The Complex Landscape of Structural Divergence Between the Drosophila pseudoobscura and D. persimilis Genomes.

Structural genomic variants are key drivers of phenotypic evolution. They can span hundreds to millions of base pairs and can thus affect large numbers of genetic elements. Although structural variation is quite common within and between species, its characterization depends upon the quality of genome assemblies and the proportion of repetitive elements. Using new high-quality genome assemblies, we report a complex and previously hidden landscape of structural divergence between the genomes of Drosophila persimilis and D. pseudoobscura, two classic species in speciation research, and study the relationships among structural variants, transposable elements, and gene expression divergence. The new assemblies confirm the already known fixed inversion differences between these species. Consistent with previous studies showing higher levels of nucleotide divergence between fixed inversions relative to collinear regions of the genome, we also find a significant overrepresentation of INDELs inside the inversions. We find that transposable elements accumulate in regions with low levels of recombination, and spatial correlation analyses reveal a strong association between transposable elements and structural variants. We also report a strong association between differentially expressed (DE) genes and structural variants and an overrepresentation of DE genes inside the fixed chromosomal inversions that separate this species pair. Interestingly, species-specific structural variants are overrepresented in DE genes involved in neural development, spermatogenesis, and oocyte-to-embryo transition. Overall, our results highlight the association of transposable elements with structural variants and their importance in driving evolutionary divergence.

Anilato-Based Coordination Polymers with Slow Relaxation of the Magnetization: Role of the Synthetic Method and Anilato Ligand.

We have prepared and characterized three coordination polymers formulated as [Dy2(C6O4Cl2)3(fma)6] ⋅ 4.5fma (1) and [Dy2(C6O4X2)3(fma)6] ⋅ 4fma ⋅ 2H2O with X=Br (2) and Cl (3), where fma=formamide and C6O4X2 2-=3,6-disubstituted-2,5-dihydroxy-1,4-benzoquinone dianion with X=Cl (chloranilato) and Br (bromanilato). Compounds 1 and 3 are solvates obtained with slow and fast precipitation methods, respectively. Compounds 2 and 3 are isostructural and only differ in the X group of the anilato ligand. The three compounds present (6,3)-gon two-dimensional hexagonal honey-comb structures. Magnetic measurements indicate that the three compounds show slow relaxation of the magnetization at low temperatures when a continuous magnetic field is applied, although with different relaxation times and energy barriers depending on X and the crystallisation molecules. Compounds 1-3 represent the first examples of anilato-based lattices with formamide and field-induced slow relaxation of the magnetization.

The Versatility of Ethylene Glycol to Tune the Dimensionality and Magnetic Properties in DyIII-Anilato-Based Single-Ion Magnets.

We exploit the high versatility of the solvent ethylene glycol (eg = CH2OH-CH2OH) acting as a ligand with three different coordination modes: terminal (κO), chelate (κ2O,O'), and bridge (1κO,2κO') to prepare a novel family of six different coordination polymers with DyIII and three different anilato ligands (3,6-disubstituted-2,5-dihydroxy-1,4-benzoquinone dianion = C6O4X22-, with X = H, Cl, and Br). With the X = H derivative (dhbq2-), we have prepared [Dy2(dhbq)3(eg)2(µ-eg)]·4eg·2H2O (1), a 3D diamond-like network with a chelate and bridging eg molecules. With the X = Cl derivative (chloranilato), we have prepared [Dy2(C6O4Cl2)3(eg)4]·2eg·H2O (2) and [Dy2(C6O4Cl2)3(µ-eg)(H2O)4]·2eg·7H2O (3). Compound 2 has a 2D (6,3)-gon brick-wall lattice and contains a chelate and a terminal eg molecule. Compound 3 has a 3D diamond-like topology as 1, although now the chelate eg has been replaced by two water molecules. Finally, with the X = Br derivative (bromanilato), we have obtained [Dy2(C6O4Br2)3(eg)2(CH3OH)2]·2eg·4CH3OH (4), [Dy2(C6O4Br2)3(eg)4]·4eg (5), and [Dy2(C6O4Br2)3(eg)3(H2O)]·2eg·H2O (6). Compound 4 has a 2D (6,3)-gon herringbone topology and contains a chelate eg and a MeOH molecule. Compounds 5 and 6 have a 2D (6,3)-gon brick-wall topology with a chelate and a terminal eg molecules (in 5 and in one of the two independent Dy centers of 6). The other Dy center in 6 has a chelate eg and a water molecule. All the compounds show slow relaxation of the magnetization at low temperatures (in compounds 1, 2, and 5 with no applied DC field). The magnetization of compounds 1-6 relaxes through Orbach and direct mechanisms when a DC field is applied and through an Orbach and/or quantum tunneling mechanism when no DC field is applied.

