Resumo Introdução: Estudos que avaliaram o manejo do refluxo laringofaríngeo por otorrinolaringologistas mostraram uma importante heterogeneidade em relação à definição, diagnóstico e tratamento, o que leva a discrepâncias no tratamento do paciente. Faltam informações sobre o conhecimento e as práticas atuais dos otorrinolaringologistas brasileiros sobre o refluxo laringofaríngeo. Objetivo: Investigar as tendências no manejo da doença do refluxo laringofaríngeo entre os otorrinolaringologistas brasileiros. Método: O questionário foi enviado por e-mail aos membros da Associação Brasileira de Otorrinolaringologia-Cirurgia de Cabeça e Pescoço. Esta pesquisa foi inicialmente conduzida pelo LPR Study Group of Young Otolaryngologists da International Federation of Otolaryngological Societies. Resultados: De acordo com os respondentes da pesquisa, a prevalência de refluxo laringofaríngeo foi estimada em 26,8% dos pacientes consultados e os sintomas mais comuns foram sensação de globus, pigarro, tosse e refluxo de ácido estomacal. Obstrução nasal, disfunção da trompa de Eustáquio, otite média aguda e crônica, nódulos nas pregas vocais e hemorragia foram considerados como não associados ao refluxo laringofaríngeo pela maioria dos respondentes. Cerca de 2/3 dos otorrinolaringologistas brasileiros basearam o diagnóstico de refluxo laringofaríngeo na avaliação dos sintomas e achados e na resposta positiva a testes terapêuticos empíricos. Inibidores de bomba de prótons uma ou duas vezes ao dia foi o esquema terapêutico mais usado. Somente 21,4% dos otorrinolaringologistas brasileiros já ouviram falar sobre refluxo laringofaríngeo não ácido e misto e o conhecimento sobre a utilidade do monitoramento de pH por impedância intraluminal multicanal foi mínimo; 30,5% dos respondentes não se consideraram tão bem informados sobre o refluxo laringofaríngeo. Conclusão: Embora os sintomas relacionados ao refluxo laringofaríngeo e as principais abordagens diagnósticas e terapêuticas referidas pelos otorrinolaringologistas brasileiros sejam consistentes com a literatura, a pesquisa identificou algumas limitações, como o conhecimento insuficiente do papel do refluxo laringofaríngeo em diversas condições otorrinolaringológicas e da possibilidade de refluxo não ácido ou misto em casos refratários. Estudos futuros são necessários para estabelecer recomendações internacionais para o manejo de doença do refluxo laringofaríngeo.

Abstract Introduction: Studies assessing the management of laryngopharyngeal reflux by otolaryngologists have reported an important heterogeneity regarding the definition, diagnosis, and treatment, which leads to discrepancies in the management of the patient. Information about the current knowledge and practices of Brazilian otolaryngologists in laryngopharyngeal reflux is lacking. Objective: To investigate the trends in management of laryngopharyngeal reflux disease among Brazilian otolaryngologists. Methods: A survey was sent by email to the members of the Brazilian Association of Otolaryngology-Head Neck Surgery. This survey has initially been conducted by the laryngopharyngeal reflux study group of young otolaryngologists of the International Federation of Otolaryngological Societies. Results: According to the survey responders, the prevalence of laryngopharyngeal reflux was estimated to be 26.8% of patients consulting in otolaryngology and the most common symptoms were globus sensation, throat clearing, cough and stomach acid reflux. Nasal obstruction, Eustachian tube dysfunction, acute and chronic otitis media, vocal fold nodules and hemorrhage were considered not associated with laryngopharyngeal reflux by the majority of responders. About 2/3 of Brazilian otolaryngologists based the diagnosis of laryngopharyngeal reflux on the assessment of both symptoms and findings and a positive response to empiric therapeutic trials. Proton pump inhibitor utilized once or twice daily, was the most commonly used therapeutic scheme. Only 21.4% of Brazilian otolaryngologists have heard about nonacid and mixed laryngopharyngeal reflux and the awareness about the usefulness of multichannel intraluminal impedance pH monitoring (MII-pH) was minimal; 30.5% of responders did not consider themselves as well-informed about laryngopharyngeal reflux. Conclusion: Although the laryngopharyngeal reflux-related symptoms, main diagnostic and treatment approaches referred by Brazilian otolaryngologists are consistent with the literature, the survey identified some limitations, such as the insufficient awareness of the role of laryngopharyngeal reflux in many otolaryngological conditions and of the possibility of non-acid or mixed reflux in refractory cases. Future studies are needed to establish international recommendations for the management of laryngopharyngeal reflux disease.

