Entre Los Research Articles

Reconsidering Social Movement Unionism in Postcrisis Argentina

The Central de Trabajadores de la Argentina, established in 1992, worked to expand its base, especially among nonunion organizations, to construct an anti-neoliberal front. Driven by the threat of neoliberalism rather than by political opportunities, it was initially outstanding among social movement unions in its reach and its unity. It excelled not only in building alliances with the community but in organizing the community itself. However, the structural weakness resulting from its not being located in a key industrial sector and its lack of legal privileges, which was originally compensated for by its alliances, eventually made it unable to take advantage of changing political opportunities.La Central de Trabajadores de la Argentina, fundada en 1992, trabajó para ampliar su base, sobre todo entre las organizaciones no sindicales, para construir un frente anti-neoliberal. Impulsada por la amenaza del neoliberalismo más que por las oportunidades políticas, inicialmente se destacaba entre los sindicatos de los movimientos sociales en su alcance y su unidad. Se destacó no sólo en la construcción de alianzas con la comunidad, sino en la organización de la propia comunidad. Sin embargo, la debilidad structural que resulta de su no estar ubicado en un sector industrial clave y su falta de privilegios legales, lo que se compensó originalmente por sus alianzas, finalmente lo hizo incapaz de aprovechar de las cambiantes oportunidades políticas.

Recurrent and high-frequency use of the emergency department by pediatric patients.

The authors sought to describe the epidemiology of and risk factors for recurrent and high-frequency use of the emergency department (ED) by children. This was a retrospective cohort study using a database of children aged 0 to 17 years, inclusive, presenting to 22 EDs of the Pediatric Emergency Care Applied Research Network (PECARN) during 2007, with 12-month follow-up after each index visit. ED diagnoses for each visit were categorized as trauma, acute medical, or chronic medical conditions. Recurrent visits were defined as any repeat visit; high-frequency use was defined as four or more recurrent visits. Generalized estimating equations (GEEs) were used to measure the strength of associations between patient and visit characteristics and recurrent ED use. A total of 695,188 unique children had at least one ED visit each in 2007, with 455,588 recurrent ED visits in the 12 months following the index visits. Sixty-four percent of patients had no recurrent visits, 20% had one, 8% had two, 4% had three, and 4% had four or more recurrent visits. Acute medical diagnoses accounted for most visits regardless of the number of recurrent visits. As the number of recurrent visits per patient rose, chronic diseases were increasingly represented, with asthma being the most common ED diagnosis. Trauma-related diagnoses were more common among patients without recurrent visits than among those with high-frequency recurrent visits (28% vs. 9%; p<0.001). High-frequency recurrent visits were more often within the highest severity score classifications. In multivariable analysis, recurrent visits were associated with younger age, black or Hispanic race or ethnicity, and public health insurance. Risk factors for recurrent ED use by children include age, race and ethnicity, and insurance status. Although asthma plays an important role in recurrent ED use, acute illnesses account for the majority of recurrent ED visits.

Bleeding Following Rattlesnake Envenomation in Patients With Preenvenomation Use of Antiplatelet or Anticoagulant Medications

Rattlesnake envenomations commonly produce coagulopathy and thrombocytopenia, yet clinically significant bleeding is uncommon. It is unknown if patients who use antiplatelet or anticoagulant medications prior to envenomation are at increased risk for bleeding after envenomation. This was a retrospective cohort study of patients age 14 years and older who were admitted to a single academic medical center for rattlesnake envenomation. Patients who reported use of antiplatelet or anticoagulant medications prior to envenomation were compared to patients not on those medications. Severity and timing of bleeding was compared between groups, as was a composite endpoint of major bleeding at any time, shock, readmission, or death. A total of 319 patients met inclusion criteria; 31 (9.7%) were documented to be taking antiplatelet or anticoagulant medications including aspirin, clopidogrel, and/or warfarin. Seventeen of the 319 patients developed bleeding associated with envenomation (major = 9; minor = 4; trivial = 4), with major bleeding occurring in five patients on antiplatelet or anticoagulant medications versus four patients not on antiplatelet or anticoagulant medications (p < 0.001). Seven of the 17 presented with early bleeding. This early bleeding occurred in three of 31 (9.7%) patients on antiplatelet or anticoagulant medications and four of 288 (1.4%) patients not on antiplatelet or anticoagulant medications (relative risk [RR] = 6.9; 95% confidence interval [CI] = 1.6 to 29.4; p = 0.022). Clinical outcome data were available for 300 of the 319 (94%) subjects following discharge. Late bleeding (bleeding after discharge from the index hospitalization) occurred in nine subjects, one of whom also had early bleeding (major = 2, minor = 3, trivial = 4). Three of these nine subjects with late bleeding were on antiplatelet or anticoagulant medications, compared with six not on antiplatelet or anticoagulant medications (p = 0.042). Both cases of late major bleeding occurred in patients on antiplatelet or anticoagulant medications. Therefore, among patients with follow-up data available, the overall rate of bleeding (early and late) was seven of 28 (25%) in patients taking antiplatelet or anticoagulant medications and 10 of 273 (3.7%) in patients not taking antiplatelet or anticoagulant medications (p < 0.001). The use of antiplatelet or anticoagulant medications was also associated with an increased risk of reaching the composite endpoint of major bleeding, shock, readmission, or death (6 of 31, or 19.4% vs. 14 of 288, or 4.9%; RR = 3.98; 95% CI = 1.65 to 9.62; p = 0.008). The risk of developing bleeding following rattlesnake envenomation is increased in patients who use antiplatelet or anticoagulant medications. This risk is greatest early after envenomation during the index hospitalization. However, risk of late, major bleeding appears also to be greatest in patients on antiplatelet or anticoagulant medications. Extra vigilance should be taken in patients on antiplatelet or anticoagulant medications and a careful risk/benefit analysis should be undertaken before continuing these medications in the weeks following the envenomation.

