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OBJECTIVE: To examine the association between low-intensity smoking (10 or less cigarettes per day) and all-cause and cause-specific mortality risk among women who smoke and by age at cessation among women who previously smoked. METHODS: In this study, 104 717 female participants of the Mexican Teachers' Cohort Study were categorised according to self-reported smoking status at baseline (2006/2008) and were followed for mortality through 2019. We estimated HRs and 95% CIs for all-cause and cause-specific mortality using multivariable Cox proportional hazards regression models with age as the underlying time metric. RESULTS: Smoking as few as one to two cigarettes per day was associated with higher mortality risk for all causes (HR: 1.36; 95% CI 1.10 to 1.67) and all cancers (HR: 1.46; 95% CI 1.05 to 2.02), compared with never smoking. Similarly, slightly higher HRs were observed among participants smoking ≥3 cigarettes per day (all causes HR: 1.43; 95% CI 1.19 to 1.70; all cancers HR: 1.48; 95% CI 1.10 to 1.97; cardiovascular disease HR: 1.58; 95% CI 1.09 to 2.28). CONCLUSIONS: In this large study of Mexican women, low-intensity smoking was associated with higher mortality risk for all causes and all cancers. Interventions are needed to promote cessation among women who smoke at low-intensity in Mexico, regardless of how few cigarettes they smoke per day.

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A escala mundial, el cáncer cervical es el cuarto tipo de cáncer más frecuente en las mujeres y tiene la cuarta tasa de mortalidad más alta de los cánceres en las mujeres. La colposcopia forma parte de los recursos con los que cuenta la medicina para el diagnóstico y seguimiento de las lesiones preinvasivas y el cáncer de cuello uterino. Se requiere de profesionales bien capacitados para realizar una colposcopia precisa y segura. El mismo resultado citológico tiene un riesgo diferente de neoplasia intraepitelial 2, 3, o cáncer en varios grupos de mujeres, por ello, varias poblaciones requieren consideraciones especiales de manejo, entre ellas, las menores de 25 años, las embarazadas, las inmunodeprimidas, las que fueron sometidas a histerectomía y las mayores de 65 años. La presente revisión se realizó para actualizar la información disponible sobre la colposcopia en estas poblaciones especiales(AU)

Globally, cervical cancer is the fourth most common type of cancer in women and has the fourth highest death rate of cancers in women. Colposcopy is part of the resources available to medicine for the diagnosis and monitoring of preinvasive lesions and cervical cancer. Well-trained professionals are required to perform an accurate and safe colposcopy. The same cytologic outcome has a different risk of intraepithelial neoplasia 2, 3, or cancer in various groups of women, so several populations require special management considerations, including those younger than 25 years, pregnant women, immunosuppressed women, those who underwent hysterectomy, and those older than 65 years. We conducted this review to update the available information on colposcopy in these special populations(AU)

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Most studies of sexual violence are with women, and although men who have sex with men (MSM) is the group of the men that has been most investigated for sexual violence, there are still several questions to be answered about sexual violence and sexual revictimization among MSM. This study aimed to estimate the prevalence of sexual violence in different stages of life and identify factors associated with sexual violence in adulthood among Brazilian MSM. We conducted an analysis with data from the study conducted in 2016 with 4,176 MSM from 12 Brazilian cities recruited through respondent-driven sampling (RDS), who answered a survey to a set of questions, among which some specific about sexual violence. Most participants were under 25 years old (56.5%), with more than 12 years of schooling (71.2%), mixed race (40.8%), single (86.2%), and belonging to some religion (50.9%). The lifetime prevalence of sexual violence was 20.3%. In our analyses, having experienced sexual violence in childhood and adolescence increased the odds of experiencing sexual violence in adulthood (prevalence ratio ratios [PRR] 4.93 (95% CI [1.99, 12.21]), as did experiencing physical violence (PRR 1.99; 95% CI [1.07, 3.71]) and receiving money for sex (PRR 2.26; 95% CI [1.17, 4.36]). In addition to violence in childhood and adolescence being risk factors for sexual violence in adulthood, we also observed that half of the sample experienced sexual violence repeatedly, characterizing sexual revictimization. It is important that health services are prepared to receive boys and men victims in order to reduce the chances of revictimization and other outcomes.

