Diagnóstico del desarrollo de la terapia manual en Colombia

Este trabajo nace de la inquietud de las autoras durante su proceso de formación académica en Terapia Manual por conocer el estado de ésta a nivel profesional, laboral, académico, personal y de agremiación a lo largo de estos seis años de aplicación en Colombia. Para ello, se recopiló la base de datos de los egresados de la Escuela Colombiana de Rehabilitación y de la Universidad del Rosario donde se obtuvieron 12 y 46 registros respectivamente., los cuales fueron contactados por medio de correo electrónico, telefónicamente (llamada local, nacional y celular), correo certificado y personalmente. Se les aplicó un formulario de recolección de información donde plasmaron sus experiencias profesionales y personales relacionadas con la especialidad.

Numerus Clausus en el mercado profesional de médicos especialistas

el objetivo principal de este texto es proponer un modelo teórico sencillo derivado de la teoría de la organización industrial y de la teoría de competencia, para explicar cómo el número de cupos para la formación de especialistas en las universidades o en los hospitales universitarios es determinado por los mismos médicos especialistas, con el fin de mantener altos sus niveles de ingresos y de beneficios. Este objetivo se pretende modelar para una especialidad específica, a partir de un modelo de competencia monopolística, en donde se analiza las decisiones de los médicos especialistas y hospitales universitarios en la determinación de los cupos de residencias en el corto plazo. Este esquema de “autorregulación” se confronta con los resultados obtenidos por un esquema de “regulación” centralizada por un planificador gubernamental, el cual establece cupos de formación mucho más flexibles, dando paso a un mayor bienestar social.

Evidence-based polytherapies and long-term mortality after acute myocardial infarction in very old subjects compared with elderly and adults: a nested case-control study

Background: Clinical trials have demonstrated that selected secondary prevention medications for patients after acute myocardial infarction (AMI) reduce mortality. Yet, these medications are generally underprescribed in daily practice, and older people are often absent from drug trials. Objectives: To examine the relationship between adherence to evidence-based (EB) drugs and post-AMI mortality, focusing on the effects of single therapy and polytherapy in very old patients (≥80 years) compared with elderly and adults (<80 years). Methods: Patients hospitalised for AMI between 01/01/2008 and 30/06/2011 and resident in the Local Health Authority of Bologna were followed up until 31/12/2011. Medication adherence was calculated as the proportion of days covered for filled prescriptions of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), β-blockers, antiplatelet drugs, and statins. We adopted a risk set sampling method, and the adjusted relationship between medication adherence (PDC≥75%) and mortality was investigated using conditional multiple logistic regression. Results: The study population comprised 4861 patients. During a median follow-up of 2.8 years, 1116 deaths (23.0%) were observed. Adherence to the 4 EB drugs was 7.1%, while nonadherence to any of the drugs was 19.7%. For both patients aged ≥80 years and those aged <80 years, rate ratios of death linearly decreased as the number of EB drugs taken increased. There was a significant inverse relationship between adherence to each of 4 medications and mortality, although its magnitude was higher for ACEIs/ARBs (adj. rate ratio=0.60, 95%CI=0.52–0.69) and statins (0.60, 0.50–0.72), and lower for β-blockers (0.75, 0.61–0.92) and antiplatelet drugs (0.73, 0.63–0.84). Conclusions: The beneficial effect of EB polytherapy on long-term mortality following AMI is evident also in nontrial older populations. Given that adherence to combination therapies is largely suboptimal, the implementation of strategies and initiatives to increase the use of post-AMI secondary preventive medications in old patients is crucial.

What happens to the bone flap? Long-term outcome after reimplantation of cryoconserved bone flaps in a consecutive series of 92 patients.

BACKGROUND Reimplantation of cryoconserved autologous bone flaps is a standard procedure after decompressive craniotomies. Aseptic necrosis and resorption are the most frequent complications of this procedure. At present there is no consensus regarding the definition of the relevant extent and indication for surgical revision. The objective of this retrospective analysis was to identify the incidence of bone flap resorption and the optimal duration of follow-up. METHODS Between February 2009 and March 2012, 100 cryoconserved autologous bone flaps were reimplanted at the Department of Neurosurgery, Inselspital Bern. Three patients were not available for follow-up, and five patients died before follow-up. All patients underwent follow-up at 6 weeks and a second follow-up more than 12 months postoperatively. A clinical and CT-based score was developed for judgment of relevance and decision making for surgical revision. RESULTS Mean follow-up period was 21.6 months postoperatively (range: 12 to 47 months); 48.9 % (45/92) of patients showed no signs of bone flap resorption, 20.7 % (19/92) showed minor resorption with no need for surgical revision, and 30.4 % (28/92) showed major resorption (in 4 % of these the bone flap was unstable or collapsed). CONCLUSIONS Aseptic necrosis and resorption of reimplanted autologous bone flaps occurred more frequently in our series of patients than in most reports in the literature. Most cases were identified between 6 and 12 months postoperatively. Clinical observation or CT scans of patients with autologous bone flaps are recommended for at least 12 months. Patient-specific implants may be preferable to autologous bone flaps.

