Bioética intercultural para la salud global

Hoy las enfermedades no tienen fronteras,por lo tanto no pueden ser concebidas en términos locales, sino como problemas conectados con la pobreza y la marginalidad en todos los países del mundo. Esta consideración de la salud global e integral obliga, por una parte, a detectar los impedimentos que dificultan crear condiciones de salud mundial y, por otra parte, buscar las vías y diseñar las estrategias necesariaspara superar los obstáculos y alcanzar las cotas de salud que se entiende constituyen la calidad de vida.

Bioética intercultural para la salud global

Hoy las enfermedades no tienen fronteras,por lo tanto no pueden ser concebidas en términos locales, sino como problemas conectados con la pobreza y la marginalidad en todos los países del mundo. Esta consideración de la salud global e integral obliga, por una parte, a detectar los impedimentos que dificultan crear condiciones de salud mundial y, por otra parte, buscar las vías y diseñar las estrategias necesariaspara superar los obstáculos y alcanzar las cotas de salud que se entiende constituyen la calidad de vida.

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 4: seminal vesicles and lymph nodes.

The 2009 International Society of Urological Pathology Consensus Conference in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to the infiltration of tumor into the seminal vesicles and regional lymph nodes were coordinated by working group 4. There was a consensus that complete blocking of the seminal vesicles was not necessary, although sampling of the junction of the seminal vesicles and prostate was mandatory. There was consensus that sampling of the vas deferens margins was not obligatory. There was also consensus that muscular wall invasion of the extraprostatic seminal vesicle only should be regarded as seminal vesicle invasion. Categorization into types of seminal vesicle spread was agreed by consensus to be not necessary. For examination of lymph nodes, there was consensus that special techniques such as frozen sectioning were of use only in high-risk cases. There was no consensus on the optimal sampling method for pelvic lymph node dissection specimens, although there was consensus that all lymph nodes should be completely blocked as a minimum. There was also a consensus that a count of the number of lymph nodes harvested should be attempted. In view of recent evidence, there was consensus that the diameter of the largest lymph node metastasis should be measured. These consensus decisions will hopefully clarify the difficult areas of pathological assessment in radical prostatectomy evaluation and improve the concordance of research series to allow more accurate assessment of patient prognosis.

Salvage treatment for venous aneurysm complicating vascular access arteriovenous fistula: use of an exoprosthesis to reinforce the vein after aneurysmorrhaphy.

OBJECTIVES: We report a new salvage technique for treating venous aneurysms (VAs) complicating vascular access arteriovenous fistula (AVF) using externally reinforced venous aneurysmorrhaphy. DESIGN: A retrospective study over a 20-month period from a single centre. PATIENTS: Patients presenting to the vascular surgery department, Bordeaux University Hospital for revision of a vascular access AVF were included. METHODS: Reinforced venous aneurysmorrhaphy consisted in removal of redundant vessel wall followed by reinforcement using an external prosthetic graft. Patency, diameter and flow were assessed by duplex ultrasound at 1, 6 and 12 months after salvage. RESULTS: Thirty-eight eligible patients were identified. Five were excluded because VA was associated with central vein stenosis; the remaining 33 underwent salvage. Indications were rapidly expanding or painful VA in seven cases; VA with frequent bleeding or damaged overlying skin in eight; VA in close relation to a stenosis in two; and VA associated with high-flow rate in 16. Cannulation was attempted after 30 days. Mean follow-up time was 12 S.D. 5 months (range: 4-22). Two repaired AVFs failed. Primary 1-year patency was 93%. No aneurysm or infection occurred. Reduction of high flow was successful in 12 of 16 patients. The remaining four required re-operation. CONCLUSIONS: Reinforced venous aneurysmorrhaphy is effective in controlling venous dilation and achieving patency. Reduction of high-flow rates was not always achieved. Further study is needed to evaluate long-term efficacy of this treatment.

