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Background: Loot boxes are an increasingly common type of random microtransaction in videogames. There is some concern about their expansion and entailed risks, especially among adolescents. The actual prevalence of engagement with loot boxes among child and adult population is uncertain, and there is still controversy over the nature of their relationship with problematic gaming and gambling., Objectives: The aims of this scoping review are to summarize the characteristics and findings of published primary empirical studies about the prevalence of engagement with loot boxes and/or their relationship with problematic gaming and gambling, taking in account the type of sample, time frame and measured variables., Methods: This study follows the Joanna Briggs Institute's "Guidance for conducting systematic scoping reviews" and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Three academic databases provided 299 articles., Results: Sixteen primary empirical studies met the inclusion criteria for this review. All studies used cross-sectional designs, and most used convenience samples. Twelve study samples were comprised exclusively of gamers, and two were comprised of gamers and/or gamblers. Only six studies included adolescents. The annual prevalence rate of loot box purchases was higher for adult gamers than for adolescents (22.7%-44.2% and 20%-33.9%, respectively), but in studies with general population samples, the opposite was true (24.9% for players aged 13-14 versus 7.8% for adults). In general, the studies suggested a significant positive relationship between engagement with loot boxes and problematic gaming and gambling, but this may be related to the type of engagement (open/purchase/sell), and the characteristics of the study participants (male/female, adolescents/adults, gamers/gamers-gamblers/general population)., Conclusions: This scoping review summarizes the results of recent empirical studies on engagement with loot boxes and discusses how methodological issues may affect their results and interpretation. Recommendations for future research are also provided., Competing Interests: The authors have declared that no competing interests exist.

The United Nations' increasing involvement in global sustainability culminated in 2015 with the release of the 2030 Agenda. This agenda puts businesses in the spotlight, and their innovation and stakeholder partnering activities are portrayed as essential strategies for achieving an ambitious set of 17 Sustainable Development Goals (SDGs). In this study, we identify six distinct dynamic stakeholder engagement strategies-resilient specialists, opportunity explorers, uncommitted diversifiers, rainbow warriors, rainbow washers, and progressive learners-and distinguish two approaches to innovate, depending on the range of SDG targets aimed to achieve simultaneously. On the one hand, for firms that take a narrow approach intended to achieve a reduced set of SDG targets, we predict that successful dynamic stakeholder engagement strategies are those that end up with an intensive collaboration with a reduced number of stakeholder groups. On the other hand, for firms adopting a broad innovation approach to satisfy a wide set of SDG targets, we predict that successful dynamic stakeholder engagement strategies are those that end up interacting with a wide number of stakeholder groups. Longitudinal analysis of more than 3900 Spanish firms supports our predictions and suggests clear implications for responsible innovation research and the advancement of sustainable development through collaboration., Competing Interests: Conflict of interestAll authors declare they have no conflict of interest., (© The Author(s), under exclusive licence to Springer Nature B.V. 2022.)

We posit that international business and the emergence and spread of communicable diseases are intrinsically connected. To support our arguments, we first start with a historical timeline that traces the connections between international business and communicable diseases back to the sixth century. Second, following the epidemiology of communicable diseases, we identify two crucial transitions related to international business: the emergence of epidemics within a host country and the shift from epidemics to global pandemics. Third, we highlight international business contextual factors (host country regulatory quality, urbanization, trade barriers, global migration) and multinationals' activities (foreign direct investment, corporate political activity, global supply chain management, international travel) that could accelerate each transition. Finally, building on public health insights, we suggest research implications for business scholars on how to integrate human health challenges into their studies and practical implications for global managers on how to help prevent the emergence and spread of communicable diseases., (© Academy of International Business 2022.)

The production of specific neutralizing antibodies by individuals is thought to be the best option for reducing the number of patients with severe COVID-19, which is the reason why multiple vaccines are currently being administered worldwide. We aimed to explore the effect of revaccination with BCG, on the response to a subsequent anti-SARS-CoV-2 vaccine, in persons occupationally exposed to COVID-19 patients. Two groups of 30 randomized participants were selected: one group received a BCG revaccination, and the other group received a placebo. Subsequently, both groups were vaccinated against SARS-CoV-2. After each round of vaccination, the serum concentration of Th1/Th2 cytokines was determined. At the end of the protocol, neutralizing antibodies were determined and the HLA-DRB loci were genotyped. The participants from the BCG group and anti-SARS-CoV-2 vaccine group had increased serum cytokine concentrations (i.e., IL-1β, IL-4, IL-6, IL-12p70, IL-13, IL-18, GM-CSF, INF-γ, and TNF-α) and higher neutralizing antibody titers, compared to the group with Placebo-anti-SARS-CoV-2. Twelve HLA-DRB1 alleles were identified in the Placebo-anti-SARS-CoV-2 group, and only nine in the group revaccinated with BCG. The DRB1*04 allele exhibited increased frequency in the Placebo-anti-SARS-CoV-2 group; however, no confounding effects were found with this allele. We conclude that revaccination with BCG synergizes with subsequent vaccination against SARS-CoV-2 in occupationally exposed personnel.

The Internet has brought about a paradigm shift in the lives of many people, especially adolescents. While it has opened great possibilities, it has also led to various risks such as cyberbullying and problematic Internet use (PIU). These two constructs have been extensively researched individually and jointly, but the existence of different profiles of problematic use according to the role a person assumes in the context of cyberbullying has not yet been explored. Therefore, the main aim of this study is to analyze the different PIU profiles of those who have been cybervictims, cyberbullies, and cyberbully victims. An analytical and cross-sectional study was conducted on 25,341 adolescents between 10 and 18 years of age (14.60 ± 1.68). The Cyberbullying Triangulation Questionnaire (CTQ) and the Spanish version of the Generalized and Problematic Internet Use Scale-2 (GPIUS2) were used. The results indicate that cybervictims (6.4 percent), cyberbullies (4.3 percent), and cyberbully victims (2.7 percent) have different profiles of PIU ( p  < 0.001). Two common profiles emerge from the three roles: one of nonproblematic use and the other of severe problematic use. Participants who presented severe problematic use are the ones who obtained higher scores in cybervictimization and cyberaggression, particularly in the case of cyberbully victims. Furthermore, this profile is 7.6 (IC99 percent:6.11-9.44) times more likely to present PIU than noninvolved adolescents. These results are relevant when planning cyberbullying-focused interventions and programs because of the association between cyberbullying and general PIU.

