Proposal to measure tourism development within a destination and segment its different territories.

Tourism offers a means of promoting a local development strategy capable of harnessing the resources available within a territory. In order to do this, we must know the potential for tourism development in each territory, as well as the factors that would condition it. In this article, a methodology (based on the design of a system of indicators, the construction of composite indexes, and segmentation by means of cluster analysis) is proposed to measure tourism development within an emerging country and segment its different territories. The case study chosen to validate this methodology is Ecuador, a country with interesting tourist potential, where individual cities have very different levels of tourism development. The results highlight the factors that drive or constrain the degree of tourism development presented by the cities analysed, thereby facilitating decision-making for major stakeholders in each of them.

Tinea capitis outbreak and other superficial mycosis in an urban community of Medellín / Brote de tinea capitis y otras micosis superficiales en una comunidad urbana de Medellín

Introduction. Dermatophytoses are superficial fungal infections of the keratinized epithelium like tinea capitis. The latte mainly affects school-vulnerable populations. Carpinelo is a peripheral neighborhood in Medellín with poor socioeconomic conditions and where a suspected tinea capitis outbreak took place. Objective. To study and characterize, clinically and microbiologically, patients with suspected dermatophytosis in Carpinelo. Material and methods. We carried out a descriptive and longitudinal study with an active case search of tinea capitis in children and their relatives from the Jardín Educativo Buen Comienzo community in Carpinelo. Patients were clinically evaluated, and samples of scales and hair were taken to perform mycological studies with a 10 % potassium hydroxide and culture in Sabouraud and Mycosel agar. We analyzed the data with the statistical program SPSS™. 25 version. Results. Fifty-seven individuals were studied: 47 were children with a mean age of six years and a ratio of 2:1 male to female. Patients with confirmed diagnosis presented the following clinical forms: tinea capitis (78.95%), tinea faciei (15.79%) or tinea corporis (10.52%). Out of the total, 69.76% of the patients had previous treatment with steroids. The direct test was positive in 53.84% of the samples, and 46.15% had positive cultures. The isolated species were: Microsporum canis (77.77%), Trichophyton spp. (11.11%), Trichophyton rubrum (5.55%), and Malassezia spp. (5.55 %). Conclusion. Tinea capitis was the most common clinical form, and M. canis was the most frequently isolated species. The use of steroids as the first and only option for empiric treatment was worth of notice. The findings of this study point out the importance of microbiological diagnosis in choosing the best treatment for the patients.

Introducción. Las dermatofitosis son infecciones fúngicas superficiales de epitelios queratinizados. La tinea capitis es una de ellas y afecta a poblaciones escolares vulnerables. Carpinelo es un barrio del área periférica de Medellín con precarias condiciones socioeconómicas. Ante la sospecha de un brote de dermatofitosis, los afectados fueron evaluados. Objetivo. Evaluar clínica y microbiológicamente pacientes del barrio Carpinelo con sospecha de micosis cutáneas para determinar la presencia de un brote por dermatofitos. Materiales y métodos. Se llevó a cabo un estudio descriptivo, de corte longitudinal, con muestreo a conveniencia. Se hizo una búsqueda activa de casos en el Jardín Educativo Buen Comienzo de Carpinelo en niños de la institución y sus familiares. Se evaluaron clínicamente y se tomaron muestras de escamas y cabellos para exámenes directos y cultivos microbiológicos. Se analizó el perfil demográfico, clínico y micológico, con el programa estadístico SPSS™, versión 25. Resultados. Se estudiaron 57 pacientes, 47 eran menores de edad con una media de edad de seis años; se observó una proporción de hombres y mujeres de 2:1. Los pacientes con resultados positivos se diagnosticaron con tinea capitis (78,95 %), tinea faciei (15,79 %) y tinea corporis (10,52 %). El 75,43 % de los pacientes recibió tratamiento previo y de estos el 69,73 % fue con esteroides. El examen directo fue positivo en el 53,84 % y los cultivos en el 46,5 % de los casos. Los agentes aislados fueron: Microsporum canis (77,77 %), Trichophyton spp. (11,11 %), Trichophyton rubrum (5,55 %) y Malassezia spp. (5,55 %). Conclusión. Tinea capitis fue la presentación clínica más común y M. canis el dermatofito más frecuentemente aislado. Llamó la atención el uso de esteroides como primera y única opción del tratamiento empírico' lo cual resalta la importancia del diagnóstico microbiológico para proporcionar la terapia apropiada.

Brote de tinea capitis y otras micosis superficiales en una comunidad urbana de Medellín

Introducción. Las dermatofitosis son infecciones fúngicas superficiales de epitelios queratinizados. La tinea capitis es una de ellas y afecta a poblaciones escolares vulnerables. Carpinelo es un barrio del área periférica de Medellín con precarias condiciones socioeconómicas. Ante la sospecha de un brote de dermatofitosis, los afectados fueron evaluados. Objetivo. Evaluar clínica y microbiológicamente pacientes del barrio Carpinelo con sospecha de micosis cutáneas para determinar la presencia de un brote por dermatofitos. Materiales y métodos. Se llevó a cabo un estudio descriptivo, de corte longitudinal, con muestreo a conveniencia. Se hizo una búsqueda activa de casos en el Jardín Educativo Buen Comienzo de Carpinelo en niños de la institución y sus familiares. Se evaluaron clínicamente y se tomaron muestras de escamas y cabellos para exámenes directos y cultivos microbiológicos. Se analizó el perfil demográfico, clínico y micológico, con el programa estadístico SPSS™, versión 25. Resultados. Se estudiaron 57 pacientes, 47 eran menores de edad con una media de edad de seis años; se observó una proporción de hombres y mujeres de 2:1. Los pacientes con resultados positivos se diagnosticaron con tinea capitis (78,95 %), tinea faciei (15,79 %) y tinea corporis (10,52 %). El 75,43 % de los pacientes recibió tratamiento previo y de estos el 69,73 % fue con esteroides. El examen directo fue positivo en el 53,84 % y los cultivos en el 46,5 % de los casos. Los agentes aislados fueron: Microsporum canis (77,77 %), Trichophyton spp. (11,11 %), Trichophyton rubrum (5,55 %) y Malassezia spp. (5,55 %). Conclusión. Tinea capitis fue la presentación clínica más común y M. canis el dermatofito más frecuentemente aislado. Llamó la atención el uso de esteroides como primera y única opción del tratamiento empírico, lo cual resalta la importancia del diagnóstico microbiológico para proporcionar la terapia apropiada.

