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En el contexto demográfico actual de envejecimiento poblacional surge un nuevo rol: el funcionario-cuidador. La persona que trabaja y, además, cuida a un familiar con discapacidad, presenta problemas personales, laborales y menor compromiso con su autocuidado. Entre las intervenciones eficaces se encuentra el mejorar la percepción del apoyo social. Se presenta un programa interdisciplinario, iniciado en el año 2009, de apoyo a trabajadores-cuidadores familiares. Su propósito es promover la salud y prevenir factores de riesgo de enfermedad a través del fortalecimiento de sus habilidades de autocuidado y el desarrollo de políticas institucionales que faciliten el cumplimiento de ambos roles en forma eficiente y saludable. Como estrategias de promoción en salud se han utilizado: la educación para el autocuidado, el fortalecimiento de redes de apoyo familiar y social, la asesoría profesional y la comunidad de pares. En las últimas tres cohortes anuales han participado sesenta funcionarios, de los cuales el 83,4% son mujeres, con un promedio de edad de cincuenta años. El programa ha cumplido con éxito los objetivos propuestos, aumentando la percepción de apoyo social manifestado por los propios participantes. A new role has emerged within the current demographic context of an aging population; namely, that of the worker-caregiver. The person who works and also cares for a disabled family member has personal and work-related problems and is less committed to their own self-care. Improving the perception of social support can be an effective intervention in this respect. The article describes an interdisciplinary program initiated in 2009 to support family workers-caregivers. Its purpose is to promote health and prevent disease risk factors by strengthening self-care skills and the development of institutional policies that facilitate efficient and healthy compliance with both roles. Some of the health promotion strategies that have been used include education for self-care, strengthening family and social support networks, professional counseling and a community of peers. Sixty workers took part in the last three annual cohorts: 83.4% were women, with an average age of fifty. The program has successfully met its proposed objectives by increasing the perception of social support expressed by the participants themselves. No contexto demográfico atual de envelhecimento populacional, surge um novo papel: o funcionario-cuidador. A pessoa que trabalha e, além disso, cuida de um familiar com necessidades especiais apresenta problemas pessoais, laborais e menor compromisso com seu auto-cuidado. Entre as intervenções eficazes, encontra-se o melhorar a percepção do apoio social. Apresenta-se um programa interdisciplinar, iniciado em 2009, de apoio a trabalhadores-cuidadores familiares. Seu propósito é promover a saúde e prevenir fatores de risco de doenças por meio do fortalecimento de suas habilidades de autocuidado e o desenvolvimento de políticas institucionais que facilitem o cumprimento de ambos os papéis de forma eficiente e saudável. Como estratégias de promoção da saúde têm sido utilizados: a educação para o auto-cuidado, o fortalecimento de redes de apoio familiar e social, a assessoria profissional e a comunidade de pares. Nas últimas três coortes anuais, participaram 60 funcionários, dos quais 83,4% são mulheres, com uma média de idade de 50 anos. O programa tem cumprido com sucesso os objetivos propostos e, assim, tem aumentado a percepção de apoio social manifestado pelos próprios participantes.

