Papel de los equipos de atención primaria en la hospitalización infantil de los niños menores de 2 años

ObjetivoDeterminar si la conformación de los equipos de atención primaria con la realización del programa de salud del niño sano da lugar a una disminución del riesgo de hospitalización en los niños menores de 2 años, respecto al sistema sanitario tradicional de consultorio o ambulatorio.DiseñoEstudio epidemiológico de casos-referencia.Casos40% de los niños hospitalizados menores de 24 meses en plantas de hospitalización pediátricas o neonatal del Hospital Universitario Marqués de Valdecilla.Referencia15% de los recién nacidos vivos en dicho hospital. Recogida de información mediante entrevista personal y consulta de la tarjeta sanitaria.Período de estudioabril de 1995 a mayo de 1996.ResultadosLos niños menores de 2 años controlados habitualmente por un médico perteneciente a un equipo de atención primaria presentan una disminución del riesgo de hospitalización para todos los diagnósticos clínicos de 0,57 (IC del 95%, 0,35–0,93), tras haber ajustado por diferentes factores de confusión como educación materna, clase social, etnia, edad materna, consumo de tabaco materno, lactancia natural al nacimiento, ingreso al nacimiento. Se observó una disminución del riesgo de hospitalización por fiebre sin localización aparente en aquellos niños controlados habitualmente por un médico de equipo (RR ajustado, 0,41; IC del 95%, 0,19–0,90).ConclusiónLas ventajas de la reforma en la asistencia sanitaria en el ámbito pediátrico, con la conformación de los equipos de atención primaria y la realización de las actividades que ello conlleva, se traduce en una disminución del riesgo de hospitalización para aquellos niños menores de 2 años cuyo control habitual es realizado por un pediatra perteneciente a un equipo de atención primaria.ObjectiveTo determine whether the structure of primary care teams on carrying out the healthy child health programme leads to a drop in the risk of admission to hospital of children under two, in comparison with the traditional clinic or out-clinic health system.DesignCase-reference epidemiological study.Cases40% of the children under 24 months admitted to paediatric or neonate floors of the Marqués de Valdecilla University Hospital.Reference15% of the recently born children alive in this hospital. Information was gathered through face-to-face interview and by examining health cards. The study ran from April 1995 to May 1996.ResultsChildren under two monitored habitually by a doctor belonging to a primary care team showed a drop in risk of hospital admission for all clinical diagnoses of 0.57 (95% CI, 0.35–0.93), after adjustment due to various confusion factors such as maternal education, social class, ethnic background, mother's age, mother's tobacco consumption, natural breast-feeding at birth, admission at birth. There was a drop of risk of hospital admission for high temperature without apparent cause in those children monitored habitually by a team doctor (adjusted RR = 0.41; 95% CI, 0.19–0.90).ConclusionsThe advantages of the paediatric health care reform with the structuring of the primary care teams and the accompanying activities performed lead to a drop in the risk of hospital admission of those children under two years old who are habitually monitored by a doctor belonging to a primary care team

METADOCK 2: a high-throughput parallel metaheuristic scheme for molecular docking

