Internalizing and externalizing behaviors in high school adolescents in a northern border city of Mexico and their type of family / Conductas internalizantes y externalizantes en adolescentes de una escuela preparatoria en una ciudad fronteriza al norte de México y su tipo de familia

Objective: Identify externalizing and internalizing behaviors in high school adolescents in three schools in a northern border city in Mexico and their type of family. Design: Cross-sectional survey. Location: Three schools in the city of Tijuana, Mexico: two public and one private. Participants: 454 baccalaureate students 14–19 years old. Main measurements: We utilized Youth Self Report Scale, adapted and validated in Spanish, that measure internalization behaviors (anxiety, depression, isolation or somatic complaints), and externalization behaviors (verbal aggressiveness, delinquent behavior and attention-seeking). For dichotomous discrimination between deviant and nondeviant scores, we use the borderline clinical range by classifying YSR scale's T scores≥60, and to analyze the relationship between behavior problems or competencies and living or not in a nuclear family we utilized multiple logistic regression. Results: 55% were female, mean age 16.4 years±0.98, and 62.3% came from a nuclear family. Prevalence of internalizing behaviors was 15.6%, and externalizing behaviors 14.8%. Women had statistically higher mean scores in depressive, anxious and verbally aggressive behavior, somatic complaints, and thought problems. The prevalence of internalizing behaviors in adolescents with nuclear family was 11.7% (n=33), and for adolescents with another type of family was 22.2% (n=38), OR 2.17 (CI 95% 1.30–3.61, p=0.003), but no differences was observed for externalizing behaviors and family type. When adjusted for sex, age, and public or private school, internalizing behaviors and specifically depressive behavior remained significant. Conclusions: We detected a moderate prevalence of internalizing behaviors in Mexican adolescents, predominantly among women, and also observed that not living with a nuclear family increases the odds of presenting internalizing behaviors...(AU)

Objetivo: Identificar conductas internalizantes y externalizantes en adolescentes de escuelas preparatorias en una ciudad fronteriza al norte de México y su tipo de familia. Diseño: Encuesta transversal. Emplazamiento: Tres escuelas de la ciudad de Tijuana, México: dos públicas y una privada. Participantes: 454 estudiantes de preparatoria de 14-19 años de edad. Principales mediciones: Se utilizó la escala Youth Self Report validada al español, que mide conductas internalizantes (ansiedad, depresión, aislamiento y quejas somáticas) y externalizantes (agresión verbal, conducta delictiva y búsqueda de atención). Para la discriminación dicotómica entre puntajes desviados y no desviados, usamos el rango clínico límite al clasificar los T scores de ≥ 60 de la escala YSR, y para analizar la relación entre problemas de comportamiento o competencias y vivir o no en una familia nuclear utilizamos regresión logística múltiple. Resultados: El 55% eran mujeres, la media de edad fue de 16.4 años±0.98, y el 62.3% procedían de familias nucleares. La prevalencia de conductas internalizantes fue de 15.6% y de conductas externalizantes de 14.8%. Las mujeres tenían puntuaciones medias estadísticamente más altas en conducta depresiva, ansiosa y verbalmente agresiva, quejas somáticas y problemas de pensamiento. La prevalencia de conductas internalizantes en adolescentes con familia nuclear fue de 11.7% (n=33), y para adolescentes con otro tipo de familia fue de 22.2% (n=38), OR 2.17 (IC 95% 1.30-3.61, p=0.003), pero no se observaron diferencias para conductas externalizantes y tipo de familia. Al ajustar por sexo, edad y escuela pública o privada, las conductas internalizantes y específicamente la conducta depresiva se mantuvieron significativas...(AU)

Internalizing and externalizing behaviors in high school adolescents in a northern border city of Mexico and their type of family.

