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One's attitude toward and fear of death in the nursing field can determine the quality of care that a dying patient receives, which makes this topic an important one to consider and discuss. It is necessary for one to learn to perceive death as a natural process. Healthcare workers treat dying patients, interpreting the phenomenon of death as well as death itself through their own personal lens and breadth of understanding. Training in thanatology and palliative care is scarcely and irregularly included in regular academic curricula. The objective of this study is to analyze the contributions of 3rd-year nursing students on the subject of palliative care upon writing a reflective journal entry about an article that surrounds a nurse's view on the process of dying. Phenomenology was used as a methodological instrument which intended to inductively draw up a standardized explanation of the phenomenon of death through the students' expressed thoughts on the matter. Relating to the attitudes that nurses that work with the terminally ill have towards death, the following facts stand out as impactful: lack of preparation, ineffective coping, and personal fears, values, and beliefs. Additionally, uneasiness associated with the use of life support and the care team's obstinate insistence on saving what cannot be saved is predominant. The results emphasize a very elevated level of the nurse's emotional involvement in caring for a dying patient. Specific preparation geared toward a better adaptation in working with terminal patients has been identified as a fundamental pillar for nurses in this line of work. Personal interest and emphasis on occupational excellence also stand out as influential factors. It is very important to analyze the problems regarding this "environment of death" and its impact on nursing students. Qualitative research in this field could be a useful tool in detecting worries and uncertainties surrounding this matter. [ABSTRACT FROM AUTHOR]

Soil organic carbon ( SOC) plays an essential role in the sustainability of natural and agricultural systems. The identification of sensitive SOC fractions can be crucial for an understanding of SOC dynamics and stabilization. The objective of this study was to assess the effect of long-term no-tillage ( NT) on SOC content and its distribution between particulate organic matter ( POM) and mineral-associated organic matter (Min) fractions in five different cereal production areas of Aragon (north-east Spain). The study was conducted under on-farm conditions where pairs of adjacent fields under NT and conventional tillage ( CT) were compared. An undisturbed soil nearby under native vegetation (NAT) was included. The results indicate that SOC was significantly affected by tillage in the first 5 cm with the greatest concentrations found in NT (1.5-43% more than in CT). Below 40 cm, SOC under NT decreased (20-40%) to values similar or less than those under CT. However, the stratification ratio ( SR) never reached the threshold value of 2. The POM-C fraction, disproportionate to its small contribution to total SOC (10-30%), was greatly affected by soil management. The pronounced stratification in this fraction ( SR>2 in NT) and its usefulness for differentiating the study sites in terms of response to NT make POM-C a good indicator of changes in soil management under the study conditions. Results from this on-farm study indicate that NT can be recommended as an alternative strategy to increase organic carbon at the soil surface in the cereal production areas of Aragon and in other analogous areas. [ABSTRACT FROM AUTHOR]

The water retention curve (θ(ψ)), which defines the relationship between soil volumetric water content (θ) and matric potential (ψ), is of paramount importance in characterizing the hydraulic behaviour of soils. However, few methods are so far available for estimating θ(ψ) in undisturbed soil samples. We present a new design of TDR-pressure cell (TDR-Cell) for estimating θ(ψ) in undisturbed soil samples. The TDR-Cell consists of a 50-mm-long and 50-mm internal diameter stainless steel cylinder (which constitutes the outer frame of a coaxial line) attached to a porous ceramic disc and closed at the ends with two aluminium lids. A 49-mm-long and 3-mm-diameter stainless steel rod, which runs longitudinally through the centre of the cylinder, constitutes the inner rod of a coaxial TDR probe. The TDR-Cell was used to determine the θ(ψ) curves of a packed sand and seven undisturbed soil samples from three profiles of agricultural soils. These θ(ψ) curves were subsequently compared to those obtained from the corresponding 2-mm sieved soils using the pressure plate method. Measurements of bulk electrical conductivity, σa, as a function of the water content, σa(θ), of the undisturbed soil samples were also performed. An excellent correlation ( R2 = 0·988) was found between the θ values measured by TDR on the different undisturbed soils and the corresponding θ obtained from the soil gravimetric water content. A typical bimodal θ(ψ) function was found for most of the undisturbed soil samples. Comparison between the θ(ψ) curves measured with the TDR-Cell and those obtained from the 2-mm sieved soils showed that the pressure plate method overestimates θ at low ψ values. The σa(θ) relationship was well described by a simple power expression ( R2 > 0·95), in which the power factor, defined as tortuosity, ranged between 1·18 and 3·75. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