Recomendaciones para el manejo inicial del síndrome inflamatorio multisistémico relacionado temporalmente con COVID-19, en niños y adolescentes / Recommendations for the initial management of multisystem inflammatory syndrome temporally related to COVID-19, in children and adolescents

El síndrome inflamatorio multisistémico en niños y adolescentes temporalmente relacionado con COVID-19 es una presentación clínica de la infección por SARS-CoV-2. Comparte algunas características con la enfermedad de Kawasaki, el shock tóxico, la sepsis, el síndrome de activación macrofágica y la miocarditis. Son escasas las publicaciones que abordan su manejo inicial, que tiene semejanzas con el propuesto para el shock séptico. Esta revisión analiza dicho abordaje basado en las características propias del síndrome inflamatorio multisistémico relacionado con COVID-19, de acuerdo con el paradigma de construcción de una "guía de práctica institucional", y sugiere estrategias de aproximación terapéutica, que incluyen detección temprana, estabilización, referencia, tratamiento específico y análisis de proceso

Multisystem inflammatory syndrome temporally related to COVID-19 in children and adolescents is a clinical presentation of SARS-CoV-2 infection. It shares some features with Kawasaki disease, toxic shock, sepsis, macrophage activation syndrome, and myocarditis. Few publications have addressed its initial management, which is similar to that proposed for septic shock. This review analyzes such approach based on the characteristics typical of multisystem inflammatory syndrome related to COVID-19 in accordance with the paradigm of an "institutional practice guideline" and suggests therapeutic approach strategies, including early detection, stabilization, referral, specific treatment, and process analysis.

Recommendations for the initial management of multisystem inflammatory syndrome temporally related to COVID-19, in children and adolescents. / Recomendaciones para el manejo inicial del síndrome inflamatorio multisistémico relacionado temporalmente con COVID-19, en niños y adolescentes.

Multisystem inflammatory syndrome temporally related to COVID-19 in children and adolescents is a clinical presentation of SARS-CoV-2 infection. It shares some features with Kawasaki disease, toxic shock, sepsis, macrophage activation syndrome, and myocarditis. Few publications have addressed its initial management, which is similar to that proposed for septic shock. This review analyzes such approach based on the characteristics typical of multisystem inflammatory syndrome related to COVID-19 in accordance with the paradigm of an "institutional practice guideline" and suggests therapeutic approach strategies, including early detection, stabilization, referral, specific treatment, and process analysis.

El síndrome inflamatorio multisistémico en niños y adolescentes temporalmente relacionado con COVID-19 es una presentación clínica de la infección por SARS-CoV-2. Comparte algunas características con la enfermedad de Kawasaki, el shock tóxico, la sepsis, el síndrome de activación macrofágica y la miocarditis. Son escasas las publicaciones que abordan su manejo inicial, que tiene semejanzas con el propuesto para el shock séptico. Esta revisión analiza dicho abordaje basado en las características propias del síndrome inflamatorio multisistémico relacionado con COVID-19, de acuerdo con el paradigma de construcción de una "guía de práctica institucional", y sugiere estrategias de aproximación terapéutica, que incluyen detección temprana, estabilización, referencia, tratamiento específico y análisis de procesos.

Averaged Scale in Electronegativity Joined to Physicochemical Perturbations. Consequences of Periodicity.