OBJECTIVE: Identify externalizing and internalizing behaviors in high school adolescents in three schools in a northern border city in Mexico and their type of family. DESIGN: Cross-sectional survey. LOCATION: Three schools in the city of Tijuana, Mexico: two public and one private. PARTICIPANTS: 454 baccalaureate students 14-19 years old. MAIN MEASUREMENTS: We utilized Youth Self Report Scale, adapted and validated in Spanish, that measure internalization behaviors (anxiety, depression, isolation or somatic complaints), and externalization behaviors (verbal aggressiveness, delinquent behavior and attention-seeking). For dichotomous discrimination between deviant and nondeviant scores, we use the borderline clinical range by classifying YSR scale's T scores≥60, and to analyze the relationship between behavior problems or competencies and living or not in a nuclear family we utilized multiple logistic regression. RESULTS: 55% were female, mean age 16.4 years±0.98, and 62.3% came from a nuclear family. Prevalence of internalizing behaviors was 15.6%, and externalizing behaviors 14.8%. Women had statistically higher mean scores in depressive, anxious and verbally aggressive behavior, somatic complaints, and thought problems. The prevalence of internalizing behaviors in adolescents with nuclear family was 11.7% (n=33), and for adolescents with another type of family was 22.2% (n=38), OR 2.17 (CI 95% 1.30-3.61, p=0.003), but no differences was observed for externalizing behaviors and family type. When adjusted for sex, age, and public or private school, internalizing behaviors and specifically depressive behavior remained significant. CONCLUSIONS: We detected a moderate prevalence of internalizing behaviors in Mexican adolescents, predominantly among women, and also observed that not living with a nuclear family increases the odds of presenting internalizing behaviors. It is important that parents, teachers, and healthcare workers remain vigilant to detect these problems in a timely manner and develop interventions to improve the mental health and well-being of adolescents.

MUM1/IRF4 is Highly Expressed in Dermatopathic Lymphadenopathy: Potential Utility in Diagnosis and Differential Diagnosis.

Dermatopathic lymphadenopathy (DL) is a distinctive type of lymph node hyperplasia that typically occurs in the setting of chronic dermatologic diseases. DL generally self-resolves following disappearance of the underlying skin stimulus and does not require any specific therapy. We recently observed multiple myeloma oncogene 1/interferon regulatory factor 4 (MUM1/IRF4) expression in a case of DL using immunohistochemical methods. The goal of this study was to systematically assess DL cases for MUM1/IRF4 expression and to survey other histiocytic and Langerhans cell lesions. We particularly focused on Langerhans cell histiocytosis (LCH) because the differential diagnosis of DL versus LCH in lymph nodes can be challenging. We identified high expression of MUM1/IRF4 in all 22 cases of DL tested. Specifically, MUM1/IRF4+ dendritic cells comprised 50% to 90% (median, 80%) of all dendritic cells in the paracortex of dermatopathic lymph nodes, always showing moderate or strong intensity. Among 10 DL cases stained for MUM1/IRF4 and langerin/CD207 using dual immunohistochemistry, MUM1/IRF4+ and langerin+ Langerhans cells represented 5% to 60% (median, 30%) of paracortical dendritic cells. MUM1/IRF4 was also positive in reactive Langerhans cells in skin biopsy specimens of all cases of spongiotic dermatitis (n=10) and normal skin (n=15), and was negative in all cases of LCH (n=24), Rosai-Dorfman disease (n=10), follicular dendritic cell sarcoma (n=5) and histiocytic sarcoma (n=4). In aggregate, our findings support the utility of MUM1/IRF4 to highlight the dendritic cells of DL and to distinguish DL from other histiocytic and Langerhans cells lesions.

Reactivation of Epstein-Barr Virus Presenting as Massive Splenomegaly after Initiation of Golimumab Treatment.

Epstein-Barr virus infection is most commonly asymptomatic in the acute setting, where the end result of infection is the adoption of a viral latency phenotype. The virus can reactivate later in life leading to the abnormal proliferation of the infected B, T, or NK cells. Hereby, we report a 71-year-old female with seronegative rheumatoid arthritis who presented with massive splenomegaly, pancytopenia, and positivization of antibodies against double-stranded deoxyribonucleic acid (dsDNA) after initiation of the anti-tumor necrosis factor (TNF) golimumab. The diagnosis of EBV-associated lymphoproliferative disorder (LPD) was demonstrated by elevation of the plasmatic EBV viral load. Withdrawal of the anti-TNF and treatment with the anti-CD20 antibody rituximab were able to revert the clinical abnormalities. EBV-associated LPDs are described after initiation of other anti-TNF agents, such as infliximab, but no reports of golimumab-associated EBV LPD are found in the literature. The mechanisms for this occurrence are not clear, but these are known to involve expression of a panel of viral proteins specific to the viral latency phenotypes.

Effectiveness and cost-effectiveness of a multicomponent intervention to implement a clinical practice guideline for systemic lupus erythematosus: protocol for a cluster-randomized controlled trial.