In semiarid agroecosystems of the Ebro valley (NE Spain) soils are characterized by tow soil organic matter (SOM) and a weak structure. In this study we investigated the individual and combined effect of tillage system (no-tillage, NT; reduced tillage, RT; conventional tillage, CT) and cropping system (barley-fallow rotation at the Peflaflor site, PN-BF and continuous barley at the Peñaflor site, PN-BB) on soil organic carbon (SOC) storage as well as the physical protection of SOM fractions by soil aggregates in three long-term experimental sites. In both cropping systems, total SOC content was more than 30% higher in NT compared with CT in the 0- to 5-cm depth. The suppression of fallowing in the PN-BB cropping system led to a greater SOC stabilization only in NT. In all the three sites, greater proportion of water-stable macroaggregates (>250 pm) was found under NT than under CT in the 0- to 5-cm depth. Macroaggregate organic C concentration (250-2000 pm) was greater in NT compared with CT in the BB cropping system, but did not differ with tillage treatment in the PN-BF rotation. Greater proportion of microaggregates within macroaggregates in NT compared with CT was only found in the Agramunt site (AG). However, greater C stabilized inside these microaggregates was observed in AG, Selvanera site (SV), and PN-BB in the 0- to 5-cm depth. The results of this study demonstrate that in the semiarid Mediterranean agroecosystems of the Ebro valley, the adoption of NT together with the suppression of long-fallowing period can significantly increase the amount of SOC stabilized in the soil surface and improve soil structure and aggregation. [ABSTRACT FROM AUTHOR]

Time domain reflectometiy (TDR) is a technique that allows simultaneous estimates of apparent permittivity (ϵa) and hence volumetric water content (θ) and bulk electrical conductivity (σa). Difficulties arise for θ and σa determination, however, when uncoated TDR probes (UP) are used in highly conductive media. This work shows that σa can be estimated in highly conductive media using a TDR probe coated with a high-dielectric insulator (CP). To this end, the Dalton method for σa estimations was applied to a 10-cm-long three-rod TDR probe insulated with a 0.2-mm-thick epoxy-ceramic composite coating with a relative permittivity, ϵr, of 32.3. This method was calibrated on different NaCl-water solutions (0-15 dS m-1) and compared with the standard long-time TDR method for σa estimations using an UP. The method was subsequently used for determining σa in four different soils with different values of θ and σa (0-6 dS m-1) and again compared with the standard TDR procedure. The low error (RMSE = 1.5) for the comparison between the ϵa measured with the CP and that calculated with the analytical solution for coaxial probes indicates that the CP is accurate enough for ϵa estimations. For σa values <4 dS m-1, the UP allows determinations of ϵa and the most accurate estimations of σa using the standard TDR method (R2 = 0.99). For higher σa values, however, estimations of ϵa were only possible using the CP, where σa was satisfactorily determined (R2 = 0.99) using the Dalton method. To this end, a previous calibration between the real and the apparent bulk electrical conductivity estimated with the CP was required. [ABSTRACT FROM AUTHOR]

Under semiarid conditions, soil quality and productivity can be improved by enhancing soil organic matter content by means of alternative management practices. In this study, we evaluated the feasibility of no-till (NT) and cropping intensification as alternative soil practices to increase soil organic C (SOC). At the same time, we studied the influence of these management practices on two SOC fractions (particulate organic matter C, POM-C, and the mineral-associated C, Min-C), in semiarid agroecosystems of the Ebro River valley. Soil samples were collected from five soil layers (0-5-, 5-10-, 10-20-, 20-30-, 30-40-cm depth) during July 2005 at three long-term tillage experiments located at different sites in the Ebro River valley (northeast Spain). Soil bulk density, SOC concentration and content, SOC stratification ratio, POM-C, and Min-C were measured. Higher soil bulk density was observed under NT than under reduced tillage (RT), subsoil tillage (ST), or conventional tillage (CT). At the soil surface (0-5-cm depth), the highest total SOC concentration, POM-C, and Min-C were measured under NT, followed by RT, ST, and CT, respectively. In the whole soil profile (0-40 cm), similarly, slightly greater SOC content was measured under NT than under CT with the exception of the Selvanera site, where deep subsoil tillage combined with moldboard plowing accumulated more SOC than NT. In semiarid Mediterranean agro-ecosystems where CT consists in moldboard plowing, NT is a viable management practice to increase SOC. [ABSTRACT FROM AUTHOR]

Losses of soil organic carbon (SOC) have contributed to CO2 emissions from soils to the atmosphere and to global climate change. We hypothesized that in semiarid agroecosystems of the Mediterranean region, a shift from the traditional management system (including conventional tillage [CT] and a cereal-fallow rotation) to a more conservative system, including no-till (NT) and continuous cropping, could reduce CO2 emissions during the cropping season. Thus, in this study, we studied the effects of tillage and cropping systems on C inputs and soil CO2 fluxes during three cropping seasons at three different sites in the Ebro River valley (northeast Spain). Carbon inputs ranged from 650 to 6000 kg ha-1 and seasonal average CO2 flux ranged from 0.10 to 1.76 g CO2 m-2 h-1. Differences in rainfall led to marked differences in C inputs and soil fluxes among growing seasons. Although differences among tillage treatments were weak, CO2 fluxes under NT were always lower. Intensification of cropping systems led to an increase in C input. A move from CT to NT together with cropping intensification is suitable to increase C inputs and to reduce soil CO2 fluxes in semiarid Mediterranean agroecosystems. [ABSTRACT FROM AUTHOR]

