Calidad de vida en personas con hemofilia: una revisión de la literatura

Introducción: La hemofilia es una enfermedad poco frecuente; no obstante, los avances en los tratamientos de pacientes hemofílicos en las últimas décadas han generado cambios en su calidad de vida. Esto ha motivado el desarrollo de múltiples investigaciones al respecto. Objetivo: Revisar la literatura sobre la calidad de vida en el paciente hemofílico, producida en el periodo 2008-2012. Método: Se consultaron algunas bases de datos científicas utilizando como palabras clave “hemofilia” y “calidad de vida”. Se recopiló la información encontrada y se organizó según los objetivos propuestos en “factores negativos” y “factores protectores” de la calidad de vida a nivel fisiológico, psicosocial y cultural; “instrumentos para la evaluación de la calidad de vida” a nivel específico y general; y antecedentes empíricos de los últimos cinco años en los que se evaluara la calidad de vida o se realizara alguna intervención en la misma. Resultados: En general la información disponible sobre el comportamiento epidemiológico de la hemofilia es limitada. El interés por factores protectores y negativos es principalmente de tipo fisiológico, aunque se encontraron factores de tipo psicosocial y cultural, lo que indica la importancia de profundizar en esta temática. Existen pocos instrumentos especializados para la evaluación de la calidad de vida en hemofílicos. La evidencia empírica se centra en la evaluación. Conclusión: El estudio de la calidad de vida en pacientes hemofílicos amerita ser abordado de manera interdisciplinaria.

La Estrategia Nacional de Defensa de Brasil como respuesta al dilema de seguridad regional con Chile, Venezuela y Colombia (1998-2008)

El interés de esta monografía es analizar la influencia que la configuración de un dilema de seguridad en Suramérica entre Chile, Venezuela y Colombia durante el periodo 1998-2008, tuvo en la formulación de la Estrategia Nacional de Defensa de Brasil de 2008. Se analiza cómo el cambio en la estructura de poder regional y en la distribución relativa de capacidades producto de las acciones de estos actores, afectó la definición de los lineamientos y acciones estratégicas de la Estrategia Nacional de Defensa, en tanto Brasil buscaba consolidar su papel como potencia en Suramérica. Teniendo en cuenta el realismo defensivo como marco explicativo y su enfoque en temas asociados a la seguridad, se realiza un análisis que permita comprender la situación suramericana descrita y el alcance de la teoría como herramienta analítica.

Créditos e insolvencia

Esta obra se encuentra estructurada en dos grandes partes. En la primera parte, el lector encontrará generalidades sobre los créditos y las maneras en que los mismos pueden hacerse valer al interior de un proceso concursal. Aspectos como la insinuación del crédito, su reconocimiento al interior de estos procesos y la impugnación, son trabajados de manera extensa, indicando en cada caso, de manera precisa, la regulación a aplicar para cada uno de estos momentos procesales al interior del concurso de acreedores. En la segunda parte, encontrarán un estudio detallado de los créditos privilegiados al interior del proceso concursal. Como podrá apreciarse, se trata de una obra comprensiva de todos los aspectos que una persona interesada en un proceso concursal, cualquiera sea su posición al interior del mismo (deudor, acreedor, etc.), debe tener en cuenta para resolver todas las dudas que le surjan, aspectos todos abordados con la mayor rigurosidad y profundidad. Como podrá apreciarse, se trata de una obra comprensiva de todos los aspectos que una persona interesada en un proceso concursal, cualquiera sea su posición al interior del mismo (deudor, acreedor, etc.), debe tener en cuenta para resolver todas las dudas que le surjan, aspectos todos abordados con la mayor rigurosidad y profundidad.

Apoyo social e ideación suicida en pacientes con cáncer

El diagnóstico de cáncer ha sido asociado con un alto riesgo de presentar ideación suicida en comparación con la población no oncológica, sin embargo se ha considerado al apoyo social como un factor protector para la ocurrencia de esta conducta. La presente investigación tuvo como objetivo identificar la relación entre el apoyo social percibido y la ideación suicida en 90 pacientes oncológicos adultos en Bogotá, bajo la hipótesis de que a mayor apoyo social percibido, menor presencia de ideación suicida. Se midió la variable de apoyo social a través del cuestionario Duke UNC y la ideación suicida a través de cuatro instrumentos: Escala de Ideación Suicida (SSI), Escala de Desesperanza de Beck (BHS), el ítem 9 del Inventario de Depresión de Beck (BDI-IA) y una entrevista semiestructurada. Los resultados mostraron que no existe relación entre el apoyo social percibido y la ideación suicida. Por otro lado se identificó una prevalencia de suicidio entre 5,6% y 22,77%, confirmando que el paciente con cáncer considera el suicidio y es fundamental evaluar esta variable en esta población. Se considera importante continuar con la realización de investigaciones que permitan generalizar los resultados a la población oncológica colombiana.

