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El desarrollo psicomotor del niño tiene que ver con la expresión de sus potencialidades, su integración social y su desempeño en la vida. La oportuna detección de problemas mediante tamizaje permite realizar intervenciones eficaces y costo-efectivas. La Dirección General de Salud Ambiental (DGSA) de la Autoridad Cuenca Matanza-Riachuelo (ACUMAR) realiza encuestas en población vulnerable. OBJETIVO: Detectar problemas de nutrición y desarrollo psicomotor en niños menores de seis años, realizar un análisis toxicológico y una investigación cualitativa sobre crianza y percepción de problemas ambientales, y efectuar una georreferenciación. MÉTODOS: Se recurrió a la Prueba Nacional de Pesquisa (PRUNAPE) y al Cuestionario PRUNAPE Pre-Pesquisa (CPPP) a cargo de la DGSA. Se realizaron nueve encuestas en las jurisdicciones de la Cuenca –14 municipios del conurbano y parte de la Ciudad Autónoma de Buenos Aires (aproximadamente 5 millones de habitantes)– en más de 7.000 niños. RESULTADOS: El estudio reveló: alta proporción de riesgo de problemas de desarrollo, mayor prevalencia en varones, aumento desde el nacimiento hasta los cuatro años y disminución a los cinco. Los principales determinantes fueron: nivel de pobreza/indigencia, nivel educativo parental y bajo peso al nacer. CONCLUSIONES: La instalación de esta problemática en la agenda de la DGSA implica un progreso en el enfoque de la salud pública y permite actuar sobre los determinantes para promover el desarrollo infantil.

Durante la celebración en Cuba del Foro Mundial para la Investigación en Salud 2009, el tema de la gobernanza y la rectoría se destacó como uno de los ejes del Sistema Nacional de Investigación para la Salud. Hubo coincidencia en que ambos aspectos son responsabilidades inherentes a la función del Estado, ubicando a la investigación para la salud como una actividad estratégica.

The article describes activities of the Center for American Studies “Americana” at Volgograd State University in 1995—2020. The authors analyze the conditions that made possible development of American studies in Volgograd in the second half of the 1990s, show what was possible with the limited resources available to the center, and what problems have become difficult for the work of “Americana” in recent years. Teaching Russian and American students, exchange programs and joint online courses, research, publications, “people's diplomacy”, organization of conferences and seminars, uniting historians, political scientists, philologists, linguists, philosophers, architects and other Volgograd scholars in the study of the countries of American continent, creating a network of colleagues and partners from many cities of Russia, as well as from the USA and Canada — looking back over this quarter of a century, we can say with confidence that the Center “Americana” has succeeded. Special attention in the article is paid to the cooperation of the center's historians with literary scholars and linguists who worked in other universities and research organizations. The authors note an institutional asymmetry in the study of Russia in the United States and the United States in Russia: American Russianists find more resources and opportunities in times of exacerbation of Russian — American relations, while Russian Americanists get better opportunities when relations between the two countries improve. Changes in bilateral relations also influenced the activities and capabilities of the Volgograd center. However, it continues to work actively, as shown by a large conference held in Volgograd in September 2020 and the release of the next, 16th issue of the collection Americana in the winter of the same year. This means that the groundwork created in the first 15 years of the research center's service in Volgograd is helping the new generation of Volgograd Americanists get through difficult times.

