Influence d'un incitatif financier destiné aux médecins de famille sur la gestion du diabète des Néo-Brunswickois

Résumé: Problématique : En réponse à la prévalence accrue de la maladie du diabète et au fardeau économique important que représente cette maladie sur le système de santé international, des programmes incitatifs pour les maladies chroniques furent instaurés à travers le monde. Ces programmes visent à inciter les médecins à appliquer les lignes directrices chez leurs patients avec besoin complexe en vue d’améliorer la santé des patients et par la suite de réduire les coûts incombés par le système de santé. Les programmes incitatifs étant nombreux et différents d’un pays à l’autre, les études actuelles ne semblent pas s’entendre sur les répercussions de tels programmes sur la santé des patients atteints de diabète. L’objectif de cette étude est d’évaluer les retombées d’un incitatif financier sur le contrôle glycémique de la population atteinte de diabète du Nouveau-Brunswick, au Canada. Méthodes : Cette étude transversale répétée et de cohorte a été menée grâce à des bases de données administratives du Nouveau-Brunswick contenant des données sur dix ans pour 83 580 patients adultes atteints de diabète et 583 médecins de famille éligibles. La santé des patients a été évaluée au niveau du contrôle glycémique, en mesurant les valeurs moyennes d’A1C annuelles à l’aide de régressions linéaires multivariées. Afin d’évaluer si les médecins changeaient leur pratique avec l’implantation du programme incitatif, nous regardions au niveau de la probabilité de recours annuel à au moins deux tests d’A1C en utilisant des régressions logistiques multivariées. Résultats : La probabilité de recours annuel à au moins deux tests d’A1C était plus élevée dans quatre sous-groupes étudiés : les patients nouvellement diagnostiqués après l’implantation du programme avaient des cotes plus élevées comparées aux nouveaux patients avant l’implantation du programme (OR=1.23 [1.18-1.28]); les patients pour lesquels un médecin avait réclamé l’incitatif comparés aux patients pour lesquels aucun médecin n’avait réclamé l’incitatif (OR=2.73 [2.64-2.81]); les patients pour lesquels un médecin avait réclamé l’incitatif avaient des cotes plus élevées après l’implantation du programme comparé à avant (OR=1.89 [1.80-1.98]); et finalement, les patients suivis par un médecin de famille qui a déjà réclamé l’incitatif avaient des cotes 24% plus élevées (OR=1.24 [1.15-1.34]). Il n’y avait pas de différence dans les valeurs d’A1C annuelles entre les 4 sous-groupes étudiés. Conclusion : L’implantation du programme incitatif a démontré que les médecins ont une meilleure probabilité de prescrire au moins deux tests d’A1C, ce qui suggère une meilleure prise en charge des patients. Cependant, le manque de changement au niveau du contrôle glycémique du patient suggère que l’étude des répercussions de l’incitatif devra être poursuivie afin de voir si elle mène à une amélioration d’issues cliniques chez les patients.

Off-label prescription of drugs at hospital

Objectives: To develop a procedure for management of off-label medications, and to analyze the treatments, indications, and hospital units which will request them more frequently, as well as which variables will have an impact on the authorization decision, and its economic impact. Methods: A procedure was designed where clinicians would complete request forms and the Hospital Unit would prepare reports assessing their efficacy, safety, convenience, and cost. The request forms for the past five years were analyzed. Results: A total of 834 applications were received, and 88.1% of these were accepted. The authorization rates were higher for Paediatric Units (95.7% vs. 86.6%; p<0.05). The reasons for considering prescriptions as off-label were: different indication (73.2%), different combination (10.2%), different line of treatment (8.6%) and different age (8%). A 73.4% of requests were for antineoplastic drugs, and the most frequently prescribed were rituximab (120) and bevacizumab (103). The quality of evidence supporting the prescriptions was moderate-low, though no direct relationship with the likelihood of approval was demonstrated (p = 0.413). The cost of the approved medications was 8,567,537 €, and the theoretical savings for those drugs rejected was of 2,268,642 €. There was a statistically significant decrease in the authorization rate (p < 0.05, Student's t test) when spending increased. Conclusions: The responsibility for assessing off-label prescriptions has fallen on the Pharmacy Unit. It has not been demonstrated that the quality of evidence represents a decisive variable for approval of treatment; on the other hand, age and cost have demonstrated a significant impact.

