Evaluación de la fiabilidad y validez de un aparato de medida de la presión arterial en la farmacia comunitaria

Introducción: La medida de la presión arterial es una práctica habitual tanto en la farmacia comunitaria como en el domicilio del paciente. Por ello, es conveniente que dispongamos de una técnica de comprobación de la fiabilidad y validez de los aparatos de medida, tanto de los propios como de los que el usuario tiene en su domicilio.Material y métodos: Al respecto se propone y se ejecuta un caso práctico de evaluación de la fiabilidad, mediante la técnica de Bland y Altman, y de la validez, mediante una prueba t para datos apareados y una adaptación de los criterios de la Sociedad Europea de Hipertensión (SEH).Resultados: En el caso práctico que exponemos, el aparato evaluado resulta ser fiable con el nuestro de referencia tanto en la presión arterial sistólica (PAS) como en la presión arterial diastólica PAD, presentando un sesgo en la PAD, midiendo como media 5,1 mmHg más que el nuestro de referencia. El aparato evaluado no pasa respecto al nuestro los criterios de validación de la SEH.Discusión: Como aportación personal se ha construido un archivo Excel® que realiza todos los cálculos anteriores, incluida la potencia de la prueba t, así como los gráficos de Bland y Altman, con solo introducir los resultados de las mediciones que se propone

COVID año 1. Día Mundial de la Diabetes

Con motivo de la celebración del Día Mundial de la Diabetes (DMD) en noviembre de 2020, a los usuarios que han acudido a la farmacia se les ha practicado una determinación de glucosa capilar. Los valores hallados se han comparado con la determinación similar que se realizó el mismo DMD en el año 2019 en la misma farmacia, con una muestra diferente. En 2020 se han captado un total de 127 personas frente a las 54 de 2019. La mediana de glucosa no ha variado significativamente de un año a otro ni en el total de pacientes (105 mg/dl en 2020 vs. 105,5 mg/dl en 2019; p=0,53) ni en los subgrupos de los que toman medicación antidiabética (157 mg/dl en 2020 vs. 187 mg/dl en 2019; p=0,16) ni en los que no toman (103 mg/dl en 2020 vs. 99 mg/dl en 2019; p=0,21). Esta no observación de cambios nos hace reflexionar sobre la forma de detectar futuras alternaciones en el control de la glucosa, sobre todo en pacientes diabéticos. Para ello, será necesario usar estimadores más robustos, como puede ser la hemoglobina glicosilada y trabajar con grupos estables de pacientes

Climate change and Saharan dust drive recent cladoceran and primary production changes in remote alpine lakes of Sierra Nevada, Spain

Recent anthropogenic climate change and the exponential increase over the past few decades of Saharan dust deposition, containing ecologically important inputs of phosphorus (P) and calcium (Ca), are potentially affecting remote aquatic ecosystems. In this study, we examine changes in cladoceran assemblage composition and chlorophyll-a concentrations over the past ~150 years from high-resolution, welldated sediment cores retrieved from six remote high mountain lakes in the Sierra Nevada Mountains of Southern Spain, a region affected by Saharan dust deposition. In each lake, marked shifts in cladoceran assemblages and chlorophyll-a concentrations in recent decades indicate a regional-scale response to climate and Saharan dust deposition. Chlorophyll-a concentrations have increased since the 1970s, consistent with a response to rising air temperatures and the intensification of atmospheric deposition of Saharan P. Similar shifts in cladoceran taxa across lakes began over a century ago, but have intensified over the past ~50 years, concurrent with trends in regional air temperature, precipitation, and increased Saharan dust deposition. An abrupt increase in the relative abundance of the benthic cladoceran Alona quadrangularis at the expense of Chydorus sphaericus, and a significant increase in Daphnia pulex gr. was a common trend in these softwater lakes. Differences in the magnitude and timing of these changes are likely due to catchment and lake-specific differences. In contrast with other alpine lakes that are often affected by acid deposition, atmospheric Ca deposition appears to be a significant explanatory factor, among others, for the changes in the lake biota of Sierra Nevada that has not been previously considered. The effects observed in Sierra Nevada are likely occurring in other Mediterranean lake districts, especially in softwater, oligotrophic lakes. The predicted increases in global temperature and Saharan dust deposition in the future will further impact the ecological condition of these ecosystemsMinisterio de Educación y Ciencia (MEC), Grant/Award Number: AP2007-00352; Programa Nacional de Movilidad de Recursos Humanos de Investigaci on (MICINN); Ministerio de Medio Ambiente (MMA), Grant/Award Number: 87/2007; Ministerio de Econom ıa, Industria y Competitividad (MINECO), Grant/Award Number: CGL2011-23483; Natural Sciences and Engineering Research Council of Canad

Alpine bogs of southern Spain show human-induced environmental change superimposed on long-term natural variations

Recent studies have proved that high elevation environments, especially remote wetlands, are exceptional ecological sensors of global change. For example, European glaciers have retreated during the 20th century while the Sierra Nevada National Park in southern Spain witnessed the first complete disappearance of modern glaciers in Europe. Given that the effects of climatic fluctuations on local ecosystems are complex in these sensitive alpine areas, it is crucial to identify their long-term natural trends, ecological thresholds, and responses to human impact. In this study, the geochemical records from two adjacent alpine bogs in the protected Sierra Nevada National Park reveal different sensitivities and long-term environmental responses, despite similar natural forcings, such as solar radiation and the North Atlantic Oscillation, during the late Holocene. After the Industrial Revolution both bogs registered an independent, abrupt and enhanced response to the anthropogenic forcing, at the same time that the last glaciers disappeared. The different response recorded at each site suggests that the National Park and land managers of similar regions need to consider landscape and environmental evolution in addition to changing climate to fully understand implications of climate and human influence.This study was supported by the project P11-RNM 7332 of the “Junta de Andalucía”, the projects CGL2013-47038-R and CGL2015-67130-C2-1-R of the “Ministerio de Economía y Competitividad of Spain and Fondo Europeo de Desarrollo Regional FEDER” and the research group RNM0190 and RNM309 (Junta de Andalucía). A.G.-A. was also supported by a Marie Curie Intra-European Fellowship of the 7th Framework Programme for Research, Technological Development and Demonstration of the European Commission (NAOSIPUK. Grant Number: PIEF-GA-2012-623027) and by a Ramón y Cajal Fellowship RYC-2015-18966 of the Spanish Government (Ministerio de Economía y Competividad). J.L.T. was also supported by a Small Research Grant by the Carnegie Trust for the Universities of Scotland and hosted the NAOSIPUK project (PIEF-GA-2012-623027). M. J. R-R acknowledges the PhD funding provided by Consejería de Economía, Innovación, Ciencia y Empleo de la Junta de Andalucía (P11-RNM 7332)

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

El niño ciego en la escuela : iniciación al Braille

Se estructura en siete capítulos : los cuatro primeros se ocupan de consideraciones sobre la ceguera en general, la recogida de la información, el lenguaje y la comunicación y los aspectos relacionados con el aprendizaje del niño ciego, respectivamente. En los capítulos 5 y 6 se abordan el sistema Braille y los aspectos metodológicos relacionados con su enseñanza. Finalmente, en el séptimo capítulo, se dan una serie de recomendaciones en torno a la escolarización del niño ciego, algunos aspectos académicos, apuntes y áreas que requieren un tratamiento específico.AndalucíaBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín, 5; 28014 Madrid; Tel. +34917748000; [email protected]