Bases Teóricas y Herramientas para el Análisis y Comparación de Sistemas de Votación de Código Abierto

Dentro del proceso de definición de las vías de participación en el PLAN DIRECTOR DE PARTICIPACIÓN CIUDADANA 2010-2015 del Ayuntamiento de Barcelona, se plantea la necesidad de fomentar mecanismos de participación directa y a, partir de esta necesidad, se plantea el desarrollo de una aplicación de Consultas Populares.Dentro de los procesos participativos, las consultas a realizar pueden ser vinculantes y por tanto resulta de la mayor importancia fundamentar su desarrollo garantizando la corrección formal de todo el proceso.Entre los requerimientos, especificados por en Instituto Municipal de Informática, el sistema de votación a plantear debe estar cubierto por alguna de las licencias consideradas libres o de código abierto. Una de las principales características de este tipo de aplicaciones es que resulta posible la utilización y modificación del código.Como primer paso se definen los conceptos básicos implicados comenzando con la del propio concepto de e-Voting. A partir de las experiencias previas realizadas en nuestro entorno geográfico, es posible establecer que los estándares más utilizados son los generados por el Consejo de Europa, qué utilizaremos para concretar las diferentes fases de un Proceso de Consulta, los actores implicados así como las diferentes funciones a de cada uno de ellos para cada una de las fases.Sobre esta base se analizan las diferentes alternativas existentes entre lo que se denominan Esquemas de Votación. Centrándonos en el escogido como más conveniente, el Esquema de Voto Oculto, se describen las características de seguridad que permiten dar validez a un proceso de consulta realizado por este medio. Así mismo se describen los principales conceptos teóricos implicados mediante una aproximación que permita su comprensión de forma intuitiva, especialmente en lo que se refiere a las técnicas criptográficas implicadas.En tercer lugar se ha realizado una búsqueda de posibles aplicaciones que sirvan de punto de partida y se han hecho pruebas comparativas para las cuales se han adaptado las herramientas correspondientes a QSOS, relacionando los estándares especificados por el Consejo Europeo y las características de seguridad que deben cumplirse.

Research into the information referents of deaf signers

La sociedad de la información está ampliando los referentes informativos de las personas sordas signantes (usuarias de una lengua de signos). Con el objetivo de explorar las vías más utilizadas para acceder a la actualidad periodística por parte del colectivo mencionado, este artículo resume una investigación cuantitativa realizada con una encuesta a 138 personas Sordas: 69 en España y 69 en EE.UU. El trabajo se complementa cualitativamente con un focus group en la Gallaudet University de Washington, en American Sign Language (ASL), y con la observación de tres conferencias-magazines en Barcelona, para participantes sordos, en Lengua de Signos Catalana (LSC).

Derechos emergentes en regiones emergentes: el derecho al agua potable y al saneamiento en Asia Central

El derecho humano al agua potable y al saneamiento viene afirmándose de manera cada vez más rotunda en el plano internacional. Supone la capacidad de cada ser humano de acceder a agua limpia y segura de manera asequible, y la obligación correlativa de los Estados de garantizar y proteger este derecho. Los Estados de Asia Central disponen de agua suficiente para garantizar este derecho a todos sus ciudadanos, pero la mala gestión y el despilfarro hace que algunas zonas, sobre todo rurales, tengan importantes carestías. Las mejoras en tarificación, servicio y cooperación transfronteriza se apuntan como posibles vías de solución.

Análisis, zonificación y manejo de la estación de monitorización Madre Selva

Este artículo es la síntesis del trabajo realizado en Costa Rica en la finca “Madre Selva” donde se encuentra una estación de monitoreo de aves. Los objetivos finales del proyecto son el análisis socioambiental, la zonificación de toda el área de la finca y el desarrollo de las vías y programas de manejo para que todas las actividades realizadas sean respetuosas con el medio ambiente. Madre Selva ocupa una superficie de 160ha y está situada en la “Reserva Forestal Los Santos” a una altura de 2600m. En esta superficie se han registrado un total de 200 especies diferentes de avifauna. Las dos actividades que se llevan a cabo son la monitorización como actividad científica y la ganadería como actividad económica. La razón por la cual se ha efectuado este estudio es la conservación del ecosistema para que las aves habiten en sus condiciones naturales y la actividad científica se realice de manera efectiva. La zonificación de Madre Selva refleja los diferentes usos del suelo y funciones del territorio. Concretamente, la finca ha quedado dividida en 7 zonas descritas con sus valores y sus correspondientes vías de manejo. Finalmente, se describen los programas de manejo que se llevan a cabo actualmente y se proponen nuevos programas así como propuestas de mejora. Se destaca la oportunidad de desarrollar nuevas actividades como la educación ambiental y el ecoturismo.

