Eficacia de la melatonina en insomnio primario en el adulto mayor: revisión sistemática de la literatura

Introducción: La melatonina, una sustancia cronobiótica endógena, es cada vez más empleada para el manejo de los problemas del sueño en adultos mayores por su aparente eficacia y buen perfil de eventos adversos. En este sentido, se intentó evaluar la eficacia de la melatonina en el tratamiento del insomnio primario en el adulto mayor (≥55 años) comparado con benzodiacepinas, zopiclona y placebo a la luz de la evidencia disponible en los últimos cinco años. Métodos: Revisión sistemática de la literatura. Resultados: En comparación con placebo, al parecer la melatonina mejora la calidad y los hábitos de sueño, no así la latencia de inicio de sueño en mediciones subjetivas ni objetivas (polisomnografía); a diferencia de otros medicamentos hipnóticos, no altera la arquitectura del sueño ni genera síntomas diurnos. Conclusiones: No se encontró evidencia que soporte el uso de melatonina en adultos mayores de 55 años para la reducción de la latencia de sueño, aumento del tiempo total de sueño, mejoría de la eficiencia del sueño, disminución de despertares nocturnos o mejoría de la calidad de sueño. Es necesario adelantar más estudios en comparación con placebo y otros medicamentos.

Apoyo social e ideación suicida en pacientes con cáncer

El diagnóstico de cáncer ha sido asociado con un alto riesgo de presentar ideación suicida en comparación con la población no oncológica, sin embargo se ha considerado al apoyo social como un factor protector para la ocurrencia de esta conducta. La presente investigación tuvo como objetivo identificar la relación entre el apoyo social percibido y la ideación suicida en 90 pacientes oncológicos adultos en Bogotá, bajo la hipótesis de que a mayor apoyo social percibido, menor presencia de ideación suicida. Se midió la variable de apoyo social a través del cuestionario Duke UNC y la ideación suicida a través de cuatro instrumentos: Escala de Ideación Suicida (SSI), Escala de Desesperanza de Beck (BHS), el ítem 9 del Inventario de Depresión de Beck (BDI-IA) y una entrevista semiestructurada. Los resultados mostraron que no existe relación entre el apoyo social percibido y la ideación suicida. Por otro lado se identificó una prevalencia de suicidio entre 5,6% y 22,77%, confirmando que el paciente con cáncer considera el suicidio y es fundamental evaluar esta variable en esta población. Se considera importante continuar con la realización de investigaciones que permitan generalizar los resultados a la población oncológica colombiana.

Eficacia de la estimulación magnética transcraneal en la disminución de severidad en el trastorno depresivo mayor en monoterapia y coadyuvante comparado con tratamientos farmacológicos. Revisión sistemática y meta-análisis

Resumen Introducción Una posible opción de tratamiento para el manejo del trastorno depresivo mayor (TDM) es la estimulación magnética transcraneal (EMT) que ha mostrado propiedades antidepresivas superiores al placebo con un buen perfil de seguridad. El objetivo del presente trabajo es determinar la reducción en la severidad del TDM y la proporción de eventos adversos (EA) en pacientes con TDM refractario y no refractario, posterior al uso de EMT administrada en monoterapia o tratamiento coadyuvante comparado con terapia farmacológica. Metodología Se planteó una pregunta PICOT de la cual se realizó una búsqueda sistemática de estudios clínicos en las bases de datos Medline, EMBASE y Cochrane. Dos investigadores en forma independiente realizaron la selección de artículos, evaluación de calidad con la herramienta de la colaboración Cochrane y extracción de datos. Se extrajeron datos de eficacia como tasa de respuesta, porcentaje de remisión, calidad de vida, diminución sintomática del trastorno depresivo mayor en la escala de Hamilton y capacidad funcional. Igualmente, proporción de pacientes con EA. Se realizó un meta-análisis de estas variables teniendo en cuenta la heterogeneidad. Resultados La presente revisión sistemática incluyó 26 estudios clínicos aleatorizados de baja calidad metodológica mostrando que la EMT presentó una eficacia superior cuando es usada como coadyuvante a las terapias con que venían siendo tratados los pacientes con TDM refractario y no refractario en los desenlaces de tasa de respuesta y porcentaje de remisión. En el caso de intervenciones farmacológicas específicas, la EMT presento eficacia similar, tanto en terapia coadyuvante como en monoterapia comparado con las intervenciones farmacológicas. En cuanto a seguridad, la EMT presenta un buen perfil de seguridad debido a que en todos los escenarios estudiados los EA fueron no serios y baja frecuencia Conclusiones La evidencia disponible sugiere que la EMT mostró ser efectivo y seguro para el manejo del TDM refractario y no refractario. Sin embargo, la evidencia es débil por lo tanto se necesita mayor investigación clínica que soporte su uso.

Barreras en el acceso a la dirección escolar : diferencias entre profesoras y directoras de centros de Educación Infantil y Primaria. 'Barriers in the access to school management : differences between teachers and head-teachers from early childhood and elementary education schools'.