Introduction: Ganser syndrome is a rare medical disorder situated between hysterical etiopathogenesis and psychosis, factitious disorders and organic lesions which results in a difficult diagnosis. It is listed in DSM VI as a dissociative disorder whose main symptom is approximate answers, other accompanying symptoms appearing in Ganser: clouding of consciousness, somatic conversion symptoms and hallucinations. Psychopathologically explains a mental state of escape from a situation difficult to being tolerated. Organically appears in pathologies involving the frontal lobes Objectives: We present a case of a XX year old man who suddenly develops a depressive disorder with no apparent cause. Initially he was a professionally developed man. Famous archaeologist. University professor. Guitarist in a musical group. He deteriorated through the years, appearing dementia data with auditive hallucinations and resistant headache. He begins to have difficulty speaking correctly, with paraphasias and short answers, continually repeating "I don't know", Short-term amnesia and bed-chair life Methods: It was impossible to perform both the Mini-Mental State Examination test and the fototest because the patient refused claiming to be very nervous. The CT and MRI showed a slight temporary atrophy and vascular age changes. Subsequently, PET was performed without notable findings. Antidepressant and anxiolytic treatment was introduced without success as well as treatment for dementia and antipsychotic treatment. Results: The headache was improved. The rest of the symptoms did not disappear Conclusions: Ganser syndrome is a psychiatric condition that is difficult to diagnose and treat. [ABSTRACT FROM AUTHOR]

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The time domain reflectometry (TDR) technique allows simultaneous estimation of apparent permittivity (εa) and bulk electrical conductivity (δa). In highly conductive media, however, the signal is completely attenuated, which precludes permittivity measurements. This study showed that δa can be estimated in conductive media by applying long-time TDR waveform analysis to a TDR probe partially insulated with a high-dielectric coating. Four 10-cm-long three-rod TDR probes with identical geometry but different percentages of rod coating were tested: an uncoated sensor (P0) and probes with 50% (P50), 75% (P75), and 95% (P95) of the rod length coated with an insulator with a relative permittivity (εr) of 32.3. A good relationship (r² = 0.99) was found between the εa estimated, if possible, with P0 immersed in several conductive and nonconductive media and the corresponding values estimated with P50, P75, and P95 The results also show that, for δa values ranging between 0.4 and 0.75 S m-1, simultaneous measurements of εa and δa were only possible using the partially coated probes. A good correlation was found between the δa estimated with P0 inserted in different soil columns wetted with highly saline solutions (i.e., δa > 0.2 S m-1) and those values estimated with P50, P75, and P95 (r² = 0.96, RMSE = 1.08, and SD = 0.38). For δa < 0.2 S m-1, the accuracy of the partially coated TDR probes for estimations of δa decreased as the percentage of the rod coating increased, with errors up to 292% when δa determined by P95 was compared with that estimated by P0. [ABSTRACT FROM AUTHOR]

