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En este escrito haremos memoria de las mártires dejándonos iluminar por estas mujeres de comienzos del cristianismo, su situación, su contexto socio-cultural, eclesial, su realidad de mujeres. El tratamiento dispensado al cuerpo femenino en los relatos de martirio, entre los siglos I al IV d. C., permite presentar a las mártires como la subversión de la debilidad y fragilidad de su sexo (infirmitas sexus), y la violencia deliberadamente experimentada por ellas, como vía por transgredir el orden social. Trataremos de realizar una aproximación al sentido del martirio cristiano. Analizaremos el martirio de algunas santas, tanto desde el punto de vista formal como observando su significado y fundamentación en las fuentes literarias. En este estudio confirmamos el puente existente entre el martirio de Jesucristo, los mártires y las mártires, ellos y ellas forman una nueva genealogía, son descendientes de Jesús y martirizados como Él; los une una misma identidad de fe, de fortaleza e integridad para entregar la vida y recordarnos que detrás de todo martirio hay un asesinato.

Background Despite longstanding epidemiologic data on the association between increased serum triglycerides and cardiovascular events, the exact level at which risk begins to rise is unclear. The Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension has conceived a protocol aimed at searching for the prognostic cutoff value of triglycerides in predicting cardiovascular events in a large regional‐based Italian cohort. Methods and Results Among 14 189 subjects aged 18 to 95 years followed‐up for 11.2 (5.3–13.2) years, the prognostic cutoff value of triglycerides, able to discriminate combined cardiovascular events, was identified by means of receiver operating characteristic curve. The conventional (150 mg/dL) and the prognostic cutoff values of triglycerides were used as independent predictors in separate multivariable Cox regression models adjusted for age, sex, body mass index, total and high‐density lipoprotein cholesterol, serum uric acid, arterial hypertension, diabetes, chronic renal disease, smoking habit, and use of antihypertensive and lipid‐lowering drugs. During 139 375 person‐years of follow‐up, 1601 participants experienced cardiovascular events. Receiver operating characteristic curve showed that 89 mg/dL (95% CI, 75.8–103.3, sensitivity 76.6, specificity 34.1, P

Abstract Aims We hypothesized that left atrial (LA) remodelling and function are associated with poor exercise capacity as prognostic marker in chronic heart failure (CHF) across a broad range of left ventricular ejection fraction (LVEF). Methods and results One hundred seventy‐one patients with CHF were analysed [age 65 ± 11 years, 136 males (80%); 86 heart failure with reduced ejection fraction (HFrEF), 27 heart failure with mid‐range ejection fraction (HFmrEF), 58 heart failure with preserved ejection fraction (HFpEF)]. All patients underwent echocardiography and maximal cardiopulmonary exercise testing and were classified according to a prognostic cut‐off of peak VO2 (pVO2; 14 mL/kg/min). Seventy‐seven (45%) patients reached pVO2

Sodium-ion batteries are considered promising alternatives to lithium-ion technology; however, the diffusion on a commercial scale is hindered by the struggle to identify materials with high electrochemical performances. Studies available in the literature are mainly focused on electrochemical performance and neglect aspects related to the environmental sustainability. In fact, the current state-of-the-art (presented in this study) shows that life cycle assessment (LCA) studies related to the production processes of electrode materials for Na-ion batteries are still very limited. The LCA methodology applied during the development of a technology phase can constitute a valid support for an eco-oriented design and, therefore, to the choice of solutions characterized by a lower environmental impact with the same electrochemical performance. In this context, a life cycle-based environmental–economic assessment was performed to evaluate the environmental impacts of the production process of cathode and anode materials for sodium-ion batteries. The study is focused on the cathodic active material Na0.66MnO2, considering two synthesis paths, and the anodic material consisting of tin (Sn) and Sn-carbon nanofiber (Sn-Cn) active material, binder, and other additives. Results illustrate the environmental performance of the different materials and constitute a useful input for their selection within an eco-design view.

