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Introducción: La alcalosis respiratoria es un trastorno ácido-base que se caracteriza por la disminución de la PaCO2, acompañada de un descenso del bicarbonato (HCO3) en sangre, al haber una eliminación produce la síntesis de H2CO3, junto a bajos niveles de iones de hidrógeno, por ende, aumenta el pH. Objetivo: Realizar una investigación sobre la alcalosis respiratoria relacionada al equilibrio acido-básico de pacientes en cuidados intensivos Metodología: La investigación se basa en fuentes bibliográficas actualizadas obtenidas de diferentes bases de datos como Pudmed, Oxford, Redalyc, Nature, y la plataforma Google Scholar. Resultados: En base al estudio realizado se identificó que este trastorno se produce principalmente como mecanismo de compensación de un trastorno primario, como consecuencia de ello se presentan las diversas manifestaciones clínicas. Conclusiones: La alcalosis respiratoria tiene diversas etiologías, incluso podría llevar a la muerte en casos severos; claro está que el tratamiento dependerá de la causa que lo origina.

El objetivo general de la presente investigación fue determinar la gestión de la enfermería en la atención primaria de la salud pública. La investigación se desarrolló desde el enfoque cuantitativo con una metodología descriptiva con diseño no experimental, la cual se apoyó en el análisis documental y bibliográfico. Se utilizó para este tipo de estudio, documentos, los investigadores los recolectan, eligen, examinan y muestran resultados. Se organizó un proceso investigativo en donde la población de estudio, se basó primordialmente en documentos escritos como tesis, artículos científicos, entre otros, para indagar los escritos con el objeto de estudiarlos y construir conclusiones. Se concluye que, la salud pública busca mediante la gestión de los recursos humanos y económicos ofrecer un servicio de atención primaria a los ciudadanos, en esta acción el personal de enfermería constituye un factor de gran importancia para el desarrollo de las diferentes políticas y planes dispensadores de salud.

El trabajo analiza las redes personales de las mujeres privadas de libertad, identificando factores de riesgo y protección en tres etapas definidas por el ingreso a prisión y orientadas a la reinserción. Se realizó una investigación documental en bases de datos (WOS, Scopus y Google Académico), empleando Mendeley como gestor. Los resultados muestran que, las redes, antes de prisión están permeadas por la violencia y ausencia de apoyo; durante la prisión se dividen en internasexternas y presentan modificaciones relacionales importantes (ruptura de pareja, distanciamiento o no de los/as hijos/as y apoyo de nuevas personas) y; en semilibertad se amplían y mejoran estas, favoreciendo la reinserción social, no obstante, la mayoría regresa al entorno familiar y comunitario inicial enfrentándose a los factores de riesgo asociados.

Background The tetravalent dengue vaccine (CYD-TDV, Dengvaxia, Sanofi Pasteur) demonstrated efficacy in 2 previous phase III trials conducted in endemic countries. Neutralizing antibodies (NAbs) elicited by 3 doses of this vaccine have been associated with efficacy. Long-term follow-up data has shown that NAb immune responses tend to wane over time, after the third dose. This study compared the immune response elicited by a booster (4th) dose of CYD-TDV with the immune responses from the same participants obtained post-dose 3 of the primary series administered 4-5 years earlier. Methods This multicenter, observer-blind, randomized, placebo-controlled, phase II noninferiority trial was conducted in healthy adolescents and adults in dengue endemic countries of Latin America (Colombia, Honduras, Brazil, Mexico and Puerto Rico). All participants had been immunized with 3 doses of CYD-TDV in phase II studies conducted 4-5 years earlier. NAb levels against each dengue virus serotype 28 days postbooster or placebo injection were reported. Results A total of 187 participants received CYD-TDV and 64 received placebo. Prospectively defined noninferiority criteria for dengue NAbs after the booster dose compared with postdose 3 were met for all 4 serotypes. Prospectively defined superiority criteria were met for 3 of the 4 serotypes. Conclusions Antidengue NAb levels can be boosted to levels at least as high as, or higher than those observed after completion of the primary 3-dose series, with an additional dose of CYD-TDV 4-5 years after the standard 3-dose vaccination schedule.

The Mexican presidentialism and its controls constitute today an institution that has been severely questioned, criticisms point to its replacement or, in the least of cases, its parliamentarization, via coalition governments. Starting from the current discussion on presidentialism and controls, we emphasize two neglected aspects: regime of responsibilities of the Executive and division of powers, the first; more effective until 1900, when the president could be accused of a broader range of behaviors including violations of the constitution and the second when the entities elected the Ministers of the Court and not the presidential will, change started by Alvaro Obregon.