In this work, we propose a new representative electronegativity scale χDC based on a statistical analysis of 11 electronegativity scales associated with electric ionic resonance energy, ionization potential, electron affinity, polarizability, electric force, average orbital energy, chemical potential, electrochemical reduction potential, and electric potential energy. Among these scales, it is the new PE° electronegativity scale, which relates the reduction potential E° to Pauling's electronegativity scale. The scale χDC gives more weight to the physicochemical factors, which influence the electronegativity, but this scale is not necessarily the best electronegativity scale for the element. This scale is based on (1) the average of the experimental electronegativity values; (2) the proximity of an experimental value to the average given by the difference and the ratio to this average; (3) in critical cases, the periodicity network of the periods and the groups; and (4) the periodicity of the sequence of the ratios of the experimental electronegativity values to the best-selected electronegativity value. We have also taken as probe scales Nagle's, Allred and Rochow's, Allen's (Hoffman's and Politzer's), PE°, Gordy's, and Ghosh's electronegativity scales in order to investigate the trend of the physicochemical factors which influence the electronegativity. With this trend, we have determined zones where a physicochemical property influences the electronegativity more. We have also found that physicochemical perturbations such as the orbital overlap, the stable configurations, the nephelauxetic effect, the width of the band gap, the ligand field stabilization energy, the penetration of the orbitals, and the lattice energy influence the electronegativity. Besides, we have analyzed the exactness of the electronegativity of the scales through the periodical ranking, the chemical tripartite separation among ionic, covalent, or metallic bond (taking into account the amplitude of the metalloid band), and the physicochemical property of bond force. The representative χDC electronegativity scale is the best in periodicity, followed by Batsanov's and Pauling's scales. In the type of chemical bond, the ranking depends on the number and kind of compounds in the sample, but in general, Pauling's, the ARS, and Batsanov's electronegativity scales are the best with a confidence interval of 95%. On the other hand, in the physical bond force, Batsanov's, Pauling's, Mulliken's, Nagle's, Allen's, the ARS, and the χDC electronegativity scales are the best scales. Also, we have considered the free atom and the in situ hypotheses of electronegativity and used the low and high oxidation states to verify these hypotheses. Besides, as an example of the utility of this ranking of scales, we have analyzed the relation of lanthanum La and lutetium Lu to Group 3, lanthanides, and hafnium Hf. We also analyze the vertical, horizontal, Knight's move, and isodiagonal periodicity of the electronegativity and associate this periodicity to a similar chemical-physical behavior of elements or ions.

Relationship between the Atomic Structure and Electrochemistry. 1. Electric Force, Standard Reduction Potential E°, and Standard Reaction Gibbs Free Energy ΔG°.

The relationship among the standard reaction Gibbs free energy ΔG°, the standard reduction potential E°, and the atomic structure parameters of radius, nuclear charge, and isoelectronic orbitals nl is accomplished through the attraction electric force F elec. In relationship with E°, it was necessary to define two new reference scales: E 0 ° with a final state of E° in the element, which allowed to have a parabolic trend of ΔG° versus F elec, and E °,0 whose final state is the ion with a more negative charge (e.g., -1, -2, -3). The relationship with ΔG° is related to the concept of chemical stability, and the relationship with E °,0 is more related to the concept of electronegativity. In relationship with ΔG°, it was necessary to predict the values of possible new cations and noncommon cations in order to find a better trend of ΔG° versus F elec, whose stability is analyzed by Frost diagrams of the isoelectronic series. This dependence of ΔG° on F elec is split into two terms. The first term indicates the behavior of the minimum of ΔG° for each isoelectronic orbital nl, while the second term deals with the parabolic trend of this orbital. For the minima of the configuration np6, a hysteresis behavior of the minima of ΔG° is found: an exponential behavior from periods 1 and 2 and a sigmoidal behavior from periods 5 and 4 to interpolate period 3. It is also found that the proximity of unfilled np or (n + 1)s orbitals induces instability of the ion in configurations ns2/nd2/4f2 and nd10/nd8(n + 1)s2, respectively. On the contrary, the stability of the orbitals np6 does not depend on the neighboring empty (n + 1)s0 orbitals. Both phenomena can be explained by the stability of the configuration of noble gas np6 and the nd10(n + 1)s2 configuration. We have also found that it is possible to increase the reduction potential E °,0 (macroscopic electronegativity), although the electric force F elec decreases because the orbital overlap influences the electronegativity.

