A literature review disclosed that even under very strict caries preventive control, in young Swedish people many initial approximal lesions slowly progress. A study was performed to investigate if the same trend could be seen in young Danish adults. In 1996 a group of Danish military conscripts were investigated clinically and radiographically. Based on the radiographs, one lesion with radiolucency up to one third in the dentine was randomly selected from each conscript. Contact was established with these former conscripts in 2002 and radiographs taken around 2002 were used to investigate the state of the selected lesions in terms of regression, stabilization or progression. It was observed that about 60% of the selected lesions had progressed during the 5 to 6 year period. Therefore there was a need to look for other preventive measures than those traditionally used in a Danish context, such as instructions in flossing and local application of fluoride. Looking through the literature, it was realized that sealing of occlusal lesions was highly effective but this procedure was not used on approximal surfaces. The next step was to investigate if it was technically possible to seal approximal lesions and if so what material should be used. A laboratory study was conducted in which 6 dental materials were compared in relation to: their handling, presence at the surface of the lesion, and ability to penetrate into a lesion. Based on that study Gluma One Bond® (Heraeus Kulzer) was selected to be used in further studies. The final step was an 18-month clinical investigation to evaluate the effect of sealing approximal lesions. About 80 young adults from Denmark and Colombia participated in this investigation; each had at least 2 initial approximal lesions. One lesion was selected for sealing; the other one acted as control. Baseline radiographs were taken by means of special equipment so new radiographs could be taken in the same position after 18 months. The sealing procedure was performed in accordance with the guideline designed in the laboratory study. The patient was instructed to floss all sealed and non-sealed approximal lesions. Radiographs were used to assess caries progression in the test and control lesions in three ways: by comparing baseline with final scoring of the lesions on the individual conventional radiographs, by reading the conventional radiographs as pairs and finally using subtraction radiography of digitized images. The examiner was blind to lesion type (test or control) for all comparisons and also blind to whether radiographs were baseline or follow up in the case of examinations of the single radiographs and paired comparison. Repeat assessment of the radiographs was conducted on 20% of the radiographs and the subtraction images. For the paired comparison of radiographs and subtraction radiography assessment significantly more control lesions progressed (47.2%; 85%) than test lesions (22.2%; 43%) (P-values<0.05). For the independent examination of the radiographs a similar pattern was seen but the difference between the two groups was not statistically significant (P=0.06). In conclusion, many approximal lesions seemed to progress on young adults irrespective of the preventive regime they were advised to take. This study has developed and investigated a technique for sealing early approximal lesions which seems to be more effective at preventing lesion progression than conventional interventions such as brushing and flossing. There is a need however, for defining more precisely criteria at selecting lesions to be sealed; for developing better materials in terms of better penetration skill and that they stay there, and for clinical investigations which evaluate the long term effect of sealing the approximal lesions.

El objetivo de esta investigación es determinar la situación actual de la oferta de servicios de salud en el país, identificando diferencias entre regiones, regímenes y naturaleza jurídica de los prestadores. A partir del análisis de distintas fuentes de información se encontró que de 1.124 municipios en Colombia, el 45% solo cuentan con IPS públicas de baja y mediana complejidad y ofrecen en promedio 18 de los 234 servicios de salud disponibles. De hecho, el 76% de las entidades territoriales ofrece entre 11 y 40 servicios. Elementos adicionales como los costos de viaje, la frecuencia con la que se requieren los servicios y la capacidad de los prestadores de atender las urgencias, necesitan considerarse cuando se evalúa la relación entre la distribución de los servicios a lo largo del territorio nacional y la calidad de la atención.

