Geographic distribution of phlebotomine sandfly species (Diptera: Psychodidae) in Central-West Brazil

This study updates the geographic distributions of phlebotomine species in Central-West Brazil and analyses the climatic factors associated with their occurrence. The data were obtained from the entomology services of the state departments of health in Central-West Brazil, scientific collections and a literature review of articles from 1962-2014. Ecological niche models were produced for sandfly species with more than 20 occurrences using the Maxent algorithm and eight climate variables. In all, 2,803 phlebotomine records for 127 species were analysed. Nyssomyia whitmani,Evandromyia lenti and Lutzomyia longipalpiswere the species with the greatest number of records and were present in all the biomes in Central-West Brazil. The models, which were produced for 34 species, indicated that the Cerrado areas in the central and western regions of Central-West Brazil were climatically more suitable to sandflies. The variables with the greatest influence on the models were the temperature in the coldest months and the temperature seasonality. The results show that phlebotomine species in Central-West Brazil have different geographical distribution patterns and that climate conditions in essentially the entire region favour the occurrence of at least one Leishmania vector species, highlighting the need to maintain or intensify vector control and surveillance strategies.

Efficacy of prescribed injectable diacetylmorphine in the Andalusian trial: Bayesian analysis of responders and non-responders according to a multi domain outcome index.

BACKGROUND The objective of this research was to evaluate data from a randomized clinical trial that tested injectable diacetylmorphine (DAM) and oral methadone (MMT) for substitution treatment, using a multi-domain dichotomous index, with a Bayesian approach. METHODS Sixty two long-term, socially-excluded heroin injectors, not benefiting from available treatments were randomized to receive either DAM or MMT for 9 months in Granada, Spain. Completers were 44 and data at the end of the study period was obtained for 50. Participants were determined to be responders or non responders using a multi-domain outcome index accounting for their physical and mental health and psychosocial integration, used in a previous trial. Data was analyzed with Bayesian methods, using information from a similar study conducted in The Netherlands to select a priori distributions. On adding the data from the present study to update the a priori information, the distribution of the difference in response rates were obtained and used to build credibility intervals and relevant probability computations. RESULTS In the experimental group (n = 27), the rate of responders to treatment was 70.4% (95% CI 53.287.6), and in the control group (n = 23), it was 34.8% (95% CI 15.354.3). The probability of success in the experimental group using the a posteriori distributions was higher after a proper sensitivity analysis. Almost the whole distribution of the rates difference (the one for diacetylmorphine minus methadone) was located to the right of the zero, indicating the superiority of the experimental treatment. CONCLUSION The present analysis suggests a clinical superiority of injectable diacetylmorphine compared to oral methadone in the treatment of severely affected heroin injectors not benefiting sufficiently from the available treatments. TRIAL REGISTRATION Current Controlled Trials ISRCTN52023186.

Efficacy and safety of acupuncture for the treatment of non-specific acute low back pain: a randomised controlled multicentre trial protocol [ISRCTN65814467]

BACKGROUND Low back pain and its associated incapacitating effects constitute an important healthcare and socioeconomic problem, as well as being one of the main causes of disability among adults of working age. The prevalence of non-specific low back pain is very high among the general population, and 60-70% of adults are believed to have suffered this problem at some time. Nevertheless, few randomised clinical trials have been made of the efficacy and efficiency of acupuncture with respect to acute low back pain. The present study is intended to assess the efficacy of acupuncture for acute low back pain in terms of the improvement reported on the Roland Morris Questionnaire (RMQ) on low back pain incapacity, to estimate the specific and non-specific effects produced by the technique, and to carry out a cost-effectiveness analysis. METHODS/DESIGN Randomised four-branch controlled multicentre prospective study made to compare semi-standardised real acupuncture, sham acupuncture (acupuncture at non-specific points), placebo acupuncture and conventional treatment. The patients are blinded to the real, sham and placebo acupuncture treatments. Patients in the sample present symptoms of non specific acute low back pain, with a case history of 2 weeks or less, and will be selected from working-age patients, whether in paid employment or not, referred by General Practitioners from Primary Healthcare Clinics to the four clinics participating in this study. In order to assess the primary and secondary result measures, the patients will be requested to fill in a questionnaire before the randomisation and again at 3, 12 and 48 weeks after starting the treatment. The primary result measure will be the clinical relevant improvement (CRI) at 3 weeks after randomisation. We define CRI as a reduction of 35% or more in the RMQ results. DISCUSSION This study is intended to obtain further evidence on the effectiveness of acupuncture on acute low back pain and to isolate the specific and non-specific effects of the treatment.