Direct electrosynthesis of formate through CO 2 electroreduction (denoted CO 2 RR) is currently attracting great attention because formate is a highly valuable commodity chemical that is already used in a wide range of applications (e.g., formic acid fuel cells, tanning, rubber production, preservatives, and antibacterial agents). Herein, we demonstrate highly selective production of formate through CO 2 RR from a CO 2 -saturated aqueous bicarbonate solution using a porous In 55 Cu 45 alloy as the electrocatalyst. This novel high-surface-area material was produced by means of an electrodeposition process utilizing the dynamic hydrogen bubble template approach. Faradaic efficiencies (FEs) of formate production (FE formate ) never fell below 90% within a relatively broad potential window of approximately 400 mV, ranging from -0.8 to -1.2 V vs the reversible hydrogen electrode (RHE). A maximum FE formate of 96.8%, corresponding to a partial current density of j formate = -8.9 mA cm -2 , was yielded at -1.0 V vs RHE. The experimental findings suggested a CO 2 RR mechanism involving stabilization of the HCOO* intermediate on the In 55 Cu 45 alloy surface in combination with effective suppression of the parasitic hydrogen evolution reaction. What makes this CO 2 RR alloy catalyst particularly valuable is its stability against degradation and chemical poisoning. An almost constant formate efficiency of ∼94% was maintained in an extended 30 h electrolysis experiment, whereas pure In film catalysts (the reference benchmark system) showed a pronounced decrease in formate efficiency from 82% to 50% under similar experimental conditions. The identical location scanning electron microscopy approach was applied to demonstrate the structural stability of the applied In 55 Cu 45 alloy foam catalysts at various length scales. We demonstrate that the proposed catalyst concept could be transferred to technically relevant support materials (e.g., carbon cloth gas diffusion electrode) without altering its excellent figures of merit.

Many programs exist to prevent bullying and cyberbullying. Nevertheless, despite evidence of the numerous overlapping risks of the Internet, programs that jointly and adequately address large sets of risks are not presently described in the scientific literature. This study's main objective was to assess the effectiveness of the Safety.net program in a pilot sample. This program prevents eight Internet risks: cyberbullying, sexting, online grooming, cyber dating abuse, problematic Internet use, nomophobia, Internet gaming disorder, and online gambling disorder. The Safety.net program comprises 16 sessions and 4 modules (digital skills, relational risks, dysfunctional risks, and change of attitudes and cognitions). Each session lasts one hour, but the program has a networked instructional design to recall previous content in later sessions. For its assessment, a pre/post-test repeated measures design with a control group and an intervention group was used. The study sample was 165 adolescents between 11 and 14 years old (M = 12.11, SD = 0.89). The intervention group demonstrated improvements compared to the control group concerning online grooming, problematic Internet use, Internet gaming disorder, and nomophobia. These results suggest that the Safety.net program is effective in preventing the increase of most of the assessed risks and that it reduces some of them with a small number of sessions.

Competing Interests: Conflicts of Interest: None.

Building on the concept of externalities, we propose an explanation of how multinationals can contribute to the enactment of the United Nations' Sustainable Development Goals as part of their ordinary investments. First, we suggest grouping the 17 Sustainable Development Goals into six categories based on whether they increase positive externalities - knowledge, wealth, or health - or reduce negative externalities - the overuse of natural resources, harm to social cohesion, or overconsumption. Second, we propose placing these categories within an extended value chain to facilitate their implementation. Third, we argue that multinationals' internal investments in host-country subsidiaries to improve their competitiveness contribute to addressing externalities in host-country communities, while external investments in host communities to solve underdevelopment generate competitiveness externalities on host-country subsidiaries., (© Academy of International Business 2021.)

Background: Oropharyngeal mucositis (OM) is one of the main side-effects of oncological therapy. There is no treatment to prevent its occurrence, but some zinc-based therapies have been proven to help in decreasing its intensity. The objective of this study was to determine the effect of zinc in OM in children with acute leukemia in the early stages of oncological treatment., Material and Methods: This quasi-experimental study evaluated OM in 2 groups (control group: conventional hospital management, and experimental group: administration of 50 mg of zinc gluconate daily plus conventional hospital management). OM severity was recorded at a two-month follow-up., Results: Forty-nine patients (26 in the control group and 23 in the experimental group) were included. The mean age of the patients was 11.1 ± 2.7 years; 65.3% had a diagnosis of pre-B acute lymphoblastic leukemia. The incidences of OM in the control group and the experimental group were 46.2% and 26.1%, respectively, but the difference was not significant. Based on a negative binomial regression model, females had, on average, 1.5 more days with OM (p = 0.002), and patients assigned to the experimental group had, on average, 2 less days with OM than the control group (p = 0.001). The pain score was higher in the control group (p = 0.0009), as was the mean score on the WHO scale (p = 0.0012)., Conclusions: Zinc facilitated a reduction in the severity and duration of OM; further studies focusing on children are needed to confirm the effects of this trace element.

A dearth of empirical research exists on female sex workers in Central America who begin selling sex under age 18. Data were collected from adult female sex workers (N = 1216) sampled using census and modified time-location sampling in three urban centers of Guatemala. In adjusted analyses, female sex workers who entered the sex trade under age 16 years were more likely to be HIV positive (AOR = 4.6, 95% CI 1.6, 13.2), have not received HIV education in their first year of sex trade (AOR = 2.8, 95% CI 1.5, 5.5), have experienced violence to force commercial sex (AOR = 4.6, 95% CI 2.2, 9.8) and have not used condoms in their first month (AOR = 2.8, 95% CI 1.3, 6.1) , relative to those who entered as adults. An interaction between age at entry and foreign migration at entry was found for HIV risk. Efforts to prevent adolescent sex trade entry are needed and may also help to reduce HIV rates in Guatemala.

