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La deficiencia transversal del maxilar es una anomalía dentomaxilar capaz de producir problemas funcionales en la oclusión, respiración y estéticos. Su presentación clínica tradicional es la mordida cruzada posterior y una alteración en la relación transversal intermaxilar, la cual impide la correcta erupción de las piezas dentarias. Su manejo corresponde a la expansión rápida del maxilar, la cual puede ser asistida mediante mini-implantes (MARPE), cirugía (SARPE) o una combinación de ambas técnicas (MISMARPE). El objetivo del presente artículo es presentar un contraste entre las técnicas empleadas en la expansión rápida del maxilar, para simplificar la toma de decisiones clínicas. Se elaboró una revisión narrativa en las bases de datos PubMed, Scopus y Epistemonikos contemplando revisiones sistemáticas, metaanálisis, ensayos clínicos aleatorizados y estudios observacionales publicados entre el año 2013 a 2023. Un total de 23 artículos fueron incluidos, los cuales cumplían con los criterios de inclusión y exclusión establecidos. El manejo clínico de la deficiencia transversal del maxilar frecuentemente requiere un abordaje interdisciplinario combinando un enfoque ortopédico y quirúrgico. Según lo encontrado en la actual revisión, tanto el MARPE, SARPE y MISMARPE reportan indicaciones y limitaciones, así como complicaciones asociadas, sin embargo, serían efectivas en la resolución de deficiencias transversales. Se recomienda al clínico considerar dicha información de acuerdo a las necesidades particulares de cada caso clínico, así como profundizar y prolongar el estudio de nuevas técnicas para analizar su estabilidad a largo plazo en comparación a las otras corrientes terapéuticas.

The transverse deficiency of the maxilla is a dentomaxillary anomaly capable of producing functional problems in occlusion, respiration and esthetics. Its traditional clinical presentation is dental crowding, which obstructs the correct eruption of the teeth. Its management corresponds to rapid maxillary expansion, which can be assisted by means of mini-implants (MARPE), surgery (SARPE) or a combination of both techniques (MISMARPE). The objective of this article is to present a contrast between the techniques used in rapid maxillary expansion to simplify clinical decision making. A narrative review was performed in PubMed, Scopus and Epistemonikos databases, including systematic reviews, meta-analyses, randomized clinical trials and observational studies published between 2013 and 2023. A total of 23 articles were included, which met the established inclusion and exclusion criteria. The clinical management of transverse deficiency of the maxilla frequently requires an interdisciplinary management, combining an orthopedic and surgical approach. As found in the current review, all techniques; MARPE, SARPE and MISMARPE, report indications and limitations, as well as associated complications. It is recommended to deepen and prolong the study of new techniques in order to analyze their long-term stability in comparison to other therapeutic currents.

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This study examines how racialization processes (conceptualized as multilevel and dynamic processes) shape prenatal mental health by testing the association of discrimination and the John Henryism hypothesis on depressive symptoms for pregnant Mexican-origin immigrant women. We analyzed baseline data (n = 218) from a healthy lifestyle intervention for pregnant Latinas in Detroit, Michigan. Using separate multiple linear regression models, we examined the independent and joint associations of discrimination and John Henryism with depressive symptoms and effect modification by socioeconomic position. Discrimination was positively associated with depressive symptoms (ß = 2.84; p < .001) when adjusting for covariates. This association did not vary by socioeconomic position. Women primarily attributed discrimination to language use, racial background, and nativity. We did not find support for the John Henryism hypothesis, meaning that the hypothesized association between John Henryism and depressive symptoms did not vary by socioeconomic position. Examinations of joint associations of discrimination and John Henryism on depressive symptoms indicate a positive association between discrimination and depressive symptoms (ß = 2.81; p < .001) and no association of John Henryism and depressive symptoms (ß = -0.83; p > .05). Results suggest complex pathways by which racialization processes affect health and highlight the importance of considering experiences of race, class, and gender within racialization processes.

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Animal behavior emerges from integration of many processes with different spatial and temporal scales. Dynamical behavioral patterns, including daily and ultradian rhythms and the dynamical microstructure of behavior (i.e., autocorrelations properties), can be differentially affected by external cues. Identifying these patterns is important for understanding how organisms adapt to their environment, yet unbiased methods to quantify dynamical changes over multiple temporal scales are lacking. Herein, we combine a wavelet approach with Detrended Fluctuation Analysis to identify behavioral patterns and evaluate changes over 42-days in mice subjected to different dietary restriction paradigms. We show that feeding restriction alters dynamical patterns: not only are daily rhythms modulated but also the presence, phase and/or strength of ~12h-rhythms, as well as the nature of autocorrelation properties of feed-intake and wheel running behaviors. These results highlight the underlying complexity of behavioral architecture and offer insights into the multi-scale impact of feeding habits on physiology.

