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Resumen Los gobiernos municipales de Costa Rica tienen un papel significativo en el Sistema Nacional de Gestión del Riesgo (SNGR) para enfrentar las múltiples amenazas y riesgos que afectan al país desde sus territorios. Los distintos marcos y políticas que trabajan en el enfoque de la Gestión del Riesgo de Desastres (GRD) promueven la realización de análisis de riesgos como proceso que contribuye a su reducción y mitigación, y destacan el enfoque de género como principio o eje para visibilizar la necesidad de realizar revisiones y acciones diferenciadas por género. El presente artículo recoge la investigación realizada que responde a la pregunta "¿Cuáles son los elementos psicosociales que influyen en la puesta en práctica de la transversalización del enfoque de género en los procesos de la GRD de las oficinas municipales?" Esta pregunta se respondió desde la Psicología Social Comunitaria y la Psicología Social Feminista. Se realizó un estudio con enfoque cualitativo y diseño fenomenológico, en el que se aplicaron entrevistas a representantes institucionales en GRD y género. Se identificaron doce elementos psicosociales que influyen en la transversalización del enfoque de género en la GRD municipal, que deben visibilizarse y pueden ser trabajados para abordar los riesgos de dos poblaciones históricamente discriminadas: mujeres y población LGTBIQ+. Trabajar las desigualdades de género como causa subyacente del riesgo es prioritario para la GRD.
Abstract The city governments of Costa Rica have a significant role in the National Risk Management System (SNGR in Spanish) to face the multiple threats and risks that affect the country from their territories. The different frameworks and policies that work with the Disaster Risk Management approach, among which are international (e. g., Sendai Framework for Action), regional (e. g., Central American Policy for Comprehensive Disaster Risk Management), and national instruments (e. g., National Risk Management Policy), promote risk analysis as a process that contributes to their reduction and mitigation, which, together with specific policies focused on gender (e. g., Convention on the Elimination of All Forms of Discrimination Against Women [CEDAW]), highlight the gender approach as a principle or axis, making the need to carry out reviews and actions differentiated by gender visible. The growth of inequalities in events such as disasters emphasizes the fact that there are gender differences in the perception of risks, the levels of vulnerability that exist and the capacities to cope. This article collects the research carried out that answers the question: "What are the psychosocial elements that influence the implementation of mainstreaming the gender approach in DRM processes in municipal offices?" from Community Social Psychology and Feminist Social Psychology. A study with a qualitative approach and phenomenological design was carried out, in which interviews were applied to institutional representatives in DRM and gender. The first seeks to promote processes of social transformation, considering the psychosocial processes that permeate community dynamics, which, in turn, are influenced by specific contexts. As for Feminist Psychology, it promotes the identification of inequalities and the creation of options for change. The relationship between feminist political perspectives and psychological practices and sexual and gender differences were considered as causes of inequalities, generating certain psychosocial analyzes not widely developed so far. A subjective perspective to the lived experience of the people participating in the research was considered in order to emphasize the meanings and knowledge as a process, based on interviews with institutional representatives of municipal offices and national institutions both focused on DRM or gender. Twelve psychosocial elements that influence the mainstreaming of the gender approach in municipal DRM were identified: the need for training and awareness, the requirement of political will, the naturalization of gender roles and stereotypes, the recognition of gender differences, resistance to mainstreaming gender, subjectivity, the presence or absence of inter and intra-institutional articulations, the social participation of women, the recognition of gender violence, the recognition of vulnerable populations, the cultural context and social inequalities. Moreover, gender inequalities are recognized as an element that affects and emphasizes the vulnerabilities of specific populations, such as women of different ages, transgender people, people with disabilities, among others. The research allowed an approach to ten different territorial contexts where DRM is put into practice from an office or as a process, and how the experience of the people who lead them understands the gender approach, contrasting with the institutional perspective applied at the national level. It is concluded that these should be made visible and can be worked on to address the risks of two historically discriminated populations: women and LGTBIQ+ population. Considering gender inequalities as an underlying cause of risk is a priority for Disaster Risk Management.