Resumen tomado de la publicación. Con el apoyo económico del departamento MIDE de la UNED

Dispersion Experiments in Central London: The 2007 DAPPLE project

In the event of a release of toxic gas in the center of London, the emergency services would need to determine quickly the extent of the area contaminated. The transport of pollutants by turbulent flow within the complex street and building architecture of cities is not straightforward, and we might wonder whether it is at all possible to make a scientifically-reasoned decision. Here we describe recent progress from a major UK project, ‘Dispersion of Air Pollution and its Penetration into the Local Environment’ (DAPPLE, www.dapple.org.uk). In DAPPLE, we focus on the movement of airborne pollutants in cities by developing a greater understanding of atmospheric flow and dispersion within urban street networks. In particular, we carried out full-scale dispersion experiments in central London (UK) during 2003, 2004, 2007, and 2008 to address the extent of the dispersion of tracers following their release at street level. These measurements complemented previous studies because (i) our focus was on dispersion within the first kilometer from the source, when most of the material was expected to remain within the street network rather than being mixed into the boundary layer aloft, (ii) measurements were made under a wide variety of meteorological conditions, and (iii) central London represents a European, rather than North American, city geometry. Interpretation of the results from the full-scale experiments was supported by extensive numerical and wind tunnel modeling, which allowed more detailed analysis under idealized and controlled conditions. In this article, we review the full-scale DAPPLE methodologies and show early results from the analysis of the 2007 field campaign data.

Stochastic resonance in a nonlinear model of a rotating, stratified shear flow, with a simple stochastic inertia-gravity wave parameterization

We report on a numerical study of the impact of short, fast inertia-gravity waves on the large-scale, slowly-evolving flow with which they co-exist. A nonlinear quasi-geostrophic numerical model of a stratified shear flow is used to simulate, at reasonably high resolution, the evolution of a large-scale mode which grows due to baroclinic instability and equilibrates at finite amplitude. Ageostrophic inertia-gravity modes are filtered out of the model by construction, but their effects on the balanced flow are incorporated using a simple stochastic parameterization of the potential vorticity anomalies which they induce. The model simulates a rotating, two-layer annulus laboratory experiment, in which we recently observed systematic inertia-gravity wave generation by an evolving, large-scale flow. We find that the impact of the small-amplitude stochastic contribution to the potential vorticity tendency, on the model balanced flow, is generally small, as expected. In certain circumstances, however, the parameterized fast waves can exert a dominant influence. In a flow which is baroclinically-unstable to a range of zonal wavenumbers, and in which there is a close match between the growth rates of the multiple modes, the stochastic waves can strongly affect wavenumber selection. This is illustrated by a flow in which the parameterized fast modes dramatically re-partition the probability-density function for equilibrated large-scale zonal wavenumber. In a second case study, the stochastic perturbations are shown to force spontaneous wavenumber transitions in the large-scale flow, which do not occur in their absence. These phenomena are due to a stochastic resonance effect. They add to the evidence that deterministic parameterizations in general circulation models, of subgrid-scale processes such as gravity wave drag, cannot always adequately capture the full details of the nonlinear interaction.

Bt cotton, pesticides, labour and health - A case study of smallholder farmers in the Makhathini Flats, Republic of South Africa

This paper describes some of the results of a detailed farm-level survey of 32 small-scale cotton farmers in the Makhathini Flats region of South Africa. The aim was to assess and measure some of the impacts (especially in terms of savings in pesticide and labour as well as benefits to human health) attributable to the use of insect-tolerant Bt cotton. The study reveals a direct cost benefit for Bt growers of SAR416 ($51) per hectare per season due to a reduction in the number of insecticide applications. Cost savings emerged in the form of lower requirements for pesticide, but also important were reduced requirements for water and labour. The reduction in the number of sprays was particularly beneficial to women who do some spraying and children who collect water and assist in spraying. The increasing adoption rate of Bt cotton appears to have a health benefit measured in terms of reported rates of accidental insecticide poisoning. These appear to be declining as the uptake of Bt cotton increases. However, the understanding of refugia and their management by local farmers are deficient and need improving. Finally, Bt cotton growers emerge as more resilient in absorbing price fluctuations.

Producing Inequalities: Regional Sequences in Later Prehistoric Southern Spain

This paper presents regional sequences of production, consumption and Social relations ill Southern Spain from the beginning of the Neolithic to the Early Bronze Age (c. 5600-1550 BC). The regions Studied are southeast Spain, Valencia, the southern Meseta and central/western Andalucia. The details presented for each region and period vary in quality but Show how Much our knowledge of the archaeological record of southern Spain has changed during the last four decades. Among the Surprises are the rapidity of agricultural adoption. the emergence of regional centres of aggregated population in enclosed/fortified settlements of up to 400 hectares in the fourth and third millennia BC. the use of copper objects as instruments of production, rather than as items With 11 purely symbolic of 'prestige' value, large-scale copper production in western Andalucia in the third millennium BC (as opposed to the usual domestic production model), and the inference of societies based oil relations of class.