Al aplicar regresiones logísticas con datos de las cuatro Encuestas Nacionales de Factores de Riesgo (enfr) de Argentina, se estudió la relación entre el status de salud individual y sus determinantes, utilizando como marco teórico la función de producción de salud. Se hace especial hincapié en los estilos de vida por ser los que mayor influencia tienen sobre esta dimensión. El análisis de la evolución temporal muestra un incremento tanto en la obesidad como en el consumo de alcohol, poniendo de manifiesto la necesidad de intensificar estrategias públicas que incentiven estilos de vida menos riesgosos a fin de mejorar la salud de la población.

Abstract Aims Ceramides exert several biological activities that may contribute to the pathophysiology of cardiovascular disease and heart failure (HF). The association between plasma levels of distinct ceramides (that have been previously associated with increased cardiovascular risk) and cardiovascular mortality in patients with chronic HF has received little attention. Methods and results In a post hoc ancillary analysis of the Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca‐Heart Failure (GISSI‐HF; NCT00336336) trial, we randomly selected a sample of 200 ambulatory patients with chronic HF who died due to cardiovascular causes and 200 patients who were alive at the end of the trial (after a median follow‐up period of 3.9 years). We measured baseline plasma concentrations of six previously identified high‐risk ceramide species [Cer(d18:1/16:0), Cer(d18:1/18:0), Cer(d18:1/20:0), Cer(d18:1/22:0), Cer(d18:1/24:0), and Cer(d18:1/24:1) and their individual plasma ratios with Cer(d18:1/24:0)]. Patients who died due to cardiovascular causes had significantly (P

BackgroundSeveral studies have reported that the combination of high TG and low HDL-C, as simplified by the TG/HDL-C ratio, was a predictor of cardiovascular disease independent of LDL-C level. Nevertheless, poor data are available on the predictive role of TG/HDL-C ratio in very high risk (VHR) patients with chronic coronary syndromes (CCS).MethodsUsing the data from the STable Coronary Artery Diseases RegisTry (START) study, an Italian nationwide registry, we assessed the association between the TG/HDL-C ratio and baseline clinical characteristics, pharmacological treatment, and major adverse cardio-cerebrovascular events (MACCE) at 1 year in a large cohort of CCS patients at VHR.ResultsVHR patients with both TG and HDL-C levels available were grouped in tertiles of TG/HDL-C ratio: low (TG/HDL-C ratio 3.3, n = 1,028). At 1 year from enrolment, 232 (7.6%) patients presented a MACCE, with a higher incidence in the higher tertile, even though not statistically significant (6.0, 8.2, and 8.4% in the low, middle and high tertile, respectively; p = 0.08). At multivariable analysis, the TG/HDL-C ratio in tertiles did not result an independent predictor of the MACCE (p = 0.29) at 1-year follow-up (HR: 1.30; 95% CI: 0.93–1.82; p = 0.12 middle vs. lower tertile, and HR: 1.22; 95% CI: 0.87–1.72; p = 0.25 higher vs. lower).ConclusionsIn the present large, nationwide cohort of CCS patients at VHR a high TG/HD ratio did not emerge as independent predictor of MACCE at 1 year. Further studies with a longer follow-up are needed to better define the prognostic role of TG/HDL ratio in CCS.

Abstract Aims To investigate the still uncertain independent prognostic impact of pulse pressure (PP) in acute heart failure (HF), in particular across the left ventricular ejection fraction (EF) phenotypes, and the potential contribution of PP in outlining the individual phenotypes. Methods and results We prospectively evaluated 1‐year death and rehospitalization in 4314 patients admitted for acute HF grouped by EF and stratified by their PP level on admission. In HF with reduced ( 60 mmHg and SBP > 140 mmHg was associated to a preserved EF with a high performance value. No prognostic significance of PP was found in the HF with mid‐range EF subgroup. Conclusions In acute HFrEF, there is an almost linear inverse relation between mortality and PP, partly mediated by SBP. In HFpEF, a J‐shaped relationship between mortality and PP was present with a better prognosis at the nadir. A combination of PP > 60 mmHg with SBP > 140 mmHg may be clinically helpful as marker of a preserved left ventricular EF.

