Trabajando con nuestros pacientes fumadores en atención primaria. Un análisis de coste-efectividad

ResumenObjetivoEl objetivo de este trabajo es realizar una evaluación económica de las intervenciones sobre tabaquismo en atención primaria.DiseñoAnálisis de coste-efectividad (ACE) comparando 2 estrategias de intervención: intensiva y breve.EmplazamientoPacientes de una consulta de medicina de familia en un centro de salud (CS) periurbano.ParticipantesTodas las historias con etiqueta de fumadores; 235 y 37 en el grupo de intervención breve e intensiva, respectivamente.IntervencionesLa intervención breve (IB) se realizó en el contexto de otro motivo de consulta (1-5 min). La intervención intensiva (II) fue exclusivamente para tabaquismo (10-15 min).Mediciones principalesLos datos de efectividad son obtenidos de la evaluación de la intervención sobre los fumadores de dicha consulta después de 6 años. Empleamos costes sanitarios directos. Excluimos fármacos, costes no sanitarios e indirectos. Aplicamos la tasa de coste-efectividad incremental (ICER) de las intervenciones breve, intensiva y total (breve+intensiva), comparando no intervenir con cada tipo de intervención e II respecto a la IB y análisis probabilístico para tratar la incertidumbre.ResultadosEl coste por paciente abstinente, globalmente, fue 406,74 €. Para la IB fue de 129,83 € y para la II, 1.034,99 €.ICER intervención total=498,87 €/paciente que deja de fumar.ICER IB=235,32 €/paciente que deja de fumar.ICER II=1.232,85 €/paciente que deja de fumar.ICER II/IB=7.772,25 €/paciente que deja de fumar.ConclusionesLas intervenciones sobre tabaquismo en AP son eficientes. Una propuesta para el abordaje del tabaquismo en AP, desde una perspectiva coste-efectiva, podría ser la IB sobre todos los fumadores e II sobre aquellos con más dificultad para abandonar.AbstractObjectiveThe aim of this work is to realize an economic evaluation of the smoking interventions in Primary Care (PC).DesignCost-Effectiveness Analysis comparing two intervention strategies; intensive and brief.SettingPatients in a general practitioner's list in a peri-urban Health Centre.ParticipantsAll the medical histories labelled as smokers; 235 and 37 in the group of brief and intensive intervention respectively.InterventionsThe brief intervention (BI) was made in the context of consultation for another purpose (1-5minutes). The intensive intervention (II) was exclusively for smoking consultation (10-15minutes).Main measurementsThe effectiveness data are obtained by the evaluation of intervention for smokers, in a general practitioner's list, after 6 years. We employ direct sanitary costs. We exclude drugs, non- sanitary and indirect costs. We apply the valuation of incremental cost-effectiveness ratio (ICER) of the brief interventions, intensive and total (brief+intensive) to compare not taking part with each type of intervention and II with regard to BI and probabilistic analysis to treat the uncertainty.ResultsThe total cost per abstinent patient was 406,74 €: 129,83 € for BI and 1.034,99 € for I.I.ICER Total intervention=€498, 87/patient who stops smoking.ICER BI=€235, 32/patient who stops smoking.ICER II=€1.232, 85/patient who stops smoking.ICER II/BI=€7.772,25/patient who stops smoking.ConclusionsSmoking interventions in PC are efficient. A proposal for smoking intervention in PC from an effective cost perspective could be an BI for smokers and an II on those who find more difficult to leave the habit

Correlación entre unidades asta-concentración carotenoide en pimentones. Predicción de la estabilidad del color durante el almacenamiento