Objectives: This multicenter cross-sectional study was conducted to assess the psychosocial impact of COVID-19 on patients with inflammatory bowel disease (IBD) in Spain during lockdown and the first wave of the pandemic., Patients and Methods: A self-report questionnaire that integrated the Spanish version of the Depression, Anxiety and Stress Scale-21 items (DASS-21) and the Perceived Stress Questionnaire (PSS) was designed to gather sociodemographic data and information related to the effects of lockdown on the lives of IBD patients. Twelve IBD units invited their patients to answer the anonymous online survey between the 1st July and the 25th August 2020., Results: Of the 693 survey participants with IBD, 67% were women and the mean age was 43 (SD 12). Sixty-one percent had ulcerative colitis, 36% Crohn's disease and 3% indeterminate colitis. DASS-21 scores indicate that during lockdown the estimated prevalence of depression was 11% [95% CI 8.2-13%], anxiety 20% [95% CI 17 to 23%] and stress 18% [95% CI 8.2-13%]. Multivariate analysis showed that the perceived high risk of COVID-19 infection because of having IBD and maladaptation to government measures to reduce the spread of disease doubled the risk of anxiety and stress during lockdown., Conclusions: In the short-term, lockdown during the COVID-19 pandemic seemed to have an impact on the already affected mental health of our IBD patients in Spain., (Copyright © 2021 Elsevier España, S.L.U. All rights reserved.)

Introduction: Type 2 (T2) biomarkers such as blood eosinophil count (BEC) and FeNO have been related to a higher risk of exacerbations in COPD. It is unknown whether combining these biomarkers could be useful in forecasting COPD exacerbations., Methods: COPD patients were enrolled in this prospective, multicenter, observational study and followed up for 1 year, during which BEC were analysed at baseline (V0) while FeNO analyses were performed at baseline (V0), 6 months (V1) and 12 months (V2). The risk of moderate or severe exacerbation during follow up was assessed by Cox regression analysis, and the predictive capacity of both measurements was assessed by ROC curves and the DeLong test. Statistical significance was assumed at P<.05., Results: Of the 322 COPD patients initially recruited, 287 were followed up. At baseline, 28.0% were active smokers, and experienced moderate airflow limitation (mean FEV 1 56.4%±17.0% predicted). Patients with at least one elevated T2 biomarker (n=125, 42.5%) were at increased risk of COPD exacerbation (HR 1.75, 95% CI 1.25-2.45, P=.001) and of shorter time to first COPD exacerbation. There was no difference between BEC and FeNO regarding the predictive capacity for moderate to severe exacerbation (AUC 0.584 vs 0.576, P=.183) but FeNO predicted severe episodes more accurately than BEC (AUC 0.607 vs 0.539, P<.05). Combining the two biomarkers enhanced the detection of moderate and severe COPD exacerbations., Conclusions: Both eosinophil count and FeNO have limited utility for predicting COPD exacerbations. Combining these T2 biomarkers could enhance the detection of future COPD exacerbations., (Copyright © 2021 SEPAR. Published by Elsevier España, S.L.U. All rights reserved.)

Estimado Editor: Escribimos esta carta en relación al artículo publicado en su revista el pasado mes de Julio de 2020, por Castro-Díaz et al., titulado "Perfil de severidad sintomática y expectativas en pacientes con vejiga hiperactiva. Estudio VHEXPECTA" (1), y que hemos leído con gran interés. A propósito de este trabajo creemos conveniente ampliar la información ofrecida por sus autores, y plantear una serie de consideraciones por nuestra parte.