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Meropenem pharmacokinetics in neonates exhibits large interindividual variability due to developmental changes occurring during the first month of life. The objective was to characterize meropenem pharmacokinetics through a population approach to determine effective dosing recommendations in neonates with severe nosocomial infections. Three blood samples from forty neonates were obtained once steady-state blood levels were achieved and plasma concentrations were determined with a validated chromatographic method. Data were used to develop and validate the one-compartment with first-order elimination population pharmacokinetic model obtained by non-linear mixed effect modeling. The final model was Clearance (L/h) = 2.23 × Creatinine Clearance (L/h) and Volume of distribution(L) = 6.06 × Body Surface Area(m2) × (1 + 0.60 if Fluticasone comedication). Doses should be adjusted based on said covariates to increase the likelihood of achieving therapeutic targets. This model explains 12.9% of the interindividual variability for meropenem clearance and 19.1% for volume of distribution. Stochastic simulations to establish initial dosing regimens to maximize the time above the MIC showed that the mean probabilities to achieve the PK/PD target (PTA) for microorganisms with a MIC of 2 and 8 µg/mL were 0.8 and 0.7 following i.v. bolus of 250 and 500 mg/m2/dose q8h, respectively. Meropenem extended 4h infusion would improve PTA in neonates with augmented creatinine clearance.

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BACKGROUND: Panama has the lowest overall prevalence of tobacco use in the Americas, however rates are almost three times higher in the indigenous territory of Kuna Yala compared with the national average. Most people who smoke started during adolescence, making this a key period for tobacco control efforts. OBJECTIVE: We aimed to examine tobacco access and use among adolescents (13 to 15 years old) in Kuna Yala compared with nationwide Panama using data from the 2017 Global Youth Tobacco Survey, a standardised international tool for assessing key tobacco control indicators among adolescents. RESULTS: The prevalence of current tobacco use among 13 to 15 year olds in Kuna Yala was 14.0% (95% CI: 11.6% to 16.9%)-almost twice the national average of 7.8% (95% CI: 6.3% to 9.4%). Half of all adolescents in Kuna Yala estimated the cost of a 20-cigarette pack as less than US$0.75, compared with 16.2% of adolescents across of Panama (p value <0.01). CONCLUSIONS: Kuna Yala is one of the few indigenous territories in Spanish-speaking countries where key tobacco control indicators have recently been assessed. Higher tobacco use and lower reported cigarette prices in that region may be linked with the presence of barter economy which may give adolescents more ready access to cigarettes than in other parts of Panama. There is a need for more indigenous-specific data to help build the evidence base to improve tobacco control and reduce commercial tobacco use among indigenous peoples.

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OBJECTIVE: To analyse trends in cigarette brand preference among Mexican smokers during the implementation period of key WHO's Framework Convention on Tobacco Control recommendations. METHODS: Data came from two nationally representative, comparable surveys, namely the Global Adult Tobacco Survey 2009 and 2015 and the National Survey on Addictions 2011 and 2016. Logistic models were used to estimate the adjusted prevalence of each brand purchased, as well as individual correlates of purchasing the single brand with a large growth over the study period. Multiple linear regressions were also employed to analyse cigarette prices across brands. RESULTS: Six brand families accounted for about 90% of the cigarette market, with Marlboro clearly dominating all brands at 54%-61%. Only the share of Pall Mall brand, however, registered a rapid increase over the period-from 1% in 2009 to 14% in 2016. Women and younger smokers (15-24 years) were more likely to prefer Pall Mall over other brands. While the typical price segmentation between international (premium) brands and national (discount) brands was observed, the price of Pall Mall is within the range of the latter. Importantly, most varieties of this brand include flavour capsule varieties (FCVs). CONCLUSIONS: This study suggests that the strong campaign of brand migration, the pricing strategy and the aggressive introduction of FCVs expanded Pall Mall in the Mexican cigarette market. Therefore, better control policies of cigarette contents and taxes that reduce price differentials across brands should be encouraged to promote public health.

