sábado, 4 de agosto de 2012

Finding Inspiration in a Doctor’s Legacy


Fuente: http://www.nytimes.com/2011/11/02/giving/charity-helps-children-with-clubfoot-without-surgery.html?pagewanted=all


Finding Inspiration in a Doctor’s Legacy


MY morning sprint through the pages of this newspaper typically goes like this: the front page, the corrections, the sports section (during baseball season) and the obituaries.
Stephen Mally for The New York Times
A 5K race for a clubfoot charity included Trista Thompson, 6, once a patient. More Photos »
Multimedia
Two years ago, a photograph on the obituary page stopped me cold. It showed what looked like a display of talismans, objects that resembled “milagros,” the tiny tin replicas of legs, arms and other body parts that supplicants in Mexico and Central America pin to religious statues in the hope of curing a loved one.
These were medical tools, though, miniature plaster casts used to treat infants born with clubfoot, a crippling birth defect. The obituary, beautifully written by my colleague Douglas Martin, recounted the life of Dr. Ignacio Ponseti, a Spanish-born orthopedic expert who had created a nonsurgical cure for clubfoot.
As a reporter covering medicine, I often see its disheartening sides: overhyped drugs, “breakthrough” procedures that prove disastrous and the consequences that the financial dance between doctors and industry can have on patients.
I have also encountered heroes, and Dr. Ponseti soon joined them, his life a testament to the value of service and the power of simplicity. It made me think about what I could do to help make things a bit better.
Bear with me, though, because this is a confession, not a shoulder pat.
Clubfoot, which affects about 200,000 infants a year, is a horribly disabling birth defect, one that can doom a child born in a poor country to a marginal life. In the condition, one or both feet are turned inward and down, forcing afflicted people to walk clumsily on the sides of their feet.
The cure developed by Dr. Ponseti in the 1950s relies on physical manipulation. In each step of the treatment, a child’s clubfoot is stretched and turned slightly outward, and a hip-to-foot plaster cast, like the ones shown in the photograph, is then applied. After about five weeks, the foot is remolded; a child then wears a brace for a few years while bones mature.
Dr. Ponseti’s story was even more compelling because the medical establishment had ignored him, not just for a few years but for five decades. Surgery remained the treatment of choice, though it was performed largely only in wealthier countries and could leave a patient with a limp.
As Dr. Ponseti put it, surgeons love “their little knives.” The parents of children cured using his technique helped change things about a decade ago by taking to the Internet to spread the word. And it even gets better: the Ponseti method, as it is known, can be taught to nondoctors, making it a treatment that can be readily transferred anywhere in the world.
As I finished the physician’s obituary, my head was spinning. In 2006, three years before the doctor’s death at age 95, the Ponseti International Association was created at the University of Iowa, where Dr. Ponseti had practiced. Its mission is simple — to train doctors and health care workers in the Ponseti method.
So I wondered, how could I help? How much money should I donate? Could I learn the technique? And if so, where would I go? For weeks, such thoughts and fantasies kept rolling around. Then, as can happen with our better instincts, they disappeared beneath the immediate demands of family, work and self.
Now, fast-forward to this fall, around the start of the Jewish New Year. An editor asked me, or so I thought, what I was doing for “forgiving.” I thought it was a reference to the holidays, then realized it was invitation to contribute to this section, Giving.
I immediately though of Dr. Ponseti, and my enthusiasm and regrets about him welled up. Here was a chance to write about the philanthropic legacy of his work.
That story is also an inspiring one, filled with people, including disciples of Dr. Ponseti, who are training hundreds of medical professionals in his technique. But the philanthropic support for that effort, much like the fate that befell the Ponseti method for so long, remains very much in the shadows.
In recent years, the Ponseti International Association has received only about $350,000 annually, with $250,000 of that sum coming from a couple in Minneapolis, Robert and Molly Whitmore. (By comparison, the Smile Train, a charity that works to treat another common birth defect, cleft palate, received $102 million in contributions and grants in 2009 and has celebrity supporters like Christie Brinkley, Tom Brokaw and Helena Bonham Carter.)
Mr. Whitmore, the chief technology officer of Seagate, a maker of computer hardware, said he and his wife were inspired to get involved by his father, an orthopedic specialist who had studied under Dr. Ponseti.
Since his retirement in 2006, Dr. William Whitmore, now 79, has traveled to Greece, Rwanda and the Philippines to train people in the Ponseti method.
“The thing that floored us was my dad,” Mr. Whitmore said. “It is a perfect thing to eradicate clubfoot, a terrible deformity, in such an inexpensive, low-tech way.”
Mr. Whitmore said he had also tried to help the organization with his business expertise, helping it to devise a fund-raising plan. It hasn’t been easy, he added, because Dr. Ponseti, while he was alive, was more interested in research than promoting his work. That role has fallen to his protégé, Dr. Jose Morcuende, who is now the chief medical officer of the Ponseti International Association.
Dr. Morcuende said the organization’s program was growing. Discussions are under way to start a training program throughout Mexico, and similar efforts have started or are about to start in the Philippines, Romania and India.
The organization’s vision, Dr. Morcuende explained, is to create a cadre of trained doctors and health care workers in every country, a permanent medical infrastructure to treat the 200,000 new cases of clubfoot that will occur every year.
“We need about 4,000 to 5,000 good, well-trained people,” he said. Currently, that group stands about 1,500 strong and he estimates that it will take seven to 10 years and about $20 million to bring it to full force.
Some children with clubfoot will continue to require surgery. But Dr. Morcuende said studies have indicated that the Ponseti method works in up to 98 percent of cases, though it needs to be performed precisely and followed up rigorously to prevent a relapse. By medical standards, such success is impressive and some of Dr. Ponseti’s disciples have found that the technique has been used on older children, including some who were teenagers.
A doctor is needed to perform a minor procedure after the work of manipulating and casting the foot has finished. So as I spoke to Dr. Morcuende, I worked our conversation around to the issue about which I had obsessed when reading his mentor’s obituary: Could anyone be trained in the Ponseti method?
No, was his answer. One needed to understand the foot’s complex anatomy, and so physical therapists or hospital workers skilled in making casts are best suited for training.
I was a little disappointed. But that’s O.K. There is always writing and donating money. And that’s good, because those are things I can do.

