Primary results from post hoc analysis of the apollo-b brazilian subpopulation, a phase 3 study of patisiran in patients with transthyretin amyloidosis with cardiomyopathy

BACKGROUND: Transthyretin amyloidosis (ATTR) is a progressive, fatal disease caused by toxic misfolded transthyretin (TTR) amyloid deposits. Patisiran, an RNA interference therapeutic, inhibits synthesis of wild-type and variant TTR and is approved for the treatment of hereditary ATTR with polyneuropathy. OBJECTIVE: Describe efficacy and safety of patisiran in patients from Brazil with ATTR cardiomyopathy (ATTR-CM) via a post hoc subgroup analysis of the global APOLLO-B study (NCT03997383). METHODS: Patients 18­85 years of age with ATTR-CM and heart failure were randomized 1:1 to patisiran 0.3 mg/kg or placebo every 3 weeks for 12 months. Primary endpoint was change from baseline (CFB) in functional capacity (6-minute walk test) at Month 12 for patisiran vs placebo. Secondary endpoints included CFB to Month 12 in health status and quality of life (Kansas City Cardiomyopathy QuestionnaireOverall Summary [KCCQ-OS]). Exploratory endpoints included CFB in cardiac biomarkers and Perugini grade by Tc-99m scintigraphy, the latter assessed in a subset of patients in an imaging study within APOLLO-B. RESULTS: Of 360 patients in APOLLO-B, 42 were from Brazil (patisiran, n=20; placebo, n=22): median (range) age at screening, 73 (51, 85) years; male, 81%; wild-type ATTR, 54.8%. No patients were receiving tafamidis at baseline. Patisiran showed benefit vs placebo in 6-minute walk test (median [95% CI] CFB [meters]: −2.02 [−58.5, 42.9] vs −30.1 [−72.2, 3.5]; HodgesLehmann estimate of median difference [95% CI]: 31.4 [−16.6, 79.4]; Figure 1A) and in KCCQ-OS (least squares mean [SEM] CFB: 9.4 [3.8] vs 2.6 [3.7]; least squares mean difference [SEM]: 6.8 [5.3]; Figure 1B). Death was reported in 0 patisiran patients vs 3 (13.6%) placebo. The ratio of adjusted geometric mean fold-change (patisiran:placebo [95% CI]) was 0.77 (0.57, 1.03) for NT-proBNP and 0.87 (0.68, 1.12) for troponin I. In the imaging subset (n=35), 11/18 (61.1%) patisiran patients improved Perugini grade vs 0/10 placebo at Month 12 (Figure 2). Few patisiran patients experienced serious (8 [40%]) or severe (4 [20%]) adverse events; none were drug related. CONCLUSION: In Brazilian patients with ATTR-CM, potential benefit was observed with patisiran on functional capacity, health status and quality of life, cardiac biomarkers, and Perugini grade, consistent with data from the global APOLLO-B population. The results are descriptive; the study was not powered to detect treatment effects specific to this subgroup.

Prognostic Factors and Markers in Non-Small Cell Lung Cancer: Recent Progress and Future Challenges.

Lung cancer is a highly aggressive neoplasm and, despite the development of recent therapies, tumor progression and recurrence following the initial response remains unsolved. Several questions remain unanswered about non-small cell lung cancer (NSCLC): (1) Which patients will actually benefit from therapy? (2) What are the predictive factors of response to MAbs and TKIs? (3) What are the best combination strategies with conventional treatments or new antineoplastic drugs? To answer these questions, an integrative literature review was carried out, searching articles in PUBMED, NCBI-PMC, Google Academic, and others. Here, we will examine the molecular genetics of lung cancer, emphasizing NSCLC, and delineate the primary categories of inhibitors based on their molecular targets, alongside the main treatment alternatives depending on the type of acquired resistance. We highlighted new therapies based on epigenetic information and a single-cell approach as a potential source of new biomarkers. The current and future of NSCLC management hinges upon genotyping correct prognostic markers, as well as on the evolution of precision medicine, which guarantees a tailored drug combination with precise targeting.