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OBJECTIVE: We studied the factorial structure and diagnostic performance in primary care of a digital version of the Alcohol Use Disorders Identification Test (d-AUDIT) for screening for excessive drinking. METHOD: In two primary care centers in Santiago, Chile, we conducted a cross-sectional study involving 330 people 18 years of age or older who had drunk alcohol six or more times in the last year. The d-AUDIT was developed from the paper version validated in Chile and was self-administered on 7-inch tablets. Trained psychologists evaluated the participants using a 1-year Timeline Followback and the alcohol use disorders section from the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. We used confirmatory factorial analysis to examine the structure of the d-AUDIT and areas under the receiver operating characteristic curves (AUCs) to examine the diagnostic performance of the d-AUDIT. RESULTS: A two-factor model presented good overall fit, with item loads in the 0.53-0.88 range. The correlation among factors was .74, reflecting a good discriminant validity. The total score and the Fast Alcohol Screening Test (FAST) score (i.e., bingeing, role failure, blackouts, and others' concern items) obtained the best diagnostic performance for problematic drinking, with AUCs of 0.94 (CI [0.91, 0.97]) and 0.92 (CI [0.88, 0.96]), respectively. The FAST could differentiate hazardous drinking (cut point three in men and one in women) from problematic drinking (cut point four in men and two in women). CONCLUSIONS: We replicated prior factor analysis findings of a two-factor structure for the d-AUDIT with a good discriminant validity. The FAST obtained excellent diagnostic performance and retained some ability to discriminate between hazardous and problematic drinking.

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Soil bacteria play a fundamental role in pedogenesis. However, knowledge about both the impact of climate and slope aspects on microbial communities and the consequences of these items in pedogenesis is lacking. Therefore, soil-bacterial communities from four sites and two different aspects along the climate gradient of the Chilean Coastal Cordillera were investigated. Using a combination of microbiological and physicochemical methods, soils that developed in arid, semi-arid, mediterranean, and humid climates were analyzed. Proteobacteria, Acidobacteria, Chloroflexi, Verrucomicrobia, and Planctomycetes were found to increase in abundance from arid to humid climates, while Actinobacteria and Gemmatimonadetes decreased along the transect. Bacterial-community structure varied with climate and aspect and was influenced by pH, bulk density, plant-available phosphorus, clay, and total organic-matter content. Higher bacterial specialization was found in arid and humid climates and on the south-facing slope and was likely promoted by stable microclimatic conditions. The presence of specialists was associated with ecosystem-functional traits, which shifted from pioneers that accumulated organic matter in arid climates to organic decomposers in humid climates. These findings provide new perspectives on how climate and slope aspects influence the composition and functional capabilities of bacteria, with most of these capabilities being involved in pedogenetic processes.

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Introducción: En la investigación desarrollada en el servicio de neonatología del hospital Docente Ginecobstétrico "Eusebio Hernández", se pudo constatar que para el personal de enfermería el cuidado del recién nacido que se encuentra en recuperación nutricional es un elemento importante para el progreso de la atención del neonato en las salas de cuidados intensivos neonatales. Objetivo: Identificar las competencias específicas de enfermería para el cuidado del recién nacido en recuperación nutricional. Métodos: Investigación de desarrollo tecnológico en el Hospital Ginecobstétrico Eusebio Hernández en La Habana durante 2020. El universo lo constituyeron 50 profesionales de enfermería que laboran en el servicio de neonatología. Para el desarrollo de la investigación se utilizó el método DACUM (desarrollo del currículum laboral), se confeccionó las funciones y tareas, con la participación de expertos, se construyó el mapa DACUM. Resultados: Se identificaron 6 competencias específicas en relación con 6 funciones y sus tareas en lo que la totalidad de los expertos estuvieron de acuerdo por tener un alto nivel científico. Conclusiones: Se identificaron las competencias específicas de enfermería para el cuidado de neo-natos en recuperación nutricional, lo que permitió mejorar la calidad de la atención a estos recién nacidos y el perfeccionamiento de los profesionales.

