Título del artículo:

Steady state signatures in the time domain for nonintrusive appliance identification

Smart Grid paradigm promotes advanced load monitoring applications to support demand side management and energy savings. Recently, considerable attention has been paid to Non-Intrusive Load Monitoring to estimate the individual operation and power consumption of the residential appliances, from single point electrical measurements. This approach takes advantage of signal processing in order to reduce the hardware effort associated to systems with multiple dedicated sensors. Discriminative characteristics of the appliances, namely load signatures, could be extracted from the transient or steady state electrical signals. In this paper the effect of impact factors that can affect the steady state load signatures under realistic conditions are investigated: the voltage supply distortion, the network impedance and the sampling frequency of the metering equipment. For this purpose, electrical measurements of several residential appliances were acquired and processed to obtain some indices in the time domain. Results include the comparison of distinct scenarios, and the evaluation of the suitability and discrimination capacity of the steady state information.

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Ingenieria e Investigacion

Título del artículo:

Etiology of musculoskeletal injuries in amateur breakdancers

Aim. The aim of this study was to assess the incidence of musculoskeletal injuries in breakdancers and investigate the association with training habits. Methods. Forty-six males and sixteen females completed a questionnaire regarding their training and competition habits (frequency, warm-up and stretching, strength training, protective equipment, move types and supervision) and the musculoskeletal injuries sustained as a result of breakdancing in the previous 12 months. The effects of training habits and sex on injury rates were analyzed by a Mann-Whitney Test and a Kruskal-Wallis Test, while a stepwise linear regression analysis assessed the link between injury rates and quantitative risk factors. Results. The injury rate was 4.02 injuries per 1000 h, with no signiicant difference between males and females (P>0.05). The main injuries affected were the knee (23.4%) and wrist (15.3%), and females were characterized by a signiicantly greater number of inger injuries and a lower number of shoulder injuries that males (P<0.05). In addition, of all the factors evaluated, only the amount of time spent performing breakdance training showed a signiicant association with injury rate (P<0.05). Conclusion. These results suggest that interventions should focus on protecting speciic body parts and improving training quality and recovery.

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Journal of Sports Medicine and Physical Fitness

Título del artículo:

Presence of IgG antibodies against reproductive infections in breeding bulls of Magdalena Medio, Colombia

Background: cattle farming is an important economic activity in several regions of Colombia. However, farmers are unaware of their cattle health status, and particularly of bacterial, parasitic, and viral diseases, which affect reproduction and profitability. Objective: to assess the presence of IgG antibodies against infectious bovine rhinotracheitis (IBR), bovine viral diarrhea (BVD), bovine leukosis, leptospirosis, brucellosis, and Neospora caninum in breeding bulls in the Magdalena Medio of Colombia, according to age, breed, and origin. Methods: a descriptive, cross-sectional study was conducted with 174 male breeding cattle from several subspecies. Animals were above 18 months of age and belonged to dual-purpose farms in the Magdalena Medio region. Presence of IgG anti-IBR, BVD, brucellosis, neosporosis, and leukosis antibodies were determined with an enzyme-linked immunosorbent assay (ELISA). A sample of 156 males was assessed for leptospirosis using a microscopic agglutination test (MAT) in a dark field. Results: IgG anti-IBR antibodies were found in 92.5% of the animals, anti-BVD in 62.6%, anti-Neospora caninum in 79.3%, anti-Brucella abortus in 4.02%, anti-Leptospira pomona in 8.33%, and anti-L. hardjo in 15.38%, with >1:100 titres. Besides, 64.94% prevalence was observed for bovine leukosis. Conclusions: a high prevalence of IgG anti-IBR, IgG anti-BVD, IgG anti-Neospora caninum, IgG anti-leukosis, and IgG anti-lepstospirosis antibodies were observed in Magdalena Medio bulls. With respect to B. abortus, confirmatory and competitive ELISA test should be performed and sanitary standards need to be established. Detection of IgG antibodies among bulls reveals poor sanitary conditions, absent of protective-vaccination antibodies and an urgent need for health control measurements.

