Factores de riesgo maternos asociados a muerte fetal tardia, Hospital "Humberto Alvarado Vazquez" en el periodo de Enero 2010 a Junio 2013

El presente trabajo titulado “Principales Factores De Riesgo Asociados A Muerte Fetal, En El Hospital Humberto Alvarado Vásquez, En El Periodo Comprendido Enero 2010 A Junio 2013”, pretende como objetivo general identificar los factores de riesgo que conllevan al óbito fetal. Se realizó un estudio analítico de casos y controles con 91 casos de muerte fetal de 28 semanas de gestación o más y 182 controles. El estudio explora la hipótesis de que el factor de riesgo más importante para óbito fetal tardío es la diabetes mellitus. Se estudiaron un total de 35 variables. Se comparó la frecuencia de diferentes variables maternas que en forma previa se han reportado asociadas a muerte fetal, se estimó la fuerza de asociación entre estas variables y muerte fetal con Odds Ratio, con un intervalo de confianza del 95% y valor de p<0.05. Se incluyen al estudio pacientes ingresadas en el Hospital Humberto Alvarado Vásquez, del área de ARO, con o sin feto vivo. Con respecto a las características sociodemográficas, solo edad materna y el estado civil tuvieron significancia estadística. Pacientes menores de 20 y mayores de 35 años tienen mayor riesgo de presentar óbito y las madres solteras tienen menos riesgo En relación con los antecedentes pre-concepcionales, las pacientes que presentan antecedentes personales patológicos de diabetes mellitus tienen casi cuatro veces más riesgo de presentar óbito fetal tardío. En cuanto a los factores obstétricos: Se encontró como factor protector un periodo intergenésico menor de dos años. Se encontraron como factores de riesgo, en orden de importancia: DPPNI (23 veces más), la circular de cordón (15 veces más), SG 41 (12 veces más), líquido amniótico meconial y oligohidramnios y presentación no cefálica (6 veces más), multiparidad y parto por cesárea (2 veces más). La diabetes gestacional no fue identificada como factor de riesgo (OR: 6.17, IC95% 0.6-60.17, p: 0.06). Aunque se acepta la hipótesis de que la DM pre-concepcional es uno de los factores de riesgo materno para la mortalidad fetal tardía, no fue el más importante. En conclusión, del total de 35 factores estudiados, se encontraron 13 factores asociados: once factores de riesgo y dos factoresprotectores. La mayoría de estos factores pueden ser prevenibles o diagnosticados precozmente y tratables. Se recomienda fomentar el uso de métodos anticonceptivos además de dar charlas acerca de atención prenatal. Tomando en cuenta que la DM como antecedente patológico es un factor de riesgo, es importante el seguimiento en intervalos más cortos de estas pacientes y darles atención especializada y personalizada. El personal de salud debe ser capacitado y evaluado constantemente en temas como CPN y factores de riesgo

Pobreza y activos en Bolivia: Qué rol juega el capital social?

Análisis recientes de la pobreza en Bolivia muestran que, a pesar de un ligero descenso en el porcentaje de la población que vive en condiciones de pobreza a lo largo de la última década, el número absoluto de hogares pobres continúa en ascenso (Jiménez y Yañez 1997a y b; Vos et al. 1997; Banco Mundial 1996). El bajo nivel de crecimiento de los ingresos de los hogares más pobres sugiere que los esfuerzos sostenidos por mantener niveles de crecimiento económico moderados e incrementar la eficiencia en la asignación del gasto e inversión pública no han sido suficientes para revertir las condiciones de pobreza crónica que caracterizan al país. Los enfoques analíticos que sostuvieron la aplicación de políticas de crecimiento y redes de protección en la región también se encuentran en un periodo de cuestionamiento y reformulación. Perspectivas que enfatizaban la medición de la pobreza por insuficiencia de ingresos o necesidades básicas (Lipton y van der Gaag 1993; Boltvinik 1992), se encuentran interpelados por modelos alternativos que procuran analizar patrones de causalidad entre pobreza y el acceso a mercados de activos de capital humano, capital físico (público y privado) y capital social (Birdsall y Londoño 1997a y b; Moser 1998; Collier 1998). Este estudio procura contribuir al análisis de la pobreza desde la perspectiva de recursos y activos, y describir los alcances de este enfoque aplicado al caso boliviano.