Abstract: Sepsis-induced myocardial dysfunction is associated with increased oxidative stress and mitochondrial dysfunction. Current evidence suggests a protective role of thioredoxin-1 (Trx1) in the pathogenesis of cardiovascular diseases. However, it is unknown yet a putative role of Trx1 in sepsis-induced myocardial dysfunction, in which oxidative stress is an underlying cause. Transgenic male mice with Trx1 cardiac-specific overexpression (Trx1-Tg) and its wild-type control (wt) were subjected to cecal ligation and puncture or sham surgery. After 6, 18, and 24 h, cardiac contractility, antioxidant enzymes, protein oxidation, and mitochondrial function were evaluated. Trx1 overexpression improved the average life expectancy (Trx1-Tg: 36, wt: 28 h; p=0.0204). Sepsis induced a decrease in left ventricular developed pressure in both groups, while the contractile reserve, estimated as the response to ?-adrenergic stimulus, was higher in Trx1-Tg in relation to wt, after 6 h of the procedure. Trx1 overexpression attenuated complex I inhibition, protein carbonylation, and loss of membrane potential, and preserved MnSOD activity at 24 h. Ultrastructural alterations in mitochondrial cristae were accompanied by reduced Optic atrophy 1 (OPA1) fusion protein, and activation of dynamin-related protein 1 (Drp1) (fission protein) in wt mice at 24 h, suggesting mitochondrial fusion/fission imbalance. PGC-1? gene expression showed a 2.5-fold increase in Trx1-Tg at 24 h, suggesting mitocondrial biogenesis induction. Autophagy, demonstrated by electron microscopy and increased LC3-II/LC3-I ratio, was observed earlier in Trx1-Tg. In conclusion, Trx1 overexpression extends antioxidant protection, attenuates mitochondrial damage, and activates mitochondrial turnover (biogenesis and mitophagy), preserves contractile reserve and prolongs survival during sepsis. Resumen: La disfunción miocárdica inducida por sepsis está asociada con estrés oxidativo y disfuncion mitocontrial. La evidencia actual sugiere un rol protector de thiorredoxina 1 en la patogénesis de la enfermedad cardiovascular. Sin embargo, es desconocido su papel en la disfunción miocárdica inducida por sepsis, en el cual el estrés oxidativo es una causa subyacente. Ratones transgénicos machos con sobreexpresión específica en músculo cardiaco (Trx1-Tg) y su control (wt) fueron sujetos a ligadura punción cecal o técnica de laparotomía sin ligadura y punción (sham). Después de 6, 18,y 24h, contractilidad cardiaca, enzimas antioxidantes, oxidación de proteínas, y función mitocondrial fueron evaluados. Sobre-expresión de Trx1 mejoró la esperanza de vida media (Trx1-Tg: 36, wt: 28 h; p = 0.0204). Sepsis indujo una reducción en la presión desarrollada del ventrículo izquierdo en ambos grupos, mientras la reserva contráctil, estimada como la respuesta al estímulo β-adrenérgico, fue superior en Trx1-Tg en relación a wt, posterior a 6 h del procedimiento. La sobre-expresión de Trx1 atenuó la inhibición del complejo I, carbonilación de proteínas, y pérdida de potencial de membrana, y preservó la actividad de la superóxido dismutasa-Mn a las 24 h. Alteraciones ultra estructurales en las crestas mitocondriales fueron acompañadas por una reducción en OPA1 y activación de Drp1 en ratones wt a las 24 h, sugiriendo un imbalance fusión/fisión mitocondrial. La expresión de PGC-1-α incrementó 2.5 veces en Trx1-Tg a las 24 h, sugiriendo inducción de biogénesis mitocondrial. Autofagia, demostrada por microscopia electrónica e incremento en la razón LC3-II/LC3-I, fue observado más tempranamente en Trx1-Tg. En conclusión, la sobre-expresión de Trx1 extiende protección antioxidante, atenúa el daño mitocondrial y activa el recambio mitocondrial (mitofagia y biogénesis), preserva la reserva contráctil y prolonga la sobrevida durante la sepsis.

