Graft infusion of adipose-derived mesenchymal stromal cells to prevent rejection in experimental intestinal transplantation: A feasibility study.

BACKGROUND: Mesenchymal stromal cells (MSC) have been proposed as a promising complement to standard immunosuppression in solid organ transplantation because of their immunomodulatory properties. The present work addresses the role of adipose-derived MSC (Ad-MSC) in an experimental model of acute rejection in small bowel transplantation (SBT). MATERIAL/METHODS: Heterotopic allogeneic SBT was performed. A single dose of 1.5x106 Ad-MSC was intra-arterially delivered just before graft reperfusion. Animals were divided into CONTROL (CTRL), CONTROL+Ad-MSC (CTRL_MSC), tacrolimus (TAC), and TAC+Ad-MSC (TAC_MSC) groups. Each Ad-MSC groups was subdivided in autologous and allogeneic third-party groups. RESULTS: Rejection rate and severity were similar in MSC-treated and untreated animals. CTRL_MSC animals showed a decrease in macrophages, T-cell (CD4, CD8, and Foxp3 subsets) and B-cell counts in the graft compared with CTRL, this decrease was attenuated in TAC_MSC animals. Pro- and anti-inflammatory cytokines and some chemokines and growth factors increased in CTRL_MSC animals, especially in the allogeneic group, whereas milder changes were seen in the TAC groups. CONCLUSION: Ad-MSC did not prevent rejection when administered just before reperfusion. However, they showed immunomodulatory effects that could be relevant for a longer-term outcome. Interference between tacrolimus and the MSC effects should be addressed in further studies.

[Neighborhood Danger and Maternal Parenting in Medellin-Rome: The Role of Negative Emotional Self-Efficacy]. / Violencia de Barrio y Crianza Materna en Medellín-Roma: Rol de la Autoeficacia Emocional Negativa.

The purpose of the present study was to analyze the effect of perceptions of neighborhood danger on positive parenting and whether it is mediated by the mothers' perceived self-efficacy in managing negative emotions, comparing two countries: Colombia and Italy. Participants were 434 mothers and children between ages of 8 and 10 years old (108 dyads from Medellin, Colombia and 109 dyads from Rome, Italy). selected by convenience, non-probabilistically and proportionally to the social stratum of each city. Mothers and children answered the neighborhood violence perception scale, mothers also answered the emotional self-efficacy scale and children the Acceptance-Rejection/Control questionnaire. The multigroup analysis found that mothers' self-efficacy in managing negative emotions behaved differently in Colombia compared to Italy. In Colombia, mothers' perceived self-efficacy in managing negative emotions mediated the link between the effect of perceived neighborhood violence and the quality of mother-child relationship. In Italy, mothers' self-efficacy in managing negative emotions did not mediate this link. Perceived self-efficacy in managing negative emotions of Colombian mothers indirectly explains the adverse effect of perceived neighborhood danger on positive parenting. With mothers from Rome-Italy, there is no significant relationship between perceived self-efficacy for the management of negative emotions and positive parenting.

Critical review of social, environmental and health risk factors in the Mexican indigenous population and their capacity to respond to the COVID-19.

The objective of this study was to conduct a critical analysis of the social, environmental and health risk factors in the Mexican indigenous population in the context of the COVID-19 disease pandemic, and to propose strategies to mitigate the impacts on these communities. Regarding social factors, we identified the return of indigenous people to their communities, poor access to water, language barriers, and limited access to the Internet, as factors that will not allow them to take the minimum preventive measures against the disease. Additionally, environmental risk factors associated with pollutants from biomass burning were identified. In health, the lack of coverage in these areas and comorbidities such as diabetes mellitus, hypertension, respiratory tract infections, and chronic pulmonary diseases were identified. Some existing government programmes were identified that could be supported to address these social, environmental and health gaps. We believe that the best way to address these issues is to strengthen the health system with a community-based approach. Health is the best element of cohesion for inserting development and progress proposals in indigenous communities, given the vulnerability to which they are exposed in the face of the COVID-19 pandemic. In this review, all information is provided (as possible) on risk factors and potential solutions in indigenous communities in the hope of providing solutions to this pandemic and providing a reference for future studies.

Barriers and Facilitators in Timely Detection of Chronic Kidney Disease: Evidences for Decision-Makers.