Understanding the use/non-use of an internet-based intervention complementing standard depression treatment: A qualitative study of user's experiences.

Introduction: There is sufficient evidence about the effectiveness of internet-based interventions; however, the users' level of adoption and utilization remains low, with this phenomenon requiring adequate explanation. Objective: The aim of this qualitative study was to explore the users' perceptions and experience of a web-based program (ASCENSO), designed to complement (usual) in-person depression treatment. Method: Twelve participants of the ASCENSO program, comprised of adult individuals (M = 44.3, SD = 13.4) of both genders (67% women) undergoing treatment for depression, were interviewed through semi-structured interviews. The data obtained from these interviews were analyzed utilizing a constructivist grounded theory approach. The interviews were transcribed and analyzed by trained coders. A constant comparative analysis of emergent themes was conducted. Results: These show that users employ and appreciate the program when their interaction with it emulates a "humanized relationship," that is, when the program is proactive in assisting users with their requests and when it responds in a pertinent and individualized manner to their emotional states and needs. Conclusions: Our findings highlight the challenges associated with the development of algorithms capable of attracting different potential users. These should be designed to generate a virtual relationship that emulates human interaction and targets the characteristics of each user, for example, considering the specific phenomenology of their health condition, their present emotional states, and perceived needs. Elements that will vary as mental symptomatology evolve.

Translational Bioinformatics Applied to the Study of Complex Diseases.

Translational Bioinformatics (TBI) is defined as the union of translational medicine and bioinformatics. It emerges as a major advance in science and technology by covering everything, from the most basic database discoveries, to the development of algorithms for molecular and cellular analysis, as well as their clinical applications. This technology makes it possible to access the knowledge of scientific evidence and apply it to clinical practice. This manuscript aims to highlight the role of TBI in the study of complex diseases, as well as its application to the understanding and treatment of cancer. An integrative literature review was carried out, obtaining articles through several websites, among them: PUBMED, Science Direct, NCBI-PMC, Scientific Electronic Library Online (SciELO), and Google Academic, published in English, Spanish, and Portuguese, indexed in the referred databases and answering the following guiding question: "How does TBI provide a scientific understanding of complex diseases?" An additional effort is aimed at the dissemination, inclusion, and perpetuation of TBI knowledge from the academic environment to society, helping the study, understanding, and elucidating of complex disease mechanics and their treatment.

Estudio piloto de un programa basado en Internet para la prevención e intervención temprana de la depresión en adolescentes / Feasibility and effectiveness of an Internet-based program for the prevention and early intervention of depression inInternet adolescents

Resumen Antecedentes: la alta prevalencia de depresión en la adolescencia y sus graves consecuencias, asociadas a su falta de detección y tratamiento, estimulan el interés en la investigación respecto a su prevención e intervención tempranas. Las intervenciones basadas en las tecnologías de la información y la comunicación (TIC), dada su flexibilidad y capacidad de difusión, representan oportunidades innovadoras; no obstante, en Latinoamérica hay poca evidencia sobre su impacto y eficacia. Objetivo y metodología: se realiza un estudio piloto cuantitativo cuasiexperimental que busca evaluar la factibilidad del programa basado en Internet "Cuida tu Ánimo", mediante las variables de uso y aceptabilidad, y la estimación del efecto, en 215 adolescentes (103 grupo activo, 112 grupo control) de dos instituciones educativas de la ciudad de Medellín. Se evaluaron las interacciones de los adolescentes con el Programa, su uso-aceptabilidad, el nivel de sintomatología depresiva y otros aspectos relacionados. Resultados: los adolescentes reportan alta aceptación y uso muy moderado del Programa. Señalan el aprendizaje sobre depresión y detección temprana del riesgo que les proporcionó el Programa; y recomiendan aumentar la interactividad de la plataforma web, generar contenidos más diversos y entretenidos, y aumentar los niveles de presencialidad de la intervención. Conclusiones: los programas basados en las TIC pueden ser un complemento favorable para la prevención e intervención tempranas de la depresión en adolescentes. Dada la dificultad de asociar la estimación del efecto del Programa con su uso, se recomienda en estudios futuros utilizar un diseño que permita relacionar los indicadores de uso con los de resultado (dosis-efecto).