Introduction. Dermatophytoses are superficial fungal infections of the keratinized epithelium like tinea capitis. The latte mainly affects school-vulnerable populations. Carpinelo is a peripheral neighborhood in Medellín with poor socioeconomic conditions and where a suspected tinea capitis outbreak took place. Objective. To study and characterize, clinically and microbiologically, patients with suspected dermatophytosis in Carpinelo. Material and methods. We carried out a descriptive and longitudinal study with an active case search of tinea capitis in children and their relatives from the Jardín Educativo Buen Comienzo community in Carpinelo. Patients were clinically evaluated, and samples of scales and hair were taken to perform mycological studies with a 10 % potassium hydroxide and culture in Sabouraud and Mycosel agar. We analyzed the data with the statistical program SPSS™. 25 version. Results. Fifty-seven individuals were studied: 47 were children with a mean age of six years and a ratio of 2:1 male to female. Patients with confirmed diagnosis presented the following clinical forms: tinea capitis (78.95%), tinea faciei (15.79%) or tinea corporis (10.52%). Out of the total, 69.76% of the patients had previous treatment with steroids. The direct test was positive in 53.84% of the samples, and 46.15% had positive cultures. The isolated species were: Microsporum canis (77.77%), Trichophyton spp. (11.11%), Trichophyton rubrum (5.55%), and Malassezia spp. (5.55 %). Conclusion. Tinea capitis was the most common clinical form, and M. canis was the most frequently isolated species. The use of steroids as the first and only option for empiric treatment was worth of notice. The findings of this study point out the importance of microbiological diagnosis in choosing the best treatment for the patients.

Pathogenic Microorganisms Linked to Fresh Fruits and Juices Purchased at Low-Cost Markets in Ecuador, Potential Carriers of Antibiotic Resistance.

The pathogenic microorganisms linked to fresh fruits and juices sold out in retail low-cost markets raise safety concerns as they may carry multidrug-resistant (MDR) genes. To evaluate the microbiological quality and safety of highly consumed fruits and derivatives in Imbabura Province, Ecuador, ready-to-eat strawberries (5 independent batches; n = 300 samples), and gooseberries (5 separate batches; n = 500 samples), purchased from a local fruit farm grower and low-cost retail market, along with 20 different natural fruit- and vegetables-based juices (3 independent batches; n = 60 samples) purchased from food courts located within the low-cost markets were analyzed. Bacteriological analysis showed that the microbial quality was lower as several indicators (n = 984) consisting of total coliforms (TCOL), total aerobes (AEROB), Enterobacter spp. (ENT), Shigella spp., (SHIGA), yeasts (YE), and molds (M) were detected. Staphylococcus spp. (STAPHY) was found in both fruits regardless of origin, while Escherichia coli (EC) isolates were found in strawberries but not gooseberries. Salmonella spp. (SALM) were detected in juices only. Antibiotic susceptibility testing showed multidrug resistance of several isolates. The hemolytic pattern revealed that 88.89% of EC and 61.11% of ENT isolates were beta-hemolytic. All STAPHY isolates were beta-hemolytic while SALM and SHIGA were alpha-hemolytic. Plasmid curing assay of MDR isolates (ENT, EC, SALM, and STAPHY) showed that the antibiotic resistance (AR) was highly indicative of being plasmid-borne. These results raise concerns about the consumption of MDR bacteria. However, good agricultural and industrial practices, behavioral change communication, and awareness-raising programs are necessary for all stakeholders along the food production and consumption supply chain.

Consecuencias neurobiológicas del abuso sexual en la infancia: revisión de literatura / Neurobiological consequences of child sexual abuse: literature review / Consequências neurobiológicas do abuso sexual infantil: revisão da literatura

RESUMEN Objetivo: Describir las consecuencias neurobiológicas en ninos, ninas y adolescentes con antecedente de abuso sexual infantil (ASI). Metodologia: Se realizó una revisión de literatura entre los años 2015 al 2020 en tres bases de datos (Pubmed, Scopus, Scielo), utilizando las palabras clave: abuso sexual infantil, neurobiologia. Se recopiló información acerca de los tipos de alteraciones neurobiológicas (estructurales, funcionales, endocrinos, psicológicos, inmunológicos y genéticos) en ninos, ninas y adolescentes con antecedente de ASI. Se excluyeron articulos cuyo titulo o resumen no incluyeran los temas de esta revisión. Resultados: Se seleccionaron 99 estudios asociados a las consecuencias neurobiológicas del ASI, con las consecuentes alteraciones estructurales, funcionales, endocrinas, inmunológicos y genéticos que afectan a un importante número de victimas. Conclusiones: Diversos autores han encontrado una relación entre la exposición al ASI y los cambios neurobiológicos, visibilizando asi, el impacto que esto ocasiona en la salud de las victimas, por tal, se hace importante promover intervenciones tempranas y tratamiento adecuado por las múltiples consecuencias que genera, algunas irreversibles.