Objective: To determine the factors associated with the unsuccessful treatment of patients diagnosed with drug-sensitive tuberculosis (TB) in Paraguay., Methods: Retrospective cohort study, with data collected from the national program between January 2016 and March 2017. Unsuccessful treatment was defined as patients who were lost to follow-up, failed treatment, or died. Factors associated with unsuccessful treatment were determined using Poisson regression; the adjusted relative risk (RR) and 95% confidence interval (95% CI) were estimated by health region., Results: A total of 3 034 cases were studied: 2 189 (72.1%) were successfully treated (cured: 1 221 [40.2%], complete treatment: 968 [31.9%]) and 845 (27.9%) were unsuccessfully treated (treatment failure: 40 [1.3%], loss to follow-up: 466 [15.4%] and deaths: 339 [11.2%]). Factors associated with unsuccessful treatment were masculine sex 1.28 (1.14- 1.42), indigenous descent 1.3 (1.09- 1.54), lack of report of area of residence 1.27 (1.02- 1.57), TB/HIV coinfection 1.97 (1, 63- 2.38), illicit drug addiction 1.38 (1.16- 1.63), alcohol consumption 1.25 (1.02- 1.52), previous treatment 1.23 (1.10- 1.38) and lack of treatment monitoring data 4.92 (3.69- 6.56). Being deprived of liberty 0.65 (0.47- 0.89) and TB/diabetes comorbidity 0.80 (0.67- 0.95) were considered protective factors., Conclusion: Paraguay has a high percentage of unsuccessful treatment in almost the entire country, without reaching the target proposed by the World Health Organization. Associated risk factors such as HIV, consumption of legal and illicit drugs, and being indigenous highlight the need to revise the treatment strategies with an inter-institutional approach.

Obesity is a major health problem worldwide and constitutes a sanitary emergency in Mexico, especially childhood obesity. Several studies have proved the relationship between obesity and oxidative stress and the influence of genetic predisposition. This work was aimed to analyze the association of antioxidant enzyme polymorphisms with overweight and obesity in Mexican children and adolescents. A case-control study was performed in 585 children and adolescents aged 3 to 17 years, using two criteria to classify obesity: body mass index (BMI) and body fat percentage (BFP). Anthropometric and biochemical measurements were carried out, and malondialdehyde serum levels were determined. Genotyping was done with the Axiom Genome-Wide LAT microarray, including 68 single nucleotide polymorphisms (SNPs) of the glutathione peroxidase (GPX) and paraoxonase (PON) families. We found six haplotypes associated with obesity-two of them (one in GPX3 and the other in GPX5 and GPX6) in a protective direction when obesity was classified by BMI. The other four haplotypes were associated with obesity when classification was based on BFP-one of them in GPX3 in a protective direction and the others in PON genes conferring obesity risk. In addition, two SNPs, GPX3 rs922429 and GPX4 rs2074451 showed protection against obesity classified by BFP. This study showed genetic susceptibility to oxidative stress in relation to obesity in Mexican children and opens up the possibility that some genetic loci related to obesity are not identified when weight classification is based on BMI.

Recent research on sexting highlighted a relationship between this new technology-mediated behavior and psychopathology correlates, although up to date results are mixed, and so far, studies have often used simple and not clinically validated measures of mental health. This study aimed to investigate sexting behaviors, online sexual victimization, and related mental health correlates using clinically validated measures for global psychopathology, anxiety, and depression; and doing so separately for men and women. The sample consisted of 1370 Spanish college students (73.6% female; 21.4 mean age; SD = 4.85) who took part in an online survey about their engagement in sexting behaviors, online sexual victimization behaviors, and psychopathological symptomatology, measured by a sexting scale and the Listado de Síntomas Breve (brief symptom checklist) (LSB-50), respectively. Out of our total sample, 37.1% of participants had created and sent their own sexual content (active sexting), 60.3% had received sexual content (passive sexting), and 35.5% had both sent and received sexual content, with significant differences between male and female engagement in passive sexting. No differences were found between men and women in the prevalence of their victimization by nonconsensual dissemination of sexual content; however, women were more pressured and threatened into sexting than men. Sex differences in psychopathology were found only for depression prevalence rates but not for global psychopathology or anxiety. Furthermore, for male participants, our results showed a significant association only between online sexual victimization and psychopathology but not for consensual active and passive sexting. However, for the female participants, active sexting, passive sexting, and online sexual victimization were all associated with poorer mental health. Implications for prevention and intervention are discussed.

Background: Educational curricula require constant improvement to respond to the needs of students, institutions and society., Objective: To evaluate the Plan de Estudios 2010 of the Facultad de Medicina de la Universidad Nacional Autónoma de México., Methods: Documentary and qualitative study of three phases. First, revision of trends of general medicine in special databases and comparison of curricula between universities. Second, focus groups with clinical teachers and basic sciences to investigate experiences and opinions in relation to trends in general medicine. Third, a "Generalists Committee" was convened to whom the results were presented (phase one and two) and the recommendations were adapted to adapt the results to the general practitioner's context. The participants were informed about the research objective and their participation was voluntary, the anonymity of theirs comments was protected., Results: The trend towards specialization in clinical practice defines the future of general medicine, and the administrative uses have an impact on the practices of the general practitioner and on the patient's medical relationship., Conclusion: Various aspects mainly educational and assistance hindered the quality of the practice of general medicine.

The practice of creating and sharing sexual images via technological devices, known as sexting, has received crescent attention in the past years, especially due to the increase of adolescent engagement in this behavior. Although consensual sexting is not prima facie a crime, as some research has shown, it has the potential to be a risky behavior, and a threshold to get exposure to dangerous kinds of victimization as sextortion, online grooming or cyberbullying. In this context, teenagers represent a vulnerable group due to their limited ability of self-regulation, their high susceptibility to peer pressure, their technophilia, and their growing sexual curiosity. The present paper aims to review the scientific literature to analyze the relationship between mental health and sexting as a potentially risky behavior and its association with online victimization. The results and implications will be discussed., Competing Interests: The authors declare no conflict of interest.

