1
|
Barbosa-Camacho FJ, Rodríguez-Machuca VU, Ibarrola-Peña JC, Chejfec-Ciociano JM, Guzmán-Ruvalcaba MJ, Tavares-Ortega JA, Delgado-Hernandez G, Cervantes-Guevara G, Cervantes-Pérez E, Ramírez-Ochoa S, Fuentes-Orozco C, Gonzalez-Ojeda A. COVID-19 pandemic and its impact on medical interns' mental health of public and private hospitals in Guadalajara. Med Educ Online 2024; 29:2308360. [PMID: 38281205 PMCID: PMC10823882 DOI: 10.1080/10872981.2024.2308360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/16/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Burnout syndrome is a global burden characterized by exhaustion, work detachment, and a sense of ineffectiveness. It affects millions of individuals worldwide, with a particularly high prevalence among medical students. Factors such as demanding education, exposure to suffering, and the COVID-19 pandemic have contributed to elevated stress levels. Addressing this issue is crucial due to its impact on well-being and health-care quality. MATERIALS AND METHODS This cross-sectional survey study assessed fear of COVID-19 and burnout levels among medical student interns in hospitals in Guadalajara, Jalisco. The study used validated scales and collected data from September 2021 to September 2022. A snowball sampling method was employed and a minimum sample size of 198 participants was calculated. RESULTS This study included 311 medical students (62.1% female and 37.9% male with a mean age of 23.51 ± 2.21 years). The majority were in their second semester of internship (60.5%) and from public hospitals (89.1%). Most students believed that the COVID-19 pandemic affected the quality of their internship (82.6%). Female students had higher personal burnout scores, while male students had higher work-related burnout scores. The mean score for fear of COVID-19 was 13.71 ± 6.28, with higher scores among women (p = 0.004) and those from public hospitals (p = 0.009). A positive weak correlation was found between COVID-19 scores and burnout subscales. CONCLUSION Our study emphasizes the significant impact of various factors on burnout levels among medical students and health-care professionals during the COVID-19 pandemic. Prolonged exposure to COVID-19 patients, reduced staffing, and increased workload contributed to burnout, affecting well-being and quality of care. Targeted interventions and resilience-building strategies are needed to mitigate burnout and promote well-being in health-care settings.
Collapse
Affiliation(s)
- Francisco José Barbosa-Camacho
- Unidad de Investigación Biomédica 02 Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
- Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | | | - Juan Carlos Ibarrola-Peña
- Hospital General y Medicina Familiar de Zona No. 2, Instituto Mexicano del Seguro Social, Nuevo León, Monterrey, México
| | - Jonathan Matías Chejfec-Ciociano
- Unidad de Investigación Biomédica 02 Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| | - Mario Jesús Guzmán-Ruvalcaba
- Unidad de Investigación Biomédica 02 Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| | - Jaime Alberto Tavares-Ortega
- Unidad de Investigación Biomédica 02 Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| | - Gonzalo Delgado-Hernandez
- Unidad de Investigación Biomédica 02 Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| | - Gabino Cervantes-Guevara
- Departamento de Bienestar y Desarrollo Sustentable, Centro Universitario del Norte, Universidad de Guadalajara, Colotlán, Jalisco, México
| | - Enrique Cervantes-Pérez
- Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Sol Ramírez-Ochoa
- Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Clotilde Fuentes-Orozco
- Unidad de Investigación Biomédica 02 Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| | - Alejandro Gonzalez-Ojeda
- Unidad de Investigación Biomédica 02 Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| |
Collapse
|
2
|
Ibarrola-Peña JC, Cueto-Valadez TA, Chejfec-Ciociano JM, Cifuentes-Andrade LR, Cueto-Valadez AE, Castillo-Cardiel G, Cervantes-Cardona GA, Cervantes-Pérez E, Cervantes-Guevara G, Guzmán-Ruvalcaba MJ, Sapién-Fernández JH, Guzmán-Barba JA, Esparza-Estrada I, Flores-Becerril P, Brancaccio-Pérez IV, Guzmán-Ramírez BG, Álvarez-Villaseñor AS, Barbosa-Camacho FJ, Reyes-Elizalde EA, Fuentes-Orozco C, González-Ojeda A. Substance Use and Psychological Distress in Mexican Adults during COVID-19 Pandemic: A Cross-Sectional Study. Int J Environ Res Public Health 2022; 20:716. [PMID: 36613036 PMCID: PMC9819856 DOI: 10.3390/ijerph20010716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES This observational cross-sectional study examined changes in substance use during the coronavirus disease 2019 (COVID-19) pandemic in the Mexican population and evaluated whether depression or anxiety was associated with these new consumption patterns. METHODS An online survey was distributed to the general population. Participants were questioned about their