Long fallowing (16 to 17 months), in the cereal/fallow rotation, may favor soil losses by wind erosion in agricultural soils of semiarid Aragon (NE Spain). With the objective of evaluating the risk of wind erosion in this area, soil losses for the most critical period of fallow (February-April) were estimated from a total of 67 fallow fields by using the Wind Erosion Equation (WEQ). All soils were medium textured, with this loam the most frequent textural class (45%). The CaCO3 content in the soil was higher than 200 g kg-1 in 90% of the fields. Mouldboard plough, chisel plough, and disk harrow were the main primary tillage tools used by farmers during fallow. Soil cover by crop residues was negligible (< 1%) in 76% of the fields, and only 20% tilling was done perpendicularly to dominant wind direction. The highest erodibility values corresponded to soils with a sandy loam texture and traditionally tilled with mouldboard plough. Predicted wind erosion was high to very high in 30% of the fields (> 20 Mg ha-1). The WEQ estimated erosion reductions to tolerable levels if reduced tillage, with chiseling as the primary tillage, is adequately adopted in the dryland cereal production areas of semiarid Aragon. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate the impact of Staphylococcus aureus phenotype (vancomycin MIC) and genotype (agr group, clonal complex CC) on the prognosis and clinical characteristics of infective endocarditis (IE)., Methods: We performed a multicentre, longitudinal, prospective, observational study (June 2013 to March 2016) in 15 Spanish hospitals. Two hundred and thirteen consecutive adults (≥18 years) with a definite diagnosis of S. aureus IE were included. Primary outcome was death during hospital stay. Main secondary end points were persistent bacteraemia, sepsis/septic shock, peripheral embolism and osteoarticular involvement., Results: Overall in-hospital mortality was 37% (n = 72). Independent risk factors for death were age-adjusted Charlson co-morbidity index (OR 1.20; 95% CI 1.08-1.34), congestive heart failure (OR 3.60; 95% CI 1.72-7.50), symptomatic central nervous system complication (OR 3.17; 95% CI 1.41-7.11) and severe sepsis/septic shock (OR 4.41; 95% CI 2.18-8.96). In the subgroup of methicillin-susceptible S. aureus IE (n = 173), independent risk factors for death were the age-adjusted Charlson co-morbidity index (OR 1.17; 95% CI 1.03-1.31), congestive heart failure (OR 3.39; 95% CI 1.51-7.64), new conduction abnormality (OR 4.42; 95% CI 1.27-15.34), severe sepsis/septic shock (OR 5.76; 95% CI 2.57-12.89) and agr group III (OR 0.27; 0.10-0.75). Vancomycin MIC ≥1.5 mg/L was not independently associated with death during hospital nor was it related to secondary end points. No other genotype variables were independently associated with in-hospital death., Conclusions: This is the first prospective study to assess the impact of S. aureus phenotype and genotype. Phenotype and genotype provided no additional predictive value beyond conventional clinical characteristics. No evidence was found to justify therapeutic decisions based on vancomycin MIC for either methicillin-resistant or methicillin-susceptible S. aureus., (Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Background: Infective endocarditis (IE) caused by anaerobic bacteria is a rare and poorly characterized disease. Most data reported in the literature are from case reports [1-3]. Therefore, we assessed the situation of anaerobic IE (AIE) in Spain using the database of the Spanish Collaboration on Endocarditis (GAMES)., Methods: We performed a prospective study from 2008 to 2016 in 26 Spanish centers. We included 2491 consecutive cases of definite IE (Duke criteria)., Results: Anaerobic bacteria caused 22 cases (0.9%) of definite IE. Median age was 66 years (IQR, 56-73), and 19 (86.4%) patients were men. Most patients (14 [63.6%]) had prosthetic valve IE and all episodes were left-sided: aortic valves, 12 (54.5%); and mitral valves, 8 (36.4%). The most common pathogens were Propionibacterium acnes (14 [63.6%]), Lactobacillus spp (3 [13.63%]), and Clostridium spp. (2 [9.0%]), and the infection was mainly odontogenic. Fifteen of the 22 patients (68.2%) underwent cardiac surgery. Mortality was 18.2% during admission and 5.5% after 1 year of follow-up. When patients with AIE were compared with the rest of the cohort, we found that although those with AIE had a similar age and Charlson comorbidity index, they were more likely to have community-acquired IE (86.4% vs. 60.9%, p = 0.01), have undergone cardiac surgery (68.2% vs 48.7% p = 0.06), and have had lower mortality rates during admission (18.2% vs. 27.3%)., Conclusion: IE due to anaerobic bacteria is an uncommon disease that affects mainly prosthetic valves and frequently requires surgery. Otherwise, there are no major differences between AIE and IE caused by other microorganisms., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

This research refers to the case study of a patient, a male college student, who was given psychotherapeutic care. Initially, the patient self-referral to the Mental Health area, which is a service permanently offered by the Autonomous University of the State of Mexico, through the Research Center in Medical Sciences (CICMED). The process of the case allowed analyzing the administrative procedure that operates in the CICMED and the process between this and the educational establishment in which the patient studied.

Summary Objective: To evaluate the current trends in the clinical characteristics and the prognosis of Streptococcus agalactiae infective endocarditis (IE), uncommon disease associated with high mortality., Methods: Descriptive analysis of 27 cases of a large cohort (961 episodes) of infective endocarditis collected in seven hospitals of Andalusia (Spain) between 1984 and 2008., Results: Native valves were affected in most cases (85. 2%), multiple valves were frequently involved (22.2%). The median age of the patients was 65 (51-76) years (59.3% men), with a comorbidity, according to the Charlson index, of 2.6+/-2.3. The most frequent underlying diseases were diabetes mellitus (25.9%), chronic obstructive pulmonary disease (14.8%), neoplasms (14.8%), urological disorders (11%) and chronic liver disease (11%). Clinical presentation was characterized by rapid worsening (median of 9 (5.7-15) days from onset of symptoms until diagnosis), a high rate of embolisms (37%) and cardiac complications (abscesses, fistulas or valve rupture) - 37% of cases. Surgery was performed in 12 patients (44.4%) and a high mortality (40.7%) was observed., Conclusion: S. agalactiae IE is a serious disease with aggressive course and high mortality rate and affects patients with debilitating diseases. We must be alert of the development of complications and consider early valve surgery when it is necessary., (Copyright (c) 2010 The British Infection Society. Published by Elsevier Ltd. All rights reserved.)