Representaciones sociales de la medicina complementaria y alternativa (MCA) para el cáncer en estudiantes universitarios de carreras de ciencias de la salud

Se realizó un estudio cualitativo exploratorio con estudiantes de carreras de Ciencias de la Salud con el objetivo de comprender las representaciones sociales que tienen acerca de la Medicina Complementaria y Alternativa (MCA) para el cáncer. Se desarrollaron grupos focales y la información obtenida fue analizada a través del Análisis Temático e interpretada con base en la Teoría de las Representaciones Sociales. Se encontraron diversas representaciones sociales asociadas con la definición, los objetivos, los tratamientos, la eficacia, las fuentes de información y el origen de la MCA. En conclusión se evidenció una alta tendencia a la aceptación y a la manifestación de una actitud positiva, aunque ambivalente frente a la MCA, además de un desconocimiento por la diferenciación conceptual entre este tipo de Medicina y la Medicina Popular. La cultura y las creencias sociales predominan en las representaciones sociales que tienen los estudiantes de la MCA para el cáncer, pese a su formación académica.

Patrones en aprendizaje : concepto, aplicación y diseño de un patrón.

Resumen basado en el de la publicación

??Tienen las futuras maestras y maestros de educaci??n primaria la formaci??n necesaria para iniciar las maniobras de reanimaci??n cardiopulmonar en caso de emergencia escolar? : un estudio descriptivo

Resumen basado en el de la publicaci??n

Reanimació cardiopulmonar sense ventilació

Aquest estudi emmarcat dins un treball de final del Màster en Promoció de la Salut m’ha servit per veure que encara hi ha un llarg recorregut a investigar en el camp de la reanimació cardiopulmonar. Les 3 línees sorgides son: com millorar la qualitat en RCP, buscar estratègies per augmentar les freqüències mitges de compressió toràcica externa i com ensenyar a retenir les tècniques de RCP Penso que totes elles s’aniran desenvolupant en els propers anys i que aquelles accions que vagin encaminades a millorar la supervivència de la principal causa de mort dels europeus en edat compreses entre els 35 i 36 anys hauria de ser una tasca prioritària en investigació

The upper end of climate model temperature projections is inconsistent with past warming

Climate models predict a large range of possible future temperatures for a particular scenario of future emissions of greenhouse gases and other anthropogenic forcings of climate. Given that further warming in coming decades could threaten increasing risks of climatic disruption, it is important to determine whether model projections are consistent with temperature changes already observed. This can be achieved by quantifying the extent to which increases in well mixed greenhouse gases and changes in other anthropogenic and natural forcings have already altered temperature patterns around the globe. Here, for the first time, we combine multiple climate models into a single synthesized estimate of future warming rates consistent with past temperature changes. We show that the observed evolution of near-surface temperatures appears to indicate lower ranges (5–95%) for warming (0.35–0.82 K and 0.45–0.93 K by the 2020s (2020–9) relative to 1986–2005 under the RCP4.5 and 8.5 scenarios respectively) than the equivalent ranges projected by the CMIP5 climate models (0.48–1.00 K and 0.51–1.16 K respectively). Our results indicate that for each RCP the upper end of the range of CMIP5 climate model projections is inconsistent with past warming.

