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OBJETIVO: Determinar la carga económica anual del asma, desde una perspectiva institucional y con base en la clasificación recomendada por GINA, en una cohorte retrospectiva de adultos atendidos en el Instituto Nacional de Enfermedades Respiratorias (INER) de México. MÉTODOS: Estudio observacional, longitudinal y retrospectivo, llevado a cabo a partir de la información recabada de 247 pacientes femeninas con asma. Se estimaron los costos directos anuales: visitas, pruebas de laboratorio, tratamiento farmacológico y de las crisis o exacerbaciones, para determinar la carga anual de la enfermedad desde una perspectiva institucional, y según la clasificación de la Iniciativa Global para el Asma. RESULTADOS: El costo promedio anual fue de $43,813,92, que aumentó en relación con la necesidad de aumento de dosis de corticoides inhalados y beta-agonistas de acción prolongada. El costo promedio de la consulta médica fue de $2004.57, $982.82 por gestión de crisis y $2645.95 por pruebas de laboratorio. El tratamiento farmacológico representó la principal carga económica, con un costo promedio anual de $38,180.58. CONCLUSIONES: Los resultados resaltan una carga económica del asma estimada en un costo anual por paciente de $43,813.92 MXN (DE=93,348.85), en el contexto del tercer nivel de atención en el sistema de salud público mexicano. La gravedad del asma, los tratamientos y los biológicos fueron los principales factores que aumentaron los costos directos de la atención.
OBJECTIVE: Determine the annual economic burden of the disease from an institutional perspective and based on GINA's recommended classification in a retrospective cohort of adults treated at Instituto Nacional de Enfermedades Respiratorias (INER) of Mexico City. METHODS: A retrospective, longitudinal observational study comprised by data from 247 female asthma patients, annual direct costs were estimated including: visits, laboratory tests, pharmacological treatment and management of crisis or exacerbations, to determine the annual burden of the disease from an institutional perspective and according to Global Initiative for Asthma classification. RESULTS: The average annual cost was $43,813.92, which increased in relation to the need of inhaled corticosteroids and long-acting beta agonists dosage increase. The average doctor's appointment cost was $2,004.57, $982.82 for crisis management and $2,645.95 for laboratory testing. Pharmacological treatment represented the main economic burden with an annual average cost of $38,180.58. CONCLUSIONS: The results highlight an economic burden of asthma estimated at an annual cost per patient of $43,813.92 MXN (SD=93,348.85) in the context of the third level of care in the Mexican public health system. The asthma severity and treatments such as biologics were the main factors that increased direct costs of care.
Asunto(s)
Asma , Costo de Enfermedad , Humanos , Asma/economía , Asma/tratamiento farmacológico , Asma/terapia , México , Estudios Retrospectivos , Femenino , Adulto , Persona de Mediana Edad , Estudios Longitudinales , Academias e Institutos/economía , Adulto Joven , Adolescente , AncianoRESUMEN
OBJECTIVES: The present paper tests the cross-national stability of the HEXACO-60 structure across 18 countries from four continents. Gender and age differences across countries will be examined. Finally, this is the first study to explicitly analyze the relationships between the HEXACO and social position. METHOD: Ten thousand two hundred and ninety eight subjects (5,410 women and 4,888 men) from 18 countries and 13 languages were analyzed. Confirmatory factor analysis techniques were used to test configural, metric and scalar invariance models. Congruence coefficients with the original structure of the HEXACO-60 were computed for every culture. Effect sizes of gender, age, and social position factors across countries were also computed. RESULTS: HEXACO-60 demonstrates configural and metric invariance, but not scalar invariance. Congruence coefficients show a great equivalence in almost all countries and factors. Only Emotionality presents a large gender difference across countries. No relevant effect of age is observed. A profile of high scores on Honesty-Humility, Extraversion, Conscientiousness, and Openness to Experience, and low scores on Emotionality increases the likelihood of achieving a higher social position, although the effect sizes are small. CONCLUSIONS: HEXACO-60 is a useful instrument to conduct personality trait research and practice around the world. Implications of gender, social position, and country differences are discussed.
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Extraversión Psicológica , Personalidad , Femenino , Humanos , Lenguaje , Masculino , Factores SexualesRESUMEN
The aim of this study was to assess the psychometric properties of the Zuckerman-Kuhlman-Aluja Personality Questionnaire shortened form (ZKA-PQ/SF) in 18 cultures and 13 languages of different African, American, Asian, and European cultures and languages. The results showed that the five-factor structure with 20 facets replicated well across cultures with a total congruence coefficient of .97. A confirmatory factor analysis (CFA) resulted in adequate fit indices for the five factors based on the comparative fit index (CFI), Tucker-Lewis index (TLI; >.90), and RMSEA (.031-.081). A series of CFA to assess measurement invariance across cultures resulted in adequate CFIs and TLIs for configural and metric invariance. However, factors did not show scalar invariance. Alpha internal consistencies of five factors ranged between .77 (Sensation Seeking) and .86 (Neuroticism). The average alpha of the 20 facets was .64 with a range from .43 (SS4) to .75 (AG1). Nevertheless, alpha reliabilities were lower in some facets and cultures, especially for Senegal and Togo. The average percentage of the variance explained based on the adjusted R2 was 2.9%, 1.7%, and 5.1% for age, sex, and, cultures, respectively. Finally, multidimensional scaling suggested that geographically or culturally close cultures share mean profile similarities.
