Small-area variation in health care affecting the choice of cesarean delivery: the case of a Colombian health insurer

In the midst of health care reform, Colombia has succeeded in increasing health insurance coverage and the quality of health care. In spite of this, efficiency continues to be a matter of concern, and small-area variations in health care are one of the plausible causes of such inefficiencies. In order to understand this issue, we use individual data of all births from a Contributory-Regimen insurer in Colombia. We perform two different specifications of a multilevel logistic regression model. Our results reveal that hospitals account for 20% of variation on the probability of performing cesarean sections. Geographic area only explains 1/3 of the variance attributable to the hospital. Furthermore, some variables from both demand and supply sides are found to be also relevant on the probability of undergoing cesarean sections. This paper contributes to previous research by using a hierarchical model and by defining hospitals as cluster. Moreover, we also include clinical and supply induced demand variables.

Universidad y sociedad. Extensión universitaria, conocimiento y redes sociales

A pesar de las múltiples inflexiones que en los últimos siglos se han dado en el mundo (Kuhn, 1962), aún se mantiene el empeño de entenderlo a través de un pensamiento limitado que debe conducir a una reflexión acerca de cómo se entiende y cómo evoluciona la vida. La transformación y el cambio de paradigmas de los últimos años no son más que una manifestación de la evolución del pensamiento humano y de las visiones de la realidad (Fritjof, 2004). La extensión del conocimiento es una respuesta a la inquietud social respecto a la necesidad sentida de un cambio en los modos de actuar y en las estructuras del pensamiento (innovación social), en la que se desarrolle un proceso de trasformación de las instituciones y la aplicación de los valores, para reorientar el curso del desarrollo humano, es decir, el curso de la realidad, para lo cual es necesaria una nueva visión de la vida.

Las adicciones a la luz del psicoanálisis, una revisión de literatura

El presente trabajo de grado es una revisión de la literatura que permite hacer un recorrido desde el psicoanálisis acerca de la compleja problemática de las adicciones. Para ello, se revisaron las bases de datos PepWeb, Ebsco, y Jstor, revisando las posiciones del psicoanálisis freudiano, lacaniano y otras corrientes psicoanalíticas respondiendo a las siguientes preguntas de investigación: (a) ¿Cómo se comprenden las adicciones desde un marco de referencia psicoanalítico? (b) ¿Cómo –desde la teoría freudiana y la teoría lacaniana - se aborda la comprensión de la adicción? (c) ¿Qué dice el psicoanálisis contemporáneo sobre ésta problemática? Se abordan temas como la concepción de una adicción desde la perspectiva de Freud y Lacan hasta psicoanalistas contemporáneos, el rol que juega el goce en la adicción y, finalmente, el complejo debate incipiente sobre la legalidad del tóxico. Se encontró que es un campo de constante publicación y es necesario que los clínicos y los psicoanalistas aborden este campo de estudio clínico permanentemente y sigan produciendo investigaciones sobre el fenómeno.

Does uncertainty cause inertia in decision making? An experimental study of the role of regret aversion and indecisiveness

Previous research has shown that often there is clear inertia in individual decision making---that is, a tendency for decision makers to choose a status quo option. I conduct a laboratory experiment to investigate two potential determinants of inertia in uncertain environments: (i) regret aversion and (ii) ambiguity-driven indecisiveness. I use a between-subjects design with varying conditions to identify the effects of these two mechanisms on choice behavior. In each condition, participants choose between two simple real gambles, one of which is the status quo option. I find that inertia is quite large and that both mechanisms are equally important.

Estudio experimental de las repercusiones del clima motivacional sobre la orientación de meta, la motivación intrínseca y los comportamientos disruptivos en las clases de educación física.

Resumen tomado de la publicación

Diseño y evaluación de un programa de intervención psicoeducativa para la educación en derechos humanos durante la adolescencia.