Conventional agricultural practices are often contrary to human health and environmental conservation. Use of and exposure to pesticides in agricultural communities in tropical countries is a pressing public health problem and an important facet of environmental degradation. This research project was undertaken by documenting use and exposure behaviors among agricultural communities in San Cristobal, Antioquia (Colombia). The research questions were: (1) What are the primary factors associated with the use of pesticides and do those factors differ between pesticide users and agroecological adherents? (2) How do campesino pesticide users and agroecological adherents(non-pesticide users) differ in their attitudes and beliefs with regards to pesticide use and exposure? and (3) How do these factors influence campesinos‟ behaviors associated with pesticide use and exposure? I implemented qualitative and quantitative methods in this investigation. The qualitative approach was based on community participatory ethnographic research. The latter involved participant observation, interviews, and focus groups aimed at existing pesticides users and agroecological adherents. The quantitative approach used questionnaires to derive demographic information, scale-based evaluations of attitudes and beliefs, pesticides decision making, perceived confidence, and perceived control. Findings showed that the most relevant factors related to pesticide use and their categories included: a) individual: beliefs, attitudes and knowledge; b) interpersonal: family support and cultural acceptance of pesticide use; c) economic: fear of living within financially unviable constraints, market conditions and lack of economic support from the government; d) cultural: collective acceptance or tolerance of pesticide use and exposure and onset of negative reactions when stopping pesticide use; e) political: deficient regulations for controlling pesticide use control and adequate utilization of protective equipment. Pesticide users experienced the most apprehension regarding stopping pesticide use as they often believed pesticides allow them to obtain better crop yields and, therefore, higher monetary gains. Pesticide users lacked a positive attitude toward personal protectionequipment, regardless of the risks to which they may be exposed. Pesticide training was deficient in this population showing a clear need to improve safety conditions and training to reduce occupational hazards. Future studies should explore with greater detail these attitudes and beliefs so as to promote mid- to long-term public health interventions that directly address the sense of food and income insecurity found among the population of pesticides users, which blocks their transition into a non-pesticide scenario for agricultural production. Over the short-term, public health programs should continue to educate the population of pesticide users on the immediate risks of exposure. The decision making process surrounding pesticide use in the studied population was influenced by a variety of factors. Campesinos who were prone to use pesticides for their crops often exhibited diminished degrees of knowledge about adverse effects of pesticides on human health, believed pesticides are necessary for their crops, had negative attitudes about stopping pesticide use, had a strong family influence toward the use of pesticides, experienced economic fear of stopping pesticide use, cultivated flowers as their main source of income, expressed strong social acceptance of pesticide use, experienced negative community reactions when attempting to stop pesticide use, received government subsidies for pesticide use, and had never received any training on the use of required protective equipment. Campesinos who showed more proclivities towards the use of pesticides were convinced that pesticides are necessary for their crops as they guarantee substantial yields and larger specimens of the different crop varieties. They also exhibited low perceived control, low perceived confidence, and a low perception of adverse pesticide effects on human health and the natural environment. Future studies are required to fully comprehend the unique occupational health and safety needs of these campesinos. Additionally, future studies should be aimed at designing and introducing long-term, well-structured public health interventions to increase awareness about the harmfulness of pesticides on human and environmental health so as to promote a well-established behavioral change in relation to pesticides use reduction among these communities.

Tesis de Nicolás Osorio para optar al título de Doctor en Medicina, en la Facultad de Medicina de París, en 1865. A lo largo del documento, escrito en francés, Osorio analiza el comportamiento de los tumores que obstruyen el líquido cefalorraquídeo.

Tesis presentada por Leonardo de la Motta para obtener el título de doctor en Medicina y Cirugía de la Facultad de Medicina en la Universidad Nacional de Colombia en 1891, en la que discute acerca de los procedimientos utilizados para curar heridas por armas de fuego. A lo largo del documento se explican los procedimientos a seguir en dos tipos de tratamiento: el general que exige reposo, y el tratamiento local que se aplica en casos de hemorragia, desbridamiento, extracción de cuerpos extraños y amputación. Adicionalmente, el autor presenta una serie de consideraciones a tener en cuenta según el sitio de la herida, estas últimas documentadas con registros de pacientes que acudieron a la clínica del Hospital San Juan de Dios y casos de hombres heridos en campos de batalla.