Proyecto de Investigación I+D+I –REINAC-“Procesos de reinserción y acompañamiento a mujeres en semilibertad”, Ref. EDU2016-79322-R (2016-2020). Financiado por el Plan Nacional de Investigación, Proyectos de Investigación I+D+I, Ministerio de Economía y Competitividad (MINECO), Agencia Estatal de Investigación (AEI) y FEDER (España)., El presente artículo tiene el objetivo de estudiar el apoyo familiar a la población femenina en el medio abierto del Sistema Penitenciario Español como uno de los factores relacionados con su proceso de reinserción y tránsito a la libertad, analizando las fuentes, el grado y tipología de apoyos familiares para la vuelta a la vida en libertad. Este trabajo se enmarca dentro del proyecto de investigación I+D+I “Procesos de reinserción y acompañamiento a mujeres en semilibertad” (ref. EDU2016-79322-R) cuya metodología ha empleado métodos cualitativos y cuantitativos, de forma complementaria, aplicados a los 310 cuestionarios mixtos y a las 67 entrevistas semiestructuradas, diseñados ad hoc, en 31 centros penitenciarios que representan los distintos recursos de cumplimiento de condena en medio abierto. Se ha hecho un análisis descriptivo de los resultados y comparado la tendencia de los apoyos en el momento anterior a prisión y en el actual mediante la realización del test de McNemar por cada figura familiar estudiada. Los resultados obtenidos evidencian que el abandono o pérdida de apoyos es relativamente bajo, oscilando entre un 3,2% y 8,1% de las participantes según los diferentes miembros de la familia; manteniendo casi un tercio de ellas los apoyos de muchas de las personas de sus familias; e incluso consiguiendo apoyos nuevos como es en el caso de un 10,6% de las participantes al hablar de sus parejas., This article aims to study family support for the female population in the open environment of the Spanish Penitentiary System as one of the factors related to their reintegration process and transit to freedom, analyzing the sources, degree and type of support relatives for the return to life in freedom. This work is part of the R + D + I research project “ Procesos de reinserción y acompañamiento a mujeres en semilibertad” (ref. EDU2016-79322-R) whose methodology has used qualitative and quantitative methods, in a complementary way, applied to the 310 mixed questionnaires and 67 semi-structured interviews, designed ad hoc, in 31 penitentiary centers representing the different resources for serving sentences in the open environment. A descriptive analysis of the results has been made and the trend of support in the moment before prison and in the current one has been compared by performing the McNemar test for each family figure studied. The results obtained show that the abandonment or loss of supports is relatively low, ranging between 3,2% and 8,1% of the participants according to the different family members; maintaining almost a third of them the support of many of the people in their families; and even getting new supports such as in the case of 10,6% of the participants when talking about their partners., EDU2016-79322-R (2016-2020). Financiado por el Plan Nacional de Investigación, Proyectos de Investigación I+D+I, Ministerio de Economía y Competitividad (MINECO), Agencia Estatal de Investigación (AEI) y FEDER (España)

The aim of this paper is to provide a theoretical and grounded approach to the culture and peace education, both linked to socio-educational inclusion, as well as to the related processes and methods. This is an original proposal from pedagogical and social education approaches where inclusion, its principles, methods, and processes are merged together and applied to peace education in order to construct/deconstruct and promote a culture of peace. The method consisted of an exhaustive and specialized documentary study of written, virtual, and database sources with a subsequent content analysis. The conclusions highlight the importance and applicability of the socio-educational approach, coherent with the social reality, especially of vulnerable and conflictive groups, where inclusion is a crucial element to improve the quality of life and social coexistence. It is also a practice that contributes to overcome risk factors and favors protective and potential situations. All of the above will have an impact on the strengthening and improvement of culture of peace as a tool for social and educational transformation, the protection of human rights, fair and sustainable development, management and transformation of life conflicts in the most comprehensive and inclusive way possible, inside and outside the school context. RESUMEN El presente trabajo tiene como objetivo realizar una aproximación teórica y fundamentada sobre la Cultura de Paz y Educación para la Paz, unida a la inclusión socioeducativa, así como a los procesos y métodos de acción intervinientes. La originalidad radica en el abordaje desde enfoques de la Pedagogía y Educación social, donde la inclusión, sus principios, métodos y procesos se funden y aplican en la Educación para la Paz, a fin de construir/ deconstruir y fomentar una Cultura de Paz. El método empleado ha sido un estudio documental exhaustivo y especializado en fuentes escritas, virtuales y bases de datos, realizándose un posterior análisis de contenido. Las Conclusiones evidencian la importancia y aplicabilidad del enfoque socioeducativo, coherente a la realidad social, especialmente en colectivos vulnerables y en conflicto, donde la inclusión es fundamental para mejorar la calidad de vida y la convivencia social, superando los factores de riesgo y favoreciendo los factores de protección y potenciales. Todo, incidirá en el fortalecimiento y mejora de una Cultura de Paz como herramienta de transformación social y educativa, la protección de los derechos humanos, el desarrollo justo y sostenible, la gestión y transformación de los conflictos, a lo largo de toda la vida, de la forma más integral e inclusiva posible, dentro y fuera de la escuela. RESUMO O presente trabalho tem como objetivo realizar uma aproximaçâo teórica e fundamentada sobre a Cultura de Paz e a Educaçâo para a Paz, somada à indusâo socioeducativa, assim como aos processos e métodos de intervençâo. A originalidade encontrase na abordagem a partir dos enfoques da Pedagogia e Educaçâo social, na qual a inclusâo, seus principios, métodos e processos se fundem e se aplicam na Educaçâo para a Paz, a fim de construir/desconstruir e fomentar uma Cultura de Paz. O método empregado foi um estudo documental exaustivo e especializado em fontes escritas, virtuais e bases de dados, realizandose uma posterior análise de conteúdo. As conclusôes evidenciam a importancia e aplicabilidade do enfoque socioeducativo coerente com a realidade social, especialmente em coletivos vulneráveis e em conflito, nas quais a inclusâo é fundamental para melhorar a qualidade de vida e a convivência social, superando os fatores de risco e favorecendo os fatores de proteçâo e as potencias. Tudo isso incidirá no fortalecimento e melhora de uma Cultura da Paz como ferramenta de transformaçâo social e educativa, a proteçâo dos direitos humanos, o desenvolvimento justo e sustentável, a gestâo e resoluçâo dos conflitos, ao longo de toda a vida, da forma mais integral e inclusiva possível, dentro e fora da escola.

