Análisis de la evolución histórica de la Sanidad y la gestión sanitaria en España

El objetivo de este artículo es poner manifiesto la evolución del sistema sanitario español a lo largo de su historia, ligándolo a su vez con la forma de gestión que han ido aplicando los diferentes Órganos de Gobierno que han tenido implicación directo en la política sanitaria. El periodo de análisis comienza en la alta edad media, siglos V-VI, y continua con el análisis de los principales acontecimientos que a lo largo de los últimos quince siglos han tenido lugar y que han hecho que la situación actual sea exactamente la que es en la actualidad. Para terminar hemos querido exponer las líneas maestras que, en nuestra opinión, deben regir el desarrollo futuro de la gestión sanitaria en el contexto de la globalización y el acelerado proceso de progreso económico y social en el que nos encontramos inmerso

Mantos inducidos por microbialitas en sedimentos siliciclásticos plio-cuaternarios? Del NO de Iberia

[EN] Microbial mats are organo-sedimentary deposits formed by bacteria that trap or synthesize certain chemical elements. This type of activity gives rise to the formation of lamellar and/or columnar bioconstructions (stromatolites) and/or concentric structures (oncolites and thrombolites). The study of microbial mats used to be restricted mainly to marine and coastal environments related to the formation of ancient carbonate sediments (Palaeozoic/Proterozoic), and/or extreme conditions in hypersaline environments. However, in recent years, the presence of these forms has been identified in continental siliciclastic rocks and sediments with a temporal distribution that reaches into modern times. In this study, several levels of ferruginous crusts associated with microbial activity are found, interspersed in a Cenozoic deposit located in the province of Zamora. This deposit consists of concentric, laminated iron structures filled with silt, interspersed throughout a clayey-silt layer of variegated colors which shows signs of bioturbation and desiccation due to fluid escape. These findings allow the inference of the sedimentary and climatic conditions responsible for the growth and preservation of microbial mats in the siliciclastic sediments of the north-western edge of the Duero Basin.[ES] Los mantos microbiales constituyen depósitos organosedimentarios formados por bacterias que atrapan o sintetizan determinados elementos químicos. Este tipo de actividad da lugar a la formación de estructuras laminares y/o columnares (estromatolitos) y/o concéntricas (oncolitos y trombolitos). Su estudio, por tanto, quedaba reducido principalmente a ambientes marinos y litorales relacionados con la formación de sedimentos carbonatados de edad muy antigua (Paleozoico/ Proterozoico), y/o condiciones extremas en ambientes hipersalinos. Sin embargo, en los últimos años, se ha identificado la presencia de estas formas en rocas y sedimentos de afinidad continental y carácter siliciclástico, que se extienden temporalmente hasta la actualidad. En este estudio, se presenta el hallazgo de varios niveles de costras ferruginosas asociadas a la actividad microbiana, intercalados en un depósito cenozoico de la provincia de Zamora. Se trata de una serie de niveles caracterizados por la presencia de capas ferruginosas laminadas y concéntricas, constituidas por limos que aparecen en el techo y muro de un nivel arcilloso-limoso de colores abigarrados y signos de bioturbación y desecación por escape de fluidos. Este singular hallazgo permite establecer las condiciones sedimentarias y climáticas responsables del crecimiento y conservación de mantos microbianos en sedimentos siliciclásticos del borde noroccidental de la cuenca del DueroSIThis work was partially funded by the Projects 0284_Esmimet_3_E (Interreg V-A Programa de Cooperación España-Portugal, 2014-2020) and LE167G18 (Junta de Castilla y León, Spain)

Levantamiento de líneas de costa a escala de detalle para el litoral de Andalucía: criterios, modelo de datos y explotación