Chronic Kidney Disease (CKD) is classified, according to the glomerular filtratation rate. Timely diagnosis during the first three stages represents a lower expenditure for health systems in the treatment of this disease. Thus, this study intends to identify barriers and facilitators in timely detection of CKD, from the perspective of healthcare providers. This is an exploratory study of the qualitative type. A mapping of the literature was carried out in order to develop the following topics: perceptions of the implications of CKD for the health system at an international level and in Mexico, as well as experience related to barriers and facilitators in timely CKD detection in Mexico. Based on the identified topics, semi-structured interviews were carried out with decision-makers, operational personnel, civil and academic associations representatives in Mexico City and Cuernavaca, Morelos. The main identified barriers were: system fragmentation; overload of services at first and second levels of care; insufficient human resources; lack of updating of the clinical practice guide and scarce training. With respect to facilitators, we found there are civil society actions. Finally, requirements for timely detection of CKD are consistent with what is described in the international guides. The identification of barriers and facilitators in timely CKD detection gives us an outlook of the problem in Mexico and leads to proposals for action. The development of a national program with a strategy for timely detection of CKD may help unify inter-institutional criteria considering the protocols for clinical practice that take into account each institution's organization and resources.

Quantifying health impacts and economic costs of PM2.5 exposure in Mexican cities of the National Urban System.

OBJECTIVES: To estimate avoidable mortality, potential years of life lost and economic costs associated with particulate matter PM2.5 exposure for 2 years (2013 and 2015) in Mexico using two scenarios of reduced concentrations (i.e., mean annual PM2.5 concentration < 12 µg/m3 and mean annual PM2.5 concentration < 10 µg/m3). METHODS: The health impact assessment method was followed. This method consists of: identification of health effects, selection of concentration-response functions, estimation of exposure, quantification of impacts quantification and economic assessment using the willingness to pay and human capital approaches. RESULTS: For 2013, we included data from 62 monitoring sites in ten cities, (113 municipalities) where 36,486,201 live. In 2015, we included 71 monitoring sites from fifteen cities (121 municipalities) and 40,479,629 inhabitants. It was observed that reduction in the annual PM2.5 average to 10 µg/would have prevented 14,666 deaths and 150,771 potential years of life lost in 2015, with estimated costs of 64,164 and 5434 million dollars, respectively. CONCLUSIONS: Reducing PM2.5 concentration in the Mexican cities studied would reduce mortality by all causes by 8.1%, representing important public health benefits.

Crianza en Colombia: Relevancia y avances de investigación / Parenting in colombia: relevance and research updates

Abstract Parenting is a valuable research topic due to its implications in comprehensive education, mental health, and violence prevention. Considerations about it include educational institutions, society and government. This article aims to identify the research trends on the phenomenon of parenting in Colombia during the decade 2004 - 2014. Conceptualization, scope, related variables, approaches, results, methodologies, and limitations of published studies were analyzed. Results indicate the need for deepening the comprehensive definition and for using methodologies that allow an explanatory and / or comprehensive analysis of the phenomenon, as well as a higher awareness in urban and rural populations. These results may help to promote new research and the creation of national intervention programs that use parenting as a tool to prevent mental health issues among children and adolescents.

Resumen La crianza es un tema de investigación valioso por sus implicaciones en la educación integral, la salud mental y la prevención de la violencia. Su reflexión compromete a las instituciones educativas, la sociedad y el estado. El presente artículo pretende identificar las tendencias investigativas sobre el fenómeno de la crianza en Colombia durante la década 2004 - 2014. Se analizaron variables relacionadas, conceptualizaciones, enfoques, metodologías, resultados, alcances y limitaciones de investigaciones publicadas. También, se ha identificado una necesidad por profundizar en la definición integral y por utilizar metodologías que permitan un análisis explicativo y/o comprensivo del fenómeno, así como también ampliar el conocimiento tanto en la población urbana como la rural. Los resultados aportan a la investigación y generación de programas en el país que utilicen la crianza como herramienta para la prevención de una baja salud mental en niños y adolescentes.

[Use of migrant's remittances from California on dependent's healthcare in Mexico]. / Utilización de remesas de migrantes en California para atención a la salud de sus dependientes en México.

