ABSTRACT
Background: Kidney transplantation (KTx) requires immunosuppressive drugs such as Tacrolimus (TAC) which is mainly metabolized by CYP3A5. TAC is routinely monitored by trough levels (C0) although it has not shown to be a reliable marker. The area-under-curve (AUC) is a more realistic measure of drug exposure, but sampling is challenging in pediatric patients. Limited-sampling strategies (LSS) have been developed to estimate AUC. Herein, we aimed to determine AUC(0-24) and CYP3A5 genotype in Chilean pediatric kidney recipients using extended-release TAC, to evaluate different LSS-AUC(0-24) formulas and dose requirements. Patients and methods: We analyzed pediatric kidney recipients using different extended-release TAC brands to determine their trapezoidal AUC(0-24) and CYP3A5 genotypes (SNP rs776746). Daily TAC dose (TAC-D mg/kg) and AUC(0-24) normalized by dose were compared between CYP3A5 expressors (*1/*1 and *1/*3) and non-expressors (*3/*3). We evaluated the single and combined time-points to identify the best LSS-AUC(0-24) model. We compared the performance of this model with two pediatric LSS-AUC(0-24) equations for clinical validation. Results: Fifty-one pharmacokinetic profiles were obtained from kidney recipients (age 13.1 ± 2.9 years). When normalizing AUC(0-24) by TAC-D significant differences were found between CYP3A5 expressors and non-expressors (1701.9 vs. 2718.1 ng*h/mL/mg/kg, p < 0.05). C0 had a poor fit with AUC(0-24) (r 2 = 0.5011). The model which included C0, C1 and C4, showed the best performance to predict LSS-AUC(0-24) (r 2 = 0.8765) and yielded the lowest precision error (7.1% ± 6.4%) with the lowest fraction (9.8%) of deviated AUC(0-24), in comparison to other LSS equations. Conclusion: Estimation of LSS-AUC(0-24) with 3 time-points is an advisable and clinically useful option for pediatric kidney recipients using extended-release TAC to provide better guidance of decisions if toxicity or drug inefficacy is suspected. The different CYP3A5 genotypes associated with variable dose requirements reinforce considering genotyping before KTx. Further multi-centric studies with admixed cohorts are needed to determine the short- and long-term clinical benefits.
ABSTRACT
Resumen El objetivo de esta investigación fue conocer y analizar los principales factores de riesgo psicosocial a los que están expuestas las profesoras que trabajan en universidades online. Para ello, se realizaron 20 entrevistas en profundidad fenomenológicas, tomando como referencia el modelo de Seidman, a 10 mujeres que trabajan bajo esta modalidad, para obtener una comprensión global y holística del problema a partir de sus puntos de vista y del contexto en el que se hallan inmersas. Los resultados muestran la existencia de distintos factores psicosociales de riesgo, como sobrecarga mental cuantitativa, subcarga mental cualitativa, aislamiento, conflicto de rol y sobrecarga emocional, aspectos que deberían formar parte de los programas preventivos y de intervención psicosocial adecuados a las características particulares de la mujer, lo cual contribuirá a promover una organización saludable, cuyo propósito no es solo intervenir sobre los aspectos disfuncionales, sino lograr la salud y bienestar de sus trabajadores, potenciando al máximo el desarrollo de la organización y sus empleados.
Abstract The advancement and integration of new Information and Communication Technologies (ICT) in the workplace has led to the emergence of new formulae such as teleworking, which have crossed the boundaries of space and time, modifying the working stage, the way of supervision of work and the reconciliation between family and personal life. Within this frame of reference, workers are more exposed to new risks emerging, like the technostress and burnout issues, as well as the trouble reconciling professional and family life, which result in negative effects on people, and can generate a higher level of exhaustion, dissatisfaction, and professional wear. In this context, the aim of this study is to know and analyze the main psychosocial risk factors female online university teachers are exposed. The interview on phenomenological depth, taking as reference the Seidman´s model, was used as a data collection technique. In particular, two scripts, one for each of the interviews to be done, were developed and we proceeded to validate them through consultation of 15 experts from the field of safety and health and university teaching, and through the Lawshe content validity study (1975), recommended by Cardona (2006), as a quantitative validity criterion, and the observations and suggestions made by the experts as a qualitative validity criterion. In practice, 20 phenomenological interviews were conducted with 10 women working under this labor formula, to obtain a comprehensive understanding and holistic approach to the problem from their point of view and the context in which they are immersed. The results show the existence of several psychosocial risk factors related to the position and the social environment. As regards the position-related psychosocial risk factors, the findings show the existence of quantitative mental overload, associated with intense periods of work or peaks of work, which are specific moments, linked to the dynamics of temporary teaching online and teaching in general, where work load increases substantially, doubling the amount of work to be carried out. Another psychosocial risk factor perceived negatively by participants, also refers to the qualitative mental under load, which occurs during certain academic monotonous and repetitive activities when teaching online. On the other hand, in relation to psychosocial factors associated with the social and organizational sphere, the isolation of participants working in their home is highlighted. This isolation is related both to the lack of contact with peers, to the absence of spontaneous talks and emotional support, that is, to the loss of informal interaction in the workplace, and to the need to share doubts, to work together on a common educational Project or to homogenize criteria in the same subjects taught by different teachers. On the other hand, the online female teachers reveal in their speeches different situations of personal-role conflict, in which demands are produced, focused mainly on situations of evaluation of both academic work and exams, which are incompatible with their beliefs and values. Finally, the results of the present study indicate the emotional over load due to conflicts with students, usually relating to their assessment. The above supports the need for further research in this field, aimed at developing and implementing preventive and psychosocial risk intervention programmes in the university context, which have an impact on the organizational and personal scope and which are adequate to the characteristics of women. This will help promote a healthy organization, an organization that develops healthy practices of structuring and managing work processes that would influence the development of healthy employees, whose purpose is not only to intervene on the dysfunctional aspects, but attain the welfare of its workers achieving the highest increase in the development of the organization and its employees.
ABSTRACT
Resumen En el marco de la investigación titulada: Práctica de los psicoanalistas en las instituciones de salud mental en el contexto latinoamericano. Un estado del arte (2000-2013), se mantuvo como eje la pregunta por la presencia del psicoanalista en contextos diferentes al dispositivo analítico clásico, el cual se enmarca en el ámbito de lo privado. Una referencia obligada en esta vía es aquella frase freudiana que evoca la aleación entre el oro puro del análisis y el cobre de la sugestión directa. El presente texto es una elaboración al respecto y sus consecuencias para una praxis psicoanalítica en el ámbito institucional. Para ello se revisaron distintas fuentes en la obra de Freud y en la enseñanza de Lacan, que, junto con otros autores, intentan dar cuenta de las dificultades y posibilidades para que ello sea viable. Se evidencia que los detractores de esta opción se concentran en lo imaginario del dispositivo, mientras que otros más orientados por la estructura del mismo y la función deseo del analista señalan la pertinencia de esta praxis por fuera del dispositivo clásico.
Abstract Within the framework of the research entitled: "Practice of psychoanalysts in mental health institutions in the Latin American context. A state of art (2000-2013) ", the question of the presence of psychoanalysts in contexts different from the classic analytical device, which is framed in the private sphere, was kept as the axis. An obligatory reference in this way is the Freudian phrase that evokes the alloy between the pure gold of the analysis and the copper of the direct suggestion. The present text is an elaboration on this and its consequences for a psychoanalytic praxis at the institutional level. For this, different sources were reviewed in the work of Freud and the lessons of Lacan, which together with other authors attempt to account for the difficulties and possibilities for this to be viable. It is evident that the detractors of this option concentrate on the imaginary of the device, while others are more oriented by the structure of the device and the desired function that the analyst points out.
ABSTRACT
The short half-life of erythropoietin (rHuEPO) leads to repeated fluctuations in hemoglobin levels and the need for frequent administration. Continuous erythropoietin receptor activator (CERA) therapy has been approved for once or twice a month in adult dialysis patients. To evaluate the efficacy and safety of CERA therapy in the management of anemia in pediatric peritoneal dialysis (PD) stable PD children under twice-a-week EPO were converted to a subcutaneous CERA, scheduled every 2 weeks. The follow-up was 6 months. The primary efficacy parameter was hemoglobin > 11 g/dL. The exclusion criteria were ferritin <100 ng/ml and Hb saturation <20%. Sixteen children, aged 9.75 ± 3.6 years, including 11 boys, participated in the study. Mean Hb level at month 0 was 10.8 ± 1.9 g/dL. A decrease in hemoglobin to 10.38 ± 1 g/dL at month 2 was observed. The CERA dose was increased from 0.86 ± 0.33 to 1.67 ± 0.4 µg/kg at month 3. The target Hb level was reached by the 3rd month. The Hb level and CERA dose were 12.2 ± 1.2 and 1.6 ± 0.67 µg/kg respectively at the end of the study. No adverse events were observed during the protocol. CERA is an effective and safe therapy for maintaining hemoglobin levels when administered twice, up to once a month, in PD children. Doses required to reach target Hb were higher than published experiences in adult populations.
