No Geographical Inequalities in Survival for Sarcoma Patients in France: A Reference Networks' Outcome?

The national reference network NETSARC+ provides remote access to specialized diagnosis and the Multidisciplinary Tumour Board (MTB) to improve the management and survival of sarcoma patients in France. The IGéAS research program aims to assess the potential of this innovative organization to address geographical inequalities in cancer management. Using the IGéAS cohort built from the nationwide NETSARC+ database, the individual, clinical, and geographical determinants of the 3-year overall survival of sarcoma patients in France were analyzed. The survival analysis was focused on patients diagnosed in 2013 (n = 2281) to ensure sufficient hindsight to collect patient follow-up. Our study included patients with bone (16.8%), soft-tissue (69%), and visceral (14.2%) sarcomas, with a median age of 61.8 years. The overall survival was not associated with geographical variables after adjustment for individual and clinical factors. The lower survival in precarious population districts [HR 1.23, 95% CI 1.02 to 1.48] in comparison to wealthy metropolitan areas (HR = 1) found in univariable analysis was due to the worst clinical presentation at diagnosis of patients. The place of residence had no impact on sarcoma patients' survival, in the context of the national organization driven by the reference network. Following previous findings, this suggests the ability of this organization to go through geographical barriers usually impeding the optimal management of cancer patients.

Assessment of mitochondrial toxicity in newborns and infants with congenital cytomegalovirus infection treated with valganciclovir.

BACKGROUND: Ganciclovir/valganciclovir is currently indicated during the first 6 months of life in symptomatic children with congenital cytomegalovirus (CMV) infection. However, this treatment may have the potential to induce mitochondrial toxicity due to off-target inhibition of DNA-polymerases. Similar anti-HIV drugs have been associated with mitochondrial toxicity but this has never been explored in CMV. OBJECTIVE: To determine the potential mitochondrial toxicity profile at the genetic, functional and biogenesis level in peripheral blood mononuclear cells from a cohort of newborns and infants with symptomatic congenital CMV infection (treated with valganciclovir, untreated and uninfected controls). DESIGN: Longitudinal, observational and controlled study. SETTING AND PATIENTS: Subjects were recruited at the tertiary referral Hospital Sant Joan de Déu and experiments were conducted at IDIBAPS-Hospital Clínic of Barcelona, Spain. CMV-infected newborns underwent comprehensive monthly clinical follow-up. METHODS: Mitochondrial parameters, audiometry and neurological assessment were measured at baseline, 3-6 and 12 months after inclusion in the study. The Kruskal-Wallis test for k-independent samples and Friedman tests for repeated measurements were applied. RESULTS: Complex IV, citrate synthase enzymatic activities and mtDNA remained preserved in congenital CMV-infected infants treated with valganciclovir compared with controls (p>0.05 in all cases). CONCLUSIONS: No evidence of mitochondrial toxicity was found in infants treated with valganciclovir for congenital CMV.

Situación de los estudiantes de la licenciatura en enfermería en tiempos de pandemia / Situation of students of the bachelor's degree in nursing in times of pandemic / Situação dos estudantes de graduação em enfermagem em tempos de pandemia

La aparición de la pandemia producida por el virus COVID-19 produjo una serie de cambios en muchas áreas de la sociedad, entre ellas la educación. Debido a la necesidad de confinamiento social, se suspendieron las clases presenciales. En dicho contexto se evidenció la vulnerabilidad de los sistemas sanitarios y demostró la necesidad e importancia de disponer de profesionales en enfermería en número adecuado y capacitados. De esta manera, surge la necesidad docente de conocer las características de la población estudiantil del programa profesionalización de auxiliares de enfermería que cursan el módulo adulto y anciano en cuanto a sus aspectos personales y familiares, de estudio, antecedentes de salud, condiciones laborales y actitud frente al rol del profesional de enfermería en contexto de pandemia. Objetivo: El objetivo de este trabajo fue analizar la situación de la población estudiantil que cursan el módulo de adulto y anciano de la licenciatura en enfermería del programa profesionalización de auxiliares de enfermería según variables socio demográficas, familiares, laborales y académicas. Método: Estudio de enfoque cuantitativo de diseño descriptivo mediante el uso de un cuestionario de preguntas cerradas y abiertas. Resultados: Como se percibe el lugar de trabajo como posible vector, los estudiantes encuestados perciben temor, ansiedad e incertidumbre con respecto al contexto de pandemia, a pesar de que se cumplen con los protocolos y los cuidados a nivel personal.