En el presente estudio se analizan los mecanismos implicados en la fragmentación del aparato de Golgi (AG) en células neuronales PC12 tratadas con las neurotoxinas 6-hidroxidopamina o metanfetamina como modelos celulares de la enfermedad de Parkinson (EP). Nuestros datos demuestran que la fragmentación del AG precede y podrían dar lugar a la agregación de la proteína ?-sinucleína, con la subsecuente formación de inclusiones, conduciendo a alteraciones en el transporte anterógrado y retrógrado entre el retículo endoplásmico y el AG, y daño en el citoesqueleto. Por el contrario, la fragmentación del AG está directamente relacionada con alteraciones en los niveles de expresión de las GTPasas Rab1, 2 y 8 y la proteína SNARE sintaxina 5. Así, la sobreexpresión de las proteínas Rab1 y 8 y la depleción de Rab 2 y sintaxina 5 restauran la morfología del AG. En conclusión, la homeostasis de un número limitado de proteínas Rab y SNARE es importante para la comprensión de la citopatología de la EP. La fragmentación del AG puede ser una especie de señal indicativa de que algo en la célula está mal y que el mecanismo de defensa celular se debe iniciar, lo que podría inducir la formación de cuerpos de inclusión del tipo agresomas, que funcionarían como un sistema de adaptación y “supervivencia” celular.

Fee-for-service (FFS) payment system has been criticized for affecting quality of care, contributing to the fragmentation of health care, and for rising costs of health care systems. Alternative payment plans (APP) have been introduced as options to the traditional FFS. Despite a link between payment methods and behaviour of physicians has been established, there is a lack of evidence about the impact of payment systems on well-being (motivation and daily distress) of physicians. This dissertation explored the impact of APP on physicians’ perceptions of professional equity and daily distress. The following questions guided this dissertation: 1) Does professional equity perceived by physicians vary among practitioners paid by FFS, APP, or blended alternatives? 2) Is the payment method associated with daily distress of medical practitioners? and 3) Are levels of professional equity, daily distress, and career satisfaction of physicians different by gender and payment methods? In 2011, Physicians practicing in the Saskatoon Health Region, the largest health authority of Saskatchewan, Canada, completed a questionnaire evaluating their perceptions of professional equity and daily distress. In total, 382 (48.1%) physicians participated in the study. Response bias was tested and found to be negligible. The study identified that physicians paid by APP perceived higher professional equity (fair economic rewards and appropriate recognition) in comparison to those paid by FFS. Particularly, family practitioners (FPs) paid by APP perceived higher professional equity than those FPs paid by FFS. The payment method was identified as a factor associated with distress; lower levels of daily distress were predicted among physicians paid by APP who see high proportions of patients with complex conditions. Notwithstanding, female physicians had poorer well-being indicators and the impact of APP on professional equity was only distinguished among males. A potential unequal impact of APP must be recognized between female and male physicians.

Tesis de Aristides Lores para obtener el título de doctor en Medicina y Cirugía de la Facultad de Medicina en la Universidad Nacional de Colombia en 1892. A lo largo del documento Lores estudia la peritonitis tuberculosa, complicación producida por inflamación del intestino. El autor define la enfermedad, su historia, etiología, causas predisponentes, causas determinantes, sintomatología, y otras particularidades como la enquistada o ulcerosa de la misma, anatomía patológica, marcha de las formas crónicas, diagnóstico, tratamiento y tratamiento quirúrgico. Finalmente, Lores presenta observaciones sobre la autopsia realizada a tres personas que murieron de esa enfermedad.

Tesis de José Manuel Vásquez para obtener el título de doctor en Medicina y Cirugía de la Facultad de Medicina en la Universidad Nacional de Colombia en 1892. A lo largo del documento Vásquez analiza varios aspectos relacionados al procedimiento quirúrgico que investiga en esta oportunidad: su historia, la anatomía de la uretra, indicaciones y contraindicaciones, manual operatorio y complicaciones que podrían presentarse durante la práctica de una uretrotomía. Finalmente, se presentan estudios de caso y breves conclusiones que surgen del análisis sobre los mismos.