Abstract INTRODUCTION Malaria case management is a pivotal intervention in malaria elimination. However, many remote areas in Brazil still lack access to basic health services. This study describes a community-based approach (CBA) for malaria case management in the large remote area of the Jaú National Park (JNP), Amazonas, Brazil. METHODS In 2001, a general health CBA was initiated with a motor group (MG); a participative community health diagnosis (PCHD) was subsequently implemented between 2001 and 2005. In 2006, a CBA for malaria case management started with an expanded MG including all sectors with a stake in malaria control, from the local residents to the federal government. In 2008, community microscopists were selected and trained to diagnose hemoparasites. A full malaria strategy was implemented in 2009 with subsequent quality control follow-up. RESULTS Two educational materials were co-created with local communities. The MG identified malaria as a major health problem and the malaria MG planned the control activities. Ten communities selected a resident to become malaria microscopists, and ten solar-operated health centers were built. The number of slide readings increased from 923 in 2006 to 1,900 in 2009, while malaria infections decreased from 354 cases in 2005 to 20 cases in 2015. The excess time (≥ 48 hours) between first symptoms and diagnosis/treatment decreased from 68.9% of cases in 2005 to 14.3% in 2010. CONCLUSIONS While many factors were likely involved in the reduction of malaria transmission in the JNP, the CBA played an important role in the sustained success of the initiative.

Abstract: INTRODUCTION: Few studies have described the risk factors of intestinal parasitic infections in the Amazon. METHODS: A cross-sectional survey was performed in a City of the State of Amazonas (Brazil) to estimate the prevalence of intestinal parasites and determine the risk factors for helminth infections. RESULTS: Ascaris lumbricoides was the most prevalent parasite. The main risk factors determined were: not having a latrine for A. lumbricoides infection; being male and having earth or wood floors for hookworm infection; and being male for multiple helminth infections. CONCLUSIONS: We reported a high prevalence of intestinal parasites and determined some poverty-related risk factors.

Aim: To analyze women's advancement compared with that of men and to determine whether advancement in hierarchical status differs from advancement in the professional recognition achieved by women from 1996 to 2008. Methods: A retrospective study was carried in Hospital Clínic in Barcelona. We analyzed data on temporary and permanent positions, hierarchy, promotions, specialty, age, and sex among the participants. Results: The female-to male ratio among trainee medical specialists was higher than 1 throughout the study period. After completion of specialist training, the proportion of women with temporary contracts more than doubled that of men. Less than 50% of women achieved permanent positions compared with 70% of men. For permanent non-hierarchical and hierarchical positions, the female-to-male ratio gradually decreased from 0.5 to below 0.2. Although more than 50% of trainee specialists were women, the number of female consultants remained 25% lower than that of men. In 2008, the final year of the study, the percentage of women who had achieved the grade of senior consultant was one-third that of men (29.5% of men vs 10.9% of women; p < 0.0001). Conclusions: The significant differences in medical positions held by men and women illustrate the 'leaky pipeline phenomenon', consisting of a disproportionately low number of women achieving leading medical positions. The full potential of the increasing number of women physicians will not be reached without continuing efforts to improve the hospital medicine environment.

Objetivo: Analizar el avance de las mujeres en comparación con los hombres en la medicina y analizar si el avance jerárquico difiere del avance en su reconocimiento profesional en el periodo 1996-2008. Métodos: Estudio retrospectivo en el Hospital Clínic de Barcelona mediante el análisis de datos relativos a posición temporal y permanente, jerarquía, carrera profesional, especialidad, edad y sexo de los médicos. Resultados: La proporción de mujeres y hombres entre residentes fue superior a 1 durante el período de estudio. Finalizada la residencia, la proporción de mujeres dobla la proporción de hombres entre posiciones médicas temporales. Menos del 50% de las mujeres en comparación con el 70% de los hombres logra posiciones médicas permanentes. La proporción de mujeres y hombres entre posiciones permanentes no jerarquizadas y jerarquizadas desciende gradualmente desde 0.5 hasta llegar a menos de 0.2. A pesar de que más del 50% de residentes son mujeres, ellas alcanzan el grado de consultor 25% menos que sus colegas masculinos. En 2008, el último año del estudio, un tercio de las mujeres (10,9%) en comparación con los hombres (29,5%) alcanzó el grado de consultor senior (p < 0.0001). Conclusiones: Diferencias significativas en posiciones médicas entre hombres y mujeres configuran el fenómeno conocido como "tuberías con fugas"', que consiste en un número desproporcionado de mujeres que llegan a posiciones médicas principales. El potencial de la feminización médica no se alcanzará sin esfuerzos de mejora ambiental continua en la medicina hospitalaria.

