Antimicrobial Sensitivity Profile in Psittacine Birds at an Avian Teaching Hospital: A Retrospective Study, 2015-2022.

Veterinary hospitals house patient populations with diverse infectious statuses, microbiota, and histories of prior antibiotic therapy. Choanal swabs are commonly used for assessing the upper respiratory tract of birds for bacterial disease, with the samples submitted for cytologic testing and/or culture and antimicrobial sensitivity testing. The aim of this retrospective study was to identify and quantify bacteria isolated from choanal swabs collected from psittacine patients at a veterinary teaching hospital in Mexico City, Mexico. Data regarding bacterial isolates from choanal swabs were obtained from the medical records of companion psittacines suspected of upper respiratory bacterial disease that presented between November 2015 and December 2022. A total of 47.8% (175 of 366) of the bacterial isolates were from specimens obtained from red-lored Amazons (Amazona autumnalis). Gram-negative bacteria predominated, with 27 different genera identified. Klebsiella, Staphylococcus, and Escherichia were the most frequently isolated genera. A total of 90.4% (331 of 366) of the isolates were resistant to at least 1 antibiotic tested in the sensitivity panel, and a single Klebsiella isolate was resistant to 13 different antibiotics. Gentamicin had a high percentage of efficacy (79.5%; 182 of 229) against the bacterial isolates, whereas isolates tested against sulfonamide-trimethoprim (46.7%, 98 of 210), streptomycin (43.8%; 88 of 201), and clindamycin (12.9%; 15 of 116) had susceptibilities <50%. This is the first study to report common bacterial isolates and their antimicrobial susceptibility patterns from choanal swab samples collected from companion psittacines suspected of upper respiratory disease in Mexico. Clinicians can use the information presented in this study as a guide for therapeutic decision-making when managing upper respiratory bacterial infections in companion psittacine patients.

Looking at maternal health of Asháninka communities from the conceptual framework of the accessibility of care.

BACKGROUND: Peru is one of the 20 countries that has significantly reduced maternal mortality before the pandemic due to implementing policies to strengthen maternal health care, mainly in rural areas with greater poverty. However, the implementation of these policies has been different across the territory; such is the case of the indigenous communities of the Peruvian Amazon that are characterized by the inaccessibility of their territory and continue to face severe problems in accessing maternity care in health services. OBJECTIVE: Analyze the main dimensions of accessibility for maternal care in public health services for women of the Asháninka community of Peru between 2016 and 2018. METHODS: Qualitative research was carried out in the Asháninka community of the Tambo River. Key informants involved in maternal health care were selected, and 60 in-depth interviews were conducted that explored geographical, financial, cultural, and organizational accessibility. The interviews were recorded and transcribed into a word processor; then, a content analysis was performed to classify the texts according to the dimensions of specified accessibility. RESULTS: Geographical accessibility: health units in the territory do not have the resolution capacity to attend maternal health problems. Financial accessibility: the programs implemented by the government have not been able to finance the indirect costs of care, such as transportation, which has high costs that a family cannot afford, given their subsistence economy. Cultural: there are efforts for cultural adaptation of maternal care, but its implementation needs to be improved, and the community cannot recognize it due to the lack of continuity of the model and the high personnel turnover. Organizational: health units are characterized by insufficient human resources, supplies, and medicines that fail to offer continuous and quality care. CONCLUSIONS: The poor geographical, financial, cultural, and organizational accessibility that women from the Asháninka community face for maternal care in public health services are evident. So, the Peruvian government must review the implementation processes of its models of care and maternal health programs in these communities and propose strategies to improve the coverage, quality and continuity of maternal care.

