RESUMO
BACKGROUND: Hospital de la Familia was established to serve the indigent population in the western highlands of Guatemala and has a full-time staff of Guatemalan primary care providers supplemented by short-term missions of surgical specialists. The reasons for patients seeking surgical care in this setting, as opposed to more consistent care from local institutions, are unclear. We sought to better understand motivations of patients seeking mission-based surgical care. METHODS: Patients presenting to the obstetric and gynecologic, plastic, ophthalmologic, general, and pediatric surgical clinics at the Hospital de la Familia from July 27 to August 6, 2015 were surveyed. The surveys assessed patient demographics, surgical diagnosis, location of home, mode of travel, and reasons for seeking care at this facility. RESULTS: Of 252 patients surveyed, 144 (59.3%) were female. Most patients reported no other medical condition (67.9%, n = 169) and no consistent income (83.9%, n = 209). Almost half (44.9%, n = 109) traveled >50 km to receive care. The most common reasons for choosing care at this facility were reputation of high quality (51.8%, n = 130) and affordability (42.6%, n = 102); the least common reason was a lack of other options (6.4%, n = 16). CONCLUSIONS: Despite long travel distances and the availability of other options, reputation and affordability were primarily cited as the most common reasons for choosing to receive care at this short-term surgical mission site. Our results highlight that although other surgical options may be closer and more readily available, reputation and cost play a large role in choice of patients seeking care.
Assuntos
Missões Médicas/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Guatemala , Custos de Cuidados de Saúde , Pesquisas sobre Atenção à Saúde , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Masculino , Missões Médicas/economia , Missões Médicas/normas , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde , Serviços de Saúde Rural/economia , Serviços de Saúde Rural/normas , Procedimentos Cirúrgicos Operatórios/economia , Procedimentos Cirúrgicos Operatórios/normas , Adulto JovemRESUMO
Se estandarizaron las condiciones de iniciación, multiplicación, enraizamiento y aclimatización de plantas hermafroditas de lechosa cv Maradol provenientes de brotes axilares, producidos en recipientes de inmersión temporal RITA®. En cada envase, contentivo de 200 ml de medio de cultivo líquido de Fitch, se colocaron cuatro brotes de 2 a 3 cm de longitud. Los biorreactores se conectaron a tres líneas de inmersión de 5, 2 y 1 min cada 4h y se colocaron 6 envases en promedio por línea, en condiciones de fotoperíodo de 16 h. Transcurridos 30 a 45 días, se cuantificaron los brotes y se clasificaron de acuerdo al tamaño: < 2 cm (pequeños), entre 2 a 3 cm (medianos), > 3 cm con y sin raíz (grandes). Los dos primeros tipos de brotes se continuaron multiplicando en los mismos medios; y los más elongados se aclimatizaron utilizando el Sistema Autotrófico Hidropónico (SAH). Se determinó la sanidad y la fidelidad de las plantas producidas mediante pruebas de ELISA y RAPD, respectivamente. Durante un periodo de 6 meses se reciclaron un total de 47 recipientes, los cuales produjeron 1.091 brotes: 377 pequeños; 482 medianos; 175 grandes sin raíz y 57 con raíz. Usando el SAH se obtuvo 89,5% de plantas aclimatizadas cuando se usaron brotes enraizados, y 41,6% a partir de brotes sin raíces. Con la combinación de las técnicas RITA y SAH se logró un sistema continuo y eficiente de producción de plantas sanas y fieles al tipo, en comparación con los métodos convencionales de micropropagación y aclimatización.
We standardized initiation, multiplication, rooting and acclimatization conditions of papaya cv Maradol hermaphrodite plants from axillary buds produced in temporary immersion reactor RITA®. Recipients contained 200 ml of Fitch liquid culture medium, and four shoots of 2 to 3 cm. in length were placed in each. The bioreactors were connected to three different immersion lines of 5, 2, and 1 min each 4h, with 6 containers per line on average, in 16 h photoperiod. After 30 to 45 days, the shoots produced were quantified and classified according to size: <2 cm (small), from 2 to 3 cm (medium), >3 cm with or without roots (large). The first two types of shoots were multiplied in the same culture media, and more elongated shoots were acclimatized using Autotrophic Hydroponic System (AHS). The sanity and fidelity of the produced plants were determined using ELISA and RAPD, respectively. For a period of six months 47 vessels were recycled and 1,091 shoots were produced: 377 small; 482 medium; 175 large without roots and 57 rooted shoots. Using AHS, 89.5% acclimatized plants were obtained when rooted shoots were used, and 41.6% from rootless shoots. With the combination of RITA and AHS techniques we achieved a continuous and efficient production of healthy and true to type papaya plants, in comparison to conventional micropropagation and acclimatization procedures.
RESUMO
La adiponectina, hormona peptídica secretada por los adipocitos, actúa inhibiendo la formación de la placa ateromatosa en casi todas sus etapas, ya sea modulando la respuesta inflamatoria, inhibiendo la expresión de moléculas de adhesión, la activación de monocitos, la formación de células espumosas y la migración y proliferación de células de músculo liso. En el presente estudio, fue evaluada la frecuencia del polimorfismo 45TMJ (rs2241766) del gen que codifica para la hormona adiponectina (ADIPOQ), junto con su posible contribución al desarrollo de enfermedad coronaria en individuos del sur de Chile. Métodos: Fueron evaluados 416 individuos adultos (30 a 68 años); 200 casos confirmados por angiografía y 216 controles. La genotipificación del polimorfismo 451>G del gen ADIPOQ se realizó mediante la técnica de PCR-RFLP. Resultados: El análisis de los resultados demuestra que la presencia del alelo G del polimorfismo 45T>G del gen ADIPOQ duplica el riesgo de padecer enfermedad coronaria en la población estudiada (OR= 2.06; I.C.95 por ciento: 1.36-3.14). Conclusión: Nuestros datos revelaron la existencia de una interesante asociación entre el polimorfismo 45T>G del gen ADIPOQ y enfermedad arterial coronaria en los sujetos analizados. Es importante destacar, que este hallazgo constituye el primer antecedente en población chilena.
Background: Adiponectin, encoded by ADIPOQ gene, is a hormone secreted by adipocytes that acts inhibiting the atheromatous plaque formation, modulating the inflammatory response and inhibiting the expression of adhesion molecules with subsequent inhibition of adhesion and macrophage activation, foam cells formation and migration and proliferation of smooth muscle cells. Aim: to evaluate the possible association between the rs2241766 polymorphism of the ADIPOQ gene with coronary artery disease (CAD) in Southern Chilean subjects. Methods: We evaluated 416 unrelated individuals (38 -68 years old); 200 with CAD confirmed by angiography and 216 control individuals from Temuco city (Chile). The rs2241766 polymorphism (45T>G) of ADIPOQ gene was determined by PCR-RFLP. Results: CAD patients exhibited a high frequency of G allele when compared to controls (17 percent vs. 9 percent; p<0.001). The OR for CAD associated to G allele was 2.06 (95 percent CI: 1.36 - 3.14) confirming the association observed. Conclusion: Our data show that the rs2241766 ADIPOQ gene polymorphism contributed to CAD risk in the studied population.