Evaluación de un Articulador Virtual para la identificación de interferencias en movimientos mandibulares excéntricos

El objetivo del estudio fue determinar la concordancia del articulador virtual Whip-Mix Denar Mark 330 soportado por 3 Shape Dental System™, para la identificación de interferencias oclusales en los movimientos excéntricos. Se utilizó una muestra probabilística de 50 pacientes adultos, mayores de 20 años, Clase-Angle-I o II, con soporte dental anterior y posterior, sin patologías articulares. Como método estándar se utilizó el análisis oclusal (presencia y ubicación de interferencias oclusales durante los diferentes movimientos mandibulares) realizado por dos examinadores cualificados -tanto en los pacientes como en los montajes en el articulador semiajustable Whip Mix serie 2240. Para determinar la exactitud se compararon las mediciones realizados por el método estándar y por el articulador virtual sobre 50 montajes de los 50 pacientes, y para evaluar la precisión se compararon tres mediciones realizadas a intervalos de 7 días por el articulador virtual sobre 35 montajes codificados a ciego para cada medición. En el análisis estadístico se calculó el coeficiente correlación intraclase. La exactitud del articulador virtual reportó fuerza de concordancia moderada para la localización de interferencias en lateralidad izquierda/balanza y protrusión derecha. Y la fuerza de concordancia regular en lateralidad derecha/trabajo, lateralidad izquierda trabajo y balanza, y protrusión izquierda. Se obtuvo una precisión muy buena en todos los casos. Concluyendo que el articulador virtual evaluado no es una prueba confiable para identificar interferencias oclusales en movimientos excéntricos.Los autores agradecen la financiación del estudio a la Vicerrectoría de Investigaciones de la Universidad El Bosque (PCI: 2013-395) y la cooperación prestada por las Clínica Odontológicas de la Universidad El Bosque

MODELO DE ASEGURAMIENTO DE LA CALIDAD EN LAS PRÁCTICAS FORMATIVAS EN LOS PROGRAMAS DEL ÁREA DE LA SALUD

This article presents the panorama of the training practices of the programs in the health area, and specifically the experience of the programs in the health area of ​​the University of Tolima based on the guidelines expressed by the quality assurance model in where two sectors converge: education and health. The review begins from the implementation of agreement 000003 of 2003 until the year 2021, the date on which the Ministry of Social Protection issues the Model for the evaluation of the teaching-service relationship for health programs.  The question that motivates the review is: Are the guidelines established by the quality assurance model in training practices evident in the training practices? Initially, the normative framework of the teaching-service relationship is presented, which involves two sectors: Health and Education; secondly, the model of the quality conditions of the training practice scenarios; to finally consider the experience of the implementation of the quality assurance model of the training practices in the programs of the health area of ​​the University of Tolima.  Este artículo presenta el panorama de las prácticas formativas de los programas del área de la salud en Colombia, específicamente la experiencia de los programas de la Facultad de Ciencias de la Salud de la Universidad del Tolima, a partir de los lineamientos expresados por el modelo de aseguramiento de la calidad en el que convergen dos sectores:  educativo y salud. La revisión de la normativa inicia desde la implementación del acuerdo No. 000003 del 2003 hasta el año 2021, fecha en la que el Ministerio de Salud y Protección Social en Colombia expide el Modelo de evaluación de la relación docencia servicio para los programas del área de la salud. La pregunta que motiva la presente revisión es: ¿Se evidencian en las prácticas formativas los lineamientos establecidos por el modelo de aseguramiento de la calidad? Inicialmente, se presenta el marco normativo de la relación docencia servicio que involucra dos sectores: Salud y Educación; en segundo lugar, el modelo de las condiciones de calidad de los escenarios de prácticas formativas; finalmente, se considera la experiencia de la implementación del modelo de aseguramiento de la calidad de las prácticas formativas en los programas de la Facultad de Ciencias de la Salud de la Universidad del Tolima

Prevalence and correlates of mild cognitive impairment among diverse Hispanics/Latinos: Study of Latinos-Investigation of Neurocognitive Aging results.

IntroductionWe estimated the prevalence and correlates of mild cognitive impairment (MCI) among middle-aged and older diverse Hispanics/Latinos.MethodsMiddle-aged and older diverse Hispanics/Latinos enrolled (n = 6377; 50-86 years) in this multisite prospective cohort study were evaluated for MCI using the National Institute on Aging-Alzheimer's Association diagnostic criteria.ResultsThe overall MCI prevalence was 9.8%, which varied between Hispanic/Latino groups. Older age, high cardiovascular disease (CVD) risk, and elevated depressive symptoms were significant correlates of MCI prevalence. Apolipoprotein E4 (APOE) and APOE2 were not significantly associated with MCI.DiscussionMCI prevalence varied among Hispanic/Latino backgrounds, but not as widely as reported in the previous studies. CVD risk and depressive symptoms were associated with increased MCI, whereas APOE4 was not, suggesting alternative etiologies for MCI among diverse Hispanics/Latinos. Our findings suggest that mitigating CVD risk factors may offer important pathways to understanding and reducing MCI and possibly dementia among diverse Hispanics/Latinos

Sleep Duration and Neurocognitive Function in the Hispanic Community Health Study/Study of Latinos

To evaluate the association between sleep duration and neurocognitive function in a representative sample of middle-aged to older Hispanic/Latino adults in the US. We tested the hypothesis that sleep duration has a nonlinear, inverted U-shaped association with neurocognitive function