Criminalización de las protestas sociales en el contexto del covid-19

Durante el proceso de confinamiento por covid-19, se presentaron diversas formas de protesta social que, aunado a la incapacidad de los Gobiernos latinoamericanos de manejar la crisis sanitaria ocasionada por la pandemia, demostraron en la mayoría de los casos que la respuesta del Estado a las movilizaciones y resistencias sociales fue la criminalización de la protesta social, a través de represión y detenciones arbitrarias para tratar de infundir miedo entre la población. Los movimientos generados en el contexto de la pandemia tuvieron diversas y novedosas aristas durante el confinamiento, entre estas el uso de las tecnologías de la información como uno de los elementos clave para la denuncia social y la organización de la protesta para la toma del espacio público. Por otra parte, las demandas de las protestas sociales se centraron principalmente en la insuficiente planeación estratégica de los Gobiernos ante la pandemia, en la precariedad y en el colapso de los sistemas de salud, en el incremento de la violencia de género, del desempleo, de la pobreza, de la desigualdad y de la violencia social.

During the covid-19 confinement process, various forms of social protest were presented, together with the inability of Latin American governments to manage the health crisis caused by the pandemic, demonstrated in most cases that the State's response to social mobilizations and resistance was the criminalization of social protest, through repression and arbitrary detentions to try to instill fear among the population. The movements generated in the context of the pandemic had several and novel edges during the confinement, among them: the use of information technologies as one of the key elements for social denunciation and the organization of protest for the seizure of public space. On the other hand, the demands of the social protests focused mainly on the insufficient strategic planning of governments in the face of the pandemic, on the precariousness and collapse of health systems, on the increase in gender violence, unemployment, poverty, inequality, and social violence.

Barreras y facilitadores en la implementación de guías de práctica clínica en México: perspectiva del personal de salud / Barriers and facilitators in the implementation of clinical practice guidelines in Mexico: perspective of health workers

Resumen: Objetivo: Identificar barreras, facilitadores y propuestas de mejora en la implementación de Guías de Práctica Clínica (GPC) desde la perspectiva de los profesionales de la salud. Material y métodos: Estudio cualitativo a través de 85 entrevistas semiestructuradas a responsables de implementación, difusión y aplicación, y del personal operativo en centros de atención primaria y hospitales en siete estados de México. El contenido fue codificado y analizado con ATLAS.ti 7.0. Resultados: Las principales barreras encontradas fueron la no actualización de las GPC y baja alineación con otras normas, e imposibilidad de implementarlas debido a la sobrecarga de trabajo y los recursos limitados. Conclusiones: El esfuerzo por implementar GPC parece haber sido errático e insuficiente, y la evaluación de su utilización inexistente. Se propone crear estrategias integradas y contextualizadas que resulten ser más efectivas y eficientes para la implementación exitosa de GPC.

Abstract: Objective: To identify barriers, facilitators and proposals for improvement in the implementation of CPG from the perspective of health professionals. Materials and methods: Qualitative study through 85 semi-structured interviews with those responsible for the implementation, dissemination and application activities, and of the operational personnel in primary care centers and hospitals in seven states of Mexico. The content was coded and analyzed with ATLAS.ti 7.0. Results: The main barriers found were the failure to update the CPGs and low alignment with other standards, and the impossibility of implementing them due to work overload and limited resources. Conclusions: The effort to implement CPG seems to have been erratic and insufficient, and the evaluation of its use non-existent. It is proposed to create integrated and contextualized strategies that prove to be more effective and efficient for the successful implementation of the CPG.

Adaptation and validation of the Screening Questionnaire for Family Abuse of the Elderly in the sociocultural context of Colombia.

