Evaluation of the impact of live pig trade network, vaccination coverage and socio-economic factors in the classical swine fever eradication program in Peru.

Classical swine fever (CSF) is a viral infectious disease of swine with significant economic impact in the affected countries due to the limitation of trade, culling of infected animals and production losses. In Latin America, CSF is endemic in several countries including Ecuador, Bolivia, Brazil and Peru. Since 2010, the National Veterinary Services of Peru have been working to better control and eradicate the disease with an intensive vaccination program. The aim of this study was to evaluate the effectiveness of the vaccination program and determine which factors are still contributing to the persistence of the disease in certain regions of Peru. We integrated the data from the vaccination campaign, the live pig movement network and other socioeconomic indicators into a multilevel logistic regression model to evaluate their association with CSF occurrence at district level. The results revealed that high vaccination coverage significantly reduces the risk of CSF occurrence (OR = 0.07), supporting the effectiveness of the vaccination program. Districts belonging to large and medium pig trade network communities (as identified with walktrap algorithm) had higher probability to CSF occurrence (OR = 2.83 and OR = 5.83, respectively). The human development index (HDI) and the presence of a slaughterhouse in the district was also significantly associated with an increased likelihood of CSF occurrence (OR = 1.52 and OR = 3.25, respectively). Districts receiving a high proportion of the movements from districts that were infected in the previous year were also at higher risk of CSF occurrence (OR = 3.30). These results should be useful to guide the prioritization of vaccination strategies and may help to design other intervention strategies (e.g., target education, movement restrictions, etc.) in high-risk areas to more rapidly advance in the eradication of CSF in Peru.

Estudio de costo del tratamiento de la aspergilosis invasora en pacientes oncológicos pediátricos: Santiago. Chile / Economical evaluation of the treatment of invasive aspergillosis in pediatric oncology patients: Santiago. Chile

Introducción: La aspergilosis invasora (AI) es una infección oportunista grave en pacientes inmunocompro- metidos. Pacientes receptores de transplantes y oncológicos representan el grupo de mayor riesgo. El tratamiento antifúngico involucra hospitalización prolongada y altos recursos económicos. Objetivo: Estimar los costos involucrados en el tratamiento de la AI como complicación intercurrente en pacientes con cáncer. Pacientes y Método: Estudio caso-control, retrospectivo. Estima el costo del tratamiento de AI en pacientes pediátricos oncológicos del Hospital Luis Calvo Mackenna durante los años 2007 y 2008. Resultados: Se incluyeron 13 pacientes con AI y sus respectivos 13 controles. El costo atribuible de la hospitalización en aquellos pacientes que cursaron con AI fue de US $23.600. El costo atribuible para cada indicador fue: US $16.500 para días de hospitalización; US $7.000 para medicamentos antifúngicos y US $100 para galactomanano sérico. Discusión: En este estudio, el costo del tratamiento de AI se debe principalmente a la estadía hospitalaria y fármacos antifúngicos. Encontramos tres pacientes que desarrollaron AI estando en ambiente protegido.

Introduction: Invasive aspergillosis (IA) is a serious opportunistic infection in immunocompromised patients. Transplant recipients and patients with cancer represent the highest risk group. The antifungal treatment involves prolonged hospitalization and high economic resources. Objective: to estimate costs represented by IA as an intercurrent complication of oncologic treatment. Patients and Method: Retrospective case-control study. Estimation of the cost of treatment in pediatric oncologic patients with IA in the Hospital Luis Calvo Mackenna during the years 2007-2008 was done. A control for each case of IA paired by sex, age, number of diagnosis and clinical department was selected. Results: There were 13 patients during the observation period. The attributable cost of treatment of aspergillosis was US $ 23,600 and the cost for each indicator was: hospital days US $ 16,500; antifungal therapy US $ 7,000; and serum galactomannan US $ 100. Discussion: In this study, the cost of treating IA is mainly due to hospitalization and antifungal medications. Three patients acquired IA in spite of staying in a protected environment.

