The impact of primary health care reform on hospital emergency department overcrowding: Evidence from the Portuguese reform.

CONTEXT: The reduction in inappropriate utilization of hospitals' emergency departments (EDs) is usually an important objective of primary health care (PHC) reforms. Existing literature provides mixed evidence on the effectiveness of PHC reforms in reducing inappropriate utilization of ED. We assess whether the specific PHC reforms ongoing in Portugal since 2005, and in particular the creation of family health units (FHUs), were successful in reducing inappropriate utilization of EDs and provide a contribution to the debate of which PHC models contribute to reduce overuse of EDs. METHODS: We use patient-level data of 117 391 ED visits from two nonurban hospitals in Portugal to estimate a multivariate logistic regression that assesses the impact of different PHC models on inappropriate ED visits. Patients in our sample had four different models of PHC provision: the new FHU type A or type B and the old personalized health care units (PHUs), with or without a specific family physician assigned. RESULTS: The percentage of episodes that correspond to appropriate visits to the ED is 2% higher for patients enrolled in an FHU type B and 0.8% higher for users of FHU type A, when compared with users enrolled in PHU. Having an assigned family physician increases appropriate use of the ED by 1%. CONCLUSION: Portugal's PHC reform was successful in reducing inappropriate utilization of EDs.

Forecasting the medical workforce: a stochastic agent-based simulation approach.

Starting in the 50s, healthcare workforce planning became a major concern for researchers and policy makers, since an imbalance of health professionals may create a serious insufficiency in the health system, and eventually lead to avoidable patient deaths. As such, methodologies and techniques have evolved significantly throughout the years, and simulation, in particular system dynamics, has been used broadly. However, tools such as stochastic agent-based simulation offer additional advantages for conducting forecasts, making it straightforward to incorporate microeconomic foundations and behavior rules into the agents. Surprisingly, we found no application of agent-based simulation to healthcare workforce planning above the hospital level. In this paper we develop a stochastic agent-based simulation model to forecast the supply of physicians and apply it to the Portuguese physician workforce. Moreover, we study the effect of variability in key input parameters using Monte Carlo simulation, concluding that small deviations in emigration or dropout rates may originate disparate forecasts. We also present different scenarios reflecting opposing policy directions and quantify their effect using the model. Finally, we perform an analysis of the impact of existing demographic projections on the demand for healthcare services. Results suggest that despite a declining population there may not be enough physicians to deliver all the care an ageing population may require. Such conclusion challenges anecdotal evidence of a surplus of physicians, supported mainly by the observation that Portugal has more physicians than the EU average.

The Impact of an Increase in User Costs on the Demand for Emergency Services: The Case of Portuguese Hospitals.

Evidence on the impact of user costs on healthcare demand in 'universal' public National Health Services (NHS) is scarce. The changes in copayments and in the regulation of the provision of free patient transportation, introduced in early 2012 in Portugal, provide a natural experiment to evaluate that impact. However, those changes in user costs were accompanied with changes in the criteria that determine which patients are exempt from copayments, implying that simple comparisons of user rates would be biased. In this paper, we develop a new methodology to evaluate the impact of increases in direct and indirect user costs on the demand for emergency services (ES) in the presence of compositional changes in co-payment exempt and non-exempt populations. Our results show that the increase in copayments did not have an effect in moderating ES demand by paying users, but we find significant effects of the change in transport regulation. Thus, our results support the conclusion that indirect costs may be more important than direct costs in determining healthcare demand in NHS-countries where copayments are small and wide exemption schemes are in place, especially for older patients. Copyright © 2015 John Wiley & Sons, Ltd.

Handling healthcare workforce planning with care: where do we stand?