Central corneal thickness, intraocular pressure, and degree of myopia in an adult myopic population aged 20 to 40 years in southeast Spain: determination and relationships.

Objective: To determine the values of, and study the relationships among, central corneal thickness (CCT), intraocular pressure (IOP), and degree of myopia (DM) in an adult myopic population aged 20 to 40 years in Almeria (southeast Spain). To our knowledge this is first study of this kind in this region. Methods: An observational, descriptive, cross-sectional study was done in which a sample of 310 myopic patients (620 eyes) aged 20 to 40 years was selected by gender- and age-stratified sampling, which was proportionally fixed to the size of the population strata for which a 20% prevalence of myopia, 5% epsilon, and a 95% confidence interval were hypothesized. We studied IOP, CCT, and DM and their relationships by calculating the mean, standard deviation, 95% confidence interval for the mean, median, Fisher’s asymmetry coefficient, range (maximum, minimum), and the Brown-Forsythe’s robust test for each variable (IOP, CCT, and DM). Results: In the adult myopic population of Almeria aged 20 to 40 years (mean of 29.8), the mean overall CCT was 550.12 μm. The corneas of men were thicker than those of women (P = 0.014). CCT was stable as no significant differences were seen in the 20- to 40-year-old subjects’ CCT values. The mean overall IOP was 13.60 mmHg. Men had a higher IOP than women (P = 0.002). Subjects over 30 years (13.83) had a higher IOP than those under 30 (13.38) (P = 0.04). The mean overall DM was −4.18 diopters. Men had less myopia than women (P < 0.001). Myopia was stable in the 20- to 40-year-old study population (P = 0.089). A linear relationship was found between CCT and IOP (R2 = 0.152, P ≤ 0.001). CCT influenced the IOP value by 15.2%. However no linear relationship between DM and IOP, or between CCT and DM, was found. Conclusions: CCT was found to be similar to that reported in other studies in different populations. IOP tends to increase after the age of 30 and is not accounted for by alterations in CCT values.

Impaired adipose tissue expandability and lipogenic capacities as ones of the main causes of metabolic disorders.

Obesity is considered a major health problem. However, mechanisms involved and its comorbidities are not elucidated. Recent theories concerning the causes of obesity have focused on a limit to the functional capacity of adipose tissue, comparing it with other vital organs. This assumption has been the central point of interest in our laboratory. We proposed that the failure of adipose tissue is initiated by the difficulty of this tissue to increase its cellularity due to excess in fat contribution, owing to genetic or environmental factors. Nevertheless, why the adipose tissue reduces its capacity to make new adipocytes via mesenchymal cells of the stroma has not yet been elucidated. Thus, we suggest that this tissue ceases fulfilling its main function, the storage of excess fat, thereby affecting some of the key factors involved in lipogenesis, some of which are reviewed in this paper (PPARγ, ROR1, FASN, SCD1, Rab18, BrCa1, ZAG, and FABP4). On the other hand, mechanisms involved in adipose tissue expandability are also impaired, predominating hypertrophy via an increase in apoptosis and a decrease in adipogenesis and angiogenesis. However, adipose tissue failure is only part of this great orchestra, only a chapter of this nightmare.

Professional Nursing Duties in the Central Services: Hospital Pharmacy Nurses.

Introduction.The new demands of a fast changing world necessitate expanding the traditional concepts of nursing, extending the classical aspects to cover new areas. Purpose. Based on their professional duties, the nursing team in the pharmacy of a second level hospital aimed to establish a theoretical and situational framework for nurses working in the central services. Material and Methods. Application of the nursing process to nursing work in an area with no direct contact with patients. Results and Discussion. The application of the NANDA diagnoses to professional practice enabled the establishment of a nursing diagnosis with the implementation of measures designed to overcome a stressful situation with a risk of becoming unmotivated. Main Conclusion. The capacity to adapt the nursing profession to undertake new roles in the field of healthcare and the power of nursing own methodological resources permit the indirect care of “faceless” patients to be complemented with the inclusion of nurses from other services as clients, forming the focus of care, who can thus be helped with their daily care work.