Ignacio Ponseti, Hero to Many With Clubfoot


Fuente: http://www.nytimes.com/2009/10/24/health/research/24ponseti.html

Ignacio Ponseti, Hero to Many With Clubfoot, Dies at 95

Published: October 23, 2009
Dr. Ignacio V. Ponseti, an orthopedist whose gentle, nonsurgical method of correcting clubfoot has become the global standard for treatment, helping thousands of children to walk, died Sunday in Iowa City. He was 95.
Susan McClellen/University of Iowa
Dr. Ignacio V. Ponseti using a skeletal model of a foot to explain his clubfoot treatment method.
University of Iowa Department Of Orthopedics and Rehabilitation
Dr. Ponseti's method involved gentle manipulation and the use of casts, shown here.
The cause was a stroke he suffered Tuesday while working in his office, said Tom Moore, a spokesman for theUniversity of Iowa, where Dr. Ponseti taught and practiced.
Dr. Ponseti came up with his method after realizing that surgery for clubfoot actually did harm. Drawing on his experience tending to the wounded in the Spanish Civil War, he found that a regimen of plaster casts, braces and manipulations by hand could avoid the costs and aftereffects of surgery.
Nearly 200,000 children are born every year with clubfoot, a vast majority of them in developing countries. The condition is a birth defect in which the feet are twisted down and inward, making them look like golf clubs with the club heads turned to face each other. It can affect one or both feet. Without treatment, the afflicted appear to walk on their ankles or the sides of their feet.
In the early 1940s, Dr. Ponseti’s research showed that the most common treatment, surgery, could leave a child with stiff ankles and a limp. His alternative involved slowly and gradually straightening and rotating each twisted foot toward its normal position.
The method was applied in stages. After each treatment, he would immobilize a child’s leg with a toe-to-groin plaster cast. A week later, he would remove the cast and shape the malleable foot a bit more, then replace the cast. The treatment would last three to five weeks.
The child would wear a special brace 23 hours a day for three months and then, for two or three years, limit its use to overnight and nap time.
Though Dr. Ponseti devised his treatment a half-century ago, it became popular only in the 1990s, when parents of afflicted children spread word about it over the Internet. Orthopedists found themselves responding to requests for the Ponseti method rather than ordering surgery.
The procedure cures clubfoot in more than 95 percent of cases, said Dr. Jose Morcuende, director of the Ponseti Clubfoot Center at the University of Iowa, citing 25 papers over the last eight years. Dr. Morcuende said a study soon to be published would show that the incidence of surgery for clubfoot had declined 90 percent over the last five or six years, as doctors switched to the Ponseti method.
The method has been endorsed by the World Health Organization, the National Institutes of Health and the American Academy of Pediatrics.
Dr. Wallace B. Lehman, chief of pediatric orthopedic surgery at N.Y.U. Hospital for Joint Diseases, said in an interview Wednesday that the method had “saved countless, countless feet of crippled babies.” In 2001, Dr. Lehman named his hospital’s clubfoot treatment center for Dr. Ponseti.
Dr. Ponseti brought an unusual background to his trailblazing medical work. He thought his delicate touch might have come in part from his youth in Spain, where he worked with his father, a watchmaker, in Barcelona. Later, as a surgeon for the government forces battling the Franco rebellion in the Spanish Civil War, he treated as many as 4,000 wounded soldiers, many with broken bones.
Ignacio Vives Ponseti was born on Minorca, an island off Spain’s Mediterranean coast, on June 3, 1914. His family moved to Barcelona when he was 8. He recalled seeing Picasso’s art and hearing Casals’ cello there. In 1936, he graduated from the University of Barcelona medical school a day before the Spanish Civil War started. Two days later he joined the Republican Army as a surgeon.
After Franco gained control of the fighting in 1939, Dr. Ponseti escaped to France, but only after working for three days to set the fractures of 40 wounded soldiers. With the help of local smugglers, he transported the 40 by mule over the Pyrenees. Penniless, he found his way to Mexico, where he became a village doctor.
Dr. Ponseti went to the University of Iowa in 1941 after a Mexican orthopedist had referred him to the chairman of its orthopedics department. His residency was in orthopedics, and clubfoot quickly became a major interest.
In one research project, he studied outcomes of clubfoot surgery over a 20-year period. After finding that surgery had rarely left a child without impairments, he pondered less invasive treatments, testing them with infants in his clinic.
He seemed to have special gifts, particularly an ability to visualize the interior of a foot and ankle by feeling with his hands. “It’s a little bit like playing the piano,” he said.
Dr. Lehman called the technique “arty” and “counterintuitive,” declaring, “The ordinary surgeon can’t do it.”
But it can be taught, and Dr. Lehman himself was teaching it when he paused to be interviewed by telephone from Israel while on a trip to the Middle East. Dr. Lehman had brought with him six of the flexible acrylic models that Dr. Ponseti developed and was providing them to doctors, Jordanians and Palestinians among them, to practice on. All but five models had disappeared, a “theft” that Dr. Lehman heartily applauded.
Dr. Morcuende, of the University of Iowa, said 80 percent of clubfoot cases were in developing countries, many in Africa. Because doctors are in short supply in those countries, medical technicians there are being trained in the treatment, he said.
By the 1990s, Dr. Ponseti and his colleagues had treated more than 2,000 cases of clubfoot. But he was frustrated that although his method had long before been described in medical journals, more doctors were not using it.
Part of the reason, Dr. Lehman said, was that there had been other manipulation and casting methods, many manifestly ineffective. In an interview with The Chicago Tribune in 2006, Dr. Ponseti offered a more cynical explanation. “Surgeons love their little knives,” he said.
So Dr. Ponseti put his story out, in many ways. He held teaching clinics all over the world and wrote a book, “Congenital Clubfoot: Fundamentals of Treatment” (Oxford, 1996). He helped found the Ponseti International Association for the Advancement of Clubfoot Treatment, whose Web site became an important source of knowledge. Scores of doctors went to Iowa City to learn at his side.
And the tide turned. At Iowa, the number of children arriving for treatment increased tenfold, to 150 a year. Orthopedists elsewhere picked up the procedure.
With the news of Dr. Ponseti’s death, parents have expressed gratitude and condolences on the Ponseti association’s Web site, www.ponseti.info. Earlier, Dr. Ponseti said he had been touched by a gift they gave him: a T-shirt with the footprints of babies whose clubfeet he had cured.