demographics, situation during the COVID-19 pandemic, and substance consumption patterns. The Patient Health Questionnaire-9 for depression and the Coronavirus Anxiety Scale were used. RESULTS A total of 866 individuals completed the survey. The mean scores for the Patient Health Questionnaire-9 and Coronavirus Anxiety Scale were 8.89 ± 6.20 and 3.48 ± 3.22, respectively. The preferred substances were alcohol (19%), tobacco (16.5%), and marijuana (5.6%). Consumption of alcohol (p = 0.042) significantly increased during the pandemic and it was higher in women than in men (p = 0.040). CONCLUSIONS Substance use patterns were affected by the pandemic, with an increase in the number of users and consumption rate, as well as the reported psychiatric symptoms.
Collapse
Affiliation(s)
- Juan Carlos Ibarrola-Peña
- Hospital General y Medicina Familiar de Zona No. 2, Instituto Mexicano del Seguro Social, Monterrey 64010, Nuevo León, Mexico
| | - Tania Abigail Cueto-Valadez
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Jalisco, Mexico
| | - Jonathan Matías Chejfec-Ciociano
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Jalisco, Mexico
| | - Luis Rodrigo Cifuentes-Andrade
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Jalisco, Mexico
| | - Andrea Estefanía Cueto-Valadez
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Jalisco, Mexico
| | - Guadalupe Castillo-Cardiel
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Jalisco, Mexico
| | - Guillermo Alonso Cervantes-Cardona
- Departamento de Disciplinas Filosófico, Metodológicas e Instrumentales, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Enrique Cervantes-Pérez
- Departamento de Medicina Interna, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Gabino Cervantes-Guevara
- Departamento de Bienestar y Desarrollo Sustentable, Centro Universitario del Norte, Universidad de Guadalajara, Colotlán 46200, Jalisco, Mexico
| | - Mario Jesús Guzmán-Ruvalcaba
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Jalisco, Mexico
| | - José Héctor Sapién-Fernández
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Jalisco, Mexico
| | - José Aldo Guzmán-Barba
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Jalisco, Mexico
| | - Isaac Esparza-Estrada
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Jalisco, Mexico
| | - Paola Flores-Becerril
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Jalisco, Mexico
| | - Irma Valeria Brancaccio-Pérez
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Jalisco, Mexico
| | - Bertha Georgina Guzmán-Ramírez
- Departamento de Pediatría, Hospital Civil de Guadalajara Fray Antonio Alcalde, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | | | - Francisco José Barbosa-Camacho
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Jalisco, Mexico
| | - Emilio Alberto Reyes-Elizalde
- Departamento de Traumatología y Ortopedia, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Tlalpan, Ciudad de Mexico 14389, Mexico
| | - Clotilde Fuentes-Orozco
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Jalisco, Mexico
| | - Alejandro González-Ojeda
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Jalisco, Mexico
| |
Collapse
|
3
|
Ibarrola-Peña JC, Barbosa-Camacho FJ, Almanza-Mena YL, Chejfec-Ciociano JM, Reyes-Elizalde EA, Romero-Limón OM, Zaragoza-Organista R, Cervantes-Pérez E, Sapién-Fernández JH, Guzmán-Barba JA, Flores-Becerril P, Ochoa-Rodríguez I, Nájar-Hinojosa R, Cueto-Valadez AE, Cueto-Valadez TA, López-Zendejas M, Fuentes-Orozco C, Cervantes-Guevara G, Miranda-Ackerman RC, González-Ojeda A. Preventive measures against the COVID-19 pandemic in Mexico: A cross-sectional study. Front Public Health 2022; 10:932010. [PMID: 36304240 PMCID: PMC9596139 DOI: 10.3389/fpubh.2022.932010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/12/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Understanding how Mexicans behave during the pandemic could present a complete picture of the phenomenon in our country and provide better management of it. Objective This study aimed to analyze the Mexican population's behavior and preventive measures. Methods This was a cross-sectional study in which a total of 4,004 participants from the general population responded to the survey. Results Almost 99% of the participants mentioned knowing the symptoms of COVID-19. Although 77.5% of participants considered that they followed proper social distancing measures, 60% of them mentioned that they knew at least six individuals who did not follow social distancing measures. Furthermore, 96.2% of participants reported using preventive measures at least 50% of the time. Only 51.3% used a certified mask. Conclusion The COVID-19 pandemic outcomes in Mexico are the result of multiple negative factors, such as high rates of comorbidities, high number of people living together at home, many people breaking social isolation, and most of the population using non-certified preventive measures that may not be effective enough.
