Educational disparities in brain health and dementia across Latin America and the United States.

BACKGROUND: Education influences brain health and dementia. However, its impact across regions, specifically Latin America (LA) and the United States (US), is unknown. METHODS: A total of 1412 participants comprising controls, patients with Alzheimer's disease (AD), and frontotemporal lobar degeneration (FTLD) from LA and the US were included. We studied the association of education with brain volume and functional connectivity while controlling for imaging quality and variability, age, sex, total intracranial volume (TIV), and recording type. RESULTS: Education influenced brain measures, explaining 24%-98% of the geographical differences. The educational disparities between LA and the US were associated with gray matter volume and connectivity variations, especially in LA and AD patients. Education emerged as a critical factor in classifying aging and dementia across regions. DISCUSSION: The results underscore the impact of education on brain structure and function in LA, highlighting the importance of incorporating educational factors into diagnosing, care, and prevention, and emphasizing the need for global diversity in research. HIGHLIGHTS: Lower education was linked to reduced brain volume and connectivity in healthy controls (HCs), Alzheimer's disease (AD), and frontotemporal lobar degeneration (FTLD). Latin American cohorts have lower educational levels compared to the those in the United States. Educational disparities majorly drive brain health differences between regions. Educational differences were significant in both conditions, but more in AD than FTLD. Education stands as a critical factor in classifying aging and dementia across regions.

Designing Prepregnation and Fused Filament Fabrication Parameters for Recycled PP- and PA-Based Continuous Carbon Fiber Composites.

Continuous carbon fiber (cCF)-based 3D-printed polymer composites are known for their excellent flexural properties; however, the optimization of the overall process is still desired, depending on the material types involved. Here, the improved manufacturing of cCF-based composites is reported, considering virgin polyamide (PA) and postindustrial waste polypropylene (PP), and the parameters affecting the material properties are evaluated. Firstly, the prepregnation technique was optimized to manufacture cCF polymer filaments with various fiber-to-polymer ratios. Secondly, the fused filament fabrication (FFF) technique was optimized. It was observed that the layer height needs to be sufficiently low for proper interlayer adhesion. The influence of the printing temperature is more complicated, with filaments characterized by a lower fiber-to-polymer ratio requiring a higher nozzle diameter and higher temperatures for efficient printing; and for lower diameters, the best flexural properties are observed for parts printed at lower temperatures, maintaining a high interspace distance. Plasma treatment of the cCF was also explored, as was annealing of the produced parts to enhance the flexural properties, the latter being specifically interesting for the PP-based composite due to a lower wetting caused by a higher viscosity, despite supportive interfacial interactions. Eventually, overall guidelines were formulated for the successful production of cCF-based composites.

Tolerance Mitigates Gall Effects When Susceptible Plants Fail to Elicit Induced Defense.

Variations in plant genotypes and phenotypes are expressed in ways that lead to the development of defensive abilities against herbivory. Induced defenses are mechanisms that affect herbivore insect preferences and performance. We evaluated the performance of resistant and susceptible phenotypes of Bauhinia brevipes (Fabaceae) against attacks by the gall-inducing insect Schizomyia macrocapillata (Diptera). We hypothesized that there is a positive relationship between resistance to S. macrocapillata and host plant performance because resistance can have a high adaptive value. We evaluated plant architecture, nutritional leaf quality, leaf fluctuating asymmetry, and reproductive capacity between phenotypes. Plant performance was evaluated at three ontogenetic stages: seed, seedling, and juvenile. Overall, there were no differences in vegetative and reproductive performance or asymmetry between the resistant and susceptible mature plants. We found no relationship between leaf nutritional quality and resistance to S. macrocapillata. Plant performance was consistent across ontogeny for both phenotypes, except for five variables. Contrary to our expectations, the susceptible plants performed equally well or better than the resistant plants, suggesting that tolerance and overcompensation to herbivory in B. brevipes may be mediated by induced defense. Our study highlights the importance of multiple layers of plant defense against herbivory, where plant tolerance acts as a secondary barrier in plants susceptible to gall-inducing insects.

Brain clocks capture diversity and disparity in aging and dementia.

Brain clocks, which quantify discrepancies between brain age and chronological age, hold promise for understanding brain health and disease. However, the impact of multimodal diversity (geographical, socioeconomic, sociodemographic, sex, neurodegeneration) on the brain age gap (BAG) is unknown. Here, we analyzed datasets from 5,306 participants across 15 countries (7 Latin American countries -LAC, 8 non-LAC). Based on higher-order interactions in brain signals, we developed a BAG deep learning architecture for functional magnetic resonance imaging (fMRI=2,953) and electroencephalography (EEG=2,353). The datasets comprised healthy controls, and individuals with mild cognitive impairment, Alzheimer's disease, and behavioral variant frontotemporal dementia. LAC models evidenced older brain ages (fMRI: MDE=5.60, RMSE=11.91; EEG: MDE=5.34, RMSE=9.82) compared to non-LAC, associated with frontoposterior networks. Structural socioeconomic inequality and other disparity-related factors (pollution, health disparities) were influential predictors of increased brain age gaps, especially in LAC (R2=0.37, F2=0.59, RMSE=6.9). A gradient of increasing BAG from controls to mild cognitive impairment to Alzheimer's disease was found. In LAC, we observed larger BAGs in females in control and Alzheimer's disease groups compared to respective males. Results were not explained by variations in signal quality, demographics, or acquisition methods. Findings provide a quantitative framework capturing the multimodal diversity of accelerated brain aging.

