Chamaecyparis lawsoniana and Its Active Compound Quercetin as Ca2+ Inhibitors in the Contraction of Airway Smooth Muscle.

The Cupressaceae family includes species considered to be medicinal. Their essential oil is used for headaches, colds, cough, and bronchitis. Cedar trees like Chamaecyparis lawsoniana (C. lawsoniana) are commonly found in urban areas. We investigated whether C. lawsoniana exerts some of its effects by modifying airway smooth muscle (ASM) contractility. The leaves of C. lawsoniana (363 g) were pulverized mechanically, and extracts were obtained by successive maceration 1:10 (w:w) with methanol/CHCl3. Guinea pig tracheal rings were contracted with KCl, tetraethylammonium (TEA), histamine (HIS), or carbachol (Cch) in organ baths. In the Cch experiments, tissues were pre-incubated with D-600, an antagonist of L-type voltage-dependent Ca2+ channels (L-VDCC) before the addition of C. lawsoniana. Interestingly, at different concentrations, C. lawsoniana diminished the tracheal contractions induced by KCl, TEA, HIS, and Cch. In ASM cells, C. lawsoniana significantly diminished L-type Ca2+ currents. ASM cells stimulated with Cch produced a transient Ca2+ peak followed by a sustained plateau maintained by L-VDCC and store-operated Ca2+ channels (SOCC). C. lawsoniana almost abolished this last response. These results show that C. lawsoniana, and its active metabolite quercetin, relax the ASM by inhibiting the L-VDCC and SOCC; further studies must be performed to obtain the complete set of metabolites of the extract and study at length their pharmacological properties.

17ß-estradiol induces hyperresponsiveness in guinea pig airway smooth muscle by inhibiting the plasma membrane Ca2+-ATPase.

High serum estrogen concentrations are associated with asthma development and severity, suggesting a link between estradiol and airway hyperresponsiveness (AHR). 17ß-estradiol (E2) has non-genomic effects via Ca2+ regulatory mechanisms; however, its effect on the plasma membrane Ca2+-ATPases (PMCA1 and 4) and sarcoplasmic reticulum Ca2+-ATPase (SERCA) is unknown. Hence, in the present study, we aim to demonstrate if E2 favors AHR by increasing intracellular Ca2+ concentrations in guinea pig airway smooth muscle (ASM) through a mechanism involving Ca2+-ATPases. In guinea pig ASM, Ca2+ microfluorometry, muscle contraction, and Western blot were evaluated. Then, we performed molecular docking analysis between the estrogens and Ca2+ ATPases. In tracheal rings, E2 produced AHR to carbachol. In guinea pig myocytes, acute exposure to physiological levels of E2 modified the transient Ca2+ peak induced by caffeine to a Ca2+ plateau. The incubation with PMCA inhibitors (lanthanum and carboxyeosin, CE) partially reversed the E2-induced sustained plateau in the caffeine response. In contrast, cyclopiazonic acid (SERCA inhibitor), U-0126 (an inhibitor of ERK 1/2), and choline chloride did not modify the Ca2+ plateau produced by E2. The mitochondrial uniporter activity and the capacitative Ca2+ entry were unaffected by E2. In guinea pig ASM, Western blot analysis demonstrated PMCA1 and PMCA4 expression. The results from the docking modeling demonstrate that E2 binds to both plasma membrane ATPases. In guinea pig tracheal smooth muscle, inhibiting the PMCA with CE, induced hyperresponsiveness to carbachol. 17ß-estradiol produces hyperresponsiveness by inhibiting the PMCA in the ASM and could be one of the mechanisms responsible for the increase in asthmatic crisis in women.

Potential of olfactory neuroepithelial cells as a model to study schizophrenia: A focus on GPCRs (Review).

Schizophrenia (SZ) is a multifactorial disorder characterized by volume reduction in gray and white matter, oxidative stress, neuroinflammation, altered neurotransmission, as well as molecular deficiencies such as punctual mutation in Disrupted­in­Schizophrenia 1 protein. In this regard, it is essential to understand the underlying molecular disturbances to determine the pathophysiological mechanisms of the disease. The signaling pathways activated by G protein­coupled receptors (GPCRs) are key molecular signaling pathways altered in SZ. Convenient models need to be designed and validated to study these processes and mechanisms at the cellular level. Cultured olfactory stem cells are used to investigate neural molecular and cellular alterations related to the pathophysiology of SZ. Multipotent human olfactory stem cells are undifferentiated and express GPCRs involved in numerous physiological functions such as proliferation, differentiation and bioenergetics. The use of olfactory stem cells obtained from patients with SZ may identify alterations in GPCR signaling that underlie dysfunctional processes in both undifferentiated and specialized neurons or derived neuroglia. The present review aimed to analyze the role of GPCRs and their signaling in the pathophysiology of SZ. Culture of olfactory epithelial cells constitutes a suitable model to study SZ and other psychiatric disorders at the cellular level.

