Tuberculosis in HIV-infected individuals in Ho Chi Minh City, Vietnam

Early and accurate detection of TB disease in HIV-infected individuals is a critical step for a successful TB program. In Vietnam, the diagnosis of TB disease, which is based predominantly on the clinical examination, chest radiography (CXR) and acid fast bacilli (AFB) sputum smear, has shown to be of low sensitivity in immunocompromised patients. The sputum culture is not routinely performed for patients with AFB negative smears, even in HIV-infected individuals.^ In that background, we conducted this cross-sectional study to estimate the prevalence of sputum culture-confirmed pulmonary tuberculosis (PTB), smear-negative PTB, and multidrug-resistant TB (MDR-TB) in the HIV-infected population in Ho Chi Minh City (HCMC), the largest city in Vietnam where both TB and HIV are highly prevalent. We also evaluated the diagnostic performance of various algorithms based on routine available tools in Vietnam such as symptoms screening, CXR, and AFB smear. Nearly 400 subjects were consecutively recruited from HIV-infected patients seeking care at the An Hoa Clinic in District 6 of Ho Chi Minh City from August 2009 through June 2010. Participants’ demographic data, clinical status, CXR, and laboratory results were collected. A multiple logistic regression model was developed to assess the association of covariates and PTB. ^ The prevalence of smear-positive TB, smear-negative TB, resistant TB, and MDR-TB were 7%, 2%, 5%, 2.5%, and 0.3%, respectively. Adjusted odds ratios for low CD4+ cell count, positive sputum smear, and CXR to positive sputum culture were 3.17, 32.04, and 4.28, respectively. Clinical findings alone had poor sensitivity, but the combination of CD4+ cell count, sputum smear, and CXR proved to perform a more accurate diagnosis.^ This study results support the routine use of sputum culture to improve the detection of TB disease in HIV-infected individuals in Vietnam. When routine sputum culture is not available, an algorithm combining CD4+ cell count, sputum smear, and CXR is recommended for diagnosing PTB. Future studies on more affordable, rapid, and accurate tests for TB infection would also be necessary to timely provide specific treatments for patients in need, reduce mortality, and minimize TB transmission to the general population.^

Posttraumatic stress disorder among veterans of the Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) wars: Psychological comorbidities, postdeployment social support and unit support

Much attention has been given to treating Operation Iraqi Freedom/Operation Enduring (OIF/OEF) Veterans with posttraumatic stress disorder (PTSD). However, little attention is given to those Veterans who do not meet diagnostic criteria for PTSD but who may still benefit from intervention. Research is needed to investigate the impact of how different racial/ethnic backgrounds, different levels of social support and comorbid mental health disorders impact OIF/OEF Veterans with varying levels of PTSD. The purpose of this dissertation is to examine the association of comorbid Axis I disorders, race/ethnicity, different levels of postdeployment social support and unit support on OIF/OEF Veterans with varying levels of PTSD. Data for this dissertation were from postdeployment screenings of OIF/OEF Veterans from a large Veterans Affairs hospital in southeast Texas. To examine the study hypotheses, we conducted multinomial logistic regressions of the clinician reported data. ^ The first article examined the prevalence of subthreshold and full levels of PTSD and compared Axis I and alcohol use comorbidity rates among 1,362 OIF/OEF Veterans with varying levels of PTSD. Results suggest that OIF/OEF Veterans with subthreshold PTSD experience similar levels of psychological distress as those with full PTSD and highlight the need to provide timely and appropriate mental health services to individuals who may not meet the diagnostic criteria for full PTSD. ^ These results suggest that OIF/OEF Veterans of all race/ethnicities can benefit from strong social support systems. Postdeployment social support was found to be a protective factor against the development of PTSD among White, Black and Hispanic veterans while deployment unit support was a protective factor only among Black Veterans. The second article investigated the association between postdeployment social support and unit support with varying levels of PTSD by race/ethnicity among 1,115 OIF/OEF Veterans. ^ The results of this study can help to formulate treatment and interventions for OIF/OEF Veterans with varying levels of PTSD and social support systems.^

