La reinserción laboral en los pacientes con cáncer colorrectal

Aim: Employment and work-related disability were investigated in a cohort of colorectal cancer patients to describe a possible discrimination and other work issues. Patients and Methods: The study included consecutively 73 colorectal cancer patients who were employed at diagnosis. The questionnaire included cancer-related symptoms and work-related factors. Clinical details were obtained from the medical record. Patients were interviewed face to face. The study was approved by the Ethical Committee of La Paz Hospital. All patients gave consent to participate. Results: Eighty six per cent of patients were unable to work after diagnosis, but 55% returned to work at the end of treatment. The age, having a metastatic illness and the sequelae of the disease or its treatment were independently associated with the ability to work after the end of treatment. Almost all patients told their employers and co-workers about their disease. Conclusions: This is the fi rst exploratory study in Spain about labour reintegration in colorectal cancer. Further studies are necessary.Objetivo: Analizar los factores que infl uyen en la vuelta al trabajo en una cohorte de enfermos con cáncer colorrectal y los posibles problemas de discriminación que pueden tener. Pacientes y métodos: El estudio incluyó 73 pacientes consecutivos diagnosticados de un cáncer colorrectal y empleados en el momento del diagnóstico. Los pacientes rellenaron un cuestionario que incluía aspectos demográficos, clínicos y laborales. El estudio fue aprobado por el Comité Ético y de Investigación Clínica del Hospital La Paz. Todos los pacientes dieron su consentimiento para participar en el estudio y para la utilización de los datos de su historia clínica. Resultados: El 86% de los pacientes pasaron a inactivos tras comenzar el tratamiento de la enfermedad y un 45% lo seguían estando tras éste. No hubo diferencias en la influencia de las distintas variables analizadas con respecto a la actividad laboral tras el diagnóstico. Sin embargo, la edad avanzada, el tener un estadio IV de la enfermedad y la presencia de secuelas derivadas del tumor o del tratamiento de éste, sí infl uyeron en la reinserción laboral una vez fi nalizado el tratamiento específico. La mayoría de los pacientes no creían que el tener la enfermedad les perjudicaría en su puesto de trabajo y, en casi todos los casos, tanto sus compañeros como sus jefes conocían que tenían un tumor. Conclusiones: Éste es el primer estudio exploratorio en nuestro país acerca de la reinserción laboral de los pacientes diagnosticados de una neoplasia maligna colorrectal. Son necesarios más trabajos para poder establecer las medidas adecuadas para la mejora de este proceso

Modelo de programación matemática para la cadena productiva del biodiesel en Colombia

This paper describes a mixed integer linear programming model for structuring and integrating strategic decisions and tactics, related to the production of biofuel biodiesel from African palm in Colombia. The model considers four regions (North, Central, Eastern and South - West),in order to coordinate a structured way fl ow of resources between the links in the chain starting with “harvesting” going through the middle steps of “extraction” and “conversion” until the fi nal step “mixture “, which are involved in the supply network.The goal of the model is to determine a distribution plan of palm, oil, biodiesel and diesel throughout the chain, along with a production and inventory plan, and a capacity increase plan for biorefi neries in a way that minimizes the total cost of the production chain over a predefi ned planning horizon. The application of the model results in a projection to the year 2043 showing the behavior of the chain, specifi cally soil requirements for such production levels.El presente trabajo describe un modelo de programación lineal entera mixta para la estructuración e integración de toma de decisiones estratégicas y tácticas, relacionadas con la producción del biocombustible biodiesel a partir de palma africana en Colombia, definiendo cuatro zonas (Norte, Central, Oriental y Sur – Occidental), con el fin de coordinar de manera estructurada el flujo de los recursos entre los eslabones de la cadena productiva definida: desde el eslabón inicial “cultivo”, pasando por los eslabones centrales “extractoras y “refinado” hasta el eslabón final “mezclado”, los cuales conforman la red de suministro.El objetivo del modelo es determinar un plan de distribución de palma, aceite y biodiesel a lo largo de la cadena, un plan de producción e inventario y un plan de aumento de capacidad de las biorrefinerías que minimice el costo total de la cadena a lo largo de un horizonte de planeación definido. La aplicación del modelo permite mostrar una proyección al año 2043 del comportamiento de la cadena y en especial de los requerimientos del suelo