ABSTRACT Objective: To describe the neurobiological consequences in children and adolescents with a history of child sexual abuse (CSA). Methodology: A literature review was carried out between the years 2015 and 2020 in three databases (Pubmed, Scopus, Scielo), using the keywords: child sexual abuse, neurobiology Information was collected about the types of neurobiological alterations (structural, functional, endocrine, psychological, immunological and genetic) in children and adolescents with a history of CSA. Articles whose title or abstract did not include the topics of this review were excluded. Results: 99 studies associated with the neurobiological consequences of CSA were selected, with the consequent structural, functional, endocrine, immunological and genetic alterations that affect a significant number of victims. Conclusions: Various authors have found a relationship between exposure to CSA and neurobiological changes, thus making visible the impact that this causes on the health of the victims, therefore, it is important to promote early interventions and adequate treatment due to the multiple consequences that generates, some irreversible.

RESUMO Objetivo: Descrever as conseqüências neurobiológicas em crianças e adolescentes com histórico de abuso sexual infantil (CSA). Metodologia: Entre 2015 e 2020 foi realizada uma revisão bibliográfica em três bancos de dados (Pubmed, Scopus, Scielo), utilizando as palavras-chave: abuso sexual infantil, neurobiologia. Foram coletadas informações sobre os tipos de alterações neurobiológicas (estruturais, funcionais, endócrinas, psicológicas, imunológicas e genéticas) em crianças e adolescentes com histórico de CSA. Foram excluidos os artigos cujo titulo ou resumo não incluia os tópicos desta revisão. Resultados: Foram selecionados 99 estudos associados às conseqüências neurobiológicas da CSA, com conseqüentes alterações estruturais, funcionais, endócrinas, imunológicas e genéticas que afetam um número significativo de vitimas. Conclusões: Vários autores encontraram uma relação entre a exposição à CSA e as mudanças neurobiológicas, tornando assim visivel o impacto que isso tem na saúde das vitimas, por isso é importante promover intervenções precoces e tratamento adequado para as múltiplas conseqüências que ela gera, algumas das quais são irreversiveis.

Metaanálisis. Frecuencia de hiperreactividad plaquetaria en pacientes con DM y HTA sometidos a ICP / Meta-analysis. Frequency of platelet hyperreactivity in patients with DM and HTA undergoing PCI

Resumen Objetivo: Realizar un metaanálisis de la frecuencia de hiperreactividad plaquetaria (HPR) para aspirina y clopidogrel con diferentes agregómetros, en pacientes con diabetes mellitus (DM) e hipertensión (HTA) sometidos a intervención coronaria percutánea (ICP). Método: Revisión sistemática con metaanálisis a partir de 40 búsquedas en tres bases de datos multidisciplinarias (PubMed, ScienceDirect y SciELO), siguiendo las fases de la guía PRISMA entre los años 2005 y 2021. Se garantizaron la reproducibilidad y la calidad metodológica por parte de dos investigadores que usaron la guía STROBE. Los análisis se basaron en frecuencias y metaanálisis de razón de disparidad, para lo cual se empleó el software Epidat con un intervalo de confianza del 95%. Resultados: Se incluyeron 22 estudios. La frecuencia de hiperreactividad plaquetaria para la aspirina fue desde el 18.8% hasta el 81.8% y para el clopidogrel desde el 18.2% hasta el 71.3%, lo que denota una importante heterogeneidad. Se observó que la frecuencia de hiperreactividad plaquetaria en pacientes diabéticos varió del 21% al 78.7%, mientras que en los pacientes hipertensos fue del 17.6% al 76.8%, y finalmente, la hiperreactividad plaquetaria fue 1,38 veces mayor en los pacientes diabéticos que en aquellos que no lo eran y 1,23 veces mayor en los pacientes hipertensos que en aquellos que no lo eran. Conclusiones: La diabetes mellitus y la hipertensión arterial, como enfermedades de base en pacientes sometidos a intervención coronaria percutánea, están asociadas a hiperreactividad plaquetaria, y esta, a su vez, como demostraron estudios previos, al desarrollo de eventos vasculares a largo plazo. De ahí que una valoración posterior al procedimiento con pruebas de agregometría plaquetaria resultaría potencialmente útil en el marco de la terapia personalizada.

Abstract Objective: To perform a metaanalyze of the frequency of platelet hyperreactivity for aspirin and clopidogrel with different aggregometers, in patients with diabetes mellitus and hypertension undergoing percutaneous coronary intervention. Method: Systematic review with metaanalysis using 40 searches in three multidisciplinary databases (PubMed, ScienceDirect and SciELO), following the phases of the PRISMA guide between the years 2005 and 2021. Reproducibility and methodological quality were guaranteed by two researchers using the STROBE guide. The analyzes were based on frequencies and odds ratio metaanalysis, using Epidat software with a 95% confidence interval. Results: 22 studies were included, the frequency of platelet hyperreactivity was from 18.8% to 81.8% in the case of aspirin, and in the case of clopidogrel from 18.2% to 71.3%, which denotes an important heterogeneity. It was observed that the frequency of platelet hyperreactivity in diabetic patients ranged from 21% to 78.7% and in hypertensive patients from 17.6% to 76.8%, and finally it was observed that the platelet hyperreactivity was 1.38 times higher in diabetic patients than in those who were not and 1.23 times higher in hypertensive patients than in those who were not. Conclusions: Diabetes mellitus and hypertension as underlying pathologies in patients undergoing percutaneous coronary intervention are associated with the presence of platelet hyperreactivity, and this in turn -as shown by previous studies-, with the development of long-term vascular events, therefore a subsequent assessment. The procedure with platelet aggregometry tests would be potentially useful in the context of personalized therapy.