Determinantes socioeconómicos y brechas de género de la sintomatología depresiva en Chile / Socioeconomic determinants and gender gaps in depressive symptoms in Chile

Background: There are marked differences associated with socio-economic factors in the prevalence of depressive symptoms (DS) in men and women. Aim: To estimate the association between socioeconomic status and DS in Chile and to estimate the gender gaps in this association. Material and Methods: The Patient Health Questionnaire-9 (PHQ-9) was applied as part of a socioeconomic survey carried out in a representative community sample (n = 2913). Using this information, we analyzed the influence of social status (education level, occupation, household income) and other psychosocial factors (gender, perceived social support, stressful life events) on DS. Results: The prevalence of DS was 23.2% in women and 13.4% in men. A socioeconomic gradient was found in the distribution of DS. This gradient was more pronounced for women than for men. Gender, social support and stressful life events were the most important predictors of severe DS, with an estimated risk twice as high among women and almost three times as high among those with low social support. Conclusions: There is a combined effect between socio-economic and gender inequalities on DS. This partially explains the greater vulnerability of poor women and the DS gap between men and women.

Factores Asociados al Autoestigma de la Depresión en Adolescentes en Santiago, Chile / Associated factors with self-stigma of depression in adolescents in Santiago, Chile

Determinar la asociación entre autoestigma de la depresión y factores sociodemográficos, historia personal y parental de depresión, sintomatología ansiosa y depresiva, y calidad de vida en adolescentes. Método: Estudio transversal correlacional, en una muestra de 192 adolescentes (8º básico a 3º medio) de tres colegios particulares subvencionados de Santiago, Chile, se aplicaron cuestionarios de factores sociodemográficos, autoestigma de la depresión, sintomatología ansiosa y depresiva, y calidad de vida. Los datos se analizaron con prueba t de Student, ANOVA, coeficiente de Pearson y Regresión Lineal. Resultados: No hubo diferencias en autoestigma de depresión entre hombres y mujeres. Fue mayor el autoestigma de la depresión en adolescentes que sospechaban que habían tenido o tenían depresión, referían que su madre o padre habían tenido depresión, tenían mayor sintomatología depresiva y/o ansiosa y menor calidad de vida. Conclusión: La presencia de depresión en los progenitores progenitores (madre y/o padre), así como el desconocimiento de los adolescentes respecto a si ellos presentan el cuadro clínico, se relaciona con mayor autoestigma de la depresión en los adolescentes, lo que inhibe la búsqueda de ayuda.

To determine the association between self-stigma of depression and sociodemographic factors, personal and parental history of depression, anxious and depressive symptomatology, and quality of life in adolescents. Methods: Non-experimental cross-sectional and correlational study. A total of 192 adolescents from 8th grade to 11th grade from three private subsidized schools in Santiago, Chile, answered questionnaires on sociodemographic factors, self-stigma of depression, anxious and depressive symptomatology, and quality of life. Data were analyzed with Student's t-test, ANOVA, Pearson's coefficient and linear regression. Results: There were no differences in self-stigma of depression between men and women. Self-stigma of depression was higher in adolescents who suspected that they had had or had depression, who reported that their mother or father had had depression, who had greater depressive and/or anxious symptomatology and lower quality of life. Conclusion: The presence of depression in the parents (mother and / or father) as well as the lack of knowledge of adolescents regarding whether they have depression is related to greater self-stigma of depression which inhibits the help-seeking in adolescents.

Demanda de atención obstétrica y densidad de recursos en salud para mujeres mexicanas en edad fértil / Demand for obstetric care and density of health resources for childbearing age Mexican women

Resumen Introducción: México registra aumento de las cesáreas e inequidad y desigualdad en la distribución de recursos para la atención obstétrica. Objetivo: Identificar las entidades y municipios en México que concentran la demanda de atención obstétrica y tasas de cesáreas y su relación con los recursos en salud y mujeres en edad fértil (MEF). Método: Se registraron los nacimientos del periodo 2008-2017, agrupados en cinco estratos municipales, y los recursos en salud y MEF de 2017. Resultados: La tasa nacional de cesáreas 2008-2017 fue de 45.3/100 nacimientos; 95 y 97 % de los nacimientos y cesáreas se concentraron en el estrato “muy alto” (470 municipios), en el cual se utilizó 80 % o más de los recursos en salud y destacó la sobreutilización. La densidad de recursos en salud destinados a las MEF reflejó inequidad y desigualdad. Conclusiones: La alta concentración de la demanda obstétrica y oferta de los recursos en salud pudiera conllevar mayor recurrencia a la cesárea. En las políticas de reducción de cesáreas es necesario considerar la organización y administración adecuadas de los recursos en salud.