BACKGROUND: Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease with significant potential morbidity and mortality. Substantial gaps have been documented between the development and dissemination of clinical practice guidelines (CPG) and their implementation in practice. The aim of this study is to assess the effectiveness and cost-effectiveness of a multi-component knowledge transfer intervention to implement a CPG for the management of SLE (CPG-SLE). METHODS: The study is an open, multicentre, controlled trial with random allocation by clusters to intervention or control. Clusters are four public university hospitals of the Canary Islands Health Service where rheumatologists are invited to participate. Patients diagnosed with SLE at least one year prior to recruitment are selected. Rheumatologists in intervention group receive a short educational group programme to both update their knowledge about SLE management according to CPG-SLE recommendations and to acquire knowledge and training on use of the patient-centred approach, a decision support tool embedded in the electronic clinical record and a quarterly feedback report containing information on management of SLE patients. Primary endpoint is change in self-perceived disease activity. Secondary endpoints are adherence of professionals to CPG-SLE recommendations, health-related quality of life, patient perception of their participation in decision making, attitudes of professionals towards shared decision making, knowledge of professionals about SLE and use of healthcare resources. Calculated sample size is 412 patients. Data will be collected from questionnaires and clinical records. Length of follow-up will be 18 months. Multilevel mixed models with repeated time measurements will be used to analyze changes in outcomes over time. Cost-effectiveness, from both social and healthcare services perspectives, will be analyzed by measuring effectiveness in terms of quality-adjusted life years gained. Deterministic and probabilistic sensitivity analyses are planned. DISCUSSION: Impact of CPGs in clinical practice could be improved by applying proven value interventions to implement them. The results of this ongoing trial are expected to generate important scientifically valid and reproducible information not only on clinical effectiveness but also on cost-effectiveness of a multi-component intervention for implementation of a CPG based on communication technologies for chronic patients in the hospital setting. TRIAL REGISTRATION: ClinicalTrial.gov NCT03537638 . Registered on 25 May 2018.

Cuba's Aging and Alzheimer Longitudinal Study.

Aging and Alzheimer is a prospective, longitudinal cohort study involving 2944 adults aged ≥65 years from selected areas in Cuba's Havana and Matanzas Provinces. This door-to-door study, which began in 2003, includes periodic assessments of the cohort based on an interview; physical exam; anthropometric measurements; and diagnosis of dementia and its subtypes, other mental disorders, and other chronic non-communicable diseases and their risk factors. Information was gathered on sociodemographic characteristics; disability, dependency and frailty; use of health services; and characteristics of care and caregiver burden. The first assessment also included blood tests: complete blood count, blood glucose, kidney and liver function, lipid profile and ApoE4 genotype (a susceptibility marker). In 2007-2011, the second assessment was done of 2010 study subjects aged ≥65 years who were still alive. The study provides data on prevalence and incidence of dementia and its risk factors, and of related conditions that affect the health of older adults. It also contributes valuable experiences from field work and interactions with older adults and their families. Building on lessons learned, a third assessment to be done in 2016-2018 will incorporate a community intervention strategy to respond to diseases and conditions that predispose to dementia, frailty and dependency in older adults. KEYWORDS Dementia, Alzheimer disease, chronic disease, aging, chronic illness, frailty, dependency, cohort studies, Cuba.

Effectiveness of Nonpharmacologic Interventions for Decreasing Fatigue in Adults With Systemic Lupus Erythematosus: A Systematic Review.

OBJECTIVE: Survival of patients with systemic lupus erythematosus (SLE) has significantly improved over the past decades. As SLE patients live longer they inevitably experience a range of clinical manifestations and somatic symptoms. Quality of life may also be impacted through a range of subjective indicators. Among these parameters, fatigue is the most prevalent complaint. Nonpharmacologic strategies seem regularly utilized for fatigue management in SLE; however, their real effects are not known. METHODS: A systematic review was conducted to analyze the effectiveness of nonpharmacologic interventions to reduce fatigue in SLE patients. Medline/PreMedline, Embase, PsycINFO, SCI-EXPANDED, Social Sciences Citation Index, and the Cochrane Library were searched (June 2014). Studies were included and assessed for quality if they fulfilled prespecified criteria. RESULTS: A total of 12 studies were finally included (n = 549): 7 randomized trials, 1 nonrandomized trial, and 4 prospective observational studies. They assessed 5 main intervention categories: exercise, behavioral and psychological approaches, diets, acupuncture, and phototherapy. All interventions produced reductions in fatigue, as measured using at least 1 instrument. Aerobic exercise was found to be effective and suitable for reducing fatigue, but results were not always consistent across instruments used. The diversity of psychological interventions limits the significance of the results; however, data point to a positive impact on fatigue. There are still few data on the effect of acupuncture, diets, and ultraviolet A radiation. CONCLUSION: Studies are few and heterogeneous; however, nonpharmacologic interventions applied to SLE patients can be effective in reducing fatigue.