El tratamiento institucional de los menores que cometen delitos antes de los 14 años

La LO 5/2000, reguladora de la responsabilidad penal de los menores ha obligado a las comunidades autónomas no sólo a asumir la responsabilidad de responder a los menores de entre 14 y 17 años que cometen delitos, sino también a trabajar formal y preventivamente con los menores de 14 años que delincan. La propia legislación de menores establecía la necesidad de trabajar con estos menores de 14 años desde los servicios de Protección de la Infancia; una institución que hasta el momento trabajaba con esquemas clásicos de desprotección de la infancia y abandono familiar y no sobre situaciones de riesgo social. El objetivo de este trabajo es sacar a la luz una realidad apenas conocida en el ámbito español: la de los delitos cometidos por menores de 14 años y las medidas desarrolladas en este tiempo por las instituciones que trabajan con ellos. En él se muestran los resultados de una investigación empírica realizada en tres comunidades autónomas españolas: Aragón, Andalucía y Castilla-La Mancha, en la que se han analizado el 25% de los expedientes de menores que cometieron un delito a lo largo del año 2004 y en la que se ha entrevistado a expertos del ámbito jurídico y social que trabajan con esta población infantil

Air quality in North America's most populous city ? overview of MCMA-2003 Campaign

International audienceExploratory field measurements in the Mexico City Metropolitan Area (MCMA) in February 2002 set the stage for a major air quality field measurement campaign in the spring of 2003 (MCMA-2003). Involving over 100 scientists from more than 30 institutions in Mexico, the United States and Europe, MCMA-2003 revealed important new insights into the meteorology, primary pollutant emissions, ambient secondary pollutant precursor concentrations, photochemical oxidant production and secondary aerosol particle formation in North America's most populated and polluted megacity. A description of meteorological and atmospheric chemistry and aerosol microphysics measurements performed during MCMA-2003 is presented. More than three dozen published or submitted MCMA-2003 research papers are reviewed and key discoveries pertinent to understanding and improving air quality in Mexico City and similar megacities in the developing world are summarized

Air quality in North America's most populous city ? overview of the MCMA-2003 campaign

International audienceExploratory field measurements in the Mexico City Metropolitan Area (MCMA) in February 2002 set the stage for a major air quality field measurement campaign in the spring of 2003 (MCMA-2003). Involving over 100 scientists from more than 30 institutions in Mexico, the United States and Europe, MCMA-2003 revealed important new insights into the meteorology, primary pollutant emissions, ambient secondary pollutant precursor concentrations, photochemical oxidant production and secondary aerosol particle formation in North America's most populated and polluted megacity. A description of meteorological and atmospheric chemistry and aerosol microphysics measurements performed during MCMA-2003 is presented. More than 40 published or submitted MCMA-2003 research papers are reviewed and key discoveries pertinent to understanding and improving air quality in Mexico City and similar megacities in the developing world are summarized

Sources and transformations of particle-bound polycyclic aromatic hydrocarbons in Mexico City

Understanding sources, concentrations, and transformations of polycyclic aromatic hydrocarbons (PAHs) in the atmosphere is important because of their potent mutagenicity and carcinogenicity. The measurement of particle-bound PAHs by three different methods during the Mexico City Metropolitan Area field campaign in April 2003 presents a unique opportunity for characterization of these compounds and intercomparison of the methods. The three methods are (1) collection and analysis of bulk samples for time-integrated gas- and particle-phase speciation by gas chromatography/mass spectrometry; (2) aerosol photoionization for fast detection of PAHs on particles' surfaces; and (3) aerosol mass spectrometry for fast analysis of size and chemical composition. This research represents the first time aerosol mass spectrometry has been used to measure ambient PAH concentrations and the first time that fast, real-time methods have been used to quantify PAHs alongside traditional filter-based measurements in an extended field campaign. Speciated PAH measurements suggest that motor vehicles and garbage and wood burning are important sources in Mexico City. The diurnal concentration patterns captured by aerosol photoionization and aerosol mass spectrometry are generally consistent. Ambient concentrations of particle-phase PAHs typically peak at ~110 ng m^-3 during the morning rush hour and rapidly decay due to changes in source activity patterns and dilution as the boundary layer rises, although surface-bound PAH concentrations decay faster. The more rapid decrease in surface versus bulk PAH concentrations during the late morning suggests that freshly emitted combustion-related particles are quickly coated by secondary aerosol material in Mexico City's atmosphere and may also be transformed by heterogeneous reactions

Determination of particulate lead using aerosol mass spectrometry: MILAGRO/MCMA-2006 observations