Although men who have sex with men (MSM) have the highest human immunodeficiency virus (HIV) prevalence in Guatemala, prevention efforts have been focused on other vulnerable populations. Respondent-driven sampling was used to recruit 444 MSM in Guatemala City to explore factors related to HIV testing among MSM. About 56% of participants reported HIV testing in the past 12 months, which was associated with a public MSM status (adjusted odds ratio (AOR) 2.08; 95% CI 1.02-4.26), participating in peer HIV prevention intervention (AOR 3.71; 95% CI 1.86-7.43), having at least one casual male partner (AOR 2.16; 95% CI 1.11-4.20), and practicing only insertive anal sex (AOR 3.35; 95% CI 1.59-7.09). Men with comprehensive HIV knowledge (AOR 2.63; 95% CI 1.38-5.02) were also more likely to have been tested. Further interventions in Guatemala targeting the most hidden MSM are needed.

The effect of Copy Number Variants (CNVs) on Type 2 Diabetes (T2D) remains little explored. The present study characterized large rare CNVs in 686 T2D and 194 non-T2D subjects of Mexican ancestry genotyped using the Affymetrix Genome-Wide Human SNP array 5.0. Rare CNVs with ≥ 100 kb length were identified using a stringent strategy based on merging CNVs calls generated using Birdsuit, iPattern and PennCNV algorithms. We applied three different strategies to evaluate the distribution of CNVs in the T2D and non-T2D samples: 1) Burden analysis, 2) Identification of CNVs in loci previously associated to T2D, and 3) Identification of CNVs observed only in the T2D group. In the CNV burden analysis, the T2D group showed a higher proportion of CNVs, and also a higher proportion of CNVs overlapping at least one gene than the non T2D group. Five of the six loci previously associated with T2D had duplications or deletions in the T2D sample, but not the non-T2D sample. A gene-set analysis including genes with CNVs observed only in the T2D group highlighted gene-sets related with sensory perception (olfactory receptors, OR) and phenylpyruvate tautomerase/dopachrome isomerase activity (MIF and DDT genes).

Little is known about online victimization of Spanish adolescents. The present study aims to determine the past-year prevalence of online victimization in a community sample of Spanish adolescents. The final sample consisted of 3,897 adolescents between 12 and 17 years old (M=14.45, SD=1.59), 1,836 males and 2,049 females, recruited from 39 secondary schools in the east of Spain. The Cuestionario de victimización juvenil mediante internet y/o teléfono móvil (hereinafter, Juvenile Online Victimization Questionnaire, JOV-Q, Montiel & Carbonell, 2012) was applied for the assessment of eight types of online victimization grouped in two major domains: sexual (sexual coercion, sexual pressure, online grooming by an adult, unwanted exposure to sexual content and violation of privacy); and nonsexual victimization (online harassment, happy slapping, pressure to obtain personal information). Sixty-one percent of adolescents reported online victimization during the last year. Online sexual victimization was reported by 39.5% of adolescents and nonsexual victimization by 53.4% of them, whereas 31% of youth reported having experienced online victimization in both domains. The highest prevalence rates were recorded for online harassment (50%), unwanted exposure to sexual content (24.4%), pressure to obtain personal information (18.4%) and online grooming by an adult (17.2%), and the lowest for sexual coercion (6.7%) and happy slapping (2.2%). Thirty-five percent of the adolescents were considered online polyvictims and most of them experienced victimization in both sexual and nonsexual domains (88%). This study illustrates that Spanish adolescents experience high levels of online victimization and that multiple online victimization appears to be the norm among cybervictims., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Capsaicin is a potent inducer of apoptosis in tumourreceptor potential vanilloid 1 (TRPV1). The present study determined the IC50 and cytotoxic and apoptotic activities of the Capsaicin analogues Rinvanil and Phenylacetylrinvanil (PhAR) on three cervical cancer cell lines: HeLa, CaSKi and ViBo. These analogues possess an increased affinity for TRPV1 receptors. The IC50 obtained proved to be cytotoxic for all three cell lines; however, in the cells treated with Capsaicin both active caspase-3 and nuclear fragmentation were present. Capsaicin and its analogues also inhibited the normal proliferation of lymphocytes, suggesting that they are non-selective antitumour compounds. Finally, we discuss the possible loss of the relation between apoptosis and affinity to TRPV1, and the need for other strategies to synthesise Capsaicin analogues that can be useful in cancer treatments., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: Since 2007, Guatemala integrated STI clinical service with an HIV prevention model into four existing public health clinics to prevent HIV infection, known as the VICITS strategy. We present the first assessment of VICITS scale-up, retention, HIV and STI prevalence trends, and risk factors associated with HIV infection among Female Sex Workers (FSW) attending VICITS clinics in Guatemala., Methods: Demographic, behavioral and clinical data were collected using a standardized form. Data was analyzed by year and health center. HIV and STI prevalence were estimated from routine visits. Retention was estimated as the percent of new users attending VICITS clinics who returned for at least one follow-up visit to any VICITS clinic within 12 months. Separate multivariate logistic regression models were conducted to investigate factors associated with HIV infection and program retention., Results: During 2007-2011 5,682 FSW visited a VICITS clinic for the first-time. HIV prevalence varied from 0.4% to 5.8%, and chlamydia prevalence from 0% to 14.3%, across sites. Attending the Puerto Barrios clinic, having a current syphilis infection, working primarily on the street, and using the telephone or internet to contact clients were associated with HIV infection. The number of FSW accessing VICITS annually increased from 556 to 2,557 (361%) during the period. In 2011 retention varied across locations from 7.7% to 42.7%. Factors negatively impacting retention included current HIV diagnosis, having practiced sex work in another country, being born in Honduras, and attending Marco Antonio Foundation or Quetzaltenango clinic sites. Systematic time trends did not emerge, however 2008 and 2010 were characterized by reduced retention., Conclusions: Our data show local differences in HIV prevalence and clinic attendance that can be used to prioritize prevention activities targeting FSW in Guatemala. VICITS achieved rapid scale-up; however, a better understanding of the causes of low return rates is urgently needed.