With the proliferation of e-commerce, the field of last-mile logistics has grown increasingly, highlighting the need to manage the environmental consequences of this phenomenon, especially to achieve decarbonization targets for cities and to improve citizens’ quality of life. Within this framework, the authors carried out a last-mile logistics life cycle assessment, to analyse and compare different logistics vehicle options performing the same service in an urban context: an electric four-wheel cargo bike, an electric van, a plug-in hybrid van, and a diesel van. The assessment shows that the e-cargo bike performs better for all the impact categories considered. The second-best option is the e-van, while the diesel van shows the worst environmental results. Focusing on decarbonization, the replacement of a diesel van with an electric one or with an e-cargo bike allows a reduction of 173 g CO2 eq/km and 250 g CO2 eq/km, respectively. Similar results are obtained for Photochemical Ozone Formation with associated emissions of 0.18, 0.31, 0.45 and 0.49 g NMVOC eq/km for the e-cargo bike, e-van, plug in hybrid van and diesel van, respectively. The only exceptions are Human Health impact categories, Acidification and Respiratory inorganics, for which the plug-in hybrid van performs worst, and Resource use, Mineral and Metals, for which the electric van performs worst.

Background Evidence regarding the relationships among high plasma triglycerides (TG), all‐cause mortality, and atherosclerotic cardiovascular disease (ASCVD) events in low‐to‐moderate risk individuals is limited. The aim of this study was to determine whether the presence of high TG levels influences the risk of all‐cause mortality and ASCVD events in a population cohort followed in the real‐world clinical setting. Methods and Results A retrospective longitudinal cohort analysis using administrative databases of 3 Italian Local Health Units was performed. All individuals with at least one TG measurement between January 1, 2010 and December 31, 2015 were followed through December 2016. Outcome measures included incident ASCVD events and all‐cause mortality. Individuals with normal TG levels (500 mg/dL). 158 042 individuals (142 289 with normal, 15 558 with high, and 195 with very high TG) were considered. In the whole cohort, the overall incidence rates of ASCVD and all‐cause mortality were 7.2 and 17.1 per 1000 person‐years, respectively. After multivariate adjustment for potential confounders, individuals with high and very high TG showed a significantly increased risk of all‐cause mortality (hazard ratio [HR]=1.49 [95% confidence interval (CI) 1.36–1.63], P

Introduction. The current use of lipid lowering therapies and the eligibility for proprotein convertase subtilisin/kexin-9 (PCSK9) inhibitors of patients surviving a myocardial infarction (MI) is poorly known. Methods. Using the data from two contemporary, nationwide, prospective, real-world registries of patients with stable coronary artery disease, we sought to describe the lipid lowering therapies prescribed by cardiologists in patients with a prior MI and the resulting eligibility for PCSK9 inhibitors according to the European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) and the Italian regulatory agency (Agenzia Italiana del Farmaco; AIFA) criteria. The study cohort was stratified according to the following low-density lipoprotein cholesterol (LDL-C) levels at the time of enrolment:

The utilization of cardiovascular rehabilitation (CR) programmes in patients with Lower Extremity Peripheral Artery Disease (LEPAD) is generally poor, with limited evidence of current policies for referral. The aim of the study was to evaluate, within a cohesive network of CR and vascular surgery facilities with facilitated referral process, the clinical characteristic of LEPAD patients referred to CR and related outcomes, as compared to patients not referred. The present is an observational prospective study of consecutive patients recruited at vascular surgery facilities. Out of 329 patients observed, the average referral rate to CR was 34% (28% and 39% in patients with and without recent peripheral revascularization, p

The prognostic insights of heart failure (HF) with mid-range (40-49%) ejection fraction (HFmrEF) are not fully elucidated. We investigated whether the six-minutes walking test (6MWT) and brain natriuretic peptide (BNP) are predictive of outcome across the spectrum of LV systolic dysfunction and whether the HFmrEF cut-off impacts the risk stratification abilities of these tests. We studied 538 outpatients, aged 70±12 years, 28% females, with stable chronic HF and EF