1) Diseñar un programa de intervención psicoeducativa para la educación en derechos humanos durante la adolescencia, 2) implementarlo semanalmente durante un curso escolar, y 3) evaluar sus efectos en diversas variables del desarrollo social y afectivo-emocional relacionadas con la educación en los derechos humanos. Hipótesis general: el programa va a ejercer un impacto positivo mejorando el desarrollo social y personal de los adolescentes. En concreto se plantean 15 hipótesis relacionadas con 5 ejes: conducta social, variables cognitivas, rasgos de personalidad, interacciones, problemas de conducta. En el capítulo 1, se presentan los antecedentes del trabajo y la fundamentación teórica del programa diseñado. 174 adolescentes de 12 a 14 años de dos centros escolares de la provincia de Guipúzcoa, ubicados en un ámbito socio-cultural y económico medio. Mediante un procedimiento de azar, se asignan 125 sujetos a la condición experimental (4 grupos) y 49 desempeñan la condición de control (2 grupos). 3 fases: al inicio del curso escolar, en 1997, se operó una evaluación pretest administrando a los adolescentes experimentales y control, distintos tests y pruebas de evaluación. Posteriormente, se implementó el programa de intervención con los 4 grupos experimentales. Consistió en la administración de una sesión de intervención semanal de 2 horas, durante todo el curso escolar. En tercer lugar, al finalizar el curso, en mayo de 1998, se realizó de nuevo una evaluación postest aplicándose a toda la muestra (experimentales y control) los mismos instrumentos de evaluación que en la fase pretest. Además, en esta última fase se incluyeron dos cuestionarios de evaluación del programa con la finalidad de captar la percepción subjetiva de los implicados en el mismo. El programa de intervención es la variable independiente mientras que las variables dependientes son: los prejuicios, la capacidad para analizar sentimientos, las estrategias cognitivas de resolución de situaciones sociales conflictivas, diversos problemas de conducta, las interacciones amistosas y prosociales intragrupo, variadas conductas sociales, el autoconcepto-autoestima, la imagen de los demás, la ansiedad y la empatía. BAS 3, Batería de socialización 1989, EPIJ: Evaluación de la Personalidad Infanto Juvenil, Silva y Martorell; AFA, Autoconcepto, Musitu, García y Gutiérrez, 1991; Inventario de altruismo, Ma y Leung, 1991; ADCA-1, Autoinforme de conducta asertiva, García y Magaz, 1994; Cuestionario de evaluación de la empatía, basado en el cuestionario de Merhabian y Epstein, 1972; STAIC, Spielberg y colaboradores, 1973-1990; EPC, Escala de problemas de conducta, Navarro, Peiró, Llacer y Silva, 1993; AC, Escala de Autoconcepto, Martorell, Aloy, Gómez y Silva, 1993; EA, Escala de asertividad, Godoy, Gavino, Blanco, Martorell y Silva, 1993; ASB, Escala de conducta antisocial, Adaptación de Martorell y Silva, 1993; varios cuestionarios de evaluación, listados de adjetivos, y de frases incompletas, y sociométricos, ad hoc, de Garaigordobil. El programa ha ejercido un efecto significativamente positivo tanto en el desarrollo personal como social al haber promovido: 1) una mejora de las Relaciones Intragrupo Amistosas y Prosociales, 2) una disminución de los prejuicios hacia distintos grupos socioculturales, y de problemas de conducta antisocial, 3) un aumento de la asertividad, 4) un descenso de la ansiedad, 5) un aumento de las conductas sociales de consideración con los demás junto con un incremento de las conductas de liderazgo, 6) la inhibición del aumento de diversas conductas antisociales algunas de las cuales son esperables en este período evolutivo, 7) un incremento de la capacidad de empatía disposicional, 8) una mejora del autoconcepto, 9) una tendencial mejora del autoconcepto-autoestima, 10) un aumento del autoconcepto social, 11) una elevación del concepto o imagen que se tiene de los compañeros del grupo, 12) un aumento de la cantidad de estrategias cognitivas asertivas de resolución de situaciones sociales, así como la cantidad total de estrategias cognitivas disponibles para afrontar situaciones sociales, 13) un incremento de las conductas asertivas en diversas situaciones de interacción social con iguales, y 14) una mejora de la capacidad para analizar sentimientos. Los resultados, por un lado, validan la eficacia del programa para un amplio conjunto de objetivos de desarrollo personal y social relacionados con la educación en derechos humanos, y por otro lado, apuntan en la misma dirección de otras investigaciones que ponen de relieve los positivos efectos de este tipo de experiencias que combinan diversas técnicas de dinámica de grupos en el contexto de actividades que promueven comunicación, cooperación, confianza en uno mismo y los demás, respeto por las diferencias,... Se destacan principalmente dos limitaciones: la dificultad de encontrar instrumentos estandarizados para explorar las variables cognitivas; y la relacionada con las características de la muestra seleccionada. Así, se podría sugerir como futuro trabajo administrar el programa en distintos ambientes socio-culturales, evaluando sus diferenciales efectos.

