El campo laboral de la antropología en México

Anthropology in Mexico has a longstanding trajectory of professional involvement, both in academia and public settings. In this essay we stress the work of those professionals of the discipline who work outside academic settings. We undertake the discussion starting from different perspectives expressed by Mexican anthropologists who have advanced contrasting views of anthropological work. We present information about current professional settings where anthropologists are employed in Mexico, stressing the growing diversity of these niches and the challenges that young anthropologists faceEn México, la antropología tiene una larga trayectoria de desempeño profesional tanto en el ámbito académico como fuera de él. En este artículo ponemos el acento en el trabajo de aquellos profesionales de la disciplina que se dedican a actividades diferentes a la investigación académica. Abordamos el tema a partir de aseveraciones de antropólogos mexicanos que han definido la actividad profesional de diversa manera, tanto desde el ámbito académico como del aplicado. Presentamos información sobre la distribución de los antropólogos entre los dos ámbitos y mencionamos diversos terrenos del trabajo antropológico en México en la actualidad, subrayando la creciente diversidad de nuevos nichos y los retos que esto representa p ara los jóvenes antropólogos

Mutations in TRIM63 cause an autosomal-recessive form of hypertrophic cardiomyopathy

Objective: Up to 50% of patients with hypertrophic cardiomyopathy (HCM) show no disease-causing variants in genetic studies. TRIM63 has been suggested as a candidate gene for the development of cardiomyopathies, although evidence for a causative role in HCM is limited. We sought to investigate the relationship between rare variants in TRIM63 and the development of HCM. Methods: TRIM63 was sequenced by next generation sequencing in 4867 index cases with a clinical diagnosis of HCM and in 3628 probands with other cardiomyopathies. Additionally, 3136 index cases with familial cardiovascular diseases other than cardiomyopathy (mainly channelopathies and aortic diseases) were used as controls. Results: Sixteen index cases with rare homozygous or compound heterozygous variants in TRIM63 (15 HCM and one restrictive cardiomyopathy) were included. No homozygous or compound heterozygous were identified in the control population. Familial evaluation showed that only homozygous and compound heterozygous had signs of disease, whereas all heterozygous family members were healthy. The mean age at diagnosis was 35 years (range 15-69). Fifty per cent of patients had concentric left ventricular hypertrophy (LVH) and 45% were asymptomatic at the moment of the first examination. Significant degrees of late gadolinium enhancement were detected in 80% of affected individuals, and 20% of patients had left ventricular (LV) systolic dysfunction. Fifty per cent had non-sustained ventricular tachycardia. Twenty per cent of patients suffered an adverse cerebrovascular event (20%). Conclusion: TRIM63 appears to be an uncommon cause of HCM inherited in an autosomal-recessive manner and associated with concentric LVH and a high rate of LV dysfunction

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

Impact of common cardio-metabolic risk factors on fatal and non-fatal cardiovascular disease in Latin America and the Caribbean: an individual-level pooled analysis of 31 cohort studies

Background: Estimates of the burden of cardio-metabolic risk factors in Latin America and the Caribbean (LAC) rely on relative risks (RRs) from non-LAC countries. Whether these RRs apply to LAC remains un- known. Methods: We pooled LAC cohorts. We estimated RRs per unit of exposure to body mass index (BMI), systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC) and non-HDL cholesterol on fatal (31 cohorts, n = 168,287) and non-fatal (13 cohorts, n = 27,554) cardiovascular diseases, adjusting for regression dilution bias. We used these RRs and national data on mean risk factor levels to estimate the number of cardiovascular deaths attributable to non-optimal levels of each risk factor. Results: Our RRs for SBP, FPG and TC were like those observed in cohorts conducted in high-income countries; however, for BMI, our RRs were consistently smaller in people below 75 years of age. Across risk factors, we observed smaller RRs among older ages. Non-optimal SBP was responsible for the largest number of attributable cardiovascular deaths ranging from 38 per 10 0,0 0 0 women and 54 men in Peru, to 261 (Dominica, women) and 282 (Guyana, men). For non-HDL cholesterol, the lowest attributable rate was for women in Peru (21) and men in Guatemala (25), and the largest in men (158) and women (142) from Guyana. Interpretation: RRs for BMI from studies conducted in high-income countries may overestimate disease burden metrics in LAC; conversely, RRs for SBP, FPG and TC from LAC cohorts are similar to those esti- mated from cohorts in high-income countries