Collapse
Affiliation(s)
- Juan Carlos Ibarrola-Peña
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | - Francisco José Barbosa-Camacho
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | - Yolanda Lorelei Almanza-Mena
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | - Jonathan Matías Chejfec-Ciociano
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | - Emilio Alberto Reyes-Elizalde
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | | | - Rafael Zaragoza-Organista
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | - Enrique Cervantes-Pérez
- Departamento de Nutrición Clínica, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de Mexico, Mexico
| | - José Héctor Sapién-Fernández
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | - José Aldo Guzmán-Barba
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | - Paola Flores-Becerril
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | - Itzel Ochoa-Rodríguez
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | - Rodrigo Nájar-Hinojosa
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | - Andrea Estefania Cueto-Valadez
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | - Tania Abigail Cueto-Valadez
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | | | - Clotilde Fuentes-Orozco
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | - Gabino Cervantes-Guevara
- Departamento de Bienestar y Desarrollo Sustentable, Centro Universitario del Norte, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico,Department of Gastroenterology, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Universidad de Guadalajara, Guadalajara, Mexico
| | | | - Alejandro González-Ojeda
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico,*Correspondence: Alejandro González-Ojeda
| |
Collapse
|
4
|
Barbosa-Camacho FJ, Romero-Limón OM, Ibarrola-Peña JC, Almanza-Mena YL, Pintor-Belmontes KJ, Sánchez-López VA, Chejfec-Ciociano JM, Guzmán-Ramírez BG, Sapién-Fernández JH, Guzmán-Ruvalcaba MJ, Nájar-Hinojosa R, Ochoa-Rodriguez I, Cueto-Valadez TA, Cueto-Valadez AE, Fuentes-Orozco C, Cortés-Flores AO, Miranda-Ackerman RC, Cervantes-Cardona GA, Cervantes-Guevara G, González-Ojeda A. Depression, anxiety, and academic performance in COVID-19: a cross-sectional study. BMC Psychiatry 2022; 22:443. [PMID: 35773635 PMCID: PMC9243721 DOI: 10.1186/s12888-022-04062-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/10/2022] [Indexed: 11/11/2022] Open
Abstract
Depression and anxiety are common after months of social isolation, and they can have a negative impact on anyone's quality of life if they are not treated promptly and appropriately. The aim of this study was to determine if the change to online modality courses and the presence of depression or anxiety symptoms during the COVID-19 pandemic was associated with a difference in the college student's academic achievement. This study was a cross-sectional survey in which we used the Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder-7 (GAD-7). Also, we examined the students' perceptions of their academic performance using the Academic Self-Concept Scale (ASCS). A total of 610 students responded to the survey. The average score on the Academic Self-Concept Scale was 2.76 ± 0.35, the students presented a risk of 61.5% for possible depressive disorder and 52.1% for possible generalized anxiety disorder. The intensity of depression and anxiety symptoms had a significant effect on Academic Self-Concept Scale scores (p < 0.001 and p < 0.05, respectively). The findings indicate that the COVID-19 pandemic has had a direct effect on students' mental health and academic performance.
