Desafíos interpretativos en el análisis de la imagen sociocultural

In current research on face analysis questions of who and what should be interpreted, as well as how, are of central interest. In English language research, this question has led to a debate on the concepts of P1 (laypersons, representing the “emic” perspective) and P2 (researchers, representing the “etic”). In our view, two points seem critical: a) are P1 and P2 sufficiently well described to be of use in the broader analytical context that is face analysis today? And b) what contribution does this distinction make towards a greater understanding of the data?  From our research on facework in Spanish and address forms in European Portuguese, we view P1 and P2 as being far more complex than the literature suggests, with subgroups (different types of laypersons and researchers, respectively). At the micro-level we will describe the roles each subgroup plays in the interpretative process; at the macro-level we discuss how P1 and P2 are integrated into the global interpretation of face. While researchers of face analysis work typically consider P1 and P2 as independent categories, we believe the contributions of P1 and P2 cannot be disassociated. Both must be taken into account in the global analysis and final interpretative framework.En la investigación actual sobre imagen social ha adquirido gran importancia la cuestión de quién, qué y cómo interpretar en el análisis. En lengua inglesa esta cuestión se ha centrado en el debate sobre P1 (perspectiva émica, la del hablante) y P2 (perspectiva ética, la del investigador), lo que supone que los investigadores prácticamente tengan que posicionarse sobre esta distinción. En nuestra opinión, hay dos cuestiones discutibles: ¿contamos en el análisis de la imagen social con una descripción adecuada de P1 y P2? ¿En qué medida esta distinción permite una mayor comprensión de los datos? Basándonos en estudios anteriores nuestros sobre actividades de imagen en español peninsular y formas de tratamiento en portugués europeo, entendemos que P1 y P2 son conceptos complejos, compuestos de subgrupos (los diferentes tipos de hablantes y de investigadores, respectivamente). Por ello, mediante un micro y un macroanálisis, describimos las diferentes funciones de cada subgrupo en el proceso interpretativo, y discutimos si debe insistirse en los valores relativos de P1 y P2, e incluso si es conveniente separarlos. En nuestra opinión, las contribuciones de P1 y P2 no se pueden diferenciar, sino que ambas perspectivas de análisis deben ser tenidas en cuenta en el marco interpretativo

La actualización del rol a través de la voz en la interacción de consultas médicas

The present paper explores the relationship between the concepts of voice (Bachtin) and role (Goffman 1961), and its consequences in the achievement of facework (Goffman 1967) in doctor-patient interaction. On the theoretical basis of Sociocultural Pragmatics (Bravo 2020), three extracts of primary care consultations in Galicia are submitted to a qualitative analysis. The results show that the interactants use voices that are characteristic of their respective roles as doctor and patient, but they exchange also their respective voices or turn to other external voices that are recontextualized in the specific situation. As a discursive strategy, the management of voices is part of the creation of facework, that is, politeness and selfface behaviors that confirm the interactants’ face role. In addition, the analysis shows that voice constitutes a discursive resource that contributes to the updating and redefinition of roles in the interaction.Este trabajo explora la relación entre el concepto de voz (Bachtin) y el de rol (Goffman 1961), y sus implicaciones en la realización de actividades de imagen (facework, Goffman 1967) en la interacción médico-paciente. Teniendo como base teórica la Pragmática sociocultural (Bravo 2020) se analizan cualitativamente tres fragmentos de consultas médicas en un centro de atención primaria gallego. Los resultados muestran que los interactuantes usan voces propias de sus roles de médico y paciente, pero también se intercambian las voces o acuden a otras externas que son recontextualizadas en la situación en que se encuentran. Dicho manejo de voces interviene, como estrategia discursiva, en la creación de actividades de imagen, en concreto en comportamientos de cortesía o autoimagen que confirman la imagen de rol de los interactuantes. El análisis muestra también cómo la voz constituye un recurso discursivo que contribuye a la renovación y redefinición de los roles en la interacción

Interpretative challenges in face analysis

En la investigación actual sobre imagen social ha adquirido gran importancia la cuestión de quién, qué y cómo interpretar en el análisis. En lengua inglesa esta cuestión se ha centrado en el debate sobre P1 (perspectiva émica, la del hablante) y P2 (perspectiva ética, la del investigador), lo que supone que los investigadores prácticamente tengan que posicionarse sobre esta distinción. En nuestra opinión, hay dos cuestiones discutibles: ¿contamos en el análisis de la imagen social con una descripción adecuada de P1 y P2? ¿En qué medida esta distinción permite una mayor comprensión de los datos? Basándonos en estudios anteriores nuestros sobre actividades de imagen en español peninsular y formas de tratamiento en portugués europeo, entendemos que P1 y P2 son conceptos complejos, compuestos de subgrupos (los diferentes tipos de hablantes y de investigadores, respectivamente). Por ello, mediante un micro y un macroanálisis, describimos las diferentes funciones de cada subgrupo en el proceso interpretativo, y discutimos si debe insistirse en los valores relativos de P1 y P2, e incluso si es conveniente separarlos. En nuestra opinión, las contribuciones de P1 y P2 no se pueden diferenciar, sino que ambas perspectivas de análisis deben ser tenidas en cuenta en el marco interpretativo

