Musculoskeletal evaluation in severe haemophilia A patients from Latin America

There is a paucity of literature on haemophilia treatment in Latin American countries, a region characterized by rapidly improving systems of care, but with substantial disparities in treatment between countries. The aim of this study was to evaluate the musculoskeletal status of haemophilia patients from Latin America and to examine the relationship between musculoskeletal status and treatment practices across countries. The Committee of Latin America on the Therapeutics of Inhibitor Groups conducted a survey of its member country representatives on key aspects of haemophilia treatment in 10 countries. Musculoskeletal status of patients was obtained during routine comprehensive evaluations between March 2009 and March 2011. Eligible patients had severe haemophilia A (factor VIII <1%) without inhibitors (<0.6 BU mL−1) and were ≥5 years of age. Musculoskeletal status was compared between three groups of countries, based primarily on differences in the availability of long‐term prophylaxis. Overall, 143 patients (5–66 years of age) were enrolled from nine countries. In countries where long‐term prophylaxis had been available for at least 10 years (Group A), patients aged 5–10 years had significantly better mean World Federation of Hemophilia clinical scores, fewer target joints and fewer affected joints than patients from countries where long‐term prophylaxis has been available for about 5 years (Group B) or was not available (Group C). In Latin America, the musculoskeletal status of patients with severe haemophilia without inhibitors has improved significantly in association with the provision of long‐term prophylaxis. As more countries in Latin America institute this practice, further improvements are anticipated

Aislamiento de Candida albicans de hisopado nasal y faríngeo en alumnos de secundaria

Objective: To determine the presence of Candida albicans in throat and nasal secretion in high school students. Design: Cross-sectional study. Setting: Institute of Tropical Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru. Participants: High school students from San Juan Macias School in Santa Anita, Lima, Peru. Interventions: Nasal and throat samples were collected from 102 14-17 year-old students. Samples were grown on sabouraud agar and Candida CHROMOagar and identified by chlamydospores study and metabolic tests. Main outcome measures: Identification of C. albicans yeast. Results: Candida yeast was isolated from 11 students (10.8%). A significant percentage of yeast (36.4%) developed moderate resistance to fluconazole. Conclusions: Continuous surveillance of medically important yeasts in nasopharyngeal carriers is suggested in order to be prepared for eventual infectious conditions.Introducción: Candida sp puede encontrarse como comensal en equilibrio en la cavidad bucal humana; pero, en la población pediátrica y adolescente con un sistema inmune inmaduro las condiciones de la levadura se tornarían favorables para su patogenia. Objetivo: Determinar la presencia de Candida albicans en secreción faríngea y nasal en alumnos de educación secundaria. Diseño: Estudio descriptivo transversal. Lugar: Instituto de Medicina Tropical, Universidad Nacional Mayor de San Marcos, Lima, Perú. Participantes: Alumnos del 4° (52) y 5° (50) años de secundaria. Intervenciones: En octubre del 2007, las muestras nasales y faríngeas de 102 estudiantes de 14 a 17 años fueron colectadas en medios de transporte y luego cultivadas en los laboratorios del Instituto de Medicina Tropical, en agar sabouraud y CHROMOagar Candida. Se identificó las colonias sospechosas de Candida sp mediante el estudio de clamiodoconidias, tubo germinativo y pruebas metabólicas. Principales medidas de resultados: Identificación de levaduras de Candida sp. Resultados: Se aisló levaduras del género Cándida en 11 de los escolares (10,8%). El 36,4% de las levaduras presentó resistencia moderada al antimicótico fluconazol. Conclusiones: Es recomendable continuar con estudios de vigilancia epidemiológica sobre las levaduras de importancia médica en portadores nasofaríngeos, con el fin estar preparados ante eventuales cuadros infecciosos

The role of supplier performance in building customer trust and loyalty: a cross-country examination