Little is known about survival and clinical prognostic factors in females with chronic obstructive pulmonary disease (COPD). The aim of the present study was to determine the survival difference between males and females with COPD and to compare the value of the different prognostic factors for the disease. In total, 265 females and 272 males with COPD matched at baseline by BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity) and American Thoracic Society/European Respiratory Society/Global Initiative of Chronic Obstructive Lung Disease criteria were prospectively followed. Demographics, lung function, St George's Respiratory Questionnaire, BODE index, the components of the BODE index and comorbidity were determined. Survival was documented and sex differences were determined using Kaplan-Meier analysis. The strength of the association of the studied variables with mortality was determined using multivariate and receiver operating curves analysis. All-cause (40 versus 18%) and respiratory mortality (24 versus 10%) were higher in males than females. Multivariate analysis identified the BODE index in females and the BODE index and Charlson comorbidity score in males as the best predictors of mortality. The area under the curve of the BODE index was a better predictor of mortality than the forced expiratory volume in one second for both sexes. At similar chronic obstructive pulmonary disease severity by BODE index and forced expiratory volume in one second, females have significantly better survival than males. For both sexes the BODE index is a better predictor of survival than the forced expiratory volume in one second.

In order to study the importance of two pontine regions modulating laryngeal resistance, electrical current or microinjections of glutamate (10-30 nl, 1-3 nmol) were made into the pontine parabrachial complex and the A5 region in spontaneously breathing anaesthetized rats. Two distinct patterns of laryngeal and respiratory responses were elicited. An increase of subglottal pressure was accompanied with an expiratory facilitatory response consisted of a decrease in both respiratory rate and phrenic nerve activity. A decrease of subglottal pressure was accompanied with an inspiratory facilitatory response consisted of an increase in both respiratory rate and phrenic nerve activity. The modification of laryngeal calibre occurred during both respiratory phases in most cases. The concomitant cardiovascular changes of these responses were also analyzed. Controls using guanethidine to block autonomic responses which might interact with respiratory control were also made. Histological analysis of stimulation sites showed a topographical organization of these responses: laryngeal constriction was evoked from Kölliker-Fuse, medial parabrachial nuclei and A5 region, whilst the laryngeal dilation was evoked from the lateral parabrachial nucleus.

The common bean (Phaseolus vulgaris L.) is cultivated widely in Central and South America and particularly in the Northwest of Argentina. In order to describe the diversity of the common bean nodulating rhizobial population from the bean producing area in Northwest Argentina (NWA), a collection of about 400 isolates of common beans recovered from nodules and soil samples from NWA were characterized by using nifH-PCR, analysis of genes coding for 16S rRNA and nodC, and REP-fingerprinting, respectively. It was found that species Rhizobium etli is predominant in common bean nodules although a high degree of diversity was found within the species. Other bean nodulating genotypes recovered from soils by using Leucaena sp. as the trapping host was found to have the 16S rDNA alleles of species such as Sinorhizobium fredii, Sinorhizobium saheli, Sinorhizobium teranga, Mesorhizobium loti, and Rhizobium tropici. Some of the bean genotypes that were found to be more efficient in green house experiments were selected and assayed in two successive bean-cropping seasons in the field environment in NWA, and an increase in yields with inoculation was found. The performance of strains isolated from the region indicates potential for exploiting the diversity.

Objective: To evaluate the effect of interventions at a highway, in the occurrence and severity of injuries by traffic accidents., Method: It was made a comparative analysis of two cross-sectional studies in 1994 and 1996., Results: In 1994 the rate was 7.96 accidents/ 100,000 vehicles and in 1996 8.49 / 100,000 vehicles. The increase was not significant (p>0.05). The rate of injured drivers in 1994 was of 2.10 / 100,000 vehicles and of 1.35 / 100,000 vehicles in 1996, which was a significant decrease (p<0.000). The self-report of use of seat belt (63.46% versus 76.6%), the small vehicles involved in accidents (7.9% versus 37.7%), nocturnal schedule (23.7% versus 31.8%) and in Mexico-Cuernavaca direction (45% versus 66.7%), were more frequent in 1996 (p<0.05). The risk of injury, using a logistic regression model, between drivers exposed to the interventions (1996) and those that were not exposed (1994) adjusted by: age, speed, use of seat belt, alcohol intake and external cause, showed a protective effect of the interventions at the highway (OR 0.42 CI95% 0.27-0.66)., Conclusion: There is an evident need of multisectorial approaches in the study and evaluation of the interventions in the field of the traffic accidents. The present research is a clear example of the repercussions over health of interventions developed by the transportation sector at the highway.