Introduction: In the research carried out in the neonatology service of the Eusebio Hernández Gyneco-Obstetric Teaching Hospital, it was found that for the nursing staff the care of the newborn who is in nutritional recovery is an important element for the progress of care of the neonate in neonatal intensive care wards. Objective: To identify the specific nursing competencies for the care of the newborn in nutritional recovery. Methods: Technological development research at the Eusebio Hernández Gyneco-Obstetric Hospital in Havana during 2020. The universe was made up of 50 nursing professionals working in the neonatology service. For the development of the research, the DACUM method (development of the work curriculum) was used, the functions and tasks were prepared, with the participation of experts, the DACUM map was constructed. Results: 6 specific competences were identified in relation to 6 functions and their tasks, in which all the experts agreed due to having a high scientific level. Conclusions: Specific nursing competencies for the care of neonates in nutritional recovery were identified, which allowed improving the quality of care for these newborns and the improvement of professionals.

Introdução: Na pesquisa realizada no serviço de neonatologia do Hospital Universitário Gineco-Obstétrico "Eusebio Hernández", constatou-se que para a equipe de enfermagem o cuidado ao recém-nascido em recuperação nutricional é um elemento importante para o andamento da assistência do recém-nascido em enfermarias de terapia intensiva neonatal. Objetivo: Identificar as competências específicas de enfermagem para o cuidado ao recém-nascido em recuperação nutricional. Métodos: Pesquisa de desenvolvimento tecnológico no Hospital "Eusebio Hernández" Gyneco-Obstétrico de Havana em 2020. O universo era formado por 50 profissionais de enfermagem que atuavam no serviço de neonatologia. Para o desenvolvimento da pesquisa, foi utilizado o método DACUM (elaboração do currículo do trabalho), foram elaboradas as funções e tarefas, com a participação de especialistas, foi construído o mapa DACUM. Resultados: identificaram-se 6 competências específicas em relação a 6 funções e respetivas tarefas, em que todos os peritos concordaram por possuírem um elevado nível científico. Conclusões: Foram identificadas competências específicas de enfermagem para o cuidado ao recém-nascido em recuperação nutricional, o que permitiu melhorar a qualidade da assistência a esses recém-nascidos e o aprimoramento dos profissionais.

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RESUMEN Solanum ferruginium es una planta que crece en lugares perturbados como maleza, es de uso medicinal poco utilizada que presenta un gran potencial como fuente de antioxidantes debido a su alto contenido en polifenoles. Debido a esto se analizó el contenido de polifenoles, flavonoides, proantocianidinas y capacidad antioxidante in vitro (ensayo de captación de radicales DPPH) en hojas, tallos y planta completa de tres localidades (Las agujas, Parque el Nabo y Bosque la Primavera) de Zapopan, Jalisco, así como su toxicidad subcronica en hojas. En general se observó diferencia significativa (p≤ 0,05), en las muestras de las tres localidades, las hojas presentaron el mayor contenido de polifenoles (15,3±0,7 a 22±0,4 mg expresado como equivalente de ácido gálico (EAG/g) en muestras de Parque el Nabo, flavonoides (7,8±0,3 a 13,3±0,3 mg EC/g) y proantocianidinas (3,4±0,1 a 4,2±0,05 mg expresado como equivalente de catequina (EC/g) en el Bosque la Primavera. La capacidad antioxidante fue similar en todas las muestras, con valores de 8,3 a 17 μg/mL de concentración media inhibitora (CI50). En la prueba toxicológica, los ratones no mostraron signos de toxicidad a ninguna dosis por efecto de la administración de la planta en estudio, por lo que la dosis letal media (DL50) es > 15 000 mg/kg de peso corporal. El contenido de polifenoles y actividad antioxidante en S. ferruginium sobre todo en hojas indican un alto potencial con propiedades farmacológicas además de su inocuidad, por lo que es importante realizar estudios de sus compuestos fenólicos individuales, antes de ser utilizada en farmacología.

ABSTRACT Solanum ferrugineum is a plant that grows like a weed. It is a new medicinal plant with great potential as an antioxidant source due to its high polyphenol content. Because of this, polyphenol, flavonoid, proanthocyanidin, and antioxidant capacity in vitro (radical scavenging test by DPPH) were analyzed in leaves, stems, and whole plants from three localities (Las agujas, Nabo Park, and La Primavera Forest) as well as the subchronic toxicity evaluation in leaves. In general, there was a significant difference (p≤ 0.05) in all samples from the three localities. The leaves showed the highest polyphenol content (15.3±0.7 to 22±0.4 mg AGE/g) in samples from the Nabo Park, flavonoid (7.8±0.3 to 13.3±0,3 mg CE/g) and proanthocyanidins (3.4±0.1 to 4.2±0.05 mg CE/g) in La Primavera Forest. Antioxidant capacity was similar across all samples, showing values of 8.3 to 17 μg/mL of IC50. During the toxicology assay, animal specimens showed no signs of toxicity to the doses resulting from the administration of the plant under study so that LD50 > 15 000 mg/kg Bodyweight. The polyphenol content and antioxidant capacity obtained from S. ferruginium leaves, together with its safety, indicate a high pharmacological potential of this plant. Therefore, it is important to carry out studies of its phenolic compounds before being used in pharmacology.