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Revista Colombiana de Ciencias Pecuarias

Título del artículo:

Evaluation of agrochemicals and bioinputs for sustainable bean management on the Caribbean coast of Colombia

The sustainable expansion of bean cultivations requires technologies that do not limit their phyto-recovering properties. Therefore, the objective of this study was to propose agronomic management of conservation for bean cultivation considering the microbiological characteristics of two mega-environments of the Colombian Caribbean coast and the compatibility between agrochemicals and bioinputs. The methodology included rhizospheric microbe population counts, identification of phytopathogenic fungi in plant tissues and soils, compatibility studies of pesticides with biocontrollers, and determination of residual contents of pesticides in bean seeds. The microbial populations corresponded to those previously registered for the lower tropics, but with quantitative differences in the genera. Phytophthora, Colletotrichum and Fusarium were registered in the humid Caribbean, while Colletotrichum and Curvularia affectedcrops in the dry Caribbean. The Beauveria bioinput was not compatible with the evaluated agrochemicals, while Trichoderma was compatible with chlorpyrifos, thiabendazole and oxycarboxin. Metarhizium was compatible with glyphosate and oxycarboxin at 10% of the recommended dose. Lindane residues were found in the beans harvested at three of the studied locations. The combined use of agrochemicals and bioinputs on bean crops is feasible as long as the time of application of the latter is made according to the half-life of the chemical and the organic matter content of the soil is increased.

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Agronomia Colombiana

Título del artículo:

Chemosensory disturbances-associated nanocholinergic dysfunction: The case of, not only, myasthenia gravis

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Journal of the Neurological Sciences

Título del artículo:

Multi-wavelength emission through self-induced second-order wave-mixing processes from a Nd³⁺ doped crystalline powder random laser

Random lasers (RLs) based on neodymium ions (Nd3+) doped crystalline powders rely on multiple light scattering to sustain laser oscillation. Although Stokes and anti-Stokes Nd3+ RLs have been demonstrated, the optical gain obtained up to now was possibly not large enough to produce selffrequency conversion. Here we demonstrate self-frequency upconversion from Nd3+ doped YAl3(BO3)4 monocrystals excited at 806 nm, in resonance with the Nd3+ transition 4I9/2 → 4F5/2. Besides the observation of the RL emission at 1062 nm, self-converted second-harmonic at 531 nm, and selfsum-frequency generated emission at 459 nm due to the RL and the excitation laser at 806 nm, are reported. Additionally, second-harmonic of the excitation laser at 403 nm was generated. These results exemplify the first multi-wavelength source of radiation owing to nonlinear optical effect in a Nd3+ doped crystalline powder RL. Contrary to the RLs based on dyes, this multi-wavelength light source can be used in photonic devices due to the large durability of the gain medium.

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Scientific Reports

Título del artículo:

Phosphine-Free Suzuki Cross-Coupling Reaction Using an Efficient and Reusable Pd Catalyst in an Aqueous Medium under Microwave Irradiation

We report here an improved, highly efficient, and general method for the ligand-free Suzuki cross-coupling reaction to the synthesis of biaryls, bipyridyls, thienylpyridine, and allylphenols. Microwave irradiation of (het)aryl halides and (hetaryl, allyl)arylboronic acid N-methyl-iminodiacetic acid (MIDA) ester, using polyurea microencapsulated palladium catalyst (Pd EnCat 30), gave the coupling adducts 1a-x in excellent yields in just 10-18 min.