Common variable immunodeficiency is a primary immunodeficiency, in which from 70 to 80 % of patients have tumors and 25 % of cases are associated with autoimmune diseases. Common variable immunodeficiency patients have a higher incidence of neoplasms, with a risk 12-18 times higher than the general population. There are few cases of common variable immunodeficiency patients with leukemia.Female of 36 years old, with left upper quadrant pain, early satiety, weight loss of 8 kg in three months and splenomegaly. The complete blood count showed: leukocytosis 206 000/mL, with 8 % blasts, platelets 530 000/mL and hemoglobin 8 mg/dL. Abdominal ultrasound: 19??12 cm splenomegaly. Karyotype BCR/ABL IS 64.20 %, 100 % Philadelphia chromosome. The diagnosis was of chronic myeloid leukemia. Given the presence of recurrent respiratory tract infection, frequent diarrheas and reduced concentrations of IgG, IgM and IgA, common variable immunodeficiency was diagnosed and human immunoglobulin was used successfully.The association between chronic myeloid leukemia and common variable immunodefficiency is unusual. Given the high frequency of hematological neoplasm in common variable immunodeficiency patients, we suggest that hematological patients with repeated infections and decreased concentrations of immunoglobulin be referred to an immunological evaluation.INTRODUCCIÓN: la inmunodeficiencia común variable es la inmunodeficiencia primaria más sintomática, 70 a 80 % de los pacientes presentan neoplasias. Existen escasos informes de pacientes portadores de leucemia mieloide crónica e inmunodeficiencia común variable. CASO CLÍNICO: mujer de 36 años, quien inició su padecimiento con dolor en hipocondrio izquierdo, pérdida de peso de 8 kg en tres meses y esplenomegalia. Los resultados de la biometría hemática indicaron cuenta leucocitaria de 206 000/mL, 8 % de blastos, cuenta plaquetaria de 530 000/mL y hemoglobina de 8 g/dL. Con la ultrasonografía abdominal se identificó esplenomegalia de 19 ´ 12 cm. El cariotipo mostró el gen BCR/ABL 64.20 % IS y cromosoma Filadelfia 100 %. Se diagnosticó leucemia mieloide crónica. Por infecciones gastrointestinales y respiratorias frecuentes, así como por concentraciones reducidas de IgG, IgM e IgA, la paciente fue valorada por el servicio de alergia e inmunología clínica, donde se diagnosticó inmunodeficiencia común variable.la relación de la leucemia mieloide crónica con la inmunodeficiencia común variable es poco frecuente. Es importante que los pacientes portadores de leucemia mieloide crónica que cursen con infecciones de repetición, se realicen cuantificación de inmunoglobulinas séricas y, en caso de disminución de las mismas, sean referidos para su valoración y tratamiento.

Introducción: el apoyo a la toma de decisiones en salud facilita el automanejo de personas con enfermedades crónicas (EC). Ob- jetivo: validar la versión en español del DSAT-cdm: herramienta de análisis del apoyo en las decisiones para el manejo de EC, desa- rrollada por Stacey (2006). Materiales y métodos: estudio descriptivo que aplica un proceso sistemático que considera, entre otros: traducción-contratraducción, desarrollo de escenarios de simulación, entrenamiento de evaluadores, entrenamiento pacientes simulados y capacitación para participantes. Muestra: 15 profesionales y 2 jueces, obteniéndose 60 DSAT-cdm versión español aplicado (pre y pos capacitación). Resultados: el instrumento presentó confiabilidad aceptable en la aplicación entre-jueces y detectó la mejora en la calidad del apoyo a la toma de decisiones en los profesionales. Sin embargo, no se obtuvieron resultados que aportaran a la validez de criterio concurrente. Conclusiones: este estudio es la primera evaluación del DSAT-cdm en idioma español, el resultado principal indica que se detecta un cambio en el desempeño de profesionales para apoyar el proceso de toma de decisiones de sus pacientes y, a pesar estos hallazgos favorables, es necesario seguir evaluando el instrumento. Introduction: Support for decision-making in health facilitates self-management by persons with chronic illness (CI). Objective: Validate the Spanish- language version of DSAT - cdm: an analytical tool developed by Stacey (2006) to support decision-making on CI management. Materials and Methods: This descriptive study applies a systematic process that considers a number of aspects, such as translation – back-translation, simulation scenario development, training evaluators, simulated patient training and training for partici- pants. Sample: 15 professionals and two judges, obtaining 60 DSAT - cdm with the applied Spanish version (pre and post training). Results: The instrument showed acceptable reliability in application among judges and found improvement in the quality of decision-making support on the part of professionals. However, no results were obtained that contribute to concurrent criterion validity. Conclusions: This study is the first assessment of DSAT – cdm in Spanish. The main result indicates a change is detected in the performance of professionals to support the decision-making process of their patients. Yet, despite this favorable finding, further evaluation of the instrument is necessary. Introdução: o apoio na tomada de decisões em saúde facilita o automanejo de pessoas com doenças crônicas (ec em espanhol). Objetivo: validar a versão em espanhol do dsta-cdm: ferramenta de análise do apoio nas decisões para o manejo de ec, desenvolvida por Stacey (2006). Materiais e métodos: estudo descritivo que aplica um processo sistemático que considera, entre outros: tradução-con- tratradução, desenvolvimento de cenários de simulação, treinamento de avaliadores, treinamento de pacientes simulados e capacitação para participantes. Amostra: 15 profissionais e 2 juízes, com obtenção de 60 dsat-cdm versão espanhol aplicado (pré e pós capacitação). Resultados: o instrumento apresentou confiabilidade aceitável na aplicação entre juízes e detectou a melhoria na qualidade do apoio na tomada de decisões nos profissionais. Contudo, não se obtiveram resultados que contribuíssem para a validade de critério concorrente. Conclusões: este estudo é a primeira avaliação do dsat-cdm em espanhol; o resultado principal indica que se detecta uma mudança no desempenho de profissionais para apoiar o processo de tomada de decisões de seus pacientes e, apesar dessas descobertas favoráveis, é necessário continuar avaliando o instrumento.