[EN] Motivation Molecular docking methods are extensively used to predict the interaction between protein-ligand systems in terms of structure and binding affinity, through the optimization of a physics-based scoring function. However, the computational requirements of these simulations grow exponentially with: (i) the global optimization procedure, (ii) the number and degrees of freedom of molecular conformations generated and (iii) the mathematical complexity of the scoring function. Results In this work, we introduce a novel molecular docking method named METADOCK 2, which incorporates several novel features, such as (i) a ligand-dependent blind docking approach that exhaustively scans the whole protein surface to detect novel allosteric sites, (ii) an optimization method to enable the use of a wide branch of metaheuristics and (iii) a heterogeneous implementation based on multicore CPUs and multiple graphics processing units. Two representative scoring functions implemented in METADOCK 2 are extensively evaluated in terms of computational performance and accuracy using several benchmarks (such as the well-known DUD) against AutoDock 4.2 and AutoDock Vina. Results place METADOCK 2 as an efficient and accurate docking methodology able to deal with complex systems where computational demands are staggering and which outperforms both AutoDock Vina and AutoDock 4.This work was partially supported by the Fundación Séneca del Centro de Coordinación de la Investigación de la Región de Murcia [Projects 20813/PI/ 18, 20988/PI/18, 20524/PDC/18] and by the Spanish Ministry of Science, Innovation and Universities [TIN2016-78799-P (AEI/FEDER, UE), CTQ2017-87974-R]. The authors thankfully acknowledge the computer resources at CTE-POWER and the technical support provided by Barcelona Supercomputing Center - Centro Nacional de Supercomputación [RES-BCV2018-3-0008].Imbernón, B.; Serrano, A.; Bueno-Crespo, A.; Abellán, JL.; Pérez-Sánchez, H.; Cecilia-Canales, JM. (2020). METADOCK 2: a high-throughput parallel metaheuristic scheme for molecular docking. Bioinformatics. 1-6. https://doi.org/10.1093/bioinformatics/btz958S16Bianchi, L., Dorigo, M., Gambardella, L. M., & Gutjahr, W. J. (2008). A survey on metaheuristics for stochastic combinatorial optimization. Natural Computing, 8(2), 239-287. doi:10.1007/s11047-008-9098-4Cecilia, J. M., Llanes, A., Abellán, J. L., Gómez-Luna, J., Chang, L.-W., & Hwu, W.-M. W. (2018). High-throughput Ant Colony Optimization on graphics processing units. Journal of Parallel and Distributed Computing, 113, 261-274. doi:10.1016/j.jpdc.2017.12.002Desiraju, G., & Steiner, T. (2001). 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LEADS-PEP: A Benchmark Data Set for Assessment of Peptide Docking Performance. Journal of Chemical Information and Modeling, 56(1), 188-200. doi:10.1021/acs.jcim.5b00234Llanes, A., Muñoz, A., Bueno-Crespo, A., García-Valverde, T., Sánchez, A., Arcas-Túnez, F., … M. Cecilia, J. (2016). Soft Computing Techniques for the Protein Folding Problem on High Performance Computing Architectures. Current Drug Targets, 17(14), 1626-1648. doi:10.2174/1389450117666160201114028McIntosh-Smith, S., Price, J., Sessions, R. B., & Ibarra, A. A. (2014). High performance in silico virtual drug screening on many-core processors. The International Journal of High Performance Computing Applications, 29(2), 119-134. doi:10.1177/1094342014528252Mehler, E. L., & Solmajer, T. (1991). Electrostatic effects in proteins: comparison of dielectric and charge models. «Protein Engineering, Design and Selection», 4(8), 903-910. doi:10.1093/protein/4.8.903Morris, G. M., Goodsell, D. S., Halliday, R. S., Huey, R., Hart, W. 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La metodología de aprendizaje basado en proyectos (ABP) aplicada a asignaturas de ciencia de los materiales en ingeniería en la red IdM@ti

En este trabajo se va a presentar una experiencia docente llevada a cabo de forma coordinada entre profesorado de la red de innovación docente en ciencia de materiales IdM@ti. Se trata por tanto de una experiencia interuniversitaria que se ha desarrollado entre cuatro universidades públicas españolas de manera simultánea. Concretamente, el presente trabajo muestra la implementación y el desarrollo de la aplicación de la metodología de aprendizaje basado en proyectos en asignaturas de grados de ingeniería en el ámbito de ciencia de los materiales e ingeniería metalúrgica. Se presentan las experiencias llevadas a cabo durante los últimos cuatro años, mostrando los puntos fuertes y débiles de esta metodología, así como la problemática asociada a la implementación de la misma en asignaturas de curso general de grado. Se presentarán también los resultados obtenidos, así como las principales conclusiones a las que ha llegado el equipo de trabajo de la red IdM@ti

Global and regional cortical thinning in first-episode psychosis patients: relationships with clinical and cognitive features

BackgroundThe thickness of the cortical mantle is a sensitive measure for identifying alterations in cortical structure. We aimed to explore whether first episode schizophrenia patients already show a significant cortical thinning and whether cortical thickness anomalies may significantly influence clinical and cognitive features.MethodWe investigated regional changes in cortical thickness in a large and heterogeneous sample of schizophrenia spectrum patients (n=142) at their first break of the illness and healthy controls (n=83). Magnetic resonance imaging brain scans (1.5 T) were obtained and images were analyzed by using BRAINS2. The contribution of sociodemographic, cognitive and clinical characterictics was investigated.ResultsPatients showed a significant total cortical thinning (F=17.55, d=−0.62, p0.53). No significant group × gender interactions were observed (all p’s>0.15). There were no significant associations between the clinical and pre-morbid variables and cortical thickness measurements (all r’s<0.12). A weak significant negative correlation between attention and total (r=−0.24, p=0.021) and parietal cortical thickness (r=−0.27, p=0.009) was found in patients (thicker cortex was associated with lower attention). Our data revealed a similar pattern of cortical thickness changes related to age in patients and controls.ConclusionsCortical thinning is independent of gender, age, age of onset and duration of the illness and does not seem to significantly influence clinical and functional symptomatology. These findings support a primary neuro-development disorder affecting the normal cerebral cortex development in schizophrenia

