Evolución de la relación entre atención primaria y especializada 1992-2001: estudio Delphi

ObjetivoValorar la tendencia en la relación de atención primaria (AP) y especializada (hospital) en 2 momentos diferentes de la reforma sanitaria, al inicio (1992) y tras una fase de consolidación (2001).DiseñoEstudio cualitativo basado en la técnica Delphi modificada.EmplazamientoComunidad Valenciana.ParticipantesSe seleccionó a un total de 196 profesionales de la Comunidad Valenciana (103 coordinadores de AP, 43 directores médicos hospitalarios y de AP, y 50 jefes de servicio de medicina interna/urgencias).ResultadosSe enviaron 196 cuestionarios, con una tasa de respuesta del 38%. Desde AP los problemas se mantienen, con un empeoramiento en la desmotivación del personal sanitario (+1,34), la falta de visión integral del paciente (+1,10) y la masificación asistencial (+1,06), y un mejoría en la presencia de especialistas de ambulatorio no integrados (–1,32). Desde el ámbito hospitalario empeora la falta de visión integral del paciente (+0,51), pero destaca la mejoría generalizada de los problemas, sobre todo la falta de comunicación y diálogo (–1,14). Las soluciones que aumentan su demanda desde AP son una historia clínica única informatizada (+1,50), la elaboración de protocolos comunes (+0,86) y las rotaciones periódicas de los médicos de AP (MAP) por servicios hospitalarios (+0,85), con una disminución de las derivaciones burocráticas a AP (–0,60) y la necesidad de especialistas en AP como consultores (–0,36). Desde el ámbito hospitalario, todas las soluciones disminuyen su valoración y entre ellas destaca facilitar el acceso de MAP para el seguimiento de los pacientes ingresados (–2,44) y la realización de guardias hospitalarias por MAP (–2,30).ConclusionesLos problemas y las soluciones siguen siendo los mismos que en 1992, pero en AP se observa una tendencia a empeorar y en el ámbito hospitalario se detecta una visión más positiva.AimTo evaluate the trends in the inter-professional relationship between primary health care (PHC) and secondary care (hospital) at 2 different moments of the health reform, at its start in 1992 and after a phase of consolidation (2001).DesignObservational study based on modified Delphi technique.SettingValencia Community, Spain.ParticipantsOne hundred and ninety six professionals from Valencia Community were selected (103 PH centre administrators, 43 hospital and PC medical directors, and 50 heads of internal medicine or emergency services).ResultsOne hundred and ninety six questionnaires were sent out, with a response rate of 38%. In PHC problems remained the same, but the following got worse: “lack of motivation” (+1.34), “lack of overall vision of patients” (+1.10), and “overuse of medical services” (+1.06). The existence of non-integrated out-patient specialists got better (–1.32). In hospitals, “lack of overall vision of patients” got worse (+0.51), but in general problems got better, especially in “lack of communication and dialogue” (–1.14). PC increased its demand for “a single computerized clinical record” (+1.50), drawing up of common protocols (+0.86), and periodic rotations of PC doctors through hospitals (+0.85), but bureaucratic referrals to PC (–0.60) and the need for specialists in PC as consultants (-0.36) diminished. In hospitals all solutions showed lower scores, particularly access of PC doctors to monitoring of admitted patients (–2.44) and PC doctors doing hospital cover (–2.30).ConclusionsProblems and solutions from PHC and hospitals remain the same, but there is a trend to the worse in PHC, whereas in hospitals the trend is more positive

A machine learning approach to support deep brain stimulation programming

Adjusting the stimulation parameters is a challenge in deep brain stimulation (DBS) therapy due to the vast number of different configurations available. As a result, systems based on the visualization of the volume of tissue activated (VTA) produced by a particular stimulation setting have been developed. However, the medical specialist still has to search, by trial and error, for a DBS set-up that generates the desired VTA. Therefore, our goal is developing a DBS parameter tuning strategy for current clinical devices that allows defining a target VTA under biophysically viable constraints. We propose a machine learning approach that allows estimating the DBS parameter values for a given VTA, which comprises two main stages: i) A K-nearest neighbors-based deformation to define a target VTA preserving biophysically viable constraints. ii) A parameter estimation stage that consists of a data projection using metric learning to highlight relevant VTA properties, and a regression/classification algorithm to estimate the DBS parameters that generate the target VTA. Our methodology allows setting a biophysically compliant target VTA and accurately predicts the required configuration of stimulation parameters. Also, the performance of our approach is stable for both isotropic and anisotropic tissue conductivities. Furthermore, the computational time of the trained system is acceptable for real-world implementations