Health and Well-Being of Hispanic/Latino Meatpacking Workers in Nebraska: An Application of the Health Belief Model.

BACKGROUND: Meatpacking is dirty, dangerous, and demanding work. In the United States, the industry predominately employs people from racial/ethnic minority backgrounds and immigrants, with 45% of the workforce identifying as Hispanic/Latino. Little is known about how the work environment affects worker engagement in health-promoting activities; however, occupational health professionals are uniquely positioned to advance worker health, safety, and general well-being. METHODS: Hispanic/Latino meatpacking workers with work-related musculoskeletal pain and active health concerns were recruited to participate in a study to explore health, health behaviors, and the work environment. Five focus groups (N = 28) were conducted in Nebraska between March 2019 and February 2020. Thematic analysis using the Health Belief Model constructs was used to explain workers' health behaviors including utilization of occupational health services at their workplace. FINDINGS: Workers believed that there was little they could do to prevent and treat health problems. They understood the perceived threat of health problems and the benefits of self-care, but the perceived barriers often outweighed the benefits. The workplace had few prompts to motivate or incentivize self-care both in and outside of work. In addition, workers did not trust the occupational health office and saw few benefits to accessing services. Together, these conditions resulted in low self-efficacy and limited engagement in health-promoting behaviors. CONCLUSION/APPLICATION TO PRACTICE: Occupational health professionals should promote Total Worker Health and foster trust by providing culturally, linguistically, and literacy appropriate services and by identifying opportunities and reducing barriers for workers to engage in activities to promote their health, safety, and well-being.

Prognostic factors for progression-free and overall survival in malignant pleural mesothelioma.

BACKGROUND: Malignant pleural mesothelioma is an infrequent neoplasia with a poor prognosis and the majority of patients already have advanced disease at the time of presentation. Exposure to asbestos is the most important risk factor for malignant pleural mesothelioma. Mesothelioma is a neoplasia with a long preclinical stage that can span from 15 to 40 years. METHODS: This was a descriptive, observational, retrospective study of 136 patients with a confirmed diagnosis of mesothelioma, which compared histological subtypes, immunohistochemical biomarkers, concomitant chronic degenerative diseases, tobacco use, age at the time of diagnosis, clinical stage and chemotherapy agents used or other treatments such as radiotherapy and surgery to identify all the factors that impact in the prognosis of overall survival (OS) and progression-free survival (PFS). RESULTS: A total of 136 patients were included in the study. In the total study population, 84 patients were male (61.8%) and 52 were female (38.2%). Median PFS was nine months (95% confidence interval [CI]: 8.4-9.5 months) and median OS was 12 months (95% CI: 11.3-12.6). The results indicated that the most determining prognostic factors for OS and PFS were cell differentiation measured by immunohistochemical biomarkers, the treatment chosen, and that RECIST was the most significant in the evaluation of patient response to treatment. CONCLUSIONS: Malignant pleural mesothelioma is a cancer with a poor prognosis usually diagnosed at an advanced stage of disease. Our study revealed that the prognostic factors for OS and PS were cell differentiation, the treatment chosen and RECIST.

A coffee berry borer (Hypothenemus hampei) genome assembly reveals a reduced chemosensory receptor gene repertoire and male-specific genome sequences.

Coffee berry borer-CBB (Hypothenemus hampei) is a globally important economic pest of coffee (Coffea spp.). Despite current insect control methods for managing CBB, development of future control strategies requires a better understanding of its biology and interaction with its host plant. Towards this objective, we performed de novo CBB genome and transcriptome sequencing, improved CBB genome assembly and predicted 18,765 protein-encoding genes. Using genome and transcriptome data, we annotated the genes associated with chemosensation and found a reduced gene repertoire composed by 67 odorant receptors (ORs), 62 gustatory receptors (GRs), 33 ionotropic receptors (IRs) and 29 odorant-binding proteins (OBPs). In silico transcript abundance analysis of these chemosensory genes revealed expression enrichment in CBB adults compared with larva. Detection of differentially expressed chemosensory genes between males and females is likely associated with differences in host-finding behavior between sexes. Additionally, we discovered male-specific genome content and identified candidate male-specific expressed genes on these scaffolds, suggesting that a Y-like chromosome may be involved in the CBB's functional haplodiploid mechanism of sex determination.

Frecuencia de ANA/DFS70 en familiares de pacientes con artritis reumatoide comparados con pacientes con artritis reumatoide y población sana y su asociación con el estado de salud / Frequency of ANA/DFS70 in Relatives of Patients with Rheumatoid Arthritis Compared to Patients with Rheumatoid Arthritis and a Healthy Population, and its Association with Health Status

