Strategies for case-based training with virtual patients: An experimental study of the impact of integrating mental model articulation and self-reflection.

Resilient system performance in high-stakes settings, which includes the ability to monitor, respond, anticipate, and learn, can be enhanced for trainees through simulation of realistic scenarios enhanced by augmented reality. Active learning strategies can enhance simulation-based training, particularly the mental model articulation principle where students are prompted to anticipate what will happen next and the reflection principle where students self-assess their performance compared to a gold standard expert model. In this paper, we compared simulation-based training for trauma care with and without active learning strategies during pauses in the simulated action for progressively deteriorating patients. The training was conducted online and real-time without a facilitator, with 42 medical students viewing training materials and then immediately taking an online quiz for three types of trauma cases: hemorrhage, airway obstruction, and tension pneumothorax. Participants were randomly assigned to either the experimental or control condition in a between-subjects design. We compared performance in the control and experimental conditions based on: A) the proportion of cues correctly recognized, B) the proportion of accurate diagnoses, C) the proportion of appropriate treatment interventions, and D) verbal briefing quality on a 1-5 scale. We found that the training intervention increased recognition of subtle cues critical for accurate diagnosis and appropriate treatment interventions; the training did not improve the accuracy of diagnoses or the quality of the verbal briefing. We conclude that incorporating active learning strategies in simulation-based training improved foundational capabilities in detecting subtle cues and intervening to rescue deteriorating patients that can increase the readiness for trainees to contribute to resilient system performance in the high-stakes setting of emergency care in hospitals.

Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis.

INTRODUCTION: Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies. METHODS: We screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale. RESULTS: We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.Pregnant women with SARS-CoV-2 infection-as compared with uninfected pregnant women-were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12).Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias. CONCLUSIONS: This analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol.

Ozone precursors and boundary layer meteorology before and during a severe ozone episode in Mexico city.

Volatile organic compounds (VOCs) data in conjunction with other inorganic pollutants, surface meteorological data and continuous measurement of the Planetary Boundary Layer height (PBLH) at an urban site in Mexico City were performed from 6 to 18 March 2016. Positive Matrix Factorization (PMF) identified four emission source factors of VOCs along with equivalent black carbon (eBC), gaseous pollutants (CO, NO, NO2, SO2, NH3) and ions (Na+, Mg2+, Ca2+, NO3-, NH4+): (1) secondary aerosol precursors, (2) evaporation and non-LPG fuel combustion, (3) geogenic source and (4) vehicle exhaust. Propylene Equivalent and Maximum Incremental Reactivity (MIR) methods identified isoprene and ethylene as the highest oxidant and O3 forming species. Pollutant data normalized to the variation of the PBLH revealed continued production of O3 precursors in the afternoon beyond the typical morning rush hour. In particular this could be observed during the second part of the measurement period (12-15 March) when a strong O3 episode occurred under weak wind and lower PBLH conditions compared to the preceding period (6-11 March) when well mixed conditions due to elevated daytime PBLH and strong advection led to overall reduced pollutant mixing ratios in the afternoon hours.

Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: a sequential, prospective meta-analysis.