Winter and Summer Northern Hemisphere blocking in CMIP5 models

The frequencies of atmospheric blocking in both winter and summer and the changes in them from the 20th to the 21st centuries as simulated in twelve CMIP5 models is analysed. The RCP 8.5 high emission scenario runs are used to represent the 21st century. The analysis is based on the wave-breaking methodology of Pelly and Hoskins (2003a). It differs from the Tibaldi and Molteni (1990) index in viewing equatorward cut-off lows and poleward blocking highs in equal manner as indicating a disruption to the westerlies. 1-dimensional and 2-dimensional diagnostics are applied to identify blocking of the mid-latitude storm-track and also at higher latitudes. Winter blocking frequency is found to be generally underestimated. The models give a decrease in the European blocking maximum in the 21st century, consistent with the results in other studies. There is a mean 21st century winter poleward shift of high- latitude blocking, but little agreement between the models on the details. In summer, Eurasian blocking is also underestimated in the models, whereas it is now too large over the high-latitude ocean basins. A decrease in European blocking frequency in the 21st century model runs is again found. However in summer there is a clear eastward shift of blocking over Eastern Europe and Western Russia, in a region close to the blocking that dominated the Russian summer of 2010. While summer blocking decreases in general, the poleward shift of the storm track into the region of frequent high latitude blocking may mean that the incidence of storms being obstructed by blocks may actually increase.

The global-scale impacts of climate change on water resources and flooding under new climate and socio-economic scenarios

This paper presents a preliminary assessment of the relative effects of rate of climate change (four Representative Concentration Pathways - RCPs), assumed future population (five Shared Socio-economic Pathways - SSPs), and pattern of climate change (19 CMIP5 climate models) on regional and global exposure to water resources stress and river flooding. Uncertainty in projected future impacts of climate change on exposure to water stress and river flooding is dominated by uncertainty in the projected spatial and seasonal pattern of change in climate. There is little clear difference in impact between RCP2.6, RCP4.5 and RCP6.0 in 2050, and between RCP4.5 and RCP6.0 in 2080. Impacts under RCP8.5 are greater than under the other RCPs in 2050 and 2080. For a given RCP, there is a difference in the absolute numbers of people exposed to increased water resources stress or increased river flood frequency between the five SSPs. With the ‘middle-of-the-road’ SSP2, climate change by 2050 would increase exposure to water resources stress for between approximately 920 and 3400 million people under the highest RCP, and increase exposure to river flood risk for between 100 and 580 million people. Under RCP2.6, exposure to increased water scarcity would be reduced in 2050 by 22-24%, compared to impacts under the RCP8.5, and exposure to increased flood frequency would be reduced by around 16%. The implications of climate change for actual future losses and adaptation depend not only on the numbers of people exposed to changes in risk, but also on the qualitative characteristics of future worlds as described in the different SSPs. The difference in ‘actual’ impact between SSPs will therefore be greater than the differences in numbers of people exposed to impact.

The HadGEM2-ES implementation of CMIP5 centennial simulations

The scientific understanding of the Earth’s climate system, including the central question of how the climate system is likely to respond to human-induced perturbations, is comprehensively captured in GCMs and Earth System Models (ESM). Diagnosing the simulated climate response, and comparing responses across different models, is crucially dependent on transparent assumptions of how the GCM/ESM has been driven – especially because the implementation can involve subjective decisions and may differ between modelling groups performing the same experiment. This paper outlines the climate forcings and setup of the Met Office Hadley Centre ESM, HadGEM2-ES for the CMIP5 set of centennial experiments. We document the prescribed greenhouse gas concentrations, aerosol precursors, stratospheric and tropospheric ozone assumptions, as well as implementation of land-use change and natural forcings for the HadGEM2-ES historical and future experiments following the Representative Concentration Pathways. In addition, we provide details of how HadGEM2-ES ensemble members were initialised from the control run and how the palaeoclimate and AMIP experiments, as well as the “emission driven” RCP experiments were performed.

Abrupt CO2 experiments as tools for predicting and understanding CMIP5 representative concentration pathway projections

A fast simple climate modelling approach is developed for predicting and helping to understand general circulation model (GCM) simulations. We show that the simple model reproduces the GCM results accurately, for global mean surface air temperature change and global-mean heat uptake projections from 9 GCMs in the fifth coupled model inter-comparison project (CMIP5). This implies that understanding gained from idealised CO2 step experiments is applicable to policy-relevant scenario projections. Our approach is conceptually simple. It works by using the climate response to a CO2 step change taken directly from a GCM experiment. With radiative forcing from non-CO2 constituents obtained by adapting the Forster and Taylor method, we use our method to estimate results for CMIP5 representative concentration pathway (RCP) experiments for cases not run by the GCMs. We estimate differences between pairs of RCPs rather than RCP anomalies relative to the pre-industrial state. This gives better results because it makes greater use of available GCM projections. The GCMs exhibit differences in radiative forcing, which we incorporate in the simple model. We analyse the thus-completed ensemble of RCP projections. The ensemble mean changes between 1986–2005 and 2080–2099 for global temperature (heat uptake) are, for RCP8.5: 3.8 K (2.3 × 1024 J); for RCP6.0: 2.3 K (1.6 × 1024 J); for RCP4.5: 2.0 K (1.6 × 1024 J); for RCP2.6: 1.1 K (1.3 × 1024 J). The relative spread (standard deviation/ensemble mean) for these scenarios is around 0.2 and 0.15 for temperature and heat uptake respectively. We quantify the relative effect of mitigation action, through reduced emissions, via the time-dependent ratios (change in RCPx)/(change in RCP8.5), using changes with respect to pre-industrial conditions. We find that the effects of mitigation on global-mean temperature change and heat uptake are very similar across these different GCMs.

