4,340 research outputs found
Out-of-pocket health expenditures in Colombia: a systematic review
Objectives
To review the evidence of out-of-pocket (OOPE) and catastrophic expenditures (CHE) in health in Colombia.
Methods
Systematic review of the literature (SLR). Searches were performed in PubMed, Scopus, Scielo and Google Scholar. We used the MESH terms: out-of-pocket, catastrophic health expenditure, health and Colombia. We included cost description or cost analysis studies. Cost-effectiveness analysis of health technologies and qualitative studies were excluded. Data about period of analysis, type of study, costing perspective, OOPE, and CHE were extracted. Studies were classified as macroeconomic, microeconomic, and diseases analysis. All costs were indexed to 2018 and reported in Colombian pesos (COP)
Video Endoscopy for Laser Photoresection in Tracheobronchial Pathology: Some Considerations After 9 Years Experience With 2105 Treatments
Between 1984 and 1993 we performed 2105 laser treatments in 1210 patients: 52% of treatments were done for malignant pathology, 45% for benign tracheal stenoses and 3% were in a miscellaneous group. The procedure was carried out with a rigid bronchoscope under general anaesthesia. In patients with malignant tumors, it is a good palliative treatment—safe, well tolerated and with immediate results; it can be repeated as many times as needed with and is well accepted by the patient. In patients without tumors, this method avoids emergency tracheotomies. The long term results are now under evaluation
Serum melatonin levels during the first seven days of severe sepsis diagnosis are associated with sepsis severity and mortality
Objective: Higher serum melatonin levels have previously been found in patients with severe sepsis who died within 30 days of diagnosis than in survivors. The objective of our study were to determine whether serum melatonin levels during the first seven days of severe sepsis diagnosis could be associated with sepsis severity and mortality.
Methods: Multicentre study in eight Spanish Intensive Care Units which enrolled 308 patients with severe sepsis. We determined serum levels of melatonin, malondialdehyde (as biomarker of lipid peroxidation) and tumor necrosis factor-alpha at days 1, 4 and 8 of severe sepsis diagnosis. The study's primary endpoint was 30-day mortality.
Results: A total of 103 patients had died and 205 survived at 30 days of severe sepsis diagnosis, with the non-survivors presenting higher serum melatonin levels at days 1 (p<0.001), 4 (p<0.001) and 8 (p<0.001) of severe sepsis diagnosis than the survivor patient group. The multiple logistic regression analysis found that serum melatonin levels at days 1, 4 and 8 of severe sepsis diagnosis (p<0.001, p = 0.01 and p = 0.001, respectively) were associated with mortality adjusted for age, serum lactic acid, SOFA score and diabetes mellitus.
Conclusions: The novel and more interesting findings of our study were that serum melatonin levels during the first seven days of severe sepsis diagnosis are associated with sepsis severity and mortality. (C) 2017 Elsevier Espana, S.L.U. and Sociedad Espanola de Enfermedades lnfecciosas y Microbiologia Clinica
Adolescent conflict and young adult couple relationships: Directionality of violence
Indexación: Scopus.The objective of this research was to study victimization and aggression in adolescent and young couple relationships, as well as to identify the directionality of violence perpetration in a sample of 984 people between 15 and 31 years of age, of which 58.2% were women and 41.8% were men. Regarding the educational level of the population under study, 26% were students of junior high school, senior high school, or vocational training and 56.5% were college students. The research design followed the nonprobability purposive sampling method and used the DVQ-R questionnaire. The results suggest that violence is 65.2% bidirectional and 14.30% unidirectional, being bidirectionality more frequent in psychological violence and decreasing when physical violence occurs. The results reveal the need to integrate the different modalities of dating violence (unidirectional and bidirectional) and unperceived violence-that gives rise to technical abuse-into the different prevention programs addressed to adolescents and youth.https://revistas.usb.edu.co/index.php/IJPR/article/view/436
A Rapamycin-Sensitive Signaling Pathway Is Essential for the Full Expression of Persistent Pain States
Translational control through the mammalian target of rapamycin (mTOR) is critical for synaptic plasticity, cell growth and axon guidance. Recently, it was also shown that mTOR signaling was essential for the maintenance of the sensitivity of subsets of adult sensory neurons. Here, we show that persistent pain states, but not acute pain behaviour, are substantially alleviated by centrally administered rapamycin, an inhibitor of the mTOR pathway. We demonstrate that rapamycin modulates nociception by acting on subsets of primary afferents and superficial dorsal horn neurons to reduce both primary afferent sensitivity and central plasticity. We found that the active form of mTOR is present in a subpopulation of myelinated dorsal root axons, but rarely in unmyelinated C- fibers, and heavily expressed in the dorsal horn by lamina I/III projection neurons that are known to mediate the induction and maintenance of pain states. Intrathecal injections of rapamycin inhibited the activation of downstream targets of mTOR in dorsal horn and dorsal roots and reduced the thermal sensitivity of A- fibers. Moreover, in vitro studies showed that rapamycin increased the electrical activation threshold of Aδ- fibers in dorsal roots. Taken together our results imply that central rapamycin reduces neuropathic pain by acting both on an mTOR positive subset of A- nociceptors and lamina I projection neurons and suggest a new pharmacological route for therapeutic intervention in persistent pain states
Dynamic Edematous Response of the Human Heart to Myocardial Infarction Implications for Assessing Myocardial Area at Risk and Salvage
BACKGROUND: Clinical protocols aimed to characterize the post-myocardial
infarction (MI) heart by cardiac magnetic resonance (CMR) need to be
standardized to take account of dynamic biological phenomena evolving
early after the index ischemic event. Here, we evaluated the time course
of edema reaction in patients with ST-segment-elevation MI by CMR and
assessed its implications for myocardium-at-risk (MaR) quantification
both in patients and in a large-animal model.
METHODS: A total of 16 patients with anterior ST-segment-elevation MI
successfully treated by primary angioplasty and 16 matched controls were
prospectively recruited. In total, 94 clinical CMR examinations were
performed: patients with ST-segment-elevation MI were serially scanned
(within the first 3 hours after reperfusion and at 1, 4, 7, and 40
days), and controls were scanned only once. T2 relaxation time in the
myocardium (T2 mapping) and the extent of edema on T2-weighted short-tau
triple inversion-recovery (ie, CMR-MaR) were evaluated at all time
points. In the experimental study, 20 pigs underwent 40-minute
ischemia/reperfusion followed by serial CMR examinations at 120 minutes
and 1, 4, and 7 days after reperfusion. Reference MaR was assessed by
contrast-multidetector computed tomography during the index coronary
occlusion. Generalized linear mixed models were used to take account of
repeated measurements.
RESULTS: In humans, T2 relaxation time in the ischemic myocardium
declines significantly from early after reperfusion to 24 hours, and
then increases up to day 4, reaching a plateau from which it decreases
from day 7. Consequently, edema extent measured by T2-weighted short-tau
triple inversion-recovery (CMR-MaR) varied with the timing of the CMR
examination. These findings were confirmed in the experimental model by
showing that only CMR-MaR values for day 4 and day 7 postreperfusion,
coinciding with the deferred edema wave, were similar to values measured
by reference contrast-multidetector computed tomography.
CONCLUSIONS: Post-MI edema in patients follows a bimodal pattern that
affects CMR estimates of MaR. Dynamic changes in
post-ST-segment-elevation MI edema highlight the need for
standardization of CMR timing to retrospectively delineate MaR and
quantify myocardial salvage. According to the present clinical and
experimental data, a time window between days 4 and 7 post-MI seems a
good compromise solution for standardization. Further studies are needed
to study the effect of other factors on these variables.This study was partially supported by a competitive grant from the
Spanish Society of Cardiology (Proyectos de Investigacion Traslacional
en Cardiologia de la Sociedad Espanola de Cardiologia 2015, for the
project Caracterizacion tiSUlar miocaRdica con resonancia magnetica en
pacientes tras inFarto agudo de mioCardio con elevacioN de ST sometidos
a angloplastia Coronaria primaria. Estudio SURF-CNIC), by a competitive
grant from the Carlos III Institute of Health-Fondo de Investigacion
Sanitaria- and the European Regional Development Fund (ERDF/FEDER)
(PI10/02268 and PI13/01979), the Spanish Ministry of economy, industry,
and competitiveness (MEIC) and ERDF/FEDER SAF2013-49663-EXP. Dr
Fernandez-Jimenez holds a FICNIC fellowship from the Fundacio Jesus
Serra, the Fundacion Interhospitalaria de Investigacion Cardiovascular,
and the Centro Nacional de Investigaciones Cardiovasculares Carlos III
(CNIC), and Dr Aguero is a FP7-PEOPLE-2013-ITN-Cardionext fellow. This
study forms part of a Master Research Agreement between the CNIC and
Philips Healthcare, and is part of a bilateral research program between
Hospital de Salamanca Cardiology Department and the CNIC. This research
program is part of an institutional agreement between FIIS-Fundacion
Jimenez Diaz and CNIC. The CNIC is supported by the MEIC and the Pro
CNIC Foundation, and is a Severo Ochoa Center of Excellence (MEIC award
SEV-2015-0505).S
Customs Law
This article summarizes important developments in 2014 in customs law, including U.S. judicial decisions, trade, legislative, administrative, and executive developments, as well as Canadian and European legal developments
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