Effectiveness of a group educational intervention - prolact - in primary care to promote exclusive breastfeeding: a cluster randomized clinical trial

Background: The rates of exclusive breastfeeding at 6months in Spain are far from recommended by the World Health Organization, which is 50% by 2025. Evidence of the efectiveness of group interventions in late postpartum is limited. The objective of this study was to evaluate the efectiveness of the PROLACT group educational intervention for increasing the proportion of mother-child dyads with exclusive breastfeeding at 6months compared to the usual practice in primary care. Method: Multicentre cluster randomized clinical trial. A total of 434 mother-child dyads who breastfed exclusively in the frst 4weeks of the children’s life and agreed to participate were included. The main outcome was exclusive breast‑feeding at 6months. Secondary variables were type of breastfeeding, reasons for abandonment, degree of adherence and satisfaction with the intervention. To study the efectiveness, the diference in the proportions of dyads with exclusive breastfeeding at 6months was calculated, and the relative risk (RR) and number needed to treat (NNT) were calculated with their 95% CIs. To study the factors associated with the maintenance of exclusive breastfeeding at 6months, a multilevel logistic regression model was ftted. All analyses were performed to intention to treat. Results: The percentage of dyads with exclusive breastfeeding at 6months was 22.4% in the intervention group and 8.8% in the control group. PROLACT intervention obtained an RR =2.53 (95% CI: 1.54–4.15) and an NNT=7 (95%CI: 5–14). The factors associated with exclusive breastfeeding at 6months were the PROLACT intervention, OR=3.51 (95%CI: 1.55–7.93); age>39 years, OR=2.79 (95%CI: 1.02–7.6); previous breastfeeding experience, OR=2.61 (95%CI: 1.29–5.29); income between 500 and 833.33 €, OR=3.52 (95%CI 1.47–8.47).); planning to start work before the infant was 6months old, OR=0.35 (0.19–0.63). Conclusions: The PROLACT intervention in primary care is more efective than the usual practice for maintaining exclusive breastfeeding at 6months, and can therefore be considered evidence-based practice for implementation in standard practice. Trial registration: The trial was registered with ClinicalTrials.gov under code number NCT01869920 (03/06/2013).This study was funded by the Projects PI12/02609 and PI12/02020 as a part of the Plan Nacional de I+D+I (National Plan for R+D+I) and co-funded by the ISCIII Subdirectorate General for Evaluation and the European Regional Development Fund (ERDF). The primary researcher received a grant for publication from the Fundación para la Investigación e Innovacion en Atención Primaria (Foundation for Research and Innovation in Primary Care) in its 2019 call. The funding source had no role in the design of this study and did not have any role in its execution, analyses, interpretation of the data or the decision to submit the results.S

EDUCORE project: a clinical trial, randomised by clusters, to assess the effect of a visual learning method on blood pressure control in the primary healthcare setting

<p>Abstract</p> <p>Background</p> <p>High blood pressure (HBP) is a major risk factor for cardiovascular disease (CVD). European hypertension and cardiology societies as well as expert committees on CVD prevention recommend stratifying cardiovascular risk using the SCORE method, the modification of lifestyles to prevent CVD, and achieving good control over risk factors. The EDUCORE (Education and Coronary Risk Evaluation) project aims to determine whether the use of a cardiovascular risk visual learning method - the EDUCORE method - is more effective than normal clinical practice in improving the control of blood pressure within one year in patients with poorly controlled hypertension but no background of CVD;</p> <p>Methods/Design</p> <p>This work describes a protocol for a clinical trial, randomised by clusters and involving 22 primary healthcare clinics, to test the effectiveness of the EDUCORE method. The number of patients required was 736, all between 40 and 65 years of age (n = 368 in the EDUCORE and control groups), all of whom had been diagnosed with HBP at least one year ago, and all of whom had poorly controlled hypertension (systolic blood pressure ≥ 140 mmHg and/or diastolic ≥ 90 mmHg). All personnel taking part were explained the trial and trained in its methodology. The EDUCORE method contemplates the visualisation of low risk SCORE scores using images embodying different stages of a high risk action, plus the receipt of a pamphlet explaining how to better maintain cardiac health. The main outcome variable was the control of blood pressure; secondary outcome variables included the SCORE score, therapeutic compliance, quality of life, and total cholesterol level. All outcome variables were measured at the beginning of the experimental period and again at 6 and 12 months. Information on sex, age, educational level, physical activity, body mass index, consumption of medications, change of treatment and blood analysis results was also recorded;</p> <p>Discussion</p> <p>The EDUCORE method could provide a simple, inexpensive means of improving blood pressure control, and perhaps other health problems, in the primary healthcare setting;</p> <p>Trial registration</p> <p>The trial was registered with ClinicalTrials.gov, number NCT01155973 [<url>http://ClinicalTrials.gov</url>].</p

