Association of reproductive risk factors and comorbidities among molecular subtypes of Breast cancer in a Tertiary care Hospital

The reasons for the recently observed increase in the incidence of breast cancer in the Indian population are not clearly understood, but thought to be largely explained by westernization of lifestyles and changes in reproductive behavior, which characterize exposure to hormones. Our aim is to review the reproductive risk factors and comorbidities and evaluate the association between molecular subtypes of breast cancer. A hospital-based analytical case-control study was conducted among the breast cancer cases with controls in a multispecialty teaching hospital for a period of one year. Totally, 130 subjects were recruited and an interview was conducted using a structured questionnaire to obtain demographic and risk factor data, including tissue marker status (ER, PR and HER-2) obtained from case files. Data were analyzed with SPSS-20 version. Results: The highest age group reported in this study was 51- 60 years which has a 3.8 times increased risk compared to other age and the age group of 31- 40 have a decrease risk of 0.33. In this study, the percentage of post menopause (68%) and mothers not breastfeeding (10%) was higher in cases compared to controls and a noted increase in the risk of breast cancer with odds ratio (OR) of 2.745 (p= <0.0001) and 9.08 (p=0.01) respectively. Duration of breastfeeding showed significantly (p=<0.0001)) moderate positive correlation (r=0.549, 0.457, 0.418 and 0.636) for luminal A, luminal B, HER+, and triple negative respectively. This study found that all the reproductive risk factors do not have correlation with a molecular subtype of breast cancer except breastfeeding. Post menopause and breastfeeding were common factors associated with all people and could be modifiable to prevent the occurrence of breast cancer through lifestyle change

The tree cover and temperature disparity in US urbanized areas: Quantifying the association with income across 5,723 communities.

Urban tree cover provides benefits to human health and well-being, but previous studies suggest that tree cover is often inequitably distributed. Here, we use National Agriculture Imagery Program digital ortho photographs to survey the tree cover inequality for Census blocks in US large urbanized areas, home to 167 million people across 5,723 municipalities and other Census-designated places. We compared tree cover to summer land surface temperature, as measured using Landsat imagery. In 92% of the urbanized areas surveyed, low-income blocks have less tree cover than high-income blocks. On average, low-income blocks have 15.2% less tree cover and are 1.5°C hotter than high-income blocks. The greatest difference between low- and high-income blocks was found in urbanized areas in the Northeast of the United States, where low-income blocks in some urbanized areas have 30% less tree cover and are 4.0°C hotter. Even after controlling for population density and built-up intensity, the positive association between income and tree cover is significant, as is the positive association between proportion non-Hispanic white and tree cover. We estimate, after controlling for population density, that low-income blocks have 62 million fewer trees than high-income blocks, equal to a compensatory value of $56 billion ($1,349/person). An investment in tree planting and natural regeneration of $17.6 billion would be needed to close the tree cover disparity, benefitting 42 million people in low-income blocks.

The relationship between demographic and occupational variables, transformational leadership perceptions and individual innovativeness in nurses.

AIM: This study aimed to describe innovativeness among nurses and examine the impact of transformational leadership and demographic and occupational variables on individual innovativeness in nurses. BACKGROUND: Staff nurses must be innovative in order to solve problems occurring in health care environments and implement evidence-based practice. METHODS: This descriptive, correlational cross-sectional study comprised 300 nurses working in two hospitals in Turkey. The data were collected with a demographic and occupational questionnaire, the Individual Innovativeness Scale and the Transformational Leadership Scale. Data were analysed using descriptive statistics, Pearson's correlation and backward regression. RESULTS: Most nurses were categorized as "early majority" (45.3%) or "early adopter" (39.3%) for innovativeness. Education level, position, high self-perceptions of leadership skills and/or perceiving transformational leadership as a high-performance expectation were associated with high levels of individual innovativeness. CONCLUSION: Almost half of the nurses were early adopters who can be role models to other nurses in the diffusion of innovation. Having higher education levels, positions, leadership skills and expectations from management affected nurses' individual innovation more positively. IMPLICATIONS FOR NURSING MANAGEMENT: It can be helpful for nurse managers to understand the adopter categories and affective variables of innovativeness for the diffusion of innovative practices and evidence-based standards at hospitals.

Prevalence, predictors and outcomes of potential drug-drug interactions in left ventricular failure: considerable factors for quality use of medicines