Conocimiento y cuidados de la mujer para la prevención de prolapso de órganos pelvicos / Knowledge and care of women for the prevention of pelvic organ prolapse

Las disfunciones del piso pélvico tienen unaelevada incidencia en la población femenina,dentrodeestassedestacanlospro-lapsos uterinos, de la cúpula vaginal, entero-cele, cistóceles, retóceles, la incontinencia uri-nariaylafecal.Seestimaquedel3%al6%de la población femenina desarrollará alguna de estas disfunciones en algún momento de sus vidas. Objetivo: Determinar los conocimientos y cuidados que tienen las mujeres en etapa reproductiva y no reproductiva para prevenir prolapsos de órganos pélvicos en el Centro de Salud Miguel Paz Barahona (CSMPB) de San Pedro Sula en el primer semestre del año 2018. Pacientes y métodos: Estudio cuantita-tivo, transversal, descriptivo, instrumento tipo cuestionario aplicado a mujeres en etapa re-productivaynoreproductivaenelCSMPB,du-rante el primer semestre del año 2018. Pobla-ción 1766, muestra probabilística 316mujeres. Resultados: El 55% de la población tenían en-tre20-35añosdeedad,58%norealizabaejer-cicio físico, más de 90% desconocían sobre el prolapso de órganos pélvicos y sus cuidados, 19.2%presentósignosysíntomasdeprolapso de órganos pélvicos. Conclusión: Los resul-tados señalan que la mayoría mujeres tienen poco conocimiento sobre el prolapso de órga-nospélvicosyunporcentajepresentósintoma-tología, por lo tanto, no realizan cuidados para prevenir algún tipo de prolapso en el trascurso de suvida...(AU)

Linear and Nonlinear Optical Properties of Functional Groups for Conjugated Polymers. Analysis of the Acceptor-Donor Pair Substituents of Benzene: The Case of meta-Nitroaniline.

The nonlinear optical (NLO) properties of meta-nitroaniline (m-NA) are evaluated via Hückel-Agrawal's approximation in a solvent environment. In this context, both the 1B and the intramolecular charge transfer (ICT) electronic transitions are considered. The benzene ring currents on the clockwise or counterclockwise direction and the corresponding Brillouin zone from 0 to π are also considered. Besides, the Bloch equations were applied to a single cell n = 1 defined on the benzene ring. We have considered that the light beam was directed along the ring benzene bonds of m-NA; this topological hypothesis changed the crystal structure to a linear chain and the calculated optical properties were found near the experimental ones. In addition, the Fermi's golden rule was applied to the crystal state and then the calculated refraction index of m-NA had an error of less than 3% of the experimental one. On the other hand, the molar absorptivity ε of m-NA in acetonitrile for the 1B and intramolecular ICT transitions was experimentally determined to be 11 981 and 1192 L mol-1 cm-1, respectively. With this methodology, we found that the change of the charge in the NO2 group has also a strong influence on the linear and NLO properties. In addition, the dipole transition moments, which are originated from the carbon between the carbons joined to NO2 and NH2, are mainly involved in the NLO properties. Thus, the first hyperpolarizability ß z was 1.69 × 10-30 esu at λLaser = 1064 nm, 27% of the experimental value. We attribute this difference to the evaluation of the excited dipole moment. If we attribute a separation of charge of 0.1 e in the excited state, the new dipole moment allows for the simulation of the experimental value. Besides, the calculated value of χ(3) for m-NA in a solution of acetonitrile is 2.9 × 10-13 esu at λLaser = 1064 nm, 158% of the experimental value. The discrepancy between these values is attributed to the influence of the electronic correlation effects, that is, because of resonance structures of the aromatic ring and the zwitterionic pair of nitro and aniline. Besides, we have also evaluated the second hyperpolarizability γ, the second-order susceptibility χ(2) of m-NA and their values have similar differences to the experimental values. This type of approach is important because it reduces computing time and gives insight into the molecular causes responsible for linear and NLO properties in this type of functional groups, which can be used as building blocks in more complex polymer systems.