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Trastornos de la Personalidad , Personalidad , Humanos , Determinación de la Personalidad , Psicometría , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
During musculoskeletal system development, mechanical tension is generated between muscles and tendon-cells. This tension is required for muscle differentiation and is counterbalanced by tendon-cells avoiding tissue deformation. Both, Jbug/Filamin, an actin-meshwork organizing protein, and non-muscle Myosin-II (Myo-II) are required to maintain the shape and cell orientation of the Drosophila notum epithelium during flight muscle attachment to tendon cells. Here we show that halving the genetic dose of Rho kinase (Drok), the main activator of Myosin-II, enhances the epithelial deformation and bristle orientation defects associated with jbug/Filamin knockdown. Drok and activated Myo-II localize at the apical cell junctions, tendon processes and are associated to the myotendinous junction. Further, we found that Jbug/Filamin co-distribute at tendon cells with activated Myo-II. Finally, we found that Jbug/Filamin and Myo-II are in the same molecular complex and that the actin-binding domain of Jbug/Filamin is necessary for this interaction. These data together suggest that Jbug/Filamin and Myo-II proteins may act together in tendon cells to balance the tension generated during development of muscles-tendon interaction, maintaining the shape and polarity of the Drosophila notum epithelium.
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Polaridad Celular/fisiología , Epitelio/metabolismo , Filaminas/metabolismo , Desarrollo Musculoesquelético/fisiología , Miosina Tipo II/metabolismo , Tendones/metabolismo , Actinas/metabolismo , Animales , Diferenciación Celular/fisiología , Células Cultivadas , Proteínas de Drosophila/metabolismo , Drosophila melanogaster/metabolismo , Drosophila melanogaster/fisiología , Músculo Esquelético/metabolismo , Músculo Esquelético/fisiología , Tendones/fisiología , Quinasas Asociadas a rho/metabolismoRESUMEN
The development of the musculoskeletal system is a great model to study the interplay between chemical and mechanical inter-tissue signaling in cell adhesion, tissue morphogenesis and differentiation. In both vertebrates and invertebrates (e.g., Drosophila melanogaster) the formation of muscle-tendon interaction generates mechanical forces which are required for myotendinous junction maturation and tissue differentiation. In addition, these forces must be withstood by muscles and tendons in order to prevent detachment from each other, deformation or even losing their integrity. Extracellular matrix remodeling at the myotendinous junction is key to resist mechanical load generated by muscle contraction. Recent evidences in vertebrates indicate that mechanical forces generated during junction formation regulate chemical signaling leading to extracellular matrix remodeling, however, the mechanotransduction mechanisms associated to this response remains elusive. In addition to extracellular matrix remodeling, the ability of Drosophila tendon-cells to bear mechanical load depends on rearrangement of tendon cell cytoskeleton, thus studying the molecular mechanisms involved in this process is critical to understand the contribution of mechanical forces to the development of the musculoskeletal system. Here, we review recent findings regarding the role of chemical and mechanical signaling in myotendinous junction formation and tendon differentiation, and discuss molecular mechanisms of mechanotransduction that may allow tendon cells to withstand mechanical load during development of the musculoskeletal system.
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The assembly of the musculoskeletal system in Drosophila relies on the integration of chemical and mechanical signaling between the developing muscles with ectodermal cells specialized as "tendon cells." Mechanical tension generated at the junction of flight muscles and tendon cells of the notum epithelium is required for muscle morphogenesis, and is balanced by the epithelium in order to not deform. We report that Drosophila Rho kinase (DRok) is necessary in tendon cells to assemble stable myotendinous junctions (MTJ), which are required for muscle morphogenesis and survival. In addition, DRok is required in tendon cells to maintain epithelial shape and cell orientation in the notum, independently of chascon (chas). Loss of DRok function in tendon cells results in mis-orientation of tendon cell extensions and abnormal accumulation of Thrombospondin and ßPS-integrin, which may cause abnormal myotendinous junction formation and muscle morphogenesis. This role does not depend exclusively on nonmuscular Myosin-II activation (Myo-II), indicating that other DRok targets are key in this process. We propose that DRok function in tendon cells is key to promote the establishment of MTJ attachment and to balance mechanical tension generated at the MTJ by muscle compaction.