Tryptophan and Cortisol Modulate the Kynurenine and Serotonin Transcriptional Pathway in the Kidney of Oncorhynchus kisutch.

Aquaculture fish are kept for long periods in sea cages or tanks. Consequently, accumulated stress causes the fish to present serious problems with critical economic losses. Fish food has been supplemented to reduce this stress, using many components as amino acids such as tryptophan. This study aims to determine the transcriptional effect of tryptophan and cortisol on primary cell cultures of salmon head and posterior kidney. Our results indicate activation of the kynurenine pathway and serotonin activity when stimulated with tryptophan and cortisol. An amount of 95% of tryptophan is degraded by the kynurenine pathway, indicating the relevance of knowing how this pathway is activated and if stress levels associated with fish culture trigger its activation. Additionally, it is essential to know the consequence of increasing kynurenic acid "KYNA" levels in the short and long term, and even during the fish ontogeny.

Is functional training an efficient approach to improve body composition in older people? A systematic review.

Introduction: Increases in fat mass and reductions in lean mass are associated with the frailty and mortality of older people. In this context, Functional Training (FT) is an option to increase lean mass and reduce fat mass in older people. Thus, this systematic review aims to investigate the effects of FT on body fat and lean mass in older people. Methods: We included randomized controlled clinical trials, with at least one intervention group that employed FT, with the age of participants ≥60 years; and participants physically independent and healthy. We performed the systematic investigation in Pubmed MEDLINE, Scopus, Web of Science, Cochrane Library, and Google Scholar. We extracted the information and used the PEDro Scale to assess the methodological quality of each study. Results: Our research found 3,056 references with five appropriate studies. Of the five studies, three presented reductions in fat mass, all of them with interventions between three and 6 months, different training dose parameters, and 100% of the sample was composed of women. On the other hand, two studies with interventions between 10 and 12 weeks presented conflicting results. Conclusion: Despite the limited literature about lean mass, it appears that long-term FT interventions may reduce fat mass in older women. Clinical Trial Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=399257, identifier CRD42023399257.

Live and inactivated Piscirickettsia salmonis activated nutritional immunity in Atlantic salmon (Salmo salar).

Nutritional immunity regulates the homeostasis of micronutrients such as iron, manganese, and zinc at the systemic and cellular levels, preventing the invading microorganisms from gaining access and thereby limiting their growth. Therefore, the objective of this study was to evaluate the activation of nutritional immunity in specimens of Atlantic salmon (Salmo salar) that are intraperitoneally stimulated with both live and inactivated Piscirickettsia salmonis. The study used liver tissue and blood/plasma samples on days 3, 7, and 14 post-injections (dpi) for the analysis. Genetic material (DNA) of P. salmonis was detected in the liver tissue of fish stimulated with both live and inactivated P. salmonis at 14 dpi. Additionally, the hematocrit percentage decreased at 3 and 7 dpi in fish stimulated with live P. salmonis, unchanged in fish challenged with inactivated P. salmonis. On the other hand, plasma iron content decreased during the experimental course in fish stimulated with both live and inactivated P. salmonis, although this decrease was statistically significant only at 3 dpi. Regarding the immune-nutritional markers such as tfr1, dmt1, and ireg1 were modulated in the two experimental conditions, compared to zip8, ft-h, and hamp, which were down-regulated in fish stimulated with live and inactivated P. salmonis during the course experimental. Finally, the intracellular iron content in the liver increased at 7 and 14 dpi in fish stimulated with live and inactivated P. salmonis, while the zinc content decreased at 14 dpi under both experimental conditions. However, stimulation with live and inactivated P. salmonis did not alter the manganese content in the fish. The results suggest that nutritional immunity does not distinguish between live and inactivated P. salmonis and elicits a similar immune response. Probably, this immune mechanism would be self-activated with the detection of PAMPs, instead of a sequestration and/or competition of micronutrients by the living microorganism.

[Direct medical costs in a cohort of patients with breast cancer]. / Costos médicos directos de la atención médica de pacientes con cáncer de mama.