Circulating microRNAs in sera correlate with soluble biomarkers of immune activation but do not predict mortality in ART treated individuals with HIV-1 infection: A case control study

Introduction: The use of anti-retroviral therapy (ART) has dramatically reduced HIV-1 associated morbidity and mortality. However, HIV-1 infected individuals have increased rates of morbidity and mortality compared to the non-HIV-1 infected population and this appears to be related to end-organ diseases collectively referred to as Serious Non-AIDS Events (SNAEs). Circulating miRNAs are reported as promising biomarkers for a number of human disease conditions including those that constitute SNAEs. Our study sought to investigate the potential of selected miRNAs in predicting mortality in HIV-1 infected ART treated individuals. Materials and Methods: A set of miRNAs was chosen based on published associations with human disease conditions that constitute SNAEs. This case: control study compared 126 cases (individuals who died whilst on therapy), and 247 matched controls (individuals who remained alive). Cases and controls were ART treated participants of two pivotal HIV-1 trials. The relative abundance of each miRNA in serum was measured, by RTqPCR. Associations with mortality (all-cause, cardiovascular and malignancy) were assessed by logistic regression analysis. Correlations between miRNAs and CD4+ T cell count, hs-CRP, IL-6 and D-dimer were also assessed. Results: None of the selected miRNAs was associated with all-cause, cardiovascular or malignancy mortality. The levels of three miRNAs (miRs -21, -122 and -200a) correlated with IL-6 while miR-21 also correlated with D-dimer. Additionally, the abundance of miRs -31, -150 and -223, correlated with baseline CD4+ T cell count while the same three miRNAs plus miR- 145 correlated with nadir CD4+ T cell count. Discussion: No associations with mortality were found with any circulating miRNA studied. These results cast doubt onto the effectiveness of circulating miRNA as early predictors of mortality or the major underlying diseases that contribute to mortality in participants treated for HIV-1 infection

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p &lt; 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Simulador de radar meteorológico basado en modelo de Reflectividades en el espacio; Weather radar simulator based on space Reflectivity distribution

<p>Los radares meteorológicos son potentes instrumentos de medición de potencia eléctrica. Los simuladores de radar permiten estudiar la influencia de todos sus parámetros en las mediciones que realiza. Su aplicación en la<br />actualidad comprende el estudio de la influencia de las propiedades físicas de los hidrometeoros y la configuración del radar en la observación; y el estudio del desempeño de los modelos climáticos a partir de la confrontación de la<br />salida del simulador con la observación real. En este trabajo se utiliza como entrada al simulador una distribución de Reflectividades (parámetro proporcional a la potencia retornada) en la atmósfera; obviando la compleja relación que existe entre esta última y las propiedades físicas del blanco meteorológico. El resultado es un simulador que posibilita el estudio de los efectos de patrón de escaneo de la atmósfera y el esquema de adquisición y<br />procesamientos de los datos, sobre la percepción de un blanco meteorológico.</p><p> </p><p>Weather radar are powerful measurement instruments for electric power. Radar simulators allows to investigate the influence of its parameter on measurements.Its application comprehend the study of influence of hydrometeor's physical properties and radar configurations in observation; and the study of climate model performance upon the confrontation of simulator output versus actual observations. In this work simulator input is given as a spacial reflectivity (proportional to returned power) distribution in atmosphere, obviating the complex relation between this and physical properties of meteorological target. The result is a simulator for the study of volume scan pattern and acquisition and processing scheme effects on weather target observation.</p

Simulador de radar meteorológico basado en modelo de Reflectividades en el espacio

Weather radar are powerful measurement instruments for electric power. Radar simulators allows to investigate the influence of its parameter on measurements.Its application comprehend the study of influence of hydrometeor's physical properties and radar configurations in observation; and the study of climate model performance upon the confrontation of simulator output versus actual observations. In this work simulator input is given as a spacial reflectivity (proportional to returned power) distribution in atmosphere, obviating the complex relation between this and physical properties of meteorological target. The result is a simulator for the study of volume scan pattern and acquisition and processing scheme effects on weather target observation.Los radares meteorológicos son potentes instrumentos de medición de potencia eléctrica. Los simuladores de radar permiten estudiar la influencia de todos sus parámetros en las mediciones que realiza. Su aplicación en la actualidad comprende el estudio de la influencia de las propiedades físicas de los hidrometeoros y la configuración del radar en la observación; y el estudio del desempeño de los modelos climáticos a partir de la confrontación de la salida del simulador con la observación real. En este trabajo se utiliza como entrada al simulador una distribución de Reflectividades (parámetro proporcional a la potencia retornada) en la atmósfera; obviando la compleja relación que existe entre esta última y las propiedades físicas del blanco meteorológico. El resultado es un simulador que posibilita el estudio de los efectos de patrón de escaneo de la atmósfera y el esquema de adquisición y procesamientos de los datos, sobre la percepción de un blanco meteorológico