Paprika obtained through the traditional process, from fruits dried in oak ovens, is stored at room temperature for 18 months. Samples are taken at 2-3 months time intervals and color quantity is evaluated, measuring it as ASTA units and carotenoid content. Values obtained from both measurements are compared, achieving a good correlation between ASTA units and total carotenoid content. As a result two equations are proposed, one linking both parameters and another which predicts the remaining ASTA unit as a function of storage time. ASTA values after 18 months of storing time are ca. 55 % of the initial values.El pimentón obtenido de forma tradicional, a partir de frutos secados en hornos de leña, se ha almacenado a temperatura ambiente durante 18 meses. Se han tomado muestras de los mismos a intervalos de 2-3 meses y se ha evaluado la cantidad de color extractable como unidades ASTA y, en paralelo, se ha controlado la concentración carotenoide. Se comparan los valores obtenidos por cada uno de los dos procedimientos, observándose que se da una buena correlación entre las unidades ASTA y la concentración total de carotenoides. Se postula una ecuación que relaciona ambos parámetros y otra ecuación que permite predecir el valor remanente de ASTA con el tiempo de conservación. La retención de color a los 18 meses se sitúa en torno al 55 % del valor inicial

Minority compounds and sensory analysis evaluation of Coffea arabica var. caturra cultivated in three different altitudinal ranges

The composition of minority compounds in samples of roasted and ground coffee (Coffea arabica var. caturra) cultivated in three altitudinal ranges 1300-1400, 1400-1600, 1600-1800 m. a. s. l., in the Huila department of Colombia were determined. The samples were collected in July of 2012. pH, total acidity and total lipids were measured. Subsequently, the composition of total lipids after esterification and gas chromatography analysis coupled to high resolution mass spectrometry (GC-MS) was established. Quality cup test considering the following attributes:  fragrance/aroma, taste, residual flavor, acidity, body, uniformity, balance, clean cup, sweetness, quality and note, were performed. No statistically significant difference (p 0.05) in pH, titratable acidity, total time of roasting and cracking time was determined. Significant difference was found in% humidity range: 1300-1400 m relative to the ranges: 1400-1600 and 1600-800 meters. As for the major compounds are predominantly: stigmasterol, sitosterol, 4-methylpentanamide and 2- (2-hydroxyphenyl) buta-1,3-diene, in the altitudinal ranges evaluated. No significant difference (p0.05) was found in the evaluated attributes at the quality cup test at different altitudinal range

Yeast Biodiversity in Fermented Doughs and Raw Cereal Matrices and the Study of Technological Traits of Selected Strains Isolated in Spain

[EN] Bakers use pure microorganisms and/or traditional sourdoughs as the leavening agent for making bread. The performance of each starter and the substances produced by the microorganisms greatly affect the dough rheology and features of breads. Modern sourdoughs inoculated with selected lactic acid bacteria and yeasts are microbiologically stable, safer than traditional sourdoughs, and easy to use. However, the commercial repertoire of baker’s yeasts is still limited. Therefore, there is a demand for new strains of yeast species, capable of conferring distinctive traits to breads made from a variety of agri-food matrices, in the design of innovative starters. In this context, we report the first comprehensive study on yeasts isolated from a wide range of fermented doughs, cereal flours, and grains of Spain. Nine yeast species were identified from 433 isolates, which were distributed among separate clades. Moreover, phenotypic traits of potential technological relevance were identified in selected yeast strains. Mother doughs (MDs) showed the greatest yeast biodiversity, whereas commercial Saccharomyces starters or related and wild strains often dominated the bakery doughs. A metataxonomic analysis of wheat and tritordeum MDs revealed a greater richness of yeast species and percentage variations related to the consistency, flour type, and fermentation time of MDs

Trabajando con nuestros pacientes fumadores en atencion primaria. Un analisis de coste-efectividad