In Colombia, like many countries in the world, due to the increase in population of elderly people, mistreatment has increased, which has physical, psychological and social consequences for the individual and major repercussions on society. The detection of abuse is a complex task, among other aspects, due to the concealment of victims and the lack of valid, reliable detection instruments that are in keeping with the sociocultural context. Professionals responsible for dealing with these situations must have an instrument that allows early detection. The objective of this study was to adapt and validate the Family Abuse Screening Questionnaire for Elderly People in Colombia. A cross-sectional study with mixed methods was carried out in two stages from 2017 to 2018. In the first stage, linguistic and semantic adaptation was carried out using translation, synthesis, back translation, expert analysis and pilot testing with 30 abused and non-abused elderly people. In the second stage, the validity and reliability of the questionnaire were obtained by means of an exploratory factor analysis and Cronbach's Alpha, using STATA 13. In the results, we provided a Socially and Culturally Adapted Family Abuse Screening Questionnaire for elderly people in Colombia with a Cronbach's Alpha of 0.82, sensitivity value of 86.9% (p < 0.05) and a specificity value of 84% (p < 0.05), detecting abuse with 4 or more positive responses to abuse. The application of the screening questionnaire by health and social services professionals will prevent further damage to social and physical health in the elderly people in Colombia, as well as reduce the costs of care in institutions.

Los Grupos de Ayuda Mutua como posible estrategia de apoyo emocional para personas indígenas que padecen diabetes / Mutual Aid Groups as a possible emotional support strategy for indigenous people with diabetes

Resumen: Objetivo: Reflexionar sobre el apoyo emocional que los Grupos de Ayuda Mutua (GAM) dan a personas indígenas con diabetes y su importancia en el apego al tratamiento. Material y métodos: Estudio cualitativo: 25 entrevistas semiestructuradas; tres grupos focales (17 participantes); y observación no participante. Se realizó análisis de contenido con el apoyo del programa Atlas-ti. Resultados: Se identificaron expresiones emocionales relacionadas con el padecimiento. La opinión sobre el trabajo grupal fue positiva. El GAM es un espacio de catarsis, pero no funciona como soporte para enfrentar las restricciones del tratamiento y el impacto emocional en caso de complicaciones mayores. Conclusiones: Con la debida capacitación del personal de salud a cargo de los grupos, los GAM pueden llegar a ser espacios de soporte emocional para las personas indígenas y contribuir a su bienestar.

Abstract: Objective: To think about the emotional support that Mutual Aid Groups (MAG) offer up to indigenous people with diabetes and their importance in adherence to treatment. Materials and methods: Qualitative study: 25 semi-structured interviews; 3 focus groups (17 participants); and non-participant observation. Content analysis was carried out with the support of the Atlas-ti program. Results: We identified emotional expressions related to the disease. The opinion about MAGs and group work was positive. The MAG is a catharsis space, but it does not work as a support to face the restrictions of the treatment and the emotional impact in case of major complications. Conclusions: With proper training of the health personnel in charge of the groups, MAGs can become emotional support spaces for indigenous people and contribute to their well-being.

Barreras y facilitadores en la implementación de guías de práctica clínica en México: perspectiva del personal de salud.

Objetivo. Identificar barreras, facilitadores y propuestas de mejora en la implementación de Guías de Práctica Clínica (GPC) desde la perspectiva de los profesionales de la salud. Material y métodos. Estudio cualitativo a través de 85 entrevistas semiestructuradas a responsables de implementa-ción, difusión y aplicación, y del personal operativo en centros de atención primaria y hospitales en siete estados de México. El contenido fue codificado y analizado con ATLAS.ti 7.0. Resultados. Las principales barreras encontradas fueron la no actualización de las GPC y baja alineación con otras normas, e imposibilidad de implementarlas debido a la sobre-carga de trabajo y los recursos limitados. Conclusiones. El esfuerzo por implementar GPC parece haber sido errático e insuficiente, y la evaluación de su utilización inexistente. Se propone crear estrategias integradas y contextualizadas que resulten ser más efectivas y eficientes para la implementación exitosa de GPC.

Manejo de pacientes con síndrome mielodisplásico en época COVID-19 / Management of patients with Myelodysplastic Syndrome in the COVID-19 era

Resumen La infección por coronavirus 2 del síndrome respiratorio agudo grave ha provocado un cambio en la forma de atender a los pacientes con enfermedades hematológicas en todo el mundo. Los pacientes con síndrome mielodisplásico (SMD) se han visto afectados por la ausencia de conocimiento del comportamiento de la enfermedad por coronavirus 2019 (COVID-19) en este tipo de padecimiento. Se han establecido lineamientos internacionales que han permitido continuar con la atención de dichos pacientes. El principal objetivo de esta revisión es definir las medidas preventivas y las estrategias de tratamiento que se deben de tomar al momento de evaluar a un paciente con SMD en la época COVID-19.

