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In 2007, Mexico implemented a strategy to combat drug trafficking through military intervention, after which a significant increase in homicides, mainly among young men, was observed and linked to structural problems as well as organized crime, especially the recruitment of youth, with adolescents being particularly vulnerable. Through a systematic review of the literature from 2013 to 2022, we have compiled the reported factors influencing the recruitment of adolescents by organized crime in Mexico and conducted a metasynthesis of the data according to the multiple levels that affect adolescents: individual, family, community, cultural, and social. This research has shown that many of the factors reported are interrelated and need to be studied holistically. In addition, many of the factors are common to other forms of juvenile delinquency, but the main difference is the presence of organized crime itself in the community and culture.
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PURPOSE: This study aimed to develop a set of criteria and indicators to evaluate the quality of care of patients with head and neck cancer (HNC). METHODS: A systematic literature review was conducted to identify valuable criteria/indicators for the assessment of the quality of care in HNC. With the aid of a technical group, a scientific committee of oncologists specialised in HNC used selected criteria to propose indicators that were evaluated with a two-round Delphi method. Indicators on which consensus was achieved were then prioritised by the scientific committee to develop a final set of indicators. RESULTS: We proposed a list of 50 indicators used in the literature or developed by us to be evaluated with a Delphi method. There was consensus on the appropriateness of 47 indicators in the first round; the remaining 3 achieved consensus in the second round. The 50 indicators were scored to prioritise them, leading to a final selection of 29 indicators related to structure (3), process (22), or outcome (4) and covering diagnosis, treatment, follow-up, and health outcomes in patients with HNC. Easy-to-use index cards were developed for each indicator, with their criterion, definition, formula for use in real-world clinical practice, rationale, and acceptable level of attainment. CONCLUSIONS: We have developed a set of 29 evidence-based and expert-supported indicators for evaluating the quality of care in HNC, covering diagnosis, treatment, follow-up, and health outcomes.
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The escalating prevalence of Type 2 Diabetes (T2D) represents a substantial burden on global healthcare systems, especially in regions such as Mexico. Existing diagnostic techniques, although effective, often require invasive procedures and labor-intensive efforts. The promise of artificial intelligence and data science for streamlining and enhancing T2D diagnosis is well-recognized; however, these advancements are frequently constrained by the limited availability of comprehensive patient datasets. To mitigate this challenge, the present study investigated the efficacy of Generative Adversarial Networks (GANs) for augmenting existing T2D patient data, with a focus on a Mexican cohort. The researchers utilized a dataset of 1019 Mexican nationals, divided into 499 non-diabetic controls and 520 diabetic cases. GANs were applied to create synthetic patient profiles, which were subsequently used to train a Random Forest (RF) classification model. The study's findings revealed a notable improvement in the model's diagnostic accuracy, validating the utility of GAN-based data augmentation in a clinical context. The results bear significant implications for enhancing the robustness and reliability of Machine Learning tools in T2D diagnosis and management, offering a pathway toward more timely and effective patient care.
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The development of medical diagnostic models to support healthcare professionals has witnessed remarkable growth in recent years. Among the prevalent health conditions affecting the global population, diabetes stands out as a significant concern. In the domain of diabetes diagnosis, machine learning algorithms have been widely explored for generating disease detection models, leveraging diverse datasets primarily derived from clinical studies. The performance of these models heavily relies on the selection of the classifier algorithm and the quality of the dataset. Therefore, optimizing the input data by selecting relevant features becomes essential for accurate classification. This research presents a comprehensive investigation into diabetes detection models by integrating two feature selection techniques: the Akaike information criterion and genetic algorithms. These techniques are combined with six prominent classifier algorithms, including support vector machine, random forest, k-nearest neighbor, gradient boosting, extra trees, and naive Bayes. By leveraging clinical and paraclinical features, the generated models are evaluated and compared to existing approaches. The results demonstrate superior performance, surpassing accuracies of 94%. Furthermore, the use of feature selection techniques allows for working with a reduced dataset. The significance of feature selection is underscored in this study, showcasing its pivotal role in enhancing the performance of diabetes detection models. By judiciously selecting relevant features, this approach contributes to the advancement of medical diagnostic capabilities and empowers healthcare professionals in making informed decisions regarding diabetes diagnosis and treatment.