Background: The economic cost of breast cancer (BC) treatment and the increase in incidence and prevalence challenges the financial stability of any healthcare system. Objective: To determine direct medical costs (DMC) of BC treatment and factors associated with DMC. Material and methods: Partial economic evaluation in a retrospective cohort of 160 patients with a confirmed diagnosis of BC. DMC was considered from the IMSS perspective. Bootstrapping analysis was used to deal with uncertainty and generalized linear model to identify factors associated with DCM. Results: The total average annual cost of BC treatment was $251,018 mexican pesos. In clinical stage I was $116,123, stage II $242,132, stage III $287,946, and stage IV $358,792 pesos. In progression disease, DMC were more elevate ($380,117) vs. without progression ($172,897), (p < 0.0001). In patients who died, DMC were $357,579 mexican pesos compared to those who survived ($218,699) (p < 0.0001). Conclusions: The average annual cost of CM treatment was $251,018 pesos. DMCs increase significantly as patients present more advanced stages of the disease. Factors associated with costs were age, stages II, III and the progression of BC.

Introducción: el costo económico del tratamiento de cáncer de mama (CM) y el aumento en su incidencia y prevalencia desafía la estabilidad financiera de cualquier sistema de salud. Objetivo: determinar los costos médicos directos (CMD) del tratamiento de CM y los factores asociados a estos costos. Material y métodos: evaluación económica parcial en una cohorte retrospectiva de 160 pacientes con diagnóstico confirmado de CM. Se consideraron CMD desde la perspectiva del IMSS. Se utilizó análisis de bootstrapping para tratar incertidumbre y el modelo lineal generalizado para identificar factores asociados a costos. Resultados: el costo promedio anual (CPA) del tratamiento de CM fue de $ 251,018 pesos. En estadio 1, $ 116,123; estadio II, $ 242,132; estadio III, $ 287,946, y estadio IV, $ 358,792 pesos. El CPA fue mayor en progresión del CM ($ 380,117 frente a no progresión $ 172,897), y en pacientes que fallecieron durante el seguimiento ($ 357,579) frente a aquellas que sobrevivieron ($ 218,699). Conclusiones: el CPA del tratamiento de CM fue de $ 251,018 pesos. Los CMD aumentan significativamente conforme las pacientes presentan estadios más avanzados de la enfermedad. Los factores asociados al CMD fueron edad, estadios II, III y la progresión del CM.

Costos médicos directos de la atención médica de pacientes con cáncer de mama / Direct medical costs in a cohort of patients with breast cancer

Introducción: el costo económico del tratamiento de cáncer de mama (CM) y el aumento en su incidencia y prevalencia desafía la estabilidad financiera de cualquier sistema de salud. Objetivo: determinar los costos médicos directos (CMD) del tratamiento de CM y los factores asociados a estos costos. Material y métodos: evaluación económica parcial en una cohorte retrospectiva de 160 pacientes con diagnóstico conf irmado de CM. Se consideraron CMD desde la perspectiva del IMSS. Se utilizó análisis de bootstrapping para tratar incertidumbre y el modelo lineal generalizado para identificar factores asociados a costos. Resultados: el costo promedio anual (CPA) del tratamiento de CM fue de $ 251,018 pesos. En estadio 1, $ 116,123; estadio II, $ 242,132; estadio III, $ 287,946, y estadio IV, $ 358,792 pesos. El CPA fue mayor en progresión del CM ($ 380,117 frente a no progresión $ 172,897), y en pacientes que fallecieron durante el seguimiento ($ 357,579) frente a aquellas que sobrevivieron ($ 218,699). Conclusiones: el CPA del tratamiento de CM fue de $ 251,018 pesos. Los CMD aumentan significativamente conforme las pacientes presentan estadios más avanzados de la enfermedad. Los factores asociados al CMD fueron edad, estadios II, III y la progresión del CM.

Background: The economic cost of breast cancer (BC) treatment and the increase in incidence and prevalence challenges the financial stability of any healthcare system. Objective: To determine direct medical costs (DMC) of BC treatment and factors associated with DMC. Material and methods: Partial economic evaluation in a retrospective cohort of 160 patients with a confirmed diagnosis of BC. DMC was considered from the IMSS perspective. Bootstrapping analysis was used to deal with uncertainty and generalized linear model to identify factors associated with DCM Results: The total average annual cost of BC treatment was $251,018 mexican pesos. In clinical stage I was $116,123, stage II $242,132, stage III $287,946, and stage IV $358,792 pesos. In progression disease, DMC were more elevate ($380,117) vs. without progression ($172,897), (p < 0.0001). In patients who died, DMC were $357,579 mexican pesos compared to those who survived ($218,699) (p < 0.0001). Conclusions: The average annual cost of CM treatment was $251,018 pesos. DMCs increase significantly as patients present more advanced stages of the disease. Factors associated with costs were age, stages II, III and the progression of BC.