[Neuromotor assessment of patients with spastic cerebral palsy treated with orthopedic surgery at the National Rehabilitation Institute]. / Evaluación neuromotora de pacientes con parálisis cerebral espástica tratados con cirugía ortopédica en el Instituto Nacional de Rehabilitación.

BACKGROUND: Cerebral palsy (CP) is a static neurologic condition resulting from a brain lesion occurring before the completion of brain development. The goal of management is not cure, but increasing patients' functionality and improving their capabilities and maintaining their locomotion, cognitive development, social interaction and independence. The best results are obtained with an early and intensive management that includes physical and occupational therapy, medical and surgical treatments, mechanical aids and the management of concomitant conditions. OBJECTIVE: To assess the neuromotor improvement in patients with spastic CP after surgical treatment at the National Rehabilitation Institute. PATIENTS AND METHODS: Patients with a diagnosis of spastic CP who presented at the Pediatric Rehabilitation outpatient service were referred to the Joint CP Clinic from January 2007 to January 2008, and underwent surgical treatment of the pelvic limbs. They were assessed 3 times and underwent neuromotor tests with gross motor function measure (GMFM), which was rated with the gross motor function classification system (GMFCS). RESULTS: Most of the patients had improvement in the muscle tone and contracture assessments as well as in the GMFM, and their self-mobility increased one level. CONCLUSIONS: Significant improvements were seen in the muscle tone and contractures after surgery; the GMFM and the self-mobility levels in the GMFCS also improved. Multiple level surgery together with a postoperative physical therapy program results in considerable improvements in the gross motor function measure of patients with spastic CP.

Different acute tolerance development to EEG, psychomotor performance and subjective assessment effects after two intermittent oral doses of alprazolam in healthy volunteers.

BACKGROUND/AIMS: Benzodiazepines (BZDs) are the most effective of the psychotropic drugs in the treatment of anxiety disorders. Tolerance has been reported for the majority of BZDs after chronic administration. However, little attention has been paid to the possibility that tolerance might be present after the intermittent oral administration of BZDs. The objectives of the present study were to assess tolerance development after the administration of two intermittent single oral doses of alprazolam given 15 days apart in healthy volunteers, and to compare the results obtained using measures from different domains: neurophysiological, psychomotor and subjective. METHODS: Twenty-four healthy volunteers received 2 mg of alprazolam orally on two experimental days, 15 days apart. Plasma concentrations and pharmacodynamics (PD) were assessed before drug intake and at different times in the following 24 h. PD was assessed through EEG (relative alpha and relative beta-1 activities), cancellation task (total and correct number of responses) and visual analogue scales (activity and drowsiness). RESULTS: No differences were observed in the PKs of alprazolam between occasions. A proteresis was present in both administrations for impairments of psychomotor performance and relative beta-1 activity, whereas it was present only after the second administration for subjective assessments and relative alpha activity. The proteresis on the second occasion was higher than on the first one. CONCLUSIONS: The administration of two single oral doses of alprazolam, 2 weeks apart in healthy volunteers, yielded the same PKs on both occasions, but significant changes were observed in the PD profile. Acute tolerance was observed after the second administration. Two patterns of acute tolerance development were obtained: (1) impairments of psychomotor performance and relative beta-1 activity, and (2) subjective assessments and relative alpha activity.

[Assessment of the presence of mutations of the epidermal growth factor receptors in tumors of various histologies]. / Valutazione della presenza di mutazioni del recettore dell'epidermal growth factor in tumori di varia istologia.