OBJECTIVE: This sequential, prospective meta-analysis sought to identify risk factors among pregnant and postpartum women with COVID-19 for adverse outcomes related to disease severity, maternal morbidities, neonatal mortality and morbidity, and adverse birth outcomes. DATA SOURCES: We prospectively invited study investigators to join the sequential, prospective meta-analysis via professional research networks beginning in March 2020. STUDY ELIGIBILITY CRITERIA: Eligible studies included those recruiting at least 25 consecutive cases of COVID-19 in pregnancy within a defined catchment area. METHODS: We included individual patient data from 21 participating studies. Data quality was assessed, and harmonized variables for risk factors and outcomes were constructed. Duplicate cases were removed. Pooled estimates for the absolute and relative risk of adverse outcomes comparing those with and without each risk factor were generated using a 2-stage meta-analysis. RESULTS: We collected data from 33 countries and territories, including 21,977 cases of SARS-CoV-2 infection in pregnancy or postpartum. We found that women with comorbidities (preexisting diabetes mellitus, hypertension, cardiovascular disease) vs those without were at higher risk for COVID-19 severity and adverse pregnancy outcomes (fetal death, preterm birth, low birthweight). Participants with COVID-19 and HIV were 1.74 times (95% confidence interval, 1.12-2.71) more likely to be admitted to the intensive care unit. Pregnant women who were underweight before pregnancy were at higher risk of intensive care unit admission (relative risk, 5.53; 95% confidence interval, 2.27-13.44), ventilation (relative risk, 9.36; 95% confidence interval, 3.87-22.63), and pregnancy-related death (relative risk, 14.10; 95% confidence interval, 2.83-70.36). Prepregnancy obesity was also a risk factor for severe COVID-19 outcomes including intensive care unit admission (relative risk, 1.81; 95% confidence interval, 1.26-2.60), ventilation (relative risk, 2.05; 95% confidence interval, 1.20-3.51), any critical care (relative risk, 1.89; 95% confidence interval, 1.28-2.77), and pneumonia (relative risk, 1.66; 95% confidence interval, 1.18-2.33). Anemic pregnant women with COVID-19 also had increased risk of intensive care unit admission (relative risk, 1.63; 95% confidence interval, 1.25-2.11) and death (relative risk, 2.36; 95% confidence interval, 1.15-4.81). CONCLUSION: We found that pregnant women with comorbidities including diabetes mellitus, hypertension, and cardiovascular disease were at increased risk for severe COVID-19-related outcomes, maternal morbidities, and adverse birth outcomes. We also identified several less commonly known risk factors, including HIV infection, prepregnancy underweight, and anemia. Although pregnant women are already considered a high-risk population, special priority for prevention and treatment should be given to pregnant women with these additional risk factors.

Intentional Storytelling to Sustain Low-cost/Free Breast Cancer Services: A Latina Example of Community-driven Advocacy.

BACKGROUND: Community-based public health advocacy efforts are crucial to sustaining the low-cost/free breast cancer services that support underserved populations. OBJECTIVES: We introduce two ways in which narrative theory may be a useful tool for developing advocacy materials and provide an example, using a community-academic partnership to promote Latina breast health in Chicago, Illinois. METHODS: Community and academic partners 1) engaged 25 Spanish-speaking Latinas in an advocacy workshop, 2) leveraged narrative theory to develop multi-media advocacy materials, and 3) disseminated materials to policymakers. LESSONS LEARNED: Our project highlights 1) that narrative theory may be useful to describe how Latinas engage policy-makers in relation to their needs and cultural norms, 2) the importance of flexibility and offering community members multiple options to engage policymakers, and 3) the importance of leveraging partners' complementary strengths. CONCLUSIONS: Narrative theory may be a useful tool for developing advocacy materials in community-academic partnerships.

Effects of post-ovariectomy time frame and age on the antidepressant-like actions of estradiol and prolame in female rats.

Estrogen replacement therapy (ERT) is an effective treatment for symptoms associated with climacteric and depression some women experience during perimenopause and menopause. The antidepressant-like effects of ERT may depend on the type of estrogen, age, and time when restitution is initiated after hormonal decline. Prolame is a synthetic steroid with estrogenic and antidepressant-like effects that may produce fewer adverse effects. We hypothesize that such actions of prolame on females depend on age and the duration of hormone deprivation period. We assessed the antidepressant-like effects of 17ß-estradiol (E2) and prolame in young and middle-aged rats across different post-ovariectomy (Ovx) time frames. Independent groups of young adults and middle-aged female rats were tested in the forced swimming test (FST) at 3, 8, 16, and 24 weeks post-Ovx. Prolame and E2 were administered in a sub-chronic schedule consisting of three injections before the FST. Likewise, the utero-trophic effects of these hormones were analyzed. We found that E2 and prolame reduced immobility in young rats 3 and 8 weeks after Ovx; in contrast, only prolame produced this effect in middle-aged rats three weeks post-Ovx. E2 and prolame increased the animals' utero-somatic index at all post-Ovx times, but the action of E2 and prolame produced a greater response in young adult rats. Our findings showed that the antidepressant-like effects of E2 and prolame depend on the post-Ovx time frame, age, and estrogen type. Interestingly, our results indicate that, in contrast to E2, prolame maintained its antidepressant effect in middle-aged rats.

Maternal outcomes and risk factors for COVID-19 severity among pregnant women.

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease.

Comparing Different Interventions' Effects on Latinas' Screening Mammography Attainment and Participant-Driven Information Diffusion.

