[Neuroanatomical mapping of inhibitory attention and working memory with functional magnetic resonance imaging in healthy children]. / Mapeo neuroanatómico de atención inhibitoria y memoria de trabajo con resonancia magnética funcional en niños sanos.

INTRODUCTION: The objective is to produce an average brain activation mapping template in healthy children using functional magnetic resonance imaging (fMRI), with specific paradigms for activating inhibitory attention and working memory functions. SUBJECTS AND METHODS: A nutritional and neuropsychological evaluation was performed on 87 right-handed children. The inclusion criteria were met by 30 children (15 boys and 15 girls) between 9 and 11 years old, who were studied with fMRI in two inhibitory attention tests (Go/No Go), with food cues, a working memory test (Continuous Performance Test Identical Pairs) and measurement of anatomical volumes. These data were subsequently processed with the FSL-v5 program, with a threshold of p < 0.05 (cluster-wise). The brain areas activated were located using a standard Montreal Neurological Institute brain template and the Harvard-Oxford structural cortical atlas. RESULTS: The inhibitory attention tests showed activation frontal areas predominantly on the right, and the cingulate, parietal and occipital areas, with preponderance in occipital areas in the food cues test. In the Continuous Performance Test-Identical Pairs test, activation was obtained predominantly in the occipital, frontal and parietal areas. CONCLUSIONS: Brain activity mapping templates are obtained in healthy children with tests for inhibitory attention, food cues and working memory. The activation areas are mostly those reported in the literature. This provides baseline brain activation patterns for studying pathologies related to inhibitory attention, impulsivity and working memory.

TITLE: Mapeo neuroanatómico de atención inhibitoria y memoria de trabajo con resonancia magnética funcional en niños sanos.Introducción. El objetivo es lograr una plantilla de mapeo de activación cerebral promedio en niños sanos usando la resonancia magnética funcional (RMf), con paradigmas específicos para activar funciones de atención inhibitoria y de memoria de trabajo. Sujetos y métodos. Se realizó una evaluación nutricional y neuropsicológica a 87 niños diestros. Cumplieron los criterios de inclusión 30 (15 niños y 15 niñas) entre 9 y 11 años, a quienes se estudió con RMf con realización de dos pruebas de atención inhibitoria (Go/No Go), con letras e imágenes de alimentos, un test de memoria de trabajo (Test de Atención Continua-Pares Idénticos) y obtención de volúmenes anatómicos. Los datos posteriormente se procesaron con el programa FSL-v5 con un umbral de p < 0,05 (cluster-wise). Las áreas cerebrales activadas se localizaron utilizando una plantilla cerebral estándar del Montreal Neurological Institute y el atlas cortical estructural de Harvard-Oxford. Resultados. En las pruebas de atención inhibitoria hay activación en áreas frontales de predominio derecho, cíngulo, parietales y occipitales, con preponderancia en áreas occipitales en la prueba con alimentos. En la prueba Test de Atención Continua-Pares Idénticos se obtuvo activación de predominio en áreas occipitales, frontales y parietales. Conclusiones. Se obtienen plantillas de mapeo de actividad cerebral en niños sanos con test de atención inhibitoria, de alimentos y de memoria de trabajo. Las áreas de activación corresponden mayoritariamente a las descritas en la bibliografía. Esto nos permite tener patrones basales de activación cerebral para estudiar patologías relacionadas con la atención inhibitoria, la impulsividad y la memoria de trabajo.