Spatial patterns of gene expression are of key importance in understanding developmental networks. Using in situ hybridization, many laboratories are generating images to describe these spatial patterns and to test biological hypotheses. To facilitate such analyses, we have developed biologist-centric software (myFX) that contains computational methods to automatically process and analyze images depicting embryonic gene expression in the fruit fly Drosophila melanogaster. It facilitates creating digital descriptions of spatial patterns in images and enables measurements of pattern similarity and visualization of expression across genes and developmental stages. myFX interacts directly with the online FlyExpress database, which allows users to search thousands of existing patterns to find co-expressed genes by image comparison.

The challenge in achieving an ideal state of justice is that each "proof" has the highest degree of reliability. This is the main responsibility of the forensic scientist. Up to now, criminal investigations in Mexico have been supported by forensic work from a wide variety of disciplinary backgrounds that give testimony in a particular area, even though they may have become forensic witnesses in a complementary and experiential manner. In January 2013, the Universidad Nacional Autónoma de México (UNAM) approved the "Forensic Science" undergraduate program that, in collaboration with various academic entities and government institutions, will develop forensic scientists trained in science, law, and criminology. This is focused on contributing to the national demand that the justice system has more elements to procure and administer justice in dealing with crime.

Context: Accreditation of medical education programmes is becoming increasingly prevalent worldwide, but beyond the face validity of these quality assurance methods, data linking accreditation to improved student outcomes are limited. Mexico and the Philippines both have voluntary systems of medical education accreditation and large numbers of students who voluntarily take components of the United States Medical Licensing Examination (USMLE). We investigated the examination performance of Mexican and Philippine citizens who attended medical schools in their home countries by medical school accreditation status., Methods: The sample included 5045 individuals (1238 from Mexico, 3807 from the Philippines) who took at least one of the three USMLE components required for Educational Commission for Foreign Medical Graduates (ECFMG) certification. We also separately studied 2702 individuals who took all three examinations (589 from Mexico, 2113 from the Philippines). The chi-squared statistic was used to determine whether the associations between outcomes (first attempt pass rate on USMLE components and rate of ECFMG certification) and medical school accreditation (yes/no) were statistically significant., Results: For the sample of registrants who took at least one USMLE component, first attempt pass rates on all USMLE components were higher for individuals attending accredited schools, although there were differences in pass rates among the components and between the two countries. The distinction was greatest for USMLE Step 1, for which attending an accredited school was associated with increases in first attempt pass rates of 15.9% for Mexican citizens and 29.2% for Philippine citizens. In registrants from the Philippines who took all three examinations, attending an accredited medical school was also associated with increased success in obtaining ECFMG certification., Conclusions: These findings support the value and usefulness of accreditation in Mexico and the Philippines by linking accreditation to improved student outcomes., (© Blackwell Publishing Ltd 2012.)

The 2010 undergraduate medical degree curriculum at the faculty of medicine of the Universidad Nacional Autonoma de Mexico (UNAM) constitutes an important curricular reform of medical education in our country. It is the result of an institutional reflective process and academic dialog, which culminated in its approval by UNAM’s Academic Council for the Biology, Chemistry, and Health Sciences areas on February 2nd, 2010. Some distinguishing characteristics of the new academic curriculum are: organization by courses with a focus on outcome competencies; three curricular axes that link three knowledge areas; four educational phases with achievement profiles; new courses (biomedical informatics, basic-clinical and clinical-basic integration, among others); and core curriculum. The aforementioned curriculum was decided within a framework of effective teaching strategies, competency oriented learning assessment methods, restructuring of the training of teaching staff, and establishment of a curriculum committee follow-up and evaluation of the program. Curricular change in medical education is a complex process through which the institution can achieve its mission and vision. This change process faces challenges and opportunities, and requires strategic planning with long-term foresight to guarantee a successful dynamic transition for students, teachers, and for the institution itself.

Obesity is a chronic disease of multifactorial origin and can be defined as an increase in the accumulation of body fat. Adipose tissue is not only a triglyceride storage organ, but studies have shown the role of white adipose tissue as a producer of certain bioactive substances called adipokines. Among adipokines, we find some inflammatory functions, such as Interleukin-6 (IL-6); other adipokines entail the functions of regulating food intake, therefore exerting a direct effect on weight control. This is the case of leptin, which acts on the limbic system by stimulating dopamine uptake, creating a feeling of fullness. However, these adipokines induce the production of reactive oxygen species (ROS), generating a process known as oxidative stress (OS). Because adipose tissue is the organ that secretes adipokines and these in turn generate ROS, adipose tissue is considered an independent factor for the generation of systemic OS. There are several mechanisms by which obesity produces OS. The first of these is the mitochondrial and peroxisomal oxidation of fatty acids, which can produce ROS in oxidation reactions, while another mechanism is over-consumption of oxygen, which generates free radicals in the mitochondrial respiratory chain that is found coupled with oxidative phosphorylation in mitochondria. Lipid-rich diets are also capable of generating ROS because they can alter oxygen metabolism. Upon the increase of adipose tissue, the activity of antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), was found to be significantly diminished. Finally, high ROS production and the decrease in antioxidant capacity leads to various abnormalities, among which we find endothelial dysfunction, which is characterized by a reduction in the bioavailability of vasodilators, particularly nitric oxide (NO), and an increase in endothelium-derived contractile factors, favoring atherosclerotic disease.