Abstract Introduction: In Mexico, there is an increase in the number of C-sections, as well as inequity and inequality in the distribution of resources for obstetric care. Objective: To identify the states and municipalities in Mexico that concentrate the demand for obstetric care and the C-section rates and their relationship with health resources and women of childbearing age (WCBA). Method: Births of the 2008-2017 period were recorded, grouped into five municipal strata, as well as 2017 health resources and WCBA. Results: The 2008-2017 national rate of C-sections was 45.3/100 births; 95 and 97 % of births and C-sections were concentrated in the “very high” stratum, where 80 % or more of health resources were used, with overuse standing out. The density of health resources assigned to WCBAs reflected inequity and inequality Conclusions: The high concentration of obstetric demand and health resources supply could entail a higher recurrence of C-sections. Policies for C-section reduction should consider proper organization and administration of health resources.

Rethinking medicalization: discursive positions of children and their caregivers on the diagnosis and treatment of ADHD in Chile / Repensando la medicalización: posiciones discursivas de niños y de sus cuidadores sobre el diagnóstico y tratamiento del TDAH en Chile

Abstract The debates around the diagnosis and pharmacological treatment of Attention Deficit and Hyperactivity Disorder (ADHD) have traditionally been approached from the perspective of the "medicalization processes" of children's behaviour. However, this perspective tends to overlook the meanings of diagnosis and treatment of ADHD for children and their caregivers. The purpose of this article is to describe the discursive positions of children and their caregivers on the diagnosis and treatment of ADHD. In-depth interviews were conducted with seven Chilean children and their caregivers. The material was analysed following the procedures of the discourse structure analysis. A discursive structure was identified that configures four emerging realities: the myth of origin of the child's behaviour and learning problems; the ambivalences in/of medicalization; the process of identity (dis)stabilization under diagnosis and treatment; and the subversion of medicalization. It is observed that the subjective experience of the diagnosis and treatment of ADHD is not homogeneous, since different discursive positions, family and institutional understandings that enter into conflict cross it. The experiences of ADHD are shaped by discursive structures that condition the meanings of this experience. The medicalization process is not univocal, but can take different forms and have consequences on children's experiences and social trajectories.

Resumen Los debates en torno al diagnóstico y tratamiento farmacológico del Trastorno de Déficit Atencional e Hiperactividad (TDAH) han sido tradicionalmente abordados desde la perspectiva de los "procesos de medicalización" del comportamiento infantil. Sin embargo, esta perspectiva tiende a pasar por alto los sentidos y significaciones del diagnóstico y tratamiento del TDAH para los niños y sus cuidadores. El objetivo de este artículo es describir las posiciones discursivas de niños y de sus cuidadores sobre el diagnóstico y tratamiento farmacológico del TDAH. Se realizaron entrevistas en profundidad a siete niños chilenos y a sus cuidadores. El material fue analizado siguiendo los procedimientos del análisis estructural del discurso. Se identificó una estructura discursiva que configura cuatro realidades emergentes: el mito de origen de los problemas de comportamiento y de aprendizaje del niño; las ambivalencias en/de la medicalización; el proceso de (des)estabilización identitaria bajo el diagnóstico y tratamiento; y la subversión de la medicalización. Se observa que la experiencia subjetiva del diagnóstico y tratamiento del TDAH no es homogénea, dado que se encuentra atravesada por distintas posiciones discursivas, comprensiones familiares e institucionales que entran en conflicto. Las experiencias del diagnóstico y tratamiento del TDAH se encuentran modeladas por estructuras discursivas que condicionan las posibilidades de dar sentido a dicha experiencia. El proceso de medicalización no es unívoco, sino que puede asumir formas diferentes y tener consecuencias diversas sobre las experiencias y trayectorias sociales de niños y niñas.

Meningitis aguda posterior a vacuna tresvírica / Acute meningitis following mumps vaccine

Resumen En Chile, la cepa del virus parotídeo utilizada en la vacuna es Leningrad-Zagreb (L-Z). Aunque la relación entre meningitis y la cepa L-Z sigue siendo controvertida, la mayoría de los casos reportados han presentado un cuadro de curso benigno y sin secuelas neurológicas. Presentamos el caso de una paciente que tres semanas post-inmunización con la vacuna tresvírica evolucionó con una meningitis aséptica de predominio mononuclear, con serología para IgM positiva contra el virus parotídeo. En este caso clínico, existió una relación temporal entre la vacunación, el inicio del cuadro parotídeo y posteriormente el meníngeo; la curva de inmunoglobulinas demostró una infección aguda posterior a la vacuna. Si bien no se logró aislar el virus en LCR, es razonable atribuir el cuadro a una infección post-vacunal.