Simulando una vía de comunicación: el tramo de la vía romana entre el Coll de Panissars y Girona

Mediante programa informático es posible simular las vías de comunicación existentes entre asentamientos humanos, siendo muchos los trabajos publicados y varias las formas de aproximación al problema. El objetivo del trabajo que nos ocupa ha consistido en la generación de un nuevo modelo a partir del cual fuera posible simular una vía de comunicación, con la salvedad de que en este caso ya existía una idea aproximada de cual sería su trayectoria a partir de trabajos de otros autores. Esta vía de comunicación es la vía Augusta, en el tramo que une el Coll de Panissars y la ciudad de Girona.

Cross-Cultural Adaptation and Validation of the Spinal Function Sort (SFS) for French- and German-Speaking Patients with Back Complaints

Aim: Functional subjective evaluation through questionnaire is fundamental, but not often realized in patients with back complaints, notably because of lack of validated tools, in accordance with recognized psychometric criteria. The Spinal Function Sort (SFS), developed according to actual standards, was only validated in English. The aim of this study is to translate, adapt and validate the French and German version of the SFS.Method and material: The translation and cross-cultural adaptation were performed following the methodology proposed by the American Association of Orthopedist Surgeon. A total of 344 patients, presenting varied back complaints (especially degenerative and traumatic), took part in this study in a tertiary French- (n=87; mean age 44y; 17 women) and German-speaking (n=257; mean age 41y; 53 women) center. Test-retest reliability was quantified using the intraclass correlation coefficient (ICC) and construct validity was assessed by estimating the Pearson's correlation with the SF-36 physical and mental scales, the Visual Analogue Scale for Pain Intensity (VAS), and subscales of the Hospital Anxiety and Depression Scale (HADS).Results: Respectively for the French and German version, ICC were 0.98 and 0.94. Correlations 0.63 and 0.67 with the SF-36 Physical Functioning subscale; 0.60 and 0.52 with the SF-36 Physical Summary Scale ; -0.33 and -0.51 with the VAS ; -0.08 and 0.25 with the SF-36 Mental Health scale; 0.01 and 0.28 with the SF-36 Mental Summary Scale; -0.26 and -0.42 with the HADS depression; -0.17 and -0.45 with the HADS anxiety.Discussion: For both the French and German version of the SFS, the reliability was excellent. Convergent construct validity with SF-36 physical scales is good, moderated with the VAS. We find out a low correlation with SF-36 mental scales (divergent construct validity). We find out a low correlation with HADS subscales in the French version, and a moderate one in the German version. Selection bias, chronicity of the complaints, as well as cultural differences could explain these results. In conclusion, both the French and German version of the SFS are valid and reliable for evaluation of perceived functional capacity for patients with back complaints.

Barriers, benefits and preferences for exercise in RA patients: A cross sectional study.