The introduction of stationary storage systems into the Italian electric network is necessary to accommodate the increasing share of energy from non-programmable renewable sources and to reach progressive decarbonization targets. In this framework, a life cycle assessment is a suitable tool to assess environmental impacts during the entire life cycle of stationary storage systems, i.e., their sustainability. A Li-ion battery (lithium–iron–phosphate (LFP), nickel–manganese–cobalt (NMC) 532, and NMC 622) entire life cycle assessment (LCA) based on primary and literature data was performed. The LCA results showed that energy consumption (predominantly during cell production), battery design (particularly binder choice), inventory accuracy, and data quality are key aspects that can strongly affect results. Regarding the battery construction phase, LFP batteries showed better performance than the NMC ones, but when the end-of-life (EoL) stage was included, NMC cell performance became very close to those of LFPs. Sensitivity and uncertainty analyses, done using the Monte Carlo methodology, confirmed that the results (except for the freshwater eutrophication indicator) were characterized by a low dispersion and that the energy mix choice, during the different battery life phases, was able to greatly influence the overall impact. The use of primary and updated data related to battery cell production, like those used in the present paper, was necessary to obtain reliable results, and the application to a European production line is an item of novelty of this paper.

Andrea Temporelli nació durante los Años de Plomo, en el mes más cruel, poco después de que en Nueva York Martin Cooper hiciera la primera llamada telefónica de la historia con un móvil y mientras se inauguraba el World Trade Centre, una vez completadas sus dos torres. Hijo de una flor y un pequeño mirlo, a los doce años se decide a entrar en el seminario cuando se entera de que allí tendrá la posibilidad de jugar a fútbol todos los días en un campo de verdad. Saldrá pronto, convencido de que los curas no pondrán nunca las redes en las porterías. Ha escrito libros de poesía como Il cielo di Marte (Einaudi, 2005) y Terramadre (Il Ponte del Sale, 2012), el libro de entrevistas literarias Smarcamenti, affondi e fughe (Ladolfi, 2016) y la novela Tutte le voci di questo aldilà (Guaraldi, 2015). Vive en: www.andreatemporelli.com

Elevated triglyceride (TG) levels seem to identify subjects at increased cardiovascular risk, independent of LDL-C levels. We sought to evaluate the predictive role of hypertriglyceridemia, defined as TG levels ≥150 mg/dl, in very high risk (VHR) patients with chronic coronary syndromes (CCS) treated with statins. Using the data from the STable Coronary Artery Diseases RegisTry (START) study, an Italian nationwide registry, we assessed the association between the TG levels and baseline clinical characteristics, pharmacological treatment and major adverse cardio-cerebrovascular events (MACCE) at 1 year in a large cohort of statin-treated patients at VHR. Of the 4751 consecutive patients with CCS enrolled in the registry and classified as VHR, 2652 (55.8%) had TG values available (mean 120.6 ± 54.9) and were treated with at least a statin at baseline: 2019 (76.1%) with TG < 150 and 633 (23.9%) with TG ≥ 150 mg/dl. At 1 year from enrolment, MACCE occurred in 168 (6.3%) patients, without differences between the two groups of TG (5.9 vs 7.6%; p = 0.14). At multivariable analysis, hypertriglyceridemia did not result as independent predictor of the MACCE (hazard ratio: 1.16; 95% confidence intervals: 0.82–1.64; p = 0.42). In the present large, nationwide cohort of consecutive CCS patients at VHR with statin-controlled LDL-C levels, hypertriglyceridemia was present in around 24% of cases and did not result as predictor of MACCE at 1 year. Further studies with a longer follow-up and larger sample size are needed to better define the prognostic role of TG levels when intensive LDL lowering therapies are used. • The role of hypertriglyceridemia, in very high-risk patients treated with statins has been poorly analysed in an Italian population. • At 1 year, MACCE occurred in 168 (6.3%) patients, without differences between patients with TG < 150 or ≥150 mg/dl (5.9 vs 7.6%; p = 0.14). • At multivariable analysis, hypertriglyceridemia did not result as independent predictor of the MACCE (HR: 1.16; 95% CI: 0.82–1.64; p = 0.42). • Further studies with a longer follow-up and larger sample size in an Italian population are needed. [ABSTRACT FROM AUTHOR]