Common variable immunodeficiency (CVID) is a primary immunodeficiency characterized by defective immunoglobulin production. Twenty percent of patients may also have associated autoimmune diseases, especially hematologic, whose prevalence is estimated at 5 to 8%.To report the occurrence of autoimmune haematological disorders in CVID adults.We included 18 patients with CVID, who underwent hematologic evaluation, which included: CBC, serum folate or vitamin B complex and bone marrow aspirate.Of a total of 18 patients, 11 women (61%), mean age 38 ± 13.5, six patients (33.3%) had autoimmune diseases, five of them had blood diseases (4 with PTI and one with Evans syndrome). Three patients had more than one autoimmune disease and one presented three autoimmune diseases (Evans syndrome, hypoparathyroidism and celiac disease with a history of autoimmune hemolytic anemia).The prevalence of autoimmune diseases in this group of patients with CVID was higher than the 20% reported in the literature. Hematological diseases should be suspected in CVID patients, since half of our cases presented them.

Latex allergy is an underdiagnosed condition, and it is the second cause of perioperative anaphylaxis. This condition represents a clinical challenge due to the severity of reactions caused by the exposure to latex in allergic individuals. It is necessary to know the risk factors in order to suspect the diagnosis of latex allergy, and to apply the preventive measures in the medical care of patients allergic to latex. Other safety measures and pre-medication, as avoiding objects and medical equipment made of latex, should be taken since they can cause anaphylaxis. We present six cases of patients with latex allergy, who underwent surgical procedures. In five of them with positive skin test with latex, we used preventive measures and pre-medication 72 hours before and 48 hours after surgery. Only one patient, a sixty year old woman, with urticaria related to kiwi, avocado and potatoes, who was surgically intervened without pre-medication, presented grade IV anaphylaxis.

The time-independent perturbation theory is developed for an arbitrary operator which can be expanded in powers of the perturbation parameter λ. A unified formulation allows the establishment of a formal interrelation between the methods of Rayleigh-Schrödinger and of Bril­ louin-Wigner. We introduce a nonunitary transformation operator to connect the nth eigenket of Ĥ(0) with the nth eigenket of Ĥ(λ) and it is proven that this operator satisfies a Lippmann-Schwinger type equation. A perturbation method based on this equation is proposed, and it is applied to describe an electron moving in a Yukawa potential.

Objective Nutritional, immunological and psychological benefits of exclusive breastfeeding for the first 6 months of life are unequivocally recognized. However, mothers should also be aware of the importance of breastfeeding for promoting adequate oral development. This study evaluated the association between breastfeeding and non-nutritive sucking patterns and the prevalence of anterior open bite in primary dentition. Material and Methods Infant feeding and non-nutritive sucking were investigated in a 3-6 year-old sample of 1,377 children, from São Paulo city, Brazil. Children were grouped according to breastfeeding duration: G1 – non-breastfed, G2 – shorter than 6 months, G3 – interruption between 6 and 12 months, and G4 – longer than 12 months. Three calibrated dentists performed clinical examinations and classified overbite into 3 categories: normal, anterior open bite and deep bite. Chi-square tests (p