A Distinctive and Host-Restricted Gut Microbiota in Populations of a Cactophilic Drosophila Species.

Almost all animals possess gut microbial communities, but the nature of these communities varies immensely. For example, in social bees and mammals, the composition is relatively constant within species and is dominated by specialist bacteria that do not live elsewhere; in laboratory studies and field surveys of Drosophila melanogaster, however, gut communities consist of bacteria that are ingested with food and that vary widely among individuals and localities. We addressed whether an ecological specialist in its natural habitat has a microbiota dominated by gut specialists or by environmental bacteria. Drosophila nigrospiracula is a species that is endemic to the Sonoran Desert and is restricted to decaying tissues of two giant columnar cacti, Pachycereus pringlei (cardón cactus) and Carnegiea gigantea (saguaro cactus). We found that the D. nigrospiracula microbiota differs strikingly from that of the cactus tissue on which the flies feed. The most abundant bacteria in the flies are rare or completely absent in the cactus tissue and are consistently abundant in flies from different cacti and localities. Several of these fly-associated bacterial groups, such as the bacterial order Orbales and the genera Serpens and Dysgonomonas, have been identified in prior surveys of insects from the orders Hymenoptera, Coleoptera, Lepidoptera, and Diptera, including several Drosophila species. Although the functions of these bacterial groups are mostly unexplored, Orbales species studied in bees are known to break down plant polysaccharides and use the resulting sugars. Thus, these bacterial groups appear to be specialized to the insect gut environment, where they may colonize through direct host-to-host transmission in natural settings.IMPORTANCE Flies in the genus Drosophila have become laboratory models for microbiota research, yet the bacteria commonly used in these experiments are rarely found in wild-caught flies and instead represent bacteria also present in the food. This study shows that an ecologically specialized Drosophila species possesses a distinctive microbiome, composed of bacterial types absent from the flies' natural food but widespread in other wild-caught insects. This study highlights the importance of fieldwork-informed microbiota research.

Transcriptional responses of ecologically diverse Drosophila species to larval diets differing in relative sugar and protein ratios.

We utilized three ecologically diverse Drosophila species to explore the influence of ecological adaptation on transcriptomic responses to isocaloric diets differing in their relative proportions of protein to sugar. Drosophila melanogaster, a cosmopolitan species that breeds in decaying fruit, exemplifies individuals long exposed to a Western diet higher in sugar, while the natural diet of the cactophilic D. mojavensis, is much lower in carbohydrates. Drosophila arizonae, the sister species of D. mojavensis, is largely cactophilic, but also utilizes rotting fruits that are higher in sugars than cacti. We exposed third instar larvae for 24 hours to diets either (1) high in protein relative to sugar, (2) diets with equal amounts of protein and sugar, and (3) diets low in protein but high in sugar. As we predicted, based upon earlier interspecific studies of development and metabolism, the most extreme differences in gene expression under different dietary conditions were found in D. mojavensis followed by D. arizonae. No differential expression among diets was observed for D. melanogaster, a species that survives well under all three conditions, with little impact on its metabolism. We suggest that these three species together provide a model to examine individual and population differences in vulnerability to lifestyle-associated health problems such as metabolic syndrome and diabetes.

[Barriers to implementing screening, brief intervention and referral to treatment for substance use in HIV/AIDS health services in Peru]. / Barreras para implementar el despistaje, intervenciones breves y referencia al tratamiento por problemas de consumo de alcohol y otras drogas en hospitales que atienden personas que viven con el VIH/SIDA en el Perú.