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Sandwich composites are widely used in the manufacture of aircraft cabin interior panels for commercial aircraft, mainly due to the light weight of the composites and their high strength-to-weight ratio. Panels are used for floors, ceilings, kitchen walls, cabinets, seats, and cabin dividers. The honeycomb core of the panels is a very light structure that provides high rigidity, which is considerably increased with fiberglass face sheets. The panels are manufactured using the compression molding process, where the honeycomb core is crushed up to the desired thickness. The crushed core breaks fiberglass face sheets and causes other damage, so the panel must be reworked. Some damage is associated with excessive build-up of resin in localized areas, incomplete curing of the pre-impregnated fiberglass during the manufacturing process, and excessive temperature or residence time during the compression molding. This work evaluates the feasibility of using rigid polyurethane foams as a substitute for the honeycomb core. The thermal and viscoelastic behavior of the cured prepreg fiberglass under different manufacturing conditions is studied. The first part of this work presents the influence of the manufacturing parameters and the feasibility of using rigid foams in manufacturing flat panels oriented to non-structural applications. The conclusion of the article describes the focus of future research.

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The manufacturing process of the aircraft cabin interior panels is expensive and time-consuming, and the resulting panel requires rework due to damages that occurred during their fabrication. The aircraft interior panels must meet structural requirements; hence sandwich composites of a honeycomb core covered with two layers of pre-impregnated fiberglass skin are used. Flat sandwich composites are transformed into panels with complex shapes or geometries using the compression molding process, leading to advanced manufacturing challenges. Some aircraft interior panels are required for non-structural applications; hence sandwich composites can be substituted by cheaper alternative materials and transformed using disruptive manufacturing techniques. This paper evaluates the feasibility of replacing the honeycomb and fiberglass skin layers core with rigid polyurethane foams and thermoplastic polymers. The results show that the structural composites have higher mechanical performances than the proposed sandwich composites, but they are compatible with non-structural applications. Sandwich composite fabrication using the vacuum forming process is feasible for developing non-structural panels. This manufacturing technique is fast, easy, economical, and ecological as it uses recyclable materials. The vacuum forming also covers the entire panel, thus eliminating tapestries, paints, or finishes to the aircraft interior panels. The conclusion of the article describes the focus of future research.

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BACKGROUND: Because of the shortage of health professionals in Chilean primary care, Health Technicians (HT) are providing Brief Interventions (BI) for risky alcohol consumption. We compared the efficacy of two AUDIT-linked interventions provided by HTs: an informative leaflet and a BI plus leaflet. METHODS: This is a parallel-group randomized controlled trial with 1:1 randomization. Participants were identified through screening with the Alcohol Use Disorders Identification Test (AUDIT) at five primary care centers between March 2016 and July 2017. People older than 18 years at intermediate-risk (AUDIT score 8 to 15, inclusive) were randomized to receive either an HT-delivered BI (n = 174) or an informative leaflet (n = 168). Only data from participants (n = 294) who completed the 6-month assessment were analyzed. The leaflet was delivered without further advice. It contains alcohol consumption limits, a change planner, and strategies to decrease drinking. The BI was a 5-min discussion on the leaflet´s content plus normative feedback, tailored information on alcohol and health, and a change plan. The change in the AUDIT risk category six months after randomization (primary outcome) was compared among groups with a Chi-squared test. Changes in the secondary outcomes, which were scores on the AUDIT and the AUDIT´s consumption items (AUDIT-C), were compared with T-tests. Mixed-effects linear models adjusted for potential confounders. Outcome adjudicators were blinded to group assignment. RESULTS: At 6-month follow-up, low-risk alcohol consumption was observed in 119 (80%) participants in the BI group, and in 103 (71%) in the leaflet group, with no difference among groups ([Formula: see text] [1, N = 294] = 2.6, p = 0.1; adjusted odds ratio 0.6; 95% confidence interval [CI] 0.34, 1.05). The mean AUDIT score decreased by 5.76 points in the BI group, and by 5.07 in the leaflet group, which represents a 0.86 AUDIT point reduction attributable to the BI (secondary outcome) (T = 2.03, p = 0.043; adjusted mean difference 0.86 CI 0.06, 1.66). CONCLUSIONS: The AUDIT-linked BI delivered by HTs was not associated with a greater reduction of risky alcohol consumption than an informative leaflet. Delivering a leaflet could be more efficient than a BI when provided by HTs; however, more research on the effectiveness of the leaflet is needed. Trial registration ClinicalTrials.gov NCT02642757 (December 30, 2015) https://clinicaltrials.gov/ct2/show/NCT02642757 .

