Switch to etravirine for HIV-positive patients receiving statin treatment: a prospective study

BACKGROUND Life style changes and statins are the cornerstones in management of dyslipidemia in HIV-infected patients. Replacement of an antiretroviral therapy (ART) component is a proposed therapeutic strategy to reduce cardiovascular risk. In dyslipidemic HIV-positive patients, we assessed the efficacy of replacing boosted protease inhibitor (bPI) or efavirenz (EFV) by etravirine (ETR) as an alternative to statin therapy. MATERIALS AND METHODS A prospective, open-label, multicentre, 12-week study of HIV-infected patients on ART including bPI or EFV, and statin treatment. Four weeks after statin interruption, bPI or EFV were switched to ETR (400 mg, 8 weeks) if serum low-density lipoprotein cholesterol (LDL-c) was ≥ 3 mmol/L. The primary endpoint was the proportion of patients on ETR with no indication for statin treatment at study completion. Serum levels of HIV-RNA, lipids, and biomarkers of cardiovascular disease were also measured. (ClinicalTrialsgov: NCT01543035). RESULTS The 31 included patients had a HIV1-RNA <50 copies/mL (median age, 52 years; median CD4, 709 cell/mL; median LDL-c, 2.89 mmol/L), 68% were on EFV, 32% on bPI. At week 4, 27 patients switched to ETR. At study completion, 15 patients (56%) on ETR did not qualify for statin treatment. After the ETR switch, serum levels of the cardiovascular biomarkers sICAM and MCP1/CCL2 decreased by 11.2% and 18.9%, respectively, and those of CCL5/RANTES and tissue inhibitor of metalloproteinase-1 increased by 14.3% and 13.4%, respectively, indicating reduced cardiovascular risk. There were no notable treatment-related adverse events. CONCLUSIONS Replacing bPI or EFV by ETR is a viable strategy to obviate primary prevention statin treatment. This article is protected by copyright. All rights reserved.

Chronic postsurgical pain in Europe: An observational study.

BACKGROUND Chronic postsurgical pain (CPSP) is an important clinical problem. Prospective studies of the incidence, characteristics and risk factors of CPSP are needed. OBJECTIVES The objective of this study is to evaluate the incidence and risk factors of CPSP. DESIGN A multicentre, prospective, observational trial. SETTING Twenty-one hospitals in 11 European countries. PATIENTS Three thousand one hundred and twenty patients undergoing surgery and enrolled in the European registry PAIN OUT. MAIN OUTCOME MEASURES Pain-related outcome was evaluated on the first postoperative day (D1) using a standardised pain outcome questionnaire. Review at 6 and 12 months via e-mail or telephonic interview used the Brief Pain Inventory (BPI) and the DN4 (Douleur Neuropathique four questions). Primary endpoint was the incidence of moderate to severe CPSP (numeric rating scale, NRS ≥3/10) at 12 months. RESULTS For 1044 and 889 patients, complete data were available at 6 and 12 months. At 12 months, the incidence of moderate to severe CPSP was 11.8% (95% CI 9.7 to 13.9) and of severe pain (NRS ≥6) 2.2% (95% CI 1.2 to 3.3). Signs of neuropathic pain were recorded in 35.4% (95% CI 23.9 to 48.3) and 57.1% (95% CI 30.7 to 83.4) of patients with moderate and severe CPSP, respectively. Functional impairment (BPI) at 6 and 12 months increased with the severity of CPSP (P < 0.01) and presence of neuropathic characteristics (P < 0.001). Multivariate analysis identified orthopaedic surgery, preoperative chronic pain and percentage of time in severe pain on D1 as risk factors. A 10% increase in percentage of time in severe pain was associated with a 30% increase of CPSP incidence at 12 months. CONCLUSION The collection of data on CPSP was feasible within the European registry PAIN OUT. The incidence of moderate to severe CPSP at 12 months was 11.8%. Functional impairment was associated with CPSP severity and neuropathic characteristics. Risk factors for CPSP in the present study were chronic preoperative pain, orthopaedic surgery and percentage of time in severe pain on D1. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01467102.