Collapse
Affiliation(s)
- Francisco José Barbosa-Camacho
- grid.419157.f0000 0001 1091 9430Unidad de Investigación Biomédica 02. Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco México
| | - Olaya Moramay Romero-Limón
- grid.419157.f0000 0001 1091 9430Unidad de Investigación Biomédica 02. Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco México ,grid.412890.60000 0001 2158 0196Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Universidad de Guadalajara, Guadalajara, Jalisco Mexico
| | - Juan Carlos Ibarrola-Peña
- grid.419157.f0000 0001 1091 9430Hospital General de Zona y Medicina Familiar number 2, Instituto Mexicano del Seguro Social, Nuevo León Monterrey, México
| | - Yolanda Lorelei Almanza-Mena
- grid.419157.f0000 0001 1091 9430Unidad de Investigación Biomédica 02. Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco México
| | | | - Verónica Alexandra Sánchez-López
- grid.419157.f0000 0001 1091 9430Unidad de Investigación Biomédica 02. Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco México
| | - Jonathan Matías Chejfec-Ciociano
- grid.419157.f0000 0001 1091 9430Unidad de Investigación Biomédica 02. Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco México ,grid.416850.e0000 0001 0698 4037Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de México, Mexico
| | - Bertha Georgina Guzmán-Ramírez
- grid.419157.f0000 0001 1091 9430Unidad de Investigación Biomédica 02. Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco México
| | - José Héctor Sapién-Fernández
- grid.419157.f0000 0001 1091 9430Unidad de Investigación Biomédica 02. Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco México
| | - Mario Jesús Guzmán-Ruvalcaba
- grid.419157.f0000 0001 1091 9430Unidad de Investigación Biomédica 02. Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco México ,grid.412890.60000 0001 2158 0196Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Universidad de Guadalajara, Guadalajara, Jalisco Mexico
| | - Rodrigo Nájar-Hinojosa
- grid.419157.f0000 0001 1091 9430Unidad de Investigación Biomédica 02. Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco México
| | - Itzel Ochoa-Rodriguez
- grid.419157.f0000 0001 1091 9430Unidad de Investigación Biomédica 02. Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco México
| | - Tania Abigail Cueto-Valadez
- grid.419157.f0000 0001 1091 9430Unidad de Investigación Biomédica 02. Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco México
| | - Andrea Estefanía Cueto-Valadez
- grid.419157.f0000 0001 1091 9430Unidad de Investigación Biomédica 02. Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco México
| | - Clotilde Fuentes-Orozco
- grid.419157.f0000 0001 1091 9430Unidad de Investigación Biomédica 02. Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco México
| | | | | | - Guillermo Alonso Cervantes-Cardona
- grid.412890.60000 0001 2158 0196Departamento de Disciplinas Filosófico, Metodológicas e Instrumentales, Centro Universitario de Ciencias de La Salud, Universidad de Guadalajara, Guadalajara, Jalisco Mexico
| | - Gabino Cervantes-Guevara
- grid.412890.60000 0001 2158 0196Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Universidad de Guadalajara, Guadalajara, Jalisco Mexico ,grid.412890.60000 0001 2158 0196Departamento de Bienestar y Desarrollo Sustentable, Centro Universitario del Norte, Universidad de Guadalajara, Colotlán, Jalisco México
| | - Alejandro González-Ojeda
- Unidad de Investigación Biomédica 02. Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México.
