Health, childlessness and poverty in Latin American countries / Salud, no tener hijos y pobreza en países latino americanos / Saúde, mulheres sem filhos e pobreza em países da América Latina

Abstract: Recent literature proposes that poverty could lead women to remain childless, thus attenuating or reverting higher fertility typically observed among women of lower schooling level. We explore the role of health in this approach: does health have a distinctive detrimental effect on fertility among women of lower schooling levels? To that end, we compute the gap in the definite childlessness rate by self-reported disability status across schooling levels. Due to the scarcity of survey data from definite childless women, in addition to the small sample sizes, we use census samples. Focusing on women between 40-50 years old and using 23 census samples from Latin America countries (2000-2011), we found that only in the group with lower schooling level there is a clear gap in the definite childlessness rate by self-reported disability status. From our descriptive analysis we conclude that health could indeed play an influential role in the childless by poverty approach.

Resumen: La literatura reciente propone que la pobreza puede llevar a las mujeres a decidir no tener hijos, por lo que se atenúa o revierte la fertilidad, típicamente más alta, observada entre mujeres con formación educativa baja. Investigamos el papel de la salud en este planteamiento: ¿Tiene la salud un efecto distinto en la fertilidad entre mujeres con baja educación? Para tal fin, calculamos la brecha en la tasa de mujeres sin hijos según el estado de discapacidad autoinformado y nivel de educación. Debido a la escasez de datos sobre mujeres sin hijos en las encuestas, además del tamaño pequeño de las muestras, usamos muestras del censo. Centrándonos en mujeres con un intervalo de edad entre 40 y 50 años, y usando 23 muestras de censos de países latinoamericanos (2000-2011), hallamos que solo en el grupo con baja educación hay una clara brecha en la tasa de mujeres sin hijos según estado de discapacidad autoinformado. Desde nuestro análisis descriptivo concluimos que la salud puede jugar de hecho un papel influyente en la ausencia de hijos por el enfoque de pobreza.

Resumo: A literatura recente sugere que a pobreza pode fazer com que as mulheres permaneçam sem filhos, assim atenuando ou revertendo as taxas de fertilidade mais elevadas observadas tipicamente em mulheres com baixa escolaridade. O estudo investiga o papel da saúde nessa abordagem: A saúde tem efeito negativo discernível na fertilidade de mulheres com baixa escolaridade? Para responder a essa pergunta, calculamos a diferença na taxa de ausência definitiva de filhos de acordo com a infertilidade autorrelatada, entre diferentes níveis de escolaridade. Devido à escassez de dados sobre mulheres definitivamente sem filhos, além das amostras pequenas, utilizamos amostras censitárias. Com foco nas mulheres na faixa etária entre 40 e 50 anos, e utilizando 23 amostras censitárias de países latino-americanos (2000-2011), detectamos que apenas no grupo de baixa escolaridade, há uma defasagem clara na taxa de ausência definitiva de filhos de acordo com a infertilidade autorrelatada. Com base em nossa análise descritiva, concluímos que a saúde pode desempenhar um papel importante na análise da ausência de filhos em mulheres pobres.

Actividad antimicrobiana in vitro del Camu Camu (Myrciaria Dubia) contra microorganismos orales: una revisión sistemática / Antimicrobial activity in vitro of Camu-Camu (Myrciaria Dubia) against oral microorganisms: a systematic review

RESUMEN Objetivos. Evaluar la actividad antimicrobiana de la Myrciaria dubia sobre microorganismos orales. Materiales y métodos . Se realizó una revisión sistemática de la literatura siguiendo las recomendaciones PRISMA mediante búsquedas en Pubmed, LILACS, SciELO, ProQuest, EBSCO y Google Scholar, de estudios publicados durante 2008 y 2018. Resultados . Se recopilaron 11 estudios, in vitro, todos los estudios evidenciaron actividad antimicrobiana positiva, principalmente por cada una de las partes de sus frutos, sobre grampositivos. Sin embargo, dicha actividad fue comparada con clorhexidina en solo dos estudios y en otro resultó ser mejor que un antibiótico. Se detectó un alto riesgo de sesgo en la mayoría de estudios. Los compuestos fenólicos incluidos polifenoles y acilfloroglucinoles fueron señalados como los responsables de su actividad. Conclusiones . Existe evidencia sobre la actividad antimicrobiana de M. dubia. Su estudio como antimicrobiano contra microorganismos orales es aún incipiente, pero se advierte un gran potencial debido a los fitoquímicos potentes que posee. Además, se necesita más estudios de calidad, que comparen su actividad versus antisépticos orales y sobre más microorganismos asociados a caries dental y enfermedad periodontal.

