Problemas metodológicos en la medición del rendimiento policial de la Guardia Civil en delincuencia organizada

El crimen organizado es un fenómeno dinámico y adaptativo, lo que dificulta enormemente su represión tanto en la actuación policial como en un desarrollo jurídico adecuado, que no evoluciona a la misma rapidez que esta forma delictiva, lo cual puede conllevar en ocasiones la impunidad de sujetos implicados. Por ello, se considera conveniente estudiar el grado de ajuste que se da entre la actividad policial y la judicial. Con el objetivo de encontrar la metodología óptima para el estudio comparativo entre la actuación policial y los resultados judiciales en materia de delincuencia organizada en España, se ha propuesto la siguiente hipótesis de trabajo: existencia de un desajuste entre las sentencias judiciales condenatorias y la actuación policial desempeñada por la Guardia Civil. A partir de Informes de explotación de operaciones sobre crimen organizado de la Guardia Civil desarrolladas entre los años 2004 y 2009, y sus sentencias correspondientes, se obtiene un conjunto de variables que permiten operativizar el esfuerzo policial y los resultados judiciales, de modo que se pueden comparar entre sí. Los resultados obtenidos mediante esta investigación preliminar permiten describir el recorrido judicial completo de las operaciones analizadas; identificar los principales problemas que se dan a la hora de conseguir sentencias a partir de los informes policiales; proponer soluciones para mejorar esa búsqueda; desarrollar unos primeros índices para cuantificar la actividad policial y el resultado judicial, que permitan llegar a formular una medida del rendimiento policial, y en suma, enunciar recomendaciones para incrementar ese rendimient

Quantification of inaccurate diagnosis of COPD in primary care medicine: An analysis of the COACH clinical audit

Background: Inaccurate diagnosis in COPD is a current problem with relevant consequences in terms of inefficient health care, which has not been thoroughly studied in primary care medicine. The aim of the present study was to evaluate the degree of inaccurate diagnosis in Primary Care in Spain and study the determinants associated with it. Methods: The Community Assessment of COPD Health Care (COACH) study is a national, observational, randomized, non-interventional, national clinical audit aimed at evaluating clinical practice for patients with COPD in primary care medicine in Spain. For the present analysis, a correct diagnosis was evaluated based on previous exposure and airway obstruction with and without the presence of symptoms. The association of patient-level and center-level variables with inaccurate diagnosis was studied using multivariate multilevel binomial logistic regression models. Results: During the study 4,307 cases from 63 centers were audited. The rate of inaccurate diagnosis was 82.4% (inter-regional range from 76.8% to 90.2%). Patient-related interventions associated with inaccurate diagnosis were related to active smoking, lung function evaluation, and specific therapeutic interventions. Center-level variables related to the availability of certain complementary tests and different aspects of the resources available were also associated with an inaccurate diagnosis. Conclusions: The prevalence data for the inaccurate diagnosis of COPD in primary care medicine in Spain establishes a point of reference in the clinical management of COPD. The descriptors of the variables associated with this inaccurate diagnosis can be used to identify cases and centers in which inaccurate diagnosis is occurring considerably, thus allowing for improvement

Adaptación de cofias metálicas confeccionadas con dos técnicas: cera pérdida colado por centrifugación convencional e inducción

Nuevas técnicas nos están permitiendo migrar de la técnica de cera perdida colado por centrifugado convencio- nal (CPCC) a técnicas como la cera perdida colado por inducción (CPCI). Objetivos: Comparar la discrepancia marginal e interna de cofias unitarias de aleación Cobalto-Cromo (Co-Cr) sobre una línea de terminación cham- fer, confeccionadas con dos técnicas: CPCC y CPCI, determinando cual técnica tuvo mejor adaptación marginal e interna. Material y Métodos: Se fabricaron13 cofias metálicas unitarias de aleación Co-Cr para cada técnica a evaluar. Se utilizó la réplica de silicona para evaluar las discrepancias marginales e internas, cada muestra fue seccionada en cruz en sentido vestíbulo-palatino y en sentido mesio-distal, luego con un estéreomicroscopio se evaluó la zona cervical, axial y oclusal.  Resultados: Se evaluó los supuestos de normalidad con la prueba de Shapiro-Wilk. Los análisis estadísticos fueron la prueba t de Student y U Mann-Whitney. La CPCI obtuvo una menor discrepancia marginal e interna en comparación con la CPC pero no se encontró diferencias estadísti- camente significativas (p>0,05) entre ambas técnicas. Conclusiones: Aunque en la mayoría de los puntos de evaluación las cofias realizadas mediante la CPCI presento mejores valores de adaptación marginal e interna en comparación con la CPCC estos resultados sólo son valores descriptivos que no fueron concluyentes, ya que en la mayoría de los puntos evaluados no existió diferencia estadísticamente significativa (p>0,05). Observamos que la mayoría de los valores de ambas técnicas se encuentran dentro del rango clínicamente aceptable