An assessment of mental health of Mexican and Colombian medical students during the COVID-19 pandemic / Una evaluación de la salud mental de estudiantes de medicina Mexicanos y Colombianos durante la pandemia de COVID-19

Abstract Introduction The COVID-19 pandemic caused the cessation of academic activities from the face-to-face format to confinement and virtual classes, in which little is studied about its effect on mental health. Objective Determine levels of depression, anxiety, and stress in medical students in Mexico and Colombia during the COVID-19 pandemic. Furthermore, depression, anxiety, and stress were compared by gender, education status, and country. Method A cross-sectional study was carried out with 426 medical students. Data was collected using an online survey containing the Depression, Anxiety, Stress Scale (DASS-21) questionnaire. Results Overall scores for depression, anxiety, and stress were 6.7 ± 1.2, 8.8 ± 1.2, and 5.6 ± 1.2, respectively. Females had significantly higher overall scores for depression (.24-fold increase), anxiety (.25-fold increase), and stress (.40-fold increase) than males (p ≤ .01). The risk for anxiety and stress by school year showed that basic years were associated with higher scores than advanced years (.25 and .38-fold increase, respectively). For females, starting medical school did show an increased risk of depression when compared to male students in their basic years (.38-fold increase). Lastly, students from Mexico had an increased risk for depression and anxiety (p ≤ .022 and p ≤ .004, respectively) but not for stress (p ≤ .402), when compared to students from Colombia. Discussion and conclusion Significant anxiety and depression were observed in medical students from Mexico and Colombia. Factors associated with an increased risk of depression and anxiety are students in their basic years as well as being female.

Resumen Introducción La pandemia de COVID-19 provocó el cese de las actividades académicas desde el formato presencial al confinamiento de las clases virtuales, de las que poco se ha estudiado sobre su efecto en la salud mental. Objetivo Determinar los niveles de depresión, ansiedad y estrés en estudiantes de medicina de México y Colombia durante la pandemia de COVID-19; además de comparar depresión, ansiedad y estrés por género, nivel educativo y país. Método Se realizó un estudio transversal con 426 estudiantes de medicina. Los datos se recopilaron mediante una encuesta en línea que contenía el cuestionario DASS-21. Resultados Las puntuaciones generales de depresión, ansiedad y estrés fueron 6.7 ± 1.2, 8.8 ± 1.2 y 5.6 ± 1.2, respectivamente. Las mujeres tuvieron puntajes generales significativamente más altos para depresión (.24-fold increase), ansiedad (.25-fold increase) y estrés (.40-fold increase). El riesgo de ansiedad y estrés por año escolar mostró que los años básicos se asociaron con puntajes más altos que los estudiantes en años los avanzados (.25 y .38-fold increase). Para las mujeres, cursar años básicos mostró un mayor riesgo de depresión en comparación con los estudiantes varones (.38-fold increase). Por último, los estudiantes mexicanos tuvieron un mayor riesgo de depresión y ansiedad (p ≤ .022 y p ≤ .004, respectivamente) pero no de estrés (p ≤ .402) en comparación con los estudiantes Colombianos. Discusión y conclusión Se observó ansiedad y depresión significativas en estudiantes de medicina mexicanos y colombianos. Los factores asociados a un mayor riesgo de depresión y ansiedad fueron; ser estudiante en años básicos además de ser mujer.

Premisas, aportes y desafíos metodológicos de la investigación etnográfica en salud mental / Premises, contributions and methodological challenges ethnographic research in mental health

La reflexividad metodológica como centro articulador de la investigación cualitativa permite definir y consolidar el posicionamiento epistemológico, teórico y ético-político de los investigadores. Este artículo reflexiona sobre los aportes y desafíos de la etnogra-fía como herramienta teórica metodológica y escritural para acercarse a la comprensión de la atención de la salud mental en el Primer Nivel de Atención, en el estado de Tabasco, México. El ejercicio presenta la toma de decisiones y dilemas hallados en el trabajo de campo; discute las implicaciones ético-políticas de trabajar con diseños etnográficos y expresa una serie de posicionamientos asumidos a lo largo de la investigación. Finalmente, plantea la urgencia de reflexionar ética, cultural y afectivamente en la investigación etnográfica en salud metal y llama la atención sobre los desafíos emocionales de trabajar con poblaciones en situación de vulnerabilidad, como los pueblos originarios y los enfermos mentales.(AU)

Methodological reflexivity as an articulator center in qualitative research allows us to define and consolidate the epistemological, theoretical and ethical-political positioning of researchers. This paper reflects about contributions and challenges of ethnography as theoretical, methodological and scriptural tool to approach the understanding about mental healthcare at First Level of Care in Tabasco state, Mexico. This exercise is about decisions and dilemmas faced at field work arguing about ethical-political implications of working using ethnographic al designs and expressing a series of position in assumed through this researching. Finally, it shows the urgent need of ethical, cultural and emotional reflection in to the ethnographic al researching in mental health besides to draw attention to emotional challenges of working with vulnerable populations such as native people and mental ills.(AU)

Violencia institucional en salud, instituciones, profesionales y usuarios / Institutional violence in health, institutions, professionals and users

