Propuesta metodológica para la planificación de inversiones en infraestructura sanitaria del primer nivel de atención en Essalud

La seguridad social en salud en el Perú está a cargo del Seguro Social de Salud (EsSalud), el cual cubre la atención de aproximadamente el 30% de la población, esto es 10.891.889 asegurados distribuidos en todo el territorio nacional a septiembre de 2016. A pesar de su vasta cobertura, EsSalud se caracteriza por disponer de una oferta de servicios de salud en las zonas de mayor concentración poblacional, con zonas de influencia que incluyen áreas pobladas muy alejadas de dicha oferta, lo cual genera un problema sistemático de baja accesibilidad que afecta a dichas poblaciones alejadas que, a la vez, son, en su mayoría, las más vulnerables. La baja accesibilidad predispone a que la población asegurada recurra a la oferta de salud cuando se encuentra en una fase avanzada de enfermedad u otras situaciones que generan en ella una percepción de urgencia o gravedad. El modelo prestacional, que promueve dicho fenómeno, se mantiene invariable a pesar de la existencia de políticas explícitas orientadas a resolver tal situación. El presente trabajo se propone describir y analiza la situación actual del acceso a los servicios de salud, la percepción de los asegurados respecto de la atención en salud, así como la situación del proceso de planificación de inversiones en EsSalud, y sobre la base de este diagnóstico, formular una propuesta metodológica que permita identificar y priorizar las necesidades de inversión en infraestructura sanitaria del primer nivel de atención, que optimice los recursos económicos y utilice la configuración de redes de salud, de tal manera que permita ofrecer servicios asistenciales de manera oportuna y equitativa a los asegurados

Study and Evolution of the Dune Field of La Banya Spit in Ebro Delta (Spain) Using LiDAR Data and GPR

La Banya spit, located at the south of the River Ebro Delta, is a sandy formation, developed by annexation of bars forming successive beach ridges, which are oriented and modeled by the eastern and southern waves. The initial ridges run parallel to the coastline, and above them small dunes developed, the crests of which are oriented by dominant winds, forming foredune ridges and barchans. This study attempted to test a number of techniques in order to understand the dune dynamic on this coastal spit between 2004 and 2012: LiDAR data were used to reconstruct changes to the surface and volume of the barchan dunes and foredunes; ground-penetrating radar was applied to obtain an image of their internal structure, which would help to understand their recent evolution. GPS data taken on the field, together with application of GIS techniques, made possible the combination of results and their comparison. The results showed a different trend between the barchan dunes and the foredunes. While the barchan dunes increased in area and volume between 2004 and 2012, the foredunes lost thickness. This was also reflected in the radargrams: the barchan dunes showed reflectors related to the growth of the foresets while those associated with foredunes presented truncations associated with storm events. However, the global balance of dune occupation for the period 2004-2012 was positive

Describing Complexity in Palliative Home Care Through HexCom : A Cross-Sectional, Multicenter Study

Complexity has become a core issue in caring for patients with advanced disease and/or at the end-of-life. The Hexagon of Complexity (HexCom) is a complexity assessment model in the process of validation in health-care settings. Our objective is to use the instrument to describe differences in complexity across disease groups in specific home care for advanced disease and/or at the end-of-life patients, both in general and as relates to each domain and subdomain. Cross-sectional study of home care was conducted in Catalonia. The instrument includes 6 domains of needs (clinical, psychological/emotional, social/family, spiritual, ethical, and death-related), 4 domains of resources (intrapersonal, interpersonal, transpersonal, and practical), and 3 levels of complexity (High (H), Moderate (M), and Low (L)). Interdisciplinary home care teams assessed and agreed on the level of complexity for each patient. Forty-three teams participated (74.1% of those invited). A total of 832 patients were assessed, 61.4% of which were cancer patients. Moderate complexity was observed in 385 (47.0%) cases and high complexity in 347 (42.4%). The median complexity score was 51 for cancer patients and 23 for patients with dementia (p<0.001). We observed the highest level of complexity in the social/family domain. Patients/families most frequently used interpersonal resources (80.5%). This study sheds light on the high-intensity work of support teams, the importance of the social/family domain and planning the place of death, substantial differences in needs and resources across disease groups, and the importance of relationship wellbeing at the end-of-life

Assessing Face Validity of the HexCom Model for Capturing Complexity in Clinical Practice : a Delphi study

