Prophylactic Activated Recombinant Factor VII in Liver Resection and Liver Transplantation: Systematic Review and Meta-Analysis

Intraoperative blood loss is a frequent complication of hepatic resection and orthotopic liver transplantation. Recombinant activated coagulation factor VII (rFVIIa) is a coagulation protein that induces hemostasis by directly activating factor X. There is no clear information about the prophylactic value of rFVIIa in hepatobiliary surgery, specifically in liver resection and orthotopic liver transplantation. The aim of this study was to assess the effect of rFVIIa prophylaxis to prevent mortality and bleeding resulting from hepatobiliary surgery.Relevant randomized trials were identified by searching The Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index. Randomized clinical trials comparing different rFVIIa prophylactic schemas against placebo or no intervention to prevent bleeding in hepatobiliary surgery were included. Adults undergoing liver resection, partial hepatectomy, or orthotopic liver transplantation were included. Dichotomous data were analyzed calculating odds ratios (ORs) and 95% confidence intervals (CIs). Continuous data were analyzed calculating mean differences (MD) and 95% CIs.Four randomized controlled trials were included. There were no significant differences between rFVIIa and placebo for mortality (OR 0.96; 95% CI 0.35-2.62), red blood cell units (MD 0.32; 95% CI -0.08-0.72) or adverse events (OR 1.55; 95% CI 0.97-2.49).The available information is limited, precluding the ability to draw conclusions regarding bleeding prophylaxis in hepatobiliary surgery using rFVIIa. Although an apparent lack of effect was observed in all outcomes studied, further research is needed

Evaluating the Validity of Self-Reported Smoking in Mexican Adolescents

Objectives We aimed to evaluate the validity of the self-reported smoking indicator used in the Global Youth Tobacco Survey (GYTS). Setting 43 middle and high-school classrooms from 26 schools were selected from Mexico City and Cuernavaca, Morelos. Participants A total of 1257 students provided both a questionnaire and a urine sample. Primary and secondary outcome Sensitivity and specificity of self-reported smoking compared to urinary cotinine. Validity indices were evaluated by subgroups of gender, social acceptability of smoking (ie, smoking parents or friends) and smoking frequency. Results Sensitivity and specificity for current smoking were 93.2% and 81.7%, respectively. Validity indices remained stable across gender. Parental smoking status moderated the validity of self-report, which had lower sensitivity in adolescents with non-smoking parents (86.7%) than in adolescents with smoking parents (96.6%). Sensitivity and specificity increased with smoking frequency. Conclusions This first validation study of self-reported current smoking used in the GYTS among Mexican adolescents suggests that self-reported smoking in the past 30 days is a valid and stable indicator of current smoking behaviour. This measure appears suitable for public health research and surveillance

Body weight impact of the sugar- sweetened beverages tax in Mexican children: A modeling study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156213/3/ijpo12636_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156213/2/ijpo12636-sup-0001-supinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156213/1/ijpo12636.pd

Inequalities in access to safe drinking water in Peruvian households according to city size: an analysis from 2008 to 2018.

BACKGROUND: Peru is one of the countries with the lowest percentage of population with access to safe drinking water in the Latin American region. This study aimed to describe and estimate, according to city size, socioeconomic inequalities in access to safe drinking water in Peruvian households from 2008 to 2018. METHODS: Secondary analysis of cross-sectional data using data from the 2008-2018 ENAHO survey. Access to safe drinking water, determined based on the presence of chlorinated water supplied by the public network, as well as socioeconomic variables were analyzed. A trend analysis from 2008 to 2018, and comparisons between 2008 versus 2018 were performed to understand and describe changes in access to safe drinking water, according to city size. Concentration curves and Erreygers concentration index (ECI) were estimated to measure inequalities in access to safe drinking water. RESULTS: In 2008, 47% of Peruvian households had access to safe drinking water, increasing to 52% by 2018 (p for trend < 0.001). For small cities, access to safe drinking water did not show changes between 2018 and 2008 (difference in proportions - 0.2 percentage points, p = 0.741); however, there was an increase in access to safe drinking water in medium (difference in proportions 3.3 percentage points, p < 0.001) and large cities (difference in proportions 12.8 percentage points, p < 0.001). The poorest households showed a decreasing trend in access to safe drinking water, while the wealthiest households showed an increasing trend. In small cities, socioeconomic inequalities showed an increase between 2008 and 2018 (ECI 0.045 and 0.140, p < 0.001), while in larger cities, socioeconomic inequality reduced in the same period (ECI: 0.087 and 0.018, p = 0.036). CONCLUSIONS: We report a widening gap in the access to safe drinking water between the wealthiest and the poorest households over the study period. Progress in access to safe drinking water has not been equally distributed throughout the Peruvian population. Promoting and supporting effective implementation of policies and strategies to safe drinking water, including equity-oriented infrastructure development and resource allocation for most vulnerable settings, including emerging small cities, is a priority

Trends in food and beverage purchases in informal, mixed, and formal food outlets in Mexico: ENIGH 1994–2020

