Modelo de atención para el tratamiento de pacientes con osteoartritis del primer al tercer nivel / Model of care for the treatment of patients with osteoarthritis from the first to the third level

Resumen: Introducción: La osteoartritis en México es una de las 10 causas más frecuentes de discapacidad. El diagnóstico temprano y la detección de factores de riesgo son determinantes para el tratamiento. La organización institucional establece las pautas terapéuticas de acuerdo con cada nivel de atención, pero no se logra un manejo efectivo. Material y métodos: Se realizó un estudio prospectivo, piloto, de intervención, clínico conformado por pacientes diagnosticados con diferentes grados de osteoartritis de rodilla en el primer, segundo y tercer nivel de atención, con un modelo integrador que incluyó un grupo de profesionales para la intervención de la evaluación nutricional, fisioterapéutica, social y sicológica desde el primer nivel. Resultados: La intervención de un grupo de atención multidisciplinaria permite una correcta evaluación y asignación del nivel de atención optimizando los recursos humanos y materiales. La participación de diferentes disciplinas en nutrición, sicología, trabajo social, fisioterapia y rehabilitación modifica el estilo de vida global al involucrar a los propios pacientes en su tratamiento. El grupo de intervención tuvo mejoras en la escala de dolor análogo visual, arcos de movilidad, bajo índice de masa corporal y mejoría en el aspecto sicológico. Conclusiones: El modelo de atención propuesto demuestra que la implementación en la institución y en cada unidad clínica de atención debe considerarse para mejorar los resultados.

Abstract: Introduction: Osteoarthritis in Mexico is one of the ten most frequent causes of disability. Early diagnosis and detection of risk factors are determinant for treatment. The institutional organization establishes therapeutic guidelines according to each level of care, but effective management is not achieved. Material and methods: A prospective, pilot, interventional, clinical study was conducted, which included patients diagnosed with different degrees of knee osteoarthritis in the first, second and third level of care, with an integrative model that includes a group of professionals for the intervention of nutritional, physiotherapeutic, social and psychological evaluation from the first level. Results: The intervention of a multidisciplinary care group allows a correct evaluation and assignment of the level of care, optimizing human and material resources. The participation of different disciplines in nutrition, psychology, social work, physiotherapy and rehabilitation modifies the global lifestyle by involving the patients themselves in their treatment. The intervention group had improvements in the visual analog pain scale, mobility arcs, low body mass index and improvement in the psychological aspect. Conclusions: The proposed model of care demonstrates that implementation in the institution and in each clinical care unit should be considered to improve outcomes.

Diagnóstico de la higiene bucal en pacientes con aparatos de ortodoncia

Fundamento:una adecuada higiene bucal es necesaria en los pacientes que portan aparatos de ortodoncia.Objetivo:identificar conocimientos, actitudes, prácticas e higiene bucal en pacientes con aparatos de ortodoncia.Métodos:se realizó un estudio con diseño no experimental, descriptivo y transversal en la Clínica Estomatológica Docente Provincial de Sancti Spíritus en el período entre septiembre de 2018 y julio de 2019. Se utilizaron métodos del nivel teórico, empírico (encuesta, entrevista, observación y estadístico). La población estuvo constituida por 30 pacientes de esta institución con tratamiento de ortodoncia. Se midieron las variables: edad y sexo del paciente, tipo de aparato de ortodoncia, nivel de conocimiento sobre salud bucodental, actitud y prácticas del paciente de higiene bucal, frecuencia, forma y eficiencia del cepillado dental, así como el cepillado o no después de la ingestión de alimentos azucarados.Resultados:el 100 % de los pacientes presentó conocimientos deficientes sobre salud bucal y prácticas desfavorables, aunque se constató actitudes favorables en el 63,3 % de los pacientes. Predominó una higiene bucal regular en la población estudiada antes de iniciar el tratamiento y después de instalar los aparatos, de manera similar en los grupos con aparatos removibles, funcionales y fijos.Conclusiones:los pacientes de la población estudiada necesitan educación para apropiarse de conocimientos suficientes para mantener actitudes, prácticas e higiene bucal saludables.[AU]

[Model of care for the treatment of patients with osteoarthritis from the first to the third level]. / Modelo de atención para el tratamiento de pacientes con osteoartritis del primer al tercer nivel.