A phase III dengue vaccine trial including 9- to 16-year-olds in Latin America (NCT01374516) was ongoing at the time of a Zika outbreak. We explored interactions between dengue and Zika, in the context of dengue vaccination. Symptomatic virologically confirmed Zika (VCZ) was evaluated using acute-phase sera from febrile participants (January 2013–March 2018). Neutralizing antibody geometric mean titers (GMTs) were evaluated pre- and post-Zika outbreak (months 25 and 72) in 2,000 randomly selected participants. Baseline dengue serostatus was determined using the plaque reduction neutralization test or inferred post hoc using nonstructural protein 1 IgG ELISA at M13 (case–cohort analysis). Vaccine efficacy against VCZ and serologically suspected Zika (SSZ) was estimated. Overall, 239/10,157 (2.4%) acute-phase samples were VCZ positive during the study. Dengue vaccine efficacy against VCZ was 27.8% (95% CI: 0.3; 47.7) among baseline dengue-seropositive participants. No vaccine effect was evident against SSZ. Zika antibody GMTs increased from pre- to post-Zika epidemic, with smaller increases observed for participants who were dengue seropositive at baseline than for those who were dengue seronegative: post-/pre-Zika GMT ratios for baseline dengue-seropositive participants were 21.5 (vaccine group) and 30.8 (placebo); and for dengue seronegatives, 88.1 and 89.5, respectively. Dengue antibody GMTs post-Zika were higher in dengue vaccine and placebo recipients with SSZ than those without SSZ in both dengue seropositives and seronegatives. Dengue vaccine did not enhance symptomatic Zika illness in dengue-seropositive individuals, rather it reduced the risk of VCZ. Zika infection boosted preexisting vaccine-induced or naturally occurring dengue-neutralizing antibodies.

Background We previously described an increased immune response 28 days after a booster dose of the live, attenuated, tetravalent dengue vaccine (CYD-TDV) in healthy adolescents and adults in Latin America (CYD64, NCT02623725). This follow-up study evaluated immune response persistence and safety of a CYD-TDV booster dose up to Month (M) 24 post-booster. Methods This study included 250 participants who previously received 3 primary doses of CYD-TDV in the CYD13 (NCT00993447) and CYD30 (NCT01187433) studies, and who were randomized 4-5 years later to receive a CYD-TDV booster or placebo (3:1). Dengue neutralizing antibodies against the parental dengue virus strains were assessed using the plaque reduction neutralization test (PRNT50) at M6, M12, and M24 post-booster. Post-booster memory B-cell responses were assessed in a subset of participants using the FluoroSpot assay up to M12 post-booster. Results In the CYD-TDV group (n = 187), dengue neutralizing antibody geometric mean titers (GMTs) declined from the peak at day 28 through to M24 for all serotypes. GMTs at M24 were similar to those at pre-booster among baseline dengue seropositives. A similar trend was observed for baseline dengue seronegatives, albeit at a lower magnitude. Previous vaccination-induced detectable B-cell memory responses in seropositives and seronegatives that decreased to pre-booster levels at M12 post-booster. The CYD-TDV booster dose was well-tolerated. Conclusions In baseline dengue seropositives, following a CYD-TDV booster dose administered 4-5 years after primary immunization, dengue neutralizing antibody GMTs and B-cell memory responses peaked in the short-term before gradually decreasing over time. A CYD-TDV booster dose could improve protection against dengue during outbreak periods.

Background A quadrivalent split-virion inactivated influenza vaccine (VaxigripTetra™, Sanofi Pasteur; IIV4) containing two A strains (H1N1 and H3N2) and B strains from both lineages (Victoria and Yamagata) was approved in Europe in 2016 for individuals aged ≥ 3 years. This study examined the efficacy and safety of IIV4 in children aged 6–35 months. Methods This was a phase III randomised controlled trial conducted in Latin America, Asia, Africa, and Europe during the Northern Hemisphere 2014/2015 and 2015/2016 and Southern Hemisphere 2014 and 2015 influenza seasons. Healthy children aged 6–35 months not previously vaccinated against influenza were randomised to receive two full doses 28 days apart of IIV4, placebo, the licensed trivalent split-virion inactivated vaccine (IIV3), an investigational IIV3 containing a B strain from the alternate lineage. The primary objective was to demonstrate efficacy against influenza illness caused by any strain or vaccine-similar strains. Results The study enrolled 5806 participants. Efficacy, assessed in 4980 participants completing the study according to protocol, was demonstrated for IIV4. Vaccine efficacy was 50.98% (97% CI, 37.36–61.86%) against influenza caused by any A or B type and 68.40% (97% CI, 47.07–81.92%) against influenza caused by vaccine-like strains. Safety profiles were similar for IIV4, placebo, and the IIV3s, although injection-site reactions were slightly more frequent for IIV4 than placebo. Conclusions IIV4 was safe and effective for protecting children aged 6–35 months against influenza illness caused by vaccine-similar or any circulating strains. Clinical trial registration EudraCT no. 2013-001231-51.

