Parental Beliefs and Perceptions of the Role of Middle Schools in Student Tobacco Use Prevention Activities in Juárez, Mexico

The purpose of this study was to examine parental beliefs and perceptions of the role that schools should play in implementing smoking prevention activities for their children in Juárez, Mexico. The parents were of sixth grade students from six randomly selected middle schools. Schools were classified by school setting and socioeconomic status. A total of 506 surveys were sent to the homes of the parents and 77% (N=390) responded. The majority of the parents (88%) were supportive of smoking prevention activities. Furthermore, mothers were significantly more likely than fathers to agree that the school had an important role to play in smoking prevention activities (p<0.01). Parents of students in the low SES category regardless of school setting were significantly more likely to support the implementation of smoking prevention activities than parents of students who attended either a middle or high SES school setting (p<0.01). However, even though 79% of parent respondents believed their child’s school should get parental input about what should be taught in tobacco prevention programs, only 62% felt that such activities should include homework and projects involving families. These results provide further evidence that if school-based adolescent tobacco prevention programs are to be successful, public health initiatives need to do a much better job not only soliciting and receiving parental input with regard to proposed anti-tobacco curricula but also in convincing parents of the importance of becoming active participants in the process

Parental Beliefs and Perceptions of the Role of Middle Schools in Student Tobacco Use Prevention Activities in Juárez, Mexico

Abstract The purpose of this study was to examine parental beliefs and perceptions of the role that schools should play in implementing smoking prevention activities for their children in Juárez, Mexico. The parents were of sixth grade students from six randomly selected middle schools. Schools were classified by school setting and socioeconomic status. A total of 506 surveys were sent to the homes of the parents and 77% (N=390) responded. The majority of the parents (88%) were supportive of smoking prevention activities. Furthermore, mothers were significantly more likely than fathers to agree that the school had an important role to play in smoking prevention activities (p<0.01). Parents of students in the low SES category regardless of school setting were significantly more likely to support the implementation of smoking prevention activities than parents of students who attended either a middle or high SES school setting (p<0.01). However, even though 79% of parent respondents believed their child's school should get parental input about what should be taught in tobacco prevention programs, only 62% felt that such activities should include homework and projects involving families. These results provide further evidence that if school-based adolescent tobacco prevention programs are to be successful, public health initiatives need to do a much better job not only soliciting and receiving parental input with regard to proposed anti-tobacco curricula but also in convincing parents of the importance of becoming active participants in the process