Acculturative trajectories descriptions and implications for health among 12 Mexican deported women who inject drugs / Descripción de trayectorias aculturativas y sus implicaciones en salud en 12 mujeres deportadas que se inyectan drogas

INTRODUCTION: Between 1999-2007, the U.S. deported 4.8 million migrants to Mexico; of these, 1.1 million migrants were deported to the border city of Tijuana, Baja California. Deportees are often returned to unfamiliar communities where they may experience emotional and socioeconomic stressors that may raise their risk for engaging in unsafe behaviors. OBJECTIVE: This exploratory study describes adaptation to the post-deportation environment among Mexican-born injection drug-using women. METHOD: In 2008, we conducted qualitative interviews in Tijuana with 12 women reporting U.S. deportation. Our analytic framework focused on acculturation stress, adaptation and social capital in relation to HIV risk, considering a gender perspective. RESULTS: We found that the stress caused by the deportation experience and acclimating to the post-deportation community may have contributed to the women's participation in high-risk HIV behaviors (e.g., unprotected sex, sex work). Female deportees reported limited access to post-deportation social capital resources (e.g., social support, healthy social networks). Social factors (e.g., discrimination, lack of a government identification) challenged women's resettlement and likely contributed to economic and health vulnerabilities. DISCUSSION AND CONCLUSION: These preliminary findings suggest that deportees may benefit from organized services at repatriation, including mental health screening. Macro-level interventions that address stigma and facilitate deportees' economic integration may help stem engagement in risk behaviors.

INTRODUCCIÓN: Entre 1999-2007, EE.UU. deportó a 4.8 millones de migrantes a México; de éstos, 1.1 millones fueron deportados a la ciudad fronteriza de Tijuana, B.C. Los deportados a menudo son devueltos a comunidades desconocidas donde pueden experimentar factores estresantes, emocionales y económicos, que pueden aumentar la probabilidad de involucrarse en conductas de riesgo. OBJETIVO: Este estudio exploratorio describe las experiencias de mujeres mexicanas que se inyectan drogas en su proceso de adaptación y su ambiente posterior a su deportación. MÉTODO: En 2008, se realizaron entrevistas cualitativas en Tijuana a 12 mujeres deportadas de EE.UU. El marco teórico utilizado para el análisis de las entrevistas fue el estrés aculturativo y el capital social relacionado con el riesgo para adquirir VIH tomando en cuenta la perspectiva de género. RESULTADOS: Encontramos que la experiencia del estrés aculturativo causado por la deportación de las mujeres entrevistadas pudo condicionar su participación en conductas de alto riesgo para VIH (ejemplo: sexo sin protección, trabajo sexual). Las mujeres reportaron posteriormente, a su deportación un acceso limitado para apoyo social y redes sociales sanas. La discriminación o la falta de una identificación oficial desafiaron el reasentamiento de las mujeres y probablemente contribuyeron a sus vulnerabilidades económicas y de salud. DISCUSIÓN Y CONCLUSIÓN: Estos resultados preliminares sugieren que los deportados podrían beneficiarse de los servicios organizados de repatriación, incluidos los exámenes de salud mental. Intervenciones a nivel macro que aborden el estigma y faciliten la integración económica de los deportados podrían ayudar a impedir su participación en conductas de riesgo.

Validity of the Mexican version of the combined Foot Care Confidence / Foot-Care Behavior scale for diabetes.

OBJECTIVE: To 1) translate / transculturally adapt the original (English-language) combined Foot Care Confidence Scale / Foot-Care Behavior instrument (FCCS-FCB) to produce a Mexican-Spanish version and 2) determine its validity and reliability in a population with diabetes in Tijuana, Mexico. METHODS: The original FCCS-FCB was translated (and back-translated), the content validated (by a group of health professional experts), and the instrument applied to 304 patients 23-78 years old in diabetes support groups in Tijuana, Mexico. Internal consistency for the study constructs ("self-efficacy," and risk / preventive foot self-care behaviors) was measured using Cronbach's alpha. The constructs were validated using principal component factor analysis. RESULTS: The Cronbach's alpha values for internal consistency were 0.782 for self-efficacy and 0.505 for behaviors. Based on the analysis, two factors explained 49.1% of the total variance for self-efficacy, and six factors explained 57.7% of the total variance for behaviors. The results were consistent with those for the original (English) version of the FCCS-FCB. CONCLUSIONS: The Mexican version of the FCCS-FCB is a reliable and valid instrument recommended for use with Mexican-Spanish-speaking patients with diabetes.