Performance of Ultrasound in the Diagnosis of Appendicitis in Children in a Multicenter Cohort

The objectives were to assess the test characteristics of ultrasound (US) in diagnosing appendicitis in children and to evaluate site-related variations based on the frequency of its use. Additionally, the authors assessed the test characteristics of US when the appendix was clearly visualized. This was a secondary analysis of a prospective, 10-center observational study. Children aged 3 to 18 years with acute abdominal pain concerning for appendicitis were enrolled. US was performed at the discretion of the treating physician. Of 2,625 patients enrolled, 965 (36.8%) underwent abdominal US. US had an overall sensitivity of 72.5% (95% confidence interval [CI] = 58.8% to 86.3%) and specificity 97.0% (95% CI = 96.2% to 97.9%) in diagnosing appendicitis. US sensitivity was 77.7% at the three sites (combined) that used it in 90% of cases, 51.6% at a site that used it in 50% of cases, and 35% at the four remaining sites (combined) that used it in 9% of cases. US retained a high specificity of 96% to 99% at all sites. Of the 469 (48.6%) cases across sites where the appendix was clearly visualized on US, its sensitivity was 97.9% (95% CI = 95.2% to 99.9%), with a specificity of 91.7% (95% CI = 86.7% to 96.7%). Ultrasound sensitivity and the rate of visualization of the appendix on US varied across sites and appeared to improve with more frequent use. US had universally high sensitivity and specificity when the appendix was clearly identified. Other diagnostic modalities should be considered when the appendix is not definitively visualized by US.

The impact of routine cryptococcal antigen screening on survival among HIV‐infected individuals with advanced immunosuppression in Kenya

To test the hypothesis that a screening and treatment intervention for early cryptococcal infection would improve survival among HIV-infected individuals with low CD4 cell counts. Newly enrolled patients at Family AIDS Care and Education Services (FACES) in Kenya with CD4≤100 cells/μl were tested for serum cryptococcal antigen (sCrAg). Individuals with sCrAg titre≥1:2 were treated with high-dose fluconazole. Cox proportional hazard models of Kaplan-Meier curves were used to compare survival among individuals with CD4≤100 cells/μl in the intervention and historical control groups. The median age was 34years [IQR: 29,41], 54% were female, and median CD4 was 43 cells/μl [IQR: 18,71]. Follow-up time was 1224 person-years. In the intervention group, 66% (514/782) were tested for sCrAg; of whom, 11% (59/514) were sCrAg positive. Mortality was 25% (196/782) in the intervention group and 25% (191/771) in the control group. There was no significant difference between the intervention and control group in overall survival [hazard ratio (HR): 1.1 (95%CI:0.9,1.3)] or three-month survival [HR: 1.0 (95%CI:0.8,1.3)]. Within the intervention group, sCrAg-positive individuals had significantly lower survival rates than sCrAg-negative individuals [HR:1.8 (95%CI: 1.0, 3.0)]. A screening and treatment intervention to identify sCrAg-positive individuals and treat them with high-dose fluconazole did not significantly improve overall survival among HIV-infected individuals with CD4 counts≤100 cells/μl compared to a historical control, perhaps due to intervention uptake rates or poor efficacy of high-dose oral fluconazole.