Evaluation of multiple community-based approaches to improve Latinas' breast cancer (BC) screening utilization has resulted in inconsistent findings. Factors contributing to this variation include heterogeneity in approaches (e.g., types of conceptual frameworks) and study quality (e.g., lack of measurement of spillover effects). This pilot study sought to clarify which approach may be most effective by evaluating the relative efficacy of two conceptual approaches using an area-level design with 145 Latinas nonadherent to U.S. Preventive Services Taskforce (USPSTF) BC screening guidelines. Each study arm included identical intervention format and duration (e.g., three group-based sessions, logistic assistance (LA) via five monthly calls and referral to free/low-cost screening programs). However, study content differed. While educate+LA addressed participants' BC prevention and screening behavior, empower+LA addressed participants' and their social networks' BC screening. After adjusting for age, insurance status, and baseline mammography intention, when compared with educate+LA participants, empower+LA participants were more likely to report obtaining mammograms, engaging more individuals about BC, initiating BC conversations in public settings, and discussing mammography specifically. Our study has important implications regarding the utility of evaluating behavioral interventions overall in terms of behavioral and spillover network effects.

Antidepressant-like effects of acupuncture via modulation of corticosterone, sex hormones, and hippocampal BDNF expression in male rats.

BACKGROUND: Post-weaning social isolated rodents exhibit pathophysiological changes associated with depression including adrenal axis hyperactivity, gonadal hormone level disturbances, molecular alterations in hippocampus, and immobility behavior in the forced swimming test (FST). Although acupuncture by absorbable thread implantation (acu-catgut, AC) elicits antidepressant-like effects in social isolated rats, AC effects on neuroendocrine and hippocampal molecular alterations have been less characterized. OBJECTIVE: To investigate the participation of gonadal hormones, corticosterone, and brain-derived neurotrophic factor (BDNF) hippocampal expression, on the AC antidepressant-like effects in social isolated male rats. METHODS: Sprague-Dawley male rats were raised in social isolation (SI) or standard conditions, for 11 weeks. AC (on Baihui (Du20), Yintang (E X-HN3), Shenshu (BL 23), Pishu (BL 20), Ganshu (BL 18), Xinshu (BL 15) and Guanyuan (Ren 4)), or Sham-AC (puncturing of acupoints without embedding the thread), was applied during the last three weeks of isolation period. Rats were evaluated in the FST; hormones plasmatic levels and hippocampal BDNF content were quantified by ELISA and Western blotting, respectively. RESULTS: Social isolated rats showed more immobility in the FST and had lower testosterone and estradiol levels, higher corticosterone levels, and reduced hippocampal BDNF content than controls. BDNF level in hippocampus inversely correlated to depression-like behavior. AC but not sham-AC normalized immobility behavior, steroid hormone levels, and BDNF content, as in rats raised in a social environment. CONCLUSIONS: AC antidepressant effect could be related to an improvement of hippocampal BDNF protein expression, as well as corticosterone and sex hormones disturbances associated with prolonged exposure to stress caused by social isolation. Present findings have implications for depression treatment in individuals early exposed to stress.

Actualización de la infección por Chlamydia trachomatis en mujeres / Update of Chlamydia trachomatis infection in women

La infección por Chlamydia trachomatis es la infección de transmisión sexual bacteriana más frecuente en el mundo. En este artículo se revisa la prevalencia reportada en Chile, cuadro clínico, diagnóstico, tratamiento, prevención y complicaciones a largo plazo en mujeres.

Chlamydia trachomatis infection is known to be the most common sexually transmitted bacterial infection world-wide. This article reviews the prevalence reported in the Chilean population, as well as the clinical manifestations, diagnosis, treatment, prevention and complications in women

Method to allocate voting resources with unequal ballots and/or education.

Apportionment in election systems refers to determination of the number of voting resources (poll books, poll workers, or voting machines) needed to ensure that all voters can expect to wait no longer than an appropriate amount, even the voter who waits the longest. Apportionment is a common problem for election officials and legislatures. A related problem is "allocation," which relates to the deployment of an existing number of resources so that the longest expected wait is held to an appropritate amount. Provisioning and allocation are difficult because the numbers of expected voters, the ballot lengths, and the education levels of voters may all differ significantly from precinct-to-precinct in a county. Consider that predicting the waiting time of the voter who waits the longest generally requires discrete event simulation.•The methods here rigorously guarantee that all voters expect to wait a prescribed time with a bounded probability, e.g., everyone expects to wait less than thirty minutes with probability greater than 95%.•The methods here can handle both a single type of resource (e.g., voting machines or scan machines) and multiple resource types (e.g., voting machines and poll books).•The methods are provided in a freely available, easy-to-use Excel software program.

