Captores del fósforo: preferencias de los pacientes en hemodiálisis y su repercusión sobre el cumplimiento del tratamiento y el control del fósforo

Introducción: En la actualidad disponemos de un amplio abanico de captores del fósforo (CF), pero sabemos poco acerca de las preferencias de los pacientes y de su repercusión sobre el cumplimiento del tratamiento y el control de los niveles de fósforo. Objetivo: Estudiar las preferencias y creencias de los pacientes respecto a los CF, y su influencia sobre el cumplimiento del tratamiento y el control de los niveles de fósforo. Pacientes y métodos: Estudio observacional transversal. Se incluyeron 121 pacientes que respondieron un cuestionario genérico de cumplimiento del tratamiento (SMAQ) y a un cuestionario específico sobre cumplimiento del tratamiento con CF, tipo de CF preferido y razones de dicha preferencia. Todos los pacientes entrevistados habían probado dos o tres CF. Las consecuencias de la falta de cumplimiento del tratamiento con CF se estimaron indirectamente analizando los valores promedio de fósforo sérico. Resultados: El 40% de los pacientes era incumplidor según el cuestionario SMAQ; se encontró una asociación estadísticamente significativa entre la falta de cumplimiento en general y no alcanzar el objetivo de fósforo sérico promedio <5,5 mg/dl (OR = 4,8; IC 95%, 1,0-6,6; p = 0,02). El 21,4% de los pacientes reconocía un incumplimiento específico para los CF; estos pacientes presentaban una mayor probabilidad de tener cifras medias de fósforo >5,5 mg/dl (OR = 4,7; IC 95%, 1,1-6,5; p = 0,03). Un 43,8% de los pacientes no refirió tener preferencias entre los diferentes tipos de CF; para el resto de pacientes, el CF preferido fue Royen®, seguido de Fosrenol®, Renagel® y Pepsamar®. Las razones expresadas para el desagrado con el Renagel® fueron las siguientes: incomodidad en la toma por su gran tamaño (28,8%), necesidad de tomar muchos comprimidos y gran consumo de agua (57,7%) e intolerancia gástrica (13,3%). En el caso del Fosrenol®: incómodo de tomar (72,7%) e intolerancia gástrica (27,2%); para el Pepsamar®: mal sabor (54,5%) e intolerancia gástrica (45,4%). Sólo al 9,4% no le gustaba el Royen®. Al analizar los conocimientos de los pacientes respecto a la utilidad de los CF, un 42% sabía que servían para controlar el fósforo; un 52% no lo sabía y un 6% tenía ideas equivocadas. En cuanto a su importancia: un 47% no conocía por qué son importantes; un 2% tenía ideas erróneas; un 9% creía que era beneficioso para la salud; un 11% creía que era bueno «porque lo dice el medico»; un 26% porque controla el fósforo y un 5% lo relacionaba con el hueso. Ningún paciente relacionó los CF con la enfermedad cardiovascular. Un 24,4% no se llevaba los CF cuando salía fuera de casa o estaba con los amigos; eran pacientes más jóvenes a quienes se les habían prescrito un mayor número de comprimidos de CF y que presentaban un mayor riesgo de no cumplir el objetivo de fósforo (OR = 10,5; IC 95%, —1,8 a —16,4; p <0,001). El porcentaje de pacientes a quienes no les gustaba el CF prescrito fue del 54,5%; dichos pacientes presentaban un mayor riesgo de tener niveles séricos de fósforo >5,5 mg/dl (OR = 13.3; IC 95%, 1,1-1,5; p = 0,0001). Paradójicamente, los pacientes que no cumplían con el tratamiento demostraban un mejor conocimiento de su uso (OR = 17,3; IC 95%, 2,2-10,1; p <0.0001) e importancia (OR = 10,4; IC 95%, 1,5-6,6; p = 0,001). Conclusión: Los pacientes a los que se les habían prescrito CF que no les gustaban tenían un peor control de los niveles de fósforo sérico y se les habían recomendado dosis más altas de los fármacos. El conocimiento de las preferencias de los pacientes acerca de las medicaciones que se les prescriben puede ser un factor esencial para conseguir un mayor cumplimiento del tratamiento y, por ende, lograr mejores resultados en la consecución de los objetivos terapéuticos.