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Algoritmos , Diabetes Mellitus , Humanos , Teorema de Bayes , Aprendizado de Máquina , Diabetes Mellitus/diagnóstico , Algoritmo Florestas AleatóriasRESUMO
Diffuse large B-cell lymphoma is the most frequent histological subtype of NHL and the paradigm for the management of aggressive lymphoma. An excisional or incisional lymph node biopsy evaluated by an experienced hemopathologist is recommended to establish the diagnosis. Twenty years following its introduction, R-CHOP remains the standard first-line treatment. No modification of this scheme (increased chemotherapy dose intensity, new monoclonal antibodies, or the addition of immunomodulators or anti-target agents) has significatively improved the clinical outcomes, whereas therapy for recurrence or progression is evolving rapidly. The irruption of CART cells, polatuzumab vedotin, tafasitamab, and CD20/CD3 bispecific antibodies are changing the natural history of relapsed patients and will challenge R-CHOP as the benchmark for newly diagnosed patients.
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Anticorpos Biespecíficos , Linfoma Difuso de Grandes Células B , Humanos , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Adjuvantes Imunológicos , Benchmarking , BiópsiaRESUMO
BACKGROUND: Urinary incontinence (UI) is a common dysfunction of the pelvic floor, affecting 10-20% of all women, and up to 70% in the elderly general prevalence of 17% 20-year-old women and 38% in women over 60 years. It is estimated that only 25% of patients seek treatment for this debilitating condition. AIM: The aim of this study was to evaluate the efficacy of a device based on top flat magnetic stimulation to treat pelvic floor disorders especially female urinary incontinence. METHODS: A total of 33 volunteer patients were divided into 5 groups according to the type of complaint. Subjects received 8 treatment sessions, with a frequency of twice a week with two different settings. Pelvic Floor Bother Questionnaire (PFBQ), Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) and Urinary Incontinence Short Form (ICIQ-UI-SF) were compiled by all patients at the beginning and after 3 months from the end of the last treatment (3MFU). RESULTS: The patient's scores from validated Questionnaires significantly decreased (p < 0.01) from baseline up to 3MFU inside most of the groups. CONCLUSIONS: The noninvasiveness and safety of device make this approach an interesting tool as alternative approach for pelvic floor dysfunctions .
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Distúrbios do Assoalho Pélvico , Prolapso de Órgão Pélvico , Incontinência Urinária , Feminino , Humanos , Idoso , Adulto Jovem , Adulto , Diafragma da Pelve , América Latina/epidemiologia , Incontinência Urinária/terapia , Distúrbios do Assoalho Pélvico/complicações , Distúrbios do Assoalho Pélvico/terapia , Prolapso de Órgão Pélvico/complicações , Prolapso de Órgão Pélvico/terapia , Inquéritos e Questionários , Fenômenos Magnéticos , Qualidade de VidaRESUMO
Nasopharyngeal carcinoma (NPC) is distinct from other cancers of the head and neck in biology, epidemiology, histology, natural history, and response to treatment. Radiotherapy (RT) is the cornerstone of locoregional treatment of non-disseminated disease and the association of chemotherapy improves the rates of survival. In the case of metastatic disease stages, treatment requires platinum/gemcitabine-based chemotherapy and patients may achieve a long survival time.
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Neoplasias Nasofaríngeas , Humanos , Carcinoma Nasofaríngeo/terapia , Neoplasias Nasofaríngeas/patologiaRESUMO
Cisplatin is the standard of treatment for squamous cell carcinoma of the head and neck (SCCHN) that has demonstrated efficacy, either in locally advanced disease when combined with radiotherapy at high doses, or in metastatic/recurrent disease when combined with other agents. However, the usual toxicities related to cisplatin, such as neurotoxicity, nephrotoxicity, ototoxicity, and hematologic toxicities, especially when high doses have been administered, have important implications in the patients' quality of life. The decision to administer cisplatin depends on several patient factors, such as age, performance status, weight loss, comorbidities, previous toxicities, chronic viral infection, or even the current SARS-CoV-2 pandemic. In order to establish recommendations for the management of patients with SCCHN, a group of experts in medical and radiation oncology from Spain and Latin-American discussed how to identify patients who are not candidates for cisplatin to offer them the most suitable therapeutic alternative.
