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FACTORES ASOCIADOS AL PERFIL DE LíPIDOS SANGUíNEOS EN LOS PACIENTES DEL áREA DE SALUD DE MONTES DE OCA, COSTA RICA
Erick G. Gutiérrez Pea,Juan José Romero Zú?iga
Revista en Ciencias del Movimiento Humano y Salud , 2011,
Abstract: En este estudio se analiza la asociación entre la exposición a diversos factores —de biotipo, socioeconómicos y patológicos— y la alteración del perfil de lípidos sanguíneos (dislipidemia) en pacientes adscritos al área de Salud de Montes de Oca. Se realizó un estudio de caso-control, con un total de 135 casos e igual cantidad de controles, entre 20 y 65 a os, a los que se les hizo un perfil de lípidos sanguíneos durante el a o 2006. Las variables estudiadas fueron: edad, sexo, índice de masa corporal, tipo de aseguramiento, estado de portador de hipertensión arterial, de diabetes mellitus o de ambas patologías crónicas a la vez. Se realizó un análisis univariado, seguido de un análisis multivariado, mediante un modelo logístico múltiple. La única variable asociada con la dislipidemia fue el índice de masa corporal, tanto en el análisis univariado como en el multivariado; las variables restantes no mostraron asociación estadística. Aquellos pacientes con mayor índice de masa corporal presentan un mayor riesgo de tener un perfil alterado de lípidos sanguíneos.
DISLIPIDEMIA Y NIVELES DE LíPIDOS SANGUíNEOS EN PACIENTES TRATADOS EN CENTROS DE ATENCIóN PRIMARIA DE LA ZONA ESTE DE SAN JOSé, COSTA RICA, A O 2006
Erick G. Gutiérrez Pea,Juan José Romero Zú?iga
Revista en Ciencias del Movimiento Humano y Salud , 2010,
Abstract: Dyslipidemia, i.e. high levels of blood lipids (cholesterol and triglycerides), is strongly related to cardiovascular disease (CVD). In order to reduce the risk of CVD at any moment in a person′s life, it is crucial to know his/her –and the population’s– lipid profile. The aim of this study was to assess the (statistical) indicators of blood lipids and the prevalence of dyslipidemia in patients treated in the Integral Health Attention Program from Universidad de Costa Rica. A descriptive study was conducted including 10,044 patients aged 20 to 65 years, who were tested for a blood lipid profile in 2006. A total of 2,969 (29.6%) male and 7,075 (70.4%) female patients took part in the study, with an average age of 43.5 years. General averages for blood lipids were: 203.3 mg/dl for total cholesterol, 50.1 mg/dl for HDL, 120.1 mg/dl for LDL, and 165.6 mg/dl for triglycerides. Prevalence of 17.2% was determined for hypercholesterolemia (≥240 mg/dl), as well as 21.3% for low HDL levels (<40 mg/dl), 11.9% for high LDL levels (≥160 mg/dl), and 26.3% for high triglyceride levels (≥200 mg/dl). Women showed higher overall levels of dyslipidemia than men. Based on health areas, no significant differences were found in general lipid levels by age or sex. Results indicate that the general prevalence of dyslipidemia is close to half the rate reported in worldwide literature and lower than results reported in Costa Rican studies. However, general averages exceeded optimal levels for each blood lipid; consequently, it is important to develop health interventions oriented to reduce the impact of dyslipidemia in the studied population.