BackgroundThe retail food environment in Mexico is characterized by the co-existence of both, formal and informal food outlets. Yet, the contribution of these outlets to food purchases over time has not been documented. Understanding the longitudinal trends where Mexican households purchase their foods is critical for the development of future food retail policies.MethodsWe used data from Mexico’s National Income and Expenditure Survey from 1994 to 2020. We categorized food outlets as formal (supermarkets, chain convenience stores, restaurants), informal (street markets, street vendors, acquaintances), and mixed (fiscally regulated or not. i.e., small neighborhood stores, specialty stores, public markets). We calculated the proportion of food and beverage purchases by food outlet for each survey for the overall sample and stratified by education level and urbanicity.ResultsIn 1994, the highest proportion of food purchases was from mixed outlets, represented by specialty and small neighborhood stores (53.7%), and public markets (15.9%), followed by informal outlets (street vendors and street markets) with 12.3%, and formal outlets from which supermarkets accounted for 9.6%. Over time, specialty and small neighborhood stores increased 4.7 percentage points (p.p.), while public markets decreased 7.5 p.p. Street vendors and street markets decreased 1.6 p.p., and increased 0.5 p.p. for supermarkets. Convenience stores contributed 0.5% at baseline and increased to 1.3% by 2020. Purchases at specialty stores mostly increased in higher socioeconomic levels (13.2 p.p.) and metropolitan cities (8.7 p.p.) while public markets decreased the most in rural households and lower socioeconomic levels (6.0 p.p. &amp; 5.3 p.p.). Supermarkets and chain convenience stores increased the most in rural localities and small cities.ConclusionIn conclusion, we observed an increase in food purchases from the formal sector, nonetheless, the mixed sector remains the predominant food source in Mexico, especially small-neighborhood stores. This is concerning, since these outlets are mostly supplied by food industries. Further, the decrease in purchases from public markets could imply a reduction in the consumption of fresh produce. In order to develop retail food environment policies in Mexico, the historical and predominant role of the mixed sector in food purchases needs to be acknowledged

Validez de constructo, confiabilidad y punto de corte de la Prueba de Síntomas Subjetivos de Fatiga en trabajadores mexicanos

Objetivo. Evaluar la validez de constructo, la confiabilidad interna y establecer un punto de corte para la Prueba de Síntomas Subjetivos de Fatiga. Material y métodos. Esta prueba fue desarrollada en Japón para medir fatiga en población trabajadora, cuenta con 30 reactivos divididos en tres esferas. La validez de constructo fue explorada por diferencias entre grupos, utilizando una población de 1 399 trabajadores de ocho empresas de la Ciudad de México que fueron estudiadas en 1999. Se utilizó como red nomológica el modelo de control-demanda de Theorell y Karasek derivando con ello hipótesis de trabajo. Los trabajadores fueron clasificados en nueve grupos dependiendo de su nivel de exigencia-control, y las diferencias en la puntuación de fatiga se derivaron mediante análisis de covarianza (ANCOVA). La confiabilidad interna se obtuvo a través del alfa de Cronbach. El punto de corte se definió a partir de la relación lineal esperada entre las exigencias laborales y la fatiga. Resultados. La distribución de la puntuación en la Prueba de Síntomas Subjetivos de Fatiga resultó similar a la esperada, que aumenta conforme se incrementa la exigencia o disminuye el control. Las diferencias entre grupos fueron estadísticamente significativas. El alfa de Cronbach para la prueba en general fue de 0.89, mientras que el valor por esfera fue siempre superior a 0.70. Los puntos de corte con una correlación más estrecha fueron 6 y 7 respuestas afirmativas (r= 0.9456 y 0.9479, respectivamente). Conclusiones. La puntuación observada en los distintos grupos se comporta de la forma esperada, cumpliendo así las hipótesis de desempeño planteadas. La confiabilidad interna para la prueba en general es adecuada. El punto de corte propuesto para población general es de siete respuestas afirmativas. El texto completo en inglés de este artículo está disponible en: http://www.insp.mx/salud/46/en

Validez de constructo, confiabilidad y punto de corte de la Prueba de Síntomas Subjetivos de Fatiga en trabajadores mexicanos Construct validity, reliability, and cutoff point of the Subjective Symptoms of Fatigue Test in Mexican workers