Recent reports from US and Japan have established that mutations in the tyrosine kinase (TK) domain of the epidermal growth factor receptor (Egfr) occur in a subset of patients with lung cancer that respond to therapy with gefitinib, a TK inhibitor. To gain further insights into the role of Egfr in carcinogenesis of lung and tumors of diverse histology, that are currently under investigation with drugs of the same class, we have taken in examination a panel of tumors consisting in 110 pulmonary adenocarcinomas, 40 pulmonary squamous carcinomas, 40 gastric adenocarcinomas and 40 colorectal adenocarcinomas. The sequence analysis of exon 19 and 21 of the Egfr has allowed the identification of 10 cases exhibiting specific deletions in exon 19 and 1 case with point mutation in a conserved residue in exon 21. All Egfr mutations occur specifically in lung adenocarcinomas while tumors of different histology result unaffected. The rate of mutation affecting these other tumors is either very rare, involves different domains of the receptor or other tyrosine kinases. The molecular analysis of the Egfr gene can help identify patients that will benefit from gefitinib therapy.

[Lung scintigraphy with technetium 99m depreotide in the assessment of solitary pulmonary nodules]. / La gammagrafía con 99mTc-depreótida en la valoración del nódulo pulmonar solitario.

A solitary pulmonary nodule (SPN) is defined as a parenchymal lesion measuring less than 3 cm in diameter that is not associated with other lesions. Ninety percent of SPNs are discovered incidentally and most are benign. The management of radiographically indeterminate SPNs has not been established and invasive procedures must be undertaken in order to understand the nature of the nodule. We review our experience with the use of somatostatin receptor scintigraphy with technetium Tc99m depreotide in 10 patients with suspected malignant SPN. We discuss the limitations and applications of this technique in the evaluation of whether SPNs are benign or malignant for the purpose of identifying patients for biopsy. For this application, this technique can be considered an alternative to positron emission tomography using fluorine-18 fluordeoxyglucose.

Psychosocial factors associated with cancer behavioural risk in relatives of cancer patients.

The European Code against Cancer includes some primary cancer prevention behaviours, which can be studied in the framework of psychosocial models of human behaviour as the ASE model (attitude-social influence-efficacy model). The objective of this study was to detect the factors that better explain cancer behavioural risk in relatives of cancer patients. A convenience sample of 3031 people was selected in primary care centres. A three-step multivariate analysis was carried out by means of a multiple linear regression, introducing cancer behavioural risk as the dependent variable and the following covariables: psychosocial factors in the ASE model, sociodemographic variables and the family history of cancer. At least five difficulties and four needs were perceived in following the preventive advice by 25% of patients. The main difficulties were tobacco and alcohol addiction and the demands of a social life. Principal needs were access to cessation programmes, family support, and being controlled and pressured by health workers. The highest risk profile is to be a young man with a low sociocultural level. The ASE determinants were the best predictors of cancer behavioural risk, so programmes that forget these predictors may not achieve any impact and may waste resources.

Regression models to predict water-soil heavy metals partition coefficients in risk assessment studies.

Risk assessment studies apply fate and transport models to predict the behaviour of chemicals in the environment. The definition of physico-chemical properties is crucial to predict the mobility of pollutants and heavy metals in particular within the environmental compartments. The conservative approach normally adopted at a screening level in attributing a value to the K(d) value, results in an extremely variable mobility in soil. In this paper a regression model to estimate rapidly the K(d) for heavy metals is proposed and applied to Pb, allowing a considerable reduction (3-4 orders of magnitude) of the estimation uncertainty. The application of a stepwise forward multiple regression to literature data provided a pH-dependent regression equation of the soil-water distribution coefficient (K(d)) for Pb: log K(d)=1.99+0.42 pH.

Valoraçäo da influência dos ritmos circadianos nop rendimento desportivo de velocistas / Valuation of the influence of the circadian rhythms in the athletic