| |
Collapse
|
5
|
Chejfec-Ciociano JM, Martínez-Herrera JP, Parra-Guerra AD, Chejfec R, Barbosa-Camacho FJ, Ibarrola-Peña JC, Cervantes-Guevara G, Cervantes-Cardona GA, Fuentes-Orozco C, Cervantes-Pérez E, García-Reyna B, González-Ojeda A. Misinformation About and Interest in Chlorine Dioxide During the COVID-19 Pandemic in Mexico Identified Using Google Trends Data: Infodemiology Study. JMIR Infodemiology 2022; 2:e29894. [PMID: 35155994 PMCID: PMC8805460 DOI: 10.2196/29894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/01/2021] [Accepted: 12/07/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND The COVID-19 pandemic has prompted the increasing popularity of several emerging therapies or preventives that lack scientific evidence or go against medical directives. One such therapy involves the consumption of chlorine dioxide, which is commonly used in the cleaning industry and is available commercially as a mineral solution. This substance has been promoted as a preventive or treatment agent for several diseases, including SARS-CoV-2 infection. As interest in chlorine dioxide has grown since the start of the pandemic, health agencies, institutions, and organizations worldwide have tried to discourage and restrict the consumption of this substance. OBJECTIVE The aim of this study is to analyze search engine trends in Mexico to evaluate changes in public interest in chlorine dioxide since the beginning of the COVID-19 pandemic. METHODS We retrieved public query data for the Spanish equivalent of the term "chlorine dioxide" from the Google Trends platform. The location was set to Mexico, and the time frame was from March 3, 2019, to February 21, 2021. A descriptive analysis was performed. The Kruskal-Wallis and Dunn tests were used to identify significant changes in search volumes for this term between four consecutive time periods, each of 13 weeks, from March 1, 2020, to February 27, 2021. RESULTS From the start of the pandemic in Mexico (February 2020), an upward trend was observed in the number of searches compared with that in 2019. Maximum volume trends were recorded during the week of July 19-25, 2020. The search volumes declined between September and November 2020, but another peak was registered in December 2020 through February 2021, which reached a maximum value on January 10. Percentage change from the first to the fourth time periods was +312.85, -71.35, and +228.18, respectively. Pairwise comparisons using the Kruskal-Wallis and Dunn tests showed significant differences between the four periods (P<.001). CONCLUSIONS Misinformation is a public health risk because it can lower compliance with the recommended measures and encourage the use of therapies that have not been proven safe. The ingestion of chlorine dioxide presents a danger to the population, and several adverse reactions have been reported. Programs should be implemented to direct those interested in this substance to accurate medical information.
Collapse
Affiliation(s)
- Jonathan Matias Chejfec-Ciociano
- Unidad de Investigación Biomédica 02 Hospital de Especialidades del Centro Médico Nacional de Occidente Instituto Mexicano del Seguro Social Guadalajara Mexico
| | - Juan Pablo Martínez-Herrera
- Unidad de Investigación Biomédica 02 Hospital de Especialidades del Centro Médico Nacional de Occidente Instituto Mexicano del Seguro Social Guadalajara Mexico
| | - Alexa Darianna Parra-Guerra
- Unidad de Investigación Biomédica 02 Hospital de Especialidades del Centro Médico Nacional de Occidente Instituto Mexicano del Seguro Social Guadalajara Mexico
| | - Ricardo Chejfec
- Max Bell School of Public Policy McGill University Montreal, QC Canada
| | - Francisco José Barbosa-Camacho
- Unidad de Investigación Biomédica 02 Hospital de Especialidades del Centro Médico Nacional de Occidente Instituto Mexicano del Seguro Social Guadalajara Mexico
| | - Juan Carlos Ibarrola-Peña
- Unidad de Investigación Biomédica 02 Hospital de Especialidades del Centro Médico Nacional de Occidente Instituto Mexicano del Seguro Social Guadalajara Mexico
| | - Gabino Cervantes-Guevara
- Hospital Civil de Guadalajara "Fray Antonio Alcalde" Universidad de Guadalajara Guadalajara Mexico.,Departamento de Bienestar y Desarrollo Sustentable Centro Universitario del Norte Universidad de Guadalajara Colotlán Mexico
| | - Guillermo Alonso Cervantes-Cardona
- Departamento de Disciplinas Filosófico, Metodológicas e Instrumentales Centro Universitario de Ciencias de la Salud Universidad de Guadalajara Guadalajara Mexico
