Adipose tissue concentrations of persistent organic pollutants and total cancer risk in an adult cohort from Southern Spain: preliminary data from year 9 of the follow-up.

There is an increasing trend in the incidence of cancer worldwide, and it has been accepted that environmental factors account for an important proportion of the global burden. The present paper reports preliminary findings on the influence of the historical exposure to a group of persistent organic pollutants on total cancer risk, at year 9 in the follow-up of a cohort from Southern Spain. A cohort of 368 participants (median age 51 years) was recruited in 2003. Their historical exposure was estimated by analyzing residues of persistent organic pollutants in adipose tissue. Estimation of cancer incidence was based on data from a population-based cancer registry. Statistical analyses were performed using multivariable Cox-regression models. In males, PCB 153 concentrations were positively associated with total cancer risk, with an adjusted hazard ratio (95% confidence interval) of 1.20 (1.01-1.41) for an increment of 100 ng/g lipid. Our preliminary findings suggest a potential relationship between the historical exposure to persistent organic pollutants and the risk of cancer in men. However, these results should be interpreted with caution and require verification during the future follow-up of this cohort.

Correcting non cephalic presentation with moxibustion: study protocol for a multi-centre randomised controlled trial in general practice.

BACKGROUND Non cephalic presentation in childbirth involves various risks to both the mother and the foetus. The incidence in Spain is 3.8% of all full-term pregnancies. The most common technique used to end the gestation in cases of non cephalic presentation is that of caesarian section, and although it provokes a lower rate of morbi-mortality than does vaginal delivery in such situations, there remains the possibility of traumatic injury to the foetal head and neck, while maternal morbidity is also increased. The application of heat (moxibustion) to an acupuncture point, in order to correct non cephalic presentation, has been practised in China since ancient times, but as yet there is insufficient evidence of its real effectiveness. METHODS/DESIGN The experimental design consists of a multi-centre randomised controlled trial with three parallel arms, used to compare real moxibustion, sham moxibustion and the natural course of events, among pregnant women with a non cephalic presentation and a gestational duration of 33-35 weeks (estimated by echography). The participants in the trial will be blinded to both interventions. The results obtained will be analyzed by professionals, blinded with respect to the allocation to the different types of intervention. In addition, we intend to carry out a economic analysis. DISCUSSION This trial will contribute to the development of evidence concerning moxibustion in the correction of non cephalic presentations. The primary outcome variable is the proportion of cephalic presentations at term. As secondary outcomes, we will evaluate the proportion of cephalic presentations at week 38 of gestation, determined by echography, together with the safety of the technique, the specificity of moxibustion and the control of the blinding process. This study has been funded by the Health Ministry of the Andalusian Regional Government. TRIAL REGISTRATION Current Controlled Trials ISRCTN10634508.

Individualized Therapy with Ranibizumab in Wet Age-Related Macular Degeneration.

Individualized treatment regimens may reduce patient burden with satisfactory patient outcomes in neovascular age-related macular degeneration. Intravitreal anti-VEGF drugs are the current gold standard. Fixed monthly injections offer the best visual outcome but this regimen is not commonly followed outside clinical trials. A PRN regimen requires monthly visits where the patient is treated in the presence of signs of lesion activity. Therefore, an early detection of reactivation of the disease with immediate retreatment is crucial to prevent visual acuity loss. Several trials suggest that "treat and extend" and other proactive regimens provide a reasonable approach. The rationale of the proactive regimens is to perform treatment anticipating relapses or recurrences and therefore avoid drops in vision while individualizing patient followup. Treat and extend study results in significant direct medical cost savings from fewer treatments and office visits compared to monthly treatment. Current data suggest that, for one year, PRN is less expensive, but treat and extend regimen would likely be less expensive for subsequent years. Once a patient is not a candidate to continue with treatment, he/she should be sent to an outpatient unit with adequate resources to follow nAMD patients in order to reduce the burden of specialized ophthalmologist services.

