Efeitos políticos na descontinuidade do orçamento participativo em municípios / Efectos políticos sobre la discontinuidad del presupuesto participativo en los municipios / Political effects on the discontinuation of participatory budgeting in municipalities

Resumo O artigo analisa fatores associados à descontinuidade do orçamento participativo (OP) em municípios brasileiros acima de 50 mil habitantes no período entre 2000 e 2016. A pesquisa foi analisada pela estimação de modelos econométricos com foco em variáveis explicativas políticas e pela propensão do ambiente local à participação. Os resultados indicam que a descontinuidade está associada positivamente com a troca do partido do prefeito municipal entre as eleições, a despeito da ideologia do partido; positivamente com a troca da ideologia do partido do prefeito, com a entrada de partidos de esquerda; negativamente com a entrada de partidos com outras ideologias; e positivamente com a troca entre partidos de esquerda. A descontinuidade não apresentou efeito com a troca entre partidos com outras ideologias. Os resultados indicam fatores locais e contextuais explicativos para a descontinuidade do OP, permitindo direcionar desenho de políticas públicas participativas e levantando reflexividade sobre mecanismos que devem ser adotados localmente para que não ocorra a descontinuidade, além de contribuir para a literatura ao demonstrar a associação entre a descontinuidade com a troca de partidos da esquerda, o que pode suscitar pesquisas futuras, dado que o resultado não era esperado.

Resumen El artículo analizó factores asociados a la discontinuidad del presupuesto participativo (PP) en municipios brasileños con más de 50.000 habitantes, en el período 2000-2016. La discontinuidad se analizó mediante la estimación de modelos econométricos con enfoque en variables políticas explicativas y la propensión del entorno local a participar. Los resultados indican que la discontinuidad se asocia: (i) positivamente con el cambio de partido del alcalde entre elecciones, independientemente de la ideología del partido; (ii) positivamente con el cambio de ideología del partido de la alcaldía, con la entrada de partidos de izquierda; (iii) negativamente con la entrada de partidos con otras ideologías; (iv) positivamente con el intercambio entre partidos de izquierda. La discontinuidad no tuvo efecto con el intercambio entre partidos con otras ideologías. Los resultados contribuyen al señalar factores locales y contextuales que explican la discontinuidad del PP, permitiendo orientar el diseño de políticas públicas participativas y planteando la reflexión sobre los mecanismos que deben ser adoptados localmente para que no ocurra la discontinuidad. También contribuye a la literatura al demostrar la asociación entre la discontinuidad y el intercambio de partidos de izquierda, lo que puede impulsar futuras investigaciones, dado que el resultado no era el esperado.

Abstract The article analyzes the factors associated with the discontinuation of participatory budgeting (PB) in Brazilian municipalities with more than 50,000 inhabitants between 2000 and 2016. We used econometric models to estimate PB's discontinuation based on political explanatory variables and people's local participation. The results indicate that discontinuation is associated: (i) positively with the election of a different local government, regardless of the winning party's ideology; (ii) positively with the election of a local government with a left-wing ideology'; (iii) negatively with the election of a non-left-wing local government; (iv) positively with the election of a left-wing local government replacing another left-wing government. Changes in local government where other non-left-wing parties replace non-left-wing parties had no significant effect on discontinuation. The results contribute to our knowledge by showing the local and contextual factors that explain the discontinuation of participatory budgeting; this should help guide the design of participatory public policies and allow practitioners to reflect on the mechanisms that could be adopted locally to avoid discontinuation. The article also contributes to the literature by demonstrating the association between discontinuation and changes in left-wing local governments, which may prompt future research, given the unexpected result.

A variável raça/cor em estudos epidemiológicos brasileiros sobre atividade física (2015-2019): formas de estratificação e principais resultados / La variable raza/color en estudios epidemiológicos brasileños sobre actividad física (2015-2019): formas de estratificación y principales resultados / The race/color variable in brazilian epidemiological studies of physical activity (2015-2019): forms of stratification and main results

Objetivou-se verificar como tem sido estratificada a variável raça/cor em estudos brasileiros que tiveram a atividade física (AF) como variável dependente e a associação entre a raça/cor com a atividade física no tempo livre (AFTL). Foram encontrados 20 estudos e nove formas de estratificação, sendo a mais comum: branco, pardo, preto. A ria "branco" esteve em todos os estudos. Doze trabalhos analisaram a relação da raça/cor com a AFTL e cinco destes observaram alguma associação, variando conforme faixa etária. Conclui-se que a raça/cor tem sido investigada de maneira diversa, que menos da metade dos estudos observaram alguma relação com a AFTL e que nos estudos que observaram associação, a direção foi diferente, dependendo da faixa etária (AU).

The objective was to verify how the race/color variable has been stratified in Brazilian studies that had physical activity (PA) as a dependent variable and the association between race/color with leisure-time physical activity (LTPA). In the 20 studies found, nine forms of stratification were observed, the most used being: white, brown, black. The "white" category was included in all studies. Twelve studies analyzed the relationship of race/color with LTPA and five of these observed some association, varying according to age group. Conclude that race/color was investigated in different ways, that less than half of the studies observed some relationship with LTPA and that in studies that observed an association, the direction of this was different depending on the age group (AU).