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Levoglucosan (LGA) is a promising chemical platform derived from the pyrolysis of biomass that offers access to a variety of value-added products. We report an efficient route to produce LGA via the pretreatment of biomass with niobium compounds (oxalate, chloride and oxide) followed by fast pyrolysis coupled with gas chromatography-mass spectrometry (Py-GC-MS) at temperatures of 350-600 °C. Catalytic pretreatment reduces the quantity of lignin in the biomass, concentrates the cellulose and enhance LGA formation during fast pyrolysis. The pretreatment also removes alkaline metals, preventing competitive side reactions. The effect of several parameters such as catalyst weight, time, temperature, and solvent, with the optimal pretreatment conditions determined to be 3 (wt.%) niobium oxalate for 1 h at 23 °C in water. Pretreatment increased the LGA yields by 6.40-fold for sugarcane bagasse, 4.15-fold for elephant grass, 4.13-fold for rice husk, 2.86-fold for coffee husk, and 1.86-fold for coconut husk as compared to the raw biomasses. These results indicate that biomass pretreatment using niobium derivates prior fast pyrolysis can be a promising technique for biomass thermochemical conversion in LGA and others important pyrolytic products.
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Nióbio , Pirólise , Biomassa , Glucose/análogos & derivados , Temperatura Alta , LigninaRESUMO
BACKGROUND: Best practices in breastfeeding are often not followed despite appropriate levels of knowledge and positive attitudes regarding the benefits of human milk. For many reasons, some women do not initiate breastfeeding, suspend breastfeeding early, or initiate complementary feeding earlier than recommended. Usual measurement methods use large sample surveys at a national scale, which are not well suited for monitoring sub-national differences. METHODS: In order to understand how local infant feeding practices could influence policy and promotion practices, we apply data pooling methodology to analyse breastfeeding patterns in different Ecuadorian settings: Cumbayá parish, located near Quito, the Ecuadorian capital; the city of Macas and rural surroundings in the Amazon basin province of Morona Santiago; and the province of Galapagos. Surveys were conducted independently between August 2017 and August 2018; while they are representative of each respective setting, sampling designs and survey methods differ, but the same demographic information and data based on standard breastfeeding indicators established by the World Health Organization (WHO) were collected. In order to account for differences in the different settings, the design effect of each survey was considered in the analysis. RESULTS: Significant differences were found in breastfeeding practices between the suburban Cumbayá parish near Quito and Galapagos on one hand, and urban and rural parts of Morona Santiago, on the other. The rates of early breastfeeding initiation and age-appropriate breastfeeding are significantly higher in urban and rural Morona Santiago then in Cumbayá or Galapagos, while the rate of exclusive breastfeeding is highest in rural parts of Morona Santiago. No significant differences were found in complementary feeding practices between Cumbayá and Galapagos, but there are with urban and rural Morona Santiago. Initiation of breastfeeding in the first hour after birth occurs in only 36.2% of cases in Cumbayá but in 75.4% of cases in urban Morona. CONCLUSIONS: Differences among regions reflect specific opportunities and barriers to practices related to promoting optimal infant health and nutrition. Consequently, regional or local conditions that often are not apparent in national-level data should orient policies and promotion activities in specific populations.
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Aleitamento Materno/psicologia , Promoção da Saúde , Adulto , Equador , Feminino , Política de Saúde , Humanos , Lactente , Saúde do Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Masculino , Mães/psicologia , Mães/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: In order to understand why rates of overweight and obesity are so high in the Ecuadorian province of Galapagos, this study analyzes changes in household food expenditures and perceptions and practices related to food consumption patterns. Galapagos is understood as an unusual but not unique case because conditions there graphically illustrate trends observed in communities and countries worldwide. A mixed methods approach was employed: a quantitative component was based on expenditures for foods classified according to the NOVA system, and a qualitative component utilized focus group discussions, key informant interviews, and structured observations. RESULTS: Galapagos residents increased consumption of processed and ultra-processed foods and decreased consumption of unprocessed and minimally processed foods. Perceived barriers to healthy diets include price, availability, and quality of fresh produce, as well as easy access to industrialized processed and ultra-processed foods. CONCLUSIONS: Changes in consumption patterns represent both local conditions and global trends; in that sense, the factors that affect Galapagos residents are not unique. Hence, these findings help elucidate processes observed in communities around the world.