Fatores de risco nas alianças em projetos de TI: estudo de casos no Banco Central do Brasil

Em resposta às crescentes mudanças e pressões da concorrência, número cada vez maior de empresas tem estabelecido alianças como forma de complementar seus recursos e assegurar suas vantagens competitivas. Embora essas alianças sejam uma boa opção estratégica para as empresas, existem evidências de grande taxa de fracasso. Muitos estudos têm analisado os fatores de sucesso das parcerias, mas poucos têm dado ênfase às dificuldades e à prevenção de riscos. O objetivo neste artigo consiste em apresentar os resultados de uma pesquisa em que se buscou identificar os fatores de risco que dificultam as alianças no caso de projetos de Tecnologia da Informação (TI). Trata-se de uma pesquisa exploratória, focada em cinco projetos estratégicos de TI do Banco Central do Brasil, desenvolvidos em parceria com outras instituições públicas e privadas, a maioria delas nacionais e uma estrangeira. Apesar de os projetos terem tido sucesso, foi possível identificar como principais fatores de risco: falta de planejamento da aliança, falta de negociação entre parceiros, falta de comprometimento dos parceiros e falta de apoio institucional. A pesquisa trouxe lições relevantes para o gerenciamento de projetos que podem beneficiar outras alianças em projetos de TI.

Efecte de la recurrència dels incendis sobre la vegetació i el sòl a les zones de matollar del Macizo Central Ourensano

El matollar sec europeu format per Erica australis, Erica arborea, Pterosparum tridentatum, Halimium lasianthum i Calluna vulgaris com a espècies predominants és cremat en les serralades del Massís Central de forma repetida durant el pas dels anys. Això ha sigut, tradicionalment, a causa de la necessitat de mantenir-lo transitable per al bestiar, encara que altres circumstàncies s’han afegit actualment a aquesta necessitat, que incrementen el risc d’incendi d’aquesta comunitat, disparant-se el número d’incendis en els últims 30 anys. Sabent això, vam decidir realitzar un estudi a les zones de matollar que trobem al Massís Central situat a la zona del Concello de Villariño de Conso, a Ourense, per conèixer com es comporten les espècies característiques d’aquest tipus d’ecosistema després dels incendis, mitjançant la realització de mostrejos i perfils del sòl. D’aquesta manera hem volgut veure com es desenvolupen les espècies vegetals de matollar al llarg del temps, després de ser cremats. Gràcies a l’estudi hem pogut veure com el matollar observat te unes característiques que li permet sobreviure als incendis i tindre una capacitat de regeneració elevada després de patir aquesta pertorbació. Això es degut a la capacitat per rebrotar d’aquestes espècies arbustives i a la seva competitivitat. També hem vist com a necessari, donar un valor econòmic a la bona conservació de l’hàbitat, per tal de que la població local abandoni pràctiques de gestió forestal nocives, com el foc.

Efecte de la recurrència dels incendis sobre la vegetació i el sòl a les zons de bosc del Macizo Central Ourensano

