Satisfacción en la prestación de servicios de salud en adultos mayores Colombia 2018

El termino envejecimiento activo es relativamente novedoso y muy poco conocido a pesar de que en los últimos tiempos se ha hablado mucho de esto. El presente trabajo tiene como objetivo revisar la literatura frente a la atención en salud del adulto mayor. El método que se utilizó fue una revisión narrativa a través de una exploración de artículos científicos en las bases de datos: Science direct, Pubmed y Scielo. En los resultados se encontró que en varios artículos los adultos mayores no  se encontraban satisfechos con la atención que recibían en salud. Como conclusiones según lo referido por las personas mayores, hay una brecha grande entre lo que se dice en las políticas públicas de envejecimiento y lo que realmente se está haciendo en la prestación de servicios. En cuanto a la percepción que tienen los adultos mayores de su salud en Antioquia, hay un porcentaje muy alto que cree que la atención en salud no es la adecuada. &nbsp

Diferencias en el sentimiento de soledad entre adultos institucionalizados y no institucionalizados

Objetivo: Comparar los niveles de soledad entre la población adulta institucionalizada y la no institucionalizada. Metodología: Investigación exploratoria de corte. Se midió el nivel de soledad reportada, usando una escala previamente validada (este) en un grupo de adultos no institucionalizados, conformado por 869 mayores de 55 años, asistentes a los grupos de la tercera edad de las diferentes comunas de Medellín, captados mediante un muestreo aleatorio por conglomerados; asimismo, se aplicó en un grupo de adultos institucionalizados de 55 y más años de edad, residentes en centros gerontológicos públicos y privados, para un total de 379 adultos. Se analizaron las variables sociodemográficas: género, estado civil, escolaridad y edad, usando las pruebas U de Mann-Whitney y KruskalWallis, con una significancia de 0,05. Resultados: Se observó mayor puntaje de soledad familiar, social y conyugal en los adultos institucionalizados. La crisis de adaptación fue similar en ambos grupos. El puntaje de soledad fue significativamente diferente en los adultos no institucionalizados en las variables de estado civil, escolaridad y edad, mientras que en los institucionalizados solo se observó diferencias con el estado civil. El puntaje total de soledad fue mayor en quienes no tenían pareja y estaban institucionalizados. Conclusiones: El sentimiento de soledad fue mayor en adultos institucionalizados. La variable estado civil estuvo asociada con la soledad en ambos grupos

YouTube y la economía del algoritmo

YouTube navega entre aguas revueltas pese a la solidez de la marca y de su altísimo consumo. Siendo la segunda página web más visitada del mundo según el índice Alexa, sólo tras el buscador de Google –propietaria de la plataforma de vídeo, además-, los nuevos competidores del vídeo online han creado un escenario de fuerte rivalidad en la que conviven diferentes modelos de negocio, contenedores de productos muy diversos, con una más que evidente identidad mutante. A YouTube se le suponía un modelo definido y una identidad consolidada: era el espacio en el que los usuarios compartían sus vídeos de manera más o menos altruista, donde las discográficas rompían los records de reproducciones con las estrellas de moda y con vídeo-eventos viralizados por sorpresa como Gangnam Style o Despacito, o donde los usuarios seguían vídeo-tutoriales o unboxings de los temas más diversos. Sin embargo, desde el momento en que la plataforma de vídeo de Google comenzó a incentivar la producción de sus usuarios más seguidos a través del patrocinio (mediante el programa de Partners) y, con más fuerza, cuando YouTube empezó a producir contenidos propios, evidenció que los vídeos virales de gatitos, los tutoriales de maquillaje y los clips de intérpretes emergentes del k-pop eran insuficientes para sostener una inversión que se adivina multimillonaria. YouTube no quiere quedarse atrás en la batalla de las OTTs comerciales y se reivindica como marca consolidada capaz de lograr el compromiso de sus clientes a través del pago de una cuota

A randomized, double-blind study on the efficacy of oral domperidone versus placebo for reducing SARS-CoV-2 viral load in mild-to-moderate COVID-19 patients in primary health care

15 p.-3 fig.-3 tab.Introduction:The clinical effect of domperidone against COVID-19 has been investigated in a double-blind phase III clinical trial (EudraCT number 2021-001228-17). Domperidone has shown in vitro antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and potential immudolatory properties through the stimulation of prolactin secretion.Patients and methods:The efficacy of oral domperidone plus standard of care (SOC; n = 87) versus placebo plus SOC (n = 86) was evaluated in a 28-day randomized double-blind multicentre study in primary health care centres. A total of 173 outpatients with mild-to-moderate COVID-19 were included. Three daily doses of 10 mg (30 mg/day) of domperidone or placebo were administered for 7 days. Reduction of viral load on day 4 was the primary efficay endpoint. It was estimated in saliva samples by reverse transcription-quantitative polymerase chain reaction (RT-qPCR), as the cycle thresholds detected ORF1ab, N Protein and S Protein genes.Results:A significant reduction in the viral load was observed (p < 0.001) from baseline to days 4, 7 and 14 of the three genes studied with non-significant differences between domperidone and placebo groups. Twenty-three patients (13.3%) experienced adverse events, 14 patients in the domperidone group (16.1%) and 9 patients in the placebo group (10.5%). No patients needed to be hospitalized.Conclusion: Results do not prove the use of domperidone as antiviral in patients with COVID-19.This research was funded by CSIC (grant no. PIE 201980E024) and by the European Commission: NextGeneration EU (Regulation EU 2020/2094) through CSIC’s Global Health Platform (PTI Salud Global). The study sponsor was Agencia Estatal Consejo Superior de Investigaciones Científicas, M.P. (CSIC), Madrid, Spain. The sponsor was involved in the design, data interpretation, manuscript review and the decision to submit the article for publication.Peer reviewe