The present work presents the different strategies and instruments concerning Vocational guidance that have been implemented at a state university in Argentina for ten years, together with an analysis of the most significant factors that have been approached within this space. The Office of Educational Guidance and Career Counseling is an area within the university that encompasses Education professionals and Psychologists, who work co-operatively with teachers, alumni, administrative and faculty authorities. At University level, Vocational guidance is a powerful tool that enables specialists to work on different underlying issues, which relate to the vocational decisions students take, especially during the entrance and graduation stages. It is at university where, apart from education, social interaction becomes possible, thus enabling the establishment of spaces that foster interaction with others, and that allow for the provision of support in the resolution of everyday concerns. The strategies and instruments that are here presented include: open days for future undergraduates; advice on how to settle-down; undergraduate vocational orientation surveys; student mentoring schemes; tutoring; workshops for learners in the first years, workshops for learners in the more advanced courses; brief questionnaires on vocational decisions; and individual interviews. As well as this, reference is here made to more informal and casual meetings given that these can frequently allow for students to express their views concerning their individual situations in particular. This experience shows that there are a number of ways in which Vocational guidance can be approached at University, and that this is especially so given that career choices are always under development, and that the choice does not take place linearly.

In electric and hybrid vehicles Life Cycle Assessments (LCAs), batteries play a central role and are in the spotlight of scientific community and public opinion. Automotive batteries constitute, together with the powertrain, the main differences between electric vehicles and internal combustion engine vehicles. For this reason, many decision makers and researchers wondered whether energy and environmental impacts from batteries production, can exceed the benefits generated during the vehicle’s use phase. In this framework, the purpose of the present literature review is to understand how large and variable the main impacts are due to automotive batteries’ life cycle, with particular attention to climate change impacts, and to support researchers with some methodological suggestions in the field of automotive batteries’ LCA. The results show that there is high variability in environmental impact assessment; CO2eq emissions per kWh of battery capacity range from 50 to 313 g CO2eq/kWh. Nevertheless, either using the lower or upper bounds of this range, electric vehicles result less carbon-intensive in their life cycle than corresponding diesel or petrol vehicles.

Background. Risk stratification is a crucial issue in heart failure. Clinicians seek useful tools to tailor therapies according to patient risk. Methods. A prospective, observational, multicenter study on stable chronic heart failure outpatients with reduced left ventricular ejection fraction (HFrEF). Baseline demographics, blood, natriuretic peptides (NPs), high-sensitivity troponin I (hsTnI), and echocardiographic data, including the ratio between tricuspid annular plane excursion and systolic pulmonary artery pressure (TAPSE/PASP), were collected. Association with death for any cause was analyzed. Results. Four hundred thirty-one (431) consecutive patients were enrolled in the study. Fifty deaths occurred over a median follow-up of 32 months. On the multivariable Cox model analysis, TAPSE/PASP ratio, number of biomarkers above the threshold values, and gender were independent predictors of death. Both the TAPSE/PASP ratio ≥0.36 and TAPSE/PASP unavailable groups had a three-fold decrease in risk of death in comparison to the TAPSE/PASP ratio

Cardiac rehabilitation (CR) is the subspecialty of clinical cardiology dedicated to the treatment of cardiac patients, early and in the long term after an acute event. The aim of CR is to improve both quality of life and prognosis through prognostic stratification, clinical stabilization and optimization of therapy (pharmacological and non), management of comorbidities, treatment of disability, as well as through the provision and reinforcement of secondary prevention interventions and maintenaince of adherence to treatment. The mission of CR has changed over time. Once centered on the acute phase, aimed primarily at short-term survival, the healthcare of cardiac patients now increasingly involves the chronic phase where the challenge is to guarantee continuity and quality of care in the medium and long-term. The aim of the present position paper is to provide the state-of-the-art of CR in Italy, discussing its trengths and weaknesses as well as future perspectives.

Introduction: malnutrition refers to imbalances (either deficit or excess) in energy intake, protein and / or nutrients including underweight and obesity. The aim of this work is identify the contribution of individual factors, habits and life conditions in nutritional status. Material and methods: estimates of relative risk ratios are obtained from a multinomial logistic model using microdata from the National Survey of Risk Factors conducted in 2005 and 2009 in Argentinean‘ cities among adult population. Results: malnutrition is associated with constitutive and socioeconomic variables, while habits are also important in the obesity case. Discussion: both types of problems coexist in Argentine due to high heterogeneity in life styles, turning difficult the design of public interventions aimed to solve them. This complexity highlights the importance of a careful and specific multidimensional approach (medical, social, economical).