Validity of the Mexican version of the combined Foot Care Confidence / Foot-Care Behavior scale for diabetes / Validez de la versión mexicana del instrumento combinado de las escalas Foot Care Confidence Scale y Foot Care Behavior para la diabetes

OBJECTIVE: To 1) translate / transculturally adapt the original (English-language) combined Foot Care Confidence Scale / Foot-Care Behavior instrument (FCCS-FCB) to produce a Mexican-Spanish version and 2) determine its validity and reliability in a population with diabetes in Tijuana, Mexico. METHODS: The original FCCS-FCB was translated (and back-translated), the content validated (by a group of health professional experts), and the instrument applied to 304 patients 23-78 years old in diabetes support groups in Tijuana, Mexico. Internal consistency for the study constructs ("self-efficacy," and risk / preventive foot self-care behaviors) was measured using Cronbach's alpha. The constructs were validated using principal component factor analysis. RESULTS: The Cronbach's alpha values for internal consistency were 0.782 for self-efficacy and 0.505 for behaviors. Based on the analysis, two factors explained 49.1% of the total variance for self-efficacy, and six factors explained 57.7% of the total variance for behaviors. The results were consistent with those for the original (English) version of the FCCS-FCB. CONCLUSIONS: The Mexican version of the FCCS-FCB is a reliable and valid instrument recommended for use with Mexican-Spanish-speaking patients with diabetes.

OBJETIVO: 1) traducir o adaptar transculturalmente el instrumento original combinado (en inglés) de las escalas Foot Care Confidence Scale (Escala de Competencia en el Cuidado del Pie) y Foot Care Behavior (Comportamientos del Cuidado del Pie) (FCCS-FCB) para crear una versión en español de México, y 2) determinar su validez y fiabilidad en una población de personas con diabetes de Tijuana, México. MÉTODOS: Se tradujo al español la escala original FCCS-FCB (y se volvió a traducir al inglés), su contenido fue validado (por un grupo de expertos), posteriormente se aplicó el instrumento a 304 pacientes de 23 a 78 años de edad, pertenecientes a grupos de apoyo al control de la diabetes de Tijuana, México. Mediante el alfa de Cronbach, se midió la coherencia interna de los constructos ("competencia personal" y "comportamientos de riesgo o preventivos de autocuidado del pie"). Los constructos fueron validados mediante análisis factorial de componentes principales. RESULTADOS: El valor de alfa de Cronbach correspondiente a competencia personal fue de 0,782 y de 0,505 para los comportamientos. En el análisis factorial, dos factores explicaron el 49,1% de la variancia total para la competencia personal, y seis factores explicaron el 57,7% de la variancia total para los comportamientos. Los resultados concordaron con los de la versión original (en inglés) del FCCS-FCB. CONCLUSIONES: La versión mexicana del FCCS-FCB es un instrumento fiable y válido recomendado para su empleo en pacientes mexicanos de habla hispana con diabetes.

Validity of the Mexican version of the combined Foot Care Confidence / Foot-Care Behavior scale for diabetes / Validez de la versión mexicana del instrumento combinado de las escalas Foot Care Confidence Scale y Foot Care Behavior para la diabetes

Objective. To 1) translate / transculturally adapt the original (English-language) combined Foot Care Confidence Scale / Foot-Care Behavior instrument (FCCS-FCB) to produce a Mexican-Spanish version and 2) determine its validity and reliability in a population with diabetes in Tijuana, Mexico. Methods. The original FCCS-FCB was translated (and back-translated), the content validat-ed (by a group of health professional experts), and the instrument applied to 304 patients 23–78 years old in diabetes support groups in Tijuana, Mexico. Internal consistency for the study constructs (“self-efficacy,” and risk / preventive foot self-care behaviors) was measured using Cronbach’s alpha. The constructs were validated using principal component factor analysis. Results. The Cronbach’s alpha values for internal consistency were 0.782 for self-efficacy and 0.505 for behaviors. Based on the analysis, two factors explained 49.1% of the total variance for self-efficacy, and six factors explained 57.7% of the total variance for behaviors. The results were consistent with those for the original (English) version of the FCCS-FCB. Conclusions. The Mexican version of the FCCS-FCB is a reliable and valid instrument recommended for use with Mexican-Spanish–speaking patients with diabetes.