Analysis of the regional pattern of sea level change due to ocean dynamics and density changes for 1993-2099 in observations and CMIP5 AOGCMs

Predictions of twenty-first century sea level change show strong regional variation. Regional sea level change observed by satellite altimetry since 1993 is also not spatially homogenous. By comparison with historical and pre-industrial control simulations using the atmosphere–ocean general circulation models (AOGCMs) of the CMIP5 project, we conclude that the observed pattern is generally dominated by unforced (internal generated) variability, although some regions, especially in the Southern Ocean, may already show an externally forced response. Simulated unforced variability cannot explain the observed trends in the tropical Pacific, but we suggest that this is due to inadequate simulation of variability by CMIP5 AOGCMs, rather than evidence of anthropogenic change. We apply the method of pattern scaling to projections of sea level change and show that it gives accurate estimates of future local sea level change in response to anthropogenic forcing as simulated by the AOGCMs under RCP scenarios, implying that the pattern will remain stable in future decades. We note, however, that use of a single integration to evaluate the performance of the pattern-scaling method tends to exaggerate its accuracy. We find that ocean volume mean temperature is generally a better predictor than global mean surface temperature of the magnitude of sea level change, and that the pattern is very similar under the different RCPs for a given model. We determine that the forced signal will be detectable above the noise of unforced internal variability within the next decade globally and may already be detectable in the tropical Atlantic.

Climate change projections and selected impacts for Vietnam

In September 2013, the 5th Assessment Report (5AR) of the International Panel on Climate Change (IPCC) has been released. Taking the 5AR cli-mate change scenarios into account, the World Bank published an earli-er report on climate change and its impacts on selected hot spot re-gions, including Southeast Asia. Currently, dynamical and statistical-dynamical downscaling efforts are underway to obtain higher resolution and more robust regional climate change projections for tropical South-east Asia, including Vietnam. Such initiatives are formalized under the World Meteorological Organization (WMO) Coordinated Regional Dynamic Downscaling Experiment (CORDEX) East Asia and Southeast Asia and also take place in climate change impact projects such as the joint Vietnam-ese-German project “Environmental and Water Protection Technologies of Coastal Zones in Vietnam (EWATEC-COAST)”. In this contribution, the lat-est assessments for changes in temperature, precipitation, sea level, and tropical cyclones (TCs) under the 5AR Representative Concentration Pathway (RCP) scenarios 4.5 and 8.5 are reviewed. Special emphasis is put on changes in extreme events like heat waves and/or heavy precipita-tion. A regional focus is Vietnam south of 16°N. A continued increase in mean near surface temperature is projected, reaching up to 5°C at the end of this century in northern Vietnam un-der the high greenhouse-gas forcing scenario RCP8.5. Overall, project-ed changes in annual precipitation are small, but there is a tendency of more rainfall in the boreal winter dry season. Unprecedented heat waves and an increase in extreme precipitation events are projected by both global and regional climate models. Globally, TCs are projected to decrease in number, but an increase in intensity of peak winds and rain-fall in the inner core region is estimated. Though an assessment of changes in land-falling frequency in Vietnam is uncertain due to difficul-ties in assessing changes in TC tracks, some work indicates a reduction in the number of land-falling TCs in Vietnam. Sea level may rise by 75-100 cm until the end of the century with the Vietnamese coastline experienc-ing 10-15% higher rise than on global average. Given the large rice and aquaculture production in the Mekong and Red River Deltas, that are both prone to TC-related storm surges and flooding, this poses a challenge to foodsecurity and protection of coastal population and assets.