We compared the follow-up data on loop diuretic use and renal function, as assessed by serum creatinine levels, and the estimated glomerular filtration rate (eGFR), of two groups of consecutive ambulatory HF patients: 1) the clinically-guided group, in which management was clinically driven based on the institutional protocol of the HF Unit of the Cardiovascular and Thoracic Department of Pisa (standard of care) and 2) the echo and B-type natriuretic peptide (BNP) guided group (patients conforming to the protocol of the Network Labs Ultrasound (NEBULA) in HF Study Group: Pisa, Perugia, Pavia; Verona, Auckland, and Veruno), in which therapy was delivered according to the serial assessment of BNP and echocardiography. Patients whose follow-up was based on standard of care had a significant higher prevalence of worsening renal function, that was likely related to higher diuretic dosages, whilst, a better management of renal function was observed in the echo-BNP-guided group. The data is related to “Echo and natriuretic peptide guided therapy improves outcome and reduces worsening renal function in systolic heart failure: An observational study of 1137 outpatients” (A. Simioniuc, E. Carluccio, S. Ghio, A. Rossi, P. Biagioli, G. Reboldi, G.G. Galeotti, F. Lu, C. Zara, G. Whalley, P.G. Temporelli, F.L. Dini, 2016; K.J. Harjai, H.K. Dinshaw, E. Nunez, M. Shah, H. Thompson, T. Turgut, H.O. Ventura, 1999; A. Ahmed, A. Husain, T.E. Love, G. Gambassi, L.J. Dell׳Italia, G.S. Francis, M. Gheorghiade, R.M. Allman, S. Meleth, R.C. Bourge, 2006) [1–3].

[This corrects the article DOI: 10.1371/journal.pone.0188383.].

Data on contemporary management patterns of angina in patients with stable coronary artery disease (CAD) are scarce. We sought to describe the current presentation, management, and quality of life of stable CAD patients with or without angina, using the data from the START (STable Coronary Artery Diseases RegisTry) study. START was a prospective, observational, nationwide study aimed to evaluate the presentation, management, treatment and quality of life of stable CAD presenting to cardiologists during outpatient visits or discharged from cardiology wards. Among the 5070 consecutive stable CAD patients enrolled in 183 participating centers over a 3-month period, 3714 (73.2%) had no angina and 1356 (26.8%) presented with angina. Patients with angina underwent more frequently coronary angiography (92.7% vs 84.9%; p

Exercise ventilation/perfusion matching in continuous-flow left ventricular assist device recipients (LVAD) has not been studied systematically. Twenty-five LVAD and two groups of 15 reduced ejection fraction chronic heart failure (HFrEF) patients with peak VO2 matched to that of LVAD (HFrEF-matched) and ≥14 ml/kg/min (HFrEF≥14), respectively, underwent cardiopulmonary exercise testing with arterial blood gas analysis, echocardiogram and venous blood sampling for renal function evaluation. Arterial-end-tidal PCO2 difference (P(a-ET)CO2) and physiological dead space-tidal volume ratio (VD/VT) were used as descriptors of alveolar and total wasted ventilation, respectively. Tricuspid annular plane systolic excursion/pulmonary artery systolic pressure ratio (TAPSE/PASP) and blood urea nitrogen/creatinine ratio were calculated in all patients and used as surrogates of right ventriculo-arterial coupling and circulating effective volume, respectively. LVAD and HFrEF-matched showed no rest-to-peak change of P(a-ET)CO2 (4.5±2.4 vs. 4.3±2.2 mm Hg and 4.1±1.4 vs. 3.8±2.5 mm Hg, respectively, both p >0.40), whereas a decrease was observed in HFrEF≥14 (6.5±3.6 vs. 2.8±2.0 mm Hg, p