Objetivo. 1) traducir o adaptar transculturalmente el instrumento original combi¬nado (en inglés) de las escalas Foot Care Confidence Scale (Escala de Competencia en el Cuidado del Pie) y Foot Care Behavior (Comportamientos del Cuidado del Pie) (FCCS-FCB) para crear una versión en español de México, y 2) determinar su validez y fiabilidad en una población de personas con diabetes de Tijuana, México. Métodos. Se tradujo al español la escala original FCCS-FCB (y se volvió a traducir al inglés), su contenido fue validado (por un grupo de expertos), posteriormente se aplicó el instrumento a 304 pacientes de 23 a 78 años de edad, pertenecientes a grupos de apoyo al control de la diabetes de Tijuana, México. Mediante el alfa de Cronbach, se midió la coherencia interna de los constructos (“competencia personal” y “comporta¬mientos de riesgo o preventivos de autocuidado del pie”). Los constructos fueron validados mediante análisis factorial de componentes principales. Resultados. El valor de alfa de Cronbach correspondiente a competencia personal fue de 0,782 y de 0,505 para los comportamientos. En el análisis factorial, dos factores explicaron el 49,1% de la variancia total para la competencia personal, y seis factores explicaron el 57,7% de la variancia total para los comportamientos. Los resultados concordaron con los de la versión original (en inglés) del FCCS-FCB. Conclusiones. La versión mexicana del FCCS-FCB es un instrumento fiable y válido recomendado para su empleo en pacientes mexicanos de habla hispana con diabetes.

Incidence of dementia and association with APOE genotype in older Cubans / Incidência de demência e associação com o genótipo APOE em idosos Cubanos

Objective: In an admixed population of older Cubans, the incidence and association of APOE and sociodemographic risk factors with dementia incidence was estimated. Methods: A single-phase survey (baseline) of all over 65-year-olds residing in seven catchment areas in Cuba (n=2944) was conducted between 2003 and 2007. Dementia diagnosis was established according to DSM-IV and 10/66 criteria. APOE genotype was determined in 2520 participants. An incidence wave was conducted 4.5 years after cohort inception in order to estimate incidence and associations with sociodemographic risk factors of the APOE ?4 genotype. Results: The incidence rate of DSM IV dementia was 9.0 per 1000 person-years (95% CI 7.2-11.3) and of 10/66 dementia was 20.5 per 1000 person-years (95% CI, 17.6-23.5). Older age, a family history of dementia and APOE e4 genotype were independent risk factors for incident 10/66 dementia. APOE genotype was associated cross-sectionally with dementiaprevalence, but the effect on the incidence of dementia was attenuated, and only apparent among those in the youngest age group. Conclusion: The incidence of dementia in the older Cuban population is relatively high and similar to levels reported in Europe and North-America. The study showed that the relationship between APOE e4 and incident dementia is stronger in the younger-old than the older-old and that this change must be taken into account in models of dementia.

Objetivo: Em uma população miscigenada de cubanos idosos, estimamos a incidência de demência e a associação entre o genótipo da APOE e os fatores de risco sociodemográficos na incidência de demência. Métodos: Realizamos uma pesquisa de uma fase (linha de base) de todos os idosos com mais de 65 anos residentes em sete áreas de Cuba (n=2944), de 2003 a 2007. O diagnóstico de demência foi estabelecido de acordo com os critérios do DSM-IV e do 10/66. O genótipo APOE foi determinado em 2520 participantes. Avaliação da incidência foi conduzida 4,5 anos após a linha de base, a fim de estimar a incidência e associações com fatores de risco sociodemográficos e o genótipo APOE 4. Resultados: A taxa de incidência de demência foi de 9,0 por 1000 pessoas-ano (IC 95% 7,2-11,3) de acordo com o DSM-IV e de 20,5 por 1000 pessoas-ano (IC95%, 17,6-23,5) de acordo com o 10/66. Idade avançada, história familiar de demência e genótipo APOE 4 foram fatores de risco independentes para a incidência de demência de acordo com os critérios do 10/66. O genótipo APOE foi associado com a prevalência de demência em estudo transversal, mas o efeito sobre a incidência de demência foi atenuado, e apenas aparente entre aqueles na faixa etária mais jovem. Conclusão: A incidência de demência na população cubana mais velha é relativamente alta, semelhante às relatadas na Europa e América do Norte. O estudo mostra que a relação entre APOE 4 incidente e demência é mais forte entre os idosos mais jovens e que esta alteração deve de ser considerada em modelos de demência.