El presente ensayo es una reflexión de la violencia en, desde, hacia y entre el personal de salud. Para lograr una aproximación, se consideran distintas fuentes de información, desde reportes periodísticos, estudios empíricos y, por supuesto, postulados conceptuales producidos para otras situaciones y campos de conocimiento. El análisis se realiza en diferentes ejes, el primero con referentes para situar el problema en el marco de propuestas enunciativas y conceptos relevantes; el segundo presenta la perspectiva del paciente o usuario; en el tercero se presentan algunos elementos de los profesionales de la salud. Por último, en último eje se delinean situaciones de las instituciones en salud, como espacio donde se desarrolla y vehiculiza la violencia, en tanto generadora y ámbito donde se ejerce tanto para los profesionales de la salud como para los pacientes usuarios. Finalmente se esbozan unas conclusiones que permiten situar el tema en sus implicaciones y consecuencias. Estos ejes nos permiten sugerir que el estudio de la violencia requiere un abordaje complejo, ya que deja un saldo de víctimas y victimarios siendo las propias instituciones en salud las generadoras de violencia alejando a los actores sociales de actos solidarios y humanizados.

This essay is a reflection about violenceexpressed inside and outside health institutions with an impact on health professionals and patients. We considered different sources of information: journalistic reports, empirical studies and conceptual postulates produced for other situations and fields of knowledge. The analysis is carried out in different axes, first, with references to place the problem within the framework of enunciativeproposals and relevant concepts; the second presents the perspective of the patient; the third presents some elements of health professionals. Finally, in the last axis, situations of health institutions are outlined, as a space where violence is developed and conveyed, as a generator and an area where it is exercised both for health professionals and patients. As conclusions we leave sketches that allow us to place the subject in its implications and consequences. These axes allow us to suggest that the study of violence requires a complex approach, since it leaves a balance of victims and perpetrators, the health institutions themselves being the generators of violence, distancing social actors from acts of solidarity and humanization.

COVID-19 y su asociación con los inhibidores de la enzima convertidora de angiotensina y los antagonistas de los receptores para angiotensina II / COVID-19 and its Association with Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Antagonists

Resumen En la pandemia de COVID-19 que se ha presentado en México y en el mundo, y que ya ha infectado alrededor de 7 millones de personas, las comorbilidades que se han asociado a esta enfermedad en orden de importancia son: hipertensión, diabetes mellitus, obesidad, enfermedad pulmonar obstructiva crónica, enfermedad cardiovascular, insuficiencia renal crónica, tabaquismo e inmunosupresión, y la hipertensión arterial es un rasgo característico en todas ellas. La enzima convertidora de angiotensina-2 (ACE2), es el receptor funcional para el SARS-CoV-2. Este virus, tiene una proteína llamada espiga (proteína S) que reconoce a la ACE2 como su receptor para ingresar a las células. La ACE2 es una proteína de la membrana plasmática y se encuentra expresada en las células alveolares tipo I y II, células epiteliales, fibroblastos, células endoteliales y macrófagos. El tratamiento con inhibidores de la enzima convertidora de angiotensina (ACEi) o con antagonistas del receptor a angiotensina II (ARBs) aumentan notablemente la expresión de ACE2. Por lo tanto, en pacientes con estas patologías y tratados con estos medicamentos, se podría incrementar el riesgo de desarrollar la COVID-19 en forma severa y fatal. Cabe destacar que los pacientes con mayor mortalidad por la COVID-19 en México son los que presentan hipertensión, diabetes mellitus, obesidad y los mayores de 65 años. Por todo lo anterior, podríamos sugerir que, durante la etapa crítica de la pandemia por SARS-CoV-2, a los pacientes, particularmente en personas de edad avanzada, con hipertensión o con diabetes mellitus y obesidad que cursan con hipertensión y si su tratamiento es con ACEi o con ARBs, se les debería modificar a medicamentos alternativos como los bloqueadores de los canales de Ca2+ tipo L (amlodipino), que hasta el momento no han sido asociados con la ACE2.

Abstract Worldwide, over 7 million people have been infected due to the pandemic of COVID-19. The comorbidities associated to this disease are: hypertension, diabetes mellitus, obesity, obstructive pulmonary disease (COPD), cardiovascular disease, chronic renal failure, smoking, immunosuppression, and hypertension. Angiotensin-converting enzyme 2 (ACE2) is the functional receptor for SARS-CoV-2. This virus has an S protein that recognizes ACE2 as its receptor to enter the cell. ACE2 is a plasmatic protein expressed in alveolar cells type I, II, fibroblasts, endothelial cells and macrophages. Treatment with inhibitors of the angiotensin-converting enzyme (ACEi) or the receptor antagonist for angiotensin II (ARBs) notably increase the expression of ACE2. Therefore, in patients with these pathologies and treated with these medicines, the risk of developing the COVID-19 in a severe and fatal way could be increased. In Mexico, the major mortality due to COVID-19 is related to hypertension, diabetes mellitus, obesity and being over 65 years of age. Therefore, we suggest that during the SARS-CoV-2 pandemic, patients with hypertension treated with ACEi or ARBs, should receive alternative treatments such as L-type Ca2+ channel blockers (amlodipine) that have not been associated with ACE2 until now.

