Women’s preferences and mode of delivery in public and private hospitals: a prospective cohort study

Background Rates of caesarean section have steadily increased in most middle- and high-income countries over the last few decades without medical justification. Maternal request is one of the frequently cited non-medical factors contributing to this trend. The objectives of this study were to assess pregnant women’s preferences regarding mode of delivery and to compare actual caesarean section rates in the public and private sectors. Methods A prospective cohort study was conducted in two public and three private hospitals in Buenos Aires, Argentina. 382 nulliparous pregnant women (183 from the private sector and 199 from the public sector) aged 18 to 35 years, with single pregnancies over 32 weeks of gestational age were enrolled during antenatal care visits between October 2010 and September 2011. We excluded women with pregnancies resulting from assisted fertility, women with known pre-existing major diseases or, with pregnancy complications, or with a medical indication of elective cesarean section. We used two different approaches to assess women’s preferences: a survey using a tailored questionnaire, and a discrete choice experiment. Results Only 8 and 6 % of the healthy nulliparous women in the public and private sectors, respectively, expressed a preference for caesarean section. Fear of pain and safety were the most frequently expressed reasons for preferring caesarean section. When reasons for delivery mode were assessed by a discrete choice experiment, women placed the most emphasis on sex after childbirth. Of women who expressed their preference for vaginal delivery, 34 and 40 % ended their pregnancies by caesarean section in public and private hospitals, respectively. Conclusions The preference for caesarean section is low among healthy nulliparous women in Buenos Aires. The reasons why these women had a rate of more than 35 % caesarean sections are unlikely related to their preferences for mode of delivery.Fil: Mazzoni, Agustina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Althabe, Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Gutierrez, Laura. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Gibbons, Luz. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Liu, Nancy H.. UCSF General Internal Medicine; Estados UnidosFil: Bonotti, Ana María. Ministerio de Salud de la Nación; ArgentinaFil: Izbizky, Gustavo H.. Hospital Italiano; ArgentinaFil: Ferrary, Marta. Hospital Magdalena; ArgentinaFil: Viergue, Nora. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”; ArgentinaFil: Vigil, Silvia I.. Hospital Británico de Buenos Aires; ArgentinaFil: Zalazar Denett, Gabriela. Hospital Materno Infantil Dr. Carlos Gianantonio; ArgentinaFil: Belizan, Jose. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentin

Bacterial immunotherapy is highly effective in reducing recurrent upper respiratory tract infections in children: a prospective observational study

Purpose Whilst immunotherapy is an appealing option as it could reduce the burden of recurrent pediatric respiratory tract infections (RTI), there is limited evidence on its effectiveness and more research was requested in order to better understand this therapeutic modality. Methods We performed a prospective cohort study involving 57 subjects to assess the safety and effectiveness a 3-month regimen of either typified or patient-specific bacterial lysates could have in reducing the number of RTIs in children aged 0 to 11 years with histories of recurrent episodes. Results After a 6-month follow-up, the number of RTIs and school absenteeism dropped sharply and significantly, from an adjusted mean (standard error) of 0.6 (0.04) episodes/month to 0.1 (0.03) episodes/month (74.7% reduction, P < 0.001), and from an adjusted mean score of 4.6 (1.06) points to 0.0 (0.01) points over 10 (99.5% reduction, P < 0.001), respectively. There was also a significant decrease in the severity of symptoms. No adverse reactions were observed. Conclusion The use of the study product is associated with a decreased risk of recurrent RTIs in children, with a very favorable safety profile that warrants further investigation in randomized clinical trials