Dielectric and electrochemical properties of sustainable concrete

It is planned to improve the durability of reinforced concrete structures and the total or partial replacement of their components by the use of recyclable materials; as strategies to contribute to the concrete industry sustainability. The electrical resistivity and its relationship with the microstructure and electrochemical corrosion resistance in reinforced concrete manufactured with sustainable characteristics, that is, with recycled aggregates and supplementary cementitious materials; was evaluated in this study. The electrical resistivity in reinforced concretes is closely related to the microstructure of the cementitious matrix, and with the pore structure and distribution. As a consequence of the their components nature, it is assumed that the proposed sustainable concretes present different microstructure and porosity than the conventional concretes; because of this, the electrical and electrochemical response of those systems was analyzed with the help of the electrochemical impedance spectroscopy technique.Postprint (published version

Carbonation rate and reinforcing steel corrosion of concretes with recycled concrete aggregates and supplementary cementing materials

Because of the significant environmental impact that the concrete production causes, and as sustainability contribution for this industry; presently some improvements are being implemented in its durability and its components are been replaced for alternative recyclable materials. Concrete carbonation is one of the main causes of reinforcement electrochemical corrosion. Coarse Recycled Concrete Aggregates (RCA) and Supplementary Cementing Materials (SCM) such as fly ash and silica fume were used to produce durable and environmentally friendly concrete and for the evaluation of its carbonation depth and carbonation-induced reinforcement corrosion when it is exposed to accelerated conditions. The depth of carbonation was observed by spraying a phenolphthalein solution on the fresh broken concrete surface. The corrosion rates of steel embedded in these concretes have been measured by the lineal polarization resistance technique. The results indicate that to use RCA and SCM increase the carbonation depth and corrosion current density.Postprint (published version

Propiedades dieléctricas y electroquímicas de concretos sustentables

Como estrategias para contribuir en la sustentabilidad de la industria del concreto se está proyectando mejorar la durabilidad de las estructuras de concreto reforzado y el reemplazo parcial o total de sus ingredientes por materiales reciclables. En este estudio se evaluó la resistividad eléctrica y su relación con la microestructura y resistencia a la corrosión electroquímica de concretos reforzados fabricados con características de sustentabilidad, es decir, con agregados reciclados y materiales cementantes suplementarios. La resistividad eléctrica del concreto está íntimamente relacionada con la microestructura de la matriz cementante y con la estructura y distribución de poros. Por la naturaleza de sus ingredientes, es de suponerse que los concretos sustentables propuestos presentan diferente microestructura y porosidad que el concreto convencional, motivo por el cual se analizó la respuesta eléctrica y electroquímica de dichos sistemas mediante la técnica de espectroscopía de impedancia electroquímica.Peer ReviewedPostprint (published version

Lactancia materna ineficaz: prevalencia y factores asociados

RESUMENIntroducción: Es posible evitar muertes neonatales mediante la lactancia materna desde el primer día devida, pues la leche materna es el alimento óptimo para el lactante por su contenido nutricional necesariofavorecer el crecimiento y desarrollo. Objetivo: Determinar la prevalencia y factores asociados aldiagnóstico de enfermería “Lactancia materna ineficaz” en lactantes menores de 6 meses hospitalizados enuna institución de tercer nivel.Metodología: Estudio de corte transversal. Se seleccionaron 108 binomios(madre e hijo) hospitalizados en una institución de tercer nivel de atención en el año 2009, se aplicó unformato validado para identificar el diagnóstico. Se realizó análisis Rasch a las variables que representanlas características definitorias del diagnóstico, con el cual se creó una escala de 0 a 100 y se construyóun modelo de regresión lineal con las variables asociadas a la medida del diagnóstico.Resultados:la prevalencia del diagnóstico fue de 93,5 %, la característica definitoria más fácil de encontrar fueIncapacidad del lactante para agarrarse al pecho materno y la más difícil fue agitación y llanto del lactantedentro de la primera hora después de la lactancia materna. La regresión lineal mostró factores asociadoscomo: género femenino, peso del lactante y necesidad de la madre de ir a orinar.Conclusiones: Existeuna tendencia desfavorable tanto en la prevalencia como en la duración de la lactancia materna para loslactantes hospitalizados; la promoción de la lactancia materna debe ser un trabajo interdisciplinario;modificar las normas hospitalarias favoreciendo el contacto del binomio y la puesta temprana al pechomaterno. Salud UIS 2011; 43 (3): 271-279Palabras clave: Lactancia materna, diagnóstico de enfermería, lactante, prevalencia,factores asociadosABSTRACTIntroduction: neonatal deaths can be prevented by breastfeeding from the first day of life, as is the optimal foodfor infants by their nutritional content required for better growth and development.Objective: To determine theprevalence and associated factors with nursing diagnosis “ineffective breastfeeding” in infants under than 6 monthshospitalized in a tertiary institution.Methodology: Cross sectional study. We selected 108 pairs (mother and child)hospitalized in an institution of tertiary care in 2009, we applied a validated format to identify the diagnosis. Raschanalysis was performed for variables that represent the defining characteristics of the diagnosis, which created ascale of 0 to 100 and built a linear regression model the variables associated with the extent of diagnosis.Results:Prevalence of diagnosis was 93,5 %, the defining characteristic was easier to find the infant’s inability to hold onto the breast and the hardest was shaking and crying of the infant within the first hour after breastfeeding. Linearregression was associated factors such as: female gender, weight infant and the mother need to urinate.Conclusions:There is an unfavorable trend in both the prevalence and duration of breastfeeding for infants hospitalized, promotionof breastfeeding should be an interdisciplinary, modify hospital policies favoring the contact of the binomial and theearly start to the chest maternal. Salud UIS 2011; 43 (3): 271-279Keywords: Breastfeeding, nursing diagnosis, infant, prevalence, associated factor