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Children's healthcare is a relevant issue, especially the prevention of domestic accidents, since it has even been defined as a global health problem. Children's activity classification generally uses sensors embedded in children's clothing, which can lead to erroneous measurements for possible damage or mishandling. Having a non-invasive data source for a children's activity classification model provides reliability to the monitoring system where it is applied. This work proposes the use of environmental sound as a data source for the generation of children's activity classification models, implementing feature selection methods and classification techniques based on Bayesian networks, focused on the recognition of potentially triggering activities of domestic accidents, applicable in child monitoring systems. Two feature selection techniques were used: the Akaike criterion and genetic algorithms. Likewise, models were generated using three classifiers: naive Bayes, semi-naive Bayes and tree-augmented naive Bayes. The generated models, combining the methods of feature selection and the classifiers used, present accuracy of greater than 97% for most of them, with which we can conclude the efficiency of the proposal of the present work in the recognition of potentially detonating activities of domestic accidents.
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RESUMEN Con el fin reflexionar sobre el impacto que ha tenido el enfoque de género consagrado en la Ley 1448 de 2001, cuyo propósito es reparar a las víctimas del conflicto armado interno, el presente artículo desarrollará algunos apuntes respecto a las experiencias de un grupo de mujeres víctimas, y de un grupo de funcionarios/as públicos, líderes sociales y ONG. Para la recolección de la información se utilizó la metodología cualitativa, con entrevistas semiestructuradas en profundidad y talleres de trabajo con diferentes actores. El análisis conlleva a identificar algunos elementos clave que empañan los éxitos legislativos y jurisprudenciales que ha logrado el Estado colombiano en materia de reparación con enfoque de género. Los resultados indican la necesidad de ir más allá del género, como categoría diferenciadora, para lograr una mayor efectividad en la reparación propuesta a las víctimas.
ABSTRACT The gender approach is enshrined in Law 1448 of 2011. With this law, the Colombian State seeks to provide reparation to the victims of the internal armed conflict. In this article we will reflect on its impact on a group of victims women, and the appraisals of its applicability, according to the experience of a group of public officials, social leaders and NGOs. The methodology used to collect the information has been qualitative, through semi-structured in-depth interviews and workshops with different actors. analysis leads to identify some key elements that obscure the legislative and jurisprudential successes that de Colombian State has achieved in terms of reparation with a gender approach. The results indicate the need to go beyond gender as a differentiating category, to achieve greater effectiveness in the reparation proposed to the victims.
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Humanos , Mulheres , Conflitos Armados , EducaçãoRESUMO
Resumen El objetivo del estudio fue evaluar, en un modelo de ecuaciones estructurales, la relación de las características negativas del vecindario y del contexto escolar, amigos de riesgo, problemas de autorregulación y sucesos de vida con la depresión en adolescentes, así como el posible papel protector del apoyo social. Previo consentimiento informado, se conformó una muestra de 113 adolescentes pertenecientes a un sector vulnerable de una ciudad del noroeste de México. Los participantes respondieron un conjunto de escalas tipo Likert validadas previamente en la región, que midieron cada una de las variables del estudio. Los resultados del modelo estructural muestran que las características negativas del contexto, los amigos y los sucesos de vida constituyen factores de riesgo para la depresión, los cuales son mitigados moderadamente por el apoyo social. Se sugiere la elaboración de programas de promoción del apoyo social en adolescentes vulnerables.
Abstract The aim of this study was to evaluate a structural equation model, the relation of negative aspects in the neighborhood, school, high-risk peers, self-regulation problems and life events with adolescent depression, as well as the protective role of social support. The subjects were 113 consenting adolescents from a vulnerable sector in a city northwest of Mexico. To measure the study's variables participants responded to a set of Likert scales which had been validated in the region. Results from the structural equation model indicate that negative aspects in the environment, friends and life events constitute risk factors for depression, which are moderately mitigated by social support. The development of programs which promote social support in vulnerable adolescents is suggested.
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Adolescente , Apoio Social , Psicologia do Adolescente , Depressão/psicologiaRESUMO
A 3-year-old, female mixed-breed dog had malformations of both thoracic limbs and the vertebral column. Radiographs of the forelimbs showed bilateral development of 2 digits and aplasia of 3 carpal bones. Kyphosis, scoliosis, and deformed vertebrae were present in the thoracolumbar vertebral column.