Durability of Construction and Demolition Waste-Bearing Ternary Eco-Cements

In recent years, the development of ternary cements has become a priority research line for obtaining cements with a lower carbon footprint, with the goal to contribute to achieve climate neutrality by 2050. This study compared ordinary Portland cement (OPC) durability to the performance of ternary cements bearing OPC plus 7% of a 2:1 binary blend of either calcareous (Hc) or siliceous (Hs) concrete waste fines and shatterproof glass. Durability was measured further to the existing legislation for testing concrete water absorption, effective porosity, pressurized water absorption and resistance to chlorides and CO2. The experimental findings showed that the 7% blended mortars performed better than the reference cement in terms of total and effective porosity, but they absorbed more pressurized water. They also exhibited lower CO2 resistance, particularly in the calcareous blend, likely due to its higher porosity. Including the binary blend of CDW enhanced chloride resistance with diffusion coefficients of 2.9 × 10−11 m2 s−1 (calcareous fines-glass, 7%Hc-G) and 1.5 × 10−11 m2 s−1 (siliceous fines-glass, 7%Hs-G) compared to the reference cement’s 4.3 × 10−11 m2 s−1. The siliceous fines-glass blend out-performed the calcareous blend in all the durability tests. As the mortars with and without CDW (construction and demolition waste) performed to similar standards overall, the former were deemed viable for the manufacture of future eco-efficient cements.This research was conducted as part of a national project funded by the Spanish Ministry of Science, Innovation and Universities (MICIU), the Spanish National Research Agency (AEI) and the European Regional Development Fund (ERDF), grant number RTI2018-097074-B-C21 and C-22

Simpatectomía dorsal bilateral en el tratamiento de la hiperhidrosis esencial : efectos sobre la función cardiopulmonar /

Introducción: La hiperhidrosis esencial se caracteriza por un exceso de sudoración a nivel de las palmas de las manos, plantas de los pies y las axilas, debido a una hiperestimulación del sistema nervioso simpático que pasa a través del segundo y tercer ganglio torácico simpático (T2-T3). El tratamiento de elección es la simpatectomía dorsal bilateral (SDB) por videotoracoscopia. Es un tratamiento seguro en el que se han descrito cambios en la función pulmonar, relacionados con la denervación simpática, lo que indica una mayor actividad del sistema nervioso autónomo en estos pacientes. El objetivo de nuestro estudio fue evaluar los efectos de la SDB sobre la función cardiopulmonar antes, a los tres meses y a los tres años de la cirugía. Material y métodos: Se estudiaron un grupo de 20 pacientes (2 hombres; 18 mujeres) con una edad media de 29 (rango 17-43) y que presentaban una clínica de hiperhidrosis esencial de más de cinco años de evolución. Se determinaron la espirometría, volúmenes pulmonares estáticos, determinación de óxido nítrico en aire exhalado, prueba de provocación con metacolina y prueba de esfuerzo máxima, antes y a los 3 meses de la cirugía. A los tres años se repitieron las mismas pruebas a excepción de la prueba de esfuerzo y se compararon con las previas a la cirugía. La SDB se realizó por videotoracoscopia y mediante electrocoagulación de los ganglios simpáticos entre T2 y T3. Resultados: Los valores de la espirometría (FVC, FEV1,FEV1/FVC) y volúmenes estáticos (RV, FRC y TLC) no mostraron diferencias estadísticamente significativas, antes y a los tres meses de la cirugía. La única variable que mostró modificaciones fue el MMEF que pasó de 105(26)% a 95(27)%; p 0.05. En 10 pacientes se observó una prueba de provocación bronquial positiva previa y se mantuvo en el mismo valor después de la cirugía, positivándose en dos pacientes más tras la intervención. La única variable que mostró modificaciones durante la prueba de esfuerzo fue la FC máxima que pasó de 172(17) lat/min a 162(15) lat/min; p 0.05. A los 3 años se detectó un incremento estadísticamente significativo del porcentaje de la capacidad vital forzada basal, que pasó de un valor medio (± desviación estándar) del 96 ± 10% al 101 ± 11% (p = 0,008). Respecto a las cifras iniciales del flujo máximo mesoespiratorio, se halló un descenso estadísticamente significativo a los 3 años de la cirugía: de un valor basal de 3,8 ± 0,9 l/s se pasó a 3,5 ± 0,9 l/s (p = 0,01). La prueba de provocación bronquial con metacolina y la concentración de óxido nítrico en aire espirado no experimentaron cambios a los 3 años. Conclusiones: La SDB es el tratamiento de elección de la hiperhidrosis esencial. Es una técnica quirúrgica segura, mínimamente invasiva y con buenos resultados a largo plazo. Las modificaciones en la función pulmonar indican una mínima afectación de la pequeña vía aérea, que persiste a los 3 años de la SDB, presencia de hiperrespuesta bronquial positiva y un ligero bloqueo sobre la frecuencia cardiaca, como consecuencia de la denervación simpática producida por la cirugía, pero sin ninguna significación clínica.Background: Essential hyperhidrosis is characterized by an overactivity of the sympathetic fibres passing through the upper dorsal ganglia T2-T3 and the treatment of choice is video-assisted thoracoscopy sympathectomy. It is a safe treatment but alterations in cardiopulmonary function after treatment have been reported, related to an overactivity of the autonomic nervous system in these patients. Study objective: To evaluate cardiopulmonary function impairment after sympathectomy in patients with essential hyperhidrosis, before, at three months and three years after surgery.. Design and setting: Prospective controlled trial at a Pulmonary Function Unit of an university hospital. Patients: Twenty patients (M: 2; F: 18) with essential hyperhidrosis. At three years, eighteen patients (M: 3; F: 15) of twenty studied previously were revisited. Measurements and results: Pulmonary function tests-including spirometry and thoracic gas volume, bronchial challenge test with methacholine and maximal exercise test-were performed before and three months after T2-T3 sympathectomy. At three years we repeated the same test with an exception, maximal exercise test and we compare the results with initial values. Video-assisted sympathectomy was performed using a one-stage bilateral procedure with electrocoagulation of T2-T3 ganglia. Pulmonary function values (spirometrics and volumes) were not statistically different in the two groups. The maximal mid-expiratory flow (MMEF) was the only variable that shows significant changes from 101%(26) to 92%(27); p 0.05. Ten patients had positive bronchial challenge tests that remained positive three months after surgery and two patients whose challenge tests were negative before surgery became positive after sympathectomy. Significant reductions in maximal heart rate and oxygen and CO2 uptakes were observed during the maximal exercise test. There was a significant statistical increment in initial forced expiratory volume (FVC) at three years, changing from 96 ± 10% to 101 ± 11%(p= 0.008). The maximal mid-expiratory flow (MMEF) shows a significant decrease at three years, changing from 3,8 ± 0,9 L/s to 3,5 ± 0,9 L/s (p= 0.01). There were no changes in bronchial challenge tests and NO determination at three years. Conclusions: Video-assisted thoracoscopic is a safe treatment and the observed modifications in cardiopulmonary function only suggest a minimal small airway alterations in, presence of positive bronchial hyperresponsiveness and mild sympathetic blockade in heart rate that remained at three years after surgery. The clinical importance of these findings is not significant