Fear of Discovery Among Latino Immigrants Presenting to the Emergency Department

Recent legislation mandating reporting of undocumented immigrants may instill fear of discovery when they access emergency department (ED) services. The objectives of this study were to: 1) characterize the knowledge and beliefs of undocumented Latino immigrants (UDLI) about health care workers' reporting (or nonreporting) of illegal immigrants in the ED, 2) determine whether UDLI fear discovery when presenting to the ED, and 3) determine the nature and sources of this fear. This was a cross-sectional study of UDLI and two comparison groups conducted in two California county EDs, from November 2009 to August 2010. The authors interviewed a convenience sample of adult UDLI, Latino legal residents (LLR), and non-Latino legal residents (NLLR) using a structured instrument in their native language. The main outcome was fear of discovery among UDLI and the sources of that fear. Of 1,224 patients approached, 1,007 (82.3%) were interviewed: 314 UDLI, 373 LLR, and 320 NLLR. The median age was 43 years (interquartile range [IQR] = 31 to 55 years), and 51% were male. UDLIs were less likely to speak English (14%, 95% confidence interval [CI] = 10% to 18%), have health insurance (39%, 95% CI 32% to 44%), or have a regular primary care provider (PCP; 39%, 95% CI = 34% to 45%), compared to LLR (English 56%, 95% CI = 51% to 61%; health insurance 50%, 95% CI = 45% to 55%; regular PCP 51%, 95% = CI 46% to 57%) and NLLR (English 95%, 95% CI = 92% to 97%; health insurance 49%, 95% CI = 43% to 54%; regular PCP 51%, 95% CI = 45% to 56%). Of the 16% of UDLI who stated that nurses and doctors treat undocumented immigrant patients differently than citizens, 41% (95% CI = 29% to 54%) reported less respect given to UDLI by staff. Thirty-two percent of UDLI had heard of Proposition 187, 13% believed hospital staff reported UDLI to immigration authorities, and 9% said they were asked about their citizenship status. Fear of coming to the hospital because of discovery was expressed by 12% (95% CI = 9% to 16%) of UDLI, with 42% (95% CI = 28% to 58%) citing discussions with friends/family, 32% (95% CI = 19% to 47%) citing media and 16% (95% CI = 7% to 30%) citing both as sources of this fear. One in eight of UDLI presenting to the ED express fear of discovery and consequent deportation. Belief that medical staff report UDLI and recent immigration are risk factors for this fear. Family, friends, and media are the primary sources of these concerns.

Race and Character in Cien años de soledad

For AndyCien anos de soledad has been viewed through many prisms but in critical readings of the novel there is very little focus on the question of race. The narrative arguably presents the novel's events through a European filter, or Pseudo-European presumed whiteness.1 A reading is sensitive to race shows racial mixture most often intersects with illegitimacy in Cien anos de soledad. White women are instrumental in policing racial hierarchy; black women are relegated to the margins of the socius, most particularly to brothels. Vivir para contarla, Garcia Marquez's 2003 autobiography, provides unsettling insights into how the Nobel laureate transmuted his experience of coastal Caribbean race relations into his novel.White identity is evident throughout the first two chapters of Cien anos de soledad. In the opening chapter Macondo's founder, Jose Arcadio Buendia, expresses contempt for the past and the Spanish Conquest haunts his movements, not as an epoch of terror but as an age of heroism, irretrievably lost. According to Avery Gordon, haunting describes how that which appears not to be there is often a seething (8). Gordon's analysis examines the invisible or uncanny historical presence of ostensibly silenced or marginalized people. Victors and conquerors haunt history as well. This is apparent in Jose Arcadio Buendia's explorations in the first chapter, in which the founder of Macondo discovers the remains of a Spanish galleon and a suit of armor from a previous heroic age. These refer to a golden age of discovery, upheld by ethnic Europeans in Latin America as justification for claims of patrimony. The golden age of discovery and exploration has been lost to the villagers of Macondo. They inhabit an isolated and degraded reality, in which the monumental object of the Spanish Conquest may only be recovered piecemeal, if at all. 2The predominantly Spanish ancestry of Macondo's family of leaders is never in doubt. Ursula Iguaran's great-grandfather was Aragonese and Jose Arcadio Buendia's was criollo cultivador de tabaco (CA 103). In the United States, creole connotes racial mixture whereas its Spanish homophone criollo refers to a native-born person of European ancestry, although the term is misleading. The ancestors of Ursula and Jose Arcadio lived on land nominally shared with the original inhabitants: del mar, en una rancheria de indios pacificos (CA 102). The Buendias' Spanish forebears leave an indelible stamp on a territory which once belonged to indigenous inhabitants: antigua rancheria que los antepasados de ambos transformaron con su trabajo y sus buenas costumbres en uno de los mejores pueblos de la provincia (103). A central myth of whiteness, as Richard Dyer notes, is its claim to aspiration and enterprise (21-23). Enterprising ancestors notwithstanding, the tale of the Buendias illustrates a criollo anxiety regarding whiteness and reproduction. Inter-racial sexuality, as Dyer brilliantly argues, threatens whiteness because bodies. ..can no longer guarantee their own reproduction as (25). In Garcia Marquez's novel, the copulation of white bodies eventually leads to bestial offspring. Due perhaps to the limited availability of socially acceptable (white) partners, the descendants of the Aragonese Spaniard and the criollo tobacco planter are threatened by endogamy, incest, and monstrosity. In warnings to her great-great-grandson, Ursula states the danger clearly: mujeres de la calle, que echaban a perder la sangre; las mujeres de la casa, que parian hijos con cola de puerco (CA 503).In the prehistory of Macondo, Ursula's attempt to avoid bearing children with tails leads to violence: Jose Arcadio Buendia murders the man who mocks his childless marriage. Prudencio Aguilar's return as a ghost precipitates the Buendias' journey across a Latin American wilderness: despues de varios meses de andar perdidos por entre los pantanos, lejos ya de los ultimos indigenas que encontraron en el camino, acamparon a la orilla de un rio pedregoso cuyas aguas parecian un torrente de vidrio helado (108). …

