Do symptoms of sleepiness and insomnia in US veterans with obstructive sleep apnea vary by age?

INTRODUCTION: The influence of aging on the clinical presentation of obstructive sleep apnea (OSA) is not well characterized in US veterans. Our aims were to (1) examine age and established predictors of sleepiness and insomnia symptoms in veterans with OSA and (2) determine if the relationship between predictors of the Epworth sleepiness scale (ESS) and insomnia severity index (ISI) depended on age. METHODS: We performed a retrospective analysis of veterans diagnosed with OSA at the Miami VA in 2014. On polysomnography (PSG) night, questionnaires were completed querying socio-demographics, insomnia (ISI), sleepiness (ESS), and self-reported sleep duration. Regression modeling was performed to explore association of variables with (1) ESS and (2) ISI. Analyses were performed in two steps: (1) variables were tested for main effects and (2) product of age and each variable found to have an association at a significance level of p < 0.10 with primary outcome were entered separately to test for interaction. RESULTS: The sample consisted of 483 veterans (93% male, age 52 ± 13 years, 41% black, 34% Hispanic). Having a regular bed partner, higher weighted medical comorbidities, chronic pain diagnosis, and shorter sleep duration were associated with ESS. Age did not moderate the relationship between these variables and ESS. Younger age, Hispanic ethnicity, higher educational level, shorter sleep duration, mood, and pain diagnoses were each associated with the ISI. Furthermore, an age-sleep duration interaction term was associated with the ISI (b = - 0.03; p = 0.005). For all participants, there was an inverse relationship between sleep duration and ISI. However, for any sleep duration, older veterans reported lower levels of insomnia than younger veterans. DISCUSSION: Older veterans with OSA may report lower ISI scores. Alternative assessment methods for comorbid insomnia among older individuals with OSA may be needed.

Categorización de los énfasis de los proyectos de investigación en malaria financiados por Colciencias durante 1995-2005 / Classification of the scope of research projects on malaria funded by Colciencias during 1995-2005

RESUMEN Objetivo Identificar los principales objetivos y énfasis de los proyectos de investigación en malaria financiada por Colciencias entre 1995 y 2005. Métodos Para la identificación del énfasis de los proyectos de investigación en malaria se utilizó el sistema de clasificación en investigación en salud desarrollado por la Colaboración de Investigación Clínica de Gran Bretaña: "Health Research Classification System" (HRCS). Resultados Se encontró que la investigación en malaria durante este periodo tiene énfasis en determinantes y causas, las principales ciudades beneficiadas con la financiación de proyectos de investigación en malaria son instituciones pertenecientes a Bogotá, Medellín y Cali. Conclusiones Estos proyectos permitieron el fortalecimiento en núcleos de investigación en malaria en las líneas de biología molecular, producción de vacunas, identificación de resistencia a antimaláricos y estudios relacionados con el cambio climático; algunos de sus resultados con capacidad de afectar políticas en malaria y formación de recurso humano.(AU)

ABSTRACT Objective To identify the main focus of research projects on malaria funded by Colciencias between 1995 and 2005. Methodology The Health Research Classification System (HRCS), developed by The UK Clinical Research Collaboration (UKCRC), was used for identifying the emphasis of research works on Malaria. Results During this period, research on malaria was mainly directed to etiology; the main cities benefited by the funding of research projects on malaria are institutions from Bogotá, Medellín and Cali. Conclusions These type of projects improve the strengthening of malaria research centers in areas such as molecular biology, production of vaccines, identification of resistance to antimalarial treatment, and climate change; some of the results obtained can affect policies and training of human resources on malaria.(AU)

Effect of process technology on the nutritional, functional, and physical quality of grapefruit powder.

The health properties of fruit are widely known. Powdered fruit may be a practical format to be offered to the consumer. Nevertheless, the process used to obtain the powder must ensure the maximum retention of the bioactive compounds and the functional value of the fruit while retaining adequate physical properties. The aim of this study was to compare freeze-drying and spray drying as the drying technologies to obtain grapefruit powder. The obtained results allow freeze-drying to be proposed as a better technology than spray drying in order to obtain a product with a higher content of vitamin C and total carotenoids. Moreover, all of the edible part of the fruit is used in this case, so a greater quantity of healthy compounds is preserved and by-product generation is avoided. Adding about 6 g water, 4 g Arabic gum and 0.6 g bamboo fibre/100 g grapefruit pulp is recommended before freeze-drying.