Manejo del dolor en pacientes hospitalizados

Objetivos: Evaluar efectividad y adecuación de la terapia analgésica en pacientes internados con dolor. Materiales y Métodos: Estudio transversal, descriptivo y observacional, mediante revisión de historias clínicas y encuesta validada que incluye el Brief Pain Inventory (BPI). Consideramos respuesta analgésica adecuada un valor ≤ 3 (0-10). Criterio de inclusión: paciente internado con dolor. Análisis estadístico: medidas de tendencia central y dispersión, IC95%. Resultados: Se incluyeron 139 pacientes, distribuidos en clínica médica 13.67%, cardiología 2.88%, cirugía 38.13%, quemados 1.44%, ginecología 9.35%, maternidad 9.35%, traumatología 20.14%, neurología 0.72% y urología 2.16%. Edad media 43.40 años (DS±17.52); 41.73% hombres. Mediana de permanencia al momento de evaluación 3 días (1-60). Presentaron dolor somático 56.83% (IC95% 65.07-48.60), visceral 39.57% (IC95% 47.70-31.44) y neuropático 5.04% (IC95% 8.67-1.40). Las principales etiologías del dolor fueron patología quirúrgica aguda 31.65% (IC95% 39.39-23.92), traumatológica 20.14% (IC95% 26.81-13.48), postoperatorio 17.99% (IC95% 24.37-11.60) y neoplásico 10.07% (IC95% 15.08-5.07). El 82.73% (IC95% 89.02-76.45) tenía indicada analgesia, 47.48% endovenosa y en 3.60% participó especialista en dolor. La dosis fue adecuada en 65.47%; el analgésico más indicado diclofenac 36.69%, ketorolac 16.55%, tramadol 6.47%, paracetamol 5.76%, ibuprofeno 2.16%. Recibía morfina 3.60%, AINE combinado con opioide débil 11.51%, corticoides 3.60% y 0.72% anticonvulsivantes. El 3.60% reportó efectos colaterales atribuibles a la analgesia. Mediante BPI el 38% controló su peor dolor y 53% su valor promedio. Existió demora mayor a 24 hs en indicación de analgesia en 7.91%. La analgesia aplicada figuraba en historia clínica en 40.29%, en indicaciones para enfermería 82.73%. La valoración del dolor fue registrada en 46.76% de las evoluciones diarias.

Infiltration of a photonic crystal fiber with cholesteric liquid crystal and blue phase

Photonic crystal fibers (PCF) have been selectively filled with a cholesteric liquid crystal (ChLC) with special interest in the blue phase (BP) of the liquid crystal. It has been observed thermal tuning of the guided light in the visible region. A dramatically enhance appears when the phase of the liquid crystal changes from cholesteric to blue phase I (BPI). When a thermal range of the blue phase I is achieved, no changes are observed while increasing temperature from BPI through BPII and to the isotropic phase.

Desarrollo de un Modelo de Gestión de Riesgos Operacionales basado en las Directrices del Comité de Basilea