Angioplastia primária em Portugal entre 2002-2013. Atividade segundo o Registo Nacional de Cardiologia de Intervenção

Introdução e objectivos: Foi nosso objectivo reportar a evolução da angioplastia coronária no tratamento do enfarte agudo do miocárdio com supradesnivelamento do segmento ST (EAMCST), entre 2002-2013. Métodos: Os dados prospectivos multicêntricos do Registo Nacional de Cardiologia de Intervenção (RNCI) e os dados oficiais da Direção Geral de Saúde (DGS) foram conjugados para estudar os procedimentos no EAMCST entre 2002 e 2013. Resultados: Em 2013 realizaram-se 3524 angioplastias primárias (ICP-P), representando um crescimento de 315% relativamente ao ano 2002. Em 2002 a ICP-P representava 16% do total de angioplastias coronárias, passando a representar 25% nos anos de 2012-2013. Entre 2002-2013 o número de procedimentos por milhão de habitantes aumentou de 106 de 338 e a angioplastia de recurso decresceu de 70,7 para 2%. Durante o período em análise, a utilização de stents eluidores de fármaco cresceu de 9,9 para 69,5%. Após 2008, observou-se uma utilização crescente de trombectomia de aspiração, atingindo 46,7% em 2013. Os inibidores das glicoproteínas IIb/IIIa registaram um decréscimo no seu uso, sendo de 73,2% em 2002 e de 23,6% em 2013. O acesso radial cresceu de 8,3% em 2008 até 54,6% em 2013. Conclusões: Durante o período em análise, a taxa de angioplastia coronária por milhão de habitantes triplicou. A angioplastia de recurso foi ultrapassada pela angioplastia primária a partir de 2006. Observaram-se novas tendências no tratamento do enfarte agudo do miocárdio com supradesnivelamento do segmento ST, salientando-se a utilização de stents eluidores de fármacos e o acesso radial.

Polski Współczynnik Wpływu a kultury cytowań w humanistyce

The article discusses the formula for a new Polish bibliometric indicator, i.e., the Polish Impact Factor (Polski Współczynnik Wpływu) from the point of view of the humanities. Our study examines two prestigious Polish humanities journals (Pamiętnik Literacki and Diametros – An Online Journal of Philosophy) to evaluate the underlying assumptions of the Polish Impact Factor. We have analyzed all articles published from 2004 to 2014 (N = 850, N = 555, respectively) and all references included in these articles (N = 21,805, N = 8,298, respectively). When interpreting the findings, we have assumed that different groups of sciences are characterized by different citation cultures. Our findings show that the formula for the Polish Impact Factor does not take into account the most cited sources in the humanities, i.e., books and chapters. Moreover, many citations will not be included in the formula because of the citation age: the formula for the Polish Impact Factor is provided for the citations whose age is not higher than 5 years. We have analyzed the citation age of all citations and used Price’s Index to interpret the result. We have found out that most of citations are older than 5 years (84,2 percent and 73,2 percent, respectively). Our analysis shows that the Polish Impact Factor is not an adequate tool for a bibliometric evaluation of the journals in the humanities in Poland. The article concludes with a discussion of how the Polish Impact Factor could be improved.

