Key dimensions to strengthen primary care in Peru to forty years of Alma Ata

El Perú es un país de ingreso mediano, con un sistema de salud fragmentado. Para fortalecer el sistema de salud basado en atención primaria de salud, existen dimensiones claves que deben ser analizadas: gobernanza, financiamiento, recursos humanos, accesibilidad, longitudinalidad, integralidad, coordinación, equidad, eficiencia y calidad. El logro del desarrollo de estas dimensiones puede llevar a garantizar una atención primaria de salud fuerte, con mejoras en la salud de las personasPeru is a middle-income country, with a fragmented health system. To strengthen the health system based on primary health care there, are key dimensions that must be analyzed: governance, financing, human resources, accessibility, longitudinality, comprehensiveness, coordination, equity, efficiency and quality. The achievement of the development of these dimensions can lead to guarantee a strong primary health care, with improvements in the health of people

Chromium Species and 3D-Fluorescence Spectroscopy in a Soil Irrigated with Industrial Wastewater

Irrigation of agricultural land with wastewater is beneficial because it incorporates organic matter into the soil, as well as organic ions (such as nitrates, sulfates, and phosphates). However, long-term application causes negative effects such as the accumulation of heavy metals. The wastewater used in the agricultural soils, also incorporates organic refractory compounds, which affect the microbial population and fertility. This chapter aimed to identify the chromium species present in agricultural soil irrigated with wastewater (679.6 mg/L for total chromium and 559.5 mg/L for Cr VI), and characterize the dissolved organic matter in the saturated solution soil. In the soil-saturated solutions (pH 6), the most stable Cr (III) species was Cr2O3. These species precipitate and accumulate in the soil in combination with natural organic matter. The highest accumulation of chromium occurred in the first 10 cm of the soil column. The 3D fluorescence analysis exposes the presence of aromatic proteins, microbiological degradation products, and humic and fulvic acids in the soil profile. The excitation-emission matrix (EEM) showed that Cr (VI) species were complexed with humic acids. In the X-ray diffraction analysis, the species Cr2O5, Cr5O12, CrO2, and Cr7C3 were found at depth with the greatest amount of organic matter

Validity Evidences of the Spanish Version of the Sexual Inhibition/Sexual Excitation Scales-Short Form (SIS/SES-SF)

Se examinó la validez de la versión española de las Sexual Inhibition/Sexual Excitation Scales–Short Form (SIS/SES-SF), relacionándo las con excitación subjetiva y respuesta genital ante estímulos sexuales. Una muestra de 164 jóvenes heterosexuales completó el SIS/SES-SF y el MGH-SFQ. Después realizaron una tarea experimental consistente en la visualización de un vídeo de contenido neutro y un video con contenido sexual explícito, mientras se evaluaba la respuesta genital y la excitación subjetiva. Los resultados mostraron diferencias significativas entre el vídeo neutro y el erótico en la excitación objetiva y subjetiva en ambos sexos. Se obtuvieron correlaciones significativas entre SES y excitación subjetiva en mujeres. La propensión a excitarse explicó el 18% de la varianza de la excitación subjetiva y el 6% de las sensaciones genitales femeninas. La inhibición sexual relacionada con el miedo a la ejecución sexual tuvo capacidad para discriminar dificultades en el funcionamiento sexual en ambos sexos. Finalmente, se avala la necesidad de evaluar conjuntamente la excitación subjetiva y la objetiva.Predictive validity of the Spanish version of the Sexual Inhibition/Sexual Excitation Scales-Short Form (SIS/SES-SF) was examined. We correlated sexual inhibition and sexual excitation with subjective arousal and genital response during exposure to visual erotic stimuli. A sample of 164 heterosexual young people completed the SIS/SES-SF and the MGH-SFQ. Participants performed an experimental sequence in which a neutral content film and an erotic film were presented. In the meantime, genital response and subjective sexual arousal were evaluated. Results showed significant differences between neutral and sexually explicit films in objective and subjective arousal in both men and women. A significant correlation between SES and subjective arousal was obtained in women. Propensity to become aroused explained 18% of the variance of female subjective arousal and 6% of female genital sensations. Sexual inhibition related to the threat of sexual performance failure was able to discriminate difficulties in sexual functioning in both men and women. Finally, there is a need to assess the subjective sexual arousal along with the objective sexual response

English Is It! (ELT Training Series) Vol. 17

The Research group From English Acquisition to English Learning and Teaching is registered at the Institute of Professional Development Teaching (IDP-ICE), at the University of Barcelona. The group, founded and led by Lourdes Montoro (September 2013 - June 2021), has involved 28 teachers and professionals. 7 of them have been members of the group, and, together with 21 guest authors, have presented their work in the publication which she also created, and coordinated to fulfill the objectives of the pedagogical project which she had devised: English Is It! (ELT Training Series) (Vols. 1-15)..