The present article starts with a quantitative remark of the elevated Colombian expense in defense, one of the highest worldwide in percentage of the GNP. What greatly worries is that most of such expenditure is addressed to the payment of retirement wages in the armed forces, becoming the number one budgeted institution in the country given the excessive increase in troops, a fact that ranks Colombia as the Latin-American country with the second largest army after Brazil. There would be, then, a difference between military success (effectiveness) and increase in troops, since according to government’s numbers, the guerillas should be practically terminated, not being the real fact. Two possible explanations for this difference exist: first, demobilization of the paramilitary groups, whose action and combatants reinforced the duty of the military forces; and second, the evidence of extra judiciary executions and the making of false positive hits, all of which would be inflating the figures that intend to show the effectiveness of military actions. Este artículo parte de una observación cuantitativa del elevado gasto colombiano en defensa, uno de los más grandes del mundo en su relación porcentual con el PIB. Lo que más preocupa es que gran parte del gasto se destina al pago del pasivo pensional en el sector defensa, el cual resulta ser el más elevado del país dado el desmesurado aumento en el pie de fuerza, un hecho que ubica a Colombia como el segundo país latinoamericano, después de Brasil, con el ejército más grande. Habría, entonces, un desfase entre éxito militar (efectividad) y aumento de pie de fuerza, ya que según las cifras del gobierno, la guerrilla debería estar prácticamente terminada, pero no es el caso. Existen dos posibles explicaciones para este desfase: primera, la desmovilización de los grupos paramilitares, cuya acción y pie de fuerza reforzaba la tarea de las Fuerzas Militares; y segunda, la evidencia de ejecuciones extrajudiciales y la fabricación de falsos positivos, lo cual estaría infl ando las cifras que pretenden mostrar la efectividad de las acciones militares.

Este artículo parte de una observación cuantitativa del elevado gasto colombiano en defensa, uno de los más grandes del mundo en su relación porcentual con el PIB. Lo que más preocupa es que gran parte del gasto se destina al pago del pasivo pensional en el sector defensa, el cual resulta ser el más elevado del país dado el desmesurado aumento en el pie de fuerza, un hecho que ubica a Colombia como el segundo país latinoamericano, después de Brasil, con el ejército más grande. Habría, entonces, un desfase entre éxito militar (efectividad) y aumento de pie de fuerza, ya que según las cifras del gobierno, la guerrilla debería estar prácticamente terminada, pero no es el caso. Existen dos posibles explicaciones para este desfase: primera, la desmovilización de los grupos paramilitares, cuya acción y pie de fuerza reforzaba la tarea de las Fuerzas Militares; y segunda, la evidencia de ejecuciones extrajudiciales y la fabricación de falsos positivos, lo cual estaría inflando las cifras que pretenden mostrar la efectividad de las acciones militares. The present article starts with a quantitative remark of the elevated Colombian expense in defense, one of the highest worldwide in percentage of the GNP. What greatly worries is that most of such expenditure is addressed to the payment of retirement wages in the armed forces, becoming the number one budgeted institution in the country given the excessive increase in troops, a fact that ranks Colombia as the Latin-American country with the second largest army after Brazil. There would be, then, a difference between military success (effectiveness) and increase in troops, since according to government's numbers, the guerillas should be practically terminated, not being the real fact. Two possible explanations for this difference exist: fi rst, demobilization of the paramilitary groups, whose action and combatants reinforced the duty of the military forces; and second, the evidence of extra judiciary executions and the making of false positive hits, all of which would be infl ating the fi gures that intend to show the effectiveness of military actions.

Las prevalencias de enfermedades como Hipertensión Arterial y Diabetes Mellitus tipo 2 tienen proyección de aumento en nuestro país y los resultados en compensación metabólica de los usuarios actualmente no son óptimos Es necesario identifi car factores susceptibles de intervenir y estrategias efectivas y efi cientes en el abordaje de personas con condiciones crónicas de salud. Se refl exiona acerca de la literacidad en salud y la necesidad de su consideración en estas intervenciones. Literacidad en salud es la habilidad de las personas para obtener, procesar y entender la información básica y los servicios que se necesitan para tomar decisiones en salud. Experiencias internacionales demuestran la asociación entre bajo nivel de literacidad en salud con efectos negativos en la salud. Para el caso de las personas con enfermedades crónicas, un bajo nivel de literacidad en salud se transforma en una barrera importante para la autogestión de su cuidado, no solo por las limitaciones en la lectura, sino también, por las difi cultades para procesar información obtenida por la comunicación oral, para la conceptualización de los riesgos de su enfermedad y para una efectiva comunicación con el profesional de la salud. Las enfermeras y profesionales de la salud en general, al incorporar esta variable dentro de la valoración y de las intervenciones dirigidas a sus usuarios con condiciones crónicas favorecen una atención centrada en las necesidades del usuario y su familia, que les permitirá desarrollar sus habilidades y competencias para tomar mejores decisiones en salud