Effect of primary care availability and health insurance coverage on risk and cost of Preventable Hospitalizations in Harris County

Preventable Hospitalizations (PHs) are hospitalizations that can be avoided with appropriate and timely care in the ambulatory setting and hence are closely associated with primary care access in a community. Increased primary care availability and health insurance coverage may increase primary care access, and consequently may be significantly associated with risks and costs of PHs. Objective. To estimate the risk and cost of preventable hospitalizations (PHs); to determine the association of primary care availability and health insurance coverage with the risk and costs of PHs, first alone and then simultaneously; and finally, to estimate the impact of expansions in primary care availability and health insurance coverage on the burden of PHs among non-elderly adult residents of Harris County. Methods. The study population was residents of Harris County, age 18 to 64, who had at least one hospital discharge in a Texas hospital in 2008. The primary independent variables were availability of primary care physicians, availability of primary care safety net clinics and health insurance coverage. The primary dependent variables were PHs and associated hospitalization costs. The Texas Health Care Information Collection (THCIC) Inpatient Discharge data was used to obtain information on the number and costs of PHs in the study population. Risk of PHs in the study population, as well as average and total costs of PHs were calculated. Multivariable logistic regression models and two-step Heckman regression models with log-transformed costs were used to determine the association of primary care availability and health insurance coverage with the risk and costs of PHs respectively, while controlling for individual predisposing, enabling and need characteristics. Predicted PH risk and cost were used to calculate the predicted burden of PHs in the study population and the impact of expansions in primary care availability and health insurance coverage on the predicted burden. Results. In 2008, hospitalized non-elderly adults in Harris County had 11,313 PHs and a corresponding PH risk of 8.02%. Congestive heart failure was the most common PH. PHs imposed a total economic burden of $84 billion at an average of $7,449 per PH. Higher primary care safety net availability was significantly associated with the lower risk of PHs in the final risk model, but only in the uninsured. A unit increase in safety net availability led to a 23% decline in PH odds in the uninsured, compared to only a 4% decline in the insured. Higher primary care physician availability was associated with increased PH costs in the final cost model (β=0.0020; p<0.05). Lack of health insurance coverage increased the risk of PH, with the uninsured having 30% higher odds of PHs (OR=1.299; p<0.05), but reduced the cost of a PH by 7% (β=-0.0668; p<0.05). Expansions in primary care availability and health insurance coverage were associated with a reduction of about $1.6 million in PH burden at the highest level of expansion. Conclusions. Availability of primary care resources and health insurance coverage in hospitalized non-elderly adults in Harris County are significantly associated with the risk and costs of PHs. Expansions in these primary care access factors can be expected to produce significant reductions in the burden of PHs in Harris County.^