La presente investigación tiene como objetivo principal diseñar un Modelo de Gestión de Riesgos Operacionales (MGRO) según las Directrices de los Acuerdos II y III del Comité de Supervisión Bancaria de Basilea del Banco de Pagos Internacionales (CSBB-BPI). Se considera importante realizar un estudio sobre este tema dado que son los riesgos operacionales (OpR) los responsables en gran medida de las últimas crisis financieras mundiales y por la dificultad para detectarlos en las organizaciones. Se ha planteado un modelo de gestión subdividido en dos vías de influencias. La primera acoge el paradigma holístico en el que se considera que hay múltiples maneras de percibir un proceso cíclico, así como las herramientas para observar, conocer y entender el objeto o sujeto percibido. La segunda vía la representa el paradigma totalizante, en el que se obtienen datos tanto cualitativos como cuantitativos, los cuales son complementarios entre si. Por otra parte, este trabajo plantea el diseño de un programa informático de OpR Cualitativo, que ha sido diseñado para determinar la raíz de los riesgos en las organizaciones y su Valor en Riesgo Operacional (OpVaR) basado en el método del indicador básico. Aplicando el ciclo holístico al caso de estudio, se obtuvo el siguiente diseño de investigación: no experimental, univariable, transversal descriptiva, contemporánea, retrospectiva, de fuente mixta, cualitativa (fenomenológica y etnográfica) y cuantitativa (descriptiva y analítica). La toma de decisiones y recolección de información se realizó en dos fases en la unidad de estudio. En la primera se tomó en cuenta la totalidad de la empresa Corpoelec-EDELCA, en la que se presentó un universo estadístico de 4271 personas, una población de 2390 personas y una unidad de muestreo de 87 personas. Se repitió el proceso en una segunda fase, para la Central Hidroeléctrica Simón Bolívar, y se determinó un segundo universo estadístico de 300 trabajadores, una población de 191 personas y una muestra de 58 profesionales. Como fuentes de recolección de información se utilizaron fuentes primarias y secundarias. Para recabar la información primaria se realizaron observaciones directas, dos encuestas para detectar las áreas y procesos con mayor nivel de riesgos y se diseñó un cuestionario combinado con otra encuesta (ad hoc) para establecer las estimaciones de frecuencia y severidad de pérdidas operacionales. La información de fuentes secundarias se extrajo de las bases de datos de Corpoelec-EDELCA, de la IEA, del Banco Mundial, del CSBB-BPI, de la UPM y de la UC at Berkeley, entre otras. Se establecieron las distribuciones de frecuencia y de severidad de pérdidas operacionales como las variables independientes y el OpVaR como la variable dependiente. No se realizó ningún tipo de seguimiento o control a las variables bajo análisis, ya que se consideraron estas para un instante especifico y solo se determinan con la finalidad de establecer la existencia y valoración puntual de los OpR en la unidad de estudio. El análisis cualitativo planteado en el MGRO, permitió detectar que en la unidad de investigación, el 67% de los OpR detectados provienen de dos fuentes principales: procesos (32%) y eventos externos (35%). Adicionalmente, la validación del MGRO en Corpoelec-EDELCA, permitió detectar que el 63% de los OpR en la organización provienen de tres categorías principales, siendo los fraudes externos los presentes con mayor regularidad y severidad de pérdidas en la organización. La exposición al riesgo se determinó fundamentándose en la adaptación del concepto de OpVaR que generalmente se utiliza para series temporales y que en el caso de estudio presenta la primicia de aplicarlo a datos cualitativos transformados con la escala Likert. La posibilidad de utilizar distribuciones de probabilidad típicas para datos cuantitativos en distribuciones de frecuencia y severidad de pérdidas con datos de origen cualitativo fueron analizadas. Para el 64% de los OpR estudiados se obtuvo que la frecuencia tiene un comportamiento semejante al de la distribución de probabilidad de Poisson y en un 55% de los casos para la severidad de pérdidas se obtuvo a las log-normal como las distribuciones de probabilidad más comunes, con lo que se concluyó que los enfoques sugeridos por el BCBS-BIS para series de tiempo son aplicables a los datos cualitativos. Obtenidas las distribuciones de frecuencia y severidad de pérdidas, se convolucionaron estas implementando el método de Montecarlo, con lo que se obtuvieron los enfoques de distribuciones de pérdidas (LDA) para cada uno de los OpR. El OpVaR se dedujo como lo sugiere el CSBB-BPI del percentil 99,9 o 99% de cada una de las LDA, obteniéndose que los OpR presentan un comportamiento similar al sistema financiero, resultando como los de mayor peligrosidad los que se ubican con baja frecuencia y alto impacto, por su dificultad para ser detectados y monitoreados. Finalmente, se considera que el MGRO permitirá a los agentes del mercado y sus grupos de interés conocer con efectividad, fiabilidad y eficiencia el status de sus entidades, lo que reducirá la incertidumbre de sus inversiones y les permitirá establecer una nueva cultura de gestión en sus organizaciones. ABSTRACT This research has as main objective the design of a Model for Operational Risk Management (MORM) according to the guidelines of Accords II and III of the Basel Committee on Banking Supervision of the Bank for International Settlements (BCBS- BIS). It is considered important to conduct a study on this issue since operational risks (OpR) are largely responsible for the recent world financial crisis and due to the difficulty in detecting them in organizations. A management model has been designed which is divided into two way of influences. The first supports the holistic paradigm in which it is considered that there are multiple ways of perceiving a cyclical process and contains the tools to observe, know and understand the subject or object perceived. The second way is the totalizing paradigm, in which both qualitative and quantitative data are obtained, which are complementary to each other. Moreover, this paper presents the design of qualitative OpR software which is designed to determine the root of risks in organizations and their Operational Value at Risk (OpVaR) based on the basic indicator approach. Applying the holistic cycle to the case study, the following research design was obtained: non- experimental, univariate, descriptive cross-sectional, contemporary, retrospective, mixed-source, qualitative (phenomenological and ethnographic) and quantitative (descriptive and analytical). Decision making and data collection was conducted in two phases in the study unit. The first took into account the totality of the Corpoelec-EDELCA company, which presented a statistical universe of 4271 individuals, a population of 2390 individuals and a sampling unit of 87 individuals. The process was repeated in a second phase to the Simon Bolivar Hydroelectric Power Plant, and a second statistical universe of 300 workers, a population of 191 people and a sample of 58 professionals was determined. As sources of information gathering primary and secondary sources were used. To obtain the primary information direct observations were conducted and two surveys to identify the areas and processes with higher risks were designed. A questionnaire was combined with an ad hoc survey to establish estimates of frequency and severity of operational losses was also considered. The secondary information was extracted from the databases of Corpoelec-EDELCA, IEA, the World Bank, the BCBS-BIS, UPM and UC at Berkeley, among others. The operational loss frequency distributions and the operational loss severity distributions were established as the independent variables and OpVaR as the dependent variable. No monitoring or control of the variables under analysis was performed, as these were considered for a specific time and are determined only for the purpose of establishing the existence and timely assessment of the OpR in the study unit. Qualitative analysis raised in the MORM made it possible to detect that in the research unit, 67% of detected OpR come from two main sources: external processes (32%) and external events (35%). Additionally, validation of the MORM in Corpoelec-EDELCA, enabled to estimate that 63% of OpR in the organization come from three main categories, with external fraud being present more regularly and greater severity of losses in the organization. Risk exposure is determined basing on adapting the concept of OpVaR generally used for time series and in the case study it presents the advantage of applying it to qualitative data transformed with the Likert scale. The possibility of using typical probability distributions for quantitative data in loss frequency and loss severity distributions with data of qualitative origin were analyzed. For the 64% of OpR studied it was found that the frequency has a similar behavior to that of the Poisson probability distribution and 55% of the cases for loss severity it was found that the log-normal were the most common probability distributions. It was concluded that the approach suggested by the BCBS-BIS for time series can be applied to qualitative data. Once obtained the distributions of loss frequency and severity have been obtained they were subjected to convolution implementing the Monte Carlo method. Thus the loss distribution approaches (LDA) were obtained for each of the OpR. The OpVaR was derived as suggested by the BCBS-BIS 99.9 percentile or 99% of each of the LDA. It was determined that the OpR exhibits a similar behavior to the financial system, being the most dangerous those with low frequency and high impact for their difficulty in being detected and monitored. Finally, it is considered that the MORM will allows market players and their stakeholders to know with effectiveness, efficiency and reliability the status of their entities, which will reduce the uncertainty of their investments and enable them to establish a new management culture in their organizations.