El Bacilo Calmette Guérin, fármaco eficaz en el tratamiento intravesical de los tumores superficiales de vejiga

The Bacillus Calmette Guerin is the drug most likely to be administered for intravesical therapy in patients with superficial bladder tumors in the Urology Department of the Arnaldo Milian Castro Provincial University Hospital in Villa Clara. The objectives of this literature review are to transmit knowledge to the medical staff, nurses and patients about Bacillus Calmette Guerin in the adjuvant treatment of superficial bladder tumors with surgical removal of the tumor by transurethral resection in order to improve the medical services received by these patients, provide information to the patient receiving treatment, avoid uncertainty in the management of their disease and positively influence the right treatment compliance to achieve maximum effectiveness of this drug in this disease. The Bacillus Calmette Guerin is an effective medication, safe and feasible in our milieu for intravesical immunotherapy of patients with superficial bladder tumors. It improves the quality of life of patients in the disease process by reducing the number of relapses of this tumor, but this requires adequate scientific information by health staff on management and use of Bacillus that allows, therefore, providing quality health care and improving the health services of our institution.El Bacilo Calmette Guérin es el fármaco más factible para administrar en la terapia intravesical en los pacientes con tumores superficiales de vejiga en el Servicio de Urología del Hospital Provincial Universitario “Arnaldo Milián Castro” de Villa Clara. Los objetivos de esta presente revisión bibliográfica consisten en transmitir conocimientos acerca del Bacilo Calmette Guérin en el tratamiento adyuvante de los tumores superficiales de vejiga con previa exéresis quirúrgica del tumor por resección transuretral al personal médico, de enfermería y a enfermos para mejorar la atención de los servicios médicos que reciben estos pacientes, facilitar la información propicia al paciente sobre el tratamiento que recibe, evitar la incertidumbre en cuanto al manejo de su enfermedad  e influir positivamente en el cumplimiento correcto del tratamiento por todos para lograr la mayor efectividad de este medicamento en esta enfermedad. El Bacilo Calmette Guérin es un medicamento eficaz, seguro y factible en nuestro medio para el tratamiento inmunoterapéutico intravesical de los pacientes con tumores superficiales de vejiga, mejora la calidad de vida de los pacientes en el proceso de su enfermedad al disminuir el número de reincidencias, pero para esto es necesaria una adecuada información científica por parte del personal de salud sobre el manejo y el uso del Bacilo que le permite, por tanto, brindar una atención de salud con calidad y eficiencia  y mejorar los servicios de salud de la institución