Significados de la profesión médica desde la ideología de las y los profesionales de la medicina / Meanings of the medical profession from the ideology of medical professionals

RESUMEN Se aborda la ideología de las y los profesionales de la medicina, desde la teoría de Thompson, para entender los significados de la profesión médica, a partir de las categorías: autonomía, normas y valores, y reconocimiento social. Se realizaron 24 entrevistas semiestructuradas a profesionales de la medicina en cuatro ámbitos de trabajo: institucional público, institucional privado, ejercicio privado y ejercicio mixto, en Amecameca, municipio del Estado de México, en el período comprendido de marzo a octubre de 2019. El análisis de los significados expresados por las y los profesionales de la medicina en cada una de las categorías de interés muestra una base condicionada por la estructura del control estatal y por la economía mercantilizada, que valora con mayor significación formas de práctica médica privada. En la conformación ideológica de la profesión médica subsiste un componente práctico inmerso en un romanticismo liberal en un escenario casi extinto que subsiste en la actualidad, sin articularlo a los procesos sociales más generales.

ABSTRACT This article deals with the ideology of medical professionals in order to understand the meanings attributed to their profession, taking Thompson's theory as a starting point and centering on the categories of autonomy, norms and values, and social recognition. Twenty-four semi-structured interviews were conducted with medical professionals in Amecameca, a municipality in the State of Mexico, from March to October 2019, in four sectors of service provision: public institutional, private institutional, private practice, and mixed practice. The analysis of meanings expressed by medical professionals with respect to each category of interest reveals that medical professionals are conditioned by the structure of state control and by the commodified economy, where private forms of medical practice are more highly regarded. In the ideological conformation of the medical profession, there remains a practical component imbued with a liberal romanticism in an extinct scenario that still exists today, without being articulated to more general social processes.

Acceso y práctica odontológica en ámbito de atención privada. Representaciones sociales y salud bucal / Dental access and practice in the private ambit of attention. Social and oral health representations

RESUMEN Las representaciones sociales producto de la forma de percibir, interpretar y significar la realidad social a partir del sentido común generan conductas que influyen directamente en la práctica y solicitud de la atención odontológica, bajo la influencia de las condiciones socioeconómicas actuales del país. Los niveles de pobreza se incrementan de manera acelerada, generando mayores desigualdades sociales, con distribución de beneficios económicos polarizados con concentración de los ingresos más altos en unos pocos. Con ello la salud-enfermedad es determinada por los niveles de ingreso, limitando el acceso a los servicios de salud para los grupos sociales más desfavorecidos. El objetivo de este estudio es conocer las representaciones sociales de salud-enfermedad odontológica y su relación con la atención y el acceso a servicios odontológicos y el tipo de atención al que acuden personas con padecimientos estomatológicos y las características de las prácticas odontológicas de quienes les atienden. Se realizó un estudio cualitativo con profesionales y pacientes del ámbito privado en una zona de la Ciudad de México. Los resultados muestran características de concepción y práctica influidas por el modelo médico hegemónico y de descontextualización de los problemas de atención odontológica de los pacientes. Se concluye que las representaciones sociales de profesionales y pacientes se construyen en el contexto de vida donde prevalece la polarización y exclusión social.

ABSTRACT The social representations resulting from the way of perceiving, interpreting and signifying social reality from the common sense, generate behaviors that directly influence the practice and application of dental care, under the influence of the current socioeconomic conditions of the country. Poverty levels increase rapidly, creating greater social inequalities, with a distribution of polarized economic benefi ts with a concentration of higher incomes in a few. With this, health- dental disease is determined by income levels, limiting access to health levels for the most disadvantaged social groups. The objective of this study is to know the social representations of health-dental disease and its relationship with care and access to dental services and the type of care that people with dental conditions access, and the characteristics of the dentistry practice of those who care for them. A qualitative study was carried out with professionals and patients from the private sector in an area of Mexico City. The results show characteristics of conception and practice infl uenced by the hegemonic medical model and decontextualization of the problems of dental care patients. It is concluded that the social representations of professionals and patients are built in the context of life where polarization and social exclusion prevail.

Purulent pericarditis as a complication of pneumonia in an infant. clinical case report

ABSTRACT Introduction: Purulent pericarditis is an inflammatory process in the pericardium caused by bacterial infection. If experienced during childhood and with untimely diagnosis, it has a high mortality rate. Case presentation: A 10-month-old infant was admitted to a high complexity pediatric hospital in the city of Bogotá D.C, Colombia, due to clinical symptoms including cough, respiratory distress and fever. A chest x-ray was taken showing cardiomegaly and multilobar pulmonary involvement. The echocardiogram showed global pericardial effusion managed with pericardiotomy, in which 50 mL of turbid fluid with whitish membranes was obtained. Cytochemical test revealed 2 600 mm3 leukocytes with 90% PMN and protein elevation. Purulent pericarditis was diagnosed based on imaging and laboratory findings. Treatment was initiated with ceftriaxone and clindamycin for four weeks, obtaining effective clinical and echocardiographic resolution. Discussion: The clinical presentation and imaging, paraclinical and electrocardiographic findings suggested purulent pericarditis as the first possibility. This diagnosis was confirmed considering the characteristics of the pericardial fluid, which was compatible with an exudate. Clinical resolution supported by antibiotic management corroborated the diagnosis, even though microbiological isolation was not obtained in cultures. Conclusion: Purulent pericarditis is a rare disease in pediatrics and has a high mortality rate. Making a timely diagnosis and administering early treatment are related to a better prognosis of this pathology.