Jealousy and Usury in “El celoso extremeño”

Felipo de Carrizales, protagonista epónimo de “El celoso extremeño,” es una de las más extravagantes creaciones cervantinas, un personaje que oscila entre los extremos conductuales de desordenada prodigalidad y arrepentimiento por sus fallos personales. La característica más notable de Carrizales son sus exagerados celos, que no se corresponden con conceptos modernos de verosimilitud psicológica sino con ideologías contemporáneas de ética comercial. En la época, el lucro y la lujuria se concebían como dos caras de la misma moneda, variantes anejas de la misma patología moral. Así, el desordenado apetito de riqueza está en consonancia con los irracionales celos: éstos vienen a ser la expresión erótica del incontrolado impulso hacia el enriquecimiento excesivo por medio de la usura. Con Carrizales, Cervantes trasciende la representación tradicional del marido celoso mediante la incorporación de un discurso económico específico, subordinando sus tópicos a un proceso de caracterización literaria para enriquecer la complejidad del personaje.

Los tratos de Argel and the Muslim Story of Joseph and Potiphar’s Wife

Los criticos tienden a leer Los tratos de Argelo como propaganda nacionalista y catolica o como una compleja combinacion de elementos ortodoxos y subversivos. Este articulo se situa en la segunda de estas corrientes. En se analiza la intriga amorosa entre Aurelio y Zahara, concluyendo que se inspira en motivo biblico de Jose y la mujer de Putifar. No es, sin embargo, libro de Genesis su fuente principal, sino versiones musulmanas de la leyenda de Jose que circulaban entre los moriscos. Estos elementos islamicos van disfrazados de motivos y temas cristianos, reflejando asi la practica de taqiyya, o disimulacion, entre los moriscos de Espana. inclusion de detalles de este tipo subvierte tono ortodoxo aparente en la superficie de la obra e implica la posibilidad de que Cervantes tuviera contacto con moriscos exiliados durante su cautiverio en Argel. ********** Los TRATOS DE ARGEL is one of Cervantes's earliest works and is the first in a series of pseudo-autobiographical accounts of his experience as a captive in Algiers. (1) He will later rework the material as Los banos de Argel and, eventually, the famous Captive's Tale in the first part of Don Quijote, but Tratos is unique in its proximity the actual events upon which it is based. Recent scholarship has paid increasing attention Cervantes's Algerian captivity and his resulting complex relationship with Islam. (2) There is also a burgeoning interest in Biblical influences on Cervantes's literary production. (3) These two tendencies converge in this study. I argue that the Aurelio-Zahara love intrigue in Tratos is based on the Biblical motif of Joseph and Potiphar's wife, but that, rather than strictly adhering the Old Testament storyline, Cervantes also incorporates elements of Muslim versions of the story that he likely learned from Morisco acquaintances during his Algerian captivity. The result is a form of literary disguise, reminiscent of a Morisco form of dissimulation known as taqiyya, which undermines the nationalistic, pro-Christian message apparent on the work's surface. Scholars have tended read the play in two oppositional, if not mutually exclusive ways. one camp ate those who see the play as a form of anti-Muslim propaganda that draws upon religious and Orientalist discourses and is meant encourage donations the Mercedarian and Trinitarian orders dedicated ransoming captives. Joaquin Casalduero seems be one of the early proponents of this reading: La vida de Argel es un hecho politico que debe mover a caridad (256). Adrienne Martin argues that to a great degree [Tratos] is a warning Spanish Christians be more charitable and pay ransoms in order save its young (9). She adds that both it and Banos serve and are served by the inevitable Orientalism of their time by associating sexual deviance with religious difference (13). Enrique Fernandez affirms that Tratos pertenece al discurso redentorista del cautiverio, con que comparte su finalidad testimonial-propagandistica (14). Certainly there is abundant evidence for this interpretation in the work. As Kenneth A. Stackhouse points out, In the text of [Tratos], Cervantes repeats almost verbatim the plea that he made on behalf of European slaves in Algiers in his letter Mateo Vasquez [the secretary Phillip II] (13). the other camp are scholars who, without necessarily denying