The emergence of the pandemic produced by the COVID-19 virus produced a series of changes in many areas of society, including education. Due to the need for social confinement, face-to-face classes were suspended. In this context, the vulnerability of the health systems was evidenced and the need and importance of having adequate and trained nursing professionals available. In this way, the teaching need arises to know the characteristics of the student population of the professionalization program of nursing assistants who study the adult and elderly module in terms of their personal and family aspects, study, health history, working conditions and attitude versus the role of the nursing professional in the context of a pandemic. Objective: The objective of this work was to analyze the situation of the student population who are studying the adult and elderly module of the nursing degree in the professionalization of nursing assistants program according to socio-demographic, family, work and academic variables. Method: Study of a quantitative approach of descriptive design through the use of a questionnaire of closed and open questions. Results: As the workplace perceived as a possible vector, the surveyed students perceive fear, anxiety and uncertainty regarding the pandemic context, despite the fact that the protocols and personal care complied with.

O surgimento da pandemia produzida pelo vírus COVID-19 produziu uma série de mudanças em muitas áreas da sociedade, incluindo a educação. Devido à necessidade de confinamento social, as aulas presenciais foram suspensas. Nesse contexto, evidenciou-se a vulnerabilidade dos sistemas de saúde e a necessidade e importância da disponibilidade de profissionais de enfermagem adequados e capacitados. Desse modo, surge a necessidade docente de conhecer as características da população discente do programa de profissionalização de auxiliares de enfermagem que cursam o módulo adulto e idoso no que se refere aos aspectos pessoais e familiares, estudo, histórico de saúde, condições e atitudes de trabalho versus papel do profissional de enfermagem no contexto de uma pandemia. Objetivo: o objetivo deste trabalho foi analisar a situação da população de estudantes que cursam o módulo adulto e idoso do curso de enfermagem no programa de profissionalização de auxiliares de enfermagem segundo variáveis sociodemográficas, familiares, laborais e acadêmicas. Método: Estudo de abordagem quantitativa de delineamento descritivo por meio da aplicação de um questionário de perguntas fechadas e abertas. Resultados: Como o local de trabalho é percebido como um possível vetor, os alunos pesquisados percebem medo, ansiedade e incerteza em relação ao contexto pandêmico, apesar de os protocolos e cuidados pessoais serem cumpridos.

Determinants of the access to remote specialised services provided by national sarcoma reference centres.

BACKGROUND: Spatial inequalities in cancer management have been evidenced by studies reporting lower quality of care or/and lower survival for patients living in remote or socially deprived areas. NETSARC+ is a national reference network implemented to improve the outcome of sarcoma patients in France since 2010, providing remote access to specialized diagnosis and Multidisciplinary Tumour Board (MTB). The IGéAS research program aims to assess the potential of this innovative organization, with remote management of cancers including rare tumours, to go through geographical barriers usually impeding the optimal management of cancer patients. METHODS: Using the nationwide NETSARC+ databases, the individual, clinical and geographical determinants of the access to sarcoma-specialized diagnosis and MTB were analysed. The IGéAS cohort (n = 20,590) includes all patients living in France with first sarcoma diagnosis between 2011 and 2014. Early access was defined as specialised review performed before 30 days of sampling and as first sarcoma MTB discussion performed before the first surgery. RESULTS: Some clinical populations are at highest risk of initial management without access to sarcoma specialized services, such as patients with non-GIST visceral sarcoma for diagnosis [OR 1.96, 95% CI 1.78 to 2.15] and MTB discussion [OR 3.56, 95% CI 3.16 to 4.01]. Social deprivation of the municipality is not associated with early access on NETSARC+ remote services. The quintile of patients furthest away from reference centres have lower chances of early access to specialized diagnosis [OR 1.18, 95% CI 1.06 to 1.31] and MTB discussion [OR 1.24, 95% CI 1.10 to 1.40] but this influence of the distance is slight in comparison with clinical factors and previous studies on the access to cancer-specialized facilities. CONCLUSIONS: In the context of national organization driven by reference network, distance to reference centres slightly alters the early access to sarcoma specialized services and social deprivation has no impact on it. The reference networks' organization, designed to improve the access to specialized services and the quality of cancer management, can be considered as an interesting device to reduce social and spatial inequalities in cancer management. The potential of this organization must be confirmed by further studies, including survival analysis.