La participación de las familias en los centros escolares de Educación Primaria

Resumen basado en el de la publicación

Mental health, coping and family-functioning in parents of young people with obsessive-compulsive disorder and with anxiety disorders

Objective. To compare mental health, coping and family-functioning in parents of young people with obsessive-compulsive disorder (OCD), anxiety disorders, and no known mental health problems. Method. Parents of young people with OCD (N=28), other anxiety disorders (N=28), and no known mental health problems (N=62) completed the Brief Symptom Inventory (Derogatis, 1993), the Coping Responses Inventory (Moos, 1990), and the McMaster family assessment device (Epstein, Baldwin, & Bishop, 1983). Results. Parents of children with OCD and anxiety disorders had poorer mental health and used more avoidant coping than parents of non-clinical children. There were no group differences in family-functioning. Conclusion. The similarities across the parents of clinically referred children suggest that there is a case for encouraging active parental involvement in the treatment of OCD in young people.

Consensus Statement: Chromosomal Microarray Is a First-Tier Clinical Diagnostic Test for Individuals with Developmental Disabilities or Congenital Anomalies

Chromosomal microarray (CMA) is increasingly utilized for genetic testing of individuals with unexplained developmental delay/intellectual disability (DD/ID), autism spectrum disorders (ASD), or multiple congenital anomalies (MCA). Performing CMA and G-banded karyotyping on every patient substantially increases the total cost of genetic testing. The International Standard Cytogenomic Array (ISCA) Consortium held two international workshops and conducted a literature review of 33 studies, including 21,698 patients tested by CMA. We provide an evidence-based summary of clinical cytogenetic testing comparing CMA to G-banded karyotyping with respect to technical advantages and limitations, diagnostic yield for various types of chromosomal aberrations, and issues that affect test interpretation. CMA offers a much higher diagnostic yield (15%-20%) for genetic testing of individuals with unexplained DD/ID, ASD, or MCA than a G-banded karyotype (similar to 3%, excluding Down syndrome and other recognizable chromosomal syndromes), primarily because of its higher sensitivity for submicroscopic deletions and duplications. Truly balanced rearrangements and low-level mosaicism are generally not detectable by arrays, but these are relatively infrequent causes of abnormal phenotypes in this population (<1%). Available evidence strongly supports the use of CMA in place of G-banded karyotyping as the first-tier cytogenetic diagnostic test for patients with DD/ID, ASD, or MCA. G-banded karyotype analysis should be reserved for patients with obvious chromosomal syndromes (e.g., Down syndrome), a family history of chromosomal rearrangement, or a history of multiple miscarriages.

Immunohistochemical analysis of neuron types in the mouse small intestine

The definition of the nerve cell types of the myenteric plexus of the mouse small intestine has become important, as more researchers turn to the use of mice with genetic mutations to analyze roles of specific genes and their products in enteric nervous system function and to investigate animal models of disease. We have used a suite of antibodies to define neurons by their shapes, sizes, and neurochemistry in the myenteric plexus. Anti-Hu antibodies were used to reveal all nerve cells, and the major subpopulations were defined in relation to the Hu-positive neurons. Morphological Type II neurons, revealed by anti-neurofilament and anti-calcitonin gene-related peptide antibodies, represented 26% of neurons. The axons of the Type II neurons projected through the circular muscle and submucosa to the mucosa. The cell bodies were immunoreactive for choline acetyltransferase (ChAT), and their terminals were immunoreactive for vesicular acetylcholine transporter (VAChT). Nitric oxide synthase (NOS) occurred in 29% of nerve cells. Most were also immunoreactive for vasoactive intestinal peptide, but they were not tachykinin (TK)-immunoreactive, and only 10% were ChAT-immunoreactive. Numerous NOS terminals occurred in the circular muscle. We deduced that 90% of NOS neurons were inhibitory motor neurons to the muscle (26% of all neurons) and 10% (3% of all neurons) were interneurons. Calretinin immunoreactivity was found in a high proportion of neurons (52%). Many of these had TK immunoreactivity. Small calretinin neurons were identified as excitatory neurons to the longitudinal muscle (about 20% of neurons, with ChAT/calretinin/+/- TK chemical coding). Excitatory neurons to the circular muscle (about 10% of neurons) had the same coding. Calretinin immunoreactivity also occurred in a proportion of Type II neurons. Thus, over 90% of neurons in the myenteric plexus of the mouse small intestine can be currently identified by their neurochemistry and shape.