Introducción: Los ANA/DFS70 han atraído el interés por su frecuencia en individuos sin evidencia clínica de enfermedad reumática sistémica autoinmune, no se han evaluado grupos de riesgo genético para artritis reumatoide (AR). Objetivo: Determinar la frecuencia de ANA y ANA/DFS70 en familiares consanguíneos (FC) de AR comparada con pacientes con AR temprana (ARt) e individuos control y su asociación con el estado de salud. Metodología: Estudio de corte transversal con componente analítico. Análisis de 60 pacientes ARt, 60 FC y 120 individuos control pareados por edad y sexo. Se analizaron ANA-HEp2 y ANA/DFS70. Establecieron las frecuencias absolutas y relativas y asociaciones con modelos de regresión logística, con un nivel de significación del 95%. Resultados: ANA de 43% en ARt, 30% en FC y 25,8% en individuos control a título 1:80. El patrón granular fino denso por Hep2 convencional se encontró en el 12,9% de las muestras positivas y el 1,66% del total de muestras. En ANA/DFS70 (+) en 1,66% en FC y 2,5% de individuos control, representando el 75% de la muestras positivas y el 1,25% del total de las muestras. No hubo detección de ANAS-DFS70 en pacientes con ARt. En ARt hubo asociación entre la presencia de ANA y articulaciones inflamadas (p=0,02), PCR (p=0,01), DAS28PCR (p=0,03) y HAQ (p=0,04). Asociación entre ANA y PCR elevada (p=0,05) en FC. En individuos control entre ANA y articulaciones dolorosas (p=0,02). En individuos ANA-DFS70 observamos asociación con VSG normal p=0,032, FR (-), p=0,044 y ausencia de articulaciones dolorosas, p=0,039. Conclusiones: La frecuencia de ANA/DFS70 en los grupos estudiados fue baja, ninguno de los pacientes con ARt fue positivo. Se confirma la presencia de ANA/DFS70 solo en individuos sanos sistémicamente.(AU)

Introduction: DFS70 ANAs have attracted interest due to their frequency in individuals with no clinical evidence of systemic autoimmune rheumatic disease, groups with genetic risk for rheumatoid arthritis (RA) were not assessed. Objective: To determine the frequency of ANA and DFS70 ANA in blood relatives (BR) of people with RA compared to patients with early RA (ERA), and control individuals, and its association with health status. Methodology: A cross-sectional study with an analytical component. Sixty ERA patients, 60 BR and 120 control individuals paired by age and sex were studied. Hep2-ANA and DFS70 ANA were studied. The absolute and relative frequencies and associations were established using logistic regression models, with a significance level of 95%. Results: 43% ANA in ERA, 30% in BR, and 25.8% in control individuals 1:80. The fine dense granular pattern based on conventional Hep2 was found in 12.9% of the positive samples, and 1.66% of the total samples. There was no detection of DFS70 ANAs in patients with ERA. In ERA there was an association between the presence of ANA and inflamed joints (p=.02), CRP (p=.01), DAS28CRP (p=.03) and HAQ (p=.04). There was an association between ANA and elevated CRP (p=.05) in the BR. In the control individuals, there was an association between ANA and painful joints (p=02). In DFS70 ANA individuals we observed an association between a normal ESR p=.032, BR (-), p=.044 and absence of painful joints, p=.039. Conclusions: The frequency of DFS70 ANA in the groups studied was low, none of the patients with ERA was positive. The presence of DFS70 ANA was only confirmed in systemically healthy individuals.(AU)

Frequency of ANA/DFS70 in Relatives of Patients with Rheumatoid Arthritis Compared to Patients with Rheumatoid Arthritis and a Healthy Population, and its Association with Health Status. / Frecuencia de ANA/DFS70 en familiares de pacientes con artritis reumatoide comparados con pacientes con artritis reumatoide y población sana y su asociación con el estado de salud.

INTRODUCTION: DFS70 ANAs have attracted interest due to their frequency in individuals with no clinical evidence of systemic autoimmune rheumatic disease, groups with genetic risk for rheumatoid arthritis (RA) were not assessed. OBJECTIVE: To determine the frequency of ANA and DFS70 ANA in blood relatives (BR) of people with RA compared to patients with early RA (ERA), and control individuals, and its association with health status. METHODOLOGY: A cross-sectional study with an analytical component. Sixty ERA patients, 60 BR and 120 control individuals paired by age and sex were studied. Hep2-ANA and DFS70 ANA were studied. The absolute and relative frequencies and associations were established using logistic regression models, with a significance level of 95%. RESULTS: 43% ANA in ERA, 30% in BR, and 25.8% in control individuals 1:80. The fine dense granular pattern based on conventional Hep2 was found in 12.9% of the positive samples, and 1.66% of the total samples. There was no detection of DFS70 ANAs in patients with ERA. In ERA there was an association between the presence of ANA and inflamed joints (p=.02), CRP (p=.01), DAS28CRP (p=.03) and HAQ (p=.04). There was an association between ANA and elevated CRP (p=.05) in the BR. In the control individuals, there was an association between ANA and painful joints (p=02). In DFS70 ANA individuals we observed an association between a normal ESR p=.032, BR (-), p=.044 and absence of painful joints, p=.039. CONCLUSIONS: The frequency of DFS70 ANA in the groups studied was low, none of the patients with ERA was positive. The presence of DFS70 ANA was only confirmed in systemically healthy individuals.

"No somos máquinas" (We are not machines): Worker perspectives of safety culture in meatpacking plants in the Midwest.

BACKGROUND: Meatpacking is dangerous, dirty, and demanding (3-D) work-much of which is done by immigrant workers. It is characterized by high rates of occupational injuries and illnesses due to the speed of the production line, repetitive motions, and other inherent exposures. The purpose of this qualitative study was to explore perceptions of safety culture among Hispanic/Latino meatpacking workers in the Midwest. METHODS: Five focus groups with a total of 28 participants were conducted between March 2019 and February 2020 with Hispanic/Latino meatpacking workers in Nebraska. Workers were asked about the type of work performed, how the work was physically done, and perceptions of health risks and exposures. Thematic analysis was used to build a description of safety culture within the meatpacking industry. RESULTS: Three main themes were found: (1) workers depicted a culture where companies cared more about production than people; (2) workers felt powerless in improving their situation; and (3) workers noted that the work was precarious, both dangerous and one where much of the responsibility for safety was shifted to the individual workers. CONCLUSIONS: The meatpacking industry has a poor safety culture. Safety culture within the industry may be improved by ensuring that organizational values and artifacts are aligned with safety by addressing the critical role of supervisors, providing culturally and linguistically appropriate consistent safety training and messaging to the workforce, and enforcing and strengthening safety regulations.