El objetivo fue verificar cómo se estratificó la variable raza/color en estudios brasileños con la actividad física (AF) como variable dependiente y la asociación entre raza/color con la actividad física en el tiempo libre (AFTL). Fueron encontrados 20 estudios y observadas nueve formas de estratificación, siendo las más utilizadas: blanco, marrón, negro. La categoría "blanca" estaba en todos los estudios. Doce artículos analizaron la relación de raza/color con AFTL y cinco de ellos observaron alguna asociación, cambiando según la edad. Concluye que la raza/color fue investigado de diferentes formas, que menos de la mitad de los estudios observaron alguna relación con la AFTL y los estudios que observaron una asociación, la dirección de esta fue diferente según el grupo de edad (AU).

Immunohistochemical assessment of lymphatic vessels in human livers with chronic hepatitis C ­ relation to histological variables

Background Viral hepatitis C is a significant public health challenge. The disease may remain clinically silent in both acute and chronic forms, and chronic infections may progress to advanced disease such as cirrhosis and hepatocellular carcinoma, requiring costly treatment, compromising the patient's quality of life and even leading to death. For this reason, it is one of the most frequent indications for liver transplantation. Although treatment with direct-acting antivirals represents remarkable progress, many patients are still infected and even those who cleared the viral infection must be followed due to their previous hepatic lesions, especially regarding the disturbances of lobular architecture and the sanguineal and lymphatic vessels. Objective To assess immunohistochemical aspects of lymphatic sprouts and mature lymphatic vascularity with histological variables of liver injury attributable to hepatitis C virus (HCV) and fatty disease. Methods The present study included 72 liver biopsies of cases with chronic hepatitis C. Morphologic changes reflecting "staging" and "activity" were analyzed. Immunohistochemical reactions were performed with monoclonal antibody D2-40 anti-podoplanin. Major histological variables were also semiquantified so as to enable the search for possible associations among histological and Immunohistochemical criteria, as well as with genotypes 1 and 3 of HCV. Results Histological findings showed that the different degrees of strutural changes were well represented in this casuistic. Intralobular/parenchymal necro-inflammatory activity was predominantly mild to moderate. Most cases did not show major evidences of fatty disease, which was found significantly higher in cases infected with HCV genotype 3. The amount of portal lymphatic sprouts increased along with the progression of structural changes, maximal at cirrhosis. Portal lymphatic sprouts as well as portal mature lymphatic vessels also showed an increase parallel to the increase in the degree of portal/septal inflammatory infiltrate. In the present study, no significant association was found between the proportion of portal lymphatic sprouts or portal mature lymphatic vessels and the degree of periportal/periseptal activity. No significant relations were detected between lymphatic sprouts/mature vessels and periportal or parenchymal inflammatory activity, nor with infections due to HCV genotype 1 or 3. Conclusion Visualization and semiquantitation of sprouts and mature lymphatic vessels were clearly yielded by Immunohistochemical staining with monoclonal antibody D2-40. The amount of lymphatics was increased along fibrogenic process, significantly related to progression of liver disease and maximal at cirrhosis. No significant relations were detected with necro-inflammatory activity at interface or in the parenchyma.

Fatores associados ao nível de segurança alimentar e nutricional no município e estado de São Paulo e no Brasil: uma análise dos resultados obtidos pela escala brasileira de insegurança alimentar / Food and nutritional security level associated factors in the city and state of São Paulo and in Brazil: an analysis of obtained results from the Brazilian food insecurity scale

A falta de segurança alimentar e nutricional (SAN) consiste em um fenômeno multifatorial, que pode afetar o estado nutricional do indivíduo por ela acometido de diversas maneiras e em qualquer faixa etária. A falta de SAN pode desencadear tanto desnutrição, como obesidade e assim favorecer o aumento da prevalência de doenças crônicas não transmissíveis, o que diminui a qualidade de vida e se constitui um importante problema de saúde pública. Objetivo: Analisar e comparar a força da associação dos fatores socioeconômicos e demográficos à segurança alimentar e nutricional (SAN) no Brasil e áreas geográficas selecionadas. Metodologia: Trata-se de um estudo ecológico, transversal e analítico, que utilizou como base os microdados da Pesquisa de Orçamento Familiar (POF/IBGE), realizada nos anos de 2017-2018, envolvendo 757 famílias residentes no município de São Paulo (MSP), 3.406 famílias do estado de São Paulo (ESP) e 49.365 famílias do Brasil. Utilizou-se a técnica de regressão logística multinomial, do tipo ordinal, para o processamento do modelo de associação entre o nível de SAN (nSAN) e as variáveis demográficas, socioeconômicas e clínicas, utilizando o módulo survey do Stata versão 14. Adotouse o nível de significância estatística de 5% e o odds ratio proporcional para descrever as associações. Resultados: A grande maioria dos indivíduos de referência dos domicílios componentes da amostra é do sexo masculino, adulta, com obesidade, sem seguro saúde e que não fazem nenhum tipo de dieta, variando as características de raça/cor e escolaridade entre as três localidades analisadas. Para as três localidades estudadas, encontrou-se proporções elevadas da população com segurança alimentar e nutricional garantida (acima de 59%). As associações encontradas demonstraram que as famílias com pessoas de referência do sexo feminino apresentam maior chance de piora do nSAN, bem como aquelas com menores níveis de saneamento básico e estratos de renda mais pobres, para os quais a chance de piora do nSAN em relação aos estratos de renda mais ricos se eleva em até 12 vezes. Ser de raça branca foi fator protetor à IAN, bem como ter idade mais avançada e mais anos de escolaridade. Conclusão: As características sociodemográficas sexo, raçacor, idade e escolaridade, e socioeconômicas, renda e presença de saneamento básico, apresentam importante associação ao nível de SAN das famílias, quando este é analisado por meio da Escala Brasileira de Insegurança Alimentar (EBIA). Entretanto, faz-se necessária a construção de um instrumento que avalie todas as dimensões da SAN