Analysis of Pacing Strategies in AMRAP, EMOM, and FOR TIME Training Models during "Cross" Modalities.

Empirically, it is widely discussed in "Cross" modalities that the pacing strategy developed by an athlete or trainee has a significant impact on the endurance performance in a WOD in the AMRAP, EMOM, or FOR TIME model. We can observe at least six pacing strategies adopted during the cyclical modalities in the endurance performance in the scientific literature. However, besides these modalities, exercises of acyclical modalities of weightlifting and gymnastics are performed in the "Cross" modalities. These exercises may not allow the same pacing strategies adopted during cyclic modalities' movements due to their motor characteristics and different intensity and level of effort imposed to perform the motor gesture. In addition to the intensity and level of effort that are generally unknown to the coach and athlete of the "Cross" modalities, another factor that can influence the adoption of a pacing strategy during a WOD in the AMRAP, EMOM, or FOR TIME model is the task endpoint knowledge, which varies according to the training model used. Thus, our objective was to evaluate situations in which these factors can influence the pacing strategies adopted in a self-regulated task with cyclic and acyclic modalities movements during an endurance workout in the AMRAP, EMOM, and FOR TIME model. Given the scarcity of studies in the scientific literature and the increasing discussion of this topic within the "Cross" modalities, this manuscript can help scientists and coaches better orient their research problems or training programs and analyze and interpret new findings more accurately.

Mathematical Model for Describing Corn Grain Dehydration Kinetics after a Nixtamalization Process.

In this research, the mathematical model associated with the hydrothermal dehydration process of Nixtamalized Corn Grains (NCG) with different Steeping Time (ST) values, allows the fitting of experimental data with initial moisture M0 and the equilibrium moisture ME as a function of Isothermal Dehydration Time (IDT). The moisture percentage for any time t and dehydration rate (isolines M(t) and isolines vI respectively) of the NCG is shown by means of matrix graphics as a simultaneous function of IDT and ST. The relationship between initial dehydration rate v0 and initial moisture M0 establishes as a function of ST. Also, the mathematical model associated with the solution of the second Fick's law allows calculating the diffusivity rate vk (H2O molecules out of NCG) and verify that the rate of change in moisture and the dynamical proportionality constant k has a non-linear dependence on the IDT and that k is directly proportional to Deff. The k values strongly relate to ST and the calcium ions percentage into NCG according to solubility lime values into cooking water (or nejayote) as a function of decreasing temperature when ST increases.

Effect of Dried Leaves of Leucaena leucocephala on Rumen Fermentation, Rumen Microbial Population, and Enteric Methane Production in Crossbred Heifers.

The effects of dietary inclusion of dried Leucaena leucocephala leaves (DLL) on nutrient digestibility, fermentation parameters, microbial rumen population, and production of enteric methane (CH4) in crossbred heifers were evaluated. Four heifers were used in a 4 × 4 Latin square design consisting of four periods and four levels of inclusion of DLL: 0%, 12%, 24%, and 36% of dry matter (DM) intake. Results showed that DM intake (DMI), organic matter intake, and gross energy intake (GEI) were similar (p > 0.05) among treatments. Apparent digestibility of organic matter, neutral detergent fiber, and energy decreased with increasing levels of DLL in the ration (p < 0.05). In contrast, digestible crude protein (CP) was higher (p < 0.05) in treatments with 12% and 24% DM of DLL. The inclusion of DLL did not affect (p > 0.05) rumen pH and total volatile fatty acids. Rumen microbial community was not affected (p > 0.05) by treatment. There was a linear reduction (p < 0.05) in CH4 emissions as the levels of DLL in the ration were increased. Results of this study suggest that an inclusion of 12% DM of ration as DLL enhances digestible CP and reduces daily production of enteric CH4 without adversely affecting DMI, rumen microbial population, and fermentation parameters.