ABSTRACT Objective: the RE-AIM framework has been widely used to evaluate internal and external validity of interventions aimed to promote physical activity, helping to provide comprehensive evaluation of the reach, efficacy, adoption, implementation and maintenance of research and programming. Despite this progress, the RE-AIM framework has not been used widely in Latin America. The purpose of this manuscript is to describe the RE-AIM framework, the process and materials developed for a one-day workshop in Guadalajara, and the acceptability and satisfaction of participants that attended the workshop. Methods: lecture, interactive examples and an agenda were developed for a one-day RE-AIM workshop over a three month period. Results: thirty two health care practitioners (M age = 30.6, SD=9.9 years) attended the workshop. Most (100%) rated the workshop as credible, useful (100%) and intended to apply it in current or future research (95%). Conclusion: results suggest intuitive appeal of the RE-AIM framework, and provide a strategy for introducing the utility and practical application of the framework in practice settings in Mexico and Latin America.

RESUMEN Objetivo: el marco RE-AIM ha sido ampliamente utilizado para evaluar la validez interna y externa de intervenciones destinadas a promover la actividad física, ayudando a proporcionar una evaluación exhaustiva de la cobertura, eficacia/efectividad, adopción, implementación y mantenimiento de programas sobre actividad física. A pesar de este progreso, el marco RE-AIM no se ha utilizado ampliamente en América Latina. El objetivo de este artículo es presentar el marco conceptual RE-AIM, describir el proceso y los materiales desarrollados para un taller en Guadalajara; y reportar la aceptabilidad y satisfacción de los participantes que acudieron al taller. Métodos: durante un período de tres meses, se desarrolló un taller sobre el marco RE-AIM. El taller duró un día e incluyó una conferencia y ejercicios interactivos. Resultados: treinta y dos profesionales de la salud (edad media = 30.6 [±9.9 años]) participaron en el taller. La mayoría calificó el taller como creíble, útil (100%) y manifestó la intención de aplicar lo aprendido en investigaciones actuales o futuras (95%). Conclusión: los resultados sugieren que el marco RE-AIM es intuitivamente atractivo y que el curso es una estrategia adecuada para introducir la utilidad y aplicación práctica del marco en espacios de práctica en América Latina.

RESUMO Objetivo: o modelo RE-AIM tem sido amplamente utilizado para avaliar a validade interna e externa de intervenções que objetivam promover atividade física, auxiliando a fornecer uma avaliação abrangente do alcance, eficácia, adoção, implementação e manutenção de pesquisas e programas. Apesar deste progresso, o modelo RE-AIM não tem sido amplamente utilizado na América Latina. O objetivo deste artigo é descrever o modelo RE-AIM, o processo e os materiais desenvolvidos para uma oficina de um dia de duração em Guadalajara e a aceitabilidade e satisfação dos participantes que compareceram na oficina. Métodos: durante o período de três meses, palestras e exercícios interativos foram desenvolvidos para uma oficina de um dia sobre o modelo RE-AIM. Resultados: trinta e dois profissionais de saúde (Média de idade=30,6±9,9 anos) participaram da oficina. A maioria dos participantes classificou a oficina como credível (100%), útil (100%) e pretende aplicar o que foi aprendido em investigações atuais ou futuras (95%). Conclusão: os resultados sugerem que o modelo RE-AIM é um recurso intuitivo e fornecem uma estratégia para a apresentação da utilidade e aplicação prática do modelo em cenários práticos no México e na América Latina.