In Chile, the strain of the mumps virus used in the vaccine is Leningrad-Zagreb (L-Z). Although the relationship between meningitis and the L-Z strain remains controversial, most of the reported cases have shown a benign course without permanent neurological sequelae. We present a case of a patient who presented an aseptic meningitis three weeks after immunization with a mumps vaccine; and laboratory confirmation showed positive serum mumps IgM antibody. In this clinical case, there was a temporal relationship between vaccination and the onset of the mumps and subsequently the meningeal involvement; the immunoglobulin curve demonstrates acute infection after vaccination. Although it was not possible to isolate the virus in CSF, it is reasonable to attribute the picture to a post-vaccinal infection.

Diferencias en las decisiones utilitarias y morales entre hombres y mujeres / Differences on Utilitarian and Moral Decision Between Male and Female / Diferencias nas decisões utilitárias e morais entre homens e mulheres

Resumen Objetivo. Los juicios morales se basan en decisiones que toman en cuenta la representación de las normas y la ley, los valores, la funcionalidad y la situación en sí. La moral se ha estudiado con "dilemas morales hipotéticos" para identificar el tipo de resultado y el proceso detrás del razonamiento moral. No obstante, los juicios en sí mismos no son suficientes para establecer diferencias en el tipo de resolución o la relación con otros procesos cognitivos. Por lo anterior, el presente estudio buscó comparar el desempeño en tareas de maximización de la utilidad, control cognitivo y juicios morales, teniendo en cuenta el sexo y otras variables sociodemográficas. Método. Participaron 73 estudiantes universitarios (50 mujeres, 20 hombres y 3 con sexo no reportado, la edad promedio fue 19.53 años (DE = 1.68 años). El Iowa Gambling Task (IGT) se utilizó para identificar comportamientos de maximización de la utilidad. Además, el estudio empleó la prueba de cambios de tarea y la aplicación web Máquina Moral. Resultados. Se encontró una diferencia entre las variables de IGT, sin observar diferencias en la prueba de cambios de tarea. Conclusión. En cuanto al juicio moral, los hombres dieron más valor al cumplimiento de normas que las mujeres. Algunas variables de la tarea IGT apoyan las diferencias entre los sexos. Los resultados son congruentes con las diferencias mostradas por la literatura.

Abstract Objective. Moral judgments are based on decisions that take into account the representation of norms and law, values, functionality and situations themselves. Morality has been studied with "hypothetic moral dilemmas", in order to identify the type of outcome and the process behind moral reasoning. But judgments by themselves are not enough to establish differences in the type of resolution or the relationship with other cognitive processes. The present paper aimed to compare performance in tasks of utility maximization, cognitive control, and moral judgments, taking into account sex and other sociodemographic variables. Method. Seventy-three university students participated (50 women, 20 men and 3 with unreported gender, the average age was 19.53 years (SD = 1.68 years). The Iowa Gambling Task (IGT) was used to identify behaviors of utility maximization. In addition, we used the switch costs and the web application of moral machine tasks. Results. A difference between variables of the IGT, but no differences in the switch costs task were found. Conclusion. Regarding moral judgment, males gave more value to respect norms than females. Some variables of the IGT task support outcomes related to differences between sexes. Results are congruent with differences shown in existing literature.

Resumo Escopo. Os juízos morais estão baseados em decisões que levam em conta a representação das normas e a lei, os valores, a funcionalidade e a situação concreta. A moral tem se estudado com "dilemas morais hipotéticos" para identificar o tipo de resultado e o processo detrás do razoamento moral. Mas os juízos em si não são suficientes para estabelecer diferencias no tipo de resolução ou a relação com outros processos cognitivos. Por tanto, o escopo de este estudo foi comparar o desempenho em tarefas de maximização da utilidade, controle cognitivo e juízos morais, levando em conta o sexo e outras variáveis sócio demográficas. Metodologia. Participaram 73 estudantes universitários (50 mulheres, 20 homens e 3 com sexo não reportado, a idade de média foi de19.3 anos, (DE = 1.68 anos). O Iowa Gambling Task (IGT) foi utilizado para identificar comportamentos de maximização da utilidade. Além, o estudo empregou a prova de mudança de tarefa e a aplicação web Máquina Moral. Resultados. Foi achada uma diferencia entre as variáveis de IGT, mas não há diferencias na prova de mudança de tarefa. Em quanto ao juízo moral, os homens deram mais valor ao cumprimento de normas que as mulheres. Algumas variáveis da tarefa IGT apoiam as diferencias entre os sexos. Conclusão. Os resultados são congruentes com as diferencias mostradas na literatura.