Background. Hypertension, diabetes and hypercholesterolemia are the most frequent and diagnosed chronic diseases in Argentina. They contribute largely to the burden of chronic disease and they are strongly influenced by a small number of risk factors. These risk factors are all modifiable at the population and individual level and offer major prospects for their prevention. We are interested in socioeconomic determinants of prevalence of those 3 specific diseases. Design and methods. We estimate 3-equation probit model, combined with 3 separate probit estimations and a probit-based Heckman correction considering possible sample selection bias. Estimations were carried out using secondary self-reported data coming from the 2013 Risk Factor National Survey. Results. We find a negative association between socioeconomic status and prevalence of hypertension, cholesterolemia and diabetes; main increases concentrate in the transition from low to high SES in hypertension and diabetes. In cholesterol, the major effect takes place when individual crosses from low to middle SES and then vanishes. Anyway, in Argentina SES exhibit and independent effect on chronic diseases apart from those based on habits and body weight. Conclusions. Public strategies to prevent chronic diseases must be specially targeted at women, poorest households and the least educated individuals in order to achieve efficacy. Also, as the probability of having a condition related to excessive blood pressure, high levels of cholesterol or glucose in the blood do not increase proportionally with age, so public campaigns promoting healthy diets, physical activity and medical checkups should be focused on young individuals to facilitate prophylaxis.

BackgroundThe independent prognostic impact of diabetes mellitus (DM) and prediabetes mellitus (pre‐DM) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre‐DM on survival outcomes in the GISSI‐HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca‐Heart Failure) trial. Methods and ResultsWe assessed the risk of all‐cause death and the composite of all‐cause death or cardiovascular hospitalization over a median follow‐up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI‐HF trial, who were stratified by presence of DM (n=2852), pre‐DM (n=2013), and non‐DM (n=2070) at baseline. Compared with non‐DM patients, those with DM had remarkably higher incidence rates of all‐cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non‐DM patients and those with pre‐DM. Cox regression analysis showed that DM, but not pre‐DM, was associated with an increased risk of all‐cause death (adjusted hazard ratio, 1.43; 95% CI, 1.28–1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI, 1.13–1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all‐cause death: adjusted hazard ratio, 1.21; 95% CI, 1.02–1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI, 1.01–1.29, respectively). ConclusionsPresence of DM was independently associated with poor long‐term survival outcomes in patients with chronic heart failure. Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00336336.

Este trabajo presenta diferentes instancias y dispositivos de Orientación que se han implementado en una institución universitaria pública argentina durante diez años, y analiza los temas que aparecen como más significativos y que se abordan allí.En el Área de Asesoría Pedagógica y Orientación Vocacional actualmente trabajan profesionales de Educación y de Psicología, y colaboran activamente docentes, egresados, autoridades y administrativos de la institución.En el ámbito de la universidad, la Orientación Vocacional (OV) es una potente herramienta para trabajar con los estudiantes (particularmente al ingreso y egreso), cuestiones que subyacen y se relacionan con sus elecciones vocacionales. En la Universidad, además de la formación, también se hace posible el intercambio social, y por eso se considera importante colaborar en la construcción de espacios que favorezcan el encuentro con otros, y que posibiliten el apoyo para resolver cuestiones comunes que preocupan.Las instancias y dispositivos que se presentan aquí son: jornadas de orientación para futuros ingresantes, ambientación universitaria, encuestas vocacionales a ingresantes, tutoría entre pares, talleres destinados a estudiantes de los primeros años, talleres destinados a estudiantes avanzados, cuestionarios breves sobre la situación vocacional y entrevistas personales. También se realiza una referencia a encuentros informales y casuales, por considerarse que éstos muchas veces posibilitan que los estudiantes se expresen respecto de su situación particular.Esta experiencia permite ver que hay muchos modos de abordar la OV en la Universidad y esto es así principalmente porque las elecciones vocacionales siempre están en construcción, y esa construcción no se realiza de manera lineal.ABSTRACTThe present work presents the different strategies and instruments concerning Vocational guidance that have been implemented at a state university in Argentina for ten years, together with an analysis of the most significant factors that have been approached within this space.The Office of Educational Guidance and Career Counseling is an area within the university that encompasses Education professionals and Psychologists, who work co-operatively with teachers, alumni, administrative and Faculty authorities.At University level, Vocational guidance is a powerful tool that enables specialists to work on different underlying issues, which relate to the vocational decisions students take, especially during the entrance and graduation stages. It is at university where, apart from education, social interaction becomes possible, thus enabling the establishment of spaces that foster interaction with others, and that allow for the provision of support in the resolution of everyday concerns.The strategies and instruments that are here presented include: open days for future undergraduates; advice on how to settle-down; undergraduate vocational orientation surveys; student mentoring schemes; tutoring; workshops for learners in the first years, workshops for learners in the more advanced courses; brief questionnaires on vocational decisions; and individual interviews. As well as this, reference is here made to more informal and casual meetings given that these can frequently allow for students to express their views concerning their individual situations in particular.This experience shows that there are a number of ways in which Vocational guidance can be approached at University, and that this is especially so given that career choices are always under development, and that the choice does not take place linearly.