Lack of food and nutrition security (FNS) is a multifactorial phenomenon, which can impact the nutritional status of individual affected by it in different ways and in any age group. The lack of FNS can trigger both malnutrition and obesity and thus favor the prevalence increase of chronic non-communicable diseases, which reduces lifes quality and constitutes an important public health problem. Objective: To analyze and compare the strength of association of socioeconomic and demographic factors with FNS in Brazil and selected geographical areas. Methodology: Ecological, crosssectional, and analytical study, which used the microdata of the Research as a basis Family Budget (POF / IBGE), carried out in 2017-2018, involving 757 families residing in São Paulo city (SPC), 3,406 families from São Paulo state (SPS) and 49,365 families from Brazil. Multinomial logistic regression technique, of the ordinal type, was used to process the association model between the FNS level (FNSl) and the demographic, socioeconomic and clinical variables, using the survey module of Stata version 14. It was adopted statistical significance of 5% and proportional odds ratio to describe the associations. Results: Most reference individuals in the sample's households are male, adult, obese, without health insurance and who do not follow any type of diet, varying the characteristics of race / color and education between the three locations analyzed. For the three locations studied, high proportions of the population were found with guaranteed FNS (above 59%). Associations found showed that families headed by female individuals are more likely to worsen FNSl, as well as those with lower levels of basic sanitation and poorer income strata, for which the chance of worsening FNSl in relation to strata wealthier income rises to 12 times. Being white was a protective factor for food insecurity, as well as being older and with more years of schooling. Conclusion: Sociodemographic characteristics of sex, race-color, age and education, and socioeconomic, income and presence of basic sanitation, present important association at the FNSl of families, when this is analyzed through the Brazilian Food Insecurity Scale (EBIA). However, it is necessary to build an instrument that assesses all dimensions of the FNS

Asociación entre síndrome metabólico, nivel socioeconómico y calidad de vida en mexicanos / Association between metabolic syndrome, socioeconomic status and quality of life in mexicans

Introducción: en México existe escasa información respecto al vínculo entre el síndrome metabólico (MetS), el nivel socioeconómico (NSE) y la calidad de vida (CdV) de la población. Objetivo: evaluar la asociación entre sujetos que tienen alto riesgo de desarrollar MetS con NSE y CdV. Métodos: se invitó a participar a pacientes de la UMF-2 del IMSS y del Centro Urbano-SSA Clínica-1. Se recolectaron medidas antropométricas y se aplicaron los cuestionarios AMAI, SF12 y ESF-I para NSE, CdV y MetS, respectivamente. La asociación se determinó calculando rho de Spearman. El riesgo se evaluó mediante regresión logística (razon de momios e intervalo de confianza del 95%). Resultados: la diferencia entre NSE (193  53 frente a 124  50) y CdV (86.3  14.8 frente a 56.0  25.4) fue significativa entre los grupos de bajo y alto riesgo, respectivamente (p < 0.001). Hubo una fuerte correlación negativa entre las puntuaciones de la ESF-I y NSE (rho = -0.623, p < 0.001) así como con la CdV (rho = -0.719, p < 0.001). El riesgo de MetS aumentó al disminuir el NSE (C+: OR = 6.4, IC95%: 3.2 - 13.0; D: OR = 66.1, IC95%: 23.2 - 188.3), mientras que el aumento de la CdV lo atenuó (OR = 0.93, IC95%: 0.91 - 0.94). Interesantemente, la CdV mitigó el efecto del NSE (C+: OR = 4.5, IC95%: 2.1 - 9.6; D: OR = 11.9, IC95%: 3.8 - 37.6). Conclusión: Una menor CdV y NSE aumentan el riesgo de MetS en la región centro de México; sin embargo, el aumento en la CdV podría disminuir el efecto que tiene el NSE en el desarrollo de MetS.

Background: In Mexico there is little information regarding the link between metabolic syndrome (MetS), socioeconomic status (SES) and quality of life (QoL) Objective: To assess the association between subjects who are at high risk of developing MetS with SES and QoL. Methods: Patients attending UMF-2 IMSS or Centro Urbano-SSA Clínica-1 were asked to participate. Anthropometric measures were collected, the AMAI, SF12, and ESF-I questionnaire where apply for SES, QoL, and MetS, respectively. Association were determined by calculating Spearman's rho and the risk (odds ratio and 95% confidence-interval) was assessed using logistic regression. Results: The difference of SES (193  53 vs. 124  50) and QoL (86.3  14.8 vs. 56.025.4) questionnaires were significantly between low-risk and high-risk groups, respectively (p < 0.001). There was a negative correlation between ESF-I and SES (rho = -0.623, p < 0.001) as well as the QoL (rho = -0.719, p < 0.001). MetS risk was augmented by decreasing SES (C+: OR = 6.4, 95%IC: 3.2-13.0; D: OR = 66.1, 95%IC: 23.2-188.3), whereas increasing QoL attenuated it (OR = 0.93, 95%CI: 0.91-0.94). However, QoL mitigated the effect of SES (C+: OR = 4.5, 95%IC: 2.1-9.6; D: OR = 11.9, 95%IC: 3.8-37.6).