[Classification of the scope of research projects on malaria funded by Colciencias during 1995-2005]. / Categorización de los énfasis de los proyectos de investigación en malaria financiados por Colciencias durante 1995-2005.

OBJECTIVE: To identify the main focus of research projects on malaria funded by Colciencias between 1995 and 2005. METHODOLOGY: The Health Research Classification System (HRCS), developed by The UK Clinical Research Collaboration (UKCRC), was used for identifying the emphasis of research works on Malaria. RESULTS: During this period, research on malaria was mainly directed to etiology; the main cities benefited by the funding of research projects on malaria are institutions from Bogotá, Medellín and Cali. CONCLUSIONS: These type of projects improve the strengthening of malaria research centers in areas such as molecular biology, production of vaccines, identification of resistance to antimalarial treatment, and climate change; some of the results obtained can affect policies and training of human resources on malaria.

OBJETIVO: Identificar los principales objetivos y énfasis de los proyectos de investigación en malaria financiada por Colciencias entre 1995 y 2005. MÉTODOS: Para la identificación del énfasis de los proyectos de investigación en malaria se utilizó el sistema de clasificación en investigación en salud desarrollado por la Colaboración de Investigación Clínica de Gran Bretaña: "Health Research Classification System" (HRCS). RESULTADOS: Se encontró que la investigación en malaria durante este periodo tiene énfasis en determinantes y causas, las principales ciudades beneficiadas con la financiación de proyectos de investigación en malaria son instituciones pertenecientes a Bogotá, Medellín y Cali. CONCLUSIONES: Estos proyectos permitieron el fortalecimiento en núcleos de investigación en malaria en las líneas de biología molecular, producción de vacunas, identificación de resistencia a antimaláricos y estudios relacionados con el cambio climático; algunos de sus resultados con capacidad de afectar políticas en malaria y formación de recurso humano.

Comparison of the removal of chlorpyrifos and dissolved organic carbon in horizontal sub-surface and surface flow wetlands.

Chlorpyrifos is an organophosphorus pesticide widely used in Colombia for agricultural and domestic pest control. It is also commonly found in water sources in rural areas. Constructed wetlands are being used as viable alternatives for the treatment of domestic wastewater with large organic loads. For this research, three pilot-scale subsurface horizontal flow constructed wetlands and three horizontal surface flow wetlands were used for the treatment of synthetic wastewater with different concentrations of chlorpyrifos (0.0 µg L(-1), 478 µg L(-1), 589 µg L(-1) and 788 µg L(-1)), 100 mg L(-1) of dissolved organic carbon and nutrients. The wetlands were constructed in equal dimensions and in the same size range as the gravel bed (3.18-6.35 mm) and planted with Phragmites australis. The efficiencies of the removal of the pesticide and dissolved organic carbon were then determined. Additionally, other physicochemical parameters, as well as 3,5,6-trichloro-2-pyridinol, the main breakdown product of chlorpyrifos, were measured. The average removals of this agrochemical and dissolved organic carbon in the subsurface horizontal flow constructed wetlands were 93% and 92%, respectively, and in the horizontal surface flow wetlands, the average removal was 95% for both compounds. The removal is the result of the joint action of microorganisms and the adsorption and absorption of roots and rhizomes of plants found in wetlands. Both types of wetlands are very efficient at treating the domestic wastewater contaminated with pesticides and dissolved organic carbon, although the results were slightly better in the surface flow wetlands.

