Presence of Triatominae (Hemiptera, Reduviidae) and Risk of Transmission of Chagas Disease in Colima, México

With the purpose of evaluating the risk of transmission of the Chagas disease in the State of Colima, México, an entomological survey was performed to obtain triatominae and the rate of infection by Trypanosoma cruzi determined by examination of its dejections. Two hundred eighteen houses located in 16 villages were sampled. In each house the intradomestic and peridomestic habitats were examined by the man-hour-house method, sensor boxes and mouse-baited traps. Also, 12 silvatic places were explored around the same areas using the same techniques as the ones sampled. In total, 456 specimens were captured, of which 139 correspond to Triatoma phyllosoma pallidipennis; 80 to T. p. longipennis; one specimen of T. dimidiata and 236 nymphs of Triatoma sp. Two hundred ninety seven insects were captured in the intradomestic habitat, 132 in the peridomestic and 26 in the silvatic. The index of positive houses was 27%, located in the central area of the state. The rate of natural infection with T. cruzi showed 25.6%. This results confirmed the presence of two important vectors of the Chagas disease in Colima. Its preference for the domestic habitat and its high levels of natural infection with T. cruzi suggested the existence of a significant risk for its transmission in this area of the country.

Breast and cervical cancer screening programme implementation in 16 countries.

OBJECTIVES: There is a continuing need to monitor and evaluate the impact of organized screening programmes on cancer incidence and mortality. We report results from a programme assessment conducted within the International Cancer Screening Network (ICSN) to understand the characteristics of cervical screening programmes within countries that have established population-based breast cancer screening programmes. METHODS: In 2007-2008, we asked 26 ICSN country representatives to complete a web-based survey that included questions on breast and cervical cancer screening programmes. We summarized information from 16 countries with both types of organized programmes. RESULTS: In 63% of these countries, the organization of the cervical cancer screening programme was similar to that of the breast cancer screening programme in the same country. There were differences in programme characteristics, including year established (1962-2003 cervical; 1986-2002 breast) and ages covered (15-70+ cervical; 40-75+ breast). Adoption of new screening technologies was evident (44% liquid-based Pap tests; 13% human papillomavirus (HPV)-triage tests cervical; 56% digital mammography breast). There was wide variation in participation rates for both programme types (<4-80% cervical; 12-88% breast), and participation rates tended to be higher for cervical (70-80%) than for breast (60-70%) cancer screening programmes. Eleven ICSN member countries had approved the HPV vaccine and five more were considering its use in their organized programmes. CONCLUSION: Overall, there were similarities and differences in the organization of breast and cervical cancer screening programmes among ICSN countries. This assessment can assist established and new screening programmes in understanding the organization and structure of cancer screening programmes.

Increased expression of monocarboxylate transporters 1, 2, and 4 in colorectal carcinomas.

Tumour cells are known to be highly glycolytic, thus producing high amounts of lactic acid. Monocarboxylate transporters (MCTs), by promoting the efflux of the accumulating acids, constitute one of the most important mechanisms in the maintenance of tumour intracellular pH. Since data concerning MCT expression in colorectal carcinomas (CRC) are scarce and controversial, the present study aimed to assess the expressions of MCT1, 2, and 4 in a well characterized series of CRC and assess their role in CRC carcinogenesis. CRC samples (126 cases) were analyzed for MCT1, MCT2, and MCT4 immunoexpression and findings correlated with clinico-pathological parameters. Expression of all MCT isoforms in tumour cells was significantly increased when compared to adjacent normal epithelium. Remarkably, there was a significant gain of membrane expression for MCT1 and MCT4 and loss of plasma membrane expression for MCT2 in tumour cells. Plasma membrane expression of MCT1 was directly related to the presence of vascular invasion. This is the larger study on MCT expression in CRC and evaluates for the first time its clinico-pathological significance. The increased expression of these transporters suggests an important role in CRC, which might justify their use, especially MCT1 and MCT4, as targets in CRC drug therapy.

Application of control measures for infections caused by multi-resistant gram-negative bacteria in intensive care unit patients

Multi-resistant gram-negative rods are important pathogens in intensive care units (ICU), cause high rates of mortality, and need infection control measures to avoid spread to another patients. This study was undertaken prospectively with all of the patients hospitalized at ICU, Anesthesiology of the Hospital São Paulo, using the ICU component of the National Nosocomial Infection Surveillance System (NNIS) methodology, between March 1, 1997 and June 30, 1998. Hospital infections occurring during the first three months after the establishment of prevention and control measures (3/1/97 to 5/31/97) were compared to those of the last three months (3/1/98 to 5/31/98). In this period, 933 NNIS patients were studied, with 139 during the first period and 211 in the second period. The overall rates of infection by multi-resistant microorganisms in the first and second periods were, respectively, urinary tract infection: 3.28/1000 patients/day; 2.5/1000 patients/day; pneumonia: 2.10/1000 patients/day; 5.0/1000 patients/day; bloodstream infection: 1.09/1000 patients/day; 2.5/1000 patients/day. A comparison between overall infection rates of both periods (Wilcoxon test) showed no statistical significance (p = 0.067). The use of intervention measures effectively decreased the hospital bloodstream infection rate (p < 0.001), which shows that control measures in ICU can contribute to preventing hospital infections.