Neste trabalho estuda-se a influência que os ritmos circadianos exercem no rendimento desportivo de velocistas em provas de 50 metros rasos. Para isso, 13 velocistas seguiräo um estrito protocolo que fixa os horários de sono/vigília, refeiçöes e controle de variáveis (rendimento em velocidade, teste de Bosco, testes de auto-estima psíquica e física e temperatura corporal) durante 3 dias näo consecutivos. No primeiro dia, segui-se o horário base, enquanto que no segundo (dia de antecipaçäo) e terceiro (dia de atraso) se adiantou e atrasou o mesmo horário em 2 horas, respectivamente. Da análise dos resultados deduz-se que o momento máximo de rendimento em velocidade se produz à tarde (19 horas). Existe uma maior dificuldade ao modificar os picos de máximo rendimento no sentido de antecipar, registrando um deterioro estatisticamente significativo do rendimento médio do dia de antecipaçäo em relaçäo ao dia de controle. Por último, o teste de Bosco, o teste de auto valoraçäo psíquica e física apresentaram uma relaçäo muito direta com o rendimento em velocidade pelo que podem ser empregues em autorritometria.

Valoracion de la influencia de los ritmos circadianos en el rendimiento deportivo de velocistas / Circadian variation in sports performance

O objetivo deste estudo foi caracterizar as reservas energéticas de metabólicos fosforilados no músculo esquelético de atletas, mediante espectroscopia de 31P-MRS.A amostra deste estudo foi formada por 14 atletas de alto nível, do Centro de Auto-Remdimento Esportivo (CAR, Sant Cugat del Vallés, Espanha).O padräo de metabólicos fosforilados foi medido no músculo vasto medial por 31P-MRS. A suplementaçäo oral foi realizada durante 14 dias, na forma de 20 g de monohidrato de creativa. Os atletas foram determinados conforme as suas características físicas (peso, altura, índice de massa corporal (IMC), VO2 max.)em dois grupos: placebo (maltodextrina) e suplementaçäo com creatina. O protocolo de exercício foi realizado no interior do túnel de ressonância (160 x 52cm), a 60 ciclos por minuto para ambas as pernas. Conclui-se que o exercício realizado pelos fundistas no CDP permitiu detectar mediante 31 PMRS, uma diminuiçäo do consumo de PCr durante os períodos de exercício, devido a suplementaçäo com creatina

Paediatric hip--ultrasound screening for developmental dysplasia of the hip: a review.

This paper will try to deal with the following questions: Which is the correct screening model for the developmental dysplasia of the hip (DDH)? What is the clinical significance of "sonographic" DDH? Can overtreatment produced by ultrasound (US) screening cause a waste of resources and eventually morbidity? We reviewed the literature since January, 1996 through December, 2000. To compare our experience with the literature, we analysed the results of the US examinations of the hip performed in our Institute. Over 4 years of US screening 11326 infants (22652 hips), aged 3 days to 4 months, were examined consecutively. Sonographic hip findings were abnormal in 531 infants (4.7%). The screening showed 381 subjects (3.36% of the population) with a type IIa hip (bilateral or unilateral); 65% of these infants were normal at follow up and only 35% worsened. On the whole we treated 282 infants (2.5%). No open reduction was performed. Avascular necrosis appeared in 2/282 treated cases (1.06%). We support the routine generalised US screening of neonatal hips. The excess of doubtful cases and, consequently, of the extra referrals may be limited, and the overtreatment decreased to the lowest rates reported by optimisation of everyone's approach.

Measuring "hang time": contamination of intra-arterial flush solutions over time.

This study reports on improved patient care through procedures that reduce the likelihood of hospital-acquired infections. This investigation found that longer "hang times" for nurse-prepared intra-arterial flush solutions did not significantly increase the patient's risk of infection. In addition, the article details cost savings and procedures to better manage nurses' time.

Mealiness assessment in apples and peaches using MRI techniques.

Mealiness (woolliness in peaches) is a negative attribute of sensory texture that combines the sensation of a desegregated tissue with the sensation of lack of juiciness. In this study, 24 apples cv. Top Red and 8 peaches cv. Maycrest, submitted to 3 and 2 different storage conditions respectively have been tested by mechanical and MRI techniques to assess mealiness. With this study, the results obtained on apples in a previous work have been validated using mathematical features from the histograms of the T2 maps: more skewed and the presence of a tail in mealy apples, similar to internal breakdown. In peaches, MRI techniques can also be used to identify woolly fruits. Not all the changes found in the histograms of woolly peaches are similar from those observed in mealy apples pointing to a different underlying physiological change in both disorders.