OBJECTIVES.: Screening and treatment for substance use among people living with HIV/AIDS (PLWHA) is highly recommended. Nevertheless, in Peru healthcare for PLWHA does not include a standardized or systematic assessment to identify substance use. The aim of this study was to assess the feasibility of implementing screening, brief intervention and referral to treatment (SBIRT) in healthcare settings attending people living with PLWHA. MATERIALS AND METHODS.: After providing training in SBIRT for PLWHA's healthcare personnel (including nurses and physicians) focus groups were conducted to explore knowledge, beliefs and perceived barriers to implementation and interviews were conducted to assess the barriers and facilitators of two tertiary hospitals in Lima, Peru. RESULTS.: focus groups and interviews' thematic coding revealed three dimensions: 1) the unknown extent of substance use within PLWHA, 2) space and time limitations hinder completion of brief interventions during routine visits, and 3) insufficient access to substance use treatment appropriate for HIV patients. CONCLUSIONS.: Multiple barriers, including lack of awareness of substance use problems, limited space and time of providers, and lack of specialized services to refer patients for treatment make it difficult to implement SBIRT in the Peruvian healthcare system.

Barreras para implementar el despistaje, intervenciones breves y referencia al tratamiento por problemas de consumo de alcohol y otras drogas en hospitales que atienden personas que viven con el VIH/SIDA en el Perú / Barriers to implementing screening, brief intervention and referral to treatment for substance use in HIV/AIDS health services in Peru

RESUMEN Objetivos. Evaluar la factibilidad de implementar la detección, intervención breve y referencia a tratamiento (SBIRT, por sus siglas en inglés) en los servicios de atención para personas viviendo con el virus de inmunodeficiencia humana/ síndrome de inmunodeficiencia adquirido (PVVS). Materiales y métodos. Se realizó un estudio de tipo cualitativo, luego de capacitar profesionales de salud (incluyendo, enfermeras y médicos) que proveen atención de salud a PVVS en la aplicación del SBIRT, se realizaron grupos focales para explorar las barreras percibidas para su implementación y se realizaron entrevistas para evaluar las barreras y facilitadores en dos hospitales de tercer nivel de Lima, Perú. Resultados. La codificación temática de los grupos focales y las entrevistas revelaron tres dimensiones principales de barreras: 1) el desconocimiento acerca del consumo de sustancias en las PVVS; 2) limitaciones de espacio y tiempo que dificultan las intervenciones breves durante las visitas de rutina, y 3) insuficientes servicios con capacidades para el tratamiento el uso de sustancias apropiadas donde puedan ser referidos los pacientes con estos problemas. Conclusiones. Múltiples barreras, incluyendo el desconocimiento por los problemas de consumo de sustancias, limitaciones de espacio y tiempo de los profesionales, y carencia de servicios especializados a donde referir los pacientes para un cuidado especializado, haría difícil implementar SBIRT en un contexto como el del sistema de salud peruano.

ABSTRACT Objectives. Screening and treatment for substance use among people living with HIV/AIDS (PLWHA) is highly recommended. Nevertheless, in Peru healthcare for PLWHA does not include a standardized or systematic assessment to identify substance use. The aim of this study was to assess the feasibility of implementing screening, brief intervention and referral to treatment (SBIRT) in healthcare settings attending people living with PLWHA. Materials and methods. After providing training in SBIRT for PLWHA's healthcare personnel (including nurses and physicians) focus groups were conducted to explore knowledge, beliefs and perceived barriers to implementation and interviews were conducted to assess the barriers and facilitators of two tertiary hospitals in Lima, Peru. Results. focus groups and interviews' thematic coding revealed three dimensions: 1) the unknown extent of substance use within PLWHA, 2) space and time limitations hinder completion of brief interventions during routine visits, and 3) insufficient access to substance use treatment appropriate for HIV patients. Conclusions. Multiple barriers, including lack of awareness of substance use problems, limited space and time of providers, and lack of specialized services to refer patients for treatment make it difficult to implement SBIRT in the Peruvian healthcare system.

Genome Evolution in Three Species of Cactophilic Drosophila.