Meta-analysis and Scientific Mapping of Well-being and Job Performance.

In this article, we present a meta-analysis and a scientific mapping about the relationship between different types of well-being and job performance. We followed The PRISMA statement for reporting systematic reviews and meta-analyses (Moher et al., 2009), and conduct the search in Web of Science, SCOPUS, Ebscohost, Proquest, and Jstor databases. We identified 43 studies from 1994 to early 2020 that represent 45 independent samples, 34,221 participants, and 77 correlations between four types of well-being and six of job performance. Meta-analysis results show that are different forms of relations between types and there is not only one form to explain the happy-productive worker hypothesis. The scientific mapping shows that there are seven clusters of topics about well-being and job performance in the Web of Science base articles: (I) Burnout and axiety, (II) Stress and depression, (III) Individual resources, (IV) Work context, (V) Work engagement and commitment, (VI) Justice, and (VII) Human resources practices. We organize the topics from each cluster in the different groups of variables of the contextual model of individual work, well-being and performance (van Veldhoven & Peccei, 2015) to explain their impact in well-being and job performance. We included the observations of our analysis and identified the future key directions for the field.

Consumo de sustancias psicoactivas desde la perspectiva de la terapia familiar / Consumption of psychoactive substances from a family therapy perspective

El consumo de sustancias psicoactivas, al considerarse una problemática contemporánea que genera alto impacto en la salud pública asociado al costo de la atención, suscita interés sobre Pedroza Molina, D. Y., Taborda Mazo, D. P. y Varela Chacón, J. (2020). La presente revisión bibliográfica, realizada desde el enfoque cualitativo-hermenéutico, plantea el análisis de las conceptualizaciones sobre el consumo de SPA desarrolladas en el ámbito de la terapia familiar, la identificación de la incidencia de las relaciones familiares en el consumo de sustancias psicoactivas y, por último, la descripción de propuestas de intervención desde la terapia familiar para familias en las que hay miembros consumidores de SPA. Dentro de los hallazgos se encuentra evidencia de las conceptualizaciones, implicaciones de la familia y propuestas de intervención en la revisión realizada, a partir de lo cual es posible señalar que, si bien no hay un consenso frente a la denominación del consumo desde esta disciplina ­ya que se usan indistintamente lo términos consumidor, drogodependiente, toxicómano, adicto, drogadicto­, se halla que independientemente de la escuela o modelo teórico existe acuerdo al conceptualizar el consumo como síntoma que emerge para garantizar la homeostasis familiar en un sistema sufriente. De igual forma, la familia tiene una alta incidencia dentro de la etiología de la situación de consumo y el proceso que genera la mantención del mismo, por lo que es claro que su implicación debe ser alta en el tratamiento y la recuperación. Se concluye que desde la terapia familiar existen diversas propuestas de intervención para abordar el tema de la adicción a SPA, que han mostrado ser efectivas y que la familia al estar involucrada en la génesis, mantenimiento y recuperación de la adicción, debe ser un foco central de la intervención.

Consumption of psychoactive substances, being considered a contemporary problem, which generates a high impact on public health associated with the cost of care, arouses interest in Pedroza Molina, Taborda Mazo & Varela Chacón (2020). This bibliographic review, carried out from a qualitative-hermeneutical approach, proposes the analysis of the conceptualizations about the consumption of PAS (Psychoactive Substances) developed in the field of family therapy, the identification of the incidence of family relationships in the consumption of psychoactive substances and, finally, the description of intervention proposals from family therapy for families in which there are members who consume PAS. Among the findings, there is evidence of the conceptualizations, implications of the family and intervention proposals in the review carried out, from which, it is possible to point out that although there is no consensus regarding the denomination of consumption from this discipline, given that the terms consumer, drug addict, addict, drug addict are used interchangeably, it was found that regardless of the school or theoretical model, there is a consensus when conceptualizing consumption as a symptom that emerges to guarantee family homeostasis in a suffering system. Similarly, the family has a high incidence within the etiology of the consumption situation and the process that generates its development, so it is clear that their involvement must be significant during treatment and recovery. It is concluded that from a family therapy perspective there are various intervention proposals to address the issue of PAS addiction, which have been shown to be effective and that the family, being involved in the genesis, development and recovery of addiction, should be a central focus of the intervention.

Meta-analysis and scientific mapping of well-beingand job performance

In this article, we present a meta-analysis and a scientific mapping about the relationship between different types of well-being and job performance. We followed The PRISMA statement for reporting systematic reviews and meta-analyses (Moher et al., 2009), and conduct the search in Web of Science, SCOPUS, Ebscohost, Proquest, and Jstor databases. We identified 43 studies from 1994 to early 2020 that represent 45 independent samples, 34,221 participants, and 77 correlations between four types of well-being and six of job performance. Meta-analysis results show that are different forms of relations between types and there is not only one form to explain the happy-productive worker hypothesis. The scientific mapping shows that there are seven clusters of topics about well-being and job performance in the Web of Science base articles: (I) Burnout and axiety, (II) Stress and depression, (III) Individual resources, (IV) Work context, (V) Work engagement and commitment, (VI) Justice, and (VII) Human resources practices. We organize the topics from each cluster in the different groups of variables of the contextual model of individual work, well-being and performance (van Veldhoven & Peccei, 2015) to explain their impact in well-being and job performance. We included the observations of our analysis and identified the future key directions for the field