Hospitalized patients with left ventricular failure (LVF) are at high risk for potential drug-drug interactions (pDDIs) and its related adverse effects owing to multiple risk factors such as old age, comorbidities and polypharmacy. This cross-sectional study conducted in two tertiary care hospitals aim to identify frequency, levels and predictors of pDDIs in LVF patients. Data about patients' demographic, hospital stay, medication therapy, sign/symptoms and laboratory test results were collected for 385 patients with LVF. Micromedex Drug-Reax® was used to screen patients' medication profiles for pDDIs. Overall prevalence and severity-wise prevalence of pDDIs were identified. Chi-square test was performed for comparative analysis of various variables. Logistic regression was applied to determine the odds-ratios (OR) for predictors of pDDIs. The prevalence of pDDIs was 96.4% (n=371). Overall 335 drug-interacting pairs were detected, which were presented in a total of 2870 pDDIs. Majority of pDDIs were of major- (48.9%) and moderate-severity (47.5%). Logistic regression analysis shows significant association of >6 all types of pDDIs with >12 drugs as compared with <8 drugs (OR=16.5; p=<0.001). Likewise, there was a significant association of >4 major-pDDIs with men as compared with female (OR=1.9; p=0.007) and >12 drugs as compared with <8 drugs (OR=10.9; p=<0.001). Hypotension (n=57), impaired renal function (23) and increased blood pressure (22) were the most frequent adverse outcomes associated with pDDIs. This study shows high prevalence of pDDIs in LVF patients. Majority of pDDIs were of major- and moderate-severity. Male patients and those prescribed greater number of medicines were more exposed to major-pDDIs

Características sociodemográficas y clínicas de pacientes con diagnóstico nuevo de VIH / Sociodemographic and clinical characteristics of patients with new HIV diagnosis

Objetivo: Caracterizar de forma sociodemográfica y clínica pacientes con diagnóstico nuevo de VIH, que fueron hospitalizados en una Clínica Universitaria de alta complejidad entre el año 2010 - 2016. Materiales y métodos: Se realizó un estudio observacional, descriptico, de corte transversal por medio de revisión de historias clínicas, que incluyo pacientes ≥14 años, a quienes se les diagnosticó VIH durante la hospitalización y tuvieran al menos un conteo de linfocitos CD4. Resultados: La mediana para la edad fue 41 años (RIC 31 - 51), el 85,1% eran hombres. Los principales síntomas al ingreso fueron generales/sistémicos (70,2%). 99 pacientes (61,5%) tenían infecciones oportunistas siendo tuberculosis la más frecuente (34,3%). La mediana para el conteo de CD4 fue 88 células/mm3 RIC (27 - 327) y el 77% se clasificó como SIDA. 29 pacientes murieron (18%) encontrando como posible factor de riesgo tener conteo de CD4 fue 88 células/mm3 RIC (27 - 327) y el 77% se clasificó como SIDA. 29 pacientes murieron (18%) encontrando como posible factor de riesgo tener conteo de CD4<200 células/mm3 , no pertenecer al régimen contributivo, ingresar con síntomas respiratorios, tener diagnóstico de neumonía, criterios de falla multiorgánica o necesidad de UCI/UCE. Conclusión: Para nuestro caso la mayoría de pacientes con diagnóstico nuevo de VIH se encontraban en estados avanzados de inmunosupresión con alta carga de enfermedades definitorias de SIDA. Es importante fortalecer las políticas de salud pública para diagnosticar más temprano la infección por VIH.

Purposes: To characterize sociodemographic and clinical aspects in newly diagnosed HIV patients that were hospitalized at a university health center between 2010 - 2016. Methods: We made an observational descriptive cross - sectional study reviewing clinical records, including patients older than 14 years old, who were diagnosed with HIV infection during hospitalization and at least a CD4 count. Results: Median age at diagnosis was 41 years old (IQR 31 - 51), 85% were men. The main symptoms were general/systemic (70.2%). 99 patients (61.5%) had opportunist infections, being tuberculosis the most frequent (34.3%). The median CD4 were 88 cells/mm3 (IQR 27 - 327) and 77% were classified as AIDS. 29 patients died (18%), finding as a risk factor for mortality don't having a good health care insurance, low CD4 count, having respiratory symptoms, pneumonia diagnosis, multiple organic failure's criteria and ICU admission. Conclusion: In our case, the majority of patients with a new diagnosis of HIV were in advanced stages of immunosuppression with a high burden of AIDS defining diseases. It is important to strengthen public health policies to diagnose HIV infection earlier.

Detección del virus Epstein Barr en escolares adolescentes en la ciudad de Cali, Colombia / Detection of epstein barr virus in adolescent students in the city of cali, colombia

Objetivo: Detectar el virus Epstein-Barr en estudiantes de secundaria entre los 14 y 17 años de la ciudad de Cali, Colombia y su posible asociación con la edad, sexo y grado escolar. Métodos: Estudio retrospectivo de corte transversal en donde se analizaron 374 muestras de saliva, tomadas entre el año 2015 y 2016, mediante PCR convencional y PCR en Tiempo real. Se evalúo la asociación entre la detección del ADN viral y las características demográficas, además de un análisis de razón de oportunidades para evaluar la medida de la asociación. Resultados: El ADN viral fue detectado en el 45% (167/374) de las muestras orales, encontrándose una presencia viral mayor en los escolares de los grados octavo y noveno (p=0,004); en donde los estudiantes de 14 años presentaron un riesgo de 2,4 veces mayor para la detección del virus (IC 95%:1,12-4,9) en comparación con los estudias de más edad. Conclusión: En el presente estudio se evidencio la exposición del VEB en la cavidad oral de estudiantes de secundaria, lo cual hace necesario que se tomen acciones de vigilancia que permitan monitorear las implicaciones de estos hallazgos en la salud de los escolares.