Aim: To evaluate the effect of antiretroviral treatment on aminotransferase serum levels in treatment-naïve patients infected with human immunodeficiency virus (HIV)., Methods: We conducted a longitudinal study in treatment-nanaïve patients infected with HIV. Patients were excluded if they had consumed alcohol during the last three months or had an opportunistic disease or co-infection. All 54 enrolled patients were evaluated and those having a CD4+ cell count <350 cells/ml (41/54) were allocated to the treatment group (TG), while those with CD4+ counts >350 cells/ml (13/54) did not receive any anti-retroviral treatment (ART). TG patients received either efavirenz (EFV) (21/41) or lopinavir/ritonavir (LPV/RTV) (20/41), each with zidovudine/lamivudine (ZDV/LMV)., Results: During the trial, 2 subjects in the EFV group were excluded due to rash and 1 subject in the LPV/RTV group due to gastric intolerance. The remaining 51 subjects (13 (25.5%) in the NTG and 38 (74.5%) in the TG) were included in the data analysis. Overall, 43 (84%) of analyzed patients were male and 8 (16%) female with an overall mean age of 33 ± 9 years. Of the 38 treated patients, 19 received LPV/RTV and 19 received EFV. Patients in the TG showed an increase in their CD4+ cell count, a decrease in aspartate aminotransferase (AST) from 39.3 ± 28 IU/ml to 22.7 ± 6 IU/ml (p = 0.02), and a decrease in alanine aminotransferase (ALT) from 52.0 ± 25 IU/ml to 23.8 ± 13 IU/ml (p < 0.01). Patients in the NTG showed no statistically significant differences in these measurements. Positive correlation was found between HIV viral load, AST (r = 0.31, p = 0.001) and ALT (r = 0.40, p = 0.04)., Conclusions: There is a significant decrease in aminotransferase serum levels following the initiation of antiretroviral treatment in HIV infected patients.

Background: The role of residents as educators is increasingly recognized, since it impacts residents, interns, medical students and other healthcare professionals. A widespread implementation of resident-as-teacher courses in developed countries' medical schools has occurred, with variable results. There is a dearth of information about this theme in developing countries. The National Autonomous University of Mexico (UNAM) Faculty of Medicine has more than 50% of the residency programs' physician population in Mexico. This report describes a needs assessment survey for a resident as teacher program at our institution., Methods: A cross-sectional descriptive survey was developed based on a review of the available literature and discussion by an expert multidisciplinary committee. The goal was to identify the residents' attitudes, academic needs and preferred educational strategies regarding resident-as-teacher activities throughout the residency. The survey was piloted and modified accordingly. The paper anonymous survey was sent to 7,685 residents, the total population of medical residents in UNAM programs in the country., Results: There was a 65.7% return rate (5,186 questionnaires), a broad and representative sample of the student population. The residents felt they had knowledge and were competent in medical education, but the majority felt a need to improve their knowledge and skills in this discipline. Most residents (92.5%) felt that their role as educators of medical students, interns and other residents was important/very important. They estimated that 45.5% of their learning came from other residents. Ninety percent stated that it was necessary to be trained in teaching skills. The themes identified to include in the educational intervention were mostly clinically oriented. The educational strategies in order of preference were interactive lectures with a professor, small groups with a moderator, material available in a website for self-learning, printed material for self-study and homework, and small group web-based learning., Conclusions: There is a large unmet need to implement educational interventions to improve residents' educational skills in postgraduate educational programs in developing countries. Most perceived needs of residents are practical and clinically oriented, and they prefer traditional educational strategies. Resident as teachers educational interventions need to be designed taking into account local needs and resources.

Objective: To identify the prevalence of caries in affiliated children and teenagers at Instituto Mexicano del Seguro Social (IMSS)., Methods: The survey was carried out according to the World Health Organization indexes. The studied was carried out in 1545 boys and girls aged three, five, six, and twelve years and selected by stratified random sampling in seven places of Mexican Republic (Guanajuato, East and West Estado de México, Northwest 1, Northeast 2, Southwest 3, and Southeast 4 DF)., Results: The prevalence of caries was 66.9 %. Rates were higher in temporary dentition than in permanent teeth (p < 3.07). The mean of caries index per tooth in primary dentition in children of six years of age was 3.57 +/- 2.8. In the 12 years of age group the average per tooth was 1.97 +/- 1.4. The main component in both primary and permanent dentition was caries with 2.49 and 1.56 respectively., Conclusions: The results of this survey showed slight changes in prevalence and high levels of caries in children.

We report our experience on 42 patients treated with atrial septal defect (ASD) occlusion using Amplatzer device. Thirty patients were females and 12 were males, mean ages 26.5-years-old +/- 12 years (interval from 7 to 69 years). Average weight was 57.1 +/- 13.8 kg (32.3-85.0 kg). Forty-two devices (ranging diameters from 13 mm to 40 mm) were deployed, 40 of which were placed successfully and attempts were unsuccessful in two cases (diameter devices 36 mm and 40 mm, respectively). We used the "balloon on the left or right upper pulmonary vein" in 5 patients, achieving good deployment. Echocardiography showed total occlusion in 37 patients (93.5%), trivial leak in 2 (4.7%), and light leak in 1 patient (2.3%). Follow up was at 1 to 12 months (mean 6.5). Total occlusion was observed at one month on both patients with trivial leak, and at 6 months on the patient with light leak. Failure to deploy the device appropriately on the two patients with unsuccessful result was due to unfavorable anatomy: very large defects in both cases (occluder size 36 mm and 40 mm), very thin postero-superior 6 mm rim on one of them and aortic rim absence on the other one. Stretched diameters were 34 mm and 38 mm on patients with 36 mm and 40 mm devices, respectively. Both of them were sent to surgery. We conclude that percutaneus closure of atrial septal defect with the Amplatzer device is a save and have good results.

Medical practice has been traditionally ruled by the principles of medical ethics and the scientific aspects that define it. However, today's medical practice is largely influenced by other aspects such as: economic interests, abuse of therapeutics, defensive medicine, unnecessary surgeries and conflicts of interests without excluding alterations in the application of the informed consent, the relation with the pharmaceutical industry, respect of confidentiality, organizational ethics, and the ethical practice that escapes the will of the medical professional.

Introduction: Headache is one of the commonest causes of consultation in neurology. There are many studies of the prevalence of migraine showing considerable variation in the results obtained., Objectives: To find the prevalence of migraine, with and without an aura, by means of a randomized transverse study carried out in a previously selected rural population, using the validated questionnaire 'Alcoi-92'. To find the overall prevalence of migraine, specifically regarding age and sex and adjusted for the European population., Patients and Methods: A door-to-door study was made by random selection of 790 persons aged over 18, in three towns in the comarca del Comtat, Alacant, Spain. A self-questionnaire was sent to all persons studies and subsequently they were seen by a medical interviewer., Results: We interviewed 548 persons (overall response rate 78%). The average age was 52.5 +/- 19.3 years. Sex distribution of the population interviewed showed a predominance of females (52.9%) as compared to males (47.1%). According to the type of headache: other types of headache 62.32%, persons with no previous history of headache 20.07%, amplified migraine 16.6%, typical migraine 12.6%, cluster type migraine 0.18%., Conclusions: The overall prevalence of amplified migraine was 16.6%. According to diagnostic groups the frequency of migraine with aura was 2.9%, migraine without aura 9.7% and typical migraine 12.6%. A predominance of women was seen in all types of migraine. The frequency of migraine, adjusted for the European population was 19.6%. Prevalence during the past year, as a measure of activity of the disorder was 15.7%.