Desarrollo y evaluación psicométrica de una forma abreviada de la escala de posicionamiento ante el diagnóstico enfermero

El Position on Nursing Diagnosis (PND) es una escala que utiliza la técnica del diferencial semántico para medir las actitudes hacia el concepto diagnóstico enfermero. El estudio objetivó desarrollar una forma abreviada de la versión española de esta escala, evaluar sus propiedades psicométricas y eficiencia. Se utilizó un doble enfoque empírico-teórico para obtener una forma reducida del PND, el PND-7-SV, que fuera equivalente a la original. Mediante un diseño transversal a través de encuesta, se evaluó la fiabilidad (consistencia interna y fiabilidad test-retest), validez de constructo (análisis factorial exploratorio, técnica de grupos conocidos y validez discriminante) y de criterio (validez concurrente), sensibilidad al cambio y eficiencia del PND-7-SV en una muestra de 476 estudiantes de enfermería españoles. Los resultados avalaron la utilidad del PND-7-SV para medir las actitudes hacia el diagnóstico enfermero de manera equivalente a la forma completa de la escala y en un tiempo más reducido.

Effects of web-based electrocardiography simulation on strategies and learning styles

OBJECTIVETo identify the association between the use of web simulation electrocardiography and the learning approaches, strategies and styles of nursing degree students.METHODA descriptive and correlational design with a one-group pretest-posttest measurement was used. The study sample included 246 students in a Basic and Advanced Cardiac Life Support nursing class of nursing degree.RESULTSNo significant differences between genders were found in any dimension of learning styles and approaches to learning. After the introduction of web simulation electrocardiography, significant differences were found in some item scores of learning styles: theorist (p < 0.040), pragmatic (p < 0.010) and approaches to learning.CONCLUSIONThe use of a web electrocardiogram (ECG) simulation is associated with the development of active and reflexive learning styles, improving motivation and a deep approach in nursing students.

Concepção de uma Estratégia de Geoconservação para Cabo Verde e sua Aplicação à Ilha de Santiago

A singularidade de certos registos geológicos impressos em rochas, as peculiaridades estruturais e dinâmicas dos diversos elementos dos geossistemas, a análise dos seus valores intrínsecos, bem como da sua vulnerabilidade e dos perigos de degradação que os podem afectar, entre outros parâmetros, são factores que concorrem para a necessidade de assegurar a conservação do património geológico. É neste contexto que surge a geoconservação que preconiza a gestão do património geológico com base num conjunto de medidas e acções para a identificação, manutenção ou recuperação do valor natural dos elementos da geodiversidade numa perspectiva de sustentabilidade dos recursos geológicos que integram a componente abiótica do sistema natural. A geoconservação, à escala internacional, tem um desenvolvimento irregular. Enquanto algumas regiões estão bastante avançadas, como na Europa, outras revelam ainda alguma inércia relativamente à implementação de iniciativas que se devem enquadrar no âmbito da conservação da Natureza e do ordenamento do território. Em África, são ainda pontuais os exemplos de geoconservação pelo que, este trabalho, pretende ser promotor de uma política de geoconservação neste continente. No presente trabalho, concebemos uma estratégia de geoconservação para Cabo Verde e aplicamo-la, a título de exemplo, à ilha de Santiago. A metodologia utilizada, baseada em critérios internacionalmente reconhecidos e aceites para o inventário do património geológico de valor científico, consiste no estabelecimento de “categorias temáticas” que representam as características e evolução geológica do arquipélago. Foram propostas nove categorias para Cabo Verde e, para cada uma delas, foram inventariados diversos locais de interesse, dos quais 40 foram propostos como geossítios na ilha de Santiago. Com base nestes geossítios, propuseram-se linhas metodológicas para as etapas subsequentes que integram uma estratégia de geoconservação, nomeadamente, a quantificação, classificação, conservação, valorização, divulgação e monitorização de geossítios. Embora a conservação da geodiversidade esteja prevista, embora de forma pouco clara, na actual legislação ambiental cabo-verdiana, a execução desta estratégia de geoconservação poderá representar um dos primeiros passos para a definição, caracterização e valorização, sistemáticas, do património geológico nacional e contribuir para a implementação de uma política de sustentabilidade ambiental para o país.