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Objetiva-se analisar a capacidade funcional antes e depois de um tratamento com cinesioterapia passiva e alongamento em populações especiais. Estudo de caso, exploratório, retrospectivo, com uma abordagem quantitativa dos dados. A amostra da pesquisa foi constituída por homens na faixa etária entre 60 a 76 anos de idade, sedentários, com coronariopatias e co-morbidades associadas. Foram analisadas as fichas de avaliação e da reavaliação realizadas com o Senior Fitness Test entre julho a agosto de 2017. A estatística foi realizada através do software SISVAR. As co-morbidades associadas mais frequentes foram: dislipidemia e Hipertensão Arterial Sistêmica. No teste T1, houve um aumento no número de repetições nos movimentos de sentar e levantar da cadeira nos participantes 3, 7 e 10. No T2, ocorreu uma melhora no movimento de flexão do antebraço nos participantes 7 e 8. No T3, os participantes 3, 9, e 10 apresentaram uma melhora na flexibilidade dos MMII. O T4 verificou que os participantes 3 e 7 foram melhores na velocidade, agilidade e equilíbrio dinâmico. O T5 confirmou que apenas o participante 8 apresentou resultados significativos quanto à flexibilidade dos MMSS. No T6 e T7, não houve diferença significativa entre paciente x tempo quanto à resistência aeróbica e IMC respectivamente após o tratamento. Os resultados do Senior Fitness Test em populações especiais parece ser uma ferramenta capaz de analisar individualmente as necessidades de cada participante de um protocolo com reabilitação cardíaca de forma segura e prática; no entanto, se faz necessária uma amostra mais significativa.

Objective: To analyze the functional capacity before and after a treatment with passive kinesiotherapy and stretching in special populations. Method: Exploratory, retrospective case study with a quantitative data approach.The research sample consisted of men in the age group between 60 and 76 years of age, sedentary, with coronary diseases and associated comorbidities. We analyzed the evaluation and revaluation sheets made with Senior Fitness Test between July and August 2017. The statistics were performed using the SISVAR software. Results: The most frequent associated comorbidities were: dyslipidemia and Systemic Arterial Hypertension. In the T1 test, there was an increase in the number of repetitions in the sit and stand movements in the participants 3, 7 and 10. In T2 there was an improvement in the movement of forearm flexion in participants 7 and 8. In T3 participants 3, 9, and 10 presented an improvement in the flexibility of LLLs. T4 found that participants 3 and 7 were better at speed, agility, and dynamic balance. The T5 confirmed that only the participant 8 presented significant results regarding the flexibility of the MMSS. At T6 and T7, there was no significant difference between patient and time for aerobic endurance and BMI respectively after treatment. Conclusion: The results of Senior Fitness Test in special populations seem to be a tool capable of analyzing individually the needs of each participant of a protocol with cardiac rehabilitation in a safe and practical way, however a more significant sample is necessary.

El objetivo es analizar la capacidad funcional antes y después de un tratamiento con kinesioterapia pasiva y estiramiento en poblaciones especiales. Estudio de caso, exploratorio, retrospectivo, con un enfoque cuantitativo de los datos. La muestra de investigación consistió en hombres sedentarios de 60 a 76 años, con enfermedades coronarias y comorbilidades asociadas. Se analizaron los formularios de evaluación y reevaluación realizados con la Prueba de aptitud física para adultos mayores entre julio y agosto de 2017. Las estadísticas se realizaron con el software SISVAR. Las comorbilidades asociadas más frecuentes fueron: dislipidemia e hipertensión arterial sistémica. En la prueba T1, hubo un aumento en el número de repeticiones en los movimientos de sentarse y levantarse de la silla en los participantes 3, 7 y 10. En T2, hubo una mejora en la flexión del antebrazo en los participantes 7 y 8. En T3, los participantes 3, 9 y 10 mostraron una mejora en la flexibilidad de las extremidades inferiores. T4 encontró que los participantes 3 y 7 fueron mejores en velocidad, agilidad y equilibrio dinámico. T5 confirmó que solo el participante 8 presentó resultados significativos con respecto a la flexibilidad del MMSS. En T6 y T7, no hubo diferencias significativas entre el paciente x el tiempo en términos de resistencia aeróbica e IMC respectivamente después del tratamiento. Los resultados del Senior Fitness Test en poblaciones especiales parecen ser una herramienta capaz de analizar individualmente las necesidades de cada participante en un protocolo con rehabilitación cardíaca de una manera segura y práctica; sin embargo, se necesita una muestra más significativa.