Mapeo neuroanatómico de atención inhibitoria y memoria de trabajo con resonancia magnética funcional en niños sanos / Neuroanatomical mapping of inhibitory attention and working memory with functional magnetic resonance imaging in healthy children

Introducción: El objetivo es lograr una plantilla de mapeo de activación cerebral promedio en niños sanos usando la resonancia magnética funcional (RMf), con paradigmas específicos para activar funciones de atención inhibitoria y de memoria de trabajo. Sujetos y métodos: Se realizó una evaluación nutricional y neuropsicológica a 87 niños diestros. Cumplieron los criterios de inclusión 30 (15 niños y 15 niñas) entre 9 y 11 años, a quienes se estudió con RMf con realización de dos pruebas de atención inhibitoria (Go/No Go), con letras e imágenes de alimentos, un test de memoria de trabajo (Test de Atención Continua-Pares Idénticos) y obtención de volúmenes anatómicos. Los datos posteriormente se procesaron con el programa FSL-v5 con un umbral de p < 0,05 (cluster-wise). Las áreas cerebrales activadas se localizaron utilizando una plantilla cerebral estándar del Montreal Neurological Institute y el atlas cortical estructural de Harvard-Oxford. Resultados: En las pruebas de atención inhibitoria hay activación en áreas frontales de predominio derecho, cíngulo, parietales y occipitales, con preponderancia en áreas occipitales en la prueba con alimentos. En la prueba Test de Atención Continua-Pares Idénticos se obtuvo activación de predominio en áreas occipitales, frontales y parietales. Conclusiones: Se obtienen plantillas de mapeo de actividad cerebral en niños sanos con test de atención inhibitoria, de alimentos y de memoria de trabajo. Las áreas de activación corresponden mayoritariamente a las descritas en la bibliografía. Esto nos permite tener patrones basales de activación cerebral para estudiar patologías relacionadas con la atención inhibitoria, la impulsividad y la memoria de trabajo.(AU)

Introduction: The objective is to produce an average brain activation mapping template in healthy children using functional magnetic resonance imaging (fMRI), with specific paradigms for activating inhibitory attention and working memory functions. Subjects and methods: A nutritional and neuropsychological evaluation was performed on 87 right-handed children. The inclusion criteria were met by 30 children (15 boys and 15 girls) between 9 and 11 years old, who were studied with fMRI in two inhibitory attention tests (Go/No Go), with food cues, a working memory test (Continuous Performance Test Identical Pairs) and measurement of anatomical volumes. These data were subsequently processed with the FSL-v5 program, with a threshold of p < 0.05 (cluster-wise). The brain areas activated were located using a standard Montreal Neurological Institute brain template and the Harvard-Oxford structural cortical atlas. Results: The inhibitory attention tests showed activation frontal areas predominantly on the right, and the cingulate, parietal and occipital areas, with preponderance in occipital areas in the food cues test. In the Continuous Performance Test-Identical Pairs test, activation was obtained predominantly in the occipital, frontal and parietal areas. Conclusions: Brain activity mapping templates are obtained in healthy children with tests for inhibitory attention, food cues and working memory. The activation areas are mostly those reported in the literature. This provides baseline brain activation patterns for studying pathologies related to inhibitory attention, impulsivity and working memory.(AU)

Actualización en carcinoma diferenciado de tiroides refractario a radioyodo / Update on iodine-refractory differentiated thyroid carcinoma

La terapia con radioyodo constituye un pilar fundamental en la terapia adyuvante de rutina de los pacientes con carcinoma diferenciado de tiroides de alto riesgo. Sin embargo, un porcentaje no despreciable de estos pacientes desarrollaran un estado de refractariedad a este tratamiento, mostrando un peor pronóstico, disminuyendo la supervivencia y la esperanza de vida, lo que demuestra una clara necesidad de explorar distintos abordajes terapéuticos. El tratamiento de los pacientes refractarios al radioyodo sigue siendo un desafío, disponiendo en la actualidad de distintas opciones terapéuticas novedosas que deben ser conocidas por las distintas especialidades relacionadas con el carcinoma diferenciado de tiroides (CDT). El objetivo del presente trabajo es hacer una revisión del CDT refractario al tratamiento con yodo radiactivo, centrándose especialmente en la definición de yodorrefractariedad, destacando su importancia por su elevada mortalidad, e introducir las diferentes opciones terapéuticas disponibles para estos pacientes (AU)