BACKGROUND: Planning the health-care workforce required to meet the health needs of the population, while providing service levels that maximize the outcome and minimize the financial costs, is a complex task. The problem can be described as assessing the right number of people with the right skills in the right place at the right time, to provide the right services to the right people. The literature available on the subject is vast but sparse, with no consensus established on a definite methodology and technique, making it difficult for the analyst or policy maker to adopt the recent developments or for the academic researcher to improve such a critical field. METHODS: We revisited more than 60 years of documented research to better understand the chronological and historical evolution of the area and the methodologies that have stood the test of time. The literature review was conducted in electronic publication databases and focuses on conceptual methodologies rather than techniques. RESULTS: Four different and widely used approaches were found within the scope of supply and three within demand. We elaborated a map systematizing advantages, limitations and assumptions. Moreover, we provide a list of the data requirements necessary to implement each of the methodologies. We have also identified past and current trends in the field and elaborated a proposal on how to integrate the different methodologies. CONCLUSION: Methodologies abound, but there is still no definite approach to address HHR planning. Recent literature suggests that an integrated approach is the way to solve such a complex problem, as it combines elements both from supply and demand, and more effort should be put in improving that proposal.

The trade-off between health system resiliency and efficiency: evidence from COVID-19 in European regions.

The objective of this paper was to investigate the existence of a trade-off between health system resilience and the economic efficiency of the health system, using data for 173 regions in the European Union and the European Free Trade Association countries. Data Envelopment Analysis was used to measure the efficiency of regional health systems before the COVID-19 pandemic. Then, a spatial econometrics model was used to estimate whether this measure of efficiency, adjusted for several covariates, has a significant impact on regional health system resilience during the COVID-19 pandemic, measured by the number of COVID-19 deaths per hundred thousand inhabitants. The results show that COVID-19 death rates were significantly higher in regions with higher population density, higher share of employment in industry, and higher share of women in the population. Results also show that regions with higher values of the health system efficiency index in 2017 had significantly higher rates of COVID-19 deaths in 2020 and 2021, suggesting the existence of a trade-off between health system efficiency and health system resilience during the COVID-19 pandemic.

Describing Trends in Maternal Mortality in the State of São Paulo, Brazil, from 2009 to 2019.

BACKGROUND: Maternal mortality is a significant public health concern, with varying impacts across different regions in Brazil, particularly affecting women from lower-income social classes with limited access to social resources. The aim of this study is to describe the trends in maternal mortality in São Paulo, Brazil, from 2009 to 2019. MATERIALS AND METHODS: This study employed an ecological approach utilizing a time-series design to examine maternal deaths. Secondary data from the Mortality Information System (SIM) and the Live Births Information System (SINASC) from 2009 to 2019 were utilized. The analysis included all maternal deaths among women aged 10 to 49 years residing in the state of São Paulo. Time-series data for maternal mortality ratios were constructed for the seven regions within São Paulo State. Joinpoint regression analysis was applied to characterize the maternal mortality ratio. The study estimated the annual percentage variation, the average annual percentage variation, and their respective 95% confidence intervals. RESULTS: In São Paulo, a total of 3075 maternal deaths were reported, resulting in a mortality ratio of 45.9 deaths per 100,000 live births. The leading causes of maternal death were eclampsia (7.13%), gestational hypertension (6.09%), and postpartum hemorrhage (5.89%). The analysis of the annual percentage change in the maternal mortality ratio for São Paulo State and its six clusters showed stationarity. CONCLUSIONS: The assessment of the maternal mortality ratio in the state of São Paulo, Greater São Paulo, and Baixada Santista revealed an increase in the maternal death ratio over the studied period.

Nucleotide polymorphism in the 5.8S nrDNA gene and internal transcribed spacers in Phakopsora pachyrhizi viewed from structural models.

The assessment of nucleotide polymorphisms in environmental samples of obligate pathogens requires DNA amplification through the polymerase chain reaction (PCR) and bacterial cloning of PCR products prior to sequencing. The drawback of this strategy is that it can give rise to false polymorphisms owing to DNA polymerase misincorporation during PCR or bacterial cloning. We investigated patterns of nucleotide polymorphism in the internal transcribed spacer (ITS) region for Phakopsora pachyrhizi, an obligate biotrophic fungus that causes the Asian soybean rust. Field-collected samples of P. pachyrhizi were obtained from all major soybean production areas worldwide, including Brazil and the United States. Bacterially-cloned, PCR products were obtained using a high fidelity DNA polymerase. A total of 370 ITS sequences that were subjected to an array of complementary sequence analyses, which included analyses of secondary structure stability, the pattern of nucleotide polymorphisms, GC content, and the presence of conserved motifs. The sequences exhibited features of functional rRNAs. Overall, polymorphisms took place within less conserved motives, such as loops and bulges; alternatively, they gave rise to non-canonical G-U pairs within conserved regions of double stranded helices. We discuss the usefulness of structural analyses to filter out putative 'suspicious' bacterially cloned ITS sequences, thus keeping artificially-induced sequence variation to a minimum.