Plantas medicinais transmontanas: principais espécies e usos e sua fiabilidade no combate a problemas de saúde

Atualmente, grande parte da população recorre às terapias alternativas, verificando-se uma multiplicidade de motivos para a sua escolha. Estas são, muitas vezes, o único tratamento disponível face aos recursos médicos existentes e ao nível económico da sociedade. As plantas medicinais são tradicionalmente recolhidas pelos habitantes ou curandeiros de uma região. Em Trás-os-Montes, a propriedade vegetativa é variada e abundante em doações e pode acarretar malefícios – aspetos abordados no presente artigo.

Monstros : a ciência do mito e a sua utilidade nos videojogos

Since the classic era that monsters have been both the subject of worship and fear. Greeks used to valorize them making up new races which lived in faraway lands, in the East. There were traveler’s reports made up, from a moralist and religious point of view, always with veracity in mind, where anatomical weird beings were described. Saint Augustin tried to prove their existence, classifying them as wonders and focusing on stopping the idea of the corruption of the human soul by denying their relation between monstrous births and divine punishment. Monsters present then two distinct aspects when it comes to their origins: one that pushes back to monstrous births, seen as omens, and other that points to the existence of fantastic races in faraway places. However when it comes to structure these fantastic beings display finite compositions, not looking too different from each other. With the passage of time, besides their fearful role, monsters were being observed as scientific curiosities and at last, as recreation subjects, first in freak shows, now in several industries, being the most well know the cinematographic industry and the videogames one. Two creatures from the world known videogame World of Warcraft from Blizzard Entertainment were selected to be analyzed from a scientific point of view, were based on their features, there will be a comparative analysis with diverse anomalies and diseases (prognathism, acromegaly, cyclopia) existent , as well as comparative anatomy with other animals

Euro-enthusiasm, Euro-rejection, and various shades of grey: The 2014 European Parliament election campaign in the Netherlands. EPIN Commentary No. 18, 29 April 2014

With less than a month to go to the European Parliament (EP) election in the Netherlands on May 22nd, the campaign has barely kicked off. It remains to be seen whether the campaign will address concrete EU policies in a palatable way and whether all parties are able to present clear visions about the future of the European Union. The traditional mainstream parties (the Christian Democratic CDA, Liberal VVD and Social Democratic PvdA) all agree that EU membership is essentially beneficial to the Netherlands, but are careful to stress the shortcomings of the EU in its present form. The parties outside the traditional three that can be expected to do well adopt a more outspoken position on European integration. These include the pro-European Democrats 66 (D66), the Eurosceptic Socialist Party (SP), and the Euroreject Freedom Party (PVV). Yet, reasons for their success should probably not be sought mainlyin their positions on European integration, but rather more in the unpopularity of the incumbent parties and the „second order‟ character of EP elections.

Citizenship in post-awakening Egypt: power shifts and conflicting perceptions.

This report links Egypt’s shifting political phases to debates more specifically about citizenship rights. It offers a general overview of Egypt’s recent political trajectory, before unpacking the various dimensions of debates over citizenship rights. In each of the three political phases since Mubarak’s ousting, citizenship rights have been curtailed. Crucially, the reasons for their constriction have been different in each phase. Some limitations have derived from largely political power plays, others from more philosophical-theological factors. It is important to distinguish between these different forms of debate if we are better to understand prospects for the future of citizenship rights in Egypt.