Introduction: In epidemiological investigation valid, reliable means of diagnosing the illnesses studies are essential., Objective: To validate the self-questionnaire 'Alcoi 1995' for the diagnosis of migraine., Methods: We used the questionnaire Alcoi-1992 (which had been validated previously) to find the prevalence of migraine in homogeneous populations. After this, we selected the significant items to obtain a shorter, more specific questionnaire for diagnosis of migraine, which we called 'Alcoi 1995'. We selected a population of patients and healthy volunteers. The diagnosis of migraine (neurologist and self-questionnaire) was made on criteria of the International Headache Society (IHS, 1988)., Results: There were 71 persons included in the study, 40 patients (5 men and 35 women those average age was 39.7 +/- 14.4 years) and 31 healthy volunteers (15 men and 16 women with an average age of 36 +/- 14.4). The sensitivity, specificity, positive and negative predictive value, and the Kappa concordance index for migraine (100%, 100%, 100%, 100% and 1); migraine with no aura (75%, 100%, 100%, 86% and 0.79) and migraine with a typical aura (100%, 88%, 63%, 100% and 0.71) were calculated., Conclusions: Our results show a high degree of validity and reliability when the self-questionnaire is used for the diagnosis of migraine. It is a tool for use in epidemiological studies which is quick and easy to use, and is cheap.

Introduction: There are numerous studies of the prevalence of migraine and very varied findings. Amongst the many reasons for this would seem to be the use of questionnaires for screening populations, absent or incorrect validation of these questionnaires and the use of impracticable diagnostic criteria., Objective: To determine the prevalence of migraine in a homogeneous population using the self-questionnaire 'Alcoi 1995' which had previously been validated for the diagnosis of migraine. A self-questionnaire was given to all workers in the same company. Diagnostic criteria of the International Headache Society (IHS, 1988) were used for diagnosis of migraine., Results: The study included 140 persons (43.6% men and 56.4% women with an average age of 26.7 +/- 4.8 years). There was a prevalence of headache and migraine (IC 95%): 90.8% (75.01-100) and 24.3% (16.3-32.3) respectively. The sex prevalence of headache and migraine was 88.5% (88.3-88.8) and 11.5% (3.4-19.4) for men and 34.2% (21.5-47) for women respectively., Conclusions: There are a large number of studies of the prevalence of migraine with wide variability in the figures obtained (1-2 at 35%). These variations depend on the population studied, age and sex sampled, diagnostic criteria used and the method employed in the survey. After validation of the questionnaire for diagnosis of migraine, this should be used in homogeneous populations before use in broad population studies. Our findings support the use of a suitably validated questionnaire as a useful method for the diagnosis of migraine in epidemiological studies.

The antiphospholipid antibodies (AAFL) are acquired antibodies of different types whose common characteristic is that they are directed against the negatively and neutrally charged phospholipids of the cell membranes. They were first described in 1952 in patients with systemic lupus erythematosus. They are also found in many pathological conditions such as: infections, solid and haematological neoplasms, chronic renal insufficiency, primary immunological deficiencies and other collagenoses, hepatobiliary diseases, etc. They are also found in other circumstances: due to the use of various drugs (which in general may induce lupus), in elderly patients and in apparently healthy people. The great interest shown in the past decade, as a result of their association with and possible etiopathogenic role in a series of thrombotic phenomena, neuropsychiatric disorders, thrombocytopenia and abortion-fetal death, has made them a major challenge to the clinician. This interest is increased by the controversial and very doubtful relationship that may exist with a series of disorders which have been described in detail. Their role as a probable risk factor for thrombosis in the general population is also discussed. For these reasons, we decided to review the basic biology of the AAFL and the aspects related to neurological disorders.

Objective: Nowadays, quality of life is considered to be important both in clinical investigation and patient care. Migraine is a particularly disabling illness, with a pronounced effect on general health and on the ability to take part in social activities. We review the instruments used for measuring quality of life and the published studies in which the relationship between migraine and quality of life is analyzed., Material and Method: In spite of increasing interest in quality of life and the means by which this is measured, there are many problems involved in studying this correctly since there is no agreement as to its definition or how to measure it. In recent years, most of the studies carried out have assessed the socio-economic cost of headache. However, at present, studies tend to focus on the human cost of the quality of life when suffering from headache. Migraine patients have a poorer quality of life than the general population and other populations with chronic illnesses which have always been considered to be severely disabling., Conclusion: Research should be aimed at finding the specific and/or generic measures necessary to improve quality of life while suffering from headache. In the future, the aim of new treatments should be to eliminate the pain of the acute crisis and restore functional capacity, reduce the period of disability and improve quality of life.

A group of universities not related with health sciences were interviewed using the questionnaire 'Alcoi 1992', based on the operational diagnostic criteria of the International Headache Society (IHS), to evaluate the prevalence of migraine. This questionnaire for the diagnosis of migraine was validated in 1993, showing a high sensibility and specificity for the diagnosis of migraine. Sensitivity, specificity, predictive value and chance-corrected agreement rate for the diagnosis of migraine was 100%, 94%, 90% (PVpos), 1008 (PVneg) and 0.71 respectively. The study group was composed by 96 students, men and women; the mean age of the group was 21 years old. The prevalence of headache, migraine, tensional headache and cluster headache was 95.4%; 7.58%; 12.2% and 1.52% cases respectively. The prevalence for male of headache, migraine, tensional headache and cluster headache was 92.5%, 12.5%, 15.9% and 2.5% cases respectively. The prevalence for female of headache, migraine, tensional headache and cluster headache was 100%; 0%; 5.5% and 0% cases respectively. The questionnaire appears like an useful, fast and easy method for the evaluation of diagnosis of migraine in populations groups.