BACKGROUND A candidate tetravalent dengue vaccine is being assessed in three clinical trials involving more than 35,000 children between the ages of 2 and 16 years in Asian– Pacific and Latin American countries. We report the results of long-term follow-up interim analyses and integrated efficacy analyses. METHODS We are assessing the incidence of hospitalization for virologically confirmed dengue as a surrogate safety end point during follow-up in years 3 to 6 of two phase 3 trials, CYD14 and CYD15, and a phase 2b trial, CYD23/57. We estimated vaccine efficacy using pooled data from the first 25 months of CYD14 and CYD15. RESULTS Follow-up data were available for 10,165 of 10,275 participants (99%) in CYD14 and 19,898 of 20,869 participants (95%) in CYD15. Data were available for 3203 of the 4002 participants (80%) in the CYD23 trial included in CYD57. During year 3 in the CYD14, CYD15, and CYD57 trials combined, hospitalization for virologically confirmed dengue occurred in 65 of 22,177 participants in the vaccine group and 39 of 11,089 participants in the control group. Pooled relative risks of hospitalization for dengue were 0.84 (95% confidence interval [CI], 0.56 to 1.24) among all participants, 1.58 (95% CI, 0.83 to 3.02) among those under the age of 9 years, and 0.50 (95% CI, 0.29 to 0.86) among those 9 years of age or older. During year 3, hospitalization for severe dengue, as defined by the independent data monitoring committee criteria, occurred in 18 of 22,177 participants in the vaccine group and 6 of 11,089 participants in the control group. Pooled rates of efficacy for symptomatic dengue during the first 25 months were 60.3% (95% CI, 55.7 to 64.5) for all participants, 65.6% (95% CI, 60.7 to 69.9) for those 9 years of age or older, and 44.6% (95% CI, 31.6 to 55.0) for those younger than 9 years of age. CONCLUSIONS Although the unexplained higher incidence of hospitalization for dengue in year 3 among children younger than 9 years of age needs to be carefully monitored during long-term follow-up, the risk among children 2 to 16 years of age was lower in the vaccine group than in the control group. (Funded by Sanofi Pasteur; ClinicalTrials .gov numbers, NCT00842530, NCT01983553, NCT01373281, and NCT01374516.)

Purpose Long-term immunogenicity and safety of the human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine when administered to adolescent girls was evaluated. Methods This open-label, follow-up study (NCT00316706) was conducted in 31 centers in Taiwan, Germany, Honduras, Panama, and Colombia. In the initial study (NCT00196924), 1,035 girls aged 10–14 years received the HPV-16/18 AS04-adjuvanted vaccine at 0, 1, and 6 months. Here, geometric mean titers (GMTs) of antibodies against HPV-16, HPV-18, and monophosphoryl lipid A (MPL), a component of the AS04 Adjuvant System, were reported up to month 48. Results In the according-to-protocol immunogenicity cohort (N = 563), GMTs at month 48 in initially seronegative participants were 2,374.9 (95% confidence interval: 2,205.7–2,557.0) EL.U/mL for anti-HPV-16 and 864.8 (796.9–938.4) EL.U/mL for anti-HPV-18, that is, six- and threefold higher than the plateau level in a reference study demonstrating vaccine efficacy in young women (age, 15–25 years). All participants remained seropositive for anti-HPV-16 and anti-HPV-18 at month 48. Most participants (81.8%) were seropositive for anti-MPL antibodies before vaccination. Anti-MPL antibody titers in initially seropositive participants increased initially, and then declined. Most initially seronegative participants for anti-MPL seroconverted; 69.6% remained seropositive at month 48, with anti-MPL antibody titers similar to the natural background level. The vaccine was generally well tolerated. No serious adverse events were considered related to vaccination. Conclusions In adolescent girls, the HPV-16/18 AS04-adjuvanted vaccine produces anti-HPV-16 and anti-HPV-18 antibody titers that are maintained for up to 4 years at higher levels than those in young women in whom vaccine efficacy against cervical lesions was demonstrated.

GlaxoSmithKline (GSK) Biologicals was the funding source and was involved in all stages of the study conduct and analysis. GSK Biologicals also funded all costs associated with the development and the publishing of the present manuscript. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Bel?m, PA, Brasil. Instituto Nacional de Pediatr?a. M?xico D.F., Mexico. Hospital del Ni?o. Panama City, Panama. Universidad de Valpara?so. Escuela de Medicina. Valpara?so, Chile. Instituto Costarricense de Investigaciones Cl?nicas. Urbanizaci?n de Los Arboles La Uruca. San Jos?, Costa Rica. Instituto Mexicano del Seguro Social. CMN-SXX. Pediatrics Hospital. Medical Research Unit on Infectious Diseases. Mexico City, Mexico. GlaxoSmithKline Biologicals M?xico. M?xico D.F., M?xico. Hospital Dr. Humberto Notti. Villa Nueva de Guaymall?n, Mendoza, Argentina. Hospital Maternidad Nuestra Sra de la Altagracia. Santo Domingo, D.N., Dominican Republic. GlaxoSmithKline Biologicals Argentina. Victoria, Buenos Aires, Argentina. Organizaci?n para el Desarrollo y la Investigaci?n Salud en Honduras. Colonia Humuya, Sendero Pastizal, Tegucigalpa, Honduras. Ciudad Hospitalaria Dr. Enrique Tejera. Hospital de Ni?os Dr. Jorge Lizarraga. Carabobo, Valencia, Venezuela. Fundaci?n para el Avance de la Investigaci?n Cl?nica y Translacional. Consultores M?dicos Am?rica. V?a Espa?a, Carrasquilla, Panama. GlaxoSmithKline Biologicals Costa Rica. San Jose, Costa Rica. GlaxoSmithKline Biologicals Belgium. Rixensart, Belgium. Rotavirus is the leading cause of severe diarrheal disease and dehydration in infants in both developed and developing countries. Vaccines have recently been developed, but detailed epidemiological information, which is needed for decisions about how and where to introduce vaccination, was lacking for many Latin American countries. The primary objective of this study was to measure the incidence and disease burden of rotavirus in young children presenting to Latin American hospitals with gastroenteritis. In addition it allowed to setting up the methodology to further conduct a large phase III trial with a rotavirus vaccine in the region. This was a prospective, multi-center surveillance study of gastroenteritis in children