En esta comunicación se presentan los resultados del proceso de incorporación de la línea de costa andaluza al Subsistema del Medio Litoral y Marino (SSLyMM) para su integración en la Rediam (Red de Información Ambiental de la Consejeria de Medio Ambiente). En relación a su levantamiento geométrico se ha desarrollado una metodología para cubrir toda la costa andaluza (más de 800 km.) pensando en aplicaciones y representaciones a escalas 1:5000- 1:10.000, lo que conlleva su digitalización a escala 1:2.500 sobre ortofotos y ortoimágenes de resolución métrica y submétrica. Los criterios de fotointerpretación (elemento clave para su posterior uso) tienen siempre, a diferencia de otras líneas de costa “oficiales”, una base ecológica diferenciándose procedimientos separados para las formaciones sedimentarias expuestas, las costas rocosas, las zonas marismeñas/estuarinas protegidas del oleaje y las infraestructuras antrópicas. A cada tramo costero, con topología independiente, se asocia un conjunto información ambiental y territorial (topologías jerárquicas, clasificaciones temáticas, toponimia, alteraciones antrópicas…) estructurada en tablas relacionadas que tienen como nexo común (ID) el tramo costero topologicamente independiente. Todo ello define un modelo de datos de gran complejidad que, una vez incorporados los datos y realizado el control topológico, se sumaran al repositorio del SSLyMM. De este complejo modelo (modelo de explotación) se extraerán, a través de sentencias SQL, la información geométrica y alfanumérica que alimentaran las diferentes aplicaciones temáticas (clasificaciones tipológicas, toponimia, dunas costeras asociadas, etc.) y la creación de servicios OGC específicos.The results of the process of incorporation of the shoreline of Andalusia to the Littoral and Marine Environment Subsystem (SSLyMM) are presented in this paper. The update of the SSLyMM with these data was made in order to be integrated in the Andalusian Environment Information Net (REDIAM) of the Environmental Regional Ministry. A methodology has been designed in order to span the complete Andalusian coast (longer than 800 km) using a high geometric accuracy, with the intention of being used at a scale of 1:5000 – 1:10000. This implies that the digitazing process was executed at 1:2500 scale based on ortoimages and ortophotographs with a high detailed spatial resolution. The photointerpretation criteria were always and only supported by ecological elements (despite other official shorelines). Different criteria have been used for sedimentary exposed coasts, cliffs, marshes and estuaries and human infrastructures. Each shoreline segment, identified by an independent topology, have been associated with different environmental information (ranked geomorpholohgical typologies, thematic classification, toponomy, human impacts, etc) structured in related attribute tables (data model). These tables share each topologically independent segment of the shoreline using a common link (the ID). All this related alphanumeric information implies a high complexity database model that, after topological and quality controls, have been added to the repository of the SSLyMM. From this complex database model there will be obtained, by means of spatial SQL sentences, the geometric and alphanumeric simplified data that would provide different thematic layers using suitable graphic treatment and, also, the initial information for the creation of specific OGC services

Exquisite wild mushrooms as a source of dietary fiber: analysis in electron-beam irradiated samples

In the present study, electron-beam irradiation was applied to dried samples of Boletus edulis and Macrolepiota procera to evaluate the effects on their fiber composition. Both species presented an important percentage of dietary fiber, soluble and insoluble in different ratios. These high fiber levels are an interesting feature, allowing considering mushrooms as an alternative source of dietary fibers in the highly competitive market of fiber-enriched food products. In B. edulis samples, insoluble fiber and total fiber amounts were significantly lower in samples irradiated with 10 kGy, but soluble fiber had no significant changes for any of the assayed doses, while total available carbohydrates were significantly lower in unirradiated samples. M. procera samples irradiated with 6 kGy presented less total fiber, insoluble fiber and carbohydrates, but the same dose allowed the highest contents in soluble dietary fiber. In general, the irradiated samples, especially for higher doses, gave some significant changes in the total available carbohydrates and dietary fibers content. Nevertheless, the resulting differences still allow considering these species as good natural fiber sources, maintaining their potential health effects, while promoting a clean way to disinfest and decontaminate these highly perishable products.Authors are grateful to the Foundation for Science and Technology (FCT, Portugal) for financial support to research centres CIMO (PEst-OE/AGR/UI0690/2011), REQUIMTE (PEst-C/EQB/LA0006/2011) and ALIMNOVA research group from UCM. Â. Fernandes and J.C.M. Barreira thank FCT, POPH-QREN and FSE for their grants (SFRH/BD/76019/2011 and SFRH/BPD/72802/2010, respectively). Dr. A. Rafalski, for e-beam irradiations and Prof. A. Chmielewski, General Director of the Institute of Nuclear Chemistry and Technology, Warsaw, Poland, for allowing e-beam irradiations

Association of kinesiophobia with catastrophism and sensitization-associated symptoms in COVID-19 survivors with post-COVID pain