Comparison of two field methods for estimating body fat in different Spanish Dance disciplines

The purpose of the present study was to investigate percentage body fat (%BF) differences in three Spanish dance disciplines and to compare skinfold and bioelectrical impedance predictions of body fat percentage in the same sample. Seventy-six female dancers, divided into three groups, Classical (n=23), Spanish (n=29) and Flamenco (n=24), were measured using skinfold measurements at four sites: triceps, subscapular, biceps and iliac crest, and whole body multi-frequency bioelectrical impedance (BIA). The skin-fold measures were used to predict body fat percentage via Durnin and Womersley's and Segal, Sun and Yannakoulia equations by BIA. Differences in percent fat mass between groups (Classical, Spanish and Flamenco) were tested by using repeated measures analysis (ANOVA). Also, Pearson's product-moment correlations were performed on the body fat percentage values obtained using both methods. In addition, Bland-Altman plots were used to assess agreement, between anthropometric and BIA methods. Repeated measures analysis of variance did not found differences in %BF between modalities (p<0.05). Fat percentage correlations ranged from r= 0.57 to r=0.97 (all, p<0.001). Bland-Altman analysis revealed differences between BIA Yannakoulia as a reference method with BIA Segal (-0.35 ± 2.32%, 95%CI: -0.89to 0.18, p=0.38), with BIA Sun (-0.73 ± 2.3%, 95%CI: -1.27 to -0.20, p=0.014) and Durnin-Womersley (-2.65 ± 2,48%, 95%CI: -3.22 to -2.07, p<0.0001). It was concluded that body fat percentage estimates by BIA compared with skinfold method were systematically different in young adult female ballet dancers, having a tendency to produce underestimations as %BF increased with Segal and Durnin-Womersley equations compared to Yannakoulia, concluding that these methods are not interchangeable.

Semen profiles of young men involved as bicycle taxi cyclists in Mangochi District, Malawi: A case-control study

Aim The purpose of this study was to evaluate the semen profiles of bicycle taxi cyclists and healthy controls in Mangochi district, Malawi. Methods Semen samples were collected from young bicycle taxi cyclists after two to three days of sexual abstinence. A control group, comprising young men who were not bicycle taxi operators also submitted semen samples. Samples were left to liquefy for 30 minutes before measurements were conducted of volume, concentration, total motility, and progressive motility. This was followed by preparation of morphology slides. Light microscopy was used for sperm analysis. Results Semen parameters such as volume (1.66 ± 0.18 mL vs. 3.64 ± 0.17 mL; p = 0.0001), concentration (28.31 ± 4.33 x 106/mL vs. 54.95 ± 5.93 x 106/ mL; p = 0.02) , total motility (56.98% ± 8.22% vs. 56.98% ± 8.22%; p = 0.03), progressive motility (22.57% ± 3.35% vs. 59.69% ± 4.82%; p = 0.004), and morphology (6.98% ± 3.23% vs. 19.73% ± 2.32%; p = 0.006) were significantly reduced in the bicycle taxi cyclists compared to the healthy controls. Conclusion In this case-control study, bicycle taxi operators had lower semen volume, concentration, total motility, and progressive motility, as well as a higher concentration of abnormally shaped spermatocytes, compared to healthy controls.

Unravelling the nanostructure of strawberry fruit pectins by atomic force microscopy