MODELO DE HOSPITALIZACIÓN Y FRECUENCIA DE REINGRESO EN PACIENTES CON EXACERBACIÓN DE EPOC

Objective: To evaluate the effectiveness of the Short Stay Unit (USS) in patients who suffer from a chronic obstructive pulmonary disease (COPD) that worsens versus conventional hospitalization (CH) in terms of readmission and mortality.Patient and Method. Non randomized retrospective study of cohorts of patients hospitalized due to exacerbation of EPOC during 2004 in a general hospital. The monitoring was prolonged until December 31st 2006 or the occurrence of an event (death or readmission). The statistical analysis was based on the Kaplan-Meier method, the log-rank test and Cox regression.Results. Of the 543 subjects, 252 were admitted in USS and 291 in CH. Those admitted in USS were more advanced in years (75.4 versus 71.7 years; p &lt; 0,001), and with a tendency to a smaller Charlson index (0.46 versus 0.58; p &lt; 0,07) than the patients in HC. The average stay was 3.2 days in UCE versus 8.9 days in CH (p &lt; 0,001). In the univariant analysis, the patients admitted in USS showed a major incidence of death or readmission (Relative Risk [RR] 1.31; p &lt; 0,001), at the expense of the readmission (RR 1.53; p = 0,013), while there were no differences in mortality (RR 0,82; p=0 ,34). After applying the Cox regression for the hospitalization covariables fit, there was no substantial change in the estimates. The analysis of the survival curves demonstrated that the differences were not due to an increase in precocious readmissions.Conclusions. In the field of the study, the patients with exacerbation of COPD admitted in USS had worse results in readmission terms than the patients admitted in CH.Objetivo. Evaluar la efectividad de (UCE) en pacientes con (EPOC) agudizada frente a (HC) en términos de reingreso y mortalidad.Método. Estudio de cohortes retrospectivo no aleatorizado de pacientes hospitalizados por exacerbación de EPOC durante 2004 en un hospital general. El seguimiento se prolongó hasta el 31 de diciembre de 2006. La censura de datos se produce en la fecha final de seguimiento o aparición de muerte o reingreso. El análisis estadístico se basó en Kaplan-Meier, test del log-rank y regresión de Cox.Resultados. De los 543 pacientes incluidos, 252 ingresaron en UCE y 291 en HC. Los pacientes de UCE eran mayores (75,4 frente a 71,7 años; p &lt; 0,001), y tendencia a un menor I. Charlson (0,46 frente a 0,58; p &lt;0,07) que los pacientes de HC. La estancia media fue de 3,2 días en UCE frente a 8,9 días en HC (p &lt;0,001). En el análisis univariante, los pacientes ingresados en UCE mostraron una mayor incidencia de muerte o reingreso (Riesgo Relativo [RR] 1,31; p&lt;0,001), a expensas de los reingresos (RR 1,53; p= 0,013), no hubo diferencias de mortalidad (RR 0,82; p=0,34). Al ajustar para las covariables del modelo de hospitalización mediante regresión de Cox, estas estimaciones no cambiaron El análisis de las curvas de supervivencia demostró que las diferencias no se debieron a un aumento de los reingresos precoces.Conclusiones. En el estudio, los pacientes con exacerbación de EPOC ingresados en UCE tuvieron peores resultados en términos de reingreso que los de H

Multiple approaches at admission based on lung ultrasound and biomarkers improves risk identification in COVID-19 patients