RESUMO Objetivo: o modelo RE-AIM tem sido amplamente utilizado para avaliar a validade interna e externa de intervenções que objetivam promover atividade física, auxiliando a fornecer uma avaliação abrangente do alcance, eficácia, adoção, implementação e manutenção de pesquisas e programas. Apesar deste progresso, o modelo RE-AIM não tem sido amplamente utilizado na América Latina. O objetivo deste artigo é descrever o modelo RE-AIM, o processo e os materiais desenvolvidos para uma oficina de um dia de duração em Guadalajara e a aceitabilidade e satisfação dos participantes que compareceram na oficina. Métodos: durante o período de três meses, palestras e exercícios interativos foram desenvolvidos para uma oficina de um dia sobre o modelo RE-AIM. Resultados: trinta e dois profissionais de saúde (Média de idade=30,6±9,9 anos) participaram da oficina. A maioria dos participantes classificou a oficina como credível (100%), útil (100%) e pretende aplicar o que foi aprendido em investigações atuais ou futuras (95%). Conclusão: os resultados sugerem que o modelo RE-AIM é um recurso intuitivo e fornecem uma estratégia para a apresentação da utilidade e aplicação prática do modelo em cenários práticos no México e na América Latina.

ABSTRACT Objective: the RE-AIM framework has been widely used to evaluate internal and external validity of interventions aimed to promote physical activity, helping to provide comprehensive evaluation of the reach, efficacy, adoption, implementation and maintenance of research and programming. Despite this progress, the RE-AIM framework has not been used widely in Latin America. The purpose of this manuscript is to describe the RE-AIM framework, the process and materials developed for a one-day workshop in Guadalajara, and the acceptability and satisfaction of participants that attended the workshop. Methods: lecture, interactive examples and an agenda were developed for a one-day RE-AIM workshop over a three month period. Results: thirty two health care practitioners (M age = 30.6, SD=9.9 years) attended the workshop. Most (100%) rated the workshop as credible, useful (100%) and intended to apply it in current or future research (95%). Conclusion: results suggest intuitive appeal of the RE-AIM framework, and provide a strategy for introducing the utility and practical application of the framework in practice settings in Mexico and Latin America.

RESUMEN Objetivo: el marco RE-AIM ha sido ampliamente utilizado para evaluar la validez interna y externa de intervenciones destinadas a promover la actividad física, ayudando a proporcionar una evaluación exhaustiva de la cobertura, eficacia/efectividad, adopción, implementación y mantenimiento de programas sobre actividad física. A pesar de este progreso, el marco RE-AIM no se ha utilizado ampliamente en América Latina. El objetivo de este artículo es presentar el marco conceptual RE-AIM, describir el proceso y los materiales desarrollados para un taller en Guadalajara; y reportar la aceptabilidad y satisfacción de los participantes que acudieron al taller. Métodos: durante un período de tres meses, se desarrolló un taller sobre el marco RE-AIM. El taller duró un día e incluyó una conferencia y ejercicios interactivos. Resultados: treinta y dos profesionales de la salud (edad media = 30.6 [±9.9 años]) participaron en el taller. La mayoría calificó el taller como creíble, útil (100%) y manifestó la intención de aplicar lo aprendido en investigaciones actuales o futuras (95%). Conclusión: los resultados sugieren que el marco RE-AIM es intuitivamente atractivo y que el curso es una estrategia adecuada para introducir la utilidad y aplicación práctica del marco en espacios de práctica en América Latina.

Objective. This cross sectional study aims to determine the effects of gender and parental perception of safety at school on children's physical activity (PA) levels. Materials and methods. Parents of school aged Mexican children residing in Guadalajara, Mexico City, and Puerto Vallarta, completed surveys about their children's PA measures. The physical activity indicators were evaluated using linear and logistical regression models. Results. Analysis did not indicate that gender moderated the relationship between parental perception of safety and PA measures, but significant gender issues exist with girls participating less than boys in the three measures of PA in this study (p<0.001). Conclusion. Results suggest the need for additional interventions promoting physical activity in girls in Mexico.