Influence of the type of childhood violence on cannabis abuse and dependence among adolescents: a systematic review and meta-analysis. / Tipos de violencia en la infancia que inciden en el abuso y dependencia de cannabis entre adolescentes: una revisión sistemática y metaanálisis.

The use of cannabis for recreational purposes has increased worldwide, and the proportion of cannabis users in the adolescent population is high. Susceptibility to cannabis use involves various factors, including childhood adversity; however, the effects of different types of violence on cannabis use have not been evaluated. The aim of this review was to analyze the effects of different types of violence on cannabis use in adolescence. We searched electronic databases (PubMed, Science Direct, Web of Science, Ovid and CONRICyT) using the following algorithm: (("Cannabis" OR "Marijuana Smoking" OR "Marijuana Abuse") AND ("Child Abuse" OR "Domestic Violence" AND "Adolescent")), considering all articles published up to November 3th, 2017. Odds ratios (ORs) were calculated for the effects of experiencing different types of violence during childhood on cannabis use. Six studies, which represented 10 843 adolescents of both sexes, were ultimately included in the systematic review and meta-analysis. Three types of early-life adversity were associated with cannabis abuse/dependence: physical abuse (OR: 1.58, 95% CI [1.01-2.46]), sexual abuse (OR: 2.35, 95% CI [1.64-3.35]), and witnessing violence (OR: 3.22, 95% CI [0.63-16.54]). The results indicated that two specific types of child maltreatment, sexual and physical abuse, were critical factors affecting vulnerability to cannabis use in adolescence. The number of studies examining other types of violence was limited. The results highlighted the importance of enhancing efforts to prevent violence, particularly sexual abuse, as part of integral programs designed to prevent cannabis abuse and dependence.

El uso recreativo de cannabis ha incrementado en todo el mundo, principalmente en la población adolescente. Se ha propuesto que la adversidad en la infancia contribuye al consumo de esta droga. El objetivo de esta revisión sistemática y metaanálisis fue analizar el efecto de diferentes tipos de violencia en la infancia sobre el consumo de cannabis en la adolescencia. Se realizó una búsqueda en diferentes bases de datos (PubMed, Science Direct, Web of Science, Ovid y CONRICyT) usando los términos de búsqueda: (("Cannabis" OR "Marijuana Smoking" OR "Marijuana Abuse") AND ("Child Abuse" OR "Domestic Violence" AND "Adolescent")), considerando todos los artículos publicados hasta el 3 de noviembre de 2017. Se calcularon los Odds Ratio (OR) del consumo de cannabis en adolescentes, para los diferentes tipos de abuso infantil, así como sus intervalos de confianza del 95% (IC 95%). Se identificaron seis estudios, que incluyeron 10 843 adolescentes de uno u otro sexo. La asociación entre la violencia y el abuso/dependencia de cannabis en la adolescencia mostró los siguientes valores: abuso físico (OR: 1,58, IC 95% [1,01­2,46]), abuso sexual (OR: 2,35, IC 95% [1,64­3,35]), y ser testigo de violencia (OR: 3,22, IC 95% [0,63­16,54]). Los resultados muestran que el abuso sexual o físico durante etapas tempranas de la vida aumenta el riesgo de consumo de cannabis en la adolescencia. Los estudios que evaluaron otras formas de violencia fueron escasos. Los resultados destacan la importancia de diseñar programas integrales para reducir el uso y dependencia de cannabis mediante estrategias enfocadas a la prevención de la violencia en la infancia.

Tipos de violencia en la infancia que inciden en el abuso y dependencia de cannabis entre adolescentes: una revisión sistemática y metaanálisis / Influence of the type of childhood violence on cannabis abuse and dependence among adolescents: a systematic review and meta-analysis