Abstract Background: the high prevalence of depression in adolescence and its serious consequences, associated with its lack of detection and treatment, stimulate interest in research regarding its early prevention and intervention. Interventions based on information and communication technologies (ICT), given their flexibility and capacity for dissemination, represent innovative opportunities; however, in Latin America there is little evidence on their impact and efficacy. Objective and Methods: a quasi-experimental quantitative pilot study was carried out to evaluate the feasibility, through the variables of use and acceptability, and the estimated effect of the Internet-based program "Cuida tu Ánimo", in 215 adolescents (103 active group, 112 control group) from two educational institutions. The adolescents' interactions with the program, its use-acceptability, and the level of depressive symptomatology and other related aspects were evaluated. Results: the adolescents report high acceptance and very moderate use of the Program. They point out that the program allowed them to learn about depression and early detection of risk; also, they recommend increasing the interactivity of the web platform, designing more diverse and entertaining content, and increasing the presence of the intervention. Conclusions: Internet-based programs such as Cuida tu Ánimo can be a favorable complement for the prevention and early intervention of depression in adolescents. Considering the difficulty in relating the estimation of the Program's effect with its use, it is recommended that future studies include a design that permits associating the use indicators with the outcome indicators (dose-effect).

An Adjunctive Internet-Based Intervention to Enhance Treatment for Depression in Adults: Randomized Controlled Trial.

BACKGROUND: Internet-based interventions promise to enhance the accessibility of mental health care for a greater number of people and in more remote places. Their effectiveness has been shown for the prevention and treatment of various mental disorders. However, their potential when delivered as add-on to conventional treatment (ie, blended care) is less clear. OBJECTIVE: The aim of this study is to study the effectiveness of an internet intervention (ASCENSO) implemented in addition to face-to-face treatment as usual (TAU) for depression. METHODS: A 2-arm, parallel-group, randomized controlled trial was conducted in an outpatient private mental health care center in Chile. In all, 167 adults, diagnosed with major depressive disorder, without severe comorbidities, and with internet access, were included. Eighty-four participants were assigned to the intervention group and received medical and psychological TAU from the mental health center plus access to the ASCENSO online platform. The control group (n=83) received only TAU. The ASCENSO platform includes psycho-educational information, depressive symptom monitoring and feedback, and managing emergencies based on the principles of cognitive behavioral therapy. Emergency management was mental health provider-assisted. TAU includes access to primary care physicians and psychiatrists, to a brief individual psychotherapy, and to medication when needed. The baseline questionnaires were administered in person, and 6- and 9-months assessments were conducted online. Depression symptoms and quality of life were measured by self-administered questionnaires, and treatment adherence was determined via the Mental Health Center's internal records. The usage of ASCENSO was assessed by server logs. Reduction on depressive symptomatology was considered as the primary outcome of the intervention and quality of life as a secondary outcome. RESULTS: Of the 84 participants in the intervention group, 5 participants (6%) never accessed the online platform. Of the remaining 79 participants who accessed ASCENSO, 1 (1%, 1/79) did not answer any of the symptom questionnaire, and most participants (72/79, 91%) answered the monitoring questionnaires irregularly. The ASCENSO intervention implemented in addition to face-to-face care did not improve the outcome of the usual care delivered at the mental health center, either in terms of reduction of depressive symptoms (F2,6087= 0.48; P=.62) or in the improvement of quality of life (EQ-5D-3L: F2,7678=0.24; P=.79 and EQ-VAS: F2,6670= 0.13; P=.88). In contrast, for the primary (F2,850=78.25; P<.001) and secondary outcomes (EQ-5D-3L: F2,1067=37.87; EQ-VAS: F2,4390= 51.69; P<.001) in both groups, there was an improvement from baseline to 6 months (P<.001), but there was no change at 9 months. In addition, no effects on adherence to or use of TAU were found. Finally, the dropout rate for the face-to-face treatment component was 54% (45/84) for the intervention group versus 39% (32/83) for the control group (P=.07). CONCLUSIONS: The fact that the adjunctive access to ASCENSO did not improve outcome could be due to both the rather high effectiveness of TAU and to patients' limited use of the online platform. TRIAL REGISTRATION: ClinicalTrials.gov NCT03093467; https://clinicaltrials.gov/ct2/show/NCT03093467.