Micosis superficiales en pacientes embarazadas en un hospital general de segundo nivel de atención / Superficial mycosis in pregnant patients in a general hospital

Resumen: ANTECEDENTES: Las micosis superficiales se generan por contacto directo con el hongo o con una persona o animal infectado, y afectan la piel, los anexos y las mucosas; las pacientes embarazadas son susceptibles a cambios cutáneos fisiológicos y patológicos. OBJETIVO: Describir las micosis superficiales en pacientes embarazadas del Servicio de Obstetricia del Hospital General Dr. Manuel Gea González. MATERIAL Y MÉTODO: Estudio descriptivo, observacional, prospectivo y transversal realizado en pacientes embarazadas de la consulta externa del Servicio de Gineco-obstetricia del Hospital General Dr. Manuel Gea González de julio de 2016 a julio de 2017. RESULTADOS: Se incluyeron 23 pacientes que acudieron al Servicio de Micología; el grupo de edad más afectado fue de 21 a 40 años de edad (86.9%); 17 tuvieron tiña plantar (73.9%) y 4 (17.9%) tuvieron onicomicosis distrófica total. Dos cultivos fueron positivos para Trichophyton rubrum. CONCLUSIONES: Las micosis superficiales fueron poco frecuentes en el grupo estudiado: 17 pacientes con tiña de los pies y 4 con onicomicosis. El agente aislado fue Trichophyton rubrum.

Abstract: BACKGROUND: Superficial mycoses are generated by direct contact with the fungus or with an infected person or animal, and affect the skin, the attachments and mucous membranes; pregnant patients are susceptible to skin changes, both physiological and pathological. OBJECTIVE: To know the frequency of superficial mycoses in pregnant patients from the obstetrics service of the Hospital General Dr. Manuel Gea González. MATERIAL AND METHOD: A descriptive, observational, prospective and crosssectional study carried out in pregnant patients of the Gineco-Obstetrics Service of the Hospital General Dr. Manuel Gea González, Mexico City, from July 2016 to July 2017. RESULTS: Twenty-three patients were included in the mycology department for their physical examination; the most affected group was between 21 and 40 age years (86.9%); 17 patients presented tinea pedis (73.9%) and 4 (17.9%) onychomycosis. CONCLUSIONS: Superficial mycosis were not frequent in the group of study: 17 patients had tinea pedis and 4 onychomycosis. The causal agent isolated was Trichophyton rubrum.

Developing a Social Cognition Task for fMRI in Patients with Mild Traumatic Brain Injury / Desarrollo de una tarea de Cognición Social para IRMf en pacientes con trauma craneoencefálico leve

Social cognition impairments are frequently found in patients with mild traumatic brain injury (TBI) when structural lesions may not reveal the severity of the injury. Though instruments used to assess social behavior are thought to be sensitive, the absence of structural damage in TBI patients may lead to underscore such problems. The aim of this study was to develop a complementary diagnostic tool such as a paradigm for functional Magnetic resonance Imaging (fMRI) involving a simple task that could tell how patients understand certain complex social behavior by identifying different movements with or without social intentions where language and complex cognitive process were not required. Eleven patients with mild TBI and social cognition difficulties and twelve control subjects were matched by demographic variables. A paradigm of social fMRI was developed by using dots in movement representing human motion, human motion with social intention such as dancing or sharing, and dots moving without meaning. Patients had less activation in parietotemporal junction and bilateral middle frontal gyrus in the social perception task movement compared with control group subjects. The fMRI paradigm developed can be an additional diagnostic tool for identifying social cognition impairments in mild TBI patients. Regardless the absence of structural injury, changes in activation areas suggest a prospective use of this tool since clinical, cognitive and functional outcomes support such finding.

Los cambios en la cognición social son encontrados frecuentemente en pacientes con trauma craneoencefálico leve (TCE) aunque no exista evidencia de lesiones estructurales. Aunque los instrumentos utilizados para evaluar la cognición social son sensibles al cambio, la ausencia de daño estructural en los pacientes con TCE puede llevar pasar por inadvertidos estos problemas. El objetivo de este estudio fue desarrollar una herramienta diagnóstica complementaria como un paradigma para resonancia magnética funcional (RMf), la cual involucra una tarea simple que pudiera explicar cómo los pacientes entienden ciertos comportamientos sociales complejos por medio de movimientos con o sin intención social sin intermediación del lenguaje. Participaron once pacientes con TCE leve y con reporte de alteraciones en cognición social, estos fueron emparejados con doce sujetos control por variables demográficas. Un paradigma de RMf fue desarrollado por medio de la animación puntos blancos sobre una pantalla negra que representan el movimiento humano, el movimiento humano con la intención social como el baile o el compartir, y puntos que se mueven sin significado. Los pacientes tuvieron menos activación en la unión parietotemporal y giro frontal medio bilateral frente al movimiento social en comparación con los sujetos del grupo de control. El paradigma de fMRI desarrollado puede ser una herramienta de diagnóstico adicional para identificar las alteraciones cognitivas sociales en pacientes con TCE leve. Independientemente de la ausencia de lesión estructural, los cambios en las áreas de activación sugieren la posibilidad de usar esta herramienta como pronóstico dado que los resultados clínicos, cognitivos y funcionales soportan este hallazgo.