Expanding the Scope of Implicit Personality Assessment: An Examination of the Questionnaire-Based Implicit Association Test (qIAT).

Self-report questionnaires can only yield information that people are able and willing to report, but implicit assessment methods are not commonly used in mainstream personality research. The Questionnaire-based Implicit Association Test (qIAT) was designed to address the limitations associated with the conventional self-concept IAT, and it enables an indirect assessment that is based on the items of standard self-reports. The present studies examined the psychometric properties of the qIAT across two personality constructs. Study 1 (N = 528) provided support for the internal consistency, test-retest reliability and convergent and discriminant validity of the qIAT that measured extraversion. Study 2 (N = 164) supported the reliability and validity of the qIAT assessment of conscientiousness, which predicted who returned to complete the second session of the study two weeks later, for which participants were paid in advance. This same prediction effect was marginally significant in Study 3 (N = 200), and across both Studies 2 and 3 the qIAT prediction of the criterion behavior was incremental to the parallel self-report questionnaire. Taken together, findings support the reliability and validity of the qIAT, which enables the indirect measurement of a wide variety of distinct personality constructs, currently measured only by self-report scales.

Contributions of Complexity Approaches to Innovative Forestry Development / Aportes de los enfoques de la complejidad para un desarrollo forestal innovador

RESUMEN El objetivo de este artículo fue contribuir a la reflexión sobre los aportes de la complejidad al desarrollo forestal a partir del caso peruano, lo cual podría servir como orientación para otros países de América Latina. El artículo recoge las propuestas que surgieron en tres jornadas denominadas "Complejidad y desarrollo forestal" organizadas por el Capítulo de Ingenieros Forestales del Colegio Departamental de Lima, Colegio de Ingenieros del Perú, realizadas entre 2018 y 2019. Se concluye que el enfoque disciplinario y sectorial de la administración forestal es insuficiente para abordar la complejidad de la realidad; consecuentemente para tratar el desarrollo forestal desde una perspectiva innovadora, existe la necesidad de incorporar el enfoque de la complejidad desde las ciencias de la complejidad y el pensamiento complejo que se traduzca en nuevas maneras de pensar y actuar.

ABSTRACT The objective of this article is to contribute to the reflection on the contributions of complexity to forest development, based on the Peruvian case, which could serve as a guide for other Latin American countries. The article gathers the proposals that arose in three days called "Complexity and Forest Development", organized by the Chapter of Foresters of the Departmental College of Lima of the Association of Engineers of Peru, carried out between 2018 and 2019. It was concluded that the disciplinary and sectorial approach of forest administration is insufficient to address the complexity of reality. Consequently, in order to address forest development from an innovative perspective, there is a need to incorporate the approach to complexity from the sciences of complexity and complex thinking, which translates into new ways of thinking and acting.

Índices triglicéridos-glucosa como estimadores de insulinorresistencia en personas con riesgo de desarrollar diabetes tipo 2 / Triglyceride-glucose indices as estimators of insulin resistance in people at risk of developing type 2 diabetes

EL HOMA-IR (homeostasis model assessment-insulin-resistance) es un estimador de insulinorresistencia (IR) pero depende de la determinación de insulina. Los índices triglicéridos-glucosa (T-G)-circunferencia de la cintura (CC) (T-G-CC) o triglicéridos-glucosa-índice de masa corporal (TG- IMC) podrían ser sustitutos. Los objetivos de este trabajo consistieron en investigar en personas con riesgo de desarrollar diabetes tipo 2 (DT2): a) los índices T-G, T-G-CC y T-G-IMC como estimadores de HOMA-IR>2,1; b) determinar su poder discriminante. Se realizó un estudio prospectivo en el que se estudiaron 223 individuos ≥45 años con riesgo de desarrollar diabetes tipo 2 (DT2). La relación T-G se calculó como ln [triglicéridos (mg/dL) x glucemia (mg/dL)/2]. La relación T-G-CC y T-G-IMC fue el producto de T-G por CC o IMC. Se utilizó análisis de regresión logística y se calcularon las áreas bajo las curvas ROC (receiver operating characteristic curves) (ABC) para comparar las asociaciones de T-G, T-G-CC y T-G-IMC con HOMA-IR>2,1. Mediante análisis discriminante se evaluó la clasificación de los sujetos entre HOMA-IR>2,1 y HOMA-IR≤2,1. ABC, sensibilidad, especificidad, poder predictivo positivo y negativo para T-G-CC y T-G-IMC fueron mayores que para T-G, con los siguientes valores de corte: T-G=8,75, T-G-CC=821 y T-G-IMC=255. Los odds ratios (OR) para HOMA-IR>2,1, ajustados para confusores, fueron: T-G>8,75, OR: 4,85 (IC 95% 2,73-8,62); T-G-CC>821, OR: 10,41 (IC 95% 5,55-19,53); T-GIMC> 255, OR: 10,41 (IC 95% 5,55-19,53). Con el análisis discriminante T-G>8,75 clasificó correctamente 69,2% individuos con HOMA-IR≤2,1 y 68,3% con HOMA-IR>2,1; T-G-CC y T-G-IMC clasificaron 74,4% y 78,2% respectivamente (p<0,001 en todos los casos). Se concluyó que T-GCC> 821 y T-G-IMC>255 fueron mejores estimadores de HOMA-IR>2,1 que T-G>8,75. Estas son determinaciones simples y accesibles y podrían ser útiles en la práctica clínica y en estudios epidemiológicos.