An Adult Case of Paratesticular Spindle Cell Rhabdomyosarcoma.

Paratesticular rhabdomyosarcoma (RMS) occurs more frequently in children and is rare in adults. Embryonal RMS is the most common subtype of paratesticular RMS. Spindle cell is a rare variant of embryonal RMS and is associated with a favorable prognosis in children. Data in adults is lacking. We present a case of paratesticular RMS in a 24-year-old man.

Do Glazed Ceramic Pots in a Mexico-US Border City Still Contain Lead?

In order to identify the presence of lead in glazed ceramic pots in a Mexico-US border city, 41 clay pots were sampled. The pots were purchased in several establishments located in different geographical areas of the city. The presence of lead was determined using LeadCheck Swabs. Most (58.5%) of the pots were from the State of Jalisco and 24.4% were of unknown origin. Only 4 pots did not contain varnish and were lead-negative. Thirty-seven (81.1%) of the glazed pots were lead positive. Among the lead-negative pots, 4 showed the label "this pot is lead-free." Thus, if we consider the remaining 33 glazed pots without the "Lead-Free" label, 90.9% were lead-positive and only 9.1% were lead-negative. We also found that earthenware glazed utensils without the "Lead-Free" label were 1.6 times more likely to contain lead (OR: 1.6, 95% CI 1.0-2.5), P = 0.003. We concluded that lead was detected in almost all acquired food containers. Government interventions in Mexico have focused on training manufacturers to make lead-free glazed ceramics but it has been difficult to eradicate this practice. Educational interventions to make and acquire lead-free glazed ceramics should be targeted to both sellers and buyers.

Incidence of dementia and association with APOE genotype in older Cubans.

OBJECTIVE: In an admixed population of older Cubans, the incidence and association of APOE and sociodemographic risk factors with dementia incidence was estimated. METHODS: A single-phase survey (baseline) of all over 65-year-olds residing in seven catchment areas in Cuba (n=2944) was conducted between 2003 and 2007. Dementia diagnosis was established according to DSM-IV and 10/66 criteria. APOE genotype was determined in 2520 participants. An incidence wave was conducted 4.5 years after cohort inception in order to estimate incidence and associations with sociodemographic risk factors of the APOE ε4 genotype. RESULTS: The incidence rate of DSM IV dementia was 9.0 per 1000 person-years (95% CI 7.2-11.3) and of 10/66 dementia was 20.5 per 1000 person-years (95% CI, 17.6-23.5). Older age, a family history of dementia and APOE ε4 genotype were independent risk factors for incident 10/66 dementia. APOE genotype was associated cross-sectionally with dementia prevalence, but the effect on the incidence of dementia was attenuated, and only apparent among those in the youngest age group. CONCLUSION: The incidence of dementia in the older Cuban population is relatively high and similar to levels reported in Europe and North-America. The study showed that the relationship between APOE ε4 and incident dementia is stronger in the younger-old than the older-old and that this change must be taken into account in models of dementia.

OBJETIVO: Em uma população miscigenada de cubanos idosos, estimamos a incidência de demência e a associação entre o genótipo da APOE e os fatores de risco sociodemográficos na incidência de demência. MÉTODOS: Realizamos uma pesquisa de uma fase (linha de base) de todos os idosos com mais de 65 anos residentes em sete áreas de Cuba (n=2944), de 2003 a 2007. O diagnóstico de demência foi estabelecido de acordo com os critérios do DSM-IV e do 10/66. O genótipo APOE foi determinado em 2520 participantes. Avaliação da incidência foi conduzida 4,5 anos após a linha de base, a fim de estimar a incidência e associações com fatores de risco sociodemográficos e o genótipo APOE ε4. RESULTADOS: A taxa de incidência de demência foi de 9,0 por 1000 pessoas-ano (IC 95% 7,2-11,3) de acordo com o DSM-IV e de 20,5 por 1000 pessoas-ano (IC 95%, 17,6-23,5) de acordo com o 10/66. Idade avançada, história familiar de demência e genótipo APOE ε4 foram fatores de risco independentes para a incidência de demência de acordo com os critérios do 10/66. O genótipo APOE foi associado com a prevalência de demência em estudo transversal, mas o efeito sobre a incidência de demência foi atenuado, e apenas aparente entre aqueles na faixa etária mais jovem. CONCLUSÃO: A incidência de demência na população cubana mais velha é relativamente alta, semelhante às relatadas na Europa e América do Norte. O estudo mostra que a relação entre APOE ε4 incidente e demência é mais forte entre os idosos mais jovens e que esta alteração deve de ser considerada em modelos de demência.