Assessment of Healthy and Harmful Maillard Reaction Products in a Novel Coffee Cascara Beverage: Melanoidins and Acrylamide.

Our research aimed to evaluate the formation of Maillard reaction products in sun-dried coffee cascara and their impact on the safety and health promoting properties of a novel beverage called "Instant Cascara" (IC) derived from this coffee by-product. Maillard reaction products in sun-dried coffee cascara have never been reported. "Instant Cascara" (IC) extract was obtained by aqueous extraction and freeze-drying. Proteins, amino acids, lipids, fatty acid profile, sugars, fiber, minerals, and vitamins were analyzed for its nutritional characterization. Acrylamide and caffeine were used as chemical indicators of safety. Colored compounds, also called melanoidins, their stability under 40 °C and in light, and their in vitro antioxidant capacity were also studied. A safe instant beverage with antioxidant properties was obtained to which the following nutritional claims can be assigned: "low fat", "low sugar" "high fiber" and "source of potassium, magnesium and vitamin C". For the first time, cascara beverage color was attributed to the presence of antioxidant melanoidins (>10 kDa). IC is a potential sustainable alternative for instant coffee, with low caffeine and acrylamide levels and a healthy composition of nutrients and antioxidants.

Incidence of surgical site infection in dogs undergoing soft tissue surgery: risk factors and economic impact.

OBJECTIVES: To determine (1) the incidence of surgical site infection (SSI) in patients undergoing soft tissue surgery at a veterinary teaching hospital and to study (2) and describe the main risk factors associated with SSI and (3) assess the economic impact of SSI. DESIGN: Prospective cohort study. SETTING: Veterinary teaching hospital. PARTICIPANTS: 184 dogs undergoing soft tissue surgery during a 12-month period (October 2013 to September 2014). PRIMARY OUTCOME MEASURE: Surgical site infection. RESULTS: Out of the 184 patients analysed, SSI was diagnosed in 16 (8.7 per cent) patients, 13 (81.3 per cent) were classified as superficial incisional infection, 2 (12.5 per cent) as deep incisional infection and 1 (6.3 per cent) as organ/space infection. The administration of steroidal anti-inflammatory drugs (P=0.028), preoperative hyperglycaemia (P=0.015), surgical times longer than 60 minutes (P=0.013), urinary catheterisation (P=0.037) and wrong use of the Elizabethan collar (P=0.025) were identified as risk factors. Total costs increased 74.4 per cent, with an increase in postsurgical costs of 142.2 per cent. CONCLUSIONS: The incidence of SSI was higher than the incidence reported in other published studies, although they were within expected ranges when a surveillance system was implemented. This incidence correlated with an increase in costs. Additionally new important risk factors for its development were detected.

Assessment of the prognostic role of a 94-single nucleotide polymorphisms risk score in early breast cancer in the SIGNAL/PHARE prospective cohort: no correlation with clinico-pathological characteristics and outcomes.