Prevalence of mental disorders in a population requesting health services at a primary health care center and its association with suicidal ideation and perceived disability

ABSTRACT: This study’s goal was to determine the most prevalent mental disorders and the impact on the perception of disability and suicidal ideation among the population from a primary health care center in the city of Cali. Methodology: a cross sectional study was conducted on 254 patients who were screened with the prime-md instrument. Descriptive statistics was used in the analysis to determine the most frequent disorders. Similarly, a multiple analysis with logistic and Poisson regressions using robust variance was conducted to determine the influence of mental disorders on disability and suicidal ideation. Results: most patients were female, young, and mature adults. Depression was present in 66.8% of all cases, followed by somatization disorder and anxiety. Half of the patients had had suicidal ideations at some point in their lives, and three out of four patients claimed to suffer from some kind of disability. Upon adjusting for the covariables, depression and anxiety disorders had a strong association with suicidal ideation and perceived disability that was overestimated by the logistic regression. Conclusion: depression and anxiety were the most common disorders and showed a strong association with suicidal ideation and disability. This is why it is necessary to screen for those disorders among adults using primary health care services. Likewise, we suggest considering Poisson regression with robust variance in cross-sectional studies in health services.RESUMEN: Conocer los trastornos mentales más frecuentes y el impacto en la percepción de discapacidad e ideación suicida en una Institución prestadora de servicios de salud de baja complejidad en Cali. Metodología: se realizó un estudio transversal con 254 pacientes a los que se les aplicó el instrumento prime-md. En el análisis se utilizó estadística descriptiva para determinar los trastornos más frecuentes y un análisis múltiple por regresiones logística y de Poisson con varianza robusta para determinar la influencia de los trastornos mentales en la discapacidad e ideación suicida. Resultados: la mayoría de los pacientes eran del sexo femenino, adultos jóvenes y maduros. La depresión estuvo presente en 66.8% de los casos, seguido del trastorno de somatización y la ansiedad. Casi la mitad de los pacientes habían tenido ideas suicidas alguna vez en la vida y 3 de cada 4 refirieron algún tipo de discapacidad. Después de ajustar por covariables, los trastornos ansiosos-depresivos mostraron una alta asociación con la ideación suicida y la discapacidad percibida, que es sobrestimada por la regresión logística. Conclusión: la depresión y la ansiedad son los trastornos mas frecuentes y tienen una alta asociación con la ideación suicida y la discapacidad y es por esto necesario realizar tamizaciones en la atención del adulto en servicios de baja complejidad. Se recomienda considerar el uso de la regresión de Poisson con varianza robusta en los estudios transversales en los servicios de salud

Population stratification may bias analysis of PGC-1α as a modifier of age at Huntington disease motor onset

Huntington’s disease (HD) is an inherited neurodegenerative disorder characterized by motor, cognitive and behavioral disturbances, caused by the expansion of a CAG trinucleotide repeat in the HD gene. The CAG allele size is the major determinant of age at onset (AO) of motor symptoms, although the remaining variance in AO is highly heritable. The rs7665116 SNP in PPARGC1A, encoding the mitochondrial regulator PGC-1α, has been reported to be a significant modifier of AO in three European HD cohorts, perhaps due to affected cases from Italy. We attempted to replicate these findings in a large collection of (1,727) HD patient DNA samples of European origin. In the entire cohort, rs7665116 showed a significant effect in the dominant model (p value = 0.008) and the additive model (p value = 0.009). However, when examined by origin, cases of Southern European origin had an increased rs7665116 minor allele frequency (MAF), consistent with this being an ancestry-tagging SNP. The Southern European cases, despite similar mean CAG allele size, had a significantly older mean AO (p < 0.001), suggesting population-dependent phenotype stratification. When the generalized estimating equations models were adjusted for ancestry, the effect of the rs7665116 genotype on AO decreased dramatically. Our results do not support rs7665116 as a modifier of AO of motor symptoms, as we found evidence for a dramatic effect of phenotypic (AO) and genotypic (MAF) stratification among European cohorts that was not considered in previously reported association studies. A significantly older AO in Southern Europe may reflect population differences in genetic or environmental factors that warrant further investigation

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

ADGRL3 (LPHN3) variants predict substance use disorder

Genetic factors are strongly implicated in the susceptibility to develop externalizing syndromes such as attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, and substance use disorder (SUD). Variants in the ADGRL3 (LPHN3) gene predispose to ADHD and predict ADHD severity, disruptive behaviors comorbidity, long-term outcome, and response to treatment. In this study, we investigated whether variants within ADGRL3 are associated with SUD, a disorder that is frequently co-morbid with ADHD. Using family-based, case-control, and longitudinal samples from disparate regions of the world (n = 2698), recruited either for clinical, genetic epidemiological or pharmacogenomic studies of ADHD, we assembled recursive-partitioning frameworks (classification tree analyses) with clinical, demographic, and ADGRL3 genetic information to predict SUD susceptibility. Our results indicate that SUD can be efficiently and robustly predicted in ADHD participants. The genetic models used remained highly efficient in predicting SUD in a large sample of individuals with severe SUD from a psychiatric institution that were not ascertained on the basis of ADHD diagnosis, thus identifying ADGRL3 as a risk gene for SUD. Recursive-partitioning analyses revealed that rs4860437 was the predominant predictive variant. This new methodological approach offers novel insights into higher order predictive interactions and offers a unique opportunity for translational application in the clinical assessment of patients at high risk for SUD