritis and BANK1 rs10516487G/A with both arthritis and keratoconjunctivitis sicca, meanwhile, BANK1 rs3733197G/A was associated with smoking in patients with pSS. This is the first study to describe an association between BLK and susceptibility to pSS in a Latin-American population. Our data also shows a first evidence of association between interactions of BLK and BANK1 in pSS, and association of BLK and BANK1with arthritis, keratoconjunctivitis sicca and smoking in patients with pSS.

Reporte de caso: Manejo anestésico en un paciente pediátrico con ictiosis más deshidratación grave / Case report: Anesthetic management of an infant patient with ichthyosis plus severe dehydration

INTRODUCTION: Ichthyosis are hereditary disorders of keratinization which are characterized for the presence of hyperkeratosis and/or peeling. This disorder group can put in danger the life of the patient because of the severe alteration of the skin barrier, associated with a severe transdermic loss of water, different grades of hypothermia and a hypernatremic dehydration. OBJECTIVE: Introducing the clinic case of an infant patient with the diagnosis of ichthyosis plus severe dehydration who is scheduled for placement of CVC. CLINICAL CASE: Male infant, 3 months old, with the diagnosis of ichthyosis and severe dehydration, scheduled for placement of CVC. CONCLUSIONS: Due to the urgency of our patient, who presented severe dehydration, an inhaled general anesthesia with sevoflurane and oxygen was decided, without instrumenting the airway which in these patients has the risk of being potentially difficult, from the placement of the face mask itself, until finding lesions within the oral cavity, ventilatory assis- tance should be maintained by the pediatric anesthesiologist, once venous access is achieved, the fluids restitution is performed with loads of 10 to 20 ml/kg of the patient's weight, hyperthermia was controlled with physical means.

INTRODUCCIÓN: Las ictiosis son trastornos hereditarios de la queratinización caracterizadas por la presencia de hiperqueratosis y/o descamación. Este grupo de patologías pueden poner en peligro la vida del paciente debido a la severa alteración de la barrera cutánea, asociada a intensa pérdida transepidérmica de agua, diferentes grados de hipotermia y la deshidratación hipernatrémica. OBJETIVO: Presentar un caso clínico de paciente lactante menor con diagnóstico de ictiosis, cursando un cuadro grave por deshidratación, al que se le instala un CVC. CASO CLÍNICO: Lactante masculino, 3 meses de edad, con diagnóstico de ictiosis y deshidratación grave programado para colocación de CVC. CONCLUSIONES: Debido a la urgencia del paciente quien presentaba un caso de deshidratación severa se decide anestesia general inhalada con sevoflurano y oxígeno, sin instrumentación de la vía área, la cual en estos pacientes tiene el riesgo de ser potencialmente difícil, desde la propia colocación de la mascarilla facial hasta encontrar lesiones dentro de la cavidad oral; se debe mantener la asistencia ventilatoria por el anestesiólogo pediatra, una vez logrado el acceso venoso se procede a la restitución hídrica con cargas de 10 a 20 ml/kg de peso del paciente, el control de la hipertermia fue con medios físicos.

Diets with lower carbohydrate concentrations improve insulin sensitivity in women with polycystic ovary syndrome: A meta-analysis.