Abstract SARS-CoV-2 infection has caused a change in the way we care for patients with hematological diseases around the world. Patients with myelodysplastic syndrome (MDS) have been affected by the lack of knowledge of the behavior of COVID-19 in this type of condition. International guidelines have been established that have made it possible to continue caring for these patients. The main objective of this review is to define the preventive measures and treatment strategies that should be taken when evaluating a patient with myelodysplastic syndrome in the COVID-19 era.

Health needs of indigenous Mayan older adults in Mexico and health services available.

Current data indicate that inequitable health service access is one of the major problems faced by indigenous people in Mexico and around the world. The aim of this study was to analyse the perceived health needs of indigenous older adults in a Mayan region of Mexico and the health services provided to address these needs. It used a qualitative design which explored health needs, perceptions of well-being, experiences with public health services and obstacles in accessing services through semi-structured interviews with 20 older adults, nine traditional healers and seven public healthcare providers from Mayan municipalities in southeastern Mexico during 2013-2014. We identified that cultural differences related to the language, values, beliefs and worldview of indigenous populations are ignored or incorporated only minimally by health services. The provision of services does not correspond to the health needs of indigenous Mayan older adults, and wide gaps still undermine their human rights and health status; despite the establishment of favourable regulations, healthcare services are organised for the non-indigenous population. The conditions of social vulnerability affecting indigenous older adults require that healthcare institutions incorporate an intercultural approach in order to improve the quality of care according to the necessities of the population.

Los Grupos de Ayuda Mutua como posible estrategia de apoyo emocional para personas indígenas que padecen diabetes.

Objetivo. Reflexionar sobre el apoyo emocional que los Grupos de Ayuda Mutua (GAM) dan a personas indígenas con diabetes y su importancia en el apego al tratamiento. Material y métodos. Estudio cualitativo: 25 entrevistas semiestructuradas; tres grupos focales (17 participantes); y observación no participante. Se realizó análisis de contenido con el apoyo del programa Atlas-ti. Resultados. Se identificaron expresiones emocionales relacionadas con el padecimiento. La opinión sobre el trabajo grupal fue positiva. El GAM es un espacio de catarsis, pero no funciona como soporte para enfrentar las restricciones del tratamiento y el impacto emocional en caso de complicaciones mayores. Conclusiones. Con la debida capacitación del personal de salud a cargo de los grupos, los GAM pueden llegar a ser espacios de soporte emocional para las personas indígenas y contribuir a su bienestar.

Zombie bugs? Manipulation of kissing bug behavior by the parasite Trypanosoma cruzi.

The parasite manipulation hypothesis states that the parasite modifies host's behavior thereby increasing the probability that the parasite will pass from an intermediate host to its final host. We used the kissing bugs Triatoma pallidipennis and T. longipennis and two isolates of the Trypanosoma cruzi parasite (Chilpancingo and Morelos) to test these ideas. These insects are intermediate hosts of this parasite, which is the causal agent of Chagas disease. The Chilpancingo isolate is more pathogenic than the Morelos isolate, in the bugs. We expected that infected bugs would be more active and likely at detecting human-like odors. Given the differences in pathogenicity between isolates, we expected the Chilpancingo isolate to induce these effects more strongly and lead to higher parasite number than the Morelos isolate. Finally, infected bugs would gain less mass (a mechanism thought to increase bite rate, and thus transmission) than non-infected bugs. Having determined that both isolate haplotypes belong to the Tc1a group, we found that: (a) young instars of both species were more active and likely to detect human odor when they were infected, regardless of the isolate; (b) there was no difference in parasite abundance depending on isolate; and, (c) infected bugs did not end up with less weight than uninfected bugs. These results suggest that T. cruzi can manipulate the bugs, which implies a higher risk to contract Chagas disease than previously thought.

