Morbilidad psiquiátrica percibida por los médicos generales y prescripción de psicofármacos en la zona sur de Madrid.

Se revisan los resultados de un estudio realizado a través de cuestionarios pasados a unos de cada siete de los 19.961 pacientes que acudieron a las consultas de medicina general del lNSAL UD en dos ambulatorios y cinco consultorios de la zona sur de Madrid durante cinco días para estudiar la prevalencia de diagnósticos psiquiátricos (se utiliza la clasificación ICHPPC-2), la prescripción de psicofármacos y las derivaciones al escalón especializado en salud mental. Se obtienen resultados congruentes con los de otros estudios realizados en nuestro país, en cuanto a porcentaje de pacientes con diagnóstico de trastorno mental (5,34 %), el porcentaje es menor que el hallado en otros países. Se discute la sensibilidad y especificidad de los diagnósticos de los trastornos "menores" por los médicos generales, no se confirma la mayor predisposición de este grupo de pacientes a padecer otro tipo de trastornos, se encuentra bien representado el grupo de pacientes con patología "pesada" y se discuten las pautas de prescripción de psicofármacos

Morbilidad psiquiátrica percibida por los médicos generales y prescripción de psicofármacos en la zona sur de Madrid.

Se revisan los resultados de un estudio realizado a través de cuestionarios pasados a unos de cada siete de los 19.961 pacientes que acudieron a las consultas de medicina general del lNSAL UD en dos ambulatorios y cinco consultorios de la zona sur de Madrid durante cinco días para estudiar la prevalencia de diagnósticos psiquiátricos (se utiliza la clasificación ICHPPC-2), la prescripción de psicofármacos y las derivaciones al escalón especializado en salud mental. Se obtienen resultados congruentes con los de otros estudios realizados en nuestro país, en cuanto a porcentaje de pacientes con diagnóstico de trastorno mental (5,34 %), el porcentaje es menor que el hallado en otros países. Se discute la sensibilidad y especificidad de los diagnósticos de los trastornos "menores" por los médicos generales, no se confirma la mayor predisposición de este grupo de pacientes a padecer otro tipo de trastornos, se encuentra bien representado el grupo de pacientes con patología "pesada" y se discuten las pautas de prescripción de psicofármacos

Human resources: the Cinderella of health sector reform in Latin America

Human resources are the most important assets of any health system, and health workforce problems have for decades limited the efficiency and quality of Latin America health systems. World Bank-led reforms aimed at increasing equity, efficiency, quality of care and user satisfaction did not attempt to resolve the human resources problems that had been identified in multiple health sector assessments. However, the two most important reform policies – decentralization and privatization – have had a negative impact on the conditions of employment and prompted opposition from organized professionals and unions. In several countries of the region, the workforce became the most important obstacle to successful reform. This article is based on fieldwork and a review of the literature. It discusses the reasons that led health workers to oppose reform; the institutional and legal constraints to implementing reform as originally designed; the mismatch between the types of personnel needed for reform and the availability of professionals; the deficiencies of the reform implementation process; and the regulatory weaknesses of the region. The discussion presents workforce strategies that the reforms could have included to achieve the intended goals, and the need to take into account the values and political realities of the countries. The authors suggest that autochthonous solutions are more likely to succeed than solutions imported from the outside

The Dry Puna as an ecological megapatch and the peopling of South America: Technology, mobility, and the development of a late Pleistocene/early Holocene Andean hunter-gatherer tradition in northern Chile

Current scientific evidence shows that humans colonized South America at least 15,000 years ago, but there are still many unknown aspects of this process, including the major and minor migratory routes involved, and the pattern of successive occupation of a diverse continental mosaic of ecosystems. In this context, the role of the Andean highlands (≥3400 meters above sea level) has been neglected, because of the supposedly harsh conditions for humans including hypoxia and cold climate. Nevertheless, the environmental and cultural resources available in the high Andes constitutes an important "megapatch" that should be assessed in terms of human settlement patterns. We review the evidence for late Pleistocene/early Holocene hunter-gatherer occupation of one part of this megapatch, the northern Chilean Dry Puna, in its palaeoecological context. We focus on lithic technology, faunal remains, radiocarbon dates, and other archaeological materials related to different social activities, which allow us to suggest that groups of hunter-gatherers organized and adapted their way of life to highland ecosystems through logistical mobility, and curatorial strategies for lithic tool kits that included projectile points and other formalized tools. The morphology and technological processes involved are recognized over vast territories along the high Andes. We identify this material expression as the high south central Andean Archaic hunter-gatherer tradition, which also featured long distance mobile settlement systems and communication processes over this broad and distinct megapatch. More speculatively, we outline the hypothesis that these highland ecosystems constituted a suitable migratory route that may have been key for the early peopling of the continent, and contrast it with the alternative hypothesis of the initially secondary and seasonally intermittent exploitation of this habitat by hunter-gatherers dispersing along the Pacific coastal corridor

Nanoparticles for Local Drug Delivery to the Oral Mucosa: Proof of Principle Studies

Purpose To determine if solid lipid nanoparticles represent a viable strategy for local delivery of poorly water soluble and unstable chemopreventive compounds to human oral tissues. Methods Nanoparticle uptake and compound retention evaluations employed monolayer-cultured human oral squamous cell carcinoma (OSCC) cell lines and normal human oral mucosal explants. Feasibility of nanoparticle delivery was also evaluated with respect to the presence of phase-III efflux transporters in normal oral mucosal tissue and OSCC tissues. Results Functional uptake assays confirmed significantly greater internalization of nanoparticle-delivered fluorescent probe relative to free-fluorescent probe delivery, while concurrently demonstrating nanoparticle uptake rate differences among the OSCC cell lines and the phagocytic control human monocyte cell line. Mucosal explants exhibited nanoparticle penetration and internalization in the spinous and basal epithelial layer

Region-Specific Expression of Mitochondrial Complex I Genes during Murine Brain Development

Mutations in the nuclear encoded subunits of mitochondrial complex I (NADH:ubiquinone oxidoreductase) may cause circumscribed cerebral lesions ranging from degeneration of the striatal and brainstem gray matter (Leigh syndrome) to leukodystrophy. We hypothesized that such pattern of regional pathology might be due to local differences in the dependence on complex I function. Using in situ hybridization we investigated the relative expression of 33 nuclear encoded complex I subunits in different brain regions of the mouse at E11.5, E17.5, P1, P11, P28 and adult (12 weeks). With respect to timing and relative intensity of complex I gene expression we found a highly variant pattern in different regions during development. High average expression levels were detected in periods of intense neurogenesis. In cerebellar Purkinje and in hippocampal CA1/CA3 pyramidal neurons we found a second even higher peak during the period of synaptogenesis and maturation. The extraordinary dependence of these structures on complex I gene expression during synaptogenesis is in accord with our recent findings that gamma oscillations – known to be associated with higher cognitive functions of the mammalian brain – strongly depend on the complex I activity. However, with the exception of the mesencephalon, we detected only average complex I expression levels in the striatum and basal ganglia, which does not explain the exquisite vulnerability of these structures in mitochondrial disorders

Comparative genome analysis and genome-guided physiological analysis of Roseobacter litoralis

<p>Abstract</p> <p>Background</p> <p><it>Roseobacter litoralis </it>OCh149, the type species of the genus, and <it>Roseobacter denitrificans </it>OCh114 were the first described organisms of the <it>Roseobacter </it>clade, an ecologically important group of marine bacteria. Both species were isolated from seaweed and are able to perform aerobic anoxygenic photosynthesis.</p> <p>Results</p> <p>The genome of <it>R. litoralis </it>OCh149 contains one circular chromosome of 4,505,211 bp and three plasmids of 93,578 bp (pRLO149_94), 83,129 bp (pRLO149_83) and 63,532 bp (pRLO149_63). Of the 4537 genes predicted for <it>R. litoralis</it>, 1122 (24.7%) are not present in the genome of <it>R. denitrificans</it>. Many of the unique genes of <it>R. litoralis </it>are located in genomic islands and on plasmids. On pRLO149_83 several potential heavy metal resistance genes are encoded which are not present in the genome of <it>R. denitrificans</it>. The comparison of the heavy metal tolerance of the two organisms showed an increased zinc tolerance of <it>R. litoralis</it>. In contrast to <it>R. denitrificans</it>, the photosynthesis genes of <it>R. litoralis </it>are plasmid encoded. The activity of the photosynthetic apparatus was confirmed by respiration rate measurements, indicating a growth-phase dependent response to light. Comparative genomics with other members of the <it>Roseobacter </it>clade revealed several genomic regions that were only conserved in the two <it>Roseobacter </it>species. One of those regions encodes a variety of genes that might play a role in host association of the organisms. The catabolism of different carbon and nitrogen sources was predicted from the genome and combined with experimental data. In several cases, e.g. the degradation of some algal osmolytes and sugars, the genome-derived predictions of the metabolic pathways in <it>R. litoralis </it>differed from the phenotype.</p> <p>Conclusions</p> <p>The genomic differences between the two <it>Roseobacter </it>species are mainly due to lateral gene transfer and genomic rearrangements. Plasmid pRLO149_83 contains predominantly recently acquired genetic material whereas pRLO149_94 was probably translocated from the chromosome. Plasmid pRLO149_63 and one plasmid of <it>R. denitrifcans </it>(pTB2) seem to have a common ancestor and are important for cell envelope biosynthesis. Several new mechanisms of substrate degradation were indicated from the combination of experimental and genomic data. The photosynthetic activity of <it>R. litoralis </it>is probably regulated by nutrient availability.</p

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112