PyMEs turísticas: aportes conceptuales para su estudio

Las pequeñas y medianas empresas (PyMEs) representan la mayor parte del entramado productivo económico en general y turístico en particular. No obstante, es en las últimas décadas que constituyen un objeto de estudio particular, tanto para la Economía como para la Administración. Una característica básica de estas empresas es que constituyen un tipo especial de organización que en la mayoría de los casos nace, crece y se desarrolla como PyME, y por lo tanto, no debe considerarse como la primera etapa de crecimiento de una gran empresa. En consecuencia, su estudio es importante para comprender su funcionamiento, su problemática y su potencial aporte a la economía

La enseñanza de las matemáticas y la música a través de un escape room: una propuesta para fomentar el aprendizaje interdisciplinar

A pesar de que Matemáticas y Música son dos asignaturas claramente diferenciadas en el currículo de la Educación Secundaria Obligatoria (12-16 años) en España, es innegable que existe una relación inherente entre ellas y que gran parte de sus contenidos pueden reforzarse simultáneamente. Desafortunadamente, ambas asignaturas suelen polarizar los gustos del alumnado. En este artículo se presenta una propuesta para el aula cuyo objetivo es fomentar la estrecha relación entre las matemáticas y la música a través de un escape room. Se concluye que este tipo de actividades de gamificación tienen potencial para convertirse en una herramienta clave para concienciar al alumnado de las similitudes entre ambas asignaturas, reforzando así el aprendizaje interdisciplinar

Dyskeratosis congenita: natural history of the disease through the study of a cohort of patients diagnosed in childhood

Aplastic anaemia; Dyskeratosis congenita; Multisystem diseaseAnemia aplásica; Disqueratosis congénita; Enfermedad multisistémicaAnèmia aplàstica; Disceratosi congènita; Malaltia multisistèmicaBackground: Dyskeratosis congenita (DC) is a multisystem and ultra-rare hereditary disease characterized by somatic involvement, bone marrow failure, and predisposition to cancer. The main objective of this study is to describe the natural history of DC through a cohort of patients diagnosed in childhood and followed up for a long period of time. Material and methods: Multicenter, retrospective, longitudinal study conducted in patients followed up to 24 years since being diagnosed in childhood (between 1998 and 2020). Results: Fourteen patients were diagnosed with DC between the ages of 3 and 17 years (median, 8.5 years). They all had hematologic manifestations at diagnosis, and nine developed mucocutaneous manifestations during the first decade of life. Seven presented severe DC variants. All developed non-hematologic manifestations during follow-up. Mutations were identified in 12 patients. Thirteen progressed to bone marrow failure at a median age of 8 years [range, 3–18 years], and eight received a hematopoietic stem cell transplant. Median follow-up time was 9 years [range, 2–24 years]. Six patients died, the median age was 13 years [range, 6–24 years]. As of November 2022, eight patients were still alive, with a median age of 18 years [range, 6–32 years]. None of them have developed myeloblastic syndrome or cancer. Conclusions: DC was associated with high morbidity and mortality in our series. Hematologic manifestations appeared early and consistently. Non-hematologic manifestations developed progressively. No patient developed cancer possibly due to their young age. Due to the complexity of the disease multidisciplinary follow-up and adequate transition to adult care are essential

Optimal Clinical Time for Reliable Measurement of Transcutaneous CO2 with Ear Probes: Counterbalancing Overshoot and the Vasodilatation Effect

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