Cervantes's charitable intentions, tend view his perspective on religious and ethnic difference as more complex. Jean Canavaggio, for example, believes that in the Algerian plays Cervantes gives us an infinitely subtler picture of the Muslim world than the caricature-like distortion which we are more often exposed in the polemical writings of his contemporaries (81-82). Moises R. Castillo, noting the contradiction between orthodox and subversive passages in Tratos, asserts that it has do with el plan cervantino de sacar a la superficie y desmantelar, con ayuda de la ironia, los ideales fatuos: honor, pureza de sangre, exagerada ortodoxia religiosa, que vienen impuestos por la ideologia dominante (221-22). …

Assessing the Influence of Insulation on Intravenous Fluid Infusion Temperature

Inducing therapeutic hypothermia using chilled saline in resuscitated cardiac arrest patients has been shown to be feasible and effective. Limited research exists assessing the efficiency of this cooling method. The objective of this study was to assess the change in temperature of 4°C saline upon exiting an infusion set in the laboratory setting while varying conditions of fluid delivery. Efficiency was studied by assessing change in fluid temperature (°C) during the infusion under four laboratory conditions. Each condition was performed four times using 1-L bags of normal saline. Fluid was infused into a 1000-mL beaker through 10 gtt/mL tubing. Flow rate was controlled using a tubing clamp and in-line transducer with a flow meter, while temperature was continuously monitored in a side port at the terminal end of the intravenous (IV) tubing using a digital thermometer. The four conditions included different insulation methods. Descriptive statistics and analysis of variance were performed to assess changes in fluid temperature. The mean (±SD) fluid temperature at time 0 was 3.2°C (95% confidence interval [CI] = 3.0 to 3.4 °C) with no significant difference in starting temperature between groups (p = 0.45). When flow rate was constant, it was determined that fluid temperatures were significantly cooler when infused using a chilled, gel-filled sleeve around the saline bag (p < 0.006). In a laboratory setting, the most efficient method of infusing cold fluid appears to be a method that both keeps the bag of fluid insulated and infused at a faster rate.

Patient Understanding of Emergency Department Discharge Instructions: Where Are Knowledge Deficits Greatest?

Many patients are discharged from the emergency department (ED) with an incomplete understanding of the information needed to safely care for themselves at home. Patients have demonstrated particular difficulty in understanding post-ED care instructions (including medications, home care, and follow-up). The objective of this study was to further characterize these deficits and identify gaps in knowledge that may place the patient at risk for complications or poor outcomes. This was a prospective cohort, phone interview-based study of 159 adult English-speaking patients within 24 to 36 hours of ED discharge. Patient knowledge was assessed for five diagnoses (ankle sprain, back pain, head injury, kidney stone, and laceration) across the following five domains: diagnosis, medications, home care, follow-up, and return instructions. Knowledge was determined based on the concordance between direct patient recall and diagnosis-specific discharge instructions combined with chart review. Two authors scored each case independently and discussed discrepancies before providing a final score for each domain (no, minimal, partial, or complete comprehension). Descriptive statistics were used for the analyses. The study population was 50% female with a median age of 41 years (interquartile range [IQR] = 29 to 53 years). Knowledge deficits were demonstrated by the majority of patients in the domain of home care instructions (80%) and return instructions (79%). Less frequent deficits were found for the domains of follow-up (39%), medications (22%), and diagnosis (14%). Minimal or no understanding in at least one domain was demonstrated by greater than two-thirds of patients and was found in 40% of cases for home care and 51% for return instructions. These deficits occurred less frequently for domains of follow-up (18%), diagnosis (3%), and medications (3%). Patients demonstrate the most frequent knowledge deficits for home care and return instructions, raising significant concerns for adherence and outcomes.