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US Latino adolescents have higher teenage birthrates and higher probabilities for early sexual initiation, compared to other racial/ethnic groups. Understanding their reasons for delaying or initiating first-time vaginal intercourse is important in designing culturally relevant health promotion programs. Using qualitative methods, we analyzed 21 semi-structured interviews with US Latino adolescents regarding their sexual initiations. Seven had sexually debuted, acknowledging sexual feelings of desire, curiosity and pleasure for their romantic partner. The remaining 14 had not debuted citing reasons of self-interest and external prohibitive factors. Eight out of 14 also attributed their status to not being in a romantic relationship. Our findings suggest several areas for increased discussion including how romantic relationships and Latino cultural values influence sexual initiation and the use of contraception. These findings could improve health promotion programs by identifying critical elements that may resonate with US Latino adolescent socio-cultural values and sexual development.

Los adolescentes latinos de Estados Unidos presentan tasas de natalidad más altas y mayores probabilidades de iniciación sexual temprana en comparación con adolescentes de otros grupos raciales-étnicos. Entender las razones de los jóvenes latinos para retrasar o iniciar el coito vaginal por primera vez es importante en el diseño de programas de promoción de salud culturalmente relevantes. En el presente estudio cualitativo se realizaron 21 entrevistas semiestructuradas con adolescentes latinos sobre las razones para iniciarse o abstenerse de practicar el coito vaginal por primera vez. Siete de los participantes habían debutado sexualmente y 14 se habían abstenido de hacerlo. Quienes se habían iniciado reconocieron haberlo hecho por curiosidad, deseo sexual y por placer, pero admitieron haberse iniciado sexualmente en el contexto de una relación romántica con su pareja. Quienes se habían abstenido reportaron razones personales (no sentirse preparados, esperar hasta el matrimonio, temor de adquirir una infección sexualmente transmisible o de quedar embarazada) y también citaron fuentes externas de prohibición (padres y religión). Ocho de los 14 adolescentes también atribuyeron el haberse abstenido al no haber establecido una relación romántica todavía. El análisis de los resultados sugiere que los adolescentes latinos de los Estados Unidos con características similares a la muestra estudiada tienen los conocimientos y están dispuestos a tomar decisiones razonadas sobre su iniciación sexual.

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We aimed to assess and synthesize the information available in the literature regarding the treatment of American tegumentary leishmaniasis in special populations. We searched MEDLINE (via PubMed), EMBASE, LILACS, SciELO, Scopus, Cochrane Library and mRCT databases to identify clinical trials and observational studies that assessed the pharmacological treatment of the following groups of patients: pregnant women, nursing mothers, children, the elderly, individuals with chronic diseases and individuals with suppressed immune systems. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The available evidence suggests that the treatments of choice for each population or disease entity are as follows: nursing mothers and children (meglumine antimoniate or pentamidine), patients with renal disease (amphotericin B or miltefosine), patients with heart disease (amphotericin B, miltefosine or pentamidine), immunosuppressed patients (liposomal amphotericin), the elderly (meglumine antimoniate), pregnant women (amphotericin B) and patients with liver disease (no evidence available). The quality of evidence is low or very low for all groups. Accurate controlled studies are required to fill in the gaps in evidence for treatment in special populations. Post-marketing surveillance programs could also collect relevant information to guide treatment decision-making.

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