ABSTRACT Objectives. To evaluate the antimicrobial activity of Myrciaria dubia on oral microorganisms. Materials and Methods. A systematic review of the literature following PRISMA guidelines was conducted through searches of studies published between 2008 and 2018 in Pubmed, LILACS, SciELO, ProQuest, EBSCO, and Google Scholar. Results. Eleven (11) in vitro studies were gathered; all the studies showed positive antimicrobial activity on gram-positives, mainly by each of the parts of its fruits. However, such activity compared to chlorhexidine in only two studies, and, in another study, it was better than an antibiotic. A high risk of bias was detected in most studies. Phenolic compounds, including polyphenols and acylphloroglucinols, were identified as responsible for its activity. Conclusions. There is evidence of antimicrobial activity in M. dubia. Its study as an antimicrobial against oral microorganisms is still incipient, but there is great potential thanks to the potent phytochemicals it contains. Also, additional quality studies are required: comparing their activity versus oral antiseptics and on microorganisms associated with dental caries and periodontal disease.

Myrciaria dubia: su potencial como adjunto en el tratamiento de enfermedad periodontal / Myrciaria dubia: its potential as adjunct in the treatment of periodontal disease

RESUMEN Introducción: El tratamiento de la enfermedad periodontal incluye la terapia mecánica, el cual se complementa con el uso de antibióticos/antisépticos, lo que podría plantear efectos adversos a largo plazo. Objetivo: Describir el potencial farmacológico del fruto de la M. dubia, y su aplicación como complemento en la terapia periodontal. Métodos: Se revisaron revistas internacionales de impacto de la Web of Science relacionadas con el tema (58 revistas). Se consultaron las bases de datos Google Académico, SciELO, PubMed y EBSCO, utilizando los descriptores: "review"; "phytotherapy"; "myrtaceae"; "gingivitis"; "periodontitis"; "periodontal diseases"; "anti-bacterial agents"; "anti-inflammatory agents"; "dental plaque"; "antioxidants"; "plants, toxic"; "adverse effects". Se obtuvo 517 artículos de los cuales 60 fueron incluidos en el estudio. El 91,7 por ciento de los artículos fueron de los últimos tres años. Integración de la información: Se expuso las propiedades y seguridad en humanos del uso de la M. dubia. Conclusiones: La M. dubia tiene actividad antimicrobiana in vitro frente a microorganismos de la biopelícula dental, siendo más sensibles el S. mutans, S. mitis y P. gingivalis al extracto hidroalcohólico de la semilla, y el S. aureus al extracto hidroalcohólico de las hojas y corteza. También se evidencia su actividad antiinflamatoria. Los hallazgos sugieren que el extracto etanólico de la M. dubia podría incorporarse en antisépticos de uso bucal, dado su potencial antibiopelícula y antiinflamatoria(AU)

ABSTRACT Introduction: Treatment of periodontal disease includes mechanical therapy complemented with antibiotics / antiseptics, which could lead to the occurrence of long-term adverse effects. Objective: Describe the pharmacological potential of the fruit of M. dubia and its use as adjunct in periodontal therapy. Methods: A review was conducted of international high impact journals from the Web of Sciences which dealt with the topic (58 journals). The databases Google Scholar, SciELO, PubMed and EBSCO were consulted, using the descriptors "review", "phytotherapy", "Myrtaceae", "gingivitis", "periodontitis", "periodontal diseases", anti-bacterial agents", "anti-inflammatory agents", "dental plaque", "antioxidants", "plants, toxic", "adverse effects". A total 517 papers were obtained, of which 60 were included in the study. 91.7 percent of the papers had been published in the last three years. Data integration: A description was provided of the properties and safety of the use of M. dubia in humans. Conclusions: M. dubia has in vitro antimicrobial activity against dental biofilm microorganisms, particularly S. mutans, S. mitis and P. gingivalis to the seed hydroalcoholic extract, and S. aureus to the leaf and peel hydroalcoholic extract. Anti-inflammatory activity was also observed. Results suggest that M. dubia ethanolic extract could be incorporated into oral antiseptics, given its antibiofilm and anti-inflammatory potential(AU)