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Synthetic Communications

Título del artículo:

Zarit burden interview: Psychometric tests for colombia

Objective: This research was designed to determine the validity and reliability of the Zarit Burden Interview, specifically the 22-item Spanish version, as an instrument to measure the burden of care perceived by family caregivers of patients in Colombia with chronic diseases. Materials and Methods: A cross-sectional study of 652 family caregivers of patients with chronic diseases who reside in five regions of Colombia was conducted to establish construct validity, with a factor analysis and internal consistency reliability measured by determining the Cronbach’s alpha value. Result: In terms of construct validity, the study reports the total loading, based on free association of a varimax rotation, and in the dimensions that include interpersonal burden, impact of care, and skills and expectations about care. The factor loadings pertain to the items introduced to measure each of the proposed dimensions. Conclusion: The results showed the 22-item Spanish version of the Zarit Burden Interview is an instrument that can be applied and understood easily in a Colombian population with different educational, socio-economic and cultural levels. It also proved to be valid and reliable for assessing the burden of care perceived by family caregivers of patients with chronic diseases.

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Aquichan

Título del artículo:

Development of a novel formulation with hypericin to treat cutaneous leishmaniasis based on photodynamic therapy in in vitro and in vivo studies

An evaluation of the leishmanicidal activity in vitro and in vivo of hypericin, an expanded-spectrum photosensitizer found in Hypericum perforatum, is presented. Hypericin was evaluated against intracellular amastigotes in vitro of Leishmania (Viannia) panamensis. A topical formulation containing 0.5% hypericin was developed and assayed in vivo in a hamster model of cutaneous leishmaniasis. Results demonstrate that hypericin induces a significant antiamastigote effect in vitro against L. panamensis by decreasing the number of parasites inside infected cells. The topical formulation of 0.5% hypericin allows healing of L. panamensis-induced lesions upon a topical application of 40 mg/day plus visible-light irradiation (5 J/cm2, 15 min), twice a week for 3 weeks.

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Antimicrobial Agents and Chemotherapy

Título del artículo:

Characterization of disabled people with permanent limitations in mobility and self-care in Giron, Colombia

Objective: To determine the characteristics of people with permanent limitations in mobility and self-care in 17 districts of the urban area of Giron, Santander 2012-2013. Materials and methods: A descriptive, observational, cross-sectional study was conducted using the tool Register for the Location and characterization of the disabled people (RLCDP), designed by the National Administrative Department of Statistics (DANE). Previously trained physiotherapy students interviewed caregivers or disabled people. Results: A total of 189 people were studied of 50.3% women, and 45.5% between 60 and 100 years old. A large majority (79.9%) had alterations in body movement, hands, arms and legs. As regards activities and participation, 91% had difficult to walk, run, jump, and 41.3% found it difficult to lead, move, and use objects with hands. Of the bodily functions, 60.3% involved mobility. General illness diseases were the main cause of disability (33.9%). Conclusions: A high percentage of persons with permanent mobility limitations and caring for themselves in the urban area of Girona are older adults from socioeconomic level 2. The predominant mobility limitations are in the hands, arms, and legs, with involvement in at least two body structures.

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Fisioterapia

Título del artículo:

A semi-decentralized solution for the economic dispatch with transmission losses using a JASON-based multiagent system

Distributed calculation of an economic dispatch can be used for efficient resource allocation in a power distribution system with local generation. The lossless dispatch can be implemented in a fully decentralized way, however, because the impact on real losses in a power distribution systems cannot be neglected, this kind of calculations might lead to suboptimal solutions. This work proposes a semi-decentralized algorithm that solves the economic dispatch with transmission losses. The algorithm was implemented in a multiagent system (MAS) with JASON programming language, using a Contract Net Protocol (CNP) to adjust power output of each generator. CNP algorithm implemented has a good behavior under unconstrained conditions, but further researches are needed to calculate the optimum if capacity constraints are included.

