Determinantes de la calidad de vida relacionada con la salud de pacientes en diálisis de Uruguay

Ana I. Galain: Departamento de Psicología Médica, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay. -- Inés Olaizola: Servicio de Asistencia Renal Integral, SARI. Centro de Diálisis Ibirapitá, Montevideo, Uruguay.-- Laura Schwartzmann: Departamento de Psicología Médica, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.-- Carlos Zúñiga: Facultad de Medicina, Universidad Católica de Concepción, Concepción, Chile.-- Juan J. Dapueto: Departamento de Psicología Médica, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay. Contacto: Juan J. Dapueto. Dirección: Departamento de Psicología Médica, Facultad de Medicina, Universidad de la República, Av. Italia 2870 piso 15, Montevideo11600, Uruguay. E-mail: [email protected] are limited studies reporting on the Health Related Quality of Life (HRQL) of patients with end stage renal disease living in non-industrialized countries. This study describes the underlying relationships among determinants of HRQL in patients under renal replacement treatment. A cross-sectional design was used with a sample of 243 patients attending five hemodialysis and peritoneal dialysis centers of Montevideo (mean age 56.6 years, SD 16.2; 58% males). A univariate linear regression analysis was performed for each independent variable. A total of 61 independent variables were included: biological/clinical, sociodemographic, and psychosocial. HRQL outcomes were evaluated using the SF-36 Health Survey eight subscales, Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Variables shown to have significant association in the univariate analysis (p<0.10) were included in a multivariate regression analysis. Ten regression models were studied, for the 8 SF-36 subscales, PCS and MCS scores. Fifteen variables were significant in the multivariable models; time in renal replacement treatment, urea, creatinine, haemoglobin, iron, hospitalizations, acute illness, blindness, age, gender, living with someone, working status, administration of antidepressants or antipsychotic medications, and maintenance of sex life, explaining 43% of the variance of PCS and 35% of MCS. The type and relevance of the explanatory variables differed along the various dimensions of HRQL. As a conclusion we underline the entwining of biological, sociodemographic and psychosocial factors as determinants of health related quality of life patients with end stage renal disease, thus supporting the multidimensional definition and modelling of the construct.Existen pocos estudios sobre la percepción subjetiva de la calidad de vida relacionada con la salud (HRQL por sus siglas en inglés) en pacientes renales cursando su etapa terminal, que vivan en países no industrializados. El propósito de este estudio fue comprender las relaciones subyacentes entre los diferentes determinantes de la calidad de vida relacionada con la salud, en los pacientes en tratamiento sustitutivo renal en Uruguay. Se realizó un estudio transversal en una muestra de 243 pacientes de cinco centros de hemodiálisis y diálisis peritoneal de la ciudad de Montevideo (edad media de 56,6 años, SD 16,2; 58% hombres). Se realizó un análisis de regresión lineal univariado para cada variable independiente. Se incluyó un total de 61 variables independientes biológicas/clínicas, sociodemográficas y psicosociales. La HRQL fue evaluada utilizando el cuestionario SF-36, que consta de ocho subescalas, más el Componente de Resumen Físico (PCS) y el Componente de Resumen Mental (MCS). Aquellas variables que mostraron una asociación significativa en el análisis univariado (p< 0.10) fueron incluidas en un análisis de regresión multivariado. Fueron estudiados diez modelos de regresión, para las 8 subescalas del SF-36, el PCS y MCS. Quince variables fueron significativas en los modelos multivariados: tiempo en tratamiento sustitutivo renal, urea, creatinina, hemoglobina, hierro, hospitalizaciones, enfermedades agudas, ceguera, edad, género, vivir con alguien, situación laboral, administración de antidepresivos o de antipsicóticos y mantenimiento de la vida sexual; explicando el 43% de la varianza de PCS y el 35% de MCS. El tipo y relevancia de las variables explicativas difieren a lo largo de las diversas dimensiones de la HRQL. Destacamos como conclusión el entrelazamiento de factores biológicos, sociodemográficos y psicosociales como determinantes de la calidad de vida relacionada con la salud en los pacientes renales cursando su etapa terminal, lo que apoya la definición y modelado multidimensional del constructo