Renewables: The great uncertainty of the EU energy strategy. Egmont Paper No. 71, November 2014

Summary. For more than two decades, the development of renewable energy sources (RES) has been an important aim of EU energy policy. It accelerated with the adoption of a 1997 White Paper and the setting a decade later of a 20% renewable energy target, to be reached by 2020. The EU counts on renewable energy for multiple purposes: to diversify its energy supply; to increase its security of supply; and to create new industries, jobs, economic growth and export opportunities, while at the same time reducing greenhouse gas (GHG) emissions. Many expectations rest on its development. Fossil fuels have been critical to the development of industrial nations, including EU Member States, which are now deeply reliant upon coal, oil and gas for nearly every aspect of their existence. Faced with some hard truths, however, the Member States have begun to shelve fossil fuel. These hard truths are as follows: firstly, fossil fuels are a finite resource, sometimes difficult to extract. This means that, at some point, fossil fuels are going to be more difficult to access in Europe or too expensive to use.1 The problem is that you cannot just stop using fossil fuels when they become too expensive; the existing infrastructure is profoundly reliant on fossil fuels. It is thus almost normal that a fierce resistance to change exists. Secondly, fossil fuels contribute to climate change. They emit GHG, which contribute greatly to climate change. As a consequence, their use needs to be drastically reduced. Thirdly, Member States are currently suffering a decline in their own fossil fuel production. This increases their dependence on increasingly costly fossil fuel imports from increasingly unstable countries. This problem is compounded by global developments: the growing share of emerging economies in global energy demand (in particular China and India but also the Middle East) and the development of unconventional oil and gas production in the United States. All these elements endanger the competitiveness of Member States’ economies and their security of supply. Therefore, new indigenous sources of energy and a diversification of energy suppliers and routes to convey energy need to be found. To solve all these challenges, in 2008 the EU put in place a strategy based on three objectives: sustainability (reduction of GHG), competitiveness and security of supply. The adoption of a renewable energy policy was considered essential for reaching these three strategic objectives. The adoption of the 20% renewable energy target has undeniably had a positive effect in the EU on the growth in renewables, with the result that renewable energy sources are steadily increasing their presence in the EU energy mix. They are now, it can be said, an integral part of the EU energy system. However, the necessity of reaching this 20% renewable energy target in 2020, combined with other circumstances, has also engendered in many Member States a certain number of difficulties, creating uncertainties for investors and postponing benefits for consumers. The electricity sector is the clearest example of this downside. Subsidies have become extremely abundant and vary from one Member State to another, compromising both fair competition and single market. Networks encountered many difficulties to develop and adapt. With technological progress these subsidies have also become quite excessive. The growing impact of renewable electricity fluctuations has made some traditional power plants unprofitable and created disincentives for new investments. The EU does clearly need to reassess its strategy. If it repeats the 2008 measures it will risk to provoke increased instability and costs.

Violencia e invisibilidad indígena : La cuestión de los pueblos originarios durante el primer peronismo

El presente trabajo busca profundizar en el análisis de los vínculos existentes entre el primer gobierno peronista y la cuestión indígena, centrándose en las políticas gubernamentales desarrolladas por el gobierno de Perón frente a dos fuertes conflictos violentos que tuvieron lugar entre 1946 y 1947: el "Malón de la paz", la movilización indígena llevada a cabo entre mayo y agosto de 1947, cuando 174 kollas caminaron 2000 kilómetros desde la Puna y el valle de Orán hasta la Capital Federal para reclamar por la titularidad de sus tierras, en manos de terratenientes y en denuncia de las condiciones de explotación en las que trabajaban; y "Masacre de Rincón Bomba", el conflicto desarrollado en una pequeña localidad de Formosa, cuando indígenas de comunidades wichi, tobas y principalmente pilagás fueron masacradas por la Gendarmería Nacional en un confuso episodio, que sale a la luz hace pocos años. El objetivo en ambos puntos es doble: por un lado analizar la relación entre los intereses e intenciones del gobierno de Juan Domingo Perón para con las comunidades originarias, visibilizando su existencia y sus condiciones de vida en tanto sujetos de derechos históricamente vulnerados. Por otro, abrir el debate historiográfico sobre el quehacer de los historiadores respecto de una temática que ha sido silenciada durante décadas, negando la existencia y la identidad de los pueblos originarios

