Apendicitis aguda perforada en adultos; aproximación a las inequidades sociales en salud, Bogotá 2012

La perforación del apéndice es una complicación temprana de la apendicitis aguda, demoras en el diagnóstico o tratamiento incrementan la tasa de perforación. Se desconoce si la perforación dl apéndice es un reflejo de inequidades sociales. Se pretendió determinar la asociación de la apendicitis aguda perforada en adultos y la equidad en acceso a salud. Estudio tipo cohorte retrospectivo documental, de historias clínicas de pacientes con apendicitis aguda; el análisis se realizó con Stata 11.1 y Epi-info. Los resultados se presentaron en tablas y figuras. Se incluyeron 540 casos (292 hombre y 248 mujeres), el grupo de edad que aporto más datos fue el de 18 a 49 años (391 pacientes); el tiempo medio de síntomas a consulta fue de 37,45 horas, y de 5,3 horas para el paso a cirugía desde el ingreso, fueron solicitadas 76 ecografías y 53 tomografías, 50 interconsultas a urología y 10 a ginecología hasta el diagnostico. El grupo de mayores de 49 años, el estrato socioeconómico tres y la tomografía fueron factores de riesgo independientes para perforación del apéndice. El análisis multivariado mostró asociación lineal entre el estrato socioeconómico y tiempo de síntomas al ingreso, tiempo para paso a cirugía, solicitud de ayudas diagnósticas e interconsultas, con buena significación estadística. La apendicitis aguda perforada en adultos, podría ser un indicador de inequidad en salud. Se requiere de estudios multi-céntricos, con mayor tiempo de evaluación y muestra para demostrar si el apéndice perforado es un trazador de inequidades en salud en Colombia.

Evaluación de una herramienta educativa en conocimiento de donación y trasplante de órganos y tejidos en Colombia

El trasplante de órganos es considerado uno de los avances más significativos de la medicina moderna y es un procedimiento cada vez más exitoso en términos de supervivencia de los pacientes, siendo actualmente la mejor opción de tratamiento para los pacientes con innumerables patologías. El proceso de donación es insuficiente para cubrir las necesidades de trasplante de la población, por lo tanto, se hace necesario el desarrollo de nuevas estrategias para fortalecer la experiencia y efectividad de los programas existentes. La falta de conocimiento de los profesionales de la salud, su percepción y actitud hacia temas relacionados con el proceso de donación, pueden convertirlos en facilitadores o barreras para la identificación de potenciales donantes. Por esta razón, los recursos disponibles, las actitudes hacia la donación, la legislación y conocimiento de los procesos involucrados en la donación de tejidos y órganos son críticos. Dada la influencia de los profesionales de salud se definen los objetivos de este proyecto de tesis: determinar cuál es el conocimiento y las habilidades de los profesionales de la salud encargados de los trasplantes de órganos y de tejidos en la regional 1, evaluados mediante una herramienta educativa para contribuir a mejorar un programa eficiente de Donación de Órganos y tejidos y así mismo, fijar recomendaciones en aras de aumentar las tasas de donación, con especial énfasis en la actividad hospitalaria en el país. METODOLOGIA Se realizó un estudio basado en el análisis de la evaluación de conocimientos del proceso donación- trasplante de órganos y tejidos en el personal de salud participante en la herramienta educativa llamada “Curso taller primer respondiente del potencial donante de órganos y tejidos”. Este curso incluía un formato evaluativo que fue diligenciado de manera anónima por los participantes antes y después de recibir el contenido del curso. El estudio se desarrolló en personal de la Salud de IPS pertenecientes a la Regional I, de la Red Nacional de donación y trasplantes de órganos y tejidos. Con el fin de evidenciar si existen diferencias en el conocimiento de los participantes del curso antes y después de asistir al mismo, se utilizó la prueba de McNemar (p< 0.05). RESULTADOS Entre julio del 2011 y junio del 2012, se realizó el “Curso taller primer respondiente del potencial donante de órganos y tejidos” y se obtuvieron 303 encuestados incluidos médicos, enfermeras y auxiliares de enfermería. Al inicio del curso las respuestas acertadas con relación a legislación, selección del donante, muerte encefálica y mantenimiento del donante estuvieron alrededor del 50%. No fue posible detectar la profesión que pudiese generar riesgo en la detección del donante y los procesos asociados. Posterior al curso, el 72% de las preguntas se respondieron de manera correcta, lo que representa un incremento estadísticamente significativo. Este cambio evidenció significancia estadística al usar la prueba de McNemar y arrojar un valor de p=0.00. .DISCUSIÓN El personal de salud participante en el curso taller proveniente de unidades involucradas como generadoras de donantes muestra un déficit de conocimientos del proceso donación trasplantes lo que puede convertirlos en limitantes para dicho proceso

Description and analysis of pulmonary rehabilitation care programs current state in four cities of Colombia

Purpose: there are many studies reporting the benefits of pulmonary rehabilitation, but few of them exhibit the behavior and activities of these services. This article presents the characteristics of services, parts management and training level of team members, in addition to the variables or instruments used to measure the effectiveness and impact in these programs. Method: it was made a cross sectional convenience sample which included seven pulmonary rehabilitation services in four Colombian cities (Bogotá, Medellín, Manizales and Cali), selected by the coverage, for having at least one year of experience and for being formally established and recognized nationwide. The interdisciplinary team of each service answered a survey that was validated through a pilot test and expert consensus. Participation was voluntary. Results: labor onset pulmonary rehabilitation services correspond to an average of a decade, with COPD and asthma pathologies of attention. The programs are characterized by an outpatient treatment with an average duration of eight to twelve weeks, with a frequency of an hour three times a week. Also, the director of the service is regularly a pulmonologist and the coordinator a physiotherapist (57.14%). The posgradual training of these professionals is notable, and they report to have procedural, administrative and communicative skills, but qualify regular there research skills. The physical and technological resources are well tested. 71.42% have done impact studies, but only 28.57% have been published. All have in common training in upper limbs, lower limbs, respiratory muscles, counseling, functional assessment and quality of life. The effectiveness and impact of programs is measured by the walking test, quality of life questionnaires and activities of daily living.

AS and A2 chemistry exam board AQA : complete revision and practice.

Libro de texto para el nivel AS y A2 en el área de química según la especificación de AQA (Assessment and Qualifications Alliance). Contiene las siguientes materias: estructura atómica, enlaces químicos y periodicidad, química orgánica y alcanos, energética, cinética, elementos y reacciones, grupo carbonilo, síntesis y análisis, termodinámica, equilibrio redox, metales de transición y reacciones inorgánicas. Al final de cada módulo se incluyen preguntas para evaluar la evolución de los conocimientos adquiridos por los alumnos (con soluciones en las últimas páginas del libro).

AQA A2 Unit 5 Biology : control in cells and in organisms.

Guía de revisión en el área de la biología para estudiantes que estén preparando el examen AQA (Assessment and Qualifications Alliance) en el nivel AS (enseñanza secundaria de segundo ciclo). El libro está dividido en tres secciones: una introducción con información sobre el examen oficial, sugerencias, consejos y técnicas de estudio; una guía de contenido con los siguientes temas: cómo detectan y responden los organismos a los cambios en su medio ambiente, cómo coordinan sus respuestas a los estímulos, músculo esquelético, homeostasis, código genético, síntesis de proteínas y mutación genética, control de los genes y tecnología de clonación y sus aplicaciones; y un apartado final con ejemplos de preguntas y respuestas reales de los alumnos con comentarios del examinador.

AQA A2 Unit 4 Chemistry : kinetics, equilibria and organic chemistry.

Guía de apoyo para alumnos de educación secundaria de segundo ciclo que sigan la especificación de AQA (Assessment and Qualifications Alliance) en el nivel A2 del área de química. Está dividida en tres secciones: una introducción con consejos y técnicas para la realización del examen; una guía de contenido con los principales conceptos y temas (cinética, equilibrio, ácidos y bases, nomenclatura e isomería en química orgánica, compuestos del grupo carbonilo, química aromática, aminas, aminoácidos, polímeros, análisis y síntesis orgánica y determinación de estructura); y una sección con preguntas de examen y respuestas comentadas por un examinador.

GCSE AQA English literature : poetry and anthology.

Libro de texto para estudiantes de enseñanza secundaria de segundo ciclo que estén preparando el examen GCSE (General Certificate of Secondary Education) en el área de Literatura Inglesa según la especificación de AQA (Assessment and Qualifications Alliance). Está estructurado en tres secciones (leer poesía, antología poética, y cuentos) divididas en lecciones que incluyen los objetivos a alcanzar, ejercicios, un resumen con los temas clave, biografías o información contextual sobre determinados escritores o textos, definiciones de los términos literarios más importantes, comentarios de examinadores, y referencias a recursos en línea con materiales adicionales.

The Assault on Human Rigths and the Resilience of the Andean Dream: Health Inequities in Ecuador. IV Annual Distinguished Lecture sponsored by the Center for Research on Ethnicity, Culture and Health; School of Public Health; University of Michigan

The point of departure for these reflections is life, since its protection is the central purpose encouraging the defense of human rights and of public health. Life in the Andes has an exceptional diversity. Particularly in Ecuador, my country, this diversity constitutes a characteristic sign that is expressed in two main forms: natural megadiversity and multiculturalism. Indeed, Ecuador’s small territory synthesizes practically all types of lifezones that exist on Earth, having received the gift of high average rates of solar energy and abundant nutritional sources, which have facilitated the natural reproduction of countless species that show their beautiful vitality in the variety of ecosystems that compose the Andean mountain range, the tropical plains, the Amazon humid forests, and the Galapagos Islands. But besides being a highly biodiverse country, it is also a plurinational and multi-cultural society, in which the activity of human beings, organized into social conglomerates of different historical and cultural backgrounds, have formed more than a dozen nations and peoples. Regrettably this natural and human wealth has not been able to bear its best fruits due to the violent operation of a deep social inequity – unfortunately also one of the highest in the Americas—which conspires against life and is reproduced in national and international inequitable relations. This structural inequity has changed its form throughout the centuries and currently has reached its highest and most perverse level of development.

Health Impact Assesment: Hints and Cautions from Critical Epidemiology

Under the format of this conference, to convey the possibilities for health impact assessment of Latin American Critical Epidemiology, sometimes referred to under the tautological designation of “social epidemiology”, I will try to sum up in the next few minutes some reflections based on them.

Aerosol optical depths over North Africa: 2. Modeling and model validation

An operational dust forecasting model is developed by including the Met Office Hadley Centre climate model dust parameterization scheme, within a Met Office regional numerical weather prediction (NWP) model. The model includes parameterizations for dust uplift, dust transport, and dust deposition in six discrete size bins and provides diagnostics such as the aerosol optical depth. The results are compared against surface and satellite remote sensing measurements and against in situ measurements from the Facility for Atmospheric Airborne Measurements for a case study when a strong dust event was forecast. Comparisons are also performed against satellite and surface instrumentation for the entire month of August. The case study shows that this Saharan dust NWP model can provide very good guidance of dust events, as much as 42 h ahead. The analysis of monthly data suggests that the mean and variability in the dust model is also well represented.

Remediation of soils contaminated with petrol and diesel with lime

Lime treatment of hydrocarbon-contaminated soils offers the potential to stabilize and solidify these materials, with a consequent reduction in the risks associated with the leachate emanating from them. This can aid the disposal of contaminated soils or enable their on-site treatment. In this study, the addition of hydrated lime and quicklime significantly reduced the leaching of total petroleum hydrocarbons (TPH) from soils polluted with a 50:50 petrol/diesel mixture. Treatment with quicklime was slightly more effective, but hydrated lime may be better in the field because of its ease of handling. It is proposed that this occurs as a consequence of pozzolanic reactions retaining the hydrocarbons within the soil matrix. There was some evidence that this may be a temporary effect, as leaching increased between seven and 21 days after treatment, but the TPH concentrations in the leachate of treated soils were still one order of magnitude below those of the control soil, offering significant protection to groundwater. The reduction in leaching following treatment was observed in both aliphatic and aromatic fractions, but the latter were more affected because of their higher solubilty. The results are discussed in the context of risk assessment, and recommendations for future research are made.

Mediterranean ecosystems: problems and tools for conservation

Mediterranean ecosystems rival tropical ecosystems in terms of plant biodiversity. The Mediterranean Basin (MB) itself hosts 25 000 plant species, half of which are endemic. This rich biodiversity and the complex biogeographical and political issues make conservation a difficult task in the region. Species, habitat, ecosystem and landscape approaches have been used to identify conservation targets at various scales: ie, European, national, regional and local. Conservation decisions require adequate information at the species, community and habitat level. Nevertheless and despite recent improvements/efforts, this information is still incomplete, fragmented and varies from one country to another. This paper reviews the biogeographic data, the problems arising from current conservation efforts and methods for the conservation assessment and prioritization using GIS. GIS has an important role to play for managing spatial and attribute information on the ecosystems of the MB and to facilitate interactions with existing databases. Where limited information is available it can be used for prediction when directly or indirectly linked to externally built models. As well as being a predictive tool today GIS incorporate spatial techniques which can improve the level of information such as fuzzy logic, geostatistics, or provide insight about landscape changes such as 3D visualization. Where there are limited resources it can assist with identifying sites of conservation priority or the resolution of environmental conflicts (scenario building). Although not a panacea, GIS is an invaluable tool for improving the understanding of Mediterranean ecosystems and their dynamics and for practical management in a region that is under increasing pressure from human impact.

Adaptation of crops to climate change through genotypic responses to mean and extreme temperatures

The importance of temperature in the determination of the yield of an annual crop (groundnut; Arachis hypogaea L. in India) was assessed. Simulations from a regional climate model (PRECIS) were used with a crop model (GLAM) to examine crop growth under simulated current (1961-1990) and future (2071-2100) climates. Two processes were examined: the response of crop duration to mean temperature and the response of seed-set to extremes of temperature. The relative importance of, and interaction between, these two processes was examined for a number of genotypic characteristics, which were represented by using different values of crop model parameters derived from experiments. The impact of mean and extreme temperatures varied geographically, and depended upon the simulated genotypic properties. High temperature stress was not a major determinant of simulated yields in the current climate, but affected the mean and variability of yield under climate change in two regions which had contrasting statistics of daily maximum temperature. Changes in mean temperature had a similar impact on mean yield to that of high temperature stress in some locations and its effects were more widespread. Where the optimal temperature for development was exceeded, the resulting increase in duration in some simulations fully mitigated the negative impacts of extreme temperatures when sufficient water was available for the extended growing period. For some simulations the reduction in mean yield between the current and future climates was as large as 70%, indicating the importance of genotypic adaptation to changes in both means and extremes of temperature under climate change. (c) 2006 Elsevier B.V. All rights reserved.

Climate change and the flowering time of annual crops

Crop production is inherently sensitive to variability in climate. Temperature is a major determinant of the rate of plant development and, under climate change, warmer temperatures that shorten development stages of determinate crops will most probably reduce the yield of a given variety. Earlier crop flowering and maturity have been observed and documented in recent decades, and these are often associated with warmer (spring) temperatures. However, farm management practices have also changed and the attribution of observed changes in phenology to climate change per se is difficult. Increases in atmospheric [CO2] often advance the time of flowering by a few days, but measurements in FACE (free air CO2 enrichment) field-based experiments suggest that elevated [CO2] has little or no effect on the rate of development other than small advances in development associated with a warmer canopy temperature. The rate of development (inverse of the duration from sowing to flowering) is largely determined by responses to temperature and photoperiod, and the effects of temperature and of photoperiod at optimum and suboptimum temperatures can be quantified and predicted. However, responses to temperature, and more particularly photoperiod, at supraoptimal temperature are not well understood. Analysis of a comprehensive data set of time to tassel initiation in maize (Zea mays) with a wide range of photoperiods above and below the optimum suggests that photoperiod modulates the negative effects of temperature above the optimum. A simulation analysis of the effects of prescribed increases in temperature (0-6 degrees C in + 1 degrees C steps) and temperature variability (0% and + 50%) on days to tassel initiation showed that tassel initiation occurs later, and variability was increased, as the temperature exceeds the optimum in models both with and without photoperiod sensitivity. However, the inclusion of photoperiod sensitivity above the optimum temperature resulted in a higher apparent optimum temperature and less variability in the time of tassel initiation. Given the importance of changes in plant development for crop yield under climate change, the effects of photoperiod and temperature on development rates above the optimum temperature clearly merit further research, and some of the knowledge gaps are identified herein.