Background/Purpose: Physical exercise is safe and effective as an adjunctive nonpharmacological treatment modality in the management of rheumatoid arthritis (RA). It is well established that patients with RA are less active compared to healthy controls. The transtheoretical model of health promotion, based on five stages of change, provides a useful framework to better understand patients' motivation towards regular exercise. The purpose of this study was to determine the distribution of exercise stages of change in a RA cohort, and to examine barriers, benefits and preferences for exercise. Methods: One hundred and twenty consecutive patients with RA followed at a hospital-based rheumatology practice were invited to participate in the study. Those who accepted to participate filled in a questionnaire to determine their exercise stage of change, their perceived benefits and barriers to exercise, and their preferences for various features of exercise. Disease activity was measured using the disease activity score (DAS28). Other variables included the Health Assessment Questionnaire (HAQ), the short version of the Arthritis Impact Measurement Scales 2 (AIMS2-SF), pain and fatigue visual analogue scales (VAS), the number of comorbidities and demographic characteristics. Characteristics of patients in the maintenance and precontemplation stages of change were compared using two-sample t tests, Wilcoxon rank-sum tests and Chi-square tests. Results: Eighty nine (74%) patients were finally included in the analyses. Mean age was 58.4 (SD 11.7) years, mean RA duration was 10.1 (9.8) years and mean DAS28 was 2.8 (1.2). The distribution of exercise stages of change was as follows: precontemplation (n_30, 34%), contemplation (n_11, 13%), preparation (n_5, 6%), action (n_2, 2%), and maintenance (n_39, 45%). Compared to patients in the maintenance stage of change, precontemplators were less often at work (P_0.05), exhibited a higher body mass index (P_0.01), poorer HAQ (P_0.01), higher pain VAS (P_0.05), poorer scores of physical (P_0.001), symptom (P_0.01), affect (P_0.01) and role (P_0.01) dimensions of the AIMS2-SF, and reported less exercise benefits (P_0.05) and more barriers to exercise (p_0.01). Most participants preferred exercising alone (40%), at home (29%), at a moderate intensity (64%), with advice provided by a rheumatologist (34%) or a specialist in exercise and RA (34%). Walking was by far the preferred type of exercise, in both the summer (86%) and the winter (51%). Conclusion: This study provides new insight into how RA interferes with exercise participation. Our cohort of patients with RA was essentially distributed across the precontemplation and maintenance exercise stages of change. These subgroups of patients exhibit psychological and functional differences that make their needs in terms of exercise counseling different. Walking appears to be a simple but promising way of promoting physical activity among RA patients.

Predictive Value of Readiness, Importance, and Confidence in Ability to Change Drinking and Smoking

Background: Visual analog scales (VAS) are used to assess readiness to changeconstructs, which are often considered critical for change.Objective: We studied whether 3 constructs -readiness to change, importance of changing and confidence inability to change- predict risk status 6 months later in 20 year-old men with either orboth of two behaviors: risky drinking and smoking. Methods: 577 participants in abrief intervention randomized trial were assessed at baseline and 6 months later onalcohol and tobacco consumption and with three 1-10 VAS (readiness, importance,confidence) for each behavior. For each behavior, we used one regression model foreach constructs. Models controlled for receipt of a brief intervention and used thelowest level (1-4) in each construct as the reference group (vs medium (5-7) and high(8-10) levels).Results: Among the 475 risky drinkers, mean (SD) readiness, importance and confidence to change drinking were 4.0 (3.1), 2.8 (2.2) and 7.2 (3.0).Readiness was not associated with being alcohol-risk free 6 months later (OR 1.3[0.7; 2.2] and 1.4 [0.8; 2.6] for medium and high readiness). High importance andhigh confidence were associated with being risk free (OR 0.9 [0.5; 1.8] and 2.9 [1.2;7.5] for medium and high importance; 2.1 [1.0;4.8] and 2.8 [1.5;5.6] for medium andhigh confidence). Among the 320 smokers, mean readiness, importance andconfidence to change smoking were 4.6 (2.6), 5.3 (2.6) and 5.9 (2.6). Neitherreadiness nor importance were associated with being smoking free (OR 2.1 [0.9; 4.7]and 2.1 [0.8; 5.8] for medium and high readiness; 1.4 [0.6; 3.4] and 2.1 [0.8; 5.4] formedium and high importance). High confidence was associated with being smokingfree (OR 2.2 [0.8;6.6] and 3.4 [1.2;9.8] for medium and high confidence).Conclusions: For drinking and smoking, high confidence in ability to change wasassociated -with similar magnitude- with a favorable outcome. This points to thevalue of confidence as an important predictor of successful change.

Traitement de la dépression résistante par l'association citalopram-lithium. Méthodologie d'une étude multicentrique en double aveugle et résultats préliminaires [Treatment of resistant depression with the citalopram-lithium combination. Methodology of a double-blind multicenter study and preliminary results].