We report genomes of two species of cactophilic Drosophila: Drosophila arizonae and D. navojoa These two are the closest relatives of D. mojavensis, forming the D. mojavensis cluster. D. mojavensis and D. arizonae diverged from D. navojoa ∼5.8 Mya, while the split between D. arizonae and D. mojavensis is more recent, at 1.5 Mya. Together the three genomes provide opportunities to examine genomic changes associated with speciation and host shifts in this ecologically defined group of flies. The three species are also separated by fixed inversion differences in three of their six chromosomes. While the levels of nucleotide divergence in the colinear chromosomes are significantly lower than in the inverted chromosomes, consistent with a past role of the inversions in preventing gene flow, the patterns differ among the inverted chromosomes when the locations of nucleotides inside or outside of the inversions are considered. For Muller element E, there is greater divergence external to the inversion breakpoints. For Muller A, the divergence is slightly higher inside the inversions, while for Muller B, the breakpoints and hence the difference in substitutions in relation to the inversions could not be determined. The differences among the inverted chromosomes, especially once the breakpoints are clearly established, could aid in dating the origins of the inversions.

[Primary care in the USA and the Peruvian experience in perspective]. / La atención primaria en los Estados Unidos y la experiencia peruana en perspectiva.

Due to a complex payment system, the health system of the United States is fragmented, expensive, and achieves the goal of improving the health of the entire population. Excessive health costs increase the budget deficit in the US. This situation makes to the government to have greater willingness to try new approaches in the delivery of health services. Is well know that the states that have a solid system of primary health care (PC), spent less money in diseases and have lower utilization of health services (reflected in fewer days of hospitalization). This is why the AP is spreading in the US making doctors, nurses and other providers to collaborate on new proposals for team-based care, coordinated and patient-oriented generating real benefits while controlling costs. The US experience with AP support evidence-based approach to propose, from a foreign perspective, strengthening the AP in Peru.

La atención primaria en los Estados Unidos y la experiencia peruana en perspectiva / Primary care in the USA and the peruvian experience in perspective

Debido a un complejo sistema de pagos, el sistema de salud de los Estados Unidos (EE. UU.) es fragmentado, costoso, y alcanza el objetivo de mejorar la salud de toda la población. Los costos excesivos de salud incrementan el déficit económico en los EE. UU., y esto hace que su gobierno tenga mayor disposición a probar nuevos enfoques en la prestación de servicios de salud. Llama la atención que los estados norteamericanos que cuentan con un sistema de atención primaria (AP) sólido, tienen menores gastos por enfermedad y menor utilización de servicios de salud (reflejado en menos días de hospitalización). Es por esto que la AP está extendiéndose en los EE. UU., haciendo que médicos, enfermeras y otros proveedores colaboren en nuevas propuestas de atención basadas en equipo, coordinadas y orientadas al paciente generando beneficios reales, al mismo tiempo que controlan los costos. Esta experiencia estadounidense con una AP con enfoque basado en evidencias ayuda a proponer, desde una perspectiva extranjera, el fortalecimiento de la AP en el Perú.

Due to a complex payment system, the health system of the United States is fragmented, expensive, and achieves the goal of improving the health of the entire population. Excessive health costs increase the budget deficit in the US. This situation makes to the government to have greater willingness to try new approaches in the delivery of health services. Is well know that the states that have a solid system of primary health care (PC), spent less money in diseases and have lower utilization of health services (reflected in fewer days of hospitalization). This is why the AP is spreading in the US making doctors, nurses and other providers to collaborate on new proposals for team-based care, coordinated and patient-oriented generating real benefits while controlling costs. The US experience with AP support evidence-based approach to propose, from a foreign perspective, strengthening the AP in Peru.

[Efficacy of the therapeutic community model in the treatment of drug use-related problems: a systematic review]. / Eficacia de las comunidades terapéuticas en el tratamiento de problemas por uso de sustancias psicoactivas: una revisión sistemática.