Feasibility and Acceptability of "Cuida tu Ánimo" (Take Care of Your Mood): An Internet-Based Program for Prevention and Early Intervention of Adolescent Depression in Chile and Colombia.

The rapid internet penetration in Latin American countries has made it possible to implement digital mental health interventions. "Cuida tu Ánimo" (Take Care of Your Mood) is an internet-based program for the prevention and early intervention of depression in adolescents. A pilot study was conducted in Chile and Colombia to study the feasibility and acceptability of the program and estimate its effects. There were 199 participants (53.3% women; mean age = 14.8 years, SD = 1.0) recruited from two schools in Chile and two schools in Colombia. Qualitative and quantitative methods were applied for data collection and analyses. Although the levels of acceptance were moderate to high across all variables, adherence was lower than expected. The participants deemed important for an intervention of this type offered a higher level of interaction with team members through internet-based and face-to-face activities. Post-intervention outcomes show a reduction in depressive and anxious symptoms in adolescents in Chile, while there were no significant changes in the level of symptomatology in adolescents in Colombia. The women used the program more than the men. Results show the need to improve the intervention by increasing its levels of customization and developing strategies to achieve better adherence. The contradictory results of the program in Chile and Colombia suggest the importance of other variables beyond the content of the intervention, such as the setting or context of the intervention.

Terminación de la psicoterapia desde la perspectiva de los pacientes / Psychotherapy Termination from the Patients' Perspective

Resumen El aumento de la oferta de servicios de psicoterapia en las últimas décadas justifica el estudio de los elementos relacionados con su terminación, y su relación con el cumplimiento de los objetivos y la adherencia de los pacientes al tratamiento. Objetivo: identificar los factores que influyen en la terminación de los procesos psicoterapéuticos desde la perspectiva de los pacientes. Metodología: se utilizó un diseño de investigación mixto de triangulación concurrente; se aplicaron encuestas estructuradas y entrevistas en profundidad sobre el fin de la terapia. A nivel cuantitativo se realizaron análisis descriptivos y de regresión, y, a nivel cualitativo, reducción de datos, comparación constante y triangulación de la información. Participaron 137 pacientes de dos centros universitarios de atención psicológica en Antioquia (Colombia), 100 participantes respondieron una encuesta y los restantes una entrevista cualitativa. Resultados: se identificaron tres dimensiones relacionadas con la terminación de los procesos psicoterapéuticos: el cumplimiento o no de los objetivos, el tipo de atribución causal del paciente (interna o externa) y la persona que decide finalizar. La mayoría de los pacientes del estudio dejaron de asistir a psicoterapia sin cumplir sus objetivos o con un cumplimiento parcial de estos, por atribuciones externas y por decisión propia. Discusión: los aspectos institucionales, terapéuticos y de la vida del paciente tienen un rol significativo en la terminación de los procesos psicoterapéuticos. Además, se plantea la importancia de considerar en la formación de los terapeutas las características de los procesos de cierre y los diferentes marcadores asociados con la terminación prematura.

Abstract The increase in the supply of psychotherapy services in recent decades justifies the study of the elements related to its termination. This is one of the main topics to understand achievement of therapeutic goals and adherence of patients in psychotherapy. Aim: to identify the factors that influence termination of psychotherapeutic processes from the patients' perspective. Method: a mixed research design of concurrent triangulation was used; and structured surveys inquiring and in-depth interviews about psychotherapy termination were conducted. It was carried out at the quantitative level, both descriptive and regression analyses, and at the qualitative level, data reduction, constant comparison, and triangulation of information. A total of 137 patients from two higher education centers of psychological care in Antioquia (Colombia) participated, 100 answered a survey and the remaining participants were interviewed in-depth. Results: Results show three dimensions that allow various conceptualizations of therapy termination: achievement of goals, causal attribution and the person who decides to terminate. Most of the patients in the study dropped out of psychotherapy without the completion of their objectives or with a partial completion of these, due to external attributions and their own decision. Discussion: it was discussed how institutional, therapeutic, and life patient´s aspects have a significant role in termination of psychotherapeutic processes. As well as the importance of considering therapists´ training in relation to the characteristics of these processes and the different indicators associated with premature termination.