Drogas, dopaje y atletas

Uso de anfetaminas y sus factores asociados en fisicoculturistas: un estudio de Terán, Irán. 
Amphetamine use and its associated factors in body builders: a study from Tehran, Iran.
Angoorani H, Narenjiha H, Tayyebi B, Ghassabian A, Ahmadi G, Assari S.
Iranian Research Center for Substance Abuse and Dependence (IRCSAD), University of Social Welfare and Rehabilitation Science, Tehran, Iran.
Arch Med Sci. 2012 May 9;8(2):362-7.
Abstract
INTRODUCTION: Epidemiological studies on all types of illicit drug use among athletes are essential for both the sport community and drug control achievements. Here, we investigated the prevalence and associated factors of amphetamine use in body builders in Tehran, Iran, 2007.MATERIAL AND METHODS: This study is a secondary analysis of a substance use survey done in 103 randomly selected gymnasia in Tehran (capital city of Iran). The survey was conducted from November 2007 to January 2008 and included 843 randomly selected bodybuilders (aged 40 years or less). By interviews via questionnaires the following data were obtained: age, job, marital status, education level, housing status, average monthly family income, number of family members, gymnasium area (m(2)), number of trainers, number of gymnasium members, initiation time (months), weekly duration of the sporting activity (h), monthly cost of the sporting activity, purpose of participating in sporting activity, and history of anabolic steroid and amphetamine use. RESULTS: One hundred twenty (13.3%) body builders reported a history of amphetamine use. According to the results of regression analysis, being married (risk ratio - RR = 0.540), and participating in body building to enhance self-esteem (RR = 0.423) or to enhance sport performance (RR = 0.545) had protective effects on amphetamine use. However, having university qualifications (RR = 1.843), using anabolic steroids (RR = 1.803) and participating in sport to maintain fitness (RR = 2.472) were linked to increased risk of amphetamine use. CONCLUSIONS: Well-educated bodybuilders were more likely to use amphetamines, and why this is so needs to be discovered. If further studies show that they are not aware of the dangers associated with amphetamine use, providing them with information should be considered.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3361051/pdf/AMS-8-18565.pdf 
¿Existe un peligro para la miopía en la educación contra el dopaje? Análisis comparativo del uso y abuso de sustancias en los deportes de raqueta Olímpicos requiere un enfoque más amplio. 
Is there a danger for myopia in anti-doping education? Comparative analysis of substance use and misuse in Olympic racket sports calls for a broader approach.
Kondric M, Sekulic D, Petroczi A, Ostojic L, Rodek J, Ostojic Z.
Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia.
Subst Abuse Treat Prev Policy. 2011 Oct 11;6:27.
Abstract
BACKGROUND: Racket sports are typically not associated with doping. Despite the common characteristics of being non-contact and mostly individual, racket sports differ in their physiological demands, which might be reflected in substance use and misuse (SUM). The aim of this study was to investigate SUM among Slovenian Olympic racket sport players in the context of educational, sociodemographic and sport-specific factors. METHODS: Elite athletes (N=187; mean age=22±2.3; 64% male) representing one of the three racket sports, table tennis, badminton, and tennis, completed a paper-and-pencil questionnaire on substance use habits. Athletes in this sample had participated in at least one of the two most recent competitions at the highest national level and had no significant difference in competitive achievement or status within their sport. RESULTS: A significant proportion of athletes (46% for both sexes) reported using nutritional supplements. Between 10% and 24% of the studied males would use doping if the practice would help them achieve better results in competition and if it had no negative health consequences; a further 5% to 10% indicated potential doping behaviour regardless of potential health hazards. Females were generally less oriented toward SUM than their male counterparts with no significant differences between sports, except for badminton players. Substances that have no direct effect on sport performance (if timed carefully to avoid detrimental effects) are more commonly consumed (20% binge drink at least once a week and 18% report using opioids), whereas athletes avoid substances that can impair and threaten athletic achievement by decreasing physical capacities (e.g. cigarettes), violating anti-doping codes or potentially transgressing substance control laws (e.g. opiates and cannabinoids). Regarding doping issues, athletes' trust in their coaches and physicians is low. CONCLUSION: SUM in sports spreads beyond doping-prone sports and drugs that enhance athletic performance. Current anti-doping education, focusing exclusively on rules and fair play, creates an increasingly widening gap between sports and the athletes' lives outside of sports. To avoid myopia, anti-doping programmes should adopt a holistic approach to prevent substance use in sports for the sake of the athletes' health as much as for the integrity of sports.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204239/pdf/1747-597X-6-27.pdf
 
Ejercicio y usos de drogas entre jóvenes Estadounidenses, 1991-2009. 
Exercise and substance use among American youth, 1991-2009.
Terry-McElrath YM, O'Malley PM, Johnston LD.
Institute for Social Research, University of Michigan, Ann Arbor, USA.yterry@umich.edu
Am J Prev Med. 2011 May;40(5):530-40.

Abstract
BACKGROUND:
The National Institute on Drug Abuse has called for increased research into the use of physical activity in substance abuse prevention, specifically research into physical activity type and context. PURPOSE: This paper examines the relationships between (1) secondary school student substance use and (2) exercise in general and school athletic team participation, and examines such relationships over time. METHODS: Nationally representative cross-sectional samples of 8th-, 10th-, and 12th-grade students were surveyed each year from 1991 to 2009. Substance use measures included past 2-week binge drinking and past 30-day alcohol, cigarette, smokeless tobacco, marijuana, and steroid use. Analyses were conducted during 2009-2010. RESULTS: Across grades, higher levels of exercise were associated with lower levels of alcohol, cigarette, and marijuana use. Higher levels of athletic team participation were associated with higher levels of smokeless tobacco use and lower levels of cigarette and marijuana use across grades and to higher levels of high school alcohol and steroid use. Exercise helped suppress the undesired relationship between team participation and alcohol use; exercise and athletic team participation worked synergistically in lowering cigarette and marijuana use. Observed relationships were generally stable across time. CONCLUSIONS: There appear to be substantive differences between exercise and team sport participation in relation to adolescent substance use. These findings from cross-sectional data suggest that interventions to improve levels of general physical activity should be evaluated to determine if they help delay or reduce substance use among youth in general as well as among student athletes.
Atentamente
Anestesiología y Medicina del Dolor

