Níveis de tiroglobulina prévia à ablação e persistência /recorrência precoce do câncer diferenciado da tireoide

Introdução: O câncer diferenciado de tireoide é a neoplasia endócrina mais frequente no mundo e a sua incidência cresce de forma acelerada. Pesquisaram-se a relação entre os níveis de tiroglobulina(Tg) prévia à ablação e a persistência/recorrência precoce do câncer diferenciado da tireoide. Materiais e métodos: Avaliaram-se 91 pacientes com câncer papilar de tireoide que foram submetidos à ablação pós-cirúrgica com iodo radiativo, numa clínica especializada, no período entre janeiro de 2006 e janeiro de 2010. A análise dos dados foi realizada utilizando-se SPSS 20 para Windows e a hipótese de pesquisa foi avaliada por meio de métodos próprios da estatística não paramétrica. Resultados: A doença progrediu em 20 pacientes durante o primeiro ano pós-ablaçãoe se encontrou relação significativa entre a Tg pré-ablação e o estado da doença ao final desse período (p = 0,000). No grupo de indivíduos que apresentaram progressão da doença, não foram observadas mudanças significativas entre os níveis da Tg avaliados seis e doze meses depois da ablação (p = 0,554). É importante ressaltar que os indivíduos com níveis de Tg prévia à ablação menores ou iguais a 2,7 ng/mL não apresentaram recorrência/persistência e que 80% dos casos corresponderam a indivíduos com níveis iniciais maiores a 24 ng/mL. Conclusão: Nos pacientes com câncer papilar de tireoide o nível sérico da Tg pré-ablação está relacionado com o estado da doença ao final do primeiro ano pós-ablação. A persistência/recorrência é menos frequente com níveis baixos e mais frequente com níveis altos.

Behavioral changes, used and benefits of a community program for the promotion in physical activity

Objective: To determine the change of behavior in physical activity and the characteristics associated with the use and benefits of Local Physical Activity Center (CLAF) in the population of the town of Santa Fe de Bogota. Materials and methods: We conducted a longitudinal study before and after, which was assessed at admission and 3 months in the intervention program CLAF physical activity, behavior change compared to the physical activity of users. Inclusion criteria: were being active user of CLAF, aged between 15 and 65 years and voluntarily express their participation in the study. Exclusion criteria: Fill incomplete measurement instruments used. The sampling frame of CLAF users, we selected n=55 subjects. To gather information, a questionnaire, which contained the behavioral stages of change, also conducted a survey which determined semistructured features about the benefits and use of CLAF. Results: The total study participants was n = 55, mean age was 40.4 ± 15.3 years, with a minimum 15 and maximum of 64 years, 83.6% were women. 78.2% do not know the purpose of the Local Centre for Physical Activity. The outreach strategy that most came to the group was 58.2 with a verbal type. The time for links to CLAF more frequently in the group evaluated was 1 to 6 months 36.4. The motivation to regularly attend the CLAF in the majority was to improve the physical and / or a 74.5% mental. 89.1% would be willing to recommend to others the use of CLAF. A 81.8% of the population physical activity performed by more than 150 min / wk at moderate intensity; Post CLAF intervention in the subjects showed positive changes in the level of physical activity (p<0.001, Test de Wilcoxon) and behavioral state (p<0.001, Test de Wilcoxon).

Caracterización de la gestión del mantenimiento de equipo biomédico en servicios de urgencia de clínicas y hospitales de Medellín en el período 2008-2009