O realismo na escrita poética de Manuel Lopes

O realismo apresenta em Cabo Verde particularidades próprias. Se em Portugal e noutros países foi um movimento literário e idiológico-político empenhado em soluções transformadoras da sociedade pela via da função social da arte, pela desmistificação da consciência e pela oposição ao capitalista e ao burguês, em Cabo Verde, por razões naturais, geográficas e sociais contextualiza-se assumindo outras preocupações. Manuel Lopes, com o tempo, sem esquecer o plano subjectivo, envereda por uma escrita poética com implicações objectivistas tematizando os problemas crioulos mais prementes: seca, isolamento, fome, emigração. A objectividade e a subjectividade são, por isso, duas características do realismo cabo-verdiano. Os paradigmas, São Vicente-Mar (urbanidade) e Santo Antão-terra (ruralidade) e ainda a dinâmica de oposição entre o partir/ficar informam decisivamente a sua poesia.

Uso de los medios digitales en la gestión de la reputación corporativa : diálogo con los públicos de interés y dimensiones de percepción en webs, blogs, Facebook y Twitter

Aquest treball busca analitzar com poden emprar-se els mitjans digitals per contribuir a la gestió de la Reputació Corporativa, per ajudar a la comprensió del fenomen i a abordar-la en la pràctica des dels marcs de referència desenvolupats i validats en l'acadèmia. En primer lloc, s'empra una metodologia qualitativa i una anàlisi de continguts per analitzar els principals mitjans digitals –Webs, Blogs, Facebook i Twitter- en funció del seu potencial per a la generació de diàleg entre les organitzacions i els seus grups d'interès. S'analitzen a profunditat els mitjans digitals de 5 companyies Top 20 en el Rànquing RepTrak 2012. En segon lloc, es planteja una anàlisi d'aquests mitjans digitals en funció de les set dimensions que impulsen la Reputació Corporativa, seguint la metodologia RepTrak del Reputation Institute

Campaña gráfica para nueva marca de vinos Enjoy Me

La presente memoria desarrolla la campaña gráfica de un nuevo producto comercializado exclusivamente online. Esto implica la creación del naming, imagen gráfica de la nueva marca y definición de un concepto que declinará en las diversas piezas gráficas desarrolladas para el lanzamiento y difusión del nuevo producto. El producto a desarrollar es un vino de alta calidad, que únicamente se comercializa online. Este vino tiene Denominación de Origen de Calidad del Priorato, en Tarragona y está elaborado con métodos biodinámicos, que otorgan al vino unas altas cualidades naturales y ecológicas. Por esta razón, el presente proyecto contiene un doble interés, desde el punto de vista de comunicación gráfica y por otro lado, vinícola ecológico, puesto que documentaremos el trabajo con información de este sector.

Treatment patterns and health care resource utilization in a 1-year observational cohort study of outpatients with schizophrenia at risk of nonadherence treated with long-acting injectable antipsychotics