Objetivo. Determinar los efectos de género y percepción paternal de la seguridad en escuelas, en niveles de actividad física (AF) en los niños. Material y métodos. Padres con hijos escolares residentes en Guadalajara, Ciudad de México, y Puerto Vallarta, completaron encuestas sobre los niveles de AF de sus hijos. Se evaluaron los indicadores de AF usando modelos de regresión lineal y logística. Resultados. El análisis no indica que el género modere la relación entre percepción de seguridad y medidas de AF, pero hay indicadores significativos de que las niñas participan menos que los varones en las medidas de AF de este estudio (p<0.001). Conclusión. Los resultados sugieren la necesidad de intervenciones adicionales que promuevan la AF en niñas mexicanas.

Objective. This cross sectional study aims to determine the effects of gender and parental perception of safety at school on children's physical activity (PA) levels. Materials and methods. Parents of school aged Mexican children residing in Guadalajara, Mexico City, and Puerto Vallarta, completed surveys about their children's PA measures. The physical activity indicators were evaluated using linear and logistical regression models. Results. Analysis did not indicate that gender moderated the relationship between parental perception of safety and PA measures, but significant gender issues exist with girls participating less than boys in the three measures of PA in this study (p<0.001). Conclusion. Results suggest the need for additional interventions promoting physical activity in girls in Mexico.

Objetivo. Determinar los efectos de género y percepción paternal de la seguridad en escuelas, en niveles de actividad física (AF) en los niños. Material y métodos. Padres con hijos escolares residentes en Guadalajara, Ciudad de México, y Puerto Vallarta, completaron encuestas sobre los niveles de AF de sus hijos. Se evaluaron los indicadores de AF usando modelos de regresión lineal y logística. Resultados. El análisis no indica que el género modere la relación entre percepción de seguridad y medidas de AF, pero hay indicadores significativos de que las niñas participan menos que los varones en las medidas de AF de este estudio (p<0.001). Conclusión. Los resultados sugieren la necesidad de intervenciones adicionales que promuevan la AF en niñas mexicanas.

Objective. To assess the informational, educational and instrumental environments among Mexican healthcare settings for their potential to promote physical activity (PA). Materials and methods. The Environmental Physical Activity Assessment Tool for Healthcare Settings (EPATHS) was developed to assess the PA environments of 40 clinics/hospitals representing the three Mexican healthcare systems in Guadalajara. The EPATHS assessed the presence and quality of PA enhancing features in the informational (e.g. signage), educational (e.g. pamphlets), and instrumental (e.g. stairs) environments of included clinics/hospitals. Results. 28 (70%) clinics/hospitals had more than one floor with stairs; 60% of these had elevators. Nearly 90% of stairs were visible, accessible and clean compared to fewer than 30% of elevators. Outdoor spaces were observed in just over half (55%) of clinics/hospitals, and most (70%) were of good quality. Only 25% clinics/hospitals had educational PA materials. Conclusions. The PA instrumental environment of Mexican healthcare settings is encouraging. The informational and educational environments could improve.

Objetivo. Evaluar el entorno informacional, educacional e instrumental de clínicas/hospitales en México y determinar su potencial para promover la actividad física (AF). Material y métodos. Se desarrolló una herramienta (Environmental physical activity assessment tool for healthcare settings [EPATHS]) para evaluar los entornos de AF en 40 clínicas/hospitales de Guadalajara afiliados a los tres sistemas de salud de México. Con el EPATHS se evaluó la presencia y calidad del entorno informacional (pe.: letreros), educacional (ep.: panfletos) e instrumental (pe.: escaleras). Resultados. Del total de clínicas/hospitales incluidos, 28 (70%) tuvieron más de un piso y escaleras; de éstos, 60% tuvo elevadores. Cerca de 90% de las escaleras eran visibles, accesibles y limpias, lo que contrasta con menos de 30% para los elevadores. En 55% de las clínicas/hospitales se observaron áreas verdes, la mayoría de éstas (80%) de buena calidad. En sólo 25% de las clínicas/hospitales se observaron materiales educativos sobre AF. Conclusiones. El entorno instrumental en clínicas/hospitales mexicanos es alentador. Los entornos informativos y educativos podrían mejorar.