We undertook this study to make an accurate cost/benefit and cost/effectiveness assessment of the "Telemedicina Anáhuac" project, which provides virtual satellite medical care via fixed teleconsultations and movable units in rural/marginal areas.The basis of the study was a bibliographical analysis of health areas.When making a monetary analysis and observing fair profits, accessibility and increase in coverage in these populations, it is easier to determine whether or not the project is viable and whether or not it accomplishes cost/benefit and cost/effectiveness conditions. It has not been possible to accurately evaluate epidemiological situations or their changes and impact on health because of the short duration of the project in each community. The most valuable benefit of "Telemedicina Anáhuac" is the appropriate medical referral of surgical patients.From the results obtained, we are aware that this project offers to our country a great opportunity to resolve health problems in marginalized areas. It offers several benefits to the population, to the Health Ministry, to the personnel and to the social service medical students who operate it. In the surgical area, better diagnoses are obtained, and the project helps to decongest the second level of medical care in Mexico.

Gender violence is a highly important social and political concern. Distorted beliefs about it are obstacles towards its comprehension and an important risk factor for its tolerance and maintenance. Some professionals often deal with gender violence issues. Thus, it is necessary to identify these obstacles towards the comprehension about gender violence and factors affecting them. The aim of this study was to analyze the existence of obstacles towards gender violence comprehension in law university students. We also investigated the impact of participants’ gender, sexist attitudes and gender education on the presence of these obstacles. One-hundred and forty seven law university students completed an anonymous and voluntary survey. Results from regression analysis evidenced that both men and women have obstacles towards gender violence comprehension. Males showed a higher level of obstacles than females. Also, hostile sexism of both, men and women, and men´s benevolent sexism levels were positively related with a higher presence of obstacles. Finally, having received training related to gender violence acted as a protective factor that was associated with lower obstacles towards gender violence comprehension.

537 p., figs., cuadros 1 ed.

Background Common Variable Immunodeficiency (CVID) is the most common primary immunodeficiency (IDP), occurs primarily in adults between the second to fourth decades of life, without gender predominance. It is characterized by concentrations of immunoglobulins (Igs) of at least 2 standard deviation (DS) of normal, recurring infections, some patients have autoimmune diseases and tumors, absence of isohemagglutinins and lack of production of antibodies (Ab) after vaccination and have excluded other causes of hypogammaglobulinemia. Objective Determine the prevalence of CVID in the Specialty Hospital—Centro Medico Nacional Siglo XXI, IMSS, Mexico City. Methods We included all patients with suspected diagnosis of CVID, clinical history, laboratory tests, determination of serum Igs and isohemagglutinins and were given a dose of gamma globulin 500 mg/kg/dose every 21 days. The results were analyzed with descriptive statistics. The protocol was approved by the local research committee. Results A total of 15 patients, 11 women and 4 men, mean age 34 years (± 11), 14 patients met all international standards and just only one patient has positive isohemagglutinins. The prevalence of CVID calculated according to the total population that is entitled in this hospital, 1, 520, 900, 1: 101, 393. In relation to the number of patients served by our service, the prevalence of 0.053% with a ratio of 1:2.533 right holders. Conclusions Our results show differences in relation to the published literature, prevalence in female sex ratio of 3:1, participating patients were diagnosed at the 34 years of average age, just only 2 patients were diagnosed before 20 years of age, unlike some of the international and national reports, we establish the definitive diagnosis according to international standards in 93% of cases evaluated. The prevalence of CVID obtained in our study is 1:101.393, higher than reported in international literature is 1:30.000 to 1:50.000, but similar to that reported in Spain in 1997 and Iran in 2006.

Resumen tomado de la revista En el curso organizado con carácter territorial en el CPR de Retiro sobre la Educación Secundaria para Personas Adultas en los IES, participó un grupo de profesores de 9 Institutos de Educación Secundaria de la Dirección del Área Territorial de Madrid-Capital en los que se han implantado por primera vez las enseñanzas de Educación Secundaria para Personas Adultas durante el curso 1999-2000. Este artículo en que, los autores pretenden describir el perfil de los alumnos que asisten a sus aulas, ha constituido uno de los trabajos elaborados durante el mismo. Madrid ESP