Objective: To detect the Epstein Barr virus in adolescent students between 14 and 17 years old in the city of Cali, Colombia and its possible association with age, gender and school grade. Methods: Retrospective cross-sectional study where 374 mouthwash samples collected between the years 2015 and 2016 was analyzed through conventional and real-time PCR. Association between viral DNA detection and sociodemographic characteristics were evaluated. The odds ratio analysis was used to assess the extent of this association. Results: The viral DNA was present in 45% (167/374) of the samples, with a higher DNA detection in the students of eighth and ninth grades (p=0.004); where the 14 years old students present a 2.4 times higher risk of detecting the virus (IC 95%: 1,12-4.9) in comparison with older students. Conclusion: In the present study, the Epstein Barr virus exposition in the oral cavity was evidenced, which make necessary to take actions on surveillance that allow monitoring the implications of these fndings in the teenage student's health.

Residential scene classification for gridded population sampling in developing countries using deep convolutional neural networks on satellite imagery.

BACKGROUND: Conducting surveys in low- and middle-income countries is often challenging because many areas lack a complete sampling frame, have outdated census information, or have limited data available for designing and selecting a representative sample. Geosampling is a probability-based, gridded population sampling method that addresses some of these issues by using geographic information system (GIS) tools to create logistically manageable area units for sampling. GIS grid cells are overlaid to partition a country's existing administrative boundaries into area units that vary in size from 50 m × 50 m to 150 m × 150 m. To avoid sending interviewers to unoccupied areas, researchers manually classify grid cells as "residential" or "nonresidential" through visual inspection of aerial images. "Nonresidential" units are then excluded from sampling and data collection. This process of manually classifying sampling units has drawbacks since it is labor intensive, prone to human error, and creates the need for simplifying assumptions during calculation of design-based sampling weights. In this paper, we discuss the development of a deep learning classification model to predict whether aerial images are residential or nonresidential, thus reducing manual labor and eliminating the need for simplifying assumptions. RESULTS: On our test sets, the model performs comparable to a human-level baseline in both Nigeria (94.5% accuracy) and Guatemala (96.4% accuracy), and outperforms baseline machine learning models trained on crowdsourced or remote-sensed geospatial features. Additionally, our findings suggest that this approach can work well in new areas with relatively modest amounts of training data. CONCLUSIONS: Gridded population sampling methods like geosampling are becoming increasingly popular in countries with outdated or inaccurate census data because of their timeliness, flexibility, and cost. Using deep learning models directly on satellite images, we provide a novel method for sample frame construction that identifies residential gridded aerial units. In cases where manual classification of satellite images is used to (1) correct for errors in gridded population data sets or (2) classify grids where population estimates are unavailable, this methodology can help reduce annotation burden with comparable quality to human analysts.

Range extension of Diclidurus scutatus (Chiroptera, Emballonuridae) to southwestern Amazonia / Extensão da distribuição de Diclidurus scutatus (Chiroptera, Emballonuridae) para o sudoeste da Amazônia

ABSTRACT Diclidurus scutatus is an aerial insectivore bat endemic of South America and considered rare throughout its distribution range. We present the first record of this species in Rondônia State, northern Brazil, expanding its distribution more than 1000 km into southwestern Amazonia. Including this record, D. scutatus is known for 20 localities from eight countries (Brazil, Colombia, Ecuador, French Guiana, Guyana, Peru, Suriname, Venezuela), and two biomes-Amazonia and Atlantic Forest.

RESUMO Diclidurus scutatus é um morcego insetívoro aéreo, endêmico da América do Sul e considerado raro em toda sua área de distribuição. Apresentamos o primeiro registro dessa espécie para o estado de Rondônia, norte do Brasil, expandindo sua distribuição em mais de 1000 quilômetros para o sudoeste da Amazônia. Incluindo o presente registro, D. scutatus é conhecido para 20 localidades em oito países (Brasil, Colômbia, Equador, Guiana Francesa, Guiana, Peru, Suriname, Venezuela) e dois biomas-Amazônia e Mata Atlântica.

Influence of macular pigment optical density spatial distribution on intraocular scatter / Influencia de la distribución espacial de la densidad óptica del pigmento macular sobre la dispersión intraocular