Screening patients with Diabetes Mellitus for Tuberculosis in China

There is a high burden of both diabetes (DM) and tuberculosis (TB) in China, and as DM increases the risk of TB and adversely affects TB treatment outcomes, there is a need for bidirectional screening of the two diseases. How this is best performed is not well determined. In this pilot project in China, we aimed to assess the feasibility and results of screening DM patients for TB within the routine healthcare setting of five DM clinics. Agreement on how to screen, monitor and record was reached in May 2011 at a national stakeholders meeting, and training was carried out for staff in the five clinics in July 2011. Implementation started in September 2011, and we report on 7 months of activities up to 31 March 2012. DM patients were screened for TB at each clinic attendance using a symptom-based enquiry, and those positive to any symptom were referred for TB investigations. In the three quarters, 72% of 3174 patients, 79% of 7196 patients and 68% of 4972 patients were recorded as having been screened for TB, resulting in 7 patients found who were already known to have TB, 92 with a positive TB symptom screen and 48 of these newly diagnosed with TB as a result of referral and investigation. All patients except one were started on anti-TB treatment. TB case notification rates in screened DM patients were several times higher than those of the general population, were highest for the five sites combined in the final quarter (774/100 000) and were highest in one of the five clinics in the final quarter (804/100 000) where there was intensive in-house training, special assignment of staff for screening and colocation of services. This pilot project shows that it is feasible to carry out screening of DM patients for TB resulting in high detection rates of TB. This has major public health and patient-related implications.

Diferencias de género en la relación entre los largos horarios de trabajo y la salud en Catalunya

To analyze gender differences in the relationship of long working hours with type of contract, psychosocial risk factors and health status in Catalonia. Cross sectional study of a representative sample of the working population in Catalonia who worked up to 60 hours per week, interviewed in the 2005 I Survey of Working Conditions in Catalonia (1624 men and 1221 women). The analysis was conducted separately by sex and multivariate logistic regression models were fitted. The reference category was employees working 30-40 hours per week. In both sexes, working 41 to 60 hours per week was associated with non fixed term temporary contracts, low autonomy, low support from colleagues and high skill discretion. In addition, among women, they were also associated with high psychological demands. No relationship with self-perceived health status was observed, but working 41 to 60 hours a week was associated with job dissatisfaction in both sexes (crude odds ratio, 95% confidence intervals: cOR=1.52; 95%CI 1.05 to 2.18 for men; cOR=2.53; 95% CI 1.44 to 4.45 for women) and in women also with nervous disorders/depression (cOR=3.41; 95%CI 1.42 to 8.22). After adjustment for psychosocial risk factors, these associations disappeared among men but not in women. Long working hours are associated with non-fixed term temporary contracts and more psychosocial hazards, as well as with some health indicators, primarily among women. It is likely that the association with health status in women is partially explained by the sum of hours of paid and domestic and family work.

“We Never Could Understand Why the Black Man Did Not Come to Us”:

“We Never Could Understand Why the Black Man Did Not Come to Us”:

“We Never Could Understand Why the Black Man Did Not Come to Us”:

“We Never Could Understand Why the Black Man Did Not Come to Us”:

Thinking with the Inquisition: Heretical Science and Popular Knowledge in Seventeenth-Century Mexico