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International Conference on the European Energy Market, EEM

Título del artículo:

Microgrid\'s Energy Management Systems: A survey

Microgrids are a new paradigm for energy distribution systems in which generation (from a local energy source or storage device) is coordinated to supply local energy needs while behaving as a sole system. Benefit maximization in a microgrid is directly related with demand reactiveness and optimal allocation of local energy resources. Because those characteristics can be implemented through an Energy Management System (EMS), knowing the elements that conforms it and how they interact is crucial for the development of microgrids. This paper presents a caracterization of the EMS and some insight about the actual state on this subject. This is done to understand the mechanisms that allow efficient EMS implementations, thus shortening the path towards a power distribution microgeneration with higher short-term/mid-term benefits based on microgrid technology.

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International Conference on the European Energy Market, EEM

Título del artículo:

Psychosocial factors and obesity in 17 high-, middle- and low-income countries: The Prospective Urban Rural Epidemiologic study

Background/Objectives:Psychosocial stress has been proposed to contribute to obesity, particularly abdominal, or central obesity, through chronic activation of the neuroendocrine systems. However, these putative relationships are complex and dependent on country and cultural context. We investigated the association between psychosocial factors and general and abdominal obesity in the Prospective Urban Rural Epidemiologic study.Subjects/Methods:This observational, cross-sectional study enrolled 151 966 individuals aged 35-70 years from 628 urban and rural communities in 17 high-, middle- and low-income countries. Data were collected for 125 290 individuals regarding education, anthropometrics, hypertension/diabetes, tobacco/alcohol use, diet and psychosocial factors (self-perceived stress and depression).Results:After standardization for age, sex, country income and urban/rural location, the proportion with obesity (body mass index ≥30 kg m - 2) increased from 15.7% in 40 831 individuals with no stress to 20.5% in 7720 individuals with permanent stress, with corresponding proportions for ethnicity- and sex-specific central obesity of 48.6% and 53.5%, respectively (P<0.0001 for both). Associations between stress and hypertension/diabetes tended to be inverse. Estimating the total effect of permanent stress with age, sex, physical activity, education and region as confounders, no relationship between stress and obesity persisted (adjusted prevalence ratio (PR) for obesity 1.04 (95% confidence interval: 0.99-1.10)). There was no relationship between ethnicity- and sex-specific central obesity (adjusted PR 1.00 (0.97-1.02)). Stratification by region yielded inconsistent associations. Depression was weakly but independently linked to obesity (PR 1.08 (1.04-1.12)), and very marginally to abdominal obesity (PR 1.01 (1.00-1.03)).Conclusions:Although individuals with permanent stress tended to be slightly more obese, there was no overall independent effect and no evidence that abdominal obesity or its consequences (hypertension, diabetes) increased with higher levels of stress or depression. This study does not support a causal link between psychosocial factors and abdominal obesity.

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International Journal of Obesity

Título del artículo:

Auditory and Lower Limb Tactile Prepulse Inhibition in Primary Restless Legs Syndrome: Clues to Its Pathophysiology

The resting sensory discomfort transiently relieved upon movement of the affected area in restless legs syndrome suggests that sensorimotor integration mechanisms, specifically gating, may be altered in the disease. The authors sought to determine the effects of prepulse auditory and tactile stimulation applied to lower limbs on the blink reflex of patients with restless legs syndrome and healthy subjects. Seventeen patients with restless legs syndrome and 17 age- and sex-matched healthy controls were investigated. Auditory stimuli and tactile lower limb stimulation were applied as prepulses. The R2 response of the blink reflex induced by electrical stimulation applied to the right supraorbital nerve was selected as the test stimulus. Time intervals between prepulses and response-eliciting stimuli were 40, 70, 90, 110, and 200 milliseconds. There were no differences in either the auditory or tactile prepulse conditions between patients and controls and no differences between these measures within subject groups. We concluded that the tactile lower limb and the auditory prepulse effects on the brainstem interneurons mediating the blink reflex share common neural pathways. Because forebrain interneurons mediate these prepulse effects, they are likely not involved in the disordered sensorimotor interaction of restless legs syndrome. ©

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Journal of Clinical Neurophysiology

Título del artículo:

Reliability and Validity of Tests to Assess Lower-Body Muscular Power in Children

The purpose of this study was to analyze the reliability and the criterion-related validity of several lower-body muscular power tests (i.e., standing long jump [SLJ], squat jump, countermovement jump, and Abalakov jump) in children aged 6-12 years. Three hundred sixty three healthy children (168 girls) agreed to participate in this study. All the lower-body muscular power tests were performed twice (7 days apart), whereas the 1 repetition maximum (1RM) leg extension test was performed 2 days after the first session of testing. All the tests showed a high reliability (intertrial difference close to 0 and no significant differences between trials, all p > 0.05). The association between the lower-body muscular power tests and 1RM leg extension test was high (all p < 0.001). The SLJ and the Abalakov jump tests showed the highest association with 1RM leg extension test (R 2 0.700, test result, weight, height, sex, and age were added in the model). The SLJ test can be a useful tool to assess lower-body muscular power in children when laboratory methods are not feasible because it is practical, time efficient, and low in cost and equipment requirements.

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Journal of Strength and Conditioning Research

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Prognostic value of grip strength: Findings from the Prospective Urban Rural Epidemiology (PURE) study

Background Reduced muscular strength, as measured by grip strength, has been associated with an increased risk of all-cause and cardiovascular mortality. Grip strength is appealing as a simple, quick, and inexpensive means of stratifying an individual\'s risk of cardiovascular death. However, the prognostic value of grip strength with respect to the number and range of populations and confounders is unknown. The aim of this study was to assess the independent prognostic importance of grip strength measurement in socioculturally and economically diverse countries. Methods The Prospective Urban-Rural Epidemiology (PURE) study is a large, longitudinal population study done in 17 countries of varying incomes and sociocultural settings. We enrolled an unbiased sample of households, which were eligible if at least one household member was aged 35-70 years and if household members intended to stay at that address for another 4 years. Participants were assessed for grip strength, measured using a Jamar dynamometer. During a median follow-up of 4·0 years (IQR 2·9-5·1), we assessed all-cause mortality, cardiovascular mortality, non-cardiovascular mortality, myocardial infarction, stroke, diabetes, cancer, pneumonia, hospital admission for pneumonia or chronic obstructive pulmonary disease (COPD), hospital admission for any respiratory disease (including COPD, asthma, tuberculosis, and pneumonia), injury due to fall, and fracture. Study outcomes were adjudicated using source documents by a local investigator, and a subset were adjudicated centrally. Findings Between January, 2003, and December, 2009, a total of 142 861 participants were enrolled in the PURE study, of whom 139691 with known vital status were included in the analysis. During a median follow-up of 4·0 years (IQR 2·9-5·1), 3379 (2%) of 139691 participants died. After adjustment, the association between grip strength and each outcome, with the exceptions of cancer and hospital admission due to respiratory illness, was similar across country-income strata. Grip strength was inversely associated with all-cause mortality (hazard ratio per 5 kg reduction in grip strength 1·16, 95% CI 1·13-1·20; p<0·0001), cardiovascular mortality (1·17, 1·11-1·24; p<0·0001), non-cardiovascular mortality (1·17, 1·12-1·21; p<0·0001), myocardial infarction (1·07, 1·02-1·11; p=0·002), and stroke (1·09, 1·05-1·15; p<0·0001). Grip strength was a stronger predictor of all-cause and cardiovascular mortality than systolic blood pressure. We found no significant association between grip strength and incident diabetes, risk of hospital admission for pneumonia or COPD, injury from fall, or fracture. In high-income countries, the risk of cancer and grip strength were positively associated (0·916, 0·880-0·953; p<0·0001), but this association was not found in middle-income and low-income countries. Interpretation This study suggests that measurement of grip strength is a simple, inexpensive risk-stratifying method for all-cause death, cardiovascular death, and cardiovascular disease. Further research is needed to identify determinants of muscular strength and to test whether improvement in strength reduces mortality and cardiovascular disease. Funding Full funding sources listed at end of paper (see Acknowledgments).