OBJETIVO: Evaluar la validez de constructo, la confiabilidad interna y establecer un punto de corte para la Prueba de Síntomas Subjetivos de Fatiga. MATERIAL Y MÉTODOS: Esta prueba fue desarrollada en Japón para medir fatiga en población trabajadora, cuenta con 30 reactivos divididos en tres esferas. La validez de constructo fue explorada por diferencias entre grupos, utilizando una población de 1 399 trabajadores de ocho empresas de la Ciudad de México que fueron estudiadas en 1999. Se utilizó como red nomológica el modelo de control-demanda de Theorell y Karasek derivando con ello hipótesis de trabajo. Los trabajadores fueron clasificados en nueve grupos dependiendo de su nivel de exigencia-control, y las diferencias en la puntuación de fatiga se derivaron mediante análisis de covarianza (ANCOVA). La confiabilidad interna se obtuvo a través del alfa de Cronbach. El punto de corte se definió a partir de la relación lineal esperada entre las exigencias laborales y la fatiga. RESULTADOS: La distribución de la puntuación en la Prueba de Síntomas Subjetivos de Fatiga resultó similar a la esperada, que aumenta conforme se incrementa la exigencia o disminuye el control. Las diferencias entre grupos fueron estadísticamente significativas. El alfa de Cronbach para la prueba en general fue de 0.89, mientras que el valor por esfera fue siempre superior a 0.70. Los puntos de corte con una correlación más estrecha fueron 6 y 7 respuestas afirmativas (r= 0.9456 y 0.9479, respectivamente). CONCLUSIONES: La puntuación observada en los distintos grupos se comporta de la forma esperada, cumpliendo así las hipótesis de desempeño planteadas. La confiabilidad interna para la prueba en general es adecuada. El punto de corte propuesto para población general es de siete respuestas afirmativas.<br>OBJECTIVE: To evaluate the construct validity and the internal reliability of the Subjective Symptoms of Fatigue Test (SSFT), as well as to establish its best cutoff point. MATERIAL AND METHODS: The SSFT was developed in Japan to measure fatigue in a population of workers; the test includes 30 items in three spheres. Construct validity was explored through differences among groups, using a population of 1399 workers from eight industries studied in Mexico City in 1999. We used the Theorell and Karasek's control-demand model as our nomological network, from which we derived two work hypotheses. Workers were divided into nine groups according to their level of control-demand; fatigue differences were assessed using analysis of covariance. The internal reliability level was tested with Cronbach's alpha. The cutoff point was obtained by means of the expected linear relation between the labor demands and fatigue. RESULTS: The distribution of SSFT values was similar to the expected values, increasing proportionally with increasing demands or with decreasing control. The differences between groups were statistically significant. Cronbach's alpha was 0.89, while the value per sphere was always above 0.70. The cut-off points most closely correlated were 6 and 7 affirmative answers. CONCLUSIONS: The observed score obtained in the distinct groups was as expected, in agreement with the study hypotheses. The internal reliability of the test was adequate. The proposed cutoff point for the general population was seven affirmative responses

Se busca mercado adolescente: internet y videojuegos, las nuevas estrategias de la industria tabacalera Aiming for the adolescent market: internet and video games, the new strategies of the tobacco industry

La exposición a publicidad sobre tabaco está asociada con el inicio en el consumo, particularmente en población joven, por lo que su control es un objetivo clave para reducir la incidencia de tabaquismo. Históricamente, la industria tabacalera ha sido pionera en la utilización de tecnologías de comunicación para posicionarse ante nuevos mercados y mantener la preferencia de los consumidores. Internet y los videojuegos han trascendido el espacio del entretenimiento, convirtiéndose en medios de comunicación masiva con un alto potencial publicitario. El presente artículo hace una revisión de la literatura existente sobre la presencia de tabaco en internet y videojuegos, con la intención de definir líneas de trabajo para desarrollar mecanismos efectivos de regulación y control de la publicidad en estos medios.Exposure to tobacco advertisement is associated with smoking initiation among the youth, its elimination is a key objective to effectively curb the tobacco epidemic. Historically, the tobacco industry has pioneered the use of new communication technologies to keep and expand their market. Nowadays, Internet and video games have transcended the entertainment sphere, becoming significant media for massive communication and providing new opportunities for advertisement. The present essay reviews the existing literature on tobacco presence in the Internet and video games to define research and policy tasks required to develop effective means for tobacco advertisement regulation and control

Hepatitis A virus infection in high-risk subjects

Original abstract: Background &amp; Aims. Several outbreaks of hepatitis A affecting homosexual men have been reported in Europe. However, the prevalence of HIV infection in patients affected by hepatitis A has not been extensively studied and hepatitis A is not considered as an indicator disease for routine HIV testing.Methods. We retrospectively analyzed all adult cases of acute hepatitis A, reported by the National Institute of Infectious Disease “L. Spallanzani”, Rome-Italy, in 2002-2008. Data on HIV infection were obtained by chart review and cross-linkage with laboratory. Information on exposure to risk factors were collected from the standard questionnaire of the Local Health Unit.Results. We analyzed a total of 473 cases of hepatitis A, 368 (77.2%) males that accounted for 75% of all reported cases in Rome, aged 25-64 years (same gender distribution). During the study period, we diagnosed a high proportion of cases among male individuals (78%). Among the male patients, HIV serology was available for 203/368 (55.2%). The overall HIV prevalence was 15.2% (56/368); it was significantly associated with same gender sex and was significantly higher than that observed among patients with hepatitis B (4.0%).Conclusions. We found a high HIV prevalence, associated with same gender sex, among adult male patients diagnosed with hepatitis A in the period 2002-2008, except for 2006. Our data suggest that in a low incidence area for hepatitis A, with a constant high proportion of cases among male individuals, all individuals with acute hepatitis A should be routinely offered an HIV test