Un procedimiento para obtener clusters utilizando la D.V.S. de una matriz. Comparaciones con el biplot y con el modelo Q-factorial

Durante las últimas décadas, el análisis de un conjunto de n individuos medidos en p variables, proporcionando una matriz de datos Xn,p, mediante técnicas de representación que utilizan la Descomposición en Valores Singulares de la matriz Xn,p (o alguna derivada), han permitido resumir la información que aportan los datos en alguna forma óptima, siendo muy útil para indicar la presencia de clusters entre los n individuos y/o para prevenir ante posibles clasificaciones erróneas producidas por técnicas de agrupamiento más complejas. En este artículo estudiaremos un procedimiento que puede utilizarse en ocasiones para obtener clasificaciones naturales de un conjunto de datos, basado en la representación biplot y en el modelo Q-factorial que puede obtenerse a partir de la DVS

Morbilidad Hospitalaria de las Personas Mayores en Andalucía (2000-2004). Informe Técnico

Este libro representa el fruto de varios años de aprendizaje y de práctica por parte de los autores, y su preparación se ha visto beneficiada de la aportación de numerosos especialistas de los hospitales de la provincia de Cádiz, que han ayudado a interpretar los datos, enriqueciendo el contenido de la obra. Las principales conclusiones de este trabajo pueden resumirse en las siguientes: las personas mayores de 65 años de la provincia de Cádiz poseen unas tasas elevadas de morbilidad hospitalaria, muy especialmente los mayores de 75. Y las patologías responsables de los ingresos hospitalarios en esta provincia no difieren de forma sustancial del resto de España, estando constituidas fundamentalmente por las enfermedades crónicas de los países desarrollados, que ya se manifestaban en la edad adulta y donde la medicina preventiva se ha mostrado como el arma más eficaz para combatirlas. Así mismo, esta investigación señala la necesidad de desarrollar un sistema de indicadores que permita conocer el estado de salud y la utilización de servicios sanitarios de las personas mayores tanto a escala local como provincial, para una evaluación permanente de la calidad de la asistencia prestada, así como para una planificación de las necesidades futuras.132 pág

Potential risk of disease modifying therapies on neoplasm development and coadjutant factors in multiple sclerosis outpatients

Neoplasm development in Multiple Sclerosis (MS) patients treated with disease-modifying therapies (DMTs) has been widely discussed. The aim of this work is to determine neoplasm frequency, relationship with the prescription pattern of DMTs, and influence of the patients' baseline characteristics. Data from 250 MS outpatients were collected during the period 1981-2019 from the medical records of the Neurology Service of the HUPM (Hospital Universitario Puerta del Mar)-in Southern Spain-and analysed using Cox models. Neoplasm prevalence was 24%, mainly located on the skin, with cancer prevalence as expected for MS (6.8%). Latency period from MS onset to neoplasm diagnosis was 10.4 +/- 6.9 years (median 9.30 [0.9-30.5]). During the observation period beta-IFN (70.4% of patients), glatiramer acetate (30.4%), natalizumab (16.8%), fingolimod (24.8%), dimethyl fumarate (24.0%), alemtuzumab (6.0%), and teriflunomide (4.8%) were administered as monotherapy. Change of pattern in step therapy was significantly different in cancer patients vs unaffected individuals (p=0.011) (29.4% did not receive DMTs [p=0.000]). Extended Cox model: Smoking (HR=3.938, CI 95% 1.392-11.140, p=0.010), being female (HR=2.006, 1.070-3.760, p=0.030), and age at MS diagnosis (AGE-DG) (HR=1.036, 1.012-1.061, p=0.004) were risk factors for neoplasm development. Secondary progressive MS (SPMS) phenotype (HR=0.179, 0.042-0.764, p=0.020) and treatment-time with IFN (HR=0.923, 0.873-0.977, p=0.006) or DMF (HR=0.725, 0.507-1.036, p=0.077) were protective factors. Tobacco and IFN lost their negative/positive influence as survival time increased. Cox PH model: Tobacco/AGE-DG interaction was a risk factor for cancer (HR=1.099, 1.001-1.208, p=0.049), followed by FLM treatment-time (HR=1.219, 0.979-1.517). In conclusion, smoking, female sex, and AGE-DG were risk factors, and SPMS and IFN treatment-time were protective factors for neoplasm development; smoking/AGE-DG interaction was the main cancer risk factor

External ophthalmomyiasis by Oestrus ovis treated with tobacco: clinical case report and medical literature review