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The Lancet

Título del artículo:

Prevalence of cardiovascular risk factors in Latin America: A review of the published evidence 2010-2015

Introduction: There are certain variables that help us to determine the probability of an individual developing cardiovascular disease, those variables are called risk factors. The more risk factors a person has, the more likely of cardiovascular disease. Objectives: To determine prevalence of cardiovascular risk factors in Latin America. Material and methods: A literature review published during the period 2010-2015, with the participation of Latin American countries, of which items were selected in English and Spanish data bases recognized worldwide as PubMed, OMIM, SCIELO, EBSCO and magazines cardiology and public health of each Latin American country. Results: Identifi ed 3,645 articles of which 45 were selected; after examine and evaluate the methodological framework of the 45 articles, the information of these variable allowed did add up the sample of the articles (n = 7,192,262) for conclude than latin american have a higher prevalence of overweight/obesity, physical inactivity, smoking and alcohol intake. Conclusions: In the Latin American population there is a high prevalence of cardiovascular risk factors without signifi cant differences by gender.

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Revista Mexicana de Cardiologia

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Analysis of operating costs for producing biodiesel from palm oil at pilot-scale in Colombia

The present study aims to evaluate the operating costs of biodiesel production using palm oil in a pilot-scale plant with a capacity of 20,000. L/day (850. L/batch). The production plant uses crude palm oil as a feedstock, and methanol in a molar ratio of 1:10. The process incorporated acid esterification, basic transesterification, and dry washing with absorbent powder. Production costs considered in the analysis were feedstock, supplies, labor, electricity, quality and maintenance; amounting to $3.75/gal ($0.99/L) for 2013. Feedstocks required for biodiesel production were among the highest costs, namely 72.6% of total production cost. Process efficiency to convert fatty acids to biodiesel was over 99% and generated a profit of $1.08/gal (i.e., >22% of the total income). According to sensitivity analyses, it is more economically viable for biodiesel production processes to use crude palm oil as a feedstock and take advantage of the byproducts such as glycerine and fertilizers.

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Bioresource Technology

Título del artículo:

Sodium intake recommendations: A subject that needs to be reconsidered

Hypertension affects 1 billion people worldwide and is considered the leading cause of death, stroke, myocardial infarction and congestive heart failure. Sodium intake is reported to be a modifiable determinant of hypertension and reductions in its consumption have been widely recommended. Various strategies have been proposed to address the observed epidemic of cardiovascular diseases, particularly in medium and low-income countries. Among these strategies, reducing dietary sodium intake and increasing dietary potassium intake are commonly included in guidelines for the treatment of hypertension and the prevention of cardiovascular disease. In the present article, we review the results of recent studies that have raised questions about potential adverse effects associated with low sodium intake on important health outcomes, including cardiovascular diseases and death. It is clear from these studies, that there are contradictory and irreconcilable positions in the interpretation of the evidence, a situation that indicates that there is an urgent need for international randomized controlled trials that consistently demonstrate that the low levels of sodium intake recommended in the guidelines are safe and beneficial for different populations around the world. In the interim, and in accordance with a number of experts, we agree that the current evidence argues against the reduction of dietary sodium as an isolated public health recommendation and that an alternative approach of recommending high quality, potassium rich diets, might achieve greater health benefits, including blood-pressure reduction, than aggressive sodium reduction alone.