HOMA-IR ((homeostasis model assessment-insulin-resistance) is a surrogate estimator of insulin resistance (IR) but it depends on insulin determination. Triglyceride-glucose-waist circumference (T-G-WC) or triglyceride-glucose-body mass index (BMI) (T-G-BMI) could be substitutes. The objectives of this work were: to investigate in people at risk of developing type 2 diabetes (T2D): a) T-G, T-G-CC and T-G-BMI as estimators of HOMA-IR>2.1 and b) to determine their discriminating power. A prospective study was conducted studying 223 individuals ≥45 years of age at risk of developing type 2 diabetes (T2D). The T-G ratio was calculated as ln [triglycerides (mg/dL) x glycemia (mg/dL)/2]. The T-G-CC and T-G-BMI ratio was the product of T-G by CC or BMI. Logistic regression analysis was used and the areas under the receiver operating characteristic curves (ROC) curves were calculated to compare the associations of T-G, T-G-CC and T-G-BMI with HOMA-IR>2.1. Using a discriminant analysis, the classification of the subjects between HOMA-IR>2.1 or HOMA-IR≤2.1 was evaluated. AUC, sensitivity, specificity, positive and negative predictive powers for T-G-CC and T-G-BMI were higher than for T-G, with the following cut-off values: TG=8.75, T-G-CC=821 and T-G-BMI=255. Odds ratios (OR) for HOMA-IR>2.1, adjusted for confounders, were: T-G>8.75, OR 4.85 (95% CI 2.73-8.62); T-G-CC>821, OR 10.41 (95% CI 5.55-19.53); T-G-BMI>255, OR 10.41 (95% CI 5.55-19.53). With the discriminant analysis T-G>8.75, 69.2% correctly classified with HOMA-IR≤2.1 and 68.3% with HOMA-IR>2.1; T-G-CC and T-G-BMI correctly classified 74.4% and 78.2% respectively (p <0.001 in all cases). It is concluded that T-G-CC>821 and T-G-BMI>255 were better estimators of HOMA-IR>2.1 than T-G>8.75. T-G-WC and T-G-BMI are simple and reliable determinations and could be useful in clinical practice and epidemiological studies.

O HOMA-IR (homeostasis model assessment-insulin-resistance) e um estimador de resistencia a insulina (RI), mas depende da determinacao da insulina. Triglicerideos-glicose (T-G), circunferencia da cintura (CC) (T-G-CC) ou triglicerideos-glicose-indice de massa corporal (T-G-IMC) poderiam ser substitutos. Os objetivos desse trabalho foram investigar em pessoas com risco de desenvolver diabetes tipo 2 (DT2): a) os indices T-G, T-G-CC e T-G-IMC como estimadores de HOMA-IR> 2,1; b) determinar seu poder discriminante. Um estudo prospectivo foi realizado em 223 pessoas ≥45 anos com risco de desenvolver diabetes tipo 2 (DT2). A razao T-G foi calculada como ln [triglicerideos (mg/dL) x glicemia (mg/dL)/2]. A razao T-G-CC e T-G-IMC foi o produto de T-G por CC ou IMC. A analise de regressao logistica foi utilizada e as areas sob as curvas ROC (receiver operating features) ABC foram calculadas para comparar as associacoes de T-G, T-G-CC e T-G-IMC com HOMA-IR>2.1. Por meio de analise discriminante, avaliou-se a classificacao dos sujeitos entre HOMA-IR>2,1 e HOMA-IR≤2,1. ABC, sensibilidade, especificidade, poder preditivo positivo e negativo para TG-CC e TG-IMC foram maiores que para TG, com os seguintes valores de corte: TG=8,75, TG-CC=821 e TG-IMC=255. Odds Ratios (OR) para HOMA-IR>2,1, ajustados para fatores de confusao, foram: TG>8,75, OR 4,85 (IC95% 2,73-8,62); T-G-CC>821, OR 10,41 (IC 95% 5,55-19,53); T-G-IMC>255, OR 10,41 (IC 95% 5,55-19,53). Com a analise discriminante T-G>8,75, 69,2% foram classificados corretamente com HOMA-IR≤2,1 e 68,3% com HOMA-IR>2,1; T-G-CC e T-G-IMC classificaram 74,4% e 78,2%, respectivamente (p<0,001 em todos os casos). Conclui-se que T-G-CC>821 e TG- IMC>255 foram melhores estimadores de HOMA-IR>2,1 que T-G>8,75. Elas sao determinacoes simples e acessiveis e poderiam ser uteis na pratica clinica e em estudos epidemiologicos.

The nonverbal expression of power, status, and dominance.

This paper reviews the nonverbal display of power, status, and dominance (PSDom). While PSDom are theoretically and often practically separate constructs, in the domain of nonverbal behaviors (NVBs) they are more often expressed similarly. Experimental research and field observations on adult humans were harvested for this review. The goals of this review were to: (1) summarize the list of reliable NVBs of PSDom (with associated references), (2) separately report those behaviors we think are associated with PSDom from those actually associated with PSDom, (3) describe the few existing distinctions between how power, status, and dominance each display NVBs and describe new reports on NVB associated with SES, social network size, and confidence, (4) address the quandary of whether the nonverbal expression of PSDom are universal across gender and culture and (5) provide a resource for researchers wishing to code nonverbal behaviors associated with PSDom.