Cost-Effectiveness of Breast Cancer Control Strategies in Central America: The Cases of Costa Rica and Mexico
Laurens M. Ni?ns, Sten G. Zelle, Cristina Gutiérrez-Delgado, Gustavo Rivera Pea, Blanca Rosa Hidalgo Balarezo, Erick Rodriguez Steller, Frans F. H. Rutten
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0095836
Abstract: This paper reports the most cost-effective policy options to support and improve breast cancer control in Costa Rica and Mexico. Total costs and effects of breast cancer interventions were estimated using the health care perspective and WHO-CHOICE methodology. Effects were measured in disability-adjusted life years (DALYs) averted. Costs were assessed in 2009 United States Dollars (US$). To the extent available, analyses were based on locally obtained data. In Costa Rica, the current strategy of treating breast cancer in stages I to IV at a 80% coverage level seems to be the most cost-effective with an incremental cost-effectiveness ratio (ICER) of US$4,739 per DALY averted. At a coverage level of 95%, biennial clinical breast examination (CBE) screening could improve Costa Rica's population health twofold, and can still be considered very cost-effective (ICER US$5,964/DALY). For Mexico, our results indicate that at 95% coverage a mass-media awareness raising program (MAR) could be the most cost-effective (ICER US$5,021/DALY). If more resources are available in Mexico, biennial mammography screening for women 50–70 yrs (ICER US$12,718/DALY), adding trastuzumab (ICER US$13,994/DALY) or screening women 40–70 yrs biennially plus trastuzumab (ICER US$17,115/DALY) are less cost-effective options. We recommend both Costa Rica and Mexico to engage in MAR, CBE or mammography screening programs, depending on their budget. The results of this study should be interpreted with caution however, as the evidence on the intervention effectiveness is uncertain. Also, these programs require several organizational, budgetary and human resources, and the accessibility of breast cancer diagnostic, referral, treatment and palliative care facilities should be improved simultaneously. A gradual implementation of early detection programs should give the respective Ministries of Health the time to negotiate the required budget, train the required human resources and understand possible socioeconomic barriers.
A supervised visual model for finding regions of interest in basal cell carcinoma images
Ricardo Gutiérrez, Francisco Gómez, Lucía Roa-Pea, Eduardo Romero
Diagnostic Pathology , 2011, DOI: 10.1186/1746-1596-6-26
Abstract: A typical pathology laboratory examines more than 100 microscopical slides per day [1], a scenario in which its workflow is based on the interaction of the pathologists with a conventional microscope. Digitization brings several advantages over the physical slides at facilitating communication between specialists, annotation of relevant structures and interaction between pathologists and virtual slides [2]. However, the lack of standardized criteria to preserve data reliability -from the early capturing process to the final interpretation-, limits the routine used of virtual microscopy techniques, in despite of its obvious technical advantages, namely, second opinions, team work, image annotation, deterioration-free digital storing. Such a standard should provide a robust frame, allowing the pathologists to achieve proper diagnoses, since it should also garantee that the image data will be free of any artifact introduced during the slide preparation, digitization, transmission or visualization. This standard should deal with three main questions: 1) What quality level meets the minimal diagnosis conditions, avoiding wrong diagnosis decisions? (legal aspect), 2) What quality level is needed for accurate diagnoses? (medical aspect) and, 3) How to measure the image quality for diagnosis? Which is the maximum quality level given by an automated process? (technical aspect) [3]. Moreover, in terms of the diagnosis quality, it is well known that different types of slides require different level of quality, i.e., simple and routine slides require lower quality levels than complex and rarely ones [4]. Furthermore, image regions, considered as relevant, require in general higher quality levels.A reliable determination of clinically meaningful Regions of Interest (RoIs) in medical images is at the very base of strategies for selective image analysis, adaptive delivering of image data and clever compression algorithms. A proper determination of these RoIs would allow to concent
El suicidio en Nari o: una mirada desde los observatorios del delito en cinco municipios del Departamento
María del Pilar Pea Silbato,Yamileth Ortiz Gómez,María Isabel Gutiérrez Martínez
Pensamiento Psicológico , 2009,
Abstract: El suicidio en Colombia es considerado de baja magnitud en relación con el promedio mundial. En la última década se ha observado una ligera tendencia al aumento, principalmente en algunas regiones del país, como en el departamento de Nari o. Para documentar este aumento se realizó un estudio descriptivo con los datos de los observatorios del delito de Pasto, Ipiales, Tumaco, Túquerres y La Unión, entre 2002 y 2007, municipios que reportaron 393 suicidios en este periodo. El 67.6% de los casos fueron en hombres, con una relación 2:1 hombre/mujer, promedio de 29 a os [DE +14.2]. El lugar de mayor ocurrencia fue la casa (70.9%). Los conflictos de pareja fueron reconocidos como el principal factor de ocurrencia, 22%. Los datos de los observatorios fueron usados para el desarrollo de un estudio de factores de riesgo, lo que permitió establecer una línea de base para evaluar y reorientar los programas que están siendo implementados a nivel departamental.