Malaria congénita por Plasmodium vivax: un caso incidental en contexto de sepsis neonatal / A case of congenital malaria by Plasmodium vivax: an incidental case within the context of neonatal sepsis

La malaria congénita es una patología relativamente rara en el contexto de las patologías neonatales. Presentamos el caso de una lactante de 20 días de vida con malaria congénita por Plasmodium vivax cuyo diagnóstico fue realizado de forma incidental al analizar una muestra de laboratorio en el estudio de sepsis neonatal. La paciente era procedente de una zona no endémica de Colombia pero con antecedente materno de malaria gestacional diagnosticada al 7º mes, la cual no fue tratada por omisión de la paciente. Las manifestaciones clínicas fueron inespecíficas, similares a las de una sepsis neonatal y el tratamiento antimalárico fue realizado con cloroquina, con adecuada respuesta clínica, confirmada mediante negativización de gota gruesa al finalizar el tratamiento. Se considera de gran importancia tenerla malaria congénita cada vez más en cuenta como diagnóstico diferencial de la sepsis neonatal sobre todo en pacientes procedentes de zonas de riesgo o endémicas (AU)

Congenital malaria is a disease relatively rare in the context of neonatal pathologies. We report the case of an infant of twenty days of life with malaria congenital whose a plasmodium vivax, the diagnosis was made incidentally while processing a laboratory sample in the context of neonatal sepsis. The patient was from non-endemic area but with no previously know maternal history of gestational malaria seven months, which was no treated by omission of the la patient. The nonspecific clinical manifestations were similar to those of neonatal sepsis and antimalarial treatment with chloroquine was carried out with adequate clinical response and confirmed by thick smear negative at the end of treatment. Hence it is considered very important to have more and more into account as differencial diagnosis in patient from risk areas besides the differential diagnosis of neonatal sepsis (AU)

Prioridades de investigación en salud en Colombia: perspectiva de los investigadores / Health research priorities in Colombia from the researchers' point of view

Colombia tiene una escasa experiencia en identificar prioridades de investigación en salud. En el año 2004 se inició un proyecto para identificar prioridades de investigación en salud, entendiendo por tales las que resultan de un ejercicio ordenado de ponderación basado en una valoración juiciosa de problemáticas sanitarias cuya respuesta y/o solución puede lograrse en gran parte por medio de conocimientos y procesos de investigación. Como referentes del proyecto se tuvieron en cuenta algunos de los métodos de priorización utilizados y recomendados en el ámbito internacional, entre ellos la matriz combinada del Global Forum for Health Resarch. Se pusieron en práctica dos trayectos metodológicos principales: por una parte, diseño y aplicación de un método para ponderar u ordenar, de manera cualitativa y cuantitativa, las problemáticas de investigación en salud; por otra parte, construcción de consensos con investigadores y representantes de comunidades científicas. Para identificar las problemáticas de salud predominantes se realizaron dos reuniones nacionales, dos reuniones regionales y un foro virtual. Una vez identificadas las problemáticas de salud predominantes, con su respectiva estimación de carga de enfermedad, estas se valoraron por políticos y decisores y se calificaron por investigadores de ciencias básicas, ciencias clínicas y salud pública, en términos del aporte del conocimiento requerido para afrontar, controlar o resolver tales problemáticas. Se obtuvieron unas prioridades de investigación en salud por áreas globales: enfermedades crónicas, enfermedades infecciosas emergentes, Tuberculosis/Lepra, infección nosocomial e infecciones de transmisión sexual/VIH/SIDA.

Colombia lacks experience in identifying health research priorities. A project for idenifying health research priorities was begun in 2004 (meaning those arising from weighting and ordering health and disease problems which could be mainly resolved by research and knowledge). The Global Forum for Health Research combined matrix method, and other methods, was used as reference for developing projects and putting two main methodological paths into practice: designing and applying a method for qualitatively and quantitatively weighting and ordering health research problems and building consensus with researchers and scientific community representatives. Two national meetings, two regional meetings and a virtual forum were held for identifying predo­minant health problems. Once the predominant health problems had been identified (with the respective estimation of disease load), then they were evaluated by politi­cians and decision-makers and rated by basic science, clinical science and public health researchers in terms of making a contribution towards knowledge for facing, controlling or resolving such problems. Some health research priorities were obtained (by areas and others being overall priorities): chronic diseases, emergent infectious diseases, tuberculosis/leprosy, nosocomial infection and sexually transmitted diseases/HIV/AIDS.

A new Inequity-in-Health Index based on Millennium Development Goals: methodology and validation.