The hemodynamic definitions of pulmonary hypertension (PH) in left heart disease have recently been refined to better match the characteristics required to reflect the presence of pulmonary vascular disease. Accordingly, we tested the hypothesis that abnormalities in the stiffness of pulmonary circulation would persist after heart transplantation in patients with combined post-capillary and pre-capillary PH (Cpc-PH) in contrast to those with isolated post-capillary PH (Ipc-PH).We retrospectively analyzed right heart hemodynamics in a cohort of 295 consecutive patients with heart failure and advanced left ventricular systolic dysfunction (LVSD) before and 1 year after heart transplantation.According to their baseline hemodynamic profile, patients were classified as: 75 Cpc-PH, 111 Ipc-PH, and 98 without PH (no-PH), and 11 pre-capillary PH. One year after heart transplantation, pulmonary artery pressures, pulmonary vascular resistance and cardiac index normalized in all patients regardless of the baseline hemodynamic profile. However, pulmonary arterial compliance remained lower in Cpc-PH patients (from 1.6±1.2 at baseline to 3.7±1.4 ml/mmHg at 1 year) than in Ipc-PH (from 1.2±2.0 to 4.4±2.3 ml/mmHg) and no-PH patients (from 3.7±2.0 to 4.5±1.8 ml/mmHg); (adjusted p = 0.03 Ipc-PH vs. Cpc-PH INT

La obesidad es un problema médico que ha sido declarada epidemia mundial por la Organización Mundial de la Salud. El aumento de su prevalencia implica incrementos en los costos de los sistemas de salud, tanto en forma directa como indirecta, conjuntamente con un deterioro de la calidad de vida. Se vuelva un tema prioritario dentro de la agenda pública de los gobiernos. Las fallas de mercado presentes en el sector constituyen un argumento que justifica la intervención estatal. En función de ello, es que el objetivo del presente trabajo es analizar las fallas de mercado presentes en el sector y realizar una recopilación exhaustiva de las políticas públicas que han sido propuestas para el tratamiento y la prevención de la obesidad.

The epidemiology of chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) are well known. Each of these conditions has an important impact on quality of life and functional status and on healthcare consumption. Through shared risk factors and pathophysiological mechanisms CHF and COPD coexist more frequently than expected from the respective populations observed by the pulmonologist or cardiologist. This has important prognostic and therapeutic implications. Several registry-based studies and post-hoc analyses of large randomized controlled trials evaluating COPD as a comorbidity in CHF outpatients have highlighted the negative prognostic impact of the comorbidity in terms of constraint in use of recommended treatments. Among them, the cardiopulmonary rehabilitation may play a significant role. Even in these patients, in fact, a rehabilitative approach focused on physical training programs can positively impact functional autonomy, exercise tolerance and quality of life. Riassunto Attraverso i fattori di rischio condivisi e simili meccanismi fisiopatologici scompenso cardiaco cronico (SCC) e malattia ostruttiva cronica polmonare (BPCO) coesistono più frequentemente di quanto previsto dalle rispettive popolazioni osservate rispettivamente dallo pneumologo o dal cardiologo. Ciò ha importanti implicazioni prognostiche e terapeutiche. Diversi studi basati su registri e analisi post-hoc di ampi studi randomizzati controllati che hanno valutato la BPCO come comorbidità in pazienti con SCC hanno messo in evidenza l'impatto prognostico negativo della comorbilità in termini soprattutto di limitazioni all’utilizzo di trattamenti raccomandati. Tra questi un ruolo non trascurabile spetta alla riabilitazione. Anche in questi pazienti infatti un approccio riabilitativo incentrato su programmi di training fisico può impattare favorevolmente sulla autonomia funzionale, sulla tolleranza allo sforzo e sulla qualità della vita.