El ciclo de la escritura romana

EL ORIGEN DE LA ESCRITURA
Nuestro alfabeto deriva del griego, pero a través del etrusco. En un principio tiene 21 letras, la letra Z desapareció y su lugar lo ocupó la letra G. Para la transcripción de nombres griegos vuelve la Y y la Z que se incorporan al final del alfabeto y algunas de las letras como la M , H y R sufren transformaciones.
MALLON, paleógrafo francés que publicó una monografía sobre la escritura romana y hacía un planteamiento nuevo. Ponia de relieve que para estudiar una escritura hay que informarse sobre todas las fuentes que existen, independientemente de su soporte, ya que anteriormente se hacia una diferencia entre materiales blandos y duros.
PERÍODO ARCAICO, abarca hasta el siglo I a.C. y se caracteriza por:
- Formación de la escritura, una vez formado el alfabeto, sufre transformaciones de las necesidades fonéticas. Ej. La G aparece derivada de la C porque los etruscos no tenían ese sonido. El sistema gráfico se inspira en los modelos griegos. Se crea la escritura originaria

 - Progresiva normalización de la escritura monumental, tiende a ejecutar una escritura más caligráfica, a mediados del siglo III a.C. la escritura presenta una alineación vacilante de los signos
- Módulo irregular
- Trazado irregular
Desde mediados del siglo III a.C. asentimos como por influencia de la escritura epigráfica griega, la escritura romana se va modificando hasta quedar insertada dentro de un sistema bilineal llegando entre siglo II-I a.C. a la canonización de la escritura. Esta escritura se caracteriza porque las intersecciones de las rectas generan un ángulo recto porque los trazos curvos de las grafías responden a los segmentos de un círculo. La escritura se inscribe en un sistema bilineal. Se puede apreciar efecto de claroscuro que se manifiesta porque el final de los trazos rectos de las letras acaban en una especie de espátula. Aparición de una tendencia cursiva que se manifestará por la desarticulación y verticalidad de los trazos o por la difusión de unos trazos con otros.
SISTEMA CLÁSICO ROMANO (s. I d.C y s.II d.C.), gran abundancia de fuentes. Junto con la escritura utilizada epigráficamente. Los romanos cubrieron otras necesidades como elaborar manuscritos, libros y generaron un sistema de mayúscula que partieron de una escritura originaria y presenta dos variedades: capital clásica y común clásica. La escritura común clásica tiene un módulo más pequeño y es más ligera en su trazado.
·         La escritura capital clásica, se conserva a través de fuentes sobre mármol, bronce, pared, papiro y pergamino. De entre el conjunto de fuentes destacamos entre los papiros el denominado Carmen de Bello actico   
que narra la batalla de Actium. Este papiro no tiene fecha pero marca una fecha para esta escritura. Se puede fechar entre el 31 y 76 d.C. que es la explosión del Danubio.
Se pueden destacar una serie de códices determinados Virgilios.
A imitación de la escritura monumental epigráfica elegante y canonizada se escribieron en la baja Natividad una serie de códices que algunos paleógrafos llamaron escritura cuadrada o elegante. Ej. Virgilio Sangalense.Este manifiesto contiene las églogas, las geórgicas y un fragmento de la Eneida. Las características de este tipo de escritura son: ángulo muy agudo, ductus pesado, módulo considerable especialmente en los papiros, letras aisladas sin ligaduras ni nexos, utiliza como signo especial con valor relativo el punto (.) que cuando acompaña a la q quiere decir, que, no hay separación de palabras b.–> bus , la T y la I son muy parecidas. La escritura cuadrada o elegante 

Tiene semejantes con la capital clásica pero hay diferencias: las letras se pueden escribir en un cuadrado, los elementos curvos tienen un eje vertical. Ej. O (la capital clásica lo tiene oblicuo)