Evaluación de atención y memoria en suje-tos drogodependientes / Attention and memory evaluation in drug-dependent subjects

La exposición a sustancias psicoactivas puede predisponer al individuo a padecer alteraciones de orden cognitivo. La atención y la memoria son las funciones que comúnmente se afectan. Objetivo:El presente estudio evaluó los niveles de atención y memoria en pacientes con trastorno por consumo de sustancia en tres centros especializados. Método:Estudio exploratorio-descriptivo con 60 participantes. La evaluación neuropsicológica se realizó con la batería Neuropsi para atención y memoria. El análisis se realizó mediante estadística descriptiva con frecuencias y porcentajes. Resultados: Se observó que la población investigada presentó un mayor deterioro en el área de memoria con un 70% y en la atención 33.3% de déficit. La memoria de trabajo se encuentra conservada en la mayoría de participantes. Conclusiones:Los resultados indican que el deterioro cognitivo en los niveles de atención y memoria están presentes en sujetos con trastorno por consumo de sustancias, siendo la memoria la función más afectada.

The exposure to psychoactive substances may predispose the individual to suffer alterations cognitive order. Attention and memory are the functions that are commonly affected. Objetive:The present study evaluated the levels of attention and memory in patients with use disorder by substance use in three specialized centers. Method:It is an exploratory-descriptive study with a 60 participants. The neuropsychological evaluation was performed with the Neuropsi battery for attention and memory. The analysis was carried out using descriptive statistics with frequencies and percentages.Results: In this case was observed that the researched population showed a greater deterioration in the area of memory with a 70% of alteration, while in the attention was evidenced 33.3% of deficit. Working memory is preserved in most of the population. Conclusions:The results indicate that cognitive deterioration in attention and memory levels are present in subjects with substance use disorder being the memory the most affected function. There was not a considerable relationship between the time of consumption and cognitive damage.

Bioelectrogenesis with microbial fuel cells (MFCs) using the microalga Chlorella vulgaris and bacterial communities

Background: Microbial Fuel Cell (MFC) technology is used in various applications such as wastewater treatment with the production of electrical energy. The objective of this study was to estimate the biodepuration of oils and fats, the elimination of blue dye brl and bioelectro-characterization in MFCs with Chlorella vulgaris and bacterial community. Results: The operation of MFCs at 32 d showed an increase in bioelectrogenic activity (from 23.17 to 327.67 mW/m2 ) and in the potential (from 200 to 954 mV), with biodepuration of fats and oils (95%) in the microalgal cathode, and a removal of the chemical oxygen demand COD (anode, 71%, cathode, 78.6%) and the blue dye brl (73%) at the anode, here biofilms were formed by the bacterial community consisting of Actinobacteria and Deltaproteobacteria. Conclusions: These findings suggest that MFCs with C. vulgaris and bacterial community have a simultaneous efficiency in the production of bioelectricity and bioremediation processes, becoming an important source of bioenergy in the future.

NiMo-sulfide supported on activated carbon to produce renewable diesel / NiMo-sulfuro soportado en carbón activado para producir diesel renovable / NiMo-sulfeto suportado em carvão ativado para produzir diesel renovável

Resumen Gracias a su débil polaridad y gran área superficial, los soportes de carbón activado tienen el potencial de aumentar la dispersión de los sulfuros metálicos. La ausencia de una interacción fuerte metal-soporte puede conducir a la formación de una fase Ni-Mo-S muy activa y estable. En este estudio se prepararon catalizadores por el método de co-impregnación, con diferentes cantidades de níquel y molibdeno y soportados sobre carbón activado comercial, y se caracterizaron por técnicas BET, XRF y SEM. Se evaluó su actividad catalítica para el hidroprocesamiento de aceite de Jatropha utilizando un reactor por lotes, y se determinó la composición de los productos líquidos y gaseosos. Los resultados mostraron que los productos gaseosos están compuestos principalmente de grandes cantidades de propano y pequeñas cantidades de otros hidrocarburos livianos (C1 a C5). Los hidrocarburos líquidos fueron principalmente una mezcla de n-parafinas de C15-C18 y de algunos compuestos oxigenados. Los catalizadores presentaron una fracción de masa de 3 % Ni, 15 % Mo (Ni3Mo15/AC) y mayor selectividad hacia hidrocarburos C17-C18, con una distribución de productos similar al catalizador Ni-Mo-S soportado en alúmina comercial.