Background: Risk stratification of COVID-19 patients is fundamental to improving prognosis and selecting the right treatment. We hypothesized that a combination of lung ultrasound (LUZ-score), biomarkers (sST2), and clinical models (PANDEMYC score) could be useful to improve risk stratification. Methods: This was a prospective cohort study designed to analyze the prognostic value of lung ultrasound, sST2, and PANDEMYC score in COVID-19 patients. The primary endpoint was in-hospital death and/or admission to the intensive care unit. The total length of hospital stay, increase of oxygen flow, or escalated medical treatment during the first 72 h were secondary endpoints. Results: a total of 144 patients were included; the mean age was 57.5 ± 12.78 years. The median PANDEMYC score was 243 (52), the median LUZ-score was 21 (10), and the median sST2 was 53.1 ng/mL (30.9). Soluble ST2 showed the best predictive capacity for the primary endpoint (AUC = 0.764 (0.658–0.871); p = 0.001), towards the PANDEMYC score (AUC = 0.762 (0.655–0.870); p = 0.001) and LUZ-score (AUC = 0.749 (0.596–0.901); p = 0.002). Taken together, these three tools significantly improved the risk capacity (AUC = 0.840 (0.727–0.953); p = 0.001). Conclusions: The PANDEMYC score, lung ultrasound, and sST2 concentrations upon admission for COVID-19 are independent predictors of intra-hospital death and/or the need for admission to the ICU for mechanical ventilation. The combination of these predictive tools improves the predictive power compared to each one separately. The use of decision trees, based on multivariate models, could be useful in clinical practice. © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/)

Developmental Changes in Dynamic Functional Connectivity From Childhood Into Adolescence

The longitudinal study of typical neurodevelopment is key for understanding deviations due to specific factors, such as psychopathology. However, research utilizing repeated measurements remains scarce. Resting-state functional magnetic resonance imaging (MRI) studies have traditionally examined connectivity as ‘static’ during the measurement period. In contrast, dynamic approaches offer a more comprehensive representation of functional connectivity by allowing for different connectivity configurations (time varying connectivity) throughout the scanning session. Our objective was to characterize the longitudinal developmental changes in dynamic functional connectivity in a population-based pediatric sample. Resting-state MRI data were acquired at the ages of 10 (range 8-to-12, n = 3,327) and 14 (range 13-to-15, n = 2,404) years old using a single, study-dedicated 3 Tesla scanner. A fully-automated spatially constrained group-independent component analysis (ICA) was applied to decompose multi-subject resting-state data into functionally homogeneous regions. Dynamic functional network connectivity (FNC) between all ICA time courses were computed using a tapered sliding window approach. We used a k-means algorithm to cluster the resulting dynamic FNC windows from each scan session into five dynamic states. We examined age and sex associations using linear mixed-effects models. First, independent from the dynamic states, we found a general increase in the temporal variability of the connections between intrinsic connectivity networks with increasing age. Second, when examining the clusters of dynamic FNC windows, we observed that the time spent in less modularized states, with low intra- and inter-network connectivity, decreased with age. Third, the number of transitions between states also decreased with age. Finally, compared to boys, girls showed a more mature pattern of dynamic brain connectivity, indicated by more time spent in a highly modularized state, less time spent in specific states that are frequently observed at a younger age, and a lower number of transitions between states. This longitudinal population-based study demonstrates age-related maturation in dynamic intrinsic neural activity from childhood into adolescence and offers a meaningful baseline for comparison with deviations from typical development. Given that several behavioral and cognitive processes also show marked changes through childhood and adolescence, dynamic functional connectivity should also be explored as a potential neurobiological determinant of such changes

Perceived control over menopausal hot flushes in mid-aged women

Background. Hot flushes (HFs) and night sweats are frequent complaints among both peri- and postmenopausal women. Perceived control of this complaint may vary from one population to another. Objective. To assess perceived control over menopausal HFs and determinant factors among mid-aged Ecuadorian women. Methods. In this cross-sectional study healthy women aged 40–59 years, seeking healthcare centres of eight main cities of Ecuador with more than 100,000 inhabitants, were assessed with the Menopause Rating Scale (MRS) and those presenting HFs were requested to fill out the Perceived Control Index (PCI) and a questionnaire containing socio-demographic data (female and partner). Results. A total of 1154 women participated in this study of which 56% presented HFs (n ¼ 646). According to the MRS, 29.1% and 9.1% of these HFs were graded as severe and very severe, respectively. Mean age of women presenting HFs was 49.5 + 5.2 years, with 51.9% having 12 years or less of education, 61.5% being postmenopausal and 47.2% living in high altitude. At the moment of the survey 13.9% were on hormone therapy, 12.8% on phytoestrogens and 7.1% on psychotropic drugs. There was a significant decreasing trend for PCI scores (total and difficulty in control items) from one menopausal stage to the next, with no differences observed for time since menopause onset. Despite this, logistic regression analysis determined that HF severity, as determined with the MRS, was the only single predictive factor related to lower HF perceived control (total PCI score 538) (OR: 1.83 CI 95% [1.15–2.90], p 5 0.01). Conclusion. As determined with the PCI, HF severity was related to a lower perceived control among mid-aged women.0000-0002-2545-4733Cuenc