Introduction: Whooping cough in patients aged under 3 months has higher rates of morbimortality. Hospitalization and treatment with azithromycin is generally recommended. Many patients with cough without other signs of alarm, are admitted and started antibiotic therapy until a result of Bordetella-PCR is available. This technique, when performed urgently, can provide the diagnosis in a few hours. The objective of this study is to determine if its generalisation in the Emergency Department allows to improve patient management., Methods: Retrospective cohort study of patients aged under 3 months who underwent Bordetella-PCR testing from upper respiratory tract secretions since March 2011 to December 2017. From December 2015 the test was performed urgently., Results: One hundred and fifty-eight PCR were performed, 16 (10%) were positive for B. pertussis. Negative results (142; 90%) were divided in 2 cohorts: conventional-PCR, with 74 cases, and urgent-PCR, with 68 cases. The 2 groups were homogeneous in terms of clinical and analytical characteristics. In the urgent-PCR group there was 18% reduction in chest X-rays performed (P=.008). There were 33 (48.5%) patients admitted in the urgent-PCR group, compared to 49 (66.2%) in the conventional-PCR (P=.042). Antibiotic treatment was initiated in 32% of the patients in the urgent-PCR group compared to 67% in the conventional-PCR group (P=.000047), without observing any significant increase in the number of visits to the Emergency Department or worse clinical performance., Conclusions: The introduction of urgent PCR in the Emergency Department is a useful tool in the management of infants under 3 months of age with suspected pertussis, since it can avoid unnecessary admissions, diagnostic tests and antibiotic treatments., (Copyright © 2020 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Introduction: Coinfections of influenza and other respiratory viruses (ORVs) are frequent in the epidemic season. The aim of this study was to examine the demographic and virological variables associated with coinfections by influenza and ORVs., Materials and Methods: We analysed respiratory samples of patients with laboratory-confirmed influenza using molecular diagnostic methods obtained in 8 consecutive influenza seasons (2011-2012 to 2018-2019). We analysed data focusing on different variables: age, sex, type of patient (hospitalized/sentinel) and detected type/subtype of influenza., Results: Coinfections of influenza and ORVs were detected in 17.8% of influenza-positive samples. The probability of detecting coinfection was significantly higher in young children (0-4 years; OR: 2.7; 95% CI: 2.2-3.4), children (5-14 years; OR: 1.6; 95% CI: 1.2-2.1) and patients infected with the A(H3N2) subtype (OR: 1.4; 95% CI: 1.14-1.79). Also, we found a significantly higher frequency of coinfections involving influenza and 2 or more other respiratory viruses in young children (0-4 years; OR: 0.5; 95% CI: 0.32-0.8), adults (40-64 years; OR: 0.5; 95% CI: 0.3-0.9) and women (OR: 0.7; 95% CI: 0.5-0.9)., Discussion: These results show that coinfections of influenza and ORVs are more frequent in young children and children, and in cases involving the A(H3N2) influenza subtype. Our findings can be useful to guide the use of multiplex diagnostic methods in laboratories with limited resources., (Copyright © 2021. Publicado por Elsevier España, S.L.U.)

Over the past decades, the advent of targeted and biological therapies has revolutionized the management of cancer and autoimmune, hematological and inflammatory conditions. Although a large amount of information is now available on the risk of opportunistic infections associated with some of these agents, the evidence regarding the susceptibility to bacterial infections is more limited. Biological agents have been shown to entail a variable risk of bacterial infections in pivotal randomized clinical trials and post-marketing studies. Recommendations on risk minimization strategies and therapeutic interventions are therefore scarce and often based on expert opinion, with only a few clear statements for some particular agents (i.e. meningococcal vaccination for patients receiving eculizumab). In the present review the available information regarding the incidence of and risk factors for bacterial infection associated with the use of different groups of biological agents is summarized according to their mechanisms of action, and recommendations based on this evidence are provided. Additional information coming from clinical research and real-world studies is required to address unmet questions in this emerging field., (Copyright © 2020 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Publicado por Elsevier España, S.L.U. All rights reserved.)

The ultrasound as care at the bedside of the patient, or POCUS (Point-Of-Care Ultrasound), has taken today a primary place as a complementary tool in the diagnosis and monitoring of patients in different intensive care units and health care services. One of these specialties is internal medicine, since in the area of hospitalization patients with complex and critical clinical conditions are treated, who benefit from this tool for diagnostic complementation, monitoring and performing safer procedures. The pulmonary ultrasound is a tool to integrate the signs, symptoms and physical examination, for a better diagnostic accuracy and monitoring of patients. That is why we consider important the training of the internist not only in the pulmonary ultrasound, but also in other areas related to this diagnostic method. For this reason, we performed a review of the basic concepts of pulmonary ultrasound, a practical guide of how to do it, the current state of education and training in this area. As well as the importance in areas of clinical performance of the internist., (Copyright: © 2020 Revista Medica del Instituto Mexicano del Seguro Social.)