Estimación de erosión potencial bajo dos sistemas de corte de caña panelera utilizando la ecuación universal de pérdida de suelos / Estimation of potential erosion under two sugarcane cutting systems using the universal soil loss equation

RESUMEN Con el fin de comparar las pérdidas de suelo en dos sistemas de corte tradicionalmente utilizados en el cultivo de caña de azúcar para la producción de panela, se llevó a cabo un estudio, en el que se realizaron mediciones en campo, utilizando un simulador de lluvia y parcelas de escorrentía, en un vertisol del municipio de Quebradanegra, Cundinamarca, en donde se presentan, simultáneamente, los dos tipos de corte: parejo (tipo de corte en el que se cosecha todo a la vez, al tener una madurez homogénea en el cultivo) y entresaque (sistema en el cual no hay madurez homogénea, por lo que se corta solo un porcentaje de las plantas a la vez). Para estimar las pérdidas de suelo potenciales asociadas a ambos sistemas de corte, se utilizó la Ecuación Universal de Pérdida de Suelos (USLE), obteniendo un factor medio C, asociado al tipo de corte, utilizando los datos determinados en campo y la erosividad de las intensidades de precipitación simuladas. Finalmente, se determinó la erosión potencial anual, bajo los dos sistemas de corte, donde se observó que el sistema de corte por parejo presenta un valor 2,2 veces mayor que el sistema de corte por entresaque. Por otra parte, al comparar las pérdidas potenciales de suelo con un lote recién preparado y sembrado, sin cobertura vegetal, se evidencia la capacidad del cultivo de caña panelera para brindar protección al suelo, presentando una erosión potencial 9 veces menor, en el caso del corte por parejo, con respecto a una condición de suelo sin cobertura vegetal.

ABSTRACT In order to compare soil losses in two cutting systems traditionally used in the cultivation of sugar cane for the production of panela, a study was carried out in which measurements were made in the field using a rainfall simulator and runoff plots in a vertisol of the municipality of Quebradanegra, Cundinamarca, where both types of cut are presented simultaneously: the cut-off system, in which everything is harvested at once having a homogeneous maturity in the crop and the thinning cut system, in which have an inhomogeneous maturity so that only a percentage of the plants is cut at the same time. To estimate the potential soil losses associated with both cutting systems, the Universal Soil Loss Equation (USLE) was used to obtain a mean C factor associated with the type of cut, using the data determined in the field and the erosivity of simulated rainfall intensities. Finally, the anual potential losses of soil was determined under the two cutting systems, where it was observed that the cut-off system has an annual potential erosion 2.2 times greater than the thinning cuy system. On the other hand, when comparing the potential losses of soil with a newly prepared and planted lot, without plant cover, the capacity of the sugarcane cane crop is demonstrated to offer a protection to the soil, presenting a potential erosion 9 times smaller, in the case of the cut-off system, with respect to a soil condition without plant cover.

Neural Net Gains Estimation Based on an Equivalent Model.

A model of an Equivalent Artificial Neural Net (EANN) describes the gains set, viewed as parameters in a layer, and this consideration is a reproducible process, applicable to a neuron in a neural net (NN). The EANN helps to estimate the NN gains or parameters, so we propose two methods to determine them. The first considers a fuzzy inference combined with the traditional Kalman filter, obtaining the equivalent model and estimating in a fuzzy sense the gains matrix A and the proper gain K into the traditional filter identification. The second develops a direct estimation in state space, describing an EANN using the expected value and the recursive description of the gains estimation. Finally, a comparison of both descriptions is performed; highlighting the analytical method describes the neural net coefficients in a direct form, whereas the other technique requires selecting into the Knowledge Base (KB) the factors based on the functional error and the reference signal built with the past information of the system.

[Circadian rhythm of blood pressure in patients with chronic hypertension and pregnancy]. / Ritmo circadiano de la presión arterial en pacientes con hipertensión crónica y embarazo.

BACKGROUND: Ambulatory blood pressure monitoring during 24 hours shows a blood pressure variability. The prevalence of chronic hypertension in pregnant women is 1-5%, so it is important to know the changes in blood pressure and cardiovascular risk and prevent complications to the mother and fetus. OBJECTIVE: To know the circadian rhythm of the blood pressure in the chronic hypertensive pregnant patients, through the ambulatory blood pressure monitoring. MATERIAL AND METHODS: A cross-sectional and descriptive study included chronic hypertensive pregnant patients, with > 20 weeks of gestation. Assessment of factors related to gynaecologic characteristics, according to the inclusion criteria underwent a washout period of two weeks and they were monitored with a Spacelabs 90207 monitor blood pressure. Quantitative variables by Student t test, one-way ANOVA and Pearson correlation were analysed. RESULTS: 16 chronic hypertensive pregnant patients were included, whose ambulatory blood pressure monitoring for the systolic blood pressure in 24 hours averaged 117.12 ± 5.85 mmHg; 24 hours diastolic blood pressure 71.31 ± 5.89 mmHg; daytime systolic blood pressure 120.18 ± 5.75 mmHg, nocturnal systolic blood pressure 110.31 ± 8.41 mmHg; daytime diastolic blood pressure 75.43 ± 7.32 mmHg, nocturnal diastolic blood pressure 64.25 ± 8.27 mmHg. Significant differences between daytime and night time were found. CONCLUSION: 56% of chronic hypertensive pregnant patients had no nocturnal reduction in systolic blood pressure and 43.75% had no nocturnal changes on diastolic blood pressure. The fact that 50% of patients were non-dippers force us to use long-action antihypertensive therapy and obtain control of the blood pressure for 24 hours.