RESUMEN Introducción. La pericarditis purulenta es un proceso inflamatorio del pericardio producto de una infección bacteriana. De no lograrse un diagnóstico oportuno, se convierte en una patología con alta mortalidad en la infancia. Presentación del caso. Lactante de 10 meses de edad que ingresó a un hospital pediátrico de alta complejidad en Bogotá D.C., Colombia, por un cuadro clínico dado por tos, dificultad respiratoria y fiebre. Se tomó una radiografía de tórax donde se observó cardiomegalia y compromiso neumónico multilobar. El ecocardiograma mostró un derrame pericárdico global que requirió pericardiotomía, en la cual se obtuvo 50 mL de líquido turbio con membranas blanquecinas. En la prueba citoquímica se encontraron 2 600mm3 leucocitos, polimorfonucleares del 90% y elevación de proteínas. Con los hallazgos de imagenología y laboratorio se hizo el diagnóstico de pericarditis purulenta, por lo que se inició tratamiento con ceftriaxona y clindamicina por 4 semanas, obteniendo una resolución clínica y ecocardiográfica efectiva. Discusión. La presentación clínica y los hallazgos imagenológicos, paraclínicos y electrocardiográficos sugirieron como primera posibilidad pericarditis purulenta, lo cual se confirmó por las características de líquido pericárdico, que era compatible con un exudado. La resolución clínica, apoyada por el manejo antibiótico y a pesar de no obtener aislamiento microbiológico en los cultivos, corroboró el diagnóstico. Conclusiones. La pericarditis purulenta es una enfermedad poco frecuente en pediatría pero con alta mortalidad. Realizar un diagnóstico oportuno sumado a un tratamiento tempano se relaciona con un mejor pronóstico de esta patología.

Propuesta de competencias profesionales para docentes de programas de salud en educación superior / Professional skills training proposal for professors of health programs

Resumen Introducción. Los profesores son reconocidos como parte fundamental de la ejecución del currículo y, por ende, como protagonistas de la calidad educativa. Objetivos. Construir un modelo de competencias profesionales para los docentes de programas de salud en educación superior que permita identificar las necesidades de formación de los profesores y, de esta manera, optimizar el proceso educativo de los estudiantes. Materiales y métodos. Se realizó una investigación cualitativa en la que se hizo una revisión de la bibliografía y se aplicaron unas entrevistas a profesionales médicos que se desempeñaban como docentes de un programa de posgrado en salud; se tuvo como criterio único de inclusión la aceptación del consentimiento informado. Se realizó triangulación de fuentes para garantizar la validez y confiabilidad. Resultados. A partir de la revisión de la bibliografía, se construyeron cuatro ejes de análisis para las entrevistas, se caracterizó al grupo de docentes del programa académico y se estudiaron las respuestas obtenidas. Luego, se construyó un modelo de competencias para profesores que se puede extrapolar a cualquier programa de formación en salud en educación superior con características similares a la del programa investigado. Conclusiones. Este estudio pone de manifiesto la necesidad urgente de generar espacios de formación docente en pedagogía, didáctica y evaluación, por lo que propone un modelo que contempla competencias cognitivas, metodológicas, sociales y personales.

Abstract Introduction: Professors are recognized as a fundamental part for the execution of the curriculum and, therefore, as protagonists of educational quality. Objectives: To propose a professional skills model for professors of health programs to identify their training needs and optimize the educational process of students. Materials and methods: Qualitative research in which a review of the literature was made and interviews were applied to medical professionals who worked as professors of a graduate health program. Signing an informed consent was the only inclusion criterion. Triangulation of sources was used to guarantee validity and reliability. Results: Based on the literature review, four axes of analysis were established for the interviews. The group of professors was characterized and all the responses were studied. Then, a skills model was created, which can be extrapolated to any health education program in higher education with similar characteristics to the investigated program. Conclusions: This study shows the urgent need for creating training spaces in pedagogy, didactics and evaluation. In consequence, a model that includes cognitive, methodological, social and personal skills is proposed.

La reforma neoliberal de un sistema de salud: evidencia del caso mexicano / A health system's neoliberal reform: evidence from the Mexican case / Reforma neoliberal de um sistema de saúde: evidencia do caso mexicano

Resumen: Este trabajo aborda la conformación en los años recientes del sistema de salud en México. Se presenta un análisis desde la determinación social que condiciona su formulación actual, las consecuencias en las condiciones de vida y trabajo de la población, los ejes de la reforma técnico-legal que dieron pauta para su transformación. La permanencia de instituciones de seguridad social y la introducción de un modelo de aseguramiento individual, sus implicaciones y consecuencias observadas hoy día. Desde una perspectiva del derecho a la salud, se contrastan las acciones, recursos e intervenciones de ambos modelos de prestación de servicios, y se observa la relevancia del sistema de seguridad social sobre el Seguro Popular. Se concluye que las soluciones implantadas para reformar el sistema de salud no tienen los resultados postulados y, por el contrario, significan reducción de intervenciones, incremento de costos, disminución de capacidad instalada y de personal profesional para su operación, así, lejos de solucionar el problema, se incrementan las inequidades y no se resuelven las contradicciones estructurales. Existen nuevos desafíos para los sistemas de salud, donde es inevitable situar los análisis en un marco más amplio, y no sólo centrarse en la operación funcional, administrativa y financiera de los sistemas de salud en nuestros países.