Chronic Expanding Hematoma Secondary to Excision of Recurrent Myxomas in a Bitch

Background: Expanding chronic hematoma is a relatively common postoperative complication in humans, not in dogs, nevertheless, is important understand this condition because it may affect the animal's health. A hematoma could be formed within hours and usually stabilizes spontaneously with the reabsorption of its content. However, occasionally the hematoma slowly expands, becomes encapsulated and forms a mass, causing a chronic expanding hematoma. Possibly skin and adipose tissue are displaced secondary to trauma, causing the formation of blood-filled cysts surrounded by a fibrous capsule. The aim of this document is to present the first report of a postsurgical chronic expanding hematoma in dog. Case: A case of chronic expanding hematoma secondary to excision of recurrent myxoma in a bitch was described. Physical examination showed a hard, firm, non-mobile mass enclosed within the deep muscular layers. This mass was between the sternum and the cranial abdomen, similar to previous lesions excised by another veterinarian. Fine needle aspiration indicated the presence of blood. Radiology demonstrated that the bone-cartilage tissue was not involved. Due to the size of the mass, a skin stretching pre-suturing technique using self-adhesive tape was applied around the mass 48 h before surgery.  The mass was removed with wide excision margins and portions of the affected muscles, but a large wound with great tension was created; consequently, a parallel to the wound incision and the thoraco-lumbar vertebrae was made.  Six months after surgery, the animal presented recurrence of the same lesion, which was also removed. The bleeding times were within the normal range, but the animal was diagnosed with hyperadrenocorticism. After both surgeries histopathological exam revealed a hematoma, that had thrombosis and granulation tissue with fibrosis and severe panniculitis, in addition of multifocal, chronic, moderate lymphohistiocytic myositis; all these changes were compatible with a chronic expanding hematoma.  Discussion: Chronic expanding hematoma is a mass that grows slowly secondary to hemorrhage and does not exhibit elements of malignancy. However, it can occasionally be confused for a soft-tissue neoplasm. It has been reported frequently in humans but not in small animals. The first case was reported in 2002: 5 puppies with a cervical hematoma classified as a chronic expanding hematoma was described. In addition, 3 cases were reported: 1 cat with perirenal chronic expanding hematoma; 1 bitch with intra-abdominal presentation, and 1 cat with this pathology on the right pelvic limb after an intramuscular injection.  The etiology of chronic expansive hematoma is unidentified in dogs, nevertheless, it is stipulated that is not an inflammatory process as previously assumed, but rather a neoplastic process. As in other cases, it was difficult to determine the origin of the chronic expanding hematoma. The coagulation times and platelets count were within ranges. Similarly, it is very complicated to relate hyperadrenocorticism with chronic expanding hematoma because dogs with Cushing’s disease generally present hypercoagulopathies. Myxomas are associated with endocrinopathies in humans and dogs, therefore, hyperadrenocorticism is possibly related with this neoplasia. Myxomas have an expansive growth pattern, contrasting with myxosarcomas, which are infiltrating; Although in the present case the skin mass appeared to be invasive, both macroscopical and histopathological appearance of it corresponded to a well-shaped capsule compatible with chronic expanding hematoma. In summary, to the best of our knowledge, this is the first report of a post-surgical chronic expanding hematoma in a dog.    Keywords: dog, canine, surgery, expanding hematoma, postoperative complications, myxomas, small animal

Intimate Partner Violence Among Female Sex Workers and Their Noncommercial Male Partners in Mexico: A Mixed-Methods Study.

Utilizing mixed methods, we examined intimate partner violence (IPV) behaviors among 428 female sex workers (FSWs) who use drugs and their noncommercial male partners in Tijuana and Ciudad Juarez, Mexico. Half of all participants reported perpetrating and experiencing at least one type of IPV behavior in the past year. In interviews, drug use emerged as an important theme associated with IPV behaviors, and we found men and women differed in their motivations for engaging in IPV behaviors. Findings highlight how gender and power are interlinked with and may exacerbate drug use and IPV behaviors among marginalized populations

Structural Determinants of Client Perpetrated Violence Among Female Sex Workers in Two Mexico-U.S. Border Cities.

Female sex workers (FSWs) are disproportionately affected by both HIV and gender-based violence, such as that perpetrated by clients (CPV). We used a structural determinants framework to assess correlates of physical or sexual CPV in the past 6 months among FSWs in the Mexico/U.S. border cities of Ciudad Juárez and Tijuana. Bivariate and multivariate logistic regression analysis identified individual, client, interpersonal, work environment and macrostructural factors associated with recent CPV. Among 496 FSWs, 5 % experienced recent CPV. Witnessing violence towards other FSWs in one's neighborhood (aOR 5.6, 95 % CI 1.8-17.2), having a majority of foreign (aOR 3.5, 95 % CI 1.4-8.4) or substance using (aOR 4.0, 95 % CI 1.5-10.4) clients, and being a street worker (aOR 3.0, 95 % CI 1.1-7.7) were independently associated with recent CPV. Our findings underscore the vulnerability of FSWs and the need to design policies and interventions addressing macro-level influences on CPV rather than exclusively targeting individual behaviors

Structural Determinants of Client Perpetrated Violence Among Female Sex Workers in Two Mexico-U.S. Border Cities.

Female sex workers (FSWs) are disproportionately affected by both HIV and gender-based violence, such as that perpetrated by clients (CPV). We used a structural determinants framework to assess correlates of physical or sexual CPV in the past 6 months among FSWs in the Mexico/U.S. border cities of Ciudad Juárez and Tijuana. Bivariate and multivariate logistic regression analysis identified individual, client, interpersonal, work environment and macrostructural factors associated with recent CPV. Among 496 FSWs, 5 % experienced recent CPV. Witnessing violence towards other FSWs in one's neighborhood (aOR 5.6, 95 % CI 1.8-17.2), having a majority of foreign (aOR 3.5, 95 % CI 1.4-8.4) or substance using (aOR 4.0, 95 % CI 1.5-10.4) clients, and being a street worker (aOR 3.0, 95 % CI 1.1-7.7) were independently associated with recent CPV. Our findings underscore the vulnerability of FSWs and the need to design policies and interventions addressing macro-level influences on CPV rather than exclusively targeting individual behaviors

Correlates of unprotected sex by client type among female sex workers that inject drugs in Tijuana and Ciudad Juarez, Mexico.