Please cite this paper as: Laguna-Torres et al. (2011) Influenza and other respiratory viruses in three Central American countries. Influenza and Other Respiratory Viruses 5(2), 123–134. Background Despite the disease burden imposed by respiratory diseases on children in Central America, there is a paucity of data describing the etiologic agents of the disease. Aims To analyze viral etiologic agents associated with influenza-like illness (ILI) in participants reporting to one outpatient health center, one pediatric hospital, and three general hospitals in El Salvador, Honduras, and Nicaragua Material & Methods Between August 2006 and April 2009, pharyngeal swabs were collected from outpatients and inpatients. Patient specimens were inoculated onto cultured cell monolayers, and viral antigens were detected by indirect and direct immunofluorescence staining. Results A total of 1,756 patients were enrolled, of whom 1,195 (68.3%) were under the age of 5; and 183 (10.4%) required hospitalization. One or more viral agents were identified in 434 (24.7%) cases, of which 17 (3.9%) were dual infections. The most common viruses isolated were influenza A virus (130; 7.4% of cases), respiratory syncytial virus (122; 6.9%), adenoviruses (63; 3.6%), parainfluenza viruses (57; 3.2%), influenza B virus (47; 2.7% of cases), and herpes simplex virus 1 (22; 1.3%). In addition, human metapneumovirus and enteroviruses (coxsackie and echovirus) were isolated from patient specimens. Discussion When compared to the rest of the population, viruses were isolated from a significantly higher percentage of patients age 5 or younger. The prevalence of influenza A virus or influenza B virus infections was similar between the younger and older age groups. RSV was the most commonly detected pathogen in infants age 5 and younger and was significantly associated with pneumonia (p

Over the past several decades there has been growing evidence of the increase in incidence rates, morbidity, and mortality for a number of health problems experienced by children. The causation and aggravation of these problems are complex and multifactorial. The burden of these health problems and environmental exposures is borne disproportionately by children from low-income communities and communities of color. Researchers and funding institutions have called for increased attention to the complex issues that affect the health of children living in marginalized communities--and communities more broadly--and have suggested greater community involvement in processes that shape research and intervention approaches, for example, through community-based participatory research (CBPR) partnerships among academic, health services, public health, and community-based organizations. Centers for Children's Environmental Health and Disease Prevention Research (Children's Centers) funded by the National Institute of Environmental Health Sciences and U.S. Environmental Protection Agency were required to include a CBPR project. The purpose of this article is to provide a definition and set of CBPR principles, to describe the rationale for and major benefits of using this approach, to draw on the experiences of six of the Children's Centers in using CBPR, and to provide lessons learned and recommendations for how to successfully establish and maintain CBPR partnerships aimed at enhancing our understanding and addressing the multiple determinants of children's health.

Pesticides, applied in large quantities in urban communities to control cockroaches, pose potential threats to health, especially to children, who have proportionately greater exposures and unique, developmentally determined vulnerabilities. Integrated pest management (IPM) relies on nonchemical tools--cleaning of food residues, removal of potential nutrients, and sealing cracks and crevices. Least toxic pesticides are used sparingly. To evaluate IPM's effectiveness, the Mount Sinai Children's Environmental Health and Disease Prevention Research Center, in partnership with two community health centers in East Harlem, New York City (NY, USA), undertook a prospective intervention trial. Families (n = 131) enrolled when mothers came to the centers for prenatal care. Household cockroach infestation was measured by glue traps at baseline and 6 months afterward. The intervention group received individually tailored IPM education, repairs, least-toxic pest control application, and supplies, with biweekly pest monitoring for 2 months and monthly for 4 months. The control group, residing in East Harlem and demographically and socioeconomically similar to the intervention group, received an injury prevention intervention. The proportion of intervention households with cockroaches declined significantly after 6 months (from 80.5 to 39.0%). Control group levels were essentially unchanged (from 78.1 to 81.3%). The cost, including repairs, of individually tailored IPM was equal to or lower than traditional chemically based pest control. These findings demonstrate that individually tailored IPM can be successful and cost-effective in an urban community.

Background In light of the increasing rate of dengue infections throughout the world despite vector-control measures, several dengue vaccine candidates are in development. Methods In a phase 3 efficacy trial of a tetravalent dengue vaccine in five Latin American countries where dengue is endemic, we randomly assigned healthy children between the ages of 9 and 16 years in a 2:1 ratio to receive three injections of recombinant, live, attenuated, tetravalent dengue vaccine (CYD-TDV) or placebo at months 0, 6, and 12 under blinded conditions. The children were then followed for 25 months. The primary outcome was vaccine efficacy against symptomatic, virologically confirmed dengue (VCD), regardless of disease severity or serotype, occurring more than 28 days after the third injection. Results A total of 20,869 healthy children received either vaccine or placebo. At baseline, 79.4% of an immunogenicity subgroup of 1944 children had seropositive status for one or more dengue serotypes. In the per-protocol population, there were 176 VCD cases (with 11,793 person-years at risk) in the vaccine group and 221 VCD cases (with 5809 person-years at risk) in the control group, for a vaccine efficacy of 60.8% (95% confidence interval [CI], 52.0 to 68.0). In the intention-to-treat population (those who received at least one injection), vaccine efficacy was 64.7% (95% CI, 58.7 to 69.8). Serotype-specific vaccine efficacy was 50.3% for serotype 1, 42.3% for serotype 2, 74.0% for serotype 3, and 77.7% for serotype 4. Among the severe VCD cases, 1 of 12 was in the vaccine group, for an intention-to-treat vaccine efficacy of 95.5%. Vaccine efficacy against hospitalization for dengue was 80.3%. The safety profile for the CYD-TDV vaccine was similar to that for placebo, with no marked difference in rates of adverse events. Conclusions The CYD-TDV dengue vaccine was efficacious against VCD and severe VCD and led to fewer hospitalizations for VCD in five Latin American countries where dengue is endemic. (Funded by Sanofi Pasteur; ClinicalTrials.gov number, NCT01374516.)