Purpose: To describe (1) the clinical profiles and the patterns of use of long-acting injectable (LAI) antipsychotics in patients with schizophrenia at risk of nonadherence with oral antipsychotics, and in those who started treatment with LAI antipsychotics, (2) health care resource utilization and associated costs. Patients and methods: A total of 597 outpatients with schizophrenia at risk of nonadherence, according to the psychiatrist's clinical judgment, were recruited at 59 centers in a noninterventional prospective observational study of 1-year follow-up when their treatment was modified. In a post hoc analysis, the profiles of patients starting LAI or continuing with oral antipsychotics were described, and descriptive analyses of treatments, health resource utilization, and direct costs were performed in those who started an LAI antipsychotic. Results: Therapy modifications involved the antipsychotic medications in 84.8% of patients, mostly because of insufficient efficacy of prior regimen. Ninety-two (15.4%) patients started an LAI antipsychotic at recruitment. Of these, only 13 (14.1%) were prescribed with first-generation antipsychotics. During 1 year, 16.3% of patients who started and 14.9% of patients who did not start an LAI antipsychotic at recruitment relapsed, contrasting with the 20.9% who had been hospitalized only within the prior 6 months. After 1 year, 74.3% of patients who started an LAI antipsychotic continued concomitant treatment with oral antipsychotics. The mean (median) total direct health care cost per patient per month during the study year among the patients starting any LAI antipsychotic at baseline was 1,407 ( 897.7). Medication costs (including oral and LAI antipsychotics and concomitant medication) represented almost 44%, whereas nonmedication costs accounted for more than 55% of the mean total direct health care costs. Conclusion: LAI antipsychotics were infrequently prescribed in spite of a psychiatrist-perceived risk of nonadherence to oral antipsychotics. Mean medication costs were lower than nonmedication costs.

Las Topografías médicas burgalesas : 1884-1917. Un intento de contribución a la historia natural, social y sanitaria de la província de Burgos en los siglos XIX y XX

Aquest és un dels treballs de López Gómez que s'insereix en la línia d'estudi de les topografies mèdiques com a material molt útil per al¿estudi de la història de la medicina a nivell local. En aquest cas estudia les topografies mèdiques de la província de Burgos a partir de documents conservats a l¿Arxiu de la Reial Acadèmia de Medicina de Barcelona. També inclou un petit estudi sobre la biografia i obra del doctor Ildefonso Díez Santaolalla (1851-1929).

Some game-theoretic grounds for meeting people half-way

It is well known that, in distributions problems, fairness rarely leads to a single viewpoint (see, for instance, Young (1994)). In this context, this paper provides interesting bases that support the simple and commonly observed behavior of reaching intermediate agreements when two prominent distribution proposals highlight a discrepancy in sharing resources. Specifi cally, we formalize such a conflicting situation by associating it with a `natural' cooperative game, called bifocal distribution game, to show that both the Nucleolus (Schmeidler (1969)) and the Shapley value (Shapley (1953a)) agree on recommending the average of the two focal proposals. Furthermore, we analyze the interpretation of the previous result by means of axiomatic arguments. Keywords: Distribution problems, Cooperative games, Axiomatic analysis, Nucleolus, Shapley value. JEL Classi fication Numbers: C71, D63, D71.

La intensificación agrícola y la diversidad vegetal en los sistemas cerealistas de secano mediterráneos: implicaciones para la conservación

El trabajo analiza la importancia de la diversidad vegetal en los agroecosistemas y los efectos de la intensificación de las prácticas agrícolas y del paisaje sobre la diversidad vegetal. La revisión de diversos estudios llevados a cabo por el equipo de investigación permite destacar que la intensificación agrícola, tanto a escala de campo como de paisaje, afecta negativamente la abundancia y la riqueza específica de la flora. La comparación de la flora arvense de los cultivos cerealistas de secano mediterráneos entre los años 50 y la actualidad refleja la reducción de la flora arvense, especialmente de la flora propia de las mieses y la disminución de la abundancia de grupos funcionales como las leguminosas y las plantas entomófilas. El efecto de las prácticas agrícolas y de la complejidad del paisaje varía en función de la flora estudiada. Así, la complejidad del paisaje es el principal factor que afecta la configuración de la vegetación de los márgenes, mientras que la intensidad de las prácticas agrícolas es el principal factor para explicar las diferencias en la flora arvense en el centro de los campos. Por último, el artículo analiza diversas propuestas para la gestión de los agrosistemas con el objetivo de conciliar la producción agrícola y la conservación de la biodiversidad en la región mediterránea.