External ophthalmomyiasis is an infestation of conjunctiva with larvae or maggots of certain lies. Oestrus ovis is the most common cause of human ophthalmomyiasis. The case of a 16-yearold female is described, who presented with foreign body sensation, pain, and redness in the left eye. Slit-lamp biomicroscopy revealed 32 tiny larvae crawling around the conjunctival sac. The larvae were mechanically removed under topical anesthesia, and identiied under a light microscope as irst-stage larvae of O. ovis causing external ophthalmomyiasis. She was successfully treated with topical tobacco juice. Follow-up examination of these cases is recommended to avoid possible complications

Psychometric Assessment of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) for Arabic/French-Speaking Migrants in Southern Europe

Improving health literacy (HL) is critical for addressing health inequalities. Low literacy rates are believed to be more prevalent in ethnic minorities, which may have an impact on people's health. For measures to be implemented in this regard, HL must be evaluated to obtain specific indicators. Our aim, therefore, was to develop a version of the European Health Literacy Survey Questionnaire (HLS-EU-Q16), which is recommended to be used with vulnerable populations, suited to Arabic/French-speaking migrants who reside in south-eastern Spain, and to explore its psychometric properties for assessing health literacy in this population. A cross-sectional survey was carried out in a convenient sample of 205 migrants. The structural validity was calculated by a confirmatory factorial analysis (CFA), which suggested appropriate adjustment indicators, and which indicated that the three-dimensional model is adequately adjusted to the data obtained in the study. The coefficient omega showed high internal consistency in the three HL dimensions (health care, disease prevention, and health promotion). Concurrent validity presented a significant correlation with the Newest Vital Sign test (r = 0.390; p < 0.001). The multigroup CFA showed that the heterogeneity of the sample used was not a problem for establishing the structural validity of the scale. The Arabic/French version showed good construct validity

Related Factors of Anemia in Critically Ill Patients: A Prospective Multicenter Study

Anemia; Blood; Practice managementAnemia; Sangre; Gestión prácticaAnèmia; Sang; Gestió pràcticaAnemia is common in critically ill patients; almost 95% of patients admitted to intensive care units (ICUs) have hemoglobin levels below normal. Several causes may explain this phenomenon as well as the tendency to transfuse patients without adequate cause: due to a lack of adherence to protocols, lack of supervision, incomplete transfusion request forms, or a lack of knowledge about the indications, risks, and costs of transfusions. Daily sampling to monitor the coagulation parameters and the acid–base balance can aggravate anemia as the main iatrogenic factor in its production. We studied the association and importance of iatrogenic blood loss and other factors in the incidence of anemia in ICUs. We performed a prospective, observational, multicenter study in five Spanish hospitals. A total of 142 patients with a median age of 58 years (IQI: 48–69), 71.83% male and 28.17% female, were admitted to ICUs without a diagnosis of iatrogenic anemia. During their ICU stay, anemia appeared in 66.90% of the sample, 95 patients, (95% CI: 58.51–74.56%). Risk factors associated with the occurrence of iatrogenic anemia were arterial catheter insertion (72.63% vs. 46.81%, p-value = 0.003), venous catheter insertion (87.37% vs. 72.34%, p-value = 0.023), drainages (33.68% vs. 12. 77%, p-value = 0.038), and ICU stay, where the longer the stay, the higher the rate of iatrogenic anemia (p-value < 0.001). We concluded that there was a statistical significance in the production of iatrogenic anemia due to the daily sampling for laboratory monitoring and critical procedures in intensive care units. The implementation of patient blood management programs could address these issues

Cancer treatment-induced oral mucositis: a critical review

Introduction.- Head and neck cancer represents actually one of the main oncological problems. In its treatment, radiotherapy and chemotherapy leads to mucositis, as well as other side effects. Objective.- To review the high-quality evidence published over the last twenty-five years on the treatment of cancer treatment-induced oral mucositis. Material and methods.- A search of double blind randomised controlled clinical trials between 1985 and 2010 was performed in the Medline database. Oral mucositis, radiotherapy, chemotherapy, head and neck were used as keywords. Results.- The different therapeutic approaches found for cancer treatment-induced oral mucositis included: intensive oral hygiene care, use of topical antiseptics and antimicrobial agents, use of anti inflammatory agents, cytokines and growth factors, locally applied non-pharmacological methods, antioxidants, immune modulators, anticholeric agents and homoeopathic agents. Discussion.- To date no intervention has been able to prevent and treat oral mucositis on its own. Therefore, it is necessary to combine interventions that act on the different phases of mucositis. Conclusions.- It is still unclear as to which strategies reduce oral mucositis, as there is not enough evidence that describes a treatment with a proven efficiency and better than the other treatments for this conditio

Structural and chemical reactivity modifications of a cobalt perovskite induced by Sr-substitution. An in situ XAS study