Objectives: Our aim was to evaluate the validity and reliability of a questionnaire to measure the functional capacity in older people., Design: Observational cross-sectional study., Setting: Community level. Three basic health areas., Participants: 519 individuals over 64 selected by systematic random sampling taking as sampling units a list of household living at least an individual over 64 years., Measurements and Main Results: A new questionnaire was developed starting from the OARS-MFAQ, the CVA. This new questionnaire is shorter but it maintains the same structure. Ten interviews were recorded in a videotape and subsequently analyzed and marked by four different observers to evaluate the inter-observer agreement. To assess the criterion validity the rates of 40 individuals in the CVA were compared with the rates assigned to the same individuals by experts in each area of the questionnaire (physical health, mental health, daily activities, economic resources, and social support). The criterion validity of the version to proxies of CVA (CVA-I) was studied comparing the answers in the CVA of 31 individuals and the answers given in the CVA-I by proxies of the same 31 individuals. The internal consistency in both versions of the questionnaire was studied in 519 individuals, agreement showed values of kappa coefficient between 0.43 and 0.69. Correlation coefficients Interobserver between expert's rates showed values between 0.54 and 0.74. Correlation coefficients between CVA and CVA-I showed values between 0.60 and 0.74 except in the social support dimension (0.16). The Cronbach alpha coefficient were 0.73 for CVA and 0.62 for CVA-I., Conclusions: The CVA questionnaire showed an acceptable validity and reliability except in the social support dimension of the CVA-I.

Background: Assessment of different diagnostic sequences, in patients VIH(+) with a suspected pulmonary infection., Methods: A cross-sectional descriptive study of 76 HIV(+) patients with suspected respiratory infection. It has been determined the validity and the pretest and post-test probability of the radiology (Rx) of thorax, 67Ga pulmonary scintigraphy and seric LDH levels, in order to design four different diagnostic algorithms., Results: The diagnostic sequence Rx-LDH-scintigraphy with normal results involved an infection probability of 58.0%. Pathological Rx with successively normal LDH and scintigraphy, implied a likelihood of 97.0%. The LDH elevation in sequence with scintigraphy and Rx rose to 96.1% if both were abnormal and diminished to 8.3% if normal., Conclusions: The LDH elevation associated with the sequence of normal Rx and scintigraphy suggests a low infection likelihood. On the contrary, associated with pathological Rx and scintigraphy in sequence, practically assures the pulmonary infection.

Aims: To analyze the association between alcohol intake and the severity of injuries sustained from traffic accidents on a Mexican highway., Design: An observational unit evaluated drivers involved in auto accidents., Setting: Mexico-Cuernavaca Highway, Mexico. A 60 km-long road with many altitude variations and sharp curves., Participants: Three hundred and eighty-six drivers involved in traffic accidents between March and September, 1994., Measurements: A questionnaire was applied to the driver, an occupant or witness at the site of the accident to collect information about the driver, vehicle characteristics, type of accident, day-night occurrence, road section (Mexico-Cuernavaca or Cuernavaca-Mexico) and weather conditions. A physical examination was carried out to determine the presence and severity of injuries., Findings: There were 177 injured people, including 12 deaths, with rates of 67.5 injuries and 4.58 deaths per 10,000 km driven. Variables associated with alcohol intake (p < 0.05) included: severity of injuries, non-use of seat belt, vehicle size and occurrence at night. Risk factors for severe injuries were: alcohol intake (adjusted OR 6.1 CI 95% 1.6-24.0); non-use of seat belt (OR 4.9 CI 2.2-10.8), age < 25 years (OR 3.6 CI 1.0-12.7), age > 54 years (OR 6.0 CI 1.4-25.0), speed > 90 km/h (OR 2.6 CI 1.1-6.3) and occurrence at night (OR 2.6 CI 1.3-5.3)., Conclusions: Alcohol intake is a major risk factor for severe injuries from highway traffic accidents. Its association with other risk factors such as non-use of seat belt and excessive speed suggests the importance of designing interventions aimed at reducing alcohol intake among automobile drivers.

A collection of rhizobial isolates from nodules of wild beans, Phaseolus vulgaris var. aborigineus, found growing in virgin lands in 17 geographically separate sites in northwest Argentina was characterized on the basis of host range, growth, hybridization to a nifH probe, analysis of genes coding for 16S rRNA (16S rDNA), DNA fingerprinting, and plasmid profiles. Nodules in field-collected wild bean plants were largely dominated by rhizobia carrying the 16S rDNA allele of Rhizobium etli. A similar prevalence of the R. etli allele was observed among rhizobia trapped from nearby soil. Intragroup diversity of wild bean isolates with either R. etli-like or Rhizobium leguminosarum bv. phaseoli-like alleles was generally found across northwest Argentina. The predominance of the R. etli allele suggests that in this center of origin of P. vulgaris the coevolution of Rhizobium spp. and primitive beans has resulted in this preferential symbiotic association.