Mealiness assessment in apples using MRI techniques.

Small samples of Top Red apples stored 6 months under controlled atmosphere (expected to be non-mealy) and 2 degrees C (expected to be mealy) have been used for MRI imaging. Multi-slice-multi-echo magnetic resonance images (64*64 pixels) have been recorded with a 8 ms echo time. Three out of four apples corresponding to the sample maintained under controlled atmosphere did not developed mealiness while three out of four fruits corresponding to the sample stored at 2 degrees C became mealy after 6 months of storage. The minimum T2 values obtained for the mealy apples show to be significantly lower (F = 13.21) when compared with non-mealy apples pointing that a more desegregated structure and a lower juiciness content leads to lower T2 signal. Also, there is a significant linear correlation (r = -0.76) between the number of pixels with a T2 value below 35 ms within a fruit image and the deformation parameter registered during the Magness-Taylor firmness test. Finally, all T2 maps of mealy apples show a regional variation of contrast which is not shown for non-mealy apples. Significant differences (F = 19.43) between mealy and non-mealy apples are found in the histograms of the T2 maps as mealy apples show a skew histogram combined with a "tail" in their high T2 extreme which is not shown in the histograms of non-mealy apples. These histogram features are also shown for an apple showing internal breakdown indicating that in mealy apples there is a differential water movement that may precede internal breakdown.

A randomized trial of the impact of certified mail on response rate to a physician survey, and a cost-effectiveness analysis.

This study's goals were to (a) determine whether sending a survey by certified mail results in a higher response rate from physicians compared to sending by first-class mail and (b) evaluate the cost-effectiveness of this method. The study sample was 409 physicians who were nonrespondents to two previous mailings of a medical specialty society survey. Eligible physicians were designated at random to receive a final mailing either by U.S. Postal Service certified mail including a return-receipt postcard or by first-class mail. There was a higher response rate from the certified mail group compared with the first-class mail group (41.3% versus 24.8%; relative risk = 1.66, 95% Confidence interval 1.25, 2.21). A cost-effectiveness analysis showed that the cost per respondent was higher using certified mail versus first-class mail in the third mailing ($2.77 versus $2.34). Thus, use of certified mail is effective in increasing survey response but more costly.

Influenza vaccination in 22 developed countries: an update to 1995.

This study expands and updates through 1995 our earlier report on influenza vaccine use in 18 developed countries. Five of the six countries with high levels of vaccine use in 1992 (> or = 130 doses/1000 population) showed little change or slight declines over the subsequent 3 years. The exception was the United States, where a new federal program for vaccination reimbursement for the elderly helped to increase vaccine distribution from 144 to 239 doses/1000 population. The six countries with medium levels of vaccine use in 1992 (76-96 doses/1000 population) increased to > or = 100 doses/1000 population by 1995. Among the six low-use countries in 1992 (< or = 65 doses/1000 population), only Finland showed substantial improvement (96 doses/1000 population) in 1995. Four new countries were added to the study. In Germany, vaccine use increased to 80 doses/1000 population in 1995, but in Ireland it remained at a low level (48 doses/1000 population). In Korea, vaccine use increased from 17 to 95 doses/ 1000 population during the period 1987-1995. In Japan, very high levels of vaccine use (approximately 280 doses/1000 population) in the early 1980s were associated with vaccination programs for school children. However, vaccine use fell precipitously when these programs were discontinued, and only 2 and 8 doses/1000 population were used in 1994 and 1995, respectively. In all 22 countries, higher levels of vaccine use were associated with vaccination reimbursement programs under national or social health insurance and were not correlated with different levels of economic development. Excluding Japan, in 1995 there was still a greater than fourfold difference between the highest and lowest levels of vaccine use among the other 21 countries in the study. Given its well established clinical effectiveness and cost-effectiveness, none of these countries has yet achieved the full benefits of its programs for influenza vaccination.