Conductas disruptivas y propagación de la COVID-19 en la ciudad de Granada

Este informe es el resultado de un proyecto de investigación y transferencia que nace en el marco institucional del Grupo Local de Lucha contra la Covid-19 del Ayuntamiento de Granada. El estudio articula un equipo de investigación interdisciplinar (sociología, ciencia política, criminología y salud pública). Su cometido es desvelar las creencias, actitudes y comportamientos de la ciudadanía de Granada ante la pandemia de la Covid-19 en un momento de post-pandemia. Sus resultados y conclusiones se desprenden del análisis del discurso de cuatro grupos de discusión y versan sobre la naturaleza de las conductas percibidas como disruptivas, el conflicto social que estas generan, la estigmatización social derivada del conflicto, el clima social crítico que lo alimenta y los fallos del sistema propiciatorios de tal clima social. Las recomendaciones que se ofrecen se apoyan en los resultados de la celebración de dos talleres de consenso con expertos, y persiguen permitir al Ayuntamiento y otras instituciones locales prevenir, gestionar y amortiguar los efectos de futuras crisis, en el marco de sus competencias.Ayuntamiento de GranadaUnión Europea a través del Fondo Europeo de Desarrollo Regional (FEDER) y la Consejería de Economía, Conocimiento, Empresas y Universidad, Junta de Andalucía,Plan Propio de Investigación y Transferencia de la Universidad de Granad

Natural History of MYH7-Related Dilated Cardiomyopathy

BACKGROUND Variants in myosin heavy chain 7 (MYH7) are responsible for disease in 1% to 5% of patients with dilated cardiomyopathy (DCM); however, the clinical characteristics and natural history of MYH7-related DCM are poorly described. OBJECTIVES We sought to determine the phenotype and prognosis of MYH7-related DCM. We also evaluated the influence of variant location on phenotypic expression. METHODS We studied clinical data from 147 individuals with DCM-causing MYH7 variants (47.6% female; 35.6 +/- 19.2 years) recruited from 29 international centers. RESULTS At initial evaluation, 106 (72.1%) patients had DCM (left ventricular ejection fraction: 34.5% +/- 11.7%). Median follow-up was 4.5 years (IQR: 1.7-8.0 years), and 23.7% of carriers who were initially phenotype-negative developed DCM. Phenotypic expression by 40 and 60 years was 46% and 88%, respectively, with 18 patients (16%) first diagnosed at <18 years of age. Thirty-six percent of patients with DCM met imaging criteria for LV noncompaction. During follow-up, 28% showed left ventricular reverse remodeling. Incidence of adverse cardiac events among patients with DCM at 5 years was 11.6%, with 5 (4.6%) deaths caused by end-stage heart failure (ESHF) and 5 patients (4.6%) requiring heart transplantation. The major ventricular arrhythmia rate was low (1.0% and 2.1% at 5 years in patients with DCM and in those with LVEF of <= 35%, respectively). ESHF and major ventricular arrhythmia were significantly lower compared with LMNA-related DCM and similar to DCM caused by TTN truncating variants. CONCLUSIONS MYH7-related DCM is characterized by early age of onset, high phenotypic expression, low left ventricular reverse remodeling, and frequent progression to ESHF. Heart failure complications predominate over ventricular arrhythmias, which are rare. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation

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

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Genetic landscape of 6089 inherited retinal dystrophies affected cases in Spain and their therapeutic and extended epidemiological implications