Objective. To assess the informational, educational and instrumental environments among Mexican healthcare settings for their potential to promote physical activity (PA). Materials and methods. The Environmental Physical Activity Assessment Tool for Healthcare Settings (EPATHS) was developed to assess the PA environments of 40 clinics/hospitals representing the three Mexican healthcare systems in Guadalajara. The EPATHS assessed the presence and quality of PA enhancing features in the informational (e.g. signage), educational (e.g. pamphlets), and instrumental (e.g. stairs) environments of included clinics/hospitals. Results. 28 (70%) clinics/hospitals had more than one floor with stairs; 60% of these had elevators. Nearly 90% of stairs were visible, accessible and clean compared to fewer than 30% of elevators. Outdoor spaces were observed in just over half (55%) of clinics/hospitals, and most (70%) were of good quality. Only 25% clinics/hospitals had educational PA materials. Conclusions. The PA instrumental environment of Mexican healthcare settings is encouraging. The informational and educational environments could improve.

Objetivo. Evaluar el entorno informacional, educacional e instrumental de clínicas/hospitales en México y determinar su potencial para promover la actividad física (AF). Material y métodos. Se desarrolló una herramienta (Environmental physical activity assessment tool for healthcare settings [EPATHS]) para evaluar los entornos de AF en 40 clínicas/hospitales de Guadalajara afiliados a los tres sistemas de salud de México. Con el EPATHS se evaluó la presencia y calidad del entorno informacional (pe.: letreros), educacional (ep.: panfletos) e instrumental (pe.: escaleras). Resultados. Del total de clínicas/hospitales incluidos, 28 (70%) tuvieron más de un piso y escaleras; de éstos, 60% tuvo elevadores. Cerca de 90% de las escaleras eran visibles, accesibles y limpias, lo que contrasta con menos de 30% para los elevadores. En 55% de las clínicas/hospitales se observaron áreas verdes, la mayoría de éstas (80%) de buena calidad. En sólo 25% de las clínicas/hospitales se observaron materiales educativos sobre AF. Conclusiones. El entorno instrumental en clínicas/hospitales mexicanos es alentador. Los entornos informativos y educativos podrían mejorar.