·         La escritura común clásica, se le ha llamado capital cursiva, cursiva romana. Es la escritura del mundo administrativo y se utiliza también en la contabilidad y en los textos literarios. La escritura común clásica se utiliza en el “mundo documental”. Sus fuentes son las tablillas que las más representativas son las de cera y aparecen también en madera. Ej. Tablillas de Pompeya, Dacia y Egipto, Herculano. Las características son: escritura mayúscula y elementos cursivos que habían hecho su aparición anteriormente, tiene el mismo ángulo y ductus que la capital clásica, el tamaño de las letras es más pequeña y no tiene contrastes, abundancia de ligaduras: a,e,b,r,s , se produce en las letras una serie de alargamientos de carácter espontáneo, la letra B tiene una curiosa evolución. La mayor parte de las tablillas provienen de la casa de un banquero pompeyano.          

TRANSFORMACIONES DE LA ESCRITURA ROMANA, entre siglo II y III d.C. hay cambios que suponen el caso de la mayúscula a la minúscula, lo cual se nota al comparar las tablillas y papiros del siglo I-III con los papiros del siglo IV. El paso en los siglos II-III bajo el imperio de Diocleciano.

* Steffens / Bouard / Batelli , defienden la teoría tradicional, señalan que la aparición de las formas minúsculas se justificaría por la evolución natural de la escritura.

* Mallot / Perrot / Marichal, de la escuela francesa, opinan que el cambio se produce entre el siglo II-III d.C., el cambio gráfico se explica en función de un cambio de ángulo de la escritura. Se pasa del ángulo agudo al recto. Se cree que se produce esto por el cambio del libro en forma de rollo a libro codex que algunos relacionan con la expansión del cristianismo, aunque esto es incorrecto porque también hay libros codex. El cambio se ve en un scriptorium en el norte de África: se comienza a notar en fragmentos de DE BELLI MACEDONIS y se consolida en EPITOME TITI LIVI, y se nota en las letras N, H, R, D, M, Q.

* Cavallo / Cencetti / Petrucci, de la escuela italiana, ya desde el siglo I en ciertas escrituras provinciales, así como en sectores administrativos o artesanales se observan las formas gráficas de lo que luego llamaremos común nueva. El paso se habia producido en los que usan diariamente la escritura que percatarían que la escritura que estaban trazando nada tenia que ver con la escritura anterior. En esta escritura también tuvo importancia el ángulo de la escritura, fruto de estos cambios se generan tres escrituras: escritura uncial (canonizada) ; semiuncial (intento de canonización) y común nueva.

LA ESCRITURA ROMANA DEL PERIODO NUEVO

* Escritura uncial, tiene una vida que va del siglo IV al IX d.C.
Se plantea en su origen una serie de teorías:
-         Origen greco-latino, apoyado por BRANDI TRAUBE, la escritura deriva directamente de la uncial griega. Relacionan su utilización en el mundo latino por la traducción de la Biblia del griego al latín. Se utiliza solo en textos cristianos. Esta teoría hoy en día no es admirable porque es usada para textos paganos y la similitud entre la escritura uncial griega y la del mundo latino es de carácter estético. Desde el punto de vista paleográfico tiene muchas  diferencias

- Solución latina(Schiaparelli), ya en el siglo III hay escritura en las que se entremezclan formas mayúsculas y minúsculas. Tiene un origen latino y se habria generado a partir de las formas que ya existían en el fragmento DE BELLIS MACEDONIS y se habia producido el nacimiento de la escritura en una zona de contacto griego.

- Escuela francesa (Mallon), en el origen se ve una mezcla de formas y un arreglo artificial de las formas gráficas que aparecen en los fragmentos de DE BELLIS MACEDONIS y el EPITOME. Nace en el siglo II en un scriptorium del norte de África.

- Escuela italiana (Cavallo), la escritura uncial es artificial en la que se mezclan formas mayúsculas y minúsculas. No es una escritura natural. Habría surgido al extenderse la cultura latina en zonas fuertemente helenizadas y poco latinizadas en torno a los siglos III-IV d.C. Sería un intento de imponer unas formas mayúsculas en un momento de predominio de la escritura minúscula. Se distinguen tres tipos de letras: letras típicas unciales, letras minúsculas, letras de la capital clásica.