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Duration of untreated psychosis (DUP) is associated with clinical outcomes in people with a diagnosis of first-episode psychosis (FEP), but factors associated with length of DUP are still poorly understood. Aiming to obtain insights into the possible biological impact on DUP, we report genetic analyses of a large multi-center phenotypically well-defined sample encompassing individuals with a diagnosis of FEP recruited from 6 countries spanning 17 research sites, as part of the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. Genetic propensity was measured using polygenic scores for schizophrenia (SZ-PGS), bipolar disorder (BD-PGS), major depressive disorder (MDD-PGS), and intelligence (IQ-PGS), which were calculated based on the results from the most recent genome-wide association meta-analyses. Following imputation for missing data and log transformation of DUP to handle skewedness, the association between DUP and polygenic scores (PGS), adjusting for important confounders, was investigated with multivariable linear regression models. The sample comprised 619 individuals with a diagnosis of FEP disorders with a median age at first contact of 29.0 years (interquartile range [IQR] = 22.0-38.0). The median length of DUP in the sample was 10.1 weeks (IQR = 3.8-30.8). One SD increases in SZ-PGS, BD-PGS, MDD-PGS or IQ-PGS were not significantly associated with the length of DUP. Our results suggest that genetic variation does not contribute to the DUP in patients with a diagnosis of FEP disorders.

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Low birth weight (LBW) is a global problem that annually affects nearly 20 million children, 96% of these in developing countries. According to the WHO, the poorest and the ethnic minorities are the groups most affected by this indicator. A cross-sectional study of the database of all newborns officially registered in Colombia in 2008-2014 was done. While dichotomizing the mestizo population and ethnic minorities (Afro-descendants, indigenous, ROM), normal and low birth weight was used as the dependent variable and ethnicity as the explanatory variable. Other variables of the parents and the newborns were used as covariates. To assess associations, bivariate and multivariate logistic regression analyses were performed. The incidence of LBW among newborns registered in Colombia fluctuated at around 9%. Among the ethnic minorities, the probability of LBW, adjusted for other variables, was significantly higher (OR 1.07, 95% CI 1.05-1.08) than among mestizos. A significantly higher risk of LBW to newborns in the ethnic minorities' group, and those with unfavorable socioeconomic conditions, was found.

RESUMEN: El bajo peso al nacer (BPN) es un problema global que afecta anualmente a casi 20 millones de niños, el 96% de estos en países en desarrollo. Según la OMS, las más pobres y las minorías étnicas son los grupos más afectados por este indicador. Se realizó un estudio transversal de la base de datos de todos los recién nacidos registrados oficialmente en Colombia en 2008-2014. La población fue dicotomizaba en mestiza y minorías étnicas (afrodescendientes, indígenas, ROM). Se utilizó Bajo Peso al Nacer (BPN) como variable dependiente y el origen étnico como variable explicativa. Otras variables de los padres y los recién nacidos se utilizaron como covariables. Para evaluar las asociaciones, se realizaron análisis de regresión logística bivariada y multivariada. La incidencia de BPN entre los recién nacidos registrados en Colombia fluctuó alrededor del 9%. Entre las minorías étnicas, la probabilidad de LBW, ajustada por otras variables, fue significativamente mayor (OR = 1.07, 95% _CI: 1.05-1.08) que entre los mestizos. Se encontró un riesgo significativamente más alto de BPN para los recién nacidos en el grupo de minorías étnicas y aquellos con condiciones socioeconómicas desfavorables.

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This work deals with the manufacture and mechanical characterization of natural-fiber-reinforced biobased epoxy resins. Biolaminates are attractive to various industries because they are low-density, biodegradable, and lightweight materials. Natural fibers such as Ixtle, Henequen, and Jute were used as reinforcing fabrics for two biobased epoxy resins from Sicomin®. The manufacture of the biolaminates was carried out through the vacuum-assisted resin infusion process. The mechanical characterization revealed the Jute biolaminates present the highest stiffness and strength, whereas the Henequen biolaminates show high strain values. The rigid and semirigid biolaminates obtained in this work could drive new applications targeting industries that require lightweight and low-cost sustainable composites.