Violencia e invisibilidad indígena : La cuestión de los pueblos originarios durante el primer peronismo

El presente trabajo busca profundizar en el análisis de los vínculos existentes entre el primer gobierno peronista y la cuestión indígena, centrándose en las políticas gubernamentales desarrolladas por el gobierno de Perón frente a dos fuertes conflictos violentos que tuvieron lugar entre 1946 y 1947: el "Malón de la paz", la movilización indígena llevada a cabo entre mayo y agosto de 1947, cuando 174 kollas caminaron 2000 kilómetros desde la Puna y el valle de Orán hasta la Capital Federal para reclamar por la titularidad de sus tierras, en manos de terratenientes y en denuncia de las condiciones de explotación en las que trabajaban; y "Masacre de Rincón Bomba", el conflicto desarrollado en una pequeña localidad de Formosa, cuando indígenas de comunidades wichi, tobas y principalmente pilagás fueron masacradas por la Gendarmería Nacional en un confuso episodio, que sale a la luz hace pocos años. El objetivo en ambos puntos es doble: por un lado analizar la relación entre los intereses e intenciones del gobierno de Juan Domingo Perón para con las comunidades originarias, visibilizando su existencia y sus condiciones de vida en tanto sujetos de derechos históricamente vulnerados. Por otro, abrir el debate historiográfico sobre el quehacer de los historiadores respecto de una temática que ha sido silenciada durante décadas, negando la existencia y la identidad de los pueblos originarios

Remunerating private psychiatrists for participating in case conferences

ABSTRACT : BACKGROUND : On 1 November 2000, a series of new item numbers was added to the Medicare Benefits Schedule, which allowed for case conferences between physicians (including psychiatrists) and other multidisciplinary providers. On 1 November 2002, an additional set of numbers was added, designed especially for use by psychiatrists. This paper reports the findings of an evaluation of these item numbers. RESULTS : The uptake of the item numbers in the three years post their introduction was low to moderate at best. Eighty nine psychiatrists rendered 479 case conferences at a cost to the Health Insurance Commission of $70,584. Psychiatrists who have used the item numbers are generally positive about them, as are consumers. Psychiatrists who have not used them have generally not done so because of a lack of knowledge, rather than direct opposition. The use of the item numbers is increasing over time, perhaps as psychiatrists become more aware of their existence and of their utility in maximising quality of care. CONCLUSION : The case conferencing item numbers have potential, but as yet this potential is not being realised. Some small changes to the conditions associated with the use of the item numbers could assist their uptake.

An investigation into the similarities and differences governing the cryopreservation success of koala (Phascolarctos cinereus: goldfuss) and common wombat (Vombatus ursinus: shaw) spermatozoa