Abstract Due to their weak polarity and large surface area, activated carbon supports have the potential to enhance the dispersion of metal-sulfides. It is expected that the absence of a strong metal-support interaction can result in the formation of a very active and stable Ni-Mo-S phase. In this study, catalysts with different amounts of nickel and molybdenum supported on a commercial activated carbon were prepared by a co-impregnation method and characterized by BET, XRF, and SEM techniques. The catalytic activity for hydroprocessing of Jatropha oil was evaluated in a batch reactor, and the composition of the liquid and gaseous products were determined. Results showed that gaseous products are mainly composed of high amounts of propane and small amounts of other light hydrocarbons (C1 to C5). Liquid hydrocarbon products consisted of a mixture containing mainly n-paraffins of C15-C18 and some oxygenated compounds. The catalysts with a mass fraction of 3 % Ni, 15 % Mo (Ni3Mo15/AC) presented the highest selectivity toward C17-C18 hydrocarbons, with a product distribution similar to a commercial alumina-supported Ni-Mo-S catalyst.

Resumo Devido a sua baixa polaridade e amplia área superficial, os suportes de carvão ativado possuem o potencial de aumentar a dispersão de sulfetos metálicos. A ausência de uma forte interação suporte-metal pode levar a formação de uma fase Ni-Mo-S muito ativa e estável. Neste estudo, foram preparados catalizadores com diferentes teores de níquel e molibdênio suportados em carvão ativado comercial por um método de co-impregnação e caracterizados pelas técnicas BET, XRF e SEM. A atividade catalítica foi avaliada para o hidroprocessamento do óleo de Jatropha em um reator por lotes, e se determinou a composição dos produtos líquidos e gasosos. Os resultados mostraram que os produtos gasosos são compostos principalmente por altos teores de propano e pequenos teores de outros hidrocarbonos leves (C1-C5). Os hidrocarbonos líquidos consistiram de uma mistura contendo principalmente n-parafinas de C15-C18 e alguns compostos oxigenados. Os catalizadores apresentaram uma fração de massa de 3 % Ni, 15 % Mo (Ni3Mo15/AC) e uma maior seletividade em relação aos hidrocarbonos C17-C18, com uma distribuição de produtos similar ao catalizador comercial Ni-Mo-S suportado em alumina.

Imagen corporal y autoestima en niños según su estado nutricional y frecuencia de actividad física / Body image and self-esteem in children according to their nutritional status and frequency of physical activity

Physical activity plays an important role in child development. The purpose of this study was to compare body image, self-esteem, cardio-metabolic risk and physical performance of children by nutritional status and frequency of physical activity. We studied 208 children (115 men and 93 women) 11.9±1.2 years of age. Participants were divided by frequency of physical activity per week: Group 1 (n= 87) was not physically active; Group 2 (n= 64) was physically active 1 or 2 times per week; Group 3 (n= 57) was physically active 3 or 4 times a week. We observed that 51 children were overweight and 40 obese. Children who were physically active 3 or 4 times per week, were less concerned about their body image and had higher self-esteem scores (both p <0.05). These children also reported lower cardio-metabolic risk and better physical performance. We conclude that there are overall developmental benefits for children who are more physically active.

La actividad física juega un papel importante en el desarrollo de los niños. El propósito de este estudio fue comparar según estado nutricional y frecuencia de actividad física la imagen corporal, autoestima, riesgo cardio-metabólico y rendimiento físico de niños. Se estudió 208 niños de 11,9±1,2 años de edad, 115 hombres y 93 mujeres. Quedaron divididos según frecuencia de actividad física a la semana: El Grupo 1 (n= 87) no realizan; Grupo 2 (n= 64) realizan 1 o 2 veces/semana; Grupo 3 (n= 57), realizan 3 o 4 veces/semana. Se observó que 51 niños presentaron sobrepeso y 40 de ellos obesidad. Los niños que realizan 3 o 4 veces actividad física/semana, presentaron menor preocupación por su imagen corporal y puntajes superiores en autoestima, ambas con significancia estadística (p<0,05), además reportaron menor riesgo cardio-metabólico y mejor rendimiento físico. Se concluye que los niños con mayor frecuencia de actividad física/semana, evidencian beneficios en su desarrollo integral.

Estudio Descriptivo: Utilidad de la Cirugía Bariátrica en el Tratamiento de la Obesidad y Comorbilidades en Pacientes del Hospital de Especialidades José Carrasco Arteaga, 2009 - 2013 / Descriptive Study: Utility of Bariatric Surgery as Treatment for Obesity and Comorbidities in Patients from José Carrasco Arteaga Specialities Hospital, 2009-2013.