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BACKGROUND: Harmful alcohol use is a leading cause of global disability and death. However, increased detection and brief intervention capacity of more severe alcohol use disorders has not been accompanied by increased availability of treatment services. Incorporating treatment for such disorders into primary care is of paramount importance for improving access and health outcomes. This study aims to estimate the effectiveness of a Brief Motivational Treatment (BMT) applied in primary care for treatment of these disorders. METHODS: A parallel-group, single-blinded, severity-stratified, randomized clinical trial will test the superiority of BMT over enhanced usual care. Eligible participants will be those seeking treatment and who fulfill DSM-V criteria for alcohol use disorder and criteria for harmful alcohol use. With an estimated a loss to follow-up of 20%, a total of 182 participants will be recruited and equally randomized to each treatment group. The intervention group will receive an adaptation of the motivational enhancement therapy, as manualized in Project MATCH. This treatment consists of four 45-min sessions provided by a general psychologist with at least 3 years of primary care experience. The primary outcome is the change from baseline in the drinks per drinking day during the last 90 days, which will be captured using the Timeline Follow Back method. Secondary outcomes will describe the changes in alcohol use pattern, motivational status, and severity of the disorder. All participants will be analyzed according to the group they were allocated, regardless of the treatment actually received. Mean differences (MD) will be computed for continuous outcomes and relative risks (RR) and RR reductions (RRR) for dichotomous results. Linear models will deliver the subgroup analyses. Missingness is assumed to be associated with the baseline alcohol use pattern and severity, so a multiple imputation method will be used to handle missing data. DISCUSSION: This trial aims to test the superiority of BMT over enhanced usual care with a reasonable superiority margin, over which the BMT could be further considered for incorporation into PC in Chile. Its pragmatic approach ultimately aims to inform policymakers about the benefit of including a brief psychosocial treatment into PC. TRIAL REGISTRATION: ClinicalTrials.gov NCT04345302 . Registered on 28 April 2020.

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INTRODUCTION: Leishmaniasis is a zoonotic disease which is caused by protozoan parasites of the genus Leishmania. Canids are the most important reservoir of the parasites; however, limited data are available on the species of Leishmania prevalent in these animals and their impact on human health. The objective of this study was to estimate the seroprevalence of leishmaniasis in dogs from an inter-Andean region of Colombia during July 2016-July 2017, and to describe the clinical and histopathological features of the disease. MATERIAL AND METHODS: A total of 155 dogs were subjected to clinical examination and a serological test for detection of antibodies against Leishmania. Necropsy was carried out on positive animals and tissue samples were processed by routine histopathology. RESULTS: Altogether 19 dogs were positive in the serological test, establishing a 12% seroprevalence of Leishmania. Clinical examination and necropsy revealed exfoliative and ulcerative dermatitis with haemorrhagic borders on the ears, head, nose, and legs. Histopathology revealed severe multifocal dermatitis with abundant Leishmania amastigotes within the cytoplasm of phagocytic cells, depletion of lymphocytes in lymphoid tissues, interstitial pneumonia, and interstitial nephritis. Tissue samples were positive for Leishmania by PCR. CONCLUSION: The macro- and microscopic changes correlated with the presence of Leishmania as established by serological test and PCR.

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Resumen: Una parte fundamental en todo proyecto de mejora continua es la apropiada información y educación para el paciente y su familia. Las expectativas de una intervención quirúrgica, del curso perioperatorio y de la experiencia del dolor, puede ser distinta, de acuerdo con las creencias y el estado previo de ansiedad provocado por la incertidumbre y el miedo a lo desconocido, lo cual puede provocar un manejo del dolor menos efectivo. Esta variabilidad en la respuesta frente al evento quirúrgico puede ser optimizada en el momento que se proporciona la información de todo el proceso de manera objetiva. Dentro del proyecto de Investigación de PAIN OUT para la optimización del manejo del dolor perioperatorio, coordinado por el departamento de Anestesiología en el INCMNSZ, se planteó la posibilidad de implementar estrategias de educación para la población general. El Departamento de Educación para la Salud del INCMNSZ, tiene como objetivo apoyar y asesorar a las distintas áreas del hospital en materia de educación y promoción de la salud, que contribuyan a generar una cultura de prevención y autocuidado en el paciente y su familia. En un esfuerzo conjunto de estos dos departamentos se planteó la posibilidad de generar material audiovisual que cumpliera con el objetivo primordial de educar en el contexto perioperatorio. Se crearon tres audiovisuales con el apoyo de diseñadores gráficos del Instituto Tecnológico y de Estudios Superiores de Monterrey, Campus Ciudad de México. El primero incluye información acerca del proceso anestésico; el segundo habla del dolor postoperatorio, su evaluación por parte del paciente y las alternativas de manejo durante la hospitalización y el egreso; mientras que el tercero tiene información sobre los mitos y realidades del uso de opioides como parte de una estrategia analgésica. Este material tiene el objetivo de ser difundido entre la población general, a través del sitio web de la Red Mexicana PAIN OUT para la optimización del manejo del dolor perioperatorio http://www.painoutmexico.com y del sitio webhttps://www.epsnutricion.com.mx/quienes.php