A contour-advective semi-lagrangian numerical algorithm for simulating fine-scale conservative dynamical fields

This paper describes a novel numerical algorithm for simulating the evolution of fine-scale conservative fields in layer-wise two-dimensional flows, the most important examples of which are the earth's atmosphere and oceans. the algorithm combines two radically different algorithms, one Lagrangian and the other Eulerian, to achieve an unexpected gain in computational efficiency. The algorithm is demonstrated for multi-layer quasi-geostrophic flow, and results are presented for a simulation of a tilted stratospheric polar vortex and of nearly-inviscid quasi-geostrophic turbulence. the turbulence results contradict previous arguments and simulation results that have suggested an ultimate two-dimensional, vertically-coherent character of the flow. Ongoing extensions of the algorithm to the generally ageostrophic flows characteristic of planetary fluid dynamics are outlined.

A link between low-frequency mesoscale eddy variability around Madagascar and the large-scale Indian Ocean variability

A connection is shown to exist between the mesoscale eddy activity around Madagascar and the large-scale interannual variability in the Indian Ocean. We use the combined TOPEX/Poseidon-ERS sea surface height (SSH) data for the period 1993–2003. The SSH-fields in the Mozambique Channel and east of Madagascar exhibit a significant interannual oscillation. This is related to the arrival of large-scale anomalies that propagate westward along 10°–15°S in response to the Indian Ocean dipole (IOD) events. Positive (negative) SSH anomalies associated to a positive (negative) IOD phase induce a shift in the intensity and position of the tropical and subtropical gyres. A weakening (strengthening) results in the intensity of the South Equatorial Current and its branches along east Madagascar. In addition, the flow through the narrows of the Mozambique Channel around 17°S increases (decreases) during periods of a stronger and northward (southward) extension of the subtropical (tropical) gyre. Interaction between the currents in the narrows and southward propagating eddies from the northern Channel leads to interannual variability in the eddy kinetic energy of the central Channel in phase with the one in the SSH-field.

Bt cotton, pesticides, labour and health - A case study of smallholder farmers in the Makhathini Flats, Republic of South Africa

This paper describes some of the results of a detailed farm-level survey of 32 small-scale cotton farmers in the Makhathini Flats region of South Africa. The aim was to assess and measure some of the impacts (especially in terms of savings in pesticide and labour as well as benefits to human health) attributable to the use of insect-tolerant Bt cotton. The study reveals a direct cost benefit for Bt growers of SAR416 ($51) per hectare per season due to a reduction in the number of insecticide applications. Cost savings emerged in the form of lower requirements for pesticide, but also important were reduced requirements for water and labour. The reduction in the number of sprays was particularly beneficial to women who do some spraying and children who collect water and assist in spraying. The increasing adoption rate of Bt cotton appears to have a health benefit measured in terms of reported rates of accidental insecticide poisoning. These appear to be declining as the uptake of Bt cotton increases. However, the understanding of refugia and their management by local farmers are deficient and need improving. Finally, Bt cotton growers emerge as more resilient in absorbing price fluctuations.

What is wrong with the global support facility for small-scale mining?

The World Bank, United Nations and UK Department for International Development (DfID) have spearheaded a recent global drive to regularize artisanal and small-scale mining (ASM), and provide assistance to its predominantly impoverished participants. To date, millions of dollars have been pledged toward the design of industry-specific policies and regulations; implementation of mechanized equipment; extension; and the launch of alternative livelihood (AL) programmes aimed at diversifying local economies. Much of this funding, however, has failed to facilitate marked improvements, and in many cases, has exacerbated problems. This paper argues that a poor understanding of artisanal, mine-community dynamics and operators’ needs has, in a number of cases, led to the design and implementation of inappropriate industry support schemes and interventions. The discussion focuses upon experiences from sub-Saharan Africa, where ASM is in the most rudimentary of states.

ALARM: Assessing large-scale environment risks for biodiversity with tested methods

The EU-funded research project ALARM will develop and test methods and protocols for the assessment of large-scale environmental risks in order to minimise negative human impacts. Research focuses on the assessment and forecast of changes in biodiversity and in the structure, function, and dynamics of ecosystems. This includes the relationships between society, the economy and biodiversity.

Culture and food: a model of yoghurt consumption in the EU

The completion of the Single European Market was expected to create a large market that would enable firms to capture economies of scale that would in turn result in lower prices to European consumers. These benefits are only likely to be realised if consumers in the various countries of the EU wish to consume the same products and respond to similar marketing strategies (with respect to promotion, distribution etc). This study examines, through a model of yoghurt consumption, whether cultural differences continue to determine food-related behaviour in the EU. The model is derived from the marketing literature and views the consumption decision as the outcome of a multi-stage process in which yoghurt knowledge, attitudes to different yoghurt attributes (such as bio-bifidus, low-fat, organic) and overall attitude towards yoghurt as a product all feed into the frequency with which yoghurt is consumed at breakfast, as a snack and as a dessert. The model uses data collected from a consumer survey in I I European countries and is estimated using probit and ordinal probit methods. The results suggest that important cultural differences continue to determine food-related behaviour in the I I countries of the study. (c) 2004 Elsevier Ltd. All rights reserved.