Diabetes relacionada a la fibrosis quística (DRFQ)

Importancia: el paciente con fibrosis quística después de las complicaciones gastrointestinales y pulmonares debe enfrentar otras comorbilidades como la diabetes relacionada a su condición . Dado el aumento en la esperanza de vida y el hecho de que virtualmente todas los pacientes con esta enfermedad pueden desarrollar alteración en el metabolismo de los carbohidratos, se requiere una sensibilización frente al tema que posibilite una detección temprana de esta entidad y un tratamiento óptimo que evite las complicaciones microvasculares e impacte entre otros el crecimiento pondo-estatural en pacientes en desarrollo y la función pulmonar. Objetivo : realizar una revisión actualizada de la literatura sobre la diabetes relacionada a la fibrosis quística, destacando las indicaciones de tamización y tratamiento. Conclusión : la FQ dentro de su abordaje requiere la detección temprana de la alteración del metabolismo de los carbohidratos con una prueba de tolerancia a la glucosa , el daño del islote pancreático , la disfunción inmune, la resistencia a la insulina, el estrés oxidativo entre otros elementos fisiopatológicos conllevan a un estado de depleción de insulina que producirán un efecto negativo microvascular así como a una reducción marcada de la función pulmonar, mayores tasa de infección e incremento de la mortalidad. La piedra angular del tratamiento en pacientes con o sin hiperglicemia es la insulina que mejora tanto el estado nutricional como la función pulmonar ; nuevos antidiabéticos orales con efecto incretinas y fármacos modificadores de la enfermedad se vislumbran como alternativas al corto plazo

Caracterización del ausentismo laboral de una IPS que presta servicios de consulta externa de medicina general, 2014

RESUMEN El ausentismo laboral genera un gran impacto económico en las empresas y a la sociedad en general. Es un problema difícil de manejar ya que es multifactorial, porque a pesar de que en su gran mayoría es generado por enfermedad general, al analizarlo se puede encontrar otros factores que conlleven a la ausencia del trabajador y con ello producir alteración al normal funcionamiento de la empresa, por lo que resulta indispensable estudiar este tema. Objetivo Caracterizar las principales causas de ausentismo laboral en los médicos generales de una IPS que presta servicios de consulta externa de medicina general a nivel nacional durante el año 2014. Materiales y Métodos: es un estudio de corte transversal sobre datos secundarios correspondientes al registro de incapacidades que presento la IPS durante el año 2014. Los criterios de inclusión fueron los médicos generales con los que contaba la IPS que presta servicios de salud a nivel nacional durante el año 2014 y los criterios de exclusión fueron las licencias de maternidad y paternidad. El tamaño de la muestra final fue de 202 médicos y el número de incapacidades que se presentó durante el año 2014 fue 313. Se realizó análisis de distribución de frecuencias, porcentaje y prevalencia de las incapacidades. Resultados: durante el año 2014 se presentaron 313 incapacidades, en una población de 202 médicos generales con prevalencia en las mujeres. El diagnóstico más frecuente de las incapacidades fue la categoría diagnostica “otros” en el cual se encuentra migraña, vértigo, alteraciones de la mama con 59 incapacidades, seguida por enfermedades gastrointestinales con 25 incapacidades. Conclusiones y recomendaciones: Las incapacidades fueron más frecuentes en mujeres que en hombres. El diagnóstico de las incapacidades más frecuente fue “enfermedad genérica o ausencia de diagnóstico”. La incapacidad más frecuente de un día que se presentaron 46 registros. El médico que mayor número de incapacidades presento fue de 18 para el año 2014. Se recomienda a la empresa tener un seguimiento de las incapacidades repetitivas, ya que estas podrían tener relación con enfermedad laboral que aún no ha sido calificada. Se recomienda complementar la base de datos con información como el antecedente de enfermedad crónica y el sedentarismo, lo que puede permitir realizar nuevos estudios respecto al riesgo cardiovascular de esta población.