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

El copyright en cuestión. Diálogos sobre propiedad intelectual

Análisis desde un enfoque editorial y legal del debate sobre la propiedad intelectual y sus formas en el contexto digital. Un debate que interesa a profesores, estudiantes, editores, divulgadores, bibliotecarios y autores. En el libro se estudia los derechos de autor y las cuestiones relacionadas con la propiedad intelectual provocadas por el impacto de la tecnología en la edición, creación, docencia e investigación al tiempo que se ofrece propuestas de futuro para conciliar los puestos de vista de autores, universidades, lectores, editoriales y bibliotecas.In the book analysis and debate, from an editorial and legal approach, intellectual property and its forms in the digital environment is made. A debate that concerns teachers, students, publishers, disseminators, librarians and authors. In the book copyright issues and intellectual property caused by the impact of technology in the editing, creating, teaching and research is studied. Finally, proposals for the future are offered to reconcile the positions of view of authors, universities, readers, publishers and libraries

Análisis de efectividad del citrato de fentanilo sublingual en pacientes con dolor irruptivo: estudio Sublime

Introduction: the scientific literature suggests that two in every three patients with chronic pain every so often suffer from transient exacerbations because of various causes, some of them predictable and some unexpected. In addition to the suffering they bring about, these episodes represent a relevant issue for patients as they trigger anxiety and add functional disability, which translates into greater difficulties in controlling baseline pain and lower quality of life. In 1990 the term "breakthrough pain" was coined in the United States to define transient cancer pain exacerbations under appropriate pain management with major opioids. In 2002, Sociedad Española de Oncología Médica (SEOM), Sociedad Española de Cuidados Paliativos (SECPAL), and Sociedad Española del Dolor (SED) defined a consensus document wherein the term "dolor irruptivo" (irruptive pain) was adopted to define sudden, transient (usually less than 20-30 minutes), severe (VAS > 7) pain breakouts on the background of stable, persistent pain that remains tolerable (VAS 5 during the last 12-24 hours and/or undesired side effects arising from the current therapy for irruptive pain. Within the primary goal an analysis of the results for each VAS follow-up, the number of irruptive pain events, and pain relief onset was performed. Similarly, an analysis was also performed to compare these variables in the cancer pain group versus the non-cancer pain group, and in the idiopathic pain group versus the incidental pain group. Regarding secondary goals, age, gender, patient profile (adverse effects and irruptive pain episodes), active substance for baseline pain management, percentage of patients taking an additional 100 mcg dose of sublingual fentanyl, fentanyl dose per episode, mean fentanyl dose a day, and adverse effects were also analyzed. Results: mean patient age in the study was 62.8 years; 49% of patients enrolled were women, and 51% were men. Of all patients included 55.6% had non-cancer pain and 44.4% had cancer pain; in 38.3% of patients irruptive pain was idiopathic, in 60% it was incidental, and in 1,7% pain type was unknown. Ninety-seven percent of patients were included because of their having a VAS score above 5, and the remaining 3% had side effects arising from their current therapy for irruptive pain. The efficacy analysis identified a significant decrease in all primary variables (VAS assessment, mean number of irruptive pain episodes, and pain relief onset) from baseline starting at the first follow-up. The between-group analysis (cancer vs. non-cancer pain) recorded no significant differences in primary variables. However, the analysis according to irruptive pain type found that all patients with incidental pain reported a milder decrease in VAS, a higher number of irruptive pain episodes, and later-onset relief. Within secondary goals, the analysis of adverse effects noted no significant differences in the prevalence of side effects between the cancer and non-cancer pain groups. Nevertheless, a significantly higher incidence of nausea, vomiting, and somnolence was found in the idiopathic pain group as compared to the incidental pain group. It was also concluded that satisfaction was comparable among patients (good-excellent = 83.7%) and investigators (good-excellent = 85.5%). Conclusions: analysis results indicate: - The effectiveness of sublingual fentanyl is demonstrated since there is a significant decrease in VAS scores from baseline. - The duration of irruptive pain episodes significantly decreases after sublingual fentanyl therapy onset. - Effectiveness as measured through primary variables (VAS, number of irruptive pain episodes, pain relief onset) was consistent regardless of underlying