Model-based assessment and neural correlates of spatial memory deficits in mild cognitive impairment.

Mild cognitive impairment (MCI) is characterized by subjective and objective memory impairments within the context of generally intact everyday functioning. Such memory deficits are typically thought to arise from medial temporal lobe dysfunction; however, differences in memory task performance can arise from a variety of altered processes (e.g., strategy adjustments) rather than, or in addition to, "pure" memory deficits. To address this problem, we applied the linear ballistic accumulator (LBA: Brown and Heathcote, 2008) model to data from individuals with MCI (n = 18) and healthy older adults (HOA; n = 16) who performed an object-location association memory retrieval task during functional magnetic resonance imaging (fMRI). The primary goals were to 1) assess between-group differences in model parameters indexing processes of interest (memory sensitivity, accumulation speed, caution and time spent on peripheral perceptual and motor processes) and 2) determine whether differences in model-based metrics were consistent with fMRI data. The LBA provided evidence that, relative to the HOA group, those with MCI displayed lower sensitivity (i.e., difficulty discriminating targets from lures), suggestive of memory impairment, and displayed higher evidence accumulation speed and greater caution, suggestive of increased arousal and strategic changes in this group, although these changes had little impact on MCI-related accuracy differences. Consistent with these findings, fMRI revealed reduced activation in brain regions previously linked to evidence accumulation and to the implementation of caution reductions in the MCI group. Findings suggest that multiple cognitive mechanisms differ during memory retrieval in MCI, and that these mechanisms may explain neuroimaging alterations outside of the medial temporal lobes.

New approach to global Mittag-Leffler synchronization problem of fractional-order quaternion-valued BAM neural networks based on a new inequality.

In this paper, a novel kind of neural networks named fractional-order quaternion-valued bidirectional associative memory neural networks (FQVBAMNNs) is formulated. On one hand, applying Hamilton rules in quaternion multiplication which is essentially non-commutative, the system of FQVBAMNNs is separated into eight fractional-order real-valued systems. Meanwhile, the activation functions are considered to be quaternion-valued linear threshold ones which help to reduce the unnecessary computational complexity. On the other hand, based on fractional-order Lyapunov technology, a new fractional-order derivative inequality is established. Mainly by employing the new inequality technique, constructing three novel Lyapunov-Krasovskii functionals (LKFs) and designing simple linear controllers, the global Mittag-Leffler synchronization problems are investigated and the corresponding criteria are acquired for the system of FQVBAMNNs and its special cases such as fractional-order complex-valued BAM neural networks (FCVBAMNNs) and fractional-order real-valued BAM neural networks (FRVBAMNNs), respectively. Finally, two numerical examples are given to show the effectiveness and availability of the proposed results.

Innovations for integrated care: The Association of Medicine and Psychiatry recognizes new models.

This editorial looks at the current state of the integration of medicine and psychiatry in clinical practice. We note selected recent triumphs and barriers to implementing integrated care, highlighting some gaps and priorities for future innovations. In contrast to the relatively more orderly culture of health services research, where some notable innovations in integrated care were funded, tested, and published, the health care marketplace can be a difficult place to identify and track the innovations that could shape health care reform. Recognizing the need to find, describe, and disseminate the most innovative models in integrated care, the Association of Medicine and Psychiatry (AMP) launched in 2016 the Innovative Models for Integrated Care Awards. Although many service innovations solve local problems, some can also act as models to be adopted in multiple settings. The projects that win AMP Innovative Models for Integrated Care Awards are selected for their innovativeness, their clinical importance, their generalizability, and their effectiveness. We briefly describe here the four models that earned these awards at the 2017 AMP Annual Meeting. They demonstrate innovations across a range of settings and populations: inpatient general hospital patients under constant observation in New York, severely mentally ill patients in a federally qualified health center in San Francisco, outpatients in a VA women's health center in Chicago, and HIV patients in an academic infectious disease clinic in Charleston, south Carolina. These model descriptions aim to encourage the implementation of innovative models that advance the integration of medicine and psychiatry.

Nine years of comparative effectiveness research education and training: initiative supported by the PhRMA Foundation.

The term comparative effectiveness research (CER) took center stage with passage of the American Recovery and Reinvestment Act (2009). The companion US$1.1 billion in funding prompted the launch of initiatives to train the scientific workforce capable of conducting and using CER. Passage of the Patient Protection and Affordable Care Act (2010) focused these initiatives on patients, coining the term 'patient-centered outcomes research' (PCOR). Educational and training initiatives were soon launched. This report describes the initiative of the Pharmaceutical Research and Manufacturers Association of America (PhRMA) Foundation. Through provision of grant funding to six academic Centers of Excellence, to spearheading and sponsoring three national conferences, the PhRMA Foundation has made significant contributions to creation of the scientific workforce that conducts and uses CER/PCOR.

The cost of switching between taxonomic and thematic semantics.