OBJECTIVES: Developing a new Inequity-in-Health Index (IHI) assuming inequity as "inequality of health outcomes," based on Millennium Development Goals (MDG). STUDY DESIGN AND SETTING: Ecological study. Countries from around the world were included from United Nations, the World Bank, and a nonprofit organization's databases. The reliability and validity of this bidimensional IHI was tested. Main factor analysis (promax rotation) and main component analysis were used. RESULTS: Six variables were used for constructing the IHI was constructed with six variables: underweight children, child mortality, death from malaria in children aged 0-4, death from malaria at all ages, births attended by skilled health personnel, and immunization against measles. The IHI had high internal consistency (Cronbach's alpha=0.8504), was reliable (Spearman>0.9, P=0.0000), and had 0.3033pi around the world (range: 0pi-0.5984pi). IHI had high correlation with the human development and poverty indexes, health gap indicator, life expectancy at birth, probability of dying before 40 years of age, and Gini coefficients (Spearman>0.7, P=0.0000). IHI discriminated countries by income, region, indebtedness, and corruption level (Kruskal Wallis, P<0.01). IHI had sensitivity to change (P=0.0000). CONCLUSION: IHI is a bidimensional, valid and reliable index to monitor MDG. A new reliable methodology for developing bidimensional indicators is shown, which could be used for constructing other ones with their corresponding scores and graphs.

Overview of hyperuricaemia and gout.

In most mammals purine degradation ultimately leads to the formation of allantoin. Humans lack the enzyme uricase, which catalyzes the conversion of uric acid to allantoin. The resulting higher level of uric acid has been hypothesized to play a role as an antioxidant. Hyperuricaemia is usually an asymptomatic condition which is hypothesized to play a role in cardiovascular disease and hypertension. Some hyperuricaemic individuals develop gout, an inflammatory arthritis caused by the deposition of monosodium urate crystals in joints. Over time, acute intermittent gouty arthritis can develop into a chronic condition with deposits of monosodium urate (MSU) crystals in joints and as tophi. The mechanisms by which MSU crystals lead to an acute inflammatory arthritis are under investigation and current knowledge is reviewed here. Treatment of gout includes management of acute flares with anti-inflammatory medications such as non-steroidal anti-inflammatory drugs or corticosteroids and long term management with urate-lowering therapy when indicated. Future directions in the treatment of gout, in part guided by a better understanding of pathophysiology, are discussed.

El agua, recurso estratégico del siglo XXI / Walter: strategic resource in the 21st century

La disponibilidad de agua dulce en todo el mundo es crítica cada día es más compleja, debido a factores como la contaminación del recurso hídrico, la manipulación económica y la fuente de poder que representa para quien la posee. la creciente demanda de agua para la agricultura, la industria y el consumo doméstico han creado competencias que se reflejarán en unos 15 años debido al crecimiento demográfico y la falta de planificación, educación y conciencia para el manejo y uso adecuado del agua, lo que genera consecuencias como acidez de los suelos y lagos, enferdades gastroinstestinales derivadas de su consumo y aumento de abortos y malformaciones géneticas por la presencia de metales pesados en aguas. La desmedida ambición que ciertos grupos económicos tienen por aumentar la explotación, control y administración de recursos como el petróleo, el gas natural y agua dulce hacen que el agua sea un elemento esencial, unico e insustituible para la supervivencia de la humanidad. Con este ensayo crítico se busca reflexionar sobre la problemática social, política y económica del agua dulce que actualmente se vislumbra para un futuro próximo.

Cystic endometrial hyperplasia-pyometra complex in cats. A review.

Presentation of complex cystic endometrial hyperplasia-pyometra is not very common in cats. As in bitches, hormonal influences result in environmental and histological changes in the uterus leading to predisposition to bacterial growth. Its influence on the organism provokes certain clinical signs. Diagnosis and treatment must be fast and aggressive. Depending on the clinical status and queen purpose, it can be both surgical or medical. Both of them offer a high rate of success if the detailed protocols are followed.

