PAs in Puerto Rico: How asociados médicos are persevering through restrictive practice laws.

ABSTRACT: As strained as Puerto Rico's healthcare infrastructure has become in recent years, the island's medical community has long resisted the idea of the physician assistant (PA). After almost 30 years of advocating for the PA profession in Puerto Rico, Law No. 71 was enacted in August 2017, recognizing the PA profession under the title of médico asistente. Eighteen months later, in February 2019, PAs were able to apply for licensure. However, the law as written severely restricts PA medical practice. This article reviews the current status of certified PAs in Puerto Rico and what steps are being taken to establish the profession to ultimately improve health outcomes and expand access to care throughout the island.

Health Care and Education Access of Transnational Children in Mexico.

Between 2001 and 2018, more than 5.5 million Mexican migrants were removed from the United States or returned to Mexico with their families as immigration enforcement escalated. Learning how this transition affected their children-also referred to as "the invisibles"-is a policy-relevant topic for both the United States and Mexico. Using representative data on 7.6 million Mexican- and U.S.-born children from the 2015 Mexican Intercensal Survey, we provide evidence of the gaps in access to education and health care between these two groups and of the factors potentially responsible for the existing barriers. Relative to children born in Mexico, U.S.-born children are at a considerable disadvantage in terms of health care access, but less so in terms of education. Lack of a Mexican-issued birth certificate is among the persistent factors responsible for the gaps in services. Policies aimed at changing the approach to immigration enforcement in the United States, lessening paperwork requirements in Mexico, and easing access to documentation in both countries could improve transnational children's access to basic services, as well as their present and long-term well-being.

Dolor óseo generalizado e hipercalcemia en un lactante mayor como síntoma inicial de linfoma linfoblástico de células B / Generalized bone pain and hypercalcemia in an infant as an initial symptom of lymphoblastic lymphoma of B cells

Resumen Introducción: Los linfomas no Hodgkin son neoplasias heterogéneas derivadas de las células linfohematopoyéticas. Es raro que se presenten antes de los 2 años de edad y la prevalencia es mayor en el sexo masculino. Caso clínico: Paciente de sexo masculino de 1 año y 11 meses que debutó con dolor en miembros inferiores y superiores, claudicación intermitente, deformidad ósea e hipotonía generalizada, por lo que se sospechaba artritis juvenil. Se trató con antiinflamatorios no esteroideos. Al no haber mejoría, ingresó a otro hospital con adenopatías y nodulaciones en la región escrotal y braquial, y hepatomegalia, por lo que se presumió la activación precoz de la pubertad con evidencia de hipercalcemia. Los estudios radiológicos indicaron una posible displasia ósea. Sin embargo, la tomografía por emisión de positrones detectó zonas compatibles con un proceso maligno. Se diagnosticó linfoma de precursores B. La hipercalcemia es una alteración metabólica que, en presencia de cáncer, se considera un síndrome paraneoplásico. Es un dato clínico excepcional que se puede observar en niños con leucemia linfoblástica aguda. Conclusiones: El dolor óseo en la edad pediátrica amerita una exploración física minuciosa para realizar un diagnóstico oportuno del cáncer infantil y mejorar el pronóstico del paciente.

Abstract Background: Non-Hodgkin lymphomas are heterogeneous neoplasms derived from lymphohematopoietic cells, which are rarely found in children < 2 years of age and have a higher prevalence in males. Case report: One-year and eleven-month-old male patient started with pain in the lower and upper limbs, intermittent claudication, bone deformity, and generalized hypotonia, for which juvenile arthritis was suspected. He received non-steroidal anti-inflammatory drug treatment. As no improvement was reported, he was admitted in a different hospital with lymph nodes and nodulations in the scrotal and brachial region and hepatomegaly. Therefore, early activation of puberty with evidence of hypercalcemia was presumed. Radiological studies indicated possible bone dysplasia; however, positron emission tomography detected areas compatible with malignant process. Precursor B lymphoma was diagnosed. Hypercalcemia is a metabolic disorder considered a paraneoplastic syndrome in the presence of cancer, which is an exceptional clinical finding in children with acute lymphoblastic leukemia. Conclusions: Bone pain in the pediatric age deserves a thorough physical examination to favor an early diagnosis of childhood cancer and a better prognosis.

[The Effect of Non-Contributory Pensions on the Subjective Wellbeing of Older Adults in Mexico]. / El efecto de las pensiones no contributivas sobre el bienestar subjetivo de los adultos mayores en México.

In this article, we estimate the impact of a non-contributory pension, in operation at the federal level between 2007 and 2012, on the subjective wellbeing of older adults. Our results suggest that, on average, this pension had a positive, and statistically significant, effect on the subjective wellbeing of older women, but not on that of older men. However, a heterogeneous impact analysis, based on socioeconomic vulnerability, reveals that there are positive impacts of this pension for men who speak an indigenous language and that the positive impacts are more pronounced for older women who did not complete their primary education.

[Dolor óseo generalizado e hipercalcemia en un lactante mayor como síntoma inicial de linfoma linfoblástico de células B].