Objective: The aim of this work is to realize an economic evaluation of the smoking interventions in Primary Care (PC). Design: Cost-Effectiveness Analysis comparing two intervention strategies; intensive and brief. Setting: Patients in a general practitioner's list in a peri-urban Health Centre. Participants: All the medical histories labelled as smokers; 235 and 37 in the group of brief and intensive intervention respectively. Interventions: The brief intervention (BI) was made in the context of consultation for another purpose (1-5 minutes). The intensive intervention (II) was exclusively for smoking consultation (10-15 minutes). Main measurements: The effectiveness data are obtained by the evaluation of intervention for smokers, in a general practitioner's list, after 6 years. We employ direct sanitary costs. We exclude drugs, non- sanitary and indirect costs. We apply the valuation of incremental cost-effectiveness ratio (ICER) of the brief interventions, intensive and total (brief + intensive) to compare not taking part with each type of intervention and II with regard to BI and probabilistic analysis to treat the uncertainty. Results: The total cost per abstinent patient was 406,74 : 129,83 for BI and 1.034,99 for I.I. ICER Total intervention = 498, 87/patient who stops smoking. ICER BI = 235, 32/patient who stops smoking. ICER II = 1.232, 85/patient who stops smoking. ICER II/BI = 7.772,25/patient who stops smoking. Conclusions: Smoking interventions in PC are efficient. A proposal for smoking intervention in PC from an effective cost perspective could be an BI for smokers and an II on those who find more difficult to leave the habit. 2011 Elsevier Espana, S.L. Todos los derechos reservados

Marcelino Weiss y Gramatges, su legado en la formación de los estomatólogos de Sancti Spíritus

Fundamento: Marcelino Weiss fue un reconocido estomatólogo que luchó para que el dentista fuera un médico especializado. Objetivo: Describir la vida personal y profesional de Marcelino Weiss y Gramatges y su legado a la estomatología de Sancti Spíritus. Metodología: Se realizó un estudio relacionado con la historia en ciencias de la salud, sobre la vida de Marcelino Weiss y Gramatges desde su nacimiento en Sancti Spíritus 1877 hasta su fallecimiento en La Habana en 1927, para lo cual se confeccionó una estrategia de búsqueda de la información, se consultaron bases de datos disponibles en el portal de Infomed. Se emplearon métodos del nivel teórico y métodos empíricos. Conclusiones: La vida y obra del Dr. Marcelino Weiss y Gramatges constituye un paradigma a seguir para las actuales y futuras generaciones de profesionales de la estomatología espirituana. Por sus valores, destacada labor patriótica, notable trayectoria asistencial, docente e investigativa, logró el reconocimiento y la admiración de todos

mtDNA Haplogroup A Enhances the Effect of Obesity on the Risk of Knee OA in a Mexican Population

[Abstract] To evaluate the influence of mitochondrial DNA haplogroups on the risk of knee OA in terms of their interaction with obesity, in a population from Mexico. Samples were obtained from (n = 353) knee OA patients (KL grade ≥ I) and (n = 364) healthy controls (KL grade = 0) from Mexico city and Torreon (Mexico). Both Caucasian and Amerindian mtDNA haplogroups were assigned by single base extension assay. A set of clinical and demographic variables, including obesity status, were considered to perform appropriate statistical approaches, including chi-square contingency tables, regression models and interaction analyses. To ensure the robustness of the predictive model, a statistical cross-validation strategy of B = 1000 iterations was used. All the analyses were performed using boot, GmAMisc and epiR package from R software v4.0.2 and SPSS software v24. The frequency distribution of the mtDNA haplogroups between OA patients and healthy controls for obese and non-obese groups showed the haplogroup A as significantly over-represented in knee OA patients within the obese group (OR 2.23; 95% CI 1.22-4.05; p-value = 0.008). The subsequent logistic regression analysis, including as covariate the interaction between obesity and mtDNA haplogroup A, supported the significant association of this interaction (OR 2.57; 95% CI 1.24-5.32; p-value = 0.011). The statistical cross-validation strategy confirmed the robustness of the regression model. The data presented here indicate a link between obesity in knee OA patients and mtDNA haplogroup A.This work is supported by Grants from Fondo de Investigación Sanitaria (PI17/00210, PI16/02124, PI20/00614, RETIC-RIER-RD16/0012/0002 and PRB3-ISCIII-PT17/0019/0014) integrated in the National Plan for Scientific Program, Development and Technological Innovation 2013–2016 and funded by the ISCIII-General Subdirection of Assessment and Promotion of Research-European Regional Development Fund (FEDER) “A way of making Europe” and Grant IN607A2017/11 from Xunta de Galicia. The authors further acknowledge AE CICA-INIBIC (ED431E 2018/03) for financial support. IRP is supported by Contrato Miguel Servet-II Fondo de Investigación Sanitaria (CPII17/00026) and AD-S is supported by Grant IN606A-2018/023 from Xunta de Galicia, Spain. The Biomedical Research Networking Center (CIBER) is an initiative from Instituto de Salud Carlos III (ISCIII)Xunta de Galicia; IN607A2017/11Xunta de Galicia; ED431E 2018/03Xunta de Galicia; IN606A-2018/02