Integración de la hepcidina a las respuestas y adaptaciones a la hipoxia en el deporte / Integration of hepcidin in responses and adaptation to hypoxia in sport

Entre las distintas estrategias empleadas con objeto de mejorar el rendimiento deportivo se ha empleado tradicionalmente las concentraciones de entrenamiento en altura. En la actualidad dicha práctica se ha hecho más común, al posibilitarse la realización de exposiciones a estímulos de hipoxia intermitente, gracias a la utilización de distintas tecnologías como las cámaras hipobáricas. Algunos estudios han intentado comprobar el efecto de distintos protocolos de exposición a ambientes hipóxicos sobre el rendimiento deportivo y sobre las variables relacionadas con el sistema sanguíneo. Sin embargo, con frecuencia, no se tiene en cuenta que, como respuesta a la hipoxia, el cuerpo reacciona con una serie de respuestas y adaptaciones a nivel multisistémico. Además, el descubrimiento de la hepcidina ha hecho comprender mejor el conocimiento existente acerca del metabolismo del hierro. Dado que condiciones de hipoxia podrían alterar la síntesis de hepcidina, el objetivo del presente estudio de revisión bibliográfica ha sido doble: I) comprobar las distintas respuestas y adaptaciones a nivel multisistémico a condiciones de hipoxia; II) integrar la hepcidina como posible variable que interviene en las respuestas que tienen lugar en relación al metabolismo del hierro.

Among the various strategies used to improve athletic performance has traditionally been used concentrations altitude training. Today this practice has become more common, making it possible exposures to intermittent hypoxia stimuli, through the use of various technologies such as hypobaric chambers. Some studies have attempted to test the effect of different protocols of exposure to hypoxic environments on athletic performance and related variables on the blood system. However, often is not taken into account that, in response to hypoxia, the body has a number of responses and adaptations to multisystem level. Furthermore, the discovery of hepcidin has done to change the existing knowledge of iron metabolism. Since hypoxic conditions could alter the synthesis of hepcidin, the objective of this literature review study was twofold: i) to test the different responses and adaptations to multisystem level hypoxic conditions; ii) integrate hepcidin as a possible intervening variable in responses that occur in relation to iron metabolism.

Percepción que tienen las madres de niños menores de 2 años sobre la calidad de la atención que brinda el profesional de enfermería en el componente crecimiento y desarrollo en la Disa II Lima-Sur. 2013 / Perception of mothers with children less than 2 years about the quality of care provided by nursing professionals in Component Growth and Development at the DISA II Lima Sur. 2013

Objetivos: El presente estudio de investigación tiene como objetivo: Identificar la percepción que tienen las madres sobre la calidad de la atención que brinda el Profesional de Enfermería en el Componente Crecimiento y Desarrollo en la DISA II Lima Sur en las Categorías "Accesible", "Educación", "Confort", "Interpersonal", "Monitoreo y Seguimiento". Método: El presente estudio de investigación es de tipo cuantitativo, teniendo en cuenta la naturaleza del problema y los objetivos del presente, corresponde a una investigación aplicativa, se utilizó el método descriptivo de corte transversal. La muestra se obtuvo mediante el tipo de muestreo no probabilístico por conveniencia, la cual estuvo conformada por 120 madres que acudieron al consultorio de Crecimiento y Desarrollo durante los meses de Agosto y Septiembre del 2013. La técnica que se utilizó fue la entrevista y el instrumento fue un cuestionario. Luego de finalizar la recolección de datos, los datos fueron procesados utilizando el paquete de datos SPSS. Resultados: En cuanto a la percepción de las madres sobre la calidad de la atención que brinda el profesional de enfermería en el Componente Crecimiento y Desarrollo se obtuvo que del 100 por ciento (120) de madres encuestadas, el 28 por ciento (34) tienen un percepción buena, el 47 por ciento (56) tienen una percepción regular y el 30 por ciento (25) tienen una percepción mala. En cuanto a la Categoría Accesible se obtuvo que del 100 por ciento (120) de madres encuestadas, el 57 por ciento (68) tienen un percepción buena. En la Categoría Educación; el 53 por ciento (64) tienen un percepción buena. En cuanto a la categoría Confort, el 57 por ciento (68) tienen un percepción buena. En la Categoría Interpersonal; el 48 por ciento (58) tienen un percepción buena y por último en la Categoría Monitoreo y seguimiento; el 47 por ciento (56) tienen una percepción buena. Conclusiones: Las madres de los niños menores de 2 años tienen en su mayoría una percepción...