En els últims 30 anys, el número d’incendis patits a Galicia han augmentat de manera important. En el Massís Central Ourensano l’home ha utilitzat el foc com a eina de gestió forestal per tal de permetre pasturar al bestiar i per tal de recuperar terres per a pastos i culius. Aquesta pràctica ha generat grans extensions de matollar sec europeu on hi hauria d’haver formacions boscoses. Partim de la necessitat de recuperar zones de bosc i ecosistema original i per això mesurem el comportament de les diferents espècies que trobem al matollar y al bosc en aquestes altituds davant la pertorbació que suposen els incendis recurrents. Per realitzar això s’ha mostrejat la vegetació de zones cremades en moments diferents o repetides vegades, mesurant superfície i alçades així com nombre d’individus de cada espècie. També s’han analitzat perfils del sòl per tal de conèixer amb més detall les característiques de cada zona. S’ha observat mitjançant el mostreig com per a la recuperació del matollar el factor determinant és el temps, encara que no trobem un sòl de bona qualitat i profund, en una mitjana de 8 anys trobem un matollar ben desenvolupat amb una bona diversitat d’espècies i grau de cobertura. En canvi, per tal d’arribar a un estat de la successió vegetal on trobem un bosc és necessari que existeixin comunitats arbòries a prop per tal de que arribin individus al matollar desenvolupat. Cal aleshores treballar en l’educació de la població i en la cerca d’alternatives a la gestió forestal vigent, donant èmfasi en la valoració econòmica dels ecosistemes en bon estat i facilitant que aquest bon estat proporcioni beneficis a la població local. Per això cal generar una infraestructura per atraure un turisme rural respectuós amb el medi al mateix temps que es duen altres iniciatives com la implantació de centrals de biomassa als pobles que puguin proporcionar calefacció o aigua calenta. Generant llocs de feina i estalvis a la població d’una zona on l’economia encara es basa potencialment en la ramaderia. Al mateix temps l’esforç monetari dedicat a les plantacions ha de dedicar-se a generar espais al territori amb espècies autòctones com el roure en aquells matollars que presentin condicions adients per a recuperar el bosc.

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The pharmacokinetic profile of imatinib has been assessed in healthy subjects and in population studies among thousands of patients with CML or GIST. Imatinib is rapidly and extensively absorbed from the GI tract, reaching a peak plasma concentration (Cmax) within 1-4 h following administration. Imatinib bioavailability is high (98%) and independent of food intake. Imatinib undergoes rapid and extensive distribution into tissues, with minimal penetration into the central nervous system. In the circulation, it is approximately 95% bound to plasma proteins, principally α1-acid glycoprotein (AGP) and albumin. Imatinib undergoes metabolism in the liver via the cytochrome P450 enzyme system (CYP), with CYP3A4 being the main isoenzyme involved. The N-desmethyl metabolite CGP74588 is the major circulating active metabolite. The typical elimination half-life for imatinib is approximately 14-22 h. Imatinib is characterized by large inter-individual pharmacokinetic variability, which reflects in a wide spread of concentrations observed under standard dosage. Besides adherence, several factors have been shown to influence this variability, especially demographic characteristics (sex, age, body weight and disease diagnosis), blood count characteristics, enzyme activity (mainly CYP3A4), drug interactions, activity of efflux transporters and plasma levels of AGP. Additionally, recent retrospective studies have shown that drug exposure, reflected in either the area under the concentration-time curve (AUC) or more conveniently the trough level (Cmin), correlates with treatment outcomes. Increased toxicity has been associated with high plasma levels, and impaired clinical efficacy with low plasma levels. While no upper concentration limit has been formally established, a lower limit for imatinib Cmin of about 1000 ng/mL has been proposed repeatedly for improving outcomes in CML and GIST patients. Imatinib is licensed for use in chronic phase CML and GIST at a fixed dose of 400 mg once daily (600 mg in some other indications) despite substantial pharmacokinetic variability caused by both genetic and acquired factors. The dose can be modified on an individual basis in cases of insufficient response or substantial toxic effects. Imatinib would, however, meet traditional criteria for a therapeutic drug monitoring (TDM) program: long-term therapy, measurability, high inter-individual but restricted intra-individual variability, limited pharmacokinetic predictability, effect of drug interactions, consistent association between concentration and response, suggested therapeutic threshold, reversibility of effect and absence of early markers of efficacy and toxic effects. Large-scale, evidence-based assessments of drug concentration monitoring are therefore still warranted for the personalization of imatinib treatment.

Aspectos ergonômicos na transferência de pacientes: um estudo realizado com trabalhadores de uma central de transportes de um hospital universitário

Com o objetivo de avaliar aspectos ergonômicos na transferência de pacientes com a utilização de maca e cadeira de rodas, observou-se 249 transferências realizadas por trabalhadores da Seção de Escolta de um Hospital Universitário. Os resultados sugerem que a existência dessa equipe é uma iniciativa que deve ser estimulada mas que esses trabalhadores precisam de treinamento específico sobre movimentação e transporte de pacientes e de terem à disposição materiais auxiliares e equipamentos mecânicos.