The Experience With Health Care of Patients With Inflammatory Arthritis: A Cross-sectional Survey Using the Instrument to Evaluate the Experience of Patients With Chronic Diseases

[Abstract] Background: Patients' experience with health care is becoming a key component for the provision of a patient-centered health care model. The aim of this study was to assess the experience with health care of patients with inflammatory arthritis and patient- and health care-related factors. Methods: Patients responded to an anonymous survey provided by their treating clinical teams. The survey comprised the validated 12-item IEXPAC (Instrument to Evaluate the EXperience of PAtients with Chronic diseases) tool and demographic variables and health care-related characteristics that may affect patients' experience. Results: A total of 359 of 625 surveys were returned (response rate, 57.4%). Overall, patient responses were positive (>60% gave "always/mostly" answers) for statements assessing the interaction between patients and health care professionals or patient self-management following health care professional guidance. However, positive patient responses for items regarding patient interaction with the health care system via the internet or with other patients were less than 13%. Only 25.6% of patients who had been hospitalized reported receiving a follow-up call or visit following discharge. In the bivariate analysis, experience scores were higher (better experience) in men, those seen by fewer specialists or by the same physician, and in patients treated with a fewer number of drugs or with subcutaneous/intravenous drugs. Multivariate analyses identified regular follow-up by the same physician and treatment with subcutaneous/intravenous drugs as variables associated with a better patient experience. Conclusions: This study identifies areas of care for patients with inflammatory arthritis with the potential to improve patients' experience and highlights the importance of patient-physician relationships and comprehensive patient care

Healthcare experience and their relationship with demographic, disease and healthcare-related variables: a cross-sectional survey of patients with chronic diseases using the IEXPAC scale.

[Abstract] BACKGROUND: Patient experience is acknowledged as a principal aspect of quality healthcare delivery, and it has implications with regard to outcomes. OBJECTIVES: Our objective was to evaluate the healthcare experience of patients with chronic diseases to identify patient-perceived healthcare gaps and to assess the influence of demographic and healthcare-related variables on patient experiences. METHODS: A cross-sectional survey was delivered to adult patients with chronic diseases: diabetes mellitus (DM), human immunodeficiency virus (HIV) infection, inflammatory bowel disease (IBD) or rheumatic diseases. Patient experiences were assessed with the Instrument for Evaluation of the Experience of Chronic Patients (IEXPAC) questionnaire, with possible scores ranging from 0 (worst) to 10 (best experience). RESULTS: Of the 2474 patients handed the survey, 1618 returned it (response rate 65.4%). Patients identified gaps in healthcare related mainly to access to reliable information and services, interaction with other patients and continuity of healthcare after hospital discharge. The mean ± standard deviation (SD) IEXPAC score was 6.0 ± 1.9 and was higher for patients with HIV (6.6 ± 1.7) than for those with rheumatic disease (5.5 ± 2.0), IBD (5.9 ± 2.0) or DM (5.9 ± 1.9) (p < 0.001). In multivariate models, better overall IEXPAC experience was associated with follow-up by the same physician, follow-up by a nurse, receiving healthcare support from others and treatment with subcutaneous or intravenous drugs. The multivariate model that confirmed patients with HIV or DM had better experience than did those with rheumatic diseases. CONCLUSIONS: Through IEXPAC, patients identified aspects for healthcare quality improvements and circumstances associated with better experience, which may permit greater redirection of healthcare toward patient-centered goals while facilitating improvements in social care and long-term healthcare quality

Primera aproximación al uso de la ocupación del tapir (Tapirella bairdii Gill, 1865) como indicador de la integridad ecológica en la Reserva de la Biosfera Maya, Guatemala

La Reserva de la Biosfera Maya (RBM) es un área protegida de relevancia nacional, regional y mundial por la diversidad biológica  asociada  y  los  beneficios  que  se  obtienen  de  esta.  En  su  plan  maestro  se  plantea  el  conjunto  de  elementos  de conservación a partir de los cuales se orientan estrategias y se evalúa la efectividad de manejo de dicha reserva, entre los cuales se incluye a Tapirella  bairdii  (tapir), por lo que es importante contar con un monitoreo de esta especie como una  herramienta para la administración de esta reserva. En el 2015 se inició el desarrollo de un protocolo de monitoreo basado en la estimación de  la  probabilidad de  ocupación  y el  presente  estudio constituye  la  continuación de  esta  iniciativa  a  través de la implementación de las  temporadas  de muestreo en 2017 y 2018. Se registró la presencia del tapir en cinco zonas núcleo de la RBM empleando trampas cámara y se estimó la probabilidad de ocupación. Los valores estimados sugieren una relación  de la ocupación con la integridad ecológica, en la cual hay una mayor ocupación en áreas con menor perturbación. Se generaron modelos con cinco covariables relacionadas con amenazas potenciales, sin embargo fue el modelo nulo el que se  seleccionó  de  acuerdo  al  criterio  definido.  Los  resultados  sugieren  que  la  integridad  ecológica  en  las  áreas  de  estudio  está siendo afectada  como consecuencia  de  las presiones antrópicas por lo que  es necesario el  fortalecimiento de  aquellas con menores valores de ocupación.