* Escritura semiuncial, tiene un periodo de utilización entre el siglo V-IV d.C. y respecto a su origen hay varias teorías.
- Traube, la escritura semiuncial se relaciona con la uncial y de procedencia cristiano.
- Prou, Stefens, la escritura semiuncial viene de la escritura cursiva, pero ejecutada con lentitud.
- Otros autores relacionan el surgimiento de la escritura semiuncial con las escrituras mixtas del siglo III donde encontramos el EPITOME TITI LIVI.
Las características son:  para que sea considerada como tal debe tener determinadas letras minúsculas. Los historiadores dividen las letras en grupos de cuatro. Las letras en minúscula son: b, d, m, r / b, g, s (u, v), tiene pocas abreviaturas, poco desarrollo de caídos y alzados, rigidez en el diseño, verticalidad en los trazos, entre las letras de su alfabeto: a, e, g, n, t, x, r , genera ligaduras: e, f, g, r, t, l , la letra s y r se pueden confundir. La letra s es redonda en la parte superior se apoya en una pauta y la r hace ángulo en la parte superior es como una s alta y se puede o no apoyar en la pauta. La letra t es corta.

* Escritura común nueva, se usa en el mundo documental. Se usa sobre papiro, el trazo de sus letras es muy fino. En un principio se pensó que esta escritura procedía de la capital cursiva, sin embargo, esta escritura hay que verla dentro del proceso de minuscularización que se produce entre los siglos II-III d.C. Se tiene que entender como una transformación más de la escritura romana. Las letras características son: a (abierta), b, e (rompe sus trazos), n (en forma mayúscula y minúscula), r y s, u, v. Juntamente además de estas formas alfabéticas como es una escritura cursiva genera abundancia de ligaduras: an, ag, eco, ce, re, ep, con, eq.

Etiquetas: Epigrafía, Escritura, Letras, Ligaduras, Papiro, Roma, Tablillas, Trazos

Fuente: 

Drogas, dopaje y atletas

Uso de anfetaminas y sus factores asociados en fisicoculturistas: un estudio de Terán, Irán. 
Amphetamine use and its associated factors in body builders: a study from Tehran, Iran.
Angoorani H, Narenjiha H, Tayyebi B, Ghassabian A, Ahmadi G, Assari S.
Iranian Research Center for Substance Abuse and Dependence (IRCSAD), University of Social Welfare and Rehabilitation Science, Tehran, Iran.
Arch Med Sci. 2012 May 9;8(2):362-7.
Abstract
INTRODUCTION: Epidemiological studies on all types of illicit drug use among athletes are essential for both the sport community and drug control achievements. Here, we investigated the prevalence and associated factors of amphetamine use in body builders in Tehran, Iran, 2007.MATERIAL AND METHODS: This study is a secondary analysis of a substance use survey done in 103 randomly selected gymnasia in Tehran (capital city of Iran). The survey was conducted from November 2007 to January 2008 and included 843 randomly selected bodybuilders (aged 40 years or less). By interviews via questionnaires the following data were obtained: age, job, marital status, education level, housing status, average monthly family income, number of family members, gymnasium area (m(2)), number of trainers, number of gymnasium members, initiation time (months), weekly duration of the sporting activity (h), monthly cost of the sporting activity, purpose of participating in sporting activity, and history of anabolic steroid and amphetamine use. RESULTS: One hundred twenty (13.3%) body builders reported a history of amphetamine use. According to the results of regression analysis, being married (risk ratio - RR = 0.540), and participating in body building to enhance self-esteem (RR = 0.423) or to enhance sport performance (RR = 0.545) had protective effects on amphetamine use. However, having university qualifications (RR = 1.843), using anabolic steroids (RR = 1.803) and participating in sport to maintain fitness (RR = 2.472) were linked to increased risk of amphetamine use. CONCLUSIONS: Well-educated bodybuilders were more likely to use amphetamines, and why this is so needs to be discovered. If further studies show that they are not aware of the dangers associated with amphetamine use, providing them with information should be considered.