Microstructural characterization of rapidly solidified and heat-treated Ti(92)B(8) eutectic alloy

In this work, Ti(92)B(8) alloy was processed via rapid solidification (splat-cooling) and then heat-treated at 700 degrees C and 1000 degrees C. A careful microstructural characterization indicated that, after rapid solidification, a very fine two-phase microstructure was produced with no significant saturation of B in alpha/beta Ti. There was no indication of amorphous formation in the rapidly solidified splats. Both alpha Ti and TiB were observed in the microstructures of the splats after heat-treatment at 700 degrees C and 1000 degrees C, confirming the stability of the alpha Ti+TiB two-phase region in this temperature range. (C) 2008 Elsevier Inc. All rights reserved.

Investigation of electrical conductivity as a function of dopant-ion radius in the systems Zr0.75Ce0.08M0.17O1.92 (M=Nd, Sm, Gd, Dy, Ho, Y, Er, Yb, Sc)

Electrical conductivity versus dopant ionic radius studies in zirconia- and ceria-based, solid oxide fuel cell (SOFC) electrolyte systems have shown that oxygen-ion conductivity is highest when the host and dopant ions are similar in size [J. Am. Ceram. Soc. 48 (1965) 286; Solid State Ionics 37 (1989) 67; Solid State Ionics 5 (1981) 547]. Under these conditions, it is thought that the conduction paths within the crystal lattice become less distorted [Solid State Ionics 8 (1983) 201]. In this study, binary ZrO2-M2O3 unit cells were expanded, via the partial substitution of Ce+4 for Zr+4 into the lattice, in an attempt to identify new, ternary, zirconia/ceria-based electrolyte systems with enhanced electrical conductivity. The compositions Zr0.75Ce0.08M0.17O1.92 (M = Nd, Sm, Gd, Dy, Ho, Y, Yb, Sc) were prepared using traditional solid state techniques. Bulk phase characterisation and precise lattice parameter measurements were performed with X-ray diffraction techniques. Four-probe DC conductivity measurements between 400 and 900 degreesC showed that the dopant-ion radius influenced electrical conductivity. The conductivity versus dopant-ion radius trends previously observed in zirconia-based, binary systems are clearly apparent in the ternary systems investigated in this study. The addition of ceria was found to have a negative influence on the electrical conductivity over the temperature range 400-900 degreesC. It is suggested that distortion of the oxygen-ion conduction path by the presence of the larger M+3 and Ce+4 species (relative to Zr+4) is the reason for the decreasing electrical conductivity as a function of increasing dopant size and ceria addition, respectively. (C) 2002 Elsevier Science B.V. All rights reserved.

Conductivity/microstructure study of a pyrochlore-type ordered phase in the compound Zr0.75Ce0.08Nd0.17O1.92

The compound Zr0.75Ce0.08Nd0.17O1.92 was investigated as part of a much larger electrical conductivity/microstructure study of the systems ZrO2-CeO2-M2O3 (where M=Nd, Sm, ..., Yb) [Solid State Ionics (2002)]. Electrical conductivity measurements performed in air at 800 degreesC showed significant conductivity degradation over a period of 200 h. Investigation of the annealed and as-fired specimens by ATEM revealed the presence of an emerging, ordered pyrochlore-type phase within the Zr0.75Ce0.08Nd0.17O1.92 defect-fluorite solid solution at much lower dopant levels than observed previously for zirconia binary systems. (C) 2002 Elsevier Science B.V. All rights reserved.

Avaliação da proteção conferida pela vacina antimeningocócica BC no Estado de Santa Catarina, Brazil, 1990/92

São apresentados os resultados da avaliação da vacina antimeningocócica BC de procedência cubana realizada com dados da vigilância epidemiológica de meningites do Estado de Santa Catarina, Brasil, dos anos de 1990-92. A eficácia para os casos confirmados por exames bacteriológicos foi de 59% (IC de 95%: 23 a 78%) para os menores de 4 anos e de 78% (IC de 95%: 54 a 90%) para as crianças de 4 a 7 anos. Com os casos confirmados como causados por sorogrupo B, as eficácias estimadas foram maiores, mas se ampliaram os intervalos de confiança. O efeito protetor da vacina em relação à mortalidade em crianças menores de 4 anos foi estimado em 76% (IC 95%: 41 a 91%). Outros dados apresentados sugerem que as mais baixas eficácias encontradas, quando se analisam os menores de 4 anos, decorrem da seletividade da confirmação diagnóstica que exclui os casos mais graves que morrem a poucas horas do início dos sintomas, associada à modificação do curso da doença (atenuação) em vacinados. Por isso, indica-se a vacinação, inclusive em menores de 4 anos, nas situações epidêmicas.

Ostracoda, bearbeitet von G. W. Müller ... Mit 92 abbildungen.

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