Atomic force microscopy (AFM) allows the analysis of individual polymers at nanostructural level with a minimal sample preparation. This technique has been used to analyse the pectin disassembly process during the ripening and postharvest storage of several fleshy fruits. In general, pectins analysed by AFM are usually visualized as isolated chains, unbranched or with a low number of branchs and, occasionally, as large aggregates. However, the exact nature of these structures is unknown. It has been suggested that pectin aggregates represent a mixture of rhamnonogalacturonan I and homogalacturonan, while isolated chains and their branches are mainly composed by polygalacturonic acid. In order to gain insight into the nature of these structures, sodium carbonate soluble pectins from ripe strawberry (Fragaria x ananassa, Duch.) fruits were subjected to enzymatic digestion with endo-Polygalacturonase M2 from Aspergillus aculeatus, and the samples visualized by AFM at different time intervals. Pectins isolated from control, non-transformed plants, and two transgenic genotypes with low level of expression of ripening-induced pectinase genes encoding a polygalacturonase (APG) or a pectate lyase (APEL) were also included in this study. Before digestion, isolated pectin chains from control were shorter than those from transgenic fruits, showing number-average (LN) contour length values of 73.2 nm vs. 95.9 nm and 91.4 nm in APG and APEL, respectively. The percentage of branched polymers was significantly higher in APG polyuronides than in the remaining genotypes, 33% in APG vs. 6% in control and APEL. As a result of the endo-PG treatment, a gradual decrease in the main backbone length of isolated chains was observed in the three samples. The minimum LN value was reached after 8 h of digestion, being similar in the three genotypes, 22 nm. By contrast, the branches were not visible after 1.5-2 h of digestion. LN values were plotted against digestion time and the data fitted to a first-order exponential decay curve, obtaining R2 values higher than 0.9. The half digestion time calculated with these equations were similar for control and APG pectins, 1.7 h, but significantly higher in APEL, 2.5 h, indicating that these polymer chains were more resistant to endo-PG digestion. Regarding the pectin aggregates, their volumes were estimated and used to calculate LN molecular weights. Before digestion, control and APEL samples showed complexes of similar molecular weights, 1722 kDa, and slightly higher than those observed in APG samples. After endo-PG digestion, size of complexes diminished significantly, reaching similar values in the three pectin samples, around 650 kDa. These results suggest that isolated polymer chains visualized by AFM are formed by a HG domain linked to a shorter polymer resistant to endo-PG digestion, maybe xylogalacturonan or RG-I. The silencing of the pectate lyase gene slightly modified the structure and/or chemical composition of polymer chains making these polyuronides more resistant to enzymatic degradation. Similarly, polygalacturonic acid is one of the main component of the aggregates.

Romanian Knowledge and Attitudes regarding Dietary Fibers

Presently, the scientists recognize the health benefits of food fibers in the menu and also plant food sources are at high interest both for general population and food companies. The food companies are responsible for a clear nutrition labelling that will assist consumers to make informed and healthy choices and health providers has to inform the population about the benefits of fibers.The aim of our study was to evaluate the Romanian knowledge and attitudes regarding dietary fibers from food products. We made a qualitative survey based on a questionnaire applied in 2015, over a period of 6 months, over 670 Romanian consumers. It was focused on testing the attitudes and knowledge towards ingestion of foods rich in fibers. For all data analysis we used the software SPSS, from IBM Inc. Our results showed that the knowledge about dietary fibers and also the ingestion of food products rich in fibers were low, and most of the subjects didn’t have any interest to read the nutritional information from food labels. The female participants ate more whole grains and fruits than males and pay more attention to food labelling. Romanian people prefer to stay and eat home than at restaurants especially in rural areas, and the knowledge about fibers benefits was significantly related to education and urban location. We underline the needs for more efficient community interventions and proper information about the importance of dietary fibers for our health and also to improve and disseminate nutritional standards and diet recommendation among population.

[Texto del convenio de colaboración suscrito entre Artesanías de Colombia S. A. y la asociación de productores de mimbre de Ibagué – ASPROMI].

32 documentos : ilustraciones, fotografías.

América Latina y el Caribe: Variables de competitividad para la dinámica empresarial 2007 - 2014

Este estudio realiza una categorización regional de los países en América Latina con respecto de las categorizaciones globales teniendo en cuenta los índices de competitividad, crecimiento económico y desarrollo humano. El objetivo es actualizar los análisis sobre la situación regional de forma cuantitativa involucrando el grado de asimetría en la competitividad. Esta relación entre el posicionamiento global y regional ha influenciado directamente la evolución del tejido empresarial