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3361051/pdf/AMS-8-18565.pdf 
¿Existe un peligro para la miopía en la educación contra el dopaje? Análisis comparativo del uso y abuso de sustancias en los deportes de raqueta Olímpicos requiere un enfoque más amplio. 
Is there a danger for myopia in anti-doping education? Comparative analysis of substance use and misuse in Olympic racket sports calls for a broader approach.
Kondric M, Sekulic D, Petroczi A, Ostojic L, Rodek J, Ostojic Z.
Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia.
Subst Abuse Treat Prev Policy. 2011 Oct 11;6:27.
Abstract
BACKGROUND: Racket sports are typically not associated with doping. Despite the common characteristics of being non-contact and mostly individual, racket sports differ in their physiological demands, which might be reflected in substance use and misuse (SUM). The aim of this study was to investigate SUM among Slovenian Olympic racket sport players in the context of educational, sociodemographic and sport-specific factors. METHODS: Elite athletes (N=187; mean age=22±2.3; 64% male) representing one of the three racket sports, table tennis, badminton, and tennis, completed a paper-and-pencil questionnaire on substance use habits. Athletes in this sample had participated in at least one of the two most recent competitions at the highest national level and had no significant difference in competitive achievement or status within their sport. RESULTS: A significant proportion of athletes (46% for both sexes) reported using nutritional supplements. Between 10% and 24% of the studied males would use doping if the practice would help them achieve better results in competition and if it had no negative health consequences; a further 5% to 10% indicated potential doping behaviour regardless of potential health hazards. Females were generally less oriented toward SUM than their male counterparts with no significant differences between sports, except for badminton players. Substances that have no direct effect on sport performance (if timed carefully to avoid detrimental effects) are more commonly consumed (20% binge drink at least once a week and 18% report using opioids), whereas athletes avoid substances that can impair and threaten athletic achievement by decreasing physical capacities (e.g. cigarettes), violating anti-doping codes or potentially transgressing substance control laws (e.g. opiates and cannabinoids). Regarding doping issues, athletes' trust in their coaches and physicians is low. CONCLUSION: SUM in sports spreads beyond doping-prone sports and drugs that enhance athletic performance. Current anti-doping education, focusing exclusively on rules and fair play, creates an increasingly widening gap between sports and the athletes' lives outside of sports. To avoid myopia, anti-doping programmes should adopt a holistic approach to prevent substance use in sports for the sake of the athletes' health as much as for the integrity of sports.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204239/pdf/1747-597X-6-27.pdf
 