Profiles, perceptions and motivations of Community Health Workers of NGOs in a border city of US-Mexico.

To analyze the profile, perceptions and motivations of Community Health Workers (CHWs) from non-governmental organizations (NGOs) in the border city of US-Mexico and to describe the type of community interventions they perform. we surveyed 121 CHWs from 9 NGOs participating in a monthly meeting between May and July of 2009. Each participating CHW answered a structured questionnaire. Furthermore, two focus groups were held, in which 10 and 8 CHWs participated, respectively. Qualitative and quantitative analyses were carried out on the data obtained. 70% of the CHWs had 9 years or less of formal education. With respect to community work, 61% volunteered between 1 and 5 h weekly; only 40% received some form of economic support. The most commonly reported activities were distribution of informational materials (59.5%) and promotion of health fairs (52.9%). Analysis of focus group discussions lead to the development of four conceptual categories: personal development, motivation, perception of their community participation and institutional relationship, some of the testimonies are "…just because the people do not respond does not mean we give up. No, we must work, persist, promote and raise awareness of the people…", "…when they compensate us, it is not really a payment. We are there because we get results, we do it happily… It is voluntary…" CHWs are an important human resource for communities. Institutions focusing on primary care should view these community players as social capital, which could improve the effectiveness of prevention strategies and achieve greater coverage of health services.

Dementia and Other Chronic Diseases in Older Adults in Havana and Matanzas: The 10/66 Study in Cuba

INTRODUCTION Chronic non-communicable diseases are the leading cause of death worldwide, except in Sub-Saharan Africa. Nonetheless, one of these conditions, dementia, is the major contributor to disability-adjusted life years in people aged ≥60 years. Few epidemiological studies exist of the prevalence and impact of dementia and selected chronic diseases in older adults in Latin America.OBJECTIVE Describe prevalence of dementia, other chronic vascular diseases and cardiovascular risk factors, as well as resulting disabilities and care needs generated in adults aged ≥65 years in Havana City and Matanzas provinces, Cuba. METHODS The 10/66 study is a prospective longitudinal study involving a cohort of 3015 adults aged ≥65 years in municipalities of Havana City and Matanzas provinces, divided into two phases: a cross-sectional door-to-door study conducted in 2003–2006, and a follow-up and assessment phase in 2007–2010. This article reports findings from the first phase. Hypertension diagnosis was based on criteria from the International Society for Hypertension; diabetes mellitus on American Diabetes Association criteria; stroke according to WHO definitions; and dementia according to criteria of the American Psychiatric Society's Diagnostic and Statistical Manual of Mental Disorders DSM-IV and the 10/66 International Dementia Research Group. Ischemic heart disease was defined by self-report of previous physician diagnosis. Study variables included age, sex, educational level, substance use (alcohol, tobacco) and dietary habits. A structured physical and neurological exam, including blood pressure measurement, was performed on all participants. Laboratory tests included complete blood count, fasting blood glucose, total cholesterol and lipoprotein fractions, triglycerides and apolipoprotein E genotype. Prevalence and standardized morbidity ratios (crude and adjusted) were calculated for chronic diseases studied with 95% confidence intervals, using a Poisson...(AU)

Condom access: Associations with consistent condom use among female sex workers in two northern border cities of Mexico.

To determine whether condom access is associated with consistent condom use among female sex workers (FSWs) in Tijuana and Ciudad Juarez, between 2004 and 2006 we administered a questionnaire to 924 FSWs who reported unprotected sex with a client in the past 2 months. Of these women, 43% reported consistent ("often" or "always") condom use, 74% said condoms were available, and 38% reported having access to free condoms. In a logistic regression, factors positively associated with consistent condom use were condom availability (adjusted odds ratio [AOR] = 2.00; 95% confidence interval [CI]: 1.32-3.03), condom affordability (AOR = 1.72; 95% CI: 1.25-2.38) and self-efficacy (AOR = 2.16; 95% CI: 1.54-3.04). Factors inversely associated with consistent condom use included poor financial status (AOR = 0.65; 95% CI: 0.47-0.90), methamphetamine use (AOR = 0.58; 95% CI: 0.40-0.83), alcohol use (AOR = 0.68; 95% CI: 0.49-0.96), and recent injection drug use (AOR = 0.62; 95% CI: 0.39-0.97). While increased condom availability may improve condom use among FSWs in general, interventions to broaden condom use among lower income and drug-using FSWs are critically needed.