AimsRisk environment factors may influence unprotected sex between female sex workers who are also injection drug users (FSW-IDUs) and their regular and non-regular clients differently. Our objective is to identify correlates of unprotected vaginal sex in the context of client type.MethodsA cross-sectional survey of 583 FSW-IDUs in Tijuana and Ciudad Juarez, Mexico, was analyzed using negative binomial regression to determine physical, social, economic, and policy risk-environment factors that affect the frequency of unprotected sex with regular and non-regular clients.ResultsMedian number of unprotected vaginal sex acts in the past month among FSW-IDUs and their regular and non-regular clients was 11 (IQR 3-30) and 13 (IQR 5-30), respectively. Correlates differed by site and client type and were most closely associated with the risk environment. In Tijuana, social factors (e.g., injecting drugs with clients) were independently associated with more unprotected sex. Factors independently associated with less unprotected sex across client type and site included social and economic risk environment factors (e.g., receiving more money for unprotected sex). In the policy risk environment, always having free access to condoms was independently associated with less unprotected sex among non-regular clients in Tijuana (Risk rate ratio = 0.64; 95% confidence interval 0.43-0.97).ConclusionsPrimarily physical, social, and economic risk-environment factors were associated with unprotected vaginal sex between FSW-IDUs and both client types, suggesting potential avenues for intervention

Evaluation of three different positions of laparoscopic ports for Nissen fundoplication in rabbits