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Dieta/estatística & dados numéricos , Fast Foods/efeitos adversos , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Adulto , Inquéritos sobre Dietas , Equador/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto JovemRESUMO
To describe disease activity and disability during the first year of follow-up, from rheumatoid arthritis (RA) patients who discontinue tofacitinib after they end participation in a clinical trial. From 2008 to 2016, 36 patients were enrolled in the "Long term follow-up study with tofacitinib (and methotrexate) for RA treatment". At the end of the study, tofacitinib was discontinued and patients were proposed to enter an observational study; 35 agree and had scheduled evaluations at baseline, at 15 and 30 days of follow-up, at month 2 and 3, and thereafter every 3 months. Disease activity was evaluated as per DAS28-ESR and disability as per HAQ. During follow-up, treatment was treat-to-target oriented, only conventional DMARDs were indicated. Descriptive statistics and nonparametric test were used. The study was approved by IRB. Patients were primarily females (N = 34), had median (Q25-75) age of 52 years (45-58), and had received tofacitinib for a median of 7.9 years (6.3-8.3). The proportion of patients with remission and low disease activity decreased from day 30 of follow-up and recovered after 270 days, meanwhile patients with high disease activity increased from 0% at baseline to 6.3% at 1 year. At study entry, 20 patients had remission/low disease activity; during follow-up, 85% deteriorated after (median) 30 days; among them, 23.5% recovered their baseline status after a median of 172.5 days. The HAQ showed a similar behavior, but 66.7% recovered. A substantial proportion of RA patients deteriorated outcomes early after tofacitinib cessation; some patients recovered baseline status with traditional DMARDS.
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Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Ética em Pesquisa , Metotrexato/uso terapêutico , Piperidinas/uso terapêutico , Inibidores de Proteínas Quinases/uso terapêutico , Pirimidinas/uso terapêutico , Pirróis/uso terapêutico , Projetos de Pesquisa , Sujeitos da Pesquisa , Populações Vulneráveis , Adulto , Idoso , Antirreumáticos/efeitos adversos , Artrite Reumatoide/diagnóstico , Avaliação da Deficiência , Progressão da Doença , Quimioterapia Combinada , Feminino , Humanos , Masculino , Metotrexato/efeitos adversos , Pessoa de Meia-Idade , Piperidinas/efeitos adversos , Inibidores de Proteínas Quinases/efeitos adversos , Pirimidinas/efeitos adversos , Pirróis/efeitos adversos , Recidiva , Indução de Remissão , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVES: To evaluate if the timing of appearance with respect to disease onset may influence the arthritis presentation pattern in antisynthetase syndrome (ASSD). METHODS: The patients were selected from a retrospective large international cohort of ASSD patients regularly followed-up in centres referring to AENEAS collaborative group. Patients were eligible if they had an antisynthetase antibody testing positive in at least two determinations along with arthritis occurring either at ASSD onset (Group 1) or during the course of the disease (Group 2). RESULTS: 445 (70%; 334 females, 110 males, 1 transsexual) out of the 636 ASSD we collected had arthritis, in the majority of cases (367, 83%) from disease onset (Group 1). Patients belonging to Group 1 with respect to Group 2 had an arthritis more commonly polyarticular and symmetrical (p=0.015), IgM-Rheumatoid factor positive (p=0.035), erosions at hands and feet plain x-rays (p=0.036) and more commonly satisfying the 1987 revised classification criteria for rheumatoid arthritis (RA) (p=0.004). Features such as Raynaud's phenomenon, mechanic's hands and fever (e.g. accompanying findings) were more frequently reported in Group 2 (p=0.005). CONCLUSIONS: In ASSD, the timing of appearance with respect to disease onset influences arthritis characteristics. In particular, RA features are more common when arthritis occurs from ASSD onset, suggesting an overlap between RA and ASSD in these patients. When arthritis appears during the follow-up, it is very close to a connective tissue disease-related arthritis. Also, the different prevalence of accompanying features between these two groups is in line with this possibility.