El uso recreativo de cannabis ha incrementado en todo el mundo, principalmente en la población adolescente. Se ha propuesto que la adversidad en la infancia contribuye al consumo de esta droga. El objetivo de esta revisión sistemática y metaanálisis fue analizar el efecto de diferentes tipos de violencia en la infancia sobre el consumo de cannabis en la adolescencia. Se realizó una búsqueda en diferentes bases de datos (PubMed, Science Direct, Web of Science, Ovid y CONRICyT) usando los términos de búsqueda: (("Cannabis" OR "Marijuana Smoking" OR "Marijuana Abuse") AND ("Child Abuse" OR "Domestic Violence" AND "Adolescent")), considerando todos los artículos publicados hasta el 3 de noviembre de 2017. Se calcularon los Odds Ratio (OR) del consumo de cannabis en adolescentes, para los diferentes tipos de abuso infantil, así como sus intervalos de confianza del 95% (IC 95%). Se identificaron seis estudios, que incluyeron 10 843 adolescentes de uno u otro sexo. La asociación entre la violencia y el abuso/dependencia de cannabis en la adolescencia mostró los siguientes valores: abuso físico (OR: 1,58, IC 95% [1,01-2,46]), abuso sexual (OR: 2,35, IC 95% [1,64-3,35]), y ser testigo de violencia (OR: 3,22, IC 95% [0,63-16,54]). Los resultados muestran que el abuso sexual o físico durante etapas tempranas de la vida aumenta el riesgo de consumo de cannabis en la adolescencia. Los estudios que evaluaron otras formas de violencia fueron escasos. Los resultados destacan la importancia de diseñar programas integrales para reducir el uso y dependencia de cannabis mediante estrategias enfocadas a la prevención de la violencia en la infancia

The use of cannabis for recreational purposes has increased worldwide, and the proportion of cannabis users in the adolescent population is high. Susceptibility to cannabis use involves various factors, including childhood adversity; however, the effects of different types of violence on cannabis use have not been evaluated. The aim of this review was to analyze the effects of different types of violence on cannabis use in adolescence. We searched electronic databases (PubMed, Science Direct, Web of Science, Ovid and CONRICyT) using the following algorithm: (("Cannabis" OR "Marijuana Smoking" OR "Marijuana Abuse") AND ("Child Abuse" OR "Domestic Violence" AND "Adolescent")), considering all articles published up to November 3th, 2017. Odds ratios (ORs) were calculated for the effects of experiencing different types of violence during childhood on cannabis use. Six studies, which represented 10 843 adolescents of both sexes, were ultimately included in the systematic review and meta-analysis. Three types of early-life adversity were associated with cannabis abuse/dependence: physical abuse (OR: 1.58, 95% CI [1.01-2.46]), sexual abuse (OR: 2.35, 95% CI [1.64-3.35]), and witnessing violence (OR: 3.22, 95% CI [0.63-16.54]). The results indicated that two specific types of child maltreatment, sexual and physical abuse, were critical factors affecting vulnerability to cannabis use in adolescence. The number of studies examining other types of violence was limited. The results highlighted the importance of enhancing efforts to prevent violence, particularly sexual abuse, as part of integral programs designed to prevent cannabis abuse and dependence

José Ángel Bustamante O' Leary. Paradigma de la Psiquiatria Cubana / Jose Ángel Bustamante O' Leary. Paradigma de la Psiquiatria Cubana

RESUMEN El profesor José Ángel Bustamante O' Leary fue un eminente psiquiatra y psicólogo cubano. El presente trabajo tiene como objetivo lograr un acercamiento a la vida y obra de este incansable médico que se dedicó, hasta pocos días antes de su muerte, a brindar sus conocimientos para la formación de los profesionales de la psiquiatría cubana y Latinoamericana. Se realizó una investigación de su trayectoria revolucionaria, académica, científica y asistencial. Los actuales médicos y especialmente los psiquiatras defienden con orgullo los aportes de este consagrado científico en la lucha por la salud mental y el bienestar de los pacientes (AU).

SUMMARY Professor José Ángel Bustamante O' Leary was an eminent Cuban psychiatrist and psychologist. This work is aimed to approaching life and work of this tireless doctor, who devoted himself and his knowledge to the training of Cuban and Latin American professionals of Psychiatry until a few days before his death. The authors researched his revolutionary, academic, scientific and welfare trajectory. Current physicians, especially current psychiatrists proudly defend the contribution of this consecrated scientist to the fight for the mental health and well-being of the patients (AU).