Adaptación de cofias unitarias en Co-Cr elaboradas con diferentes técnicas de fabricación y sobre dos líneas de terminación

Nuevas tecnologías nos han permitido migrar de la técnica de cera perdida colada por centrifugado (CPC) a la fabricación aditiva como la fusión selectiva por láser (SLM), proporcionando una mejor adaptación marginal e interna. Objetivos: Comparar la discrepancia marginal e interna en cofi as unitarias de Co-Cr sobre 2 líneas de terminación: chamfer y bisel, fabricadas con la CPC y SLM, determinando cual tuvo mejor adaptación marginal e interna. Material y Métodos: Se tuvo 4 grupos de estudio: CPC chamfer (n=13), CPC bisel (n=13), SLM chamfer (n=13) y SLM bisel (n=13). Para evaluar la discrepancia marginal e interna se usó el método de la réplica en silicona, seccionando primero en sentido vestíbulo-palatino (V-P) y segundo en sentido mesio-distal (M-D). Se midió las zonas cervical, axial y oclusal con un estéreo microscopio a 40X. Resultados: Se evaluó los supuestos de normalidad con la prueba de Shapiro-Wilk, y el análisis estadístico fue con las pruebas t de Student y U Mann-Whitney. La menor discrepancia marginal fue para la SLM chamfer con promedios menores de 24,70±10,29 μm en el corte V-P y de 21,82±5,94 μm en el corte M-D, seguido por la SLM bisel en el corte V-P de 34,12±16,23 μm y en el corte M-D de 35,34±8,91 μm. La CPC bisel en el corte V-P fue de 27,17±21,11 μm y en el corte M-D de 47,91±16,77 μm y para la CPC chamfer en el corte V-P fue de 89,65±58,39 μm y en el corte M-D de 91,72±67,13 μm; la diferencia fue estadísticamente signifi cativa solo para las cofi as de SLM chamfer comparándolas con la CPC chamfer. En la discrepancia interna los valores en los 4 grupos no tuvieron diferencias estadísticas. Conclusiones: Según los valores, la mejor adaptación marginal fue para la SLM chamfer, seguida por la SLM bisel, CPC bisel y la CPC chamfer. En cuanto a la adaptación interna, los valores no fueron concluyentes para decir que técnica fue mejor, pero se logró mejor adaptación en la zona axial que la zona oclusal

Multi-infection screening for migrant patients in UK primary care: Challenges and opportunities

Background Migrants in Europe face a disproportionate burden of undiagnosed infection, including tuberculosis, blood-borne viruses, and parasitic infections and many belong to an under-immunised group. The European Centre for Disease Control (ECDC) has called for innovative strategies to deliver integrated multi-disease screening to migrants within primary care, yet this is poorly implemented in the UK. We did an in-depth qualitative study to understand current practice, barriers and solutions to infectious disease screening in primary care, and to seek feedback on a collaboratively developed digitalised integrated clinical decision-making tool called Health Catch UP!, which supports multi-infection screening for migrant patients. Methods Two-phase qualitative study of UK primary healthcare professionals, in-depth semi-structured telephone-interviews were conducted. In Phase A, we conducted interviews with clinical staff (general practitioners (GPs), nurses, health-care-assistants (HCAs)); these informed data collection and analysis for phase B (administrative staff). Data were analysed iteratively, using thematic analysis. Results In phase A, 48 clinicians were recruited (25 GPs, 15 nurses, seven HCAs, one pharmacist) and 16 administrative staff (11 Practice-Managers, five receptionists) in phase B. Respondents were positive about primary care's ability to effectively deliver infectious disease screening. However, we found current infectious disease screening lacks a standardised approach and many practices have no system for screening meaning migrant patients are not always receiving evidence-based care (i.e., NICE/ECDC/UKHSA screening guidelines). Barriers to screening were reported at patient, staff, and system-levels. Respondents reported poor implementation of existing screening initiatives (e.g., regional latent TB screening) citing overly complex pathways that required extensive administrative/clinical time and lacked financial/expert support. Solutions included patient/staff infectious disease champions, targeted training and specialist support, simplified care pathways for screening and management of positive results, and financial incentivisation. Participants responded positively to Health Catch-UP!, stating it would systematically integrate data and support clinical decision-making, increase knowledge, reduce missed screening opportunities, and normalisation of primary care-based infectious disease screening for migrants. Conclusions Our results suggest that implementation of infectious disease screening in migrant populations is not comprehensively done in UK primary care. Primary health care professionals support the concept of innovative digital tools like Health Catch-UP! and that they could significantly improve disease detection and effective implementation of screening guidance but that they require robust testing and resourcing