Abstract: A fundamental part of any continuous improvement project is the appropriate information and education for the patient and his family. The expectations of a surgical intervention, of the perioperative course and of the experience of pain, can be different, according to the beliefs and previous state of anxiety caused by uncertainty and fear of the unknown, which can favor a less effective management of pain. This variability in the response to the surgical event can be optimized if the information of the entire process is provided objectively beforehand. The PAIN OUT Research project for the optimization of perioperative pain management, coordinated by the Department of Anesthesiology at INCMNSZ, provides the possibility of implementing education strategies for the general population was raised. The Department of Health Education of INCMNSZ aims to support and advise the different areas of the hospital in terms of education and health promotion, which contribute to generate a culture of prevention and self-care in the patient and his family. In a joint effort of these two departments, the possibility of generating audiovisual material that met the primary objective of educating in the perioperative context was done. Three audiovisuals were created with the support of graphic designers from the Tecnológico y Estudios Superiores de Monterrey, Mexico City Campus. The first includes information about the anesthetic process, the second includes information about postoperative pain, its evaluation by the patient and management alternatives during hospitalization and discharge, and the third includes information about the myths and realities of the use of opioids as part of an analgesic strategy. This material is intended to be disseminated to the general population, through the website of the Mexican PAIN OUT Network for the optimization of perioperative pain management http://www.painoutmexico.com and the website https://www.epsnutricion.com.mx/quienes.php

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En la investigación desarrollada en el salón de Partos del hospital Docente "Eusebio Hernández", se pudo constatar que para el personal de enfermería el cuidado de la mujer en trabajo de parto es un elemento importante para el progreso de la perinatología. El presente trabajo es una investiga-ción de desarrollo tecnológico con el objetivo de identifi car las competencias específi cas del enfer-mero que labora en el salón de partos. Se trabajó con: análisis documental, encuestas a expertos y entrevistas a profesionales de enfermería que laboran en el salón de partos. Se elaboró, a partir de la identifi cación de competencias específi cas para el personal de enfermería que labora en el salón de parto, un mapa para el desarrollo del currículo laboral (mapa DACUM) donde se incluyen las tareas y funciones que debe realizar el personal de enfermería

In the investigation developed in the living room of Childbirths of the Educational hospital Eu-sebio Hernández Pérez, could ascertain that for the personnel of infi rmary the care of the woman in work of childbirth. " e present work is an investigation of technological development with the aim to identify thespecifi c competitions of infi rmary. We worked with: documentary analysis, expert surveys and interviews with nursing professionals who work in the delivery room. It was elaborated, from the identifi cation of specifi c competencies for the nursing staff that works in the delivery room, a map for the development of the labor curriculum (DACUM map) which includes the tasks and func-tions that the nursing staff must perform

Na pesquisa realizada na sala de parto do Hospital Universitário "Eusebio Hernández", consta-tou-se que para a equipe de enfermagem o cuidado da mulher em trabalho de parto é um elemento importante para o progresso da perinatologia. O presente trabalho é uma pesquisa de desenvol-vimento tecnológico com o objetivo de identifi car as competências específi cas do enfermeiro que trabalha na sala de parto. Trabalhamos com: análise documental, pesquisas de especialistas e en-trevistas com profi ssionais de enfermagem que atuam na sala de parto. Foi elaborado, a partir da identifi cação de competências específi cas para a equipe de enfermagem que trabalha na sala de parto, um mapa para o desenvolvimento do currículo de trabalho (mapa DACUM) que inclui as tarefas e funções que a equipe de enfermagem deve realizar.