La gestión de mantenimiento es una herramienta de gran impacto que apoya al personal de Ingeniería en el desarrollo, control y dirección de programas de mantenimiento para el equipo médico. Objetivo: caracterizar la gestión de mantenimiento en servicios de urgencia de clínicas y hospitales del área metropolitana de Medellín en el período 2008-2009. Materiales y métodos: se realizó una encuesta a jefes y técnicos de mantenimiento en once entidades prestadoras de servicios de salud, clasificadas en tercer nivel y pertenecientes a la red de salud del municipio de Medellín. Resultados: entre las instituciones encuestadas se encontró que la causa de falla más común en los equipos del servicio de urgencia es el mal manejo de los equipos (75%) por partede los operarios y que 70% del mantenimiento es realizado por personal con experiencia en el área (tecnólogos en mantenimiento de equipo biomédico e ingenieros biomédicos). En las once instituciones públicas y privadas encuestadas se halló que solo se contaban con cronogramas de mantenimiento y/o con información desactualizada concerniente a las hojas de vida de los equipos, planes de mantenimiento o adquisición y baja de equipos. Conclusión: el estudio muestra la existencia de debilidades en ciertos puntos de la gestión, incluyendo mala organización, poca disponibilidad de repuestos originales y falta de capacitación en el personal que maneja los equipos.

Implementation of ‘School Back’ by the ‘Core’ technique in a factory of geotextiles to prevent back pain

Introduction: This article aims to show an alternative intervention for the prevention and control of back pain to the people of a production plant of geotextiles for the construction exposed to handling and awkward postures through the implementation of the Back School using the CORE technique. This technique being understood as trainer of the stability musculature of the spine; whose benefit is proportionate the muscular complex of the back, stability and avoid osteomuscular lesions and improved posture. Objective: To present the results about the implementation of the back school by the CORE technique for prevention of back pain in a population of forty-eight male collaborators. Materials and methods: The back school began with talks of awareness by the occupational health physician explaining the objectives and benefits of it to all participants. Once this activity was done, was continued to evaluate all plant employees to establish health status through the PAR-Q questionnaire, who were surveyed for the perception of pain using visual analog scale (VAS) and stability was determined column through the CORE assessment, to determine the training plan. Then, were made every six months the revaluations and implementation of a survey of assistant public perception to identify the impact of the implementation of the school back on the two variables referred (pain perception and stability of column). Results: The pain perception according VAS increased in the number of workers asymptomatic in 12% and based in the satisfaction survey 94% of population reported that with the development of this technique decrease the muscle fatigue in lumbar level; and 96% of population reported an improvement in the performance of their work activities. Discussion: Posterior to the analysis of all results, it is interpreted that back schools practice through CORE technique, contributes to the prevention and / or control of symptoms at the lumbar level in population of productive sector exposed to risks derived from the physical load, provided that ensure its continuously development and supervised for a competent professional.

Effect of joint mobilization on the H Reflex amplitude in people with spasticity

Objective: To determine the effect of ankle joint mobilization on the H reflex amplitude of thesoleus muscle in people with spasticity. Materials and methods: A quasi-experimental study withcrossover design and simple masking was conducted in 24 randomized subjects to initiate thecontrol or experimental group. Traction and rhythmic oscillation were applied for five minutesto the ankle joint. H wave amplitude changes of Hoffmann reflex (electrical equivalent of themonosynaptic spinal reflex) was assessed, stimulating the tibial nerve at the level of the poplitealfossa and recording in the soleus muscle. In each subject 12 measurements were taken: basalrate, during and after mobilization. Changes in H reflex amplitude were calculated in relationto basal measurement. For each measurement a hypothesis test was performed (Student t test).Results: In groups of patients with brain injury and incomplete spinal cord injury, a significantdifference was found between measurements of both studies, concerning variation in H reflexamplitude during the application of joint mobilization techniques, with a decrease in the experimentalgroup and an increase in the control group. In contrast, no significant differences werefound after mobilization therapy. Patients with complete spinal cord injury showed no significantdifferences in any measurements. Conclusion: We demonstrate the effectiveness of jointmobilization in the decrease of H reflex amplitude in patients with brain injury or incompletespinal cord injury during the mobilization maneuver, but no residual effect after completion ofthe trial. This research showed no evidence regarding excitability reduction in complete spinalcord injury. We suggest that therapeutic interventions to decrease muscle tone based on the jointmobilization should be reconsidered.