An opsonic function of the neutrophil bactericidal/permeability-increasing protein depends on both its N- and C-terminal domains

The host response to Gram-negative bacterial infection is influenced by two homologous lipopolysaccharide (LPS)-interactive proteins, LPS-binding protein (LBP) and the bacteridical/permeability-increasing protein (BPI). Both proteins bind LPS via their N-terminal domains but produce profoundly different effects: BPI and a bioactive N-terminal fragment BPI-21 exert a selective and potent antibacterial effect upon Gram-negative bacteria and suppress LPS bioactivity whereas LBP is not toxic toward Gram-negative bacteria and potentiates LPS bioactivity. The latter effect of LBP requires the C-terminal domain for delivery of LPS to CD14, so we postulated that the C-terminal region of BPI may serve a similar delivery function but to distinct targets. LBP, holoBPI, BPI-21, and LBP/BPI chimeras were compared for their ability to promote uptake by human phagocytes of an encapsulated, phagocytosis-resistant strain of Escherichia coli. We show that only bacteria preincubated with holoBPI are ingested by neutrophils and monocytes. These findings suggest that, when extracellular holoBPI is bound via its N-terminal domain to Gram-negative bacteria, the C-terminal domain promotes bacterial attachment to neutrophils and monocytes, leading to phagocytosis. Therefore, analogous to the role of the C-terminal domain of LBP in delivery of LPS to CD14, the C-terminal domain of BPI may fulfill a similar function in BPI-specific disposal pathways for Gram-negative bacteria.