Post-treatment improvement of NK cell numbers predicts better survival in myeloma patients treated with thalidomide-based regimens.

Multiple myeloma (MM) is a disease characterized by antitumoral immune dysfunction. The objective of the present study was to determine lymphocyte subsets (B, T, NK, NKT, iNKT, dendritic cells, and regulatory T cells) in 68 newly diagnosed patients and 113 healthy donors. Lymphocyte subsets were studied in the same patients 6 months after treatment. Pre-treatment values of CD4+ T cells, NK cells, type 2 dendritic cells, and B cells in MM patients were lower than in healthy donors. Forty patients (59%) received MPT treatment and 28 (41%) thal-dex. Patients with no response to treatment, exhibited a decrease in CD4+ T cells and NK cells, as well as an increase in Treg cell numbers. Median DFS and OS was lower in patients not achieving response, in patients having low numbers of NK cells, and higher values of LDH. The number of CD4 T cells, NK, DC2, and B cells at diagnosis is lower in patients with MM. Non-responder patients had lower CD4 and NK, but higher Treg cell values. Patients in which response is not achieved, and those holding lower values of NK cells and higher levels of LDH, have poor DFS and OS.

Development and validation of a Screening Questionnaire of Family Mistreatment against Older Adults for use in primary care settings in Mexico.

The abuse of older adults is a serious public health issue that can be difficult to identify at the first level of care. Medical and nursing personnel are sometimes unable to identify older adults who suffer family mistreatment. This can occur when victims feel shame or as a result of cultural factors. In the light of this, healthcare personnel require a screening tool that can be used to identify signs of mistreatment. The aim of this study was to develop and validate a screening tool for detecting the familial mistreatment of older adults in primary care settings. A mixed method cross-sectional study was carried out in three phases between 2009 and 2012 in Mexico. The formative phase involved using a qualitative methodology to identify terms that older adults use to identify practices defined as forms of mistreatment. On this basis, the second phase involved the design of a screening tool through the formation of items in collaboration with a panel of experts. These items were tested on older adults to ensure their intelligibility. Finally, validity and reliability levels were evaluated through the application of the screening tool to a sample of older adults at a primary care facility and at a legal centre. These findings were discussed with gerontologists, and the data were analysed through an exploratory factor analysis with orthogonal rotation and Cronbach's alpha using STATA v13. From the results, we generated a screening tool that is culturally and socially tailored to older adults in Mexico. The tool has a Cronbach's alpha of 0.89, a sensitivity value of 86% (p < .05) and a specificity value of 90% (p < .05) for positive answers to the tool's 15 items. Applying this tool at the first level of care could limit damage to older adults' health and could lower the frequency of emergency room use in hospitals.

Significado de salud: la vivencia del adulto mayor / Meaning of Health: The Experience of the Elderly / Significado de saúde: a vivência do idoso

RESUMEN Durante la vejez, el significado de salud se basa en alcanzar un estado de bienestar; por ello, es importante comprender los factores que benefician o afectan el logro de este propósito. Objetivo: analizar los significados de salud que los adultos mayores construyen a partir de sus vivencias y experiencias. Materiales y métodos: investigación cualitativa con técnica de análisis de contenido y entrevista semiestructurada. Participaron veinte adultos mayores, que acudieron a un centro de atención geriátrica, seleccionados de manera intencionada y determinada por índice de saturación. Resultados: el significado de salud se manifiesta en la capacidad de poder hacer cosas; así, la salud se concibe como un medio útil para obtener un beneficio, ya sea material, moral o físico. Los vínculos familiares son importantes, incluso los comparan con la salud; también, identifican la salud con la ausencia de dolor y enfermedad. Conclusión: la salud del adulto mayor es vivida en contexto familiar; el bienestar es percibido como la capacidad de hacer cosas, aunque el dolor y la enfermedad estén presentes.