disease (cancer versus non-cancer). - No significant differences were found in the analysis of fentanyl doses per pain episode according to underlying disease of pain type. - Its safety profile is demonstrated with no differences in the incidence of adverse effects between cancer and non-cancer pain groups.Introducción: la literatura científica indica que dos de cada tres pacientes con dolor crónico sufren con cierta frecuencia exacerbaciones puntuales del mismo debido a diferentes causas, en ocasiones previsibles, y en otras inesperadas. Además del sufrimiento que conllevan, estos episodios constituyen un problema importante para el paciente pues generan ansiedad y añaden incapacidad funcional, lo cual se traduce en una mayor dificultad para controlar el dolor basal y una menor calidad de vida. En 1990 se acuñó en Estados Unidos el término "break-through pain", para definir a las exacerbaciones transitorias de un dolor oncológico, que está bien controlado con la utilización de opioides mayores. En el año 2002, la Sociedad Española de Oncología Médica (SEOM), la Sociedad Española de Cuidados Paliativos (SECPAL) y la Sociedad Española del Dolor (SED), establecieron un documento de consenso en el que asumieron el término "dolor irruptivo", para definir una exacerbación del dolor de forma súbita y transitoria, de gran intensidad (EVA > 7) y de corta duración (usualmente inferior a 20-30 minutos), que aparece sobre la base de un dolor persistente estable, cuando este se encuentra reducido a un nivel tolerable (EVA 5 en las últimas 12-24 horas y/o efectos secundarios indeseables originados por el tratamiento actual del dolor irruptivo. Dentro del objetivo principal, se realizó un análisis de los resultados en cada control de la escala EVA, número de episodios de dolor irruptivo e inicio del alivio del dolor. Así mismo, se realizó también un análisis comparando estas mismas variables en el grupo dolor oncológico vs. dolor no oncológico, y en el grupo dolor idiopático vs. dolor incidental. Acerca de los objetivos secundarios, se analizaron las variables edad, género, perfil del paciente (efectos adversos y episodios de dolor irruptivo), principio activo como tratamiento analgésico basal, porcentaje de pacientes que añadieron otros 100 mcg de fentanilo sublingual, dosis de fentanilo por episodio, media por día y efectos adversos. Resultados: la edad media de los pacientes incluidos en el estudio era de 62,8 años. El 49% de los pacientes incluidos eran mujeres y el 51% eran hombres. De todos los pacientes incluidos un 55,6% presentaba dolor de tipo no oncológico y el 44,4% presentaba dolor oncológico; en el 38,3% el dolor irruptivo era de tipo idiopático, en un 60% era de tipo incidental, y en un 1,7% desconocido. El 97% de los pacientes fueron incluidos por presentar una valoración de la escala EVA mayor de 5 y el 3% restante presentaban efectos secundarios indeseables originados por el tratamiento actual del dolor irruptivo. En el análisis de eficacia se detectó, desde el primer control, un descenso significativo en todas las variables principales (valoración de la escala EVA, número medio de episodios de dolor irruptivo e inicio del alivio del dolor) en comparación a la valoración basal. En el análisis entre grupo (dolor oncológico vs. dolor no oncológico), no se registraron diferencias significativas en las variables principales. Sin embargo, en el análisis en función del tipo de dolor irruptivo, se observó que los pacientes con dolor incidental registraban menor descenso del EVA, mayor número de episodios de dolor irruptivo y un inicio más tardío del alivio. Dentro de los objetivos secundarios, en el análisis de efectos adversos se observó que no existían diferencias significativas acerca de la prevalencia de efectos secundarios en los grupos de dolor oncológico y no oncológico. No obstante, sí se apreció, de forma significativa, mayor incidencia de náuseas, vómitos y somnolencia en el grupo de dolor idiopático comparado con el grupo de dolor incidental. También se pudo concluir que el grado de satisfacción en el paciente (bueno-excelente = 83,7%) y en el investigador (bueno-excelente = 85,5%) eran equivalentes. Conclusiones: los resultados del análisis indican que: - Se demuestra la eficacia de fentanilo sublingual, ya que existe un descenso significativo en la evaluación de la escala EVA en comparación a la valoración basal. - La duración de los episodios de dolor irruptivo disminuye significativamente una vez comienza el tratamiento con fentanilo sublingual. - La efectividad medida a través de las variables principales (escala EVA, número episodios dolor irruptivo, inicio del alivio del dolor) fue la misma independientemente del tipo de patología principal (oncológica o no oncológica). - No se detectaron diferencias significativas en el análisis de las dosis de fentanilo por episodio de dolor según patología principal o tipo de dolor. - Se demuestra su perfil de seguridad, no existiendo diferencias en la incidencia de efectos adversos en los grupos de dolor oncológico y no oncológico