Funding: This research was funded by INSTITUT CATALÀ DE LA SALUT, grant number 7Z19/008.Capturing complexity is both a conceptual and a practical challenge in palliative care. The HexCom model has proved to be an instrument with strong reliability and to be valid for describing the needs and strengths of patients in home care. In order to explore whether it is also perceived to be helpful in enhancing coordinated and patient-centred care at a practical level, a methodological study was carried out to assess the face validity of the model. In particular, a Delphi method involving a group of 14 experts representing the full spectrum of healthcare professionals involved in palliative care was carried out. The results show that there is a high level of agreement, with a content validity index-item greater than 0.92 both with regard to the complexity model and the HexCom-Red, HexCom-Basic, and the HexCom-Clin instruments, and higher than 0.85 regarding the HexCom-Figure and the HexCom-Patient instruments. This consensus confirms that the HexCom model and the different instruments that are derived from it are valued as useful tools for a broad range of healthcare professional in coordinately capturing complexity in healthcare practice

Gender and observed complexity in palliative home care : A prospective multicentre study using the hexcom model

This study analyses gender differences in the complexity observed in palliative home care through a multicentre longitudinal observational study of patients with advanced disease treated by palliative home care teams in Catalonia (Spain). We used the HexCom model, which includes six dimensions and measures three levels of complexity: high (non-modifiable situation), medium (difficult) and low. Results: N = 1677 people, 44% women. In contrast with men, in women, cancer was less prevalent (64.4% vs. 73.9%) (p < 0.001), cognitive impairment was more prevalent (34.1% vs. 26.6%; p = 0.001) and professional caregivers were much more common (40.3% vs. 24.3%; p < 0.001). Women over 80 showed less complexity in the following subareas: symptom management (41.7% vs. 51,1%; p = 0.011), emotional distress (24.5% vs. 32.8%; p = 0.015), spiritual distress (16.4% vs. 26.4%; p = 0.001), socio-familial distress (62.7% vs. 70.1%; p = 0.036) and location of death (36.0% vs. 49.6%; p < 0.000). Men were more complex in the subareas of "practice" OR = 1.544 (1.25-1.90 p = 0.000) and "transcendence" OR = 1.52 (1.16-1.98 p = 0.002). Observed complexity is related to male gender in people over 80 years of age. Women over the age of 80 are remarkably different from their male counterparts, showing less complexity regarding care for their physical, psycho-emotional, spiritual and socio-familial needs

Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain : Large-Scale Epidemiological Study

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD-Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)-during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31-56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery

Correction : Chaparro et al. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study. J. Clin. Med. 2021, 10, 2885

The authors wish to make the following corrections to this paper [...]

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Adelante / Endavant

Séptimo desafío por la erradicación de la violencia contra las mujeres del Institut Universitari d’Estudis Feministes i de Gènere "Purificación Escribano" de la Universitat Jaume

CVD Conditions for MWCNTs Production and Their Effects on the Optical and Electrical Properties of PPy/MWCNTs, PANI/MWCNTs Nanocomposites by In Situ Electropolymerization

In this work, the optimal conditions of synthesizing and purifying carbon nanotubes (CNTs) from ferrocene were selected at the first stage, where decomposition time, argon fluxes, precursor amounts, decomposition temperature (at 1023 K and 1123 K), and purification process (HNO3 + H2SO4 or HCl + H2O2), were modulated through chemical vapor deposition (CVD) and compared to commercial CNTs. The processing temperature at 1123 K and the treatment with HCl + H2O2 were key parameters influencing the purity, crystallinity, stability, and optical/electrical properties of bamboo-like morphology CNTs. Selected multiwalled CNTs (MWCNTs), from 1 to 20 wt%, were electropolymerized through in-situ polarization with conductive polymers (CPs), poly(aniline) (PANI) and poly(pyrrole) (PPy), for obtaining composites. In terms of structural stability and electrical properties, MWCNTs obtained by CVD were found to be better than commercial ones for producing CPs composites. The CNTs addition in both polymeric matrixes was of 6.5 wt%. In both systems, crystallinity degree, related to the alignment of PC chains on MWCNTs surface, was improved. Electrical conductivity, in terms of the carrier density and mobility, was adequately enhanced with CVD CNTs, which were even better than the evaluated commercial CNTs. The findings of this study demonstrate that synergistic effects among the hydrogen bonds, stability, and conductivity are better in PANI/MWCNTs than in PPy/MWCNTs composites, which open a promissory route to prepare materials for different technological applications