OBJECTIVE: This paper focuses on public and private healthcare utilization among dependents living in Mexico of Mexican migrants in California, analyzing the link between remittances and enrollment in Seguro Popular, a social health insurance plan. MATERIALS AND METHODS: We surveyed 1353 migrants who visited the Mexican consulate of Los Angeles in 2010. RESULTS: 53.9% sent remittances; 72.2% of households receiving remittances used a share of remittances for health care and 74.4% of them were covered by Seguro Popular. The annual median with private health care expenditure was USD 825, compared to USD 293 for public providers. The main predictors remittances utilization for healthcare were having a sick dependent, purchase of prescription drugs, experiencing problems paying for health care and time of U.S. residence. CONCLUSIONS: Seguro Popular increases healthcare utilization with public providers, which provides an opportunity to reallocate the use of migrant's remittances for health purposes.

Utilización de remesas de migrantes en California para atención a la salud de sus dependientes en México / Use of migrant's remittances from California on dependent's healthcare in Mexico

Objetivo. Este trabajo se enfoca en la utilización de servicios públicos y privados por los dependientes de migrantes en México, analizando de manera particular su relación con remesas y afiliación al Seguro Popular. Material y métodos. Se aplicó un cuestionario a 1 353 migrantes en el Consulado de México en Los Ángeles en 2010. Resultados. 53.9% envía remesas; 72.2% de hogares receptores utilizan remesas para atención a la salud y 74.4% tienen Seguro Popular. La media de gasto en servicios privados fue 825 dólares anuales, comparado con 293 dólares con proveedores públicos. Los principales predictores del uso de remesas por salud fueron, familiares enfermos, compra de medicamentos, problemas para pagar y tiempo de residencia en EUA. Conclusiones. El Seguro Popular presenta una oportunidad para incidir en la eficiencia del gasto en salud proveniente de las remesas, mediante la promoción de la utilización de servicios públicos de salud entre los dependientes de migrantes.

Objective. This paper focuses on public and private healthcare utilization among dependents living in Mexico of Mexican migrants in California, analyzing the link between remittances and enrollment in Seguro Popular, a social health insurance plan. Materials and methods. We surveyed 1353 migrants who visited the Mexican consulate of Los Angeles in 2010. Results. 53.9% sent remittances; 72.2% of households receiving remittances used a share of remittances for health care and 74.4% of them were covered by Seguro Popular. The annual median with private health care expenditure was USD 825, compared to USD 293 for public providers. The main predictors remittances utilization for healthcare were having a sick dependent, purchase of prescription drugs, experiencing problems paying for health care and time of U.S. residence. Conclusions. Seguro Popular increases healthcare utilization with public providers, which provides an opportunity to reallocate the use of migrant's remittances for health purposes.

Oncogenic transformation induced by cell-free nucleic acids circulating in plasma (genometastasis) remains after the surgical resection of the primary tumor: a pilot study.

BACKGROUND: The oncogenic transformation by cell-free nucleic acids circulating in plasma has been named as genometastasis. The feasibility of this phenomenon has been demonstrated and now it is necessary to value the impact of this phenomenon and to determine what conditions could promote or inhibit it. The goal of this study was to examine the transforming ability of plasma from colorectal cancer patients in a long-term follow-up after the surgical excision of the primary tumor, and to try correlate it with the clinical picture of patients. MATERIALS AND METHODS: Blood samples were taken from eight patients with K-ras-mutated colorectal tumors, who were under surgical primary tumor resection at least 2 years before. Plasma was isolated by two centrifugations and added to cultures of NIH-3T3 cells and human adipose-derived stem cells (hASCs). In two cases, plasma was separated from cells by a membrane with 0.4-µm pores. The presence of mutated and non-mutated human K-ras sequences was tested by real-time PCR in cultured cells. After 30 days, cells were subcutaneously injected into athymic nude mice in order to test their ability to generate tumors. RESULTS: In four of the eight patients analyzed after surgery, tumor DNA was detected in plasma. Plasmas from three of them were able to oncogenically transform NIH-3T3 cells in culture and, when those cells were injected in mice, carcinomas were generated. After a 2-year follow-up, metastases were found in two of the three patients whose plasmas were able to transform cells, and in two of the four in whom plasma tumor DNA was not detected. Thus, after a mean follow-up of 29.5 months, only four of 13 patients (30.8%) were alive and disease-free. CONCLUSION: Primary tumor resection does not assure a complete clean of blood of circulating oncogenes, in spite of a disease-free clinical picture. Moreover, in some cases plasma kept their oncogenic capabilities. The value of these findings as prognosis factor remains unclear and needs further investigations.