Citalopram, a new bicyclic antidepressant, is the most selective serotonin reuptake inhibitor. In a number of double-blind controlled studies, citalopram was compared to placebo and to known tricyclic antidepressants. These studies have shown their efficacy and good safety. The inefficacy of a psychotropic treatment in at least 20% of depressives has led a number of authors to propose original drug combinations and associations, like antidepressant/lithium (Li), antidepressant/sleep deprivation (agrypnia), antidepressant/ECT, or antidepressant/LT3. The aim of this investigation is to evaluate the clinical effectiveness and safety of a combined citalopram/lithium treatment in therapy-resistant patients, taking account of serotonergic functions, as tested by the fenfluramine/prolactin test, and of drug pharmacokinetics and pharmacogenetics of metabolism. DESIGN OF THE STUDY: A washout period of 3 days before initiating the treatment is included. After an open treatment phase of 28 days (D) with citalopram (20 mg D1-D3; 40 mg D4-D14; 40 or 60 mg D15-D28; concomitant medication allowed: chloral, chlorazepate), the nonresponding patients [less than 50% improvement in the total score on the 21 item-Hamilton Depression Rating Scale (HDRS)] are selected and treated with or without Li (randomized in double-blind conditions: citalopram/Li or citalopram/placebo) during the treatment (D29-D35). Thereafter, all patients included in the double-blind phase subsequently receive an open treatment with citalopram/Li for 7 days (D36-D42). The hypothesis of a relationship between serotoninergic functions in patients using the fenfluramine/prolactin test (D1) and the clinical response to citalopram (and Li) is assessed. Moreover, it is evaluated whether the pharmacogenetic status of the patients, as determined by the mephenytoin/dextromethorphan test (D0-D28), is related to the metabolism of fenfluramine and citalopram, and also to the clinical response. CLINICAL ASSESSMENT: Patients with a diagnosis of major depressive disorders according to DSM III are submitted to a clinical assessment of D1, D7, D14, D28, D35, D42: HDRS, CGI (clinical global impression), VAS (visual analog scales for self-rating of depression), HDRS (Hamilton depression rating scale, 21 items), UKU (side effects scale), and to clinical laboratory examens, as well as ECG, control of weight, pulse, blood pressure at D1, D28, D35. Fenfluramine/prolactin test: A butterfly needle is inserted in a forearm vein at 7 h 45 and is kept patent with liquemine. Samples for plasma prolactin, and d- and l-fenfluramine determinations are drawn at 8 h 15 (base line). Patients are given 60 mg fenfluramine (as a racemate) at 8 h 30. Kinetic points are determined at 9 h 30, 10 h 30, 11 h 30, 12 h 30, 13 h 30. Plasma levels of d- and l-fenfluramine are determined by gas chromatography and prolactin by IRNA. Mephenytoin/dextromethorphan test: Patients empty their bladders before the test; they are then given 25 mg dextropethorphan and 100 mg mephenytoin (as a racemate) at 8 h 00. They collect all urines during the following 8 hours. The metabolic ratio is determined by gas chromatography (metabolic ratio dextromethorphan/dextrorphan greater than 0.3 = PM (poor metabolizer); mephenytoin/4-OH-mephenytoin greater than 5.6, or mephenytoin S/R greater than 0.8 = PM). Citalopram plasma levels: Plasma levels of citalopram, desmethylcitalopram and didesmethylcitalopram are determined by gas chromatography--mass spectrometry. RESULTS OF THE PILOT STUDY. The investigation has been preceded by a pilot study including 14 patients, using the abovementioned protocol, except that all nonresponders were medicated with citalopram/Li on D28 to D42. The mean total score (n = 14) on the 21 item Hamilton scale was significantly reduced after the treatment, ie from 26.93 +/- 5.80 on D1 to 8.57 +/- 6.90 on D35 (p less than 0.001). A similar patCitalopram, a new bicyclic antidepressant, is the most selective serotonin reu