Cinnamon Use in Type 2 Diabetes: An Updated Systematic Review and Meta-Analysis

PURPOSE Cinnamon has been studied in randomized controlled trials (RCTs) for its glycemic-lowering effects, but studies have been small and show conflicting results. A prior meta-analysis did not show significant results, but several RCTs have been published since then. We conducted an updated systematic review and meta-analysis of RCTs evaluating cinnamon’s effect on glycemia and lipid levels. METHODS MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched through February 2012. Included RCTs evaluated cinnamon compared with control in patients with type 2 diabetes and reported at least one of the following: glycated hemoglobin (A1c), fasting plasma glucose, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), or triglycerides. Weighted mean differences (with 95% confidence intervals) for endpoints were calculated using random-effects models. RESULTS In a meta-analysis of 10 RCTs (n = 543 patients), cinnamon doses of 120 mg/d to 6 g/d for 4 to 18 weeks reduced levels of fasting plasma glucose (−24.59 mg/dL; 95% CI, −40.52 to −8.67 mg/dL), total cholesterol (−15.60 mg/dL; 95% CI, −29.76 to −1.44 mg/dL), LDL-C (−9.42 mg/dL; 95% CI, −17.21 to −1.63 mg/dL), and triglycerides (−29.59 mg/dL; 95% CI, −48.27 to −10.91 mg/dL). Cinnamon also increased levels of HDL-C (1.66 mg/dL; 95% CI, 1.09 to 2.24 mg/dL). No significant effect on hemoglobin A1c levels (−0.16%; 95%, CI −0.39% to 0.02%) was seen. High degrees of heterogeneity were present for all analyses except HDL-C (I2 ranging from 66.5% to 94.72%). CONCLUSIONS The consumption of cinnamon is associated with a statistically significant decrease in levels of fasting plasma glucose, total cholesterol, LDL-C, and triglyceride levels, and an increase in HDL-C levels; however, no significant effect on hemoglobin A1c was found. The high degree of heterogeneity may limit the ability to apply these results to patient care, because the preferred dose and duration of therapy are unclear

Relating gravitational wave constraints from primordial nucleosynthesis, pulsar timing, laser interferometers, and the CMB: implications for the early universe

We derive a general master equation relating the gravitational-wave observables r and Omega_gw(f). Here r is the tensor-to-scalar ratio, constrained by cosmic-microwave-background (CMB) experiments; and Omega_gw(f) is the energy spectrum of primordial gravitational-waves, constrained e.g. by pulsar-timing measurements, laser-interferometer experiments, and Big Bang Nucleosynthesis (BBN). Differentiating the master equation yields a new expression for the tilt d(ln Omega_gw(f))/d(ln f). The relationship between r and Omega_gw(f) depends sensitively on the uncertain physics of the early universe, and we show that this uncertainty may be encapsulated (in a model-independent way) by two quantities: w_hat(f) and nt_hat(f), where nt_hat(f) is a certain logarithmic average over nt(k) (the primordial tensor spectral index); and w_hat(f) is a certain logarithmic average over w_tilde(a) (the effective equation-of-state in the early universe, after horizon re-entry). Here the effective equation-of-state parameter w_tilde(a) is a combination of the ordinary equation-of-state parameter w(a) and the bulk viscosity zeta(a). Thus, by comparing constraints on r and Omega_gw(f), one can obtain (remarkably tight) constraints in the [w_hat(f), nt_hat(f)] plane. In particular, this is the best way to constrain (or detect) the presence of a ``stiff'' energy component (with w > 1/3) in the early universe, prior to BBN. Finally, although most of our analysis does not assume inflation, we point out that if CMB experiments detect a non-zero value for r, then we will immediately obtain (as a free by-product) a new upper bound w_hat < 0.55 on the logarithmically averaged effective equation-of-state parameter during the ``primordial dark age'' between the end of inflation and the start of BBN.Comment: v1: 12 + 6 pages (main text + appendices), 7 figures; v2: fonts fixed in figure

Scalar and Tensor Inhomogeneities from Dimensional Decoupling

We discuss some perturbative techniques suitable for the gauge-invariant treatment of the scalar and tensor inhomogeneities of an anisotropic and homogeneous background geometry whose spatial section naturally decomposes into the direct product of two maximally symmetric Eucledian manifolds, describing a general situation of dimensional decoupling in which $d$ external dimensions evolve (in conformal time) with scale factor $a(\eta)$ and $n$ internal dimensions evolve with scale factor $b(\eta)$. We analyze the growing mode problem which typically arises in contracting backgrounds and we focus our attention on the situation where the amplitude of the fluctuations not only depends on the external space-time but also on the internal spatial coordinates. In order to illustrate the possible relevance of this analysis we compute the gravity waves spectrum produced in some highly simplified model of cosmological evolution and we find that the spectral amplitude, whose magnitude can be constrained by the usual bounds applied to the stochastic gravity waves backgrounds, depends on the curvature scale at which the compactification occurs and also on the typical frequency of the internal excitations.Comment: 31 pages, Latex, DAMTP 96-92, UCM 96-04, to appear in Phys. Rev. D 55 (1997