| | - Clotilde Fuentes-Orozco
- Unidad de Investigación Biomédica 02 Hospital de Especialidades del Centro Médico Nacional de Occidente Instituto Mexicano del Seguro Social Guadalajara Mexico
| | - Enrique Cervantes-Pérez
- Departamento de Nutriología Clínica Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" Ciudad de Mexico Mexico
| | | | - Alejandro González-Ojeda
- Unidad de Investigación Biomédica 02 Hospital de Especialidades del Centro Médico Nacional de Occidente Instituto Mexicano del Seguro Social Guadalajara Mexico
| |
Collapse
|
6
|
Fuentes-Orozco C, Agredano-Jiménez R, Alvarez-Villaseñor AS, Mares-País R, Barbosa-Camacho FJ, Cortés-Flores AO, Reyes-Elizalde EA, Guzmán-Ramírez BG, Flores-Becerril P, Guzmán-Barba JA, Chejfec-Ciociano JM, Ibarrola-Peña JC, Brancaccio-Pérez IV, González-Ojeda A. Effects of Oral Zafirlukast, Sildenafil, or Pirfenidone on the Formation of Postsurgical Intra-abdominal Adhesions in an Experimental Rat Model. Eur Surg Res 2021; 63:145-154. [PMID: 34818645 DOI: 10.1159/000521036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Intra-abdominal adhesions' main etiology is surgical procedures that commonly require reintervention. Oral treatments with Sildenafil, Zafirlukast, and Pirfenidone have yielded decreased severity of fibrotic phenomena secondary to the introduction of foreign material. This study aimed to evaluate the efficacy of oral Zafirlukast, Sildenafil or Pirfenidone treatment on reducing or preventing intra-abdominal adhesions in an experimental rat model. METHODS Four groups, each of 10 male Wistar rats weighing 250-300 g, were used. A midline laparotomy was used to excise an area of 1.5´1.5cm and reconstructed with polypropylene mesh fixed to the abdominal wall. After 12 h, oral doses of Zafirlukast (1.25 mg/kg, group B), Sildenafil (15 mg/kg, group C), or Pirfenidone (500 mg/kg, group D) were given every day for eight days. The control group, A, received no treatment. At day nine, animals were reoperated. The implant was resected after ethically approved euthanasia and specimens were fixed in 10% formaldehyde for histopathology. RESULTS Control group A yielded adhesions with greater fibrovascular density and neighboring organ involvement than the other groups (P = 0.001), as well as intense inflammatory infiltrates and numerous granulomas (P = 0.04). Adhesions in group C had less fibrovascular density (P = 0.03) with decreased serosal injuries (P = 0.001) and less organ involvement. Group D had reduced adhesions without organ involvement (P < 0.01), and less inflammatory infiltrates, collagen fibers, and foreign body granulomas than groups B or C (P < 0.01). CONCLUSIONS Oral administration of these agents did not prevent adhesions but ameliorated them. Oral Pirfenidone offered the best performance and could be recommended for human use.
Collapse
Affiliation(s)
- Clotilde Fuentes-Orozco
- Biomedical Research Unit 02, Western National Medical Center, Social Security Mexican Institute, Guadalajara, Mexico
| | - Ruben Agredano-Jiménez
- Biomedical Research Unit 02, Western National Medical Center, Social Security Mexican Institute, Guadalajara, Mexico
| | | | - Roberto Mares-País
- Biomedical Research Unit 02, Western National Medical Center, Social Security Mexican Institute, Guadalajara, Mexico
| | | | | | - Emilio Alberto Reyes-Elizalde
- Biomedical Research Unit 02, Western National Medical Center, Social Security Mexican Institute, Guadalajara, Mexico
| | | | - Paola Flores-Becerril
- Biomedical Research Unit 02, Western National Medical Center, Social Security Mexican Institute, Guadalajara, Mexico
| | - José Aldo Guzmán-Barba
- Biomedical Research Unit 02, Western National Medical Center, Social Security Mexican Institute, Guadalajara, Mexico
| | | | - Juan Carlos Ibarrola-Peña
- Biomedical Research Unit 02, Western National Medical Center, Social Security Mexican Institute, Guadalajara, Mexico
| | - Irma Valeria Brancaccio-Pérez
- Biomedical Research Unit 02, Western National Medical Center, Social Security Mexican Institute, Guadalajara, Mexico
| | - Alejandro González-Ojeda
- Biomedical Research Unit 02, Western National Medical Center, Social Security Mexican Institute, Guadalajara, Mexico
| |
Collapse
|
7
|