Returning to work in colorectal cancer patients

Aim: Employment and work-related disability were investigated in a cohort of colorectal cancer patients to describe a possible discrimination and other work issues. Patients and Methods: The study included consecutively 73 colorectal cancer patients who were employed at diagnosis. The questionnaire included cancer-related symptoms and work-related factors. Clinical details were obtained from the medical record. Patients were interviewed face to face. The study was approved by the Ethical Committee of La Paz Hospital. All patients gave consent to participate. Results: Eighty six per cent of patients were unable to work after diagnosis, but 55% returned to work at the end of treatment. The age, having a metastatic illness and the sequelae of the disease or its treatment were independently associated with the ability to work after the end of treatment. Almost all patients told their employers and co-workers about their disease. Conclusions: This is the fi rst exploratory study in Spain about labour reintegration in colorectal cancer. Further studies are necessary

Mitos, creencias y temores en la cardiopatía isquémica

Los pacientes que sufren cardiopatía isquémica conviven con frecuencia con mitos y falsas creencias al respecto de su nueva situación; que pueden traer consecuencias que se pueden manifestar en forma de una incorrecta prevención de procesos posteriores y el desarrollo de prácticas y modos de vida nocivos para el individuo. Este estudio de diseño cualitativo realizado sobre pacientes con enfermedad coronaria aguda ingresados en nuestra unidad de cuidados críticos pretende evaluar el grado de conocimiento de la población que sufre esta enfermedad coronaria con respecto a la gravedad, calidad de vida y cuidados preventivos y paliativos que manejaban estos usuarios, revisando temas como la estima, las creencias, la sexualidad, los roles familiares y laborales, etc. Las conclusiones extraídas del análisis de los datos ofrecidos por los pacientes entrevistados muestran que existe un claro desconocimiento con respecto a su situación, sus posibilidades y sus perspectivas, que los introducen en marcos erróneos que traen como consecuencia el aumento de sus miedos y preocupaciones, siendo éste el mayor causante de estrés y preocupaciones, con consecuencias negativas para su evolución y afrontamiento a la nueva situació

SARS-CoV-2 viral load in nasopharyngeal swabs is not an independent predictor of unfavorable outcome

The aim was to assess the ability of nasopharyngeal SARS-CoV-2 viral load at first patient’s hospital evaluation to predict unfavorable outcomes. We conducted a prospective cohort study including 321 adult patients with confirmed COVID-19 through RT-PCR in nasopharyngeal swabs. Quantitative Synthetic SARS-CoV-2 RNA cycle threshold values were used to calculate the viral load in log10 copies/mL. Disease severity at the end of follow up was categorized into mild, moderate, and severe. Primary endpoint was a composite of intensive care unit (ICU) admission and/or death (n = 85, 26.4%). Univariable and multivariable logistic regression analyses were performed. Nasopharyngeal SARS-CoV-2 viral load over the second quartile (≥ 7.35 log10 copies/mL, p = 0.003) and second tertile (≥ 8.27 log10 copies/mL, p = 0.01) were associated to unfavorable outcome in the unadjusted logistic regression analysis. However, in the final multivariable analysis, viral load was not independently associated with an unfavorable outcome. Five predictors were independently associated with increased odds of ICU admission and/or death: age ≥ 70 years, SpO2, neutrophils > 7.5 × 103/µL, lactate dehydrogenase ≥ 300 U/L, and C-reactive protein ≥ 100 mg/L. In summary, nasopharyngeal SARS-CoV-2 viral load on admission is generally high in patients with COVID-19, regardless of illness severity, but it cannot be used as an independent predictor of unfavorable clinical outcome

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Un análisis comparativo de la experiencia de competitividad de colombia y corea del sur