ABSTRACT The meaning of health during old age is based on achieving a state of well-being. Therefore, it is important to understand the factors that benefit or affect accomplishing that goal. Objective: Analyze what health means to older adults, based on their experiences. Materials and methods: This is a qualitative study based on content analysis and semi-structured interviews. Twenty elderly adults who frequented a geriatric care center were selected intentionally and determined by means of a saturation index. Results: The meaning of health is manifest in the ability to do things. Accordingly, health is conceived as a useful means to obtain a benefit, be it material, moral or physical. Family ties are important and were even compared to health. The participants also equated health with the absence of pain and disease. Conclusion: Health is experienced by the elderly in a family context. Well-being is perceived as the ability to do things, even if pain and illness are present.

RESUMO Durante a velhice, o significado de saúde está baseado em atingir um estado de bem-estar; por isso, é importante compreender os fatores que beneficiam ou afetam conquistar esse propósito. Objetivo: analisar os significados de saúde que os idosos constroem a partir de suas vivências e experiências. Materiais e método: pesquisa qualitativa com técnica de análise de conteúdo e entrevista semiestruturada. Participaram vinte idosos que foram a um centro de atenção geriátrica, selecionados de maneira intencionada e determinada por índice de saturação. Resultados: o significado de saúde se manifesta na capacidade de poder fazer coisas; assim, a saúde é concebida como um meio útil para obter um benefício - material, moral ou físico. Os vínculos familiares são importantes, inclusive os comparam com a saúde; também identificam a saúde com a ausência de dor e doença. Conclusões: a saúde do idoso é vivida em contexto familiar; o bem-estar é percebido como a capacidade de fazer coisas, embora a dor e a doença estejam presentes.

Aging in rural, indigenous communities: an intercultural and participatory healthcare approach in Mexico.

From an ethno-gerontological perspective, new models are needed to fulfill the health needs of the indigenous older adult population in Mexico. In this paper we developed a comprehensive healthcare model, interculturally appropriate, designed to meet the needs of Mexican indigenous older adults. The model was constructed using a qualitative design with semi-structured interviews of older adults, health providers, and available health resources in three Mexican indigenous regions. An ethnographical review was carried out to contextually characterize these communities. At the same time, a comprehensive bibliographic revision was made to identify socio-demographic markers. Results pointed out that Mexican indigenous older adults are not covered by any type of social health insurance program. Their health problems tend in large part to be chronic in nature due to the lack of early diagnosis and treatment. There is a need for trained human resources in the field of gerontology encompassing the sociocultural context of the indigenous groups. The geographical location of these communities limits the permanent presence of healthcare givers and thus limits access to continuous care. Traditional healthcare givers, able to speak the native language, are a great asset allowing the invaluable possibility of direct verbal communication. Based upon the data gathered from indigenous older adults and service providers, in tandem with evidence from the literature, we identified key elements for successful intervention and designed an intervention model. We concluded that indigenous older adults are a more vulnerable group, given that aside from being elderly in a country where the health needs of these populations exceed the capacity of existing healthcare services, their ethnicity serves as an added barrier preventing their access to the limited available healthcare resources. To achieve uniformity in providing health care, today's health systems need to address intercultural and participative aspects of healthcare models.