Reproducibilidad de las pruebas Arm Curl y Chair Stand para evaluar resistencia muscular en población adulta mayor

Objetivo: evaluar la reproducibilidad prueba-reprueba y el nivel de acuerdo entre mediciones de las pruebas 30 seg (30-s) Arm Curl y 30-s Chair Stand en una muestra de adultos mayores de Bucaramanga. Materiales y métodos: se realizó un estudio de evaluación de tecnologías diagnósticas. Ambas pruebas fueron administradas en dos oportunidades por el mismo evaluador a 111 adultos mayores de 59 años (70,4 ± 7,3), con un intervalo de 4 a 8 días. En el análisis se determinó la reproducibilidad prueba-reprueba mediante el coeficiente de correlación intraclase, CCI= 2,1 con sus respectivos intervalos de confianza de 95% (IC 95%). El nivel de acuerdo se estableció mediante el método de Bland y Altman. Resultados: la reproducibilidad prueba-reprueba para el 30-s Arm Curl test fue muy buena, con un CCI= 0,88 y para el 30-s Chair Stand test fue buena,con un CCI= 0,78. Así, el acuerdo fue muy bueno para las dos pruebas de resistencia muscular. Los límites de acuerdo de 95% estuvieron entre -3,8 y 3,2 repeticiones para la prueba 30-s ChairStand y entre -3,1 y 2,8 repeticiones para la prueba 30-s Arm Curl. Conclusión: las pruebas 30-s Arm Curl y 30-s Chair Stand tienen buena reproducibilidad y nivel de acuerdo para evaluar resistencia muscular en adultos mayores funcionalmente independientes.

Analysis of the alveolar recruitment maneuvers applied at seven intensive care units

Introduction: During the past years, alveolar recruitment maneuvers (RM) have produced growing interest due to their beneficial potential in pulmonary protection, and have been introduced in clinical practice. Objective: To describe and analyze the knowledge of MR and its application at seven intensive care units in the city of Cali, Colombia. Methods and materials: Descriptive Cross-Sectional Study with an intentional sample of 64 professionals working in seven intensive care units and who apply MR. The self-completed survey was made up of thirteen questions, and the application period was two months. Results: Out of 64 professionals surveyed, 77.8% of them follow a protocol guide; 54.7% employes during RM the ideal Positive end-expiratory pressure (PEEP), which maintains a saturation > 90% and a PaO2 > 60 mmHg; 42.1% tolerates airway pressures between 35 and 50 cmH2O; 48.4% perform RM with a progressive increase of the PEEP and a low tidal volume. Conclusions: Regarding the knowledge related to RM, heterogeneity was found in the answers. There is currently no consensus about which is the most effective and secure way to implement an MR. This study can be the starting point to create awareness towards the revision of knowledge, capacities and abilities that are required to perform RM.

Description of the risk factors for relapse in patients diagnosed with severe mental disorders

Objective: The objective of this paper is to describe the population served in mental health institutionsfor mental illness relapse, and the process of identifying risk factors in relapsing patientsdiagnosed with severe mental illness. To this end a descriptive exploratory multicenter, multistageepidemiological study was carried out in mental health institutions of the Order of San Juan deDios Hospital (OHSJD) with hospitalized relapsing patients with a diagnosis of severe mentaldisorder. This study comes from a working network of Psychology professionals in the OHSJDnationwide. Materials and methods: The population sample was of 1005 patients diagnosed withsevere mental disorders, who had presented relapse during the last year. First, the characterizationof the general population was conducted; then, it was narrowed down to the centers, taking intoaccount similarities and differences found according to the clinical and demographic variables.Results: Major risk factors for relapse found in patients diagnosed with severe mental disorderswere: having between 38 and 58 years of age, being female, single, graduates, unemployed, witha prevalence of bipolar affective disorder diagnosis, number of hospitalizations between 2 and10, number of drugs at the time of leaving hospital 2 to 6, with severe difficulties relating withothers and difficulties in adherence to treatment. The need for a caregiver was also found, as wellas a limited number of received psychological interventions. How the system of beliefs affects thedisease and the poor adherence to treatment was identified. Conclusions: These results indicatethe requirement of a design of team intervention strategies, ranging from the assessment team(home), definition of therapeutic action plans (for) and the posthospitalizacion (egress) following.There is a poor support network and limited adherence to comprehensive treatment.