Caracterización de la atención psicoterapéutica en la IPS CES Sabaneta, Colombia, 2014-2015 / Characterization of psychotherapeutic assistance in the IPS CES Sabaneta, Colombia, 2014-2015

Resumen Los cambios en la cosmovisión imperante en los últimos decenios han traído consigo sujetos con nuevas características, intereses y exigencias, que han impactado a la psicología clínica en tanto le exigen nuevas formas de comprender e intervenir las problemáticas demandadas por ellos en contextos institucionales, entre otros. De cara a estas nuevas realidades y con el fin de hacer más pertinentes las intervenciones psicoterapéuticas, se realizó una caracterización de las mismas en la Institución Prestadora de Servicios de Salud -IPS- CES Sabaneta (Colombia) durante los años 2014-201 5, a través de un análisis descriptivo de 9.140 registros de atención y 532 historias clínicas elegidas aleatoriamente. Se estudiaron aspectos sociodemográficos, administrativos y teórico-técnicos de la atención a partir de análisis de frecuencia, medidas de tendencia central, de dispersión y de forma. Se encontró que consultan tres hombres por cada mujer, siendo la población entre los 6 y 18 años la que tiene el mayor peso (59,77%). Los trastornos emocionales y del comportamiento fueron el principal diagnóstico (44,92%), seguido por los trastornos neuróticos secundarios a situaciones estresantes y somatomorfos (18,6%). Llama la atención la baja prevalencia de los trastornos de personalidad (0,56%) y que el 48,9% de los pacientes asistió a un máximo de seis sesiones. Los resultados permiten ajustar los perfiles y estrategias de atención de acuerdo con las problemáticas más prevalentes, así como los procesos administrativos y formativos relacionados con ellas.

Abstract The changes happened in the prevailing worldview in the last decades have brought subjects with new characteristics, interests and requirements, which have had an impact on the clinical psychology, as a consequence, they require from clinical psychology new ways of understanding and controlling the arisen issues that concern the institutional contexts. In order to face these realities, relevant psychotherapeutic interventions were implemented through a characterization of health attendance carried out in IPS CES Saba-neta during 2014-201 5, conducted by a descriptive analysis of 9140 records of assistance and an analysis of 532 clinical records, chosen randomly. Sociodemographic, administrative and theoretical-technical aspects of the care service were studied based on frequency analysis, measures of central tendency and dispersion using the SPSS software. It was found that 3 men in 1 woman attend to medical service, being the population between ages of 6 and 18 the one that present the highest weight (59, 77 %). Emotional and behavioral disorders were the main diagnosis (44.92%), followed by neurotic disorders secondary to stressful and somatomorphic situations (18.6%). It is noticed the low prevalence of personality disorders (0.56%) even though 48.9% of patients attended a maximum of six sessions. The results allow adjusting the profiles and care service strategies according to the most prevalent problems, as well as the administrative and formative processes that involve these issues.

Annual Trends in Follow-Up Visits for Pediatric Concussion in Emergency Departments and Physicians' Offices.

OBJECTIVE: To assess whether children and youth with concussion receive follow-up visits in accordance with the recommended guidelines. STUDY DESIGN: We conducted a retrospective, population-based study using linked health administrative data from all concussion-related visits to emergency department and physician offices by children aged 5 through 18 years (range, 5.00-18.99) in Ontario between 2003 and 2013. We analyzed the percentage of children and youth seen for follow-up. The Mann-Kendall test for trends was used to assess a monotonic increasing trend over time in concussion follow-up visits. RESULTS: A total of 126 654 children and youth were evaluated for an index concussion visit. The number of children and youth assessed for concussion follow-up (N = 45 155) has increased significantly over time (P < .001). In 2003, 781 of 7126 patients (11.0%; 95% CI, 10.3-11.7) with an index visit for concussion had a follow-up assessment. By 2013, 6526 of 21 681 (30.1%; 95% CI, 29.5-30.7) patients received follow-up care. CONCLUSIONS: The proportion of children and youth receiving follow-up after an acute concussion has significantly increased between 2003 and 2013. Nevertheless, more than two-thirds of all patients do not seek medical follow-up or clearance as recommended by current concussion guidelines, suggesting that ongoing efforts to improve and monitor compliance with recommended guidelines by patients and physicians are important.