Formal considerations of rule-based messaging for Business Process Integration

In the last decade, with the expansion of organizational scope and the tendency for outsourcing, there has been an increasing need for Business Process Integration (BPI), understood as the sharing of data and applications among business processes. The research efforts and development paths in BPI pursued by many academic groups and system vendors, targeting heterogeneous system integration, continue to face several conceptual and technological challenges. This article begins with a brief review of major approaches and emerging standards to address BPI. Further, we introduce a rule-driven messaging approach to BPI, which is based on the harmonization of messages in order to compose a new, often cross-organizational process. We will then introduce the design of a temporal first order language (Harmonized Messaging Calculus) that provides the formal foundation for general rules governing the business process execution. Definitions of the language terms, formulae, safety, and expressiveness are introduced and considered in detail.

Developing and evaluating a methodology for business process improvement

Purpose – There appears to be an ever-insatiable demand from markets for organisations to improve their products and services. To meet this, there is a need to provide business process improvement (BPI) methodologies that are holistic, structured and procedural. Therefore, this paper describes research that has formed and tested a generic and practical methodology termed model-based and integrated process improvement (MIPI) to support the implementation of BPI; and to validate its effectiveness in organisations. This methodology has been created as an aid for practitioners within organisations. Design/methodology/approach – The research objectives were achieved by: reviewing and analysing current methodologies, and selecting a few frameworks against key performance indicators. Using a refined Delphi approach and semi-structured interview with the “experts” in the field. Intervention, case study and process research approach to evaluating a methodology. Findings – The BPI methodology was successfully formed and applied by the researcher and directly by the companies involved against the criteria of feasibility, usability and usefulness. Research limitations/implications – The paper has demonstrated a new knowledge on how to systematically assess a BPI methodology in practice. Practical implications – Model-based and integrated process improvement methodology (MIPI) methodology offers the practitioner (experienced and novice) a set of step-by-step aids necessary to make informed, consistent and efficient changes to business processes. Originality/value – The novelty of this research work is the creation of a holistic workbook-based methodology with relevant tools and techniques. It extends the capabilities of existing methodologies.

Reduced gray matter volume in ventral prefrontal cortex but not amygdala in bipolar disorder:significant effects of gender and trait anxiety

Neuroimaging studies in bipolar disorder report gray matter volume (GMV) abnormalities in neural regions implicated in emotion regulation. This includes a reduction in ventral/orbital medial prefrontal cortex (OMPFC) GMV and, inconsistently, increases in amygdala GMV. We aimed to examine OMPFC and amygdala GMV in bipolar disorder type 1 patients (BPI) versus healthy control participants (HC), and the potential confounding effects of gender, clinical and illness history variables and psychotropic medication upon any group differences that were demonstrated in OMPFC and amygdala GMV. Images were acquired from 27 BPI (17 euthymic, 10 depressed) and 28 age- and gender-matched HC in a 3T Siemens scanner. Data were analyzed with SPM5 using voxel-based morphometry (VBM) to assess main effects of diagnostic group and gender upon whole brain (WB) GMV. Post-hoc analyses were subsequently performed using SPSS to examine the extent to which clinical and illness history variables and psychotropic medication contributed to GMV abnormalities in BPI in a priori and non-a priori regions has demonstrated by the above VBM analyses. BPI showed reduced GMV in bilateral posteromedial rectal gyrus (PMRG), but no abnormalities in amygdala GMV. BPI also showed reduced GMV in two non-a priori regions: left parahippocampal gyrus and left putamen. For left PMRG GMV, there was a significant group by gender by trait anxiety interaction. GMV was significantly reduced in male low-trait anxiety BPI versus male low-trait anxiety HC, and in high- versus low-trait anxiety male BPI. Our results show that in BPI there were significant effects of gender and trait-anxiety, with male BPI and those high in trait-anxiety showing reduced left PMRG GMV. PMRG is part of medial prefrontal network implicated in visceromotor and emotion regulation.

