Scoping review of measures of treatment burden in patients with multimorbidity: advancements and current gaps

Objectives: To identify, assess, and summarize the measures to assess burden of treatment in patients with multimorbidity (BoT-MMs) and their measurement properties. Study Design and Setting: MEDLINE via PubMed was searched from inception until May 2021. Independent reviewers extracted data from studies in which BoT-MMs were developed, validated, or reported as used, including an assessment of their measurement properties (e.g., validity and reliability) using the COnsensus-based Standards for the selection of health Measurement INstruments. Results: Eight BoT-MMs were identified across 72 studies. Most studies were performed in English (68%), in high-income countries (90%), without noting urban-rural settings (90%). No BoT-MMs had both sufficient content validity and internal consistency; some measurement properties were either insufficient or uncertain (e.g., responsiveness). Other frequent limitations of BoT-MMs included absent recall time, presence of floor effects, and unclear rationale for categorizing and interpreting raw scores. Conclusion: The evidence needed for use of extant BoT-MMs in patients with multimorbidity remains insufficiently developed, including that of suitability for their development, measurement properties, interpretability of scores, and use in low-resource settings. This review summarizes this evidence and identifies issues needing attention for using BoT-MMs in research and clinical practice

Evaluación de la arteria alveolar superior posterior durante el levantamiento del seno maxilar con uso de la tomografía computarizada como diagnóstico

La implantología oral, ha evolucionado mucho en los últimos años, brindando a los dentistas y a los pacientes, másopciones de tratamiento dependiendo de cada caso; como es el caso de pacientes parcialmente desdentados con insuficientehueso para colocarse implantes en la zona postero superior precediendo a una elevación del seno maxilar. Esimportante conocer y evaluar la anatomía del seno maxilar antes de su elevación, para evitar complicaciones quirúrgicas.La arteria alveolar posterior superior (AAPS) es una rama de la arteria maxilar que suministra irrigación a la pared lateraldel seno y subyacente a la membrana. El uso de la tomografía computarizada (CT) cumple un rol muy importanteen el diagnóstico de patología sinusal, septum y ubicación de la AAPS y como plan de tratamiento. El siguiente artículopresenta un caso clínico que localiza la AAPS durante el levantamiento de seno maxilar

Charged Higgs in 3-3-1 Model Through e−e+e^-e^+ Collisions

In this work we present an analysis of production and signature of charged Higgs bosons $H_2^{\pm}$ in the version of the 3-3-1 model containing heavy leptons at the CLIC (Cern Linear Collider). The production rate is found to be significant for the direct production of $e^{-} e^{+} \rightarrow H_{2}^{+} H_{2}^{-}$. We also studied the possibility to identify it using their respective branching ratios.Comment: 16 pages, 9 Figures. arXiv admin note: substantial text overlap with arXiv:1408.5944; text overlap with arXiv:1311.0845, arXiv:1205.404

Geographic information systems: Practical application to study car accidents involving pedestrians in cercado de Lima, Peru [Sistemas de información geográfica: Aplicación práctica para el estudio de atropellos en el cercado De Lima, Perú]

The aim of this study was to geospatially explore the occurrence rates of car accidents involving pedestrians in Cercado de Lima (Lima District), Peru. Car accidents involving pedestrians recorded in the 2015 National Police Station Census of the National Statistics and Information Institute were described and georeferenced. Subsequently, a Kernel Density analysis was carried out to locate areas with high, medium, and low density events. Records of 171 car accidents involving pedestrians were studied: the types of vehicles involved were automobiles (56.7%) and smaller vehicles (22.8%). The highest percentage of car accidents involving pedestrians (38.6%) took place between 12:00 p.m. and 5:00 p.m. There were two densely populated areas and two areas with intermediate density for car accidents involving pedestrians, locations that were previously reported as critical due to their deficiencies and high probability of traffic accidents. The use of geographic information systems offers a quick overview of the occurrence rates of car accidents involving pedestrians to make comparisons and enable the local implementation of strategies. © 2016, Instituto Nacional de Salud. All rights reserved

Trends and patterns of the double burden of malnutrition 1 (DBM) in Peru: A pooled analysis of 129,159 mother-child dyads

Background This study aims to evaluate trends of DBM in Peru over the last 20 years. Methods Using individual-level data collected in nationally representative household surveys from Peru between 1996 and 2017, we analysed trends in the prevalence and patterning of the DBM. We classified the nutritional status of children and their mothers as undernourished (either underweight, stunted or wasted for children), normal, overweight or obese. Children classified as experiencing the DBM were those undernourished and living with an overweight or obese mother. We also fitted logistic regression models to evaluate the probability of children having an overweight/obese mother across subgroups of socioeconomic status, place of residence and education. Results The overall percentage of children experiencing the DBM in 2016 was 7%, and constitutes ~203,600 children (90% of whom were stunted). Between 1996 and 2016, undernourished children have seen the largest relative increase in the risk of having an overweight mother (31% vs. 37%) or obese mother (6% vs. 17%); however, due to the substantial decrease in the absolute number of undernourished children, the DBM has not grown. Moreover, all children, irrespective of their own nutritional status, are now more likely to live with an overweight or obese mother, a consistent pattern across wealth, location and education subgroups, and all regions of Peru. Conclusions DBM prevalence in Peru has decreased, although the number of DBM cases is estimated to be above 200,000. In addition, all children are now more likely to live with overweight or obese mothers. The basic pattern has shifted from one of undernourished children whose mothers have a ‘normal’ BMI, to one where now most children have a ‘normal’ or healthy anthropometric status, but whose mothers are overweight or obese. This suggest that Peru is on the cusp of a major public health challenge requiring significant action