Purpose: This study evaluated the summed measures of macular pigment optical density (MPOD) spatial distribution and their effects on intraocular scatter using a commercially available device (C-Quant, Oculus, USA). Methods: A customized heterochromatic flicker photometer (cHFP) device was used to measure MPOD spatial distribution across the central 16º using a 1º stimulus. MPOD was calculated as a discrete measure and summed measures across the central 1º, 3.3º, 10º and 16º diameters. Intraocular scatter was determined as a mean of 5 trials in which reliability and repeatability measures were met using the C-Quant. MPOD spatial distribution maps were constructed and the effects of both discrete and summed values on intraocular scatter were examined. Results: Spatial mapping identified mean values for discrete MPOD [0.32 (s.d. = 0.08)], MPOD summed across central 1º [0.37 (s.d. = 0.11)], MPOD summed across central 3.3º [0.85 (s.d. = 0.20)], MPOD summed across central 10º [1.60 (s.d. = 0.35)] and MPOD summed across central 16º [1.78 (s.d. = 0.39)]. Mean intraocular scatter was 0.83 (s.d. = 0.16) log units. While there were consistent trends for an inverse relationship between MPOD and scatter, these relationships were not statistically significant. Correlations between the highest and lowest quartiles of MPOD within the central 1º were near significance. Conclusions: While there was an overall trend of decreased intraocular forward scatter with increased MPOD consistent with selective short wavelength visible light attenuation, neither discrete nor summed values of MPOD significantly influence intraocular scatter as measured by the C-Quant device (AU)

Objetivo: Este estudio evaluó la suma de las mediciones de la distribución espacial de la densidad óptica del pigmento macular (MPOD) y sus efectos sobre la dispersión intraocular, utilizando un dispositivo comercialmente disponible (C-Quant, Oculus, EEUU). Métodos: Se utilizó un fotómetro intermitente heterocromático personalizado (cHFP) para medir la distribución espacial de la MPOD a lo largo de los 16º centrales, utilizando un estímulo de 1º. La MPOD se calculó como medición discreta y como las sumas de las mediciones a lo largo de los diámetros centrales de 1º, 3,3º, 10º y 16º. Se calculó la dispersión intraocular como media de los cinco ensayos en los que se lograron mediciones de fiabilidad y repetibilidad utilizando el dispositivo C-Quant. Se construyeron mapas de distribución espacial de la MPOD, examinándose los efectos sobre la dispersión intraocular, tanto de los valores discretos como de la suma de valores. Resultados: El mapeado espacial identificó valores medios para la MPOD discreta [0,32 (DE = 0,08)], la suma de MPOD a lo largo de 1º central [0,37 (DE = 0,11)], la suma de MPOD a lo largo de 3,3◦ centrales [0,85 (DE = 0.20)], la suma de MPOD a lo largo de 10º centrales [1,60 (DE = 0,35)] y la suma de MPOD a lo largo de 16◦ centrales [1,78 (DE = 0,39)]. La dispersión intraocular media fue de 0,83 (DE = 0,16) unidades log. A pesar de producirse una tendencia consistente hacia una relación inversa entre MPOD y dispersión, dichas relaciones no fueron estadísticamente significativas. Las correlaciones entre los cuartiles superior e inferior de la MPOD dentro de 1º central fueron próximas a la significación estadística. Conclusiones: A pesar de producirse una tendencia general hacia la disminución de la dispersión intraocular con el incremento de la MPOD, consistente con una atenuación selectiva de la luz visible con longitud de onda corta, ni los valores discretos ni la suma de valores de la MPOD reflejaron una influencia significativa sobre la dispersión intraocular, según las mediciones realizadas con el dispositivo C-Quant (AU)

Associations between demographic characteristics and physical activity practices in Nevada schools.

Schools are important settings for not only providing and promoting children's physical activity (PA) but also for reducing PA disparities. We investigated associations between school-level demographic characteristics (racial/ethnic and socioeconomic composition, urban-rural status, and student-to-teacher ratio) and 16 PA-promoting practices in 347 Nevada public elementary, middle, and high schools in 2014. We found that low-cost and easy-to-implement practices are most prevalent. There is relative demographic equity in ten of 16 PA practices and significant differences in six PA practices in Nevada schools. Schools with comparatively larger percentages of Black students are the most disadvantaged, as they have the fewest PA-supportive practices in place. Higher percent black was associated with lower odds of providing classroom activity breaks (AOR=0.632, 95% CI=0.453-0.881) and bike racks (AOR=0.60, 95% CI=0.362-0.996), greater odds of withholding recess/PE for disciplinary reasons (AOR=1.377, 95% CI=1.006-1.885), and lower odds of having recess supervisors who are trained to promote PA (AOR=0.583, 95% CI=0.374-0.909). Schools with greater percentages of Hispanic students have lower odds of providing before-school PA programs (AOR=0.867, 95% CI=0.761-0.987), whereas schools with greater percentages of low-SES students have greater odds of providing after-school PA programs (AOR=1.135, 95% CI=1.016-1.268). Higher student-to-teacher ratio was also associated with greater odds of providing after-school PA programs (AOR=1.135, 95% CI=1.016-1.268). Urban-rural status was unrelated to all PA practices.

Resultados del tratamiento médico de la embolia de pulmón en una unidad de corta estancia de un hospital de tercer nivel: ¿es el lugar adecuado? / Results of pulmonary embolism treatment in a tertiary hospital short stay unit. Is this the right place?