Objective: To estimate de magnitude of Pb poisoning (≥5μg/dL blood) in 1-4 year old children and to identify the contribution of lead-glazed ceramics use (LGC) as a source of exposure in the 32 Mexican states., Materials and Methods: Using the results from a sample of capillary blood lead (BPb) we estimated the prevalence of Pb poisoning, it's association with LGC and national distribution., Results: The national prevalence of Pb poisoning was 17.4% representing 1.4 million children. The prevalence was 30.7% among LGC users and 11.8% in non-users. In 17 states the prevalence of Pb poisoning was ≥10%, in 11 states between 5-10%, and in 4 states <5%., Conclusions: There is a geographic differential distribution of the problem; confirming the association with LGC and estimating the contribution of other Pb exposure sources. This information offers a guide to implement preven-tion and control actions in Mexico., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

Objective: We aimed to develop recommendations for the management of methotrexate (MTX) when considering the combination with biological (b) or targeted synthetic (ts) disease modifying drugs (DMARDs) in rheumatoid arthritis (RA)., Methods: Eleven experts on RA were selected. Two coordinators formulated 13 questions about the combination therapy of MTX with bDMARDs or tsDMARDs. A systematic review was conducted to answer the questions. Inclusion and exclusion criteria were established as well as the search strategies (Medline, Embase and the Cochrane Library were searched up to January 2019). Two reviewers selected the articles and collected data. Simultaneously, EULAR and ACR meeting abstracts were evaluated. Based on this evidence, the coordinators proposed preliminary recommendations that the experts discussed and voted in a nominal group meeting. The level of evidence and grade of recommendation was established using the Oxford Center for Evidence Based Medicine and the level of agreement with a Delphi. Agreement was established if at least 80% of the experts voted 'yes' (yes/no)., Results: The systematic review retrieved 513 citations of which 61 were finally included. A total of 10 recommendations were generated, voted and accepted. The level of agreement was very high in all of them and it was achieved in the first Delphi round. Final recommendations cover aspects such as the optimal MTX dosage, tapering strategy or patients' risk management., Conclusions: This document is intended to help clinicians solve usual clinical questions and facilitate decision making when treating RA patients with MTX in combination with bDMARDs or tsDMARDs., (Copyright © 2020 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Oral cancer has a 5-year survival rate of 50% because diagnosis is commonly performed at an advanced stage of the disease, so new diagnostic tools are needed. Nowadays, there is a vast number of publications suggesting the use of salivary biomarkers for oral cancer and potentially malignant disorders diagnosis, but their diagnostic accuracy is unclear. Thus, the goal of this systematic review is to evaluate the diagnostic accuracy of salivary biomarkers for oral cancer and potentially malignant disorders., Methods: This protocol is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). We will include primary studies assessing the diagnostic accuracy of salivary biomarkers for oral cancer and potentially malignant disorders. Studies must report data about sensitivity and specificity; gold standard must be the histopathology diagnosis. We will search MEDLINE, EMBASE, the Cochrane Library, and gray literature. Two authors will independently select the studies and extract the data. The methodology quality of studies will be determined using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2)., Expected Results and Conclusion: Our findings will provide information about the diagnostic accuracy of salivary biomarkers for oral cancer and potentially malignant disorders.

Background and Objective: Diabetes mellitus can affect the lungs, in its various structures and functions. Current research is being conducted to establish the clinical impact of hyperglycaemia on lung function. The objective of this study is to determine if the glycaemic state (euglycaemic, prediabetes or diabetes) is associated with a decrease in lung volume, determined by spirometry., Patients and Methods: An analytical cross-sectional study was carried out at the Ticomán General Hospital in Mexico City. Glucose and glycosylated haemoglobin concentration were used as the parameters to determine if the subjects had a glycaemic disorder. They were further categorised into euglycaemic, prediabetic and diabetic subjects according to ADA criteria guidelines. The subjects underwent forced spirometry testing, obtaining expiratory volume at the first second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, and peak expiratory flow (FEP). The lung volumes between the groups were compared., Results: A total of 55 subjects were studied; 43 women, and 12 men; 14 euglycaemic, 9 prediabetic, and 32 with diabetes. Diabetic individuals presented a %FEP decrease compared to the prediabetic and euglycaemic subjects. The fasting serum glucose values correlated with decrease of %FEV1, FEV1/FVC and %FEP, while the HbA1c concentration only correlated with the decrease of %FEP., Conclusions: Subjects with diabetes have a lower %PEF than euglycaemic and prediabetic subjects, while the %FEV1, %FVC and the FEV1/FVC ratio do not vary between the different glycaemic states. Acute glycaemic non-control correlated with a decrease in more spirometric parameters than chronic glycaemic non-control., (Published by Elsevier España, S.L.U.)