Building trust in buyer–seller relationships is a focal issue in relationship marketing. However, there are mixed results concerning the performance outcomes of trust. Also, no attention has been given to linking supplier performance aspects to the development of trusting relationships. In this study we propose a conceptual model of supplier performance drivers and customer loyalty consequences of trust in supplier–organizational customer relationships. We test the model relationships using data from three different countries, namely, France, Hungary, and the U.K., in an effort to assess the extent to which the development and outcomes of trust are consistent across different countries. The results suggest that supplier performance in product quality and sales service quality is conducive to trust building across all three countries. Supplier performance in technical repair service support enhances trust in the market contexts of France and Hungary, but has no significant effect in the case of the U.K. Nonetheless, supplier performance in complaint handling has a positive effect on trust in the U.K. and French contexts, but no link is established in the context of Hungary. Further, the results show that trust enhances customer loyalty across all countries. Moreover, we find that firm size negatively moderates the trust–loyalty relationship in all the countries, with this link being not significant among larger firms in France and Hungary. The results have important theoretical and practical implications for international relationship marketing

Musculoskeletal evaluation in severe haemophilia A patients from Latin America

There is a paucity of literature on haemophilia treatment in Latin American countries, a region characterized by rapidly improving systems of care, but with substantial disparities in treatment between countries. The aim of this study was to evaluate the musculoskeletal status of haemophilia patients from Latin America and to examine the relationship between musculoskeletal status and treatment practices across countries. The Committee of Latin America on the Therapeutics of Inhibitor Groups conducted a survey of its member country representatives on key aspects of haemophilia treatment in 10 countries. Musculoskeletal status of patients was obtained during routine comprehensive evaluations between March 2009 and March 2011. Eligible patients had severe haemophilia A (factor VIII <1%) without inhibitors (<0.6BUmL(-1)) and were 5years of age. Musculoskeletal status was compared between three groups of countries, based primarily on differences in the availability of long-term prophylaxis. Overall, 143 patients (5-66years of age) were enrolled from nine countries. In countries where long-term prophylaxis had been available for at least 10years (Group A), patients aged 5-10years had significantly better mean World Federation of Hemophilia clinical scores, fewer target joints and fewer affected joints than patients from countries where long-term prophylaxis has been available for about 5years (Group B) or was not available (Group C). In Latin America, the musculoskeletal status of patients with severe haemophilia without inhibitors has improved significantly in association with the provision of long-term prophylaxis. As more countries in Latin America institute this practice, further improvements are anticipated.201E63E70Novo Nordisk Latin America Regional Office and affiliatesNordisk Health Care A

Abortamento induzido: vivência de mulheres baianas

O abortamento representa grave problema de saúde pública, que envolve questões legais, econômicas, sociais e psicológicas. Estudo qualitativo que teve como objetivo identificar situações que interferem na decisão pelo aborto e os sentimentos diante do processo de abortar. O estudo foi realizado em uma Maternidade Pública, no Município de Salvador-BA, e os sujeitos foram constituídos por nove mulheres hospitalizadas por aborto provocado. Para a coleta de dados, utilizamos a entrevista acompanhada por um formulário semiestruturado. Foram considerados os aspectos éticos baseados na Resolução 196/96 do Conselho Nacional de Saúde. Para a análise das falas, usamos como referencial a técnica de análise de conteúdo de Bardin. A amostra caracterizou-se por mulheres adultas eminentemente negras; casadas/união estável; dependentes financeiramente do companheiro. Na análise dos discursos, surgiram dois temas: Motivação e Sentimentos. Dentre os motivos que levam ao aborto, encontram-se a dificuldade financeira, o número de filhos, a vivência de violência conjugal e a perda de sua autonomia. O processo de abortamento gera medo de morrer, tristeza e alívio. As mulheres vivenciam o aborto induzido, revelando um processo muito doloroso, desde o momento em que descobrem a gravidez, passando pela difícil decisão de interrompê-la. Quando não são ajudadas, essas mulheres perpetuam essa dor, vivendo dias de angústia e culpa. O exercício da escuta e do acolhimento devem estar presentes na vida dos profissionais de saúde, independentemente de suas opiniões com relação ao aborto, a fim de que a mulher possa expressar seus sentimentos, e então obter ajuda e encaminhamento adequados