"Hospital utilization by Mexican migrants returning to Mexico due to health needs".

BACKGROUND: A total of 12.7 million Mexicans reside as migrants in the United States, of whom only 45% have health insurance in this country while access to health insurance by migrants in Mexico is fraught with difficulties. Health insurance has been shown to impact the use of health care in both countries. This paper quantifies hospitalizations by migrants who return from the US seeking medical care in public and private hospitals in the US-Mexico border area and in communities of origin. The proportion of bed utilization and the proportion of hospitalizations in Mexico out of the total expected by migrants in the US were estimated. METHODS: The universe included 48 Ministry of Health and 47 private hospitals serving municipalities of high or very high migration in Mexico, where 17% of remittance-receiving households are located, as well as 15 public and 159 private hospitals in 10 Mexican cities along the border with the US. Hospitals were sampled through various methods to include 27% of beds. Patients and staff were interviewed and data triangulated to quantify migrants that returned to Mexico seeking medical care. Official hospital discharge statistics and secondary data from migration databases and published statistics were analyzed to identify bed occupancy, general migrant hospitalization rates and the size of the migrant population that maintains close relationships with households in communities of origin. RESULTS: Up to 1609 migrants were admitted to public hospitals (76.6%) and 492 to private hospitals (23.4%) serving municipalities of high and very high migration intensity in 2008. Up to 0.90% of public hospital capacity was used. In the border area up to 908 and 2416 migrants were admitted to public (27.3%) and private (72.7%) hospitals, respectively. Up to 1.18% of public hospital capacity was used. Between 2.4% and 20.4% of the expected hospitalization needs of migrants with dependent households are satisfied through these services. The most common diagnostic categories mentioned across hospitals were traumatisms, complications of diabetes and elective surgery, in that order. Private hospitals mention elective surgeries as the main diagnostic category followed by complications of diabetes. CONCLUSIONS: Hospitals in communities of origin in Mexico are devoting few resources to respond to hospitalization needs of migrants in the US. Currently no hospital programs exist to stimulate migrant demand or to cater to their specific needs. Registering migratory history in clinical and administrative records can be readily implemented. Developing bi-national referral networks and insuring migrants in the US within current Mexican federal programs could greatly increase migrant access to hospitals.

La evaluación Psicopedagógica, revisión de sus componentes / The psichopedagogical assessment, a review of its components

Existen diferencias entre la evaluación psicopedagógica y otras evaluaciones como la psicológica, pedagógica y neuropsicológica, por tal razón este artículo cobra relevancia en la medida que define y contextualiza la evaluación psicopedagógica como prioritaria para demarcar cómo y que tipo de intervención se debe llevar a cabo en las instituciones educativas. Se teorizan aspectoscomo, enfoques psicopedagógicos, habilidades personales necesarias para el rendimiento escolar y aspectos a tener en cuenta a nivel de institución escolar.

Impact of the clinical context on the 14-3-3 test for the diagnosis of sporadic CJD.

BACKGROUND: The 14-3-3 test appears to be a valuable aid for the clinical diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) in selected populations. However, its usefulness in routine practice has been challenged. In this study, the influence of the clinical context on the performance of the 14-3-3 test for the diagnosis of sCJD is investigated through the analysis of a large prospective clinical series. METHODS: Six hundred seventy-two Spanish patients with clinically suspected sCJD were analyzed. Clinical classification at sample reception according to the World Health Organization's (WHO) criteria (excluding the 14-3-3 test result) was used to explore the influence of the clinical context on the pre-test probabilities, and positive (PPV) and negative (NPV) predictive values of the 14-3-3 test. RESULTS: Predictive values of the test varied greatly according to the initial clinical classification: PPV of 98.8%, 96.5% and 45.0%, and NPV of 26.1%, 66.6% and 100% for probable sCJDi (n = 115), possible sCJDi (n = 73) and non-sCJDi (n = 484) cases, respectively. According to multivariate and Bayesian analyses, these values represent an improvement of diagnostic certainty compared to clinical data alone. CONCLUSION: In three different contexts of sCJD suspicion, the 14-3-3 assay provides useful information complementary to clinical and electroencephalographic (EEG) data. The test is most useful supporting a clinical impression, whilst it may show deceptive when it is not in agreement with clinical data.