Mental health of internally displaced preschool children: a cross-sectional study conducted in Bogotá, Colombia

A causa de los conflictos armados, como el de Colombia, se han desplazado por la fuerza a millones de personas, entre ellas una importante parte de la población infantil. Este estudio tuvo como objetivo evaluar la salud mental de los niños desplazados internos en edad preescolar en Bogotá Colombia, e identificar los determinantes de la salud mental en estos niños. Métodos: Estudio transversal realizado entre 279 niños que asisten a cuatro jardines infantiles en un barrio marginal de Bogotá. La salud mental infantil se evaluó con el instrumento validado de Comportamiento Infantil (CBCL) 1,5-5 años, aplicados a padres y cuidadores. Se realizo un análisis univariado y multivariado de regresión logística para evaluar la asociación entre el desplazamiento y la salud mental de los niños y para identificar las relaciones con la salud mental en los niños desplazados. Resultados: los Niños desplazados (n = 90) se identificaron con más frecuencia sobre los puntos de corte límite para las escalas CBCL que los no desplazados (n = 189) (por ejemplo, problemas totales 46,7 vs 22,8%;p \ 0,001). La asociación entre el desplazamiento y la presencia de problemas CBCL totales se mantuvo después del ajuste por factores socio-demográficos (OR Ajustado 3.3 del 95%: 1,5; 6,9). Donde la salud mental del cuidador explica en parte la asociación. En los niños desplazados, la salud mental del cuidador (p \ 0,01) y el funcionamiento familiar (p \ 0,01) se asociaron independientemente con la salud mental de los niños. La exposición a eventos traumáticos y el apoyo social también se asociaron con la salud mental del niño, sin embargo, las asociaciones no fueron independientes. Conclusión: En este barrio marginal de Bogotá, los niños en edad preescolar registrados como desplazados internos presentan peor salud mental que los no desplazados. El funcionamiento familiar y la salud mental del cuidador fueron fuerte e independientemente asociados con la salud mental de los niños y niñas desplazados.

Utilidad de la electromiografía de esfínter anal en el diagnóstico diferencial de la atrofia multisistémica: una revisión de la literatura

La atrofia multisistémica (AMS) es una enfermedad degenerativa caracterizada por disautonomías y síntomas extrapiramidales. El diagnóstico diferencial con otros parkinsonismos es difícil, por lo cual se requiere una ayuda paraclínica para soportar el diagnóstico clínico. La degeneración del núcleo de Onuf, exclusiva en esta enfermedad, podría sugerir que la presencia de denervación en el esfínter anal podría ser tomada en cuenta como criterio diagnóstico de AMS. Se realizó una revisión sistemática con el fin de determinar la utilidad de la electromiografía de esfínter anal (EMG-EA) en el diagnóstico diferencial de AMS contra otros parkinsonismos. Se incluyeron 17 estudios que analizaron los resultados de EMG-EA en pacientes con AMS. De éstos, 11 de estudios fueron analíticos y compararon pacientes con AMS y otros parkinsonismos. Los 6 estudios restantes fueron descriptivos. La duración de los potenciales de unidad motora (PUM) es significativamente mayor en pacientes con AMS comparados con otros parkinsonismos, y utilizando un punto de corte > 13 ms muestra características operativas que hacen a este parámetro potencialmente útil. Solo un estudio encontró diferencias significativas en el porcentaje de PUM polifásicos, el cual tuvo una sensibilidad y especificidad clínicamente útil cuando el punto de corte es mayor a 60%. El resto de los estudios no reportan diferencias estadísticamente significativas entre parkinsonismos. La literatura disponible apunta a la potencial utilidad de la EMG-EA en el diagnóstico diferencial de la AMS de otros parkinsonismos; sin embargo es necesario conducir más estudios para solventar las limitaciones metodológicas existentes.

Normalization procedure for the Baptista Depression Scale - Adult Version (EBADEP-A): transferring of norms

Regarding the standardization of psychological assessment instruments, that is, the construction of referential interpretations of a test, we can find different procedures performed both by Classical Test Theory (CTT) and the Theory of Item Response (IRT). Especially in this case (IRT), we can admit one test as a default, so to use its standardization and transfer the cut-off point to another instrument. Based on this information, the present study aimed to provide a cutoff score for the Baptista Depression Scale - Adult Version (EBADEP-A) through procedures of norms-transfer based on the Center for Epidemiologic Studies – Depression Scale (CES-D). The EBADEP-A presented good distribution and ability to discriminate depressive symptoms, and the sample, consisting of Brazilian College students, received a cutoff score of 32 points. It is emphasized that this is an exploratory and preliminary study, and it is suggested further analyzes to be performed with clinical samples for which results can be corroborated or confronted.

Plan Colombia’s Onset: Effects on Homicides and Violent Deaths

In this paper, the link between Plan Colombia and violence is explored. This paper exploits the difference in the success of the program among the different regions to identify the potential side effects on homicides and violent deaths. Results show no significant effects observed on homicides. On the other hand, evidence was found of increases in the number of violent deaths for women living in urban areas, and an opposite negative effect for men living in rural areas. These findings are consistent for different specifications of the model, the cut-off end of the program, and the classification of the regions’ criteria.

La Hipertensió arterial a la pràctica: optimització de la mesura de la pressió arterial i de l'avaluació de l'afectació dels òrgans diana

Objectius: a) avaluar la utilitat de la mesura de la pressió arterial a la consulta pel diplomat d'infermeria; b) establir quin és el punt de tall pel valor normal de l'automesura de la pressió arterial al domicili del propi malalt; c) determinar si l'exploració del fons d'ull als malalts hipertensos permet una millor estratificació del risc cardiovascular. Resultats: a) primer objectiu: els valors de la PAC de la infermera són molt similars a l'AMPA i les decisions s'han de prendre en funció d'aquesta mesura. b) segon objectiu: el risc de presentar alguna AOD en els hipertensos recent diagnosticats amb hipertensió clínica aïllada passa de forma progressiva d'una OR de 2.5 per un punt de tall de <125/80 mmHg a una OR de 4.0 pel punt de tall <135/85 mmHg. c) tercer objectiu: un nombre significatiu de pacients canvien de grup de risc quan es consideren els resultats de l'exploració del fons d'ull.

Enhanced convolution approach for CAC in ATM networks, an analytical study and implementation

The characteristics of service independence and flexibility of ATM networks make the control problems of such networks very critical. One of the main challenges in ATM networks is to design traffic control mechanisms that enable both economically efficient use of the network resources and desired quality of service to higher layer applications. Window flow control mechanisms of traditional packet switched networks are not well suited to real time services, at the speeds envisaged for the future networks. In this work, the utilisation of the Probability of Congestion (PC) as a bandwidth decision parameter is presented. The validity of PC utilisation is compared with QOS parameters in buffer-less environments when only the cell loss ratio (CLR) parameter is relevant. The convolution algorithm is a good solution for CAC in ATM networks with small buffers. If the source characteristics are known, the actual CLR can be very well estimated. Furthermore, this estimation is always conservative, allowing the retention of the network performance guarantees. Several experiments have been carried out and investigated to explain the deviation between the proposed method and the simulation. Time parameters for burst length and different buffer sizes have been considered. Experiments to confine the limits of the burst length with respect to the buffer size conclude that a minimum buffer size is necessary to achieve adequate cell contention. Note that propagation delay is a no dismiss limit for long distance and interactive communications, then small buffer must be used in order to minimise delay. Under previous premises, the convolution approach is the most accurate method used in bandwidth allocation. This method gives enough accuracy in both homogeneous and heterogeneous networks. But, the convolution approach has a considerable computation cost and a high number of accumulated calculations. To overcome this drawbacks, a new method of evaluation is analysed: the Enhanced Convolution Approach (ECA). In ECA, traffic is grouped in classes of identical parameters. By using the multinomial distribution function instead of the formula-based convolution, a partial state corresponding to each class of traffic is obtained. Finally, the global state probabilities are evaluated by multi-convolution of the partial results. This method avoids accumulated calculations and saves storage requirements, specially in complex scenarios. Sorting is the dominant factor for the formula-based convolution, whereas cost evaluation is the dominant factor for the enhanced convolution. A set of cut-off mechanisms are introduced to reduce the complexity of the ECA evaluation. The ECA also computes the CLR for each j-class of traffic (CLRj), an expression for the CLRj evaluation is also presented. We can conclude that by combining the ECA method with cut-off mechanisms, utilisation of ECA in real-time CAC environments as a single level scheme is always possible.

Alterações nas queixas subjetivas de memória e na escala de depressão geriátrica em adultos e idosos em Portugal estão associadas a um suplemento alimentar

A perda de memória é uma das principais queixas entre a população idosa. Reivindicada para melhorar a função cognitiva e de fácil obtenção em farmácias e dietéticas, a suplementação com fosfolípidos produziu resultados mistos em vários estudos. Um grupo de adultos e idosos saudáveis (n = 522) com idade 65,84 ± 10,74 anos, e com um nível de escolaridade de 7,90 ± 4,90 anos participaram do estudo. Os participantes foram submetidos a Avaliação Breve do Estado Mental (ABEM), Escala de Queixas de Memória (EQM) e Escala de Depressão Geriátrica (EDG). Três indivíduos apresentaram disfunção cognitiva, 505 queixas de memória apresentadas e 257 estavam acima do ponto de corte para a EDG. Subsequentemente, um grupo de mulheres (n = 17) utilizaram a suplementação com fosfolípidos durante 4 semanas. Após o período de suplementação, foi observada uma diminuição nos valores médios de EQM e EDG. A suplementação de fosfolípidos, ao longo de 4 semanas reduziu significativamente os valores EQM (p <0,05) neste grupo de mulheres.

“Alterações nas Queixas Subjetivas de Memória e na Escala de Depressão Geriátrica em adultos e idosos em Portugal estão associadas a um suplemento alimentar”: Revisitado

Para avaliar o efeito da suplementação de fosfatidilserina nos resultados obtidos na Escala de Queixas de Memória (EQM) e na Escala de Depressão Geriátrica (EDG), um grupo de adultos e idosos saudáveis (n= 915) com idade 65,65 ± 11,10 anos, e com um nível de scolaridade de 7,56 ± 4,56 anos participaram do estudo. Os participantes foram submetidos a Avaliação Breve do Estado Mental ABEM), Escala de Queixas de Memória (EQM) e Escala de Depressão Geriátrica (EDG). Quatro indivíduos apresentaram disfunção cognitiva, 874 queixas de memória apresentadas e 436 estavam acima do ponto de corte para a EDG. Subsequentemente, um grupo de mulheres (n= 48) utilizaram a suplementação de fosfatidilserina durante 4 semanas. A suplementação de fosfatidilserina, ao longo de 4 semanas reduziu significativamente os valores EQM (p=0,000) e de EDG (p=0,009) neste grupo de mulheres.

The counter-propagating Rossby-wave perspective on baroclinic instability. II: Application to the Charney model

The constant-density Charney model describes the simplest unstable basic state with a planetary-vorticity gradient, which is uniform and positive, and baroclinicity that is manifest as a negative contribution to the potential-vorticity (PV) gradient at the ground and positive vertical wind shear. Together, these ingredients satisfy the necessary conditions for baroclinic instability. In Part I it was shown how baroclinic growth on a general zonal basic state can be viewed as the interaction of pairs of ‘counter-propagating Rossby waves’ (CRWs) that can be constructed from a growing normal mode and its decaying complex conjugate. In this paper the normal-mode solutions for the Charney model are studied from the CRW perspective. Clear parallels can be drawn between the most unstable modes of the Charney model and the Eady model, in which the CRWs can be derived independently of the normal modes. However, the dispersion curves for the two models are very different; the Eady model has a short-wave cut-off, while the Charney model is unstable at short wavelengths. Beyond its maximum growth rate the Charney model has a neutral point at finite wavelength (r=1). Thereafter follows a succession of unstable branches, each with weaker growth than the last, separated by neutral points at integer r—the so-called ‘Green branches’. A separate branch of westward-propagating neutral modes also originates from each neutral point. By approximating the lower CRW as a Rossby edge wave and the upper CRW structure as a single PV peak with a spread proportional to the Rossby scale height, the main features of the ‘Charney branch’ (0

Linear amplification of marginally neutral baroclinic waves

Baroclinic wave development is investigated for unstable parallel shear flows in the limit of vanishing normal-mode growth rate. This development is described in terms of the propagation and interaction mechanisms of two coherent structures, called counter-propagating Rossby waves (CRWs). It is shown that, in this limit of vanishing normal-mode growth rate, arbitrary initial conditions produce sustained linear amplification of the marginally neutral normal mode (mNM). This linear excitation of the mNM is subsequently interpreted in terms of a resonance phenomenon. Moreover, while the mathematical character of the normal-mode problem changes abruptly as the bifurcation point in the dispersion diagram is encountered and crossed, it is shown that from an initial-value viewpoint, this transition is smooth. Consequently, the resonance interpretation remains relevant (albeit for a finite time) for wavenumbers slightly different from the ones defining cut-off points. The results are further applied to a two-layer version of the classic Eady model in which the upper rigid lid has been replaced by a simple stratosphere.

Atmospheric electricity coupling between earthquake regions and the ionosphere

We propose a mechanism to explain suggested links between seismic activity and ionospheric changes detected overhead. Specifically, we explain changes in the natural extremely low-frequency (ELF) radio noise recently observed in the topside ionosphere aboard the DEMETER satellite at night, before major earthquakes. Our mechanism utilises increased electrical conductivity of surface layer air before a major earthquake, which reduces the surface-ionosphere electrical resistance. This increases the vertical fair weather current, and (to maintain continuity of electron flow) lowers the ionosphere. Magnitudes of crucial parameters are estimated and found to be consistent with observations. Natural variability in ionospheric and atmospheric electrical properties is evaluated, and may be overcome using a hybrid detection approach. Suggested experiments to investigate the mechanism involve measuring the cut-off frequency of ELF “tweeks”, the amplitude and phase of very low frequency radio waves in the Earth–ionosphere waveguide, or medium frequency radar, incoherent scatter or rocket studies of the lower ionospheric electron density.

Dipole modes on open periodic structures — an experimental study

An experimental study is made of the lower pass-band of waveguides built as necklaces of oblate spheroids. Short lengths of guide are tested in open resonators. The dominant mode is found to be a glow-wave dipole type having no low-frequency cut off. High Q factors indicate low attenuations. Perturbation measurements demonstrate this energy to be concentrated in the vicinity of the guide.

Categorisation of synoptic environments associated with mesoscale convective systems over the UK

Mesoscale convective systems (MCSs) are relatively rare events in the UK but, when they do occur, can be associated with weather that is considered extreme with respect to climatology (as indicated by the number of such events that have been analysed as case studies). These case studies usually associate UK MCSs with a synoptic environment known as the Spanish plume. Here a previously published 17 year climatology of UK MCS events is extended to the present day (from 1998 to 2008) and these events classified according to the synoptic environment in which they form. Three distinct synoptic environments have been identified, here termed the classical Spanish plume, modified Spanish plume, and European easterly plume. Detailed case studies of the two latter, newly defined, environments are presented. Composites produced for each environment further reveal the differences between them. The classical Spanish plume is associated with an eastward propagating baroclinic cyclone that evolves according to idealised life cycle 1. Conditional instability is released from a warm moist plume of air advected northeastwards from Iberia that is capped by warmer, but very dry air, from the Spanish plateau. The modified Spanish plume is associated with a slowly moving mature frontal system associated with a forward tilting trough (and possibly cut-off low) at 500 hPa that evolves according to idealised life cycle 2. As in the classical Spanish plume, conditional instability is released from a warm plume of air advected northwards from Iberia. The less frequent European easterly plume is associated with an omega block centred over Scandinavia at upper levels. Conditional instability is released from a warm plume of air advected westwards across northern continental Europe. Unlike the Spanish plume environments, the European easterly plume is not a warm sector phenomena associated with a baroclinic cyclone. However, in all environments the organisation of convection is associated with the interaction of an upper-level disturbance with a low-level region of warm advection.

Revisiting youden’s index as a useful measure of the misclassification error in meta-analysis of diagnostic studies

The paper considers meta-analysis of diagnostic studies that use a continuous score for classification of study participants into healthy or diseased groups. Classification is often done on the basis of a threshold or cut-off value, which might vary between studies. Consequently, conventional meta-analysis methodology focusing solely on separate analysis of sensitivity and specificity might be confounded by a potentially unknown variation of the cut-off value. To cope with this phenomena it is suggested to use, instead, an overall estimate of the misclassification error previously suggested and used as Youden’s index and; furthermore, it is argued that this index is less prone to between-study variation of cut-off values. A simple Mantel–Haenszel estimator as a summary measure of the overall misclassification error is suggested, which adjusts for a potential study effect. The measure of the misclassification error based on Youden’s index is advantageous in that it easily allows an extension to a likelihood approach, which is then able to cope with unobserved heterogeneity via a nonparametric mixture model. All methods are illustrated at hand of an example on a diagnostic meta-analysis on duplex doppler ultrasound, with angiography as the standard for stroke prevention.

Revisiting Youden's index as a useful measure of the misclassification error in meta-analysis of diagnostic studies

The paper considers meta-analysis of diagnostic studies that use a continuous Score for classification of study participants into healthy, or diseased groups. Classification is often done on the basis of a threshold or cut-off value, which might vary between Studies. Consequently, conventional meta-analysis methodology focusing solely on separate analysis of sensitivity and specificity might he confounded by a potentially unknown variation of the cut-off Value. To cope with this phenomena it is suggested to use, instead an overall estimate of the misclassification error previously suggested and used as Youden's index and; furthermore, it is argued that this index is less prone to between-study variation of cut-off values. A simple Mantel-Haenszel estimator as a summary measure of the overall misclassification error is suggested, which adjusts for a potential study effect. The measure of the misclassification error based on Youden's index is advantageous in that it easily allows an extension to a likelihood approach, which is then able to cope with unobserved heterogeneity via a nonparametric mixture model. All methods are illustrated at hand of an example on a diagnostic meta-analysis on duplex doppler ultrasound, with angiography as the standard for stroke prevention.