BACKGROUND: Genome-wide association studies (GWAS) have to date identified 94 genetic variants (single nucleotide polymorphisms (SNPs)) associated with risk of developing breast cancer. A score based on the combined effect of the 94 risk alleles can be calculated to measure the global risk of breast cancer. We aimed to test the hypothesis that the 94-SNP-based risk score is associated with clinico-pathological characteristics, breast cancer subtypes and outcomes in early breast cancer. METHODS: A 94-SNP risk score was calculated in 8703 patients in the PHARE and SIGNAL prospective case cohorts. This score is the total number of inherited risk alleles based on 94 selected SNPs. Clinical data and outcomes were prospectively registered. Genotyping was obtained from a GWAS. RESULTS: The median 94-SNP risk score in 8703 patients with early breast cancer was 77.5 (range: 58.1-97.6). The risk score was not associated with usual prognostic and predictive factors (age; tumor, node, metastasis (TNM) status; Scarff-Bloom-Richardson grade; inflammatory features; estrogen receptor status; progesterone receptor status; human epidermal growth factor receptor 2 (HER2) status) and did not correlate with breast cancer subtypes. The 94-SNP risk score did not predict outcomes represented by overall survival or disease-free survival. CONCLUSIONS: In a prospective case cohort of 8703 patients, a risk score based on 94 SNPs was not associated with breast cancer characteristics, cancer subtypes, or patients' outcomes. If we hypothesize that prognosis and subtypes of breast cancer are determined by constitutional genetic factors, our results suggest that a score based on breast cancer risk-associated SNPs is not associated with prognosis. TRIAL REGISTRATION: PHARE cohort: NCT00381901 , Sept. 26, 2006 - SIGNAL cohort: INCa RECF1098, Jan. 28, 2009.

Strategies for serum chemokine/cytokine assessment as biomarkers of therapeutic response in HCV patients as a prototype to monitor immunotherapy of infectious diseases.

In this study, strategies for serum biomarker assessment were developed for therapeutic monitoring of HCV patients. For this purpose, serum chemokine/cytokine levels were measured by cytometric-bead-array in HCV patients, categorized according to immunotherapy response as: non-responder/NR, relapser/REL and sustained-virologic-responder/SVR. The results demonstrated an overall increase of serum chemokine/cytokine levels in HCV patients. In general, therapeutic failure was associated with presence of a predominant baseline proinflammatory pattern with enhanced CCL5/RANTES, IFN-α, IFN-γ along with decreased IL-10 levels in NR and increased IL-6 and TNF in REL. SVR displayed lower baseline proinflammatory status with decreased CXCL8/IL-8, IL-12 and IL-17 levels. The inability to uphold IFN-α levels during immunotherapy was characteristic of NR. Serum chemokine/cytokine signatures further support the deleterious effect of proinflammatory baseline status and the critical role of increased/persistent IFN-α levels to guarantee the sustained virologic response. The prominent baseline proinflammatory milieu observed in NR and REL yielded a restricted biomarker network with small number of neighborhood connections, whereas SVR displayed a network with integrated cytokine connectivity. Noteworthy was that SVR presented a shift towards a proinflammatory pattern upon immunotherapy, assuming a pattern similar to that observed in NR and REL at baseline. Moreover, the immunotherapy guided REL towards a profile similar to SVR at baseline. Analysis of baseline-fold changes during treatment pointed out IFN-α and TNF as high-performance biomarkers to monitor immunotherapy outcome. This knowledge may contribute for novel insights into the treatment and control of the continuous public health threat posed by HCV infection worldwide.

Chronotherapeutics of conventional blood pressure-lowering medications: simple, low-cost means of improving management and treatment outcomes of hypertensive-related disorders.

Correlation between blood pressure (BP) target organ damage, cardiovascular risk, and long-term prognosis is greater for ambulatory monitored (ABPM) than daytime in-clinic measurements. Additionally, consistent evidence of numerous studies substantiates the ABPM-determined asleep BP mean is an independent and stronger predictor of risk and incidence of end-organ injury and cardiovascular events than the awake or 24-h means. Hence, cost-effective control of sleep-time BP is of great clinical relevance. Ingestion time, according to circadian rhythms, of hypertension medications of six different classes and their combinations significantly impacts beneficial and/or adverse effects. For example, because the high-amplitude circadian rhythm of the renin-angiotensin-aldosterone system activates during nighttime sleep, bedtime versus morning ingestion of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers better controls the asleep than awake BP means, with additional benefit independent of terminal half-life of converting the 24-h BP profile into more normal dipper patterning. Recent findings authenticate therapeutic reduction of sleep-time BP, best achieved when the full daily dose of ≥1 hypertension medications is routinely ingested at bedtime, is the most significant independent predictor of lowered cardiovascular and cerebrovascular risk.