Trastorno Bipolar. Consideraciones clínicas y epidemiológicas / Bipolar disorder. Clinical and epidemiologic characteristics

RESUMEN El trastorno bipolar es un trastorno crónico y recurrente que se caracteriza por fluctuaciones patológicas del estado del ánimo. Las fases de la enfermedad incluyen episodios hipomaniacos, maniacos y depresivos. Estos episodios interfieren de forma significativa en la vida cotidiana del paciente y en su entorno, con importante repercusión en su salud y calidad de vida. Para los psiquiatras es de suma importancia el diagnóstico precoz de esta enfermedad para proporcionar un tratamiento oportuno a los pacientes, teniendo en cuenta la severidad de los síntomas y las complicaciones a las que lleva esta enfermedad. Ante esta realidad se decidió describir las características generales de este desorden mediante una revisión bibliográfica donde se exponen sus principales manifestaciones clínicas, clasificación, aspectos epidemiológicos, curso de la enfermedad, complicaciones y comorbilidad. Para ello se realizó una revisión de los trabajos más relevantes publicados y con ello contribuir al proceso de educación médica continuada para los profesionales de la salud.

ABSTRACT Bipolar disorder is a chronic and recurrent disorder characterized by pathological fluctuations of the mood states. The stages of the disease include hypomanic, maniac and depressive episodes. These episodes interfere in a significant way in the patient´s daily life and his surroundings, with an important repercussion on his health and life quality. For the psychiatrists, the precocious diagnosis of this disease is very important, in order to provide a timely treatment to patients, taking into account the severity of the symptoms and the complications of this disease. Due to this reality, the authors decided to describe the general characteristics of this disorder through a bibliographic review where they exposed the main clinical manifestations, classification, epidemiological aspects, the course of the disease, complications and co-morbidity. The most relevant published works were reviewed to contribute to the process of continued medical education of the health professionals.

Trastorno de insomnio. Consideraciones actuales / Insomnia disorder. Current considerations

RESUMEN El insomnio es el trastorno del sueño más frecuente en la población, se acompaña de un nivel significativo de malestar o deterioro de áreas importantes del funcionamiento humano. Es importante realizar un diagnóstico correcto de este desorden con el objetivo de instaurar un tratamiento adecuado que permita mejorar la calidad de vida de los pacientes que lo padecen. El objetivo de este artículo es ofrecer una revisión actualizada que contribuya al incremento y actualización de la información sobre este tema. Se realizó una revisión en artículos, principalmente de los últimos cinco años y se sistematizan los resultados para de esta forma contribuir a la superación de los profesionales.

ABSTRACT Insomnia is the most frequently sleep disorder in the population. It is linked to a significant discomfort and an impairment of important areas of the human functioning. The correct diagnosis of this disorder is important with the objective of prescribing an adequate treatment for improving the life quality of the patients suffering it. The aim of this article is offering an up-dated review contributing to increase and update the information on this topic. The authors carried out a review of articles published mainly during the last five years, and the results were systematized for contributing to the professionals´ upgrading.

Trastorno de insomnio. Consideraciones actuales / Insomnia disorder. Current considerations

RESUMEN El insomnio es el trastorno del sueño más frecuente en la población, se acompaña de un nivel significativo de malestar o deterioro de áreas importantes del funcionamiento humano. Es importante realizar un diagnóstico correcto de este desorden con el objetivo de instaurar un tratamiento adecuado que permita mejorar la calidad de vida de los pacientes que lo padecen. El objetivo de este artículo es ofrecer una revisión actualizada que contribuya al incremento y actualización de la información sobre este tema. Se realizó una revisión en artículos, principalmente de los últimos cinco años y se sistematizan los resultados para de esta forma contribuir a la superación de los profesionales (AU).

ABSTRACT Insomnia is the most frequently sleep disorder in the population. It is linked to a significant discomfort and an impairment of important areas of the human functioning. The correct diagnosis of this disorder is important with the objective of prescribing an adequate treatment for improving the life quality of the patients suffering it. The aim of this article is offering an up-dated review contributing to increase and update the information on this topic. The authors carried out a review of articles published mainly during the last five years, and the results were systematized for contributing to the professionals upgrading (AU).