The impact of immunization depends on timely application of the vaccines, especially relevant in children. Successful strategies for improving timeliness include the use of nominalized records and follow-up mechanisms. This study assessed the result of reminders before and after the scheduled date of vaccination to improve timely vaccination at six months. A before-and-after intervention study was performed with a time series and comparator group with 1,856 children from Villa María, Córdoba, Argentina. The strategy was implemented in the city's public services and consisted of preparing weekly vaccination schedules, performing follow-up, and contacting and/or making active searches for no-show cases. Assessment of the result used the percentage of timely vaccination with the third dose of the pentavalent vaccine. Time series were built for each group, before and after, and were analyzed with a simple linear model. Means of the percentages were calculated with their confidence intervals, using bootstrap, and compared with the permutation method. In the intervention group, the mean percentage of timely vaccination increased significantly by 2.6 times, reaching 61.7% (56.2; 78.1). No significant increase occurred in the comparator group: p = 0.1101. The mean rates were similar before the implementation. Timely vaccination improved in children receiving the intervention. The results indicate that the proposed strategy to use nominalized records can reduce the delay in application of vaccines.

Objective: To estimate the prevalence of elevated (≥5.0μg /dL) blood lead levels (BLL) and its association with the use of lead glazed ceramics (LGC)., Materials and Methods: In 2018, we measured capillary BLL in a representative sample of children 1 to 4 years old residing in Mexican localities under 100 000 inhabitants (Ensanut 100k). We inquired about use of LGC for food preparation and consumption. To estimate its association with BLL, multinomial logit models stratified by region were generated., Results: The prevalence of elevated BLL levels was 21.8%. For the North, Central and South regions, the prevalence were 9.8, 20.7 and 25.8%, respectively. The association with use and frequency of LGC was highly significant and differential by region., Conclusions: Lead exposure remains a public health problem in Mexico, particularly in the Central and South regions, and is strongly associated with the use of LGC., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

Objective: We analyzed state anxiety and trait anxiety in a population of nurses specialising in gynecology and obstetrics (nurse midwives) and a group of generalist nurses., Methods: Cross-sectional descriptive study using the State-Trait Anxiety Inventory questionnaire (STAI), administered to a group of non-specialist nurses (n=96) and nurse midwives (n=63) who practice in the Madrid Health Service of Spain., Results: State anxiety was similar in generalist nurses and in midwives (5,01±1,62 and 5,17±1,75, respectively). Levels of trait anxiety were lower in nurse midwives (3,46±1,58) than in the non-specialist group (4,36±2,84), with the latter presenting higher levels of habitual anxiety as a personality trait (p=0,013)., Conclusion: Nurse midwives may adapt better to the stress derived from their work than generalist nurses. This could be attributed to the greater training and safety that specialties provide for the development of nursing care functions., (Copyright belongs to the Associació Catalana de Salut Laboral.)

Estimado Editor: Escribimos esta carta en relación al artículo publicado en su revista el pasado mes de Diciembre de 2017, por Tardáguila Calvo et al., titulado "Reconstrucción genital con dermis artificial Integra® tras resección radical en un niño con linfangiomatosis difusa" (1), y que hemos leído con gran interés. A propósito de este trabajo creemos conveniente ampliar la información de los autores compartiendo nuestra experiencia previa (2,3).