La definición de Competitividad resulta compleja por la gran cantidad de autores que escriben sobre la misma; una práctica acepción es la que suministran el IMD/WEF (Escuela de Negocios IMD/World Economic Forum): “es la habilidad de un país para crear sostenibilidad e incrementar espacios en los mercados con rentabilidad”.Las estructuras económicas de Corea del Sur y Colombia se encontraban en similares condiciones a finales de la segunda mitad del siglo pasado (años setentas, aproximadamente), pero hoy, desafortunadamente para Colombia, la situación es muy distinta: la nación oriental se ubica en el puesto 19 y Colombia en el puesto 69, según el Índice de Competitividad Global1. Sólo hay un país latinoamericano dentro de los treinta más competitivos y es Chile, precisamente ocupando esa posición. Observando el ranking desde una perspectiva regional, Corea del Sur es el quinto mejor país desarrollado de su región, después de Singapur, Japón,Hong Kong y Taiwán (puestos 3, 8, 11 y 12, respectivamente). En Latinoamérica, Colombia está en el puesto octavo; encabeza Chile. Los subsiguientes puestos son para Puerto Rico, Costa Rica, Brasil,Panamá, México y Uruguay, en orden descendente.¿Por qué esta situación? Los especialistas describen con gran propiedad los excelentes manejos económicos de los orientales,en contraste con las políticas de desarrollo poco expansivas de los latinoamericanos. A continuación se exponen los detalles relativos

Mathematical Programming Model of Biodiesel Supply Chain in Colombia

El presente trabajo describe un modelo de programación lineal entera mixta para la estructuración e integración de toma de decisiones estratégicas y tácticas, relacionadas con la producción del biocombustible biodiesel a partir de palma africana en Colombia, definiendo cuatro zonas (Norte, Central, Oriental y Sur – Occidental), con el fin de coordinar de manera estructurada el flujo de los recursos entre los eslabones de la cadena productiva definida: desde el eslabón inicial “cultivo”, pasando por los eslabones centrales “extractoras y “refinado” hasta el eslabón final “mezclado”, los cuales conforman la red de suministro.El objetivo del modelo es determinar un plan de distribución de palma, aceite y biodiesel a lo largo de la cadena, un plan de producción e inventario y un plan de aumento de capacidad de las biorrefinerías que minimice el costo total de la cadena a lo largo de un horizonte de planeación definido. La aplicación del modelo permite mostrar una proyección al año 2043 del comportamiento de la cadena y en especial de los requerimientos del suelo.This paper describes a mixed integer linear programming model for structuring and integrating strategic decisions and tactics, related to the production of biofuel biodiesel from African palm in Colombia. The model considers four regions (North, Central, Eastern and South - West),in order to coordinate a structured way fl ow of resources between the links in the chain starting with “harvesting” going through the middle steps of “extraction” and “conversion” until the fi nal step “mixture “, which are involved in the supply network.The goal of the model is to determine a distribution plan of palm, oil, biodiesel and diesel throughout the chain, along with a production and inventory plan, and a capacity increase plan for biorefi neries in a way that minimizes the total cost of the production chain over a predefi ned planning horizon. The application of the model results in a projection to the year 2043 showing the behavior of the chain, specifi cally soil requirements for such production levels

Mathematical Programming Model of Biodiesel Supply Chain in Colombia

This paper describes a mixed integer linear programming model for structuring and integrating strategic decisions and tactics, related to the production of biofuel biodiesel from African palm in Colombia. The model considers four regions (North, Central, Eastern and South - West), in order to coordinate a structured way fl ow of resources between the links in the chain starting with “harvesting” going through the middle steps of “extraction” and “conversion” until the fi nal step “mixture “, which are involved in the supply network. The goal of the model is to determine a distribution plan of palm, oil, biodiesel and diesel throughout the chain, along with a production and inventory plan, and a capacity increase plan for biorefi neries in a way that minimizes the total cost of the production chain over a predefi ned planning horizon. The application of the model results in a projection to the year 2043 showing the behavior of the chain, specifi cally soil requirements for such production levels