Objectives: This study aims to research, identify the perception of mothers about the quality of care provided by nursing professionals in Component Growth and Development in the Health Center in the DISA Lima Sur II in category "accessible", "Education", "Comfort", "Interpersonal", "Monitoring and tracking". Method: This study is quantitative research, taking into account the nature of the problem and the objectives of this corresponds to an applicative research, cross-sectional descriptive method was used. The sample was obtained by the type of non-probability convenience sampling, which consisted of 120 mothers who attended the clinic on Growth and Development during the months of August and September 2013. The technique used was the interview and the instrument was a questionnaire. After completing data collection, the data were processed using the software package SPSS data. Results: Regarding the perception that mothers have on the quality of care provided by the nurse on the Growth and Development Component was obtained 100 per cent (120) of mothers surveyed, 28 per cent (34) have a good perception, 47 per cent (56) have a regular perception and 30 per cent (25) have a bad perception. As regards the Affordable category was obtained 100 per cent (120) of mothers surveyed, 57 per cent (68) have a good perception. In the category Education, 53 per cent (64) have a good perception. As for the category Comfort, 57 per cent (68) have a good perception. On the Interpersonal category; 48 per cent (58) have a good perception and finally in category Monitoring and tracks, 47 per cent (56) have a good perception. Conclusions: The mothers of children under 2 years are mostly regular perception of the quality of care provided by the nurse on the Growth and Development Component. As for the category, "accessible", "Education" and "Comfort" most mothers of children less than 2 year have a good perception of the quality of care provided by the nurse. Finally, in...

[Cost of health care in children with haemophilia]. / Costo directo de la atención médica en niños con hemofilia.

OBJECTIVE: To determine the cost of health care in hemophilic children. METHODS: A study of costs analysis of children under 16 years with haemophilia type A and B with different severity grade in one year period was performed. Sociodemographic and clinical data were included. The costs of: 1) ambulatory care, 2) use of emergency services, 3) hospital stay, 4) drugs, 5) antihaemophilic treatment, 6) laboratory and 7) image studies were estimated. We obtained costs for each patient during a year with micro costs technique. RESULTS: We found 52 children (92.3% with haemophilia type A). Mean Age was 9.1 years. A half of them started treatment at the age of one year old, with 7.4 years of following. They had 6.7 average visits per year and 13 emergency hospitalization; haemartrosis was the main cause of hospitalization. Five children had more than 40 hospitalization and 27 cases with 1.9 hospitalization. The hospital average stay was 7.4 days. Total annual cost was 116,000 pesos. Higher cost was for the anti hemophilic factor with 73 052 pesos. CONCLUSIONS: The cost was similar to others Latin American studies and lower than in developed countries, however, factor replacement therapy accounts for most of the costs.

[Breast cancer mortality. Trend and geographical distribution, 1981-2001]. / Mortalidad per cáncer de mama. Tendencia y distribución geográfica, 1981-2001.

OBJECTIVE: to describe trend and geographical distribution of breast cancer mortality, in Mexico. METHODS: it was done an ecological and tendency study from 1981 to 2001, 52,739 deaths by breast cancer in women > or = 20-year-old. Mortality was studied according to the International Classification of Diseases. The data were obtained from the National Institute of Statistics, Geography and Informatics and from the General Census of Population. The period studied was three-yearly. Adjusted rates were calculated with the direct method. It was utilized a lineal regression model for the analysis of mortality tendencies. Map was built from the distribution of the mortality along the country. RESULTS: the mortality tendency was increased in the first decade and in the second it was maintained stable, with an important drop in four states (p<0.05). The 66% of the states had rates over the national adjusted rate, all of them in the north of the country. Nayarit, Guerrero, and Mexico State had an increment of 300%. CONCLUSIONS: the ascending tendency and stabilization of the mortality is similar to other countries. The north states had the greater rate of mortality, intermediate rates in the middle of country and drops in the south. It is possible that these changes were secondary to environmental, social and medical care factors.