Natural History of MYH7-Related Dilated Cardiomyopathy

BACKGROUND Variants in myosin heavy chain 7 (MYH7) are responsible for disease in 1% to 5% of patients with dilated cardiomyopathy (DCM); however, the clinical characteristics and natural history of MYH7-related DCM are poorly described. OBJECTIVES We sought to determine the phenotype and prognosis of MYH7-related DCM. We also evaluated the influence of variant location on phenotypic expression. METHODS We studied clinical data from 147 individuals with DCM-causing MYH7 variants (47.6% female; 35.6 +/- 19.2 years) recruited from 29 international centers. RESULTS At initial evaluation, 106 (72.1%) patients had DCM (left ventricular ejection fraction: 34.5% +/- 11.7%). Median follow-up was 4.5 years (IQR: 1.7-8.0 years), and 23.7% of carriers who were initially phenotype-negative developed DCM. Phenotypic expression by 40 and 60 years was 46% and 88%, respectively, with 18 patients (16%) first diagnosed at <18 years of age. Thirty-six percent of patients with DCM met imaging criteria for LV noncompaction. During follow-up, 28% showed left ventricular reverse remodeling. Incidence of adverse cardiac events among patients with DCM at 5 years was 11.6%, with 5 (4.6%) deaths caused by end-stage heart failure (ESHF) and 5 patients (4.6%) requiring heart transplantation. The major ventricular arrhythmia rate was low (1.0% and 2.1% at 5 years in patients with DCM and in those with LVEF of <= 35%, respectively). ESHF and major ventricular arrhythmia were significantly lower compared with LMNA-related DCM and similar to DCM caused by TTN truncating variants. CONCLUSIONS MYH7-related DCM is characterized by early age of onset, high phenotypic expression, low left ventricular reverse remodeling, and frequent progression to ESHF. Heart failure complications predominate over ventricular arrhythmias, which are rare. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation

Investigación joven con perspectiva de género III

Actas del III Congreso Internacional de Estudios de Género, Perspectivas y Retos de Futuro: Jóvenes Investigadores (Getafe, 13 - 15 de junio de 2018) organizado por el Instituto Universitario de Estudios de Género de la Universidad Carlos III de Madrid

IL-6 serum levels predict severity and response to tocilizumab in COVID-19: An observational study

Background: Patients with coronavirus disaese 2019 (COVID-19) can develop a cytokine release syndrome that eventually leads to acute respiratory distress syndrome requiring invasive mechanical ventilation (IMV). Because IL-6 is a relevant cytokine in acute respiratory distress syndrome, the blockade of its receptor with tocilizumab (TCZ) could reduce mortality and/or morbidity in severe COVID-19. Objective: We sought to determine whether baseline IL-6 serum levels can predict the need for IMV and the response to TCZ. Methods: A retrospective observational study was performed in hospitalized patients diagnosed with COVID-19. Clinical information and laboratory findings, including IL-6 levels, were collected approximately 3 and 9 days after admission to be matched with preadministration and postadministration of TCZ. Multivariable logistic and linear regressions and survival analysis were performed depending on outcomes: need for IMV, evolution of arterial oxygen tension/fraction of inspired oxygen ratio, or mortality. Results: One hundred forty-six patients were studied, predominantly males (66%); median age was 63 years. Forty-four patients (30%) required IMV, and 58 patients (40%) received treatment with TCZ. IL-6 levels greater than 30 pg/mL was the best predictor for IMV (odds ratio, 7.1; P < .001). Early administration of TCZ was associated with improvement in oxygenation (arterial oxygen tension/fraction of inspired oxygen ratio) in patients with high IL-6 (P = .048). Patients with high IL-6 not treated with TCZ showed high mortality (hazard ratio, 4.6; P = .003), as well as those with low IL-6 treated with TCZ (hazard ratio, 3.6; P = .016). No relevant serious adverse events were observed in TCZ-treated patients. Conclusions: Baseline IL-6 greater than 30 pg/mL predicts IMV requirement in patients with COVID-19 and contributes to establish an adequate indication for TCZ administrationThis study was funded by Spanish Ministry of Economy, Industry and Competitiveness (MINECO) and Instituto de Salud Carlos III (grant nos. RD16/0011/0012 and PI18/ 0371 to I.G.A., grant no. PI19/00549 to A.A., and grant no. SAF2017-82886-R to F.S.-M.) and co-funded by the European Regional Development Fund. The study was also funded by ‘‘La Caixa Banking Foundation’’ (grant no. HR17-00016 to F.S.-M.) and ‘‘Fondos Supera COVID19’’ by Banco de Santander and CRUE. None of these sponsors have had any role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publicatio

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis