Anaesthetic induction with etomidate in cardiac surgery: A randomised controlled trial.

BACKGROUND Etomidate is perceived as preserving haemodynamic stability during induction of anaesthesia. It is also associated with adrenocortical dysfunction. The risk/benefit relationship is controversial. OBJECTIVES We tested the hypotheses that single-dose etomidate increases cumulative vasopressor requirement, time to extubation and length of stay in the ICU. DESIGN Double-blind randomised controlled trial. SETTING Bern University Hospital, Switzerland, from November 2006 to December 2009. PATIENTS There were 90 patients undergoing coronary artery bypass grafts (CABG) and 40 patients undergoing mitral valve surgery (MVS). Reasons for noninclusion were known adrenocortical insufficiency, use of etomidate or propofol within 1 week preoperatively, use of glucocorticoids within 6 months preoperatively, severe renal or liver dysfunction, or carotid stenosis. INTERVENTIONS CABG patients were allocated randomly to receive either etomidate 0.15 mg kg with placebo, propofol 1.5 mg kg with placebo or etomidate 0.15 mg kg with hydrocortisone (n = 30 in each arm). Risk stratification (low vs. high) was achieved by block randomisation. MVS patients received either etomidate 0.15 mg kg or propofol 1.5 mg kg (n = 20 in each arm). MAIN OUTCOME MEASURES Cumulative vasopressor requirements, incidence of adrenocortical insufficiency, length of time to extubation and length of stay in ICU. RESULTS Cumulative vasopressor requirements 24 h after induction did not differ between treatments in patients who underwent CABG, whereas more noradrenaline was used in MVS patients following propofol induction (absolute mean difference 5.86 μg kg over 24 h P = 0.047). The incidence of relative adrenocortical insufficiency was higher after etomidate alone than propofol (CABG 83 vs. 37%, P < 0.001; MVS: 95 vs. 35%, P < 0.001). The time to extubation, length of stay in ICU and 30-day mortality did not differ among treatments. Within low and high-risk subgroups, no differences in vasopressor use or outcomes were found. CONCLUSION In elective cardiac surgery, laboratory indicators of etomidate-induced adrenal insufficiency do not translate into increased vasopressor requirement or inferior early outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT 00415701.

Lordoplasty: midterm outcome of an alternative augmentation technique for vertebral fractures.

OBJECTIVE Vertebroplasty and balloon kyphoplasty are effective treatment options for osteoporotic vertebral compression fractures but are limited in correction of kyphotic deformity. Lordoplasty has been reported as an alternative, cost-effective, minimally invasive, percutaneous cement augmentation technique with good restoration of vertebral body height and alignment. The authors report on its clinical and radiological midterm results. METHODS A retrospective review was conducted of patients treated with lordoplasty from 2002 to 2014. Inclusion criteria were clinical and radiological follow-up evaluations longer than 24 months. Radiographs were accessed regarding initial correction and progressive loss of reduction. Complications and reoperations were recorded. Actual pain level, pain relief immediately after surgery, autonomy, and subjective impression of improvement of posture were assessed by questionnaire. RESULTS Sixty-five patients (46 women, 19 men, age range 38.9-86.2 years old) were treated with lordoplasty for 69 vertebral compression and insufficiency fractures. A significant correction of the vertebral kyphotic angle (mean 13°) and segmental kyphotic angle (mean 11°) over a mean follow-up of 33 months (range 24-108 months) was achieved (p < 0.001). On average, pain was relieved to 90% of the initial pain level. In 24% of the 65 patients a second spinal intervention was necessary: 16 distant (24.6%) and 7 adjacent (10.8%) new osteoporotic fractures, 4 instrumented stabilizations (6.2%), 1 new adjacent traumatic fracture (1.5%), and 1 distant microsurgical decompression (1.5%). Cement leakage occurred in 10.4% but was only symptomatic in 1 case. CONCLUSIONS Lordoplasty appeared safe and effective in midterm pain alleviation and restoration of kyphotic deformity in osteoporotic compression and insufficiency fractures. The outcomes of lordoplasty are consistent with other augmentation techniques.

LRH-1 May Rescue SF-1 Deficiency for Steroidogenesis: An in vitro and in vivo Study

Steroidogenic factor 1 (NR5A1/SF-1) mutations usually manifest in 46,XY individuals with variable degrees of disordered sex development and in 46,XX women with ovarian insufficiency. So far, there is no genotype-phenotype correlation. The broad spectrum of phenotype with NR5A1 mutations may be due to a second hit in a gene with similar function to NR5A1/SF-1. Liver receptor homologue-1 (LRH-1/NR5A2) might be a good candidate. We performed in vitro studies for the interplay between SF-1, LRH-1 and DAX-1, expression profiles in human steroidogenic tissues, and NR5A2 genetic studies in a cohort (11 patients, 8 relatives, 11 families) harboring heterozygote NR5A1/SF-1 mutations. LRH-1 isoforms transactivate the CYP17A1 and HSD3B2 promoters similarly to SF-1 and compensate for SF-1 deficiency. DAX-1 inhibits SF-1- and LRH-1-mediated transactivation. LRH-1 is found expressed in human adult and fetal adrenals and testes. However, no NR5A2/LRH-1 mutations were detected in 14 individuals with heterozygote NR5A1/SF-1 mutations. These findings demonstrate that in vitro LRH-1 can act like SF-1 and compensate for its deficiency. Expression of LRH-1 in fetal testis suggests a role in male gonadal development. However, as we found no NR5A2/LRH-1 mutations, the 'second genetic hit' in SF-1 patients explaining the broad phenotypic variability remains elusive.

Mutation Update of the CLCN5 Gene Responsible for Dent Disease 1

Dent disease is a rare X-linked tubulopathy characterized by low molecular weight proteinuria, hypercalciuria, nephrocalcinosis and/or nephrolithiasis, progressive renal failure, and variable manifestations of other proximal tubule dysfunctions. It often progresses over a few decades to chronic renal insufficiency, and therefore molecular characterization is important to allow appropriate genetic counseling. Two genetic subtypes have been described to date: Dent disease 1 is caused by mutations of the CLCN5 gene, coding for the chloride/proton exchanger ClC-5; and Dent disease 2 by mutations of the OCRL gene, coding for the inositol polyphosphate 5-phosphatase OCRL-1. Herein, we review previously reported mutations (n = 192) and their associated phenotype in 377 male patients with Dent disease 1 and describe phenotype and novel (n = 42) and recurrent mutations (n = 24) in a large cohort of 117 Dent disease 1 patients belonging to 90 families. The novel missense and in-frame mutations described were mapped onto a three-dimensional homology model of the ClC-5 protein. This analysis suggests that these mutations affect the dimerization process, helix stability, or transport. The phenotype of our cohort patients supports and extends the phenotype that has been reported in smaller studies.

[Influence of the pelvic trauma registry of the DGU on treatment of pelvic ring fractures].

Fractures of the pelvic ring are comparatively rare with an incidence of 2-8 % of all fractures depending on the study in question. The severity of pelvic ring fractures can be very different ranging from simple and mostly "harmless" type A fractures up to life-threatening complex type C fractures. Although it was previously postulated that high-energy trauma was necessary to induce a pelvic ring fracture, over the past decades it became more and more evident, not least from data in the pelvic trauma registry of the German Society for Trauma Surgery (DGU), that low-energy minor trauma can also cause pelvic ring fractures of osteoporotic bone and in a rapidly increasing population of geriatric patients insufficiency fractures of the pelvic ring are nowadays observed with no preceding trauma.Even in large trauma centers the number of patients with pelvic ring fractures is mostly insufficient to perform valid and sufficiently powerful monocentric studies on epidemiological, diagnostic or therapeutic issues. For this reason, in 1991 the first and still the only registry worldwide for the documentation and evaluation of pelvic ring fractures was introduced by the Working Group Pelvis (AG Becken) of the DGU. Originally, the main objectives of the documentation were epidemiological and diagnostic issues; however, in the course of time it developed into an increasingly expanding dataset with comprehensive parameters on injury patterns, operative and conservative therapy regimens and short-term and long-term outcome of patients. Originally starting with 10 institutions, in the meantime more than 30 hospitals in Germany and other European countries participate in the documentation of data. In the third phase of the registry alone, which was started in 2004, data from approximately 15,000 patients with pelvic ring and acetabular fractures were documented. In addition to the scientific impact of the pelvic trauma registry, which is reflected in the numerous national and international publications, the dramatically changing epidemiology of pelvic ring fractures, further developments in diagnostics and the changes in operative procedures over time could be demonstrated. Last but not least the now well-established diagnostic and therapeutic algorithms for pelvic ring fractures, which could be derived from the information collated in registry studies, reflect the clinical impact of the registry.

B cells in ADA deficiency

Deficiency of the enzyme adenosine deaminase (ADA) results in severe lymphopenia in humans. Mice with an inactivating mutation in the ADA gene also exhibit profound lymphopenia, as well as pulmonary insufficiency and ribcage abnormalities. In fact, the mouse model has a phenotype that is remarkably similar to that of the human disease, making the mice valuable tools for unraveling the mechanism of lymphocyte destruction in absence of this housekeeping gene. T cell deficiency in ADA deficiency has been extensively studied by others, revealing a block in early thymocyte development. In contrast, our studies revealed that early B cell development in the bone marrow is normal. ADA-deficient mice, however, exhibit profound defects in germinal center formation, preventing antigen-dependent B cell maturation in the spleen. ADA-deficient spleen B cells display significant defects in proliferation and activation signaling, and produce more IgM than their normal counterparts, suggesting that extrafollicular plasmablasts are overrepresented. B cells from ADA-deficient mouse spleens undergo apoptosis more readily than those from normal mouse spleens. Levels of ADA's substrates, adenosine and 2′-deoxyadenosine, are elevated in both bone marrow and spleen in ADA-deficient mice. S ′-adenosyihomoeysteine hydrolase (SAH hydrolase) activity is significantly inhibited in both locales, as well. dATP levels, though, are only elevated in spleen, where B cell development is impaired, and not in bone marrow, where B cell ontogeny is normal. This finding points to dATP as the causative agent of lymphocyte death in ADA deficiency. ADA deficiency results in inhibition of the enzyme ribonucleotide reductase, thereby depleting nucleoside pools needed for DNA repair. Another mouse model that lacks a functional gene encoding a protein involved in DNA repair and/or cell cycle checkpoint regulation, p53-binding protein 1, exhibits blocks in T and B cell development that are similar to those seen in ADA-deficient mice. Unraveling the mechanisms of lymphocyte destruction in ADA deficiency may further understanding of lymphocyte biology, facilitate better chemotherapeutic treatment for lymphoproliferative diseases, and improve gene and enzyme therapy regimens attempted for ADA deficiency. ^

Persistently elevated troponin I in heart failure patients - a suitable prognosticator and a possible boon to public health?

Baseline elevation of troponin I (TnI) has been associated with worse outcomes in heart failure (HF). However, the prevalence of persistent TnI elevation and its association with clinical outcomes has not been well described. HF is a major public health issue due to its wide prevalence and prognosticators of this condition will have a significant impact on public health. Methods: A retrospective study was performed in 510 patients with an initial HF admission between 2002 to 2004, and all subsequent hospital admissions up to May 2009 were recorded in a de-identified database. Persistent TnI elevation was defined as a level ≥0.05 ng/ml on ≥3 HF admissions. Baseline characteristics, hospital readmissions and all cause mortality were compared between patients with persistent TnI elevation (Persistent), patients with no persistence of TnI (Nonpersistent) and patients who had less than three hospital admissions (admission <3) groups. Also the same data was analyzed using the mean method in which the mean value of all recorded troponin values of each patient was used to define persistence i.e. patients who had a mean troponin level ≥0.05 ng/ml were classified as persistent. Results: Mean age of our cohort was 68.4 years out of which 99.6% subjects were male, 62.4% had ischemic HF. 78.2% had NYHA class III to IV HF, mean LVEF was 25.9%. Persistent elevation of TnI was seen in 26% of the cohort and in 66% of patients with more than 3 hospital admissions. Mean TnI level was 0.67 ± 0.15 ng/ml in the 'Persistent' group. Mean TnI using the mean method was 1.11 ± 7.25 ng/ml. LVEF was significantly lower in persistent group. Hypertension, diabetes, chronic renal insufficiency and mean age did not differ between the two groups. 'Persistent' patients had higher mortality (HR = 1.26, 95% CI = 0.89–1.78, p = 0.199 when unadjusted and HR = 1.29, 95% CI = 0.89–1.86, p = 0.176 when adjusted for race, LVEF and ischemic etiology) HR for mortality in persistent patients was 1.99 (95% CI = 1.06–3.73, p = 0.03) using the mean method. The following results were found in those with ischemic cardiomyopathy (HR = 1.44034, 95% CI = 0.92–2.26, p = 0.113) and (HR = 1.89, 95% CI = 1.01–3.55, p = 0.046) by using the mean method. 2 out of three patients with HF who were readmitted three or more times had persistent elevation of troponin I levels. Patients with chronic persistence of troponin I elevation showed a trend towards lesser survival as compared to patients who did not have chronic persistence, however this did not reach statistical significance. This trend was seen more among ischemic patients than non ischemic patients, but did not reach statistical significance. With the mean method, patients with chronic persistence of troponin I elevation had significantly lesser survival than those without it. Also ischemic patients had significantly lesser survival than non ischemic patients. ^

Elevated cystatin C & heart failure prognosis a systematic review

Renal insufficiency is one of the most common co-morbidities present in heart failure (HF) patients. It has significant impact on mortality and adverse outcomes. Cystatin C has been shown as a promising marker of renal function. A systematic review of all the published studies evaluating the prognostic role of cystatin C in both acute and chronic HF was undertaken. A comprehensive literature search was conducted involving various terms of 'cystatin C' and 'heart failure' in Pubmed medline and Embase libraries using Scopus database. A total of twelve observational studies were selected in this review for detailed assessment. Six studies were performed in acute HF patients and six were performed in chronic HF patients. Cystatin C was used as a continuous variable, as quartiles/tertiles or as a categorical variable in these studies. Different mortality endpoints were reported in these studies. All twelve studies demonstrated a significant association of cystatin C with mortality. This association was found to be independent of other baseline risk factors that are known to impact HF outcomes. In both acute and chronic HF, cystatin C was not only a strong predictor of outcomes but also a better prognostic marker than creatinine and estimated glomerular filtration rate (eGFR). A combination of cystatin C with other biomarkers such as N terminal pro B- type natriuretic peptide (NT-proBNP) or creatinine also improved the risk stratification. The plausible mechanisms are renal dysfunction, inflammation or a direct effect of cystatin C on ventricular remodeling. Either alone or in combination, cystatin C is a better, accurate and a reliable biomarker for HF prognosis. ^

The association between parity and selected structural birth defects

BACKGROUND: Parity is a risk factor in neonatal morbidity and mortality. This dissertation examined the association between first births and selected birth defects. The first aim was to assess the risk of 66 birth defects among first births and third or greater births. The second aim was to determine if maternal race, maternal age, infant sex or infant birth weight modify the association between first births and selected birth defects. METHODS: The Texas Birth Defects Registry provided data for 1999-2009. For the first aim, odds ratios were calculated for each birth defect. For the second aim, analysis was restricted to the ten birth defects significantly associated with first births. Stratified analyses were conducted and interaction terms were added to logistic regression models to assess whether differences in the odds ratios for the effect of first birth were statistically significant across strata. RESULTS: Findings for the first aim showed that first births had significantly increased odds of having an infant with 24 of the 66 birth defects. Third or greater births had significantly increased odds of having four of the 66 birth defects. For the second aim, a number of significant effect modifiers were observed. For patent ductus arteriosis, obstructive urinary defects and gastroschisis, the effect of first births was significantly modified by black or U.S.-born Hispanic mothers. The effect of first birth was also significantly modified among mothers ≥30 years for mitral valve insufficiency, atrial septal defect and congenital hip dislocation. The effect of first births was significantly modified among infants with low birth weight for hypospadias, congenital hip dislocation and gastroschisis. CONCLUSIONS: First births were associated with an elevated risk of 24 categories of birth defects. For some of the birth defects studied, the effect of first birth is modified by maternal age, maternal race and low birth weight. Knowledge of the increased risk for birth defects among women having their first birth allows physicians and midwives to provide better patient care and spur further research into the etiology of associated birth defects. This knowledge may bring about interventions prior to conception in populations most likely to conceive.^

Estrategias de orientación educativa y ocupacional en Adultos Mayores

El presente trabajo se propone articular el Modelo Teórico Operativo en Orientación, desarrollado por la Dra. Gavilán y el Modelo de Envejecimiento Activo con el objetivo de profundizar los aportes que pueden realizarse desde la Orientación y diseñar estrategias de intervención acordes a la población objeto de estudio. Presenta continuidad temática con los proyectos de investigación ?La Orientación en el Nuevo Modelo de Envejecimiento Activo: elecciones educativas, laborales, personales y sociales? y ?Estrategias orientadoras para la elaboración de proyectos en adultos mayores?, llevados a cabo como becaria de la Secretaría de Ciencia y Técnica de la Universidad Nacional de La Plata. Surge de la insuficiente producción teórica al respecto, así como de la inexistencia de enfoques, programas y estrategias de intervenciones de este tipo con sujetos adultos mayores a nivel local, a diferencia de lo que sucede con otras etapas evolutivas, fundamentalmente la adolescencia. Asimismo, son escasos los desarrollos internacionales sobre la temática. A los fines de esta investigación, se han tomado en consideración datos relativos a la expectativa de la vida de las personas, la transición demográfica de nuestro país y los lineamientos de organismos nacionales e internacionales en cuanto a la promoción de un envejecimiento activo y saludable. Con respecto a la Orientación Vocacional se adopta el enfoque de la orientación continua, es decir, como un proceso a lo largo de la vida. La insuficiencia de investigaciones sobre las cuestiones planteadas, pone de relieve el interés y el aporte de esta investigación, en la medida en que comporta una apertura a nuevas oportunidades de desarrollo y realización personal de un porcentaje significativo de la población, destinada a facilitar la comprensión de la elaboración de proyectos en la etapa considerada. El estudio sobre la vejez ha tomado gran relevancia desde las distintas disciplinas ya que el envejecimiento poblacional plantea nuevos escenarios y nuevos desafíos a la ciencia y a la sociedad en general. El fenómeno de transformación demográfica ha dado lugar a numerosas investigaciones y a diversas políticas para brindar una mejor calidad de vida a las personas mayores desde distintos sectores. Como fenómeno social requiere de una mirada desde el paradigma de la complejidad, de un abordaje interdisciplinario y del diseño de estrategias integrales

Sobre los orígenes de las caballerías en Castilla y León. Siglos X-XII

En el proceso de constitución de la caballería medieval es inevitable hablar de la formación de la clase de poder y la estructuración del feudalismo. Pero la insuficiencia de esta perspectiva se revela ante el caso particular de Castilla y León, para el cual deben considerarse dos estamentos diferenciados: los infanzones, asimilados a la última escala de la clase feudal y los caballeros villanos, privados de poder de mando propio y sin vínculos personales de vasallaje. Al criterio de que el enriquecimiento fue un presupuesto del poder se opone otro, que se explorará en esta contribución, que enfatiza los mecanismos de subordinación política de los campesinos para dar cuenta de la génesis del sistema. Las evoluciones se cumplían con distintas cronologías en cada localidad, imagen que difiere de la que brindaron los autores que afirmaban la llamada "mutación feudal" (un cambio sincrónico en toda una región que se habría verificado en un tiempo muy corto hacia el año mil, producido por un desmembramiento de las soberanías políticas). Los documentos de Castilla y León indican que los cambios fueron lentos y muy desiguales en cada lugar. Así, pues, en la Extremadura Histórica la caballería surgió de una comunidad campesina. En cuanto a la condición social del Cid, se puede afirmar que Rodrigo Díaz, como otros infanzones, estaba al servicio de su señor en una relación personal de vasallaje. Esa dependencia honorable (que, sin embargo, podía interrumpirse) era la base para recibir feudos que se sumaban al patrimonio propio.

Estrategias de orientación educativa y ocupacional en Adultos Mayores

El presente trabajo se propone articular el Modelo Teórico Operativo en Orientación, desarrollado por la Dra. Gavilán y el Modelo de Envejecimiento Activo con el objetivo de profundizar los aportes que pueden realizarse desde la Orientación y diseñar estrategias de intervención acordes a la población objeto de estudio. Presenta continuidad temática con los proyectos de investigación ?La Orientación en el Nuevo Modelo de Envejecimiento Activo: elecciones educativas, laborales, personales y sociales? y ?Estrategias orientadoras para la elaboración de proyectos en adultos mayores?, llevados a cabo como becaria de la Secretaría de Ciencia y Técnica de la Universidad Nacional de La Plata. Surge de la insuficiente producción teórica al respecto, así como de la inexistencia de enfoques, programas y estrategias de intervenciones de este tipo con sujetos adultos mayores a nivel local, a diferencia de lo que sucede con otras etapas evolutivas, fundamentalmente la adolescencia. Asimismo, son escasos los desarrollos internacionales sobre la temática. A los fines de esta investigación, se han tomado en consideración datos relativos a la expectativa de la vida de las personas, la transición demográfica de nuestro país y los lineamientos de organismos nacionales e internacionales en cuanto a la promoción de un envejecimiento activo y saludable. Con respecto a la Orientación Vocacional se adopta el enfoque de la orientación continua, es decir, como un proceso a lo largo de la vida. La insuficiencia de investigaciones sobre las cuestiones planteadas, pone de relieve el interés y el aporte de esta investigación, en la medida en que comporta una apertura a nuevas oportunidades de desarrollo y realización personal de un porcentaje significativo de la población, destinada a facilitar la comprensión de la elaboración de proyectos en la etapa considerada. El estudio sobre la vejez ha tomado gran relevancia desde las distintas disciplinas ya que el envejecimiento poblacional plantea nuevos escenarios y nuevos desafíos a la ciencia y a la sociedad en general. El fenómeno de transformación demográfica ha dado lugar a numerosas investigaciones y a diversas políticas para brindar una mejor calidad de vida a las personas mayores desde distintos sectores. Como fenómeno social requiere de una mirada desde el paradigma de la complejidad, de un abordaje interdisciplinario y del diseño de estrategias integrales

Sobre los orígenes de las caballerías en Castilla y León. Siglos X-XII

En el proceso de constitución de la caballería medieval es inevitable hablar de la formación de la clase de poder y la estructuración del feudalismo. Pero la insuficiencia de esta perspectiva se revela ante el caso particular de Castilla y León, para el cual deben considerarse dos estamentos diferenciados: los infanzones, asimilados a la última escala de la clase feudal y los caballeros villanos, privados de poder de mando propio y sin vínculos personales de vasallaje. Al criterio de que el enriquecimiento fue un presupuesto del poder se opone otro, que se explorará en esta contribución, que enfatiza los mecanismos de subordinación política de los campesinos para dar cuenta de la génesis del sistema. Las evoluciones se cumplían con distintas cronologías en cada localidad, imagen que difiere de la que brindaron los autores que afirmaban la llamada "mutación feudal" (un cambio sincrónico en toda una región que se habría verificado en un tiempo muy corto hacia el año mil, producido por un desmembramiento de las soberanías políticas). Los documentos de Castilla y León indican que los cambios fueron lentos y muy desiguales en cada lugar. Así, pues, en la Extremadura Histórica la caballería surgió de una comunidad campesina. En cuanto a la condición social del Cid, se puede afirmar que Rodrigo Díaz, como otros infanzones, estaba al servicio de su señor en una relación personal de vasallaje. Esa dependencia honorable (que, sin embargo, podía interrumpirse) era la base para recibir feudos que se sumaban al patrimonio propio.

Sobre los orígenes de las caballerías en Castilla y León. Siglos X-XII

En el proceso de constitución de la caballería medieval es inevitable hablar de la formación de la clase de poder y la estructuración del feudalismo. Pero la insuficiencia de esta perspectiva se revela ante el caso particular de Castilla y León, para el cual deben considerarse dos estamentos diferenciados: los infanzones, asimilados a la última escala de la clase feudal y los caballeros villanos, privados de poder de mando propio y sin vínculos personales de vasallaje. Al criterio de que el enriquecimiento fue un presupuesto del poder se opone otro, que se explorará en esta contribución, que enfatiza los mecanismos de subordinación política de los campesinos para dar cuenta de la génesis del sistema. Las evoluciones se cumplían con distintas cronologías en cada localidad, imagen que difiere de la que brindaron los autores que afirmaban la llamada "mutación feudal" (un cambio sincrónico en toda una región que se habría verificado en un tiempo muy corto hacia el año mil, producido por un desmembramiento de las soberanías políticas). Los documentos de Castilla y León indican que los cambios fueron lentos y muy desiguales en cada lugar. Así, pues, en la Extremadura Histórica la caballería surgió de una comunidad campesina. En cuanto a la condición social del Cid, se puede afirmar que Rodrigo Díaz, como otros infanzones, estaba al servicio de su señor en una relación personal de vasallaje. Esa dependencia honorable (que, sin embargo, podía interrumpirse) era la base para recibir feudos que se sumaban al patrimonio propio.

Estrategias de orientación educativa y ocupacional en Adultos Mayores

El presente trabajo se propone articular el Modelo Teórico Operativo en Orientación, desarrollado por la Dra. Gavilán y el Modelo de Envejecimiento Activo con el objetivo de profundizar los aportes que pueden realizarse desde la Orientación y diseñar estrategias de intervención acordes a la población objeto de estudio. Presenta continuidad temática con los proyectos de investigación ?La Orientación en el Nuevo Modelo de Envejecimiento Activo: elecciones educativas, laborales, personales y sociales? y ?Estrategias orientadoras para la elaboración de proyectos en adultos mayores?, llevados a cabo como becaria de la Secretaría de Ciencia y Técnica de la Universidad Nacional de La Plata. Surge de la insuficiente producción teórica al respecto, así como de la inexistencia de enfoques, programas y estrategias de intervenciones de este tipo con sujetos adultos mayores a nivel local, a diferencia de lo que sucede con otras etapas evolutivas, fundamentalmente la adolescencia. Asimismo, son escasos los desarrollos internacionales sobre la temática. A los fines de esta investigación, se han tomado en consideración datos relativos a la expectativa de la vida de las personas, la transición demográfica de nuestro país y los lineamientos de organismos nacionales e internacionales en cuanto a la promoción de un envejecimiento activo y saludable. Con respecto a la Orientación Vocacional se adopta el enfoque de la orientación continua, es decir, como un proceso a lo largo de la vida. La insuficiencia de investigaciones sobre las cuestiones planteadas, pone de relieve el interés y el aporte de esta investigación, en la medida en que comporta una apertura a nuevas oportunidades de desarrollo y realización personal de un porcentaje significativo de la población, destinada a facilitar la comprensión de la elaboración de proyectos en la etapa considerada. El estudio sobre la vejez ha tomado gran relevancia desde las distintas disciplinas ya que el envejecimiento poblacional plantea nuevos escenarios y nuevos desafíos a la ciencia y a la sociedad en general. El fenómeno de transformación demográfica ha dado lugar a numerosas investigaciones y a diversas políticas para brindar una mejor calidad de vida a las personas mayores desde distintos sectores. Como fenómeno social requiere de una mirada desde el paradigma de la complejidad, de un abordaje interdisciplinario y del diseño de estrategias integrales