Un modelo para la superación postgraduada del sector Salud Pública

Se expone un modelo para el desarrollo del proceso de postgrado en el sector salud. Es parte una tesis de doctorado y ya ha sido aplicado en diferentes modalidades de postgrado en la provincia Guantánamo y parte de la consideración de los presupuestos de la Teoría Holístico-Configuracional del DrC. Homero Calixto Fuentes González del centro de Estudios para la Educación Superior “Manuel F. Gran” de Santiago de Cuba. En este se destaca el vínculo con elementos epistemológicos de la Filosofía, la Sociología, la Pedagogía y la Psicología, entendiéndose que la Pedagogía es la ciencia dominante en el modelo. Si bien en el trabajo se exponen los aspectos generales del diseño del proceso de superación, en próximas publicaciones se explicará la dinámica y evaluación, lo que permitirá tener una mayor comprensión de la naturaleza del objeto que se investiga y del proceso que se modela. Para el desarrollo del trabajo fueron consultadas numerosas fuentes bibliográficas de autores nacionales y extranjeros reconocidos y que muestran un adecuado nivel de actualidad

Prevalence of high-risk HPV genotypes, categorised by their quadrivalent and nine-valent HPV vaccination coverage, and the genotype association with high-grade lesions

BACKGROUND: The new nine-valent vaccine against human papillomavirus (HPV) includes the four HPV genotypes (6, 11, 16, and 18) that are targeted by the older quadrivalent HPV vaccine, plus five additional oncogenic types (31, 33, 45, 52, and 58) remain significantly associated with high grade lesions. We aimed to determine the prevalence of high-risk HPV genotypes in unvaccinated subjects and the association of these genotypes with the incidence of high-grade lesions. We also assessed which, if either, of these two HPV vaccines could have prevented these cases. METHODS: This cross-sectional study, conducted from 4 January 2010 to 30 December 2011, was composed of 595 women attending the Hospital General Universitario de Elche (Spain) gynaecology department who were positively screened for opportunistic cervical cancer by pap smears and HPV detection during a routine gynaecological health check. The pap smear results were classified using the Bethesda system. HPV genotyping was performed with the Linear Array HPV genotyping test, and viruses were classified by the International Agency for Research on Cancer assessment of HPV carcinogenicity. Odds ratios (ORs) with their 95% confidence intervals (95% CI) were estimated by logistic regression, adjusting for age and immigrant status. The prevented fraction among those exposed (PFe-adjusted) was determined as a measure of impact. RESULTS: At least one of the additional five high-risk HPV genotypes present in the nine-valent HPV vaccine was detected in 20.5% of subjects. After excluding women with genotype 16 and/or 18 co-infection, high-risk genotypes (31, 33, 45, 52, and 58) were associated with a higher risk of intraepithelial lesion or malignancy: adjusted OR?=?3.51 (95% CI, 1.29-9.56), PFe-adjusted?=?0.72 (95% CI, 0.22-0.90). Genotypes that are still non-vaccine-targeted were detected in 17.98% of the women, but these were not significantly associated with high-grade lesions. CONCLUSION: The greater protection of the nine-valent HPV vaccine is likely to have a positive impact because, in the absence of genotype 16 or 18 infection, these five genotypes on their own remained significantly associated with high-grade lesions

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Mortalidad en el menor de 5 años. Principales factores de riesgo