The impact of cancellations in waiting times analysis: evidence from scheduled surgeries in the Portuguese NHS.

BACKGROUND: Equity in access to scheduled surgery has been a topic of attention of researchers and decision-makers on healthcare. Most studies analyse the number of days that patients wait before undergoing surgery, and ignore patients that have been on the waiting list but have not benefited from surgery. This study contributes to the existing literature on waiting lists by analysing cancellations along with surgery episodes. METHODS: We use a database comprising all patients that entered the waiting list for scheduled surgeries in the Portuguese National Health Service from 2011 to 2015 (around 3 million observations) and estimate survival models to explain waiting times, where cancellations are introduced as censored data. RESULTS: The cancellation rate is significant (around 14%), and has a considerable impact on results: ignoring cancellations biases estimates, in particular for gender differences (that are overestimated without cancelations), and for the age effect (that is underestimated). CONCLUSION: Thus, our approach provides a more accurate understanding of the impact that several factors have on overall access to scheduled surgery.

Comparing the cost-effectiveness of two screening strategies for latent tuberculosis infection in Portugal.

INTRODUCTION AND OBJECTIVES: Screening for latent tuberculosis infection (LTBI) in close contacts of infectious TB cases might include Tuberculin Skin Test (TST) and Interferon-Gamma Release Assays (IGRA), in combination or as single-tests. In Portugal, the screening strategy changed from TST followed by IGRA to IGRA-only testing in 2016. Our objective was to compare the cost-effectiveness of two-step TST/IGRA with the current IGRA-only screening strategy in immunocompetent individuals exposed to individuals with respiratory TB. MATERIALS AND METHODS: We reviewed clinical records of individuals exposed to infectious TB cases diagnosed in 2015 and 2016, in two TB outpatient centers in the district of Porto. We estimated medical, non-medical and indirect costs for each screening strategy, taking into account costs of tests and health care personnel, travel distance from place of residence to screening site and employment status. We calculated the incremental cost-effectiveness ratio (ICER) as the cost difference between the two screening strategies with the difference number of LTBI diagnosis as a measure of cost-effectiveness, assuming that treating LTBI is a cost-effective intervention. We also calculated adjusted odds-ratios to test the association between diagnosis of LTBI and screening strategy and estimated the total cost for averting a potential TB case. RESULTS: We compared 499 contacts TST/IGRA screened with 547 IGRA-only. IGRA-only strategy yielded a higher screening effectiveness for diagnosing latent tuberculosis infection (aOR 2.12, 95%CI: 1.53 - 2.94). ICER was €106 per LTBI diagnosis, representing increased effectiveness with a slightly increased cost of IGRA-only screening strategy. CONCLUSIONS: Our data suggests that in Portugal LTBI screening with IGRA-only is more cost-effective than the two-step TST/IGRA testing strategy, preventing a higher number of cases of TB cases.

The Use of Cardiac Autonomic Responses to Aerobic Exercise in Elderly Stroke Patients: Functional Rehabilitation as a Public Health Policy.