Liderazgo como proceso transformador: Caso Lácteos el Pomar

Las organizaciones de hoy en día entienden más el valor de las personas dentro de estas, por ser el elemento dinamizador. Por esto es necesario transmitirles constantemente la visión, misión y objetivos de la empresa para que las personas contribuyan a este fin. Dado el reconocimiento por parte de las organizaciones hacia el recurso humano y su administración, se hace necesario la existencia de un liderazgo bastante eficiente que sea capaz de asegurar condiciones favorables de trabajo y que garanticen el cumplimiento de los objetivos de las empresas. Las organizaciones del Siglo XXI exigen líderes con cualidades, habilidades y actitudes para afrontar todos los factores externos con los que se pueden enfrentar. Es por eso que surge la necesidad de estudiar la empresa Lácteos El Pomar ya que es una empresa que resurgió de las cenizas después de haber entrado en liquidación y que tiene como referente de un líder al gerente de la compañía. El propósito de este estudio de caso será describir y analizar el liderazgo y la motivación como herramientas transformadoras en la nueva gerencia de Lácteos El Pomar, como también entender cómo estas se implementaron e influenciaron al grupo de trabajadores para salir de la crisis. Mediante este estudio de caso se espera comprender si el gerente de la empresa es percibido como líder e identificar su estilo de liderazgo. Por otro lado, mediante entrevistas al personal de la empresa, se esperará identificar los factores que influyeron de manera negativa para acentuar la crisis de la compañía. Finalmente se espera analizar aquellas estrategias de liderazgo realizadas por la dirección que conllevaron a la permanencia de la compañía a pesar de la crisis.

Índice acumulativo de riesgo (nice) como prueba diagnóstica con base en tomografía corneal por elevación en la prevención de ectasia corneal post-lasik

Antecedentes La ectasia corneal post-lasik (ECPL) es una complicación infrecuente, pero devastadora en la cirugía lasik (queratomileusis asistida con éxcimer láser) para el tratamiento de la miopía con o sin astigmatismo. Con base en la tomografía corneal por elevación por imágenes de Scheimpflug (Sistema Pentacam HR, Oculus Wetzlar, Alemania), se propone un novedoso índice acumulativo de riesgo para ser utilizado como prueba diagnóstica de tamizaje y así prevenir esta complicación. Metodología Se realizó un estudio observacional analítico, de corte transversal tipo pruebas diagnósticas, con el fin de evaluar las características operativas del índice NICE teniendo como estándar de referencia el módulo de Belin-Ambrosio (Pentacam HR) utilizando un modelo de regresión logística binaria, tablas de contingencia y estimando el área bajo la curva ROC. Resultados Se evaluaron 361 ojos de los cuales el 59,3% provenían de pacientes de sexo femenino, la edad media global fue de 30 años (RIC 11,0). El modelo logístico binario aplicado se construyó con base en cuatro variables independientes cuantitativas (K2, PAQUI, EP e I-S) y una cualitativa (SEXO), y se determinó su relación con la variable dependiente, NICE (puntaje final). Las variables predictoras fueron estadísticamente significativas clasificando adecuadamente el 92,9% de los ojos evaluados según presencia o ausencia de riesgo. El coeficiente de Nagelkerke fue de 74,4%. Conclusiones El índice acumulativo de riesgo NICE es una herramienta diagnóstica novedosa en la evaluación de candidatos a cirugía refractiva lasik para prevenir la ectasia secundaria.

Relación entre velocidad/agilidad con indicadores de desempeño muscular y estado nutricional en escolares de 9 a 17 años en Bogotá, D.C. Estudio Fuprecol.