Lactancia materna ineficaz: prevalencia y factores asociados

RESUMENIntroducción: Es posible evitar muertes neonatales mediante la lactancia materna desde el primer día devida, pues la leche materna es el alimento óptimo para el lactante por su contenido nutricional necesariofavorecer el crecimiento y desarrollo. Objetivo: Determinar la prevalencia y factores asociados aldiagnóstico de enfermería “Lactancia materna ineficaz” en lactantes menores de 6 meses hospitalizados enuna institución de tercer nivel.Metodología: Estudio de corte transversal. Se seleccionaron 108 binomios(madre e hijo) hospitalizados en una institución de tercer nivel de atención en el año 2009, se aplicó unformato validado para identificar el diagnóstico. Se realizó análisis Rasch a las variables que representanlas características definitorias del diagnóstico, con el cual se creó una escala de 0 a 100 y se construyóun modelo de regresión lineal con las variables asociadas a la medida del diagnóstico.Resultados:la prevalencia del diagnóstico fue de 93,5 %, la característica definitoria más fácil de encontrar fueIncapacidad del lactante para agarrarse al pecho materno y la más difícil fue agitación y llanto del lactantedentro de la primera hora después de la lactancia materna. La regresión lineal mostró factores asociadoscomo: género femenino, peso del lactante y necesidad de la madre de ir a orinar.Conclusiones: Existeuna tendencia desfavorable tanto en la prevalencia como en la duración de la lactancia materna para loslactantes hospitalizados; la promoción de la lactancia materna debe ser un trabajo interdisciplinario;modificar las normas hospitalarias favoreciendo el contacto del binomio y la puesta temprana al pechomaterno. Salud UIS 2011; 43 (3): 271-279Palabras clave: Lactancia materna, diagnóstico de enfermería, lactante, prevalencia,factores asociadosABSTRACTIntroduction: neonatal deaths can be prevented by breastfeeding from the first day of life, as is the optimal foodfor infants by their nutritional content required for better growth and development.Objective: To determine theprevalence and associated factors with nursing diagnosis “ineffective breastfeeding” in infants under than 6 monthshospitalized in a tertiary institution.Methodology: Cross sectional study. We selected 108 pairs (mother and child)hospitalized in an institution of tertiary care in 2009, we applied a validated format to identify the diagnosis. Raschanalysis was performed for variables that represent the defining characteristics of the diagnosis, which created ascale of 0 to 100 and built a linear regression model the variables associated with the extent of diagnosis.Results:Prevalence of diagnosis was 93,5 %, the defining characteristic was easier to find the infant’s inability to hold onto the breast and the hardest was shaking and crying of the infant within the first hour after breastfeeding. Linearregression was associated factors such as: female gender, weight infant and the mother need to urinate.Conclusions:There is an unfavorable trend in both the prevalence and duration of breastfeeding for infants hospitalized, promotionof breastfeeding should be an interdisciplinary, modify hospital policies favoring the contact of the binomial and theearly start to the chest maternal. Salud UIS 2011; 43 (3): 271-279Keywords: Breastfeeding, nursing diagnosis, infant, prevalence, associated factor