Eficacia de la estimulación magnética transcraneal en la disminución de severidad en el trastorno depresivo mayor en monoterapia y coadyuvante comparado con tratamientos farmacológicos. Revisión sistemática y meta-análisis

Resumen Introducción Una posible opción de tratamiento para el manejo del trastorno depresivo mayor (TDM) es la estimulación magnética transcraneal (EMT) que ha mostrado propiedades antidepresivas superiores al placebo con un buen perfil de seguridad. El objetivo del presente trabajo es determinar la reducción en la severidad del TDM y la proporción de eventos adversos (EA) en pacientes con TDM refractario y no refractario, posterior al uso de EMT administrada en monoterapia o tratamiento coadyuvante comparado con terapia farmacológica. Metodología Se planteó una pregunta PICOT de la cual se realizó una búsqueda sistemática de estudios clínicos en las bases de datos Medline, EMBASE y Cochrane. Dos investigadores en forma independiente realizaron la selección de artículos, evaluación de calidad con la herramienta de la colaboración Cochrane y extracción de datos. Se extrajeron datos de eficacia como tasa de respuesta, porcentaje de remisión, calidad de vida, diminución sintomática del trastorno depresivo mayor en la escala de Hamilton y capacidad funcional. Igualmente, proporción de pacientes con EA. Se realizó un meta-análisis de estas variables teniendo en cuenta la heterogeneidad. Resultados La presente revisión sistemática incluyó 26 estudios clínicos aleatorizados de baja calidad metodológica mostrando que la EMT presentó una eficacia superior cuando es usada como coadyuvante a las terapias con que venían siendo tratados los pacientes con TDM refractario y no refractario en los desenlaces de tasa de respuesta y porcentaje de remisión. En el caso de intervenciones farmacológicas específicas, la EMT presento eficacia similar, tanto en terapia coadyuvante como en monoterapia comparado con las intervenciones farmacológicas. En cuanto a seguridad, la EMT presenta un buen perfil de seguridad debido a que en todos los escenarios estudiados los EA fueron no serios y baja frecuencia Conclusiones La evidencia disponible sugiere que la EMT mostró ser efectivo y seguro para el manejo del TDM refractario y no refractario. Sin embargo, la evidencia es débil por lo tanto se necesita mayor investigación clínica que soporte su uso.

Diabetes gestacional como factor de riesgo para incontinencia urinaria: revisión sistemática de la literatura

La diabetes mellitus es una de las patologías frecuentes durante el embarazo, existe literatura que la ha relacionado con un mayor riesgo de aparición de incontinencia urinaria en el postparto patología que de manera clara afecta la calidad de vida de las mujeres, pero a la fecha la literatura no es concluyente. Con la presente revisión sistemática se pretendió evaluar la evidencia relacionada con la diabetes gestacional como causa de incontinencia urinaria en el postparto.

Uptake of a free coronary heart disease risk screening programme in community pharmacy: the Healthy Heart Assessment service

Introduction Health promotion (HP) aims to enhance good health while preventing ill-health at three levels of activity; primary (preventative), secondary (diagnostic) and tertiary (management).1 It can range from simple provision of health education to ongoing support, but the effectiveness of HP is ultimately dependent on its ability to influence change. HP as part of the Community Pharmacy Contract (CPC) aims to increase public knowledge and target ‘hard-to-reach’ individuals by focusing mainly on primary and tertiary HP. The CPC does not include screening programmes (secondary HP) as a service. Coronary heart disease (CHD) is a significant cause of morbidity and mortality in the UK. While there is evidence to support the effectiveness of some community pharmacy HP strategies in CHD, there is paucity of research in relation to screening services.2 Against this background, Alliance Pharmacy introduced a free CHD risk screening programme to provide tailored HP advice as part of a participant–pharmacist consultation. The aim of this study is to report on the CHD risk levels of participants and to provide a qualitative indication of consultation outcomes. Methods Case records for 12 733 people who accessed a free CHD risk screening service between August 2004 and April 2006 offered at 217 community pharmacies were obtained. The service involved initial self-completion of the Healthy Heart Assessment (HHA) form and measurement of height, weight, body mass index, blood pressure, total cholesterol and highdensity lipoprotein levels by pharmacists to calculate CHD risk.3 Action taken by pharmacists (lifestyle advice, statin recommendation or general practitioner (GP) referral) and qualitative statements of advice were recorded, and a copy provided to the participants. The service did not include follow-up of participants. All participants consented to taking part in evaluations of the service. Ethical committee scrutiny was not required for this service development evaluation. Results Case records for 10 035 participants (3658 male) were evaluable; 5730 (57%) were at low CHD risk (<15%); 3636 (36%) at moderate-to-high CHD risk (≥15%); and 669 (7%) had existing heart disease. A significantly higher proportion of male (48% versus 30% female) participants were at moderate- to-high risk of CHD (chi-square test; P < 0.005). A range of outcomes resulted from consultations. Lifestyle advice was provided irrespective of participants’ CHD risk or existing disease. In the moderate-to-high-risk group, of which 52% received prescribed medication, lifestyle advice was recorded for 62%, 16% were referred and 34% were advised to have a re-assessment. Statin recommendations were made in 1% of all cases. There was evidence of supportive and motivational statements in the advice recorded. Discussion Pharmacists were able to identify individuals’ level of CHD risk and provide them with bespoke advice. Identification of at-risk participants did not automatically result in referrals or statin recommendation. One-third of those accessing the screening service had moderate-to-high risk of CHD, a significantly higher proportion of whom were men. It is not known whether these individuals had been previously exposed to HP but presumably by accessing this service they may have contemplated change. As effectiveness of HP advice will depend among other factors on ability to influence change, future consultations may need to explore patients’ attitude towards change in relation to the Trans Theoretical Model4 to better tailor HP advice. The high uptake of the service by those at moderate-to-high CHD risk indicates a need for this type of screening programme in community pharmacy, perhaps specifically to reach men who access medical services less.