IDENTIFICATION AND ANALYSIS OF A NOVEL ROLE FOR THE TOUSLED-LIKE KINASE IN REGULATING MITOTIC SPINDLE DYNAMICS

Deregulation of kinase activity is one example of how cells become cancerous by evading evolutionary constraints. The Tousled kinase (Tsl) was initially identified in Arabidopsis thaliana as a developmentally important kinase. There are two mammalian orthologues of Tsl and one orthologue in C. elegans, TLK-1, which is essential for embryonic viability and germ cell development. Depletion of TLK-1 leads to embryonic arrest large, distended nuclei, and ultimately embryonic lethality. Prior to terminal arrest, TLK-1-depleted embryos undergo aberrant mitoses characterized by poor metaphase chromosome alignment, delayed mitotic progression, lagging chromosomes, and supernumerary centrosomes. I discovered an unanticipated requirement for TLK-1 in mitotic spindle assembly and positioning. Normally, in the newly-fertilized zygote (P0) the maternal pronucleus migrates toward the paternal pronucleus at the posterior end of the embryo. After pronuclear meeting, the pronuclear-centrosome complex rotates 90° during centration to align on the anteroposterior axis followed by nuclear envelope breakdown (NEBD). However, in TLK-1-depleted P0 embryos, the centrosome-pronuclear complex rotation is significantly delayed with respect to NEBD and chromosome congression, Additionally, centrosome positions over time in tlk-1(RNAi) early embryos revealed a defect in posterior centrosome positioning during spindle-pronuclear centration, and 4D analysis of centrosome positions and movement in newly fertilized embryos showed aberrant centrosome dynamics in TLK-1-depleted embryos. Several mechanisms contribute to spindle rotation, one of which is the anchoring of astral microtubules to the cell cortex. Attachment of these microtubules to the cortices is thought to confer the necessary stability and forces in order to rotate the centrosome-pronuclear complex in a timely fashion. Analysis of a microtubule end-binding protein revealed that TLK-1-depleted embryos exhibit a more stochastic distribution of microtubule growth toward the cell cortices, and the types of microtubule attachments appear to differ from wild-type embryos. Additionally, fewer astral microtubules are in the vicinity of the cell cortex, thus suggesting that the delayed spindle rotation could be in part due to a lack of appropriate microtubule attachments to the cell cortex. Together with recently published biochemical data revealing the Tousled-like kinases associate with components of the dynein microtubule motor complex in humans, these data suggest that Tousled-like kinases play an important role in mitotic spindle assembly and positioning.

Modelo de organización de la información territorial : observatorio ambiental

La gestión del territorio no cuenta hasta el presente con una respuesta clara en cuanto a acciones a desarrollar para una concreta toma de decisiones. Para ello es necesario contar con información precisa y oportuna. Aquí los SIG se presentan como verdaderos sistemas de gestión en los que interactúan los componentes tecnológicos, organizacionales, metodológicos y estadísticos, que permiten elaborar planes de ordenamiento territorial y de manejo ambiental, monitorear la biodiversidad y construir indicadores ambientales. Su organización se basa en subsistemas tales como: • modelo de organización de la información espacial (que sustenta la plataforma SIG y de la Teledetección ), el que genera una base de datos relacional asociada a información contenida en el observatorio, representa cartográficamente los inicadores ambientales y el monitoreo de los mismos; • la metadata que incorpora las fuentes y datos vinculados a la documentación de datos geoespaciales digitales estandarizados y, por ultimo, • el modelo de monitoreo de la biodiversidad que conlleva a una serie de procesos tendientes especializar y analizar la dinámica presente en la cobertura vegetal a partir de imágenes del programa Landsat. El modelo involucra una integración de procesos apoyados en métodos científicos de teledetección y Sistemas de Información geográfica, permitiendo así el monitoreo para el diagnostico de estado actual de la cobertura marítima y terrestre, el análisis multitemporal, la espacialización y la transferencia de resultados. Un resultado directo de esta metodología es la detección de alertas tempranas.

Análisis económico de la brecha tecnológica en la producción de uva de mesa sanjuanina

Este estudio se realizó en una zona productora de uva de mesa de la provincia de San Juan, que incluyó los departamentos Zonda, Ullum, Albardón, Pocito, Caucete, 25 de Mayo, San Martín y 9 de Julio. De 335 explotaciones existentes, según la base obtenida a partir del CNA 2002, se tomó una muestra de 83 casos, para 2 sigmas de intervalo de confianza y 10 % de error. Los objetivos planteados fueron: determinar el nivel tecnológico para este rubro productivo, medir el grado de severidad de un grupo de restricciones asociadas a la incorporación de tecnología y estimar el beneficio económico alcanzado por el cierre de la brecha tecnológica. De este modo, se plantearon tres dimensiones de estudio, evaluando oportunamente las variables asociadas, de acuerdo a los estudios preeliminares. Los datos fueron procesados con el programa SPSS 11. Se realizó, para el estudio de la primera dimensión, análisis de componentes principales, escalamiento multidimensional y análisis de conglomerados no jerárquicos y en dos fases. En el caso de la segunda dimensión, se utilizaron tablas de contingencia con los estadísticos chi-cuadrado y t de student. Para estimar el beneficio económico alcanzado por el cierre de la brecha tecnológica, se utilizó un programa de simulación SIGMA 2.0. Se encontró la existencia de dos niveles tecnológicos dentro del rubro productivo uva de mesa de exportación, en donde existen inconvenientes referidos a la carencia de infraestructura, falta de rentabilidad asociada a los ingresos de la alternativa tecnológica, incompatibilidad entre los intereses al crédito que se puede acceder y las ganancias de la alternativa tecnológica y, por último, falta de planificación empresarial. Del cierre de la brecha tecnológica, en un escenario positivo, de cinco años, se concluye que el beneficio social medido como excedente bruto de la producción, puede ascender a casi $ 27 millones.

Construcción de capacidad estatal y procesos de modernización

En el marco de un nuevo paradigma sobre gestón pública, los recientes procesos de reforma y modernización reconocen como denominador común la necesidad de aumentar y mejorar la capacidad institucional del Estado, proponiendo distintas formas y herramientas de gestión para optimizar el desempeño de las organizaciones estatales. La necesidad de que las organizaciones públicas respondan en tiempo y forma a las demandas de la sociedad provoca la búsqueda permanente de mejoras en su desempeño. Sin embargo, el énfasis puesto en el tipo de mejoras ha variado en el tiempo, pasando de la reforma de las estructuras, sistemas y estrategias de la organización, a la definición de nuevos roles estatales y la necesidad de asegurar la gobernabilidad democrática. Este artículo indaga en las herramientas, tecnologías y modalidades utilizadas por Nación y Provincia para mejorar la gestión pública.

Advance provision of emergency contraception for pregnancy prevention (Review)

Background Emergency contraception can prevent pregnancy when taken after unprotected intercourse.Obtaining emergency contraception within the recommended time frame is difficult for many women. Advance provision could circumvent some obstacles to timely use. Objectives To summarize randomized controlled trials evaluating advance provision of emergency contraception to explore effects on pregnancy rates, sexually transmitted infections, and sexual and contraceptive behaviors. Search strategy In November 2009, we searched CENTRAL, EMBASE, POPLINE,MEDLINE via PubMed, and a specialized emergency contraception article database. We also searched reference lists and contacted experts to identify additional published or unpublished trials. Selection criteria We included randomized controlled trials comparing advance provision and standard access (i.e., counseling whichmay ormay not have included information about emergency contraception, or provision of emergency contraception on request at a clinic or pharmacy). Data collection and analysis Two reviewers independently abstracted data and assessed study quality. We entered and analyzed data using RevMan 5.0.23. Main results Eleven randomized controlled trials met our criteria for inclusion, representing 7695 patients in the United States, China, India and Sweden. Advance provision did not decrease pregnancy rates (odds ratio (OR) 0.98, 95% confidence interval (CI) 0.76 to 1.25 in studies for which we included twelve-month follow-up data; OR 0.48, 95% CI 0.18 to 1.29 in a study with seven-month follow-up data; OR 0.92, 95% CI 0.70 to 1.20 in studies for which we included six-month follow-up data; OR 0.49, 95% CI 0.09 to 2.74 in a study with three-month follow-up data), despite reported increased use (single use: OR 2.47, 95% CI 1.80 to 3.40; multiple use: OR 4.13, 95% CI 1.77 to 9.63) and faster use (weighted mean difference (WMD) -12.98 hours, 95% CI -16.66 to -9.31 hours). Advance provision did not lead to increased rates of sexually transmitted infections (OR 1.01, 95% CI 0.75 to 1.37), increased frequency of unprotected intercourse, or changes in contraceptive methods.Women who received emergency contraception in advance were equally likely to use condoms as other women. Authors’ conclusions Advance provision of emergency contraception did not reduce pregnancy rates when compared to conventional provision. Results from primary analyses suggest that advance provision does not negatively impact sexual and reproductive health behaviors and outcomes. Women should have easy access to emergency contraception, because it can decrease the chance of pregnancy.However, the interventions tested thus far have not reduced overall pregnancy rates in the populations studied.