Current models and theories of semantic knowledge primarily capture taxonomic relationships (DOG and WOLF) and largely do not address the role of thematic relationships in semantic knowledge (DOG and LEASH). Recent evidence suggests that processing or representation of thematic relationships may be distinct from taxonomic relationships. If taxonomic and thematic relations are distinct, then there should be a cost associated with switching between them even when the task remains constant. This hypothesis was tested using two different semantic-relatedness judgment tasks: Experiment 1 used a triads task and Experiment 2 used an oddball task. In both experiments, participants were faster to respond when the same relationship appeared on consecutive trials than when the relationship types were different, even though the task remained the same and the specific relations were different on each trial. These results are consistent with the theory that taxonomic and thematic relations rely on distinct processes or representations.

A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test.

Disparities in the care and outcomes of US racial/ethnic minorities are well documented. Research suggests that provider bias plays a role in these disparities. The implicit association test enables measurement of implicit bias via tests of automatic associations between concepts. Hundreds of studies have examined implicit bias in various settings, but relatively few have been conducted in healthcare. The aim of this systematic review is to synthesize the current knowledge on the role of implicit bias in healthcare disparities. A comprehensive literature search of several databases between May 2015 and September 2016 identified 37 qualifying studies. Of these, 31 found evidence of pro-White or light-skin/anti-Black, Hispanic, American Indian or dark-skin bias among a variety of HCPs across multiple levels of training and disciplines. Fourteen studies examined the association between implicit bias and healthcare outcomes using clinical vignettes or simulated patients. Eight found no statistically significant association between implicit bias and patient care while six studies found that higher implicit bias was associated with disparities in treatment recommendations, expectations of therapeutic bonds, pain management, and empathy. All seven studies that examined the impact of implicit provider bias on real-world patient-provider interaction found that providers with stronger implicit bias demonstrated poorer patient-provider communication. Two studies examined the effect of implicit bias on real-world clinical outcomes. One found an association and the other did not. Two studies tested interventions aimed at reducing bias, but only one found a post-intervention reduction in implicit bias. This review reveals a need for more research exploring implicit bias in real-world patient care, potential modifiers and confounders of the effect of implicit bias on care, and strategies aimed at reducing implicit bias and improving patient-provider communication. Future studies have the opportunity to build on this current body of research, and in doing so will enable us to achieve equity in healthcare and outcomes.

The Effects of Probe Similarity on Retrieval and Comparison Processes in Associative Recognition.

In this study, we investigated the information processing stages underlying associative recognition. We recorded EEG data while participants performed a task that involved deciding whether a probe word triple matched any previously studied triple. We varied the similarity between probes and studied triples. According to a model of associative recognition developed in the Adaptive Control of Thought-Rational cognitive architecture, probe similarity affects the duration of the retrieval stage: Retrieval is fastest when the probe is similar to a studied triple. This effect may be obscured, however, by the duration of the comparison stage, which is fastest when the probe is not similar to the retrieved triple. Owing to the opposing effects of probe similarity on retrieval and comparison, overall RTs provide little information about each stage's duration. As such, we evaluated the model using a novel approach that decomposes the EEG signal into a sequence of latent states and provides information about the durations of the underlying information processing stages. The approach uses a hidden semi-Markov model to identify brief sinusoidal peaks (called bumps) that mark the onsets of distinct cognitive stages. The analysis confirmed that probe type has opposite effects on retrieval and comparison stages.

Factores de riesgo asociados con la aparición de conductas suicidas en adolescentes / Risk Factors Associated with the Appearance of Suicidal Behaviors in Adolescents / Fatores de risco associados ao aparecimento de comportamentos suicidas nos adolescentes

Introducción: El suicidio en adolescentes es un problema de salud pública dada su elevada incidencia y el gran impacto que este genera no solo a nivel individual, sino familiar y social. Existen algunos factores que, de acuerdo con la literatura, han sido asociados con el desarrollo de conductas suicidas en los adolescentes, sin embargo, su descripción se ha realizado de manera aislada, desconociendo la multicausalidad del problema. Objetivo: Revisar en la literatura científica los factores personales, familiares y sociales asociados con la aparición de conductas suicidas en adolescentes. Metodología: Se efectuó una búsqueda y análisis de la información empleando los descriptores adolescentes, suicidio, ideación suicida, factores de riesgo, atención primaria en salud y salud mental. Dicha búsqueda se realizó en los buscadores Google, Google Académico y en las bases de datos ScienceDirect, PubMed, ProQuest, Scielo, Redalyc. Resultados: Se encontraron factores de riesgo para la aparición de conductas suicidas en adolescentes relacionados con el género, el nivel educativo y socioeconómico, las relaciones familiares y las redes de apoyo social, entre otros. Conclusiones: La oportuna detección de los factores de riesgo podría aportar en gran medida al diseño e implementación de programas de prevención más integrales y eficientes frente al suicidio de adolescentes. [Serrano-Ruiz CP, Olave-Chaves JA. Factores de riesgo asociados con la aparición de conductas suicidas en adolescentes. MedUNAB2017; 20(2): 139-147].