[2013 Ambulatory blood pressure monitoring recommendations for the diagnosis of adult hypertension, assessment of cardiovascular and other hypertension-associated risk, and attainment of therapeutic goals (summary). Joint recommendations from the International Society for Chronobiology (ISC), American Association of Medical Chronobiology and Chronotherapeutics (AAMCC), Spanish Society of Applied Chronobiology, Chronotherapy, and Vascular Risk (SECAC), Spanish Society of Atherosclerosis (SEA), and Romanian Society of Internal Medicine (RSIM)]. / Recomendaciones 2013 para el uso de la monitorización ambulatoria de la presión arterial para el diagnóstico de hipertensión en adultos, valoración de riesgo cardiovascular y obtención de objetivos terapéuticos (resumen). Recomendaciones conjuntas de la International Society for Chronobiology (ISC), American Association of Medical Chronobiology and Chronotherapeutics (AAMCC), Sociedad Española de Cronobiología Aplicada, Cronoterapia y Riesgo Vascular (SECAC), Sociedad Española de Arteriosclerosis (SEA) y Romanian Society of Internal Medicine (RSIM).

Correlation between systolic (SBP) and diastolic (DBP) blood pressure (BP) level and target organ damage, cardiovascular disease (CVD) risk, and long-term prognosis is much greater for ambulatory BP monitoring (ABPM) than daytime office measurements. The 2013 ABPM guidelines specified herein are based on ABPM patient outcomes studies and constitute a substantial revision of current knowledge. The asleep SBP mean and sleep-time relative SBP decline are the most significant predictors of CVD events, both individually as well as jointly when combined with other ABPM-derived prognostic markers. Thus, they should be preferably used to diagnose hypertension and assess CVD and other associated risks. Progressive decrease by therapeutic intervention in the asleep BP mean is the most significant predictor of CVD event-free interval. The 24 h BP mean is not recommended to diagnose hypertension because it disregards the more valuable clinical information pertaining to the features of the 24 h BP pattern. Persons with the same 24 h BP mean may display radically different 24 h BP patterns, ranging from extreme-dipper to riser types, representative of markedly different risk states. Classification of individuals by comparing office with either the 24 h or awake BP mean as "masked normotensives" (elevated clinic BP but normal ABPM), which should replace the terms of "isolated office" or "white-coat hypertension", and "masked hypertensives" (normal clinic BP but elevated ABPM) is misleading and should be avoided because it disregards the clinical significance of the asleep BP mean. Outcome-based ABPM reference thresholds for men, which in the absence of compelling clinical conditions are 135/85 mmHg for the awake and 120/70 mmHg for the asleep SBP/DBP means, are lower by 10/5 mmHg for SBP/DBP in uncomplicated, low-CVD risk, women and lower by 15/10 mmHg for SBP/DBP in male and female high-risk patients, e.g., with diabetes, chronic kidney disease (CKD), and/or past CVD events. In the adult population, the combined prevalence of masked normotension and masked hypertension is >35%. Moreover, >20% of "normotensive" adults have a non-dipper BP profile and, thus, are at relatively high CVD risk. Clinic BP measurements, even if supplemented with home self-measurements, are unable to quantify 24 h BP patterning and asleep BP level, resulting in potential misclassification of up to 50% of all evaluated adults. ABPM should be viewed as the new gold standard to diagnose true hypertension, accurately assess consequent tissue/organ, maternal/fetal, and CVD risk, and individualize hypertension chronotherapy. ABPM should be a priority for persons likely to have a blunted nighttime BP decline and elevated CVD risk, i.e., those who are elderly and obese, those with secondary or resistant hypertension, and those diagnosed with diabetes, CKD, metabolic syndrome, and sleep disorders.

Integrating health promotion and disease prevention interventions with vaccination in Honduras.