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Artrite/epidemiologia , Miosite/epidemiologia , Adulto , Artrite/diagnóstico , Artrite/imunologia , Autoanticorpos/sangue , Biomarcadores/sangue , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Miosite/diagnóstico , Miosite/imunologia , Fenótipo , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de TempoRESUMO
Interstitial lung disease (ILD) is a severe rheumatoid arthritis (RA) manifestation. The worst survival has been associated with usual interstitial pneumonia (UIP) definitive pattern in high-resolution chest tomography (HRCT) scans. Moreover, the use of methotrexate in RA-ILD is controversial. Our aim was to evaluate prognostic factors including methotrexate in an RA-ILD cohort and their association with survival. RA-ILD patients referred for medical evaluation and treatment at a single center were included. At the baseline, pulmonary function tests were carried out and a HRCT was obtained. A radiologist evaluated the ILD tomographic pattern and the extent of lung disease. Patients were considered as receiving methotrexate therapy if this drug was specifically prescribed for the treatment of RA-ILD at the beginning of follow up. Seventy-eight patients were included. UIP definite pattern in HRCT was not associated to worse survival. Variables associated with mortality reflected the severity of lung disease. Treatment with methotrexate was associated with survival (HR 0.13, 95% CI 0.02-0.64); older patients had worse prognosis (HR 1.04, 95% CI 1.003-1.09). After adjusting for confounding variables, methotrexate was strongly associated with survival. Methotrexate treatment during follow up was associated with survival. The severity of lung disease and not the tomographic pattern is associated with mortality; older patients had worse prognosis.
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Antirreumáticos/uso terapêutico , Artrite Reumatoide/complicações , Doenças Pulmonares Intersticiais/etiologia , Metotrexato/uso terapêutico , Adulto , Idoso , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/tratamento farmacológico , Feminino , Humanos , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prognóstico , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
OBJECTIVE: to describe the clinical manifestations and survival of patients with ILD and myositis-specific and associated autoantibodies, and to evaluate the performance of the new ATS/ERS classification criteria for IPAF. PATIENTS AND METHODS: Patients with ILD and positive in at least one of the following autoantibodies: anti-Jo-1, anti-Ej, anti-PL7, anti-PL 12, anti-PM/SCL 75 and anti-PM/SCL100 were included. Patients were separated into three groups according to their autoantibody profile: 1. Jo-1 positive patients, 2. Non-Jo-1 antisynthetase autoantibody positive patients, and 3. PM/SCL positive patients. Relevant clinical characteristics were registered. Patients were evaluated had they fulfilled Bohan and Peter's criteria (BPC) for inflammatory myopathies. We evaluated the performance of the IPAF ATS/ERS proposal to classify as such the patients that did not fulfilled BPC, and evaluated whether IPAF patients had a worse survival that BPC patients. RESULTS: Sixty-eight patients were included. Jo-1 was the most frequent autoantibody (65%), followed by non Jo1 anti-synthetase autoantibodies (31%). Non-Jo1 patients had lower Creatin Kinase serum levels at the baseline and less frequency of arthritis. Only 50% of patients fulfilled BPC. All patients not complying with BPC did comply with IPAF criteria. There was no difference in survival between IPAF and BPC patients. Anti Jo-1 positive was associated to survival and the extent of lung inflammation was associated to mortality. CONCLUSIONS: Patients differ in clinical manifestations according to the autoantibody profile. All patients not complying with BPC did comply with the new IPAF criteria. There was no difference in survival between BPC and IPAF patients. Jo-1 patients had a better survival. Extent of lung inflammation was associate to mortality.
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Autoanticorpos/sangue , Doenças Autoimunes/imunologia , Doenças Pulmonares Intersticiais/imunologia , Miosite/imunologia , Adulto , Anticorpos Antinucleares/sangue , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/diagnóstico por imagem , Biomarcadores/sangue , Feminino , Humanos , Estimativa de Kaplan-Meier , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Miosite/diagnóstico por imagem , Prognóstico , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Infective endocarditis is a disease with high morbidity and mortality. The clinical characteristics differ among populations. Therefore it is important to know the characteristics of the disease in our region. METHODS: This is an observational study that included all patients diagnosed with infective endocarditis from 1 January 2009 until 31 December 2014. The data are showed as frequencies and percentages altogether with medians with interquartile range. RESULTS: 10 cases were included. The median age was 34 years (IQR 26-41). Several risk factors were identified and included: previous valvular heart disease, patients with chronic kidney disease who have had a vascular access and previous history of immunological disease. The native mitral valve was the most affected. The size of vegetations had a median length of 14 mm (IQR 9.3-16). Streptococcus alpha hemolytic was the most common organism. In-hospital mortality rate was 10 %. CONCLUSIONS: The behavior of the disease is similar to other national series. We identify risk factors that could be related to the type of morbidities in the region.