Radioiodine therapy represents a fundamental pillar in the routine adjuvant therapy of patients with high-risk differentiated thyroid carcinoma. However, a non-negligible percentage of these patients will develop iodine refractoriness, showing a worse prognosis, as well a lower survival, which demonstrates a clear need to explore different therapeutic approaches. Iodine refractory patient treatment continues to be a challenge, currently having different novel therapeutic options that should be known by the different specialties related to differentiated thyroid carcinoma (DTC). The aim of this work is to review iodine refractory thyroid carcinoma treatment, focusing especially on the definition of iodine refractoriness, highlighting its importance due to its high mortality, and introducing the different therapeutic options available for these patients (AU)

Update on iodine-refractory differentiated thyroid carcinoma.

Radioiodine therapy represents a fundamental pillar in the routine adjuvant therapy of patients with high-risk differentiated thyroid carcinoma. However, a non-negligible percentage of these patients will develop iodine refractoriness, showing a worse prognosis, as well a lower survival, which demonstrates a clear need to explore different therapeutic approaches. Iodine refractory patient treatment continues to be a challenge, currently having different novel therapeutic options that should be known by the different specialties related to differentiated thyroid carcinoma (DTC). The aim of this work is to review iodine refractory thyroid carcinoma treatment, focusing especially on the definition of iodine refractoriness, highlighting its importance due to its high mortality, and introducing the different therapeutic options available for these patients.

A variant-dependent molecular clock with anomalous diffusion models SARS-CoV-2 evolution in humans.

The evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in humans has been monitored at an unprecedented level due to the public health crisis, yet the stochastic dynamics underlying such a process is dubious. Here, considering the number of acquired mutations as the displacement of the viral particle from the origin, we performed biostatistical analyses from numerous whole genome sequences on the basis of a time-dependent probabilistic mathematical model. We showed that a model with a constant variant-dependent evolution rate and nonlinear mutational variance with time (i.e., anomalous diffusion) explained the SARS-CoV-2 evolutionary motion in humans during the first 120 wk of the pandemic in the United Kingdom. In particular, we found subdiffusion patterns for the Primal, Alpha, and Omicron variants but a weak superdiffusion pattern for the Delta variant. Our findings indicate that non-Brownian evolutionary motions occur in nature, thereby providing insight for viral phylodynamics.

Gramian angular fields for leveraging pretrained computer vision models with anomalous diffusion trajectories.

Anomalous diffusion is present at all scales, from atomic to large ones. Some exemplary systems are ultracold atoms, telomeres in the nucleus of cells, moisture transport in cement-based materials, arthropods' free movement, and birds' migration patterns. The characterization of the diffusion gives critical information about the dynamics of these systems and provides an interdisciplinary framework with which to study diffusive transport. Thus, the problem of identifying underlying diffusive regimes and inferring the anomalous diffusion exponent α with high confidence is critical to physics, chemistry, biology, and ecology. Classification and analysis of raw trajectories combining machine learning techniques with statistics extracted from them have widely been studied in the Anomalous Diffusion Challenge [Muñoz-Gil et al., Nat. Commun. 12, 6253 (2021)2041-172310.1038/s41467-021-26320-w]. Here we present a new data-driven method for working with diffusive trajectories. This method utilizes Gramian angular fields (GAF) to encode one-dimensional trajectories as images (Gramian matrices), while preserving their spatiotemporal structure for input to computer-vision models. This allows us to leverage two well-established pretrained computer-vision models, ResNet and MobileNet, to characterize the underlying diffusive regime and infer the anomalous diffusion exponent α. Short raw trajectories of lengths between 10 and 50 are commonly encountered in single-particle tracking experiments and are the most difficult ones to characterize. We show that GAF images can outperform the current state-of-the-art while increasing accessibility to machine learning methods in an applied setting.

Predicting COVID-19 pandemic waves including vaccination data with deep learning.