Introduction: Suicide in adolescents is a public health problem given its high incidence and the great impact it generates not only at an individual level, but also at a family and social level. There are some factors that, according to literature, have been associated with the development of suicidal behavior in adolescents; however, their descriptions have been made in isolation, ignoring the multi-causality of the problem. Objective: To review in the scientific literature the personal, family and social factors associated with the appearance of suicidal behaviors in adolescents. Methodology: Asearch and an analysis of the information was carried out using some descriptors such as adolescent, suicide, suicidal ideation, risk factors, primary health care and mental health. This search was carried out in search engines like Google, Google Scholar and in the databases ScienceDirect, PubMed, ProQuest, Scielo and Redalyc. Results: Some risk factors were found related to the appearance of suicidal behaviors in adolescents which are associated to gender, educational and socioeconomic level, family relationships and social support networks, amongothers. Conclusions: Timely detection of risk factors could greatly contribute to the designand implementation of more comprehensive and efficient prevention programs against adolescent suicide. [Serrano-Ruiz CP, Olave-Chaves JA. Risk Factors Associated with the Appearance of Suicidal Behaviors in Adolescents. MedUNAB 2017; 20(2): 139-147].

Introdução: O suicídio nos adolescentes é um problema de saúde pública porque sua alta incidência e o grande impacto que gera não só a nível individual, mas também a nível familiar e social. Existem alguns fatores que, de acordo com a literatura, foram associados ao desenvolvimento dos comportamentos suicidas nos adolescentes, no entanto, sua descrição foi realizada de forma isolada, ignorando a multi-causalidade do problema. Objetivo: Revisar na literatura científica os fatores pessoais, familiares e sociais associados ao aparecimento dos comportamentos suicidas nos adolescentes. Metodologia: Realizamos uma pesquisa e análise da informação usando os relatos dos adolescentes, do suicídio, da concepção suicida, dos fatores de risco, dos cuidados de saúde primários e de saúde mental. Esta pesquisa foi realizada em motores de busca do Google, Google Acadêmico e nas bases de dados ScienceDirect, PubMed, ProQuest, Scielo, Redalyc. Resultados: Os fatores de risco encontrados no aparecimento de comportamentos suicidas em adolescentes, estão relacionados com o gênero, o nível de educação e ao contexto socioeconómico, às relações familiares e às redes de apoio social, entre outros. Conclusões: Detectar os fatores de risco a tempo poderia contribuir grandemente na elaboração do projeto e implementação de programas de prevenção mais completos e eficientes contra o suicídio do adolescente. [Serrano-Ruiz CP, Olave-Chaves JA. Fatores de risco associados ao aparecimento de comportamentos suicidas nos adolescentes. MedUNAB 2017; 20(2): 139-147].

Guías para la inmunización del adolescente y adulto en Colombia. Documento de actualización, 2016 / Guidelines for the immunization of adolescents and adults living in Colombia. Update document, 2016

Este documento fue preparado por un grupo multidisciplinario de expertos seleccionados por la Asociación Colombiana de Infectología (ACIN) para poner al día las recomendaciones previas dadas por nuestro grupo en cuanto a la inmunización del adolescente, de la población adulta y de aquellos mayores de 60 años de edad. Para este último grupo, hemos decidido, como lo han hecho en otros países, el inmunizar a esta edad (y no después), debido a la carga de enfermedad incrementada por afecciones respiratorias y otros factores propios para América Latina y las condiciones socioeconómicas de nuestro país. Esta edición reescribe ciertos párrafos y actualiza en parte las recomendaciones hechas anteriormente y publicadas en Infectio en mayo de 2012. Las guías están orientadas al uso por aquellos que cuidan de estos pacientes y hacemos énfasis en el anciano, el inmunocomprometido y en aquellos que sufren de varias comorbilidades. Aunque en un momento dado el documento pudiera parecer incompleto, la intención deseada fue la de abarcar los recientes cambios en la administración de nuevas vacunas y otros regímenes en dosificación. Se incluye por primera vez el uso de las vacunas de 4 valencias contra la influenza. El uso de la vacuna contra el herpes zóster se discute, y se toma un cuidado especial en cuanto a la redacción del "cuándo y por qué" de la vacunación contra Streptococcus pneumoniae. En la administración de esta vacuna, el tiempo de aplicación y la secuencia asociada con la aplicación de la administración de la vacuna polisacárida de 23 valencias puede variar de acuerdo con la edad del paciente,las comorbilidades y en aquellos previamente vacunados con dicha vacuna. Finalmente, exponemos las nuevas recomendaciones de vacunación contra fiebre amarilla y dengue y le damos la bienvenida a la vacuna nonavalente contra el virus humano del papiloma.

This document was prepared by a multi-disciplinary panel of experts who have been selected by the Asociación Colombiana de Infectologia (ACIN) to revise and update previous recommendations (by our group) for the immunization of adolescents and adult population and those older than 60 years of age. For the latter group, we have chosen to move forward, like many others, and immunize them at that age because of the particular burden of disease due to respiratory conditions, and other factors strictly related to Latin America and Colombian socio-economic conditions. This edition replaces in part, updates or ads to previous recommendations published in Infectio, May 2012. The guidelines are intended to assist those caring for these patients, and emphasizes on the elderly, the immunocompromissed and on those who suffer from several co-morbidities.The contents of the guidelines could seem in complete at some point; nevertheless, they were purposefully thought as such to embrace on major changes in new vaccines or new dosin gregimens. It is included for the first time the use of cuadri-valent vaccines against influenza. The use of herpes zoster vaccine is discussed and special care is placed in the phrasing for the reader so he (she) understands the "when and why" of vaccine administration against Streptococcus pneumoniae. With pneumococcal vaccines, timing of administration may vary according to age, co-morbidities and in those previously vaccinated with the 23-polyvalent polysaccharide vaccine. There are new recommendations for the vaccination against yellow fever and dengue and we welcome the new nona-valent vaccine against the human papillomavirus.