Tuberculosi

Peer Reviewe

Impacto en los resultados de salud cardiovascular de la implantación del contrato de Dirección Clínica en atención primaria de Tarragona

ObjetivoLos objetivos del presente estudio son: a) determinar la mejora en la salud cardiovascular de una población tras la implantación del contrato de Dirección Clínica en los profesionales de los Equipos de Atención Primaria de Tarragona-Reus y Terres de l’Ebre (provincia de Tarragona), y b) identificar los factores predictivos que determinan una mejor salud cardiovascular tras la implantación del contrato de Dirección Clínica. La implantación del contrato de Dirección Clínica (basada en el liderazgo profesional, feedback de la información asistencial, control de los indicadores de riesgo cardiovascular basados en la evidencia científica concretadas en guías de práctica clínica) mejorará los resultados de salud cardiovascular de la población de referencia.DiseñoSe trata de un estudio antes-después y multicéntrico.EmplazamientoAtención primaria de salud.ParticipantesParticipan 30 centros de salud (totalidad de los centros de salud del ámbito de atención primaria del Institut Català de la Salut).Mediciones principalesCaracterísticas del centro. Variables de proceso: indicadores de buena práctica asistencial, cálculo del riesgo cardiovascular, aplicación de la guía de práctica clínica (hipertensión arterial, diabetes, dislipemia, tabaquismo y factores de riesgo cardiovascular), estándares de calidad de la prescripción farmacológica. Variables de resultados: cifras de riesgo cardiovascular, número de visitas en atención continuada, urgencias hospitalarias e ingresos por angina, infarto agudo de miocardio y accidente cerebrovascular, y cribados poblacionales de factores de riesgo.DiscusiónEste estudio es útil, ya que la dirección clinica pretende ser un motor para que los profesionales lideren la gestión asistencial y, mediante el control de indicadores y la «retroalimentación» de estos resultados a los profesionales, se mejore la calidad asistencial. Con este trabajo se pretende demostrar que una estrategia de gestión puede mejorar la salud cardiovascular de la población. La originalidad de este proyecto se basa en el desarrollo de una nueva herramienta de evaluación basada en una novedosa estrategia de gestión para medir resultados en salud cardiovascular.ObjectiveThe objectives of this study are: 1) to determine the improvement in the cardiovascular health of the population after the introduction of the clinical governance contract for primary care team professionals in Tarragona-Reus and the Terres de l’Ebre area (Tarragona province, Spain); 2) to identify the factors predictive of better cardiovascular health after the introduction of the clinical governance contract. The introduction of the clinical governance contract, which is based on professional leadership, feed-back of care information, and monitoring of indicators of cardiovascular risk based on scientific evidence and concretised in clinical practice guidelines, will improve the cardiovascular health results of the reference population. Improvements in indicators of procedure and result are specified in “Material and methods.”DesignThis is a before-and-after, multicentre study.SettingPrimary health care.ParticipantsTirty health centres (all the primary care Centres in the area).Main measurementsCharacteristics of the centre. Variables in procedures: indicators of good care practice, calculation of cardiovascular risk, application of clinical practice guidelines (hypertension, diabetes, lipaemia, tobacco and cardiovascular risk) and quality standards for drug prescription. Result variables: cardiovascular risk figures, number of ongoing care visits, hospital emergencies and admissions for angina, heart attack or stroke, and risk factor screenings of the population.DiscussionThis study is useful, in that clinical governance aims to be a dynamic device to bring professionals into the leadership of health care management and, through monitoring indicators and feeding the findings back to the professionals, to improve health care quality. The study aims to show that management strategy can improve the populatiońs cardiovascular health. The originality of the study lies in the development of a new tool of evaluation based on a novel management strategy for measuring cardiovascular health findings

Biozonacion del Paleogeno continental de la zona oriental de la Cuenca del Ebro mediante carofitas: implicacions en la biozonacion general de carofitas de Europa occidental