Tracoma: de lo básico a lo clínico / Trachoma: from basics to clinic / Tracoma: do básico ao clínico

RESUMEN El tracoma es una de las Enfermedades Tropicales Desatendidas; lo producen los serotipos A, B, Ba y C de la bacteria intracelular Chlamydia trachomatis, adquirida a partir de la diseminación directa por contacto ocular, propagación indirecta por fómites, transmisión por moscas que buscan los ojos y contacto con los dedos contaminados con secreciones oculares y nasales. En la actualidad es la principal causa de ceguera prevenible en el mundo, representa el 1,4 % de los casos totales y genera el deterioro visual de 1,8 millones de personas, de las cuales 500 000 tienen ceguera. Se calcula que hay 51 países endémicos distribuidos en África, Asia, Latinoamérica y Oceanía. En América hay focos activos en Brasil, México, Guatemala y Colombia. Las manifestaciones oculares iniciales son epífora, inyección conjuntival y secreción mucopurulenta; con el curso crónico se producen queratitis, entropión, triquiasis y opacidades corneales. El diagnóstico es básicamente clínico. Para eliminar esta enfermedad, la Organización Mundial de la Salud formuló el Programa Global para la Eliminación del Tracoma para 2020, basado en la implementación de la estrategia SAFE, consistente en cirugía para evitar complicaciones, tratamiento antibiótico, higiene facial y corporal y mejoramiento de las condiciones ambientales.

SUMMARY Trachoma is one of the Neglected Tropical Diseases. It is caused by the serotypes A, B, Ba and C o the intracellular bacteria Chlamydia trachomatis, acquired directly by ocular contact, and indirectly by fomites; also, transmitted by eye-seeking flies, and fingers contaminated with ocular and nasal secretions. Currently, trachoma is the leading cause of preventable blindness in the world, it represents 1.4 % of the total cases and generates visual deterioration in 1.8 million people, of which 500 000 are blind. It is estimated that 51 countries are endemic, distributed in Africa, Asia, Latin America and Oceania. Outbreaks in America take place in Brazil, Mexico, Guatemala, and Colombia. Initial ocular manifestations are epiphora, conjunctival injection and mucopurulent discharge; in the course of chronicity keratitis, entropion, trichiasis and corneal opacities are produced. Diagnosis is basically clinical. In order to eliminate this disease, the World Health Organization formulated the Global Program for the Elimination of Trachoma for 2020, based on the implementation of the SAFE strategy, which consists of surgery to avoid complications, antibiotic therapy, facial and body hygiene and the improvement of environmental conditions.

RESUMO O tracoma é uma das Doenças Tropicais Desatendidas; o produz os serótipos A, B, Ba e C da bactéria intracelular Chlamydia trachomatis, adquirida a partir da disseminação direta por contato ocular, propagação indireta por fómites, transmissão por moscas que buscam os olhos e contato com os dedos contaminados com secreções oculares e nasais. Na atualidade é a principal causa de cegueira evitável no mundo, representa 1,4 % dos casos totais e gera o deterioro visual de 1,8 milhões de pessoas, das quais 500 000 têm cegueira. Se calcula que há 51 países endêmicos distribuídos na África, na Ásia, na América Latina e na Oceania. Na América há focos ativos no Brasil, no México, na Guatemala e na Colômbia. As manifestações oculares iniciais são epífora, injeção conjuntival e secreção mucopurulenta; com o curso crônico se produz ceratiti, entropio, triquíase e opacidades corneais. O diagnóstico é basicamente clínico. Para eliminar esta doença, a Organização Mundial da Saúde formulou o Programa Global para a Eliminação do Tracoma para 2020, baseado na implementação da estratégia SAFE, consistente na cirurgia para evitar complicações, tratamento antibiótico, higiene facial e corporal e melhoramento das condições ambientais.