BACKGROUND AND PURPOSE: The development of public policies must be guided by full knowledge of the health-disease process of the population. Aerobic exercises are recommended for rehabilitation in stroke patients, and have been shown to improve heart rate variability (HRV). Our aim was to compare the cardiac autonomic modulation of elderly stroke patients with that of healthy elderly people during and after an acute bout of aerobic exercise. METHODS: A total of 60 elderly people participated in the study (30 in the control group, mean age of 67 ± 4 years; 30 in the stroke group, mean age of 69 ± 3 years). HRV was analyzed in rest-10 min of rest in supine position; exercise-the 30 min of peak exercise; and recovery-30 min in supine position post-exercise. RESULTS: Taking rest and exercises together, for SDNN, RMSSD, pNN50, RRTri, and TINN, there was no difference between the stroke and control groups (p = 0.062; p = 0.601; p = 0.166; p = 0.224, and p = 0.059, respectively). The HF (ms2) was higher and the LF/HF ratio was lower for the stroke group than the control group (p < 0.001 and p = 0.007, respectively). The SD2 was lower for the stroke group than for the control group (p = 0.041). CONCLUSION: Stroke patients present reduced variability at rest, sympathetic predominance during exercise, and do not return to baseline after the 30 min of recovery, with similar responses found in the healthy elderly group.

Insecticide susceptibility of Euschistus heros (Heteroptera: Pentatomidae) in Brazil.

Euschistus heros (F.) (Heteroptera: Pentatomidae) is the most prevalent stink bug pest in Brazil, and populations can be difficult to manage using organophosphates or endosulfan. Because E. heros is difficult to rear in the laboratory, no baseline insecticide susceptibility data have been published. Therefore, we conducted dose-mortality studies using field-collected insects, and, using the results from the dose-mortality studies, we surveyed susceptibility to acephate, methamidophos, and endosulfan in populations from southern and central Brazil. In addition, esterase activity was evaluated among populations as these enzymes have been related to organophosphate resistance. Finally, newer chemistries were evaluated for E. heros population management in small-plot field studies. In the dose-mortality bioassays, variation in susceptibility to methamidophos and endosulfan among populations was significant, but the variation in susceptibility to acephate was not. The population from Londrina (at the Embrapa Soybean Research Station, northern Parana state) was among the most susceptible, whereas the population from Pedrinhas Paulista (southwestern Sao Paulo state) was among the least susceptible. Significant variation among populations was observed in esterase activity with the population from Pedrinhas Paulista having the highest esterase levels and the population from Londrina having among the lowest levels. To survey populations, we used the dose-mortality data for the Londrina population (because it was, consistently, one of the most susceptible populations) to estimate the insecticide concentration that killed 99% of the population (LC99). The corresponding doses were 5.9 microg (AI) of acephate adult(-1), 0.7 microg (AI) methamidophos adult(-1), and 1,600 microg (AI) endosulfan adult(-1). The survey data confirmed the data from the dose-mortality bioassays in that the population from Pedrinhas Paulista was identified as one of the least susceptible and the population from Londrina was one of the most susceptible. The field tests confirmed that older chemistries provided minimal control (< 50% control), whereas the products containing mixtures of pyrethroids and neonicotinoids provided better control (> 60%).

Distinct biphasic mRNA changes in response to Asian soybean rust infection.

Asian soybean rust (ASR), caused by Phakopsora pachyrhizi, is now established in all major soybean-producing countries. Currently, there is little information about the molecular basis of ASR-soybean interactions, which will be needed to assist future efforts to develop effective resistance. Toward this end, abundance changes of soybean mRNAs were measured over a 7-day ASR infection time course in mock-inoculated and infected leaves of a soybean accession (PI230970) carrying the Rpp2 resistance gene and a susceptible genotype (Embrapa-48). The expression profiles of differentially expressed genes (ASR-infected compared with the mock-inoculated control) revealed a biphasic response to ASR in each genotype. Within the first 12 h after inoculation (hai), which corresponds to fungal germination and penetration of the epidermal cells, differential gene expression changes were evident in both genotypes. mRNA expression of these genes mostly returned to levels found in mock-inoculated plants by 24 hai. In the susceptible genotype, gene expression remained unaffected by rust infection until 96 hai, a time period when rapid fungal growth began. In contrast, gene expression in the resistant genotype diverged from the mock-inoculated control earlier, at 72 h, demonstrating that Rpp2-mediated defenses were initiated prior to this time. These data suggest that ASR initially induces a nonspecific response that is transient or is suppressed when early steps in colonization are completed in both soybean genotypes. The race-specific resistance phenotype of Rpp2 is manifested in massive gene expression changes after the initial response prior to the onset of rapid fungal growth that occurs in the susceptible genotype.