Functional neuroimaging studies of bipolar disorder:examining the wide clinical spectrum in the search for disease endophenotypes

Bipolar disorder (BP) is among the top ten most disabling illnesses worldwide. This review includes findings from recent studies employing functional neuroimaging to examine functional abnormalities in neural systems underlying core domains of the psychopathology in BP: emotion processing, emotion regulation and executive control, and common comorbid features of BP, that are relevant to the wide spectrum of BP rather than focused on the more traditional BPI subtype, and that may facilitate future identification of diagnostically-relevant biomarkers of the disorder. In addition, an emerging number of studies are reviewed that demonstrate the use of neuroimaging to elucidate biomarkers whose identification may help to (1) identify at-risk individuals who will subsequently develop the illness to facilitate early intervention, (2) identify targets for treatment and markers of treatment response. The use of newer neuroimaging techniques and potential confounds of psychotropic medication upon neuroimaging findings in BP are also examined. These approaches will help to improve diagnosis and the mental well-being of all individuals with BP.

Investigating group processes in a positive youth development program for multi -problem youth

This study investigated group processes as potential mediators or moderators of positive development outcome and negative reduction intervention response by evaluating the utility of a group measure modified from a widely known measure of group impact found in the group therapy research literature. Four group processes were of primary interest, (1) Group Impact; (2) Facilitator Impact; (3) Skills Impact; and (4) Exploration Impact as assessed by the Session Evaluation Form (SEF). Outcome measures included the Personally Expressive Activities Questionnaire (PEAQ), Erikson Psycho-Social Index (EPSI) and the Zill Behavior Items, Behavior Problem Index (ZBI (BPI)). The sample consisted of 121 multi-ethnic participants drawn from four alternative high schools from the Miami-Dade County Public School system. Utilizing a Latent Growth Curve Modeling approach with Structural Equation Modeling (SEM) statistics, preliminary analyses were conducted to evaluate the psychometric properties of the SEF and its role in the mediation or moderation of intervention outcome. Preliminary results revealed evidence of a single higher order factor representing a "General" global reaction, which was hypothesized to be a "Positive Group Climate" construct to the program as opposed to the four distinct group processes that were initially hypothesized to affect outcomes. The results of the evaluation of the mediation or moderation role of intervention outcome of the single "General" global latent factor ("Positive Group Climate" construct) did not significantly predict treatment response on any of the outcome variables. Nevertheless, the evidence of an underlying "General" global latent factor ("Positive Group Climate" construct) has important future directions for research on positive youth development programs as well as in group therapy research.

Affective Instability, Childhood Trauma and Major Affective Disorders

Background and Aims Affective instability (AI), childhood trauma, and mental illness are linked, but evidence in affective disorders is limited, despite both AI and childhood trauma being associated with poorer outcomes. Aims were to compare AI levels in bipolar disorder I (BPI) and II (BPII), and major depressive disorder recurrent (MDDR), and to examine the association of AI and childhood trauma within each diagnostic group. Methods AI, measured using the Affective Lability Scale (ALS), was compared between people with DSM-IV BPI (n = 923), BPII (n = 363) and MDDR (n = 207) accounting for confounders and current mood. Regression modelling was used to examine the association between AI and childhood traumas in each diagnostic group. Results ALS scores in descending order were BPII, BPI, MDDR, and differences between groups were significant (p < 0.05). Within the BPI group any childhood abuse (p = 0.021), childhood physical abuse (p = 0.003) and the death of a close friend in childhood (p = 0.002) were significantly associated with higher ALS score but no association was found between childhood trauma and AI in BPII and MDDR. Conclusions AI is an important dimension in bipolar disorder independent of current mood state. There is a strong link between childhood traumatic events and AI levels in BPI and this may be one way in which exposure and disorder are linked. Clinical interventions targeting AI in people who have suffered significant childhood trauma could potentially change the clinical course of bipolar disorder.