Social Responsibility, an Approach to the Executive Peruvian Perspective

In recent years the issue of social responsibility is becoming more important, which isreflected in the companies have incorporated it into their agenda of interests. In this sense,the article is intended to make a first approach to the level of implementation efforts, aswell as their prospects for the future. We interviewed a total of 144 people representingdifferent economic sectors. We conclude that the majority of executives do not have aclear understanding of the modern concept of RS nor of its benefits, it limits the concept tophilanthropy and actions are oriented to the community and environment.

Las mipymes artesanales como un medio de desarrollo para los grupos rurales en México

La actividad artesanal sigue teniendo vigencia a nivel regional en muchos países, no sólo subdesarrollados, sino también del primer mundo, lo que permite a algunos grupos sociales tener una fuente de ingresos única o complementaria. En este trabajo se hace una descripción de este sector, comenzando con conceptos de los términos relacionados con la artesanía, su importancia económica y social dentro de las micro, pequeñas y medianas empresas, los tipos de productos artesanales en el mundo y en México. Se establecen, igualmente, las problemáticas y los retos que habrá de enfrentar, así como las contribuciones posibles desde los ámbitos gubernamental y académico.

Paradoxes of resilience: lessons learnt from a comparison between Columbia and France

This paper investigates a discrepancy concerning resilience. International institutions such as ISDR try to promote resilience as a notion useful for preventing disasters. And some searchers, mainly coming from ecology, such as Resilience Alliance group, found the notion relevant enough to promote it as a brand for their studies on disaster prevention. Yet, the second part of the paper will verify how other searchers are still not convinced by the relevance of the notion. Territorial managers are reluctant as well, in line with the poor number of policies trying to bring resilience to reality, be it in Columbia or in France. How can we make sense of this discrepancy? The paper will stress on various political, institutional and cultural conditionings hidden behind the notion. It will also enlighten the contradictions embedded within the notion, because resilience, as disaster, depends on the scales and the actors the analysis relies on first. Which resilience to whom and at what scale? These are critical questions that should be addressed in order to give sense to these contradictions. Resilience has no absolute meaning. However, it helps identifying trends towards future disasters. This is one of the main reasons why it may be found useful.

Economía institucional de la intervención urbanística estatal

La intervención urbanística del Estado es insustituible. En primer lugar porque el capital privado no está dispuesto a asumir el riesgo de depreciación virtual inherente a la provisión de bienes públicos. Tampoco ha alcanzado los  niveles de acumulación previa que de manera individual estén en capacidad de reemplazar los esfuerzos colectivos que se deben movilizar para tal efecto. Es por ello que estratégicamente el capital privado ha seducido al público con la idea de la eficiencia de las alianzas público-privadas y la gobernanza. En segundo lugar porque el mercado inmobiliario residencial formal es un mercado segmentado e imperfecto en el que el poder de mercado de los estructuradores urbanos y metropolitanos alcanza niveles cuasi-monopólicos. Por tanto, y siguiendo a Commons, la regulación y el control de la oferta inmobiliaria residencial incide positivamente en la ampliación de la libertad en la producción y en la elección de localización de las familias que habitan en las metrópolis. Un orden menos segregado que el perseverante se torna posible. Este trabajo se ocupa de analizar, desde una perspectiva teórica pluridisciplinar como la economía institucional urbana, las posibilidades e instrumentos con que se cuenta para alcanzar tal orden.