Se realiza un estudio de caso y control durante los años 2003 y 2011, en el Hospital Pediátrico Docente “Pedro Agustín Pérez” de Guantánamo, para identificar los principales factores de riesgo que influyeron en la mortalidad en el menor de 5 años. Se estudian todos los niños egresados fallecidos (n=139) y una muestra sistemática de niños con la misma edad que ingresaron por enfermedades similares, pero que no fallecieron. Se analizaron factores de riesgo biológicos y socioambientales. Como riesgo biológico se encontró la enfermedad asociada al embarazo (anemia y sepsis urinaria). La edad materna fue inferior a 18 años y superior a 35. El peso al nacer inferior a 2 500 gramos, el estado nutricional deficiente y la lactancia materna nula o insuficiente. Entre los factores socioambientales: el estado conyugal soltero o acompañado, la escolaridad de los padres insuficiente, las malas condiciones de vida, el hábito de fumar y la ingestión de bebidas alcohólicas durante el embarazo.  A study of case  control is done during 2003 and 2011, at the Teaching Pediatric Hospital “Pedro Agustín Pérez“of Guantanamo, to identify the main factors of risk that influenced the mortality in the person younger than 5 years. All the deceased gone away (n=139 children) and a systematic children sample with the same age whom were admitted for similar illnesses, but children didn't die. Biological risk factors were analyzed and socioenvironmental too. As biological risk was found the illness associated with the pregnancy (anemia and urinary sepsis. The maternal age was lower than 18 years and superior to 35. The weight on having been born lower than 2 500 grams, the deficient nutritional state and the void or insufficient breast feeding. Socioenvironmental factors such as: the single or accompanied conjugal state, the insufficient schooling of the parents, the bad living conditions, the habit of smoking and the consumption of alcoholic beverages during the pregnancy

Comportamiento de la mortalidad por infecciones respiratorias agudas

Se realizó un estudio descriptivo transversal, con el objetivo de caracterizar la mortalidad por infecciones respiratorias agudas durante 8 años (1996-2003) en el Hospital Pediátrico Docente “Pedro Agustín Pérez”, de la provincia de Guantánamo. El universo estuvo constituido por los 45 fallecidos que hubo por esta causa durante el período de estudio. El dato primario se obtuvo de la revisión de las historias clínicas mediante el uso de un formulario confeccionado previamente. Las variables estudiadas fueron: mortalidad según edad, sexo, factores asociados, como bajo peso al nacer, atopia, estado nutricional, condiciones de vida, lactancia materna, síntomas y signos al ingreso, y causas básicas de muerte. Se encontró una disminución de la mortalidad en los últimos tres años. Mayormente afectados resultaron los menores de un año, masculinos, con bajo peso al nacer como principal factor asociado. Los síntomas y signos más frecuentes fueron: la tos y la fiebre. La causa básica de muerte que prevaleció fue la neumonía

Salud y paisaje: contribución desde el termalismo a la revitalización de zonas rurales (el caso de Pozo Amargo, Cuenca Del Guadaira, España) Health and landscape: a contribution to the renew of rural lands (the case of Pozo Amargo, Cuenca Del Guadaira, España)

Ubicado en la contaminada cuenca del río Guadaíra (Andalucía, España) el balneario de Pozo Amargo es una buena muestra del rico patrimonio arquitectónico vinculado al agua que han generado sus habitantes a lo largo de estos últimos siglos. Este patrimonio ha experimentado un abandono similar al del propio río pero tanto el movimiento ciudadano como la respuesta de la administración han permitido paliar ambas situaciones. Hoy en día, la rehabilitación del antiguo balneario puede suponer una interesante iniciativa que aúne la mejora ambiental y paisajística del alto Guadaíra con la recuperación del patrimonio artístico y etnográfico de la zona, así como la puesta en marcha de una experiencia pionera de proyecto paisajístico aplicado a destinos turísticos de salud capaz de generar riqueza en la zona.<br>Located in the polluted basin of Guadaira's river (Andalusia, Spain), the Pozo Amargo's spa is a good example of a rich architectonical heritage related to water that inhabitants have created over the last few centuries. This heritage has suffered a similar degradation to the river, but both the citizen's movement and the Administration's response have made possible the mitigation of both situations. Nowadays, the restoration of the former spa can be an exciting initiative that joins the environmental improvements and the landscape value of the Alto Guadaira's with the recovery of artistic and ethnographic heritage of this area. Moreover, it will make possible the launching of a pioneering experience of a landscape's project applied to touristic and health destinations that can generate wealth in the area