LaCoO3 and La0.5Sr0.5CoO3-δ perovskites have been studied by in situ Co K-edge XAS. Although the partial substitution of La(III) by Sr(II) species induces an important increase in the catalytic oxidation activity and modifies the electronic state of the perovskite, no changes could be detected in the oxidation state of cobalt atoms. So, maintaining the electroneutrality of the perovskite requires the generation of oxygen vacancies in the network. The presence of these vacancies explains that the substituted perovskite is now much more reducible than the original LaCoO3 perovskite. As detected by in situ XAS, after a consecutive reduction and oxidation treatment, the original crystalline structure of the LaCoO3 perovskite is maintained, although in a more disordered state, which is not the case for the Sr doped perovskite. So, the La0.5Sr0.5CoO3-δ perovskite submitted to the same hydrogen reduction treatment produces metallic cobalt, while as determined by in situ XAS spectroscopy the subsequent oxidation treatment yields a Co(III) oxide phase with spinel structure. Surprisingly, no Co(II) species are detected in this new spinel phase.Ministerio de Ciencia y Educación ENE2011-2441

A cross-sectional study to assess inhalation device handling and patient satisfaction in COPD

Delivery of inhaled medications via an inhaler device underpins the effectiveness of treatment for patients with chronic obstructive pulmonary disease (COPD). Correct inhaler technique among patients is also a predictor of achieving treatment compliance and adherence. Reporting of patient satisfaction with inhalers is therefore gaining increasing attention and is now recognized as an important patient-reported outcome in clinical trials involving patients with COPD or asthma. In this cross-sectional study, we use the validated Patient Satisfaction and Preference Questionnaire (PASAPQ) to assess the handling and satisfaction for Respimat (R) Soft Mist (TM) Inhaler (SMI) compared with the Breezhaler (R) dry powder inhaler (DPI) among patients with COPD in Spain. Patients were already assigned to therapy with either SPIRIVA (R) (tiotropium) Respimat (R) or with Hirobriz (R)/Onbrez (R)/Oslif (R) (indacaterol) Breezhaler (R) for at least 3 but not more than 6 months before completing the PASAPQ at a single visit to the study site. The primary endpoint of the trial was the mean total PASAPQ score. Secondary endpoints were the performance score domain of the PASAPQ, the convenience score domain of the PASAPQ, and the overall satisfaction score of the PASAPQ. For the primary endpoint, the mean PASAPQ total score in the Respimat (R) and Breezhaler (R) groups was 80.7 and 79.9, respectively (difference of 0.8, 95% confidence interval [CI] -2.9 to 4.5; P= 0.67). The mean total performance scores were 82.5 and 78.2 (difference of 4.3, 95% CI -0.3 to 8.9; P= 0.06), and the mean total convenience scores were 78.6 and 81.9 (difference of -3.3, 95% CI -7.0 to 0.4; P= 0.08) for the Respimat (R) and Breezhaler (R) groups, respectively. Patients gave the Respimat (R) SMI and the Breezhaler (R) DPI overall satisfaction PASAPQ scores of 6.0 and 5.9, respectively, which shows that patients were satisfied with these inhalers

A Semiautomated Classification System for Producing Service Directories in Social and Health Care (DESDE-AND): Maturity Assessment Study

Background: DESDE-LTC (Description and Evaluation of Services and DirectoriEs for Long-Term Care) is an international classification system that allows standardized coding and comparisons between different territories and care sectors, such as health and social care, in defined geographic areas. We adapted DESDE-LTC into a computer tool (DESDE-AND) for compiling a directory of care services in Andalucia, Spain. Objective: The aim of this study was to evaluate the maturity of DESDE-AND. A secondary objective of this study is to show the practicality of a new combined set of standard evaluation tools for measuring the maturity of health technology products. Methods: A system for semiautomated coding of service provision has been co-designed. A panel of 23 domain experts and a group of 68 end users participated in its maturity assessment that included its technology readiness level (TRL), usability, validity, adoption (Adoption Impact Ladder [AIL]), and overall degree of maturity [implementation maturity model [IMM]). We piloted the prototype in an urban environment (Seville, Spain). Results: The prototype was demonstrated in an operational environment (TRL 7). Sixty-eight different care services were coded, generating fact sheets for each service and its geolocation map. The observed agreement was 90%, with moderate reliability. The tool was partially adopted by the regional government of Andalucia (Spain), reaching a level 5 in adoption (AIL) and a level 4 in maturity (IMM) and is ready for full implementation. Conclusions: DESDE-AND is a usable and manageable system for coding and compiling service directories and it can be used as a core module of decision support systems to guide planning in complex cross-sectoral areas such as combined social and health care