Introduction: During the recent COVID-19 pandemics, many models were developed to predict the number of new infections. After almost a year, models had also the challenge to include information about the waning effect of vaccines and by infection, and also how this effect start to disappear. Methods: We present a deep learning-based approach to predict the number of daily COVID-19 cases in 30 countries, considering the non-pharmaceutical interventions (NPIs) applied in those countries and including vaccination data of the most used vaccines. Results: We empirically validate the proposed approach for 4 months between January and April 2021, once vaccination was available and applied to the population and the COVID-19 variants were closer to the one considered for developing the vaccines. With the predictions of new cases, we can prescribe NPIs plans that present the best trade-off between the expected number of COVID-19 cases and the social and economic cost of applying such interventions. Discussion: Whereas, mathematical models which include the effect of vaccines in the spread of the SARS-COV-2 pandemic are available, to the best of our knowledge we are the first to propose a data driven method based on recurrent neural networks that considers the waning effect of the immunization acquired either by vaccine administration or by recovering from the illness. This work contributes with an accurate, scalable, data-driven approach to modeling the pandemic curves of cases when vaccination data is available.

COVID-19 outbreaks analysis in the Valencian Region of Spain in the prelude of the third wave.

Introduction: The COVID-19 pandemic has led to unprecedented social and mobility restrictions on a global scale. Since its start in the spring of 2020, numerous scientific papers have been published on the characteristics of the virus, and the healthcare, economic and social consequences of the pandemic. However, in-depth analyses of the evolution of single coronavirus outbreaks have been rarely reported. Methods: In this paper, we analyze the main properties of all the tracked COVID-19 outbreaks in the Valencian Region between September and December of 2020. Our analysis includes the evaluation of the origin, dynamic evolution, duration, and spatial distribution of the outbreaks. Results: We find that the duration of the outbreaks follows a power-law distribution: most outbreaks are controlled within 2 weeks of their onset, and only a few last more than 2 months. We do not identify any significant differences in the outbreak properties with respect to the geographical location across the entire region. Finally, we also determine the cluster size distribution of each infection origin through a Bayesian statistical model. Discussion: We hope that our work will assist in optimizing and planning the resource assignment for future pandemic tracking efforts.

Quartic Kerr cavity combs: bright and dark solitons.

We theoretically investigate the dynamics, bifurcation structure, and stability of localized states in Kerr cavities driven at the pure fourth-order dispersion point. Both the normal and anomalous group velocity dispersion regimes are analyzed, highlighting the main differences from the standard second-order dispersion case. In the anomalous regime, single and multi-peak localized states exist and are stable over a much wider region of the parameter space. In the normal dispersion regime, stable narrow bright solitons exist. Some of our findings can be understood using a new, to the best of our knowledge, scenario reported here for the spatial eigenvalues, which imposes oscillatory tails to all localized states.

Subphenotyping of Mexican Patients With COVID-19 at Preadmission To Anticipate Severity Stratification: Age-Sex Unbiased Meta-Clustering Technique.