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Epidemiología de los desórdenes venosos crónicos y factores asociados en amerindios nativos embera-chamí, Antioquia / Epidemiology of chronic venous disorders and associated factors in embera-chami native amerindians, Antioquia / Epidemiologia das doenças venosas crônicas e fatores associados em ameríndios nativos embera-chamí, Antioquia

Resumen Objetivo: Analizar la prevalencia de los desórdenes venosos crónicos (dvc) en los embera-chamí de Cristianía (Karmata Rua), en el suroeste de Antioquia, y conocer sus posibles factores asociados (fa). Metodología: Estudio de corte de una muestra aleatoria de 488 sujetos. El diagnóstico se realizó mediante ecoduplex venoso. Se recolectó información sobre fa sociodemográficos, comportamentales y antropométricos. Los fa más relevantes se seleccionaron por regresión logística binaria múltiple. Resultados: La prevalencia de várices fue del 27,5 % y la de insuficiencia venosa crónica (ivc) del 0,8 %. Hubo compromiso de segmentos anatómicos superficiales en el 34,8 % de los individuos. La edad fue el fa más importante, con Odds Ratio (or) entre 3,33 y 6,30 según el tipo de dvc (excepto C1). El sexo femenino, la paridad, la grasa en el muslo y pierna y la talla alta se asociaron a telangiectasias. La edad, la grasa abdominal y la forma de la pierna fueron fa de várices. A las venas superficiales, en ambos sexos, se asociaron la edad y la grasa abdominal y, en mujeres, también los antecedentes familiares de várices. A las profundas y perforantes se asociaron la edad y la depleción de grasa periférica. Conclusiones: El patrón de baja prevalencia de los dvc en embera-chamí puede ser consecuencia de los estilos de vida relacionados con la actividad física diaria y las diferencias genéticas compartidas con amerindios. En los programas de atención en salud diferencial deberían considerarse los desórdenes profundos y perforantes respecto a mestizos.

Abstract Objective: To analyze the prevalence of chronic venous disorders (CVD) in the embera-chamí from Cristianía (Karmata Rua), in the southwest of Antioquia, and to study possible associated factors (AF). Methodology: A cross sectional study of a random sample of 488 subjects. The diagnosis was performed through Doppler ultrasonography. Information about sociodemographic, behavioral and anthropometric AFs was collected. The most relevant AFs were selected through multiple binary logistic regression. Results: The prevalence of varicose veins was 27.5% and that of chronic venous insufficiency (cvi) was 0.8%. Superficial anatomical segments were compromised in 34.8% of individuals. Age was the most important AF, with an Odds Ratio (OR) between 3.33 and 6.30 according to the type of cvd. Being a female, parity, fat in the thigh/leg and large size were associated with telangiectasias. Age, abdominal fat and leg shape were AF of varicose veins. Superficial veins in both sexes were associated with age and abdominal fat and in women, also with a family background of varicose veins. Deep and perforator veins were associated with age and peripheral fat depletion. Conclusions: The low prevalence pattern of CVDs in embera-chamí may be a consequence of lifestyles involving daily physical activity and genetic differences shared with Amerindians. Deep and perforating disorders should be considered in differential health care programs in relation to mestizos.

Resumo Objetivo: Analisar a prevalência de doenças venosas crônicas (dvc) na Embera-Chami Christiania (KarmataRua), no sudoeste do estado de Antioquia, e conhecer seus fatores associados (AF). Metodologia: Um estudo de coorte de uma amostra aleatória de 488 indivíduos. O diagnóstico foi feito por ecoduplex venoso. Informações sobre FA sócio demográficas, comportamentais e antropométricas foram coletadas. Os FAs mais relevantes foram selecionados para múltipla regressão logística binária. Resultados: A prevalência de varizes foi de 27,5% e a de insuficiência venosa crônica (ivc) foi de 0,8%. Houve comprometimento dos segmentos anatômicos superficiais em 34,8% dos indivíduos. A idade foi a FA mais importante, com Odds Ratio (OR) entre 3,33 e 6,30 de acordo com o tipo de dvc. Sexo feminino, paridade, gordura na coxa e perna e altura foram associados a telangiectasias. Idade, gordura abdominal e formato de perna foram FA de varizes. Nas veias superficiais, em ambos os sexos, idade e gordura abdominal estavam associadas e, nas mulheres, também a história familiar de varizes. Às profundas e perfurantes foram associadas a idade e depleção de gordura periférica. Conclusões: O padrão de baixa prevalência de DVC em embera-chamí pode ser uma consequência de estilos de vida relacionados à atividade física diária e diferenças genéticas compartilhadas com ameríndios. Em programas diferenciais de atenção à saúde, distúrbios profundos e perfurantes devem ser considerados em relação aos mestiços.

Expression of estrogen receptor beta (ERß) and its prognostic value in pleural mesothelioma.