¿es el letargo nn signo frecuente en la invaginación intestinal? / Is lethargy a frequent sign in the intestinal intussusception?

Aunque el letargo ha sido considerado desde hace décadas un signo frecuente de invaginación, no aparece entre los elementos clásicos de esta entidad y algunos opinan que es un signo inusual y de aparición tardía. Con el objetivo de determinar la frecuencia conque el letargo ha estado presente en los niños con invaginación y la etapa de la enfermedad en que se ha constatado, se realizó un estudio descriptivo de serie de casos de los pacientes menores de dos años que acudieron con invaginación intestinal al Hospital Pediátrico de Camagüey entre enero de 1995 y diciembre de 2005. Se estudiaron las variables: edad, síntomas y signos, asociaciones clínicas al ingreso, y relación entre la presencia de letargo con el tiempo de evolución de la invaginación. Los métodos empleados fueron estadística descriptiva y distribución de frecuencia. Se constató el letargo en 76 de los 121 pacientes (62.80 %). La asociación de letargo, dolor cólico, vómitos y sangramiento rectal fue la más frecuente (33.88 %). El letargo estuvo presente en 59 niños durante las primeras 24h (77.63 %), incluyendo 35 pacientes en las primeras 12h (46.05%). El letargo debe ser considerado uno de los signos importantes de invaginación por la elevada frecuencia conque se presenta; en la mayoría de los pacientes estudiados ha sido evidente en fases tempranas de la enfermedad (menos de 24 h de evolución). En niños con letargo de causa no explicada, debe tenerse presente el diagnóstico de invaginación, sobre todo cuando se acompaña de otros elementos clínicos sugestivos de la enfermedad.

Eventhoug lethargy has been considered for decades a frequent sign of intussusception, not appear among the classic elements of this entity and someones express that is an unusual sign and late onset. With the aim to determine the frequency of lethargy and the stage in the course of the disease, a descriptive case series study of children less than 2 years old with intussusception was performed at the Paediatric Hospital of Camagüey, from January 1995 to December 2005. Age, symptoms and signs, clinical associations at admission and the relation between the presence of lethargy and the evolution time of the intussusception were the studied variables. Descriptive statistic and frequency distribution were the methods used. Lethargy was present in 76 children (62.80 %). The clinical association of lethargy, colic pain, vomiting and rectal is bleeding were the most frequent (33.88 %). Lethargy was found in 59 patients during the first 24 hours (77.63 %), including 35 patients in the first 12 hours (46.05%). Lethargy should be considered as one of the most important signs of intussusception due to the high frequency of presentation, in the majority of the cases has been evident in early stages of the disease (less than 24 hours of evolution). In children with lethargy of not explained cause, intussusception diagnosis should be present, especially when appear with other suggestive clinical elements of the disease.

Calidad de atención y satisfacción del usuario con cita previa en medicina familiar de Guadalajara / Quality of care and level of satisfaction of user with previous appointment in family medicine practice in Guadalajara

OBJETIVO: evaluar la calidad de la atención y satisfacción del usuario con cita previa en unidades de medicina familiar. MÉTODOS: se aplicó un diseño transversal analítico a una muestra probabilística de 983 usuarios, se usaron dos cuestionarios validados para explorar calidad del servicio y satisfacción del usuario, se registraron variables sociodemográficas y cita previa. Se aplicaron las pruebas estadísticas F de Fisher, y chi cuadrado. RESULTADOS: la muestra se caracterizó por tener 67 por ciento de sexo femenino, edad 40,83 ± 21,6 años, 40 por ciento asalariados, 67 por ciento casados, tiempo de espera 55,46 ± 74,03 min, 56 por ciento con cita previa. La calidad de la atención calificó alta en seis de siete dimensiones, el tiempo de espera en dos de las tres unidades alcanzó el 36 por ciento de calidad. La satisfacción del usuario en dimensión médico familiar ³ 79 por ciento (no significativo), unidad de medicina familiar mostró calificación ³59 (p= 0,00), otros servicios calificaron 53 por ciento. Cita previa se asoció con satisfacción en todas las dimensiones (p= 0,00). CONCLUSIONES: la calidad de atención fue alta, excepto en tiempo de espera. La satisfacción del usuario se asoció con la cita previa.