Pain symptoms after the acute phase of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are present in almost 50% of COVID-19 survivors. The presence of kinesiophobia is a risk factor which may promote and perpetuate pain. This study aimed to investigate variables associated with the presence of kinesiophobia in a sample of previously hospitalized COVID-19 survivors exhibiting post-COVID pain. An observational study was conducted in three urban hospitals in Spain, including one hundred and forty-six COVID-19 survivors with post-COVID pain. Demographic (age, weight, height), clinical (intensity and duration of pain), psychological (anxiety level, depressive level, sleep quality), cognitive (catastrophizing), sensitization-associated symptoms, and health-related quality of life variables were collected in 146 survivors with post-COVID pain, as well as whether they exhibited kinesiophobia. Stepwise multiple linear regression models were conducted to identify variables significantly associated with kinesiophobia. Patients were assessed a mean of 18.8 (SD 1.8) months after hospital discharge. Kinesiophobia levels were positively associated with anxiety levels (r: 0.356, p < 0.001), depression levels (r: 0.306, p < 0.001), sleep quality (r: 0.288, p < 0.001), catastrophism (r: 0.578, p < 0.001), and sensitization-associated symptoms (r: 0.450, p < 0.001). The stepwise regression analysis revealed that 38.1% of kinesiophobia variance was explained by catastrophism (r² adj: 0.329, B = 0.416, t = 8.377, p < 0.001) and sensitization-associated symptoms (r² adj: 0.381, B = 0.130, t = 3.585, p < 0.001). Kinesiophobia levels were associated with catastrophism and sensitization-associated symptoms in previously hospitalized COVID-19 survivors with post-COVID pain. Identification of patients at a higher risk of developing a higher level of kinesiophobia, associated with post-COVID pain symptoms, could lead to better therapeutic strategies.Funding: The project was supported by a grant of Comunidad de Madrid y la Unión Europea, a través del Fondo Europeo de Desarrollo Regional (FEDER), Recursos REACT-UE del Programa Operativo de Madrid 2014–2020, financiado como parte de la respuesta de la Unión a la pandemia de COVID-19 (LONG-COVID-EXP-CM), by a grant from Next-Val 2021 de la Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), and by a grant from the Novo Nordisk Foundation 0067235. The sponsors had no role in the design, collection, management, analysis, or interpretation of the data, draft, review, or approval of the manuscript or its content. The authors were responsible for the decision to submit the manuscript for publication, and the sponsor did not participate in this decision

Effects of calcium supplementation on oxidative status and oxidative damage in great tit nestlings inhabiting a metal-polluted area

Calcium has been proposed to diminish metal toxicity by the modulation of the oxidative stress. This study explores the effects of Ca availability and metal exposure on oxidative stress biomarkers in great tit (Parus major) nestlings. Nests were supplemented with Ca (Ca-supplemented group) or not supplemented (Control group) in a metal-polluted and a background zone in SW Finland. Metal concentrations were analyzed from feces. We analyzed antioxidants (tGSH, GSH:GSSG ratio, CAT, GST, GPx, SOD), protein carbonylation and lipid peroxidation in red cells of nestlings.Ca-supplemented and fast-growing nestlings showed higher CAT activity to cope with reactive oxygen species (ROS) generated during intensive growth and metabolism. SOD and GPx (the latter not statistically significant) were more active in the polluted area, possibly reflecting higher ROS production in nestlings from this zone due to the enhanced metal exposure and smaller size. Antioxidant levels changed over the range of metal concentrations depending on the Ca levels in plasma, suggesting that higher Ca levels stimulate antioxidants and mitigate the impacts of metals. Ca supplementation may improve nestling traits and reproductive output when antioxidants are enhanced in a situation of oxidative challenge. Therefore, Ca should be considered in future studies assessing metal exposure and effects on wild birds

Planeamiento estratégico de Ferreycorp S.A.A

El planeamiento estratégico 2016-2020 elaborado para Ferreycorp es una respuesta al desafío de asumir con liderazgo el nuevo escenario que se revela para la industria de bienes de capital en Latinoamérica para los próximos años. La corporación, cuya existencia se remonta a más de 92 años de trayectoria, ha logrado desarrollar capacidades distintivas que no sólo le han permitido afrontar con éxito las diversas coyunturas experimentadas en el Perú, sino también le han brindado la oportunidad de trascender sus operaciones a un nivel internacional, iniciando su incursión en América del Sur y Centroamérica. Para los próximos años, la mayoría de los países de América Latina no sólo seguirán aprovechando sus ventajas comparativas a través de la ejecución de megaproyectos que se encuentran en cartera, sino que también desarrollarán ventajas competitivas a través del plan de diversificación productiva, acontecimientos que ayudarán a dinamizar los sectores económicos claves y otros motores internos. Debido a que este panorama propicia las condiciones favorables para los intereses de Ferreycorp, el presente plan estratégico define los lineamientos para aprovechar las oportunidades a través del despliegue de estrategias para atender a diversos sectores económicos, incluso diferentes de la minería, expandiendo y consolidando su presencia en otros países de América Latina con diferentes ciclos económicos. Los objetivos y estrategias del plan estratégico responden a los intereses de Ferreycorp y se encuentran alineadas a su visión. El camino hacia la visión requiere que la propuesta de valor sea entregada cumpliendo los principios corporativos con el propósito de agregar valor a las operaciones de los clientes, y requiere también que su posición competitiva se fortalezca constantemente con el fin de lograr un impacto positivo en los stakeholders, a contribuir responsablemente al crecimiento de los países donde participa y a generar un retorno atractivo y sostenible para los accionistas.The 2016-2020 strategic planning for Ferreycorp is a response to the challenge of assuming, with leadership, the new opportunities that are emerging in the capital goods industry in Peru and Latin America. The corporation, with over 92 years of reputation, has not only developed distinctive capabilities that allow it to successfully face diverse circumstances and economic cycles, but it has also had the opportunity to spread its operations to international markets, beginning with South and Central America. Over the next few years, most Latin American countries will continue to take advantage of their comparative advantages through the execution of planned mega-projects, and they will also develop competitive advantages through a product diversification plan that will help revitalize key economic sectors and other internal engines of their economies. Because the current environment is conducive to favorable conditions for Ferreycorp, this strategic plan outlines how to take advantage of these opportunities through the deployment of strategies to address various economic sectors, including different mining sectors, to expand and consolidate its presence in other Latin American countries. The objectives and strategies in this document serve the interests of Ferreycorp, and they are aligned to its vision. The designed value proposition rests in the synergies of its subsidiaries to provide comprehensive and differentiated solutions that allow deliver value to customer operations. The path to this vision requires that this proposal be followed, complying with corporate principles to add value to client operations, and it also requires their competitive positioning to be constantly strengthened in order to achieve a positive impact for stakeholders, to contribute to the responsible growth of the relevant countries, and to generate a sustainable and attractive return for shareholders.Tesi