A charophyte biozonation of the Paleogene (Thanetian-Chattian) sequences of the Eastern Ebro Basin (NE Spain) is proposed. This biozonation has been based on an intensive sampling carried out on well correlated sections which included, in some cases, fossil mammal localities. Bothfacts haveresultedin agood chronostratigraphic control of the biozonation. One of the most noticeable contributions from this local point of view is the characterization of the Ilerdian in the continental Ebro Basin sequences by the Maedleriella lavocati biozone. Although in afirst approach this biozonation is intended to be local the new data in the Eastern Ebro Basin have enlarged the ranges of some widespread charophyte index species. These changes in the charophyte sp&ies ranges has led to suggest some remarkable modifications of the preexistin~ Riveline' s (1986) charophyte biozonationfor western Europe: 1) TheN. (T. ) thaleri biozone siaried in the Ilerdian and not in the Cuisian. 2) The definition of new Late Eocene (S. labellata) and Late Oligocene (H. lagenalis) biozones. 3) The enlargement of the range of severa1 species which has resulted in suppressionof the Chara notata biozone and in redefinition of Chara microcera, St. pinguis, St. vectensis and Sr. berdotensis biozones. From apaleogeographic point of view the global percentages of pluricontinental, european and iberian species of the Paleogene Eastern Ebro Basin charophyte record suggest some kind of isolation of the charophyte populations in NE Iberia. This isolation could be enhanced by paleogeographic constraints during Bartonian and Latest Priabonian to Stampian transition.Peer Reviewe

Drainage basins evolution during the Neogene-Quaternary. Ebro Basin eastern margin

The monocline layout of the sedimentary pile of the Ebro Basin in its Eastern margin determines the generation and emptying of the adjacent erosive basins. It controls the drainage changes in the original sedimentary basin. A model of emptying erosive basins corresponding to a drainage architecture and sediment production is proposed. The emptying of erosive basins is achieved by two vectors: A) A drainage basin area growth due to anaclinal streams eroding into the resistant layers of the monocline stratigraphic succession. These streams empty and link small depressions generated at the expense of the lateral extension on the less resistant lithologic member. B) The drainage basin outlet point base level controls the drainage network entrenchment facilitated by the gradients created by Neogene extensional faults from the Valencia Trough. A model of the growth and entrenchment of erosive basins as well as the generated landforms and sediment production is described and analyze

Temporal dynamics of soil fungal communities after partial and total clear-cutting in a managed Pinus sylvestris stand

Forest management aimed to maximize timber production might impact soil fungi, especially those symbiotically associated to tree roots. In this study, we analyse the temporal dynamics of soil fungi along five sampling years after tree removal in a managed Pinus sylvestris stand in northern Spain, where timber production is combined with regular mushroom harvesting. Two management methods were tested: total and partial clear-cutting leaving retention trees for seedling regeneration. Undisturbed, uncut plots were also included in the experiment as a control treatment. The whole fungal community (phylotypes and ecological guilds) were analysed by high-throughput Illumina MiSeq sequencing of fungal ITS1 amplicons. We hypothesized that (1) ectomycorrhizal fungal communities will decrease after both clear-cutting treatments with a concurrent increase in the abundance of saprotrophs, (2) the abundance and diversity of the ectomycorrhizal guild will be more preserved in partially clear-cut than in total clear-cut plots, and (3) the overall fungal diversity will decrease in the cut plots leading to major losses of ectomycorrhizal species. Our results show that soil fungal composition changed across the five years after clear-cutting by decreasing ectomycorrhizal fungi and increasing saprotrophs. However, these changes did not significantly affect fungal diversity and there were taxa-specific responses to tree harvest treatments. Boletus edulis, the most abundant ectomycorrhizal species fruiting in the study area and a valuable local non-forest resource, was negatively affected by either clear-cutting treatments. Soil fungal community composition in partially clear-cut areas was not different from that of total clear-cut areas. Our results indicate a strong effect of tree harvest on the relative abundance of ectomycorrhizal fungi along the first years after clear-cutting. However, levels of fungal diversity were comparable to the undisturbed forest, thus suggesting a potential further recovery of ectomycorrhizal fungi through the colonization of the regenerated seedlings.info:eu-repo/semantics/acceptedVersio