Essential role of nuclear factor-kappa B for NADPH oxidase activity in normal and anhildrotic ectodermal dysplasia leukocytes

This work investigated the functional role of nuclear factor-kappa B (NF-kappa B) in respiratory burst activity and in expression of the human phagocyte nicotinamide adenine dinucleotide phosphate (NADPH) oxidase genes CYBB, CYBA, NCF1, and NCF2. U937 cells with a stably transfected repressor of NF-kappa B (IKB alpha-S32A/S36A) demonstrated significantly lower superoxide release and lower CYBB and NCF1 gene expression compared with control U937 cells. We further tested Epstein-Barr virus (EBV)-transformed B cells from patients with anhidrotic ectodermal dysplasia with immunodeficiency (EDA-ID), an inherited disorderof NF-kappa B function. Superoxide release and CYBB gene expression by EDA-ID cells were significantly decreased compared with healthy cells and similar to cells from patients with X-linked chronic granulomatous disease (X91 degrees CGD). NCF1 gene expression in EDA-ID S321 cells was decreased compared with healthy control cells and similar to that in autosomal recessive (A47 degrees) CGD cells. Gel shift assays demonstrated loss of recombinant human p50 binding to a NF-kappa B site 5` to the CYBB gene in U937 cells treated with NF-kappa B inhibitors, repressor-transfected U937 cells, and EDA-ID patients cells. Zymosan phagocytosis was not affected by transfection of U937 cells with the NF-kappa B repressor. These studies show that NF-kappa B is necessary for CYBB and NCF1 gene expression and activation of the phagocyte NADPH oxidase in this model system.

Occurrence of herpes simplex virus 1 and three periodontal bacteria in patients with chronic periodontitis and necrotic pulp

Viral and bacterial associations appear to be implicated in the development of periodontal infections. Little information is available describing the periodontopathic agents in root canals with necrotic pulp. In this study, the occurrence and the combinations among herpes simplex virus type 1 (HSV-1) and Dialister pneumosintes, Tannerella forsythia.. and Treponema denticola in patients with chronic periodontitis and necrotic pulp were evaluated. Clinical samples from healthy subjects and patients with periodontal or pulp infections were analyzed using a nested polymerase chain reaction PCR to detect HSV and PCR to detect the 3 periodontal bacteria. The presence of Tannerella forsythia and Treponema denticola was observed in healthy, periodontitis, and necrotic pulp patients. HSV was observed in periodontitis and necrotic pulp patients, and no healthy subject harbored D. pneumosintes or HSV. The occurrence of Tannerella forsythia was not statistically significant in patients with necrotic pulp (P = 0.704). Periodontal bacteria were observed varying from 10.3% to 20.7% in periodontitis and necrotic pulp patients. The presence of Treponema denticola - HSV association was predominant in patients showing necrotic pulp (24.1%); however, HSV alone was observed in one patient with periodontitis and in another patient with necrotic pulp. The presence of double association among bacteria or bacteria - HSV could indicate a role in both periodontitis and necrotic pulp, and Tannerella forsythia - Treponenta denticola - HSV and Tannerella forsythia - D. pneumosintes - Treponema denticola - HSV associations might be important in periodontitis.

Association of Human T Lymphotropic Virus 1 Amplification of Periodontitis Severity with Altered Cytokine Expression in Response to a Standard Periodontopathogen Infection

Background. Periodontal diseases (PDs) are infectious diseases in which periodontopathogens trigger chronic inflammatory and immune responses that lead to tissue destruction. Recently, viruses have been implicated in the pathogenesis of PDs. Individuals infected with human T lymphotropic virus 1 (HTLV-1) present with abnormal oral health and a marked increased prevalence of periodontal disease. Methods. In this study, we investigated the patterns of periodontopathogen infection and local inflammatory immune markers in HTLV-1-seropositive individuals with chronic periodontitis (CP/HTLV-1 group) compared with HTLV-1 -seronegative individuals with chronic periodontitis (CP group) and periodontally healthy, HTLV-1 -seronegative individuals (control group). Results. Patients in the CP/HTLV-1 group had significantly higher values of bleeding on probing, mean probing depth, and attachment loss than patients in the CP group. The expression of tumor necrosis factor a and interleukin (IL) 4 was found to be similar in the CP and CP/HTLV-1 groups, whereas IL-12 and IL-17 levels trended toward a higher expression in the CP/HTLV-1 group. A significant increase was seen in the levels of IL-1 beta and interferon gamma in the CP/HTLV-1 group compared with the CP group, whereas expression of the regulatory T cell marker FOXp3 and IL-10 was significantly decreased in the lesions from the CP/HTLV-1 group. Interestingly, similar frequency and/or load of periodontopathogens (Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Aggregatibacter actinomycetemcomitans) and frequency of viruses (herpes simplex virus 1, human cytomegalovirus, and Epstein-Barr virus) characteristically associated with PDs were found in the CP/HTLV and CP groups. Conclusions. HTLV-1 may play a critical role in the pathogenesis of periodontal disease through the deregulation of the local cytokine network, resulting in an exacerbated response against a standard periodontopathogen infection.