BACKGROUND: Overexpression of estrogen receptors in malignant pleural mesothelioma has shown an independent relation with a better prognosis of survival, and the use of selective estrogen receptor beta (ERß) agonists increases the susceptibility to antitumor treatment. METHODS: This was a retrospective single center study that analyzed the response of malignant pleural mesothelioma with an expression of ERß to first-line chemotherapy. The study included patients with pleural mesothelioma pathologically confirmed between 2013 and 2016 at the National Institute for Respiratory Disease (INER), who underwent an immunohistochemistry assay for ERß (mouse monoclonal antibody PPG5/10). The primary endpoint was the response to chemotherapy based on RECIST 1.1 according to the ERß expression; secondary outcomes were the overall survival (OS) and progression-free survival (PFS). RESULTS: We included 22 patients, regarding the expression of ERß, 17 (77.2%) patients had high or moderate degree, while 5 (22.7%) had low degree or null expression. The response to treatment as by RECIST 1.1, 12 (54.5%) had partial response, 5 (22.7%) had stable disease, and 3 (13.6%) had progression. None of the patients had a complete response. Of those who had a partial response, 9 (75%) had a high or moderate degree of ERß expression in tumor cells, and 3 (25%) had a low or null degree of expression. CONCLUSIONS: High and moderate expression of ERß group with advanced clinical stage malignant pleural mesothelioma was associated with a tendency of higher OS and better response to chemotherapy treatment resulting in longer PFS although statistical significance was not achieved.

Armonización iberoamericana de los instrumentos PCAT para la evaluación del primer nivel de atención

Cuarenta años después de Alma Ata, el mundo está reforzando la consciencia sobre la importancia de los atributos y funciones del primer nivel de atención, pero aún queda mucho por hacer para implementarlos, medirlos y aprender de las experiencias exitosas de algunos países. El conjunto de instrumentos Primary Care Assessment Tools (PCAT), desarrollados en los años 90 en Estados Unidos de América por Starfield y Shi (1), se ha mostrado como la herramienta más completa para el análisis de la atención primaria de la salud (APS) y su utilidad fue reconocida en numerosos países y regiones del mundo. El objetivo de esta carta es comunicar preliminarmente el proceso de armonización de las versiones PCAT ya adaptadas en diversos países de Iberoamérica y subrayar la importancia de estas herramientas para evaluar y comparar el primer nivel de atención, particularmente en sistemas de salud fundados en la estrategia de APS.

La deshumanización en el parto: significados y vivencias de las mujeres asistidas en la red pública de Medellín / A desumanização no parto: significados e vivências das mulheres atendidas na rede pública de Medellín Colômbia) / Dehumanization during Delivery: Meanings and Experiences of Women Cared for in the Medellín Public Network

Objective. This work sought to describe the meanings constructed in the experiences of women in relation to the care received by the healthcare staff at the moment of delivery. Methods. Qualitative study using the procedures proposed by the Grounded theory for data analysis. The sample comprised 18 women over 14 years of age, between 40 days and 6 months postpartum. Twelve of the participants were selected through convenience and to reach saturation of the categories, six more participants were included by using theoretical sampling. Semi-structured interviews were conducted in three information collection phases, and said interviews were analyzed line by line by using coding and categorization techniques. Results. The mothers described the parturition experience negatively, perceiving it as the implicit imposition of stoicism to repress their emotions, pain, and discomfort and prefer an attitude of submission to the health staff. The participating mothers critically conjure up the care received, which translates into procedures performed and verbal and psychological abuse. Conclusion. The mothers assign meanings to their experiences of the delivery process not so much as a transcendent human experience, but rather as a super-experience to the dehumanization of giving birth within the biomedical context.(AU)

Objetivo. Describir los significados construidos a partir de la experiencia vivida por mujeres en relación con la atención recibida por parte del personal asistencial en el momento del parto. Métodos. Estudio cualitativo que utilizó los procedimientos propuestos por la Teoría Fundada para realizar el análisis de los datos. La muestra estuvo compuesta por 18 mujeres mayores de 14 años, entre 40 días y seis meses de postparto. Doce de las participantes se seleccionaron por conveniencia, y para llegar a la saturación de las categorías, se incluyeron otras seis participantes usando el muestreo teórico. Se realizaron entrevistas semiestructuradas durante tres fases de recolección de información, las cuales se analizaron línea por línea, utilizando técnicas de codificación y categorización. Resultados. Las madres describieron la experiencia del parto de forma negativa, pues la perciben como la imposición implícita del estoicismo para reprimir sus emociones, dolor e incomodidad y prefieren una actitud de sometimiento frente al personal de salud. Las madres evocan la asistencia recibida de manera crítica, la cual se traduce en procedimientos realizados sin consentimiento y maltrato verbal y psicológico. Conclusión. Las madres asignan significados a sus vivencias del proceso de parto no tanto como una experiencia humana trascendente, sino más bien como una supervivencia a la deshumanización del dar a luz en el contexto biomédico.(AU)

Objetivo. Descrever os significados construídos na experiência vivida das mulheres em relação com a atenção recebida por parte do pessoal assistencial no momento do parto. Métodos. Estudo qualitativo que utilizou os procedimentos propostos pela Teoria fundada para realizar a análise dos dados. A amostra foram 18 mulheres maiores de 14 anos, entre 40 dias e seis meses de pós-parto. Doze das participantes foram selecionadas por conveniência, e para chegar à saturação das categorias, se incluíram outras seis participantes usando a amostragem teórico. Se realizaram entrevistas semiestruturadas durante três fases de recolhimento de informação, as quais se analisaram linha por linha, utilizando técnicas de codificação e categorização. Resultados. As mães descreveram a experiência do parto de forma negativa, a percebem como a imposição implícita do estoicismo para reprimir suas emoções, dor e incomodidade e preferem uma atitude de submissão perante ao pessoal da saúde. As mães evocam a assistência recebida de maneira crítica, a qual se traduz em procedimentos realizados e maltrato verbal e psicológico. Conclusão. As madres designam significados as suas vivências do processo de parto no tanto como uma experiência humana transcendente, senão melhor como uma supervivência à desumanização de dar a luz no contexto biomédico.(AU)