INTRODUCTION: Osteoarthritis in Mexico is one of the ten most frequent causes of disability. Early diagnosis and detection of risk factors are determinant for treatment. The institutional organization establishes therapeutic guidelines according to each level of care, but effective management is not achieved. MATERIAL AND METHODS: A prospective, pilot, interventional, clinical study was conducted, which included patients diagnosed with different degrees of knee osteoarthritis in the first, second and third level of care, with an integrative model that includes a group of professionals for the intervention of nutritional, physiotherapeutic, social and psychological evaluation from the first level. RESULTS: The intervention of a multidisciplinary care group allows a correct evaluation and assignment of the level of care, optimizing human and material resources. The participation of different disciplines in nutrition, psychology, social work, physiotherapy and rehabilitation modifies the global lifestyle by involving the patients themselves in their treatment. The intervention group had improvements in the visual analog pain scale, mobility arcs, low body mass index and improvement in the psychological aspect. CONCLUSIONS: The proposed model of care demonstrates that implementation in the institution and in each clinical care unit should be considered to improve outcomes.

INTRODUCCIÓN: La osteoartritis en México es una de las 10 causas más frecuentes de discapacidad. El diagnóstico temprano y la detección de factores de riesgo son determinantes para el tratamiento. La organización institucional establece las pautas terapéuticas de acuerdo con cada nivel de atención, pero no se logra un manejo efectivo. MATERIAL Y MÉTODOS: Se realizó un estudio prospectivo, piloto, de intervención, clínico conformado por pacientes diagnosticados con diferentes grados de osteoartritis de rodilla en el primer, segundo y tercer nivel de atención, con un modelo integrador que incluyó un grupo de profesionales para la intervención de la evaluación nutricional, fisioterapéutica, social y sicológica desde el primer nivel. RESULTADOS: La intervención de un grupo de atención multidisciplinaria permite una correcta evaluación y asignación del nivel de atención optimizando los recursos humanos y materiales. La participación de diferentes disciplinas en nutrición, sicología, trabajo social, fisioterapia y rehabilitación modifica el estilo de vida global al involucrar a los propios pacientes en su tratamiento. El grupo de intervención tuvo mejoras en la escala de dolor análogo visual, arcos de movilidad, bajo índice de masa corporal y mejoría en el aspecto sicológico. CONCLUSIONES: El modelo de atención propuesto demuestra que la implementación en la institución y en cada unidad clínica de atención debe considerarse para mejorar los resultados.

PIMA: A population informative multiplex for the Americas.

We describe an ancestry-informative autosomal SNP multiplex designed to be a small-scale, flexible panel that can complement uniparental markers in assessing the American variability (i.e. pre-Colombian) found in contemporary indigenous American populations. This study centered on choosing SNPs with the specific characteristics of: 1) extreme allele frequency differences between indigenous Americans and the African, European and East Asian population groups that contribute to present-day population variation in the Americas; 2) high informativeness-for-assignment In values; and 3) well-spaced genomic distribution and chromosomal separation from existing small-scale forensic ancestry marker sets. The resulting capillary electrophoresis SNaPshot single base extension test was named: PIMA (Population Informative Multiplex for the Americas), comprising 26 autosomal SNPs, a single X-chromosome SNP plus the amelogenin sex marker adapted for SNaPshot. PIMA complements the established 34plex forensic ancestry panel to provide a powerful and simple tool for the analysis of American populations, including those with admixed histories, commonly encountered in America. Comparing the results obtained with the combined marker panels of PIMA and 34plex to SNP data from a much larger ancestry panel allowed us to gauge their relative efficiency. PIMA+34plex gives equivalent power to the 314-SNP 'LACE' genomic ancestry control panel, while requiring a much smaller genotyping effort. The ancestry profiles and genetic structure of 22 populations spread across the American continent were estimated using PIMA+34plex data, and those estimates were contrasted with information provided by uniparental markers (mtDNA and Y-chromosome loci) for a small set of admixed individuals from Venezuela. Our results indicate that an American genetic component is efficiently detected in contemporary American populations using a small set of ancestry informative SNPs, and these co-ancestry estimates are consistent with the known history and demography of the Americas. The small scale and high population differentiation power of PIMA, particularly when combined with 34plex, provides a practical and powerful tool for genetic studies of American populations as well as forensic DNA analyses.

Exploring iris colour prediction and ancestry inference in admixed populations of South America.