Correlation of the highest-energy cosmic rays with the positions of nearby active galactic nuclei

Data collected by the Pierre Auger Observatory provide evidence for anisotropy in the arrival directions of the cosmic rays with the highest-energies, which are correlated with the positions of relatively nearby active galactic nuclei (AGN) [Pierre Auger Collaboration, Science 318 (2007) 938]. The correlation has maximum significance for cosmic rays with energy greater than similar to 6 x 10(19) eV and AGN at a distance less than similar to 75 Mpc. We have confirmed the anisotropy at a confidence level of more than 99% through a test with parameters specified a priori, using an independent data set. The observed correlation is compatible with the hypothesis that cosmic rays with the highest-energies originate from extra-galactic sources close enough so that their flux is not significantly attenuated by interaction with the cosmic background radiation (the Greisen-Zatsepin-Kuz`min effect). The angular scale of the correlation observed is a few degrees, which suggests a predominantly light composition unless the magnetic fields are very weak outside the thin disk of our galaxy. Our present data do not identify AGN as the sources of cosmic rays unambiguously, and other candidate sources which are distributed as nearby AGN are not ruled out. We discuss the prospect of unequivocal identification of individual sources of the highest-energy cosmic rays within a few years of continued operation of the Pierre Auger Observatory. (C) 2008 Elsevier B.V. All rights reserved.

Update on the correlation of the highest energy cosmic rays with nearby extragalactic matter

Data collected by the Pierre Auger Observatory through 31 August 2007 showed evidence for anisotropy in the arrival directions of cosmic rays above the Greisen-Zatsepin-Kuz`min energy threshold, 6 x 10(19) eV. The anisotropy was measured by the fraction of arrival directions that are less than 3.1 degrees from the position of an active galactic nucleus within 75 Mpc (using the Veron-Cetty and Veron 12th catalog). An updated measurement of this fraction is reported here using the arrival directions of cosmic rays recorded above the same energy threshold through 31 December 2009. The number of arrival directions has increased from 27 to 69, allowing a more precise measurement. The correlating fraction is (38(-6)(+7))%, compared with 21% expected for isotropic cosmic rays. This is down from the early estimate of (69-(+11)(13))%. The enlarged set of arrival directions is examined also in relation to other populations of nearby extragalactic objects: galaxies in the 2 Microns All Sky Survey and active galactic nuclei detected in hard X-rays by the Swift Burst Alert Telescope. A celestial region around the position of the radiogalaxy Cen A has the largest excess of arrival directions relative to isotropic expectations. The 2-point autocorrelation function is shown for the enlarged set of arrival directions and compared to the isotropic expectation. (C) 2010 Elsevier B.V. All rights reserved.

Diz-me quanto ganhas e te direi como te sentes: análise do overpayment no funcionalismo público no Brasil

O contexto do funcionalismo público como fonte empregadora tem chamado crescente atenção, uma vez que as práticas de remuneração acima da média de mercado adotadas neste contexto vêm atraindo cada vez mais indivíduos altamente qualificados (Bender & Fernandes, 2006). Entretanto, trata-se de um setor que adota práticas de remuneração que também são caracterizadas pela desigualdade, uma vez que carreiras bem remuneradas co-existem com outras mal remuneradas, por vezes, dentro do mesmo espaço organizacional e executando tarefas similares. Estudos demonstram que, a priori, um ambiente de trabalho que favorece uma situação de desigualdade afeta negativamente diversos aspectos comportamentais dos funcionários que nele exercem atividades (e.g. De Cremer & Van Kleef, 2009; Peters & Van den Bos, 2008; Peters, Van den Bos & Bobocel, 2004). Desta forma, o presente estudo buscou entender como uma situação de desigualdade remuneratória – em que alguns membros se encontram em uma situação de overpayment, enquanto que outros na situação de underpayment – pode influenciar fatores como a autoestima e o comprometimento afetivo dos funcionários públicos com relação aos seus trabalhos. Um órgão público do Poder Executivo Federal, foi escolhido como lócus de pesquisa para analisar estes impactos. A metodologia utilizada na pesquisa teve uma natureza quantitativa e qualitativa. Numa primeira etapa, aplicaram-se 105 questionários a dois grupos distintos de servidores desse órgão público (um grupo tido como overpaid e outro tido como underpaid), tendo sido analisadas, por meio de regressões hierárquicas, os impactos da percepção de justiça salarial na auto-estima e no comprometimento dos funcionários. Posteriormente, realizaram-se 20 entrevistas com funcionários dos dois grupos com o intuito de aprofundar e discutir aspectos mais sensíveis relacionados com os resultados. Dessas análises foi possível confirmar a influência direta do senso de justiça remuneratória que o indivíduo possui na sua auto-estima e no seu comprometimento afetivo. Os resultados da pesquisa demonstram que representantes das carreiras bemremuneradas tendem a comparar-se com outras carreiras melhor remuneradas, evitando a comparação com os colegas do trabalho pertencentes a carreiras menos favorecidas. Entretanto, a influência que o sentimento de justiça tem em ambos os resultados comportamentais analisados é potencializada quanto maior for a percepção do indivíduo acerca da satisfação dos seus pares com o trabalho e com a sua remuneração. Observou-se ainda o efeito moderador da motivação epistêmica nesta relação. Esta pesquisa espera ter contribuído para melhor entender os impactos que políticas salariais podem ter nos funcionários públicos.

Dores e cores nas mal traçadas linhas dos devotos do Padre Cícero: as trocas linguísticas instauradas entre o discurso eclesial e o discurso epistolar dos romeiros

This study is concerned with analyzing the letters sent by the devotees tothe religious patriarch, Father Cicero, checking as is the relationship of linguistic exchanges between the pilgrims and the Father Cicero through the issuance of letters; and, between the Church and the pilgrims, through homilies uttered these devotees, focusing on the appeals contained therein, for, then, to define a parameter between the requirements contained in the letters and the religious discourse of the Church workers in the liturgical celebrations in view of social and religious demands of the market in question. Our purposes resided in understanding the causes that lead to the production of the letters by devotees, holding us in prayers of intercession to the Father Cicero. Finally, check and understand how is the process of inter - relationship between the writing of devotee and the clerical discourse, with regard to meeting this demand, noting especially the game force a religious field, based on postulates of Pierre Bourdieu (2008), to conceive the communicative act as linguistic exchanges, surpassing the sign and therefore decipherable speech character as well as the interactive strength of the wording and voice advocated by Paul Zumthor (2010) e Bakhtin (2006). Regarding the composition of the corpus, were determined, as the universe of research, letters of pilgrims, sent to Father Cicero, deposited in his own tomb, as well as in the Church of the Horto (Gethsemane) in Juazeiro do Norte-CE (Brazil); beyond religious sermons intended for pilgrims during the massin pilgrimage time

Search for neutral, long-lived particles decaying into two muons in p(p)over-bar collisions at root s=1.96 TeV

We present a search for a neutral particle, pair produced in pp collisions at root s=1.96 TeV, which decays into two muons and lives long enough to travel at least 5 cm before decaying. The analysis uses approximate to 380 pb(-1) of data recorded with the D0 detector. The background is estimated to be about one event. No candidates are observed, and limits are set on the pair-production cross section times branching fraction into dimuons + X for such particles. For a mass of 10 GeV and lifetime of 4x10(-11) s, we exclude values greater than 0.14 pb (95% C.L.). These results are used to limit the interpretation of NuTeV's excess of dimuon events.

Search for large extra spatial dimensions in dimuon production with the D0 detector

We present the results of a search for the effects of large extra spatial dimensions in p (p) over bar collisions at root s = 1: 96 TeV in events containing a pair of energetic muons. The data correspond to 246 pb(-1) of integrated luminosity collected by the D0 experiment at the Fermilab Tevatron Collider. Good agreement with the expected background was found, yielding no evidence for large extra dimensions. We set 95% C. L. lower limits on the fundamental Planck scale between 0.85 and 1.27 TeV within several formalisms. These are the most stringent limits achieved in the dimuon channel to date.

Search for the standard model Higgs boson in the p(p)over-bar -> ZH -> v(v)over-barb(b)over-bar channel

We report a search for the standard model (SM) Higgs boson based on data collected by the D0 experiment at the Fermilab Tevatron Collider, corresponding to an integrated luminosity of 260 pb(-1). We study events with missing transverse energy and two acoplanar b jets, which provide sensitivity to the ZH production cross section in the nu nu bb channel, and to WH production when the lepton from the W ->center dot nu decay is undetected. The data are consistent with the SM background expectation, and we set 95% C.L. upper limits on sigma(pp -> ZH/WH) x B(H -> bb) from 3.4/8.3 to 2.5/6.3 pb, for Higgs-boson masses between 105 and 135 GeV.

Measurement of the lifetime difference in the B-s(0) system

We present a study of the decay B-s(0)-> J/psi phi. We obtain the CP-odd fraction in the final state at time zero R-perpendicular to = 0.16 +/- 0.10 (stat) +/- 0.02(syst), the average lifetime of the (B-s(0), (B) over bar (0)(s)) system, (tau) over bar (B-s(0)) = 1.39(-0.16)(+0.13)(stat)(-0.02)(+0.01)(syst) ps, and the relative width difference between the heavy and light mass eigen-states, Delta Gamma/(Gamma) over bar = (Gamma(L) - Gamma(H))/(Gamma) over bar = 0.24(-0.38)(+0.28)(stat)(-0.04)(+0.03)(syst). With the additional constraint from the world average of the B-s(0) lifetime measurements using semileptonic decays, we find (tau) over bar (B-s(0)) = 1.39 +/- 0.06 ps and Delta Gamma/(Gamma) over bar = 0.25(-0.15)(+0.14). For the ratio of the B-s(0) and B-0 lifetimes we obtain (tau) over bar (B-s(0))/tau(B-s(0)) = 0.91 +/- 0.09(stat) +/- 0.003(syst).

Direct limits on the B-s(0) oscillation frequency

We report results of a study of the B-s(0) oscillation frequency using a large sample of B-s(0) semileptonic decays corresponding to approximately 1 fb(-1) of integrated luminosity collected by the D0 experiment at the Fermilab Tevatron Collider in 2002-2006. The amplitude method gives a lower limit on the B-s(0) oscillation frequency at 14.8 ps(-1) at the 95% C.L. At Delta m(s)=19 ps(-1), the amplitude deviates from the hypothesis A=0 (1) by 2.5 (1.6) standard deviations, corresponding to a two-sided C.L. of 1% (10%). A likelihood scan over the oscillation frequency, Delta m(s), gives a most probable value of 19 ps(-1) and a range of 17

Simultaneous measurement of the ratio R = B(t -> Wb)/B(t -> Wq) and the top-quark pair production cross section with the D0 detector at root s=1.96 TeV

We present the first simultaneous measurement of the ratio of branching fractions, R = B(t --> Wb)/B(t --> Wq), with q being a d, s, or b quark, and the top-quark pair production cross section sigma(t (t) over bar) in the lepton plus jets channel using 0.9 fb(-1) of p (p) over bar collision data at root s = 1.96 TeV collected with the D0 detector. We extract R and sigma(t (t) over bar) by analyzing samples of events with 0, 1, and >= 2 identified b jets. We measure R = 0.97(-0.08)(+0.09) (stat + syst) and sigma(t (t) over bar) = 8.18(-0.84)(+0.90) (stat + syst) +/- 0.50(lumi) pb, in agreement with the standard model prediction.