BACKGROUND Stroke is the major cause of adult disability. Selective serotonin reuptake inhibitors (SSRIs) have been used for many years to manage depression. Recently, small trials have demonstrated that SSRIs might improve recovery after stroke, even in people who are not depressed. Systematic reviews and meta-analyses are the least biased way to bring together data from several trials. Given the promising effect of SSRIs on stroke recovery seen in small trials, a systematic review and meta-analysis is needed. OBJECTIVE To determine whether SSRIs improve recovery after stroke, and whether treatment with SSRIs was associated with adverse effects. METHODS Search methods: We searched the Cochrane Stroke Group Trials Register (August 2011), Cochrane Depression Anxiety and Neurosis Group Trials Register (November 2011), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 8), MEDLINE (from 1948 to August 2011), EMBASE (from 1980 to August 2011), CINAHL (from 1982 to August 2011), AMED (Allied and Complementary Medicine) (from 1985 to August 2011), PsycINFO (from 1967 to August 2011) and PsycBITE (Pyschological Database for Brain Impairment Treatment Efficacy) (March 2012). To identify further published, unpublished and ongoing trials we searched trials registers, pharmaceutical websites, reference lists, contacted experts and performed citation tracking of included studies. Selection criteria: We included randomized controlled trials that recruited stroke survivors (ischaemic or haemorrhagic) at any time within the first year. The intervention was any SSRI, given at any dose, for any period. We excluded drugs with mixed pharmacological effects. The comparator was usual care or placebo. In order to be included, trials had to collect data on at least one of our primary (dependence and disability) or secondary (impairments, depression, anxiety, quality of life, fatigue, healthcare cost, death, adverse events and leaving the trial early) outcomes. Data collection and analysis: We extracted data on demographics, type of stroke, time since stroke, our primary and secondary outcomes, and sources of bias. For trials in English, two review authors independently extracted data. For Chinese papers, one review author extracted data. We used standardized mean differences (SMD) to estimate treatment effects for continuous variables, and risk ratios (RR) for dichotomous effects, with their 95% confidence intervals (CIs). MAIN RESULTS We identified 56 completed trials of SSRI versus control, of which 52 trials (4059 participants) provided data for meta-analysis. There were statistically significant benefits of SSRI on both of the primary outcomes: RR for reducing dependency at the end of treatment was 0.81 (95% CI 0.68 to 0.97) based on one trial, and for disability score, the SMD was 0.91 (95% CI 0.60 to 1.22) (22 trials involving 1343 participants) with high heterogeneity between trials (I2 = 87%; P < 0.0001). For neurological deficit, depression and anxiety, there were statistically significant benefits of SSRIs. For neurological deficit score, the SMD was -1.00 (95% CI -1.26 to -0.75) (29 trials involving 2011 participants) with high heterogeneity between trials (I2 = 86%; P < 0.00001). For dichotomous depression scores, the RR was 0.43 (95% CI 0.24 to 0.77) (eight trials involving 771 participants) with high heterogeneity between trials (I2 = 77%; P < 0.0001). For continuous depression scores, the SMD was -1.91 (95% CI -2.34 to -1.48) (39 trials involving 2728 participants) with high heterogeneity between trials (I2 = 95%; P < 0.00001). For anxiety, the SMD was -0.77 (95% CI -1.52 to -0.02) (eight trials involving 413 participants) with high heterogeneity between trials (I2 = 92%; P < 0.00001). There was no statistically significant benefit of SSRI on cognition, death, motor deficits and leaving the trial early. For cognition, the SMD was 0.32 (95% CI -0.23 to 0.86), (seven trials involving 425 participants) with high heterogeneity between trials (I2 = 86%; P < 0.00001). The RR for death was 0.76 (95% CI 0.34 to 1.70) (46 trials involving 3344 participants) with no heterogeneity between trials (I2 = 0%; P = 0.85). For motor deficits, the SMD was -0.33 (95% CI -1.22 to 0.56) (two trials involving 145 participants). The RR for leaving the trial early was 1.02 (95% CI 0.86 to 1.21) in favour of control, with no heterogeneity between trials. There was a non-significant excess of seizures (RR 2.67; 95% CI 0.61 to 11.63) (seven trials involving 444 participants), a non-significant excess of gastrointestinal side effects (RR 1.90; 95% CI 0.94 to 3.85) (14 trials involving 902 participants) and a non-significant excess of bleeding (RR 1.63; 95% CI 0.20 to 13.05) (two trials involving 249 participants) in those allocated SSRIs. Data were not available on quality of life, fatigue or healthcare costs. There was no clear evidence from subgroup analyses that one SSRI was consistently superior to another, or that time since stroke or depression at baseline had a major influence on effect sizes. Sensitivity analyses suggested that effect sizes were smaller when we excluded trials at high or unclear risk of bias. Only eight trials provided data on outcomes after treatment had been completed; the effect sizes were generally in favour of SSRIs but CIs were wide. AUTHORS' CONCLUSIONS SSRIs appeared to improve dependence, disability, neurological impairment, anxiety and depression after stroke, but there was heterogeneity between trials and methodological limitations in a substantial proportion of the trials. Large, well-designed trials are now needed to determine whether SSRIs should be given routinely to patients with stroke.