Aplicación de algoritmos de control clásico, adaptable y robusto a sistemas dinámicos de parámetros variables; Classic, adaptable and robust control algorithm application, to variant parameter dynamic system

<p>Existen múltiples sistemas dinámicos cuyos modelos matemáticos se caracterizan por ser de primer orden y parámetros variables con el tiempo. En estos casos las herramientas clásicas no siempre logran un sistema de<br />control que sea estable, posea un buen desempeño dinámico y rechace adecuadamente las perturbaciones, cuando el modelo de la planta se desvía del nominal, para el cual se realizó el diseño.En este trabajo se evalúa el comportamiento de tres estrategias de control en presencia de variación de parámetros. Estas son: control clásico, control adaptable y control robusto. Se realiza un estudio comparativo de las mismas en cuanto a complejidad del diseño, costo computacional de la implementación y sensibilidad ante variaciones en los parámetros y/o presencia de disturbios. Se llega a conclusiones que permiten disponer de criterios para la elección más adecuada, en dependencia de los requerimientos dinámicos que la aplicación demande, así como de los medios técnicos de que se disponga.</p><p> </p><p> </p><p>Many dynamic systems have first order mathematic models, with time variable parameters. In these cases, the classical tools do not satisfy at all control system stability, good performance and perturbation rejection, when the plant model differs from the nominal one, for which the controller was designed.In this article, three control strategies are evaluated in parameter variations and disturbance presence. The strategies are the followings: classical control, adaptive control and robust control. A comparative study is carried out, taking into account the design complexity, the computational cost and the sensitivity. The obtained conclusions helps to provide the criterion to choose the most<br />adequate control strategy, according to the necessary dynamic, as well as the available technical means.</p

Radares meteorológicos alimentados por vías alternativas; Weather Radars with Power Supply from Alternatives Ways

<p>La red de radares meteorol&oacute;gicos de Cuba est&aacute; compuesta por siete radares antiguos (cuatro rusos y tres<br />japoneses), los cuales son mantenidos y operados por el Instituto de Meteorolog&iacute;a de Cuba. En 1997 el<br />Instituto de Meteorolog&iacute;a decidi&oacute; modernizar todos sus radares, tarea que tom&oacute; diez a&ntilde;os para su ejecuci&oacute;n.<br />Los sistemas de accionamiento el&eacute;ctrico de las antenas tambi&eacute;n fueron sometidos a la modernizaci&oacute;n,<br />pero junto a los requerimientos impuestos por el nuevo sistema de adquisici&oacute;n, los sistemas de<br />accionamiento dibieron cumplir con las exigencias energ&eacute;ticas para ser alimentados de bater&iacute;as. Este<br />art&iacute;culo describe las soluciones t&eacute;cnicas implementadas en el nuevo sistema de accionamiento el&eacute;ctrico<br />de las antenas.</p><p>&nbsp;</p><p>&nbsp;</p><p>Weather radar network in Cuba is composed by seven old-fashioned radars (four Russian and three Japanese)<br />and they are maintained and operated by Cuban Meteorological Institute. In 1997 Cuban Meteorological<br />Institute decided to modernize all those radars, and this task was accomplished along ten years.<br />Antenna motor drives were also a matter of modernization, but along with restrictions imposed by data<br />acquisition, drives needed to complain energy restrictions in order to be used with a battery supply. This<br />paper describes technical solutions implemented in newly designed antenna motor drives.</p

Automatización de puestos de trabajo de accionamientos eléctricos

This work shows two automated production systems in the electric drives laboratory at the university of Camagüey, to become laboratories sets, geared to the needs of modern industry. Production systems were electrically coupled to a PLC, so you can regulate speed and working regime using frequency converters. Finally the paper presents the possibility to interact with a SCADA which monitors the system in real time using a personal computer automation of different tasks that correspond to simulations of real technical problems. In addition, we developed a manual that allows the use of automated laboratory system in a manner which ensures blended teaching present and future.En el presente trabajo se muestra como fueron automatizados dos sistemas productivos existentes en el laboratorio de accionamiento eléctrico de la universidad de Camagüey para que se convirtieran en puestos de laboratorios acordes a las necesidades de la industria moderna. Los sistemas productivos fueron acoplados eléctricamente a un PLC, con esto, se les puede regular la velocidad y el régimen de trabajo con ayuda de convertidores de frecuencia. Por último el trabajo presenta la posibilidad de interactuar con un SCADA que supervisa en tiempo real con ayuda de una computadora personal diferentes tareas de automatización que se corresponden con simulaciones de problemas técnicos reales. Además se desarrolló un manual que permite la utilización del sistema de laboratorio automatizado de manera semipresencial lo que garantiza la docencia presente y futura