El aprendizaje lúdico como estrategia didáctica: El territorio en Juego

[EN] The game learning as a didactic strategy in matters of Urban and Regional Planning is the challenge of the Project of Innovation and Educational Improvement (PIME) "The territory in play". The project intend to build a teaching-learning environment that encourages students to create their own knowledge and experience, through the design of a board game. The proposal is designed to alleviate the weaknesses and threats detected, strengthen the strengths and take advantage of the possibilities of the didactic play resource, to improve learning, apply knowledge, reflect on the territory and motivate students. The results of the first phase of the PIME are presented here, in which using a methodology based on implicative and reflexive techniques, three commercialized games are tested. The games tested propose extreme situatins: absolutely cooperative, absolutely competitive, with collaboration being a commercial instrument and sustainability a principle that is little contemplated or nullified. However, each provide elements and that, properly combined into the very model of game playing techniques interesting, may be useful for improving learning and therefore the results of students of Urban and Regional Planning, ultimate end of PIME that is presented here.[ES] El aprendizaje lúdico como estrategia didáctica en materias de Ordenación del Territorio y Urbanismo es el reto del Proyecto de Innovación y Mejora Educativa (PIME) “El territorio en juego”. Se pretende construir un entorno de enseñanza-aprendizaje que estimule al alumnado a crear su propio conocimiento y experiencia, a través del diseño de un juego de mesa. La propuesta está diseñada para paliar las debilidades y amenazas detectadas, potenciar las fortalezas y aprovechar las posibilidades del recurso lúdico didáctico, para mejorar el aprendizaje, aplicar conocimientos, reflexionar sobre el territorio y motivar al alumnado. Se presentan aquí los resultados de la primera fase del PIME, en la cual utilizando una metodología basada en técnicas implicativas y reflexivas, se testean tres juegos comercializados. Los juegos testeados nos sitúan ante situaciones que se posicionan en los extremos: absolutamente cooperativo-absolutamente competitivo, siendo la colaboración un instrumento comercial y la sostenibilidad un principio escasamente contemplado o anulado. Sin embargo, cada uno de ellos proporcionan elementos y técnicas de juego interesantes que, adecuadamente combinados en el modelo propio de juego, pueden ser útiles para mejorar el aprendizaje y por tanto los resultados de los alumnos de Urbanismo y Ordenación del Territorio, fin ultimo del PIME que aquí se presenta.Sosa Espinosa, A.; Gielen, E.; Palencia Jiménez, JS.; Pérez Alonso, Y.; Moreno Navarro, M.; Temes Córdovez, RR.; Miralles García, J.... (2018). El aprendizaje lúdico como estrategia didáctica: El territorio en Juego. En IN-RED 2018. IV Congreso Nacional de Innovación Educativa y Docencia en Red. Editorial Universitat Politècnica de València. 1493-1503. https://doi.org/10.4995/INRED2018.2018.8876OCS1493150