[Comparison of five methods of disinfection of disposable Petri dishes]. / Comparacíon de cinco métodos de desinfeccíon de cajas de Petri desechables.

The use of disposable materials in the clinical laboratories has significantly reduced the use of glass and other reusable materials, due to their low cost. However, the increase in its price has demanded to reuse them in laboratories from developing countries. The purpose of this prospective and parallel trial was to determine the efficacy of disinfection of five procedures among 7088 Petri dishes (PD) filled with selective media for Gram negative organisms (MacConkey, XLD and Salmonella-Shigella agar) in comparison with 2150 new PD. The first procedure was a strong washing with detergent (1821 PD); the second was the same method followed by immersion in a warm (50-60 degrees C) sodium hypochlorite solution (0/6%) (2127 PD); the third was similar to the former and followed by microwave irradiation at 700 watts for 15 min (1542 PD); the fourth was a rinse with warm (50-60 degrees C) tap water followed by microwave irradiation (958 PD), and the fifth was a rinse with warm tap water (640 PD). The following results were obtained: the rate of contamination was 0.165, 0.2, 0.07, 0.8, 1.4 y 0, respectively; the cost of labor on 1000 PD 10.7, 15.8, 22.4, 9.3, 2.7 y 103.5 US dollars;the initial investment 136.7, 139.5, 623.5, 613, 128.7 y 103.5 US dollars; the time of performance (hours) 5.5, 9.8, 18.3, 13.5, 5 y 0; the number of reused PD to amortise the initial investment 1324, 1350, 6038, 5937, 1247 and no value; and the saving per thousand PD was 92.5, 82.5, 80.7, 93.9, 100.4, and 0 US dollars. Our data show that: procedures 1,2 and 3 were more efficacious than procedures 4 and 5 (p is less than 0.001); although, the third procedure had less contamination the initial investment and the small potential saving do not support its use, and the first and the second methods may be reliable procedures for disinfection of PD as part of a program of reusing disposable medical devices.

[Advertising, advertising legislation and health]. / Publicidad, legislación publicitaria y salud.

The media and specifically magazines and sunday supplements contain advertisements, some of which can be dangerous to one's health. We have investigated these types of advertisements, which were included in the 15 top sales magazines in Spain. The period of analysis corresponded to the period april-may, 1991. We have compared the results obtained with the results of a previous investigation carried our in 1987, using an identical method. We have tried to test if the so-called Law of Publicity of 1988 has had any effect on publicity. We have found, 1383 advertisements that could have a damaging effect on one's health. Although the total number of advertisements have decreased over this four year period, the law has hardly produced any influence on publicity, and we have found breaking of the law in the investigated material.

Hospital cost development in coronary bypass surgery.

The rapid expansion of open-heart surgery together with steadily rising costs of health services has elicited criticism against uncontrollably expanded costs of coronary bypass surgery. However, critical analyses of the cost structures and the attempts for cost containment can only rarely be found in medical literature. This study emphasizes self-evident surgical principles which have led to surprisingly high cost reductions. Further savings can be obtained by constant financial education of the surgical staff, in spite of some controversial experiences gained elsewhere. The conditions needed are more accurate, up-to-date hospital bookkeeping and closer contacts between the hospital administration and the medical staff.

Direct hospital costs in coronary bypass surgery.

The direct hospital costs of 100 coronary artery bypass grafting operations are calculated. The basis of the calculations is the detailed, function-based, market-priced analysis of the files, including the hospital deaths, complication and reoperations of this patient group. The price of a CABG operation proved to lie somewhere between FIM 30,000 and 50,000, the mean value being FIM 46,800. The variation range is wide: FIM 18,200-FIM 249,500 (SD +/- FIM 26,000). It must be emphasized, however, that all preoperative hospital costs including coronary angiography costs and also postoperative follow-up hospital costs fall beyond this study.