Annual and Seasonal Trends in Ambulatory Visits for Pediatric Concussion in Ontario between 2003 and 2013.

OBJECTIVE: To investigate annual and seasonal trends in physician office and emergency department (ED) visit rates for pediatric concussion in Ontario between 2003 and 2013. STUDY DESIGN: A retrospective, population-based study was conducted using linked health administrative data from all concussion-related visits to ED and physician office by children aged 5 through 18 years. Time series analysis was used to assess whether periodic components exist in the monthly number of concussion-related visits. RESULTS: Over the 11-year study period, there were 176 685 pediatric visits for concussion in EDs and physician offices in Ontario. Standardized concussion-related visits showed a 4.4-fold (95% CI 4.37-4.45) increase per 100 000 from 2003 to 2013, with nearly 35 000 total visits in 2013. Concussion-related visits demonstrated a steep increase from 2010 onward. The greatest increases in standardized visits were in females (6.3-fold, 95% CI 6.23-6.46 vs 3.6-fold, 95% CI 3.56-3.64 in males) and 13-18.99 year olds (5.0-fold, 95% CI 4.93-5.08 vs 4.1-fold, 95% CI 3.99-4.27 in 9-12 years and 2.3-fold, 95% CI 2.23-2.42 in 5-8 years). A strong seasonal variability (R2autoreg = 0.87, P < .01) in the number of concussion-related visits was present, with most occurring in fall and winter. CONCLUSIONS: Pediatric concussion-related ED and physician office visit rates have greatly increased in the last decade, particularly since 2010. Prevention strategies may be targeted at those most at risk and at seasonal-related activities carrying the greatest risk of concussion.

On the preventive management of sediment-related sewer blockages: a combined maintenance and routing optimization approach.

In this work we tackle the problem of planning and scheduling preventive maintenance (PM) of sediment-related sewer blockages in a set of geographically distributed sites that are subject to non-deterministic failures. To solve the problem, we extend a combined maintenance and routing (CMR) optimization approach which is a procedure based on two components: (a) first a maintenance model is used to determine the optimal time to perform PM operations for each site and second (b) a mixed integer program-based split procedure is proposed to route a set of crews (e.g., sewer cleaners, vehicles equipped with winches or rods and dump trucks) in order to perform PM operations at a near-optimal minimum expected cost. We applied the proposed CMR optimization approach to two (out of five) operative zones in the city of Bogotá (Colombia), where more than 100 maintenance operations per zone must be scheduled on a weekly basis. Comparing the CMR against the current maintenance plan, we obtained more than 50% of cost savings in 90% of the sites.

Violencia laboral en el Programa de Especialización en Obstetricia y Ginecología: percepción del residente

Objetivo: Caracterizar la violencia laboral presente en las diferentes sedes del Programa de Especialización en Obstetricia y Ginecología de Caracas según la percepción del residente. Métodos: Se realizó estudio prospectivo, descriptivo, de corte transversal, que incluyó 120 residentes del Programa de Especialización de Obstetricia y Ginecología durante el período comprendido entre julio 2012 y julio 2013. Previo consentimiento informado se aplicó una encuesta anónima a residentes seleccionados mediante una tabla de números aleatorios. Resultados: La frecuencia de violencia laboral fue de 97,5 % (117), prevaleciendo entre las víctimas el tipo de violencia institucional (96,6 %) seguida por la violencia psicológica (92,3 %) (P= 0,03). No se demostró relación entre la violencia laboral y el sexo (P= 0,713) o año de residencia de posgrado (P= 0,571) de las víctimas ni sede hospitalaria encuestada (P= 0,146). Los perpetradores de los actos de violencia identificados fueron el residente de año superior, médicos especialistas, familiares de pacientes y pacientes, entre otros. Conclusiones: Existe un alto índice de violencia laboral en el Programa de Especialización de Obstetricia y Ginecología, predominantemente institucional y psicológico que puede conducir a consecuencias adversas entre los residentes de posgrado.