Aim: To analyze women's advancement compared with that of men and to determine whether advancement in hierarchical status differs from advancement in the professional recognition achieved by women from 1996 to 2008. Methods: A retrospective study was carried in Hospital Clínic in Barcelona. We analyzed data on temporary and permanent positions, hierarchy, promotions, specialty, age, and sex among the participants. Results: The female-to male ratio among trainee medical specialists was higher than 1 throughout the study period. After completion of specialist training, the proportion of women with temporary contracts more than doubled that of men. Less than 50% of women achieved permanent positions compared with 70% of men. For permanent non-hierarchical and hierarchical positions, the female-to-male ratio gradually decreased from 0.5 to below 0.2. Although more than 50% of trainee specialists were women, the number of female consultants remained 25% lower than that of men. In 2008, the final year of the study, the percentage of women who had achieved the grade of senior consultant was one-third that of men (29.5% of men vs 10.9% of women; p < 0.0001). Conclusions: The significant differences in medical positions held by men and women illustrate the 'leaky pipeline phenomenon', consisting of a disproportionately low number of women achieving leading medical positions. The full potential of the increasing number of women physicians will not be reached without continuing efforts to improve the hospital medicine environment.

Objetivo: Analizar el avance de las mujeres en comparación con los hombres en la medicina y analizar si el avance jerárquico difiere del avance en su reconocimiento profesional en el periodo 1996-2008. Métodos: Estudio retrospectivo en el Hospital Clínic de Barcelona mediante el análisis de datos relativos a posición temporal y permanente, jerarquía, carrera profesional, especialidad, edad y sexo de los médicos. Resultados: La proporción de mujeres y hombres entre residentes fue superior a 1 durante el período de estudio. Finalizada la residencia, la proporción de mujeres dobla la proporción de hombres entre posiciones médicas temporales. Menos del 50% de las mujeres en comparación con el 70% de los hombres logra posiciones médicas permanentes. La proporción de mujeres y hombres entre posiciones permanentes no jerarquizadas y jerarquizadas desciende gradualmente desde 0.5 hasta llegar a menos de 0.2. A pesar de que más del 50% de residentes son mujeres, ellas alcanzan el grado de consultor 25% menos que sus colegas masculinos. En 2008, el último año del estudio, un tercio de las mujeres (10,9%) en comparación con los hombres (29,5%) alcanzó el grado de consultor senior (p < 0.0001). Conclusiones: Diferencias significativas en posiciones médicas entre hombres y mujeres configuran el fenómeno conocido como "tuberías con fugas"', que consiste en un número desproporcionado de mujeres que llegan a posiciones médicas principales. El potencial de la feminización médica no se alcanzará sin esfuerzos de mejora ambiental continua en la medicina hospitalaria.

Introduction: The first line of treatment for hypertriglyceridemic (HTG) includes a well-balanced diet, although the association of dietary components with triglyceride (TG) concentrations in hypertriglyceridemic patients is not fully understood. Objective: To describe the main dietary patterns in a cohort of hypertriglyceridaemic patients and to evaluate the association between dietary components and TG levels. Methods: This multicentre cross-sectional study included subjects (n = 1.394) with HTG (TG > 2.25 mmol/L) visiting lipid units affiliated with the Spanish Atherosclerosis Society. A validated 14-item food questionnaire was performed to assess diet. Clinical, anthropometry and biochemical parameters were also obtained. Results: Two dietary patterns were defined a posteriori by cluster analysis. Patients following the "prudent dietary pattern" (predominantly fish, fruits, vegetables, low-fat dairy and legumes) had lower TG levels than those with the "western dietary pattern" (predominantly red and processed meat products, alcohol, cakes and pastries and sugar) (3.51 ± 2.41 vs. 3.96 ± 3.61 mmol/L, P = 0.002). In a multivariant test, low-fat dairy products (B: -0.089; 95% IC: -16.1, -3.1, P = 0.004) and alcohol intake (B: 0.070; 95% IC: 1.1, 13.1, P = 0.022) were significantly associated with TG concentrations independently of potential confounders. Conclusions: Mediterranean dietary pattern including low-fat dairy products and abstaining from alcohol intake is highly associated with lower TG concentration in hypertriglyceridaemic patients even under lipid-lowering treatment. The reinforcement in nutritional counselling mainly in these food groups should be done and further specifically studies about the direct association of these and other dietary groups should be carried out to the development of more effective nutritional recommendations.