New DNA-based predictive tests for physical characteristics and inference of ancestry are highly informative tools that are being increasingly used in forensic genetic analysis. Two eye colour prediction models: a Bayesian classifier - Snipper and a multinomial logistic regression (MLR) system for the Irisplex assay, have been described for the analysis of unadmixed European populations. Since multiple SNPs in combination contribute in varying degrees to eye colour predictability in Europeans, it is likely that these predictive tests will perform in different ways amongst admixed populations that have European co-ancestry, compared to unadmixed Europeans. In this study we examined 99 individuals from two admixed South American populations comparing eye colour versus ancestry in order to reveal a direct correlation of light eye colour phenotypes with European co-ancestry in admixed individuals. Additionally, eye colour prediction following six prediction models, using varying numbers of SNPs and based on Snipper and MLR, were applied to the study populations. Furthermore, patterns of eye colour prediction have been inferred for a set of publicly available admixed and globally distributed populations from the HGDP-CEPH panel and 1000 Genomes databases with a special emphasis on admixed American populations similar to those of the study samples.

Analysis of the SNPforID 52-plex markers in four Native American populations from Venezuela.

The SNPforID 52-plex single nucleotide polymorphisms (SNPs) were analyzed in four native Venezuelan populations: Bari, Pemon, Panare and Warao. None of the population-locus combinations showed significant departure from Hardy-Weinberg equilibrium. Calculation of forensic and statistical parameters showed lower values of genetic diversity in comparison with African and European populations, as well as other, admixed populations of neighboring regions of Caribbean, Central and South America. Significant levels of divergence were observed between the four Native Venezuelan populations as well as with other previously studied populations. Analysis of the 52-plex SNP loci with Structure provided an optimum number of population clusters of three, corresponding to Africans, Europeans and Native Americans. Analysis of admixed populations indicated a range of membership proportions for ancestral populations consisting of Native American, African and European components. The genetic differences observed in the Native American groups suggested by the 52 SNPs typed in our study are in agreement with current knowledge of the demographic history of the Americas.

Caracterización de la población usuaria que ingresa al programa interrupción legal del embarazo en un hospital del sector salud del df / Population characterization user entering the program legal abortion in a hospital health sector DF

Introducción: El embarazo no deseado, lleva a la mujer a practicarse un aborto. De acuerdo a International Projects Assistance Services (IPAS) en México, el aborto y sus complicaciones son la 5ª causa de muerte materna. En el D.F. la despenalización de la interrupción del embarazo antes de las 12 semanas de gestación es una ley, lo que ha significado derecho a elegir voluntaria y libremente sobre la maternidad y por lo tanto a decidir la interrupción de un embarazo. Objetivo: Caracterizar a la población que acude al programa de Interrupción Legal del Embarazo (ILE) en un hospital del sector salud del D.F. Metodología: Estudio cuantitativo, descriptivo y transversal, encuestando a 61 mujeres, que deseaban ingresar al programa ILE y aceptaron participar en el estudio. Se realizó y aplicó un instrumento de valoración con 27 ítems. Resultados: Mujeres asistentes al ILE de entre 16 y 42 años; el 46% se dedican al hogar; 50% solteras y el resto en unión libre o casadas; el 23% reportó no emplear ningún método para control de la natalidad. Principales razones para acudir al programa ILE: problemas económicos (36%), embarazo no deseado (20%), paridad satisfecha (20%). Principal sentimiento que despierta el ingreso al programa ILE: tranquilidad (82%). El 100% de las mujeres sometidas a ILE aseguran haber sido tratadas con ética y dignidad. Discusión: Se concuerda con Gutmacher que la legalización de la interrupción del embarazo coincide con el incremento en solicitudes de la mujer a este procedimiento. Respecto a las razones tales como embarazo no deseado y los problemas económicos, ello corresponde con los resultados de la encuesta IPSOS- Bimsa para Population Council en la población Mexicana. Conclusiones. Debe ser creciente la calidad de atención a la salud reproductiva, se debe priorizar en la prevención de embarazos no deseados, orientando y educando a la población y ofreciendo métodos de planificación a hombres y mujeres con vida sexual activa.