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BACKGROUND: Cannabis use is associated with increased risk of later psychotic disorder but whether it affects incidence of the disorder remains unclear. We aimed to identify patterns of cannabis use with the strongest effect on odds of psychotic disorder across Europe and explore whether differences in such patterns contribute to variations in the incidence rates of psychotic disorder. METHODS: We included patients aged 18-64 years who presented to psychiatric services in 11 sites across Europe and Brazil with first-episode psychosis and recruited controls representative of the local populations. We applied adjusted logistic regression models to the data to estimate which patterns of cannabis use carried the highest odds for psychotic disorder. Using Europe-wide and national data on the expected concentration of Δ9-tetrahydrocannabinol (THC) in the different types of cannabis available across the sites, we divided the types of cannabis used by participants into two categories: low potency (THC <10%) and high potency (THC ≥10%). Assuming causality, we calculated the population attributable fractions (PAFs) for the patterns of cannabis use associated with the highest odds of psychosis and the correlation between such patterns and the incidence rates for psychotic disorder across the study sites. FINDINGS: Between May 1, 2010, and April 1, 2015, we obtained data from 901 patients with first-episode psychosis across 11 sites and 1237 population controls from those same sites. Daily cannabis use was associated with increased odds of psychotic disorder compared with never users (adjusted odds ratio [OR] 3·2, 95% CI 2·2-4·1), increasing to nearly five-times increased odds for daily use of high-potency types of cannabis (4·8, 2·5-6·3). The PAFs calculated indicated that if high-potency cannabis were no longer available, 12·2% (95% CI 3·0-16·1) of cases of first-episode psychosis could be prevented across the 11 sites, rising to 30·3% (15·2-40·0) in London and 50·3% (27·4-66·0) in Amsterdam. The adjusted incident rates for psychotic disorder were positively correlated with the prevalence in controls across the 11 sites of use of high-potency cannabis (r = 0·7; p=0·0286) and daily use (r = 0·8; p=0·0109). INTERPRETATION: Differences in frequency of daily cannabis use and in use of high-potency cannabis contributed to the striking variation in the incidence of psychotic disorder across the 11 studied sites. Given the increasing availability of high-potency cannabis, this has important implications for public health. FUNDING SOURCE: Medical Research Council, the European Community's Seventh Framework Program grant, São Paulo Research Foundation, National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London and the NIHR BRC at University College London, Wellcome Trust.

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Age-related reference intervals (RIs) of aortic pulse wave velocity (Ao-PWV) obtained from a large healthy population are lacking in South America. The aims of this study were to determine Ao-PWV RIs in a cohort of healthy children and adolescents from Argentina and to generate year-to-year percentile curves. Ao-PWV was measured in 1000 healthy subjects non-exposed to traditional cardiovascular risk factors (Age: 10-22 y. o., 56% males). First, we evaluated if RIs for males and females were necessaries (correlation and covariate analysis). Second, mean (M) and standard deviation (SD) age-related equations were obtained for cf-PWV, using parametric regression methods based on fractional polynomials. Third, age-specific (year to year) percentiles curves (for all, males and females children and adolescents) were generated using the standard normal distribution. They were, age-specific 1st, 2.5th, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97.5th and 99th percentile curves and values. After covariate analysis (i.e., adjusting by age, jugulum-symphysis distance, body weight and height), specific RIs for males and females of children and adolescents were evidenced as necessaries. The equations were For all subjects: Ao-PWV_Mean = 4.98 + 12.86x10-5 Age3. Ao-PWV_SD = 0.47 + 21.00x10-6Age3. For girls: Ao-PWV_Mean = 5.07 + 10.23x10-5Age3. Ao-PWV_SD = 0.50 + 10.00x10-6Age3. For boys: Ao-PWV_Mean = 4.87 + 15.81x10-5Age3. Ao-PWV_SD = 0.46 + 22.34x10-6Age3. Our study provides the largest database to-date concerning Ao-PWV in healthy children and adolescents in Argentina. Age-related equations (M and SD values) for Ao-PWV are reported by the first time. Specific RIs and percentiles of Ao-PWV are now available according to age and sex for an Argentinian population.

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Herpes simplex virus type 2 (HSV-2) is among the most prevalent sexually transmitted infections in the United States. Despite this, there has been limited research on the correlates to HSV-2 among disadvantaged and marginalized women, particularly among Latinas. Data for the present analysis include 125 young adult Mexican-American women enrolled in a longitudinal study in a disadvantaged urban community in San Antonio, Texas. The current rate of tested HSV-2 infection is 56.8%. Our findings suggest strong comorbidity of genital herpes with injecting heroin use, Hepatitis C, sexual violence, incarceration, and mental illness. Contributing to this population's nexus of risk are the low rates of health service utilization among those infected with HSV-2. Integration between behavioral health and primary care, including access to preventative services, are essential for improving the health of Latinas living in disadvantaged neighborhoods.

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