Impacto de una intervención educativa para mejorar la adherencia a las recomendaciones sobre sueño seguro del lactante / Impact of an educational intervention to improve adherence to the recommendations on safe infant sleep

Introducción. Las campanas públicas en países desarrollados con recomendaciones para el sueño seguro del lactante lograron aumentar la adherencia a la posición supina para dormir a más del 70% y generaron, simultáneamente, una reducción del 53% en la incidencia del síndrome de muerte súbita del lactante. Objetivo. Valorar el impacto a los 60 días de vida de una intervención educativa realizada en las maternidades para mejorar la adherencia a las recomendaciones sobre sueño seguro del lactante. Población, material y métodos. Estudio de intervención con control histórico entre el 1/2 y el 30/9 de 2014, realizado en la Maternidad Meisner y el Hospital Universitario Austral. Dicha intervención se denominó "tapeta cuna" y consistió en capacitar al equipo de salud y brindar información a las familias sobre sueño seguro a través de clases, adhesivos en las cunas y material escrito. Resultados. Fueron incluidos 550recién nacidos. Se observó un incremento del 35% en la posición supina al dormir tras la intervención (p < 0,0001); la lactancia materna exclusiva se incrementó un 11% (p= 0,01); se redujo el colecho de un 31% a un 18% (p < 0,0005). No se encontraron diferencias en la cohabitación, entre convivientes fumadores ni en la utilización del chupete a los 60 días. Conclusiones. La intervención educativa resultó útil para mejorar la adherencia a las recomendaciones sobre sueño seguro a los 60 días de vida: se evidenció una mejora en la posición supina, la lactancia materna y la reducción del colecho. No existieron cambios en la proporción de convivientes fumadores, la cohabitación y el uso del chupete.

Introduction. In developed countries, public campaigns promoting recommendations on safe infant sleep increased adherence to the supine sleeping position to more than 70% and, at the same time, reduced the incidence of sudden infant death syndrome by 53%. Objective. To determine the impact, at 60 days of life, of an educational intervention conducted in maternity centers aimed at improving adherence to the recommendations on safe infant sleep. Population, material and methods. Intervention study with historical control conducted between February 1st and September 30th of 2014 at the Maternity Center of Hospital Meisner and Hospital Universitario Austral. The intervention was called "crib card" and consisted in training health care team members and providing families with information on safe infant sleep by means of lessons, written material and using stickers on cribs. Results. Five hundred and fifty newborn infants were included. After the intervention, a 35% increase in the supine sleeping position (p < 0.0001) was observed; exclusive breastfeeding increased by 11% (p= 0.01); and co-sleeping decreased from 31% to 18% (p < 0.0005). No differences were observed in relation to bedroom sharing, living with tobacco users, or pacifier use at 60 days of life. Conclusions. The educational intervention was useful to improve adherence to the recommendations on safe sleep at 60 days of life: using the supine position and breastfeeding improved, and the rate of co-sleeping decreased. No changes were observed in the number of household members who smoke, bedroom sharing, and pacifier use.

Prevalencia del síndrome de Down en México utilizando los certificados de nacimiento vivo y de muerte fetal durante el periodo 2008-2011 / Prevalence of Down syndrome using certificates of live births and fetal deaths in México 2008-2011

Introducción: El síndrome de Down (SD) o trisomía 21 es la causa genética más frecuente de retraso mental. Clínicamente presenta una serie de características bien definidas. Se ha asociado la edad materna avanzada con la presencia de SD. Métodos: Se conjuntaron las bases de datos de los certificados de nacimientos vivos y de muerte fetal. Se seleccionaron los códigos con base en la Clasificación Internacional de Enfermedades décima revisión (CIE-10) del capítulo XVII: <

Background: Down syndrome (DS) or trisomy 21 is the most common genetic cause of mental retardation with the clinical presentation of a series of well-defined characteristics. Advanced maternal age has been associated with DS. Methods: The databases of all the certificates of live births and fetal deaths in Mexico were combined. Codes based on the International Classification of Diseases 10th Revision (ICD-10) in Chapter XVII "Congenital malformations, deformations and chromosomal abnormalities" were selected. Results: A database of 8,250,375 births during the period 2008-2011 was constructed: 99.2% were live births with 0.8% of fetal deaths and 3,076 cases diagnosed with DS. Conclusions: The importance of this report is to initiate an epidemiological surveillance of newborn cases of DS nationwide and by state using census information systems available in the country since 2008. An increased risk has been observed for having a child with DS since the mother is ≥ 35 years, as has been reported in other studies.