Impactos e implicaciones del TLC Colombia-Estados Unidos: un análisis desde la perspectiva institucional

El análisis de los impactos e implicaciones de un acuerdo de integración sobre un país debe abarcar no sólo consideraciones de tipo económico, sino que debe incluirse la perspectiva institucional. No es un secreto que el éxito o fracaso de la economía de un país, no importa su tamaño, depende en gran medida de la calidad de sus instituciones. En este orden de ideas, desde finales de la década de los ochenta el análisis de las instituciones ha sido un lugar común en escenarios donde la internacionalización y la apertura económica han sido estudiadas, así como las causas del crecimiento económico y el desarrollo.-----The analysis of the impacts and implications that an integration agreement can have on a country should include not only economic but also institutional considerations. It is no secret that a country’s economic failure or success, no matter how small that country is, depends to a large extent on the quality of its institutions. Thus, since the late 80’s, the analysis of institutions has been commonplace in scenarios where internationalization and economic openingup have been studied, as well as in those where the causes of economic growth and development have been examined.

Elementos de la reforma constitucional en Colombia y el nuevo marco institucional

El artículo examina el impacto social y político que tuvo lugar con el cambio constitucional ocurrido en Colombia desde la década de los noventa, y resultante del modelo consagrado en la Constitución Política de 1991.Partiendo de ese proceso, el análisis revisa las principales características de la introducción y posterior coexistencia de dos modelos de Estado antagónicos: el Estado Social de Derecho y el Estado Neoliberal, convergentes en el articulado de la Constitución de 1991. Así mismo, se revisan las innovaciones institucionales que ambos modelos le introducen al régimen político colombiano, especialmente en lo atinente a la administración de justicia, la estructura del poder público y la articulación de la participación como eje de la democracia.Simultáneamente, se estudian los elementos característicos de la coexistencia de estos dos modelos mediante el análisis del comportamiento de actores individuales y colectivos y de los hechos políticos concretos que han configurado dicha relación durante la última década del siglo XX, así como su incidencia en la inestabilidad del régimen político colombiano. Finalmente, se consideran las deficiencias en la cultura política y la constante interferencia de los sectores tradicionales y de los actores armados como rasgo estructural que impide concretar las aspiraciones del proyecto de reforma y progresión democráticas contemplado en la Constitución de 1991.-----From a critical perspective, this essay examines the root socioeconomic and political impact of the constitutional change that occurred in Colombia during the decade of the 90s, and the resultant model consecrated in the Political Constitution of 1991.Taking that process as a starting point, the analysis reviews the principal characteristics of the introduction and subsequent coexistence of two antagonistic models of state: The Social State of Right and the Neoliberal State convergent in the articulation of the Constitution of 1991. Also, the article studies the institutional innovations that both models introduce to the Columbian political regime, especially in regards to the justice administration, the structure of public power and the srticulation of participation as the axis of democracy.At the same time, the article reviews the elements that exemplify the coexistence of these two models, by means of analytical pursuit of the behabior of the individual and collective actors and of the concrete political facts that have formed said relation throughout the last decade of the 20th century, as well as its impact on the instability of the Columbian political regime. Finally, the essay considers the deficiencies in the political culture and the constant interference of the traditional sectors and of the armed actors as a characteristically structural obstacle to the achievement of the aspirations of the great project of democratic reform and progress contemplated in the Constitution of 1991.

El significado e implicaciones del bicameralismo en la dinámica institucional con especial referencia al caso mexicano

El presente artículo describe el origen histórico que ha tenido el sistema bicameral en los regímenes representativos y en el contexto de las democracias contemporáneas, también el cauce seguido por éste en los distintos modelos de Estado, con especial énfasis en el caso mexicano.-----This article describes the source that has taken the bicameral system in the historical representative regimes and in the context of the democracies contemporary, so as also the path followed in the different models of States, putting special emphasis on the mexican political system.