Revisión de la enfermedad del pulmón de granjero / Farmer's Lung Disease. A Review

La enfermedad del pulmón de granjero (EPG) es una forma de neumonitis por hipersensibilidad (NH) producida por la inhalación de microorganismos procedentes del heno o grano almacenado en condiciones de alta humedad en el ámbito laboral agrícola. Se trata de una enfermedad probablemente infradiagnosticada, sobre todo en el Norte de España, donde las condiciones climáticas son propicias para el desarrollo de la misma. Según estudios previos los antígenos más frecuentes suelen ser hongos y actinomicetos termofílicos. La epidemiología de la enfermedad no es del todo bien conocida, y se basa en estudios realizados por grupos centroeuropeos y asiáticos. La presentación clínica puede ser variada, diferenciándose las formas agudas (tras exposición a elevadas concentraciones del antígeno) y las crónicas (exposición a menores concentraciones del antígeno, pero más prolongada en el tiempo). En estos casos es esencial, en aquellos pacientes con clínica respiratoria durante la exposición laboral agrícola, demostrar una radiología y función pulmonar compatible, así como una sensibilización al antígeno, una linfocitosis en el lavado broncoalveolar en su caso y/o una anatomía patológica concordante. El tratamiento principal es la evitación antigénica, por lo que la educación de los pacientes en las medidas preventivas es fundamental. Por el momento, no existen estudios controlados que permitan evaluar el papel de tratamientos inmunosupresores en esta enfermedad. El tratamiento con corticosteroides solo ha demostrado acelerar la resolución de las formas agudas, pero no hay estudios que demuestren su efectividad a largo plazo, con el fin de evitar la progresión de la enfermedad ni disminuir su mortalidad

Farmer's lung disease (FLD) is a form of hypersensitivity pneumonitis (HP) caused by inhaling microorganisms from hay or grain stored in conditions of high humidity in the agricultural workplace. It is probably underdiagnosed, especially in northern Spain, where climatic conditions favor the development of this disease. According to previous studies, the most common antigens are usually thermophilic actinomycetes and fungi. The epidemiology of the disease is not well known, and is based on studies conducted by Central European and Asian groups. The clinical presentation may vary, differentiating the chronic (exposure to lower concentrations of the antigen over a longer period time) and the acute forms (after exposure to high concentrations of the antigen). In patients with respiratory symptoms and agricultural occupational exposure, radiological, lung function and/or anatomical pathology findings must be compatible with FLD, bronchoalveolar lavage must show lymphocytosis, and tests must find sensitivity to the antigen. The main treatment is avoidance of the antigen, so it is essential to educate patients on preventive measures. To date, no controlled studies have assessed the role of immunosuppressive therapy in this disease. Corticosteroid treatment has only been shown to accelerate resolution of the acute forms, but there is no evidence that it is effective in preventing disease progression in the long-term or reducing mortality

Prevalence and factors associated with violence and abuse of older adults in Mexico's 2012 National Health and Nutrition Survey.

BACKGROUND: Factors associated with violence and the abuse of older adults are understudied and its prevalence in Mexico has not been reported. The aim of this study was to identify the prevalence and factors associated with violence and abuse of older adults in Mexico. METHODS: We used Mexico's 2012 National Health and Nutrition Survey, which included a sample of 8,894 individuals who are 60 years or older and who self-reported a negative health event related to robbery, aggression or violence in the previous 12 months. We used chi-squared test and Fisher's exact test to analyze the variables related to violence. Adjusted estimates were completed with multiple logistic regression models for complex surveys. RESULTS: The prevalence of violence was 1.7 % for both men and women. In 95 % of the cases, the aggression was from an unknown party. Verbal aggressions were the most prevalent (60 %). Among men, physical aggression was more common. Violence frequently occurred in the home (37.6 %); however, men were primarily assaulted in public places (42.4 %), in comparison to women (30.7 %). There were also differences in the risk factors for violence. Among men, risk was associated with younger age (60-64 years), higher education (secondary school or above) and higher socioeconomic status. Among women, risk was associated with depression, not being the head of the family, and region of the country. CONCLUSIONS: Violence against older adults presents differently for men and women, which means it is necessary to increase knowledge about the dynamics of the social determinants of violence, particularly in regards to the role of education among men. The relatively low prevalence found in this study may reflect the difficulty and fear of discussing the topic of violence. This may occur because of cultural factors, as well as by the perception of helplessness perpetuated by the scarce access to social programs that ensure protection and problem solving with regards to the complex social determinants of individual and family violence that this population group endures.