Introduction: Unwanted pregnancy leads women to undergo abortion. According to the International Projects Assistance Services (IPAS), abortion and its complications are the 5th cause of maternal death in Mexico. However, in Mexico's Federal District (D.F.), it is legal to interrupt pregnancy before the 12th week of gestation, a situation which gives women the right to freely and voluntarily decide about their maternity. Objective: To characterize the people who enroll a Legal Pregnancy Interruption Program in a D.F. health sector's hospital. Methodology: Basic and descriptive study involving 61 women who were willing to enroll the program and be part of this study. We used a 27-item instrument. Results: Out of all participants (16 to 42 years old), 46% had home activities; 50% were single; 50% were married (or de-facto); and 23% said they were not using pregnancy-prevention methods. Among the main reasons to enroll the Legal Pregnancy Interruption Program were: economical problems (36%); unwanted pregnancy (20%); and being satisfied with the number of sons (20%). 82% reported a feeling of tranquility after having enrolled the program, and all of them reported having been treated with ethics and dignity. Discussion: In agreement with Gutmacher, pregnancy interruption legalization is in parallel with the increment in women's application to pregnancy interruption procedures. Findings on economical problems and unwanted pregnancy reasons were similar to those found in the Population Council's IPSOS-Bimsa survey on the Mexican population. Conclusions: Reproductive health attention must be enhanced, emphasizing unwanted pregnancy prevention programs and thus, orienting and offering people family planning methods.

Salmonella contamination during production of cantaloupe: a binational study.

Six cantaloupe farms and packing plants in South Texas (950 cantaloupe, 140 water, and 45 environmental samples), including the Rio Grande Valley area, and three farms in Colima State, Mexico (300 cantaloupe, 45 water, and 15 environmental samples), were sampled to evaluate cantaloupe contamination with Salmonella and Escherichia coli during production and processing. Samples collected from external surfaces of cantaloupes, water, and the environments of packing sheds on cantaloupe farms were examined for the presence of Salmonella and E. coli. Of a total of 1,735 samples collected, 31 (1.8%) tested positive for Salmonella. Fifteen Salmonella serotypes were isolated from samples collected in Texas, and nine from samples collected in Colima. Two serotypes (Poona and Oranienburg) that have been associated with three large Salmonella outbreaks in the United States and Canada linked to the consumption of contaminated cantaloupe were found in water samples collected at four farms (three from the United States). Susceptibility of Salmonella isolates to 10 antimicrobials was evaluated by disk diffusion. Eighty-eight percent of the isolates from the United States and Mexico were pansusceptible to the antimicrobials tested; eight isolates from the United States demonstrated an intermediate susceptibility to streptomycin and only two isolates were resistant to the same antimicrobial. From Mexico, four isolates showed an intermediate susceptibility to streptomycin and one isolate was resistant to nalidixic acid and streptomycin. Repetitive sequence-based PCR analysis of Salmonella isolates helped to trace potential sources of Salmonella contamination in source water and in subsequent water samples obtained after the filtration systems of U.S. and Mexican cantaloupe farms. No differences could be seen between the levels of Salmonella contamination in melons from both countries.

Melatonin, vitamin E, and estrogen reduce damage induced by kainic acid in the hippocampus: potassium-stimulated GABA release.

Melatonin, vitamin E and estrogen have been shown to exert neuroprotective effects against kainic acid (KA)-induced damage in the hippocampus. The aim of the present study was to examine the changes in potassium-evoked gamma-aminobutyric acid (GABA) release in the hippocampus of KA-treated rats and to test the possible protective effects of melatonin, vitamin E or estrogen. Following the treatment of mice with KA, a marked reduction in potassium-evoked [3H]GABA release was observed. Melatonin or estrogen prevented the reduction in potassium-evoked GABA release due to kainate administration. Vitamin E also exhibited some protective effect, but it was less than that provided by melatonin or estrogen. Melatonin, estrogen and, to a lesser extent, vitamin E reduce the physiological toxicity of KA. Since KA is believed to cause neuronal alterations via oxidative processes, it is assumed that the free radical scavenging and oxidative properties of melatonin, estrogen and vitamin E account for the protective effects of these agents.

Affective Bicultural and Global-Human Identity Scales for Mexican-American adolescents.

Scales were developed to measure affective aspects of Latino, American, and global-human identities among first- and second-generation Mexican-American adolescents. Participants were 84 boys and 93 girls from the Los Angeles high schools. 60 were born in Mexico, and 117 were born in the United States and had at least one parent born in Mexico. The affective Latino and American measures were independent and predictably related to a behaviorally oriented measure of acculturation. They were also used to identify Berry's four modes of acculturation: Separated, Assimilated, Marginalized, and Bicultural. The four acculturation groups rated similarly on self-esteem and academic aspiration. The first and second generations each scored higher on Latino identity than on American identity.

Pneumoconiosis en el Perú / Pneumoconiosis at Peru

En este trabajo se analiza la severidad de la pneumoconiosis, su relación con la antropología, la patogenia, el diagnóstico radiológico y su interpretación. Finalmente, se detallan algunas recomendaciones, previa historia ocupacional y radiografía del paciente