We report the first measurements of particulate lead (Pb) from Aerodyne Aerosol Mass Spectrometers, which were deployed in and around Mexico City during the Megacity Initiative: Local and Global Research Observations (MILAGRO)/Mexico City Metropolitan Area 2006 (MCMA-2006) field campaigns. The high resolution mass spectrometer of one of the AMS instruments (HR-AMS) and the measured isotopic ratios unequivocally prove the detection of Pb in ambient particles. A substantial fraction of the lead evaporated slowly from the vaporizer of the instruments, which is indicative of species with low volatility at 600 °C. A model was developed in order to estimate the ambient particulate Pb entering the AMS from the signals in the "open" and the "closed" (or "background") mass spectrum modes of the AMS. The model suggests the presence of at least two lead fractions with ~25% of the Pb signal exhibiting rapid evaporation (1/e decay constant, τ<0.1 s) and ~75% exhibiting slow evaporation (τ~2.4 min) at the T0 urban supersite and a different fraction (70% prompt and 30% slow evaporation) at a site northwest from the metropolitan area (PEMEX site). From laboratory experiments with pure Pb(NO3)2 particles, we estimated that the Pb ionization efficiency relative to nitrate (RIEPb) is 0.5. Comparison of time series of AMS Pb with other measurements carried out at the T0 supersite during MILAGRO (using Proton Induced X-ray Emission (PIXE), Inductively-Coupled Plasma Mass Spectrometry (ICP-MS) and single-particle counts from an Aerosol Time-of-Fight Mass Spectrometer (ATOFMS)) shows similar levels (for PIXE and ICP-MS) and substantial correlation. During part of the campaign, sampling at T0 was alternated every 10 min with an Aerosol Concentrator, which enabled the detection of signals for PbCl+ and PbS+ ions. PbS+ displays the signature of a slowly evaporating species, while PbCl+ appears to arise only from fast evaporation, which is likely due to the higher vapor pressure of the compounds generating PbCl+. This is consistent with the evaporation model results. Levels of particulate Pb measured at T0 were similar to previous studies in Mexico City. Pb shows a diurnal cycle with a maximum in the early morning, which is typical of primary urban pollutants. Pb shows correlation with Zn, consistent with previous studies, while the sources of Pb appear to be at least partially disjoint from those of particulate chloride. Back trajectory analysis of the T0 Pb data suggests the presence of sources inside the urban area SSW and N of T0, with different chemical forms of Pb being associated with different source locations. High signals due to particulate lead were also detected in the PEMEX site; again, no correlation between Pb and chloride plumes was observed, suggesting mostly different sources for both species.National Science Foundation (U.S.) (grant ATM-0449815)National Science Foundation (U.S.) (grant ATM- 0528634)National Science Foundation (U.S.) (grant ATM-0810950)National Science Foundation (U.S.) (grant ATM-0528227)United States. Dept. of Energy (BER/ASP grant DE-FG02-05-ER63981)United States. Dept. of Energy (BER/ASP grant DE-FG02-05-ER63980)Comision Ambiental Metropolitana (Mexico)United States. National Oceanic and Atmospheric Administration/OGP (grant NA08OAR4310565

Characterization of ambient aerosols in Mexico City during the MCMA-2003 campaign with Aerosol Mass Spectrometry ? Part II: overview of the results at the CENICA supersite and comparison to previous studies

International audienceAn Aerodyne Aerosol Mass Spectrometer (AMS) was deployed at the CENICA Supersite during the Mexico City Metropolitan Area field study from 31 March?4 May 2003. The AMS provides real time information on mass concentration and composition of the non-refractory species in particulate matter less than 1 µm (NR-PM1) with high time and size-resolution. Measurements of Black Carbon (BC) using an aethalometer, and estimated soil concentrations from Proton-Induced X-Ray Emission (PIXE) analysis of impactor substrates are also presented and combined with the AMS in order to include refractory material and estimate the total PM2.5 mass concentration at CENICA during this campaign. In Mexico City, the organic fraction of the estimated PM2.5 at CENICA represents 54.6% of the mass, with the rest consisting of inorganic compounds (mainly ammonium nitrate and sulfate/ammonium salts), BC, and soil. Inorganic compounds represent 27.5% of PM2.5; BC mass concentration is about 11%; while soil represents about 6.9%. The NR species and BC have diurnal cycles that can be qualitatively interpreted as the interplay of direct emissions, photochemical production in the atmosphere followed by condensation and gas-to-particle partitioning, boundary layer dynamics, and/or advection. Bi- and trimodal size distributions are observed for the AMS species, with a small combustion (likely traffic) organic particle mode and an accumulation mode that contains mainly organic and secondary inorganic compounds. The AMS and BC mass concentrations, size distributions, and diurnal cycles are found to be qualitatively similar to those from most previous field measurements in Mexico City