Farmer's Lung Disease. A Review. / Revisión de la enfermedad del pulmón de granjero.

Farmer's lung disease (FLD) is a form of hypersensitivity pneumonitis (HP) caused by inhaling microorganisms from hay or grain stored in conditions of high humidity in the agricultural workplace. It is probably underdiagnosed, especially in northern Spain, where climatic conditions favor the development of this disease. According to previous studies, the most common antigens are usually thermophilic actinomycetes and fungi. The epidemiology of the disease is not well known, and is based on studies conducted by Central European and Asian groups. The clinical presentation may vary, differentiating the chronic (exposure to lower concentrations of the antigen over a longer period time) and the acute forms (after exposure to high concentrations of the antigen). In patients with respiratory symptoms and agricultural occupational exposure, radiological, lung function and/or anatomical pathology findings must be compatible with FLD, bronchoalveolar lavage must show lymphocytosis, and tests must find sensitivity to the antigen. The main treatment is avoidance of the antigen, so it is essential to educate patients on preventive measures. To date, no controlled studies have assessed the role of immunosuppressive therapy in this disease. Corticosteroid treatment has only been shown to accelerate resolution of the acute forms, but there is no evidence that it is effective in preventing disease progression in the long-term or reducing mortality.

Tratamiento de periodontitis agresiva localizada con plasma rico en plaquetas y aloinjerto óseo: Un caso clínico / Treatment of localized aggressive periodontitis with platelet-rich plasma and bone allograft: Clinical case report

Introducción: El plasma rico en plaquetas ha emergido como una alternativa en la terapia periodontal. Hoy tenemos una curva de aprendizaje basada en la evidencia que nos muestra una primera etapa donde se utilizó como biomaterial cementante y como estimulante de la regeneración de tejido óseo. En una segunda etapa actual se aplica para la curación de heridas en tejidos blandos basado y fundamentado en la evidencia biológica, lo que ha generado grandes expectativas en varias especialidades médicas, entre las que se encuentra la odontología. Método: Se presenta un caso clínico de una paciente de 29 años de edad, no fumadora y sin enfermedad sistémica, la cual fue captada en la DEPeI de la UNAM. El diagnóstico fue una periodontitis agresiva localizada. Después de la fase I se le realizó una cirugía por colgajo con PRP y aloinjerto óseo. Resultados: Se valoró a la paciente a los 6 y 12 meses después del tratamiento y se clasificó como paciente de bajo riesgo a la recurrencia de enfermedad periodontal durante el mantenimiento con base en los seis parámetros del Dr. Lang y Tonetti. Conclusiones: El clínico de hoy entiende cada vez más la necesidad de tomar decisiones basadas en la evidencia científica. Hasta este momento, sabemos que biológicamente es posible que una concentración más alta de plaquetas puede ayudar en la cicatrización.

Introduction: Platelet-rich plasma (PRP) has emerged as an alternative in periodontal therapy. Presently, there is an evidence-based learning curve showing a first stage when it was used as cementing biomaterial as well as bone tissue regeneration stimulant. In a second current stage based and substantiated on biological evidence, it is applied for soft tissue wounds healing. This has elicited great expectations in several medical specialties, including dentistry. Method: The case here presented is of a healthy, non-smoker, 29 year old female patient who attended the Graduate and Research School, National School of Dentistry, National University of Mexico (UNAM). Diagnosis emitted was localized aggressive periodontitis. After phase I, the patient was subjected to flap surgery with PRP and bone allograft. Results: The patient was assessed 6 and 12 months after treatment. Based on the six maintenance parameters established by Drs. Lang and Tonetti, she was classified as presenting low risk of periodontal disease recurrence. Conclusions: Today's clinical operator increasingly understands the need of making decisions based upon scientific evidence. To the present date we recognize that it is biologically possible for a higher platelet concentration to foster healing.