García-Reyna B, Castillo-García GD, Barbosa-Camacho FJ, Cervantes-Cardona GA, Cervantes-Pérez E, Esparza-Estrada I, Brancaccio-Pérez IV, Silva-González G, Fuentes-Orozco C, Pintor-Belmontes KJ, Guzmán-Ramírez BG, Navarro DR, Ibarrola-Peña JC, López VAS, Chejfec-Ciociano JM, Sapién-Fernández JH, González-Ojeda A, Cervantes-Guevara G. Anxiety and COVID-19: Coronavirus Anxiety Scale scores in medical and non-medical personnel in urban hospitals in Guadalajara. A cross-sectional survey study. Death Stud 2021; 46:581-589. [PMID: 34181508 DOI: 10.1080/07481187.2021.1936297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The world is facing the worst health crisis in modern history. In addition to general concerns about the effects of COVID-19 on health, hospital personnel are developing numerous mental health conditions. This cross-sectional survey study evaluated the prevalence and severity of anxiety caused by the COVID-19 pandemic using the Coronavirus Anxiety Scale (CAS) in 2136 hospital employees. For the employees who presented scores ranging from 1-20 (n = 1090, 51%), the CAS mean score was 4.22 (SD = 3.95). The mean score was higher in women than men. By work category, non-clinical hospital personnel presented the highest CAS scores.
Collapse
Affiliation(s)
| | | | - Francisco José Barbosa-Camacho
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Guillermo Alonso Cervantes-Cardona
- Departamento de Disciplinas Filosófico, Metodológicas e Instrumentales, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Enrique Cervantes-Pérez
- Departamento de Nutrición Clínica, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, México
| | - Isaac Esparza-Estrada
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Irma Valeria Brancaccio-Pérez
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Gabriela Silva-González
- Departamento de Odontología para la Preservación de la Salud, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Clotilde Fuentes-Orozco
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Kevin Josue Pintor-Belmontes
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Bertha Georgina Guzmán-Ramírez
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Dinorah Rodríguez Navarro
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Juan Carlos Ibarrola-Peña
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Veronica Alexandra Sánchez López
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Jonathan Matias Chejfec-Ciociano
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - José Héctor Sapién-Fernández
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Alejandro González-Ojeda
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Gabino Cervantes-Guevara
- Centro Universitario del Norte, Universidad de Guadalajara, Colotlan, Mexico
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Universidad de Guadalajara, Guadalajara, México
| |
Collapse
|
8
|
Portilla-de Buen E, Ramirez-Contreras JP, Chejfec-Ciociano JM, Lopez-Falcony R, Garcia-Martinez D, Vazquez-Camacho JG, Fuentes-Orozco C, Barbosa-Camacho FJ, Ibarrola-Peña JC, Gonzalez-Ojeda A. Hyaluronic Acid Reduces Fibrosis in a Rabbit Model of Urethral Anastomosis. Res Rep Urol 2021; 13:257-262. [PMID: 34017802 PMCID: PMC8131090 DOI: 10.2147/rru.s307397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/20/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Urethral stricture caused by fibrosis is a common medical condition, but top-line therapy for this pathology has a high recurrence rate. This study aimed to determine the efficacy of hyaluronic acid (HA) treatment in preventing the development of fibrosis in a rabbit model of urethral anastomosis. MATERIALS AND METHODS This experimental study involved 20 rabbits. HA (0.5 mL, 25 μg/mL) was applied in the experimental group (n = 10) during an experimental urethral anastomosis, and sterile saline (0.9%) solution was applied in the control group (n = 10). Animals underwent reoperation 12 weeks later for urethral resection. Fibrosis, inflammation, and urethral diameter were measured by two blinded pathologists at the site of the anastomosis. RESULTS The amount of inflammatory infiltrate was similar in both groups. The thicknesses of the collagen fiber band were 275.9 ± 62.3 and 373.4 ± 44.3 μm in the study and control groups (p = 0.001), respectively, and the urethral lumen diameters at the anastomosis site at follow-up were 2575 ± 167 and 2382 ± 214 μm, respectively (p = 0.04). CONCLUSION HA treatment reduced fibrosis at the anastomosis site during this experiment; we suggest further research to corroborate its efficacy in the treatment of urethral stricture.