Abstract: This study addressed the shaping of Mexico's health system in recent years, with an analysis of the social determination conditioning the system's current formulation, the consequences for the population's living and working conditions, and the technical and legal reform measures that shaped the system's transformation. The article then analyzes the survival of social security institutions and the introduction of an individual insurance model and its current implications and consequences. From the perspective of the right to health, the article compares the measures, resources, and interventions in both health care models and highlights the relevance of the social security system for Popular Insurance. The article concludes that the measures implemented to reform the Mexican health system have failed to achieve the intended results; on the contrary, they have led to a reduction in interventions, rising costs, and a decrease in the installed capacity and professional personnel for the system's operation, thus falling far short of solving the problem, rather aggravating the inequities without solving the system's structural contradictions. Health systems face new challenges, inevitably requiring that the analyses be situated in a broader framework rather than merely focusing on the functional, administrative, and financial operation of the systems in the respective countries.

Resumo: Este trabalho aborda a conformação, nos últimos anos, do sistema de saúde no México. Apresenta uma análise a partir da determinação social que condiciona a sua formulação atual, as consequências sobre as condições de vida e de trabalho da população, as diretrizes da reforma técnico-legal que embasaram a sua transformação. A permanência de instituições de seguridade social e a introdução de um modelo de plano de seguro individual, suas implicações e consequências observadas hoje. Desde a perspectiva do direito à saúde, comparam-se as ações, recursos e intervenções de ambos os modelos de prestação de serviços, e se examina a relevância do sistema de seguridade social com relação ao Seguro Popular. A conclusão é que as soluções implementadas para reformar o sistema de saúde não alcançaram os resultados pretendidos e, ao contrário, redundaram em redução de atos médicos, aumento dos custos, diminuição da capacidade instalada e do número de profissionais para a sua operação. Dessa forma, longe de solucionar o problema, aumentaram as desigualdades e não foram resolvidas as contradições estruturais. Existem novos desafios para os sistemas de saúde, para os quais é inevitável situar as análises em um marco mais amplo, e não apenas focando a operação funcional, administrativa e financeira dos sistemas de saúde em nossos países.

Relationship between gender, income and education and self-perceived oral health among elderly Mexicans. An exploratory study / Relação entre gênero, renda e educação com a autopercepão da saúde bucal em idosos mexicanos. Um estudo exploratório

The aim of this study was to identify the relationship between sociodemographic factors and self-perceived oral health (SPOH) among the elderly. A cross-sectional, exploratory examination of 150 elderly subjects whose ages ranged from 60-86 was conducted. These subjects used the Geriatric Oral Health Assessment Index (GOHAI) to assess their SPOH. In addition, sociodemographic data were collected from study participants. Data were analyzed using Student's t-test, the examination of odds ratio (OR) of logistic regression analysis, the chi-square test, and analysis of variance (ANOVA). The mean decayed, missing, and filled teeth (DMFT) index for the study participants was 20.1 ± 5.8; 21.3% of subjects were edentulous, and 69.3% of subjects wore removable dentures. 62.7% of study participants had poor SPOH (defined as GOHAI score <44). Poor SPOH was significantly more frequent among males (OR = 2.72, 95% CI: 1.03-7.13, p < 0.05), low-income individuals (OR = 2.7, 95% CI: 1.3 -5.8, p < 0.01), and subjects with less education (OR = 2.26, 95% CI: 1.1-4.6, p < 0.05) than among the overall subject population. The findings suggest that gender (male), low income and low educational levels have a significant influence on the self-perceived oral health status of elderly individuals, irrespective of tooth loss.

O objetivo deste estudo foi identificar a relação entre os fatores sociodemográficos com a autopercepção da saúde bucal (SPOH) em idosos. Realizou-se um estudo transversal exploratório de 150 idosos. Para avaliar a sua percepção da saúde bucal utilizou-se o Geriatric Oral Assesment Index (GOHAI) e também foram coletados dados sociodemográficos. Os dados foram analisados utilizando o teste T Student, a razão de chances (OR) de análise de regressão logística, o teste Chi Quadrado (p < 0.05) e análise de variância ANOVA. A média do índice de dentes cariados, perdidos ou obturados (CPO-D) dos participantes no estudo foi de 20.1 ± 5.8; 21.3% foram edêntulos e 69.3% eram portadores de prótese removível. O 62.7% dos participantes no estudo teve pobre autopercepção da saúde bucal (definida com uma suma de GOHAI < 44), a qual foi significativamente mais frequente nos homens (OR = 2.72, 95% Cl: 1.03-7.13, p < 0.05), com baixa renda (OR = 2.7, 95% Cl: 1.3 - 5.8, p < 0.01), e com menor escolaridade (OR = 2.26, 95% Cl: 1.1-4.6, p <0.05) do que entre a população em geral. Os resultados presentes sugerem que nos idosos a baixa renda e a menor escolaridade têm influência significativa na autopercepção da saúde bucal, independentemente da perda dentária.