The role of private non-profit healthcare organizations in NHS systems: Implications for the Portuguese hospital devolution program.

The national health services (NHS) of England, Portugal, Finland and other single-payer universalist systems financed by general taxation, are based on the theoretical principle of an integrated public sector payer-provider. However, in practice one can find different forms of participation of non-public healthcare providers in those NHS, including private for profit providers, but also third sector non-profit organizations (NPO). This paper reviews the role of non-public non-profit healthcare organizations in NHS systems. By crossing a literature review on privatization of national health services with a literature review on the comparative performance of non-profit and for-profit healthcare organizations, this paper assesses the impact of contracting private non-profit healthcare organizations on the efficiency, quality and responsiveness of services, in public universal health care systems. The results of the review were then compared to the existing evidence on the Portuguese hospital devolution to NPO program. The evidence in this paper suggests that NHS health system reforms that transfer some public-sector hospitals to NPO should deliver improvements to the health system with minimal downside risks. The very limited existing evidence on the Portuguese hospital devolution program suggests it improved efficiency and access, without sacrificing quality.

Diaporthe endophytica and D. terebinthifolii from medicinal plants for biological control of Phyllosticta citricarpa.

The citrus industry is severely affected by citrus black spot (CBS), a disease caused by the pathogen Phyllosticta citricarpa. This disease causes loss of production, decrease in the market price of the fruit, and reduction in its export to the European Union. Currently, CBS disease is being treated in orchards with various pesticides and fungicides every year. One alternative to CBS disease control without harming the environment is the use of microorganisms for biological control. Diaporthe endophytica and D. terebinthifolii, isolated from the medicinal plants Maytenus ilicifolia and Schinus terebinthifolius have an inhibitory effect against P. citricarpa in vitro and in detached fruits. Moreover, D. endophytica and D. terebinthifolii were transformed by Agrobacterium tumefaciens for in vivo studies. The transformants retained the ability to control of phytopathogenic fungus P. citricarpa after transformation process. Furthermore, D. endophytica and D. terebinthifolii were able to infect and colonize citrus plants, which is confirmed by reisolation of transformants from inoculated and uninoculated leaves. Light microscopic analysis showed fungus mycelium colonizing intercellular region and oil glands of citrus, suggesting that these two new species are capable of colonizing citrus plants, in addition to controlling the pathogen P. citricarpa.

Tuberculosis of the spine and spinal cord.

Tuberculosis remains an important problem in underdeveloped countries, especially in individuals under the age of 20 years. In developed countries, there was an increase of the disease due to several factors, especially the appearance of A.I.D.S. The arterial haematogenous seeding is the most important way to the propagation of the disease to the rachis. The bacillus mycobacterium tuberculosis is characterized by a slow growth, propention for an oxygen rich environment and the absence of proteolytic enzymes. These characteristics are responsible for the imaging particularities of tuberculous osteomyelitis. The diagnosis can be confirmed by the bacteriologic and histological studies from samples removed by punction biopsy.

Demand uncertainty and hospital costs: an application to Portuguese public hospitals.

In this paper, we evaluate the effect of demand uncertainty on hospital costs. Since hospital managers want to minimize the probability of not having enough capacity to satisfy demand, and since demand is uncertain, hospitals have to build excess capacity and incur the associated costs. Using panel data comprising information for 43 Portuguese public hospitals for the period 2007-2009, we estimate a translog cost function that relates total variable costs to the usual variables (outputs, the price of inputs, some of the hospitals' organizational characteristics) and an additional term measuring the excess capacity related to the uncertainty of demand. Demand uncertainty is measured as the difference between actual and projected demand for emergency services. Our results indicate that the cost function term associated with the uncertainty of demand is significant, which means that cost functions that do not include this type of term may be misspecified. For most of our sample, hospitals that face higher demand uncertainty have higher excess capacity and higher costs. Furthermore, we identify economies of scale in hospital costs, at least for smaller hospitals, suggesting that a policy of merging smaller hospitals would contribute to reducing hospital costs.