Emergency Obstetric Care: Strategy for Reducing Maternal Mortality in Developing Countries

Twenty-five years have passed since the global community agreed in Nairobi to address the high maternal mortality by implementing the Safe Motherhood Initiative. However, every year nearly three million women die due to pregnancy related causes. This tragedy is avoidable if women have timely access to required emergency obstetric care. Emergency obstetric care refers to life-saving services for maternal and neonatal complications provided by skilled health workers. Since the beginning of the 1980’s, several efforts have been intensified to improve maternal and child health status and reducing the high morbidity and mortality. There was built on a worldwide consensus to provide improved maternal and child health care for addressing the high morbidity and mortality. All participant countries agreed to integrate emergency obstetric care services in their national health care system. Emergency obstetric care is one of the strategies for reducing the maternal mortality as pregnancy related complications are unpredictable. However, many women in developing countries do not have access to essential health care services including emergency obstetric care. Basic emergency obstetric care by skilled birth attendants or timely referral for further comprehensive emergency obstetric care can reduce maternal deaths and disabilities significantly. This paper is based on the results published in PubMed, Medline, Lancet, WHO and Google Scholar web pages from 1990 to 2013.

Las muchachas ahorrativas : El rol de las mujeres peronistas en el Plan Económico de Austeridad y el 2° Plan Quinquenal

En este trabajo propongo analizar el rol asignado a las mujeres peronistas y a las unidades básicas femeninas del Partido Peronista Femenino como promotoras del ahorro y la economía doméstica dentro del Plan Económico de Austeridad y el 2° Plan Quinquenal. Luego de la amplia confirmación de la popularidad del gobierno obtenida en las elecciones de noviembre de 1951, el presidente Perón consideró oportuno producir una rectificación y un ajuste en el rumbo de la política económica. Se trataba de una serie de medidas imprescindibles para superar una coyuntura que se tornaba crítica, y que se resumían en el aumento de la producción y la austeridad en el consumo. Esta última responsabilidad recayó en la mujeres - amas de casa amparadas en la acción de las unidades básicas femeninas que actuaron como consejeras y promotoras de los planes de austeridad implementando una serie de medidas que iban desde la cursos de cocina que enseñaban a cocinar con productos alternativos y más económicos hasta la fiscalización de los comercios que no cumplían con los precios máximos oficiales.

Sociedad, familia y aprendizaje. El papel de los contextos hogareños

En este trabajo se aborda el estudio de las relaciones entre sociedad, familia y aprendizaje. Particularmente refiere a las características del contexto alfabetizador hogareño de poblaciones carenciadas y sus repercusiones en las habilidades y conocimientos prelectores de sus hijos. Para examinar dichas relaciones, se seleccionaron aleatoriamente 62 niños de 4/5 años de edad y sus madres. Las madres fueron entrevistadas con una adaptación de una encuesta sobre contexto familiar alfabetizador (Whitehurst, 1992). Los niños fueron evaluados utilizando pruebas específicas que permitieran estimar la dimensión `alfabetización temprana'. Los resultados encontrados informan sobre una gran variabilidad en las prácticas y características del contexto hogareño de las familias examinadas y sobre conocimientos y habilidades prelectores infantiles muy incipientes. Las relaciones entre las dos dimensiones bajo estudio, si bien alcanzan significación estadística, muestran valores de bajos a moderados, circunstancia cuya interpretación se discute. Por último, la caracterización de los niños y de los hogares de donde provienen, tiene como finalidad última encontrar indicadores específicos que permitan diseñar estrategias de intervención adecuadas, oportunas y sistemáticas para la prevención de dificultades en el aprendizaje del lenguaje escrito en situaciones que pueden ser consideradas de riesgo