REHABILITACIÓN CARDIACA EN PACIENTES CON CARDIOPATÍA CORONARIA EN EL INSTITUTO NACIONAL CARDIOVASCULAR DE ESSALUD SETIEMBRE 2017-FEBRERO 2018

Las enfermedades cardiovasculares (ECV), constituyen un problema de salud pública a nivel mundial; en EsSalud, se ubica en séptimo puesto de las patologías con mayor carga de enfermedad. Los programas de rehabilitación cardiaca basados en ejercicios equipan un conjunto de intervenciones diseñadas para mejorar la recuperación del paciente con problemas cardiovasculares agudos o crónicos, los cuales mejoran la capacidad funcional, calidad de vida y ayudan al control de los factores de riesgo. OBJETIVO: Evaluar el efecto de un Programa de Rehabilitación Cardiaca (PRC) en pacientes con enfermedad coronaria. MATERIALES Y MÉTODOS: El estudio fue de tipo observacional, analítico, retrospectivo y longitudinal. La población estuvo constituida por pacientes que ingresaron al Programa de Rehabilitación Cardiaca del INCOR-ESSALUD entre los meses de setiembre a diciembre del 2017 con diagnóstico de enfermedad coronaria y que completaron las evaluaciones pertinentes. RESULTADOS: Se analizaron 109 historias clínicas de pacientes con enfermedad coronaria la mayoría de sexo masculino y con hipertensión arterial como el principal factor de riesgo cardiovascular. Se encontró que luego de completar la PRC, los participantes disminuyeron la circunferencia abdominal (p = 0.000), la presión arterial (p = 0.000) y mejoraron su consumo de oxígeno estimado en METS (p = 0.000); asimismo hubo una reducción de la obesidad abdominal (p = 0.008) y mejoría de la clase funcional (p = 0.000); además existe una mejoría significativa en la calidad de vida de los pacientes (p = 0.000). CONCLUSIONES: El PRC tiene efectos significativos sobre la obesidad abdominal, mejoría del consumo de oxígeno estimado, capacidad funcional y calidad de vida de los pacientes con enfermedad coronaria

Greenlight Photoselective Vaporisation of the Prostate in 133 High Surgical Risk Patients: A 5-Year Outcome Study

ABSTRACT Greenlight photoselective vaporisation of the prostate (GPVP) is progressively becoming an established treatment in patients with LUTS because it is a minimally invasive technique that achieves efficient haemostasis, making it the ideal technique for patients at high surgical risk. Material and Methods: To study of 133 patients with an ASA surgical risk score of 3 or 4, undergoing GPVP, with an analysis of perioperative outcome, IPSS, Qmax, IIEF-5 and complications during a five-year follow-up. Results: At 5 years the mean annual improvement in IPSS was stable, and at 5 years there was a 15.2 point improvement versus the preoperative score (p &lt; 0.05). The Qmax showed an improvement of 14.9 ml/sec and was maintained at five years after surgery (p &lt; 0.05). No patients were transfused or suffered urinary incontinence. 2.25% suffered major complications and there were no deaths. 3.1% of patients suffered de novo urgency. In the 5-year follow-up, five patients had to be reoperated. The quality of sexual health assessed by IIEF-5 before the procedure was scored at 14 points; the 5-year follow-up covering the preoperative period and all revisions did not show any worsening in the IIEF-5 score (p &gt; 0.05). Conclusions: Due to its physical characteristics, in our opinion GPVP is now the treatment of choice in patients at high surgical risk. In our series, the risk of major/minor complications and transfusions was much lower than the same risks in conventional techniques. The objective results (Qmax and quality of life questionnaire) are equivalent to conventional techniques and persist over a 5-year follow-up