OBJECTIVE: Women with polycystic ovary syndrome (PCOS) are associated with increased levels of insulin resistance (IR). Other than treatment with insulin-sensitizing drugs, specialized diets have also been implemented to reduce the patient's IR. However, the capacity of certain diets, concerning with the severity of the patient's IR, to improve insulin sensitivity has not fully been explored. Therefore, we conducted a meta-analysis to determine in PCOS subjects from low to severe IR, if hypocaloric diets improve insulin sensitivity. STUDY DESIGN: PubMed, SCOPUS, EBSCO, and LILACS databases and retrieved studies' bibliographies were searched for prospective studies that investigated the association between diets and IR in PCOS women until October 2018. Diet was defined as a modification of the patients' nutrition intake according to caloric restriction, change in protein intake, or by using a specialized diet. IR measures (HOMA1-IR), pre- and post-intervention were extracted. Using Comprehensive Meta-Analysis software, depending on the level heterogeneity, determined by the ψ2-based Q-test and the I2-test, fixed-effects or random-effects models were used to calculate the pooled standard paired differences (SPD) and 95 %CI. RESULTS: 20 publications (25 studies) fulfilled the inclusion criteria. Due to the heterogeneity of the diets, the random-effects model was used. In 48 % of the studies, the diets led to a decrease of IR, where 44 % had no effect. In 2 studies, the diets increased IR. Overall, the diets decreased IR (SPD=-0.58; 95 %CI: -0.81 to -0.36). Subjects with severe IR (HOMA1-IR>4.2) had a marked improvement (SPD=-1.22; 95 %CI: -1.61 to -0.84). Moreover, diets low in carbohydrate (<50 %) was also determined to improve IR (SPD=-0.86; 95 %CI: -1.23 to -0.50). CONCLUSIONS: Here, we demonstrate that diets are more likely to improve IR in PCOS women with severe IR. Therefore, it is crucial to determine a subject's IR status before considering any intervention containing a diet.

Dificultad en evaluaciones frecuentes y finales en contenidos de Anatomía de Ontogenia Humana y SOMA / Difficulty of Quizzes and Final Evaluations in Contents about Anatomy of Human Ontogeny and Osteo-Muscular-Articulatory System

Introducción: En el marco de la validación del plan de estudio D de la carrera de Medicina en Cuba, se analiza la calidad de los instrumentos evaluativos aplicados en asignaturas del nuevo plan de estudio. Objetivo: Comparar el nivel de dificultad de las evaluaciones frecuentes y finales de la asignatura Ontogenia Humana y SOMA, en el contenido correspondiente a la anatomía de los músculos. Métodos: Se realizó una investigación pedagógica en la Universidad de Ciencias Médicas de Matanzas durante el curso 2016-2017. Se analizaron 2763 preguntas escritas de clases prácticas y 553 exámenes ordinarios. Se aplicaron métodos teóricos, empíricos y procesamientos estadísticos de datos. Resultados: Predominó el nivel medianamente fácil en las preguntas de las evaluaciones frecuentes, con una media en 0,78. El resultado estuvo influenciado por el diseño de complejidad ascendente en la forma de abordar los contenidos en dichas evaluaciones, que favoreció un entrenamiento en los estudiantes sobre la forma de evaluar. En el examen final el 65 por ceinto de los incisos correspondientes a la pregunta de anatomía de los músculos presentó dificultad media. De dificultad medianamente fácil resultó el 20 por ciento de los incisos y el 15 por ciento restante medianamente difícil. Conclusiones: El nivel de dificultad del examen final fue mayor que en las evaluaciones parciales en el 80 por ciento de los temas y el cambio fue de una categoría a la siguiente. La evaluación del contenido de músculos en la asignatura se correspondió con un nivel adecuado al cumplir con los requisitos de calidad que exige la acreditación(AU)

Introduction: During the validation process for the study plan D of the medical major in Cuba, the quality is analyzed of the evaluative tools applied in subjects of the new study plan. Objective: To compare the level of difficulty of quizzes and final evaluations of the subject Human Ontogeny and Osteo-Muscular-Articulatory System, regarding the content for the anatomy of the muscles. Methods: A pedagogical research was carried out at the University of Medical Sciences of Matanzas during the academic year 2016-2017. We analyzed 2763 quizzes from workshops and 553 first-call exams. Theoretical and empirical methods, together with statistical data processing were applied. Results: The moderately easy level prevailed in the questions of quizzes, with a mean of 0.78. The result was influenced by the design of ascending complexity in the way of addressing the contents in such evaluations, which favored a training in the students regarding the way to evaluate. In the final exam, 65 percent of the items corresponding to the question of anatomy of the muscles presented average difficulty, while 20 percent of the items were of moderately easy difficulty and the other 15 percent were moderately difficult. Conclusions: The level of difficulty of the final exam was higher than in quizzes in 80 percent of the subjects and the change was from one category to the next. The evaluation of the content of muscles in the subject corresponded to an adequate level, since it met the quality requirements for accreditation(AU)

Rapid Identification and Simultaneous Quantification of Aristolochic Acids by HPLC-DAD and Confirmations by MS in Aristolochia chilensis Using a Limited Biomass.