Análisis praxiológico de la dinámica de juego en fútbol : Estudio de equipos canarios en categoría nacional

Este trabajo de investigación es un ANÁLISIS PRAXIOLÓGICO DE LA ACCIÓN DE JUEGO EN FÚTBOL, en el que se estudian equipos canarios en categoría nacional y forma parte de una tesis doctoral en la que estamos trabajando en la actualidad. En una primera fase nos dispusimos a grabar partidos de equipos canarios en categoría nacional (Temporada 2008 / 2009 y temporada 2009 / 2010). De esta forma, al final de estas dos temporadas, obtuvimos un total de 45 partidos. De ellos 15 partidos de la U. D. Las Palmas y C. D. Tenerife, militando en Segunda División A, 15 partidos de equipos que militaban en Segunda División B, y 15 partidos de Tercera División Grupo Canario. Aplicamos una metodología observacional sistemática, estudiando y analizando lo que transcurre en la acción de juego en fútbol, tratando de proporcionar una visión más clara, contrastada y rigurosa. Los objetivos planteados para este estudio: 1. Identificar las secuencias de acción colectivas teniendo en consideración exclusivamente las conductas motrices generadas por los deportistas en su relación con el balón: 2. Se corresponde a los momentos en que el equipo está en posesión del balón, con el fin de ganar espacio, aproximarse a la meta contraria y, a ser posible, finalizar para buscar la obtención de un tanto. 3. Interacciones positivas y significativas entre los jugadores del mismo equipo.Departamento de Educación Físic

Experiencia del Sistema Nacional de Salud Mexicano en el desarrollo de guías de práctica clínica

ResumenAntecedentesLas guías de práctica clínica son herramientas que han demostrado hacer más racionales las decisiones en salud y disminuir la brecha entre la acción clínica y la evidencia científica.ObjetivoEl estudio tiene como objetivo compartir la experiencia en el desarrollo y actualización de guías por el Sistema Nacional de Salud de México.Material y métodosLa metodología en el desarrollo de guías consta de 5 fases: priorización, conformación de grupos de trabajo, desarrollo por adopción de guías internacionales o de novo, validación e integración en el Catálogo maestro de guías de práctica clínica para su difusión.ResultadosEl Catálogo maestro de guías de práctica clínica aloja 664 guías, distribuidas de la siguiente forma: 42% son de Medicina Interna, 22% de Cirugía, 24% de Pediatría y el 12% de Ginecología y Obstetricia. Del total de las guías, se da cobertura al 85% del Catálogo universal de servicios de salud, al 84% del Fondo de protección contra gastos catastróficos y al 61% del Seguro Médico Siglo XXI de la Comisión Nacional de Protección Social en Salud.DiscusiónEl resultado es la suma de un esfuerzo de coordinación y cooperación de las instituciones del Sistema Nacional de Salud, de las voluntades políticas y del compromiso de 3,477 profesionales de la salud que participan en el desarrollo y actualización de las guías.ConclusionesLa integración, difusión e implantación de las guías del Catálogo maestro mejora la calidad de la atención y seguridad de los usuarios del Sistema Nacional de Salud.AbstractBackgroundClinical practice guidelines are tools that have been able to streamline decisions made in health issues and to decrease the gap between clinical action and scientific evidence.ObjectiveThe objective of the study is to share the experience in the development and to update the guidelines by the National Health System of Mexico.Material and methodsThe methodology in the development of the guidelines consists of 5 phases: prioritisation, establishment of work groups, development by adoption of international guidelines of de novo, validation and integration in the Master catalogue of clinical practice guidelines for its dissemination.ResultsThe Master catalogue of clinical practice guidelines contains 664 guidelines, distributed in 42% Internal Medicine, 22% Surgery, 24% Pediatrics and 12% Gynecology. From the total of guidelines coverage is granted at an 85% of the Universal catalogue of health services, an 84% of the Catastrophic expenses protection fund and a 61% of the XXI Century Medical Insurance of the National Commission of Social Protection in Health.DiscussionThe result is the sum of a great effort of coordination and cooperation between the institutions of the National Health System, political wills and a commitment of 3,477 health professionals that participate in guidelines’ development and update.ConclusionMaster catalogue guidelines’ integration, diffusion and implantation improve quality of attention and security of the users of the National Health System

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

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p &lt; 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics