El costo de la atención ambulatoria del lupus eritematoso sistémico en Colombia. Contrastes y comparaciones con otras poblaciones.

Introducción: el lupus eritematoso sistémico (LES) es considerado una enfermedad de alto costo. La expresión clínica de la enfermedad depende de la ubicación geografía y la etnicidad. El objetivo de este estudio fue el calcular los costos ambulatorios relacionado al LES en una cohorte colombiana, identificar los predictores de costos y comparar nuestro resultados con otras poblaciones. Métodos: Se realizó una aproximación de tipo prevalencia en 100 pacientes LES en quienes se evaluaron los costos directos médicos, directos no médicos, indirectos e intangibles. Todos los costos médicos fueron evaluados usando una metodología abajo hacia arriba. Los costos directos fueron valorados desde una perspectiva social usando una metodología de micro-costeo. Los costos indirectos se evaluaron mediante una aproximación de capital humano, y los costos intangibles calculados a partir de los años de vida ajustados por calidad (AVAC). Se analizaron los datos por medio de un análisis multivariado. Para comparaciones con otras poblaciones todos los costos fueron expresados como la razón entre los costos y producto interno bruto nacional per cápita. Resultados: La media de costos totales fue 13.031±9.215 USD (ajustados por el factor de conversión de paridad del poder adquisitivo), lo cual representa el 1,66 del PIB per capita de Colombia. Los costos directos son el 64% de los costos totales. Los costos médicos representan el 80% de los costos directos,. Los costos indirectos fueron el 10% y los costos intangibles el 25% de los costos totales. Los medicamentos representaron el 45% de los costos directos. Mayores costos se relacionaron con el estrato socioeconómico, seguro médico privado, AVAC, alopecia, micofenolato mofetilo, y terapia anticoagulante. Los costos directos ajustados de los pacientes con LES en Colombia fueron mayores que en Norte América y en Europa. Conclusiones: el LES impone una carga económica importante para la sociedad. Los costos relacionados con la atención médica y AVAC fueron los principales contribuyentes al alto costo de la enfermedad. Estos resultados pueden ser referencia para determinar políticas en salud pública así como comparar el gasto en salud de forma internacional.

Transformación de la Doctrina de Seguridad de la OTAN, en la Post- Guerra Fría, y sus efectos en la intervención en Macedonia (2001-2003)

El objetivo de esta monografía es examinar la transformación de la doctrina de seguridad de la OTAN en la Post-Guerra Fría y sus efectos en la intervención en la República de Macedonia. La desintegración del bloque soviético implicó la variación en la definición de las amenazas que atentan contra la supervivencia de los países miembro de la Alianza Atlántica. A partir de la década de los noventa, los conflictos de naturaleza interétnica pasaron a formar parte de los riesgos que transgreden la seguridad de los Aliados y la estabilidad del área Euro-Atlántica. Por lo anterior, la OTAN intervino en aquellos Estados en los que prevalecían las confrontaciones armadas interétnicas, como por ejemplo: en Macedonia. Allí, la Alianza Atlántica ejecutó operaciones de gestión de crisis para contrarrestar la amenaza. El fenómeno a estudiar en esta investigación será analizado a partir del Realismo Subalterno y de la Teoría de la Seguridad Colectiva.

Desempeño de las RISS en relación al acceso, coordinación y calidad de la atención en cáncer de mama y diabetes mellitus tipo 2 en Colombia

El objetivo de este capítulo es mostrar los resultados de investigación del desempeño de las redes de servicios de salud frente a diferentes dimensiones relacionadas al acceso, coordinación y calidad de la atención en dos enfermedades crónicas como es el cáncer de mama y la diabetes en Colombia, importantes patologías por su incidencia e impacto así como por la necesidad de la mecanismos efectivos de coordinación para la adecuada atención de los usuarios del sistema de salud. Por tanto, se realiza el análisis del desempeño de dos redes de servicios de salud en la atención de usuarias con diagnostico confirmado de cáncer de mama, vinculadas unas a redes pertenecientes al régimen contributivo y otras al régimen subsidiado. Redes que también fueron consideradas para el análisis del desempeño en la atención de usuarios con diagnostico confirmado de diabetes, en el que de manera adicional participó otra red perteneciente al régimen subsidiado con área de operación en el municipio de Soacha, puesto que las dos anteriores tiene influencia en la ciudad de Bogotá. La fuente primaria de los datos fue la historia clínica y éstos fueron extraídos de acuerdo a ciertos indicadores seleccionados por el equipo investigador a través de un previo proceso de validación y a partir de su importancia para evidenciar el desempeño de las redes de servicios de salud en las dimensiones enunciadas anteriormente. Se muestran los resultados del estudio, a partir de los cuales se propone una breve discusión y conclusiones.

Eficacia y seguridad de la melatonina para el manejo de los trastornos del sueño en el autismo: meta-análisis

INTRODUCCIÓN: El 80% de los niños y adolescentes con trastornos del espectro autista (TEA) presenta algún trastorno del sueño, en cuya génesis al parecer intervienen alteraciones en la regulación de la melatonina. El objetivo de este metaanálisis fue determinar la eficacia y seguridad de la melatonina para el manejo de ciertos trastornos del sueño en niños con TEA. MÉTODOS: Tres revisores extrajeron los datos relevantes de los ensayos clínicos aleatorizados doble ciego de alta calidad publicados en bases de datos primarias, de ensayos clínicos, de revisiones sistemáticas y de literatura gris; además se realizó búsqueda en bola de nieve. Se analizaron los datos con RevMan 5.3. Se realizó un análisis del inverso de la varianza por un modelo de efectos aleatorios para las diferencias de medias de los desenlaces propuestos: duración del tiempo total, latencia de sueño y número de despertares nocturnos. Se evaluó la heterogeneidad interestudios con el parámetro I2 RESULTADOS: La búsqueda inicial arrojó 355 resultados, de los cuales tres cumplieron los criterios de selección. La melatonina resultó ser un medicamento seguro y eficaz para aumentar la duración total del sueño y disminuir la latencia de sueño en niños y adolescentes con TEA; hasta el momento la evidencia sobre el número de despertares nocturnos no es estadísticamente significativa. DISCUSIÓN: A la luz de la evidencia disponible, la melatonina es una elección segura y eficaz para el manejo de ciertos problemas del sueño en niños y adolescentes con TEA. Es necesario realizar estudios con mayores tamaños muestrales y comparados con otros medicamentos disponibles en el mercado.

Poder e influencia en el liderazgo transformacional

Como proyecto de grado, el presente trabajo consiste en una revisión teórica de los conceptos de liderazgo, poder e influencia, junto con las posibles relaciones que entre ellos se pueden presentar. Para ello, cada concepto es definido de manera individual, y con base en ello, se identifica la dependencia que tienen estos conceptos entre sí y la importancia dentro del desarrollo del liderazgo transformacional actual. Para lograr lo propuesto, se llevó a cabo la revisión de una parte de la literatura académica presente en libros, revistas académicas, bases de datos y documentos relacionados con los temas y conceptos tratados. A partir de ello, se entendió la evolución del concepto del liderazgo y los enfoques presentados desde la década de los 1920´s hasta la actualidad, junto con el modelo de rango total y el tipo transaccional y transformacional del liderazgo, para luego definir el papel y la importancia de los conceptos de poder, los tipos de poder, la influencia y las tácticas de influencia, y así, identificar las posibles relaciones que se presentan entre los conceptos y la importancia de estos en el entorno organizacional actual.

Advances in Model-Based Traffic Vision

Model based vision allows use of prior knowledge of the shape and appearance of specific objects to be used in the interpretation of a visual scene; it provides a powerful and natural way to enforce the view consistency constraint. A model based vision system has been developed within ESPRIT VIEWS: P2152 which is able to classify and track moving objects (cars and other vehicles) in complex, cluttered traffic scenes. The fundamental basis of the method has been previously reported. This paper presents recent developments which have extended the scope of the system to include (i) multiple cameras, (ii) variable camera geometry, and (iii) articulated objects. All three enhancements have easily been accommodated within the original model-based approach

Is 15 per cent very common? Informing people about the risks of medication side effects

Objectives - To assess the general public's interpretation of the verbal descriptors for side effect frequency recommended for use in medicine information leaflets by a European Union (EU) guideline, and to examine the extent to which differences in interpretation affect people's perception of risk and their judgments of intention to comply with the prescribed treatment. Method - Two studies used a controlled empirical methodology in which people were presented with a hypothetical, but realistic, scenario about visiting their general practitioner and being prescribed medication. They were given an explanation that focused on the side effects of the medicine, together with information about the probability of occurrence using either numerical percentages or the corresponding EU verbal descriptors. Interpretation of the descriptors was assessed. In study 2, participants were also required to make various judgments, including risk to health and intention to comply. Key findings - In both studies, use of the EU recommended descriptors led to significant overestimations of the likelihood of particular side effects occurring. Study 2 further showed that the "overestimation" resulted in significantly increased ratings of perceived severity of side effects and risk to health, as well as significantly reduced ratings of intention to comply, compared with those for people who received the probability information in numerical form. Conclusion - While it is recognised that the current findings require replication in a clinical setting, the European and national authorities should suspend the use of the EU recommended terms until further research is available to allow the use of an evidence-based approach.

Cognitive-behavior therapy for compulsive checking in OCD

There is substantial evidence for the effectiveness of psychological treatments for OCD, and various approaches have been widely recommended. These approaches tend to be characterized by exposure and response prevention (ERP) and also tend to be applied equally to all forms of OCD. Patients/clients (and some therapists) often find ERP to be a difficult treatment, and both dropout and refusal rates are unacceptably high. Based on specific cognitive conceptualizations of different manifestations of OCD, new and refined cognitive treatment methods are now available. The present article describes a specific cognitively based approach to the treatment of compulsive checking.

Developing protocols for nursery based scheduling trials

Most existing crop scheduling models are cultivar specific and are developed using academic resources. As such they rarely meet the particular needs of a grower. A series of protocols have been created to generate effective schedules for a changing product range using data generated on site at a commercial nursery. A screening programme has been developed to help determine a cultivar's photoperiod sensitivity and vernalisation requirement. Experimental conditions were obtained using a cold store facility set to 5degreesC and photoperiod cloches. Eight and 16 hour photoperiod treatments were achieved at low cost by growing plants in cloches of opaque plastic with a motorised rolling screen. Natural light conditions were extended where necessary using a high pressure sodium lamp. Batches of plants were grown according to different schedules based on these treatments. The screening programme found Coreopsis grandiflora 'Flying Saucers' to be a long day plant. Data to form the basis of graphical tracks was taken using variations on commercial schedules. The work provides a nursery based approach to the continuous improvement of crop scheduling practises.

Likelihood-based estimation of microsatellite mutation rates

Microsatellites are widely used in genetic analyses, many of which require reliable estimates of microsatellite mutation rates, yet the factors determining mutation rates are uncertain. The most straightforward and conclusive method by which to study mutation is direct observation of allele transmissions in parent-child pairs, and studies of this type suggest a positive, possibly exponential, relationship between mutation rate and allele size, together with a bias toward length increase. Except for microsatellites on the Y chromosome, however, previous analyses have not made full use of available data and may have introduced bias: mutations have been identified only where child genotypes could not be generated by transmission from parents' genotypes, so that the probability that a mutation is detected depends on the distribution of allele lengths and varies with allele length. We introduce a likelihood-based approach that has two key advantages over existing methods. First, we can make formal comparisons between competing models of microsatellite evolution; second, we obtain asymptotically unbiased and efficient parameter estimates. Application to data composed of 118,866 parent-offspring transmissions of AC microsatellites supports the hypothesis that mutation rate increases exponentially with microsatellite length, with a suggestion that contractions become more likely than expansions as length increases. This would lead to a stationary distribution for allele length maintained by mutational balance. There is no evidence that contractions and expansions differ in their step size distributions.

Learning from risks: A tool for post-project risk assessment

Risk management (RM) comprises of risk identification, risk analysis, response planning, monitoring and action planning tasks that are carried out throughout the life cycle of a project in order to ensure that project objectives are met. Although the methodological aspects of RM are well-defined, the philosophical background is rather vague. In this paper, a learning-based approach is proposed. In order to implement this approach in practice, a tool has been developed to facilitate construction of a lessons learned database that contains risk-related information and risk assessment throughout the life cycle of a project. The tool is tested on a real construction project. The case study findings demonstrate that it can be used for storing as well as updating risk-related information and finally, carrying out a post-project appraisal. The major weaknesses of the tool are identified as, subjectivity of the risk rating process and unwillingness of people to enter information about reasons of failure.

The ethical challenges of ubiquitous healthcare

Ubiquitous healthcare is an emerging area of technology that uses a large number of environmental and patient sensors and actuators to monitor and improve patients’ physical and mental condition. Tiny sensors gather data on almost any physiological characteristic that can be used to diagnose health problems. This technology faces some challenging ethical questions, ranging from the small-scale individual issues of trust and efficacy to the societal issues of health and longevity gaps related to economic status. It presents particular problems in combining developing computer/information/media ethics with established medical ethics. This article describes a practice-based ethics approach, considering in particular the areas of privacy, agency, equity and liability. It raises questions that ubiquitous healthcare will force practitioners to face as they develop ubiquitous healthcare systems. Medicine is a controlled profession whose practise is commonly restricted by government-appointed authorities, whereas computer software and hardware development is notoriously lacking in such regimes.

Classification-based probabilistic modeling of texture transition for fast line search tracking and delineation

We introduce a classification-based approach to finding occluding texture boundaries. The classifier is composed of a set of weak learners, which operate on image intensity discriminative features that are defined on small patches and are fast to compute. A database that is designed to simulate digitized occluding contours of textured objects in natural images is used to train the weak learners. The trained classifier score is then used to obtain a probabilistic model for the presence of texture transitions, which can readily be used for line search texture boundary detection in the direction normal to an initial boundary estimate. This method is fast and therefore suitable for real-time and interactive applications. It works as a robust estimator, which requires a ribbon-like search region and can handle complex texture structures without requiring a large number of observations. We demonstrate results both in the context of interactive 2D delineation and of fast 3D tracking and compare its performance with other existing methods for line search boundary detection.

Sparse kernel density estimation technique based on zero-norm constraint

A sparse kernel density estimator is derived based on the zero-norm constraint, in which the zero-norm of the kernel weights is incorporated to enhance model sparsity. The classical Parzen window estimate is adopted as the desired response for density estimation, and an approximate function of the zero-norm is used for achieving mathemtical tractability and algorithmic efficiency. Under the mild condition of the positive definite design matrix, the kernel weights of the proposed density estimator based on the zero-norm approximation can be obtained using the multiplicative nonnegative quadratic programming algorithm. Using the -optimality based selection algorithm as the preprocessing to select a small significant subset design matrix, the proposed zero-norm based approach offers an effective means for constructing very sparse kernel density estimates with excellent generalisation performance.

Regression based D-optimality experimental design for sparse kernel density estimation

This paper derives an efficient algorithm for constructing sparse kernel density (SKD) estimates. The algorithm first selects a very small subset of significant kernels using an orthogonal forward regression (OFR) procedure based on the D-optimality experimental design criterion. The weights of the resulting sparse kernel model are then calculated using a modified multiplicative nonnegative quadratic programming algorithm. Unlike most of the SKD estimators, the proposed D-optimality regression approach is an unsupervised construction algorithm and it does not require an empirical desired response for the kernel selection task. The strength of the D-optimality OFR is owing to the fact that the algorithm automatically selects a small subset of the most significant kernels related to the largest eigenvalues of the kernel design matrix, which counts for the most energy of the kernel training data, and this also guarantees the most accurate kernel weight estimate. The proposed method is also computationally attractive, in comparison with many existing SKD construction algorithms. Extensive numerical investigation demonstrates the ability of this regression-based approach to efficiently construct a very sparse kernel density estimate with excellent test accuracy, and our results show that the proposed method compares favourably with other existing sparse methods, in terms of test accuracy, model sparsity and complexity, for constructing kernel density estimates.