Thermal history of the plasma and high-frequency gravitons

Possible deviations from a radiation-dominated evolution, occurring prior the synthesis of light nuclei, impacted on the spectral energy density of high-frequency gravitons. For a systematic scrutiny of this situation, the $\Lambda$CDM paradigm must be complemented by (at least two) physical parameters describing, respectively, a threshold frequency and a slope. The supplementary frequency scale sets the lower border of a high-frequency domain where the spectral energy grows with a slope which depends, predominantly, upon the total sound speed of the plasma right after inflation. While the infra-red region of the graviton energy spectrum is nearly scale-invariant, the expected signals for typical frequencies larger than 0.01 nHz are hereby analyzed in a model-independent framework by requiring that the total sound speed of the post-inflationary plasma be smaller than the speed of light. Current (e.g. low-frequency) upper limits on the tensor power spectra (determined from the combined analysis of the three large-scale data sets) are shown to be compatible with a detectable signal in the frequency range of wide-band interferometers. In the present context, the scrutiny of the early evolution of the sound speed of the plasma can then be mapped onto a reliable strategy of parameter extraction including not only the well established cosmological observables but also the forthcoming data from wide band interferometers.Comment: 47 pages, 31 included figures, to appear in Classical and Quantum Gravit

Gravitational Wave Experiments and Early Universe Cosmology

Gravitational-wave experiments with interferometers and with resonant masses can search for stochastic backgrounds of gravitational waves of cosmological origin. We review both experimental and theoretical aspects of the search for these backgrounds. We give a pedagogical derivation of the various relations that characterize the response of a detector to a stochastic background. We discuss the sensitivities of the large interferometers under constructions (LIGO, VIRGO, GEO600, TAMA300, AIGO) or planned (Avdanced LIGO, LISA) and of the presently operating resonant bars, and we give the sensitivities for various two-detectors correlations. We examine the existing limits on the energy density in gravitational waves from nucleosynthesis, COBE and pulsars, and their effects on theoretical predictions. We discuss general theoretical principles for order-of-magnitude estimates of cosmological production mechanisms, and then we turn to specific theoretical predictions from inflation, string cosmology, phase transitions, cosmic strings and other mechanisms. We finally compare with the stochastic backgrounds of astrophysical origin.Comment: 99 pages, Latex, 17 figures. To appear in Physics Report. v4: conceptual changes in sect. 7.

Portuguese Ministers, 1851-1999: Social Background and Paths to Power

Disponível em: http://193.136.113.6/Opac/Pages/Search/Results.aspx?SearchText=UID=bb8aa8d5-c6b6-466a-81bb-fe8a67693cee&DataBase=10449_UNLFCSHThis paper provides an empirical analysis of the impact of regime changes in the composition and patterns of recruitment of the Portuguese ministerial elite throughout the last 150 years. The ‘out-of-type’, violent nature of most regime transformations accounts for the purges in and the extensive replacements of the political personnel, namely of the uppermost officeholders. In the case of Cabinet members, such discontinuities did not imply, however, radical changes in their social profile. Although there were some significant variations, a series of salient characteristics have persisted over time. The typical Portuguese minister is a male in his midforties, of middle-class origin and predominantly urban-born, highly educated and with a state servant background. The two main occupational contingents have been university professors - except for the First Republic (1910-26) - and the military, the latter having only recently been eclipsed with the consolidation of contemporary democracy. As regards career pathways, the most striking feature is the secular trend for the declining role of parliamentary experience, which the democratic regime did not clearly reverse. In this period, a technocratic background rather than political experience has been indeed the privileged credential for a significant proportion of minister

Stochastic backgrounds of relic gravitons: a theoretical appraisal

Stochastic backgrounds or relic gravitons, if ever detected, will constitute a prima facie evidence of physical processes taking place during the earliest stages of the evolution of the plasma. The essentials of the stochastic backgrounds of relic gravitons are hereby introduced and reviewed. The pivotal observables customarily employed to infer the properties of the relic gravitons are discussed both in the framework of the $\Lambda$CDM paradigm as well as in neighboring contexts. The complementarity between experiments measuring the polarization of the Cosmic Microwave Background (such as, for instance, WMAP, Capmap, Quad, Cbi, just to mention a few) and wide band interferometers (e.g. Virgo, Ligo, Geo, Tama) is emphasized. While the analysis of the microwave sky strongly constrains the low-frequency tail of the relic graviton spectrum, wide-band detectors are sensitive to much higher frequencies where the spectral energy density depends chiefly upon the (poorly known) rate of post-inflationary expansion.Comment: 94 pages, 32 figure