Objetivo: Estimar la relación entre indicadores de desempeño muscular y estado nutricional con la velocidad/agilidad, en una muestra de escolares de instituciones educativas del Distrito de Bogotá, Colombia, perteneciente al estudio FUPRECOL. Materiales y Métodos: estudio transversal, en 2803 niños y 3952 niñas (58.5 %), entre 9 y 17 años de edad, pertenecientes a 24 instituciones educativas del sector oficial, en Bogotá, Colombia. La velocidad/agilidad se evaluó con la prueba de carrera de ida y vuelta 4x10 m y los indicadores de fuerza muscular fueron medidos por medio de fuerza prensil, salto longitudinal. Las asociaciones se estimaron por medio de regresión logística binaria. Resultados: el 74.6 % de las mujeres y el 68.6 % de los varones mostraron bajos niveles de velocidad/agilidad; en mujeres, el modelo de regresión logística binario se observa que aquellas que tener bajos niveles de velocidad/agilidad se asociaba con obesidad (OR 2.25 IC 95 % 1.53-3.11), sobrepeso (OR 1.43 IC 95 % 1.19-1.72), bajos niveles de salto longitudinal (OR 2.06 IC 95 % 1.73-2.44) y tener valores de fuerza prensi no saludable (OR 1.45 IC 95 % 1.25-1.88). En hombres, tener entre 9-12 años, (OR 1.89 IC 95% 1.53-2.53), padecer de sobrepeso (OR 2.11 IC 95% 1.63-2.74) u obesidad (OR 3.00 IC 95% 2.03-4.43), se asoció con bajos niveles de velocidad/agilidad. Conclusión: se encontró que un alto porcentaje de la muestra estudiada tiene bajos niveles de velocidad/agilidad; adicionalmente, se observó una fuerte relación entre los indicadores de adiposidad y desempeño muscular, con los niveles de velocidad/agilidad. Se sugiere la implementación de programas escolares, que contrarresten la aparición de manifestaciones de riesgo cardiometabólico.

Patterns of Cactaceae species distribution in a protected area in the semiarid caatinga biome of North-Eastern Brazil.

2016

CO2-EVAR: An innovative approach to Automated Carbon Dioxide Angiography during Endovascular Abdominal Aortic Aneurysm repair

Objectives CO2-EVAR was proposed for treatment of AAA especially in patients with CKD. Issues regarding standardization, such as visualization of lowest renal artery (LoRA) and quality image in angiographies performed from pigtail or introducer-sheath, are still unsolved. Aim of the study was to analyze different steps of CO2-EVAR to create an operative protocol to standardize the procedure. Methods Patients undergoing CO2-EVAR were prospectively enrolled in 5 European centers (2018-2021). CO2-EVAR was performed using an automated injector. LoRA visualization and image quality (1-4) were analyzed and compared at different procedure steps: preoperative CO2-angiography from Pigtail/Introducer-sheath (1st Step), angiographies from Pigtail at 0%,50%,100% main body (MB) deployment (2nd Step), contralateral hypogastric artery (CHA) visualization with CO2 injection from femoral Introducer-sheath (3rd Step) and completion angiogram from Pigtail/Introducer-sheath (4th Step). Intra-/postoperative adverse events were evaluated. Results Sixty-five patients undergoing CO2-EVAR were enrolled, 55/65(84.5%) male, median age 75(11.5) years. Median ICM was 20(54)cc; 19/65(29.2%) procedures were performed with 0-iodine. 1st Step: median image quality was significantly higher with CO2 injected from femoral introducer [Pigtail2(3)vs.3(3)Introducer,p=.008]. 2nd Step: LoRA was more frequently detected at 50% (93%vs.73.2%, p=.002) and 100% (94.1%vs.78.4%, p=.01) of MB deployment compared with first angiography from Pigtail; image quality was significantly higher at 50% [3(3)vs.2(3),p=<.001] and 100% [4(3) vs.2(3),p=.001] of MB deployment. CHA was detected in 93% cases (3rd Step). Mean image quality was significantly higher when final angiogram (4th Step) was performed from introducer (Pigtail2.6±1.1vs.3.1±0.9Introducer,p=<.001). Rates of intra-/postoperative adverse events (pain,vomit,diarrhea) were 7.7% and 12.5%. Conclusions Preimplant CO2-angiography should be performed from Introducer-sheath. MB steric bulk during its deployment should be used to improve image quality and LoRA visualization with CO2. CHA can be satisfactorily visualized with CO2. Completion CO2-angiogram should be performed from femoral Introducer-sheath. This operative protocol allows to perform CO2-EVAR with minimal ICM and low rate of mild complications.