Introducción: Los linfomas no Hodgkin son neoplasias heterogéneas derivadas de las células linfohematopoyéticas. Es raro que se presenten antes de los 2 años de edad y la prevalencia es mayor en el sexo masculino. Caso clínico: Paciente de sexo masculino de 1 año y 11 meses que debutó con dolor en miembros inferiores y superiores, claudicación intermitente, deformidad ósea e hipotonía generalizada, por lo que se sospechaba artritis juvenil. Se trató con antiinflamatorios no esteroideos. Al no haber mejoría, ingresó a otro hospital con adenopatías y nodulaciones en la región escrotal y braquial, y hepatomegalia, por lo que se presumió la activación precoz de la pubertad con evidencia de hipercalcemia. Los estudios radiológicos indicaron una posible displasia ósea. Sin embargo, la tomografía por emisión de positrones detectó zonas compatibles con un proceso maligno. Se diagnosticó linfoma de precursores B. La hipercalcemia es una alteración metabólica que, en presencia de cáncer, se considera un síndrome paraneoplásico. Es un dato clínico excepcional que se puede observar en niños con leucemia linfoblástica aguda. Conclusiones: El dolor óseo en la edad pediátrica amerita una exploración física minuciosa para realizar un diagnóstico oportuno del cáncer infantil y mejorar el pronóstico del paciente.

Prevalence and incidence of systemic lupus erythematosus in Tucumán, Argentina.

The aim of this study was to determine the prevalence and incidence of Systemic Lupus Erythematosus (SLE) in Tucumán, Argentina. METHODS: The study included inpatient and outpatient charts from four public hospitals and private practice rheumatology clinics, all of them members of the Tucumán Rheumatology Society. Patients older than 16 years with diagnosis of SLE between January 2005 and December 2012 were included. Prevalence and annual incidence were calculated as the number of cases per 100.000 inhabitants during the period 2005 to 2012. RESULTS: Three hundred fifty-three patients were identified. The mean age at diagnosis was 30.5 ± 11.7 years, 93.5% women, 83% mestizos. Prevalence was 24.3 cases/100.000 inhabitants (CI 95% 22.6-28.8) and age-adjusted (≥16 years) of 34.9 cases/100.000 inhabitants (CI 95% 32.8-41.1). The annual incidence in 2005 was 1.8 cases/100.000 inhabitants (95% CI 1-2.9) and 2012 of 4.2 cases/100.000 inhabitants (95% CI 2.9-5.8). Mortality was 9.1%, with infections being the most frequent cause (14/32). CONCLUSION: The prevalence of SLE in the province of Tucumán was 34.9 cases/100.000 inhabitants.

Paternal and maternal mutations in X-STRs: A GHEP-ISFG collaborative study.

The GHEP-ISFG organized a collaborative study to estimate mutation rates for the markers included in the Investigator Argus X-12 QS kit Qiagen. A total of 16 laboratories gathered data from 1,612 father/mother/daughter trios, which were used to estimate both maternal and paternal mutation rates, when pooled together with other already published data. Data on fathers and mothers' age at the time of birth of the daughter were also available for ∼93 % of the cases. Population analyses were computed considering the genetic information of a subset of 1,327 unrelated daughters, corresponding to 2,654 haplotypes from residents in several regions of five countries: Argentina, Brazil, Ecuador, Portugal and Spain. Genetic differentiation analyses between the population samples from the same country did not reveal signs of significant stratification, although results from Hardy-Weinberg and linkage disequilibrium tests indicated the need of larger studies for Ecuador and Brazilian populations. The high genetic diversity of the markers resulted in a large number of haplotype combinations, showing the need of huge databases for reliable estimates of their frequencies. It should also be noted the high number of new alleles found, many of them not included in the allelic ladders provided with the kit, as very diverse populations were analyzed. The overall estimates for locus specific average mutation rates varied between 7.5E-04 (for DXS7423) and 1.1E-02 (for DXS10135), the latter being a troublesome figure for kinship analyses. Most of the found mutations (∼92 %) are compatible with the gain or loss of a single repeat. Paternal mutation rates showed to be 5.2 times higher than maternal ones. We also found that older fathers were more prone to transmit mutated alleles, having this trend not been observed in the case of the mothers.

Body image and size perceptions of Mexican American women.

Purpose was to examine in Mexican American women the influences of age, weight, socioeconomic status and acculturation level on body image, perceptions of attractive and acceptable female shapes, and tolerance for overweight and obesity. Participants were 276 Mexican American women. Age, body mass index, socioeconomic status, and acculturation level were measured. The Figure Rating Scale was used to assess body image, preferences for body size, and perceptions of underweight to obese and acceptable body sizes. Significant effects for acculturation level and current weight were found. Women who were more Anglo oriented showed greater preference for thinner figures. As compared to normal weight women, obese women chose larger figures as ideal, realistic, attractive, and thinnest acceptable. Findings point to the impact of acculturation and obesity on body image and size perceptions. Health professionals working with Mexican Americans should consider each individual's current weight and level of acculturation.