OBJECTIVE: We sought to review and describe health interventions integrated with immunization delivery, both routine and during national vaccination weeks, in Honduras between 1991 and 2009. METHODS: We compiled and examined all annual evaluation reports from the national Expanded Program on Immunization and reports from the national vaccination weeks (NVWs) between 1988 and 2009. We held discussions with the persons responsible for immunization and other programs in the Health Secretary of Honduras for the same time period. RESULTS: Since 1991, several health promotion and disease prevention interventions have been integrated with immunization delivery, including vitamin A supplementation (since 1994), folic acid supplementation (2003), early detection of retinoblastoma (since 2003), breastfeeding promotion (2007-2008), and disease control activities during public health emergencies, such as cholera control (1991-1992) and dengue control activities (since 1991, when a dengue emergency coincides with the NVW). Success factors included sufficient funds and supplies to ensure sustainability and joint planning, delivery, and monitoring. CONCLUSIONS: Several health interventions have been integrated with vaccination delivery in Honduras for nearly 20 years. The immunization program in Honduras has sufficient structure, organization, acceptance, coverage, and experience to achieve successful integration with health interventions if carefully planned and suitably implemented.

Are health journalists' practices tied to their perceptions of audience? An attribution and expectancy-value approach.

This study examines a national survey of U.S. health journalists (N = 774) to ascertain how journalists' perceptions of audience use of health news shapes their journalistic practices. We establish a framework through attribution theory and expectancy-value theory for how journalists choose to fulfill their roles as providers of health information. Using these theoretical lenses, we look at whether health journalists' audience orientation is associated with their use of accessibility-oriented or credibility-focused practices. Our findings show that, overall, journalists believe readers are individually responsible for their health outcomes and that journalists focus on providing accessibility-oriented information when they feel their audience's ability to understand information may be compromised. Journalists' beliefs about audience behavior are associated with their attitudes toward communication practices.

Long-term assessment of didanosine, lamivudine, and efavirenz in antiretroviral-naive patients: 3-year follow-up.

The aim of this study was to evaluate the long-term efficacy and safety of didadosine (ddI), lamivudine (3TC), and efavirenz (EFV). This was a follow-up to the VESD study, a 12-month open-label, observational, multicenter study of adult patients with HIV infection who started antiretroviral treatment with the ddI-3TC-EFV once-daily regimen. Of the 167 patients originally included, 106 patients remained on the same triple therapy at the end of the study (1 year), and they were offered an extra 24 months of follow-up; 96 were enrolled in this study (VESD-2). Seventy patients out of the initial cohort were still on the same regimen at month 36, with 97% of them with plasma viral load <50 copies /ml. An intention-to-treat analysis showed that the percentage of patients with plasma viral load <50 copies/ml was 73% at 36 months. CD4 cell counts increased 344 cells/microl over the 36 months. Safety and tolerance were good with no unexpected long-term toxicity. After 3 years of treatment with ddI-3TC-EFV, more than 40% of the patients were still receiving the initial antiretroviral therapy with sustained, durable immunovirological benefit and good acceptance. Long-term toxicity and virological failure were low.

Assessment of care by breast cancer patients participating or not participating in a randomized controlled trial: a report with the Patients' Committee for Clinical Trials of the Ligue Nationale Contre le Cancer.

PURPOSE: Cancer patients participating in randomized controlled trials (RCTs) have not been found to have better clinical outcomes than other patients. Our objective was to assess the impact of RCTs on patients' satisfaction with care. PATIENTS AND METHODS: A prospective study was carried out in a cohort of women with breast cancer (N = 455) divided into those invited to participate in an RCT (201 acceptances, 66 refusals) and a comparable control group not invited to participate (n = 188). All the patients underwent the same treatment (fluorouracil, epirubicin, and cyclophosphamide 100 mg/m2 for six cycles). One and 7 months after the beginning of chemotherapy, self-administered satisfaction scores were used to compare the women's assessment of their care (Comprehensive Assessment of Satisfaction with Care validated scale). RESULTS: At the beginning of chemotherapy, women to whom RCT had been proposed rated the doctors' availability (average +/- standard deviation [SD]: RCT acceptance group, 3.60 +/- 0.78; RCT refusal group, 3.68 +/- 0.87; control group, 3.41 +/- 0.82; P < or = .02) and the doctors' communication (average +/- SD: RCT acceptance group, 3.56 +/- 0.88; RCT refusal group, 3.67 +/- 0.88; control group, 3.39 +/- 0.84; P .05) higher than those to whom the trial was not proposed. After the treatment, participants in the RCT felt that their doctor was more supportive (average +/- SD: RCT acceptance group, 3.04 +/- 0.92; control group, 2.77 +/- 0.85; P = .005) and more informative about their illness and treatment (average +/- SD: RCT acceptance group, 3.34 +/- 0.88; control group, 3.08 +/- 0.92; P = .006) than those in the control group. The general level of satisfaction was also higher in the RCT acceptance group. CONCLUSION: Women participating in an RCT have a more positive picture of their doctors' care than others, probably because of the structural effects of the informed consent and data collection processes.