Ejercicio y usos de drogas entre jóvenes Estadounidenses, 1991-2009. 
Exercise and substance use among American youth, 1991-2009.
Terry-McElrath YM, O'Malley PM, Johnston LD.
Institute for Social Research, University of Michigan, Ann Arbor, USA.yterry@umich.edu
Am J Prev Med. 2011 May;40(5):530-40.

Abstract
BACKGROUND:
The National Institute on Drug Abuse has called for increased research into the use of physical activity in substance abuse prevention, specifically research into physical activity type and context. PURPOSE: This paper examines the relationships between (1) secondary school student substance use and (2) exercise in general and school athletic team participation, and examines such relationships over time. METHODS: Nationally representative cross-sectional samples of 8th-, 10th-, and 12th-grade students were surveyed each year from 1991 to 2009. Substance use measures included past 2-week binge drinking and past 30-day alcohol, cigarette, smokeless tobacco, marijuana, and steroid use. Analyses were conducted during 2009-2010. RESULTS: Across grades, higher levels of exercise were associated with lower levels of alcohol, cigarette, and marijuana use. Higher levels of athletic team participation were associated with higher levels of smokeless tobacco use and lower levels of cigarette and marijuana use across grades and to higher levels of high school alcohol and steroid use. Exercise helped suppress the undesired relationship between team participation and alcohol use; exercise and athletic team participation worked synergistically in lowering cigarette and marijuana use. Observed relationships were generally stable across time. CONCLUSIONS: There appear to be substantive differences between exercise and team sport participation in relation to adolescent substance use. These findings from cross-sectional data suggest that interventions to improve levels of general physical activity should be evaluated to determine if they help delay or reduce substance use among youth in general as well as among student athletes.
Atentamente
Anestesiología y Medicina del Dolor

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Depresión. Alerta

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¿Depresión o simple tristeza?
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El licenciado en psiquiatría Julio Torales, define la depresión como un trastorno de ánimo y su manifestación habitual es un estado de abatimiento e infelicidad que puede ser transitorio o permanente. Se presenta con tristeza intensa, decaimiento, ...
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Andrés Pajares, de nuevo ingresado por depresión
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Un Gobierno en depresión
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Adolescentes, los más susceptibles a la depresión
NTR Zacatecas .com
La encargada del Servicio de Medicina del Adolescente del Antiguo Hospital Civil “Fray Antonio Alcalde”, Adriana Ascencio Cervantes, afirmó que este sector es muy susceptible a la depresión. Por ello, indicó que desde 2002 el nosocomio ofrece atención ...
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Disfunción familiar: factor principal en depresión de adolescentes
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Detalló que antes acudían por problemas menstruales, obesidad y problemas en la escuela por baja calificación y ahora es principalmente por déficit de atención e hiperactividad, así como por ladepresión. Añadió la especialista que al mes atienden al ...
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La depresión y el suicidio en la época actual
Ojinaga Hoy
La depresión es un trastorno del estado de ánimo, acompañado de abatimiento e infelicidad, que puede llegar a acompañarse de tristeza, decaimiento, irritabilidad, stress, ansiedad, desinterés por la vida cotidiana, incapacidad de disfrutar placeres, falta de ...
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