Objetivo. Describir la estancia media (EM) de la embolia de pulmón (EP) en una unidad de trombosis (UT) dependiente de una unidad de corta estancia (UCE) de un hospital de tercer nivel. Comparar estos datos con el resto de hospitales de nuestra región, con los del resto de comunidades autónomas (CCAA) y con el mismo hospital durante un año previo a nuestra existencia. Material y método. Estudio observacional retrospectivo descriptivo en el que se incluyeron los pacientes con diagnóstico de EP en el Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA) durante el año 2012. Clasificamos estos datos por servicio hospitalario, calculando la EM. Comparamos esta con la del resto de hospitales de nuestra región, con el resto de CCAA y con nuestros datos en el año 2007, cuando no existía aun la UT. Resultados. Se incluyeron 113 pacientes: 60 (53%) ingresaron en la UT, siendo la EM de 4,39 días, en Oncología, de 7,45, y en Medicina Interna (MI), de 15,38. No hubo ningún fallecido en la UT y solo se produjeron 3 reingresos (5%). Los datos publicados mostraron que la EM en todos los hospitales de nuestra región fue de 8,25 días; en nuestro hospital fue de 5,18 días y en el resto de hospitales, mayor. La CCAA con mejor EM fue el País Vasco con 6,85 días. En el año 2007, hubo 70 pacientes con EP en el HCUVA: 34 (49%) en MI con una EM de 8,50 días, 11 (31%) en Oncología con una EM de 9,64 días y 3 (4,3%) en Neumología, con una EM de 19 días; la mortalidad global fue del 11% y la tasa de reingresos en MI, del 6%. Conclusión. La EM de la EP en la UT en una UCE fue menor que en el resto de servicios de nuestro hospital, menor que en el resto de hospitales de nuestra comunidad, menor que en el resto de CCAA y menor que en cualquier servicio de nuestro hospital en una época anterior a nuestra existencia, sin aumentar la tasa de reingreso ni la mortalidad (AU)

Objectives. To determine the mean stay (MS) of patients with pulmonary embolism (PE) in a thrombosis unit (TU) with a short stay unit (SSU) in a tertiary hospital. To compare the data collected with those of other hospitals in the same region, of other regions (Autonomous Communities [AACC]), and within the same hospital in the year before the SSU opened. Material and methods. A descriptive retrospective observational study that included patients with a diagnosis of PE in the University Hospital Virgen de la Arrixaca (HCUVA) in 2012. These data were classified by hospital department, and used for calculating the mean stay. This was then compared with that of other hospitals in our region, with the rest of the regions, and with the data in 2007 (the last year without a TU). Results. A total of 113 patients with PE were included, 60 (53%) in the TU with an MS of 4.39, in Oncology, 7.45, and Internal Medicine (IM), 15.38 days. There were no deaths in the TU and only 3 (5%) readmissions. Published data showed that the MS in all hospitals in our region was 8.25, 5.18 in our hospital, and higher in the rest of hospitals. The best AACC was the Basque Country with an MS of 6.85 days. In 2007, there were 70 patients with PE in the HCUVA, 34 (49%) in IM, with an MS of 8.50, Oncology 11 (31%) with an MS 9.64, and Chest Diseases 3 (4.3%) with an MS 19 days, and with an overall mortality of 11% and a rate of readmissions in IM of 6%. Conclusion. The mean stay for a PE in the SSU of a TU was lower than in the rest of the hospital departments, lower than the rest hospitals of our region, lower than the rest of the regions, and lower than any department of our hospital before the SSU existed, without increasing the readmission or mortality rate (AU)

Test de la figura compleja de Taylor: administración y corrección según un proceso de normalización y estandarización en población española / Taylor Complex Figure test: administration and correction according to a normalization and standardization process in Spanish population

Introducción. La figura compleja de Taylor (FCT) fue creada como alternativa a la figura compleja de Rey-Osterrieth. Aunque ambas figuras son instrumentos ampliamente utilizados, no se ha realizado hasta la fecha la normalización de la FCT para población española. Objetivo. Normalizar y estandarizar la FCT, considerando las características sociodemográficas de la población española. Sujetos y métodos. El presente estudio se enmarca dentro del proyecto Normacog. Se seleccionaron 700 participantes (rango: 18-90 años), y se evaluaron la capacidad visuoconstructiva y la memoria visual inmediata mediante la FCT. Se analizaron el efecto de la edad, el nivel educativo y el sexo sobre el rendimiento de la FCT, y se crearon los percentiles, las puntuaciones escalares para ocho rangos de edad y la puntuación escalar ajustada por el nivel educativo. Resultados. Los resultados muestran un efecto significativo de la edad y el nivel educativo sobre el rendimiento en copia y memoria de la FCT, mientras que el sexo no influyó significativamente. La edad y la educación explicaban el 25,3-35,7% de la varianza en la FCT. A mayor edad y menor nivel educativo, peor era el rendimiento obtenido en la FCT. Se obtienen los percentiles, las puntuaciones escalares para cada rango de edad y la puntuación escalar individual ajustada por el nivel educativo. Conclusión. Se aportan los materiales para la administración y corrección del test de FCT, así como los datos normativos de la FCT teniendo en cuenta las características sociodemográficas españolas para todo el rango adulto en nuestro país (AU)