The purpose of this study was to conduct a pilot randomized trial of dialectical behavior therapy (DBT) versus psychosocial treatment as usual (TAU) for adolescents diagnosed with bipolar disorder (BP).We recruited participants 12-18 years of age with a primary BP diagnosis (I, II, or operationalized not otherwise specified [NOS] criteria) from a pediatric specialty clinic. Eligible patients were assigned using a 2:1 randomization structure to either DBT (n=14) or psychosocial TAU (n=6). All patients received medication management from a study-affiliated psychiatrist. DBT included 36 sessions (18 individual, 18 family skills training) over 1 year. TAU was an eclectic psychotherapy approach consisting of psychoeducational, supportive, and cognitive behavioral techniques. An independent evaluator, blind to treatment condition, assessed outcomes including affective symptoms, suicidal ideation and behavior, nonsuicidal self-injurious behavior, and emotional dysregulation, quarterly over 1 year.Adolescents receiving DBT attended significantly more therapy sessions over 1 year than did adolescents receiving TAU, possibly reflecting greater engagement and retention; both treatments were rated as highly acceptable by adolescents and parents. As compared with adolescents receiving TAU, adolescents receiving DBT demonstrated significantly less severe depressive symptoms over follow-up, and were nearly three times more likely to demonstrate improvement in suicidal ideation. Models indicate a large effect size, for more weeks being euthymic, over follow-up among adolescents receiving DBT. Although there were no between-group differences in manic symptoms or emotional dysregulation with treatment, adolescents receiving DBT, but not those receiving TAU, evidenced improvement from pre- to posttreatment in both manic symptoms and emotional dysregulation.DBT may offer promise as an adjunct to pharmacotherapy in the treatment of depressive symptoms and suicidal ideation for adolescents with BP. The DBT focus on commitment to treatment may be important for the treatment of early-onset BP. Larger controlled trials are needed to establish the efficacy of this approach, examine impact on suicidal behavior, and demonstrate cost effectiveness.

Maghsoudi, Behzad/0000-0002-1279-8799; Kritsotakis, Evangelos/0000-0002-9526-3852; Yalcin, Ata Nevzat/0000-0002-7243-7354; Mikaszewska-Sokolewicz, Malgorzata A/0000-0002-1148-7817; ALDEMIR KOCABAS, Bilge/0000-0002-6396-5243; Masjedi, Mohammad Reza/0000-0002-6871-382X; Masjedi, Mansoor/0000-0001-6175-9289; Gan, Chin Seng/0000-0002-6758-4798; Oncul, Oral/0000-0002-1681-1866; Sabetian, Golnar/0000-0001-8764-2150; YAMAN, Ayhan/0000-0002-5651-1286; Ozdemir, Halil/0000-0002-7318-1688; Leon, Hector Armando Rincon/0000-0003-0715-200X; Delia, Muntean/0000-0001-9100-4530; Atasay, Fatma Begum/0000-0002-9114-5293; Zand, Farid/0000-0003-3489-3372; Kuchenbecker, Ricardo/0000-0002-4707-3683; Medeiros, Eduardo A/0000-0002-6205-259X; ROMERO LOPEZ-ALBERCA, CRISTINA/0000-0001-5856-8668; Salomao, Reinaldo/0000-0003-1149-4598; ozdemir, sonay incesoy/0000-0003-2863-901X; Meco, Basak Ceyda/0000-0003-2951-9634; Horoz, Ozden Ozgur/0000-0001-7590-650X; Horhat, Florin George/0000-0001-6133-0204; Kazi, Mohammad Mukhit/0000-0003-3824-5540; Ciftci, Ergin/0000-0002-4955-160X; Abouqal, Redouane/0000-0002-6117-4341; Leblebicioglu, Hakan/0000-0002-6033-8543; Garcell, Humberto Guanche/0000-0001-7279-0062; Kendirli, Tanil/0000-0001-9458-2803; de Souza, Maria Cecilia B V/0000-0003-0318-3087; Sanaei Dashti, Anahita/0000-0002-2827-3575; UNAL, SERHAT/0000-0003-1184-4711; alvarez Moreno, carlos Arturo/0000-0001-5419-4494; Barahona G., Nayide/0000-0003-3559-6900; Rodriguez Ferrer, Marena Luz/0000-0002-8053-8454; Karabay, Oguz/0000-0003-0502-432X; Kaya, Sehnaz/0000-0003-0002-1517; ERDEVE, OMER/0000-0002-3193-0812; Gonzalez Martinez, Marisela del Rocio/0000-0003-1474-736X; Gikas, Achilleas/0000-0002-8455-9631; Baylan, Orhan/0000-0002-6529-7824; Mitrev, Zan/0000-0001-7859-8821; yildizdas, dincer/0000-0003-0739-5108; Ngo, Quy Chau/0000-0002-6787-2757; Duszynska, Wieslawa/0000-0002-5880-4904; KAYA, ZEYNEP/0000-0002-8468-2103; Dragan, Barbara/0000-0003-3108-4211; Gupta, Umesh/0000-0001-7717-1404; Navarro Fuentes, Karla Reyna/0000-0002-6894-8872; zali, Mohammadreza/0000-0002-9027-4560; Morocho Tutillo, Diego Rolando/0000-0002-4974-7856; El Kholy, Amani/0000-0002-0645-7664; Kanj, Souha/0000-0001-6413-3396; Assiri, Abdullah/0000-0002-5605-2876; Unal, Necmettin/0000-0002-9440-7893; Jayatilleke, Kushlani/0000-0002-3931-6630; KARABAY, OGUZ/0000-0003-1514-1685 WOS: 000341307100001 PubMed: 25179325 We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line-associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U. S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN. Copyright (C) 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

BACKGROUND: Commonly used trivalent vaccines contain one influenza B virus lineage and may be ineffective against viruses of the other B lineage. We evaluated the efficacy of a candidate inactivated quadrivalent influenza vaccine (QIV) containing both B lineages. METHODS: In this multinational, phase 3, observer-blinded study, we randomly assigned children 3 to 8 years of age, in a 1:1 ratio, to receive the QIV or a hepatitis A vaccine (control). The primary end point was influenza A or B confirmed by real-time polymerase chain reaction (rt-PCR). Secondary end points were rt-PCR-confirmed, moderate-to-severe influenza and rt-PCR-positive, culture-confirmed influenza. The vaccine efficacy and the effect of vaccination on daily activities and utilization of health care resources were assessed in the total vaccinated cohort (2584 children in each group) and the per-protocol cohort (2379 children in the QIV group and 2398 in the control group). RESULTS: In the total vaccinated cohort, 62 children in the QIV group (2.40%) and 148 in the control group (5.73%) had rt-PCR-confirmed influenza, representing a QIV efficacy of 59.3% (95% confidence interval [CI], 45.2 to 69.7), with efficacy against culturecon-firmed influenza of 59.1% (97.5% CI, 41.2 to 71.5). For moderate-to-severe rt-PCR-confirmed influenza, the attack rate was 0.62% (16 cases) in the QIV group and 2.36% (61 cases) in the control group, representing a QIV efficacy of 74.2% (97.5% CI, 51.5 to 86.2). In the per-protocol cohort, the QIV efficacy was 55.4% (95% CI, 39.1 to 67.3), and the efficacy against culture-confirmed influenza 55.9% (97.5% CI, 35.4 to 69.9); the efficacy among children with moderate-to-severe influenza was 73.1% (97.5% CI, 47.1 to 86.3). The QIV was associated with reduced risks of a body temperature above 39°C and lower respiratory tract illness, as compared with the control vaccine, in the per-protocol cohort (relative risk, 0.29 [95% CI, 0.16 to 0.56] and 0.20 [95% CI, 0.04 to 0.92], respectively). The QIV was immunogenic against all four strains. Serious adverse events occurred in 36 children in the QIV group (1.4%) and in 24 children in the control group (0.9%). CONCLUSIONS: The QIV was efficacious in preventing influenza in children. Copyright © 2013 Massachusetts Medical Society.

The efficacy of a rotavirus vaccine against severe rotavirus gastroenteritis when coadministered with routine Expanded Program on Immunization (EPI) vaccines including oral polio vaccine (OPV) was evaluated in this study.Double-blind, randomized (2:1), placebo-controlled study conducted across 6 Latin American countries. Healthy infants (N = 6568) 6 to 12 weeks of age received 2 doses of RIX4414 vaccine or placebo following a 0, 1- to 2-month schedule. Routine vaccines including OPV were coadministered according to local EPI schedule. Vaccine efficacy (VE) against severe rotavirus gastroenteritis caused by circulating wild-type rotavirus from 2 weeks post-Dose 2 until 1 year of age was calculated with 95% confidence interval [CI]. Safety was assessed during the entire study period. Immunogenicity of RIX4414 and OPV was also assessed.During the efficacy follow-up period (mean duration = 7.4 months), 7 and 19 cases of severe rotavirus gastroenteritis were reported in the vaccine and placebo groups, respectively, with a VE of 81.6% (95% CI: 54.4-93.5). VE against severe rotavirus gastroenteritis caused by G1 type was 100% (95% CI:0-100) and 80.6% (95% CI: 51.4-93.2) against the pooled non-G1 rotavirus types, respectively. There was no difference (P = 0.514) in the incidence of serious adverse events reported in the 2 groups. Antirotavirus IgA seropositivity rate at 1 to 2 months post-Dose 2 was 61.4% (95% CI: 53.7-68.6) in the RIX4414 group; similar seroprotection rates (≥96.0%) against the 3 antipoliovirus types was observed 1 month post-Dose 3 of OPV in both groups.RIX4414 was highly efficacious against severe rotavirus gastroenteritis caused by the circulating wild-type rotavirus (G1 and non-G1) when coadministered with routine EPI vaccines including OPV.

Please cite this paper as: Laguna‐Torres et al. (2011) Influenza and other respiratory viruses in three Central American countries. Influenza and Other Respiratory Viruses 5(2), 123–134. Background Despite the disease burden imposed by respiratory diseases on children in Central America, there is a paucity of data describing the etiologic agents of the disease. Aims To analyze viral etiologic agents associated with influenza‐like illness (ILI) in participants reporting to one outpatient health center, one pediatric hospital, and three general hospitals in El Salvador, Honduras, and Nicaragua Material & Methods Between August 2006 and April 2009, pharyngeal swabs were collected from outpatients and inpatients. Patient specimens were inoculated onto cultured cell monolayers, and viral antigens were detected by indirect and direct immunofluorescence staining. Results A total of 1,756 patients were enrolled, of whom 1,195 (68.3%) were under the age of 5; and 183 (10.4%) required hospitalization. One or more viral agents were identified in 434 (24.7%) cases, of which 17 (3.9%) were dual infections. The most common viruses isolated were influenza A virus (130; 7.4% of cases), respiratory syncytial virus (122; 6.9%), adenoviruses (63; 3.6%), parainfluenza viruses (57; 3.2%), influenza B virus (47; 2.7% of cases), and herpes simplex virus 1 (22; 1.3%). In addition, human metapneumovirus and enteroviruses (coxsackie and echovirus) were isolated from patient specimens. Discussion When compared to the rest of the population, viruses were isolated from a significantly higher percentage of patients age 5 or younger. The prevalence of influenza A virus or influenza B virus infections was similar between the younger and older age groups. RSV was the most commonly detected pathogen in infants age 5 and younger and was significantly associated with pneumonia (p

Describimos dos pacientes con linfoma no Hodgking y niveles sericos elevados del antigeno CA-125: un caso de una mujer de 75 anos de edad con perdida de peso y leucoeritroblastosis con cifras de CA-125 de 165 U/ml (valores de referencia: o a 35). El segundo caso fue un hombre de 92 anos estudiado por perdida ponderal, astenia, adinamia y ascitis con cifras de CA-125 de 1.246 U/ml. Ambos pacientes fallecieron pronto despues de haberse hecho el diagnostico. Los niveles sericos de CA-125, considerado como un marcador de cancer de ovario, pueden incrementarse en pacientes con linfoma no Hodgkin, y hay datos que indican que este hallazgo puede ser un factor pronostico adverso.

Hospital del Ni?o. Infectious Disease Department. Ciudad de Panam?, Panama. Instituto Mexicano del Seguro Social. Medical Research Unit on Infectious Diseases. CMN-SXXI. Mexico City, Mexico. Centro de Estudios en Infectologia Pediatrica. Clinica Materno Infantil Los Farallones. Cali, Colombia. Universidad Nacional Aut?noma de Nicaragua. Edificio Central. Le?n, Nicaragua. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Hospital Dr. Humberto Notti. Villa Nueva de Guaymall?n, Mendoza, Argentina Universidad de Concepci?n. Concepci?n, Chile. Universidad de Concepci?n. Concepci?n, Chile. Universidad de Valpara?so. Escuela de Medicina. Valpara?so, Chile. Hospital Nacional de Ni?os. Paseo Col?n, San Jos?, Costa Rica. Organizaci?n para el Desarrollo y la Investigaci?n Salud en Honduras. Colonia Humuya, Tegucigalpa, Honduras. Hospital General de Tlanepantla ?Valle Ceyl?n?. Tlanepantla, Mexico. Hospital Infantil de Mexico. Calle Dr. M?rquez . M?xico DF, Mexico / Ministry of Health. National Center for Child and Adolescent Health. Colonia Merced Gomez, Mexico DF, Mexico. Instituto Nacional de Pediatr?a. M?xico DF, Mexico. Instituto Nacional de Ciencias M?dicas y Nutrici?n Salvador Zubir?n. Mexico DF, Mexico. Hospital Maternidad Nuestra Sra de la Altagracia. Santo Domingo, DN, Rep?blica Dominicana. Fundaci?n para el Avance de la Investigaci?n Cl?nica y Translacional, Consultorios M?dicos Am?rica. V?a Espa?a, Carrasquilla, Panama / GlaxoSmithKline Vaccines. Clayton, Panama. GlaxoSmithKline Vaccines M?xico. M?xico DF, Mexico. GlaxoSmithKline Vaccines Argentina. Buenos Aires, Argentina / Independent Medical Professional. Buenos Aires, Argentina. GlaxoSmithKline Vaccines Costa Rica. San Jose, Costa Rica / GlaxoSmithKline Vaccines. Ciudad del Saber, Clayton, Panama. GlaxoSmithKline Vaccines. Philadelphia, USA / Merck & Co., Global Health Outcomes Vaccines. Philadelphia, PA, USA. GlaxoSmithKline Vaccines. Rixensart, Belgium / Philadelphia Department of Public Health. Philadelphia, USA. GlaxoSmithKline Vaccines. Rixensart, Belgium / P95 Excellence in Pharmacovigilance and Epidemiology, Leuven, Belgium. GlaxoSmithKline Vaccines. Rixensart, Belgium / GlaxoSmithKline Vaccines, Parc de la Noire Epine. Wavre, Belgium. Background: Intussusception (IS) is a form of acute intestinal obstruction that occurs mainly in infants and is usually of unknown cause. An association between IS and the first licensed rotavirus vaccine, a reassortanttetravalent, rhesus-based rotavirus vaccine (RRV-TV), led to the withdrawal of the vaccine. New rotavirus vaccines have now been developed and extensively studied for their potential association with IS. This study aimed to describe the epidemiology and to estimate the incidence of IS in Latin American infants prior to new vaccine introduction. Methods: Children under 2 years of age representing potential IS cases were enrolled in 16 centers in 11 Latin American countries from January 2003 to May 2005. IS cases were classified as definite, probable, possible or suspected as stated on the Brighton Collaboration Working Group guidelines. Results: From 517 potential cases identified, 476 (92 per cent) cases were classified as definite, 21 probable, 10 possible and 10 suspected for intussusception. Among the 476 definite IS cases, the median age at presentation was 6.4 months with 89 per cent of cases aged 1 year. The male to female ratio was 1.5:1. The incidence of definite IS per 100,000 subject-years ranged from 1.9 in Brazil to 62.4 in Argentina for children 2 years of age, and from 3.8 in Brazil to 105.3 in Argentina for children aged 1 year. Median hospital stay was 4 days with a high prevalence of surgery as the primary treatment (65 per cent). Most cases (88 per cent) made a complete recovery, but 13 (3 per cent) died. No clear seasonal pattern of IS cases emerged. Conclusions: This study describes the epidemiology and estimates the incidence of IS in Latin American infants prior to the introduction of new rotavirus vaccines. The incidence of IS was found to vary between different countries, as observed in previous studies.