FUNDAMENTO: A estenose arterial renal (EAR) é uma causa potencialmente reversível de hipertensão arterial sistêmica (HAS) e nefropatia isquêmica. Apesar da revascularização bem sucedida, nem todos os pacientes (pt) apresentam melhora clínica e alguns podem piorar. OBJETIVO: O presente estudo se destina a avaliar o valor do índice de resistividade renal (IR) como preditor dos efeitos da revascularização renal. MÉTODOS: Entre janeiro de 1998 e fevereiro de 2001, 2.933 pacientes foram submetidos ao duplex ultrassom renal. 106 desses pacientes apresentaram EAR significativa e foram submetidos a angiografia e revascularização renal. A pressão arterial (PA) foi medida antes e depois da intervenção, em intervalos de até 2 anos e as medicações prescritas foram registradas. Antes da revascularização, o IR foi medido em 3 locais do rim, sendo obtida uma média dessas medições. RESULTADOS: Dos 106 pacientes, 81 tiveram IR<80 e 25 RI>80. A EAR foi corrigida somente por angioplastia (PTA) em 25 pts, PTA + stent em 56 pts e cirurgicamente em 25 pts. Dos pacientes que se beneficiaram da revascularização renal; 57 dos 81 pacientes com IR <80 apresentaram melhora em comparação a 5 de 25 com IR > 80. Usando um modelo de regressão logística múltipla, o IR esteve significativamente associado à evolução da PA (p = 0,001), ajustado de acordo com os efeitos da idade, sexo, PAS, PAD, duração da hipertensão, o tipo de revascularização, número de fármacos em uso, nível de creatinina, presença de diabete melito, hipercolesterolemia, volume sistólico, doença arterial periférica e coronariana e tamanho renal (OR 99,6-95%CI para OR 6,1-1.621,2). CONCLUSÃO: A resistividade intrarrenal arterial, medida por duplex ultrassom, desempenha um papel importante na predição dos efeitos pós revascularização renal para EAR.

BACKGROUND: Renal artery stenosis (RAS) is a potentially correctable cause of hypertension and ischemic nephropathy. Despite successful renal revascularization, not all patients (pt) overcome it and some get worse. OBJECTIVE: This study was designed to assess the value of renal resistance index (RI) in predicting the outcome of renal revascularization. METHODS: Between Jan 1998 and Feb 2001, 2,933 pts were referred to renal duplex ultrasound. 106 out of these had significant RAS and underwent angiography and renal revascularization. Arterial blood pressure (BP) was measured before and after the intervention, at intervals of up to 2 years and medications recorded. Prior to revascularization, RI was measured at 3 sites of each kidney and averaged. RESULTS: Out of the 106 patients, 81 had RI<80 and 25 RI>80. RAS was corrected with angioplasty (PTA) alone in 25 pts, PTA + stent in 56 pts and corrected by surgery in 25 pts. Of patients who benefited from renal revascularization; 57 of the 81 patients with RI <80 improved as compared to 5 of 25 with RI>80. Using a multiple logistic regression model, RI was significantly associated with BP outcome (p=0.001), adjusted for the effects of age, sex, SBP, DBP, duration of hypertension, type of revascularization, number of medication in use, creatinine level, presence of diabetes mellitus, hypercholesterolemia, stroke, peripheral and coronary artery disease and kidney size (OR 99.6 - 95%CI for OR 6.1 to 1,621.2). CONCLUSION: Intrarenal arterial resistance measured by duplex ultrasound plays an important role in predicting BP outcome after renal revascularization for RAS.