Introducción: la endocarditis infecciosa es una enfermedad con elevada morbilidad y mortalidad. La expresión clínica es variable en diferentes poblaciones, por lo que es imperativo conocer las características de la enfermedad en nuestra región. Métodos: estudio observacional que incluyo la totalidad de los pacientes diagnosticados con endocarditis bacteriana entre el 1 de enero de 2009 hasta el 31 de diciembre de 2014. Los datos se presentan como frecuencias con porcentajes y medianas con rango intercuartílico, según sea el caso. Resultados: se incluyen 10 casos. La mediana de edad fue 34 años (RIC 26-41). Los factores de riesgo identificados fueron: enfermedad valvular previa, enfermedad renal crónica con acceso vascular y enfermedad inmunológica. La válvula mitral nativa fue la más afectada. La mediana de longitud de las vegetaciones fue de 14 mm (RIC 9.3-16). El estreptococo alfa hemolítico fue el microorganismo más común. La tasa de mortalidad intrahospitalaria fue del 10 %. Conclusiones: el comportamiento de la enfermedad es similar a otras series nacionales. Identificamos factores de riesgo que pueden circunscribirse a las morbilidades en la región.
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Endocardite/epidemiologia , Adolescente , Adulto , Endocardite/diagnóstico , Endocardite/etiologia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária , Adulto JovemRESUMO
Objetivo: Determinar la asociación entre lactancia materna exclusiva (LME) y enfermedades prevalentes de la infancia en niños menores de seis meses en Perú el año 2012. Métodos: Análisis secundario de la Encuesta Demográfica de Salud Familiar (ENDES) 2012. Se definen variables y establece asociación de LME con enfermedad diarreica aguda (EDA), infecciones respiratorias agudas (IRA), infección inespecífica (fiebre) y problema de salud infeccioso. Análisis estad¡stico univariado, bivariado con Chi-cuadrado, OR (IC95%) y multivariado con regresión logística binaria con p<0,05 en SPSS 20, según procedimiento de ponderación del INEI. Resultados: Se incluyó a 829 niños peruanos menores de seis meses. 97,4% de niños se encontraba actualmente lactando, solo 48,7 % recib¡a LME. Se encontró un OR ajustado (ORa) de 0,37 IC95% 0,22 0,62) entre LME y EDA, ORa de 0,57 (IC95% 0,37 0,89) entre LME e infección inespecífica y ORa de 0,46 (IC95% 0.31 0.69) entre LME y problema de salud infeccioso en comparación a quienes no recib¡an LME. No se encontró asociación entre LME e IRA. Conclusiones: La lactancia materna exclusiva se asoció a menor probabilidad de presentar enfermedad diarreica aguda, infección inespecífica y algún problema de salud infeccioso en niños peruanos menores de seis meses.
Objective: To determine the association between exclusive breastfeeding (EBF) and infectious diseases in infants younger than 6 months in Peru in 2012. Methods: Secondary analysis of Encuesta Demogr fica de Salud Familiar (ENDES) survey database of 2012. Variables were defined on the database and association established based between EBF and fever (non-specific infection), acute diarrhea (AD), respiratory tract infections (RTI) and infectious health problem. Univariate and bivariate analysis performed with Chi-squared test and Odds Ratio (IC95%); multivariate analysis with binary logistic regression, p<0.05 using SPSS 20, according to weighing procedures of INEI. Results: 829 peruvian children under 6 months were included in the study. 97,4% of infants received breastfeeding, and only 48,7% received EBF. Compared with non-EBF infants, EBF infants presented lower risks of AD (adjusted OR [aOR]= 0,38; 95%CI 0,23-0,63); non-specific infection (aOR=0,60; 95%CI 0,39-0,93) and infectious health disease (aOR=0,47; 95%CI 0,32-0,69). No association was found between RTI and EBF. Conclusion: Exclusive breastfeeding was associated with lower risk of presenting acute diarrhea, non-specific infection and infectious health problems.