Introduction. The Taylor Complex Figure (TCF) was created as an alternate form for the Rey-Osterrieth Complex Figure. Although both figures are widely used, to date, it has not been carried out the normalization of the TCF for Spanish population. Aim. To normalize and standardize the TCF taking into account the sociodemographic characteristics of the Spanish population. Subjects and methods. The present study is part of the Normacog Project. Seven hundred participants were recruited (18-90 years old), assessing the visuo-constructive ability and immediate visual memory by TCF. The effect of age, level of education and gender was analyzed on the performance of TCF and percentiles and scalar score for eight ranges of age and scalar score adjusted by the level of education. Results. Results showed a significant effect of age and level of education on the performance in copy and memory of TCF, whereas gender was not significant. Age and education explained from 25.3% to 35.7% of the variance of TCF performance. The older and less educated, the worse performance shown in TCF. Percentiles, scalar score for each range of age and scalar score adjusted by the level of education were obtained. Conclusion. Administration instructions, scoring and the normative data of the TCF are provided taking into account the Spanish sociodemographic characteristics for adults in our country (AU)

Populations of Odontesthes (Teleostei: Atheriniformes) in the Andean region of Southern South America: body shape and hybrid individuals

The original distribution area of the Patagonian 'pejerrey' Odontesthes hatcheri has been subjected to the introduction of a related species; the Bonaerensean 'pejerrey' Odontesthes bonariensis. This species currently coexists with O. hatcheri in lakes and reservoirs, and can interbreed and produce fertile hybrid offspring. The purposes of this study were; a) the extensive sampling of Patagonian and Andean-Cuyan populations of pejerrey, b) the species identification according to taxonomic key, c) validation of taxonomic results on the basis of mitochondrial DNA composition, and d) applying morphometric analysis to explore the effects of hybridization and environmental conditions on body shape. Cytochrome b sequence analysis showed a high degree of genetic divergence between species and low intraspecific variation in O. hatcheri. Geometric Morphometric Analyses detected shape differences in agreement with diagnostic characteristics of each species. Putative hybrids exhibiting intermediate diagnostic characteristics were identified by Geometric Morphometric Analysis. Significant regressions between body shape and total phosphorus and altitude were found, suggesting a dependence on trophic web structure. This multi-level approach suggests the introgression of O. bonariensis into several O. hatcheri populations throughout Patagonia. Managers should take this into account when considering further exotic introductions into regions where non-native fishes have not yet become established.

La distribución original del 'pejerrey' patagónico Odontesthes hatcheri ha sido sometida en las últimas décadas a la introducción de una especie relacionada; el 'pejerrey' Bonaerense Odontesthes bonariensis. Ambas especies coexisten actualmente en algunos lagos y embalses debido a prácticas de siembra y pueden cruzarse y producir progenie híbrida y fértil. Los propósitos de este estudio fueron a) un amplio muestreo de las poblaciones patagónicas y andino-cuyanas del pejerrey, b) la identificación de las especies de acuerdo con la clave taxonómica, c) la validación de los resultados taxonómicos sobre la base de la composición del ADN mitocondrial y d) aplicar el análisis morfométrico para explorar los efectos de la hibridización y las condiciones ambientales sobre la forma corporal. El análisis de la secuencia del Citocromo b mostró un alto grado de divergencia genética entre ambas especies y una muy baja variación intraespecífica en O. hatcheri. El análisis de la Morfometría Geométrica detectó diferencias de forma coincidentes con las características diagnósticas de cada especie. Presuntos híbridos exhibiendo características diagnósticas intermedias fueron identificados por el análisis de la Morfometría Geométrica. Regresiones significativas entre la forma corporal y la concentración total de fósforo y la altitud fueron halladas, sugiriendo una dependencia con la estructura de la trama trófica. Este enfoque múltiple sugiere la introgresión de genes de O. bonariensis dentro de varias poblaciones de O. hatcheri a lo largo de la Patagonia. Las autoridades de aplicación deberían tomar en cuenta estos riesgos al momento de considerar nuevas introducciones de especies exóticas en regiones donde estas especies no se encuentren previamente establecidas.

Public health workforce taxonomy.

Thoroughly characterizing and continuously monitoring the public health workforce is necessary for ensuring capacity to deliver public health services. A prerequisite for this is to develop a standardized methodology for classifying public health workers, permitting valid comparisons across agencies and over time, which does not exist for the public health workforce. An expert working group, all of whom are authors on this paper, was convened during 2012-2014 to develop a public health workforce taxonomy. The purpose of the taxonomy is to facilitate the systematic characterization of all public health workers while delineating a set of minimum data elements to be used in workforce surveys. The taxonomy will improve the comparability across surveys, assist with estimating duplicate counting of workers, provide a framework for describing the size and composition of the workforce, and address other challenges to workforce enumeration. The taxonomy consists of 12 axes, with each axis describing a key characteristic of public health workers. Within each axis are multiple categories, and sometimes subcategories, that further define that worker characteristic. The workforce taxonomy axes are occupation, workplace setting, employer, education, licensure, certification, job tasks, program area, public health specialization area, funding source, condition of employment, and demographics. The taxonomy is not intended to serve as a replacement for occupational classifications but rather is a tool for systematically categorizing worker characteristics. The taxonomy will continue to evolve as organizations implement it and recommend ways to improve this tool for more accurate workforce data collection.