Objective: To evaluate the effect of "traffic-light" nutritional labeling on the purchase of soft drinks and on their nutritional content in Ecuador., Methods: Two databases were used: the first was provided by Ecuador's National Agency for Health Regulation, Control, and Surveillance; the second was obtained from the international market research company Kantar World Panel. A before/after study was conducted of introducing traffic-light labeling, using Student's t-tests to evaluate changes in average nutritional content and the purchase of soft drinks. Multiple linear regression methods were used to evaluate changes in purchases resulting from the introduction of traffic-light labeling., Results: After labeling, average per capita consumption of soft drinks declined by 0.003 L/month--a small change with respect to average per capita consumption of 1.678 L/month. The results of the Student's t-tests indicated that this difference was not statistically significant. Furthermore, the regression analyses found no empirical evidence that traffic-light labeling affected soft drink consumption. With regard to sugar content, an average reduction of 0.93 gm/100 ml of beverage was observed., Conclusions: No empirical evidence was found that implementation of traffic-light labeling changed soft-drink purchase habits in Ecuador, but there is evidence that it reduced sugar content in carbonated beverages in the country., Competing Interests: Conflictos de interés. Los autores declaran no tener conflictos de interés

The impact of body mass index (BMI) and body weight on hospitalization rates in haemodialysis patients is unknown. This study hypothesizes that being either underweight or obese is associated with a higher hospitalization rate. Observational study of 6296 European haemodialysis patients with prospective data collection and follow-up every six months for three years (COSMOS study). The risk of being hospitalized was estimated by a time-dependent Cox regression model and the annual risk (incidence rate ratios, IRR) by Poisson regression. We considered weight loss, weight gain and stable weight. Weight change analyses were also performed after patient stratification according to their baseline BMI. A total of 3096 patients were hospitalized at least once with 9731 hospitalizations in total. The hospitalization incidence (fully adjusted IRR 1.28, 95% CI [1.18-1.39]) was higher among underweight patients (BMI <20kg/m 2 ) than patients of normal weight (BMI 20-25kg/m 2 ), while the incidence of overweight (0.88 [0.83-0.93]) and obese patients (≥30kg/m 2 , 0.85 [0.79-0.92]) was lower. Weight gain was associated with a reduced risk of hospitalization. Conversely, weight loss was associated with a higher hospitalization rate, particularly in underweight patients (IRR 2.85 [2.33-3.47]). Underweight haemodialysis patients were at increased risk of hospitalization, while overweight and obese patients were less likely to be hospitalized. Short-term weight loss in underweight individuals was associated with a strikingly high hospitalization rate., (Copyright © 2018 Sociedad Española de Nefrología. All rights reserved.)

Introduction and Objective: Cardiovascular disease (CVD) mortality is predicted to increase in Latin America countries due to their rapidly aging population. However, there is very little information about CVD risk assessment as a primary preventive measure in this high-risk population., Material and Methods: We predicted the national risk of developing CVD in Ecuadorian elderly population using the Systematic COronary Risk Evaluation in Older Persons (SCORE OP) High and Low models by risk categories/CVD risk region in 2009. Data on national cardiovascular risk factors were obtained from the Encuesta sobre Salud, Bienestar y Envejecimiento. We computed the predicted 5-year risk of CVD risk and compared the extent of agreement and reclassification in stratifying high-risk individuals between SCORE OP High and Low models. Analyses were done by risk categories, CVD risk region, and sex., Results: In 2009, based on SCORE OP Low model almost 42% of elderly adults living in Ecuador were at high risk of suffering CVD over a 5-year period. The extent of agreement between SCORE OP High and Low risk prediction models was moderate (Cohen's kappa test of 0.5), 34% of individuals approximately were reclassified into different risk categories and a third of the population would benefit from a pharmacologic intervention to reduce the CVD risk., Conclusions: Forty-two percent of elderly Ecuadorians were at high risk of suffering CVD over a 5-year period, indicating an urgent need to tailor primary preventive measures for this vulnerable and high-risk population., (Copyright © 2017 Elsevier España, S.L.U. All rights reserved.)