The aim of this study was to determine the relative cryopreservation success of koala and wombat spermatozoa and to investigate reasons for their respective post-thaw survival by examining the sperm's response to a range of osmotic media and determining the presence and distribution of F-actin. An hypothesis was proposed that F-actin may be imparting a degree of structural inflexibility to the koala sperm plasma membrane; hence, exposure of spermatozoa to cytochalasin D (5 mu M), a F-actin depolymerisation agent, should result in increased plasticisation of the membrane and greater tolerance of cell volume changes that typically occur during cryopreservation. In experiment 1, koala (n = 4) and wombat (n = 4) spermatozoa packaged in 0.25 mL straws were cryopreserved using two freezing rates (fast-3 cm above liquid N2 interface; slow-6 degrees C/min in a freezing chamber) and two glycerol concentrations (8 and 14% v/v) in a tris-citrate glucose buffer with 15% (v/v) egg yolk. Wombat spermatozoa showed better (P < 0.01) post-thaw survival (% motile, % intact plasma membranes, % decondensed sperm heads) than koala spermatozoa. When exposed to media of varying osmolality, koala spermatozoa were less tolerant (% intact plasma membrane) of hyper-osmotic conditions (920 and 1410mOsmol/kg) than wombat spermatozoa. F-actin was localised using a monoclonal antibody but only found in the wombat sperm head. When koala and wombat spermatozoa were exposed to media of varying osmolality, cytochalasin D had no beneficial effect on sperm survival (% intact plasma membranes). This study has demonstrated that wombat spermatozoa are highly tolerant of cryopreservation when compared to koala sperm but that spermatozoa from both species show greatest post-thaw survival when frozen slowly in 14% glycerol. Koala sperm are also particularly susceptible to hyper-osmotic environments but lack of detectable F-actin in the koala spermatozoan suggests that poor cryopreservation success in this species is unlikely to be associated with F-actin induced plasma membrane inflexibility. (c) 2006 Elsevier Inc. All rights reserved.

MIGRAÇÃO BOLIVIANA E RELIGIÃO NA CIDADE DE SÃO PAULO: UM ESTUDO SOBRE A PRIMERA IGLESIA BAUTISTA HISPANA DE BRASIL

Esta pesquisa analisa o impacto da religião em um grupo de migrantes bolivianos na cidade de São Paulo, que organizaram uma comunidade evangélica batista na região do Pari Primeira Iglesia Bautista Hispana de Brasil. Para a realização da mesma conduzimos entrevistas com os líderes da igreja que nos ajudaram a compreender a sua organização e aplicamos 30 questionários que nos possibilitaram traçar o perfil socioeconômico de seus membros e ajudaram a identificar os motivos de sua migração e adesão a esta comunidade.

O IMPACTO DAS REDES SOCIAIS NA PROFISSÃO DOCENTE

Diante do grande avanço tecnológico e utilização de equipamentos e diversas ferramentas no ensino, além da conectividade a qualquer momento, é possível perceber o grande crescimento do uso das redes sociais tanto pelos alunos como pelos professores. Com este crescimento observa-se uma comunicação mais intensa entre aluno e professor fora do ambiente da sala de aula, principalmente por intermédio das redes sociais, com a comunicação eletrônica envolvendo e-mails, conversas online, trocas de arquivos, fotos, vídeos etc. Considerando essa nova realidade esta pesquisa objetivou investigar se existe um impacto dessa nova forma de comunicação na profissão docente. Nesse contexto, tendo como foco privilegiado o facebook, emergiram alguns questionamentos para análise: essa nova ferramenta auxilia na relação professor-aluno? Ela pode trazer algum impacto positivo e/ou negativo para o professor? Qual a influência do uso dessa rede social nas relações trabalhistas? Sua existência e o seu uso podem influenciar nas decisões da coordenação/direção da escola? O estudo partiu do pressuposto de que as redes sociais exercem impactos positivos e negativos, pois podem se constituir como ferramentas que auxiliam a prática pedagógica. No entanto, no que se refere às relações trabalhistas e também, às relações interpessoais, o professor pode estar vulnerável quanto às suas relações institucionais e profissionais. Fundamentada nas concepções de autores que discorrem sobre a utilização dessas redes, e sobre as características do trabalho frente às novas demandas do capital, a pesquisa de campo, do tipo exploratória, direcionou-se no sentido de identificar esses fatores por meio da análise dos dados investigados com professores que utilizam a rede social facebook. Os resultados confirmaram que há impactos de diversas naturezas no trabalho docente. Esta nova ferramenta, ao mesmo tempo em que pode auxiliar na relação professor-aluno, expõe o docente, e é utilizada, pelas instituições de ensino, como instrumento de controle e de exercício de poder que se refletem nas relações trabalhistas.