Digo, que entre los libros de mi uso matematico, filologos, humanistas y otros diferentes, hay algunos que necesitan de alguna expurgacion asi en elogios de herejes, como en errores que incidentemente traen y no de proposito controvertidos ni asumptados ... --Carlos de Siguenza y Gongora In his influential genealogy of the Latin American intellectual, La ciudad letrada [The Lettered City] (1984), Angel Rama interprets the relationship between colonial erudite and popular culture as an antagonistic competition between two linguistic registers. One of these registers that of public pomp and ostentation and was strongly impregnated by peninsular courtly norms [fue la publica y de aparato, que resulto fuertemente impregnada por la norma cortesana procedente de la peninsula], while the other popular and everyday, used by Hispano and Lusophone speakers in their private lives and in their social relations within the same lower class [fue la popular y cotidiana utilizada por los hispano y lusohablantes en su vida privada y en sus relaciones sociales dentro del mismo estrato bajo] (Rama 43-44). (1) In Rama's analysis, writing and orality are coextensive with social categories: encircling the colonial writerly city [ciudad escriturarial was the real city [ciudad real] composed of urban and rural subjects, collectively associated with the plebe or vulgo. To illustrate the attitude of the colonial elite toward the urban lower class, Rama cites a passage from the Mexican Creole scholar Siguenza y Gongora's 1692 letter to his friend the Admiral Pez, at the time a resident in the Spanish court in Madrid. In his letter Siguenza describes the massive riot that occurred in Mexico City the same year, blaming the disturbances on the resentment and ingratitude of the urban plebe. As Rama notes, Siguenza describes Mexico City's plebeian subjects in a cascade of racial epithets after declaring that they were extremely plebeian plebeians that they can only be known as the most wretched [plebe tan en extremo plebe, que solo ella lo puede ser de la que se reputare por la mas infame] (Siguenza y Gongora, Seis obras 113; Rama 46). Yet although he is correct in assigning language a central place in the articulation of the social relationships among colonial subjects, Rama's absolute division between high and low societies obfuscates the extensive areas of their mutual interaction as well as the particular ways in which the writings of colonial letrados invested social categories with meaning. The works of Carlos de Siguenza y Gongora are a case in point. While Siguenza's 1692 letter to which Rama refers clearly reflects elite anxieties about social and ethnic mixture, as he says the condemnable folly with which we live amid so many plebeians at the same time that we consider ourselves to be formidable [culpabilisimo descuidado con que vivimos entre tanta plebe al mismo tiempo que presumimos de formidables] (Siguenza y Gongora, Seis obras 119-20), the Creole scholar's invocation of terms such as plebe and vulgo is also part of his larger project to imagine a local public sphere. Without contradicting the political and theological models that underpinned Spanish absolutism and orthodox Catholicism, Siguenza's works anticipate a public arena in which what Rama calls the letrado would communicate directly with local citizens. This imagined public was the recipient of his most impassioned projects. In what some scholars have interpreted as an anticipation of Enlightenment values, Siguenza was one of the earliest examples of Creole antiquarianism and scientific modernity in a colonial context dominated by elite displays of loyalty to peninsular administration and scholastic orthodoxy in the Church and University. (2) Yet it is not often noted that both history and science were integral to Siguenza's vision of a Mexican patria, an expansive local homeland that demanded a concept of both patrimony (material documents of a local tradition) and citizenship (the interpellated subject of the love of patria), and thus are only fully explicable in reference to the political context in which they appeared. …

Soporte nutricional y factores de riesgo de aparición de fístulas enterocutáneas

Introduction: Among the different factors described, nutritional support has been associated to prevention and management of enterocutaneous fistulae (ECF). Objectives: To assess the influence that the parameters related to nutritional, clinical status, and surgical variables have on the occurrence of ECF. Methods: An observational case/control retrospective study was performed on patients admitted to the General and Digestive Surgery Department. The parameters analyzed were: diagnosis, body mass index (BMI), pathologic personal history, number of surgical interventions (SI) and complications (previous infection, bleeding, and ischemia). In patients with SI, we analyzed: number and type of SI, time until onset of nutritional support, and type of nutritional support. We performed a multiple logistic uni- and multivariate regression analysis by using the SPSSv.19.0 software. Results: The primary diagnoses related to the occurrence of ECF were pancreatic pathology (OR = 5.346) and inflammatory bowel disease (IBD) (OR = 9.329). The surgical variables associated to higher prevalence of ECF emergency SI (OR = 5.79) and multiple SI (OR = 4.52). Regarding the nutritional variables, the late onset of nutrition (more than three days after SI) was associated to the occurrence of ECF (OR = 3.82). Conclusions: In surgical patients, early nutritional support , independently of the route of administration, decreases the occurrence of fistulae. Pancreatic pathology, IBD, emergency SI, and multiple SI were associated to higher prevalence of ECF. The variable hyponutrition appears as a risk factor that should be confirmed in further studies. (Nutr Hosp. 2012;27:213-218) DOI:10.3305/nh.2012.27.1.5405 Resumen Introduccion: Entre los diferentes factores descritos, el soporte nutricional se ha asociado a la prevencion y el tratamiento de las fistulas enterocutaneas (FEC). Objetivos: Evaluar la influencia que los parametros relacionados con variables nutricionales, estado clinico y quirurgicas tienen sobre la aparicion de FEC. Metodos: Se realizo un estudio retrospectivo observacional de casos/controles en pacientes ingresados en Cirugia General y Digestiva. Se analizaron: diagnostico, indice de masa corporal (IMC), antecedentes patologicos, numero de intervenciones quirurgicas (IQ) y complicaciones (infeccion previa, sangrado e isquemia). En los pacientes