Changes in public health workforce composition: proportion of part-time workforce and its correlates, 2008-2013.

BACKGROUND: State and local public health department infrastructure in the U.S. was impacted by the 2008 economic recession. The nature and impact of these staffing changes have not been well characterized, especially for the part-time public health workforce. PURPOSE: To estimate the number of part-time workers in state and local health departments (LHDs) and examine the correlates of change in the part-time LHD workforce between 2008 and 2013. METHODS: We used workforce data from the 2008 and 2013 National Association of County and City Health Officials (n=1,543) and Association of State and Territorial Health Officials (n=24) profiles. We employed a Monte Carlo simulation to estimate the possible and plausible proportion of the workforce that was part-time, over various assumptions. Next, we employed a multinomial regression assessing correlates of the change in staffing composition among LHDs, including jurisdiction and organizational characteristics, as well measures of community involvement. RESULTS: Nationally representative estimates suggest that the local public health workforce decreased from 191,000 to 168,000 between 2008 and 2013. During that period, the part-time workforce decreased from 25% to 20% of those totals. At the state level, part-time workers accounted for less than 10% of the total workforce among responding states in 2013. Smaller and multi-county jurisdictions employed relatively more part-time workers. CONCLUSIONS: This is the first study to create national estimates regarding the size of the part-time public health workforce and estimate those changes over time. A relatively small proportion of the public health workforce is part-time and may be decreasing.

Clinical and Epidemiological Characteristics of Suicides Committed in Medellin, Colombia / Características clínicas y epidemiológicas del suicidio consumado en Medellín, Colombia

Background: The purpose of this study was to identify the characteristics of individuals who committed suicide in Medellín between 2008 and 2010, and to identify variables related to the type of events. Methods: A retrospective and descriptive analysis was conducted on data provided by the National Institute of Legal Medicine and Forensic Sciences. In addition, a univariate and bivariate analysis was used to identify the sociodemographic and medical-legal characteristics of the deceased. Multiple correspondence analysis was also used in order to establish typologies. The information was analyzed using STATA 11.0. Results: Of the 389 cases occurring between 2008 and 2010, 84.6% (n = 329) were men. The male to female ratio was 5:1; 64% of the cases occurred in people aged 18-45 years; 6.7% occurred in children under 18, with hanging being the method most chosen by the victims (48.3%). Exploratory analysis was used to identify a possible association between the use of violent methods and events occurring in the housing and social strata 1, 2 and 3. Conclusions: Some factors could be associated with suicide, providing data that could consolidate health intervention strategies in our population.

Antecedentes: El propósito del estudio es identificar las características de los individuos que cometieron suicidio en la ciudad de Medellín entre 2008 y 2010, además de identificar variables relacionadas con la tipología de los eventos. Métodos: Análisis descriptivo retrospectivo de los datos suministrados por el Instituto Nacional de Medicina Legal y Ciencias Forenses. Además, análisis univariable y bivariable para identificar las características sociodemográficas y médico-legales de los fallecidos. Para establecer posibles tipologías, se utilizó el análisis de correspondencias múltiples. La información se analizó utilizando el programa STATA 11.0. Resultados: De los 389 casos ocurridos entre 2008 y 2010, el 84,6% (n = 329) correspondió a varones. La razón varones:mujeres es 5:1. El 64% de los casos ocurrió en personas de 18-45 anños y el 6,7%, en menores de 18 años. El ahorcamiento fue el método más elegido por las víctimas (48,3%). El análisis exploratorio permitió identificar una posible asociación entre el uso de métodos violentos con los eventos que ocurren en la vivienda y los estratos sociales 1, 2 y 3. Conclusiones: Se pudo delinear algunos factores asociados al suicidio consumado, aportando elementos que pueden consolidar estrategias de intervención en la salud de nuestra población.