Body mass index and disease activity in chronic inflammatory rheumatic diseases: results of the cardiovascular in rheumatology (Carma) project

Objective: Since obesity has been associated with a higher inflammatory burden and worse response to therapy in patients with chronic inflammatory rheumatic diseases (CIRD), we aimed to confirm the potential association between body mass index (BMI) and disease activity in a large series of patients with CIRDs included in the Spanish CARdiovascular in rheuMAtology (CARMA) registry. Methods: Baseline data analysis of patients included from the CARMA project, a 10-year prospective study of patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) attending outpatient rheumatology clinics from 67 Spanish hospitals. Obesity was defined when BMI (kg/m2) was >30 according to the WHO criteria. Scores used to evaluate disease activity were Disease Activity Score of 28 joints (DAS28) in RA, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in AS, and modified DAS for PsA. Results: Data from 2234 patients (775 RA, 738 AS, and 721 PsA) were assessed. The mean ± SD BMI at the baseline visit were: 26.9 ± 4.8 in RA, 27.4 ± 4.4 in AS, and 28.2 ± 4.7 in PsA. A positive association between BMI and disease activity in patients with RA (β = 0.029; 95%CI (0.01- 0.05); p = 0.007) and PsA (β = 0.036; 95%CI (0.015-0.058); p = 0.001) but not in those with AS (β = 0.001; 95%CI (-0.03-0.03); p = 0.926) was found. Disease activity was associated with female sex and rheumatoid factor in RA and with Psoriasis Area Severity Index and enthesitis in PsA. Conclusions: BMI is associated with disease activity in RA and PsA, but not in AS. Given that obesity is a potentially modifiable factor, adequate control of body weight can improve the outcome of patients with CIRD and, therefore, weight control should be included in the management strategy of these patients

Latin America Echinoderm Biodiversity and Biogeography: Patterns and Affinities

We investigated the current patterns of diversity by country and by class of echinoderms, and analyzed their biogeographical, depth, and habitat or substratum affinities, using the database of the appendix of this book. Traditionally, the area has been divided into five biogeographical Regions and nine Provinces that cover a wide climate range. Currently, the echinoderm fauna of Latin America and Canary islands is constituted by 1,539 species, with 82 species of Crinoidea, 392 species of Asteroidea, 521 species of Ophiuroidea, 242 species of Echinoidea and 302 species of Holothuroidea. Species richness is highly variable among the different countries. The number of species for the countries is highly dependent on its coast length. The echinoderm fauna of the Panamic, Galápagos and the Chilean regions are biogeographically related. Other regions that are closely related are the Caribbean, West Indian, Lusitania and Brazilian. Cosmopolitan species are an important component in all the regions. Affinities between faunas are a consequence of the combination of climatic and trophic factors, connectivity as a function of distance, currents patterns and historical processes. Moreover, different environmental factors would be responsible for the faunal composition and species distribution at different spatial scales. The bathymetrical distribution of the echinoderm classes and the species richness varies according to the depth range and the ocean. Most species occurred at depths between 20 and 200 m. The Caribbean-Atlantic regions are richest in shallow depths, while the Pacific coast has higher values in deeper waters. The domination of each class in each substrate and habitat categories also varies differentially along each coast.Fil: Pérez Ruzafa, Ángel. Universidad de La Laguna; EspañaFil: Alvarado, Juan José. Universidad de Costa Rica. Centro de Investigación en Ciencias del Mar y Limnología; Costa RicaFil: Solís Marín, F. A.. Universidad Nacional Autónoma de México; MéxicoFil: Hernández, José Carlos. Universidad de La Laguna; EspañaFil: Morata, Alex. Universidad de La Laguna; EspañaFil: Marcos, C.. Universidad de La Laguna; EspañaFil: Abreu Pérez, M.. Ministerio de Ciencia, Tecnología y Medio Ambiente.; CubaFil: Aguilera, Orangel. Museu Paraense Emilio Goeldi; BrasilFil: Alió, J.. Instituto Nacional de Investigaciones Agrícolas; VenezuelaFil: Bacallado Aránega, J. J.. Muso de la Naturaleza y El Hombre de Tenerife; EspañaFil: Barraza, E. Tomás. Ministerio de Medio Ambiente y Recursos Naturales; El SalvadorFil: Benavides Serrato, M.. Instituto de Investigaciones Marinas y Costeras; ColombiaFil: Benítez Villalobos, F.. Universidad del Mar; MéxicoFil: Betancourt Fernández, L.. Programa Ecomar, Inc; República DominicanaFil: Borges, Margarida. Universidade Estadual de Campinas; BrasilFil: Brandt, M.. University Brown; Estados UnidosFil: Brogger, Martin Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; ArgentinaFil: Borrero Pérez, G. H.. Instituto de Investigaciones Marinas y Costeras; ColombiaFil: Buitrón Sánchez, B. E.. Universidad Nacional Autónoma de México; MéxicoFil: Campos, L. S.. Universidade Federal do Rio de Janeiro; BrasilFil: Cantera, J. R.. Universidad del Valle; ColombiaFil: Clemente, Sabrina. Universidad de La Laguna; EspañaFil: Cohen Renfijo, M.. Universite de la Mediterranee; FranciaFil: Coppard, S. E.. Smithsonian Tropical Researchh Institute; PanamáFil: Costa Lotufo, L. V.. Universidade Federal do Rio de Janeiro; BrasilFil: Guanuco de García, María del Valle. Ministerio de Ciencia, Tecnología y Medio Ambiente.; CubaFil: Díaz de Vivar, María Enriqueta Adela. Universidad Nacional de la Patagonia. Facultad de Ciencias Naturales. Sede Puerto Madryn; ArgentinaFil: Díaz Martinez, J. P.. Universidad del Mar; MéxicoFil: Díaz, Yudiesky Cancio. Universidad Simón Bolívar; VenezuelaFil: Durán González, A.. Universidad Nacional Autónoma de México; MéxicoFil: Epherra, Lucía. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico; ArgentinaFil: Rubilar Panasiuk, Cynthia Tamara. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico; ArgentinaFil: Pérez, Analía Fernanda. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentin

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p &lt; 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p &lt; 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p &lt; 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease