Changes in the Household Calorie Supply during the 1994 Economic Crisis in Mexico and Its Implications on the Obesity Epidemic

To characterize the effects of the 1994 economic crisis on calorie sources of Mexican households, five nutrition surveys done every leap year (1992–2000) in national representative samples (> 10,000 households) were analyzed. Each household was visited during 7 days to collect data on foods purchased, exchanged or home-grown and their monetary value. We selected 88 food items to calculate kilocalories/ person/day and cost in pesos/megacalorie (CPMC) for rural-urban strata (localities <2500, ≥2500). The food items were classified in 8 groups and the summation of kilocalories and CPMCs of items in each group were our units of analysis. Linear regressions for 1992–2000 were performed, and slopes and intercepts were used to characterize changes. Available calories showed very little change at the height of the economic crisis. Expensive calories (meat in ur-bans, eggs and milk in rurals, and industrialized meat and soft drinks in both) tended to increase, whereas the most inexpensive staples (cereals, legumes, sugars) decreased their share in both strata. An increase in obesigenic calories was seen, notably in soft drinks, despite a cost increase second only to meat. Main conclusions were: (1) the economic crisis did not affect total calories availability in Mexican households; (2) the 1992–2000 trends in calorie sources were contrary to any crisis effect in rurals and urbans (i.e., expensive foods increased and inexpensive staples decreased); (3) there were sizable rural-urban differences in number, source, and cost of calories; and (4) obesigenic calories increased and soft drinks emerged as a food with its own dynamic.     

Attention deficit disorders: Are we barking up the wrong tree?

Attention deficit disorder (AAD) and attention deficit/hyperactivity disorder (ADHD) are very frequent and protean developmental disorders without a definite biologic marker. This review proposes a framework to understand the enlarged spectrum of its manifestations based on current knowledge of the mechanisms underlying arousal and attention variations during sleep/wake cycle. The neuro-modulation's pivotal role in this process as well as in the fine tuning of synaptic architecture during development must be taken into account when trying to understand the marked fuzziness of the symptoms and the very high prevalence of reported co-morbidities. The series of related interactions includes a cyclic deactivation of the dorso-lateral portion of the prefrontal cortex (DLPFC) during sleep, suspending executive functions, co-occurring with rhythmic periods of decreased noradrenergic tonus. A protracted unbalance in modulation, with catecholaminergic relative deficiency, could explain less-than-optimum waking DLPFC activation and the most important manifestations of ADD. Beside the well documented dopaminergic effects of stimulant medication used in ADD and ADHD, a more important role must be assigned to noradrenaline (NA). At this light hyperactivity and impulsivity are less important dimensions. Rather, an attention deficit spectrum disorder should probably be regarded as a complication of a core defect in prefrontal cortex dependent inhibitory control, underlying inattention.     

Psychosocial effect of mastectomy versus conservative surgery in patients with early breast cancer

Purpose To compare the quality-of-life (QoL) and psycho-social changes in a group of patients with early breast cancer who underwent conservative surgery (BCS) or modified radical mastectomy (MRM). Methods Self-administered questionnaire assessing body image perception, social habits, sexual attraction and self-consciousness with relatives/friends, was randomly assigned to 125 patients (61 BCS, 64 MRM; aged 53±8 and 50±9 years, respectively, p=NS). Results MRM patients reported a significantly higher frequency of changes in body image perception and other related social behaviour such as avoiding going to the beach or using low-cut clothes, and reticence with friends. Conversely, no differences were found regarding sexuality, denial of the disease by the husband/partner, or concealing the disease from family members. Also, no significant differences were found between patients above and below the age of 50 years, for all variables studied after adjustment for surgical procedure. Conclusions Modified radical mastectomy has a negative effect on body image perception and in social behaviour patterns of patients and with a concomitant decrease in QoL. The sexuality of the patient is not significantly affected.     

TP53 mutations in ovarian carcinomas from sporadic cases and carriers of two distinct BRCA1 founder mutations; relation to age at diagnosis and survival

Background  

Ovarian carcinomas from 30 BRCA1 germ-line carriers of two distinct high penetrant founder mutations, 20 carrying the 1675delA and 10 the 1135insA, and 100 sporadic cases were characterized for somatic mutations in the TP53 gene. We analyzed differences in relation to BRCA1 germline status, TP53 status, survival and age at diagnosis, as previous studies have not been conclusive.     

Effect of reminder cards on compliance with antihypertensive medication

Objective Poor compliance to antihypertensive medications has been identified as a primary cause of uncontrolled blood pressure (BP), with consequent increases in hypertension‐related morbidity and mortality. Therefore, any measure known to improve compliance should be encouraged. This study assessed the impact of reminder cards on compliance to antihypertensive therapy. Method A field trial was undertaken in pharmacies located in the districts of Lisbon and Porto. Eligible participants comprised those aged 30–74 years, prescribed an angiotensin‐converting enzyme inhibitor (ACEI) in monotherapy, and taken on a once‐daily regimen. Patients were allocated to control group (CG) or intervention group (IG), the latter being provided with a reminder card, an alarm‐type device due to remind the patient of the time to take his medication. Patients were monitored monthly during 3 months for compliance and blood pressure control. Key findings Seventy‐one patients participated in the study (intervention: 35; control group: 36). Compliance was similar between the groups in the first 2 months of follow‐up (97.1% IG vs 94.9% CG at first follow‐up and 97.5% IG vs 94.2% CG at second follow‐up) and higher in the intervention group at the end of the study (97.3% IG vs 87.3% CG; P = 0.011). There were no mean blood pressure differences between compliant and non‐compliant subjects at the end of the study (P value for differences in systolic BP (P_syst) = 0.580; and P value for differences in diastolic BP (P_dlast) = 0.175). Conclusion This small‐scale study indicates a possible positive impact on patients' compliance resulting from the use of reminder cards. However, this needs confirming in larger scale studies with longer monitoring periods.     

Linfadenitis por micobacterias no tuberculosas: experiencia de 15 años

Objective

To study the epidemiology, clinical features, diagnosis, therapeutic management, and outcome of non-tuberculous mycobacterial lymphadenitis in a paediatric population of Aragón (Spain).

Intimate partner violence (IPV) and preeclampsia among Peruvian women

OBJECTIVE: Mounting evidence supports the view that intimate partner violence (IPV) is an important cause of maternal mortality. Some, but not all, prior studies suggest that IPV is associated with increased risks of maternal medical conditions such as hypertensive disorders of pregnancy which are leading causes of maternal mortality worldwide. We assessed the relation between IPV and risk of preeclampsia among Peruvian women. STUDY DESIGN: We conducted a case-control study at two large hospitals in Lima, Peru. Preeclampsia cases were 339 women with pregnancy-induced hypertension and proteinuria (i.e., preeclampsia). Controls were 337 normotensive women. Information concerning women's exposure to physical and emotional violence during pregnancy was collected during in-person interviews conducted after delivery and while patients were in hospital. Odds ratios (OR) and 95% confidence intervals (CI) were estimated from logistic regression models. RESULTS: The prevalence of IPV was 43.1% among cases and 24.3% among controls. Compared with those reporting never exposure to IPV during pregnancy, women reporting any exposure had a 2.4-fold increased risk of preeclampsia (OR=2.4; 95% CI: 1.7-3.3). The association was strengthened slightly after adjusting for maternal age, parity and pre-pregnancy adiposity (OR=2.7; 95% CI: 1.9-3.9). Emotional abuse in the absence of physical violence was associated with a 3.2-fold (95% CI: 2.1-4.9) increased risk of preeclampsia. Emotional and physical abuse during pregnancy was associated with a 1.9-fold increased risk of preeclampsia (95% CI: 1.1-3.5). CONCLUSIONS: IPV among pregnant women is common and is associated with an increased risk of preeclampsia. These data support recent calls for coordinated global health efforts to prevent violence against women.     

Successful incorporation of robotic surgery into gynecologic oncology fellowship training

Background

The increasing role of robotic surgery in gynecologic oncology may impact fellowship training. The purpose of this study was to review the proportion of robotic procedures performed by fellows at the console, and compare operative times and lymph node yields to faculty surgeons.

Methods

A prospective database of women undergoing robotic gynecologic surgery has been maintained since 2008. Intra-operative datasheets completed include surgical times and primary surgeon at the console. Operative times were compared between faculty and fellows for simple hysterectomy (SH), bilateral salpingo-oophorectomy (BSO), pelvic (PLND) and paraaortic lymph node dissection (PALND) and vaginal cuff closure (VCC). Lymph nodes counts were also compared.

Results

Times were recorded for 239 SH, 43 BSOs, 105 right PLNDs, 104 left PLNDs, 34 PALND and 269 VCC. Comparing 2008 to 2011, procedures performed by the fellow significantly increased; SH 16% to 83% (p < 0.001), BSO 7% to 75% (p = 0.005), right PLND 4% to 44% (p < 0.001), left PLND 0% to 56% (p < 0.001), and VCC 59% to 82% (p = 0.024). Console times (min) were similar for SH (60 vs. 63, p = 0.73), BSO (48 vs. 43, p = 0.55), and VCC (20 vs. 22, p = 0.26). Faculty times (min) were shorter for PLND (right 26 vs. 30, p = 0.04, left 23 vs. 27, p = 0.02). Nodal counts were not significantly different (right 7 vs. 8, p = 0.17 or left 7 vs. 7, p = 0.87).

Conclusions

Robotic surgery can be successfully incorporated into gynecologic oncology fellowship training. With increased exposure to robotic surgery, fellows had similar operative times and lymph node yields as faculty surgeons.