More Cercospora Species Infect Soybeans across the Americas than Meets the Eye.

Diseases of soybean caused by Cercospora spp. are endemic throughout the world's soybean production regions. Species diversity in the genus Cercospora has been underestimated due to overdependence on morphological characteristics, symptoms, and host associations. Currently, only two species (Cercospora kikuchii and C. sojina) are recognized to infect soybean; C. kikuchii causes Cercospora leaf blight (CLB) and purple seed stain (PSS), whereas C. sojina causes frogeye leaf spot. To assess cryptic speciation among pathogens causing CLB and PSS, phylogenetic and phylogeographic analyses were performed with isolates from the top three soybean producing countries (USA, Brazil, and Argentina; collectively accounting for ~80% of global production). Eight nuclear genes and one mitochondrial gene were partially sequenced and analyzed. Additionally, amino acid substitutions conferring fungicide resistance were surveyed, and the production of cercosporin (a polyketide toxin produced by many Cercospora spp.) was assessed. From these analyses, the long-held assumption of C. kikuchii as the single causal agent of CLB and PSS was rejected experimentally. Four cercosporin-producing lineages were uncovered with origins (about 1 Mya) predicted to predate agriculture. Some of the Cercospora spp. newly associated with CLB and PSS appear to represent undescribed species; others were not previously reported to infect soybeans. Lineage 1, which contained the ex-type strain of C. kikuchii, was monophyletic and occurred in Argentina and Brazil. In contrast, lineages 2 and 3 were polyphyletic and contained wide-host range species complexes. Lineage 4 was monophyletic, thrived in Argentina and the USA, and included the generalist Cercospora cf. flagellaris. Interlineage recombination was detected, along with a high frequency of mutations linked to fungicide resistance in lineages 2 and 3. These findings point to cryptic Cercospora species as underappreciated global considerations for soybean production and phytosanitary vigilance, and urge a reassessment of host-specificity as a diagnostic tool for Cercospora.

O impacto económico da prevenção de quedas em idosos: uma análise custo- -utilidade à intervenção das Equipas de Cuidados Continuados Integrados / Economic impact of falls prevention in the elderly: a cost-utility analysis of Integrated Continuing Care Teams intervention

Objetivo: Estimar o impacto económico da intervenção das Equipas de Cuidados Continuados Integrados (ECCI) na comunidade no domínio da prevenção de quedas em idosos. Métodos: Avaliação económica custo-utilidade à intervenção das Equipas de Cuidados Continuados Integrados a prevenção de quedas em idosos. Resultado: A intervenção das ECCI na prevenção de quedas em idosos proporcionou ganhos em saúde estimados em 4,46 QALYs e uma poupança de custos aproximados a 16.952,46 €. Conclusão: A intervenção das ECCI é custo-efetiva, pelo que se recomenda o seu benchmarking a outras instituições de saúde.

Objective: Estimate the economic impact of Integrated Continuing Care Teams (ECCI) intervention in the community in the field of prevention of falls in the elderly. Methods: Cost-utility analysis to the intervention of Integrated Continuing Care Teams in the prevention of falls in the elderly. Result: ECCI intervention in the prevention of falls in the elderly provided an estimated health gains of 4.46 QALYs and a cost saving of approximately € 16,952.46. Conclusion: The ECCI intervention is cost-effective, and its benchmarking is recommended to other health institutions.

Gênero e identidade masculina no novo milênio: A homoafetividade e a visão social baseada na filosofia comportamental gØy (g-zero-y)