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Doenças do Cão/diagnóstico , Cães/anormalidades , Cifose/veterinária , Escoliose/veterinária , Anormalidades Múltiplas/veterinária , Animais , Doenças do Cão/patologia , Cães/anatomia & histologia , Feminino , Dedos/anormalidades , Dedos/patologia , Membro Anterior/anormalidades , Membro Anterior/anatomia & histologia , Deformidades Congênitas da Mão/diagnóstico , Deformidades Congênitas da Mão/patologia , Deformidades Congênitas da Mão/veterinária , Cifose/diagnóstico , Cifose/patologia , Deformidades Congênitas dos Membros , Escoliose/diagnóstico , Escoliose/patologia , Coluna Vertebral/anormalidades , Coluna Vertebral/anatomia & histologia , Vértebras TorácicasRESUMO
La calidad de vida es objeto de interés de diferentes disciplinas. Indagar acerca de que los ciudadanos vivan bien tiene que ver con alcanzar el desarrollo de ciertas capacidades humanas que les permita llevar una vida plena. Se hace una revisión de las diferentes concepciones que hay sobre la calidad de vida tomando como referencia autores con diferentes enfoques filosóficos y epistemológicos. Se incluyen las posturas utilitaristas, la ética de las capacidades, la bioética y una visión desde la complejidad. Se intenta resaltar que la Calidad de vida es un área que merece atención por las facetas que abarca, por su interdimensionalidad y por la incertidumbre que lleva implícita, por lo que se demanda su abordaje desde el paradigma epistemológico de la complejidad.
The quality of life is the object of interest of several disciplines. Making inquiries about the possibilities of the people to live well has to do with developing some human capabilities that allow them to enjoy full life. A review was made of the various conceptions about quality of life, taking several philosophic and epistemological approaches as reference. Utilitarian standpoints, the ethics of capacities, bioethics and vision based on complexity were included. It was intended to stress that the quality of life is an area deserving attention because of the facets that it embraces, its inter-dimensionality and the uncertainty inherent to it. Hence, this area requires to be approached from the epistemological paradigm of complexity.
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Follicular lymphoma (FL) is the second most common subtype of non-Hodgkin's lymphoma (NHL) in the Western world. FL constitutes the most frequent indolent lymphoma, well characterized by its clinical presentation related to nodal involvement and its morphologic and biologic features. It is often managed as an incurable disease. However, several active therapeutic approaches from the "wait and watch" strategy to the allogeneic transplantation are available for management of patients with FL and clearly have changed the natural history of this disease, achieving a long-term disease-free survival. Therapeutic decision is mostly conditioned by patient's characteristics, stage, histological grade, tumor burden, and risk-predicting factors. This article try to summarizes the diagnosis and treatment of this heterogeneous group of patients.
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Linfoma Folicular/terapia , Linfoma não Hodgkin/terapia , Oncologia/métodos , Guias de Prática Clínica como Assunto , Algoritmos , Humanos , Sociedades Médicas , EspanhaRESUMO
Hodgkin's lymphoma is a malignant disease with an incidence of 2.2 cases/100,000. The main goals of staging are to measure the extent of disease and associated prognostic factors. Distinct recommendations were produced for initial work-up, first-line therapy of early and advanced stage disease and treatment of relapsed or resistant patients.
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Doença de Hodgkin/terapia , Oncologia/métodos , Guias de Prática Clínica como Assunto , Algoritmos , Humanos , Sociedades Médicas , EspanhaRESUMO
Diffuse large B-cell non-Hodgkin's lymphoma (LDCGB) is one of the best examples of chemotherapy curable malignant diseases. This "Oncoguía SEOM" summarizes the basic directions of staging and recommended treatment options. The staging study should be thorough and includes clinical, laboratory, diagnostic imaging and nuclear medicine. Treatment depends on patient characteristics and comorbidity and on disease extension and prognostic factors. In localized cases, chemoimmunotherapy (CHOP-R) of short duration, followed by involved-field irradiation is the preferred option. In advanced stages, the association of CHOP-like chemotherapy and Rituximab has been a major breakthrough in terms of cure rate. It is important do not forget the supportive treatment in these patients.
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Linfoma Difuso de Grandes Células B/terapia , Oncologia/métodos , Guias de Prática Clínica como Assunto , Algoritmos , Humanos , Oncologia/tendências , Sociedades Médicas , EspanhaRESUMO
Neutropenia is a common complication of cancer chemotherapy. Colony-stimulating factors (CSF) may be used to avoid neutropenia-associated complications. The Spanish Society of Medical Oncology (SEOM) recently constituted a working group to review the main issues concerning the use of CSF and carried out a consensus process about the use of CSF in cancer patients, held in Madrid on 26 May 2006. The group concluded the following recommendations: prophylactic use of CSF is recommended when a rate of febrile neutropenia (FN) higher than 20% is expected without the use of CSF or when additional risk factors for neutropenia exist; therapeutic use of CSF is recommended in order to treat FN episodes but not to treat afebrile neutropenic episodes. In addition, the use of CSF is considered effective when used to mobilise stem cells before high-dose chemotherapy and when used for chemotherapy schedule optimisation in dose-dense and in dose-intense regimens.