The clinical case: A strategy for effective learning / El caso clínico: una estrategia para el aprendizaje efectivo

There are different teaching strategies for ensuring significant learning, including research seminars, workshops, directed independent reading, the clinical case, the problem-based learning methods, in-depth lines of study, etc. In many departments of the clinical area, such as the Department of Pediatrics, a clinical case taken from real life is used as an effective learning method. It consists of providing the case to all participants (students, professors, pediatricians) for study and analysis. This study is discussed in small groups and the solution or possible responses are presented in a meeting scheduled for this purpose.

Existen diferentes estrategias de enseñanza para garantizar un aprendizaje significativo, incluidos seminarios de investigación, talleres, lecturas independientes dirigidas, casos clínicos, métodos de aprendizaje basados en problemas, líneas de estudio en profundidad, etc. En muchos departamentos del área clínica, como el Departamento de Pediatría, se utiliza un caso clínico tomado de la vida real como un método de aprendizaje efectivo. Consiste en proporcionar el caso a todos los participantes (estudiantes, profesores, pediatras) para su estudio y análisis. Este estudio se analiza en grupos pequeños y la solución o posibles respuestas se presentan en una reunión programada para este fin.

Complicated congenital malaria due to Plasmodium vivax / Paludismo congénito complicado debido a Plasmodium vivax

La malaria congénita es una enfermedad que aparece en el período neonatal y que, si no se trata oportunamente, puede tener consecuencias fatales para el recién nacido. Según las estadísticas publicadas en el Informe del Estado Mundial de la Infancia 2009, actualmente mueren 3.7 millones de niños menores de 28 días en todo el mundo. El 8% de los casos corresponden a niños menores de 5 años con malaria (1). De manera similar, los estudios en áreas endémicas han reportado incidencias de malaria congénita de entre 0.83 y 5.93% (2). Aquí, presentamos un caso de malaria congénita en un lactante de un mes de edad cuya madre recibió tratamiento para la malaria por Plasmodium vivax (P. vivax) durante la gestación pero sufrió una recaída con el consiguiente compromiso del bebé en el útero. Es necesario reconocer la alta prevalencia de esta enfermedad en nuestro contexto y saber cómo vigilar y tratar la enfermedad en casos especiales como los de las madres gestantes y los recién nacidos con infecciones congénitas.

Congenital malaria is a disease that appears in the neonatal period and that, if not treated in a timely manner, may have fatal consequences for the newborn. According to statistics published in The State of the World Children 2009 Report, 3.7 million children under the age of 28 days die annually around the world at present. 8% of cases correspond to children under 5 years of age with malaria (1). Similarly, studies in endemic areas have reported incidences of congenital malaria of between 0.83 and 5.93% (2). Here, we present a case of congenital malaria in a one-month-old nursing infant whose mother received treatment for malaria from Plasmodium vivax (P. vivax) during gestation but suffered a relapse with a consequent compromise of the infant in utero. There is a need to recognize the high prevalence of this disease in our context and to know how to monitor and treat the disease in special cases like those of gestating mothers and newborn infants with congenital infections.

La medicina familiar y su práctica médica en el Instituto Mexicano del Seguro Social / Family medicine and practice in the Mexican Social Security Institute

Los ejes de este trabajo se remiten a nociones sobre la práctica médica de especialistas en medicina familiar, en los que se trata de ubicar los significados de esta práctica, su origen, problemas, características, procesos, gestiones, alcances, virtudes, limitaciones, extensiones y pertenencia; para hacer visible la cotidianeidad de la práctica de la medicina familiar en la atención primaria del Instituto Mexicano del Seguro Social. Esta aproximación requirió de una investigación cualitativa de tipo hermenéutica, apegada a la teoría de funcionalismo estructural. Dentro de este marco teórico, la práctica médica se interpretó como la ecuación significado = acción + función/estructura. Con ello se ofrece un acercamiento a la realidad a partir de entrevistas y observaciones en cinco categorías: identidad, actividad, propósitos, valores/normas, poder/relación. La medicina familiar en su práctica está delimitada a un acto médico en el Instituto Mexicano del Seguro Social. Dicho acto se reduce a un breve interrogatorio y a emitir receta, condicionándolo a una atención efímera, corta y medicalizada. De esta forma se reproduce un imaginario social negativo por parte de los individuos respecto del médico, de los usuarios y en toda la sociedad.

The central ideas of this research paper are related to the practice of family medicine as a specialty. It focuses in its origins, problems, unique characteristics, limitations, scope, management, and processes within the context of primary care of the Mexican Social Security System. This approach was based on a qualitative, hermeneutical study closely related to the Structural Functionalism Theory. Within this framework, medical practice is seen as an equation: Meaning = action + function/structure. This offers an approach to the understanding of reality through surveys and observations in five categories: identity, activity, purpose, values/norms, and power/relationship. The practice of family medicine is defined as a medical act in the Mexican Social Security Institute. This act is limited to a brief encounter and a prescription, which makes it a short, fleeting, medicalized interaction. The result is a negative social imaginary of the physician, the patient and the whole of society. Thus, individuals and society host a negative social imaginary bestowed on doctors and users of the health system.