O artigo aborda o coletivo masculino denominado G0ys. O conceito de homem g0y foi desenvolvido nos Estados Unidos, chegando também a América Latina e outras partes do mundo. A sua visibilidade atual é crescente e as formas de sociabilidade predominantes se dão por meio de sites, redes sociais, grupos de mailing, bem como, fraternidades masculinas reais. Os g0ys no cenário internacional mostram uma realidade/perspectiva intermediária da sexualidade, até então renegada. Colocando-se como meio termo na tradicional dicotomia héteroversus homo, os g-zero-y afirmam constituir um movimento composto por homens com orientação homoerótica alicerçado em restrições a determinados tipos de práticas que são tipicamente homossexuais (tais como o sexo anal, seja insertivo ou passivo), além da total abstinência nesse quesito, os g0ys universalmente valorizam os atributos masculinos, se aproximam dos valores e dos comportamentos héteros e rejeitam a seu modo a política do "coming out";os pensamentos do movimento surpreendem o mundo exterior ao assumir uma postura aparentemente autêntica, entretanto que vai contra aos preceitos do movimento gay e vai contra também aos preceitos do mundo heterossexual normativo. Seria o mundo da sexualidade intermediária finalmente ganhando uma identidade? Apesar de recente na história, o campo dos g0ys se estabelece enquanto o poder inerente que é apropriado pelo coletivo, fazendo com que o dito intermediário se replique e se transforme ao mediar construções particulares e estabelecer contrastes entre os grupos e indivíduos, ao criar e prover formas, práticas e identidades homoeróticas atuais.

This article discusses the male collective denominated g0ys. The concept of g0y man was created in the United States, also coming to Latin America and other parts of the world. Your current visibility is growing and the predominant forms of socializing occur through websites, social networks, mailing groups, as well as men's real fraternities. The g0ys in the international arena show an intermediate reality/perspective of sexuality, until now renegade. Posing as middle ground in the traditional straight versus gay dichotomy, the g-zero-y say constitute a compound movement by men with homoerotic orientation anchored in restrictions on certain types of practices that are typically homosexuals (such as anal sex, either top or bottom), in addition to total abstinence in this aspect, the g0ys universally valued male attributes and approach the values ​​and behaviors of heterosexuals and reject their way the policy of "coming out";the thoughts of the movement surprise the outside world to take a stance seemingly authentic, but that goes against the precepts of the gay movement and will also counter to the precepts of normative heterosexual world. It would be the world of mid sexuality finally gaining an identity? Although in history recent, the field of g0ys settles as the inherent power that is suitable for the collectivity, causing such intermediate to replicate and become the particular constructions and mediate establish and contrasts between groups and individuals to create and provide forms, practices and current homoerotic identities.

Este artículo aborda lo colectivo masculino denominado g0ys. El concepto de hombre g0y fue creado en los Estados Unidos, también viene a América Latina y otras partes del mundo. Su visibilidad actual es creciente, y las formas predominantes de sociabilidad se producen a través de sitios web, redes sociales, grupos de correo, así como fraternidades reales de hombres. Los g0ys en el ámbito internacional muestran una realidad/perspectiva intermedia de la sexualidad, antes renegada. Posando suelo como media en tradicional dicotomía gay frente a rectos, los g-cero-y decir constituye un movimiento compuesto por hombres con orientación homoerótica anclado en restricciones a ciertos tipos de prácticas que suelen ser homosexuales (como el sexo anal, ya sea activo o pasivo), además de la abstinencia total en este aspecto, los g0ys universalmente valorados atributos masculinos y se acercan a los valores y comportamientos del heterosexuales y rechazan a su modo la política de "salir del armario"; los pensamientos del movimiento sorprenden al mundo para tomar una posición aparentemente auténtica, pero que va en contra de los preceptos del movimiento gay y también en contra el preceptos de la normativa heterosexual. ¿Sería el mundo de la sexualidad intermedia finalmente ganando una identidad? Aunque de historia reciente, el campo de g0ys asienta mientras que el poder inherente que es adecuado para la colectividad, haciendo que dicho compuesto intermedio para replicarse y convertirse en las construcciones para mediar y establecer contrastes entre grupose individuos, para crear y proporcionar formas, prácticas e identidades homoeróticas actuales.

[Tuberculous spondilodiskitis: imaging features]. / Espondilodiscite tuberculosa: aspectos imagiológicos.

The spine is the most common site of osseous involvement by tuberculosis. Diagnosis of tuberculous spondylodiskitis, also known as Pott's disease, is often difficult due to its insidious onset and nonspecific clinical presentation. Along with a high level of suspicion, familiarity with its imaging characteristics is the basis for establishing the correct diagnosis, allowing early and focused treatment.