A group of medical students were interviewed using the 'Alcoi 1992' questionnaire based on the diagnostic criteria of the International Headache Society (IHS) in order to assess the prevalence and various characteristics of migraine. This questionnaire for headache diagnosis was approved in 1993, showing both high sensitivity and exactness in diagnosing migraine. Sensitivity, exactness, predictive value and agreement index of the questionnaire in migraine diagnosis were 100%, 94%, 90% (positive) or 100% (negative) and 0.71% respectively. The group was made up of 96 students of both sexes, with an average age of 23.3 years (standard deviation 1.87). A total of 92 students, 35 male and 57 female, reported headaches. The total prevalence rate for headache was 95.8%, the reliability interval (RI) being 76.7-114.9. In the case of female students, the prevalence rate for headache was 96.6% (RI 71.7-121.5) and in the case of male students it was 94.6% (RI 63-125.7). A total of 20 students, six male and 14 female, fulfilled the criteria for migraine. The overall prevalence rate for migraine was 20.8% (RI 11.9-29.7), the prevalence for females being 23.7% (RI 11.6-35.8) and that for males 16.2% (RI 3.7-28.7). The questionnaire would appear to be a useful, rapid and simple method in the assessment of migraine diagnostic.

Migraine is a paroxysmic abnormality in which asymtomatic periods alternate with the appearance of attacks. Such attacks are the end result of a chain of events leading on to the acute clinical syndrome. Amongst those phenomena which occur in the days prior to the attack starting, the factors which bring such attacks on have been widely studied by a great number of researchers. Identifying these initiating factors is a fundamental preventive element and looking into the behavioural mechanisms of such factors could prove useful in clarifying the pathogenic mechanisms of migraine. In the present study we review most of the works which have sought to identify these factors concerning the development of attacks and to work out their behavioural patterns.

Stress is the precipitating factor in migraine which is most commonly recognized by patients. There are many affected who describe headaches brought on by stressful situations and events, although they also speak of the onset of their attacks during the period of calm immediately after such moments of stress. There are however few objective works in the literature which study the relationship between stress and migraine. In the present work we review that literature which does exist concerning such a relationship.

Throughout the many studies carried out on patients suffering from migraine, we find that a series of diseases or abnormalities with cardiovascular etiologies may be associated with the risk of migraine. In some studies published so far there is a greater prevalence of distinct cardiovascular diseases among those patients suffering from migraine. The shortage of case-control studies which might otherwise definitely establish a relationship between migraine and other cardiovascular diseases leads us to cautiously interpret the meaning of these associations. We studied family and personal history of cardiovascular disease in a group of patients with migraine, and we carried out a case-control study to try to establish the greatest risk of suffering from these diseases by our patients. We found that family antecedents of migraine with the next of kin was a risk factor for getting migraine and that Raynaud's disease was associated with a greater risk of suffering with this pathology.

Migraine headache is a common, recurrent and often incapacitating disorder resulting in a substantial loss of work days and productivity, significant consumption of medicines, and considerable economic cost. We performed this study in order to determine the characteristic features of migrainous patients with regular or frequent intake of ergotamine preparations and non steroidal anti-inflammatory drugs (NSAIDs) and the existence of significant differences between both groups. 186 patients were included in the study, 36.6% suffering from migraine without aura and 63.4% from migraine with aura. 24.7% were males and 75.3% females. Mean age of the sample was 35.6 +/- 12.9 years. With regard to medication used for immediate relief of headache, 74.7% patients reported an intake of analgesics and 25.3% ergotamine preparations. In patients with analgesic intake the mean age was significantly lower than in patients with ergotamine for treatment of migraine. When clinic features of these two headache groups were examined, the duration of migraine attacks in the analgesic group was significantly higher (p = 0.0014) than in the ergotamine group, and the severity of migraine was lower (p < 0.05) than in this group. Among associated symptoms, nausea and vomiting were significantly less frequent (p = 0.024) in the analgesic group than in the group of patients with ergotamine intake.

Knowing the epidemiology of migraine is important for a host of reasons. Migraine is one of the most prevalent types of headache. In addition, it constitutes a pathology which due to its cyclic, recurring and highly incapacitating characteristics has enormous repercussions on the quality of life of those affected; it is responsible for the loss of an important number of working days and of production; responsible too for the vast consumption of medicaments and consequently represents a considerable economic cost. An epidemiological study, however, of its pathology poses countless difficulties owing to its characteristics and its association with risk factors. In this present work we review the obstacles to carrying out migraine epidemiological studies and we also comment upon many such studies found in the literature. In each section we present the data obtained in such studies as were performed by our working group.

Background: The behavior of brain flow on acute stress has not been previously evaluated. Transcranial Doppler ultrasonography (TD) is a bloodless method to evaluate the speed of cerebral flow in the arteries of the Willis polygon. The present study was designed to analyze the changes which occur in the same during two situations of acute stress., Methods: The mean speed of cerebral flow (MS) and the pulsation rate (PR) of the right and left middle cerebral artery (MCA) were measured basally and following a mental stress test (calculation) and physical stress (cold test) by TD and through the temporal window. Twenty-five healthy volunteers (18 women and 8 men) with a mean age of 27.8 +/- 7.3 years were studied., Results: In response to mental stress an increase was observed in MS in both the right MCA (10 +/- 8.6 cm/sec) and the left MCA (10.4 +/- 8.7 cm/sec) with a decrease in the MCA (0.14 +/- 0.23 in the right MCA, 0.14 +/- 0.18 cm/sec in the left MCA). In response to the cold test an increase in MS (7.3 +/- 7.5 cm/sec in the right MCA, 14.8 +/- 14.7 cm/sec in the left MCA) was also observed with a decrease in the PR (0.2 +/- 0.2 in the right MCA and 0.2 +/- 0.16 in the left MCA). No significant differences were observed in the changes induced in the right or left artery or in those induced by the mental or cold tests., Conclusions: These results suggest that the acute stress produces an increase in cerebral flow in the arteries of the Willis polygon.