BACKGROUND: The COVID-19 pandemic has led to an unprecedented global health care challenge for both medical institutions and researchers. Recognizing different COVID-19 subphenotypes-the division of populations of patients into more meaningful subgroups driven by clinical features-and their severity characterization may assist clinicians during the clinical course, the vaccination process, research efforts, the surveillance system, and the allocation of limited resources. OBJECTIVE: We aimed to discover age-sex unbiased COVID-19 patient subphenotypes based on easily available phenotypical data before admission, such as pre-existing comorbidities, lifestyle habits, and demographic features, to study the potential early severity stratification capabilities of the discovered subgroups through characterizing their severity patterns, including prognostic, intensive care unit (ICU), and morbimortality outcomes. METHODS: We used the Mexican Government COVID-19 open data, including 778,692 SARS-CoV-2 population-based patient-level data as of September 2020. We applied a meta-clustering technique that consists of a 2-stage clustering approach combining dimensionality reduction (ie, principal components analysis and multiple correspondence analysis) and hierarchical clustering using the Ward minimum variance method with Euclidean squared distance. RESULTS: In the independent age-sex clustering analyses, 56 clusters supported 11 clinically distinguishable meta-clusters (MCs). MCs 1-3 showed high recovery rates (90.27%-95.22%), including healthy patients of all ages, children with comorbidities and priority in receiving medical resources (ie, higher rates of hospitalization, intubation, and ICU admission) compared with other adult subgroups that have similar conditions, and young obese smokers. MCs 4-5 showed moderate recovery rates (81.30%-82.81%), including patients with hypertension or diabetes of all ages and obese patients with pneumonia, hypertension, and diabetes. MCs 6-11 showed low recovery rates (53.96%-66.94%), including immunosuppressed patients with high comorbidity rates, patients with chronic kidney disease with a poor survival length and probability of recovery, older smokers with chronic obstructive pulmonary disease, older adults with severe diabetes and hypertension, and the oldest obese smokers with chronic obstructive pulmonary disease and mild cardiovascular disease. Group outcomes conformed to the recent literature on dedicated age-sex groups. Mexican states and several types of clinical institutions showed relevant heterogeneity regarding severity, potentially linked to socioeconomic or health inequalities. CONCLUSIONS: The proposed 2-stage cluster analysis methodology produced a discriminative characterization of the sample and explainability over age and sex. These results can potentially help in understanding the clinical patient and their stratification for automated early triage before further tests and laboratory results are available and even in locations where additional tests are not available or to help decide resource allocation among vulnerable subgroups such as to prioritize vaccination or treatments.

Objective comparison of methods to decode anomalous diffusion.

Deviations from Brownian motion leading to anomalous diffusion are found in transport dynamics from quantum physics to life sciences. The characterization of anomalous diffusion from the measurement of an individual trajectory is a challenging task, which traditionally relies on calculating the trajectory mean squared displacement. However, this approach breaks down for cases of practical interest, e.g., short or noisy trajectories, heterogeneous behaviour, or non-ergodic processes. Recently, several new approaches have been proposed, mostly building on the ongoing machine-learning revolution. To perform an objective comparison of methods, we gathered the community and organized an open competition, the Anomalous Diffusion challenge (AnDi). Participating teams applied their algorithms to a commonly-defined dataset including diverse conditions. Although no single method performed best across all scenarios, machine-learning-based approaches achieved superior performance for all tasks. The discussion of the challenge results provides practical advice for users and a benchmark for developers.

How the Wakamola chatbot studied a university community's lifestyle during the COVID-19 confinement.

This work aimed to study the effect of confinement on weight and lifestyle using the Wakamola chatbot to collect data from 739 adults divided into two groups (341 case-control, 398 confinement). Nutrition score (0-100 scale) improved for men (medians 81.77-82.29, p < 0.05), with no difference for women (medians 82.29 in both cases). Both genders reduced the consumption of sweetmeats and sugared drinks (p < 0.01); men increased their consumption of vegetables, salad, and legumes (p < 0.01). Both genders reduced their physical activity score (men 100-40.14, p < 0.01, women 80.42-36.12, p < 0.01). Women sat less hours/week, men's medians 28.81-28.27, women's medians 35.97-23.33, p = 0.03. Both genders slept longer (hours/day), men 7-7.5, women 7-8 (p < 0.01) (medians). Their overall health score was significantly reduced (men 85.06-74.05, p < 0.01, women 84.47-72.42, p < 0.01), with no significant weight difference in either gender. Wakamola helped to contact participants and confirm changes in their lifestyle during confinement.

A User-Centered Chatbot (Wakamola) to Collect Linked Data in Population Networks to Support Studies of Overweight and Obesity Causes: Design and Pilot Study.