Urbanization in Peru is inversely associated with double burden of malnutrition: pooled analysis of 92,841 mother-child pairs

Objective: This study assessed the relationship between urbanization and the double burden of malnutrition (DBM) in Peru. Methods: Cross-sectional analysis of the Demographic and Health Survey (2009-2016). A DBM ‘case’ comprised a child with undernutrition and their mother with overweight/obesity. For urbanization, we used three indicators: an eight-category variable based on district-level population density (inhabitants/km2); a dichotomous urban/rural variable; and place of residence (countryside, towns, small cities, or capital/large cities). Results: The prevalence of DBM was lower in urban than in rural areas (prevalence ratio [PR]0.70; 95% confidence interval [CI] 0.65–0.75); and compared to the countryside, the DBM was less prevalent in towns (PR 0.75; 95% CI 0.69-0.82), small cities (PR 0.73; 95% CI 0.67-0.79) and capital/large cities (PR 0.53; 95% CI 0.46-0.61). Using population density, the adjusted prevalence of DBM was 9.7%(95% CI 9.4-10.1)in low-density settings(1-500 inhabitants/km2), 5.9% (95% CI 4.9-6.8)in mid-urbanized settings (1,001-2,500inhabitants/km2), 5.8% (95% CI 4.5-7.1)in more densely populated settings(7,501-10,000inhabitants/km2), and 5.5% (95% CI 4.1-7.0) in high-density settings (>15,000 inhabitants/km2). Conclusions: The prevalence of DBM is higher in the least urbanized settings such as rural and peri-urban areas, particularly those under 2,500 inhabitants/km2

Endotoxins in surgical instruments of hip arthroplasty

Abstract OBJECTIVE To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. METHOD A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60 surgical instruments, which were tested for endotoxins in three different stages. The EndosafeTM Gel-Clot LAL (Limulus Amebocyte Lysate method) was used. RESULT There was consistent gel formation with positive analysis in eight instruments, corresponding to 13.3%, being four femoral rasps and four bone reamers. CONCLUSION Endotoxins in quantity ≥0.125 UE/mL were detected in 13.3% of the instruments tested

The large aperture gamma ray observatory as an observational alternative at high altitude

To appear in Conference Title (2007). Rev Mex AA(SC)A pesar de que las observaciones por satélite han permitido desvelar algunos misterios sobre el origen y localización de rayos cósmicos a bajas energías, hay preguntas aún no resueltas en los rangos mas altos de energías (> 1 GeV). El ujo de partículas a altas energías es muy bajo, necesitando de grandes áreas de medición, por lo que la detección de partículas secundarias en observatorios sobre la super cie terrestre representa una solución viable. Aunque el Observatorio Pierre Auger tiene esa capacidad, dados sus 16:000m2 de detectores, su baja altura sobre el nivel del mar reduce en gran medida su capacidad de detección. El proyecto LAGO es una alternativa de observación aceptable, que intenta superar ésta limitación. Este proyecto iniciado en el 2005, sitúa detectores Cherenkov de agua a gran altura. Los sitios de observaci on han sido seleccionados siguiendo algunos requisitos básicos, a saber: altitud, infraestructura académica y técnica, existencia de un grupo de investigación responsable del montaje y mantenimiento de los detectores así como de la visualización, análisis, divulgación y preservación de los datos. Este artículo presenta el estado general de los observatorios de Sierra Negra-México, Chacaltaya-Bolívia, Marcapomacocha-Perú, Mérida-Venezuela y [email protected] satellite observations have revelaedsome mysteries about the origin and location of cosmic rays at low energies, questions remain to be resolved in higher energy ranges (> 1 GeV). However, the ow of particles at high energies is very low, large sensitive areas are necessary, so that the detection of secondary particles from observatories on the surface of the earth is a technically viable solution. While the Pierre Auger Observatory has such capacity given its 16000 m2 of detectors, low height above sea level greatly reduces its detection capability. The Large Aperture Gamma Ray Observatory (LAGO) is an observational alternative that attempts to overcome this limitation. This project was started in 2005, placing water Cherenkov Detectors at high altitude. Observation sites have been selected with some basic requirements: altitude, academic and technical infrastructure, existence of a research group responsible for assembly and maintenance of the detectors and the analysis, visualization, divulgation and data storage. This paper presents the general status of the observatories of Sierra Negra-México, Chacaltaya-Bolívia, Marcapomacocha-Perú, Mérida-Venezuela and Bucaramanga-Colombi