Criteria for establishing shielding of multi-detector computed tomography (MDCT) rooms.

The aim of this work is to compare two methods used for determining the proper shielding of computed tomography (CT) rooms while considering recent technological advances in CT scanners. The approaches of the German Institute for Standardisation and the US National Council on Radiation Protection and Measurements were compared and a series of radiation measurements were performed in several CT rooms at the Lausanne University Hospital. The following three-step procedure is proposed for assuring sufficient shielding of rooms hosting new CT units with spiral mode acquisition and various X-ray beam collimation widths: (1) calculate the ambient equivalent dose for a representative average weekly dose length product at the position where shielding is required; (2) from the maximum permissible weekly dose at the location of interest, calculate the transmission factor F that must be taken to ensure proper shielding and (3) convert the transmission factor into a thickness of lead shielding. A similar approach could be adopted to use when designing shielding for fluoroscopy rooms, where the basic quantity would be the dose area product instead of the load of current (milliampere-minute).

Cardiorespiratory responses during running and sport-specific exercises in handball players

To determine whether a 4-a-side handball (HB) game is an appropriate aerobic stimulus to reach and potentially enhance maximal oxygen uptake (V O(2)max), and whether heart rate (HR) is a valid index of V O(2) during a handball game. Nine skilled players (21.0+/-2.9 yr) underwent a graded maximal aerobic test (GT) where V O(2)max and HR-V O(2) relationship were determined. V O(2), HR and blood lactate ([La](b)) were recorded during a 2 x 225 s (interspersed with 30s rest) 4-a-side handball game and were compared to those measured during an 480-s running intermittent exercise (IE). Mean V O(2) tended to be higher in handball compared to IE (93.9+/-8.5 vs. 87.6+/-7.4% O(2)max, p=0.06), whereas HR was similar (92.3+/-4.9 vs. 93.9+/-3.9% of the peak of HR, p=0.10). [La](b) was lower for handball than for IE (8.9+/-3.5 vs. 11.6+/-2.1 mmol l(-1), p=0.04). Time spent over 90% of V O(2)max was higher for handball than for IE (336.1+/-139.6s vs. 216.1+/-124.7s; p=0.03). The HR-V O(2) relationship during GT was high (r(2)=0.96, p<0.001) but estimated V O(2) from HR was lower to that measured (p=0.03) in handball, whereas there was no difference in IE. 4-a-side handball game can be used as a specific alternative to IE for enhancing aerobic fitness in handball players. Nevertheless, the accuracy of HR measures for estimating V O(2) during handball is poor.

Report of an audit of child protection research in Ireland 1990-2009.

A total of 190 research documents were identified in line with the criteria agreed between the researchers and the CAAB, and are included in the audit. The key findings from the analysis of the audit are as follows:    - Research identified in the audit has tended to focus on child protection and the child protection system generally, as well as sexual abuse. This research has primarily been undertaken by clinicians and academics, and spans across sectors.   - Over half, (110 or 58%) of the research falls under the heading of policy/practice reviews/analysis. This is further reflected in the fact that the research most commonly focused on operating procedures, followed by practice issues and the policy framework, both in studies with a single focus and those with multiple foci.   - The most common type of publication was peer reviewed article (74 or 39%), with commissioned research accounting for just 7% (13). This is in line with the findings that 68% (128) of commissioning/publishing bodies and 74% (139) of research bodies were in the academic sector.   - The research published and/or commissioned by the statutory sector follows the pattern found in the audit generally, with the most common type of study being policy/practice review/analysis (27 or 48%) and the most common focus being operating procedures (22 or 39%).   - Information sources rarely incorporated primary research with children, with only 14 studies (8%) citing direct contact with children and young people. Information on children was more commonly gathered from case files, professionals and family members.   - The topics covered in the identified research were very wide-ranging but closely related to the primary subject area (type of abuse) and the sector in which the research was located.   One conclusion stated that: There is a shortage of child protection-focused research on the factors that cause and perpetuate child abuse, such as homelessness, addiction, parental mental illness and domestic violence. The need for material on these areas is demonstrated by the nature and scale of reports to the child protection system and the removal of some children from their families into out of home care as a result of the above mentioned adversities.This resource was contributed by The National Documentation Centre on Drug Use.