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Current Hypertension Reviews

Título del artículo:

Remote dysfunctions in spinal cord injury: Closer than ever

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Clinical Neurology and Neurosurgery

Título del artículo:

Male and female relative caregivers of people with chronic disease in Colombia: More similarities than differences

Objective: To describe and compare the burden level of the male and female relative caregivers of people with chronic diseases in Colombia. Methodology: A descriptive and comparative cross-sectional study that was carried out between 2012 and 2014 with 1,555 relative caregivers of people with chronic disease living in the five geographical regions of Colombia. The GCPC-A-C instruments for characterization and the Caregiver Perception of Burden Survey of Zarit in order to determine the perceived burden were used. Results: In the group of relative caregivers of the study, 80.3% belong to the Andean region, 5.6% were from the Pacific region, 3.6 % from the Orinoco region, 6.6% from the Caribbean region, and 3.6% from the Amazon region. The average age is 50. Most of them are spouses, children or parents of the care receiver and they spend at least a quarter of the day for his/her work as caregivers. Most of them have more than 36 months caring for the sick relative. 31% of male caregivers and 33% of female careers expressed to be experiencing an overload with the care of his/her relative. Conclusions: The findings reflect the existence of a majority of female relative caregivers of people with chronic disease, as reported in another studies in Latin America. Unlike previous research, there is no strong difference in the perceived and the expressed load by caregivers, according to gender.

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Salud Uninorte

Título del artículo:

Fitness testing for children: Let\'s mount the zebra!

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Journal of Physical Activity and Health

Título del artículo:

Participation in a fitness program and functional capacity in patients undergoing angioplasty for acute coronary syndrome

Objective: To describe the functional capacity of subjects who participated compared to those who did not participate in a Fitness program after undergoing coronary angioplasty. Methodology: A cross-sectional study was conducted in 19 subjects (68.4% men) with acute coronary syndrome undergoing coronary angioplasty between June and August 2010, who were appropriate for conducting a stress test. The dependent variable was functional capacity assessed by the modified Bruce and Bruce protocols. The main independent variable was participation in the fitness program. Simple and multiple linear regression analyses were performed to establish the variables associated with functional capacity. Results: We found that the subjects who attended the program achieved 2.57 MET above those who did not attend the program (P=.003), adjusted for history of hypertension and obesity. Conversely, obese people reached 3.04 MET less when compared with non-obese individuals, adjusted for program assistance and hypertension (P=.003). Conclusions: In the adjusted analysis, an association was found between participation in a fitness program and functional capacity. Thus, inclusion and participation of subjects who have received percutaneous revascularization in a fitness program within their rehabilitation process is recommended.

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Fisioterapia

Título del artículo:

Neuromuscular performance deficits in low birthweight children: A target for physical activity interventions?

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Developmental Medicine and Child Neurology

Título del artículo:

Patients\' knowledge, attitudes, behaviour and health care experiences on the prevention, detection, management and control of hypertension in Colombia: A qualitative study

Hypertension is a leading cause of premature death worldwide and the most important modifiable risk factor for cardiovascular disease. Effective screening programs, communication with patients, regular monitoring, and adherence to treatment are essential to successful management but may be challenging in health systems facing resource constraints. This qualitative study explored patients\' knowledge, attitudes, behaviour and health care seeking experiences in relation to detection, treatment and control of hypertension in Colombia. We conducted in-depth interviews and focus group discussions with 26 individuals with hypertension and 4 family members in two regions. Few participants were aware of ways to prevent high blood pressure. Once diagnosed, most reported taking medication but had little information about their condition and had a poor understanding of their treatment regime. The desire for good communication and a trusting relationship with the doctor emerged as key themes in promoting adherence to medication and regular attendance at medical appointments. Barriers to accessing treatment included co-payments for medication; costs of transport to health care facilities; unavailability of drugs; and poor access to specialist care. Some patients overcame these barriers with support from social networks, family members and neighbours. However, those who lacked such support, experienced loneliness and struggled to access health care services. The health insurance scheme was frequently described as administratively confusing and those accessing the state subsidized system believed that the treatment was inferior to that provided under the compulsory contributory system. Measures that should be addressed to improve hypertension management in Colombia include better communication between health care professionals and patients, measures to improve understanding of the importance of adherence to treatment, reduction of co-payments and transport costs, and easier access to care, especially in rural areas.

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PLoS ONE