Darío Jaramillo Agudelo: el amor, un pájaro muerto
Isaías Pea Gutiérrez
Nómadas , 1998,
Abstract: Este texto realiza un breve recorrido por el ejercicio literario del poeta y narrador Darío Jaramillo Agudelo, quien desde sus primeros escritos hasta hoy ha vislumbrado la inutilidad de la búsqueda del amor y sin embargo no ha claudicado en ella.
Diversity of Emergency Codes in Hospitals  [PDF]
Nilsa Padilla-Elías, Marisol Pea-Orellana, Ralph Rivera-Gutiérrez, Juan A. Gónzalez-Sánchez, Heriberto A. Marín Centeno, Héctor Alonso-Serra, Liza Millán-Pérez, Patricia Monserrrate-Vázquez
International Journal of Clinical Medicine (IJCM) , 2013, DOI: 10.4236/ijcm.2013.411088
Abstract:

Background: Hospitals must be prepared to deal efficiently and effectively with different emergencies. To accomplish this, several countries have standardized their hospital emergency codes to improve their response capability. This is particularly important in Puerto Rico given that many health professionals, particularly physicians and nurses, provide services in more than one hospital. This study examined the emergency codes and alerts utilized in Puerto Rican hospitals. Objective: To assess hospitals’ level of emergency preparedness and response capability related to the variability of emergency codes and alerts utilized to respond to a situation in Puerto Rico. Method: A survey was conducted to characterize hospital emergency department level of preparedness and response to a mass fatality incident. A total of 39 out of a sample of 44 hospitals participated in the study. Semi-structured questionnaires were administered by the research team to members of each hospital’s administrative staff to explore the following: general hospital characteristics, emergency plans, emergency department capacity, collaborative agreements, personnel training, emergency communications, laboratory facilities, treatment protocols, security, epidemiologic surveillance, equipment and infrastructure. Results: Some hospitals in Puerto Rico use color coded emergency alerts, while others use key words or codes. Single color emergency codes can have different meanings in different hospitals. Conclusions: The findings clearly show that there is a lack of uniformity and clarity in the emergency codes utilized by hospitals in Puerto Rico. Single color codes have diverse meanings in different hospitals. This could adversely affect hospitals efficient and effective emergency response.

Assessing Healthcare Facilities Preparedness for Mass Fatalities Incident  [PDF]
Marisol Pea-Orellana, Ralph Rivera-Gutiérrez, Juan A. Gónzalez-Sánchez, Nilsa Padilla-Elías, Heriberto Marín Centeno, Héctor Alonso-Serra, Liza Millán-Pérez, Patricia Monserrate-Vázquez
International Journal of Clinical Medicine (IJCM) , 2013, DOI: 10.4236/ijcm.2013.412091
Abstract:

Background: Any healthcare facility must be prepared to handle a dramatic increase in deaths that can be produced by a catastrophic disaster. A mass fatality incident (MFI) will significantly increase the usual number of deaths that hospitals or forensic science services can manage on a daily basis. A survey was conducted to assess the hospital emergency department level of preparedness to deal with an MFI. Objective: To examine healthcare facilities level of preparedness for an MFI and morgue capacity. Methods: A total of 39 out of a sample of 44 hospitals participated in the study. Seven questionnaires were administered to explore: hospital general characteristics; emergency plans; equipment and infrastructure; collaborative agreements; personnel trainings; emergency communications; laboratory facilities; treatment protocols; security; and, epidemiologic surveillance. Results: Three-fourths (79.5%) of the healthcare facilities reported having a morgue, their average storage capacity was of three bodies. More than two-thirds (66.7%) of the institutions stated that they could not increase their morgue’s capacity. Most installations without a morgue do not possess an agreement with any other institution for the management of bodies. Hospitals have a very limited number of body bags utilized for the handling and transport of bodies. Conclusion:

La percepción geográfica como factor en el desarrollo local
Carlos Gutiérrez,Jaime Pea
Ultima Década , 1996,
Abstract:
Bayesian Predictive Configural Frequency Analysis
Eduardo Gutiérrez-Pea
Psychological Test and Assessment Modeling , 2012,
Abstract: Configural Frequency Analysis is a method for cell-wise inspection of cross-classifications. CFA searches for patterns of variable categories that occur either more often or less often than expected from a given base model. In this paper, we propose and discuss an alternative notion of types and antitypes that focuses on the likely values of the cell frequencies in future experiments, as opposed to the average values of such frequencies. The idea is developed from a Bayesian point of view.
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