OBJECTIVE: to Evaluate the quality of assistance and level of satisfaction of the user with previous appointment in family medicine centers. METHODS: a cross-sectional analytical design was applied to a probabilistic sample of 983 users; two validated questionnaires were used to track quality of service and level of satisfaction of users; sociodemographic variables and previous appointments were recorded. Fisher´s F and Chi-square tests were performed. RESULTS: the probablistic sample was characterized by having 67 percent of females, age 40.83 ± 21,6 years; 40 percent workers, 67 percent married, waiting time 55.46 ± 74.03 min, 56 percent had previous appointment. The quality of assistance was high in six out of seven dimensions; waiting time had 36 percent of quality in two of the three centers. The level of satisfaction of the users in dimension family physician ³ 79 percent (not significant), and in family medicine centers, the qualification was ³ 59 percent (p= 0,00). Other services rated 53 percent. Previous appointment was associated to satisfaction in all the dimensions (p= 0,00). CONCLUSIONS: the quality of assistance was high except for waiting time. The level of satisfaction of users was related to previous appointment.

[Prescription and drug expenditure in gynecology and obstetrics in Northwest medical units from IMSS]. / Análisis de la prescripción y gasto de medicamentos en gineco-obstetricia en unidades médicas del noroccidente del IMSS.

BACKGROUND: Drug prescription is the most frequent medical intervention in Gynecology and Obstetrics; however, studies of prescription profile are limited. In this study, we analyzed differences of expense by drug prescription for gynecologic and obstetrics health problems. PATIENTS AND METHOD: It was performed a cross sectional study for one year analysis in each medical area that shape IMSS western district. We calculated spending and consumption coefficients for each drug and therapeutic groups. User coefficients were ordered to compare consumption differences. Besides the statistical ratio of consumption between drugs groups, we described the differences found and analyzed the prescription profile among medical regions. RESULTS: Data related to the expenses in each one of the regions show important differences in each one of the drugs and therapeutic groups. The most common expense for drugs is related to the treatment of osteoporosis, menopause and fertility problems. We also found differences in prescription drug preferences in each therapeutic subgroup. DISCUSSION: Drug prescription studies are useful as a basis for further specific studies in each pharmacologic subgroup. There are few studies that analyze the drug prescription profile on Gynecology and Obstetrics. In this study it is possible to suppose that medical prescription was not based on known medical evidences; therefore, we must reconsider the need of a permanent actualization and systematic medical evaluation.

Success in control of hypertension in a low-resource setting: the Cuban experience.

BACKGROUND: Pharmacologic control of hypertension is an essential component of the current strategy to control cardiovascular diseases. Much concern has been focused in recent years on the challenge that cardiovascular disease poses for developing countries. Available medical therapies should be equally effective in low- and high-resource settings; however, this has not yet been demonstrated. Cuba has a well-organized primary-care system and has made reduction of cardiovascular diseases a priority, particularly through detection and treatment of hypertension. METHODS: To determine current hypertension control rates a population-based sample of 1667 persons aged 15-74 years was examined in the city of Cienfuegos. RESULTS: The prevalence of hypertension, weighted to the age structure of the sampled population, was 20%. Among all hypertensives, 78% were previously aware of the condition, 61% were currently taking medications, and 40% had systolic/diastolic blood pressures < 140/90 mmHg (men = 29%, women = 49%). Among treated hypertensives, 62% had blood pressures < 140/90 mmHg. DISCUSSION: The level of control documented in this survey is higher than reported previously from population surveys in other countries. If confirmed in broader samples in Cuba, these findings would suggest that effective control of hypertension is highly feasible in low-resource settings.

Cardiovascular disease and associated risk factors in Cuba: prospects for prevention and control.

OBJECTIVES: An adequate description of the trends in cardiovascular disease (CVD) is not available for most of the developing world. Cuba provides an important exception, and we sought to use available data to offer insights into the changing patterns of CVD there. METHODS: We reviewed Cuban public health statistics, surveys, and reports of health services. RESULTS: CVD has been the leading cause of death since 1970. A 45% reduction in heart disease deaths was observed from 1970 to 2002; the decline in stroke was more limited. There are moderate prevalences of all major risk factors. CONCLUSIONS: The Cuban medical care system has responded vigorously to the challenge of CVD; levels of control of hypertension are the highest in the world. Nonindustrialized countries can decisively control CVD.