Lactancia materna ineficaz: prevalencia y factores asociados

RESUMENIntroducción: Es posible evitar muertes neonatales mediante la lactancia materna desde el primer día devida, pues la leche materna es el alimento óptimo para el lactante por su contenido nutricional necesariofavorecer el crecimiento y desarrollo. Objetivo: Determinar la prevalencia y factores asociados aldiagnóstico de enfermería “Lactancia materna ineficaz” en lactantes menores de 6 meses hospitalizados enuna institución de tercer nivel.Metodología: Estudio de corte transversal. Se seleccionaron 108 binomios(madre e hijo) hospitalizados en una institución de tercer nivel de atención en el año 2009, se aplicó unformato validado para identificar el diagnóstico. Se realizó análisis Rasch a las variables que representanlas características definitorias del diagnóstico, con el cual se creó una escala de 0 a 100 y se construyóun modelo de regresión lineal con las variables asociadas a la medida del diagnóstico.Resultados:la prevalencia del diagnóstico fue de 93,5 %, la característica definitoria más fácil de encontrar fueIncapacidad del lactante para agarrarse al pecho materno y la más difícil fue agitación y llanto del lactantedentro de la primera hora después de la lactancia materna. La regresión lineal mostró factores asociadoscomo: género femenino, peso del lactante y necesidad de la madre de ir a orinar.Conclusiones: Existeuna tendencia desfavorable tanto en la prevalencia como en la duración de la lactancia materna para loslactantes hospitalizados; la promoción de la lactancia materna debe ser un trabajo interdisciplinario;modificar las normas hospitalarias favoreciendo el contacto del binomio y la puesta temprana al pechomaterno. Salud UIS 2011; 43 (3): 271-279Palabras clave: Lactancia materna, diagnóstico de enfermería, lactante, prevalencia,factores asociadosABSTRACTIntroduction: neonatal deaths can be prevented by breastfeeding from the first day of life, as is the optimal foodfor infants by their nutritional content required for better growth and development.Objective: To determine theprevalence and associated factors with nursing diagnosis “ineffective breastfeeding” in infants under than 6 monthshospitalized in a tertiary institution.Methodology: Cross sectional study. We selected 108 pairs (mother and child)hospitalized in an institution of tertiary care in 2009, we applied a validated format to identify the diagnosis. Raschanalysis was performed for variables that represent the defining characteristics of the diagnosis, which created ascale of 0 to 100 and built a linear regression model the variables associated with the extent of diagnosis.Results:Prevalence of diagnosis was 93,5 %, the defining characteristic was easier to find the infant’s inability to hold onto the breast and the hardest was shaking and crying of the infant within the first hour after breastfeeding. Linearregression was associated factors such as: female gender, weight infant and the mother need to urinate.Conclusions:There is an unfavorable trend in both the prevalence and duration of breastfeeding for infants hospitalized, promotionof breastfeeding should be an interdisciplinary, modify hospital policies favoring the contact of the binomial and theearly start to the chest maternal. Salud UIS 2011; 43 (3): 271-279Keywords: Breastfeeding, nursing diagnosis, infant, prevalence, associated factor

From Nuevo León to the USA and Back Again: Transnational Students in Mexico

The movement of Mexicans to the United States is both longstanding and long studied and from that study we know that for many newcomers the attachment to the receiving community is fraught and tentative. The experience of immigrant children in U.S. schools is also relatively well studied and reveals challenges of intercultural communication as well as concurrent and contradictory features of welcome and unwelcome. What is less well known, in the study of migration generally and of transnational students in particular, is how students moving in a less common direction — from the U.S. to Mexico — experience that movement. Based on visits to 173 randomly selected classrooms in the state of Nuevo León Mexico, this study shares survey and interview data from 208 of the 242 students encountered who had previous experience attending school in the United States

Lovastatin delays infection and increases survival rates in AG129 mice infected with dengue virus serotype 2

ABSTARCT: It has been reported that treatment of DENV-infected cultures with Lovastatin (LOV), can affect viral assembly. The objective of this study was to evaluate the effect of LOV on the survival rate and viremia levels of DENV-2-infected AG129 mice. Methodology/Principal Findings: Mice were inoculated with 16106 plaque-forming units (PFU/ml) of DENV-2 and treated with LOV (200 mg/kg/day). Pre-treatment with one or three doses of LOV increased the survival rate compared to untreated mice (7.3 and 7.1 days, respectively, compared to 4.8 days). Viremia levels also decreased by 21.8% compared to untreated mice, but only in the group administered three doses prior to inoculation. When LOV was administered after viral inoculation, the survival rate increased (7.3 days in the group treated at 24 hpi, 6.8 days in the group treated at 48 hpi and 6.5 days in the group treated with two doses) compared to the untreated group (4.8 days). Interestingly, the serum viral titer increased by 24.6% in mice treated at 48 hpi with a single dose of LOV and by 21.7% in mice treated with two doses (at 24 and 48 hpi) of LOV compared to untreated mice. Finally histopathological changes in the liver and spleen in infected and untreated mice included massive extramedullary erythropoiesis foci and inflammatory filtration, and these characteristics were decreased or absent in LOV-treated mice. Conclusions/Significance: Our results suggest that the effect of LOV on viremia depends on the timing of treatment and on the number of doses administered. We observed a significant increase in the survival rate in both schemes due to a delay in the progression of the disease. However, the results obtained in the post-treatment scheme must be handled carefully because this treatment scheme increases viremia and we do not know how this increase could affect disease progression in humans