Inherited retinal diseases (IRDs), defined by dysfunction or progressive loss of photoreceptors, are disorders characterized by elevated heterogeneity, both at the clinical and genetic levels. Our main goal was to address the genetic landscape of IRD in the largest cohort of Spanish patients reported to date. A retrospective hospital-based cross-sectional study was carried out on 6089 IRD affected individuals (from 4403 unrelated families), referred for genetic testing from all the Spanish autonomous communities. Clinical, demographic and familiar data were collected from each patient, including family pedigree, age of appearance of visual symptoms, presence of any systemic findings and geographical origin. Genetic studies were performed to the 3951 families with available DNA using different molecular techniques. Overall, 53.2% (2100/3951) of the studied families were genetically characterized, and 1549 different likely causative variants in 142 genes were identified. The most common phenotype encountered is retinitis pigmentosa (RP) (55.6% of families, 2447/4403). The most recurrently mutated genes were PRPH2, ABCA4 and RS1 in autosomal dominant (AD), autosomal recessive (AR) and X-linked (XL) NON-RP cases, respectively; RHO, USH2A and RPGR in AD, AR and XL for non-syndromic RP; and USH2A and MYO7A in syndromic IRD. Pathogenic variants c.3386G > T (p.Arg1129Leu) in ABCA4 and c.2276G > T (p.Cys759Phe) in USH2A were the most frequent variants identified. Our study provides the general landscape for IRD in Spain, reporting the largest cohort ever presented. Our results have important implications for genetic diagnosis, counselling and new therapeutic strategies to both the Spanish population and other related populations.This work was supported by the Instituto de Salud Carlos III (ISCIII) of the Spanish Ministry of Health (FIS; PI16/00425 and PI19/00321), Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER, 06/07/0036), IIS-FJD BioBank (PT13/0010/0012), Comunidad de Madrid (CAM, RAREGenomics Project, B2017/BMD-3721), European Regional Development Fund (FEDER), the Organización Nacional de Ciegos Españoles (ONCE), Fundación Ramón Areces, Fundación Conchita Rábago and the University Chair UAM-IIS-FJD of Genomic Medicine. Irene Perea-Romero is supported by a PhD fellowship from the predoctoral Program from ISCIII (FI17/00192). Ionut F. Iancu is supported by a grant from the Comunidad de Madrid (CAM, PEJ-2017-AI/BMD7256). Marta del Pozo-Valero is supported by a PhD grant from the Fundación Conchita Rábago. Berta Almoguera is supported by a Juan Rodes program from ISCIII (JR17/00020). Pablo Minguez is supported by a Miguel Servet program from ISCIII (CP16/00116). Marta Corton is supported by a Miguel Servet program from ISCIII (CPII17/00006). The funders played no role in study design, data collection, data analysis, manuscript preparation and/or publication decisions

Megaproyectos urbanos y productivos. Impactos socio-territoriales

El desarrollo de megaproyectos productivos trae consigo oportunidades para el crecimiento económico, la generación de empleos y el desarrollo regional. No obstante, en la actualidad, los grandes temas como la expansión urbana, el desarrollo industrial, las cementeras, la minería, el uso intensivo del agua y demás recursos naturales, preocupan a las comunidades por los impactos generados y porque en lo general, no consideran la racionalidad y responsabilidad ambiental y social hacia el entorno. En este contexto son diversos los estudios científicos que, en el marco de la política de económica imperante, intentan posicionarse como alternativas a proyectos económicos que confrontan los intereses particulares y comunitarios y que afectan la salud humana y ambiental. Megaproyectos urbanos y productivos. Impactos socio-territoriales, reúne veinticinco textos académicos sobre las afectaciones que éstos emprendimientos tienen para la sociedad y el entorno. Los temas expuestos recogen experiencias en el desarrollo urbano, industrial, turístico, portuario y aeroportuario, entre otros. Así mismo se retoman temas como la ética, la dialéctica, la política y la economía y su relación en el emprendimiento de megaproyectos. La búsqueda de esquemas productivos racionales y responsables con el entorno, que reivindiquen el derecho de las comunidades a un medio ambiente sano, a la preservación del territorio y sus recursos y de las formas de vida tradicionales, son los referentes para la realización del presente libro. Como elemento central se concibe el territorio como contenedor de identidad y vida, siendo preocupación y tema de estudio de la comunidad académica, las organizaciones de la sociedad civil y las redes de activistas organizados.UAEM, CONACyT, se