MODELADO Y SIMULACIÓN DE UN ROBOT PARA CIRUGÍA ENDOSCÓPICA TRANSLUMINAL / EVALUATION METHOD OF THE USE OF MEDICAL DEVICES IN THE HOMECARE ENVIRONMENT

El uso de dispositivos médicos en el hogar, originalmente diseñados para uso hospitalario, ha aumentado. Su uso es complejo e inseguro debido a la inexperiencia del usuario y el entorno no controlado. El objetivo de este estudio es evaluar la seguridad en el uso de este tipo de dispositivos a través de la creación de un modelo conceptual que identifica los riesgos que podrían surgir para un grupo de usuarios inexpertos que los operan. A través de un estudio de usabilidad y siguiendo la metodología Grounded Theory se identificaron problemas y errores que emergen a través del uso en el hogar de dos dispositivos médicos distintos con la finalidad de crear un modelo conceptual. El modelo conceptual obtenido es representado en una herramienta de evaluación, que permite a los interesados identificar el dispositivo médico más apropiado para un usuario específico, detectando las debilidades que pueden llevar a un uso inseguro. La herramienta creada efectivamente permite detectar las características de riesgo, considerando cada situación particular de uso.

The use of medical devices in the home environment, originally designed for hospital use has increased. Its use is complex and uncertain because of the inexperience of the lay user and the uncontrolled environment. The objective of this study is to evaluate the safety in the use of these devices through the creation of a conceptual model that identifies the risks that could arise for a group of lay users who operate them. Through a usability study and following the Grounded Theory methodology problems and errors were identified emerging through the home use of two different medical devices in order to create a conceptual model. The conceptual model obtained is reified as an evaluation tool that allows stakeholders to identify the most suitable medical device for a specific user, detecting the weaknesses that may lead to an unsafe use. The evaluation tool created effectively allows detecting risky characteristics, considering the particular situation of use.

Prevalencia de malformaciones congénitas registradas en el certificado de nacimiento y de muerte fetal: México, 2009-2010 / Prevalence of congenital malformations recorded on the birth certificate and fetal death, Mexico, 2009 to 2010

Introducción. Las malformaciones congénitas son causas importantes de mortalidad infantil, enfermedad crónica y discapacidad en muchos países. La frecuencia esperada es de 2 a 3% en nacidos vivos y de 15 a 20% en muertes fetales. En México, en 2010, la mortalidad infantil ocupó el segundo lugar, con una tasa de 336.3/100,000 nacimientos. El objetivo de este trabajo fue estimar la prevalencia de malformaciones congénitas en México al nacimiento y las principales causas registradas en los certificados de nacimiento y muerte fetal para el período 2009-2010. Métodos. Se conjuntaron las bases de datos del certificado de nacimiento de nacido vivos y del de muerte fetal. Resultados. La población total fue de 4'123,531 registros, 99.3% nacidos vivos y 0.7% muertes fetales. Se registró un total de 30,491 casos de malformaciones congénitas en 91.7% nacidos vivos y 8.3% muertes fetales. La prevalencia fue de 73.9/10,000 nacimientos. Conclusiones. La tasa de prevalencia fue más baja que la esperada. Se requieren programas de validación y capacitación para fortalecer estos sistemas de registro.

Background. Congenital malformations are a main cause of infant death, chronic illness and disability in several countries. The expected frequency is ~2-3% in live newborns and ~15-20% in stillbirths. In 2010 in Mexico, infant mortality ranked in second place with a rate of 336.3/100,000 births. In order to estimate prevalence and main causes of congenital malformations in live births and stillbirths, national base registries of newborns and stillbirths were evaluated for 2009-2010. Methods. Databases of neonatal live births and fetal deaths were combined. Results. From a total population of 4,123,531 certificates, 99.3% were live born and there were 0.7% fetal deaths. Congenital malformations were registered in 30,491 cases, 91.7% of live newborns and 8.3% of fetal deaths with a prevalence rate of congenital malformations of 73.9/10,000. Conclusions. The reported prevalence was lower than expected. It is necessary to enforce registry systems through system validation and training of personnel.

Efecto a largo plazo del policosanol en la recuperación funcional de pacientes con ictus isquémico no cardioembólico: estudio de un año / Long-term eff ect of policosanol on the functional recovery of non-cardioembolic ischemic stroke patients: a one year study

Introducción. El ictus es una causa principal de mortalidad y discapacidad. El policosanol ha sido efi caz en modelos de isquemia cerebral. Este estudio investiga si el tratamiento a largo plazo con policosanol, añadido a la terapia con ácido acetilsalicílico (AAS), dentro de los 30 días posteriores a un ictus, es mejor que el placebo + AAS en la recuperación de los pacientes. Pacientes y métodos. Estudio aleatorizado, doble ciego, controlado con placebo. Se incluyeron 80 pacientes (edad media: 69 años) que sufrieron un ictus en los 30 días previos y con una puntuación de 2-4 en la escala de Rankin modifi cada(mRS). Se distribuyeron aleatoriamente en dos grupos y recibieron policosanol + AAS o placebo + AAS durante 12 meses. Resultados. El tratamiento con policosanol + AAS disminuyó signifi cativamente la puntuación en la mRS desde el primer control intermedio (1,5 meses). El efecto del tratamiento incluso mejoró con la terapia a largo plazo. El número de pacientes que alcanzaron valores de mRS menores o iguales a 1 fue superior en el grupo de policosanol + AAS (87,5%) que en el de placebo + AAS (0%). El tratamiento con policosanol + AAS aumentó signifi cativamente el índice de Barthel, disminuyó el colesterol LDL y aumentó el colesterol HDL frente a placebo + AAS. Conclusiones. El tratamiento a largo plazo (12 meses) con policosanol + AAS fue más efectivo que el tratamiento con placebo + AAS en la recuperación funcional de los pacientes después de sufrir un ictus isquémico no cardioembólico de moderada gravedad (AU)