Our understanding of violence gains from perspectives contributed by several different disciplines. The differences among goals and points of view are often reflected in their vocabularies and interfere in to integrate the advances by each of them. Three big disciplines have studied violence, those are: Social Sciences, Criminal Justice and most recently Public Health. This paper discusses the theoretical perspectives by discipline and try to dimensionate the violence problem measured by mortality and morbidity by intentional injuries in México.

Traffic accidents are a well-known public health problem worldwide. In Mexico research into risk factors for motor involving vehicles accidents and their consequences has recently been taken into account. The relevant literature does not normally describe the methodological aspects involved in the collection of primary data, since most studies have used secondary data the good quality and validity of which are assumed. The paper presented seeks to discuss and share with researchers in this field, some of the methodological aspects to be considered in the attempt to recreate the scene of the accident and obtain information approximating to reality. The measurements in situ of, such traffic accident variables as injury, use of seat belt, speed and alcohol intake are discussed.

Objective: To analyze the association between the severity of car accident injuries and the use of safety belts., Material and Methods: The unit of observation and analysis was car drivers in the Mexico-Cuernavaca toll highway. Variables included were those of car drivers, the vehicles and the physical environment at the accident site. Statistical analysis was carried out by means of chi square, odds ratios, 95% confidence intervals and logistic regression. Data was collected in 422 questionnaires for 324 accident events., Results: There were 177 injured people, including 12 deaths, with rates of 67.5 injuries and 4.58 deaths per 10 000 kilometers driven. Variables associated with not using a safety belt (p < 0.05) were: alcohol drinking, vehicle size, night-time and road section. Risk factors for severe injuries were: not using a safety belt (raw OR 4.9, 95% CI 2.2-10.8, adjusted OR 2.94, 95% CI 1.13-7.66); age < 25 years (OR 3.6, 95% CI 1.0-12.7) and > 54 (OR 6.0, 95% CI 1.4-25.0); alcohol drinking (OR 10.8, 95% CI 3.8-30.4); and night time (OR 2.8, 95% CI 1.4-5.8)., Conclusions: Theses findings suggest the need to formulate interventions aimed at enforcing the use of safety belts and prevention of related factors.

Unlabelled: A study of homicide in the population of Mexico, was undertaken for the purpose of discovering the mortality panorama by this cause during 1979-1992. Homicide mortality trends were analyzed, as well as the main causes by age and sex. Rate by cause and sex were also analyzed using a Poisson Regression model. The variables were: age, sex, year, external cause of intentional injuries ICD 9th. E960-E969., Results: The total number of deaths due to homicide was 198,485. Each day 35 persons die in Mexico as a result of homicide. Men were more affected than women with a RR of 10.1 and CI (95%) 14.9-16.0, adjusted for age. The main cause 56% was homicide by fire-arms and explosives. The high relative risk was for those aged from 35 to 39 with an RR of 15.4 CI 14.9-16.0. To the cause assault by other and unspecified means, the elderly population has a RR of 21.2 IC 19.7-22.9. Further research in the area and prevention should make use of a multidisciplinary approach in considering the multiple causes and solutions to this problem.

When the death causes are understood as a result of morbility process that may have been avoided with different kinds of economic, social and welfare services policies and the advance of scientific and technologic knowledges, there is clearly a structural determinism so that many population social sectors can't reach the "modern epidemiological patterns". This study used annual data bases of register death 1979-1991 brought by INEGI/DGE-SSA from five Mexican federal border entities. It were adjusted by Preston-Coale method and Life Tables were generated in 1980 and 1990. The percentage contributions of avoidable causes' groups by sex and age of the increases in the Expectation of Life (Ex) were calculated in the same years following Pollard's method. As result of this research, limited increments of Ex were found because of the permanence of high contribution of deaths, that may have been avoided (50%). Contrary to popular beliefs, Ex male diminished the difference compared with Ex female. Highest male mortality is explained even for this kind of causes, where accidents and violence deaths are bringing high percentages of total mortality.