La deconstrucción de la medicina familiar en México: el caso del Instituto Mexicano del Seguro Social / The deconstruction of family medicine in Mexico: the case of the Mexican Institute of Social Security

La medicina familiar es la esencia de la asistencia médica. Es el principal acceso en atención primaria de salud y la puerta de entrada al sistema de salud más grande de América Latina: el Instituto Mexicano del Seguro Social. Esta condición le confiere complejidad en el modelo organizacional de asistencia en salud. Luego cabe preguntarse ¿qué existe detrás de la medicina familiar respecto al elemento biomédico de control hegemónico estatal en salud, que permite y promueve una medicina familiar con ataduras? La deconstrucción es un elemento teórico que puede desfragmentar los elementos de estudio de un todo, permitiéndonos acercarnos al desarrollo y redefinición de una nueva medicina familiar. Este artículo analiza a la medicina familiar de México desde la teoría de la deconstrucción, mirando específicamente la que se instala y reproduce en el Instituto Mexicano del Seguro Social.

Family medicine is the essence of medical care. It is the main access to primary health care and the gateway to the largest health system in Latin America: the Mexican Institute of Social Security. This condition leads to complexity in the organizational model of health care. The question, thus, is what constraints are set from the hegemonic biomedical State system that allows and promotes family medicine with limits? Deconstruction is a theoretical framework that can defragment study elements of a whole, allowing us to approach the development and redefinition of a new family medicine. This article looks at the model of Mexican family medicine from the standpoint of deconstruction theory, specifically looking at the case of the Mexican Institute of Social Security.

Comunicación para la salud y estilos de vida saludables: aportes para la reflexión desde la salud colectiva / Health communication and healthy lifestyles: contributions towards reflection on collective health / Comunicação em saúde e estilos de vida saudáveis: contribuições para a reflexão sobre a saúde coletiva

Este trabajo plantea la necesidad de una mirada compleja hacia la comunicación para la salud, con el fin de ir más allá de una visión instrumental de su concepción y ejercicio. Analizando en particular los enfoques de comunicación dirigidos al cambio de conducta que promueven la adopción de estilos de vida saludables, propone ampliar desde el momento de la problematización la forma en que se concibe la comunicación para la salud, integrando algunos ejes analíticos que permitan dar cuenta de las múltiples aristas y contradicciones de los procesos de comunicación para la salud.

This study discusses the need for a complex perspective regarding health communication, in order to go beyond an instrumental view of its conception and implementation. In particular, through analyzing the focus of communication directed towards behavioral change that promotes healthy lifestyles, it was proposed to extend the way in which health communication is conceived, starting from setting the problem. This would integrate some analytical strands that would make it possible to account for the many aspects and contradictions of the health communication process.

O presente trabalho discute a necessidade de uma perspectiva complexa sobre a comunicação em saúde, a fim de ir além de uma visão instrumental de sua concepção e exercício. Analisando, em particular, os enfoques de comunicação dirigidos à mudança das condutas que promovem a adoção de estilos de vida saudáveis, propõe ampliar, a partir do momento da problematização, a maneira em que a comunicação em saúde é concebida, integrando alguns eixos analíticos que permitem dar conta das múltiplas facetas e contradições do processo de comunicação em saúde.

La salud colectiva para el análisis de la medicina familiar / Collective health and family medicine

En México, el espacio social de la práctica clínica ha sido influido en su organización por la toma de decisiones que buscan mejorar los indicadores de salud transformando al paciente en un número. La medicina familiar se ha practicado dentro de los límites de un modelo biomédico institucional donde el proceso salud-enfermedad es visto desde una perspectiva biologicista. Por otra parte, la salud colectiva aborda este proceso desde lo colectivo con reflexiones sociales y biológicas, otorgándole un peso importante a la sociedad. De igual forma, sitúa a la política como determinante de la mejora en salud social vinculando los asuntos políticos como asuntos de salud. La medicina familiar debe ser el eje que atienda las necesidades en salud asociadas a las condicionantes sociales que embargan a cada individuo en su familia, englobando a las colectividades desde una mirada transdisciplinaria y no sólo acotada al perfil biomédico. En este contexto, la salud colectiva brindará aportes teóricos para el debate de la medicina familiar en los próximos años.

In Mexico, the arrangement of clinical practice has been influenced by a decision-making process that seeks to improve health indicators, thus transforming the patient into a number. Family medicine has been practiced within the limits of an institutional biomedical model where the health-disease process is approached from a biologist perspective. On the other hand, collective health understands this process as stemming from the collective sphere and includes social and biological perspectives, giving an important standing to society. Likewise, it puts policy as a determinant in bettering social health bringing together public policy with health matters. Family medicine must become the axis around which health needs are catered to, together with social conditioning factors that affect families and individuals. This leads to a trans-disciplinary approach to communities set free from a mere biomedical profile. In this context, collective health provides theoretical support to the upcoming debate on family medicine.