Perspectivas actuales en la aplicación del derecho

El presente volumen recoge las intervenciones del Tercer Seminario Internacional Permanente del Departamento de Derecho Internacional, Eclesiástico y Filosofía del Derecho de la Universidad Carlos III de Madrid, celebrado a lo largo del curso académico 2011-12El capítulo "Derechos fundamentales y tradiciones constitucionales comunes en la aplicación del Derecho europeo" de Francisco Javier Ansuátegui Roig se desarrolla en el marco de los proyectos Consolider-Ingenio 2010 “El tiempo de los derechos”. CSD2008-00007, y “Los derechos humanos en el s. XXI. Retos y desafíos del Estado de Derecho global” (DER 2011-25114), Plan Nacional de I+D+I, Ministerio de Ciencia e Innovación.Presentación / Óscar Celador Angón. - In memoriam : sobre Gregorio Peces-Barba / Rafael de Asís Roig. - La represión de los crímenes más graves de trascendencia internacional / Antoni Pigrau Solé. - El juez y la aplicación del Derecho / Ramón Ruiz Ruiz. - La aplicación del Derecho Canónico en España : la eficacia civil de las decisiones eclesiásticas de nulidad y disolución matrimonial / Raquel Tejón Sánchez. - Pluralismo, monismo y problemas de aplicación del Derecho / Francesco Belvisi. - Globalización y justicia : (cinco supuestos de la aplicación de las normas de Derecho Internacional Público y de Derecho europeo por los tribunales españoles) / Santiago Ripoll Carulla. - La eficacia civil del Derecho de las confesiones con acuerdo en España / David García-Pardo. - Eficacia en el ordenamiento jurídico español de las decisiones del TEDH en el ámbito de las libertades de pensamiento, de conciencia y de religión / Isidoro Martín Sánchez. - La aplicación del Derecho de la Unión Europea / Lucía Millán Moro. - Derechos fundamentales y "tradiciones constitucionales comunes" en la aplicación del Derecho europeo / Francisco Javier Ansuátegui Roig. - La responsabilidad de proteger como nuevo mecanismo de aplicación coercitiva del Derecho Internacional de los Derechos Humanos / Rocío Yudith Canchari Canchari. - Pluralismo jurídico y derecho de las mujeres indígenas : el caso de las mujeres Awajún de Perú / Mercedes Manríquez Roque. - El juez y la aplicación del derecho en el pensamiento de Owen Fiss, ¿interpretación objetiva? : entre el movimiento de Estudios Jurídico-Críticos y el Análisis Económico del Derecho / Rodrigo Pérez Espinosa. - Antitrust Law and Policy on A2k Compulsory Licensing : Early First Experiences of Judicial Activism / Pablo Zapatero Miguel

Medical versus surgical approach to initial treatment in septic arthritis: A single spanish center’s 8-year experience

Objective The aim of this study was to compare the functional results of 2 different procedure types, medical or surgical used in treating native joint septic arthritis. Methods In this cohort study, we reviewed the clinical registries of patients admitted to a single third-level hospital with the diagnosis of septic arthritis during the period of January 1, 2008, to January 31, 2016. Results A total of 63 cases of septic arthritis were identified in which the initial approach for 49 patients was medical (arthrocentesis), whereas the initial approach for 14 patients was surgical (arthroscopy or arthrotomy). Of the 49 patients who received initial medical treatment (IMT), 15 patients (30%) later required surgical treatment because of poor progress. The median age of the patients was 60 (SD, 18) years. The group who received IMT were older than those who received initial surgical treatment (median, 64 years [interquartile range {IQR}, 54–76 years], vs. 48 years [IQR, 30–60 years]). There was a larger percentage of male patients in the surgical group (78% vs. 42% [p = 0.018]). Thirty percent of the medical group had been receiving corticosteroid treatment (p = 0.018). Results of complete recovery of joint functionality showed no significant differences after 1 year (68% with MT vs. 67% with ST, p = 0.91). Both groups had similar symptom duration until diagnosis, duration of antibiotic therapy (median, 30 days [IQR, 28–49 days], vs. 29.5 days [IQR, 27–49] days), and mortality rate (3 in the medical group). Conclusions The results of the study show that initial surgical treatment in patients with native joint septic arthritis is not superior to IMT. However, half of the patients with shoulder and hip infections treated with IMT eventually required surgical intervention, suggesting that perhaps this should be the preferred initial approach in these cases