A study was conducted in children under five years old, in order to establish the association between the mother's work and the severity of unintentional injuries. The study was carried out at the emergency room of six pediatric hospitals in Mexico City. Cases were children with major injuries that required hospitalization, intensive care, surgery, or who died as a result of the injury. Controls were children of similar age, with minor injuries resolved at the emergency room. Sample size was 350 cases and 350 controls. Variables were grouped according to: mother's occupation; characteristics of the child, socioeconomic status, child care, and those related with home risk factors. Results showed a protective effect on severity of injuries when the mother worked outside home in comparison to mothers who do not work, (or 0.79, 95%CI 0.57-1.07). No differences were found with respect to sex and age of children. Mother age under 24 years old and low schooling (< 3 years of elementary school) were statistically significant with a risk of major injuries (or 2.30, 95%CI 1.5-3.4). Delay of demand of medical care after 60 minutes of injury occurrence is related with a risk of major injury (or 1.68, 95% CI 1.2-2.3). No differences related with household risk factors were found. Results provide valuable information about risk factors related with injury severity and the association with mother's work.

We present the case of a 38-years-old tertipara at full term with a diagnosis by ultrasound of placenta previa who underwent elective cesarean under spinal anesthesia. After a difficult birth, anomalous adhesion of the placenta prevented its removal and caused massive hemorrhage of the placental bed and hypovolemic shock. Blood volume was restored and emergency hysterectomy under general anesthesia was effected, as bleeding and hemodynamic state were brought under control. Abnormal heart rhythm appearing after the operation responded to treatment; postoperative recovery was unremarkable. Placenta accreta is a rare complication of placenta previa. Given that massive obstetric hemorrhage is associated with significant mortality and morbidity, both maternal and fetal, the anesthesiologist must be aware of potential problems that might arise in cases of placental accreta so that readiness can keep risk to a minimum.

Introduction: The main objective was to determine the risk factors involved in unintentional injuries in children under 10 years old occurring at home., Material and Methods: A Case Control study was conducted in the emergency room of three pediatrics hospitals in Mexico City. The sample size was 160 cases and 320 controls., Results: Boys were more affected than girls (OR) 1.7, C.I. (95%) 1.2-2.5. The age group more affected was two-three years old (OR) 1.6, C.I.1.1-2.2. When children play outside home (roof, stairs, patio) the risk was OR 2.48, C.I. 1.63-3.76. If mother is not encharged of children care (OR) 2.9, C.I. 1.8-4.8. The age > 40 years old of the person encharged of children care (OR) 2.2, C.I. 1.4-3.5., Conclusions: The results showed us how necessary is to develop injury prevention programs especially to implement passive measures, with target populations people encharged of children care.

A case-control study was carried out, aimed at identifying and defining the individual, family, household and childcare social support network characteristics, more likely to be associated with the occurrence of accidental home injuries in 0-9 year-old children. This study was carried out in the emergency units of three pediatric hospitals in the Federal District. In this article we report the results of the descriptive analysis only of the cases. The results were as follows: male children (62%) and the one and two year-old children group (37%) were the most affected. Contusions, head injuries and fractures occupied the first three places, the main three causes being falls from one level to another (mainly in stairways and off the bed) falls on the same level (sliding, tripping or stumbling) and burns with boiling liquids (most frequently boiling water for bathing). A history of injuries was documented in only 15% of cases. Thirty nine percent of cases requested medical attention after one hour of the accident; 51% of these were hospitalized. In 25% of cases, the mother worked outside the home, being absent from 6 to 12 hours. Risk factors occurring most frequently were: unprotected electricity inlets (40%); products within reach of children: cleaning products (38%), makeup products (34%), plastic bags (30%) and tools (30%); lack of protection rails for cradles (30%) and for staircases (48%), and free access to roofs (44%). In 62 percent of cases some care was provided in the house of the injured child; twenty six percent counted on a support network, and 3 percent were by themselves. We present some proposals for epidemiologic and health services research, and stress the necessity to implement health education, social security and health services policies to favorably influence the solution of these problems.

The optimal treatment, surgical or conservative, for multicystic dysplastic kidney (MDK) is still undetermined. We analyzed prospectively the evolution of 12 children with MDK who were managed conservatively. After a mean follow-up of 32 months, the only complication found was an episode of urinary tract infection in 3 patients. Complete involution of MDK was observed in 9 patients (75%), the mean period for sonographical disappearance being 16 months. Infants with MDK should be closely monitored and nephrectomy performed when MDK compresses neighbor organs or hypertension develops. There is no agreement on the best therapeutic approach in patients in whom MDK involution has not occurred after a prudential waiting time still not determined.

We report the case of a 37 year old male from rural area who presented as an emergency with symptoms compatible with the existence of a retropharyngeal tumoration. By the clinic it suggested an abscess but the CT scan as compatible with a carcinoma. On complementary examinations it appeared in a chest X ray an image which strongly suggested the possibility of a hydatidic cyst of the lung. Specific serologic reactions supported this and post-surgical pathological study lately confirmed the diagnosis. We believe of interest reporting this case because of it's unusual localization and difficulty in diagnosis.