Society, family and learning. The role of home literacy environments

This paper explores the relation between society, family, and learning. In particular, it addresses the features of home literacy environments in low income families and their impact on children's pre-literacy skills and knowledge. Sixty-two four/five-year-old children and their mothers were randomly selected for this study. The mothers were interviewed using an adaptation of a family literacy environment survey (Whitehurst, 1992). The children were assessed with specific tests to examine the scope of their 'early literacy'. The results revealed significant variability in the features and practices of home literacy environments as well as in the children's emerging pre-literacy skills and knowledge. The correlation between the two variables shows low to moderate statistical significance. The implications of such findings are discussed. Additionally, the purpose of isolating relevant features of the children and their home environments is to identify specific indicators related to the literacy fostering process. Ultimately, the goal is to design adequate, timely, and systematic intervention strategies aimed at preventing difficulties related to written language learning in children that could be considered at risk.

Las muchachas ahorrativas : El rol de las mujeres peronistas en el Plan Económico de Austeridad y el 2° Plan Quinquenal

En este trabajo propongo analizar el rol asignado a las mujeres peronistas y a las unidades básicas femeninas del Partido Peronista Femenino como promotoras del ahorro y la economía doméstica dentro del Plan Económico de Austeridad y el 2° Plan Quinquenal. Luego de la amplia confirmación de la popularidad del gobierno obtenida en las elecciones de noviembre de 1951, el presidente Perón consideró oportuno producir una rectificación y un ajuste en el rumbo de la política económica. Se trataba de una serie de medidas imprescindibles para superar una coyuntura que se tornaba crítica, y que se resumían en el aumento de la producción y la austeridad en el consumo. Esta última responsabilidad recayó en la mujeres - amas de casa amparadas en la acción de las unidades básicas femeninas que actuaron como consejeras y promotoras de los planes de austeridad implementando una serie de medidas que iban desde la cursos de cocina que enseñaban a cocinar con productos alternativos y más económicos hasta la fiscalización de los comercios que no cumplían con los precios máximos oficiales.

Sociedad, familia y aprendizaje. El papel de los contextos hogareños

En este trabajo se aborda el estudio de las relaciones entre sociedad, familia y aprendizaje. Particularmente refiere a las características del contexto alfabetizador hogareño de poblaciones carenciadas y sus repercusiones en las habilidades y conocimientos prelectores de sus hijos. Para examinar dichas relaciones, se seleccionaron aleatoriamente 62 niños de 4/5 años de edad y sus madres. Las madres fueron entrevistadas con una adaptación de una encuesta sobre contexto familiar alfabetizador (Whitehurst, 1992). Los niños fueron evaluados utilizando pruebas específicas que permitieran estimar la dimensión `alfabetización temprana'. Los resultados encontrados informan sobre una gran variabilidad en las prácticas y características del contexto hogareño de las familias examinadas y sobre conocimientos y habilidades prelectores infantiles muy incipientes. Las relaciones entre las dos dimensiones bajo estudio, si bien alcanzan significación estadística, muestran valores de bajos a moderados, circunstancia cuya interpretación se discute. Por último, la caracterización de los niños y de los hogares de donde provienen, tiene como finalidad última encontrar indicadores específicos que permitan diseñar estrategias de intervención adecuadas, oportunas y sistemáticas para la prevención de dificultades en el aprendizaje del lenguaje escrito en situaciones que pueden ser consideradas de riesgo

Society, family and learning. The role of home literacy environments

This paper explores the relation between society, family, and learning. In particular, it addresses the features of home literacy environments in low income families and their impact on children's pre-literacy skills and knowledge. Sixty-two four/five-year-old children and their mothers were randomly selected for this study. The mothers were interviewed using an adaptation of a family literacy environment survey (Whitehurst, 1992). The children were assessed with specific tests to examine the scope of their 'early literacy'. The results revealed significant variability in the features and practices of home literacy environments as well as in the children's emerging pre-literacy skills and knowledge. The correlation between the two variables shows low to moderate statistical significance. The implications of such findings are discussed. Additionally, the purpose of isolating relevant features of the children and their home environments is to identify specific indicators related to the literacy fostering process. Ultimately, the goal is to design adequate, timely, and systematic intervention strategies aimed at preventing difficulties related to written language learning in children that could be considered at risk.