Propuesta de competencias profesionales para el perfil del egresado en la especialidad de Medicina Interna en Cuba

Introducción: El programa vigente de la especialidad Medicina Interna todavía no cuenta con una definición de las competencias de la especialidad. Objetivo: Proponer las competencias profesionales para el perfil del egresado en la especialidad de Medicina Interna en Cuba. Material y Métodos: Se trabajó en grupos nominales y seminarios-talleres, dirigidos a definir y normalizar las competencias a evaluar según norma la Comisión Nacional de competencia y desempeño del Ministerio de Salud Pública. Resultados: Se definieron: 4 áreas de competencias; 5 competencias asistenciales centradas en el método clínico; 3 competencias docentes centradas en la estructura de la actividad; 4 competencias centradas en el ciclo de dirección y 4 competencias centradas en el ciclo de investigación. Además 19 elementos de competencias asistenciales. Conclusiones: La propuesta de competencias concibe la aplicación del análisis en matriz para lograr la validez de contenido y externa de los elementos de competencias. Palabras clave: Competencias clínicas, medicina interna, programa, diseño curricular, desempeño, perfil profesional, Cuba. ABSTRACTIntroduction: The program in use of the specialty Internal Medicine not yet has a definition of the competitions of this specialty. Objective: Propose the professional competences for the profile of exit of the Internal Medicine's specialist in Cuba. Material and Methods: Work at nominal groups and workshops in order to define and to normalize competences to evaluate according to standard of the National Commission for competence and performance of the Health Ministry. Results: It were defined: 4 areas of competence; 5 assistance competences centered in the clinical method; 3 teaching competences centered in the structure of the activity; 4 competences centered in the cycle of administration and 4 competences centered in the cycle of investigation. Besides 19 elements of competences y the assistance functions. Conclusions: The proposal of competences conceives the application of the analysis in matrix to achieve the contents and external validity of the elements of competences.  Key words: Clinical competences, internal medicine, program, curricular design, performance, professional profile, Cuba</p

Pensar la infancia I

La Maestría en Infancia de la Universidad Tecnológica de Pereira-Colombia, se complace en entregar al público interesado el primer volumen de su serie “Pensar la infancia”. El cual reúne los aportes de profesores nacionales e internacionales y egresados de las dos primeras promociones del programa. La figura del “calidoscopio” nos sirve para exponer la variedad de “temas, imágenes y representaciones” de la infancia que caracteriza a esta publicación. Solo hasta hace poco tiempo (década del ochenta del siglo pasado), la infancia mereció la atención de la sociología, desde entonces, y de manera paulatina, ella se convierte en un objeto de investigación independiente. Este desplazamiento se interesa por un objeto y sujeto social, cuya imagen es a la vez objeto de fascinación y de controversias: la infancia. Imagen que oscila entre numerosas contradicciones, particularmente visibles en los títulos de gran cantidad de publicaciones: niño rey, niño víctima, y con frecuencia, niño problema, entre otros.PRESENTACIÓN ....................................................................................... 13 PARTE I INFANCIAS ...................................................................................... 21 1. Paulo Freire: Otras infancias para la infancia Walter Omar Kohan..................................................................................................23 2. Pensamiento pedagógico en Agustín Nieto Caballero: la infancia moderna y la irrupción de la Escuela Activa en Colombia Absalón Jiménez Becerra ....................................................................................... 69 3. Literatura e infancia: las niñas y los niños como actores sociales Diana Alexandra Jiménez Perea y Natalia Ximena Castrillón García ............ 109 4. Philippe Ariès: nacimiento, posteridad y vigencia de un modelo de interpretación de la infancia. Una revisión de la literatura historiográfica francófona Miguel Ángel Gómez Mendoza ........................................................................... 127 5. Concepciones de infancia en la posmodernidad Sandra Liliana Osorio Rodríguez ........................................................................ 143 6. Sociología de la infancia: surgimiento de un campo de estudio, evolución y perspectivas María Victoria Alzate Piedrahíta ......................................................................... 167 7. El carácter material de la infancia perspectivas teóricas para el estudio del consumo infantil Diana Marcela Aristizábal García......................................................................... 181 PARTE II EXPERIENCIAS DE INFANCIA Y EDUCACIÓN ........................ 217 8. Desarrollo del pensamiento filosófico en el marco de un proyecto bilingüe en la Primera Infancia Paola Andrea Hincapié Rincón y Diana Carolina Durango Isaza ................... 221 9. Pensar las infancias desde el Bicentenario Slendi Paola Valbuena Velandia............................................................................ 289 10. Infancia en el Bicentenario: una reflexión desde la práctica docente Misael Andrés Moreno Buitrago .......................................................................... 317 11. Pedagogía hospitalaria, infancia y educación Yenny Alejandra Ramírez García y Maritza Arango Puerta............................. 343 12. Representaciones sociales de la infancia desde la perspectiva de los niños y las niñas Leonardo Fabio Gómez Ramírez y Leydi Marcela Rivera Noreña................... 381 13. La participación de la infancia: un camino al reconocimiento de la ciudadanía Elizabeth Martínez ............................................................................................... 415 14. El coraje de ser auténticos. Análisis de la categoría familia en tres relatos de vida de jóvenes con experiencia de vida en calle en su infancia Humberto Gómez Duque y Benicio Enrique Montes Posada.......................... 431 15. Cultura infantil Embera Chamí Daniela Benavides Rosero y Milton Andrés Valencia Forero........................... 469 CONTENIDO PARTE III TRADUCCIONES: INFANCIA, HISTORIA Y SOCIOLOGÍA ... 505 16. La infancia como forma estructural Jans Qvortrup ........................................................................................................ 507 17. Agencia Allison James ......................................................................................................... 535 18. La infancia: una mirada desde las ciencias sociales Régine Sirota ......................................................................................................... 559 19. ¿Historia de la infancia, historia sin palabras? Egle Becchi y Dominique Julia ............................................................................ 597 20. Tomando en serio un rito de la infancia: el aniversario Régine Sirota .......................................................................................................... 641 PARTE IV RESEÑAS ....................................................................................... 653 21. Historia de la infancia: a propósito de la obra de Egle Becchi y Dominique Julia Miguel Ángel Gómez Mendoza............................................................................ 65