Conhecimento da agenda estadual de saúde pelos diretores e coordenadores de serviço dos distritos sanitários de Brotas e subúrbio ferroviário / The level of knowledge of the state's health agenda by directors and coordinators of the districts of Brotas and Suburbio Ferroviario

Este estudo apresenta uma avaliação acerca do conhecimento dos Diretores e Coordenadores de Serviço das Unidades de Saúde dos Distritos Sanitários de Brotas e Subúrbio Ferroviário do Município de Salvador sobre a Agenda Estadual de Saúde de 2004. Foi realizada uma pesquisa qualitativa, nos Distritos Sanitários de Brotas e Subúrbio Ferroviário, Salvador, em 2005. Os indicadores escolhidos foram a Redução da Mortalidade Infantil e a Redução da Mortalidade Materna. A análise dos dados demonstrou que os Diretores e Coordenadores de Serviço das unidades de saúde desconhecem a Agenda. O maior percentual de conhecimento foi apresentado pela unidade Azul, devido a sua especificidade. Apesar do desconhecimento do instrumento de gestão entre os entrevistados, algumas ações estratégicas estão sendo executadas por coincidirem com a demanda da própria unidade e orientações da Diretoria.

Pathological and virological assessment of acute HTLV-I-associated myelopathy complicated with encephalopathy and systemic inflammation.

HTLV-I-associated myelopathy, also known as tropical spastic paraparesis (HAM/TSP), is a chronic inflammatory disease of the spinal cord. Acute cases are uncommon. We report the case of a 41-year-old woman with acute HAM/TSP complicated with encephalitis, an intense inflammatory reaction of the nervous system and lymphocytic infiltration of skeletal muscles, liver, salivary, adrenal and pituitary glands. The immunohistochemical studies of the lymphocytes surrounding blood vessels showed both B- and T-lymphocytes, in similar proportion, with both CD4- and CD8-positive cells. In addition, many perivascular and scattered macrophages were observed. Adult T-cell leukemia/lymphoma (ATL) was ruled out. The marrow aspirate was normal. Serial cerebrospinal fluid (CSF) analysis showed presence of HTLV-I antibodies, but without intrathecal synthesis of specific antibodies. Determination of HTLV-I viral loads demonstrated increased levels in the CSF relative to the peripheral blood and may be associated with widespread inflammation. The pathological and immunological findings may help understand the role of immune-reactive cells in the pathogenesis of HTLV-I-associated myelopathy.

Seguridad social / Social security

Trabajo presentado durante el ano social obligatorio en la Clinica Infantil Colsubsidio. La seguridad social se considera como la agrupacion de normas y leyes orientadas y dirigidas por organismos competentes cuyo objetivo es otorgar el derecho a la seguridad social y proteccion en aspectos sociales, culturales recreativos etc. La seguridad social es tan antigua como el hombre mismo. y ha ido evolucionando a traves de la historia hasta lograr actualmente una organizacion legal obligatoria por medio de la cual se deben afiliar todos lo trabajadores en todos los niveles. En Colombia ha habido diversas leyes relacionadas con la seguridad social.El subsidio familiar es una forma de seguridad social y en Colombia constituye una forma de proteccion al individo y a su familia y es pagadera en dinero o especie de acuerdo al numero de personas que este tenga a su cargo.En el comportamiento humano es fundamental la satisfaccion de las necesidades humanas desde las primarias hasta la mas altas en jerarquia y van siguiendo un proceso ascendente para lograr un optimo desarrollo humano..