Introducción: Una dieta cardiosaludable constituye el tratamiento de primera línea en la hipertrigliceridemia (HTG) aunque la asociación de los diferentes componentes de ésta con la concentración de triglicéridos (TG) en pacientes con HTG no está completamente establecida. Objetivo: Estudiar los patrones dietéticos en una cohorte de pacientes hipertrigliceridémicos y evaluar la asociación entres los diferentes componentes de la dieta y la concentración de TG. Métodos: El estudio, multicéntrico y transversal, incluyó sujetos (n = 1.394) diagnosticados de HTG (TG > 2,25 mmol/L) que fueron remitidos a diferentes Unidades de Lípidos pertenecientes a la Sociedad Española de Arteriosclerosis. Se realizó una valoración dietética mediante un cuestionario validado de 14 items además de la obtención de otras variables clínicas, antropométricas y bioquímicas. Resultados: Se definieron dos patrones dietéticos mediante análisis tipo cluster. Aquellos pacientes que seguían una "dieta cardiosaludable" (en la que predominaba el consumo de pescado, fruta, verduras, lácteos desnatados y legumbres) presentaron menores niveles de TG que aquellos que mantenían una "dieta no cardiosaludable" (con consumo de carne roja, productos cárnicos procesados, alcohol, bollería y azúcar predominantemente) (3,51 ± 2,41 vs. 3,96 ± 3,61 mmol/L, P = 0,002). El análisis multivaríante determinó que el consumo de lácteos desnatados (B: -0,089; 95% IC: -16,1, -3,1, P = 0,004) y el de alcohol (B: 0,070; 95% IC: 1,1, 13,1, P = 0,022) se asoció significativa, e independientemente de otros factores de confusión, con la concentración de TG. Conclusiones: Un patrón dietético típicamente mediterráneo incluyendo lácteos desnatados y un bajo consumo de alcohol se relaciona con menores concentraciones de TG en pacientes hipertrigliceridémicos, incluso en aquellos con tratamiento hipolipemiante. Queda patente así la importancia y necesidad del refuerzo del consejo dietético en esta población además de futuros estudios que analicen directamente la asociación de éstos y otros grupos de alimentos que permitan el desarrollo y la consecución de recomendaciones nutricionales más efectivas.

Aims: 1) to study lipoprotein (a) (Lp(a)) plasma values in subjects with familial ligand-defective apo B 100 (FDB) . Methods: We studied 19 heterozygous FDB subjects (8 males) from 12 families, carriers of R3500Q mutation on apo B gene and 90 controls (34 males). The genetic diagnosis was established with PCR-SSCP analysis and automatic sequencing. In all subjects plasma lipids, apolipoprotein B and Lp(a) levels were determined with standard procedures. Results: Subjects carriers of R3500Q mutation on apo B gene have significantly higher plasma Lp(a) and log transformed Lp(a) values and prevalence of Lp(a) > 30 cut point for coronary heart disease than controls. Conclusions: Subjects with FDB showed higher Lp(a) plasma values than controls, although the mechanism and the clinical consequences of these result are not known.

Objetivo: Estudiar los valores plasmáticos de Lp(a) en el defecto familiar de unión de apo B 100 (DFB) en poblaciones sur Europea donde no existen datos al respecto. Métodos: Hemos estudiado a 19 heterocigotos DFB (8 varones), portadores de la mutación R3500Q del gen de la apo B y a 90 controles (34 varones). El diagnóstico genético se realizó por técnica de PCR-SSCP y secuenciación automática. En todos los sujetos se determinó de forma estandarizada las concentraciones plasmáticas de lípidos, apolipoproteína B y Lp(a). Resultados: Los valores plasmáticos de Lp(a) y su transformación logarítmica fueron significativamente mayores en el grupo con DFB frente al grupo control. Además, la prevalencia de Lp(a) > de 30 mg/dl, como punto de corte de alto riesgo para cardiopatía isquemia fue significativamente mayor en el grupo portador de la mutación R3500Q. Conclusión: Los sujetos portadores de la mutación R3500Q del gen de apo B mostraron valores plasmáticos superiores de Lp(a) que los controles, sin que conozcamos por el momento el mecanismo y sus implicaciones clínicas.