Análisis de la gestión integral de residuos sólidos en la zona sur del Área Metropolitana del valle del Aburrá (2004) / Analysis of the integrated management of solid residues in the south zone of Medellín Metropolitan Area in 2004

Objetivo: analizar la gestión integral de residuos sólidos en la zona sur del área metropolitana del valle del Aburrá durante el año 2004. Metodología: se realizó un estudio descriptivo en que se observaron las condiciones socioeconómicas, técnicas, ambientales e institucionales relacionadas con el manejo de los residuos sólidos municipales en sus diferentes etapas. Resultados: al examinar la información se evidenció que la prestación del servicio público de aseo se ha orientado principalmente hacia la recolección y transporte hasta el sitio de disposición final, restándole importancia a las demás fases previstas dentro de la gestión integral de residuos. Por medio de un diagnóstico se hallaron las deficiencias y necesidades que sirvieron de base para el estudio de las alternativas de solución y elaboración de estrategias, lo que facilitó la propuesta de programas y proyectos encaminados al mejoramiento de la administración de los residuos desde la generación hasta la disposición final. Conclusión: se pudo verificar la prioridad de implementar campañas permanentes de sensibilización y educación para el logro de un cambio de actitud de los actores que intervienen en el manejo de los residuos municipales; además, se proponen estrategias de solución, con el fin de que se apropien de la problemática local y de que participen en el mejoramiento continuo de dicha gestión.

Utilización de servicios de salud y perfiles epidemiológicos como parámetros de adecuación del Plan Obligatorio de Salud en Colombia / Use of health services and epidemiological profiles as parameters for adjusting the Compulsory Health Plan in Colombia

OBJETIVOS: Evaluar la utilización de los servicios de salud y los perfiles epidemiológicos, como parámetros de ajuste de los contenidos del Plan Obligatorio de Salud-POS. METODOLOGíA: Se realizó un estudio evaluativo de los contenidos del POS con respecto a la utilización de servicios y los perfiles epidemiológicos regionales, en el marco de la problemática actual del Sistema General de Seguridad Social en Salud. La utilización de los servicios se estimó por medio de la Encuesta sobre Equidad en la Gestión Fiscal de 1994, la Encuesta Nacional de Calidad de Vida de 1997 y la Encuesta Nacional de Hogares de 2000. Los perfiles epidemiológicos se obtuvieron de los datos de mortalidad del DANE del año 2000. RESULTADOS: La afiliación al sistema de salud ha logrado llegar sólo a un 56 por ciento del total de la población. Sin embargo, el aumento del gasto en salud ha sido constante entre 1993 y el año 2000, pasando de un 7,2 por ciento del PIB a cerca de un 10 por ciento. Al tiempo se observan diferencias en la mortalidad por regiones. Se encontró mayor utilización de servicios a mayor edad y a mayor nivel de gasto de las personas. Las mujeres son las que más utilizan servicios de salud, especialmente las que residen en zonas urbanas y en el quintil de gasto más alto. La menor utilización es la de los hombres residentes en la zona rural, del primer quintil de gasto. CONCLUSIONES: Organizando el POS con una estructura modular es posible ajustarlo por medio de los parámetros de utilización de los servicios y los perfiles epidemiológicos, de tal manera que contribuya a mejorar los problemas de oportunidad y pertinencia de los servicios, así como acrecentar la afiliación al sistema.

Residual pulmonary abnormalities in adult patients with chronic paracoccidioidomycosis: prolonged follow-up after itraconazole therapy.

Itraconazole effectively controls active paracoccidioidomycosis but appears not to hinder lung fibrosis. Clinical records and chest radiographs from 47 itraconazole-treated patients with prolonged posttherapy follow-up (mean follow-up period, 5.6 years) were analyzed; the radiographs were interpreted following pneumoconiosis standards that consider the lungs as 6 fields and grade damage according to the number of fields involved. Infiltrative lesions were observed at diagnosis in 93.6% of the patients. Fibrosis was observed in 31.8% of the patients at diagnosis and had not cleared at the end of the observation period in any of these patients. Fibrosis also developed de novo in 11 patients (25%), so that by the end of the follow-up period it was seen in 53.2% of patients overall. Fibrosis correlated with severity of infiltrates at diagnosis: fibrosis was present in 83% of patients with very severe infiltration and in 12.5% of patients with minor infiltration. Among patients with severe infiltration, fibrosis was present in 30%; this increased (to 75%) when bullae were concomitantly present at diagnosis. Prompt initiation of treatment is necessary to avoid the development of fibrosis.