Six aristolochic acids were identified in the Chilean species Aristolochia chilensis using high-performance liquid chromatography coupled to a diode array detector (HPLC-DAD) and subsequent confirmation with mass spectrometry (MS). The fractions of each signal were collected and injected directly into an Orbitrap mass detector model Q Exactive Focus (Thermo Scientific). The acids extraction was done with 0.10-0.50 g of lyophilized and pulverized sample and concentrated in Soxhlet extraction equipment. The liquid-liquid separations and a subsequent solid phase extraction (SPE) C18 were performed using 100 µL of the extract that contains the aristolochic acids present in the Aristolochia chilensis plant. The HPLC conditions used a single mobile phase acetonitrile : water (1 : 1) acidified with 0.1% acetic acid and an isocratic elution to 1 mL·min-1. The column InertSustain C18 250 × 4.6 mm and 3 µm was used, the injection volume was 20 µL, and the time of run was reduced to 15 min. Calibration curves were constructed with r2 being 0.9997. The quantification limit for AAI was 0.138 ± 0.010 µg/mL, and for AAII, it was 0.558 ± 0.042 µg/mL.

Los incentivos y actores de los Sistemas de Salud de Costa Rica, Estados Unidos, Canadá, Chile y Ecuador - 2015 / Incentives and actors of Health Systems in Costa Rica, The United States of America, Canada, Chile and Ecuador - 2015

Ante los diferentes sistemas de salud propuestos en cada país surge la necesidad de analizar la participación de cada uno de los elementos que lo componen. Este análisis se realiza con el fin de identificar y analizar los actores que intervienen en los sistemas de salud, especialmente, el uso de incentivos y la relación intersectorial que entre estos existe. Para ello, se llevó a cabo un estudio cualitativo descriptivo, mediante una revisión bibliográfica de los sistemas implementados en Costa Rica, Estados Unidos, Canadá, Chile y Ecuador. Se tuvieron en cuenta dos factores: el sistema de salud, definido por la Organización Mundial de la Salud como la suma de todas las organizaciones, instituciones y recursos empleados, cuyo objetivo consiste en mejorar la salud. El segundo, los incentivos, que brindan una motivación a los trabajadores, mejorando sus expectativas frente al trabajo y la manera de ejecutarlo, favoreciendo el cumplimiento de metas establecidas por las empresas. Como resultado, se encontró que en los sistemas de salud expuestos, si bien existen similitudes en relación con su desarrollo e implementación, también hay profundas diferencias, en especial, en la participación de actores públicos y privados. Conclusión: los incentivos existentes en los sistemas de salud estudiados no tienen un enfoque estratégico que articule a los actores en pro de la salud y el bienestar de la población.

Before the different systems of health proposed in every country there arises the need to analyze the participation of each one of the elements that compose it. This analysis is realized in order identify and to analyze the actors who intervene in the systems of health, especially, the use of incentives and the intersectorial relation that between these exists. For it, there was carried out a qualitative descriptive study, by means of a bibliographical review of the systems implemented in Costa Rica, The United States, Canada, Chile and Ecuador. Two factors were born in mind: the system of health, defined by the World Health Organization (WHO) like the sum of all the organizations, institutions and used resources, which aim consists of improving the health. The second one, the incentives, that offer a motivation to the workers, improving his expectations opposite to the work and the way of executing it, favoring the fulfillment of goals established by the companies. As result, one found that, in the systems of health exposed, though similarities exist in relation with his development and implementation, also there are deep differences, especially, in the participation of public and private actors. Conclusion, incentives in health care systems do not have strategic perspective so that there are many problems to obtain wellbeing for all citizens.