OBJECTIVE: To summarize the scientific evidence about the efficacy of therapeutic communities (TC) to reduce substance use and related problems among people with substance use disorders. METHODS: This systematic review builds from the work performed by Smith et al. (2006). We searched MEDLINE, EMBASE, Web of Science, Scielo, and LILACS for randomized trials that compare a TC with no treatment, a different type of treatment or another type of TC published from March 2004 to May 2011. RESULTS: 5 publications from 4 randomized trials were identified. All the studies had serious methodological limitations according to the CONSORT. The heterogeneity among studies did not allow for metaanalytic analysis to calculate pooled estimates. The primary analysis showed that, in prison, certain models of TC might be marginally superior to other types of treatments regarding levels of alcohol use, days in prison and re-incarceration rates. Also, evidence from a community setting (i.e., not in-prison) suggests that a community-based TC is not superior to an outpatient treatment model regarding levels of substance use, crime and unemployment at the 12-month follow-up. CONCLUSIONS: In general, there is no evidence to support superiority of TC over other more accessible and less costly types of treatment for drug use. However, in a prison context, TC might be of more benefit than other types of treatment. More research with solid experimental methodology is needed to add to the still weak body of evidence that supports the use of TC over other more affordable types of treatment for drug use disorders.

Eficacia de las comunidades terapéuticas en el tratamiento de problemas por uso de sustancias psicoactivas: una revisión sistemática / Efficacy of the therapeutic community model in the treatment of drug use-related problems: a systematic review

Objetivos. Extender la revisión hecha por Smith et al. el 2006 y resumir la evidencia disponible actualmente respecto a la eficacia de las comunidades terapéuticas (CT) en disminuir el consumo de sustancias o sus consecuencias en personas con trastornos por uso de sustancias. Materiales y métodos. Se consultaron las bases de MEDLINE, EMBASE, Web of Science, Scielo, LILACS, y otras, buscando estudios experimentales controlados aleatorizados con grupos paralelos, publicados entre marzo de 2004 a mayo de 2011. Resultados. Se ubicaron cinco publicaciones de cuatro ensayos controlados. Todos los estudios tuvieron serias limitaciones metodológicas de acuerdo al CONSORT. La heterogeneidad de los estudios no permitió agrupamientos en el análisis. En los análisis primarios, modelos específicos de CT en prisión mostraron superioridad marginal frente a otros tipos de tratamiento respecto a niveles de consumo de alcohol, días de encarcelamiento y tasa de rencarcelamiento. Respecto al modelo de CT ambulatorio basado en la comunidad, no hubo evidencia de superioridad de este frente a otro tratamiento ambulatorio, tanto en reducir el nivel de consumo de sustancias, como en la ocurrencia de crimen y desempleo a los doce meses de seguimiento. Conclusiones. No hay suficiente evidencia científica que apoye una superioridad de la metodología de CT respecto a otras formas de tratamiento menos costosos. Sin embargo, en el contexto carcelario, las comunidades terapéuticas podrían ser más beneficiosas que otros modelos. Son necesarios ensayos clínicos con metodología rigurosa para resolver las controversias respecto a la eficacia de este tipo de tratamiento de trastornos por uso de drogas.

Objective: To summarize the scientific evidence about the efficacy of therapeutic communities (TC) to reduce substance use and related problems among people with substance use disorders. Methods: This systematic review builds from the work performed by Smith et al. (2006). We searched MEDLINE, EMBASE, Web of Science, Scielo, and LILACS for randomized trials that compare a TC with no treatment, a different type of treatment or another type of TC published from March 2004 to May 2011. Results: 5 publications from 4 randomized trials were identified. All the studies had serious methodological limitations according to the CONSORT. The heterogeneity among studies did not allow for metaanalytic analysis to calculate pooled estimates. The primary analysis showed that, in prison, certain models of TC might be marginally superior to other types of treatments regarding levels of alcohol use, days in prison and re-incarceration rates. Also, evidence from a community setting (i.e., not in-prison) suggests that a community-based TC is not superior to an outpatient treatment model regarding levels of substance use, crime and unemployment at the 12-month follow-up. Conclusions: In general, there is no evidence to support superiority of TC over other more accessible and less costly types of treatment for drug use. However, in a prison context, TC might be of more benefit than other types of treatment. More research with solid experimental methodology is needed to add to the still weak body of evidence that supports the use of TC over other more affordable types of treatment for drug use disorders.