Moderate exercise blunts oxidative stress induced by normobaric hypoxic confinement

PURPOSE: Both acute hypoxia and physical exercise are known to increase oxidative stress. This randomized prospective trial investigated whether the addition of moderate exercise can alter oxidative stress induced by continuous hypoxic exposure. METHODS: Fourteen male participants were confined to 10-d continuous normobaric hypoxia (FIO2 = 0.139 +/- 0.003, PIO2 = 88.2 +/- 0.6 mm Hg, approximately 4000-m simulated altitude) either with (HCE, n = 8, two training sessions per day at 50% of hypoxic maximal aerobic power) or without exercise (HCS, n = 6). Plasma levels of oxidative stress markers (advanced oxidation protein products [AOPP], nitrotyrosine, and malondialdehyde), antioxidant markers (ferric-reducing antioxidant power, superoxide dismutase, glutathione peroxidase, and catalase), nitric oxide end-products, and erythropoietin were measured before the exposure (Pre), after the first 24 h of exposure (D1), after the exposure (Post) and after the 24-h reoxygenation (Post + 1). In addition, graded exercise test in hypoxia was performed before and after the protocol. RESULTS: Maximal aerobic power increased after the protocol in HCE only (+6.8%, P < 0.05). Compared with baseline, AOPP was higher at Post + 1 (+28%, P < 0.05) and nitrotyrosine at Post (+81%, P < 0.05) in HCS only. Superoxide dismutase (+30%, P < 0.05) and catalase (+53%, P < 0.05) increased at Post in HCE only. Higher levels of ferric-reducing antioxidant power (+41%, P < 0.05) at Post and lower levels of AOPP (-47%, P < 0.01) at Post + 1 were measured in HCE versus HCS. Glutathione peroxidase (+31%, P < 0.01) increased in both groups at Post + 1. Similar erythropoietin kinetics was noted in both groups with an increase at D1 (+143%, P < 0.01), a return to baseline at Post, and a decrease at Post + 1 (-56%, P < 0.05). CONCLUSIONS: These data provide evidence that 2 h of moderate daily exercise training can attenuate the oxidative stress induced by continuous hypoxic exposure.

Implication des hôpitaux en évaluation des technologies de la santé : quel rôle pour les hôpitaux? : éléments théoriques et enquête auprès d'établissements suisses et québécois

Le présent mémoire traite de l'implication des hôpitaux universitaires en évaluation des technologies de la santé. Le champ d'étude est vaste : - L'évaluation des technologies de la santé est une discipline dont l'étendue fait appel aux sciences exactes (physique, statistiques, ingénierie, méthodologie de la recherche analytique, etc.) ainsi qu'aux sciences sociales (économie, éthique, etc.) - L'hôpital universitaire est une organisation des plus complexes qui soit. Le "produit final" - l'amélioration de la santé du patient - est totalement non standardisé, il n'existe pas de modèle d'hôpital universitaire type et unique (inclusion ou non d'un centre de recherche, d'une faculté de médecine, d'un comité de gestion politique, etc.) et les corps de métiers qui le composent sont des plus variés et représentés en grand nombre Ainsi, l'étendue du champ relève des domaines interdépendants tels que la technologie (elle-même incluse dans le domaine de l'innovation aujourd'hui en développement), le management (ou administration des soins, du système de santé dans lequel s'inscrit l'hôpital universitaire), le financement de l'institution (mais aussi la rémunération des professionnels) et enfin la stratégie de l'hôpital. Le présent travail ne fait qu'effleurer ce large spectre d'investigation. La thématique de l'évaluation des technologies de la santé n'est guère connue en Suisse, ou plutôt elle n'est que peu développée et reconnue comme une science interdisciplinaire destinée à porter un jugement de valeur afin d'aider la prise de décision, sens profond qui la définit dans d'autres pays tel le Canada et plus particulièrement le Québec. Enfin, il convient de souligner que le présent travail n'a pas comme objectif de comparer les systèmes de santé québécois et suisse ou de réaliser toute autre critique de l'un ou de l'autre. Le but du stage ([à l'Université de Montréal], cf. Préambule) était d'observer des structures reconnues au niveau international et nullement de juger de l'ensemble du système de santé. Si l'on peut s'inspirer des réussites ailleurs, il convient de s'en tenir à l'inspiration de celles-ci pour ensuite, éventuellement, les contextualiser dans d'autres lieux. Ainsi, à chaque fois qu'il sera fait mention du Québec par la suite, ce sera dans l'intention de démontrer l'originalité de la démarche et d'élargir le débat dans le contexte qui nous intéresse. [Auteur p. 7]

Mejora del enfoque comercial en la fase de definición de un proyecto informático

Aquest TFC mira d'analitzar els aspectes comercials que intervenen en les fases inicials de l'execució de projectes informàtics, concretament en la fase d'aprovació i, encara més detingudament, en la fase de definició. Aquestes fases són les mes crítiques per a les entitats dedicades a la gestió de projectes, perquè és on es decideix si són viables.