Definição do status taxonômico do complexo Shannoni (Diptera: Psychodidae:Phlebotominae) no Brasil / Definition of taxonomic status of the complex shannoni (Diptera: Psychodidae: Phlebotominae) in Brazil

Alguns táxons inseridos na série Shannoni do gênero Psathyromyia ((Diptera, Psychodidae, Phlebotominae) apresentam grande semelhança morfológica: Psathyromyia cuzquena, Pa. abonnenci, Pa. pestanai e Pa. shannoni o que têm levado a proposição de várias sinonímias e identificações errôneas. Psathyromyia shannoni apresenta vários sinônimos-júniores: Phlebotomus limai, Ph. bigeniculata, Ph. microcephala e Ph. pifanoi, e ampla distribuição geográfica, desde os Estados Unidos até a Argentina. Além destas espécies, uma afim de Pa. pestanai, ainda não descrita, foi encontrada no Vale do Ribeira. O objetivo foi discutir o status taxonômico e distribuição geográfica das espécies do complexo. Foram realizados estudos morfológicos e morfométricos de espécimes depositados em coleções e obtidos em coletas no alto e baixo Vale do Ribeira e Serra da Cantareira no Estado de São Paulo. Os espécimes foram analisados de forma individual, ignorando a identificação inicial contida na etiqueta de cada lâmina. Posteriormente foram separados em grupos de morfoespécie e após esse processo, foram feitas medidas as quais foram submetidas à análise de variância. A análise possibilitou revalidar as quatro espécies consideradas sinônimos júniores de Pa. shannoni e um sinônimojúnior foi proposto. Uma espécie nova é descrita e um táxon afim de Pa. microcephala foi identificado. Portanto, o complexo Shannoni passou a ter a seguinte composição: Pa. abonnenci, Pa. shannoni, Pa. microcephala stat. rev.; comb. nov., Pa. pifanoi stat. rev.; comb. nov., Pa. bigeniculata stat. rev.; comb. nov., Pa. limai stat. rev.; comb. nov. (Pa. pestanai syn. nov.) e Psathyromyia sp. nov. Psathyromyia cuzquena possivelmente é sinônimo-júnior de Pa. pifanoi, no entanto, mais estudos são necessários. O táxon que ocorre no baixo Vale do Ribeira corresponde a Pa. limai, e no alto Vale do Ribeira, pertence à nova espécie. O táxon afim de Pa. microcephala ocorre nas regiões Sul e Sudeste do Brasil, Argentina e Colômbia. A ampla distribuição de Pa. shannoni, em parte, corresponde a de Pa. bigeniculata, Pa. abonnenci, Pa. limai e Pa. aff. microcephala. O desconhecimento do atual local de depósito do tipo de Pa. microcephala e a descrição sucinta dos holótipo não possibilitam a sua diferenciação do táxon afim desta espécie. Estudos de espécimes da localidade-tipo de Pa. microcephala são necessários para definição do status de Pa. aff. microcephala

Características clínicas y sociodemográficas de los casos con tuberculosis resistente en el municipio de Armenia, Quindío (Colombia) / Clinical and socio-demographic characteristics of tuberculosis with antimicrobial resistance in Armenia, Quindio (Colombia)

Objetivo: Analizar los factores sociodemográficos y clínicos de los pacientes con diagnóstico de tuberculosis resistente en el municipio de Armenia durante el período 2006-2009. Métodos: Se realizó un estudio descriptivo y retrospectivo con base en la notificación de pacientes con tuberculosis resistentes durante el período de estudio. Los datos fueron tomados de los registros consignados en las fichas de notificación y las tarjetas individuales de tratamiento categoría IV. Resultados: Entre 2006 y 2009, 678 pacientes ingresaron en el programa de control de la tuberculosis. De ellos, 14 casos (2,0%) fueron resistentes al menos a un medicamento, y entre estos, 7 (50%) fueron multirresistentes. El 21% estuvo asociado a infección por virus de la inmunodeficiencia humana. La tasa de fallecimientos en pacientes con tuberculosis con farmacorresistencia múltiple fue del 71%. Se encontró amplificación de la resistencia en 2 casos, quienes presentaron deterioro en el estado de salud y deceso. Conclusión: La situación en Armenia de resistencia a antituberculosos es de proporción similar a la del resto del país. Se encontraron factores de riesgo conocidos en los casos de resistencia (coinfección con virus de la inmunodeficiencia humana, farmacodependencia, abandono social) en la mayoría de casos, pero también de resistencia primaria y sin factores de riesgo con farmacorresistencia múltiple y una alta mortalidad, lo que llama la atención para mejorar la vigilancia y el control de los casos en tratamiento en la ciudad.

Objective: To analyze the socio-demographic and clinical diagnosis of patients with resistant tuberculosis in the municipality of Armenia in the period 2006-2009. Methods: We performed a retrospective descriptive study based on the notification of patients with resistant tuberculosis during the study period, data were taken from registrations under notification forms and individual treatment cards category IV. Results: 678 patients were admitted to the program of tuberculosis control between 2006 and 2009, 14 cases (2,0%) were resistant to at least one drug and from these cases 7 were multidrug resistant (MDR). In 21% of cases there was co-infection with HIV. The death rate in patients with MDR-TB was 71%. Amplification in resistance was observed in two cases which lead to further deterioration in the health status and death. Conclusion: Armenia has levels of resistance to anti tuberculosis drugs similar to the reported in the rest of Colombia. We found factors already know to be associated with resistance (drug addiction, social abandon, HIV co infection) but there were also cases without these factors and with primary MDR and high mortality, therefore is urgent to improve the public health measures for cases under treatment in this city.