Introducción

Sexualidad y Escritura (1850-2000) is a collection of thirteen essays which focus on the complex relationship between gender and writing in Spain from 1850 to 2000. This collection aims to provide a specifically Spanish cultural and historical context to the study of gender and writing and to challenge the effectiveness and validity of applying and adapting some feminist theory (based mainly in French and Anglo literary traditions) to works by both male and female Spanish writers. The introduction sets the tone of the essays it contains by discussing the Gilbert and Guar’s concept of female authors anxiety of authorship, and the reasons why their notions of the male dominated writing profession does not necessarily apply to Spanish literature of the nineteenth century in particular. The notable presence and success of female writers during the Romantic period and the way in which they in effect managed to feminize the writing profession illustrates how very different the Spanish literary context is from French, English or American models. The editors state that, rather than needing to work up the courage to take up the pen and publish their works, the issue facing Spanish women writers during parts of the last 150 years has been how to either maintain or regain their authorial voice and their place in letters, fighting to keep their heads above the rising and falling tides of literary trends.

The influence of age and trait attributions on recruitment selection

The role of interpersonal attraction into the recruitment selection is gaining research attention. Early work in the domain of the influence of attraction in organisations suggested that men are given more resources, such as higher salaries and promotions. However, recent research has found women have an automatic in-group bias. It was suggested that female interviewers are more likely to hire another female. In contrast, male interviewers were found to be equally as likely to hire men as women. To resolve these two conflicting findings a behavioural experiment was set up looking at gender, attractiveness and recruitment selection. Forty participants, twenty male and twenty female, of varying ages (18-65) were recruited through age stratified sampling. Participants took on the role of manager of a medium sized company and were shown twenty photographs of faces previously rated for attractiveness. On initial viewing participants were asked to decide whether they would firstly hire the person and secondly give as many reasons for their decision. Findings from this research show that in all age groups male and female participants gave females (especially attractive females) more jobs, except in the case of the 18-21 year old females who gave attractive males more jobs. On examining the reasons behind the participant’s decisions, it was evident that if you appeared confident, friendly, youthful and attractive you were 46% more likely to receive the job. However, if you were perceived to be untrustworthy, lazy, arrogant and unintelligent you were 49% more likely not to receive the job. These findings shed light on the various processes that may underpin human resource decisions in an organisational setting.

Appraising qualitative research for inclusion in systematic reviews:A quantitative and qualitative comparison of three methods

Objective: Qualitative research is increasingly valued as part of the evidence for policy and practice, but how it should be appraised is contested. Various appraisal methods, including checklists and other structured approaches, have been proposed but rarely evaluated. We aimed to compare three methods for appraising qualitative research papers that were candidates for inclusion in a systematic review of evidence on support for breast-feeding. Method: A sample of 12 research papers on support for breast-feeding was appraised by six qualitative reviewers using three appraisal methods: unprompted judgement, based on expert opinion; a UK Cabinet Office quality framework; and CASP, a Critical Appraisal Skills Programme tool. Papers were assigned, following appraisals, to 1 of 5 categories, which were dichotomized to indicate whether or not papers should be included in a systematic review. Patterns of agreement in categorization of papers were assessed quantitatively using κ statistics, and qualitatively using cross-case analysis. Results: Agreement in categorizing papers across the three methods was slight (κ =0.13; 95% CI 0.06-0.24). Structured approaches did not appear to yield higher agreement than that by unprompted judgement. Qualitative analysis revealed reviewers' dilemmas in deciding between the potential impact of findings and the quality of the research execution or reporting practice. Structured instruments appeared to make reviewers more explicit about the reasons for their judgements. Conclusions: Structured approaches may not produce greater consistency of judgements about whether to include qualitative papers in a systematic review. Future research should address how appraisals of qualitative research should be incorporated in systematic reviews. © The Royal Society of Medicine Press Ltd 2007.