Collapse
Affiliation(s)
- Eliseo Portilla-de Buen
- Surgical Research Division, Western Biomedical Research Center, Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Juan Pablo Ramirez-Contreras
- Biomedical Research Unit 02, Specialties Hospital, Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Jonathan Matias Chejfec-Ciociano
- Biomedical Research Unit 02, Specialties Hospital, Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Rodrigo Lopez-Falcony
- Guanajuato State Transplant Center, Institute of Public Health of Guanajuato, Guanajuato, México
| | - David Garcia-Martinez
- Surgical Research Division, Western Biomedical Research Center, Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Jose Gonzalo Vazquez-Camacho
- Cellular Biology Laboratory, School of Medicine, Instituto Tecnológico de Estudios Superiores de Monterrey, Campus Guadalajara, Jal, México
| | - Clotilde Fuentes-Orozco
- Biomedical Research Unit 02, Specialties Hospital, Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Francisco Jose Barbosa-Camacho
- Biomedical Research Unit 02, Specialties Hospital, Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Juan Carlos Ibarrola-Peña
- Biomedical Research Unit 02, Specialties Hospital, Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Alejandro Gonzalez-Ojeda
- Biomedical Research Unit 02, Specialties Hospital, Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| |
Collapse
|
9
|
Cervantes-Guevara G, Maciel-Saldierna M, Elizondo-Hernández E, Cervantes-Pérez LA, Cervantes-Cardona GA, García-Reyna B, Ibarrola-Peña JC, Almanza-Mena YL, Barbosa-Camacho FJ, Fuentes-Orozco C, Chejfec-Ciociano JM, Guzmán-Barba JA, Flores-Becerril P, Reyes-Elizalde EA, González-Ojeda A. Fear of COVID-19 in High School Personnel: a Survey Study in Western Mexico. Int J Ment Health Addict 2021; 20:1687-1694. [PMID: 33519317 PMCID: PMC7831620 DOI: 10.1007/s11469-020-00473-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Gabino Cervantes-Guevara
- Centro Universitario del Norte, Universidad de Guadalajara, Colotlan, Jalisco Mexico.,Hospital Civil de Guadalajara "Fray Antonio Alcalde", Universidad de Guadalajara, Guadalajara, Jalisco México
| | - Manuel Maciel-Saldierna
- Secundaria 56 Mixta "Juana de Asbaje", Secretaría de Educación Jalisco, Guadalajara, Jalisco Mexico
| | | | | | - Guillermo Alonso Cervantes-Cardona
- Departamento de Disciplinas Filosófico, Metodológicas e Instrumentales, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco Mexico
| | - Bejanmín García-Reyna
- Centro Universitario del Norte, Universidad de Guadalajara, Colotlan, Jalisco Mexico
| | - Juan Carlos Ibarrola-Peña
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Belisario Domínguez 1000 Col. Independencia, Guadalajara, Jalisco Mexico
| | - Yolanda Lorelei Almanza-Mena
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Belisario Domínguez 1000 Col. Independencia, Guadalajara, Jalisco Mexico
| | - Francisco José Barbosa-Camacho
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Belisario Domínguez 1000 Col. Independencia, Guadalajara, Jalisco Mexico
| | - Clotilde Fuentes-Orozco
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Belisario Domínguez 1000 Col. Independencia, Guadalajara, Jalisco Mexico
| | - Jonathan Matias Chejfec-Ciociano
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Belisario Domínguez 1000 Col. Independencia, Guadalajara, Jalisco Mexico
| | - José Aldo Guzmán-Barba
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Belisario Domínguez 1000 Col. Independencia, Guadalajara, Jalisco Mexico
| | - Paola Flores-Becerril
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Belisario Domínguez 1000 Col. Independencia, Guadalajara, Jalisco Mexico
| | - Emilio Alberto Reyes-Elizalde
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Belisario Domínguez 1000 Col. Independencia, Guadalajara, Jalisco Mexico
| | - Alejandro González-Ojeda
- Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Belisario Domínguez 1000 Col. Independencia, Guadalajara, Jalisco Mexico
| |
Collapse
|