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Fatores Estimuladores de Colônias/uso terapêutico , Neoplasias/complicações , Neutropenia/prevenção & controle , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Consenso , Quimioterapia Combinada , Humanos , Oncologia , Neutropenia/tratamento farmacológico , Neutropenia/etiologia , Neutropenia/urina , EspanhaRESUMO
La necesidad de regular la actividad científica ha ido en aumento, requiriendo cada vez instrumentos más estrictos de control bioético. En 2002, el Consejo de Organizaciones Internacionales de Ciencias Médicas (CIOMS) actualizó las pautas internacionales sobre la ética de los estudios biomédicos y epidemiológicos. Este trabajo examina los problemas que se presentan en esta clase de investigación.
The need to regulate scientific activity has been increasing; it requires much more instruments for a strict bioethics checking. In 2002, the Council of the Medical Sciences' International Organisations (CIOMS) updated the international patterns on biomedical and epidemiological ethics. This work examines the problems involved in this type of investigation.
A necessidade de regular a atividade científica cresceu muito, exigindo cada vez mais instrumentos de controle bioético. Em 2002, O Conselho das Organizações Internacionais de Ciências Médicas (CIOMS) atualizou as diretrizes internacionais sobre a ética dos estudos biomédicos e epidemiológicos. Este trabalho examina os problemas que se apresentam neste tipo de pesquisa.
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Bioética , Educação , Métodos Epidemiológicos , Ética , Pesquisa Biomédica/éticaRESUMO
La paracoccidioidomicosis (PCM), es una micosis profunda sistémica, restringida a América Latina, causada por el hongo Paracoccidioides brasiliensis. En el laboratorio de Micología de la Universidad de Carabobo, (1992-2005), se estudiaron 2.407 pacientes y se diagnosticó PCM en 97 de ellos (4,0%). Las características epidemiológicas más resaltantes fueron: edades comprendidas entre 29-83 años, relación masculino/femenino de 6:1 y enfermedad más frecuente en hombres con edades entre: 40-50 (29,6 %) y 51-61 (24,7 %) años de edad. Los pacientes provenían del estado Carabobo 88 (90,7 %) y de todos los municipios, especialmente del Carlos Arvelo 24 (27,3 %), así como de los estados Yaracuy, Trujillo, Barinas, Monagas y Lara. En su mayoría eran agricultores (86/97: 88,7 %). Las formas clínicas de la enfermedad, evaluadas según el criterio del III Encuentro Internacional sobre Paracoccidioidomicosis, fueron: Crónica Multifocal 50 (51,6 %) y Crónica Pulmonar Unifocal, 47 (48,4%). Los pacientes con estudio serológico positivo fueron 94 (96,9%). El diagnóstico fue confirmado mediante estudio micológico en 88 pacientes (90,7%) e histopatológico en 13. Estos resultados contribuyen al conocimiento de la PCM en Venezuela.
Paracoccidioidomycosis (PCM), is a systemic deep mycoses restricted to Latin America, produced by the fungus Paracoccidioides brasiliensis. The Mycology Laboratory of Universidad de Carabobo (1992- 2005) studied 2.407 patients and diagnosed PCM in 97 (4,0%) of them. The most outstanding epidemiological characteristics were: ages, between 29-83 years, male/female relationship 6:1; the disease was more frequent in men with ages between: 40-50 (29,6%) and 51-61 (24,7%) years. Most patients came from Carabobo State, 88 (90,7%) and all off its municipalities, especially Carlos Arvelo one 24 (27,3 %); there were also patients from Yaracuy, Trujillo, Barinas, Monagas and Lara States. Most were agricultural workers 86 (88,7%). The clínical forms of the disease, evaluated according to the criteria of the III Internacional Encounter on Paracoccidioidomycosis, were: Chronic Multifocal 50 (51,5 %) and Pulmonary Chronic Unifocal, 47 (48,4%). Patients with positive serologic results were, 94 (96,9%). Diagnosis was confirmed through mycological study in 88 patients (90,7%) and histopatológical study in 13. These results contribute to the knowledge about PCM in Venezuela.