Objective: To characterize workplace violence present in the several branches of the Caracas Ginecology and Obstetrics Specialization Program as perceived by the resident. Methods: Prospective, descriptive, cross-sectional study that included 120 residents of the Ginecology and Obstetrics Specialization Program for the period between July 2012 and July 2013. Informed consent an anonymous survey of residents selected using a random number table was used. Results: The frequency of workplace violence was 97.5 % (117), prevalent among victims of institutional violence type (96.6 %) followed by psychological violence (92.3 %) (P = 0,03). No relationship between workplace violence and sex (P = 0,713), year of graduate residence (P = 0,571) of the victims or respondent hospital (P= 0,146) was demonstrated. The perpetrators of violence were upper year resident, attendant, patient’s family and patient, among others. Conclusions: There is a high rate of workplace violence in the specialization of Obstetrics and Gynecology, predominantly institutional and psychological that may lead to adverse consequences among residents graduate.

Estudio ecológico sobre parasitismo intestinal, anemia y estado nutricional en indígenas emberá-chamí / Ecological study on intestinal parasites, anemia and nutritional status in emberá-chamí indigenous

Introducción: las parasitosis intestinales en indígenas son un problema de salud pública que puede conllevar a anemia y desnutrición, además de estar asociado con factores demográficos y socioeconómicos. Objetivo: comparar la prevalencia de parasitismo intestinal, desnutrición y anemia en cuatro zonas de un resguardo emberá-chamí colombiano, y explorar su asociación con condiciones sociodemográficas y sanitarias. Métodos: estudio ecológico con fuente de información primaria. Se determinó la prevalencia de parasitismo intestinal, anemia y desnutrición en cuatro zonas del resguardo. Para identificar factores asociados a los tópicos de investigación se realizaron pruebas de estadística no paramétrica en SPSS 21.0®...

Introduction: Intestinal parasitism in indigenous population is a public health problem that leads to anemia and malnutrition, and is known to be associated with demographic and socioeconomic factors. Aim: To compare the prevalence intestinal parasitosis, malnutrition and anemia in four emberá-chamí indigenous shelters, and explore its association with sociodemographic and health conditions. Methods: An ecological study with primary information source was done. The prevalence of anemia, intestinal parasites, and malnutrition in four areas of the shelter was determined. To obtain measures of association, nonparametric statistical tests were performed in SPSS 21.0®...

Niveles basales de colinesterasa en una población trabajadora no expuesta a plaguicidas inhibidores de estas enzimas, en Santafé de Bogotá / Basal levels of cholinesterase in working population not exposed to the inhibitor pesticides of these enzymes

La medición comparativa y periódica de los niveles de colinesterasas es el único medio de control biológico universalmente aceptado para evaluar la exposición a plaguicidas inhibidores de estas enzimas. En la actualidad los valores de referencia, que se emplean en los programas de vigilancia epidemiológica de exposición a plaguicidas, son extraídos de poblaciones extranjeras, cuyas características físicas, culturales y socioeconómicas son definitivamente diferentes a las nuestras. Esta situación hace dudar de la validez de estos valores como parámetro de comparación para evaluar a nuestros trabajadores expuestos. Los métodos empleados para determinar la actividad colinesterásica fueron Michel y EQM. Se tomó un grupo de 123 trabajadores voluntarios, elegidos aleatoriamente, no expuestos a plaguicidas. Se analizó el comportamiento de la actividad de la Acetil Colinesterasa de acuerdo con la edad, sexo, estado nutricional y hábito de fumar, para cada uno de los métodos. Para la técnica de EQM los resultados del percentil 5 y percentil 95 fueron de 25,9 U/gm ACHE/Hb y 44,5 U/gm ACHE/Hb, respectivamente. El valor mínimo encontrado en este estudio es mayor al encontrado en otros estudios similares. Para la técnica de Michel los resultados encontrados fueron semejantes a los encontrados en estudios similares.