FUNDAMENTO: La estenosis arterial renal (EAR) es una causa potencialmente reversible de hipertensión arterial sistémica (HAS) y nefropatía isquémica. Pese a que la revascularización sea exitosa, ni todos los pacientes (pt) expresan mejora clínica y algunos pueden empeorar. OBJETIVO: El presente estudio está destinado a evaluar el valor del índice de resistividad renal (IR) como predictor de los efectos de la revascularización renal. MÉTODOS: Entre enero de 1998 y febrero de 2001, 2933 pacientes se sometieron al ultrasonido Doppler dúplex renal. Un total de 106 de estos pacientes expresaron EAR significativa y fueron sometidos a angiografía y revascularización renal. Se midió la presión arterial (PA) antes y después de la intervención, en intervalos de hasta 2 años y las medicaciones prescriptas fueron registradas. Antes de la revascularización, el IR se midió en 3 locales del riñón, con la obtención de un promedio de estas mediciones. RESULTADOS: De los 106 pacientes, 81 tuvieron IR < 80 y 25 RI > 80. La EAR se corrigió solamente por angioplastia (PTA) en 25 pts, PTA + stent en 56 pts y quirúrgicamente en 25 pts. De los pacientes que se beneficiaron de la revascularización renal; 57 de los 81 pacientes con IR <80 presentaron mejora en comparación a 5 de 25 con IR > 80. Usando un modelo de regresión logística múltiple, el IR estuvo significativamente asociado a la evolución de la PA (p = 0,001), ajustado de acuerdo con los efectos de la edad, sexo, PAS, PAD, duración de la hipertensión, el tipo de revascularização, número de fármacos en uso, nivel de creatinina, presencia de DM, hipercolesterolemia, volumen sistólico, enfermedad arterial periférica y coronaria y tamaño renal (OR 99,6-95%CI para OR 6,1-1.621,2). CONCLUSIÓN: La resistividad intrarrenal arterial, medida por ultrasonido Doppler dúplex, desempeña un rol importante en la predicción de los efectos post revascularização renal para EAR.

Hay una creciente aceptación de que no existe un único enfoque para el suministro de servicios rurales que pueda satisfacer las necesidades de todos los usuarios de los recursos naturales. Agrupamos a los usuarios según las siguientes categorías: familias agrícolas con acceso a mercados, comunidades rurales con ingresos derivados de una variedad de actividades, y comunidades con acceso a recursos de propiedad común. Cada grupo tiene necesidades particulares y en muchos casos los sistemas privatizados dejan por fuera aquellos con menos capacidad para relacionarse con los mercados. Exploramos el potencial de sistemas alternativos basado en: el enfoque de sistemas, sistemas de conocimiento, las tecnologías de comunicación e información (TIC) y la comunicación para el desarrollo. Se proyectan tres tipos de entrega de servicios que responden a tres grupos de usuarios de recursos naturales: productores con acceso a mercados, hogares con producción de subsistencia y organizaciones comunitarias. Para cada grupo, se contempla el nivel de análisis y acción y de entrega de servicios, la naturaleza de la información buscada, y las funciones de la comunicación. Una segunda proyección describe los temas de demanda y oferta de TIC para cada grupo. Una tercera proyección aborda la dimensión de planificación estratégica, con énfasis en las características de los resultados e impacto en términos de recursos naturales y de información y comunicación. El artículo concluye con una revisión de aquellos principios que pueden ayudarnos en el diseño de los diferentes sistemas de entrega de servicios que responden a las necesidades de cada grupo de usuarios.

The emerging trend in the literature is an acknowledgment that no single approach to rural service delivery will satisfy the needs of all natural resource users. Rural resources users are grouped broadly into farm families with access to markets, rural communities with diversified livelihoods that include onfarm income, and communities that access common property resources as part of their livelihoods. Each group has very distinct needs, and in many cases privatized systems leave out those that are least able to link to markets. The potential of alternative systems is explored with a theoretical foundation based on systems thinking, knowledge systems, and the applied fields of information and communication technologies (ICTs) and communication for development. The paper projects three complementary types of service delivery levels that respond to three broad natural resource groups: farmers with access to markets, subsistence households with migrant family members, and community organizations and federations. For each of these groups, the scenarios address the level of analysis and action, service delivery levels, the nature of the information sought, and the communication functions that best respond to each groups needs. A second projection describes several ICT demand and supply issues that require clarification for each major group of stakeholders. A third projection describes the strategic planning dimension, with emphasis on the characteristics of the outcomes and outputs in terms of natural r esource and information and communication. The paper closes with a review of the principles that may help guide the design of the different targeted delivery systems.