BACKGROUND: Obesity and overweight are a serious health problem worldwide with multiple and connected causes. Simultaneously, chatbots are becoming increasingly popular as a way to interact with users in mobile health apps. OBJECTIVE: This study reports the user-centered design and feasibility study of a chatbot to collect linked data to support the study of individual and social overweight and obesity causes in populations. METHODS: We first studied the users' needs and gathered users' graphical preferences through an open survey on 52 wireframes designed by 150 design students; it also included questions about sociodemographics, diet and activity habits, the need for overweight and obesity apps, and desired functionality. We also interviewed an expert panel. We then designed and developed a chatbot. Finally, we conducted a pilot study to test feasibility. RESULTS: We collected 452 answers to the survey and interviewed 4 specialists. Based on this research, we developed a Telegram chatbot named Wakamola structured in six sections: personal, diet, physical activity, social network, user's status score, and project information. We defined a user's status score as a normalized sum (0-100) of scores about diet (frequency of eating 50 foods), physical activity, BMI, and social network. We performed a pilot to evaluate the chatbot implementation among 85 healthy volunteers. Of 74 participants who completed all sections, we found 8 underweight people (11%), 5 overweight people (7%), and no obesity cases. The mean BMI was 21.4 kg/m2 (normal weight). The most consumed foods were olive oil, milk and derivatives, cereals, vegetables, and fruits. People walked 10 minutes on 5.8 days per week, slept 7.02 hours per day, and were sitting 30.57 hours per week. Moreover, we were able to create a social network with 74 users, 178 relations, and 12 communities. CONCLUSIONS: The Telegram chatbot Wakamola is a feasible tool to collect data from a population about sociodemographics, diet patterns, physical activity, BMI, and specific diseases. Besides, the chatbot allows the connection of users in a social network to study overweight and obesity causes from both individual and social perspectives.

Immunotherapy, cancer and PET. / Inmunoterapia, cáncer y PET.

The treatment of cancer by immunotherapy has been a revolution, as it is the first strategy that manages to control the disease for prolonged periods of time. Its efficacy is associated with different imaging response patterns and the appearance of new toxicities. We would highlight two patterns of tumour response: pseudoprogression, or growth of tumour lesions after the start of immunotherapy treatment, followed by a significant reduction in lesions, and hyperprogression, acceleration of tumour progression and metastasis early after the start of treatment. The emergence of such patterns has generated new metabolic response criteria, such as PECRIT, PERCIMT, imPERCIST and IPERCIST. Of particular interest are the new immunoPET-specific biomarkers, as they allow the identification of patients presenting the tumour target and are useful for predicting response to immunotherapy.

A multidisciplinary consensus on the morphological and functional responses to immunotherapy treatment

The implementation of immunotherapy has radically changed the treatment of oncological patients. Currently, immunotherapy is indicated in the treatment of patients with head and neck tumors, melanoma, lung cancer, bladder tumors, colon cancer, cervical cancer, breast cancer, Merkel cell carcinoma, liver cancer, leukemia and lymphomas. However, its efficacy is restricted to a limited number of cases. The challenge is, therefore, to identify which subset of patients would benefit from immunotherapy. To this end, the establishment of immunotherapy response criteria and predictive and prognostic biomarkers is of paramount interest. In this report, a group of experts of the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Medical Radiology (SERAM), and Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM) provide an up-to-date review and a consensus guide on these issues (AU)

Reversible Self-Replication of Spatiotemporal Kerr Cavity Patterns.

We uncover a novel and robust phenomenon that causes the gradual self-replication of spatiotemporal Kerr cavity patterns in cylindrical microresonators. These patterns are inherently synchronized multifrequency combs. Under proper conditions, the axially localized nature of the patterns leads to a fundamental drift instability that induces transitions among patterns with a different number of rows. Self-replications, thus, result in the stepwise addition or removal of individual combs along the cylinder's axis. Transitions occur in a fully reversible and, consequently, deterministic way. The phenomenon puts forward a novel paradigm for Kerr frequency comb formation and reveals important insights into the physics of multidimensional nonlinear patterns.

A multidisciplinary consensus on the morphological and functional responses to immunotherapy treatment.