Introduction: Paediatric laparoscopic surgery provides new challenges for surgeons; therefore there is a need for adequate training before performing procedures directly on patients. Several different models were designed for training, including both virtual simulators and live animals. However, training with animal models is the most appropriate method for surgical instruction, as it reproduces similar surgical conditions. The objective of this study was to establish the best localization of surgical ports for Nissen fundoplication in rabbit cadavers for both experimental and teaching purposes. Method: The research was conducted using six New Zealand white rabbit cadavers. The location of the trocars was established by two veterinary and one paediatric with experience in laparoscopy surgery. The model was evaluated by four paediatric surgeons. A 5 mm trocar was used, and a laparoscope of 5 mm and 30° attached to a microcamera was inserted. The abdomen was insufflated (to a pressure of 6-8 mm Hg). The placement of secondary trocars was conducted with direct visualization. Diverse factors were considered to establish the location of the trocars such the anatomy of the rabbit stomach and esophagus, laparoscopic Nissen fundoplication performed in rabbits with conventional laparoscopic instruments, and the length of paediatric laparoscopic instruments. Three approaches were repeated in order to locate a satisfactory view of the surgical area. Every position of the ports received a score: one point was scored when the instrumentation was crossed, one point when the organs were too far away to manipulate, and one point when the organs were too close to manipulate. The position was considered ideal when a zero value was obtained. Fleiss Kappa coefficient for 4 raters was used to estimate the level of concordance between observers. Results: It was possible to obtain a value of zero in the latter approach. The position of the trocars was established in the following way: the telescope port positioned at midline 1.6 cm caudal to the umbilical scar (2.0 cm with insufflation), and with the secondary ports placed slightly lateral to the third mammary glands. To establish the exact location of these trocars a point was established at 1.5 cm caudal to the telescope trocar. After forming an angle of 90°, 3.3 cm were measured on each side. These last measures were taken with the abdomen insufflated. Discussion or Conclusion: In this research was established the appropriate positions of the working ports, without causing fatigue of the operator’s wrist joint and with adequate space for comfortable movement. In addition, this would also reduce the use of live rabbits for the establishment of the ports in future research, accepting the concept of the three "Rs" for animal experimentation. With these models was obtained an excellent view of the surgical field without interference between the instruments and telescope.Introducción: La cirugía laparoscópica pediátrica establece nuevos desafíos para los cirujanos; Consecuentemente, existe la necesidad de una formación adecuada antes de realizar los procedimientos directamente en los pacientes. Han sido diseñados diferentes modelos para el entrenamiento quirúrgico, incluyendo simuladores virtuales y animales vivos. Sin embargo, el entrenamiento con modelos animales es el método más apropiado para la instrucción quirúrgica, puesto que reproduce condiciones quirúrgicas similares. El objetivo de este estudio fue establecer la localización adecuada de los puertos de entrada para la fundoplicatura de Nissen en cadáveres de conejos, tanto para fines experimentales como de enseñanza. Método: El estudio fue llevado a cabo usando seis cadáveres de conejo Nueva Zelanda. La ubicación de los trocares fue establecida por dos veterinarios y un pediatra con experiencia en cirugía laparoscópica. El modelo fue evaluado por cuatro cirujanos pediatras. Se utilizó un trocar de 5 mm, y se insertó un laparoscopio de 5 mm con 30° conectado a una micro-cámara. Se insufló el abdomen (a una presión de 6-8 mm Hg). La colocación de trocares secundarios se realizó con visualización directa. Para establecer la ubicación de los trocares se consideraron varios factores como la anatomía del estómago y esófago del conejo, la realización de la fundoplicatura laparoscópica de Nissen en conejos con instrumental laparoscópico convencional y la longitud de los instrumentos laparoscópicos pediátricos. Se realizaron tres abordajes con el fin de establecer una vista satisfactoria de la zona quirúrgica. A cada posición nueva de los puertos se les asignó una puntuación: un punto cuando existió cruce de los instrumentos, un punto cuando los órganos estaban demasiado lejos para manipular y un punto cuando estaban muy cerca para manipular. La posición se consideró ideal cuando el valor fue cero. Para estimar el grado de concordancia entre observadores se utilizó el coeficiente Kappa de Fleiss para 4 observadores. Resultados: Fue posible obtener un valor de cero en el último abordaje. La posición de los trócares quedó establecida de la siguiente manera: el puerto del telescopio fue colocado en la línea media 1,6 cm caudal a la cicatriz umbilical (2.0 cm insuflado) y con los puertos secundarios situados ligeramente laterales a las terceras glándulas mamarias. Para establecer la localización exacta de estos trócares se implantó un punto 1,5 cm caudal al puerto del telescopio. Después de formar un ángulo de 90°, se midieron 3,3 cm en cada lado. Estas últimas medidas se tomaron con el conejo insuflado. Discusión o Conclusión: En esta investigación se establecieron las posiciones apropiadas de los puertos de trabajo, sin causar fatiga de la articulación de la muñeca del cirujano y con un espacio adecuado para un movimiento confortable. Además, se reducirá el uso de conejos vivos para el establecimiento de los puertos en investigaciones futuras, abrazando el concepto de las tres “Rs” en la experimentación con animales. Con este modelo se obtuvo una excelente visión del campo quirúrgico sin interferencia entre el instrumental y el telescopio

Evaluación de tres diferentes posiciones de los puertos de entrada para la funduplicatura de Nissen laparoscópica en conejos

El Algoritmo de Recocido Simulado, cristalización simulada o enfriamiento simulado, es un algoritmo de búsqueda metaheurística para problemas de optimización; el objetivo general de este tipo de algoritmos es encontrar una buena aproximación al valor óptimo de una función en un espacio de búsqueda grande. A este valor se lo denomina "óptimo local u óptimo global". El nombre e inspiración viene del proceso de recocido del acero y cerámicas, una técnica que consiste en calentar y luego enfriar lentamente el material para variar sus propiedades físicas. El calor causa que los átomos aumenten su energía y que puedan así desplazarse de sus posiciones iniciales (un mínimo local de energía); el enfriamiento lento les da mayores probabilidades de recristalizar en configuraciones con menor energía que la inicial (mínimo global). El método fue descrito independientemente por Scott Kirkpatrick, C. Daniel Gelatt y Mario P. Vecchi en 198