Circulating microRNAs in sera correlate with soluble biomarkers of immune activation but do not predict mortality in ART treated individuals with HIV-1 infection: A case control study

Introduction: The use of anti-retroviral therapy (ART) has dramatically reduced HIV-1 associated morbidity and mortality. However, HIV-1 infected individuals have increased rates of morbidity and mortality compared to the non-HIV-1 infected population and this appears to be related to end-organ diseases collectively referred to as Serious Non-AIDS Events (SNAEs). Circulating miRNAs are reported as promising biomarkers for a number of human disease conditions including those that constitute SNAEs. Our study sought to investigate the potential of selected miRNAs in predicting mortality in HIV-1 infected ART treated individuals. Materials and Methods: A set of miRNAs was chosen based on published associations with human disease conditions that constitute SNAEs. This case: control study compared 126 cases (individuals who died whilst on therapy), and 247 matched controls (individuals who remained alive). Cases and controls were ART treated participants of two pivotal HIV-1 trials. The relative abundance of each miRNA in serum was measured, by RTqPCR. Associations with mortality (all-cause, cardiovascular and malignancy) were assessed by logistic regression analysis. Correlations between miRNAs and CD4+ T cell count, hs-CRP, IL-6 and D-dimer were also assessed. Results: None of the selected miRNAs was associated with all-cause, cardiovascular or malignancy mortality. The levels of three miRNAs (miRs -21, -122 and -200a) correlated with IL-6 while miR-21 also correlated with D-dimer. Additionally, the abundance of miRs -31, -150 and -223, correlated with baseline CD4+ T cell count while the same three miRNAs plus miR- 145 correlated with nadir CD4+ T cell count. Discussion: No associations with mortality were found with any circulating miRNA studied. These results cast doubt onto the effectiveness of circulating miRNA as early predictors of mortality or the major underlying diseases that contribute to mortality in participants treated for HIV-1 infection

Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Ristola M. on työryhmien DAD Study Grp ; Royal Free Hosp Clin Cohort ; INSIGHT Study Grp ; SMART Study Grp ; ESPRIT Study Grp jäsen.Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe

Renewable Energy in Urban Areas: Worldwide Research Trends

This study aims to highlight the contribution made by different international institutions in the field of urban generation of renewable energy, as a key element to achieve sustainability. This has been possible through the use of the Scopus Elsevier database, and the application of bibliometric techniques through which the articles content published from 1977 to 2017 has been analysed. The results shown by Scopus (e.g., journal articles and conferences proceedings) have been taken into account for further analysis by using the following search pattern (TITLE-ABS-KEY ({Renewable energy} AND ({urban} OR ({cit*})). In order to carry out this study, key features of the publications have been taken into consideration, such as type of document, language, thematic area, type of publication, and keywords. As far as keywords are concerned, renewable energy, sustainability, sustainable development, urban areas, city, and energy efficiency, have been the most frequently used. The results found have been broken down both geographically and by institution, showing that China, the United States, the United Kingdom, Italy, Germany and India are the main research countries and Chinese Academy of Sciences, Ministry of Education China and Tsinghua University the major contributing institutes. With regard to the categories, Energy, Environmental Sciences, and Engineering are positioned as the most active categories. The scientific community agrees that the study of the renewable energy generation in cities is of vital importance to achieve more sustainable cities, and for the welfare of a growing urban population. Moreover, this is in line with the energy policies adopted by most of developed countries in order to mitigate climate change effects

Sustainable Thermal Energy Generation at Universities by Using Loquat Seeds as Biofuel

Global energy consumption has increased the emission of greenhouse gases (GHG), these being the main cause of global warming. Within renewable energies, bioenergy has undergone a great development in recent years. This is due to its carbon neutral balance and the fact that bioenergy can be obtained from a range of biomass resources, including residues from forestry, agricultural or livestock industries, the rapid rotation of forest plantations, the development of energy crops, organic matter from urban solid waste, and other sources of organic waste from agro-food industries. Processing factories that use loquats to make products such as liqueurs and jams generate large amounts of waste mainly in the form of skin and stones or seeds. These wastes are disposed of and sent to landfills without making environmentally sustainable use of them. The University of Almeria Sports Centre is made up of indoor spaces in which different sports can be practiced: sports centre pavilion (central court and two lateral courts), rocodrome, fitness room, cycle inner room, and indoor swimming pool. At present, the indoor swimming pool of the University of Almeria (UAL) has two fuel oil boilers, with a nominal power of 267 kW. The main objective of this study is to propose an energetic analysis to determine, on the one hand, the energetic properties of the loquat seed and, on the other hand, to evaluate its suitability to be used as a solid biofuel to feed the boilers of the heated swimming pool of the University of Almeria (Spain), highlighting the significant energy and environmental savings obtained. Results show that the higher calorific value of loquat seed (17.205 MJ/kg), is like other industrial wastes such as wheat straw, or pistachio shell, which demonstrates the energy potential of this residual biomass. In addition, the change of the fuel oil boiler to a biomass (loquat seed) boiler in the UAL&rsquo;s indoor swimming pool means a reduction of 147,973.8 kg of CO2 in emissions into the atmosphere and an annual saving of 35,739.5 &euro;, which means a saving of 72.78% with respect to the previous fuel oil installation. A sensitivity analysis shows that fuel cost of base case is the variable with the most sensitivity changing the initial cost and net present value (NPV)

Clinical manifestations of intermediate allele carriers in Huntington disease

Objective: There is controversy about the clinical consequences of intermediate alleles (IAs) in Huntington disease (HD). The main objective of this study was to establish the clinical manifestations of IA carriers for a prospective, international, European HD registry. Methods: We assessed a cohort of participants at risk with <36 CAG repeats of the huntingtin (HTT) gene. Outcome measures were the Unified Huntington's Disease Rating Scale (UHDRS) motor, cognitive, and behavior domains, Total Functional Capacity (TFC), and quality of life (Short Form-36 [SF-36]). This cohort was subdivided into IA carriers (27-35 CAG) and controls (<27 CAG) and younger vs older participants. IA carriers and controls were compared for sociodemographic, environmental, and outcome measures. We used regression analysis to estimate the association of age and CAG repeats on the UHDRS scores. Results: Of 12,190 participants, 657 (5.38%) with <36 CAG repeats were identified: 76 IA carriers (11.56%) and 581 controls (88.44%). After correcting for multiple comparisons, at baseline, we found no significant differences between IA carriers and controls for total UHDRS motor, SF-36, behavioral, cognitive, or TFC scores. However, older participants with IAs had higher chorea scores compared to controls (p 0.001). Linear regression analysis showed that aging was the most contributing factor to increased UHDRS motor scores (p 0.002). On the other hand, 1-year follow-up data analysis showed IA carriers had greater cognitive decline compared to controls (p 0.002). Conclusions: Although aging worsened the UHDRS scores independently of the genetic status, IAs might confer a late-onset abnormal motor and cognitive phenotype. These results might have important implications for genetic counseling. ClinicalTrials.gov identifier: NCT01590589