The implementation of immunotherapy has radically changed the treatment of oncological patients. Currently, immunotherapy is indicated in the treatment of patients with head and neck tumors, melanoma, lung cancer, bladder tumors, colon cancer, cervical cancer, breast cancer, Merkel cell carcinoma, liver cancer, leukemia and lymphomas. However, its efficacy is restricted to a limited number of cases. The challenge is, therefore, to identify which subset of patients would benefit from immunotherapy. To this end, the establishment of immunotherapy response criteria and predictive and prognostic biomarkers is of paramount interest. In this report, a group of experts of the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Medical Radiology (SERAM), and Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM) provide an up-to-date review and a consensus guide on these issues.

Potential limitations in COVID-19 machine learning due to data source variability: A case study in the nCov2019 dataset.

OBJECTIVE: The lack of representative coronavirus disease 2019 (COVID-19) data is a bottleneck for reliable and generalizable machine learning. Data sharing is insufficient without data quality, in which source variability plays an important role. We showcase and discuss potential biases from data source variability for COVID-19 machine learning. MATERIALS AND METHODS: We used the publicly available nCov2019 dataset, including patient-level data from several countries. We aimed to the discovery and classification of severity subgroups using symptoms and comorbidities. RESULTS: Cases from the 2 countries with the highest prevalence were divided into separate subgroups with distinct severity manifestations. This variability can reduce the representativeness of training data with respect the model target populations and increase model complexity at risk of overfitting. CONCLUSIONS: Data source variability is a potential contributor to bias in distributed research networks. We call for systematic assessment and reporting of data source variability and data quality in COVID-19 data sharing, as key information for reliable and generalizable machine learning.

Perspectiva de mujeres mexicanas sobre lactancia materna asociada al cambio del modelo cultural / Mexican women breastfeeding perspective associated with the cultural model change / Perspectiva das mulheres mexicanas sobre a aleitamento materno associado ao câmbio do modelo cultural

RESUMEN Introducción: La lactancia materna es importante para el desarrollo saludable del recién nacido. A pesar de sus beneficios, la decisión de no amamantar se incrementa entre las mujeres de la Ciudad de México debido a la influencia de la globalización y del cambio de modelo cultural moderno al posmoderno. Objetivo: Comprender la perspectiva de las mujeres mexicanas sobre el ofrecer y abandonar la lactancia materna asociada al cambio del modelo cultural. Metodología: Se llevó a cabo un estudio cualitativo con enfoque exploratorio, descriptivo: participaron 12 diadas (madre-hijo lactante), residentes de la Ciudad de México, quienes ofrecieron y abandonaron la lactancia materna. Se realizaron entrevistas en profundidad. Los datos obtenidos se grabaron, transcribieron y codificaron para garantizar el rigor de la investigación. Resultados: Se reconocieron dos categorías que sustentan el por qué las mujeres brindan o abandonan la lactancia materna, vistas desde el modelo cultural. En el modelo moderno las mujeres consideran una convicción sentida el ofrecer lactancia materna, reconocen los beneficios de dicho alimento para su hijo; mientras que, en el modelo posmoderno, las mujeres tienen una convicción negativa de amamantar. Conclusiones: Al asociar la lactancia materna con modelos culturales, en el moderno se considera la lactancia como un deber, mientras que en el posmoderno un derecho. Al encontrarnos en transición entre ambos modelos, las mujeres están influenciadas por discursos y prácticas culturales que en ocasiones son contradictorias. Comprender estos fenómenos permitirá diseñar estrategias efectivas desde la enfermería para fomentar la lactancia materna.