Burden and outcome of HIV infection and other morbidities in health care workers attending an Occupational Health Program at the Provincial Hospital of Tete, Mozambique

To investigate the burden and outcome of HIV infection and other morbidities amongst a Mozambican hospital staff. Within an occupational health service set up in April 2008 in the provincial hospital of Tete, Mozambique, we offered to all staff members an initial clinical, laboratory and radiological screening and followed them up prospectively until April 2010. A total of 47.5% of 423 health workers attended the program. The cohort (female-to-male ratio: 2.2; mean age: 39 years) consisted mostly of auxiliary staff (43%) and nurses (29.8%). At initial screening, 71% were asymptomatic. HIV infection (28.4%) and tuberculosis (TB) (21%) were the main reported antecedent illnesses. Laboratory screening revealed anaemia (haemoglobin level <10 mg/dl) in 9% participants, abnormal liver enzymes in 23.9% and a reactive non-treponemal syphilis test in 5%. Of 145 performed chest X-rays, 13% showed abnormalities. All 113 health workers not recently tested for HIV were screened, and 31 were newly diagnosed with HIV infection (resulting in an overall HIV prevalence of 43.8%). Nine cases of TB were diagnosed at screening/during follow-up. In April 2010, all but one of the participants were alive. All HIV-infected health workers under antiretroviral therapy were actively followed-up. Serious conditions were frequently diagnosed in health workers, in particular HIV infection. Mid-term outcome was favourable within this program. Creation of screening and care services dedicated to caregivers should be of highest priority in similar African settings.

An alternative strategy for perinatal verbal autopsy coding: single versus multiple coders

To determine the comparability between cause of death (COD) by a single physician coder and a two-physician panel, using verbal autopsy. The study was conducted between May 2007 and June 2008. Within a week of a perinatal death in 38 rural remote communities in Guatemala, the Democratic Republic of Congo, Zambia and Pakistan, VA questionnaires were completed. Two independent physicians, unaware of the others decisions, assigned an underlying COD, in accordance with the causes listed in the chapter headings of the International classification diseases and related health problems, 10th revision (ICD-10). Cohen's kappa statistic was used to assess level of agreement between physician coders. There were 9461 births during the study period; 252 deaths met study enrolment criteria and underwent verbal autopsy. Physicians assigned the same COD for 75% of stillbirths (SB) (K = 0.69; 95% confidence interval: 0.61-0.78) and 82% early neonatal deaths (END) (K = 0.75; 95% confidence interval: 0.65-0.84). The patterns and proportion of SBs and ENDs determined by the physician coders were very similar compared to causes individually assigned by each physician. Similarly, rank order of the top five causes of SB and END was identical for each physician. This study raises important questions about the utility of a system of multiple coders that is currently widely accepted and speculates that a single physician coder may be an effective and economical alternative to VA programmes that use traditional two-physician panels to assign COD.

High failure rate of the dissolution tests for 500-mg amoxicillin capsules sold in Cambodia: is it because of the product or the test method?

During the survey of substandard medicines in Cambodia in 2007, it was found that more than 90% of 500-mg amoxicillin (AMPC) capsules failed the United States Pharmacopeia (USP) 30 TEST 1 dissolution test. In the USP, several monographs provide multiple methods for performing the dissolution test. By using the 500-mg AMPC capsule as an example, we aimed to identify the problems and implications of the USP methods adopted for the dissolution test as a global standard. All AMPC samples were collected from the Cambodian market in 2007. For the quantitative test, we referred to USP 30. We performed the USP 28 and USP 30 TEST 2 dissolution tests and compared these results with those of the USP 30 TEST 1. All 500-mg AMPC capsules used for the comparison passed the quantitative test. Samples that passed the USP 28 and USP 30 TEST 2 dissolution tests were identical, and the pass rate was 97.1% (34/35), whereas the pass rate with the USP 30 TEST 1 was 8.6% (3/35). The difference in the dissolution results between the three methods was significant (P<0.0001). This study revealed that many users would select the most stringent method when multiple methods exist in the USP. This may lead to a high failure rate of the tests. Because USP is a global standard, we recommend that it take into consideration the developing countries and create a more detailed user-friendly manual for selection for appropriate methods.