Dolor en población laboral y su interferencia en actividades de la vida diaria

Introducción: El dolor es una sensación subjetiva, modulada por la experiencia previa y estado emocional del afectado que resulta complejo evaluar objetivamente, por lo que se utilizan diferentes escalas y herramientas. Es objetivo de este trabajo es valorar la afectación en calidad de vida del dolor en población laboral, cuantificándola y estableciendo la repercusión que suponen variables como la edad, el género y el tipo de trabajo desempeñado. Material y métodos: Se realiza un estudio observacional transversal en una muestra de 1.080 trabajadores, con edades comprendidas entre los 18 y 65 años, durante los reconocimientos periódicos de vigilancia de la salud de empresas del sector servicios en España. Se valoran mediante cuestionario BPI reducido, autocompletado por el trabajador, los efectos del dolor en diferentes esferas del individuo (actividad general, estado de ánimo, capacidad para caminar, trabajo habitual, relaciones con otras personas, sueño y disfrute de la vida), puntuando de 0 a 10. Se empleó para el cálculo de las diferentes pruebas el paquete estadístico SPSS 20.0. Resultados: Las mujeres presentan mayor interferencia en AVD que los hombres, aunque en ambos géneros la mayor interferencia se refiere al trabajo. La interferencia en AVD en ambos géneros se incrementa con la edad, aunque las mujeres presentan valores superiores. Con relación al trabajo desempeñado, los valores son superiores en los trabajadores no manuales (white collar) frente a los manuales (blue collar) pero, al aplicar la corrección de Bonferroni, se observa que sólo hay diferencias estadísticamente significativas en estado de ánimo, relaciones personales, sueño y ganas de disfrutar de la vida. Las mujeres presentan valores mayores en aspectos no relacionados con actividad física, mientras que las variables con mayor componente físico, salvo caminar, no muestran diferencias en ambos géneros. Conclusiones: Los resultados de este trabajo muestran que el dolor interfiere en las AVD con diferencias por género, de forma creciente en relación con la edad y en puestos concretos de trabajo, lo que puede influir en la planificación asistencial y preventiva, dentro de un concepto selectivo que contemple las diferencias encontradas.

Oxidative Stress in Diabetic Neuropathy

For treating chronic pain, a multifactorial condition, is needed a suitable diagnosis which allows the differentiation in its many components. Diabetic neuropathy is a worldwide disease with great impact in the modern society. Diabetes may leads to the production of reactive oxygen species that are associated to oxidative stress, which may be a key factor in the development of diabetic neuropathy. The main goal is to inquire a potential association between chronic pain, diabetic neuropathy and oxidative stress. Thus, was performed a meta-analysis that permitted the causal evaluation between oxidative stress and diabetic neuropathy, and, a pain evaluation was accomplished in a convenience sample using validated surveys – Brief Pain Inventory (BPI) and Douleur Neuropathique 4 (DN4). Through the meta-analysis it was possible evaluate oxidative stress biomarkers, such lipid peroxidation, superoxide dismutase and catalase activities, and reduced glutathione. 9 studies were selected and all were performed in mouse models. The levels of lipid peroxidation were increased in all the studies, however the levels of the other biomarkers were diminished in diabetic models comparatively to healthy controls. In the evaluation of convenience sample, 84 surveys were collected along the four seasons: summer, autumn, winter and spring. The pain complaints were described in terms of local, intensity, impact, relief by medication and its effect on daily activities using BPI questionnaire. The scores obtained in BPI indicate the presence of moderate to severe pain, with increased complaints in autumn and spring, and implications in daily activities, transversal to all groups. To determine the main features associated with neuropathic pain it was used DN4 questionnaire. The DN4 indicated the presence of nearly 50% of patients with neuropathic pain. The results suggest that being female, the increased age and being retired can influence chronic pain and neuropathic pain in patients. As main conclusions, it was possible to verify an association between oxidative stress, and neuropathic pain, and, also, that weather conditions may influence the pain complaints and its prevalence.