ABSTRACT Introduction: Breastfeeding is an important activity for the healthy development of the newborn, but nevertheless the benefits, the decision of women to avoid breastfeeding is becoming more prevalent in Mexico City. Perhaps this decision is the result of the influence of the globalization process with its cultural model change from the modern to the postmodern. Objective: To better understand the perspective of Mexican women regarding breastfeeding or not breastfeeding and the relationship of this decision with the cultural model change. Methodology: This is a qualitative, descriptive, and exploratory study on 12 mothers in Mexico City, who decided to terminate breastfeeding their babies. In-Depth interviews were conducted. The gathered data were recorded, transcribed, and coded in order to procure rigour of research. Results: Two categories related to the cultural model that reflect why women breastfeed or not were identified. In the modern model, women consider breastfeeding as a solid conviction which has benefits to their babies, while in the postmodern model, women tend to have a negative image of breastfeeding. Conclusions: From the association of breastfeeding with the cultural models, in the modern model, women consider breastfeeding as a duty, while in the postmodern one, women consider breastfeeding as a right. Currently, we are in a transition between these possibly contradicting cultural models. Therefore, better understanding these phenomena can help nursing professionals design strategies which can foster a healthy decision on breastfeeding.

RESUMO Introdução: O aleitamento materno é importante para o desenvolvimento saudável do recém-nascido. Apesar de seus benefícios, a decisão de não amamentar aumenta entre as mulheres da Cidade do México devido à influência da globalização e da mudança do modelo cultural moderno para o pós-moderno. Objetivo: Compreender a perspectiva das mulheres mexicanas sobre a oferta e o abandono do aleitamento materno associado à mudança do modelo cultural. Metodologia: Realizou-se um estudo qualitativo com abordagem exploratória e descritiva: participaram 12 díades (mãe-filho em lactação), residentes na Cidade do México, que ofereceram e abandonaram a amamentação. Entrevistas em profundidade foram realizadas. Os dados obtidos foram gravados, transcritos e codificados para garantir o rigor da pesquisa. Resultados: Foram reconhecidas duas categorias que sustentam porque as mulheres oferecem ou abandonam a amamentação, visto a partir do modelo cultural. No modelo moderno, as mulheres consideram o fato da amamentação uma convicção sincera, reconhecem os benefícios dessa alimentação para o filho; enquanto no modelo pós-moderno as mulheres têm uma convicção negativa de amamentar. Conclusões: Ao associar o aleitamento materno aos modelos culturais, no moderno amamentar é considerado um dever, enquanto na pós-moderna um direito. Ao encontrarmos em transição entre os dois modelos, as mulheres são influenciadas por discursos e práticas culturais que às vezes são contraditórios. Compreender esses fenômenos permitirá o desenho de estratégias de enfermagem eficazes para promover o aleitamento materno.

Early Surgical Management of Medical Tourism Complications Improves Patient Outcomes.

BACKGROUND: Complications from medical tourism can be significant, requiring aggressive treatment at initial presentation. This study evaluates the effect of early surgical versus conservative management on readmission rates and costs. METHODS: A single-center retrospective review was conducted from May of 2013 to May of 2017 of patients presenting with soft-tissue infections after cosmetic surgery performed abroad. Patients were categorized into two groups based on their management at initial presentation as either conservative or surgical. Demographic information, the procedures performed abroad, and the severity of infection were included. The authors' primary outcome was the incidence of readmission in the two groups. International Classification of Diseases, Ninth Revision; International Classification of Diseases, Tenth Revision; and CPT codes were used for direct-billed cost analysis. RESULTS: Fifty-three patients (one man and 52 women) presented with complications after procedures performed abroad, of which 37 were soft-tissue infections. Twenty-four patients with soft-tissue infections at initial presentation were managed conservatively, and 13 patients were treated surgically. The two groups were similar in patient demographics and type of procedure performed abroad. Patients who were managed conservatively at initial presentation had a higher rate of readmission despite having lower severity of infections (OR, 4.7; p = 0.037). A significantly lower total cost of treatment was shown with early surgical management of these complications (p = 0.003). CONCLUSIONS: Conservative management of complications from medical tourism has resulted in a high incidence of failure, leading to readmission and increased costs. This can contribute to poor outcomes in patients that are already having complications from cosmetic surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.