Trastorno Bipolar. Consideraciones clínicas y epidemiológicas / Bipolar disorder. Clinical and epidemiologic characteristics

RESUMEN El trastorno bipolar es un trastorno crónico y recurrente que se caracteriza por fluctuaciones patológicas del estado del ánimo. Las fases de la enfermedad incluyen episodios hipomaniacos, maniacos y depresivos. Estos episodios interfieren de forma significativa en la vida cotidiana del paciente y en su entorno, con importante repercusión en su salud y calidad de vida. Para los psiquiatras es de suma importancia el diagnóstico precoz de esta enfermedad para proporcionar un tratamiento oportuno a los pacientes, teniendo en cuenta la severidad de los síntomas y las complicaciones a las que lleva esta enfermedad. Ante esta realidad se decidió describir las características generales de este desorden mediante una revisión bibliográfica donde se exponen sus principales manifestaciones clínicas, clasificación, aspectos epidemiológicos, curso de la enfermedad, complicaciones y comorbilidad. Para ello se realizó una revisión de los trabajos más relevantes publicados y con ello contribuir al proceso de educación médica continuada para los profesionales de la salud (AU).

ABSTRACT Bipolar disorder is a chronic and recurrent disorder characterized by pathological fluctuations of the mood states. The stages of the disease include hypomanic, maniac and depressive episodes. These episodes interfere in a significant way in the patient´s daily life and his surroundings, with an important repercussion on his health and life quality. For the psychiatrists, the precocious diagnosis of this disease is very important, in order to provide a timely treatment to patients, taking into account the severity of the symptoms and the complications of this disease. Due to this reality, the authors decided to describe the general characteristics of this disorder through a bibliographic review where they exposed the main clinical manifestations, classification, epidemiological aspects, the course of the disease, complications and co-morbidity. The most relevant published works were reviewed to contribute to the process of continued medical education of the health professionals (AU).

Role of Estradiol in the Expression of Genes Involved in Serotonin Neurotransmission: Implications for Female Depression.

BACKGROUND: In women, changes in estrogen levels may increase the incidence and/or symptomatology of depression and affect the response to antidepressant treatments. Estrogen therapy in females may provide some mood benefits as a single treatment or might augment clinical response to antidepressants that inhibit serotonin reuptake. OBJECTIVE: We analyzed the mechanisms of estradiol action involved in the regulation of gene expression that modulates serotonin neurotransmission implicated in depression. METHOD: Publications were identified by a literature search on PubMed. RESULTS: The participation of estradiol in depression may include regulation of the expression of tryptophan hydroxylase-2, monoamine oxidase A and B, serotonin transporter and serotonin-1A receptor. This effect is mediated by estradiol binding to intracellular estrogen receptor that interacts with estrogen response elements in the promoter sequences of tryptophan hydroxylase-2, serotonin transporter and monoamine oxidase-B. In addition to directly binding deoxyribonucleic acid, estrogen receptor can tether to other transcription factors, including activator protein 1, specificity protein 1, CCAAT/enhancer binding protein ß and nuclear factor kappa B to regulate gene promoters that lack estrogen response elements, such as monoamine oxidase-A and serotonin 1A receptor. CONCLUSION: Estradiol increases tryptophan hydroxylase-2 and serotonin transporter expression and decreases the expression of serotonin 1A receptor and monoamine oxidase A and B through the interaction with its intracellular receptors. The understanding of molecular mechanisms of estradiol regulation on the protein expression that modulates serotonin neurotransmission will be helpful for the development of new and more effective treatment for women with depression.

Relationship between androgen deficiency and memory impairment in aging and Alzheimer’s disease.

Aging and Alzheimer’s disease (AD) are associated with a declination of cognition and memory, whose severity increases in AD. Recent investigations point to a greater participation of neurofibrillary tangles (NFTs) than that of senile plaques, as responsible for cognitive impairment in AD and normal aging. On the other hand, aging is related with reduced levels of dehydroepiandrosterone (DHEA) and its sulfate (DHEA-S) as well as testosterone (T). Basic and clinical studies give evidence that hypoandrogenism is associated with memory impairment. Accordingly, some animal studies show that the administration of these hormones improves the performance of cognitive tasks. However, effects of DHEA, DHEA-S, and T in the clinical setting, are not clear in part because of the balance between the benefits and risks of hormone therapy in aging subjects and because the cellular mechanism underlying its effects on memory in old age and related pathologies are unknown. The objective of this review is to analyze the role of DHEA, DHEA-S, and T, on memory in normal aging and in AD, and to determine whether these hormones modulate the hyperphosphorylation of tau protein, a molecular marker in AD pathology. The method used in the review included articles from the PubMed database, using the following search terms: DHEA, DHEA-S, T, memory, androgen deprivation therapy, tau protein, aging, and AD. Finally, we analyze the use of these steroids as an adjunct in the treatment of memory deficits in aging subjects and AD patients.