The Third International Symposium on Fungal Stress – ISFUS

Stress is a normal part of life for fungi, which can survive in environments considered inhospitable or hostile for other organisms. Due to the ability of fungi to respond to, survive in, and transform the environment, even under severe stresses, many researchers are exploring the mechanisms that enable fungi to adapt to stress. The International Symposium on Fungal Stress (ISFUS) brings together leading scientists from around the world who research fungal stress. This article discusses presentations given at the third ISFUS, held in São José dos Campos, São Paulo, Brazil in 2019, thereby summarizing the state-of-the-art knowledge on fungal stress, a field that includes microbiology, agriculture, environmental science, ecology, biotechnology, medicine, and astrobiology

Quantification of inaccurate diagnosis of COPD in primary care medicine: an analysis of the COACH clinical audit

[Background] Inaccurate diagnosis in COPD is a current problem with relevant consequences in terms of inefficient health care, which has not been thoroughly studied in primary care medicine. The aim of the present study was to evaluate the degree of inaccurate diagnosis in Primary Care in Spain and study the determinants associated with it.[Methods] The Community Assessment of COPD Health Care (COACH) study is a national, observational, randomized, non-interventional, national clinical audit aimed at evaluating clinical practice for patients with COPD in primary care medicine in Spain. For the present analysis, a correct diagnosis was evaluated based on previous exposure and airway obstruction with and without the presence of symptoms. The association of patient-level and center-level variables with inaccurate diagnosis was studied using multivariate multilevel binomial logistic regression models.[Results] During the study 4,307 cases from 63 centers were audited. The rate of inaccurate diagnosis was 82.4% (inter-regional range from 76.8% to 90.2%). Patient-related interventions associated with inaccurate diagnosis were related to active smoking, lung function evaluation, and specific therapeutic interventions. Center-level variables related to the availability of certain complementary tests and different aspects of the resources available were also associated with an inaccurate diagnosis.[Conclusions] The prevalence data for the inaccurate diagnosis of COPD in primary care medicine in Spain establishes a point of reference in the clinical management of COPD. The descriptors of the variables associated with this inaccurate diagnosis can be used to identify cases and centers in which inaccurate diagnosis is occurring considerably, thus allowing for improvement.Peer reviewe

Strengthening screening for infectious diseases and vaccination among migrants in Europe: What is needed to close the implementation gaps?

Migration to the European Union (EU)/European Economic Area (EEA) affects the epidemiology of infectious diseases, including tuberculosis (TB), HIV, hepatitis B/C, and parasitic diseases. Some sub-populations of migrants are also considered to be an under-immunised group and thus at risk of vaccine-preventable diseases. Providing high-risk migrants access to timely and efficacious screening and vaccination, and understanding how best to implement more integrated screening and vaccination programmes into European health systems ensuring linkage to care and treatment, is key to improving the health of migrants and their communities, alongside meeting national and regional targets for infection surveillance, control, and elimination. The European Centre for Disease Prevention and Control (ECDC) has responded to calls to action to improve migrant health and strengthen universal health coverage by developing evidence-based guidance for policy makers, public health experts, and front-line healthcare professionals on how to approach screening and vaccination in newly arrived migrants within the EU/EEA. In this Commentary, we provide a perspective towards developing efficacious screening and vaccination of newly arrived migrants, with a focus on defining implementation challenges and evidence gaps in high-migrant receiving EU/EEA countries. There is a need now to leverage the increasing momentum around migrant health to both strengthen the evidence-base and to advocate for universal access to health care for all migrants in the EU/EEA, including undocumented migrants. This should include voluntary, confidential, and non-stigmatising screening and vaccination that should be free of charge and facilitate linkage to appropriate care and treatment