Introduction. Stroke is a leading cause of mortality and disability. Policosanol has been eff ective in brain ischemia models. The aim of this study is to investigate whether policosanol, added to aspirin therapy within 30 days of stroke onset, is better than placebo + aspirine for the long-term recovery of non-cardioembolic ischemic stroke subjects. Patients and methods. Randomized, double-blind, placebo-controlled study. Eighty patients (mean age: 69 years) within 30 days of onset, with a modifi ed Rankin Scale score (mRS) 2 to 4, were included. They were randomized in two groups (policosanol + aspirine or placebo + aspirine) for 12 months. Results. Policosanol + aspirine decreased signifi cantly mean mRS from the fi rst interim check-up (1.5 months). The treatment even improved after long-term therapy. More policosanol + aspirin (87.5%) than placebo + aspirine (0%) patients achieved mRSs ≤ 1. Policosanol + aspirine increased signifi cantly Barthel Index, lowered LDL-cholesterol and increased HDL-cholesterol versus placebo + aspirin. Conclusions. Long-term (12 months) administration of policosanol + aspirin given after suff ering non-cardioembolic ischemic stroke was shown to be better than placebo + aspirin in improving functional outcomes when used among patients with non-cardioembolic ischemic stroke of moderate severity (AU)

Impacto espacial diferenciado en el consumo y adicción a las drogas en la frontera norte de México: el caso del Estado de Baja California / Drug use and addiction among the young population of Mexico’s Northern Border: The Case of the Baja California State / Consumo e vício às drogas na população jovem da beira norte de México: o caso do Estado de Baixa Califórnia

En el artículo se resalta la distribución del uso de drogas en México, destacando el papel de la región del norte, la cual presenta los porcentajes de consumo más altos del país. A un nivel más específico, se abordan las implicaciones individuales y sociales en el abuso del consumo de bebidas alcohólicas entre la población, así como los efectos del ambiente familiar, trayectorias escolares y laborales de los adictos a las drogas ilícitas en Baja California, al igual que las correlaciones estadísticas entre adicción a drogas y otras variables sociales.El objetivo principal fue evidenciar el impacto espacial diferenciado que tiene el proceso del consumo de drogas en México. Para esto, se utilizaron datos empíricos provenientes de encuestas nacionales de adicciones de los años 1993, 1998, 2002 y 2008, coordinadas por la Secretaría de Salud, e información generada a través de diversos estudios realizados en Baja California, a efectos de dimensionar este problema de salud a nivel local. Los resultados concluyen que la región norte de México presenta un efecto más severo en el problema del uso y abuso de drogas, figurando de manera primordial el Estado de Baja California

This article highlights the distribution of drug use in Mexico, stressing the role of the northern region since it exhibits the highest percentages in the country. At a more specific level, the individual and social implications of alcohol abuse within the population are dealt with, as well as family environment effects, school and labor experiences of drug addicts in Baja California, and the statistical correlations between drug addiction and other social variables.The main purpose has been to evidence the differentiated spatial effect of the drug-consumption process in Mexico. For this purpose, empirical data taken from national surveys on addictions in 1993, 1998, 2002 and 2008 coordinated by the Secretariat of Health were used, along with information generated through diverse studies carried out in Baja California in order to gauge this health problem at the local level. Results conclude that Mexico’s northern region exhibits a more severe effect in the drug use and abuse issue, particularly in the State of Baja California

No artigo enfatiza-se a distribuição do uso das drogas em México, destacando o papel da região do norte, que apresenta as porcentagens mais elevadas do consumo do país. Em um nível mais específico, são abordadas as implicações individuais e sociais no abuso do consumo de bebidas alcoólicas entre a população, assim como os efeitos do ambiente familiar, trajetórias escolares e laborais dos viciados às drogas ilícitas em Baixa Califórnia, como as correlações estatísticas entre o vício às drogas e outras variáveis sociais. O objetivo preliminar era demonstrar o impacto espacial diferenciado que tem o processo do consumo de drogas em México. Para este efeito, dados empíricos de questionários nacionais dos vícios dos anos 1993, 1998, 2002 e 2008 foram usados, coordenadas pela Secretaria de Saúde, e a informação gerada através dos estudos diversos feitos em Baixa Califórnia, com o objeto de determinar as proporções deste problema da saúde ao nível local. Os resultados concluem que a região norte do México apresenta um efeito mais severo no problema do uso e do abuso das drogas, figurando da maneira fundamental o Estado de Baixa Califórnia