INTRODUCCIÓN: La cirugía bariátrica constituye en la actualidad una alternativa terapéutica eficaz en pacientes con obesidad y comorbilidades. El objetivo fue describir los resultados obtenidos en una serie de pacientes tratados con cirugía bariátrica en el Hospital de Especialidades José Carrasco Arteaga. MÉTODO: Estudio descriptivo, longitudinal y retrospectivo realizado en los pacientes tratados con cirugía bariátrica e ingresados en el departamento de Cirugía del Hospital de Especialidades José Carrasco Arteaga durante el periodo comprendido entre 2009 y 2013. Se estudiaron las medidas antropométricas, niveles de glicemia, perfil lipídico (colesterol, triglicéridos y HDL) y los niveles de tensión arterial previos a la cirugía y 3 controles posteriores (tercer, sexto y duodécimo mes posquirúrgico) para proceder a describir los resultados y compararlos en el tiempo de seguimiento. RESULTADOS: Se estudiaron 71 pacientes con diagnóstico de obesidad mórbida (81.5 % mujeres y 18.5 % varones) con una edad media de 44 ±10 años. El peso medio prequirúrgico fue de 110.16 ±18.6 kg y el IMC de 42.6 ±46 Kg/m2. Al tercer mes, sexto mes y un año después del procedimiento quirúrgico, el IMC promedio fue de 34.54 Kg/m2, 31.64 Kg/m2 y 30.36 Kg/m2 respectivamente. El 90.8 % de los pacientes con dislipidemia, el 100 % de los diabéticos y el 98.5 % de los hipertensos normalizaron sus perfiles correspondientes tras 12 meses. El 7.04 % de los pacientes presentaron complicaciones posquirúrgicas y la mortalidad alcanzó un 5.6 %. CONCLUSIÓN: La cirugía bariátrica constituye un procedimiento útil en la actualidad para el control de la obesidad en sus distintos grados y la reducción de los efectos de las comorbilidades asociadas a ésta como la hipertensión, diabetes y dislipidemia.(au)

BACKGROUND: Bariatric surgery is consideredan effective treatment option in patients with obesity and comorbidities. The aim was to describe the results of bariatric surgery in patients from José Carrasco Arteaga Specialities Hospital. METHODS: A retrospective longitudinal descriptive study was performed in patients treated with bariatric surgery and admitted to Surgery department at José Carrasco Arteaga Specialities Hospital from 2009 to 2013. Anthropometric measures, glucose blood levels, lipid panel (cholesterol, triglycerides and HDL) and blood pressure measures were registered before the surgery and three, six and twelve months after it to describe the results and compare them through follow-up. RESULTS: 71 patients diagnosed with morbid obesity (81.5 % male and 18.5 % female) were studied; their mean age was 45 ±10 years. Average preoperative weight was 110.16 ±18.6 kg and BMI was 42.6 ±4.6 kg/m2. BMI decreased to 34.54kg/m2, 31.64kg/m2 and 30.36kg/m2 after three, six and twelve months respectively. 90.8 % of patients with dyslipidemia, 100 % of diabetics and 98.5 % of hypertensive patients had normal values of their profiles after 12 months. Postoperative complications represented 7.04 % and mortality rate reached 5.6 %. CONCLUSION: Bariatric surgery is a useful procedure to control obesity and the effects associated to its comorbidities such as arterial hypertension, diabetes and dyslipidemia.(au)

Overactive bladder - 18 years - Part I

ABSTRACT Abstract: Overactive bladder syndrome is one of the lower urinary tract dysfunctions with the highest number of scientific publications over the past two decades. This shows the growing interest in better understanding this syndrome, which gathers symptoms of urinary urgency and increased daytime and nighttime voiding frequency, with or without urinary incontinence and results in a negative impact on the quality of life of approximately one out of six individuals – including both genders and almost all age groups. The possibility of establishing the diagnosis just from clinical data made patients' access to specialized care easier. Physiotherapy resources have been incorporated into the urological daily practice. A number of more selective antimuscarinic drugs with consequent lower adverse event rates were released. Recently, a new class of oral drugs, beta-adrenergic agonists has become part of the armamentarium for Overactive Bladder. Botulinum toxin injections in the bladder and sacral neuromodulation are routine modalities of treatment for refractory cases. During the 1st Latin-American Consultation on Overactive Bladder, a comprehensive review of the literature related to the evolution of the concept, epidemiology, diagnosis, and management was conducted. This text corresponds to the first part of the review Overactive Bladder 18-years.

Overactive bladder - 18 years - Part II

ABSTRACT Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics – pillars of the overactive bladder pharmacotherapy – started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning – as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder – 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.

Desarrollo de habilidades conductuales maternas para promover la alfabetización inicial en niños preescolares / Development of maternal skills to implement early literacy with preschool children / Desenvolvimento de habilidades condutuais maternas para promover a alfabetização inicial em crianças pré-escolares

El objetivo del presente estudio fue probar la efectividad de un programa conductual (taller) dirigido a madres de familia de estrato sociocultural bajo, para capacitarlas en la realización de actividades y estrategias para promover en sus hijos preescolares habilidades lingüísticas y preacadémicas relacionadas con la alfabetización inicial. El programa se enfocó en dos contextos específicos de interacción: la lectura conjunta de cuentos y el juego con títeres. Participaron 20 madres, con prácticas alfabetizadoras limitadas, cuyos hijos preescolares mostraron pocas habilidades preacadémicas y lingüísticas. Diez madres conformaron el Grupo Experimental, recibiendo el programa de intervención y otras diez fungieron como Grupo Control. Se realizaron tres sesiones de evaluación (pre test, post test y seguimiento) y siete sesiones de intervención. El programa se aplicó de manera grupal y se utilizaron técnicas de exposición oral, discusión en grupo, modelamiento, juego de roles, retroalimentación y práctica reforzada. Los resultados mostraron que el programa fue eficaz para desarrollar algunas de las prácticas alfabetizadoras en las madres. Los mayores efectos se observaron en el contexto interactivo de lectura conjunta de cuentos. Se discuten los resultados y limitaciones del estudio, y se derivan algunas sugerencias para programas futuros.

The aim of this study was to test the effectiveness of a behavioral program aimed to mothers from low socio-cultural background in order to train them in conducting activities and strategies to promote language and pre-academic skills related to early literacy in their preschool children. The program was carried out focusing on two interactive contexts: joint reading of stories and puppet play. 20 women participated, with limited literacy practices whose preschool children showed low levels in pre-academic and linguistic skills. 10 mothers formed the experimental group, receiving the intervention program and 10 served as control group. There were three testing sessions (pretest, post-test and follow-up) and seven intervention sessions. The program was implemented in a group mode and it used techniques such as oral presentation, group discussion, modeling, role playing, feedback and reinforced practice. Results showed that the program was effective in developing some of the literacy practices in mothers. The main effects were observed in the interactive context of joint reading of stories. The results and limitations of the study are discussed and some recommendations are given for future programs.

O objetivo do presente estudo foi provar a efetividade de um programa condutual (oficina) dirigido a mães de família de classe sociocultural baixa, para capacitá-las na realização de atividades e estratégias para promover em seus filhos pré-escolares habilidades linguísticas e pré-acadêmicas relacionadas com a alfabetização inicial. O programa enfocou-se em dois contextos específicos de interação: a leitura conjunta de contos e brincadeiras com marionetes. Participaram 20 mães, com práticas alfabetizadoras limitadas, cujos filhos pré-escolares mostraram poucas habilidades pré-acadêmicas e linguísticas. Dez mãe formaram o Grupo Experimental, recebendo o programa de intervenção e outras dez participaram como Grupo de Controle. Realizaram-se três sessões de avaliação (pré-teste, pós-teste e acompanhamento) e sete sessões de intervenção. O programa foi aplicado de maneira grupal e se utilizaram técnicas de exposição oral, discussão em grupo, modelagem, jogo de papéis, retroalimentação e prática reforçada. Os resultados mostraram que o programa foi eficaz para desenvolver algumas das práticas alfabetizadoras nas mães. Os maiores efeitos foram observados no contexto interativo de leitura conjunta de contos. Discutemse os resultados e limitações do estudo, e se derivam algumas sugestões para programas futuros.

Typical and atypical stem cells in the brain, vitamin C effect and neuropathology

Stem cells are considered a valuable cellular resource for tissue replacement therapies in most brain disorders. Stem cells have the ability to self-replicate and differentiate into numerous cell types, including neurons, oligodendrocytes and astrocytes. As a result, stem cells have been considered the "holy grail" of modern medical neuroscience. Despite their tremendous therapeutic potential, little is known about the mechanisms that regulate their differentiation. In this review, we analyze stem cells in embryonic and adult brains, and illustrate the differentiation pathways that give origin to most brain cells. We also evaluate the emergent role of the well known anti-oxidant, vitamin C, in stem cell differentiation. We believe that a complete understanding of all molecular players, including vitamin C, in stem cell differentiation will positively impact on the use of stem cell transplantation for neurodegenerative diseases.

Diagnóstico de infarto miocárdico perioperatorio dentro de las primeras 72 horas posteriores a la cirugía cardiaca / Diagnosis of perioperative myocardial infarction within the first seventy-two hours after cardiac surgery

One of the most frequent complications of cardiac surgery is the perioperative myocardial infarction (PMI). Incidence of PMI shows a wide variation because an accurate detection of this complication is difficult in the early postoperative stage. The objectives of the present study were to determine in our population of patients the incidence of PMI during the first seventy two hours after cardiac surgery as well as associations among the accepted criteria to diagnose this complication. PATIENTS AND METHODS: One hundred sixty four adults patients undergoing elective cardiac surgery were studied. With baselines preoperative studies, serial electrocardiographic, enzymatic [(determination of serum creatine kinase isoenzyme (CK-MB)] and echocardiographic studies were performed during the first 72 hours after cardiac surgery. Diagnosis of PMI was established with two or all the three positive criteria [electrocardiographic (ECG), enzymatic (CK-MB) and echocardiographic (ECHO)]. RESULTS: In 24 (15%) patients PMI was diagnosed. In this group 13 (54%) all the three criteria were positive. In 8 (33%) patients CK-MB and ECHO were positive. In 3 (13%) patients CK-MB and ECG were positive. CONCLUSIONS: In our population the incidence of PMI (15%) is agree with the reported in previous studies. In most of cases of PMI all the three diagnostic criteria are positive. When diagnosis is established only with two criteria, in most of cases these are CK-MB and ECHO.

La adecuación cultural de las infraestructuras de salud / The cultural appropriateness of health infrastructure

Con la finalidad de desarrollar estrategias que permitan alcanzar los objetivos del milenio en Bolivia estrategias dirigidas a la disminución de la mortalidad materna e infantil y a mejorar la accesibilidad y la calidad de los servicios de salud.

Habilidades matemáticas en alumnos de bajo nivel sociocultural / Mathematical skills in students from a low social and cultural stratum / Habilidades matemáticas em alunos de baixo nível sociocultural

La temática abordada es la calidad de la educación básica en México. Con el propósito de dar cuenta del proceso de desarrollo de diversas habilidades matemáticas en alumnos de primer grado de primaria, se realizó un estudio longitudinal en el cual participaron 169 alumnos de estrato sociocultural bajo. Se aplicó un instrumento referido a criterio y basado en análisis de tareas, que permitió analizar los aciertos y errores a lo largo del ciclo escolar 2004-2005. Los resultados indican que los alumnos ingresaron con deficiencias preacadémicas, que se desarrollaron algunas habilidades, pero que los niveles de aptitud matemática fueron bajos al finalizar el curso. Se discuten las implicaciones de los resultados y se proponen alternativas para la educación, basadas en el modelo conductual de desarrollo psicológico.

In this paper, the quality of primary education in Mexico is dealt with A longitudinal study was carried out with the aim of analyzing the process of development for various mathematical skills with first grade students; 169 students from a low social and cultural stratum participated. An instrument referred to criteria and based on task analysis was used to analyze the errors and the correct responses throughout the 2004-2005 school year Results show that students had enrolled with previous academic deficiencies and developed some skills; however, the levels of mathematical skills were still low at the end of the school term. The implications of these results are discussed and some alternatives for education based on a behavioural model of psychological development are proposed.

Neste artigo, é examinada a qualidade do ensino primária em México. Para dar conta do processo de desenvolvimento de várias habilidades matemáticas nos alunos do primeiro grau de ensino primária, foi realizado um estudo longitudinal em que participaram 169 alunos de estrato sociocultural baixo. Foi aplicado um instrumento referido a critério e baseado em análise de tarefas, que possibilitou a análise de acertos e erros durante o ciclo escolar 2004-2005. Os resultados sinalam que os alunos tenham deficiências pré-acadêmicas, que desenvolveram algumas habilidades, mais que os níveis de aptitude matemática foram baixos ao final do curso. São discutidas as implicações dos resultados e são propostas alternativas para a educação, baseadas no modelo condutista de desenvolvimento psicológico.

Validación de un instrumento de tamizaje para el estudio de la prevalencia de enfermedades cerebrovasculares en la población chilena / Assessment of a screening instrument to study the prevalence of cerebrovascular diseases in the chilean population

We assessed a screening instrument, adapted from a model suggested by WHO, aimed to perform population studies on the prevalence of cerebrovascular disease in Chile. Sixty-two subjects, 31 with cerebrovascular diseases and 31 without, were asked about symptoms and requested to do simple movements by trained interviewers. The results of the instrument were compared with a neurological examination performed by two specialists. Global sensitivity and specificity of the instrument, using WHO evaluation criteria, were 100 and 38.7 percent respectively. When three or more symptoms and one positive sign were considered as cutoff points, global specificity increased to 61 percent and sensitivity decreased to 93 percent. It is concluded that the present instrument is highly sensitive but lacks specificity

Brote de carbunco en un sector cordillerano de Nahuelbuta: un caso de enteritis carbuncosa fatal / Outbreak of carbuncle in a mountain area of Nahuelbuta: one case of fatal carbuncular enteritis

Se analiza un brote de carbunco humano aparecido en 1985 en un sector de la Cordillera de Nahuelbuta, comuna de Contulmo, provincia de Arauco, Octava Región. El cuadro afectó a 9 personas en todas las cuales existía el antecedente de ingesta de carne de vacuno muerto a consecuencia de infección por Bacillus anthracis, comprobada por el laboratorio. Las manifestaciones de carbunco cutáneo se presentaron en todos los pacientes, comprobándose clínicamente hemorragia en dos de ellos. En uno la evolución resultó fatal a consecuencia del compromiso gastrointestinal, descrito como muy infrecuente en la literatura revisada. Este caso desafortunado confirma la gravedad y alta letalidad que se atribuye a esta forma de la afección. Se destaca que no existe criterio unificado con respecto al tratamiento de esta enfermedad en el ser humano. No obstante, parece existir buena respuesta a la penicilina sódica en las formas cutáneas, lo que permite aconsejarla como antibiótico de elección en la mayoría de los casos.

Cetoacidosis diabética grave: tratamiento / Severe diabetic ketoacidosis: treatment

El tratamiento de la cetoacidosis diabética grave incluye: hidratación, insulina, reposición de electrólitos y soluciones alcalinizantes. La hidratación se inicia con solución salina isotónica, 1.000 ml por hora en las primeras tres horas, disminuyendo luego el ritmo de infusión, según respuesta clínica; cuando la glicemia desciende a 250 mg/dl se continúa con solución glucosada al 5% hasta completar las primeras 24 horas. La insulinoterapia se realiza con dosis bajas de insulina cristalina, existiendo tres sistemas para su administración: infusión endovenosa continua con bomba, bolos endovenosos horarios e inyecciones vía intramuscular horaria, cuyos resultados son igualmente efectivos y seguros. Nosotros empleamos el esquema intramuscular horario por su mayor facilidad de manejo; se recomienda una dosis inicial de 5 U. e.v. y 5 U. i.m., seguida de 5 U. i.m. por hora, hasta lograr glicemia cercana a 250 mg/dl, en que se prosigue con 5-10 U. subcutánea cada 6 horas, segun controles de glicemias. La reposición de electrólitos se refiere fundamentalmente a la administración de potasio, en dosis de 30 a 40 mEq por cada 1.000 ml de infusión a partor del segundo litro de hidratación, completando 100 a 140 mEq en las primeras 24 horas. El uso de soluciones alcalinizantes actualmente se reserva sólo para los casos con pH inferior a 7,1 o HCO3- bajo 10 mEq/1, recomendándose una dosis de 50 a 100 mM de bicarbonato de sodio a pasar en 30 a 60 minutos. La transición al tratamiento habitual incluye la alimentación oral que se reinicia cuando el sujeto está consciente y sin vómitos, en forma de régimen líquido fraccionado; la insulina cristalina se mantiene por 48 horas, 5-15 U. subcutánea cada 6 a 8 hrs., pasando luego a insulina de acción intermedia en la dosis previa al episodio agudo o 1/2 a 2/3 de la dosis total de I. cristalina usada el día anterior; el potasio por vía oral se prolongará durante 5 a 7 días...